MEDICINE– 1&PSYCHIATRYT&DJUNE2020PaperDiscussionDR. DEEPAKMARWAH

1.30-year-oldladyhasdevelopedweaknessofbothlegs3daysaftereatingataseafoodrestaurant.Shehasbeenhavingloosewaterystoolsabout10timesperdayandhastakenORS.Onexaminationsheishavingflaccidparaplegia,areflexiawithabsentplantars.Armandtruncalexaminationisnormal.Cranialnervesandhighmentalfunctionarenormal.FirstdifferentialDiagnosisis?

a.Multiplesclerosisb.Malingeringc.Gullian barresyndromed.Dyselectrolytemia

2.Punchedoutulcersinoesophagusaresuggestiveof?a.Eosinophilicesophagitisb.Refluxesophagitisc.Herpesoesophagitisd.Chemicaloesophagitis

3.A50-year-oldtallthinsmokerwaspuffingonacigarettewhenhedevelopedasevereboutofcough.Subsequentlyhedevelopedrespiratorydistress,wasunabletotalk,developedcyanosisandwasrushedtothehospital.OnexaminationRR– 30/minwithretractionsandhyper-resonantpercussionnoteonrightmiddlelobe.Auscultationshowsabsentbreathsoundsinrightmiddlezone.Whatisthediagnosis?

a.Acuteexacerbationofchronicbronchitisb.Pneumothoraxc.Bronchopleuralfistulad.Acutecor pulmonale

4.75-year-oldhypertensivepatienthasdevelopedasuddenonsetleftsidedfacialasymmetryandinabilitytouseleftarm.HewasrushedtothehospitalwhereanurgentNCCTheadwasperformedafter3hoursofonsetofsymptoms.Commentondiagnosis?a.Rightsidedintraparenchymalhaemorrhageb.Rightsidedacuteischemicstrokec.Rightsidedintraventricularhaemorrhaged.Rightsidedcorticalvenousthrombosis

5.A40-year-oldmanishavingsevereepigastricpainepisodesrespondingtoPPIbutrecurswhenhedoesnottakePPI.Nowhehasalsodevelopeddiarrhoeawithpurgerateabout5-6timesperdayforlastonemonth.TheDiarrhea isnonresponsivetofasting.UGIEshowsagiantduodenalulcer.Whattestshouldbedonenexttodiagnosetheetiology?a.Breathureatestb.72-hourprolongedfastingtestc.Secretinstudyd.Smallintestinalmucosalbiopsy

6.30-year-oldladyishavingbutterflymalarrashwithanemia andjointpains.Whichisthebesttestfordiagnosisofthispatient?

a.Anti-smithantibodyb.DsDNAc.ANAd.Anti-histoneantibody

7.35-year-oldalcoholiccomestoyouwithreportofabnormalSchillingtest.Youhaveprescribedpancreaticsupplementstothepatientandschilling’testhasbecomenormal.Whatisthelikelyaetiologyofabnormalschillingtest?

a.TypeAgastritisb.Chronicpancreatitisc.Whipplediseased.Bacterialovergrowthsyndrome

8.Thrombolysisinacaseofacuteischemicstrokeshouldbedonewithin?a.3hoursb.4.5hoursc.6hoursd.12hours

9.Commentondiagnosisofthis40-year-oldmanwithhighgradefeverandbreathlessnessforlast3days.Onexaminationtracheaisshiftedtoleft,RR=30/minwithdullnessonpercussioninrightinframammaryandinfra-axillaryareas.Airentryisreducedonrightside.CXRwasperformedandIVazithromycinwasstarted.Diagnosis?

a.Pneumothoraxb.Hydropneumothoraxc.Pneumoniad.Parapneumonicpleuraleffusion

10.Whichofthefollowingconditionhasmuscleweaknesswithpreserveddeeptendonreflexes?a.Guillainbarresyndromeb.Polioc.MyastheniaGravisd.Leadpoisoning

11.Oedipuscomplexis?a.Expressivesexualfeelingofparentforoppositesexchildandrivalrywithsamesexparentb.Repressedsexualfeelingofparentforoppositesexchildandrivalrywithsamesexparentc.Repressedsexualfeelingofchildforoppositesexparentandrivalrywithsamesexparentd.Repressedsexualfeelingofchildforsamesexparentandrivalrywithoppositesexparent

