Practice of Medicine final preparation

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examPractice of Medicine final preparation

Dr Anil BHMS
Senior Medical Officer
Br Sur Hmoeopathy Medical College. Delhi

E.C.G.

  1. P wave (represents atrial depolarization): Duration: < 2.5mm (0.10 sec.).
  2. PR interval: 0.12-0.20 sec (3-5 squ.).
  3. Q wave: < 0.04 sec. Wide & < 2mm depth.
  4. QRS complex (represents ventricular depolarization): In limb leads amplitude should be 5mm or more. In chest lead 10mm or more. Duration of QRS Complex 0.10 sec.
  5. QT interval: In males – 0.42 sec.; In females – 0.43 sec.
  6. ST segment: Usually isoelectric. Planar elevation (> 1mm) or depression (> 0.5 mm). Usually implies infarction (p105) or ischaemia (p91) respectively.
  7. T wave (represents ventricular repolarisation): Abnormal if inverted in I, II & V4-V6. It is peaked in hyperkalaemia (p89) & flattened in hypokalaemia. T waves are termed tall when the height exceeds 10mm.
  8. U wave: Increase in U wave amplitude in hypokalaemia.

Abnormal E.C.G.

  1. P wave: Enlarged & notched (M-shaped) in Lt atrium enlargement, known as p-mitral. When p wave is tall and peak is called p-pulmonale.
  2. QRS amplitude: It is decreased (low voltage ECG) in emphysema, myxoedema, and pericardial effusion.
  3. Pathological Q wave: Seen in V1-V4 in anteroseptal MI. Seen in lead II, III, and AVF in inferior MI.
  4.  ST segment elevation: Due to MI or acute pericarditis.
  5. QT interval: increased in hypokalaemia and hypocalcaemia.
  6. Osborn wave or ‘J’ wave: seen in hypothermia.

Murmurs

  1. Austin flint murmur: Mid-diastolic murmur seen in AR.
  2. Graham Steel murmur: Early diastolic murmur of PR.
  3. Carey Coombs murmur: Mid diastolic murmur of Acute Rheumatic Fever.
  4. Gibson murmur or machinery murmur: In PDA.
  5. Carvallo murmur: Systolic murmur seen in TS.

Heart sounds

  1. H(S1): Closure of mitral and tricuspid valve. Loud S1 in mitral stenosis (MS); Increased cardiac output (CO); large stroke volume.
  2. H(S2): Closure of pulmonary and aortic valve. Loud S2: in hypertension (HTN). Wide splitting of S2 in PS & RBB. Fixed splitting of S2 in ASD. Paradoxical splitting in AS, LBB, Hypertrophic cardiomyopathy.
  3. H(S3): Caused by ventricular filling, after the opening of AV valve. It is pathological after the age of 40 years, seen in MR., Weak LV.
  4. H(S4): It is pathological, caused by forceful atrial contraction. Heard in HTN & AS.

ASSOCIATED CONGENITAL ABNORMALITIES

  1. Down’s syndrome: ASD, VSD, TOF, Endocardial Cushing defect.
  2. Edward’s syndrome: VSD, PDA.
  3. Congenital Rubella syndrome: PDA, PS, ASD, VSD.
  4. CMV: Purpura.
  5. Marfan syndrome: AR, MR.
  6. Carcinoid syndrome: TS, PS, Effects esp. rt. side of heart.
  7. Ehler Danlos syndrome: MR.
  8. Osteogenesis imperfecta: MR.
  9. Mitral Valve Prolapse: Marfan syndrome, Ehler Danlos, and Hurles.
  10. Patau’s syndrome: VSD, PDA.

DNA                                                                               RNA

Herpes simplex                                                       Poliovirus

Varicella zoster                                                      Hepatitis A, C & G

CMV                                                                            Measles

Hepatitis B                                                                 Mumps

EB virus                                                                      Rabies

Cox virus                                                                   Rubella

Herpes virus                                                             KFD

Japanese Encephalitis

Yellow Fever

Dengue Fever

HIV

Ebola

Chickungunia

Coxsackie’s

H5N1

EB virus causes: Burkitt’s lymphoma, oesopharyngeal carcinoma, Hodgkin’s disease, B cell lymphoma.

