Medicine

Endocrinology
Carbohydrates
1. eAG (Estimated Average Glucose) is based on HBA1C
2. For diagnosis of DM, FBS >126mg/dl.
3. HbAlC > 6.5% is a new diagnostic criterion for DM
4. Impaired glucose tolerance on an oral GTT is indicated by 2 hrs after
glucose load is 140-199 mg/dl; or fasting blood sugar < 126 mg/dl or
HbAlC between 5.7 to 6.4 %.
Types of Diabetes
Type -I DM
1. Patient has normal Weight or under weight
2. Anti-glutamic acid decarboxylase (GAD) antibodies
3. HLADR3, DR4

Type - 2 DM
1. Patient has over Weight
2. Family history strongly positive
3. Initially Serum insulin levels are very high (hyperinsulinemia)
4. Thrifty Genes Cause over eating and obesity
5. Leptin reduces insulin resistance

Newer Types of Diabetes

1. Potential Diabetes:Patient's Positive familyhistory but he himself does not
havediabetes.
 2. Latent Diabetes: Diabetes under stressful conditions
3. Acute Fulminant DM is caused by viral infection.
4. MODY is Autosomal dominant
5. LADA: Type 1 DM in elderly person.
6. Brittle Diabetes: wide fluctuation in blood sugar level, seen in children
7. Tropical diabetes: Pancreatic calcification and pain abdomen.

Other causes of diabetes mellitus

1. Drug induced: steroids, thiazides, nicotinic acid, phenytoin, alpha IF,
Protease inhibitor, beta agonist, clozapine.
2. Pancreatic: pancreatitis; surgery (where >90% pancreas is removed);
trauma pancreatic destruction (hemochromatosis, cystic fibrosis);
pancreatic cancer. Fibrocalculous pancreatopathy/ Tropical calcific
pancreatitis/Malnutrition related DM.
3. Other Conditions Endocrine: Cushing's disease; acromegaly;
pheochromocytoma; hyperthyroidism. Glucagonoma, Somatostatinoma
(Note = In Addison disease, hypoglycemia occurs)

Treatment of diabetes
1. For any obese type II diabetic patient best initial therapy is diet therapy and
exercise
2. BMI = body weight (kg) / height in meters2
3. Metformin Best Initial Drug in type II obese diabetic
4. Sulfonylurea is a Insulin secretogogue
5. Thiazolidinediones (Pioglitazone) can precipitate heart failure
6. Alpha-glucosidaseinhibitor can be given in both type I & type II DM
7. Meglitinide is a insulin secretogogue
INSULIN
1. Ultra Short-acting a. Aspart b. Glulisine
2. Long acting a. Detemir b. Glargine
3. Insulin degludec is an ultra-long-acting insulin
4. Injection Dulaglutide it itself is a GLP-1. It is given once a week
5. Insulin Resistance when requirement of Insulin is more than 200 units per
day.
6. Insulin resistance in liver disease is due to steatosis

Recent Advances Newer drugs

1. GLP -1 and GIP Agonist a. Exenatide b. Liraglutide c. Dulaglutide
2. DPP-IV inhibitors a. Sitagliptin b. Vildagliptin
3. Amylin agonist a. Pramlintide
4. Drugs which do not cause hypoglycemia are:
a. Metformin b. Alpha glucosidaseinhibitor
c. Pioglitazone d.DPP-IV inhibitor
5. Linagliptin can be given in renal failure
6. Colesevelam is a Bile Acid Sequestrant
7. Canagliflozin Renal glucose transporter inhibitors
8. Resveratrol is a Anorexic drug
9. Lorcaserin is a 5HT2C agonist. It is an anorexic drug
10. Bromocriptine Reduces blood sugar.
11. Anti-Obesity Drugs a. Topiramate, b. Naltrexone
12. Epalrestat is a aldose reductase inhibitor
13. Sorbitol acts as a tissue toxin

Goals of treatment in a diabetic patient

1. HbAlC<7
2. BP < 140 / <90 mmHg. (In Younger patient <130/80)
3. LDL<100mg%
4. Pre-prandial blood sugar 70 - 130 mg% PP blood sugar < 180 mg%
5. BP < 140 / <90 mmHg. In Younger patient <130/90)
6. HDL >40mg% in male, >50mg% in female
7. Tg <150 mg%

Diabetic Ketoacidosis
Clinical feature
1. Abdominal pain
2. Kussmaul respiration
3. Fruity odour of the breath
4. Pseudohyponatremia
5. Hyperkalemia
6. Leucocytosis
7. Metabolic acidosis with increase anion gap
8. Treatment: l/v Regular insulin, normal saline, Antibiotic
9. Cerebral edema is the most dangerous complication of DKA

Lactic Acidosis
1. The Cohen-Woods classification is for lactic acidosis
2. Thiamine deficiency causes lactic acidosis
3. In lactin acidosis, there is metabolic acidosis with increase anion gap

Non Ketotic Hyperosmolar Coma (NKHOC)

Clinical Features
1. Serum osmolality= [2 x (serum Na + serum K) + plasma glucose (mg%)/18 +
BUN (mg%) / 2.8)]
2. RBS = is in the range of 600 to 1200 mg%
3. Increase serum osmolality
4. Pseudohyponatremia occurs
5. Nausea, vomiting, pain abdomen are not the feature
6. l/v regular insulin and normal saline is given

Chronic Complications of Diabetes Mellitus CVS Complications

1. CAD is the commonest cause of death in diabetes.
2. Earliest dyslipidemia to occur is diabetes is raised Tg
3. Legacy effect or Metabolic memory is related to CVS complication in DM
4. ACEI are the drug of choice in diabetic with hypertension
5. Telmisartan is the only ARB which acts on PPAR gamma receptor. So it is
the ARB of choice that should be used in diabetes
6. Wet gangrene occurs in DM
7. DM is the second most common cause of amputation in the world (M/C is
trauma)
8. Saroglitazar Acts on PPAR alpha & gamma receptor so it reduces both blood
sugar & lipid. It is a new drug.
9. Alicuromab is a new drug for hyperlipidemia. It is PCSK-9 Inhibitor.

Nephropathy
1. TGFR is the 1st manifestation of diabetic nephropathy.
2. Microalbuminuria is the most reliable marker of diabetic nephropathy.
3. ACEI are given as nephro protective drug.
4. ACEI are contraindicated in CRF because they cause hyperkalemia
5. In Diabetes Hyperkalemia can occur due to RTA type IV

Eye Involvement in Diabetes

1. Bevacizumab and Ranibizumab (VGEF Inhibitor) are used in the treatment
of diabetic retinopathy
2. DM is a common cause of blindness
3. Snow flake cataract is seen in diabetes
4. Rubeosis iridis (New Vessel Formation in Iris) can cause glaucoma

Neuropathy& Diabetic Foot

1. Callus formation is the earliest manifestation of diabetic foot.
2. Vibration sensation is the first to be lost in DM polyneuropathy
3. Frequency of the tuning fork used to assess vibration sense is 128.
4. Erythromycin acts on the motilin receptor
5. Drug used for ED- a. Sildenafil, b. Apomorphine, c. Yohimbine, d. PgEl
6. In DM lllrd nerve is involved most commonly but pupillary reaction remains
normal
7. Distal sensory neuropathy is the m/c neuropathy
8. Proximal muscle weakness can occur

Other Complications of DM
1. Malignant otitis Extern caused by Pseudomonas infection
2. Rhino cerebral mucormycosiscaused by Fungus
3. Emphysematous pyelonephritis caused by E. coli
4. Emphysematous cholecystitis caused by Clostridium or E. coli
Skin Involvement in DM
1. Pigmented pretibial papules
2. Necrobiosis lipoidica
3. Acanthosis nigricans
4. Granuloma annulare
5. Lipoatrophy and lipohypertrophy
6. Scleredema
7. Dupuytren's contracture.

