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Practice Test

Medicine - 3 Questions

1
Medicine
A boy was diagnosed to have vitamin D resistant rickets. His serum Ca2++ was 9 mg/dL and PO42- was 2.4 mg/dL and alkaline phosphatase was 1041 IU/L. The parathormone level was 59 units. The diagnosis is most likely to be
1. Hypophosphatemic rickets 
2. Vitamin D dependant rickets 
3. Hyperparathyroidism 
4. Distal renal tubular acidosis

๐Ÿ“ Explanation:

Hypophosphatemic rickets, also known as vitamin D resistant rickets, is characterized by renal phosphate wasting, leading to low serum phosphate levels (hypophosphatemia), while serum calcium levels and parathyroid hormone levels typically remain normal. The high alkaline phosphatase level is consistent with bone disease (rickets). 

The lab values provided (Ca++ 9 mg/dL, PO4-- 2.4mg/dL), PTH (59units) fit this profile.      

Vitamin D dependent rickets (Type 1 and 2) typically presents with hypocalcemia (low calcium) and hypophosphatemia. 

Hyperparathyroidism is characterized by hypercalcemia (high calcium) and hypophosphatemia. 

Distal renal tubular acidosis can cause rickets, but it usually involves hypercalcemia and metabolic acidosis.

2
Medicine
In mitral stenosis, the radiological findings are all except
1. Double atrial shadow
2. Indentation of esophagus
3. Narrow airspace behind the sternum
4. Elevation of left bronchus

๐Ÿ“ Explanation:

Mitral Stenosis Radiological Findings

 

  • Double atrial shadow: This is a common finding in mitral stenosis due to left atrial enlargement.
  • Indentation of esophagus: The enlarged left atrium can compress the esophagus, leading to this finding.
  • Narrow airspace behind the sternum: This is not typically associated with mitral stenosis. Instead, it may indicate other conditions such as lung pathology.
  • Elevation of left bronchus: This can occur due to the enlarged left atrium pushing against the bronchus.

3
Medicine
The treatment of choice in pauci immune crescentic glomerulonephritis is
1. Methylprednisolone + cyclophosphamide
2. Oral prednisolone
3. Immunoglobulin
4. Cyclophosphamide

๐Ÿ“ Explanation:

Pauci-immune crescentic glomerulonephritis (GN) is typically associated with ANCA-associated vasculitis. The standard treatment for this condition involves a combination of high-dose corticosteroids (such as methylprednisolone) and an immunosuppressive agent, most commonly cyclophosphamide, to induce remission. This combined approach is more effective than monotherapy with either agent alone.

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