HIV associated with Kaposi’s sarcoma, primary CNS lymphoma, NHL.

Diagnostic Tests

  1. Shick test: Diphtheria
  2. Dick test: Scarlet fever.
  3. Casoni’s test: Echinococcus Granulosa.
  4. Paul Bunnel, Monospot: Infectious mononucleosis.
  5. Sabin Fieldman dye test: Toxoplasmosis.
  6. Frei test: LGV
  7. Aldehyde & ketone test: Leishmaniasis.
  8. Kveim test: Sarcoidosis.
  9. ANCA test: Wegner’s granulomatosis
  10. Serum angiotensin converting enzyme: Sarcoidosis.
  11. Ito test:

Name of the disease

Vector

Causative organism

Incubation period

Chickungunia

Aedes egypti

Arbo virus

2-4 days

Kysanur Forest disease (monkey’s disease)

Tics

(Haemophyllis turura)

Arbo virus

2-7 days

Dengue fever

Aedes egypti, A. albopictus

Arbo virus

3-10 days

Yellow fever

Aedes egypti

Arbo virus

3-6 days

Japanese encephalitis

C. tritaeniochynchus

Arbo virus

6-16 days

Filariasis

W. bancrofti

Brugaria Malaya

Loa Loa

Culex mosquito

Mansonin mosquito

Chrysops flies

Area affected

  1. Typhoid ulcer- terminal ileum.
  2. Tubercular ulcer- terminal ileum.
  3. Crohn’s disease- ileum.
  4. Amoebiasis- caecum
  5. Ulcerative colitis- rectum in 95% cases.
  6. Peutz Josher syndrome- jejunum
  7. Pseudomembranous colitis- rectum & anal canal
  8. Coeliac disease- Duodenojejunal junction
  9. Ascaris and tapeworm- jejunum
  10. Hookworm- jejunum
  11. Enterobius- caecum, appendix
  12. Giardia- duodenum & jejunum

Normal pressure

  • Intracranial- 10 mm of Hg  (as per Harrison ICP should be maintained below 20 mm of Hg).
  • Intraoccular- 20 mm of Hg.
  • Portal Pressure- 2-5 mm of Hg (complication developed when pressure is above 12 mm of Hg.)

Characteristic abnormalities of stool colour.

  1. Tarry Black: Upper GI haemorrhage (malena), proximal to transverse colon e.g. Peptic ulcer, caecal angiodysplasia. Iron or colloidal bismuth therapy.
  2. Bloody: Ulcerative colitis, colorectal tumours, and colonic diverticulitis.
  3. Pale: Fat malabsorption (steatorrhoea) from either small bowel or pancreatic disease.
  4. Silvery or lead paint stool: Combination of steatorrhoea & GIT haemorrhage eg. Pancreatic carcinoma.
  5. Pea soup diarrhea: Typhoid.
  6. Red current jelly stool: Intussusceptions.
  7. Toothpaste like stool: Hirchsprungs disease.
  8. Pellet like stool: Irritable bowel syndrome.
  9. Pipe stem stool:  Stricture of rectum
  10. Rabbit stool: congenital, Hypertrophic pyloric stenosis.

Pneumonia

  1. Klebsiella pneumonia: upper lobes are involved. Seen in patients of chronic illness.
  2. Staphylococcal pneumonia: seen in extremes of age. X-ray shows pneumatocele (thin walled cystic cavities).
  3. Legionella pneumonia (Legionnaire’s disease): caused by L. pneumophilla. Incubation period-10 days. Transmission-droplets.
  4. Chlamydia pneumonia: Incubation period: 1-2 weeks.

Sputum

Type of sputum

Causes

1. Copious, pink, frothy Pulmonary Oedema
2. Copious, purulent, pungent Bronchiectasis, lung abscess
3. Copious, clear, watery Alveolar cell carcinoma
4. Rusty staining of mucoid sputum Early pneumococcal pneumonia
5. Anchovy sauce sputum Amoebic liver abscess
6. Black (melanoptysis) Coal dust
7. Blood oyster (frank blood embedded within mucopurulent sputum) Tuberculosis

Valvular abnormalities

Disease

Cause

Sex predilection

Murmurs

MS

Rheumatic

Congenital

Females

1st heart sound prominent

MVP

Idiopathic

Familial

Rheumatic heart disease

Marfan’s

Females

Late systolic and mid diastolic murmur.

