tag:blogger.com,1999:blog-10660188501075501802024-03-09T01:56:40.479+05:30Free Medical MCQSurgery MCQ | Medicine MCQ | Pediatrics MCQ | Psychiatry MCQ | Gynecology and obstetrics answers | Short Notes in all subjects | World largest online free medical MCQ gallery...Supun Godakumburahttp://www.blogger.com/profile/13661591972693741916noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-1066018850107550180.post-79243207773409445342020-05-17T15:05:00.003+05:302020-05-17T15:07:28.040+05:30Breast MCQ - Part II - Surgery - with answers<b><font size="4">01. 60yrs old lady presented with 2cm painless lump in the left breast for 2 weeks duration. In clinical examination it suggested malignancy which of the following are T/F</font></b><div><font size="4"><br /></font></div><div><div><div><font size="4">a) Tethering with skin indicate poor prognosis </font></div><div><font size="4">b) Mammography is done of the triple assessment </font></div><div><font size="4">c) FNAC negative no need to go for further investigation </font></div><div><font size="4">d) Hormonal treatment compare with CT is best in this patient than young patient with same features </font></div><div><font size="4">e) If decided to do breast conservation surgery, radiotherapy should not given</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><b><font size="4">02. Regarding breast carcinoma;</font></b></div><div><font size="4"><br /></font></div><div><font size="4">a) Detected by self breast examination is free of metastatic disease </font></div><div><font size="4">b) In 80 year old woman can effectively treat with tamoxifen only. </font></div><div><font size="4">c) Her-2-neu receptor represents poor prognosis </font></div><div><font size="4">d) Micro metastases can be excluded if the isotope bone scan is normal </font></div><div><font size="4">e) Treated with mastectomy has better overall survival rather than breast conservative surgery combined with radiotherapy</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><b><font size="4">03. Features of metastatic breast CA</font></b></div><div><font size="4"><br /></font></div><div><font size="4">a) Bone pain </font></div><div><font size="4">b) High ALP level </font></div><div><font size="4">c) Hypocalcaemia </font></div><div><font size="4">d) Pathological fractures </font></div><div><font size="4">e) Pleural effusions</font></div><div><font size="4"><br /></font></div><div><b><font size="4"><br /></font></b></div><div><b><font size="4">04. Regarding breast CA</font></b></div><div><font size="4"><br /></font></div><div><font size="4">a) Fibro adenoma is an AND! arising from a single terminal duct lobule </font></div><div><font size="4">b) Typical hyperplasia of fibrocystic disease has a high risk for developing malignancies c) USS is a method of screening </font></div><div><font size="4">d) Hormonal therapy is the first line therapy for elderly patients</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><b><font size="4">05. A 40 year old female presented with pain in both breasts & upper limbs for 6 months. Features favoring the diagnosis of fibrocystic disease are,</font></b></div><div><font size="4"><br /></font></div><div><font size="4">a) Cyclical pain </font></div><div><font size="4">b) Nodules like feeling in the respective area c) Presence in upper medial quadrant </font></div><div><font size="4">d) Bilateral involvement</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><b><font size="4">06. What is the most common complication following simple mastectomy and axillary clearance</font></b></div><div><b><font size="4"><br /></font></b></div><div><font size="4">a) Bleeding </font></div><div><font size="4">b) Thoracodorsal never damage </font></div><div><font size="4">c) Seroma formation </font></div><div><font size="4">d) Surgical site infection </font></div><div><font size="4">e) Flap necrosis mastectomy</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><font size="4"><b>07. Risk factors for breast carcinoma</b> </font></div><div><font size="4">a) Hormone replacement therapy </font></div><div><font size="4">b) Menopause at 35y of age</font></div></div><div><div><font size="4">c) Oral contraceptive pills for 5 years </font></div><div><font size="4">d) Null parity </font></div><div><font size="4">e) Breast feeding</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><b><font size="4">08. Regarding breast disorders, </font></b></div><div><font size="4"><br /></font></div><div><font size="4">a) Acute mastitis needs incision and drainage. </font></div><div><font size="4">b) Female with malignant lump without any metastasis can be treated with lumpectomy. c) Cyclical mastalgia can be treated with cyst aspiration. </font></div><div><font size="4">d) 2cm fibro adenoma need wide local excision. </font></div><div><font size="4">e) Mastalgia is common at perimenopause age.</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><b><font size="4">09. Breast carcinoma, </font></b></div><div><font size="4"><br /></font></div><div><font size="4">a) Characterized by macro calcifications on mammogram. </font></div><div><font size="4">b) Detected on self breast examination stands the best chance of cure. </font></div><div><font size="4">c) When locally advanced, best treated with neo adjuvant chemotherapy. </font></div><div><font size="4">d) Micro metastasis cannot be excluded if the isotope bone scan is normal. </font></div><div><font size="4">e) Survival is superior when treated by modified radical mastectomy comparing with breast conservation surgery combine with radiotherapy.</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><b><font size="4">10. Regarding breast carcinoma </font></b></div><div><font size="4"><br /></font></div><div><font size="4">a) Tumor situated in sub areolar area is the best situation for breast conservative surgery <br /></font></div><div><font size="4">b) Estrogen receptor positive breast carcinoma has good prognosis <br /></font></div><div><font size="4">c) Estrogen ,progesterone and HER2 receptors can be identified <br /></font></div><div><font size="4">d) Usually sensitive to chemotherapy</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><font size="4"><b>11. True or False regarding benign breast disease </b><br /></font></div><div><font size="4"><br /></font></div><div><font size="4">a) Fibro adenoma has irregular margins <br /></font></div><div><font size="4">b) Usually grows up to 2-3cm in size <br /></font></div><div><font size="4">c) Giant fibro adenoma can be seen in pregnancy <br /></font></div><div><font size="4">d) Well lobulated</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><b><font size="4">12. WOF are true or false</font></b></div><div><font size="4"><br /></font></div><div><font size="4">a) Middle thyroid vein drains to the internal jugular vein <br /></font></div><div><font size="4">b) Clinical features of L5/S1 disc prolapse affecting the S1 root includes parasthesia of the lateral aspect of the foot</font></div><div><font size="4">c) 80% of blood supply to the liver is from the portal vein <br /></font></div><div><font size="4">d) Iliohypogastric nerve passes through the external inguinal ring along with the spermatic cord <br /></font></div><div><font size="4">e) Abductor pollicis brevis muscle is supplied by the ulnar nerve</font></div><div><font size="4"><br /></font></div><h3 style="text-align: left;"><font size="4">Answers </font></h3><div><font size="4">01. a) T b) T c) F d) F e) F</font></div><div><font size="4"><br /></font></div><div><font size="4">02. a) F b) F c) T d) F e) F</font></div><div><font size="4"><br /></font></div><div><font size="4">03. a) T b) T c) F d) T e) T</font></div><div><font size="4"><br /></font></div><div><font size="4">04. a) T b) F c) T d) F</font></div><div><font size="4"><br /></font></div><div><font size="4">05. a) T b) T c) F d) T</font></div><div><font size="4"><br /></font></div><div><font size="4">06. a</font></div><div><font size="4"><br /></font></div><div><font size="4">07. a) T b) F c) T d) T e) F</font></div><div><font size="4"><br /></font></div><div><font size="4">08. a) F b) F c) F d) F e) F</font></div><div><font size="4"><br /></font></div><div><font size="4">09. a) F b) F c) T d) T e) F</font></div><div><font size="4"><br /></font></div><div><font size="4">10. a) F b) T c) T d) T</font></div><div><font size="4"><br /></font></div><div><font size="4">11. a) F b) T c) F d) F</font></div><div><font size="4"><br /></font></div><div><font size="4">12. a) T b) T c) T d) F e) F</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><font size="4"><a href="https://www.globalmedcast.com/" target="_blank">Global Medcast - Health and Wellness Website</a><br /></font></div></div><div><b><br /></b></div></div>Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com1tag:blogger.com,1999:blog-1066018850107550180.post-41248923338438468032020-05-09T08:00:00.001+05:302020-05-09T08:00:08.408+05:30Rickets - Short Note - Paediatrics<div><div><h2 style="text-align: left;"><font size="4">Vitamin D deficiency</font></h2></div><div><font size="4"><br /></font></div><font size="4"> • Bony deformity and rickets. <br /> • Without bone abnormalities but with symptoms of hypocalcaemia, i.e. seizures, neuromuscular irritability (tetany), apnoea, stridor. (common before 2 years of age and in adolescence-high demand for calcium in rapidly growing bone results in hypocalcaemia before rickets develops)</font></div><div><font size="4"><br /></font></div><h1 style="text-align: left;"></h1><div style="text-align: left;"><h1 style="text-align: left;"><font size="4">Rickets</font></h1></div><div><font size="4"><br /></font></div><font size="4"> • Rickets signifies a failure in mineralisation of the growing bone or osteoid tissue. <br /> • Failure of mature bone to mineralise is osteomalacia. <br /><br /></font><h2 style="text-align: left;"><font size="4">Aetiology</font></h2><font size="4"></font><div><font size="4">Nutritional (primary) rickets</font></div><div><font size="4"><br /></font></div><div><font size="4">Risk factors</font></div><div><font size="4"><br /></font></div><font size="4">• Living in northern latitudes<br />• Dark skin<br />• Decreased exposure to sunlight<br />• Maternal vitamin D deficiency<br />• Diets low in calcium, phosphorus and vitamin D, e.g. exclusive breast-feeding into late infancy <br />• Macrobiotic, strict vegan diets<br />• Prolonged parenteral nutrition in infancy <br /></font><div><br /></div><div><br /></div><font size="4">Intestinal malabsorption<br />• Small bowel enteropathy (e.g. coeliac disease)<br />• Pancreatic insufficiency (e.g. cystic fibrosis)<br />• Cholestatic liver disease<br />• High phytic acids in diet (e.g. chapattis)<br /><br />Defective production of 25(OH)D2<br />• Chronic liver disease<br /><br />Increased metabolism of 25(OH)D3<br />• Enzyme induction by anticonvulsants (e.g. phenytoin, phenobarbital)<br /><br />Defective production of 1,25(OH)2D3<br />• Hereditary type I vitamin D-resistant (or dependent) rickets (mutation which abolishes activity of renal hydroxylase)<br />• Familial (X-linked) hypophosphataemic rickets (renal tubular defect in phosphate transport)<br />• Chronic renal disease<br />• Fanconi syndrome (renal loss of phosphate)<br /><br />Target organ resistance to 1,25(OH)2D3<br />• Hereditary vitamin D-dependent rickets type II<br />(due to mutations in vitamin D receptor gene).<br /><br /><br /></font><h3 style="text-align: left;"><font size="4">Clinical manifestations</font></h3><font size="4"><br />• Misery<br />• Failure to thrive/short stature<br />• Frontal bossing of skull<br />• Craniotabes (ping-pong ball sensationof the skull elicited by pressing firmly over the occipital or posterior parietal bones)- Earliest sign<br />• Delayed closure of anterior fontanelle<br />• Delayed dentition<br />• Rickety rosary (palpable or visible costochondral junctions)<br />• Harrison sulcus (a horizontal depression on the lower chest corresponding to attachment of the softened ribs and with the diaphragm) <br /> • Pigeon chest / violin case deformity<br /> • Pot belly <br /> • Kyphoscoliosis <br />• Expansion of metaphyses (especially wrist in crawling individuals, in ankle in walking infants)<br />• Bowing of weight-bearing bones<br /> • Knock knees <br />• Hypotonia<br /> • Proximal myopathy resulting waddling gait<br /> • Bone pain- axial skeleton, spine, shoulders, ribs & pelvis<br /> • Localized pain due to green stick fractures<br />• Seizures & tetani due to hypocalcaemia <br /><br /></font><h3 style="text-align: left;"><font size="4">Diagnosis</font></h3><font size="4">• Dietary history for vitamin and calcium intake<br />• Blood tests – serum calcium is low or normal, phosphate low, plasma alkaline phosphatase activity greatly increased, 25-hydroxyvitamin D may be low and parathyroid hormone elevated.<br /></font><div><font size="4">• X-ray of the wrist joint – shows cupping and fraying of the metaphyses and a widened epiphyseal plate, looser’s zone <br /></font></div><div><font size="4"><br /></font></div><h3 style="text-align: left;"><font size="4">Management</font></h3><font size="4">Nutritional rickets is managed by,<br /> • Balanced diet, <br /> • Correction of predisposing risk factors <br /> • Administration of vitamin D3 (cholecalciferol).<br /><br />Healing occurs in 2–4 weeks and can be monitored from the,<br /> • Lowering of alkaline phosphatase,<br /> • Increasing vitamin D levels<br /> • Healing on X-rays (but complete reversal of bony deformities may take years)<br /></font>Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com2tag:blogger.com,1999:blog-1066018850107550180.post-2097092577079539612020-05-09T07:52:00.001+05:302020-05-17T14:51:09.442+05:30Jaundice - Short Note - Paediatric<h1 style="text-align: left;"><font face="Times New Roman, serif" size="4">Jaundice in Children<br /></font></h1><font size="4">
</font><p align="center" style="line-height: 100%; margin-bottom: 0in;"><font size="4"><br /></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Babies
become clinically jaundiced when the bilirubin level reaches about 80
μmol/L. </font></font></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Management
varies according to</font></font></font></p><font size="4">
</font><ul><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Infant’s
gestational age</font></font></font></p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Age
at onset</font></font></font></p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Bilirubin
level and rate of rise</font></font></font></p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Overall
clinical condition</font></font></font></p></li></ul><div><font size="4"><br /></font></div><font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif"><i><u>Age
at onset</u></i></font></font></font><font size="4">
</font><ol><li><p style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.1in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><i>Jaundice
</i></span></font></font><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><</span></font></font><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><i>24
h of age </i></span></font></font>
</p>
</li><li><p style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.1in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><i>Jaundice
at 2 days to 2 weeks of age </i></span></font></font>
</p>
</li><li><p style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.1in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><i>Jaundice
at </i></font></font><font color="#000000" size="4"><font face="Times New Roman, serif">></font></font><font color="#000000" size="4"><font face="Times New Roman, serif"><i>2
weeks of age </i></font></font>
</p>
</li></ol><font size="4">
</font><p lang="en-US" style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.1in;">
<font size="4"><br /></font>
<font size="4"><br /></font>
</p><font size="4">
</font><h2 style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.1in; text-align: left;">
<font size="4"><span style="font-family: "arial";"><font color="#000000"><span lang="en-US"><i>1.</i> Jaundice
</span></font><font color="#000000"><span lang="en-US"><</span></font><font color="#000000"><span lang="en-US">24
h of age</span></font></span><font color="#000000"><font face="Times New Roman, serif"><span style="font-family: "arial";"> </span><br /></font></font></font></h2><p style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.1in;"><font color="#000000" size="4"><font face="Times New Roman, serif"><br /></font></font></p><p style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.1in;"><font color="#000000" size="4"><font face="Times New Roman, serif">Usually
results from haemolysis </font></font>
</p><p style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.1in;">
<font size="4"><br /></font>
<font size="4"><br /></font>
</p><font size="4">
</font><p lang="en-US" style="line-height: 0.14in; margin-bottom: 0.03in; margin-top: 0.1in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif"><b>a.
Haemolytic disorders </b></font></font></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif"><i>Rhesus
haemolytic disease </i></font></font></font>
</p><font size="4">
</font><ul><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Unconjugated
bilirubin </font></font></font>
</p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Antibodies
may develop to rhesus antigens other than D and to the Kell and
Duffy blood groups, but haemolysis is usually less severe. </font></font></font>
</p>
</li></ul><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif"><i>ABO
incompatibility </i></font></font></font>
</p><font size="4">
</font><ul><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Unconjugated
bilirubin</font></font></font></p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">More
common than rhesus haemolytic disease</font></font></font></p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Most
ABO antibodies are IgM so do not cross the placenta, but some group
O women have an IgG anti-A-haemolysin effect blood group A infant.</font></font></font></p></li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Occasionally,
group B infants are affected by anti-B haemolysins. </font></font></font>
</p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Can
cause severe jaundice but it is usually less severe than in rhesus
disease. </font></font></font>
</p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">The
Hb level normal or only slightly reduced</font></font></font></p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">No
hepatosplenomegaly </font></font></font>
</p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Direct
Coombs’ test positive</font></font></font></p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">The
jaundice usually peaks in the first 12–72 h. </font></font></font>
</p>
</li></ul><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif"><i>G6PD
deficiency</i></font></font><font color="#000000"><font face="Times New Roman, serif">–
</font></font></font>
</p><font size="4">
</font><ul><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Unconjugated
bilirubin </font></font></font>
</p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">X
linked recessive inheritance </font></font></font>
</p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">some
females develop significant jaundice</font></font></font></p>
</li></ul><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4"><br /></font>
</p><font size="4">
</font><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><i>Spherocytosis
</i></span></font></font><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">–</span></font></font></p><font size="4">
</font><ul><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Unconjugated
Bilirubin </span></font></font>
</p>
</li><li><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
</p>
<font size="4"><br /></font></li></ul><font size="4">
</font><p style="line-height: 0.14in; margin-bottom: 0.03in; margin-top: 0.1in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b>b.