Hypoglycemia
1. Somogyiphenomena = hypoglycemia at Midnight and hyperglycemiain the
morning (8 am)
2. Dawn phenomena = hyperglycemia at Midnight and hyperglycemiain the
morning (8 am)
3. In Addison disease, hypoglycemia occurs
4. In Nesidioblastosis, Infants and Children have fasting endogenous
hyperinsulinemic hypoglycemia
5. Glucagonoma is characterized by Necrolytic migratory erythema

Insulinoma
1. Weight gain occurs in Insulinoma
2. 72 hours Fasting blood glucose levels is the "gold standard" test for
Insulinoma
3. Whipple criteria is used in hypoglycemia
4. Diazoxide and octreotide are used in the treatment of Insulinoma

Metabolic Syndrome
1. Raised LDL cholesterol is not a feature of metabolic syndrome

Hyperthyroidism
1. If we give high dose of iodine for short period it inhibits T4 synthesis (Wolf
Chaikoff effect)
2. If we give low dose of iodine for a long period it increases T4 synthesis (Job
Basedow effect)
3. Drugs which inhibit peripheral conversion of T4 to T3 are:
a. Propranolol b. Dexamethasone c. Propylthiouracil
d. High dose of iodine e. Radiographic contrast media
4. Raised TSH is the best test to assess primary hypothyroid.
5. Thyrotoxicosis with reduced RAIL) is seen in
a. Factitious hyperthyroid
b. De Quervain thyroiditis (Sub acute thyroiditis)
6. Hypothyroid with increased RAIU = l2 deficiency Hypothyroid (endemic
hypothyroid)

Graves disease
1. Pre tibial myxedema occurs in dermopathy of Grave disease
2. Grave disease = HLA B8, DR3
3. Clinical features
a. Means Lerman sound (it is scratchy sound heard over the precordium), AR,
Systolic HT
b. Proximal myopathy, Periodic paralysis
c. Diplopia occurs when patient looks up and laterally. Inferior rectus is most
commonly involved
d. Thyroid acropathy (clubbing) occur in Grave disease
4. Propyl thiouracil (PTU) is DOC in pregnancy with hyperthyroid
5. Carbimazole& PTU can cause skin rash and aplastic anemia

Factitious Thyrotoxicosis
1. Factitious thyrotoxicosis occurs in nurses
2. In Factitious Thyrotoxicosis RAIU is low.

Hypothyroidism
Causes of Hypothyroidism
1. Amyloidosis, sarcoidosis, hemochromatosis, scleroderma, cystinosis
2. Drugs-amiodarone, Lithium
3. Hashimoto thyroiditis
Hypothyroidism
Clinical Features
1. Ankle Jerk relaxation is delayed (Hung up reflex).
2. Toad like face
3. Non-pitting oedema
4. Proximal myopathy
5. Sideroblastic anemia
6. Cerebellar ataxia

Thyroiditis
Parasitic diseases Causing thyroiditis = Strongyloidiasis, Echinococcosis,
Cysticercosis (MNEMONIC = SEC)

Hashimoto's Thyroiditis(Chronic Lymphocytic Thyroiditis)

1. Hurthle cells are seen
2. Anti-thyroglobulin antibody and Thyroid peroxidase antibodies are present
in the serum
3. M/C of goitrous hypothyroid

Riedel's Thyroiditis
1. Hard, non-tender Goiter,
2. Diagnosis is by open biopsy

J Subacute Granulomatous Thyroiditis (De

Quervain's thyroiditis or viral thyroiditis).

Clinical Features
1. Painful and enlarged thyroid
2. High ESR
3. Low RAIU
Lymphocytic (Silent I Painless/Post-Partum) Thyroiditis
a. RAIU xk
b. ESR Is Normal

Dyshormonogenesis
The combination of dyshormonogenesis goitre and sensorineural deafness is
known as PENDRED'S SYNDROME.

Hypothyroid and CAD

1. Levothyroxine should be started in the lowest possible dose
2. In children with hypothyroid levothyroxine should be started with full dose.

Myxoedema Coma
Clinical feature
1. Myxoedema coma is a medical emergency
2. I/V Hydrocortisone (1st to be given) ,T3 should be given after that
3. Hypoglycemia, hypothermia, hyponatremia occur

Hyper parathyroid
Bone conditions with increase ALP =
1. Hyper parathyroid
2. Paget disease,
3. Bone metastases,
4. Rickets, osteomalacia,
5. Osteogenesisimperfecta
6. Osteogenic sarcoma.

Secondary hyperparathyroidism
Causes
a. Low vitamin D intake
b. Chronic renal failure
c. Rickets
d. Osteomalacia
e. Malabsorption
 Tests Serum abnormality in Hyper parathyroid
Serum Serum Alkaline PTH
Ca phosphate phosphatase
Primary hyperparathyroidism t t t
Secondary hyperparathyroidism 4- t t t
due to CRF
Secondary hyperparathyroidism T T
due to malnutrition
Important Point
1. Hypercalcemia in malignancy occur due to increase level of PT HRP. In this
PTH level are not raised.
2. Hypercalcemia occurs in squamous cell lung cancer

Features of hypoparathyroid
1. Polyuria
2. Constipation
3. Short QT interval in ECG
4. Psychiatric manifestation
5. Pain abdomen
6. Renal stones
7. Ectopic calcification

X-Ray Finding in Hyper parathyroid

1. Brown tumours
2. Osteitis fibrosa cystica
3. Tufting of the phalanges
4. Pepper pot appearance
5. Ratification on the radial side of fingers

William syndrome
a. Chromosome -7
b. Cocktail party personality
c. Elfin facies
d. Aortic stenosis
e. Hypercalcemia

Hypercalcemia Causes of Hypercalcemia

1. Drugs: Lithium, Thiazide
2. Cancer of breast, Squamous cell Lung cancer, Renal cell carcinoma, MM,
lymphoma
3. Hyperparathyroidism, Hyperthyroid, Addison, Pheochromocytoma, MEN-1
4. Vit. D intoxication, Vit. A intoxication, Aluminium intoxication
5. Milk alkali syndrome
6. Prolong Immobilization
7. Sarcoidosis
8. Familial hypocalciuric hypercalcemia (FHH)

Treatment
1. Treatment of acute hypercalcemia = Saline + Frusemide
2. Thiazide cause hypercalcemia so they are never used in the treatment of
hypercalcemia.
3. Treatment of chronic hypercalcemia = a. Biphosphonatesb. Prednisolone
4. Cinacalcet is used for primary hyper parathyroid

In PHP and PPHP

1. Short fourth and Fifth metacarpals and metatarsal
2. PTH levels are high
3. Imprinting occur
4. In PHP serum Ca is low, in PPHP & Calcium in high.

Magnesium Disorders
1. Hypomagnesemia occurs in
a. Gitelman syndrome b. Foscarnet
2. The clinical features (Tetany) and ECG finding (Prolong QT Interval) of
hypomagnesemia are same as of hypocalcemia
Hypermagnesemia
1. Bradycardia, Hypotension occur in Hypermagnesemia.
2. Treatment of hypermagnesemia Cal. Gluconate, Frusemide

Tumor lysis syndrome

1. Hypocalcemia occurs in tumor lysis syndrome

Bony Lesion in Vitamin A Intoxication

1. In Vitamin D intoxication, metastatic calcification occurs

Hypophosphatemia
Drugs causing hypophosphatemia
•Diuretics • Cisplatin .Ifosfamide .Foscarnet
•Calcitonin .Pamidronate

Hyperphosphatemia
Causes
1. CRF
2. Pseudo Hypoparathyroidism
3. Vitamin D intoxication
4. Tumour lysis syndrome

Multiple Endocrine Neoplasia MEN

1. VHL is autosomal dominant and is associated with cerebellarhemangio
blastoma
2. Polycythemia occurs in VHL (Von Hippel-Lindau Syndrome)

Cushing's Syndrome
1. Loss of diurnal variation of cortisol level is the earliest features of Cushing
syndrome
2. High dose DM suppression test is done to differentiate between pituitary
adenoma and ectopic secretion of ACTH
3. Medical adrenalectomy is done by
i. Metyrapone ii. Mitotane iii. Aminoglutethimideiv. Ketoconazole

Adrenal insufficiency
1. TB is the most common cause of Adrenal Insufficiency in India
2. The most common site of primary Cancer in a patient presenting with
secondaries to adrenals is Melanoma
3. Due to low BP &hypoglycemia, the commonest presenting symptom of
Addison's disease is Asthenia (Fatigue, Malaise).
4. ACTH stimulation test is the Most Confirmatory Test for Addison Disease
5. Low plasma cortisol (<3 mcg/dl) at 8 AM is diagnostic of Addison Disease
especially if accompanied by simultaneous elevation of plasma ACTH level
(usually >200 pg/ml)
6. Clinical Feature of addisonian crises, a. Extreme weakness
b. Pain in low back/ leg c.
Intractable vomiting d. Acute pain abdomen
e. Hypotension f. Fever g. Coma and death

Hyperaldosteronism
1. Oedema feet is not a feature of primary hyperaldosteronism& SIADH
2. Polyuria is a feature of primary hyperaldosteronism

Pheochromocytoma
1. Headache, palpitation & diaphoresis are the classic triad of
pheochromocytoma
2. Pheochromocytoma is a highly vascular tumor that is why FNAC is not done
in this case.
3. Beta blocker alone are contraindicated in pheochromocytoma
4. Most common post operative complication is Hypotension which is
managed by giving normal saline.

