(Study Material) ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes) (Pg-8)
PAPER : ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)
Page -8
Q.176 Cluster headache is characterized by all, except:
1 Affects predominantly females.
2 Unilateral headache.
3 Onset typically in 20-50 years of life.
4 Associated with conjunctival congestion.
Answer is 21 H15TH/78
CLUSTER HEADACHE RAEDER'S SYNDROME, HISTAMINE CEPHALALGIA, AND
SPHENOPALATINE NEURALGIA
0.Episodic type is most common and is characterized by one to three short-lived
attacks of periorbital pain per day over a 4- to 8-week period, followed by a
pain-free interval that averages 1 year.
0.Men are affected seven to eight times more often than women;
0. Hereditary factors are usually absent.
0. Although the onset is generally between ages 20 and 50, it may occur as early
as the first decade of life.
Clinical Features
|
Pain |
®Periorbital
pain begins without warning |
|
Associated symptoms |
®Homolateral
lacrimation |
®The cluster syndrome is thus clinically, genetically, and therapeutically different from migraine.
®Alcohol provokes attacks in about 70% of patients but ceases to be provocative when the bout remits; this on-off vulnerability to alcohol is pathognomonic of cluster headache.
®Only rarely do foods or emotional factors precipitate pain, in contrast to migraine.
®Propranolol and amitriptyline are largely ineffective. Lithium is beneficial for cluster headache and ineffective in migraine.
TREATMENT
®The most satisfactory treatment is the administration of drugs to prevent cluster attacks until the bout is over.
® Effective prophylactic drugs are
prednisone, lithium, methysergide, ergotamine, sodium valproate, and verapamil.
®Lithium (600 to 900 mg daily) appears to be particularly useful for the chronic form of the disorder.
®ergotamine is most effective when given 1 to 2 h before an expected attack
®For the attacks themselves, oxygen inhalation (9 L/min via a loose mask) is the most effective modality.
Q.177 The most sensitive test for the diagnosis of myasthenia gravis is:
1 Elevated serum Ach-receptor binding antibodies.
2 Repetitive nerve stimulation test.
3 Positive edrophonium test.
4 Measurement of jitter by single fibre electromyography.
Oxford textbook of medicine /disorder of neuromuscular juncton/pg1169
For practical purposes, the presence of anti-AchR antibodies is confirmatory and no further diagnostic investigations are required. It is the most specific test for M.G. but it is not the most sensitive test. In seronegative patients, electromyography and the intravenous edrophonium (Tensilon) test are helpful edrophonium test. The test is therefore likely to be of most use in patients with purely ocular symptoms and signs. False-negative and false-positive results are not uncommon.
The conventional electromyographic measure for diagnosing myasthenia gravis is the demonstration of a decremental response of the compound muscle action potential in response to repetitive nerve stimulation at 3 Hz. More sensitive, but not specific and only available in specialist centres, is the presence of increased jitter and blocking, as assessed by single-fibre electromyography.
Table 1 Ion channels responsible for the different clinical disorders
Ion channel Clinical disorder
Acetylcholine receptor Myasthenia gravis
Voltage-gated calcium channel Lambert-Eaton myasthenic syndrome
Voltage-gated potassium channel Acquired neuromyotonia
Q.178 Vitamin B12 deficiency can give rise to all of ithe following, except:
1 Myelopathy.
2 Optic atrophy.
3 Peripheral neuropathy.
4 Myopathy.
Answer is 4 H15TH/2432
SUBACUTE COMBINED DEGENERATION (VITAMIN B12 DEFICIENCY)
|
Site of involvement |
Symptoms |
|
Myelopathy (involvement of the posterior and lateral tracts) |
-Parasthesias in the
hands and feet |
|
Peripheral neuropathy |
-Loss of deep tendon reflexes |
|
Optic atrophy |
-Loss of vision |
®Optic atrophy and irritability
and other mental changes may be prominent in advanced cases and on occasion are
the presenting symptoms (megaloblastic adness).
® The diagnosis is confirmed by the
finding of a low serum B12 concentration, elevated levels of homocysteine
(homocysteinemia), methylmalonyluria, and a positive Schilling test
Q.179 EEG is usually abnormal in all of the following, except.
1 Sub acute sclerosing panencephalitis.
2 Locked-in state.
3 Creutzfoldt Jackob disease
4 Hepatic encephalopathy.
Answer is 2 H15TH/2491,1765,2333
SSPE is a rare chronic progressive demyelinating disease of the CNS associated
with measles virus. Most patients give a history of primary measles infection at
an early age (2 years), with a latent interval of 6 to 8 years by the
development of a progressive neurologic disorder.