Congenital infection </b></span></font></font>
</p><font size="4">
</font><ul><li><p style="line-height: 100%; margin-bottom: 0in;"><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Conjugated
bilirubin </span></font></font>
</p>
</li><li><p style="line-height: 100%; margin-bottom: 0in;"><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Abnormal
clinical signs, such as growth restriction, hepatosplenomegaly and
thrombocytopenic purpura.</span></font></font></p>
</li></ul><font size="4">
</font><p lang="en-US" style="line-height: 100%; margin-bottom: 0in;"><font size="4"><br /></font>
</p><font size="4">
</font><h2 lang="en-US" style="line-height: 100%; margin-bottom: 0in; text-align: left;"><font size="4"><br /><span style="font-family: "arial";">
</span></font></h2><h2 style="text-align: left;"><font size="4"><span style="font-family: "arial";">
</span></font></h2><h2 style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.1in; text-align: left;"><font size="4"><span style="font-family: "arial";">
<font color="#000000"><span lang="en-US">2. Jaundice
at 2 days to 2 weeks of age </span></font></span></font>
</h2><font size="4">
</font><p lang="en-US" style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.1in;">
<font size="4"><br /></font>
<font size="4"><br /></font>
</p><font size="4">
</font><p style="line-height: 0.14in; margin-bottom: 0.03in; margin-top: 0.01in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b>a.
Physiological jaundice </b></span></font></font>
</p><font size="4">
</font><ul><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Mildly
or moderately jaundiced </span></font></font>
</p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Unconjugated
bilirubin </span></font></font>
</p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Term
‘physiological jaundice’ can only be used after other
causes have been considered. </span></font></font></p></li></ul><ul><li><p lang="en-US" style="line-height: 0.13in; margin-bottom: 0in; margin-top: 0.04in;">
<font color="#000000" size="4"><font face="BrandingSans-Roman, serif"><font color="#000000"><font face="Times New Roman, serif">Due
to high Hb concentration at birth, Short RBC life span (70 days),
less efficient hepatic bilirubin metabolism </font></font></font></font></p></li></ul><div><font size="4"><br /></font></div><font size="4">
</font><p style="line-height: 0.14in; margin-bottom: 0.03in; margin-top: 0.13in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b>b.
Breast milk jaundice </b></span></font></font>
</p><font size="4">
</font><ul><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Common
and more prolonged in breast-fed infants. </span></font></font>
</p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Unconjugated
bilirubin</span></font></font></p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">May
be due to increased enterohepatic circulation of bilirubin. </span></font></font></p></li></ul><div><font size="4"><br /></font></div><font size="4">
</font><p style="line-height: 0.14in; margin-bottom: 0.03in; margin-top: 0.13in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b>c.
Dehydration/ Breast feeding jaundice </b></span></font></font>
</p><font size="4">
</font><ul><li><p style="line-height: 0.14in; margin-bottom: 0.03in; margin-top: 0.13in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Unconjugated
bilirubin </span></font></font>
</p>
</li></ul><font size="4">
</font><ul><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Due
to poor milk intake or delay in establishing breast-feeding </span></font></font>
</p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">The
infant becomes dehydrated</span></font></font></p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Breast-feeding
should be continued, some times IV fluid are needed to correct
dehydration. </span></font></font></p></li></ul><div><font size="4"><br /></font></div><font size="4">
</font><p style="line-height: 0.14in; margin-bottom: 0.03in; margin-top: 0.13in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b>d.
Infection </b></span></font></font>
</p><font size="4">
</font><ul><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Unconjugated
hyperbilirubinaemia due to poor fluid intake, haemolysis,
reduced hepatic function and an increase in the enterohepatic
circulation. </span></font></font>
</p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">In
particular, urinary tract infection may present in this way. </span></font></font>
</p>
</li></ul><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b>e.
haemolysis usually presents in the first day of life, it may occur
during the first week. </b></span></font></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><b><br />
</b></font></p><font size="4"><b>
</b></font><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><b><font color="#000000"><font face="Times New Roman, serif"><span lang="en-US">f.
Extravascular blood</span></font></font></b></font></p><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;"><font size="4"><b><font color="#000000"><font face="Times New Roman, serif"><span lang="en-US"><br /></span></font></font></b></font></p><font size="4">
</font><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"> <font face="Times New Roman, serif"><span lang="en-US">Bruising
</span></font></font>
</p><font size="4">
</font><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">cephal
haematoma</span></font></font></p><font size="4">
</font><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">IVH</span></font></font></p><font size="4">
</font><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Maternal
blood in babies GIT </span></font></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b>g.
polycythaemia (venous haematocrit is >0.65) will exacerbate the
infant’s jaundice</b></span></font></font></p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;"><font size="4">
<font color="#000000"><font face="Times New Roman, serif"><span lang="en-US"><b>h.
Crigler–Najjar syndrome</b></span></font></font><font color="#000000"><font face="Times New Roman, serif"><span lang="en-US">-
enzyme glucuronyl transferase is deficient or absent, may result
in extremely high levels of unconjugated bilirubin. </span></font></font></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p lang="en-US" style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.14in;">
<font color="#000000" size="4"><font face="BrandingSansItalic-SemiBold, serif"><font color="#000000"><font face="Times New Roman, serif"><i>3.
Jaundice at </i></font></font><font color="#000000"><font face="Times New Roman, serif">></font></font><font color="#000000"><font face="Times New Roman, serif"><i>2
weeks of age </i></font></font></font></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">Jaundice
in babies more than 2 weeks old (3 weeks if preterm), is called
persistent or prolonged neonatal jaundice. </font></font></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in; text-indent: 0.15in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p align="justify" style="line-height: 0.13in; margin-bottom: 0in; text-indent: 0.15in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b>Unconjugated
hyperbilirubinaemia ( commonest cause) <br /></b></span></font></font></p><p align="justify" style="line-height: 0.13in; margin-bottom: 0in; text-indent: 0.15in;"><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b><br /></b></span></font></font>
</p><font size="4">
</font><p style="line-height: 0.13in; margin-bottom: 0in; margin-left: 0.15in; margin-top: 0.04in; text-indent: -0.15in;">
<font color="#000000" size="4">• <font face="Times New Roman, serif"><span lang="en-US">Breast
milk jaundice’ is the most common cause, affecting up to 15% of
healthy breast-fed infants; the jaundice gradually fades and
disappears by 4–5 weeks of age. </span></font></font>
</p><font size="4">
</font><p style="line-height: 0.13in; margin-bottom: 0in; margin-left: 0.15in; text-indent: -0.15in;">
<font color="#000000" size="4">• <font face="Times New Roman, serif"><span lang="en-US">Infection,
particularly of the urinary tract, needs to be considered. </span></font></font>
</p><font size="4">
</font><p style="line-height: 0.13in; margin-bottom: 0.04in; margin-left: 0.15in; text-indent: -0.15in;">
<font color="#000000" size="4">• <font face="Times New Roman, serif"><span lang="en-US">Congenital
hypothyroidism may cause prolonged jaundice before the clinical
features of coarse facies, dry skin, hypotonia and constipation
become evident. Affected infants should be identified on routine
neonatal biochemical screening (Guthrie test). </span></font></font>
</p><font size="4">
</font><p lang="en-US" style="line-height: 0.13in; margin-bottom: 0.04in; margin-left: 0.15in; text-indent: -0.15in;">
<font size="4"><br /></font>
<font size="4"><br /></font>
</p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font color="#000000" size="4">
</font><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b>Conjugated
hyperbilirubinaemia (>_25 μmol/L) </b></span></font></font>
</p><font size="4">
</font><p lang="en-US" style="line-height: 100%; margin-bottom: 0in;"><font size="4"><br /></font>
</p><font size="4">
</font><ul><li><p style="line-height: 100%; margin-bottom: 0in;"><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">neonatal
hepatitis syndrome </span></font></font>
</p>
</li><li><p style="line-height: 100%; margin-bottom: 0in;"><font color="#000000" size="4">
<font face="Times New Roman, serif"><span lang="en-US">biliary
atresia</span></font></font></p>
</li></ul><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">suggested
by the baby passing dark urine and unpigmented pale stools.
Hepatomegaly and poor weight gain are other clinical signs that may
be present. </span></font></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p align="center" lang="en-US" style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.13in;">
<font size="4"><br /></font>
<font size="4"><br /></font>
</p><font size="4">
</font><p align="center" lang="en-US" style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.13in;">
<font size="4"><br /></font>
<font size="4"><br /></font>
</p><font size="4">
</font><p align="center" style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.13in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><i><u>Severity
of jaundice</u></i></span></font></font></p><font size="4">
</font><ul><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Blanching
the skin with one’s finger. </span></font></font>
</p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">The
jaundice tends to start on the head and face and then spreads down
the trunk and limbs.</span></font></font></p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">If
clinically jaundiced, the bilirubin should be checked with a
transcutaneous bilirubin meter or blood sample.</span></font></font></p></li></ul><div><font size="4"><br /></font></div><font size="4">
</font><p align="center" style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.13in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><i><u>Rate
of change & bilirubin level (Neonatal Guideline page 29)</u></i></span></font></font></p><font size="4">
</font><ul><li><p lang="en-US" style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.1in;">
<font face="BrandingSans-SemiBold, serif" size="4"><font color="#000000"><font face="Times New Roman, serif">The
rate of rise tends to be linear until a plateau is reached, so
serial measurements can be plotted on a chart and used to anticipate
the need for treatment before it rises to a dangerous level. </font></font></font>
</p>
</li></ul><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4"><br /></font>
</p><font size="4">
</font><p align="center" style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.13in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><i><u>Gestation</u></i></font></font><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><i><u>(Neonatal
Guideline page 28,27)</u></i></span></font></font></p><font size="4">
</font><ul><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Preterm
infants are more susceptible to damage from raised bilirubin, so the
intervention threshold is lower. </span></font></font></p></li></ul><div><font size="4"><br /></font></div><font size="4">
</font><p align="center" style="line-height: 0.17in; margin-bottom: 0.03in; margin-top: 0.1in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><i><u>Clinical
condition</u></i></span></font></font></p><font size="4">
</font><ul><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Infants
who experience severe hypoxia, hypothermia or any serious illness
may be more susceptible to damage from severe jaundice.</span></font></font></p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"> <font face="Times New Roman, serif"><span lang="en-US">Drugs
which may displace bilirubin from albumin, e.g. sulphonamides
and diazepam, are therefore avoided in newborn infants. </span></font></font>
</p>
</li></ul><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><h2 style="line-height: 0.17in; margin-bottom: 0.13in; margin-top: 0.15in; text-align: left;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b>Management
of Jaundice<br /></b></span></font></font></h2><p style="line-height: 0.17in; margin-bottom: 0.13in; margin-top: 0.15in;"><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b><br /></b></span></font></font>
</p><font size="4">
</font><ul><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Breast-feeding
& avoid dehydration (but studies have failed to show that
routinely supplementing breast-fed infants with water or dextrose
solution reduces jaundice)</span></font></font></p></li></ul><div><font size="4"><br /></font></div><ul><li><p style="line-height: 0.14in; margin-bottom: 0.03in; margin-top: 0.1in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b>Phototherapy
-</b></span></font></font><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Only
given for unconjugated hyperbilirubinaemia </span></font></font></p></li></ul><div><font size="4"><b><br /></b></font></div><font size="4"><b>
</b></font><p style="line-height: 100%; margin-bottom: 0in;">
<font size="4"><b><font face="Times New Roman, serif"><span lang="en-US">Preparation
for phototherapy</span></font></b></font></p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4">
• <font face="Times New Roman, serif"><span lang="en-US">This
involves exposure of the naked baby to blue light / CFL/LED of wave
length 450-460nm</span></font></font></p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4">
• <font face="Times New Roman, serif"><span lang="en-US">Keep
babies at the distance recommended by the manufacturer for the
phototherapy lights to be maximally effective and safe (avoid
hyperthermia). In case of fluorescent light phototherapy machines
baby should be kept about 18 inches away from the light.</span></font></font></p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4">
• <font face="Times New Roman, serif"><span lang="en-US">Ideal
irradiance: Use of intensive phototherapy with irradiance in
blue-green spectrum of at least 20-30μW/cm2/nm and delivered to as
much of the infant’s surface area as possible.</span></font></font></p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4">
• <font face="Times New Roman, serif"><span lang="en-US">The
light waves convert the bilirubin to water soluble nontoxic forms
which are then easily excreted.</span></font></font></p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4">
• <font face="Times New Roman, serif"><span lang="en-US">Advantages
of phototherapy: non-invasive, effective, inexpensive and easy to use</span></font></font></p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4">
• <font face="Times New Roman, serif"><span lang="en-US">Frequent
feeding, every 2-3 hours and change of posture should be promoted in
an infant receiving phototherapy. </span></font></font>
</p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4">
• <font face="Times New Roman, serif"><span lang="en-US">Eyeshades
should be fixed., External genitalia should be covered to prevent
soiling from urine and stools. The nappy should cover only a minimum
area of body surface of the baby.</span></font></font></p><font size="4">
</font><p lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;">
<font size="4"><b><font face="Times New Roman, serif"><span lang="en-US">Side
effects of phototherapy</span></font></b></font></p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4">
• <font face="Times New Roman, serif"><span lang="en-US">Increased
insensible water loss when providing phototherapy in cots: breastfeed
more frequently / provide adequate fluids to avoid dehydration</span></font></font></p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4">
• <font face="Times New Roman, serif"><span lang="en-US">Loose
green stools: weigh often and compensate with breast milk.</span></font></font></p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4">
• <font face="Times New Roman, serif"><span lang="en-US">Skin
rashes (macular popular): harmless, no need to discontinue
phototherapy;</span></font></font></p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4">
• <font face="Times New Roman, serif"><span lang="en-US">Bronze
baby syndrome: occurs if baby has conjugated hyperbilirubinaemia. If
so, discontinue phototherapy</span></font></font></p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;"><font size="4">
• <font face="Times New Roman, serif"><span lang="en-US">Hypo
or hyperthermia: monitor temperature frequently.</span></font></font></p><font size="4">
</font><p lang="en-US" style="line-height: 100%; margin-bottom: 0in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in;">
<font face="Times New Roman, serif" size="4"><span lang="en-US">All
the side effects are reversible & no long term consequences
noted. </span></font>
</p><font size="4">
</font><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;">
<font size="4"><br /></font></p><p align="justify" lang="en-US" style="line-height: 0.13in; margin-bottom: 0in;"><font size="4"><br /></font>
</p><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US"><b>Exchange
transfusion </b></span></font></font><font size="4">
<br /></font><ul><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Exchange
transfusion is required if the bilirubin rises to levels which are
considered potentially dangerous. Blood is removed from the baby in
small aliquots, (usually from an arterial line or the umbilical
vein) and replaced with donor blood (via peripheral or umbilical
vein). </span></font></font>
</p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Twice
the infant’s blood volume (2 × _80 ml/kg) is exchanged.</span></font></font></p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Donor
blood should be as fresh as possible </span></font></font>
</p>
</li><li><p align="justify" style="line-height: 0.13in; margin-bottom: 0in;">
<font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">Intravenous
immunoglobulin reduces the need for exchange transfusion. </span></font></font>
</p>
</li><li><p style="line-height: 100%; margin-bottom: 0in;"><font color="#000000" size="4"><font face="Times New Roman, serif"><span lang="en-US">There
is no bilirubin level known to be safe or which will definitely
cause kernicterus. In rhesus haemolytic disease, it was found that
kernicterus could be prevented if the bilirubin was kept below
340 μmol/L (20 mg/dl).</span></font></font></p>
</li></ul><font size="4">
</font><p lang="en-US" style="line-height: 100%; margin-bottom: 0in; margin-left: 0.5in;">
<font size="4"><br /></font>
</p><font size="4">
</font><p style="line-height: 100%; margin-bottom: 0in; margin-left: 0.5in;"><font size="4"><br /></font>
</p><font size="4">
<style type="text/css"><font size="4">