Anterior Pituitary
1. Insulin induced hypoglycemia is the most accurate test to diagnose
hypopituitarism
Craniopharyngioma
1. Most common cause of hypopituitarism in children
2. Pituitary Calcification
3. Bitemporal hemianopia

Acromegaly
1. Increase heal pad thickness seen on X-ray
2. OGTT test is the most definite test

Diabetes Insipidus
1. Polyuria = Urine Output >3L/day
2. Urine osmolality < 250 mOsmol = diabetes insipidus
3. Urine osmolality (>300 mOsm/kg) = Solute Diuresis

Endocrine Paraneoplastic Syndrome

Hypercalcemia occur in squamous cell lung cancer.

Respiratory Systems
Pulmonary Function Test (PFT)
1. Feature of restrictive lung disease is FEV1/FVC increases and compliance
decreases
2. Compliance is increase inEmphysema
3. Decreased maximum mid-expiratory flow rate indicates obstruction in Small
airways
4. Most common cause of cyanosis is Chronic bronchitis
5. In methemoglobinemia the color of blood is Chocolate brown

Respiratory failure
1. In type I respiratory failure: A-a gradient is increased
2. In type - II respiratory failure, there is Low paO2 and high paCO2
3. Commonest cause of type II respiratory failure is Chronic bronchitis
4. Most common cause of type III respiratory failure is Lung atelectasis
5. Most common cause of type IV respiratory failure is Shock
6. Hypoxia is if PaO2 is less than 60 mmHg.

Acute respiratory distress syndrome (ARDS)

1. Diffuse alveolar damage occur in ARDS.
2. In ARDS type I failure occurs.
3. Stiff lung is seen in ARDS.
4. In ARDS left atrial pressure, (PCWP) is normal.
5. ARDS is characterized by Pa02/Fi02<300mm Hg.

Chronic obstructive pulmonary disease (COPD)

1. Reid's index is used in Chronic bronchitis.
2. Weight loss is seen inEmphysema.
3. Pneumothorax occur in Emphysema.
4. Polycythemia occurs in Chronic bronchitis.
5. GOLD criteria is used for severity of COPD.
6. Bode index is for Lung transplant.
7. "Sleep apnoea", is defined as a temporary pause in breathing during sleep
lasting at least 10 seconds.

Asthma
1. Bronchial Asthma is best diagnosed by Demonstration of Reversible
obstruction.
2. In Asthma Small airways are involved.
3. In Idiosyncratic Asthma IgE is not increased.
4. Aspirin-sensitive asthma is associated withNasal polyp.
5. Charcot Leyden crystals consist of Granules of eosinophils.
6. The size of a droplet for a drug is to be delivered by a nebulizer should be
<2.5 micron.
7. Bradycardia indicate the most severe attack of bronchial asthma.
8. Montelukast is not useful in the treatment of a patient with acute bronchial
asthma.
9. Drug used in refractory asthma is Omalizumab.
10. Most effective drug to treat brittle asthma is Epinephrine.

Bronchiectasis
1. Bronchiectasis is most common in left lower lobe.
2. Lung cancer is NOT a complication of bronchiectasis.
3. TB is not a cause of clubbing.

Pneumonia
1. Most important cause of nosocomial pneumoniae is Gram negative
enterobacteria.
2. Tubular breathing is heard in Consolidation.
3. CURB - 65 score is used in pneumonia to assess its Severity.
4. Cavitatory lesion in lung are seen in Staph aureus.
5. Chocolate color sputum is seen in Klebsiella.
6. Hemolytic anemia is seen in Mycoplasma pneumonitis.
7. Indication for prophylaxis in Pneumocystiscarinii pneumonia is CD4 count
<200 /p.1.
8. Pneumocystic Jiroveci is best diagnosed by BAL.
9. Commonest sign of aspiration pneumonitis is tachypnea.
10. Most common cause of empyema is Bacterial pneumonia.
11. Hypotension is not a Feature of SIRS.
12. Endotoxic shock is initiated by Endothelium damage.

TB
1. The most infective form of TB is Cavitary lesion.
2. Rich focus is present at Meninges.
3. True regarding presentation of primary T.B. is U/L hilar lymphadenopathy
4. Cavitatory lesion is not a feature of primary Tuberculosis.
5. Features indicating is hypersensitivity to Mycobacteria Phlyctenular
conjunctivitis.
6. The commonest feature in Poncet's disease is Joint pains.
7. In Miliary Tuberculosis Mantoux is negative.
8. Cavity formation is not a feature of TB in HIV.
9. Streptomycin is not given in TBM.
10. Source of recurrent hemoptysis is Bronchial artery.

Tropical Pulmonary Eosinophilia (TPE)

1. Presence of Microfilaria in Peripheral blood is not a feature of Tropical
pulmonary Eosinophilia.
2. Pulmonary eosinophilic granuloma is not associated with peripheral blood
eosinophilia .

Pulmonary Embolism (PE)

1. Most important cause of acute Right Heart Failure is Massive Pulmonary
embolism.
2. The most common symptom of Acute pulmonary embolism is sudden
onset of Dyspnea.
3. In acute pulmonary embolism, the most frequent ECG finding is Sinus
tachycardia.
4. D-dimer is a very useful diagnostic test for Pulmonary embolism.
5. Best investigation for pulmonary embolism is CT angiography.
6. Me Connell Sign is seen ECHO in Pulmonary embolism.
7. Caisson's disease is due to Gas embolism.

Pleural Effusion / Pneumothorax

1. Exudative pleural effusion occurs in Bronchogenic carcinoma.
2. Left -sided pleural effusion seen in a. Pancreatitis,b. Rheumatoid arthritis,
c. Esophageal rupture.
3. In tubercular Pleural fluid has normal or slightly reduced glucose level.
4. Decreased Glucose in pleural effusion is seen in Rheumatoid arthritis.
5. A high amylase level in pleural fluid is seen in Malignancy.
6. Presence of cholesterol crystal in pleural effusion is a feature of
Myxoedema.
7. True about hydropneumothoraxa. Horizontal fluid level, b. Succussion
splash.
8. In an adult patient with plural effusion, the most appropriate site for
pleurocentesis done by inserting a needle is in 7th intercostal space in mid
axillary line.
9. Primary spontaneous pneumothorax is common in young age.

Sarcoidosis
1. B/L hilar lymphadenopathy, along with non caseating granulomas is a
characteristic feature of Sarcoidosis.
2. Cavity formation of lungs is not a feature of sarcoidosis.
3. Seventh cranial nerve is most commonly involved in patients with
sarcoidosis.
4. Uveoparotid fever is seen in Sarcoidosis.
5. Cause of nephrocalcinosis in Chronic granulomatous disease is Increased
extrarenal conversion of 25 (OH) cholecalciferol to 1, 25 (OH)2
cholecalciferol vitamin D.
6. Serum ACE level is raised in sarcoidosis.
7. True about sarcoidosis = CD4/CD8 ratio is more than 3.5 in BAL.
8. PANDA sign is sarcoidosis is seen in Gallium scan.
9. Treatment of sarcoidosis is steroid.

Pneumoconiosis (ILD)
1. Silicosis
a. Has predilection for upper lobes
b. Is associated with calcific Hilar Adenopathy
c. Is associated with Tuberculosis
2. Tobacco smoking is characteristically not associated with the development
of interstitial lung disease.
3. Pleural plaques are seen in asbestosis.
4. Disease seen in weavers is Byssinosis.
5. Byssinosis occur due to Cotton fiber.

PAH
1. In primary pulmonary hypertension basic abnormality in gene lies in Bone
morphogenic protein receptor II.
2. Sickle cell disease can cause PAH.
3. T Pulmonary capillary wedge pressure is not seen in pre capillary pulmonary
hypertension.
Cor Pulmonale
1. The most common cause for chronic cor pulmonale is COPD.
2. Murmur seen in cor pulmonale TR.