AR

Rheumatic heart disease

Infective endocarditis

Syphilis

Males

Early diastolic and mid diastolic

PDA

Congenital

Females

Gibson’s murmur

TS

Rheumatic heart disease

Congenital

Males

Ejection systolic murmur

CA LUNG

I Non-small cells Ca

  1. Adenocarcinoma- 32% of cases
  2. Squamous cell carcinoma-29% of cases
  3. Large cell carcinoma (anaplastic)-9%

II Small cell carcinoma (oat cell)-18%

  1. In non-smokers, adenocarcinoma is common.
  2. Clubbing is common in non-small cell carcinoma.
  3. Hypertrophic pulmonary osteo arthropathy is seen in adenocarcinoma.
Ca oesophagus
  • Common in males.
  • Middle one third usually affected.
  • 90% are sq. cell carcinoma
  • In Barrett’s oesophagus, adenocarcinoma is developed.
  • Ba meal shows rat tailed deformity
  • Dysphagia and related symptoms are developed when lumen is less than 14 mm.
Ca stomach
  • Common in males
  • Blood group ‘A’ is more prone.
  • Common location is antrum.
  • 30-90% of cases are associated with H.pylori
  • Metastatic nodules in umbilicus is called sister Joseph nodules
  • Metastatic mass in peri rectal pouch is called Blumer shelf.
  • Ovarian metastasis is called Krukenburg tumor.
  • Left supra clavicular lymphnode enlargement is called Virchow’s node or Troisier’s sign.
Ulcerative colitis
  • Autoimmune.
  • Common in females.
  • Rectal mucosa involved more commonly. (> 95% of cases)
  • X-ray shows loss of haustrations, lead pipe appearance.
  • P-ANCA +ve in 60-70% of cases.
  • Bloody diarrhoea is hallmark.

Crohn’s disease (Regional ileitis/ regional eneritis)

  • Common in males.
  • Intestine is commonly involved.
  • Barium meal shows string sign, skip lesions.
  • Patient presents with mass in right iliac fossa.
  • Sigmoidoscopy shows oedematous mucosa having cobblestone appearance.
  • Anti saccharomyces cerevisiae antibodies (ASCA) +ve in 60-70% of cases.
  • Rectum not involved usually.

Intestinal TB

  • Ileocecal area commonly affected.
  • Tubercular ulcer lies transverse to long axis of gut.
  • Ba meal x-ray shows +ve string sign.
  • Fleischern’s sign- obliteration of ileocecal angle with formation of triangle with its base towards caecum. (Inverted umbrella sign).
  • Sterlin’s sign-Rapid transit and lack of barium retention in an inflamed segment of small bowel.
Pancreatitis
  • Causes: Gall bladder stone, ethyl alcohol, trauma, scorpion bite, mumps, steroids, hyperparathyroidism, autoimmune, ERCP, drugs etc.
  • Grey Turner’s sign +ve (discoloration of flanks)
  • Cullen sign +ve.
  • Pseudo cyst formation (complication).
  • X-ray shows colon cut-off sign-Dilatation of ascending colon as a result of spasm of proximal transverse colon (inflammation of head of pancreas) or spasm of descending colon with dilatation of transverse colon are included in colon cut-off sign.
  • Sentinel loop are also common.
Achalasia cardia
  • LOS does not relax.
  • X-ray shows absence of fundal gas shadow.
  • Ba meal shows oesophageal dilatation and beak like narrowing (rat tail deformity).
Gerd
  • Retrograde flow of gastric contents because of reduced LOS pressure. (Less than 10 mm).
  • Normal LOS pressure is 10-30 mm of Hg.
Signs
  • ALFRED DE MUSSET’S SIGN: Forward and backward jerking of the head or visible movements of the ears, synchronous with the beating of the heart, seen in ear.
  • BOA’S SIGN: Hyperaesthesia over right to subscapular area, seen in acute cholecystitis.
  • BRUDZINSKI’S NECK SIGN: Flexion of hips and knees and flexion of neck in meningitis.
  • CARVALLO’S SIGN: Murmurs of TR & TS accentuated by inspiration.
  • CHADDOCK’S SIGN: Extensor plantar response stroking the lateral malleolus.
  • GORDON’S SIGN: A Babiniski’s like response on squeezing the calf muscle.
  • CHVOSTEK’S SIGN: A light tap over the facial nerve, in front of the ear, in case of latent tetany, results in a sudden contraction of the facial muscles. It can also occur in an appreciable number of normal people.
  • INVERTED UMBRELLA SIGN/ FLEISCHMER’S SIGN: Thickening of ileocaecal valve give rise to broad triangular appearance with the base toward caecum in intestinal TB.