12.25-year-oldyoungladyhasthecomplaintshownintheimageandherANAtestisstronglypositive.Whichdiseasewouldyoususpect?a.SLEb.Sclerodermac.Buerger diseased.Polyarteritisnodosa

13.A20-year-oldcollegestudentcomplainsofthunderclapheadacheandnuchalrigidity.Whatisbesttesttoconfirmthediagnosis?

a.GuardedLumbarpunctureb.NCCTHeadc.CECTheadd.MRA

14.40-year-oldrickshawpullerisadmittedduetomultipleepisodesoffocalseizuresoccurringonalmostdailybasisforlastfewweeks.Hismedicationstatusisnotknown.NCCTheadimageisshownbelow.Whatinvestigationwillbebesttoestablishetiology oflesions?a.CSFimmunoblotforneurocysticercosisantigenb.CSFELISAForcryptococcalantigenc.Beta1,3glucantestd.IgM/IgGtitrefortoxoplasmosis

15.20-year-oldladyishavingcomplaintsofbilateralptosisonwatchingtelevision,chewingmuscleandshouldergirdleweakness.Whichtestwouldbeusefulforherdiagnosis?a.Anti- Endomysial antibodiesb.Anti- P/Qvoltagegatedcalciumchannelantibodiesc.Anti- Ach- receptorantibodytiterd.Anti- synthetasesyndrome

16.Notseeninmassivepulmonaryembolismexcept?a.Inter-ventricularseptumdeviationb.FallofSBPc.Pulmonaryplethorad.ElevatedJVP

17.TypeofanaemiaisSLEis?a.Microcytichypochromicb.Normocyticnormochromicc.Macrocyticanemiad.Dimorphicanemia

18.Post-tussivesuctionisheardin?a.Pertussisb.Pleuraleffusionc.Pneumothoraxd.Cavity

19.DisseminatedTBleadsto?a.Gohn focusb.Assman focusc.Puhl’s lesiond.Richfocus

20.MostcommonbodysysteminvolvementinSLE?a.Skinb.Musculoskeletalc.Haematologicald.Neurological

21.NotusefulfordiagnosisofDiabetesmellitus?a.Fastingsugarof>126mg%b.RBSof>200mg%c.HbA1Cof>6.5%d.PPvalueof>250mg%

22.Mostcommoncauseofacutecor-pulmonaleis?a.PAHduetoPulmonaryembolismb.PAHduetoDeepVeinthrombosisc.PAHduetoLVpathologyd.PAHduetoidiopathicreason

23.Restlesslegssyndromeisseenin?a.Cirrhosisb.Wilsondiseasec.Anaemiad.GITmalignancy

24.Whichofthefollowingleadstomelena?a.Constipationb.Rectalpolypc.Angiodysplasiacolond.Dileufoys lesion

25.Whichofthefollowingdiseasesleadstometabolicalkalosis?a.Massivehematemesisb.Gastricoutletobstructionc.Dengueshocksyndromed.Acutetubularnecrosis

26.Mostcommontumor associatedwithsuperiorvenacavasyndrome?a.Lungcancerb.Lymphomac.Metastasisd.Thyroidcancer

27.FirstantibodytodetectrecentinfectiondevelopingwithDaneparticleis?a.HbsAgb.Anti-HbsAgc.Anti-HbcAg IgMd.Anti- HbeAg IgM

28.A50yearoldmanhaspresentedwithoneepisodeofhematemesis.OnvitalexaminationHR=110/minwithBPof110/80mmHg.Systemicexaminationshowsenlargedspleenwithdilatedtortous veinsaroundtheumbilicus.Firstdifferentialdiagnosisis?a.KalaAzarb.Decompensatedcirrhosisc.Fattyliverd.TenseAscites

29.Whichofthefollowingisnotincludedintriadofmeningitis?a.Feverb.Headachec.Nuchalrigidityd.Alteredsensorium

30.Allareslowwavesleepdisordersexcept?a.Nightmaresb.Somniloquoyc.Bruxismd.Nocturnaldiuresis

31.Whichisbestformanagementofbacterialmeningitis?a.Cefepime+Vancomycinb.Cefotaxime+Amikacinc.Ampicillin+Gentamycind.Cefepime+gentamycin

32.Caprgras syndromeisseenin?a.Severedepressionb.Paranoidschizophreniac.Delusionaldisorderd.Othellosyndrome