Lung Cancer
1. Skeletal connective tissue syndromes including clubbing is usually seen in
non small cell carcinomas
2. Clubbing is least common with small cell carcinoma of lung.
3. Most common histological variant associated with clubbing non small cell
carcinoma
4. Most common histological variant presenting at peripheral location non
small cell carcinoma.
5. Most common primary bronchogenic carcinoma is Adenocarcinoma.
6. Most common type of primary carcinoma lung in India is Squamous cell
carcinoma.
7. Commonest type of primary lung carcinoma in non-smokers is
Adenocarcinoma.
8. True statement about adenocarcinoma lung are a. Common in females, b.
Not associated with smoking, c. Peripheral involvement is common.
9. Lung to lung metastasis is most commonly seen in Adenocarcinoma of lung.
10. In a chronic smoker, a highly malignant aggressive and metastatic lung
carcinoma is Small cell Carcinoma.
11. Oat cell type carcinoma lung responding best to chemotherapy.
12. Most common symptom of primary lung carcinoma is Cough.
13. Bronchial adenoma commonly present as Recurrent hemoptysis.
 Neurology

1. A lesion in the paracentral lobule causes Contralateral foot weakness

2. The characteristic feature of a frontal lobe tumor is Antisocial behaviour
3. Lesions of the medial temporal lobe may produce VisualAmnesia,
AuditoryAmnesia, AntegradeAmnesia
4. Memory impairment occurs in embolism of posterior cerebral artery
because of damage to Hippocampusgyrus
5. Cortical blindness is seen in lesion of Occipital Lobe
6. Akinetic mutism is seen in lesion of Frontal Lobe
7. HIV does not affect Cingulate cortex

Speech
1. Broca's area is located at Dominant inferior frontal gyrus
2. Wernicke area is located at Dominant superior temporal gyrus
3. Motor aphasia refers to defect in Verbal expression
4. Lesion in inferior frontal gyrus causes Motor aphasia
5. If Wernicke's area is damaged in the dominant hemisphere, it will result in
Irrelevant and rapid speech

Urinary Bladder
1. Nerve carries parasympathetic fibers to urinary bladder Pelvic
2. Pudendal nerve supplies External sphincter
3. Site of disease of autonomous bladder is S2-4
4. Loss of social inhibition occurs when the site of disease is Frontal cortex

Headache
1. Dura is a pain sensitive structure.
2. Ophthalmoplegic migraine means When the headache is followed by partial
paralysis of the IIIrd nerve on the same side
3. Telecagepant is a new drug for treatment of migraine
Cerebrovascular Diseases
1. Most common cause of stroke in young women in India among OCP users
Cortical vein thrombosis
2. Most common cause of cerebrovascular accident is Embolism
3. Most common cause of intracranial hemorrhage is Intracerebral
hemorrhage
4. The commonest cause of Intracerebral Bleed is Trauma
5. Lacunar infarcts are caused by Lipo hyalinosis of penetrating arteries
6. The most common location of hypertensive hemorrhage is Putamen
7. Anterior cerebral artery occlusion can cause Contralateral lower leg
weakness
8. Hemiplegia is commonly associated with infarction of the area of
distribution of the Middle cerebral artery
9. Posterior Communicating Artery Aneurysm can cause compression of
Oculomotor nerve
10. Nerve most commonly involved in aneurysm of anterior cerebral artery is
oculomotor (III)
11. Thalamic syndrome occurs due to involvement of PCA
12. Artery is involved in locked in is syndrome Basilar artery
13. True about carotid stenosis Aspirin reduces risk of TIA
14. In cerebral infarct maximum enhancement in CT scan is seen in 14 days
15. Investigation of choice for screening of proximal internal carotid artery
stenosis is Doppler flow study
16. The only thrombolytic agent approved for the treatment of acute ischemic
stroke is Tissue Plasminogen activator.
17. Watershed infract is most commonly seen in Brain
18. Dejerine -Roussy syndrome is seen in recover phase Thalamus Bleeding
19. Jackson's Sign is seen in Hemiplegia
20. B/L positive Babinski sign is seen in Pontine hemorrhage

Neurosurgery
J. Most common cause of SAH Trauma
2. The most common site of Berry aneurysm is Junction of anterior
communicating artery with anterior cerebral artery
3. Sudden excruciating headache is most characteristic of SAH
4. Most common nerve involved in intracranial aneurysm is Oculomotor
5. Triple H therapy is done in SAH
6. Subdural hematoma most commonly results from rupture of Superior
cerebral veins
7. Lucid interval is seen in Extra dural hematoma
8. Extradural hematoma occur most commonly due to trauma to Temporal
bone.

Benign Intra Cranial Hypertension (Pseudo Tumour Cerebri)

1. The earliest manifestations of increased intracranial pressure following head
injury is Altered mental status
2. Pseudotumor cerebri occurs due to vitamin A toxicity

Herniation
1. Nerve is most commonly involve in uncal herniation is lllrd
2. Part of the brain which herniates in central herniation is Thalamus
3. Part of the brain which herniates in cingulate herniation is Medial Frontal
Lobe

Spinal Cord
1. Sensation transmitted by the Dorsal Tract / Posterior column Fine are
position, vibration
2. Temperature sense not affected in lesion of posterior column of spinal cord
3. Type of sensation lost on same side in Brown Sequard syndrome is
Proprioception, vibration
4. Painless burn in hand is a characteristic feature of Syringomyelia
5. Sacral sparing is a feature of Intramedullary tumour
6. In conus medullaris syndrome Ankle reflex is Absent
7. Beevor sign is seen in Abdominal muscle

Cranial Nerves
1. Olfactory cranial nerve is involved in Kallmann syndrome
2. In superior quadrantic hemianopia site of lesion in Temporal Lobe
3. Head ache with bitemporal hemianopia with 6/6 vision...seen with Chiasmal
lesions
4. Trigeminal cranial nerve is involved in Tic Douloureux
5. TRUE regarding upper motor neuronVIlth nerve paralysis is Contralateral
lower face paresis
6. In mimic paralysis Emotional movement of face impaired
7. Lateral medullary syndrome is caused by thrombosis of Vertebral artery or
by posterior cerebellar artery.
8. Lesion of posterior inferior cerebellar artery at brain involves/affects Spinal
tract of trigeminal nerve
9. Wallenberg's syndrome involves Ipsilateral 5, 8, 10 nerve palsy
10. Clinical features of medial medullary syndrome Ipsilateral 12th nerve palsy,
Contralateral pyramidal tract sign
11. Contralateral hemiplegia is a feature of Medial Medullary Syndrome
12. True about Weber's syndrome Ipsilateral 3rd nerve palsy + contralateral
hemiparesis
13. Facial Paralysis is a feature of Mobius syndrome
14. Facial Paralysis is a feature of Melkersson-Rosenthal syndrome
15. Ramsay - Hunt Syndrome is due to Herpes virus
16. Griesinger's sign is seen in Sigmoid sinus thrombosis

Multiple sclerosis
1. Impotence is a feature of Multiple sclerosis
2. Uhthoff's phenomenon is worsening of symptom due to Exposure to heat
3. Hydrocephalus is not a feature of multiple sclerosis
4. Dawson's finger sign is seen in MRI of MS
5. Visual evoke potential is used in the diagnosis of MS
6. Oligoclonal bands in CSF occur in multiple sclerosis.
7. Interferon Beta used in the prophylaxis of Multiple Sclerosis.

Parkinsonism
1. Parkinson can occur in Wilson disease
2. Drug of choice in phenothiazine-induced Dystonia is Benztropine
3. Lazabemide is a MAO-B inhibitor
4. In Shy Drager syndrome is Parkinson + Autonomic neuropathy
5. Pick's body in pick's disease is Tau protein
6. In Parkinson's disease the deposit seen in the brain are Alpha-synuclein
7. Milkmaid's sign is seen in Chorea

Cerebellar Diseases
1. Akinesia is a feature of cerebellar disease
2. Pendular jerk is best elicited at Knee joint
3. Dysmetria is seen in Cerebellar lesion

Dementia
1. A chromosomal anomaly associated with Alzheimer's dementia is Trisomy
21
2. Neurofibrillary tangles is a feature of Alzheimer's disease.
3. Part of the brain is most commonly involved in Alzheimer disease Nucleus
basalis of Meynert
4. Biochemical abnormality in the brain in Alzheimer disease is Decrease
Acetylcholine
5. Loss of consciousness is not a feature of Alzheimer disease
6. 'Huntington's disease is due to the loss of Intra striatal cholinergic and
GABAergic neurons
7. Gait difficulty, urinary incontinence, memory loss, occur in Normal pressure
hydrocephalus
8. Localised regional cerebral atrophy is seen in Frontotemporal dementia
9. Vitamin B12 Deficiency is a cause of reversible dementia.
10. Increase level of Homocystine can lead to dementia