p { margin-bottom: 0.1in; direction: ltr; line-height: 115%; text-align: left; orphans: 2; widows: 2; background: transparent }</font></style></font>Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com0tag:blogger.com,1999:blog-1066018850107550180.post-78055238150750001272020-05-08T14:43:00.003+05:302020-05-08T14:50:11.491+05:30Biliary Atresia - Short Note - Paediatrics<div><font size="4">Biliary atresia is not very common. However it's the major differential diagnosis of Obstructive jaundice in a neonate. Here are the common DD for obstructive jaundice,</font></div><div><font size="4"><br /></font></div><div><ul style="text-align: left;"><li><font size="4">Biliary atresia</font></li><li><font size="4">Neonatal hepatitis</font></li><li><font size="4">Choledocal cyst</font></li><li><font size="4">Tyrosinaemia</font></li><li><font size="4">Alpha 1 antitrypsin deficiency <br /></font></li></ul></div><div><font size="4"></font><br /><h1 style="text-align: left;">Biliary atresia</h1></div><div><br /></div> <font size="4">• This occurs in 1 in 14 000 live births.<br /> • It is a progressive disease, in which there is destruction or absence of the extra-hepatic biliary tree and intrahepatic biliary ducts. <br /> • This leads to chronic liver failure and death unless surgical intervention is performed. <br /><br /></font><div><h2 style="text-align: left;"><font size="4">Clinical features</font></h2></div><div><font size="4"><br /></font></div><font size="4"> • Normal birth weight but fail to thrive as the disease progresses. <br /> • They are usually mildly jaundiced<br /> • Pale stools<br /> • Dark Urine<br /> • Hepatomegaly <br /> • Splenomegaly (secondary to portal hypertension)<br /> • Features of cirrhosis may be present in advance cases (clubbing, palmar erythema, spider nevi, gynaecomastia, caput medusa)<br /><br /></font><h2 style="text-align: left;"><font size="4">Investigations</font></h2><div><font size="4"><br /></font></div><div><font size="4"> • Liver function tests - little value in the differential diagnosis. <br /></font></div><div><font size="4"><br /></font></div><div><font size="4"> • Fasting abdominal ultrasound may demonstrate a contracted or absent gallbladder</font></div><div><font size="4"><br /></font></div><div><font size="4"> • Radioisotope scan with TIBIDA shows good uptake by the liver, but no excretion into the bowel.</font></div><div><font size="4"><br /></font></div><div><font size="4"> • Liver biopsy demonstrates features of extrahepatic biliary obstruction</font></div><div><font size="4"><br /></font></div><font size="4"> • Diagnosis is confirmed at laparotomy<br /> <br /><br /></font><h2 style="text-align: left;"><font size="4">Management<br /></font></h2><font size="4"><br /></font><div><font size="4">Surgical bypass of the fibrotic ducts, hepatoportoenterostomy (<span style="color: #7b1fa2;">Kasai procedure</span>) -loop of jejunum is anastomosed to the cut surface of the porta hepatis, facilitating drainage of bile from any remaining patent ductules. <br /></font></div><div><font size="4"><br /></font></div><div><font size="4">(If surgery is performed before the age of 60 days, 80% of children achieve bile drainage. The success rate diminishes with increasing age)</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><font size="4">Postoperative complications -cholangitis<br /> -malabsorption of fats and fat-soluble vitamins <br /></font><div><font size="4"> -cirrhosis and portal hypertension can occur even after Kasai procedure</font></div><div><font size="4"><br /></font></div><div><font size="4">If the operation is unsuccessful, liver transplantation (Biliary atresia is the single most common indication for liver transplantation in the paediatric age group.)</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><h3 style="text-align: left;"><font size="4">Answer the following question.</font></h3><div><br /></div><div><br /></div><div><font size="4"><b>01. A 3 week old breast fed infant has deep jaundice. On physical examination the liver is 3cm below the costal margin. What is the most important laboratory test in this child to diagnose the condition at this time?</b></font></div><div><font size="4"><br /></font></div><div><font size="4">a. Serum ceruloplasmin level</font></div><div><font size="4">b. Direct and total bilirubin levels</font></div><div><font size="4">c. Hepatic ultasonography</font></div><div><font size="4">d. Full blood count</font></div><div><font size="4">e. Urine urobilinogen level</font></div><div><font size="4"><br /></font></div><div><font size="4"><br /></font></div><div><font size="4">Comment your answer.</font><br /></div></div>Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com0tag:blogger.com,1999:blog-1066018850107550180.post-11218464229896078852020-05-07T20:05:00.002+05:302020-05-07T20:10:15.964+05:30Breast MCQ - Part I - Surgery - with answers<font size="4"><b>1. A 50 years old mother of two breast fed children presents with a lump in her right breast. There is no</b><br />
<b>personal or family history of breast cancer. The report on ultrasound and mammogram reads 'suggestive of malignancy. FNAC report reads C4. What is the next appropriate step in the management?</b><br />
<br />
a. Perform a core biopsy<br />
b. Excisional biopsy<br />
c. Lumpectomy<br />
d. Wide local excision<br />
e. incisional biopsy<br />
<br />
<br />
<b>2. 30year old female ,4days after the delivery of her first baby, presented with pain and swelling of upper outer quadrant of the left breast. On examination the area is reddish. Which of the following is/are true</b><br />
<br />
a) commonly caused by lactobacillus<br />
b) diagnosed by USS<br />
c) treat with cloxacillin<br />
d) need to rest the breast until the pain subsidies<br />
e) IM pethidine can be given for pain<br />
<b><br /></b>
<b><br /></b>
<b>3. 23 year old married women came to take an advice for nipple retraction since childhood. There are no palpable lumps. She wish to Breast feed her children. What is the most appropriate initial management option.</b><br />
<br />
a) refer her to a surgeon for surgery<br />
b) perform biopsy of nipple<br />
c) request USS of breast<br />
d) prescribe her a suction device<br />
e) reassure her that this will resolve during pregnancy<br />
<br />
<b><br /></b>
<b>4. 25-year-old woman complained of painless lump in l/breast for 2/52 her grandmother had breast CA @60uears.on examination well defined mobile lump 2cm in size @ the upper outer quadrant/breast is normal and lymphadenopathy. The next step of management</b><br />
<br />
a) Perform FANC<br />
b) Reassure and review in 6/12<br />
c) Arrange mammogram<br />
d) Arrange USS breast<br />
e) Schedule her for excision of the lump<br />
<b><br /></b>
<b><br /></b>
<b>5. Risk factors for breast cancer includes</b><br />
<br />
a) Hx of Breast CA on contralateral side of the breast<br />
b) family history<br />
c) breast feeding<br />
d) null parity<br />
e) OCP<br />
<br />
<br />
<b>6. 25yr female present with lump in right breast on EX lump was mobile, well demarcated non tender and 3*5cm in size. Mother Rx for breast CA .appropriate step in Mx</b><br />
<br />
a) mammogram<br />
b) USS<br />
c) FANC<br />
d) incision biopsy<br />
e) reassurance and review in 6months<br />
<br />
<br />
<b>7. A 35 yr old female T4N1Mx breast carcinoma. What is the most appropriate initial treatment ?</b><br />
<br />
a) Breast conservative surgery<br />
b) salvage mastectomy<br />
c) neo adjuvant chemotherapy<br />
d) total mastectomy<br />
e) tamoxifen therapy<br />
<br />
<br />
<b>8. A 35yr old came female came with blood stained nipple discharge from the R breast. On examination there is no lump. She has no past hx or family hx of breast carcinoma. On examination there was no palpable lump in the breast. What is the most likely diagnosis?</b><br />
<br />
a) Duct ectasia<br />
b) Intraductal papilloma<br />
c) Phylloid tumor<br />
d) Atypical duct hyperplasia<br />
e) Fibrocystic disease<br />
<br />
<br />
<b>9. Regarding the Breast carcinoma</b><br />
<br />
a) BRCA tumour suppressor genes<br />
b) Due to mutation of BRACA gene.<br />
c) Most of the breast carcinoma has family inheritance<br />
d) Women with mutated gene can undergo prophylactic mastectomy<br />
e) Patient with Breast carcinoma need to refer to genetic service<br />
<br />
<br />
<b>10. 56yr old patient undergone wide local excision and axillary clearance. Resu its came as stage 1 invasive ductal CA. Two core biopsies were taken, but came as normal. What is the next management?</b><br />
<br />
a. Tamoxifen<br />
b. Radiotherapy to axilla<br />
c. Radiation to the breast<br />
d. Reassure and follow up the patient<br />
e. 6 cycles of chemotherapy<br />
<br />
<br />
<b>11. 28yr old female R quadrant Breast lump. USS done, no significant finding. 2 core biopsies also done and they are normal. What is the next step of management?</b><br />
<br />
a) Repeat core biopsy<br />
b) Breast MRJ<br />
c) Excision biopsy<br />
d) PET scan<br />
e) Wide local excision<br />
<br />
<br />
<b>12. 50yr old lady had undergone wide local excision and sentinel nod biopsy. Hist report revealed complete excision of invasive ductal carcinoma and sentinel node contained to metastatic features.ER receptor negative. What is the most appropriate next step of Mx</b><br />
<br />
a) Aromatase inhibitor<br />
b) Chemotherapy<br />
c) Radiotherapy for whole Breast<br />
d) Systemic therapy<br />
e) Mastectomy<br />
<br />
</font><h3><font size="4">
Answers </font></h3><font size="4">
</font><div>
<font size="4"><br /></font></div><font size="4">
</font><div><font size="4">
1. d</font></div><font size="4">
</font><div>
<font size="4"><br /></font></div><font size="4">
</font><div><font size="4">
2. a) F b) T c) T d) T e) F</font></div><font size="4">
</font><div>
<font size="4"><br /></font></div><font size="4">
</font><div><font size="4">
3. d</font></div><font size="4">
</font><div>
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</font><div><font size="4">
4. d</font></div><font size="4">
</font><div>
<font size="4"><br /></font></div><font size="4">
</font><div><font size="4">
5. a) T b) T c) F d) T e) T</font></div><font size="4">
</font><div>
<font size="4"><br /></font></div><font size="4">
</font><div><font size="4">
6. b</font></div><font size="4">
</font><div>
<font size="4"><br /></font></div><font size="4">
</font><div><font size="4">
7. c</font></div><font size="4">
</font><div>
<font size="4"><br /></font></div><font size="4">
</font><div><font size="4">
8. b</font></div><font size="4">
</font><div>
<font size="4"><br /></font></div><font size="4">
</font><div><font size="4">
9. a) T b) T c) T d) T e) -</font></div><font size="4">
</font><div>
<font size="4"><br /></font></div><font size="4">
</font><div><font size="4">
10. d</font></div><font size="4">
</font><div>
<font size="4"><br /></font></div><font size="4">
</font><div><font size="4">
11. c</font></div><font size="4">
</font><div>
<font size="4"><br /></font></div><font size="4">
</font><div><font size="4">
12. b</font></div><font size="4">
</font><div>
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</font><div>
<font size="4"><br /></font></div><font size="4">
</font><div>
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</font>Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com1tag:blogger.com,1999:blog-1066018850107550180.post-41613184523992437352020-05-03T20:12:00.000+05:302020-05-03T21:53:24.960+05:30Renal MCQ - Part II - Renal Failure - with answers<h2>
<span style="font-size: large;">
Acute Kidney Injury</span></h2>
<div>
<div>
<span style="font-size: large;"><b>01. Increase serum Creatinine seen in </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Pregnancy</span><br />
<span style="font-size: large;">b) Myocardial infarction</span><br />
<span style="font-size: large;">c) Treatment with cimetidine</span><br />
<span style="font-size: large;">d) Early DM nephropathy</span><br />
<span style="font-size: large;">e) Russell’s Viper bite</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;"><b>02. Increased blood urea is seen in </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Na valproate treatment,</span><br />
<span style="font-size: large;">b) Rhabdomyolysis.</span><br />
<span style="font-size: large;">c) Addison's disease</span><br />
<span style="font-size: large;">d) Severe liver disease</span><br />
<span style="font-size: large;">e) Tetracycline therapy</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span></div>
<div>
<span style="font-size: large;"><b>03. In acute renal failure, due to a pre-renal cause WOTF can be true, </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) BP = 80/60 mmHg</span><br />
<span style="font-size: large;">b) Severely dehydrated patient</span><br />
<span style="font-size: large;">c) Concentrated urine</span><br />
<span style="font-size: large;">d) Serum K+ level of 6.2 mmol/l.</span><br />
<span style="font-size: large;">e) Sepsis</span></div>
</div>
<div>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span></div>
<div>
<div>
<span style="font-size: large;"><b>04. Acute renal failure </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Commonest cause is acute tubular necrosis</span><br />
<span style="font-size: large;">b) Presence of anemia should raise the suspicion of Rhabdomyolysis</span><br />
<span style="font-size: large;">c) Small kidneys on USS</span><br />
<span style="font-size: large;">d) May have prolonged bleeding time</span><br />
<span style="font-size: large;">e) Long QT syndrome may be a rare cause of death</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;"><b>05. Regarding a patient with acute renal failure, the following are correctly paired, </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Red cell casts - acute glomerular nephritis</span><br />
<span style="font-size: large;">b) Field full of pus cells - pyelonephritis</span><br />
<span style="font-size: large;">c) Microscopic haematuria - Leptospirosis d) Jaundice and bleeding - Hepato renal syndrome</span><br />
<span style="font-size: large;">e) Hypernatremia - acute tubular necrosis</span></div>
</div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<h2>
<span style="font-size: large;">
Chronic Kidney Disease </span></h2>
</div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<div>
<span style="font-size: large;"><b>06. Expected findings in CKD </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Sclerosed glomeruli in biopsy</span><br />
<span style="font-size: large;">b) 15.5cm sized kidneys</span><br />
<span style="font-size: large;">c) Pallor</span><br />
<span style="font-size: large;">d) Increased serum potassium level</span><br />
<span style="font-size: large;">e) A negative mantoux despite exposure to TB</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;"><b>07. Typical biochemical abnormalities of CKD</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Hyperglycemia</span></div>
</div>
<div>
<div>
<span style="font-size: large;">b) Hypophosphatemia</span><br />
<span style="font-size: large;">c) Hypercalcaemia</span><br />
<span style="font-size: large;">d) Metabolic acidosis</span><br />
<span style="font-size: large;">e) Proteinuria> 3.5g/l</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;"><b>08. Features suggestive of CKD</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Intravascular volume constriction</span><br />
<span style="font-size: large;">b) Hypophosphatemia</span><br />
<span style="font-size: large;">c) Hyperuricaemia</span><br />
<span style="font-size: large;">d) Hypertriglyceridemia</span><br />
<span style="font-size: large;">e) Hypernatremia</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span></div>
<div>
<span style="font-size: large;"><b>09. Which of the following helps in diagnosis of CKD over AKI? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Raised S.Cr</span><br />
<span style="font-size: large;">b) Small kidneys</span><br />
<span style="font-size: large;">c) Normochromic normocytic anemia</span><br />
<span style="font-size: large;">d) Raised urea with normal S.Cr</span><br />
<span style="font-size: large;">e) Osteodystrophy</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span></div>
<div>
<span style="font-size: large;"><b>10. Factors that help to differentiate CKD from AKI</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) B/L small kidneys</span><br />
<span style="font-size: large;">b) Increase in creatinine level</span><br />
<span style="font-size: large;">c) Anemia</span><br />
<span style="font-size: large;">d) Hyperkalemia</span><br />
<span style="font-size: large;">e) Bilateral ankle oedema</span><br />
<span style="font-size: large;"><br /></span></div>
</div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;"><b>11. Regarding treatment of CKD</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Blood transfusions are best avoided in treatment of anemia</span><br />
<span style="font-size: large;">b) Osteoporosis is a complication due to treatment</span><br />
<span style="font-size: large;">c) Glycosuria is an indication to start anti DM drugs</span><br />
<span style="font-size: large;">d) Moderate protein restriction may have a value</span><br />
<span style="font-size: large;">e) Blood pressure should be reduced to 130/90mmHg</span></div>
<div>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<h2>
<span style="font-size: large;">
Answers </span></h2>
</div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">01. a) F b) - c) T d) F e) T</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">02. a) F b) F c) T d) F e) T</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">03. a) T b) T c) T d) F e) T</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">04. a) T b) - c) F d) T e) F</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">05. a) T b) T c) T d) T e) F</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">06. a) T b) F c) T d) T e) T</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">07. a) F b) F c) F d) T e) -</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">08. a) F b) F c) T d) T e) F</span></div>
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<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">09. a) F b) T c) T d) F e) T</span></div>
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<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">10. a) T b) F c) T d) F e) F</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">11. a) T b) T c) F d) F e) F</span></div>
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<span style="font-size: large;"><br /></span></div>
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Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com0tag:blogger.com,1999:blog-1066018850107550180.post-18571061886741057842020-05-03T18:24:00.003+05:302020-05-03T18:24:54.747+05:30Renal MCQ - Part I - Glomerular Diseases - with answers<span style="font-size: large;"><b>01. Regarding proteinuria in glomerular diseases </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Is between 150mg/day and 2g/day in glomerular leakage </span><br />
<span style="font-size: large;">b) Is > 3.5g/day is invariably due to glomerular disease </span><br />
<span style="font-size: large;">c) Is usually greater in the night than during the day </span><br />
<span style="font-size: large;">d) In patients with suspected myoglobinuria appositive dipstick maybe produced </span><br />
<span style="font-size: large;">e) In early diabetic nephropathy typically predominantly albumin is present</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>02. RBC casts can be seen in</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Diabetes mellitus </span><br />
<span style="font-size: large;">b) Chronic GN </span><br />
<span style="font-size: large;">c) Bladder carcinoma </span><br />
<span style="font-size: large;">d) Renal stone </span><br />
<span style="font-size: large;">e) BPH</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>03. Microscopic hematuria is expected in</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) DM nephropathy </span><br />
<span style="font-size: large;">b) Minimal change disease </span><br />
<span style="font-size: large;">c) Focal segmental glomerulonephritis </span><br />
<span style="font-size: large;">d) Membranous proliferative nephropathy e) AKI</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>04. Microscopic hematuria features of</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) G6PD deficiency </span><br />