33.Allaretrueaboutdepressionexcept?a.Omegasignb.Pseudodementiac.Delusionofnihilismd.Flightofideas

34.45yearoldmanhaslittleinterestinactivitiesheformerlyenjoyed.Hehaslost8kgweight;andhewakesup2hoursbeforealarmgoesoff.Hesaysmyfamilywillbebetterwithoutme.Hefeelsbetterineveningthaninmorning.Whatisthebesttreatmentforthisperson?a.Phototherapyb.SSRIc.Psychotherapyd.C.B.T

35.A3-year-oldboyshowsnointerestorconnectionwithhisparentsandneitherplayswithotherchildreninplayschool.Hedoesnotspeakvoluntarilyandisfascinatedwatchingrotatingobjects.Hescreamsfiercelywhenhisenvironmentischanged.Diagnosisis?

a.Autismb.ADHDc.Aspergersyndromed.Rettsyndrome

36.A7-year-oldchildfrequentlygetsintotroubleatschool.Heisfriendlywithotherchildrenbutgetsaggressivetowardstheteacherandprincipalincludingbitingtheschoolattendant.Diagnosisis?a.Autismb.ADHDc.Oppositionaldefiantdisorderd.SeparationAnxietydisorder

37.28-year-oldwomansaysshefrequentlyexperiencespalpitations,shortnessofbreathandchronicindigestion.Shesayssheaslongasshecanremembershefeelstenseandnervousformostpartofthedayforlast2years.Diagnosisis?

a.Generalisedanxietydisorderb.Depressionc.Schizophreniad.Panicdisorder

38.A50-year-oldwomanwith30yearhistoryofbeingunwellandsaysherfamilyphysicianhasnotbeenabletodiagnoseorhelpher.HersymptomsofunwellnessincreaseswithstressDiagnosisis?

a.Hypochondriasisb.Somatizationdisorderc.Post-traumaticstressdisorderd.Bodydysmorphicdisorder

39.Thefollowingclinicalfindingisfoundinallexcept?a.Lungabscessb.Bronchiectasisc.Chronicbronchitisd.Inflammatoryboweldisease

40.Metabolicacidosiswithhyperkalemia isseenin?a.Hyperaldosteronismb.Vomitingc.Acutekidneyinjuryd.Diarrhea withseveredehydration

41.A34-year-oldpathologistcomplainsoffeelingsleepyallthetimeandfallsasleepinlabeveryday.Hestoppeddrivinghisbikebecausehefellasleepdrivinghismotorcycle.Whatiscorrectaboutthecondition?

a.Morbidobesitywithsnoringb.HLADR2c.Malingeringd.Sleeptalking

42.Dreamingandpenileerectionisseenin?a.REMb.NREM1c.NREM2d.NREM3

43.A30yearoldmansaysthatmostnightsinlast1yearhelaysawakeinbedfor2-3hoursbeforehefallsasleep.Hissleepisofteninterrupted.Thenextdayhefeelstiredandforgetfulandmakesmultiplemistakesinhiswork.Alldrugswillbeusefulforhimexcept?a.Flunazepamb.Zolpidemc.Rameltond.Modafinil

44.Mostprevalentpsychiatricdisorderis?a.Anxietydisordersb.Bipolardisordersc.Stressdisodersd.Schizophrenia

45.Respiratoryacidosisisseenin?a.Highaltitudeb.Anxietyneurosisc.Inadequatepost-operativeanalgesiad.MyasthenicCrisis

46.AllaretrueaboutBuspironeexcept?a.Non-BZDanxiolyticagentnotproducingtoleranceb.Noabusepotentialc.Non-sedatingd.Preferredtoinitiatetreatmentingeneralisedanxietydisorder

47.Blackoutisseenin?a.ChronicAlcoholismb.Bhangintakec.Stroked.Alcoholwithdrawl

48.Symptomsofalcoholwithdrawalappearmaximumbyhowmuchtimeaftercompletecessationofdrinkinginchronicalcoholic?a.0-1daysb.2-3daysc.3-4daysd.4-5days

49.Reversetoleranceisseenwith?a.Phenytoinb.Phenobarbitonec.Alcohold.Smoking

50.Markersforheavyalcoholconsumption?a.GammaGlutamyltransferaseandCarbohydratedeficienttransferrinb.GammaGlutamyltransferaseandMeancorpusclevolumec.HighMCHandincreasedserumuricacidd.LowMCHandLowMCV

