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mcq 2

Paralysis of 3rd, 4th and 6th cranial nerves with involvement of ophthalmic division of trigeminal, localizes the lesion to:
A. Cavernous sinus
B. Apex of orbit
C. Brainstem
D. Base of skull

Answers to Pharmacology MCQS 2

 

1- A

2- D

3- C

4-C

5- C

6- B

7- D

8- C

9- A

10- B

11- A

12- B

13- C

14- D

15- B

16- D

17- D

18- C

19- D

20- C

21- B

22- A

Answers to Pharmacology MCQS 1

 

Q1. Answer – 2. Dilatation of pupils. Acetylcholine causes pupillary constraiction by acting on M3 receptors.

Q2. Answer – 1. Scopolamine. It is an anticholinergic like atropine.

Q3. Answer – 4. Ipratropium. Why is it preferred over atropine for bronchial asthma?

Q4. Answer – 2. It crosses the blood brain barrier. Since it does not it is preferred for myasthenia gravis.

Q5. Answer – 1. Doxycycline. It is primarily excreted in faeces.

Q6. Answer – 4. Pseudomonas aeruginosa. Despite being broad spectrum antibiotics none of the tetracyclines are effective in pseudomonas infection.

Q7. Answer – 3. Streptococcal pneumonia. A beta-lactam antibiotic is the drug of choice in this condition.

Q8. Answer – 2. Amikacin. It is resistant to aminoglycoside inactivating enzymes.

Q9. Answer – 3. Streptomycin. Topical use is avoided because of high sensitization potential (allergic reactions).

Q10. Answer – 4. Postantibiotic effect. The other statements are wrong.
Aminoglycosides exhibit concentration dependent killing, are more active in alkaline pH and poorly absorbed orally.

Q11. Answer – 4. Lesser incidence of neutropenia

Q12. Answer – 2. 2-3. INR = International normalized ratio.

Q13. Answer – 1. Fresh blood transfusion. Its a medical emergency.
 Q14. Answer – 2. Total parenteral nutrition
 Q15. Answer – 4. Clopidogrel.

Medical MCQS 1

1-severity of acute panreatits determined by:
A concentration of serum amylase
B. amount of urinary amylase secreted over 24 hours
C.clinical scoring system
D. amount of peripanreatic fluid collection as determined by ct scan
E. all of above

 

2-One of the most recognised features of the VATER anomaly is

a) Choanal Atresia
b) Laryngomalacia
c) Tracheoesophageal Fistula
d) Double aortic arch
e) Foreign body aspiration

 

3-Q. Which is the antibody class most often seen in the immune complexes associated with Henoch-Schönlein Purpura

A. IgG
B. IgA
C. IgM
D. IgE
E. IgD

 

4-Q. Which of the positions best describes the location of celiac plexus
A. Anterolateral to aorta
B. Posterolateral to aorta
C. Anterolateral to sympathetic chain
D. Anteromedical to sympathetic chain

 

5-Deafness can be caused by
a. Barbiturates
b. Quinine
c. Nifedipine
d. Mannitol

 

6-Optic neuritis is a complication of
a. Streptomycin
b. Ethambutol
c. INH
d. Pyrazinamide

 

7-Which of the following is a contraindication for using a laryngeal mask airway ?
a) when inhalational anaesthesia is required
b) large obstructive lesion in the oropharynx
c) Maintaining airway during difficult intubation
d) Emergency management of airway in failed intubation
e) bronchoscopy in the awake patient

 

8-Use of which drug is contraindicated in pregnancy?
A. Digoxin
B. Nifedipine
C. Amoxycillin
D. Enalapril

 

9-Hemophilia A (classical hemophilia) is due to deficiency of
A. Factor I
B. Factor VIII
C. Calcium
D. Factor XI

 

10-Bone metastasis in male commonly arises from cancer of :

A. Lung
B. Prostate
C. Kidney
D. Thyroid
E. Liver

11-Among the cardiovascular anomalies of newborns, the one most likely to present with cyanosis is :

a. Patent ductus arteriosus
b. Coarctation of the aorta
c. Atrial septal defect
d. Ventricular septal defect
e. Transposition of the great vessels

 

12-Which of the following are absolute contraindications to the use of an intrauterine contraceptive device.
(a) Past history of pelvic inflammatory disease.
(b) Past history of sickle cell disease.
(c) Past history of termination of pregnancy.
(d) Past history of an abnormal cervical smear.
(e) Past history of heart valve replacement..

 

13-Auspitz sign is seen in
a. Neurodermatitis
b. Psoriasis
c. Sarcoidosis
d. Herpes zoster

 

14-Which of the following is the most common cause of portal hypertension

A. Hepatic vein thrombosis

B. Hepatic venoocclusive disease

C. Noncirrhotic portal fibrosis

D. Portal vein obstruction

E. Cirrhosis

 

15-Libman-Sachs endocarditis is a feature of
a. SLE
b. Rheumatic fever
c. Marfan’s syndrome
d. Sclerderma

 

16-Di George syndrome is commonly associated with all of the following except
A. cono-truncal anomalies in heart
B. dysmorphic facies
C. cellular immunodeficiency
D. hypercalcemia

 

17-Which of the two antibodies strongly suggest Systemic Lupus Erythematosus?

A. Anti centromere antibodies
B. Anti Smith antigen antibodies
C. Anti-DNA topoisomerase antibodies
D. Anti-double strand DNA antibodies

 

18-Most common cause of Coarctation of Aorta is?