<span style="font-size: large;">b) DM nephropathy, </span><br />
<span style="font-size: large;">c) Krait bite. </span><br />
<span style="font-size: large;">d) Malignant HT. </span><br />
<span style="font-size: large;">e) OP poisoning</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>05. 32 year old male presented with haematuria for 1 day duration. There is a past history of haematuria 1 month back. He is on treatment for DM. No oedema. BP elevated. UFR, RBC-200, Pus cells - 3-4, protein- nil. No dysmorphic RBC or hyaline casts. Serum creatinine - Normal. Urinary protein - high. Possibilities are:-</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Post streptococcal GN </span><br />
<span style="font-size: large;">b) UTI </span><br />
<span style="font-size: large;">c) Renal cell CA </span><br />
<span style="font-size: large;">d) IGA nephropathy </span><br />
<span style="font-size: large;">e) CKD</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>06. Causes of Nephrotic syndrome are</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Infective endocarditis </span><br />
<span style="font-size: large;">b) Gold </span><br />
<span style="font-size: large;">c) Penicillamine </span><br />
<span style="font-size: large;">d) Amyloidosis </span><br />
<span style="font-size: large;">e) Falciparum malaria</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>07. Which of the following are more favor of minimal change nephritic syndrome? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Highly selective proteinuria </span><br />
<span style="font-size: large;">b) Plasma volume increased </span><br />
<span style="font-size: large;">c) Increased risk of thromboembolism </span><br />
<span style="font-size: large;">d) Mainly peri-orbital oedema </span><br />
<span style="font-size: large;">e) Microscopic haematuria</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>08. Clinical and biochemical features of minimal change disease are </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Proteinuria >3g/24hrs </span><br />
<span style="font-size: large;">b) Gross oedema </span><br />
<span style="font-size: large;">c) Microscopic haematuria </span><br />
<span style="font-size: large;">d) High LDL cholesterol </span><br />
<span style="font-size: large;">e) Venous thrombosis</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>09. 36 year old male has facial and ankle swelling for 3 weeks. Which is more suggestive of nephritic syndrome?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) UFR +++ protein</span><br />
<span style="font-size: large;">b) Serum albumin- 2.8 </span><br />
<span style="font-size: large;">c) 24hour urine protein- 4g </span><br />
<span style="font-size: large;">d) Serum cholesterol- 328 </span><br />
<span style="font-size: large;">e) Serum creatinine- 1.6</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>10. 36 year old female presented with B/L ankle oedema. Her BP is 130/80mmHg. Her Ix results are as follows</b></span><br />
<span style="font-size: large;"><b>S.Cr. Normal UFR - protein 3+</b></span><br />
<span style="font-size: large;"><b>Red cell/hyaline granular casts 24 hr. urinary protein - 3.4g What is the most likely histological type in renal biopsy? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Minimal change GN </span><br />
<span style="font-size: large;">b) Post streptococcal GN </span><br />
<span style="font-size: large;">c) Membrano-proliferative GN </span><br />
<span style="font-size: large;">d) Chronic interstitial nephritis </span><br />
<span style="font-size: large;">e) Diffuse mesangioproliferative with crescent formation</span><br />
<span style="font-size: large;"><br /></span>
<h3>
<span style="font-size: large;">Answers</span></h3>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">01. a) F b) T c) F d) T e) T</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">02. </span><span style="font-size: large;">a) F b) T c) F d) F e) F</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">03. </span><span style="font-size: large;">a) F b) F c) T d) T e) T</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">04. </span><span style="font-size: large;">a) F b) F c) F d) T e) -</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">05. </span><span style="font-size: large;">a) F b) T c) T d) T e) -</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">06. </span><span style="font-size: large;">a) F b) T c) T d) T e) T</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">07. </span><span style="font-size: large;">a) T b) F c) T d) T e) F</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">08. </span><span style="font-size: large;">a) T b) T c) F d) T e) T</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">09. e</span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">10. a</span></div>
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<span style="font-size: large;"><br /></span></div>
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<span style="font-size: large;"><br /></span></div>
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<span style="font-size: large;"><br /></span></div>
Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com0tag:blogger.com,1999:blog-1066018850107550180.post-80147849939868644512020-05-03T09:02:00.003+05:302020-05-03T09:02:26.933+05:30Gallstones MCQ - Surgery - with answers<b><span style="font-size: large;">1. A 34 year old female presented with acute cholecystitis. She was treated with Co-amoxiclav 1.2g IV. After 48 hours of treatment, she develops swinging fever with severe right hypochondrial tenderness. Most appropriate next investigation is, </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. CT scan </span><br />
<span style="font-size: large;">b. ERCP </span><br />
<span style="font-size: large;">c. MRCP </span><br />
<span style="font-size: large;">d. FBC </span><br />
<span style="font-size: large;">e. USS of abdomen</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;">2. Regarding gallstones </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Calcium bilirubinate is the predominant constituent of the mixed stones </span><br />
<span style="font-size: large;">b. Pigment stones are caused due to haemolytic anaemia </span><br />
<span style="font-size: large;">c. Majority of stones are radiolucent </span><br />
<span style="font-size: large;">d. Majority of stones are pigment stones. </span><br />
<span style="font-size: large;">e. Majority are of mixed type</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span></b>
<b><span style="font-size: large;">3. A 50 year old otherwise healthy male presented with recurrent, vague upper abdominal pain which was worsening after meals. He had lost 5 kg during last 2 months. USS showed multiple stones in gallbladder with mild thickening of the gallbladder wall. Extrahepatic ducts looked normal. No pericholedochal fluid. What is the next appropriate step of management? </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. ERCP </span><br />
<span style="font-size: large;">b. ESWL </span><br />
<span style="font-size: large;">c. Laparoscopic cholecystectomy </span><br />
<span style="font-size: large;">d. MRCP </span><br />
<span style="font-size: large;">e. UGIE</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;">4. 45 year old female in routine USS Scan found 4cm solitary stone in gall bladder; </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Most likely is a pigment stone </span><br />
<span style="font-size: large;">b. Acute cholecystitis is likely to occur </span><br />
<span style="font-size: large;">c. Requires regular USS to monitor size of the stone </span><br />
<span style="font-size: large;">d. Is at an increased risk of malignancy </span><br />
<span style="font-size: large;">e. Should undergo Cholecystectomy to prevent complications</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span></b>
<span style="font-size: large;"><b>5. In a 50 year old man with gall stone disease who is otherwise healthy, the indications for cholecystectomy are</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. History of biliary colic </span><br />
<span style="font-size: large;">b. Passage of flatus after meals </span><br />
<span style="font-size: large;">c. History of recurrent epigastric pain </span><br />
<span style="font-size: large;">d. Porcelain gall bladder </span><br />
<span style="font-size: large;">e. Serum cholesterol level of 425mg/dl</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span></b>
<span style="font-size: large;"><b>6. T/F regarding ascending cholangitis</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Considered as DD in patient presenting with collapse </span><br />
<span style="font-size: large;">b. Caused by stone impacted in cystic duct </span><br />
<span style="font-size: large;">c. Common bile duct stone obstruction is relieved by endoscopy </span><br />
<span style="font-size: large;">d. Lead to liver abscess </span><br />
<span style="font-size: large;">e. Usually caused by gram + organisms</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>7. 45 year old male presented with yellowish discolouration of eyes & pruritus for 2/52 which progressed gradually. 2/52 prior to presentation he noticed stools were tarry. On examination slightly pale, deeply icteric. The abdomen slightly distended, liver palpable 4cm below the costal margin. The gall bladder is palpable & non tender. The most likely diagnosis</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. CBD calculus </span><br />
<span style="font-size: large;">b. CA head of the pancrease </span><br />
<span style="font-size: large;">c. Hilar cholangio CA </span><br />
<span style="font-size: large;">d. Duodenal CA </span><br />
<span style="font-size: large;">e. Periampullary CA</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span></b>
<b><span style="font-size: large;">8. 40 year old female presented with right hypochondrial pain for 3 days duration with moderate fever. What features in this history most help distinguishing acute cholangitis from acute cholecystitis?</span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Family history of haemolytic anaemia </span><br />
<span style="font-size: large;">b. LOA </span><br />
<span style="font-size: large;">c. Passage of tea coloured urine </span><br />
<span style="font-size: large;">d. Past history of biliary colic </span><br />
<span style="font-size: large;">e. Radiation of pain to back</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;">9. 30yr old male patient presented with progressive jaundice and darkening of urine. USS revealed dilated intrahepatic and common hepatic ducts. But CBD measured 7 mm.GB is not dilated and no GB calculi.What is the most appropriate management? </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Pecrutaneous transhepatic cholangiogram </span><br />
<span style="font-size: large;">b. Contrast enhanced CT </span><br />
<span style="font-size: large;">c. MRCP </span><br />
<span style="font-size: large;">d. ERCP </span><br />
<span style="font-size: large;">e. HIDA</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>10. 60yr old male with Hx of progressive jaundice going to have a CECT, his RFT are marginally elevated. Which of the following agent/fluid is needed to use during procedure</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. 0.9% NS </span><br />
<span style="font-size: large;">b. NaHCO3 </span><br />
<span style="font-size: large;">c. N-AC </span><br />
<span style="font-size: large;">d. IV hydrocortisone </span><br />
<span style="font-size: large;">e. N/2 + 5% Dextrose</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;">11. A 60y old male presents with loss of appetite and loss of weight for 6 months. He is deeply icteric and USS of abdomen shows dilatation of intrahepatic ducts but no dilatation of cystic duct or gall bladder, What is the most probable diagnosis? </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Peri-hilar cholangiocarcinoma </span><br />
<span style="font-size: large;">b. Pancreatic head carcinoma </span><br />
<span style="font-size: large;">c. Peri-ampullary carcinoma </span><br />
<span style="font-size: large;">d. Cholangiocarcinoma of distal CBD </span><br />
<span style="font-size: large;">e. Malignant stricture of CBD</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>12. 65 year old man presented with worsening jaundice & pruritis for 2months, also has anorexia & loss of weight for 4 months. USS gallbladder not distended & has multiple gall stones. CBD not dilated but intrahepatic duct dilated. S.Bilirubin 220umol/, S.Alkaline phosphate -- 1250. What is the diagnosis</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Common bile cut stone </span><br />
<span style="font-size: large;">b. Hilar cholangio CA </span><br />
<span style="font-size: large;">c. Mirizi syndrome </span><br />
<span style="font-size: large;">d. Periampulary CA </span><br />
<span style="font-size: large;">e. Sclerosing cholangitis</span><br />
<b><span style="font-size: large;"><br /></span></b>
<b><span style="font-size: large;"><br /></span></b>
<b><span style="font-size: large;">13. Which of the following is not a recognized cause of postoperative jaundice following laparoscopic cholecystectomy? </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Ascending cholangitis </span><br />
<span style="font-size: large;">b. Ligation of the left hepatic duct </span><br />
<span style="font-size: large;">c. Ligation of the common hepatic duct </span><br />
<span style="font-size: large;">d. Gallstone retention in the common bile duct </span><br />
<span style="font-size: large;">e. Thermal injury due to use of electrocautery during dissection.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>14. Operations that require perioperative use of antibiotics in otherwise healthy patient include</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Herniotomy repair in a 3yr old baby </span><br />
<span style="font-size: large;">b. Thyroidectomy </span><br />
<span style="font-size: large;">c. Elective left hemicolectomy </span><br />
<span style="font-size: large;">d. Transurethral resection of prostate </span><br />
<span style="font-size: large;">e. Knee joint replacement</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span></b>
<b><span style="font-size: large;">15. Which of the following is not a risk factor for gallstone formation? </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Smoking </span><br />
<span style="font-size: large;">b. Pregnancy </span><br />
<span style="font-size: large;">c. Crohn's disease </span><br />
<span style="font-size: large;">d. Diet high in fats </span><br />
<span style="font-size: large;">e. Contraceptive pills</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;">16. Laparoscopic cholesystectomy is contraindicated in, </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Acute cholecystitis </span><br />
<span style="font-size: large;">b. Large solitary gallstone</span><br />
<span style="font-size: large;">c. Empyema of the gallbladder. </span><br />
<span style="font-size: large;">d. Patient with bleeding disorder </span><br />
<span style="font-size: large;">e. Carcinoma of the gallbladder</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<br />
<h3>
<span style="font-size: large;">Answers</span></h3>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">01. e</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">02. a) F b) T c) T d) F e) T</span><br />
<br />
<span style="font-size: large;">03. c</span><br />
<br />
<span style="font-size: large;">04. a) F b) F c) F d) T e) F</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">05. </span><span style="font-size: large;">a) T b) F c) F d) T e) F</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">06. </span><span style="font-size: large;">a) T b) F c) T d) T e) F</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">07. e</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">08. c</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">09. c</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">10. a</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">11. a</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">12. c</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">13. </span><span style="font-size: large;">a) F b) T c) F d) F e) F</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">14. </span><span style="font-size: large;">a) F b) F c) T d) T e) T</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">15. </span><span style="font-size: large;">a) T b) T c) T d) T e) T</span></div>
<div>
<span style="font-size: large;"> </span></div>
<div>
<span style="font-size: large;">16. </span><span style="font-size: large;">a) F b) F c) F d) T e) T</span><span style="font-size: large;"></span>
<span style="font-size: large;"><br /></span>
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</div>
Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com0tag:blogger.com,1999:blog-1066018850107550180.post-52724277138264517072020-05-01T09:24:00.000+05:302020-05-01T09:25:54.158+05:30Rheumatology MCQ - Medicine - with answers<span style="font-size: large;"><b> 1. Characteristic Features of RA.</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Atlanto -axial subluxation.</span><br />
<span style="font-size: large;">b) Bone cyst formation.</span><br />
<span style="font-size: large;">c) Juxta-ordicular osteopenia.</span><br />
<span style="font-size: large;">d) Calcification of the spinal ligament.</span><br />
<span style="font-size: large;">e) Poriarticular bone erosion.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>2. Pulmonary findings in rheumatoid arthritis.</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Fibrosing alveolitis.</span><br />
<span style="font-size: large;">b) Pleural effusion.</span><br />
<span style="font-size: large;">c) Caplan syndrome.</span><br />
<span style="font-size: large;">d) Bronchoalveolar carcinoma.</span><br />
<span style="font-size: large;">e) Chronic Obstructive Pulmonary Disease</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>3. Regarding Rheumatoid arthritis.</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Back ache is a common presentation.</span><br />
<span style="font-size: large;">b) DIP joints are involved.</span><br />
<span style="font-size: large;">c) Erethyma of the affected joints predominates.</span><br />
<span style="font-size: large;">d) May present with pyramidal signs.</span><br />
<span style="font-size: large;">e) Pleural effusions with high glucose content.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>4. Characteristic features of rheumatoid arthritis.</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Plantar fasciitis.</span><br />
<span style="font-size: large;">b) Atlanto-axial subluxation.</span><br />
<span style="font-size: large;">c) Scleritis.</span><br />
<span style="font-size: large;">d) Subcutaneous nodules.</span><br />
<span style="font-size: large;">e) Involvement of DIP joint.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>5. Characteristic features of rheumatoid arthritis.</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Asymmetrical arthritis.</span><br />
<span style="font-size: large;">b) Morning stiffness.</span><br />
<span style="font-size: large;">c) Male predominance.</span><br />
<span style="font-size: large;">d) Onset after 60 years.</span><br />
<span style="font-size: large;">e) Involvement of thoracolumbar spine.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>6. In a patient with polyarthritis, the diagnosis is more likely to be rheumatoid arthritis than OA in the presence of.</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Elevated ESR.</span><br />
<span style="font-size: large;">b) Symmetrical involvement of PIPjoints.</span><br />
<span style="font-size: large;">c) Involvement of temporo mandibular joints.</span><br />
<span style="font-size: large;">d) Presence of rheumatoid factor.</span><br />