Infective endocarditis:

  • Acute endocarditis is caused by Staph aureus.
  • SABE caused by Strept viridans.
  • Other causes are HACEK organisms (Hemophilus, Actinobacillus, Cardiobacterium, Eikenella and Kingella).
  • Left side is more affected generally.
  • Infection of normal valve is very rare.
  • In drug users Staphylococcal endocarditis of tricuspid valve is common.
  • Duke’s criteria:
Major criteria
  1. Positive blood culture.
  2. evidence of Endocardial involvement.
  3. positive echocardiogram.
Minor criteria
  1. predisposing heart condition or injection drug abuse.
  2. Fever > 100.4 degrees F.
  3. Vascular phenomena-emboli, infarcts, aneurysms, janeway lesions etc.
  4. Immunologic phenomena-glomerulonephritis, Osler’s nodes, Roth’s spots etc.
  5. Microbiologic evidence.

Investigations:

  • ESR increased.
  • Normocytic, normochromic anaemia.
  • Raised CRP
  • Repeated blood culture.
  • Echocardiography.

Clinical features:

  • Pallor.
  • Painful clubbing.
  • Osler’s nodes.
  • Spleenomegaly. (In coxiella infection).

Postoperative endocarditis after cardiac surgery may affect native or prosthetic heart valves or other prosthetic materials. The most common organism is a coagulase negative Staphylococcus epidermidis, which is a normal skin commensal.

MVP (Barlow’s syndrome or floppy valve syndrome):

  • Common in females associated with marfan’s syndrome, Ehler’s Danlos syndrome, and pseudo Xanthoma elastica.

C/F:

  • Chest pain.
  • Palpitation.

On Examination: Midsystolic click with or without late systolic murmur.

MS: 

  • Common in females.
  • Commonly in rheumatic heart disease.
  • Normal valve orifice (4-6 cm sq) when it is less than 2, obstruction starts.

C/F:

  • Dyspnoea.
  • Hemoptysis.
  • Palpitations.

On examination:

  • 1st heart sound is loud.
  • Early diastolic murmur.
  • ECG shows p-mitrale especially in lead-II

MR:

  • Only males.
  • Rheumatic heart disease is the common cause.

On examination:

  • Loud S3
  • PAN systolic murmur.

AS:

  • Common in males.
  • Common cause is congenital.
  • Normal aortic valvular area is 3-4 sq cm. Symptoms are developed when it is > 1 sq cm.

C/F:

  • Syncope.
  • Angina and
  • Breathlessness are the triad.

On examination:

  • Ejection systolic murmur.

ASD: 

  • Commonest congenital disease in adults.
  • Common in females.
  • H/o ostium secundum is commonest.
  • Symptoms develop after the 4th decade of life.

On examination:

  • Wide and fixed splitting of the 2nd heart sound.
  • Mid diastolic murmur.
  • Flouroscopy shows hilar dance.

VSD:

  • Perimemberanous VSD is the commonest.
  • Splitting of S2
  • In infants VSD becomes symptomatic by 6-10 weeks.

PDA: 

  • Common in females.
  • It is due to the failure of closure of ductus arteriosus (it is a vessel leading from the bifurcation of the pulmonary artery to the aorta just distal to the left subclavian vein.
  • Continuous machinery murmur with systolic accentuation. (Gibson’s murmur).

FALLOT’S TETROLOGY: 

  • It includes VSD, Rt. ventricular outflow tract obstruction, overriding of aorta and rt. ventricular hypertrophy.
  • It accounts for 10-15% of all CHDs.
  • Cyanosis is noticed at the end of 1 yr, clubbing present, praecordium is silent.
  • X-ray shows boot shaped heart.