Meningitis & Encephalitis

1. Subdural effusion is most commonly caused by H influenza
2. Normal CSF glucose level is 2/3 plasma glucose
3. CSF finding seen in TBM Increased protein, decreased sugar, increased
lymphocytes
4. Characteristic finding in CT in a TB case is Exudate seen in basal cistern
5. True about CSF finding in TB meningitis is ProteinLymphocyte
6. The drug of choice in Cryptococcal Meningitis is Amphotericin B
7. Commonest cause of sporadic encephalitis is Herpes Simplex Virus
8. Most common cause of epidemic viral encephalitis Arbovirus.
9. The drug of choice in Herpes Simplex Encephalitis is Acyclovir

Neurocysticercosis.
1. Neurocysticercosis is the most common central nervous system parasitic
infection.
2. Commonest presentation of neurocysticercosis is Seizures
3. Brain parenchyma is the most common location of intracranial
neurocysticercosis
4. Albendazole is superior to praziquantel in the treatment of
neurocysticercosis

Slow virus diseases

1. Myoclonic seizure typically seen in Creutzfeldt - Jakob disease
2. Inclusions in oligodendrocyte is a feature of Progressive multiple
encephalopathy
3. Fatal familial insomnia is associated with Prion disease
4. Creutzfeldt - Jakob disease can be transmitted by corneal transplant also
5. Burst- suppression in EEG is seen in Subacute sclerosingPanencephalitis

Seizure Disorder
1. Absence seizures are seen in Petit mal epilepsy
2. Absence seizures are characterized on EEG by 3 Hz spike & wave
3. Commonest type of seizure in newborn Subtle
4. Lamotrigine drug has a wide range of action
5. Carbamazepine is not used for managing status epilepticus
6. Generalized Tonic clonic status epilepticus, Rx of choiceis Lorazepam
7. Valproate has a very wide range of action
8. Catamenial epilepsy occur most common is Young ladies during
Menstruation.
9. Urinary incontinence is the characteristic feature to distinguish seizure
from syncope
10. Epileptic surgery is the most effective treatment for medically non
responsible seizures
Ataxia
1. Bilateral loss of ankle jerk and extensor plantar response is seen in
Friedreich's ataxia
2. Regions of the spinal cord involved first in Friedreich's Ataxia Dorsal Root
ganglion
3. Subacute combined degeneration due to Vit. B12 deficiency mainly
involves Corticospinaltract Posterior column

Neurocutaneous Syndrome
1. The most common tumor associated with type I neurofibromatosis Optic
nerve glioma
2. Acoustic neuromas is important feature of Neurofibromatosis type 2
3. Neurofibromatosis type-ll is associated with
a. B/L acoustic schwannoma, b. Chromosome-22,
c. Posterior subcapsular lenticular cataract
4. CNS tumor seen in Von Hippel-Lindau syndrome is Cerebellar
hemangioblastoma
5. Seizures, Mental retardation and Sebaceous adenoma are seen in
Tuberous sclerosis
6. Brain tumor is not associated with Sturge Weber syndrome
7. Ophthalmoplegia &hemolytic anemia occur in deficiency of Vit E

Peripheral Neuropathy
1. Neuropathy is not seen in Tuberculosis
2. Pure motor paralysis is seen in Polio
3. Predominantly sensory neuropathy are caused by a. Cisplatin b. Pyridoxine
excess
4. Organism is involved in the pathogenesis of GBS Campylobacter jejuni
5. Best Treatment of GBS is Plasmapheresis
6. Autonomic neuropathy is characterized by Resting tachycardia
7. Onion bulb appearance on nerve biopsy is seen in CIDP

Myasthenia Gravis
1. Myasthenia gravis is associated with Decreased myoneural junction
transmission
2. The most sensitive test for the diagnosis of myasthenia gravis is
Measurement of jitter by single fibre electromyography.
3. Drug of choice for myasthenia gravis is Pyridostigmine
4. In Myasthenia Gravis, thymectomy Should be done in all cases of
generalized myasthenia between the age 20-55.
5. Hypogammaglobulinemia is associated with Thymomas
6. Thymoma is associated with Myastheniagravis
7. Eaton-Lambert syndrome Repeated electrical stimulation enhances muscle
power in it.
8. Site of dubious abscess is Thymus

Muscular Dystrophies
1. Dystrophic gene mutation leads to Duchenne muscular dystrophy
2. Dystrophin pathy is not a limb girdle dystrophy
3. Duchenne Muscular Dystrophy is a disease of Sarcolemmal proteins
4. In Duchenne's muscular dystrophy, muscle not involved is Vastusmedial
5. Gene for myotonic dystrophy is coded on chromosome number 19
6. Age of onset of Duchenne muscular dystrophy is 1 to 5 years
7. Inverted Champaign bottle muscle atrophy occurs in Peroneal muscular
atrophy
8. Muscular weakness due to deficiency of magnesium is enhanced by
presence of Metabolic alkalosis
9. Primary idiopathic polymyositis does not involve Ocular muscles
10. In dermato polymyositis CPK is Increased
11. Critical illness myo neuropathy, is due to Diaphragm atrophy due to
prolonged mechanical ventilation
12. Heat stiffening occurs when a person is exposed at a temp of 60°C

Channelopathy
1. Hypokalemic Periodic Paralysis Attack are precipitated by heavy exercise
followed by Heavy Meals & Rest.
2. Hyperkalemic Periodic Paralysis Attack are precipitated by heavy exercise
followed by No Meals & Rest.
 Motor Neuron Disease
1. UMN lesion is characterized by Weakness & spasticity
2. Lower motor neuron lesions is associated with Flaccid paralysis
3. Fasciculation is seen in LMN type of lesions
4. Bulbar paralysis refers to LMN lesion Paralysis of cranial nerve IX to XII
5. Fasciculation is pathognomonic for motor neuron disease
6. Spinomuscular atrophy is seen in lesion of Anterior horn
7. Amyotrophic lateral sclerosis involves Anterior horn cell + cortico spinal
tract
8. Ocular motility is spared in Motor neuron disease.
9. Cerebellar degeneration is seen in Hodgkin Lymphoma

Syncope
1. Point which helps to exclude the diagnosis of seizure in a patient with
sudden loss of consciousness is Sudden return to normal mental function
upon awakening.

Acute Spinal Cord Injury

1. Hypotension in Acute Spinal Cord Injury is due to Loss of Sympathetic tone
2. Spinal shock is characterized by a). Sensory loss b). Urinary retention c).
Areflexia
3. Cervical cord injury does not cause a). Loss of sensation over face b. Wasting
with fasciculations of lower limb
4. Dose of methylprednisolone following spine injury 30mg/kg within 3 hrs of
injury
5. In Neurogenic shock Hypotension with bradycardia occur

Glasgow Coma Scale

1. Best prognostic factor for head injury is Glasgow coma scale
2. According to the Glasgow Coma Scale (GCS), a verbal score of 1 indicates No
response
3. Pupil size is not a component of Glasgow Coma Scale
4. Highest score of Glasgow coma scale is 15
5. Lowest score of Glasgow coma scale is 3
6. Anterograde amnesia is characteristic of Post traumatic head injury
 Cardiology

Arterial pulse
1. Slow rising pulse is seen in AS
2. Pulsus alternans occurs in CHF
3. Pulses bigeminus is seen in Digoxin therapy
4. Dicrotic pulse is seen in Dilated cardiomyopathy
5. Pulsus paradoxus is seen in
a. Cardiactamponade
b. Constrictivepericarditis
c. Severeasthma
6. Water hammer pulse is seen in Aortic regurgitation
7. Pulsus bisferiens is best felt in Radial artery

Jugular Venous Pulse (JVP)

1. 'C' wave in JVP is due to Tricuspid valve bulging into right atrium
2. In JVP. Cannon wave Complete heart block
3. In the JVP, 'a' waves are absent in Atrial fibrillation
4. Typical finding in cardiac tamponade- Absent 'Y' descent
5. "A" wave in JVP is absent in Hyperkalemia

Heart Sounds
1. Loud SI is caused by a. Short PR interval b. Tachycardia
2. Loud SI in Mitral stenosis is caused by Prolonged flow through mitral valve
3. Reverse splitting of 2nd heart sound in heard in a. LBBB b.AS
4. Wide fixed split S2 occurs in ASD
5. Wide and variable -split second heart sound is seen in
a. RBBB x b. PS
6. Single second heart sound is seen in
a. TOF b. Pulmonary atresia c. Severe pulmonary stenosis
7. Loud pulmonary component of second heart sound heard in
a. Pulmonary hypertension
b. Eisenmenger's syndrome
8. Fourth heart sound S4 IS Heard during ventricular filling late phase
9. Opening snap is a high-pitched diastolic sound.