<span style="font-size: large;">e) Symptomatic response to steroids.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>7. Following statements about infective arthritis are true.</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) The onset is typically insidious.</span><br />
<span style="font-size: large;">b) Pre existing arthritis is a recognized predisposing factor.</span><br />
<span style="font-size: large;">c) Small peripheral joints are involved more commonly than larger joints.</span><br />
<span style="font-size: large;">d) H-influenzae is the commonest organism in adult patients.</span><br />
<span style="font-size: large;">e) Joint aspiration should be avoided due to risk of septicaemia.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>8. In psoritic arthritis</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) DIP are involved.</span><br />
<span style="font-size: large;">b) Sacroilitis.</span><br />
<span style="font-size: large;">c) Oligoarthritis.</span><br />
<span style="font-size: large;">d) Arthritis mutilans.</span><br />
<span style="font-size: large;">e) Bamboo spine.</span><br />
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>9. Clues for the cause of arthritis</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Scaly lesions over extensors of knee</span><br />
<span style="font-size: large;">b) History of dysentery</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>10. A 50 year old lady presented with two weeks of right knee joint pain and swelling. Which of the following favours a diagnosis of osteoarthritis?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) ESR 100/1st hour</span><br />
<span style="font-size: large;">b) pain on walking</span><br />
<span style="font-size: large;">c) history of trauma to knee joint</span><br />
<span style="font-size: large;">d) loss of joint space</span><br />
<span style="font-size: large;">e) .Neutrophil count over 10000</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>11. Polyarthragia is a common presenting complain in</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Rubella</span><br />
<span style="font-size: large;">b) Depression</span><br />
<span style="font-size: large;">c) tuberculosis</span><br />
<span style="font-size: large;">d) Hypothyroidism</span><br />
<span style="font-size: large;">e) Chickungunya</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>12. Joint erosions seen in</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Osteoarthritis</span><br />
<span style="font-size: large;">b) Psoriatic arthritis</span><br />
<span style="font-size: large;">c) Gout</span><br />
<span style="font-size: large;">d) SLE</span><br />
<span style="font-size: large;">e) Rheumatoid arthritis</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>13. Recognized causes of osteoporosis are,</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Cushing's syndrome</span><br />
<span style="font-size: large;">b) Acromegaly</span><br />
<span style="font-size: large;">c) Long term steroid use</span><br />
<span style="font-size: large;">d) Early menopause</span><br />
<span style="font-size: large;">e) Acute renal failure</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>14. Tram line calcification in a skull x-ray can be seen in,</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Thalassaemia</span><br />
<span style="font-size: large;">b) Tuberous sclerosis</span><br />
<span style="font-size: large;">c) Rickets</span><br />
<span style="font-size: large;">d) Sturge weber syndrome</span><br />
<span style="font-size: large;">e) Congenital toxoplasmosis</span><br />
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>15. 56 yr old man presented with tender swollen 1 metatarsophalangeal joint. He was on frusemide for ankle oedema. Investigation revealed Hb-10.1g/dl, WBC-19,000; ESR -95 , S.cr-3.42. what is the most likely diagnosis,</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Gouty arthropathy</span><br />
<span style="font-size: large;">b) cellulitis</span><br />
<span style="font-size: large;">c) TB arthropathy</span><br />
<span style="font-size: large;">d) Rheumatoid arthritis</span><br />
<span style="font-size: large;">e) Septic arthritis</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>16. A 41 year old male presents with pain and swelling in left knee for 3 days. He was a hypertensive patient started on HCT and amilodipine recently. On examination, knee joint is tender, warm and swollen, What is the appropriate investigation to get specific. diagnosis?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) ESR</span><br />
<span style="font-size: large;">b) FBC</span><br />
<span style="font-size: large;">c) Joint aspiration</span><br />
<span style="font-size: large;">d) Rheumatic factor</span><br />
<span style="font-size: large;">e) X-ray knee joint</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>17. T/F</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Duchenne's muscular dystrophy present at birth as a floppy baby</span><br />
<span style="font-size: large;">b) Dystrophiamyotonica patients can develop baldness & cataract</span><br />
<span style="font-size: large;">c) Patient with Duchenne's muscular dystrophy live longer than beckers</span><br />
<span style="font-size: large;">d) Cardiomyopathy is a recognized complication of Duchenne's muscular dystrophy</span><br />
<span style="font-size: large;">e) Chromosomal studies are needed for the diagnosis of Duchenne's muscular dystrophy</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>18. T/F regarding Duchenne's muscular dystrophy,</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) X linked recessive disorder</span><br />
<span style="font-size: large;">b) Has low level of dystrophin</span><br />
<span style="font-size: large;">c) Has good prognosis</span><br />
<span style="font-size: large;">d) Associated with learning difficulties</span><br />
<span style="font-size: large;">e) Serum creatine phosphokinase is elevated</span><br />
<span style="font-size: large;"><br /></span>
<br />
<h2>
<span style="font-size: large;">
Answers</span></h2>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">01. a) T b) F c) T d) - e) T</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">02. a) T b) T c) T d) F</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">03. a) F b) F c) T d) T e) -</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">04. a) F b) T c) T d) T</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">05. a) F b) T c) F d) F e) F</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">06. a) T b) T c) F d) T e) F</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">07. a) T b) T c) F d) F e) F</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">08. a) T b) F c) T d) T e) F</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">09. a) T b) T</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">10. b</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">11. N/A</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">12. a) T b) T c) T d) F e) T</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">13. a) T b) F c) T d) T e F</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">14. d</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">15. a</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">16. c</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">17. a) F b) T c) F d) T e) F</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">18. a) T b) T c) F d) T e) T</span><br />
<span style="font-size: large;"><br /></span>Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com0tag:blogger.com,1999:blog-1066018850107550180.post-76342894828732335442020-04-24T13:39:00.001+05:302020-04-24T13:50:41.248+05:30Neurology MCQ - Pediatrics<h2>
<span style="font-size: large;">MOTOR DISEASES</span></h2>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>1) About 12 days after a mild upper respiratory tract infection, a 12 year old boy complains of weakness in his lower extremities. Over several days, the weakness progress to include hid hand. On examination he has the weakness described and no lower extremity deep tendon reflex, muscular atrophy or pain. Spinal fluid studies are notable for elevated protein only. likely diagnosis would be</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">A. Bell palsy </span><br />
<span style="font-size: large;">B. Muscular dystrophy </span><br />
<span style="font-size: large;">C. Guillen barre syndrome </span><br />
<span style="font-size: large;">D. Charcot marie tooth disease </span><br />
<span style="font-size: large;">E. Werdnig Hoffman disease</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>2) 5 year old boy presented with progressive lower limb weakness for 3 days. one week after starting school. an examination lower limb power G 2. leg reflex absent. no bladder symptoms. indication for viral isolation.</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. to identify surveillance </span><br />
<span style="font-size: large;">b. possible diagnosis of polio </span><br />
<span style="font-size: large;">c. to exclude the polio </span><br />
<span style="font-size: large;">d. to identify the immunization problem </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large; font-weight: bold;"><br /></span>
<span style="font-size: large;"><b>3) Regarding Guillain Barre Syndrome </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) CSF protein characteristically reduces in amount with progression of diseases </span><br />
<span style="font-size: large;">b) It is an illness ascending asymmetrical type of muscle weakness </span><br />
<span style="font-size: large;">c) This is An autosomal recessive condition </span><br />
<span style="font-size: large;">d</span><span style="font-size: large;">) There is no change in bowel or bladder function </span><br />
<span style="font-size: large;">e) Immunoglobin infusion is preferable to plasma exchange</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>4) 5 year old child with TOF presented with progressive right side hemiparesis after diarrhea. Most likely diagnosis?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Left middle cerebral artery thrombosis </span><br />
<span style="font-size: large;">b) Left middle cerebral artery embolism </span><br />
<span style="font-size: large;">c) Left middle cerebral artery septic emboli </span><br />
<span style="font-size: large;">d) Left cerebral abscess </span><br />
<span style="font-size: large;">e) Left cerebral hemispheric infraction</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>5) A grade 1 student present with bilateral lower limb flaccid paralysis, areflexia and no bladder involvement 1 week after school admission. What is the most appropriate reason for you to send his stool samples for polio virology?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) To confirm case of polio</span><br />
<span style="font-size: large;">b) To exclude cases of polio </span><br />
<span style="font-size: large;">c) To detect vaccine derived poliomyelitis following school admission </span><br />
<span style="font-size: large;">d) To follow polio surveillance guidelines </span><br />
<span style="font-size: large;">e) To make measures to prevent spreads of polio to other students</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>6) About 12 days after a mild upper respiratory tract infection, a 12 year old young boy complains of weakness of his lower extremities. Over several days the weakness progress to include his trunk. On the examination, he has the weakness described and no lower extremity deep tendon reflexes, muscular atrophy or pain. Spinal fluid studies are notable for elevated protein only. The most likely diagnosis would be,</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Bell’s palsy </span><br />
<span style="font-size: large;">b) Muscular dystrophy </span><br />
<span style="font-size: large;">c) Guillen barre syndrome </span><br />
<span style="font-size: large;">d) Charcot maries tooth disease </span><br />
<span style="font-size: large;">e) Werdnig Hoffman disease</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">7) Guillain- Barre syndrome </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Is associated with asymmetrical flaccid paralysis </span><br />
<span style="font-size: large;">b. Is an ascending paralysis </span><br />
<span style="font-size: large;">c. Is associated with sensory deficits </span><br />
<span style="font-size: large;">d. Is treated with immunoglobulins </span><br />
<span style="font-size: large;">e. Leads to permanent brain damage</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<br />
<h2>
<span style="font-size: large;">CNS INFECTIONS </span></h2>
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">1)18 month old child presented with a 6 days history of fever, vomiting, irritability and dry cough. She was treated with oral antibiotics by several practitioners prior to admission. Result of CSF analysis: Appearance-colourless, protein-80mg/di, sugar 40mg/dl, cells:Neutrophil-25, lymphocyte-40, RBS-100. Basic investigation to identify underlying causative organism, </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Bacterial antigen test in CSF </span><br />
<span style="font-size: large;">b. Blood culture and ABST</span><br />
<span style="font-size: large;">c. CSF culture and ABST </span><br />
<span style="font-size: large;">d. CSF direct smear and gram stain </span><br />
<span style="font-size: large;">e. CSF direct smear and Zilch-Nelson stain</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>2).months old boy having a dry cough presented with fever and drowsiness. He was previously treated by a GP with oral antibiotics. CSF full report; colourless, glucose 40mg/dl, protein elevated, lymphocytes- 60%, polymorphs-high, RBS-100mg/dl.</b></span><br />
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">What is the best investigation to diagnose? </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Detection of bacterial antigens in CSF </span><br />
<span style="font-size: large;">b) Blood culture and ABST </span><br />
<span style="font-size: large;">c) CSF for culture and ABST</span><br />
<span style="font-size: large;">d) CSF for gram stain </span><br />
<span style="font-size: large;">e) CSF for Zeil-Neilson stain</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>3) CSF analysis? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Increased polymorpho nuclear leucolytes in bacterial meningitis</span><br />
<span style="font-size: large;">b. Decreased sugar in tuberculosis meningitis </span><br />
<span style="font-size: large;">c. Protein increased in viral infection </span><br />
<span style="font-size: large;">d. Lymphocytes predominant in TB meningitis </span><br />
<span style="font-size: large;">e. Mycobacterium on gram stain</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>4). 1 year old girl presented with left sided weakness and dilated left pupil while treating for meningitis. Lumbar puncture: appearance turbid, lymphocyte 75, neutropil 5, protein 3000[15-40), glucose 3 mmol, gram stain organism, culture- no growth, ESR-120, imaging revealed calcified region in the right cerebral cortex. Which of the following is the likely dx? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Viral encephalitis </span><br />
<span style="font-size: large;">b. SSPE </span><br />
<span style="font-size: large;">c. meningitis with abscess </span><br />
<span style="font-size: large;">d. Bacterial encephalitis </span><br />
<span style="font-size: large;">e. Aseptic meningitis</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>5) In a suspected case of Meningitis </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Treatment should be with held to confirm the diagnosis </span><br />
<span style="font-size: large;">b. LP is done without local anesthesia If the child not responding pain </span><br />
<span style="font-size: large;">C Delay until the FBC report is available </span><br />
<span style="font-size: large;">d. Presence of lung signs makes diagnosis unlikely </span><br />
<span style="font-size: large;">e. Immunization history is of no value</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>6) Regarding clinical presentation of meningitis?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Neck stiffness is more useful sign in 1 year old child with meningitis. </span><br />
<span style="font-size: large;">b) Seizures occur in 50% of patients. </span><br />
<span style="font-size: large;">c) Fever is not always present at presentation in acute bacterial meningitis. </span><br />
<span style="font-size: large;">d) Bulging or tense anterior fontanella is a useful sign in young infants. </span><br />
<span style="font-size: large;">e) Papilloedema is rare in acute uncomplicated bacterial meningitis.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>7) A nine year old boy was admitted to the paediatric ward with tingling sensation of both lower limbs for 2 days duration.On the day of admission, he had a fall while climbing stairs. On examination, lower limb power was grade 3. Few hours later he complained of difficulty in breathing What is the most likely etiological agent for this child's problem? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Polio virus </span><br />
<span style="font-size: large;">b) Clostidium botulinum</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">8). Regarding management of CNS infection in children </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a.) Gp-B Streptococcal infection treated for 21 days of antibiotics </span><br />
<span style="font-size: large;">b). Close contact of Meningococcal meningitis should receive prophylaxis </span><br />
<span style="font-size: large;">c.)Multiple cranial nerve involvement is seen in TB meningitis </span><br />
<span style="font-size: large;">d.) Herpes virus infection leads to temporal sclerosis </span><br />
<span style="font-size: large;">e.)HSV encephalitis should need Hearing assessment</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>9) A 3 month old baby with bacterial meningitis is on IV cefotaxime. In spite of the above treatment she continued to have fever spikes and looked unwell. What is the most appropriate next step in the management at this stage? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Change the antibiotics to a higher spectrum </span><br />
<span style="font-size: large;">b) Request a repeat CRP and FBC </span><br />
<span style="font-size: large;">c) Request an USS brain </span><br />
<span style="font-size: large;">d) Refer for neurosurgical opinion</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>10) Regarding management of CNS infection in children </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a). Gp-B Streptococcal infection treated for 21 days of antibiotics </span><br />
<span style="font-size: large;">b.) Close contact of Meningococcal meningitis should receive prophylaxis </span><br />
<span style="font-size: large;">c)Multiple cranial nerve involvement is seen in TB meningitis </span><br />
<span style="font-size: large;">d)</span><span style="font-size: large;">. Herpes virus infection leads to temporal sclerosis</span><br />
<span style="font-size: large;">e). HSV encephalitis should need Hecring assessment</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>11) Which of the following can occur as the complication of Bacterial meningitis? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Waterhouse-Friderichsen syndrome. </span><br />
<span style="font-size: large;">b) Cerebral abscess. </span><br />
<span style="font-size: large;">c) Necrotizing enterocolitis. </span><br />
<span style="font-size: large;">d) Purpurafulminans. </span><br />
<span style="font-size: large;">e) Spinal muscular dystrophy.</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">12)Prophylactic antibiotics are indicated for close contacts of a patient with meningitis when the aetiological agent is </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Streptococcus pneumoniae </span><br />
<span style="font-size: large;">b) GBS </span><br />