TGA:

  • Common in males.
  • 30% infants die in the 1st week and 90% in the 1st year.

Acute Compression Triad (Beck’s Triad):

Occurs in cardiac tamponade

  • Rising venous pressure
  • Falling arterial pressure and
  • Small quiet heart

Hulls Triad:

  • Diastolic gallop
  • Anasarca
  • Small pulse pressure

Trilogy of Fallot: Fallot’s Triad)

  • Pulmonary stenosis
  • Ventricular septal defect
  • Overriding of aorta

Tetralogy of Fallot:

  • Pulmonary stenosis
  • Ventricular septal defect
  • Overriding of aorta
  • Right ventricular hypertrophy

Pentalogy of Fallot

  • Pulmonary stenosis
  • Ventricular septal defect
  • Overriding of aorta
  • Right ventricular
  • hypertrophy Atrial septal defect

Behcet’s syndrome Triad

  • Recurrent oral ulcers
  • Genital ulcers
  • Relapsing iritis

Charcot’s Triad:

  • Fluctuating jaundice
  • Recurrent pain
  • Intermittent fever with rigors

Murphy’s Triad: (in appendicitis)

  • Pain first
  • Vomiting next
  • Fever last

Portal hypertension Triad:

  • Splenomegaly
  • Ascites
  • Oesophageal varices

Saint’s Triad:

  • Diverticulosis
  • Gall stones
  • Hiatus hernia

Whipple’s Triad

  • Symptoms of hypoglycemia in the fasting state
  • Hypoglycemia less than 45 mg
  • Relief with glucose in insulinomas

 MCQs IN CARDIOLOGY 

1. Following is the largest protein molecule.

a. titin  b. actin  c. myosin  d. troponin  e. tropomyosin

ans…a.titin

  • titin (connectin)—— myofibrillar protein
  • longest gene is for cardiac  dystrophin.

2.The following finding differentiates acute LVF from a/c respiratory dyspnoea.

a .accentuated p2  b.bilateral rhonchi  c.sinus tachycardia d.pulsus alternans  e.tachypnea

ans  …..d…Pulsus alternans ….occurs in severe LVT.

  • Exaggerated in presence of AR, HTN and by reducing venous return.
  • Better felt in peripheral arteries—brachial/femoral.
  • Anacrotic,dicrotic and bisferiens better felt over the carotids.
  • Slow rising pulse—AS
  • Collapsing pulse-AR,PDA
  • Bisferens pulse—AS+AR
  • pulsus paradoxus—Pericardial tamponade,Constrictive pericarditis,RCM,pulmonary embolism,pregnancy,hypovolemia,COPD
  • corrigan’s pulse—AR
  • Pistal shot pulse—AR
  • Quinke’s pulse—-AR
  • Pulsus bigeminus—AV Block,digitalis toxicity.

3.Cannon  a waves is seen in  which of the following

a.TS  b.PS  c.TR   d.Ebsttein anomaly  e.Complete heart  block.

Ans……..e…..complete heart block

  • Large a waves –TS, Ebstein anomaly, PS, Pulmonary hypertension, c/c Corpulmonale, Cardiomyopathy
  • Cannon waves—Complete AV dissociation,eg. Complete heart block,Venticular tachycardia.
  • Absent a waves— Atrial flutter,Fibrillation
  • Large v wave—TR,ASD
  • Large x descent—c/c Constrictive pericarditis(normally x is more prominent)
  • Large y descent—Constrictive pericarditis(Frederich’s sign)
  • In cardiac tamponade x is sharper,y is unimpressive
  • Cardiac filling in cardiac tamponade is unimodal;(normal is bimodal filling)
  • Shallow y descent—TS
  • Absent hepatojugular reflux—IVC obstruction,Budd Chiari syndrome

4.. Figure of 8 appearance in x-ray is seen in

a. TAPVC b.TGV c.DORV d.Pulmonary atresia e.Tricuspid atresia

ans…….a.TAPVC

  • TGV— egg on side appearance
  • pericardial effusion—stenciled appearance
  • Ebstein’s anomaly –Box shaped heart—–lithium?
  • Ebstein anomaly  is associated with WPW Syndrome type B

5.Following features helps to distinguish a/c Aortic dissection  from a/c MI.

a. the pain is severe b. radiation of pain to neck c. h/o hypertension d. hypotension e. pain is maximum at the onset itself

ans……..e.pain is maximum at the onset itself

  • Aortic dissection more in hypertensives
  • cause of a/c ar
  • X-ray –calcium sign
  • best investigation –MRI

6.Cyanosis at birth is seen in the following conditions except

a.tetrology of fallot b.transposition of great arteries c.truncus arteriosus d.pulmonary atresia e.tricuspid atresia.

