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Correct Answer - C
Ans. c. Symptoms are more pronounced than signs
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Correct Answer - A
Answer is A (Optic Neuritis):
Optic Neuritis is the most frequent initial presenting feature of MS
amongst the options provided.
The most common earliest presenting features of multiple sclerosis are transient sensory defects followed by visual disturbances due to optic neuritis.
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Correct Answer - A
Answer- A. Hypertension
Most common cause of pontine hemorrhage is hypertension.
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Examination of CVS (Ref. Harrison 20th ed. pg. 1666)
Arterial Pulse
*Types of Pulse
1. Pulsus parvus et tardus (low amplitude with slow rise ) Severe valvular AS. Some patients with AS may also have a slow, notched, or interrupted upstroke (anacrotic pulse, with a thrill or shudder
2. Bisferiens pulse (Two systolic peaks) a. AR , b. AR with AS , c. HOCM
3. Dicrotic pulse (Two peaks – one is systole and one is diastole) Dilated cardiomyopathy .
4. Pulses alternans (Regular alteration of amplitude with regular rhythm) Severe LVF.
5. Pulses bigeminus (one Premature beats following each regular beat) - Digoxin therapy (PGI Nov 2017)
6. Pulsus paradoxus (decrease in systolic arterial pressure more than 10 mm if Hg during inspiration)
a. Pericardial tamponade.
b. Severe COPD
c. Bronchial Asthma
d. Sup. vena cava obstruction.
e. Constrictive pericarditis (rare)
f. Pulmonary embolism
g. Hypovolemic shock
7. Water hammer pulse / collapsing pulse /Corrigan’s pulse
a. AR
b. PDA
c. A-V fistula
d. Beri - Beri
e. Hyperthyroidism
f. Pregnancy
8. Irregularly irregular – Atrial fibrillation (MCQ) Extra Edge
1. Character – Best assessed in carotid artery. But Bisferiens pulse & pulsus alternans are best felt in peripheral artery (Radial Artery) Jerky carotid pulsation − HOCM
2. Rhythm – Best assessed in peripheral artery – radial.
3. Volume – Best assessed in carotid artery .
4. Radio– femoral delay – seen in coarctation of aorta
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Correct Answer - A:B
Answer- A. Injection Iron Dextran deep IM & B. Injection
Hydroxyzine hydrochloride deep IM
With intramuscular injections medications can leak upward into the subcutaneous tissues causing staining, bruising and significant pain for several weeks or longer with some medications.
Nurses are encouraged to use the Z track technique (causing a
needle track or pathway in the shape of Z) any time an intramuscular injection is given, to prevent leakage and associated pain.
The Z track technique must be used whenever a deep intramuscular injection of iron dextran, and other irritating solutions such as hydroxyzine hydrochloride and several antipsychotic agents are
given.
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Correct Answer - A
Answer. A. HOCM
Murmur will get softer with Valsalva or standing from squatting because less blood is being ejected through the aortic valve.
Rapid squatting from a standing position forces increased venous return and would have the opposite effect of Valsalva or rapid standing.
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Correct Answer - B
Ans, B. Preovulatory
The testing of tubal patency and detecting tubal pathology are done
in pre-ovulatory phase of the menstrual cycle.
If performed in the post-ovulatory period, insufflation might disturb
an implanted or fertilized ovum and may also cause pelvic endometriosis.
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Correct Answer - B
Sickle cell anemia is an autosomal recessive disorder, caused by an amino acid substitution of valine for glutamine in the sixth position on the beta-globin chain.
Onset of the disease starts during the first year of life especially after 6 months of age, when hemoglobin F levels falls, as a signal is sent to switch from production of gamma globin to beta globin.
Hemoglobin S is unstable and polymerizes during hypoxemia and acidosis, leading to sickling of red blood cells.
Patients develops jaundice, pigmented gallstones,
spleenomegaly, and poorly healing ulcers over the lower tibia. Acute painful episodes can occur due to acute vaso-occlusion by clusters of sickled red cells during infection,
dehydration, or hypoxia. Common sites of acute painful episodes include the bones and the
chest.
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Correct Answer - C
Ans. is 'c' i.e., Conduction aphasia
Arcuate fibers are bundle of nerve fibres that connect Brocas area to
the Wernicke 's area.
Damage to the arcuate fasciculus causes a disorder called conduction aphasia
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Parvovirus B19 most classically causes erythema infectiosum (also called fifth
disease), a mild febrile illness with rash.
Clinical features include prodromal symptoms, such as fever, coryza, headache, nausea, and diarrhea. These constitutional symptoms coincide with the onset of viremia.
Two to five days later, the classic erythematous malar rash appears with relative circumoral pallor (the so-called slapped cheek rash). This facial rash is often followed several days later by a reticulated or lacelike rash on the trunk and extremities.
It is also referred to as "fifth disease" because it was fifth in a list of historical classifications of common skin rash illnesses in children.
Parvovirus can cause transient aplastic anemia
in individuals with hematologic abnormalities.
Above image shows saddle nose deformity, which occurs due to the collapse of the nasal septum. History of proteinuria, hypertension, and renal failure are suggestive of Wegener's granulomatosis (granulomatosis with polyangiitis GPA).
Patients with GPA more typically have evidence of bone and cartilage destruction, resulting in a saddle nose deformity.
GPA is primarily associated with PR3-ANCA (c-ANCA), while microscopic polyangiitis is primarily associated with MPO-ANCA (p- ANCA).
Disease process typically evolves slowly over years and it involves
• Upper respiratory tract
Lower respiratory tract
Renal involvement: glomerulonephritis, which can lead to renal failure
Cutaneous manifestations include leukocytoclastic vasculitis
This image shows Janeway lesion, which is highly suggestive of infective endocarditis
(IE).
Janeway lesions are nontender erythematous macules on the palms and soles.
They are more common in acute than subacute IE; histologically, they reflect microabscesses with neutrophil infiltration
of capillaries. Other lesions that are highly suggestive of IE are
⚫ Osler nodes ⚫Roth spots.
Osler nodes are tender subcutaneous violaceous nodules mostly on the pads of the fingers and toes, which may also occur on the thenar and hypothenar eminences.
• Roth spots are exudative, edematous hemorrhagic lesions of the retina with pale centers.
Different chest signs
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Correct Answer - D
Answer- D. Scirrhous
MC type of breast carcinoma is invasive ductal carcinoma
(schirrhous).
MC form seen (60- 75%)
Hard lump, yellow whitish, non capsulated , irregular margin with cartilagenous consistency.
Retracted nipple
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