51.Alcoholwithdrawalisassociatedwithallexcept?a.Formicationb.Lilliputhallucinationsc.Mcewan signd.Auditoryhallucinations

52.Allarecorrectaboutlithiumusageexcept?a.Therapeuticlevelsforacutemaniaare0.6-0.8meq/dlb.Shouldbestopped24hoursbeforesurgeryc.Causesincreasedurineoutputandragingthirstd.Inhibitshydrolysisofinositol1phosphate

53.Neuroleptmalignantsyndromeistreatedwith?a.Bromocriptineb.Dantrolenec.Botulinumtoxind.Baclofen

54.MasterandJohnsonsqueezetechniqueisusedfor?a.Frigidityb.Prematureejaculationc.Vaginismusd.Impotence

55.BestforAlcoholdeaddictionis?a.Chlordiazepoxideb.Diazepamc.Acamprosate– Naltrexoned.Antabuse(Disulfiram)

56.OCDdevelopsduetodefectinwhichphaseofpsychosexualdevelopment?a.Oralphaseb.Analphasec.Phallicphased.Genitalphase

57.Rabbitsyndromeis?a.Tardivedyskinesiab.Akathisiac.Akinesiad.Acutedystonia

58.Besttreatmentforphobia?a.Systemicdesensitizationb.Cognitivebehaviourtherapyc.Betablockerd.Alloftheabove

59.AllareincludedinBleuler’scardinalsymptomsofschizophrenia(4A)?a.Autismb.Ambivalencec.Affectdisturbancesd.Apraxia

60.Allareeffectsofalcoholexcept?a.Bergmangliosisb.Morbidjealouslyc.Blackoutd.Dropattacks

61.Kleptomaniais?a.Impulsecontroldisorderb.Conductdisorderc.OCDd.Neuroticdisorder

62.WhichislongestactingSSRI?a.Fluoxetineb.Fluvoxaminec.Paroxetined.Escitalopram

63.MostimportantcontraindicationtoECT?a.RaisedIOPb.RaisedICPc.RaisedJVPd.RaisedCVP

64.Minimumdurationofsymptomstodefinemania?a.7daysb.14daysc.30daysd.180days

65.Truthserumis?a.Sodiumpentobarbitalb.Sodiumbenzoatec.SodiumAmobarbitald.SodiumThiopentone

66.Hyperphosphatemiaoccursina.Vomitingb.Malnutritionc.Chronickidneydiseased.Hyperparathyroidism

67.Normalaniongapisseenina.Diarrheab.Acutekidneyinjuryc.Acutetubularnecrosisd.LacticacidosistypeA

68.Whichconditionhaswatermelonstomach?a.Linitis plasticab.Menetrier’s diseasec.TypeAgastritisd.Gastricantralvascularectasia

69.Whichofthefollowingisusedinrapidcyclingbipolardisorder?a.Lithiumb.Valproatec.BZDd.Alloftheabove

70.Drugpreferredfornegativesymptomsinschizophrenia?a.Clozapineb.Haloperidolc.Chlorpromazined.Insulincoma

71.A55-year-oldmanwithhypertensionistoldtogethisBPcheckedregularly.OneveryvisithisBPistoldtohimandheistaughtmentalrelaxationtechniquestolowerBPwithemphasisoncontinuingmedicationdaily.Thisisanexampleof?

a.Biofeedbackb.Cognitivebehaviourtherapyc.Aversiveconditioningd.Systemicdesensitization

72.MetabolicacidosiswithHypokalemia isseenin?a.Diarrheab.Acutetubularnecrosisc.Ethyleneglycolpoisoningd.Rhadbomyolysis

73.Notafeatureoftumourlysissyndrome?a.Hyperphosphatemiab.Hypercalcemiac.Hyperkalemiad.Hyperuricemia

74.Pendularkneejerkisseenin?a.Cerebellitisb.Transversemyelitisc.Arachnoiditisd.Subduralabscess

75.Commentondiagnosis?a.Extraduralhaemorrhageb.Brainabscessc.TBmeningitisd.Hydrocephalus

76.Commentondiagnosisofthispatientwithacuteabdomen?a.Perforationb.Ileusc.Malrotationd.Volvulus