<span style="font-size: large;">c) H.influenza type b </span><br />
<span style="font-size: large;">d) E.coli </span><br />
<span style="font-size: large;">e) Neisseria meningitidis</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">13) Niesseria meningitidis </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Is a gram negative cocci</span><br />
<span style="font-size: large;">b) well sensitive to macroiides </span><br />
<span style="font-size: large;">c) is a common cause of aseptic meningitis</span><br />
<span style="font-size: large;">d) commonest cause for pre school age meningitis </span><br />
<span style="font-size: large;">e) can cause severe respiratory distress</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>14). 10 year old girl presented with left sided weakness and dilated left pupil while treating for meningitis. lumbar puncture- appearance turbid, lymphocyte 75, neutrophil 5, Pr 3000 (15-40), glucose 3 mmoles , gram stain no Organism, culture-no Growth. ESR- 120. imaging study revealed calcified lesion in the right cerebral cortex. WOF is the likely diagnosis</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) viral encephalitis </span><br />
<span style="font-size: large;">b) SSPE </span><br />
<span style="font-size: large;">c) bacterial meningitis with Abscess </span><br />
<span style="font-size: large;">d) herpetic encephalitis </span><br />
<span style="font-size: large;">e) TB meningitis</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>15) 18 month old boy having a dry cough presented with fever and drowsiness. he was previously treated by GP with oral antibiotics. CSF full report; colorless, glucose 40 mg/dL, protein- elevated, lymphocytes60%, RBS- 100 mg/dL.</b></span><br />
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>What is the best investigation to diagnose?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Detection of bacterial antigens in CSF </span><br />
<span style="font-size: large;">b) blood culture an ABST</span><span style="font-size: large;"> </span><br />
<span style="font-size: large;">c) CSF for culture and ABST </span><br />
<span style="font-size: large;">d) CSF for gram stain </span><br />
<span style="font-size: large;">e) CSF 4 Zeil- Neilson stain</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>16) Regarding rabies </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Domestic rat have been implicated in the transmission of rabies</span><br />
<span style="font-size: large;">b) Rabies virus will penetrate the intact mucus membrane </span><br />
<span style="font-size: large;">c) Vaccination give 100% sero-conversion </span><br />
<span style="font-size: large;">d) Sensitivity test should be done before giving human rabies immunoglobulin </span><br />
<span style="font-size: large;">e) If patient develops reaction to rabies immunoglobulin should not give IV hydrocortisone</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">17) Clinical features more favors of herpes simplex encephalitis: </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Involve frontal and temporal lobe </span><br />
<span style="font-size: large;">b) Focal convulsion </span><br />
<span style="font-size: large;">c) Focal change in EEG </span><br />
<span style="font-size: large;">d) Presence of RBC in non traumatic CSF </span><br />
<span style="font-size: large;">e) Increased C reactive protein</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<br />
<h2>
<span style="font-size: large;">UNCONSCIOUS PATIENT</span></h2>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>1) A 3 year old girl is presented with a sudden onset LOC. she's having multiple bruises over the trunk, what is the next step in the Mx? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Urgent CT brain </span><br />
<span style="font-size: large;">b) skeletal survey </span><br />
<span style="font-size: large;">c) Judicial medical referral </span><br />
<span style="font-size: large;">d) start head injury observation </span><br />
<span style="font-size: large;">e) order and EEG</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">2) A 2 year old child admitted because of weakness proceeding to coma. According to the parents, he had been well until several hours prior to admission, when they noted diarrhoea, cough, wheezing and sweating. Physical examination reveals a comatose child with diffuse weakness. Pupils are pinpoint and unresponsive. Examination of the chest reveals generalized wheezing. Oral secretions are copious. Which of the following should you administer at this time</span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Adrenaline </span><br />
<span style="font-size: large;">b) Atropine </span><br />
<span style="font-size: large;">c) Cefotaxime </span><br />
<span style="font-size: large;">d) Methylprednisolone</span><br />
<span style="font-size: large;">e) Edrophonium </span><br />
<span style="font-size: large;"><br /></span>
<br />
<h2>
<span style="font-size: large;"><br /></span><span style="font-size: large;">CEREBELLAR</span><span style="font-size: large;"> DISEASE</span></h2>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>1) 4 year old girl presented with torticollis and ataxia for 3 weeks. On examination she is irritable, head deviation, ataxia, past pointing, dysdiadokokinaesia. Bp 120/80, pr 60, what is the diagnosis? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Transverse myelitis </span><br />
<span style="font-size: large;">b) Meduloblastoma </span><br />
<span style="font-size: large;">c) Fedrich ataxia </span><br />
<span style="font-size: large;">d) </span><span style="font-size: large;">Dystonic reaction to drug </span><br />
<span style="font-size: large;">e) Viral encephalitis</span><br />
<span style="font-size: large;"><br /></span>
<br />
<h2>
<span style="font-size: large;">SEIZURE</span></h2>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>1) A 2 week old baby born by Em LSCS presented to the hospital with 2 episodes of seizures and feeding also not well for 12 hours duration. Baby is drowsy. Temperature 35.5°C Blood glucose – 40mg/dl S.calcium – 8.2mg/dl(NL 8.2-10.9) S.Na+ - 132mmol/l(NL 130-142) S.K+ - 4.3mmol/l(NL 3.2-5.2) What is the most likely diagnosis? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Hypoglycaemia </span><br />
<span style="font-size: large;">b) Meningitis </span><br />
<span style="font-size: large;">c) Hypocalcaemia </span><br />
<span style="font-size: large;">d) Hyponatremia </span><br />
<span style="font-size: large;">e) Hypoxic ischemic encephalopathy</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>2) A eight month old child was seen with inconsolable cry and one episode of seizure and feeding febrile and recent scar was noted on his anterior chest. Further examination revealed, full fontanelle and reduced movements in right upper limb. Above findings are more consistent with,</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Acute pyogenic meningitis </span><br />
<span style="font-size: large;">b) Viral encephalitis </span><br />
<span style="font-size: large;">c) Non accidental injury </span><br />
<span style="font-size: large;">d) Space occupying lesion </span><br />
<span style="font-size: large;">e) Cerebral oedema</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">3). Regarding simple febrile convulsions </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Occur after the 1st 48 hours of the illness</span><br />
<span style="font-size: large;">b) Long term anti-epileptics are indicated </span><br />
<span style="font-size: large;">c) Can cause status epilepticus</span><br />
<span style="font-size: large;">d) Requires neuro imaging </span><br />
<span style="font-size: large;">e) Contraindication for DPT vaccination</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>4). Febrile fits </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. Fit with low grades of fever indicate higher risk of recurrence </span><br />
<span style="font-size: large;">b. Fits lasting more than 30 minutes should be treated with IV antibiotics </span><br />
<span style="font-size: large;">c. Fits within few hours of fever should be evaluate for meningitis </span><br />
<span style="font-size: large;">d. Risk of neurological impact can be reduces by AED </span><br />
<span style="font-size: large;">e. Are common among children with neurological impairment</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">5). An 18 month old child presents to the emergency centre having had a brief, generalized tonic clonic seizure. He is now postictal and has a temperature of 40C. during the lumbar puncture (which proves to be normal) he has a large watery stool that has both blood and mucous in it. The most likely diagnosis in this patient is </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a. salmonella </span><br />
<span style="font-size: large;">b. enterovirus </span><br />
<span style="font-size: large;">c. Rotavirus </span><br />
<span style="font-size: large;">d. campylobacter </span><br />
<span style="font-size: large;">e. Shigella</span><br />
<span style="font-size: large;"><br /></span>
<br />
<b><br /></b>
<span style="font-size: large;"><b>6). A 2 year old child presents with fever and one episode of generalized tonic clonic seizure of 5 minutes duration. Most appropriate management ache. time of discharge is.</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Start sodium valproate from next seizure </span><br />
<span style="font-size: large;">b)Reassure </span><br />
<span style="font-size: large;">c) Inform mother about the increased risk of developing epilepsy</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">7) Features to differentiate pseudo seizures from epileptic seizures </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a.gradual onset </span><br />
<span style="font-size: large;">b. pelvic thrusting </span><br />
<span style="font-size: large;">c. cyanosis </span><br />
<span style="font-size: large;">d. body roling </span><br />
<span style="font-size: large;">e. tongue biting</span><br />
<br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>8) Epilepsy </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Recurrent uncontrolled discharge of electrical activities should result in motor manifestations. </span><br />
<span style="font-size: large;">b) Should be treated with AED </span><br />
<span style="font-size: large;">c) Hypocalcaemia may be the cause</span><span style="font-size: large;"> </span><br />
<span style="font-size: large;">d) Schooling should be avoided </span><br />
<span style="font-size: large;">e) May develop fits with fever</span><br />
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">9) In the management of tonic convulsions (status epilepticus) </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Measuring blood glucose is not important </span><br />
<span style="font-size: large;">b) Diazepam IV can be given </span><br />
<span style="font-size: large;">c) If not responding for first bolus of diazepam phenytoin IV should be given </span><br />
<span style="font-size: large;">d) Defined as seizure lasting more than 30 mins </span><br />
<span style="font-size: large;">e) Paraldehyde is given IM</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>10) Correctly matched pair </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Absence seizure – sodium valproate </span><br />
<span style="font-size: large;">b) Infantile spasms – prednisolone </span><br />
<span style="font-size: large;">c) Myotonic seizure – phenobarbitone </span><br />
<span style="font-size: large;">d) Status epilepticus – phenytoin </span><br />
<span style="font-size: large;">e) Temporal lobe epilepsy – ethosuximide</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">11) Following are commonly matched </span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Déjà vu – temporal lobe epilepsy </span><br />
<span style="font-size: large;">b) Night terrors – petite mal </span><br />
<span style="font-size: large;">c</span><span style="font-size: large;">) Vacant episodes – abscense seizures </span><br />
<span style="font-size: large;">d) Aura of fear – benign rolandic epilepsy </span><br />
<span style="font-size: large;">e) Development regression – west syndrome</span><br />
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><br /></span>
<span style="font-size: large;">12) A 4 year old girl presented with a GTC convulsion. She had abdominal pain and watery stools with mucus for 3 days. She has not passed urine for 12 hours. Tempersture was 37.20C, WBC – 30000/mm3 ( N – 82% , L – 18% , platelets – 110,000/mm3 ). What feature in the blood picture will confirm the diagnose?</span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Burr cells with acanthocytes </span><br />
<span style="font-size: large;">b) Heinzbodies with polychromasia </span><br />
<span style="font-size: large;">c) Marked anisopoikilocytosis</span><br />
<span style="font-size: large;"><br /></span>
Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com0tag:blogger.com,1999:blog-1066018850107550180.post-8178572565809776972020-04-24T10:02:00.003+05:302020-04-24T10:02:24.213+05:30Cardiovascular system (CVS) MCQ - Part II - Medicine<h2>
<span style="font-size: large;">Hypertension (HTN)</span></h2>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>1. Regarding systemic hypertension </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Low birth weight is associated with adult hypertension </span><br />
<span style="font-size: large;">b) Peripheral vascular disease is a complication </span><br />
<span style="font-size: large;">c) Can be caused by excessive intake of alcohol</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>2. A 25 yr old male presents with a BP of 180/110 mmHg. WOTF investigations will help to find out a cause </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) ECG </span><br />
<span style="font-size: large;">b) USS abdomen </span><br />
<span style="font-size: large;">c) Estimation of urinary catecholamines </span><br />
<span style="font-size: large;">d) Serum Electrolytes </span><br />
<span style="font-size: large;">e) Chest X ray</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>3. Regarding malignant hypertension, </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Headache is a typical feature </span><br />
<span style="font-size: large;">b) Papilledema is common </span><br />
<span style="font-size: large;">c) Intravenous nitrate is contraindicated </span><br />
<span style="font-size: large;">d) Blood pressure should be brought down to normal levels within 10 minutes </span><br />
<span style="font-size: large;">e) Essential to look for secondary causes</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>4. Following drugs are appropriate for management of chronic hypertension, </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Captopril </span><br />
<span style="font-size: large;">b) Verapamil </span><br />
<span style="font-size: large;">c) Spironolactone </span><br />
<span style="font-size: large;">d) Digoxin </span><br />
<span style="font-size: large;">e) Metaprolol</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>5. Treatment of hypertension. </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Calcium Chanel blockers are contraindicated in patients over 65 y. </span><br />
<span style="font-size: large;">b) Spironolactone is recommended in resistant HT </span><br />
<span style="font-size: large;">c) Combination of ACEI & ARB best avoided </span><br />
<span style="font-size: large;">d) Methyl dopa is contraindicated in pregnancy </span><br />
<span style="font-size: large;">e) Weight reduction alone decrease BP</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>6. Which of the following statements regarding hypertension is/are true?</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) ACEI is drug of choice in HTN associated with systemic sclerosis </span><br />
<span style="font-size: large;">b) ARB is contraindicated in diabetic nephropathy </span><br />
<span style="font-size: large;">c) Prazocin causes postural hypotension </span><br />
<span style="font-size: large;">d) CCB are safe during pregnancy </span><br />
<span style="font-size: large;">e) Thiazides are contraindicated in elderly</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>7. 22 yr old girl with BP-160/100 mmHg. Which of the causes are correctly matched, </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Hypokalemia – Crohn’s disease </span><br />
<span style="font-size: large;">b) Café au lait spots – pheochromocytoma </span><br />
<span style="font-size: large;">c) Short lower limbs – coarctation of aorta </span><br />
<span style="font-size: large;">d) Presence of red cells – renal artery stenosis</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>8. Review of the patient's medical records showed that her systolic blood pressure was greater than 140 mmHg at both of her last clinic appointments. Her medical history is otherwise significant only for diabetes mellitus. Today her blood pressure is 160/90 mmHg. What is the best next step in her blood pressure management?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Ask the patient to keep written records of her blood pressure and bring with her to the next appointment </span><br />
<span style="font-size: large;">b) Advise the patient to begin a heart healthy, low sodium diet and refer to a nutritionist. </span><br />
<span style="font-size: large;">c) Prescribe an ACE inhibitor in addition to heart healthy life. </span><br />
<span style="font-size: large;">d) Prescribe a calcium channel blocker in addition to a heart healthy diet. </span><br />
<span style="font-size: large;">e) Arrange for echocardiogram to assess for end organ damage.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>9. A 67 years old male patient presents to your clinic to establish primary care. He is asymptomatic and he has a history of hypertension for which he takes a thiazide. His father had a myocardial infarction at age of 62. The patient smoked until 5 years ago, but has been abstinent from tobacco since then. His blood pressure is 130/80 mmHg. Aside from being over-weight, the remainder of the physical examination is unremarkable. Which of the following preventive health interventions would be most appropriately offered to him today?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"></span><br />
<span style="font-size: large;">a) Carotid ultrasound to evaluate for carotid artery stenosis. </span><br />
<span style="font-size: large;">b) Abdominal ultrasound to evaluate for aortic aneurysm. </span><br />
<span style="font-size: large;">c) Lipoprotein assay to evaluate coronary heart disease risk. </span><br />
<span style="font-size: large;">d) Exercise (treadmill) stress testing to evaluate for coronary artery disease. </span><br />
<span style="font-size: large;">e) Homocysteine level to evaluate coronary heart disease risk.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>10. A 25 year old previously healthy school teacher underwent pre employment screening and found to have elevated blood pressure. Her blood pressure recording for 2 weeks in various occasions ranged from 160/90 to 170/90 mmHg. Her other examinations were normal what is the least Important preliminary Investigation?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) ECHO </span><br />
<span style="font-size: large;">b) ECG </span><br />
<span style="font-size: large;">c) Serum creatinine </span><br />
<span style="font-size: large;">d) Serum electrolytes </span><br />
<span style="font-size: large;">e) Urine albumin and sediments</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<h2>
<span style="font-size: large;">Arrhythmia</span></h2>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>1. Following is/are true of atrial fibrillation? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) ASD is a known cause </span><br />
<span style="font-size: large;">b) has saw-toothed 'p' wave in ECG </span><br />