A .drug toxicity
B. Prematurity
C. Chromosomal abnormality
D. Viral infection

 

19-Drug used in estrogen dependent breast cancer

1. Estrogen
2. Adriamycin
3. Tamoxifen
4. Clomiphene citrate

 

20-Reticulocytosis after iron treatment of
IDA peaks after
a. 48 hrs.
b. 7 days.
c. 4 weeks.
d. 3 months.

See Answers

cardiac examination

Cardiovascular Examination

 

 

Introduction

 

 

Begin the examination by introducing yourself to the patient, gaining consent, and washing your hands.

Observe the patient and the surroundings.  Look for any medications, infusions, or medical instruments.  These provide useful clues to the patient’s diagnosis.

Listen carefully for the close and snap of a prosthetic heart valve.  These can sometimes be heard from the end of the bed and indicate that the patient already has a history of valvular heart disease.

Finally, look at the patient and form a general opinion about whether they look ill.  Consider whether the patient is breathless at rest, cyanosed, or unconscious.

Next inspect the hands.  Check capillary refill by pressing firmly on the patient’s nail bed for five seconds.  Color should return to the nail bed within two seconds when the pressure is released.  A delay suggests peripheral circulatory shut down or very cold hands.

Look for signs of peripheral cyanosis.  A purple tinge to the skin that indicates decreased oxygenated blood in the peripheral arterial circulation.

Check for finger clubbing by assessing loss of nail bed angle.  Clubbing is found in congenital heart disease and infective endocarditis.

Look in the nails for splinter hemorrhages.  These are tiny red infarcts produced by emboli in infective endocarditis.  Also, look for the yellow stains of cigarette smoke on the fingers.  Smoking is a major cardiovascular risk factor.

Finally, look for Jane way palms.  These are **** rushes on the palms and pulps of the fingers and Osler’s nodes, which are red, tender nodules on the finger pulps.  These are both rare features of infective endocarditis.

 

palpate the radial pulse.  The radial pulse can be located just medial to the styloid process of the radius.  Feel the rate to determine whether the pulse is bradycardic, tachycardic, or normal.  Assess the rhythm to determine whether it is sinus, irregular, or the irregularly irregular rhythm of atrial fibrillation.

Feel for a collapsing pulse.  Place your fingers across the flexor tendons of the patient’s wrist and grasp tightly.  You should feel a pulse against your fingers.  If aortic regurgitation is present, elevation will cause the patient’s pulse to collapse.

Palpate the brachial pulse.  The brachial pulse is located just medial to the biceps tendon in the antecubital fossa.  Again, assess for rate and rhythm.

You may also assess blood pressure at this point.

The next step is to assess the jugular venous pressure of the patient.  Rotate their head to the left and look for the inward flickering of the internal jugular vein beneath the sterno **** mastoid.  If you cannot see this, elicit the hepatojugular reflux maneuver.  Note that a raised JVP is indicative of right heart failure or fluid overload.

 

Inspect the face.  Look for a corneal arcus and xanthelasma.  Both of these are indicative of hypercholesterolemia.

Check the sclera for the jaundice of hemolytic anemia and inspect the mucous membranes for the pallor associated with anemia.  Anemia is a common and reversible cause of high output heart failure.

Inspect the mouth, looking for central cyanosis and poor dental hygiene, associated with infective endocarditis.

 

Finally, assess the carotid pulses.  Assess the pulse volume and the character.  Look especially for the slow-rising pulse of aortic stenosis.

 

Precordial Examination

 

Begin the precordial examination by inspecting the patient’s chest.  Look for sternotomy scars, chest malformations, and any obvious chest pulsations.

Feel for the apex, the apex beat is normally located in the fifth intercostal space in the mid-clavicular line.  A laterally displaced apex suggests dilated cardiomyopathy.  A forceful apex is consistent with the diagnosis of left ventricular hypertrophy.  A tapping apex beat is indicative of mitral stenosis.

Palpate the right sternal edge for heaves.  These are forceful heartbeats associated with right ventricular hypertrophy.  Palpate each of the valvular surface markings for thrills.  A thrill is a palpable heart murmur.

Next, auscultate the apex.  Identify the first and second heart sound.  You may need to palpate the carotid pulse simultaneously, the pulse upstroke corresponding to the first heart sound.

Auscultate each of the valvular areas, listening for added sounds.

Listen for specific heart murmurs.  Mitral regurgitation has a pansystolic murmur heard loudest at the apex, with the radiations to the axilla.

Mitral stenosis is a mid-diastolic murmur heard loudest at the apex when the patient is lying on their left-hand side.

Aortic stenosis is an ejection systolic murmur, heard loudest at the aortic area, with radiation to the carotids.

Aortic regurgitation is an early diastolic murmur heard loudest at the left lower sternal edge with the patient sitting upright and leaning forward.  There is apical radiation.

Auscultate the lungs for crackles or decreased air entry.  These are important and may indicate pulmonary edema or pulmonary effusion, both associated with heart failure.

Check for sacral oedema.

 

Final Considerations

 

To complete your examination, now some final considerations.

Perform an abdominal examination.

Check for ankle oedema.

Fundoscopy looking for Roth’s spots.

And hypertensive and diabetic retinopathy.

An ECG should be performed to identify any arrhythmias.

Finally, dip the patient’s urine looking for evidence of kidney injury.  In congestive heart failure, look for raised specific gravity and raised urinary protein.  These are associated with chronic renal failure.

In infective endocarditis, emboli cause renal infarctions and these produced raised urinary blood and protein.

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