Endocrinology for AIPGMEE, JIPMER, MCCEE

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1. Levothyroxin (T4) supplementation in the dose of 25 micrograms per day is a preferred initial dose for:

A)   All adults newly diagnosed as hypothyroid

B)   If  the diagnosis is made during pregnancy

C)   Persons with stable angina

D)   Persons with myxedema

2. Over correction of hypothyroidism with levothyroxin increases the risk of:

A)   Exophthalmos

B)   Osteoporosis

C)   Hypercholestolemia

D)   Goiter

  

3. Parathyroid hormone is normally secreted in response to:

A)   Low calcium ion concentration

B)   Low levels of serum vitamin D

C)   High calcium ion concentration

D)   High Vitamin D concentration

  

4. Following endocrinopathy is associated with Peptic ulcer disease:

A)   Hyperthyroidism

B)   Hypothyroidism

C)   Hyperparathyroidism

D)   Hypoparathyroidism

  

5. Estimation of calcium ion concentration is important to diagnose hypertension secondary to:

A)   Hyperaldostrerinism

B)   Hyperparathyroidism

C)   Renal artery stenosis

D)   Syndrome of inappropriate Anti-diuretic Hormone secretion (SIADH)

  

6. Hypovitaminosis D causes:

A)   Primary Hyperparathyroidism

B)   Secondary hyperparathyroidism

C)   Tertiary hyperparathyroidism

D)   Malignant hyperparathyroidism 

7. Which is the commonest malignancy in MEN 2a (multiple endocrine neoplasia 2a)?

A)   Gastrinoma

B)   Insulinoma

C)   Medullary thyroid carcinoma

D)   Pheochromocytoma

  

8. Commonest cause of secondary adrenal insufficiency is:

A)   Iatrogenic

B)   Tuberculosis

C)   Autoimmunity

D)   Waterhouse friederichsen syndrome

9. True about gynecomastia:

A)   Estrogen: Androgen ratio is increased

B)   It can normally occur at puberty

C)   Prolactin levels are increased

D)   Spironolactone can cause iatrogenic gynecomastia

10. Which is the cause of primary hyperaldosteronism?

A)   Renal artery stenosis

B)   Cirrhosis of liver

C)   Congestive cardiac failure

D)   Glucocorticoid remediable aldosteronism

Answers:

Ans: 1-C

The usual starting dose for any adult with hypothyroidism is 50-100 microgram per day. Elderly people and people with heart disease should be given lower initial doses as increase in heart rate can precipitate myocardial ischemia. Pregnant women can be treated with usual dosage of thyroxin. Myxedema is a manifestation of hypothyroidism and the treatment remains the same.

Ans: 2-B

Exophthalmos is one of the manifestations of autoimmune process associated with Grave’s disease. Hypothyroidism can elevate levels of LDL cholesterol. Treatment of hypothyroidism may correct hypercholesterolemia to some extent. Osteoporosis and atrial fibrillation are associated with overcorrection or iatrogenic hyperthyroidism.

Ans: 3-A

Low calcium ion concentration is the only stimulation for secretion of parathyroid hormone from the glands. Vitamin D does not directly affect secretion of parathyroid hormone.

Ans: 4-A

Hyperparathyroidism is associated with Acid peptic disease causing duodenal ulcer more frequently than gastric ulcers. It is important to do calcium levels in all cases of peptic ulcer disease.

Ans: 5-B

Hyperparathyroidism can cause hypertension. The condition can be suspected if serum calcium is raised.

Ans: 6-B

Parathyroid adenoma (80%) and hyperplasia (20%) cause primary hyperparathyroidism. Low vitamin D levels cause low serum calcium level stimulating parathyroid stimulation and secondary hyperparathyroidism. When parathyroid gland is stimulated for long duration, it may become autonomous causing high calcium levels and high parathyroid levels resulting in tertiary hyperparathyroidism. Secretion of parathyroid related protein from some lung, breast or kidney cancers causes malignant hyperparathyroidism

Ans: 7-C

Medullary thyroid carcinoma occurs in 100% cases of MEN 2a. Gene involving MEN 2 a and b is ret proto onchogene. Those testing positive for ret mutation can be treated with prophylactic thyroidectomy, usually before three years of age.

Ans: 8-A

Tuberculosis and autoimmunity are common causes of primary adrenal insufficiency or Addison’s disease, when the insult is directly to the adrenal gland due to which they stop functioning. Waterhouse freidrichsen syndrome causes acute adrenal insufficiency due to adrenal hemorrhage. Long term use of steroids (iatrogenic) suppress pituitary adrenal axis, which remains suppressed even after stoppage of steroid, causing secondary adrenal insufficiency. During periods of stress steroid supplementation is needed in such cases.