.Ans…a…TOF

  • Commonest CHD  presenting with cyanosis is TGV
  • TOF—cyanosis usually begins after 6 months
  • Spells between 2 months and 2 years (cyanotic spells, tet spells)
  • Commonest cyanotic CHD
  • X-ray findings—normal sized boot shaped heart, oligemic lung fields
  • Central cyanosis, squatting position,
  • PS+VSD+ Over riding of aorta+ RVH

7.Following is true about normal JVP except

a.Normal pressure is 3-8 mmof Hg b.A wave is more prominent than V

c.Y descent is more prominent than X d.H wave is seen before A

e.Y descend occurs after the opening of tricuspid valve

Ans……..c… (normally x is more prominent)

8.Exertional  syncope   can occur in all the following, except

a.AS b.HCM c.primary pulmonary hypertension d.complet heart block e.AR.

Ans……e…

9.Non ejection click is heard in

a.AS b.PS c.TOF d.MVP e.Idiopathic dialatation of aorta

Ans…….d……MVP

10.Following condition causes reverse split

a. RBBB b. LBBB  c .Left anterior hemiblock d. Left posterior hemiblock  e. None

Ans…b…..LBBB

Reverse split..

  • delayed electrical activation of LV—LBBB, RV pacing, WPW®
  • obstruction to LV ejection—AS, HOCM
  • large LV output with low resistance—AR, PDA
  • LV dysfunction
  • Systolic hyperfunction

Wide split

  • RBBB, LV pacing, WPW(l)
  • PSs
  • ASD, PR
  • RV failure
  • Pulmonary embolism

Wide fixed split

  • ASD, TAPVC,  Single atrium, Pulmonary embolism, Constructive pericarditis

11.A late diastolic sound can occur in all the following ,except

a.hypertension b.coronary artery disease c.as d.ms e.hcm

ans.d…

early diastolic sounds  –os,s3,pericardial knock,tumor plop in myxoma

12. Continous murmur is heard in the following conditions except

a. ruptured aneurysm of sinus of Valsalva b. PDA c. AP window d. following BT shunt  e. AS+AR

PDA—Gibson murmur

13.Normal PR interval (milliseconds)  in ECG is

a.100-200 b.100—220  c.120-200 d.120—220 e.120—240

Ans…..c…

short PR interval—WPW syndrome, junctional rhythm, low atrial,  rhythm, infants

14.  25yr old female presents with episodes of muscle weakness. O/E BP –220/120,ECG showed LVH, prominent U waves. The likely diagnosis is

a. pheochromocytoma b. renal artery stenosis c. nephritis  d. coarctation of aorta e. conn’s syndrome

  • prominent u waves – bradycardia, hypokalemia, hypomagnesaemia, raised intracranial pressure, hypothyroidism, digoxin

15. The most posterior structure of heart is 

a. left atrium b .right atrium c. left ventricle d. right ventricle e. right atrial appendage

ans….a

16. A 5 yr old child is brought with fever and skin rash. O/E cervical lymphadenopathy, splenomegaly. Echocardiogram revealed the following finding

a. MVP b. Aortic dilatation c. Pulmonary artery dilatation d. coronary dilatation e. coronary atresia

ans…….b.