Heart Murmurs
1. AS has mid systolic murmur
2. MVP has late systolic murmur
3. AR has early diastolic murmur
4. Atrial myxoma has late diastolic murmur
5. Continuous murmur is found in Systemic A V fistula
6. HOCM murmur increases with Valsalva

ECG
1. Heart rate is 1500 / RR interval
2. P wave is due to Atrial depolarization
3. PR interval is reduced in WPW syndrome
4. In LVH, SV1 + RV6 is more than 35 mm
5. QT interval is shortened in Hypercalcemia
6. Congenital long QT syndrome can lead to Polymorphic ventricular
tachycardia
7. ECG findings seen in Hypokalemiadncreased PR interval with ST depression,
Prolong QT, U wave.
8. ECG changes in a patient with left pneumothorax Right axis deviation
9. Alternating RBBB with LBBB is seen in Trifascicular block
10. Prolongation of QRS is a feature of Bundle Branch Block.
11. Tachycardia is the commonest ECG finding in pulmonary embolism
12. Most characteristic finding in ECG in pulmonary embolism is Si Qm Tm
13. Normal axis is Between -30° and +100°
14. Left axis deviation is seen in Septum primum ASD
15. Low voltage ECG in seen in Hypothyroid
16. Osborn wave is seen in Hypothermia
17. Electrical alternans is seen in Cardiactamponade
18. Treatment of asymptomatic bradycardia is No treatment is required
19. Earliest finding in acute Ml is Tall T wave
20. Correct sequence of ECG changes in acute Ml is ST elevation, T inversion, Q
wave
21. Most important ECG finding in non Q Ml is Symmetrical T wave inversion
22. Saw tooth appearance in ECG is seen in Atrial flutter
23. Embolic phenomena is most likely seen in Atrial fibrillation
24. Broad complex tachycardia, due to ventricular a tachycardia is suggested
by a. Fusion Beats b. A V dissociation c. Capture Beats
25. Feature of Torse de pointes is Prolonged QTc interval
26. High idio ventricular rhythm is seen in Digitalis toxicity
27. Best Treatment of congenital long QT syndrome is Implantable
cardioverter/defibrillator
28. Morbus Caeruleus is Congenital Heart Diseases with Cyanosis
29. Digoxin is not a treatment of WPW syndrome
30. Sudden RBBB is seen Ashman's phenomenon

Heart Failure
1. Most common cause of acute right heart failure is Pulmonary embolism
2. Anaemia is a cause of high output failure
3. Hepatomegaly is a minor Framingham criteria in CHF
4. Left atrial filling pressure closely approximates Pulmonary capillary wedge
pressure (PCWP)
5. Normal PCWP with pulmonary oedema is seen in High altitude
6. Normal Ejection Fraction is 50 to 75%
7. Nesiritide is an BNP Analogue
8. Levosimendan is used in the treatment of CHF
9. Coenzyme Q is used in the treatment of CHF
10. First line Treatment of acute pulmonary edema Sublingual nitroglycerin

CAD
1. Risk factors for coronary artery disease (CAD)
a. Increased homocysteine levels
b. Increased lipoproteins a
2. Nephrotic syndrome increases the susceptibility to coronary artery disease
3. In an old patient, the best indicator of probability of developing
cardiovascular disease can be calculated by LDL/HDL ratio.
4. Tendon xanthoma is seen in Familial hypercholesteremia
5. MC cause of abdominal aortic aneurysm Atherosclerosis
6. Coronary flow is maximum at early diastole phase of cardiac cycle
7. Angina pectoris is best diagnosed by History
8. A criteria of positive TMT: ST Depression >0.1 mm lasting for >0.08 sec
9. Agatston score is used for Quantification of calcified plaque
10. Test performed to detect stunned (reversible) myocardial ischemia PET
scan
11. Complete occlusion of coronary artery is denoted by 0 in TIMI by
angiography
12. Agent of first choice in an acute attack of Prinzmetal's angina is Nitrates
13. Ranolazine is used in the treatment of Angina
14. Echo is not a part of diagnostic criteria of acute Ml in WHO criteria
15. Bradycardia is a feature of Inferior wall Ml
16. Murmur that can be there in acute Ml isMRandVSD
17. Anterior septal wall of left ventricle is the most common site of myocardial
infraction.
18. ST segment elevation is diagnostic of fresh myocardial infarction in ECG
19. Tall T wave is the first feature of acute Ml in ECG
20. ECG is poor at detecting ischemia in areas supplied by Right coronary
artery
21. Intraoperative myocardial infarction is best diagnosed by Trans esophageal
echocardiography
22. In stable angina The levels of cardiac markers remain unchanged
23. In Ml, enzyme raised in 4 to 6 hrs & decreases in 3 to 4 days is CPK
24. Drug used to perform stress ECHO Dobutamine
25. The best possible intervention for acute myocardial infarction is
Streptokinase or PTCA.
26. Death in acute Ml with thrombolytic therapy is due to Intracranial
hemorrhage
27. Reperfusion is useful for Hibernating myocardium
28. Right ventricular infarction is the most likely cause of shock
29. A patient had an inferior wall myocardial infarction and was in shock. The
reason for the patient being in shock is- Right ventricular infarction
30. Myocardial infarction the mortality and morbidity of the patient is best
indicated by Left ventricular ejection fraction
31. In a patient with myocardial infarction the valvular lesion commonly seen
in- Mitral regurgitation
32. Maximum mortality of Ml occurs in day 1
33. Pulmonary edema, systolic BP >90 indicate which class of Killipe's
classification in acute Ml Class III
34. Dressler's syndrome is seen in Ml
35. Raised level of biomarker which predict the increased risk of Ml is CRP
36. LAD also known as Widow's artery
37. Best biomarker of acute Mi is Troponin T
38. In Ml, thrombolytics can be given if patient comes within 12hrs

Cardiomyopathy
1. Amyloidosis is the most common cause for 'Restrictive cardiomyopathy
2. A young basketball player suddenly collapsed and has sudden cardiac death,
is due to HOCM
3. The murmur of hypertrophic obstructive cardiomyopathy is decreased in
Supine position
4. Aggravation of symptoms of angina in a patient when given nitrates is seen
in Idiopathic hypertrophic sub aortic stenosis (HOCM)
5. Double apex beat is seen in HOCM
6. Digoxin is contraindication in HOCM

Pericardial diseases
1. Hydralazine causes pericarditis
2. Acute rheumatic fever is least likely to cause constrictive pericarditis (CP)
3. Kussmaul's sign is seen in Constrictive Pericarditis (CP)
4. Nephrotic syndrome is seen in CP
5. During ventricular pressure pulses square root wave is seen in Constrictive
pericarditis
6. Pulsus paradoxus is a characteristic feature of Cardiac Tamponade
7. Beck's triad seen in Cardiactamponade
8. Ewart's sign is seen in Cardiactamponade
9. Electric alternans is seen in Cardiac tamponade
Hypertension
1. Mean arterial pressure is Diastolic + l/3rd Pulse pressure
2. Pulse pressure is Systolic - diastolic B.P.
3. The blood pressure measured by a sphygmomanometer Is higher than the
intraarterial pressure
4. Spuriously high BP is seen in Silent gap
5. Critical ischemia for peripheral arterial disease if Ankle brachial index is 0.3
6. J curve phenomena is related to Hypertension
7. Characteristic feature seen in the kidney in malignant hypertension is
Fibrinoid necrosis
8. Sustained severe hypertension in children is most commonly suggestive of
Renal parenchymatous disease
9. MRI angiography is a specific and a sensitive screening test for
Renovascular Hypertension.
10. In hypertensive retinopathy A-V nipping is seen in class II
11. Best drug for angina with hypertension is Metoprolol
12. Drugs contraindicated in diabetes with hypertension Thiazide
13. Drug of choice in BHP with hypertension is Alpha blocker
14. Side effect of ACEI Hyperkalemia
15. Side effect of hydralazine is SLE like feature
16. Aliskiren is a Renin antagonist
17. Main action of Ivabradine is Bradycardia
18. Fenoldopam is a DI receptor agonist
19. Urapidil is Alpha 1 blocker

Myxoma
1. Most common tumour of heart is Myxoma
2. Distant metastasis is not seen in Cardiac myxoma
3. Gradient in pulmonary artery wedge pressure and left ventricular end
diastolic pressure is seen in Left atrial myxoma
4. Secondary in the heart which come maximum from primary tumor is
MeL :oma
Rheumatic Fever
1. In Rheumatic fever Chorea is aggravated during pregnancy
2. Earliest valvular lesion in a case of acute rheumatic fever is Mitral
regurgitation (MR)
3. True statement about Rheumatic fever in children a. Polyarthritis b. MC
valve involvement is Mitral
4. Erythema Marginatum in Acute Rheumatic fever is Usually associated with
carditis
5. Subcutaneous nodule in Rheumatic fever a. Non tender b. Present in
extensor surfaces
6. Fever is a minor criteria for diagnosis of RF according to modified Jones
criteria
7. Diagnostic feature in rheumatic heart disease is Aschoff's nodule
8. McCallum's patch is diagnostic of Rheumatic heart disease.