Ans: 9-C

Increase in prolactin levels causes galactorrhea.

Ans: 10-D

Glucocorticoid remediable aldosteronism is a genetic condition where aldosterone production is under control of ACTH, when steroid suppresses ACTH, aldosterone secretion reduces. Option A, B and C are causes of secondary hyperaldostreronism.

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Basic medical genetics for AIPGEE, FMGE, PGIEE, MCCEE

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1. A series of three nucleotides on a gene that encodes a protein is called:                                          

A)     Intron

B)      Exon

C)      Codon

D)     Messenger RNA

2. Antibiotic resistance in bacteria is genetically transmitted through:                                                     

A)     Chromatid

B)      Chromosome

C)      Plasmid

D)     Centrioles

3. Chromosomal makeup in Turner syndrome is:                                                                                              

A)     45XO

B)      45XX

C)      46XX

D)     46XXX

4. A newborn female child presenting with hypoplastic left heart syndrome was found to have 45XO chromosomes. The diagnosis is:                                                                                                                                       

A)     Klinefelter syndrome

B)      Down’s syndrome

C)      Turner syndrome

D)     Robertsonian translocations

5. All of the following are single gene disorders except:                                                                                

A)     Klinefelter syndrome

B)      Marfan syndrome

C)      Cystic fibrosis

D)     Hemophilia

6. Choose an option that does not represent chromosomal disorder:                                                     

A)     Klinefelter syndrome

B)      Down Syndrome

C)      Turner syndrome

D)     Duchenne muscular dystrophy

7. All of the following conditions represent autosomal recessive inheritance EXCEPT:                     

A)     Sickle cell anemia

B)      Cystic fibrosis

C)      Haemophilia

D)     Phenylketonuria

8. What is the most common viable aneuploidy (abnormal number of chromosomes) in humans?

A)     Klinefelter syndrome

B)      Down syndrome

C)      Edwards syndrome

D)     Turner syndrome

9. The commonest mechanism of genetic abnormality in a case of Trisomy 21 is:

A)     Nondysjunction in maternal gamete

B)      Nondysjunction in paternal gamete

C)      Translocation to chromosome 14

D)     Translocation to any autosome

10. Chorionoc villus sampling is done at what gestation?

A)     6-9 weeks

B)      10-12 weeks

C)      14-20 weeks

D)     14-28 weeks

Answers:

Ans: 1- C

Genetic code is represented by codons, which are a series of three nucleotides. The code specifies the amino acid to be added next, in the process of protein synthesis. Messenger RNA is the RNA that conveys genetic information from DNA to ribosomes. When a messenger RNA is synthesised, exons (nucleotide sequence encoded by gene) become part of mature messenger RNA, whereas introns are spliced away.

Ans: 2-C

A plasmid is DNA material separate from chromosomal DNA. The plasmid DNA can be transmitted by horizontal gene transfer to bacteria of same or other species. This is the mechanism of antibiotic resistance in bacteria.

ANS: 3-A

Turner syndrome is also known as monosomy X, as one of the X chromosome is missing from all cells or from some cells (mosaicism). Characteristic features of turner syndrome are; Short stature, low hair line, low set ears and webbed neck.

Ans: 4- C

45XO represents monosomy X or Turner syndrome. Most commonly observed congenital heart disease are obstructive lesions of the left side of the heart including coarctation of aorta, bicuspid aortic valve and hypoplastic left heart syndrome.

Ans: 5-A

Klinefelter syndrome is a chromosomal disorder in which there is at least one extra X chromosome in the genetic makeup. Thus it is known as the chromosomal disorder and is not a single gene mutation.

Ans: 6- D

Duchenne muscular dystrophy is X- linked recessive condition.

Ans: 7- C

Haemophilia is recessive disorder of X- chromosome. Males are affected more frequently than females. Mothers are carriers. Others are autosomal recessive disorders.

Ans: 8- B

Down syndrome ( Trisomy 21) is the most common autosomal aneuploidy that the infant can servive with. Klinefelter syndrome (at least one extra X chromosome) is the most common sex chromosome aneuploidy. Most cases of Turner syndrome (Monosomy X) result in abortions. Edwards syndrome (trisomy 18) is rare.