<span style="font-size: large;">c) often asymptomatic</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>2. Regarding atrial fibrillation </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) is more common with thyrotoxicosis due to Graves disease </span><br />
<span style="font-size: large;">b) Irregularity of the pulse is corrected after exercise </span><br />
<span style="font-size: large;">c) Presents as broad complex tachycardia </span><br />
<span style="font-size: large;">d) May occur in young individuals with no cardiac disease </span><br />
<span style="font-size: large;">e) Pneumonia is a known cause</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>3. Recognized features of atrial fibrillation are </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Irregular pulse volume </span><br />
<span style="font-size: large;">b) Variable first heart sound </span><br />
<span style="font-size: large;">c) Fixed splitting of heart sound </span><br />
<span style="font-size: large;">d) Mid diastolic murmur at the apex </span><br />
<span style="font-size: large;">e) 4th heart sound</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>4. Features of a complete heart block, </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Irregular cannon 'a' waves </span><br />
<span style="font-size: large;">b) Dissociation of P waves and QRS complexes on ECG </span><br />
<span style="font-size: large;">c) Varying intensity of first heart sound </span><br />
<span style="font-size: large;">d) Mid diastolic murmur at apex </span><br />
<span style="font-size: large;">e) Presents with syncopal attacks</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>5. T/F regarding complete heart block </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Cannon waves seen in JVP </span><br />
<span style="font-size: large;">b) Digoxin improves the survival </span><br />
<span style="font-size: large;">c) Increase the incidence of systolic embolism </span><br />
<span style="font-size: large;">d) Insert a pace maker if anterior MI occurs </span><br />
<span style="font-size: large;">e) Can occur due to inferior MI</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<b><span style="font-size: large;"><span style="font-size: medium;"></span>
</span>
<span style="font-size: large;">6. An 80 year old woman was admitted to the ward with dizziness. Cardiac monitoring initially revealed atrial fibrillation with rapid ventricular response. Her ventricular rate was controlled with beta blocker. An echocardiogram revealed an enlarged left atrium and an ejection fraction of 50%. No evidence of diastolic </span><span style="font-size: large;">heart dysfunction was noted. She is now asymptomatic, with blood pressure 130/80 mmHg, heart rhythm irregularly irregular, and heart rate around 80 beats/min. Which of the following is the best management strategy of this patient's arrhythmia?</span></b><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Electrical cardioversion plus prolonged anticoagulation </span><br />
<span style="font-size: large;">b) Electrical cardioversion without anticoagulation </span><br />
<span style="font-size: large;">c) Chemical cardioversion plus prolonged anticoagulation </span><br />
<span style="font-size: large;">d) Chemical cardioversion without anticoagulation </span><br />
<span style="font-size: large;">e) Continued rate control plus prolonged anticoagulation.</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>7. Which of the following suggest a VT than a SVT as the likely cause </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) QRS >0.14 s </span><br />
<span style="font-size: large;">b) Presence of capture beats </span><br />
<span style="font-size: large;">c) Irregular rhythm </span><br />
<span style="font-size: large;">d) Q waves in V1 </span><br />
<span style="font-size: large;">e) History of angina pectoris</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>8. A 30 year old male had a blackout while exercise at the gymnasium and remained unconscious for about 2 min till he was revived by cardiac massage. Most appropriate investigation(s) to arrive at a diagnosis is/was?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Plain CT </span><br />
<span style="font-size: large;">b) ECG </span><br />
<span style="font-size: large;">c) ECHO </span><br />
<span style="font-size: large;">d) EEG </span><br />
<span style="font-size: large;">e) Holter monitoring</span><br />
<span style="font-size: large;"><br /></span>
<h2>
<span style="font-size: large;"><br /></span><span style="font-size: large;">Valvular heart diseases</span></h2>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>1. Regarding aortic stenosis</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Pulse pressure is widened </span><br />
<span style="font-size: large;">b) Loud 2nd heart sound </span><br />
<span style="font-size: large;">c) Thrusting apex </span><br />
<span style="font-size: large;">d) Can present with angina </span><br />
<span style="font-size: large;">e) ECG may show LVH</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>2. Regarding aortic stenosis </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Manifest as syncope </span><br />
<span style="font-size: large;">b) Is a complication of bicuspid valve </span><br />
<span style="font-size: large;">c) Associated with low volume pulse </span><br />
<span style="font-size: large;">d) Is the commonest valve involved in Rheumatic fever </span><br />
<span style="font-size: large;">e) Can manifest as angina</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>3. Mitral stenosis </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Causes left ventricular failure </span><br />
<span style="font-size: large;">b) Heaving apex </span><br />
<span style="font-size: large;">c) Presystolic accentuation is prominent with atrial fibrillation </span><br />
<span style="font-size: large;">d) Slow rising pulse </span><br />
<span style="font-size: large;">e) Common in rheumatic fever</span><br />
<span style="font-size: large;"></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>4. Mitral regurgitation </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Acute rheumatic carditis can be a cause </span><br />
<span style="font-size: large;">b) Third heart sound signifies bad prognosis </span><br />
<span style="font-size: large;">c) Thromboembolism is less common than in MS. </span><br />
<span style="font-size: large;">d) May occur due to aortic valve disease </span><br />
<span style="font-size: large;">e) Murmur may radiate to the neck</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>5. Recognized signs of mitral regurgitation include, </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Loud S1 </span><br />
<span style="font-size: large;">b) Rumbling mid diastolic murmur at apex </span><br />
<span style="font-size: large;">c) Third heart sound </span><br />
<span style="font-size: large;">d) Parasternal heave </span><br />
<span style="font-size: large;">e) Reversed splitting of second heart sound</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>6. 55 year old patient with rheumatic valvular heart disease is admitted in confused state. Pulse is irregularly irregular. Pulse rate is 160. BP is 70/50. What is the most appropriate management of this patient?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) IV amiodarone </span><br />
<span style="font-size: large;">b) DC cardioversion </span><br />
<span style="font-size: large;">c) IV digoxin </span><br />
<span style="font-size: large;">d) Infusion of Normal Saline </span><br />
<span style="font-size: large;">e) Infusion of dobutamine</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>7. 28 yr old man with known valvular heart disease presented with fever for 2 weeks duration and SOB. O/E temperature -38.3 C, harsh pansystolic murmur and mild bibasal crepitations. Blood cultures were taken. What is the most appropriate next step in Management,</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) ECG </span><br />
<span style="font-size: large;">b) IV antibiotics </span><br />
<span style="font-size: large;">c) throat swab </span><br />
<span style="font-size: large;">d) furosemide </span><br />
<span style="font-size: large;">e) 2D-Echo</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>8. A 79 year old female presents with recurrent falls and transient loss of consciousness for a few minutes. Most of these episodes occurred while she was walking. Examination does not show any focal neurological signs. Her pulse is regular and blood pressure is 110/90 mmHg. There is no cardiomegaly. Auscultation reveals an ejection systolic murmur best heard over the aortic area which radiates to carotids, what is the most appropriate investigation to find the cause for her presentation?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Contrast enhanced CT brain </span><br />
<span style="font-size: large;">b) EEG </span><br />
<span style="font-size: large;">c) ECG </span><br />
<span style="font-size: large;">d) Echocardiogram </span><br />
<span style="font-size: large;">e) Holter monitoring</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<h2>
<span style="font-size: large;">ECG</span></h2>
<span style="font-size: large;"></span><br />
<span style="font-size: large;"><b>1. Which of the following ECG abnormalities usually no need for specific treatment</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) First degree heart block </span><br />
<span style="font-size: large;">b) Sinus arrhythmia</span><br />
<span style="font-size: large;">c) Atrial flutter </span><br />
<span style="font-size: large;">d) Mobitz II 2° heart block </span><br />
<span style="font-size: large;">e) Wenckebach 2° heart block</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>2. Which of the following are correctly paired </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) ST depression & T inversion - digoxin toxicity </span><br />
<span style="font-size: large;">b) Short QT interval - hypo Ca2+ </span><br />
<span style="font-size: large;">c</span><span style="font-size: large;">) Prominent U wave - hypokalemia </span><br />
<span style="font-size: large;">d) Subarachnoid hemorrhage - T inversions in v2-v5 </span><br />
<span style="font-size: large;">e) Tall p waves - hyper K+</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>3. Causes of tall R waves in V1 </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Wolf Parkinson white syndrome </span><br />
<span style="font-size: large;">b) LBBB </span><br />
<span style="font-size: large;">c) Right ventricular hypertrophy </span><br />
<span style="font-size: large;">d) Atrial fibrillation </span><br />
<span style="font-size: large;">e) Posterior MI</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>4. A 37 year old male with CKD presents with shortness of breath. His ECG reveals tall T wave and wide QRS complex. What is the next step in the management?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Dextrose IV </span><br />
<span style="font-size: large;">b) Hemodialysis </span><br />
<span style="font-size: large;">c) Calcium gluconate </span><br />
<span style="font-size: large;">d) Nebulize with salbutamol </span><br />
<span style="font-size: large;">e) Oral resin</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<h2>
<span style="font-size: large;">Cardiomyopathies</span></h2>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>1. True or false regarding dilated cardiomyopathy</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Characterized by right ventricular dilation </span><br />
<span style="font-size: large;">b) Associated with thyrotoxicosis </span><br />
<span style="font-size: large;">c) Fourth heart sound</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>2. Regarding Infective Endocarditis </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Staph epidermidis the commonest cause </span><br />
<span style="font-size: large;">b) Treated for 2 weeks</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>3. Causes of pericarditis</b></span><br />
<br />
<span style="font-size: large;">a) Uraemia </span><br />
<span style="font-size: large;">b) SLE </span><br />
<span style="font-size: large;">c) hypothyroidism </span><br />
<span style="font-size: large;">d) Dressler’s syndrome</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"></span><br />
<span style="font-size: large;"><b>4. Infective endocarditis (IE)</b> </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Acute IE cannot occur in normal valves</span><br />
<span style="font-size: large;">b) More common with increasing age </span><br />
<span style="font-size: large;">c) Staphylococcus is the commonest agent after cardiac surgery </span><br />
<span style="font-size: large;">d) Almost always leads to macroscopic hematuria </span><br />
<span style="font-size: large;">e) Manifest with hypochromic microcytic blood picture</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<h2>
<span style="font-size: large;">CVS clinical signs</span></h2>
<br />
<span style="font-size: large;"><b>1. In JVP </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) ‘a’ wave indicates atrial contraction </span><br />
<span style="font-size: large;">b) There are 3 positive waves </span><br />
<span style="font-size: large;">c) V wave Indicates TR </span><br />
<span style="font-size: large;">d) V wave indicates SVC obstruction </span><br />
<span style="font-size: large;">e) a wave absent in atrial fibrillation</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>2. Regarding JVP </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Increase with inspiration in constrictive pericarditis. </span><br />
<span style="font-size: large;">b) С wave correspond to iso volumetric contraction of the ventricles </span><br />
<span style="font-size: large;">c) Large V wave occur in tricuspid stenosis </span><br />
<span style="font-size: large;">d) a wave coincide with p wave in the ECG </span><br />
<span style="font-size: large;">e) Easily seen when the patient is supine if the patient has heart failure</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>3. Which of the following is compatible with BP 120/50 mmHg in right upper arm? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Aortic stenosis </span><br />
<span style="font-size: large;">b) MR </span><br />
<span style="font-size: large;">c) AR </span><br />
<span style="font-size: large;">d) PDA </span><br />
<span style="font-size: large;">e) VSD</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>4. Central cyanosis is more likely than peripheral cyanosis </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) If cyanosis is in pinna </span><br />
<span style="font-size: large;">b) cyanosis of nails at warm extremities</span><span style="font-size: large;"> </span><br />
<span style="font-size: large;">c) If cyanosis disappears with O2 therapy </span><br />
<span style="font-size: large;">d) If clubbing is present </span><br />
<span style="font-size: large;">e) SPO2<95 mmHg in</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>5. Clinical features of cardiac tamponade </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Reduced JVP </span><br />
<span style="font-size: large;">b) muffled heart sounds </span><br />
<span style="font-size: large;">c) hypotension </span><br />
<span style="font-size: large;">d) bradycardia </span><br />
<span style="font-size: large;">e) pulses paradoxes</span><br />
<span style="font-size: large;"></span><br />
<br />
<br />
<span style="font-size: large;"><b>6. Regarding CVS examination </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Pulses alterance – HOCM </span><br />
<span style="font-size: large;">b) Loud SI - 1st degree heart block </span><br />
<span style="font-size: large;">c) Reverse splitting of S2 - LBBB</span><br />
<span style="font-size: large;">d) Third heart sound – hypertension </span><br />
<span style="font-size: large;">e) Double impulse at the apex - aortic stenosis</span>Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com0tag:blogger.com,1999:blog-1066018850107550180.post-43157326611658017062020-04-24T09:32:00.000+05:302020-04-24T09:32:11.193+05:30Cardiovascular system (CVS) MCQ - Part I - Medicine<h2>
<span style="font-size: large;">Ischemic Heart Disease (IHD)</span></h2>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>1) 55 years old man presented with severe central chest pain for 2 hours duration. ECG showed dome shaped (convex upward) ST elevations in the anterior chest leads. An ECG taken on the previous day was normal. Regarding this patient,</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Acute myocardial infarction is a likely diagnosis </span><br />
<span style="font-size: large;">b) CK-MB levels will be elevated </span><br />
<span style="font-size: large;">c) Streptokinase is indicated </span><br />
<span style="font-size: large;">d) Pethidine is the drug of choice for analgesia </span><br />
<span style="font-size: large;">e) Aspirin improves mortality due to its anticoagulant effect</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>2. T/F regarding myocardial infarction </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Bradycardia common in anterior MI than inferior MI </span><br />
<span style="font-size: large;">b) Streptokinase is indicated in normal ECG with typical symptoms </span><br />
<span style="font-size: large;">c) Beta blocker improves survival rate </span><br />
<span style="font-size: large;">d) Aspirin is with held until diagnosed by ECG </span><br />
<span style="font-size: large;">e) Statin is given even in normal LDL level</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>3. What are the treatment options in patient with NSTEMI? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Streptokinase </span><br />
<span style="font-size: large;">b) Heparin </span><br />
<span style="font-size: large;">c) Clopidogrel </span><br />
<span style="font-size: large;">d) Warfarin </span><br />
<span style="font-size: large;">e) Atorvastatin</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>4. Regarding stable angina </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Resting ECG is abnormal in 50% </span><br />
<span style="font-size: large;">b) Upward sloping ST segment depression is more suggestive of ischemia </span><br />
<span style="font-size: large;">c) May undergo spontaneous improvement with time </span><br />
<span style="font-size: large;">d) Treatment with nitrates improve the survival </span><br />
<span style="font-size: large;">e) Aortic stenosis may have a similar presentation</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>5. Regarding unstable angina </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Hypothyroidism is a risk factor </span><br />
<span style="font-size: large;">b) Thrombolytic therapy is indicated in severe disease </span><br />
<span style="font-size: large;">c) Men & women are equally affected </span><br />
<span style="font-size: large;">d) Troponin T elevated in most cases</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>6. Regarding thrombolysis in MI </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) If LBBB is present, ST elevation should be confirmed before thrombolysis </span><br />
<span style="font-size: large;">b) Arrhythmias during the thrombolysis carry a worst prognosis </span><br />
<span style="font-size: large;">c) Q waves may not develop if successful thrombolysis occurs </span><br />
<span style="font-size: large;">d) Can be repeated if chest pain recur within 1 week </span><br />
<span style="font-size: large;">e) Has a long term mortality benefit</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>7. Regarding MI </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Sub-endocardial Ml manifest in specific leads </span><br />
<span style="font-size: large;">b) Pericardial rub occurs simultaneously with 1st ECG changes </span><br />
<span style="font-size: large;">c) Pansystolic murmur at apex may signify papillary muscle dysfunction </span><br />
<span style="font-size: large;">d) Breathlessness may be the only symptom </span><br />