Valvular Heart Disease

1. LVH is not a feature of MS
2. S3 is not a feature of MS
3. Straitening of the left border of heart is the early feature of CXR of MS
4. MITRA clip is used in the treatment of MR.
5. Edward Sapiens valve is used for treatment of AS
6. Reduce EF slope in echo is seen in MS
7. Commonest valvular lesion in India & the World isMVP
8. MVP isAutosomal dominant
9. Valvular lesion seen in William's syndrome AS
10. Gallavardin sign is seen in AS
11. Sudden death can occur in AS
12. Commonest symptoms of AR is Palpitation
13. Austin flint murmur is heard in AR
14. Commonest cause of TR is Cor pulmonale
15. Carvallo's sign is seen in TR
16. Pulsatile liver is seen in TR
17. In TS,Giant a wave and slowY descent is seen
18. Pulmonary valve is least commonly involved in RHD
19. Graham steels murmur is heard in PR
20. Pulsatile liver and ascites is found in TR
21. Mid-diastolic murmur with presystolic accentuation is heard in MS
22. TEE is better than Trans thoracic Echo to identify the atrial
thromboembolism

Endocarditis
1. Infective endocarditis is least likely to occur in Atrial septal defect
(Secondary)
2. Most common heart valve involved in IV drug user is Tricuspid valve
3. Bacterial endocarditis is most commonly caused by Staphylococcus aureus
4. A patient has prosthetic valve replacement and he develops endocarditis 8
months later. Organism responsible is Coagulase negative staphylococci
(CoNS)
5. Vegetations on under surface of AV. valves are found in Libman Sacks
endocarditis
6. Flat vegetations in pockets of valves are due to Libman sacks Endocarditis
7. Osler's nodes are seen at Tip of Palm & Sole
8. Roth spots are seen in Endocarditis
9. Best investigation to diagnose endocarditis is Echo and blood culture.
10. Duke criteria is used in Endocarditis
11. MVP without MR has very low risk factor for endocarditis
12. In a patient of heart disease antibiotic prophylaxis for dental extraction is
Amoxicillin

Liver & GIT

Jaundice
1. Unconjugated Bilirubin is absent in urine because it is attached to albumin
2. Unconjugated hyperbilirubinemia is seen in hemolytic anemia
3. Crigler-Najjar type II syndrome is Autosomal Recessive trait
4. The test used to diagnose Dubin Johnson syndrome is BSP test.
5. Conjugated hyperbilirubinemia is seen in Dubin Johnson syndrome
6. 5'-Nucleotidase activity is increased in Cholestatic disorders.
7. Low serum alkaline phosphatase is seen in Hypothyroid
8. Menghini needle is used for biopsy of Liver
9. HIDA scan is done to diagnose Acute cholecystitis

Viral Hepatitis
1. Non-parenteral hepatitis is Hepatitis E & A.
2. Councilman Bodies are seen in Acute viral hepatitis in liver biopsy.
3. The commonest hepatotropic virus progressing to chronicity is HCV
4. Hepatitis B viruses have significant perinatal transmission
5. Window period in hepatitis B is Disappearance of HBsAg and the
appearance of anti HBs
6. Chance of vertical transmission in Hepatitis B is 90%

Hepatitis B
1. Acute infection of hepatitis B virus is diagnosed by IgM antibody of HBc Ag
2. Hepatitis B infectivity is indicated by HBsAg + HBeAg
3. A blood donor is not considered for safe transfusion, if he has HBS Ag +ve.
4. Reserve transcriptase of hepatitis B virus is coded on the P gene

Hepatitis E
1. The most common route of spread in hepatitis E is feco-Oral
2. During an epidemic of hepatitis E, Fatality is maximum in Pregnancy
3. Most common type of hepatitis responsible for epidemics in India is
Hepatitis E
4. Human immunoglobulin are used in prophylaxis for hepatitis A

Chronic Hepatitis
1. Chronic persistent hepatitis can be differentiated from chronic active
hepatitis by Liver biopsy
2. Treatment of a case of chronic hepatitis B is needed if Increase in DNA
copies & raised ALT
Chronic Hepatitis C
1. Chronic liver disease is most commonly caused by Hepatitis C
2. Treatment of hepatitis C is Sofosbuvir
3. Cryoglobulinemia is seen in Hepatitis C
4. Characteristic episodic pattern of aminotransferase activity is seen in
Hepatitis C

Cirrhosis
1. Ratio of A5T/ALT > 1 is present in Alcoholic hepatitis and in Pregnancy.
2. Enzyme assay useful to diagnose alcoholism Glutamyl aminotransferase
3. Pentoxifylline is useful to decrease mortality and renal failure in acute liver
disease due to alcoholism
4. Steroid is used with treatment of Discriminant function
5. Most common symptom of primary biliary cirrhosis is Pruritus
6. Nutmeg liver is seen in Cardiac cirrhosis

Portal Hypertension
1. Normal portal pressure is 2-5 mmHg (10-15 cm of water)
2. In portal hypertension portal pressure is more than 30 cm of saline. (10
mm of Hg)
3. For severe hematemesis,the management of choice to increase the BP is
Whole blood transfusion
4. Rockall score is used for Upper Gl bleed
5. Propranolol is not a treatment for acute variceal blood
6. USG can detect as little as 100 ml of peritoneal fluid
7. First line of treatment in Ascites is Salt and water Restriction
8. Most common organism causing spontaneous bacterial peritonitis E. coli
9. Features of Hepatorenal syndrome are
a. Urine sodium < 10 mEq/l
b. Normal renal histology
c. Proteinuria < 500 mg/day
10. Best treatment of Hepato renal syndrome is Liver transplantation
11. Vasodilation in spider Naevi is due to Estrogen
12. Orthodeoxia is a feature of Hepatopulmonary syndrome
 Hepatic Encephalopathy
1. First lab abnormality to occur in hepatic encephalopathy is Raised PT
2. In child with acute liver failure, the most important prognostic factor for
death is Increasing prothrombin time
3. A symmetric high-voltage, triphasic slow wave pattern is seen on EEG in the
Hepatic encephalopathy
4. Terry's nails are seen in Liver failure

Non-Cirrhotic portal fibrosis

1. Ingestion of arsenic causes Non cirrhotic portal fibrosis
2. Upper gastrointestinal bleeding is the most common presenting symptom
of non-cirrhotic portal hypertension

Non-Alcoholic Fatty Liver Disease (NAFLD)

1. Gall stone is not a cause of NASH
2. Treatment of NASH is weight loss Pioglitazone

Drug Induce Hepatotoxicity

1. Rifampicin causes acute hepatitis
2. Drug which causes venous outflow obstruction is Busulphan
3. Drug lead to liver fibrosis is Methotrexate

Budd-Chiari Syndrome
1. Most common site of Budd Chiari syndrome is Hepatic veins
2. Common cause for Budd Chiari syndrome is Polycythemia vera, PNH

Wilson disease
1. It is a Autosomal recessive disorder occurs in persons under age 40.
2. Excessive deposition of copper in the liver and brain.
3. Basic defect is reduce biliary copper excretion
4. K F ring seen in Wilson's disease
5. Diagnosis of Wilson disease
 a. Increased urinary copper excretion
b. Low serum ceruloplasmin levels
c. The most confirmatory test is elevated hepatic copper concentration
(>250 mcg/g of dry liver).
6. Treatment of Wilson's Disease
a. Zinc (Drug of choice for initial hepatic disease)
b. Trientine

Hemochromatosis
1. Aetiology
a. Autosomal recessive,
b. Gene is located on chromosome 6.
c. Approximately 90% of patient have a single-point mutation at position
C282Y & H63D in a protein (HFE).