Ans: 9- A

Trisomy 21 is caused by a meiotic nondysjunction event most commonly in the ovum. The affected ovum has 24 chromosomes with an extra copy of chromosome 21. When it combines with a normal sperm, the embryo has 47 chromosomes with trisomy 21. Mechanisms mentioned in other options are less common causes of Down syndrome.

Ans: 10- B

Chorionic villus sampling is done after 9 weeks of gestation till 12.5 weeks of gestation. Amniocentesis can be done from about 14 weeks till 20weeks.

Orthopedic MCQs for AIPGMEE, PFI, JIPMER, FMGE, MCCEE

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1. Commonest risk factor for fracture neck femur is:

A)     Osteoporosis

B)      Osteomalacia

C)      Bone tumour

D)     Osteomyelitis

2. What is NOT true about indication of X-ray in a case of ankle sprain? X-ray is indicated:

A)     If there is persistence inability to bear weight for four steps

B)      When tenderness is present at the tip of medial meleolus

C)      When tenderness is present at the tip of lateral meleolus

D)     In all ankle injuries as most cases are associated with fracture

3. Pain of carpal tunnel syndrome characteristically                                                                                         

A)     Increases on exposure to cold

B)      Increases on exposure to heat

C)      Has no diurnal variation

D)     Is most severe at night

4. Ankylosis is : 

A)     Restriction of motion in a joint

B)      Degenerative changes of vertebra

C)      Dislocation of vertebra

D)     Loss of normal vertebral curvature

                                                       

5. Most commonly diseased cervical vertebral disc is:                                                                                     

A)     Between C1-C2

B)      Between C3- C4

C)      Between C5-C6

D)     Between C6-C7

6. Unilateral involvement of deltoid muscle is seen in:                                                                                   

A)     Erb’s palsy

B)      Klumpke’s palsy

C)      Proximal myopathy

D)     Duchenne muscular dystrophy

7. Which nerve roots are damaged in Erb’s palsy:                                                                                             

A)     C1-C2

B)      C3-C4

C)      C5-C6

D)     C7-T1

8. Dislocation of shoulder is most commonly:                                                                                     

A)     Anterior in location

B)      Posterior in location

C)      Inferior in location

D)     Superior in location

9. All the statements about Giant cell tumor of bone are true, EXCEPT:

A)     On an X-ray, it appear as an area of bone sclerosis

B)      rarely converts to malignancy

C)      are epiphyseal in location

D)     Local pain is the most common presentation

10. Baker’s cyst is a synovial cyst seen at:

A)     Anterior aspect of knee

B)      Posterior aspect of knee

C)      Medial aspect of ankle

D)     Lateral aspect of ankle

Answers:

Ans: 1-A

Fracture neck femur is a pathological fracture due to osteoporosis in old age. Osteomalacia is less common and is less frequently a cause of the fracture. Rarely pathological fracture due to bone tumour or osteomyelitis involves neck of femur.

Ans: 2-D

Ottawa ankle guidelines are sensitive guidelines to decide about the need for X-ray, in a case of ankle sprain. Options A,B,C are the indications for X-ray as per the guidelines. All cases of ankle sprain do not require X-rays, as most are ligament injuries only.

Ans: 3- D

Worsening of pain on exposure to cold occurs in Raynaud’s disease. The increase in severity of neuropathic pain in carpal tunnel syndrome during night is attributed to night time posture of hand.

Ans: 4- A

Ans: 5- C

The vertebral mobility is more at C5-C6 level; hence the disc is most affected cervical spine disc.

Ans: 6-A

Erb’s palsy is caused by injury to C5-C6 nerve roots during difficult labour. The nerves most affected are suprascapular, musculocutaneous and axillary nerves. Deltoid, biceps and brachialis muscles are involved. The injury is due to traction and is always unilateral. The muscles of arm including deltoid are paralysed. Klumple’s palsy involves lower roots of brachial plaxus. Muscles of hand and forearm are affected. Both proximal myopathy and Duchenne muscular dystrophy have bilateral distribution.

Ans: 7- C

Ans: 8-A

The shoulder joint has great range of motion due to which it is particularly susceptible to dislocation. 95% of shoulder dislocations are anterior in location and may cause injury to axillary artery and axillary nerve.

Ans: 9-A

The giant cell tumor (GCT) appears on an X-ray as lytic lesions, described as soap bubble appearance. It is not surrounded by area of sclerosis. Most GCTs are benign, only 5% metastasize to lungs. They are epiphyseal in location and most commonly manifests as local pain.

Ans: 10-B

Baker’s cyst also known as popliteal cyst is found at the posterior aspect of knee, easily visualised when the patient is standing with knee extended. It is associated with knee arthritis or cartilage tear.