17.  Ejection fraction is calculated as

a.. SV/EDV b.. SV/ESV c.  ESV/EDV d.  EDV-ESV e.  none of  the above 

18.During phase 0 of action potential

a.sodium enters the cell b. sodium goes out of the cell c. potassium enters the cell

d. potassium goes out of the cell e. calcium leaves the cell

Ans……a…

  • phase 1..chloride shift.
  • phase 2 .calcium entry
  • phase  3.potassium exit

19.Commonest cause of sec-HTN is

a.renal parenchymal disease b.rena artery stenosis c.pheochromocytoma d.primary aldosteronism e.aortoarteritis

Ans………..a

20.The apoprotein in LDL is 

a.B100 b.B48 c.A1 d.A11 e.C11

Ans……..a

  • Apo B48 is for chylomicrons
  • Apo A1 is –HDL
  • Cholestrol  <200, LDL<100, HDL >45 in males  >55 in females, TG<150

21.Cardiac lesion seen in Noonan’s syndrome is

a.COA b.Dyplstic pulmonary valve c.PS d.supra valvular AS e.PDA

Ans……b

  • Holt Oram sy-osteum secundum ASD
  • TAR-ASD
  • Ellis Van Creveld-primumASD
  • Turner’s-COA
  • Tuberoussclerosis-rhabdomyoma
  • LEOPARD –PS
  • William’s –supravalvularAS
  • Kaetageners-dextrocardia
  • Marfan’s-AR,MVP
  • Down’s-VSD-endocardial cushion defect
  • Rubella-PDA,PS
  • Lithium-Ebstein anomaly
  • AR- Murfans,osteogenesis imperfecta,pseudoxanthoma elasticum,Morquio’s

22.Commonest organism producing myocarditis is

a. coxackie virus b. adeno virus c. SARS virus d. mumps virus e. leptospira

ans—a…….

23.Following are true about HCM,except

a.famlial b.risk of sudden death c.fixed LV outflow obstruction d.deep t inversion in ECG

e.echo shows asymmetric septal hypertrophy

ans…c……

  • LVOT obstruction is dynamic in HOCM
  • Increases with exercise, ionotropic agents, increase in heart rate, reduction in LV size, vasodilators
  • Lutembacker syndrome –ASD+RHD(MS)
  • Brugada syndrome—ST elevation in V1-V3, mainly Thaiwan, familial
  • Long QT syndrome—familial 5-types ;sudden cardiac death-LQT -3( highest SCD)

24.According to the Starling’s law, the ventricular force of contraction is determined by a. EDV b. ESV c. EDPressure d. ESP e. SV

ans….EDV

25.Width of adult BP cuff is (In inches)

a. 1.5” b. 3” c. 5” d. 7” e. 8”

 Ans ……  c……

26. Widening of QRS  occurs in

a .hypokalemia b. hyperkalemia c. hypomagnesimia d. hypercalcemia e. hypocalcemia

Ans….b

  • hypokalemia –prominent U waves.ST_Tchanges,QU prolongation
  • hyperkalemia-tall T waves

27 .Normal right ventricular systolic pressure.

a. 5-10 b.10-15 c.15-30 d.20-40 e.30-45

Ans……c

  • Early diastolic sounds-OS,pericardial knock[constrictive pericarditis],S3tumor plop[LA myxoma]
  • LVSP-100-140mmhg
  • LVEDP-4-12
  • LA/PAWP-4-14
  • PA-15-30/5-15[mean-8-18]
  • RVDEP-3-8
  • RA-3-8 

Self assessment

1) 3 day fever is also known as——. (sandfly fever,leishmania, rubella,  measles)

2) ——— is not transmitted by Aedes aegypticus  (yellow fever, dengue, chikungunya, malaria)

3) In bilharziasis,urinary tract infections are more common in — infection  (S. haematobium,Sjaponicum,Smansonii)

4) Chancroid is transmitted by (T.pallidum,H ducrei,donovana grnulomatus,chlamydia trachomatus)

5) —-% of streptococcus tonsillitis progress to rheumatic fever(less than 3%, 10-15%, 50-60%,80-90%)

6) Filarial dance sign is observed in—(x ray, blood, urine, ultrasonography)

7) Eczema herpeticum is a complication of (Impetigo,herpes simplex homonus,atopic eczema,Ied)

8) Flag sign is seen in  —(simple malnutrition,marasmus,kwashorker,tinea capitis)

10) Typhus is diagnosed  by  (widal test,kahn test,Weil felix reaction,jopling reaction)

11) Mitsuda reaction is read after—(24 h,72 h,2 weeks,3 weeks)

12) Frei skin test is used in   –(hydatid disease,lynphogranuloma venerum,Scarlet fever,diphteria)

13) Chipmunk facies are a feature of  ( thalassemia minima, thalassemia major,Christmas disease, haemophilia)