Creutzfeldt-Jakob disease (CJD) is a degenerative disease of the central nervous
system (CNS) that is caused prions. CJD typically presents with dementia and
myoclonus, and is relentlessly progressive, usually results in death within a
year of onset
|
SSPE |
Characteristic periodic pattern with bursts every 3 to 8 s of high-voltage, sharp slow waves, followed by periods of attenuated ("flat") background |
|
CJD |
®Advanced cases shows repetitive, high voltage, triphasic, and polyphasic sharp discharges ®Stereotyped periodic bursts of <200 ms duration, occurring every 1 to 2 s, makes the diagnosis of CJD very likely |
|
Hepatic enceph. |
Grade I TO III shows triphasic waves while grade IV shows delta activity. |
PEARL POINTS
EEG changes are produced by abnormality of cerebral cortex. Locked-in
state is a pontine lesion (lies deep in posterior cranial fossa), so how it can
produce the EEG changes.
Q.180 All of the following are neurologic channelopathies except:
1 Hypokalemic periodic paralysis.
2 Episodic ataxia type 1.
3 Familial hemiplegic migraine.
4 Spinocerebellar ataxia I.
Answer is 4 H15TH/74,2345,2409
|
Hypo K.P.P. |
Voltage-sensitive, skeletal muscular calcium channel, |
|
FHM |
P/Q type calcium channel subunit expressed only in the central nervous system |
|
Episodic Ataxia Types 1 Type 2 |
Potassium channel a1A voltage-dependent calcium channel subunit |
The SCA1 gene product, called ataxin-1, is a novel protein of unknown
function
Q.181 According to the Glasgow Coma Scale (GCS), a verbal score of 1 indicates:
1 No response.
2 Inappropriate words.
3 Incomprehensible sounds.
4 Disoriented response.
Answer is 1 H15TH/2440
Glasgow coma scale
Clinical observation
Score
Eye opening
Spontaneous
4
To verbal command
3
To pain
2
None
1
Motor response
Obeys commands
6
Localises pain
5
Flexion withdrawal to pain
4
Abnormal flexion (decorticate)
3
Extension to pain (decerebrate)
2
None
1
Verbal response
Orientated
5
Confused conversation
4
Inappropriate words
3
Incomprehensible words
2
None
1
Q.182 Which of the following is not a neuroparasite?
1 Taenia solium.
2 Acanthamoeba.
3 Naegleria.
4 Trichinella spiralis.
Answer is 4
H15TH/1231,1202,1249
Cysticercoids can be found anywhere in the body, most commonly in the brain and
the skeletal muscle. It is caused by Taenia solium.
Acanthamoeba species causes Granulomatous Amebic Encephalitis
Primary amebic meningoencephalitis caused by Naegleria fowleri follows the
aspiration of water contaminated with trophozoites
Trichinellosis develops after the ingestion of meat containing cysts of
Trichinella. While
most infections are mild and asymptomatic, heavy infections can cause severe
enteritis,
periorbital edema, myositis, and (infrequently) death. But CNS involvement is
not seen.
Q.183 A 50 year old man, an alcoholic and a smoker
presents with a 3 hour history of severe retrosternal chest pain and increasing
shortness of breath. He started having this pain while eating, which was
constant and radiated to the back and interscapular region. He was a known
hypertensive. On examination, he was cold and clammy with a heart rate of
130/min. and a BP of 80/40 mmHg. JVP was normal. All peripheral pulses were
present and equal. Breath sounds were decreased at the left lung base and chest
X-ray showed left pleural effusion.
Which one of the following is the most likely diagnosis?
1 Acute aortic dissection.
2 Acute myocardial infarction.
3 Rupture of the esophagus.
4 Acute pulmonary embolism.
Answer is 4 H 15TH/1432
The factors that predispose to aortic dissection include
systemic hypertension, a coexisting condition in 70% of patients,
peak incidence is in the sixth and seventh decades.
Men are more affected than women by a ratio of 2:1.
The pain may be localized to the front (retrosternal) or back of the chest,
often the
interscapular region, and typically migrates with propagation of the dissection
to the back. Other symptoms include syncope, dyspnea, and weakness.
Physical findings may include hypertension or hypotension, loss of pulses,or
feeble pulses.
chest x-ray often reveals a widened superior mediastinum. A pleural effusion
(usually
left-sided) also may be present. This effusion is typically serosanguinous and
not indicative of rupture unless accompanied by hypotension and falling
hematocrit.
Q.184 Which of the following is a cause of reversible dementia?
1 Subacute combined degeneration.
2 Picks disease.
3 Creutzfeldt - Jakob disease.
4 Alzheimer’s disease.
Answer is 1 H 15TH/
Q.185 Which one of the following drugs is ‘Topoisomerase 1 inhibitor’?.
