MDS PREP
What gene is commonly associated with Peutz-Jeghers syndrome?
1) APC
2) LKB1/STK11
3) MUTYH
4) TP53
Peutz-Jeghers syndrome is associated with mutations in the LKB1/STK11 gene. This autosomal dominant disorder is characterized by gastrointestinal hamartomatous polyps and mucocutaneous hyperpigmentation, and it increases the risk of various malignancies.
Hypercalcaemia occurs in which type of lung cancer?
1) Oat cell
2) Giant cell
3) Squamous cell
4) Alveolar cell
General Medicine
Answer: 3
Hypercalcaemia is commonly associated with squamous cell lung carcinoma due to parathyroid hormone-related peptide (PTHrP) production, which mimics parathyroid hormone and raises calcium levels.
What is the role of factor Xa in the coagulation cascade?
1) Activation of fibrinogen to fibrin
2) Conversion of prothrombin to thrombin
3) Activation of factor V
4) Activation of factor VIII
Factor Xa is a serine protease that plays a pivotal role in the common pathway of the coagulation cascade. It, along with factor Va, forms the prothrombinase complex that converts prothrombin (factor II) to thrombin (factor IIa), which in turn activates fibrinogen to form fibrin, leading to clot formation.
Most likely precursor to bronchiectasis is
1) TB
2) Carcinoma
3) Bronchial adenoma
4) Bronchopneumonia
General Medicine
Answer: 4
The most likely precursor to bronchiectasis is bronchopneumonia
A patient with known sickle cell anemia presents with severe pain in the left upper quadrant of the abdomen. His white blood cell count is elevated, and his ultrasound shows a dilated gallbladder with multiple gallstones. Which of the following is the most appropriate initial treatment?
1) Antibiotics
2) Hydration and analgesics
3) Surgical cholecystectomy
4) Endoscopic retrograde cholangiopancreatography (ERCP)
In a patient with sickle cell anemia and symptoms of biliary colic, the most likely diagnosis is cholelithiasis due to the increased incidence of gallstone formation in this population. Initial management should focus on hydration and pain relief with analgesics, as surgery is typically reserved for cases of cholecystitis or pancreatitis.
What is the primary mechanism by which proteinuria occurs in minimal-change disease?
1) Increased glomerular permeability due to alterations in the glomerular basement membrane
2) Immune complex deposition in the glomeruli
3) Alteration in the podocyte slit diaphragm
4) Reduced synthesis of plasma proteins
In minimal-change disease, the primary mechanism of proteinuria is thought to be increased permeability of the glomerular capillary wall to proteins due to changes in the glomerular basement membrane, rather than structural damage to the membrane itself.
Pulsus alternans is
1) An innocuous feature
2) Denotes severe cardiac decompensation
3) Sign of digoxin toxicity
4) Sign of mitral imcompetence
General Medicine
Answer: 4
Pulsus alternans is characterized by alternating strong and weak heartbeats
and is often associated with severe heart conditions, including mitral
incompetence. It indicates significant cardiac dysfunction.
Signs of Pulsus Alternans
Alternating Pulse Amplitude:
The most defining characteristic of pulsus alternans is the
alternating pattern of pulse strength. When palpating the radial pulse,
a healthcare provider will notice that one beat is strong (high
amplitude) and the next is weak (low amplitude).
Irregular Pulse Rhythm:
While the rhythm may appear regular, the variation in amplitude can
create an irregular sensation when palpating the pulse.
Blood Pressure Variability:
Blood pressure readings may also show variability, with alternating
high and low readings corresponding to the strong and weak beats.
Heart Sounds:
On auscultation, the heart sounds may also reflect this alternation,
with variations in the intensity of the heart sounds corresponding to
the pulse amplitude.
Symptoms Associated with Pulsus Alternans
Pulsus alternans itself is a sign rather than a symptom, but it is often
associated with symptoms of underlying cardiac dysfunction, including:
Shortness of Breath (Dyspnea):
Fatigue:
Palpitations:
Patients may report feeling their heart racing or irregular
heartbeats, which can be distressing.
Edema:
Swelling in the legs, ankles, or abdomen may occur due to fluid
retention associated with heart failure.
Chest Pain or Discomfort:
Some patients may experience chest pain or discomfort, particularly
if there is underlying ischemic heart disease.
Cough:
A persistent cough, especially when lying down, may occur due to
pulmonary congestion.
Dizziness or Lightheadedness:
Patients may feel dizzy or lightheaded, particularly when standing
up (orthostatic hypotension) due to fluctuating blood pressure.
In emphysema, the dilatation occurs
1) Beyond major bronchus
2) In alveolar region
3) Beyond terminal bronchioles
4) Beyond minor bronchus
General Medicine
Answer: 3
In emphysema, the dilatation occurs beyond terminal bronchioles