<span style="font-size: large;">e) Vomiting is more common with anterior MI</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>8. A 56 year old male with a past history of myocardial infarction is admitted with sudden onset palpitations. ECG shows a broad complex tachycardia. The patient is conscious with blood pressure of 110/80 mmHg. What is the most appropriate treatment?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Carotid massage </span><br />
<span style="font-size: large;">b) Intravenous adenosine </span><br />
<span style="font-size: large;">c) Intravenous amiodarone </span><br />
<span style="font-size: large;">d) DC cardioversion </span><br />
<span style="font-size: large;">e) Intravenous digoxin</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>9. A 45y old male complains of recurrent episodes of left sided chest pain on exertion. Resting ECG is normal, the next most appropriate ix to arrive a diagnosis is</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Coronary angiogram </span><br />
<span style="font-size: large;">b) Brain natriuretic peptide </span><br />
<span style="font-size: large;">c) Echo </span><br />
<span style="font-size: large;">d) Exercise ECG </span><br />
<span style="font-size: large;">e) Troponin I</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>10. 75 year old woman who has recurrent angina on GTN spray, aspirin, atorvastatin, enalapril and verapamil came to clinic. On examination her BP was 130/80, Pulse 60 bpm. To prevent the above problem what is your appropriate next management?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Changing verapamil to diltiazem </span><br />
<span style="font-size: large;">b) Changing enalapril to captopril </span><br />
<span style="font-size: large;">c) Add beta-blocker d) Give daily oral GTN </span><br />
<span style="font-size: large;">e) Reassure that it is normal</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>11. 55 year old female with diabetes mellitus and hypertension presented to ETU with retrosternal chest pain for 1 hour. ECG reveals 4 mm ST elevation in V1-V6. After excluding all contraindications, streptokinase 1.5 units were given. 2 hours later pain was persistent and there was 3 mm ST elevation in same leads of ECG. What is the best management?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Urgent coronary artery bypass graft </span><br />
<span style="font-size: large;">b) Rescue PCI </span><br />
<span style="font-size: large;">c) Repeat streptokinase </span><br />
<span style="font-size: large;">d) S/C enoxaparin </span><br />
<span style="font-size: large;">e) IV GTN</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<h2>
<span style="font-size: large;">Heart Failure (HF)</span></h2>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>1. Heart failure </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) MI is the commonest cause of LVF </span><br />
<span style="font-size: large;">b) Increased preload can maintain the cardiac output in severe heart failure</span><br />
<span style="font-size: large;">c) Rennin angiotensin mechanism is activated </span><br />
<span style="font-size: large;">d) Diastolic dysfunction is more common in elderly </span><br />
<span style="font-size: large;">e) Pansystolic murmur that best heard in inspiration may occur in LVF</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b>2. Regarding chronic heart failure</b></span><br />
<br />
<span style="font-size: large;">a) Arrhythmias is the commonest cause of death in class II of NYHA classification </span><br />
<span style="font-size: large;">b) Angiotensin levels are elevated </span><br />
<span style="font-size: large;">c) Survival benefit of Furosemide is well proved in clinical trials</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>3. A 30 year old man who presented with progressive shortness of breathing. He found to have a blood pressure of 80/50 mmHg and elevated JVP with muffled heart sounds. Which of the following are expected findings,</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Ankle oedema </span><br />
<span style="font-size: large;">b) Pulses paradoxes </span><br />
<span style="font-size: large;">c) Bilateral basal crepitations of the lungs </span><br />
<span style="font-size: large;">d) ECG showing small complexes </span><br />
<span style="font-size: large;">e) Globular heart in chest x-ray</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">4. In heart failure </span><br />
<span style="font-size: large;">a) ACE inhibitors are the 1st choice in management </span><br />
<span style="font-size: large;">b) Treatment with furosemide reduces the cardiac output </span><br />
<span style="font-size: large;">c) Beta blockers are prescribed to relieve the symptoms </span><br />
<span style="font-size: large;">d) Calcium channel blockers has special role in diastolic dysfunction </span><br />
<span style="font-size: large;">e) Implanted devices has no place in the management f) Digoxin is given only if atrial fibrillation is present</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>5. Which of the following has mortality benefit in CCF? </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) spironolactone </span><br />
<span style="font-size: large;">b) captopril </span><br />
<span style="font-size: large;">c) Isosorbide mononitrate </span><br />
<span style="font-size: large;">d) furosemide </span><br />
<span style="font-size: large;">e) metaprolol</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>6. Which of the following give survival benefit in cardiac failure </b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Captopril </span><br />
<span style="font-size: large;">b) HCT </span><br />
<span style="font-size: large;">c) Carvedilol </span><br />
<span style="font-size: large;">d) Digoxin </span><br />
<span style="font-size: large;">e) Spironolactone</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>7. A 50 year old man develops shortness of breath and leg swelling while away on a business trip. He was told that he had congestive cardiac failure, but asymptomatic now, with normal vital signs & physical examination. An echocardiogram shows an estimated ejection fraction of 38%. The patient likes to keep medications to a minimum. He is currently on aspirin and simvastatin. Which would be the most appropriate additional treatment?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Begin an ACE inhibitor and a beta-blocker on a scheduled basis. b) Begin digoxin plus furosemide on a scheduled basis. </span><br />
<span style="font-size: large;">c) Begin spironolactone on a scheduled basis. </span><br />
<span style="font-size: large;">d) Begin furosemide plus nitroglycerin.</span><br />
<span style="font-size: large;">e) Given his preferences, no other medication is needed unless shortness of breath and swelling occur.</span><br />
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>8. A 60 year old previously well male complained of progressive breathlessness, abdominal discomfort and swelling of the legs. On examination there was a gross ascites, elevated JVP, bibasal crepitations and enlarged liver. BP - 180/80 mmHg, RR-25/min, PR - 36 bpm. On ECG heart rate is 96 bpm. What is the best management option?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Digoxin </span><br />
<span style="font-size: large;">b) Digoxin + Furosemide </span><br />
<span style="font-size: large;">c) Furosemide </span><br />
<span style="font-size: large;">d) Abdominal paracentesis </span><br />
<span style="font-size: large;">e) Transthoracic pacemaker</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>9. 54 y old man treated for heart failure had SOB in exertion. Had P/Hx of MI back. PR=80 regular, BP=130/90 mmHg. RS Ex normal. CXR-cardiomegaly he is on Furosemide 40 mg, Enalapril 10 mg. next drug?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) Digoxin </span><br />
<span style="font-size: large;">b) Metoprolol </span><br />
<span style="font-size: large;">c) HCT </span><br />
<span style="font-size: large;">d) Atenolol </span><br />
<span style="font-size: large;">e) Losartan</span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;"><b><br /></b></span>
<span style="font-size: large;"><b>10. 35 year old male with a previous history of STEMI presented with SOB & ankle Oedema after 2/52. Echo showed scarring of the L/ventricle. What is the best drug with survival benefit for this patient?</b></span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">a) ISMN </span><br />
<span style="font-size: large;">b) Carvedilol </span><br />
<span style="font-size: large;">c) Diltiazem </span><br />
<span style="font-size: large;">d) Warfarin </span><br />
<span style="font-size: large;">e) Furosemide</span><br />
<br />Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com0tag:blogger.com,1999:blog-1066018850107550180.post-59978705807475726992020-04-23T22:44:00.000+05:302020-04-23T22:44:19.259+05:30Schizophrenia MCQ - Psychiatry - with answers<!-- wp:paragraph -->
<span style="font-size: large;"><b>1) Regarding Schizophrenia,</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Poor prognosis if the onset is young<br /> b. No evidence that there is a genetic predisposition<br /> c. Enlarged ventricles are seen in some<br /> d. Prognosis is better in developed countries<br /> e. Highly expressed emotions increase the risk of relapse</span><br />
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<span style="font-size: large;"><b><br />2) Passive symptoms of schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Blunting of mood<br /> b. Poor speech<br /> c. Auditory hallucinations<br /> d. Poverty of thought<br /> e. Social withdrawal</span><br />
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<span style="font-size: large;"><b><br />3) Regarding epidemiology of schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Life time risk is 1% in general population<br /> b. Onset is typically between 15-35 years of age<br /> c. Onset is earlier in females<br /> d. Incidence is similar worldwide<br /> e. Prognosis is worse in developing countries</span><br />
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<span style="font-size: large;"><br /><b>4) Following are Schneider’s first rank symptoms of schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Nihilistic delusions<br /> b. Depersonalization <br /> c. Visual Hallucinations <br /> d. Thought broadcasting <br /> e. Suicidal thoughts</span><br />
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<span style="font-size: large;"><br /><b>5) Regarding the treatment of schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. ECT is effective in patients with chronic schizophrenia<br /> b. Family psycho-education aiming at reducing emotional over involvement has proved to reduce relapse<br /> c. Antipsychotic medication should be started in high doses and reduced gradually <br /> d. Antipsychotics should not be given for more than a year <br /> e. Behaviour therapy has no place in management </span><br />
<span style="font-size: large;"><br /></span>
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<span style="font-size: large;"><b>6) Good prognostic factors in schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Early onset of disease<br /> b. Male sex<br /> c. Presence of affective symptoms<br /> d. Prodromal symptoms for 1 year prior to onset of illness<br /> e. Onset following a stressful event</span><br />
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<span style="font-size: large;"><b><br />7) Regarding treatment of schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. An episode should be treated for 1year after symptom resolution<br /> b. Young age has a good prognosis <br /> c. Lifetime risk is 10:1000<br /> d. Concurrent use of anticholinergics reduce the risk of tardive dyskinesia<br /> e. Sodium valproate reduces relapses</span><br />
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<span style="font-size: large;"><br /><b>8) True or false regarding schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Has a neurodevelopmental basis<br /> b. Acute symptoms respond to treatment better than chronic<br /> c. Lifetime risk is 10:10000<br /> d. Young patients have a better prognosis than old patients<br /> e. Point prevalence is 5 in 1000</span><br />
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<span style="font-size: large;"><b><br />9) Following are characteristic features of chronic schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Lethargy<br /> b. Hallucinations<br /> c. Disturbed behaviour<br /> d. Formal thought disorder<br /> e. Abnormal movements</span><br />
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<span style="font-size: large;"><br /><b>10) Features of chronic schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Elevation of mood<br /> b. Negative symptoms<br /> c. Obsessional phenomenon<br /> d. Loss of self-coping skills<br /> e. Apparent cognitive impairment</span><br />
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<!-- wp:paragraph -->
<span style="font-size: large;"><br /><b>11) Schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Usually begins in old age<br /> b. Usually does not interfere with day to day life<br /> c. Is known to relapse when maintenance medicine is stopped<br /> d. Is the rarest psychosis<br /> e. Carries a very poor prognosis </span><br />
<span style="font-size: large;"><br /></span>
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<br />
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<span style="font-size: large;"><b>12) In the treatment of schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Medication is continued at least for one year after resolution of symptoms<br /> b. Atypical antipsychotics should not be used in young patients<br /> c. Deport preparations are used in patients with poor drug compliance<br /> d. Sodium valproate is used to reduce relapses<br /> e. Rehabilitation is needed for chronic cases</span><br />
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<span style="font-size: large;"><br /><b>13) The following strongly support the diagnosis of schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Third person auditory hallucinations <br /> b. Disorientation<br /> c. Visual hallucinations<br /> d. Passivity experience<br /> e. History of sexual abuse in childhood</span><br />
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<span style="font-size: large;"><br /><b>14) Schizophrenia</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Is diagnosed based on clinical presentation<br /> b. According to ICD 10 symptoms should last at least 6 months<br /> c. If the symptoms are for less than 1 month it is called acute psychotic disorder<br /> d. 30% of patients will recover<br /> e. Risk of suicide is highest when the disorder is in its early stages</span><br />
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<span style="font-size: large;"><br /><b>15) True or False</b></span><br />
<span style="font-size: large;"><b><br /></b> a. Delusional disorder is when one only has delusions without other symptoms<br /> b. In delusional disorder the delusions get encapsulated<br /> c. Schizoaffective disorders may need both antipsychotic and antidepressant or mood stabilizing drugs<br /> d. Primary delusions are common<br /> e. Primary delusions are significant in diagnosing schizophrenia</span><br />
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<h2>
<span style="font-size: large;"><br /></span></h2>
<h2>
<span style="font-size: large;">Answers</span></h2>
<!-- /wp:heading -->
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<span style="font-size: large;">01. a) T b) F c) F d) F e) T</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
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<span style="font-size: large;">02. a) T b) T c) F d) T e) T</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
<!-- wp:paragraph -->
<span style="font-size: large;">03. a) T b) T c) F d) T e) F</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
<!-- wp:paragraph -->
<span style="font-size: large;">04. a) F b) F c) F d) T e) F</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
<!-- wp:paragraph -->
<span style="font-size: large;">05. a) T b) T c) F d) F e) F</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
<!-- wp:paragraph -->
<span style="font-size: large;">06. a) F b) F c) F d) F e) T</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
<!-- wp:paragraph -->
<span style="font-size: large;">07. a) F b) F c) T d) T e) F</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
<!-- wp:paragraph -->
<span style="font-size: large;">08. a) T b) T c) F d) F e) T</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
<!-- wp:paragraph -->
<span style="font-size: large;">09. a) F b) F c) F d) F e) T</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
<!-- wp:paragraph -->
<span style="font-size: large;">10. a) F b) T c) T d) T e) F</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
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<span style="font-size: large;">11. a) F b) F c) T d) F e) F</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
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<span style="font-size: large;">12. a) F b) F c) T d) F e) T</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
<!-- wp:paragraph -->
<span style="font-size: large;">13. a) T b) F c) F d) T e) F</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
<!-- wp:paragraph -->
<span style="font-size: large;">14. a) T b) F c) T d) T e) T</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->
<!-- wp:paragraph -->
<span style="font-size: large;">15. a) T b) T c) T d) F e) T</span><br />
<span style="font-size: large;"><br /></span>
<!-- /wp:paragraph -->Global Medcasthttp://www.blogger.com/profile/02140141520245991718noreply@blogger.com0tag:blogger.com,1999:blog-1066018850107550180.post-173719804727106332013-09-28T23:10:00.000+05:302020-04-23T22:08:44.533+05:30It's a new beginning!<span style="font-size: large;">Hello there, </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">There are plenty of blogs and websites which give medical education. But most of them are not free. So this step is to overcome it. </span><br />
<br />
<span style="font-size: large;">Medical education is a rapidly developing science and specialty with an exponential increase in factual knowledge occurring daily.</span><br />
<br />
<span style="font-size: large;">Even knowledge on the basic principles of medicine required at undergraduate level is overwhelming for most students at this rapid pace of expansion. It is therefore imperative for educators to develop new and innovative teaching method in medical education. Here comes the online approach of the medical platform. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">We know that life of a medical student doesn't have much free time. They have limited time and limited environment. Smart time management is the key of success. </span><br />
<span style="font-size: large;"><br /></span>
<span style="font-size: large;">First we are going to place several mainstream subjects in medicine here. You can find MCQs of all the key subjects.</span><br />
<span style="font-size: large;"><br /></span>
<br />
<ul>
<li><span style="font-size: large;">Medicine</span></li>
<li><span style="font-size: large;">Surgery</span></li>
<li><span style="font-size: large;">Pediatrics </span></li>
<li><span style="font-size: large;">Gynecology and Obstetrics</span></li>
<li><span style="font-size: large;">Psychiatry</span></li>
</ul>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">New subjects will be added later on. </span></div>
<div>
<span style="font-size: large;"><br /></span></div>
<div>
<span style="font-size: large;">The concept of online MCQs is not new in medical education. But those designed with a thorough understanding of requirements of the medical students in worldwide is rare. So we are trying to make a real difference here. </span></div>
Supun Godakumburahttp://www.blogger.com/profile/13661591972693741916noreply@blogger.com0