Tuberculosis MCQs for AIPGMEE, MCCEE, JIPMER, FMGE

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Tuberculosis (TB)

1. AntiTB drug that has bacteriociddal and sterilizing effect on tissue is:

A)     Rifampicin

B)      INH

C)      Ethambutol

D)     Pyrazinamide

2. Following type of pulmonary TB is most likely to be associated with AFB sputum positivity:

A)     Primary complex

B)      Fifronodular

C)      Cavitary

D)     Pleural effusion

3. Following antiTB drug is associated with major visual side effects:

A)     INH

B)      Rifampicin

C)      Ethambutol

D)     Pyrazinamide

4. Empyema necessitans is:

A)     Common manifestation of post primary TB:

B)      Extension of empyema to the thoracic cage

C)      Empyema associated with pneumonia

D)     Part of Primary complex

5. Fibro-cavitary lung lesion on x-ray is a feature of:

A)     Primary TB

B)      Post primary TB

C)      Metastatic lung disease

D)     Lung abscess

6. Miliary TB on CT scan has:

A)     Peribronchial distribution of lesions

B)      Lesions randomly distributed measuring 1-2 mm

C)      Small granulomas with satellite lesions

D)     Small nodules with caseation

7. Gohn’s focus is usually:

A)     Subpleural

B)      Peribronchial

C)      Apical

D)     In lyphnode

8. Mantoux  test :

A)     Is carried out by intradermal inoculation of live attenuated bacilli.

B)      Positivity indicates prior exposure of the individual to M. Tuberculosis.

C)      Positivity indicates good immunity against TB

D)     Is a measure of individuals humoral immunity

9. Anti TB drugs with maximum CNS penetration are:

A)     INH and Rifampicin

B)      INH and Streptomicin

C)      INH and Ethambutol

D)     INH and Pyrazinamide

10. When TB is associated with AIDS:

A)     Mantaox reading is affected

B)      CSF parameters are affected

C)      First line management is affected

D)     TB is caused by atypical mycobacteria

Answers and discussions:

Answer: 1-A

Rifampicin is a bacteriocidal antiTB drug that kills both multiplying and dormant bacteria hence it sterilizes the tissue. INH is effective against multiplying bacilli. Ethambutol in low dose is bacteriostatic and in high dosages, is bacteriocidal. Pirazinamide is a mild bacteriocidal drug but has a property of killing bacilli in acidic environment such as, in macrophages and areas of acute inflammation. It can cross blood brain barrier in good concentration.

Answer: 2-C

Cavities represent necrosis of tissue resulting in communication of the infected material with the airways. The bacteria are thus discharged in the bronchial tree from where they can be coughed out with sputum. The infected material can cause tubercular bronchopneumonia in host by spread to other parts of lungs or gastro-intestinal tuberculosis by means of swallowed secretions. The risk of spread to other individual is very high with cavitary tuberculosis.

Answer: 3-C

Hepatotoxicity is the most common side effect of antiTB treatment. INH, rifampicin and  pyrazinamide ate hepatotoxic. INH may cause sensory neuropathy. Rifampicin may cause itching in first two weeks and may cause thrombocytopenia. Ethambutol can cause retrobulbar neuritis which, in some cases, may be irreversible.

Answer: 4-B

Empyema necessitance is an uncommon manifestation of TB when TB empyema extends to the thoracic cage.

Answer: 5-B

Primary complex is a small area of consolidation in subpleural parenchyma. Post primary TB occurs in immunocompetent hosts and causes caseating granulomas. The caseous material gets drained out through bronchi resulting in small cavities surrounded by fibrosis. Lung abscess is a thick walled cavity on X-ray.

Answer: 6-B

Miliary TB is caused by hematogenous spread of TB bacilli and has characteristic appearance on CT scan of chest with randomly distributed lesions measuring 1-2 mm.

Answer: 7-A

Answer: 8-B

Mantoux test is carried out by intradernmal injection of purified protein derivative extracted from tubercular bacilli culture. It is a sterile solution and does not contain live bacteria. Positive mantoux test indicates prior exposure to TB. It is a measure of cell mediated immunity and not of humoral immunity. Positive test does not necessarily mean good immunity.

Answer: 9-D

INH and pyrazinamide have 100% CNS penetration and are important in treatment of TB meningitis.

Answer: 10- A

In an immunodeficient person such as, a case of AIDS, cell mediated immunity is deficient. Mantaox test detects cell mediated response of an individual to tuberculin antigen. Hence the test will show lower induration or less positivity. Rest of the parameters are not affected.