14)In dandy walker syndrome patency between 4th ventricle  and —– is obstructed(spinal  canal,subarachnoid,3rd ventricle,2nd ventricle)

15)trisomy 18 is (Edward syndrome,pataus syndrome,downs syndrome,di george syndrome)

16)Cavernous breathing is heard over areas of – ( bronchial consolidation,over pneumothorax,over   communicating cavities,pneumonic consolidation)

17) In Williams syndrome – is not a feature(hypocalaemia,mental retardation,supravalvular stenosis)

18) Wet beriberi is due to deficiency of which vitamin   (B1,B2,B3,B6)

19) In dry drowning death occurs due to—-(cardiac arrest,laryngeal spasm,lung oedema,pneumothorax)

20) Virchows glands are    (right supraclavicular L N,left supraclavicular L N,right gastric L N,left gastric L N)

21) VMA is increased in      ( acute pancreatitis,addisons diease, pheochromocytoma, Cushings disease)

22) In positive Vandenbergs test   bilirubin is confirmed (total,conjugated,unconjugated)

23 )A severe form of erythema multiforme with involvement of mucous membrane  ( Scalded skin Syn,stven johnsons syn,pemphigus ,angiooedema)

24) Mikulicz’s Syn is seen in (ALL,CLL,AML,CML)

25) Mees lines are seen in — poisoning(Ars,mercury,Gold,Phos)

26) In mobitz type 1block – is the chracteristic feature(prolonged  PR interval, progressive prolongation followed by missed beat, PR interval is fixed but some beats are not conducted,dissociation between P and QRS )

27) Normal tidal volume is (2L,.5L,1300ml,3.8 L,1.6L)

28) In pendred syndrometis……….. is not a feature (deafness, mutinism, hypothyroidism, blindness)

29) Pepper pot skull is a feature of( hyperparathyroidism, hyperthyroidism,hyperphosphataemia,hypervitaminosis D)

30) Paulbunnel test is used in   (ALL,CLL,infectious mononucleosis, myelofibrosis)

31) Pel ebstein fever is characteristic of (Hodgkins lymphoma, non hodgkins lymphoma,multiple myeloma,ALL)

32) Capacitation of male sperms occur in (seminal vesicle,vas deferens,testes,female genital tract)

33) The most common occupational disease which predispose to T.B( asbestosis,silicosis,byssinosis,bagassosis)

34) Constipation in elderly is defined as    ( less than three stool per week,less than one stool per day,less than onestool in two days,less than a stool per week)

35) Roths spots are observed in ( Rheumatoid arthritis,rheumatic fever,typhoid,SABE)

36) Skip lesions are seen in (IBS,tropical sprue,Crohns disease,ulcerative colitis

37) Shick intradermal test is used for (Scarlet fever, typhoid, diphtheria, hydatid disease)

38) Austin flint murmer is obtained in (MR,AR,AS,MR)

39) In Rinnes test positive result is indicated when (AC>BC,BC>AC,BC=AC) ( a )

40) Bull dog facies is found in (leprosy,thalassemia,sickle cell anaemia, congenital syphilis)

41)—is not afeature of nephrotic syndrome(oedema, haematuria, lipiduria, hypertension) ( b,d)

42) The most common cause of UTI is( E Coli, Pseudomonas, proteus, klebsiella)

43) Calculi not visible by X Ray are (oxalate,cystine,uric acid,phoshate)

44) The spinal cord extends down up to    (L1, L3, L5,S1)

45) Lumbar puncture is done at the level  (L1L2, L3L4, L5S1,T12L1)

46) The sign elicited by raising the lower limb held straight held by the examiner when the patient is in supine position is called( Kernings sign,Lasaegues sign,Lhermittes sign, Littens sign)

47) The area of brain affected in Parkinsonism is (Red nuclei,substantia nigra,corpus callosum,cerebral cortex)

48) Slow  sinous writhing involuntary movements of limbs,face body  are known as (Tremors,Chorea,Athetosis, myoclonus)

49) The most common cause of amnesia in students is  ( alzheimers disease,epilepsy,ADHD,anxiety)

50) The most common chromosomal cause causing mental retardation (Fragile X Syn, Down Syn, Edwards Syn, Micro cephaly)

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