1 Doxorubicin.
2 Irinotecan.
3 Etoposide.
4 Vincristine.
Answer is 2
H 15TH/536
Q.186 Study the following carefully:
Read the pedigree. Inheritance pattern of the disease in the family is:
1 Autosomal recessive type.
2 Autosomal dominant type.
3 X Linked dominant type.
4 X linked recessive type.
Q.187 Palpable purpura could occur in the following conditions, except:
1 Thrombocytopenia.
2 Small-vessel vasculitis.
3 Disseminated gonococcal infection.
4 Acute meningococcemia.
Q.188 A 59 year old man with severe myxomatous mitral regurgitation is
asymptomatic, with a left ventricular ejection fraction of 45% and an
end-systolic diameter index of 2.9 cm/m2. The most appropriate treatment is:
1 Mitral valve repair of replacement.
2 No treatment.
3 ACE inhibitor therapy.
4 Digoxin and diuretic therapy.
Q.189 The gold standard for the diagnosis of osteoporosis is:
1 Dual energy X-ray absorptiometry.
2 Single energy X-ray absorptiometry.
3 Ultrasound.
4 Quantitative computed tomography.
Q.190 Nevirapine is a:
1 Protease inhibitor.
2 Nucleoside reverse transcriptase inhibitor.
3 Non-nucleoside reverse transcriptase inhibitor.
4 Fusion inhibitor.
Q.191 With reference to infections with Escherichia coli the following are true
except:
1 Enteroaggregative E.coli is associated with Persistent diarrhoea.
2 Enterohemorrhagic E.coli can cause haemolytic uraemic syndrome.
3 Enteroinvasive E.coli produces a disease similar to salmonellosis.
4 Enterotoxigenic E.coli is a common cause of travelers’ diarrhoea.
Q.192 The following statements are true regarding melioidosis except:
1 It is caused by Burkholderia mallei.
2 The agent is a gram negative aerobic bacteria.
3 Bipolar staining of the aetiological agent is seen with methylene blue stain.
4 The most common form of melioidosis is pulmonary infection.
Q.193 The following bacteria are most often associated with acute neonatal
meningitis except:
1 Escherichia coli.
2 Streptococcus agalactiae.
3 Neisseria meningitides.
4 Listeria monocytogenes.
Q.194 All of the following Vibrio sp. are halophilic, except:
1 V. cholerae.
2 V. parahaemolyticus.
3 V.alginolyticus.
4 V.fluvialis.
All members of the genus are highly motile, facultatively anaerobic, curved
gram-negative rods with one or more polar flagella. Except for V. cholerae and
V. mimicus, all require salt for growth ("halophilic vibrios").
Q.195 All of the following organisms are known to survive intracellularly
except:
1 Neisseria meningitides.
2 Salmonella typhi.
3 Streptococcus pyogenes.
4 Legionella pneumophila.
Q.196 The capsule of Cryptococcus neoformans in a CSF sample is best seen by
1 Grams stain.
2 India ink preparation.
3 Giemsa stain.
4 Methanamine - Silver stain.
Q.197 In Von Hippel-Lindau Syndrome, the retinal vascular tumours are often
associated with intracranial hemangioblastoma. Which one of the following
regions is associated with such vascular abnormalities in this syndrome?
1 Optic radiation.
2 Optic tract.
3 Cerebellum.
4 Pulvinar.
Q.198 Viruses can be isolated from clinical samples by cultivation in the
following except:
1 Tissue culture.
2 Embryonated eggs.
3 Animals.
4 Chemically defined media.
Ananthnarayan,s Textbook of microbiology,
Q.199 It is true regarding the normal microbial flora present on the skin and
mucous membranes that:
1 It cannot be eradicated by antimicrobial agents
2 It is absent in the stomach due to the acidic pH.
3 It establishes in the body only after the neonatal period.
4 The flora in the small bronchi is similar to that of the trachea.
Q.200 An army jawan posted in a remote forest area had fever and headache. His
fever was 104 F and pulse was 70 per min. He had an erythematous lesion of about
1 cm on the leg surrounded by small vesicles, along with generalized
lymphadenopathy at the time of presentation to the referral hospital. His blood
sample was collected to perform serology for the diagnosis of Rickettsial
disease. Which one of the following results in Weil-felix reaction will be
diagnostic in this clinical setting:
1 High OX-2
2 High OX-19.
3 High OX-K.
4 High OX-19 and OX-2.
Answer is 3
PANICKAR 6TH/
This is a case of scrub typhus with classical clinical presentaqtion. The
classic case description includes an eschar at the site of chigger feeding,
regional lymphadenopathy, and a maculopapular rash. After an incubation period
of 6 to 21 days (usually 8 to 10 days), the onset of disease is characterized by
fever, headache, myalgia, cough, and gastrointestinal symptoms. Severe cases
typically include prominent encephalitis and interstitial pneumonia as key
features of vascular injury. Scrub typhus is found in environments that harbor
the infected chiggers, particularly areas of heavy scrub vegetation where the
forest is regrowing after being cleared and along riverbanks.
On Weil-felix reaction scrub typhus shows
|
OX-K |
OX-2 |
OX-19 |
|
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