Preventive and social medicine MCQs for AIPGMEE, MCCEE, FMGE, JIPMER

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1. Intervention that is directed to arrest disease progress and prevent complications is:                

A )     Primordial prevention

B)      Primary prevention

C)      Secondary prevention

D)     Tertiary prevention

2. Screening mammography is an example of:

A)     Primordial prevention

B)      Primary prevention

C)      Secondary prevention

D)     Tertiary prevention

3. Which is the most cost effective intervention of disease prevention?                                                

A)     Environmental modification

B)      Nutritional intervention

C)      Vaccination

D)     Health education

4. Improving sanitation in a village is:                                      

A)     Primary prevention

B)      Primordial prevention

C)      Secondary prevention

D)     Not a preventive measure

5. Following is an example of a person’s handicap.                                                                                          

A)     Accidental injury to right upper limb.

B)      Inability to write due to the injury

C)      Permanent deformity caused by the injury

D)     Inability to find a job because of disability

6. An epidemic is defined as occurrence of a disease more than:                                                                             

A)     Is normally expected at the same time and place.

B)      Its occurrence in similar geographical areas

C)      The international occurrence rate

D)      The national occurrence rate

7. 200 persons developed gastroenteritis after consuming food at a party. Affected individuals developed symptoms within 6-8hours after intake of food, and recovery from the symptoms was observed within 24 hours of treatment. This description matches:                                                     

A)     Point source (single exposure) epidemic

B)      Multiple exposure epidemic

C)      Slow epidemic

D)     Propagated epidemic

8. What is not true about case control studies?

A)     The disease under study has happened before the onset of study

B)      The study is retrospective in nature

C)      The study can be used to determine incidence of a disease

D)     It is suitable to investigate risk factors of chronic diseases

9. Advantages of case control studies are all, EXCEPT:

A)     Compared to cohort studies they are rapid and inexpensive

B)      Require comparatively few subjects

C)      Risk factors of chronic diseases can be identified

D)     Suitable for evaluation of therapy

10. Lung cancer occurred in 50 people among 5000 smokers and 2 persons out of 2000 non-smokers. The relative risk of developing carcinoma lung in smokers is:

A)     5/2

B)      10

C)      100

D)     5

Answers and Discussion:

Ans: 1- C

Primordial prevention is to modify environment or economic and social or cultural factors to minimize factors negatively affecting health. Improving sanitation and promoting healthy lifestyle in children are examples of primordial prevention. Primary prevention is to reduce risk of specific disease by intervention to prevent its onset. Vaccination and smoking cessation are primary prevention. 

Secondary prevention deals with early diagnosis and treatment of diseases. Hence, an intervention that arrests disease progress and prevents complications is secondary prevention. Tertiary prevention includes interventions undertaken after treatment of a disease, to improve function and longevity. Rehabilitation is tertiary prevention.

Ans: 2- C

Screening mammography is used for early diagnosis of breast cancer, hence it is secondary prevention.

Ans: 3- D

Health education can be imparted by variety of inexpensive measures such as mass media and education in schools. Environmental modification, nutritional intervention and vaccination require ample resources and efforts.

Ans: 4- B

Improvement of sanitation improves general wellbeing of the population and is likely to prevent several diseases. Hence it is an example of primordial prevention.

Ans: 5-D

Inability to write due to injury is impairment. Permanent deformity is a disability. Inability to find a job due to disability is handicap.

Ans: 6-A

Ans: 7- A

When the exposure occurs from a single source at one particular time and all the affected individuals develop symptoms within one incubation period, the epidemic is known as single source epidemic.

Ans: 8- C 

Case control study is a retrospective study where both the exposure and the disease have occurred before the study. To study association between thiazide diuretic and new onset diabetes, people with diabetes and matched non-diabetic control are selected and their exposure to thiazide is plotted on 2x2 table. It is possible to calculate relative risk, attributable risk, and odds ratio; but it is not possible to know incidence of a disease because of the study design.

Ans: 9-D

Case control studies have no attrition or case dropout, since it is a retrospective study. It requires relatively few subjects and information about single risk factor can be easily obtained. It is not suitable for evaluation of a therapy, as evaluation of a therapy requires prospective study.

Ans: 10- B

Relative risk = Incidence of disease among exposed / Incidence of disease among non- exposed

                        = 50 per 5000 / 20 per 2000 = 10 per 1000 / 1 per 1000 =10