2. Clinical features
a. Features of hepatic cirrhosis (especially hepatomegaly),
b. Diabetes mellitus
c. Heart failure.
d. Leaden-grey skin pigmentation due to excess melanin & iron occurs,
especially in exposed parts, ('bronzed diabetes').
e. Impotence, loss of libido, testicular atrophy.
f. Arthritis with chondrocalcinosis secondary to calcium pyrophosphate
deposition, (pseudogout)
g. Joints of hands especially 2nd& 3rd MCP joint are 1st to be involved.

Managements
1. Main treatment consists of weekly venesection phlebotomy of 500 ml blood
until the serum iron is normal.

Miscellaneous Liver Diseases

1. Jaundice is not a feature of liver abscess
2. Treatment of Hydatid cysts is Albendazole
3. CMV virus is most likely to cause liver dysfunction in HIV patient
4. Intrahepatic cholestasis occurs most likely at 3rd trimester of pregnancy
5. Acute fatty liver of pregnancy occurs most likely at 32-36 week of
pregnancy.

Liver Carcinoma
1. a-fetoprotein levels are Normal in fibrolamellar hepatic carcinoma
2. Fibrolamellar carcinoma Has good prognosis
3. Following liver transplantation, recurrence of primary disease in the liver
most likely occursin Autoimmune hepatitis
4. Hepatomegaly is not the important feature of Porphyria

Esophageal Reflux Disease (GERD)

1. Barrett's esophagus is diagnosed by Intestinal metaplasia
2. Barrett'sesophagus can lead to Stricture
3. Barrett's esophagus is Premalignant
4. Barrett's esophagus is commonly associated with Adenocarcinoma

Peptic Ulcer
1. Stress ulcers seen in burns are Curling's ulcer
2. Helicobacter pylori is not associated with Gastricleiomyoma
3. Endoscopic biopsy from a case of H. pylori related duodenal ulcer is most
likely to reveal Antral predominant gastritis
4. Epidemiological studies of H. pylori are done by using Serological markers
5. The best method to detect presence of residual H. Pylori infection is Urea
breath test
6. Commonest site of peptic ulcer is First part of duodenum
7. Most common complication of chronic gastric ulcer is Haemorrhage
8. Artery to bleed in duodenal ulcer haemorrhage Gastroduodenal artery
9. Hypergastrinemia with hypochlorhydria is seen in Pernicious anemia
10. Best screening test for ZES is Secretin injection test.
11. Best treatment for ZES is Proton pump inhibitor

Diarrhea
1. A patient is said to have chronic diarrhea if it is occurring for more than 4
Weeks.
2. Treatment of pseudomembranous colitis Oral Vancomycin
3. Giardiasis is parasitic infestation can lead to malabsorption syndrome
4. Most common site of TB of abdomen is lleocaecal junction

Coeliac disease
1. Celiac sprue is associated with Dermatitis herpetiformis
2. Rice can be used safely in patients with celiac sprue
3. Most sensitive and most specific immunological test to diagnosis coeliac
disease is Anti tissue transglutaminase antibodies
4. Most common CNS manifestation of Whipple's disease is Dementia
5. An intestinal biopsy is diagnostic in Whipple's disease
6. Macrophages containing large quantities of undigested and partial digested
bacteria in intestine are seen in Whipple's disease

Irritable Bowel Syndrome (IBS)

1. Tegaserod is 5-HT4 agonist

Inflammatory Bowel Disease

1. Pseudopolyps are features of Ulcerative colitis
2. Cryptitis and crypt abscesses are seen in Ulcerative colitis
3. Toxic megacolon is most commonly associated with Ulcerative colitis
4. 5-amino salicylicacid is drug of choice for ulcerative colitis
5. Skip granulomatous lesions are seen in Crohn's disease
6. Multiple fistulae in the perineum and multiple stricture in small intestine
seen in Crohn's disease
7. The presence of anti-Saccharomycescerevisiae antibody is a marker of
Crohn's disease
8. Lynch syndrome associated with Colon, endometrium, ovary
9. Mutations in NOD2 gene have been associated with Crohn's disease
10. Most common site of ulcerative colitis is Rectum
11. Anterior uveitis is a feature of ulcerative colitis
12. Ankylosing spondylitis is a feature of ulcerative colitis
13. Sclerosing cholangitis is seen in Ulcerative colitis
14. Clostridiumdifficileorganism has been implicated in Crohn's disease
15. Most common site of carcinoid is Appendix
 Kidney

Kidney Function Test

1. Presence of 20% dysmorphic RBC's in the urine is diagnostic of glomerular
injury
2. Dysmorphic R.B.C& R.B.cast is feature of glomerular hematuria.
3. Recurrent gross hematuria is seen in a. Alport'ssyndrome , b. IgA
nephropathy
4. White cell casts is indicative of renal tubular disease
5. Most specific urinary finding Acute pyelonephritis Bacteria in gram stain
6. In differentiating glomerular proteinuria from Tubular proteinuria,
Glomerular proteinuria is indicated best by Proteinuria >3.0 - 3.5 g/day
7. Bence Jones protein mostly derived from Gamma chains
8. Serum creatinine increased out of proportion to BUN is seen in a person
with muscular body
9. In a child, non-functioning kidney is best diagnosed by DTPA renogram.
10. A patient with ARF with complete anuria, but a normal ultrasound. Next
investigation is DTPA Renogram
11. Creatinine clearance measures GFR

Acute Renal Failure

1. The most common cause of Post Operative ARF occurs due to Decreased
renal perfusion
2. As per Rifle criteria, for acute kidney injury urine production <0.5 ml/kg for
12 hours indicates Injury
3. Values suggestive of acute tubular necrosis Urine sodium>40 mmol/l
4. Fractional excretion of sodium <1 is seen in Prerenal azotemia
5. Prerenal and renal azotemia is best differentiated on the basis of fractional
Excretion of Na (FENa)
6. In Acute Tubular Necrosis Blood urea creatinine ratio < 20:1
7. Fastest treatment of hyperkalemia is Dextrose insulin drip
CRF (End Stage Renal Disease = ESRD)
1. Type of glomerulonephritis is least likely to cause CRF Minimal change
glomerulonephritis
2. Signs and symptoms of CRF appear when GFR goes down below 50%
3. The best initial test to know about CRF is GFR
4. Cockcroft Gault equation is used to calculate Creatinine clearance
5. Painless pericarditis is a feature of CRF
6. Restless leg syndrome (RLS) is seen in Chronic renal failure
7. Treatment of restless leg syndrome is Risperidone
8. Renal osteodystrophy differs from nutritional and genetic forms of
osteomalacia in having Hyperphosphatemia
9. Nail and half nail sign, seen in uremia is due to increased capillary density at
the distal half of nails
10. Band shaped keratopathy is seen in CRF
11. In urinary system disease, Gl symptoms appears because of Renogastric
reflex
12. In Digoxin poisoning dialysis is not done
13. Hypotension is the commonest complication of hemodialysis
14. Fluid used in peritoneal dialysis is rich in Dextrose
15. Ultrafiltration is done mainly to remove Water

Glomerulonephritis
1. Post-Streptococcal Glomerulonephritis secondary to skin infection, is more
common in summer
2. Crescent formation is characteristic of Rapidly progressive
glomerulonephritis
3. The prognosis of rapidly proliferating glomerulo-nephritis (Crescentic GN)
depends upon Number of crescents

IgA nephropathy
1. IgA-nephropathy is seen in Mesangioproliferative glomerulonephritis
2. Henoch - Schonlein Purpura Platelet count is Normal
3. A feature of Renal vasculitis in children is IgA nephropathy
Nephrotic syndrome
1. Edema is nephrotic syndrome is predominantly due to Hypoalbuminemia
2. Most common cause of nephrotic range proteinuria in an adult is Diabetes
Mellitus
3. Nephrotic syndrome may be associated with HDL cholesterol
4. True about light microscopy in minimal change disease is No change seen
5. Minimal change glomerulopathy may progress to FSGS
6. Reflux nephropathy is most likely to cause FSGS
7. Tram Tract appearance is seen in Membrano proliferative GN
8. Complement level is reduced in Membrano proliferative GN
9. Renal Vein Thrombosis is most common in Membranous GN
10. Most sensitive test for renal vein thrombosis CT Angiography

Kidney involvement in systemic disease

1. Most common pathological features in diabetes mellitus is Diffuse
glomerulo sclerosing
2. HIV associated nephropathy is a type of Collapsing glomerulopathy
3. In Collapsing glomerulopathy, features is Visceral epithelium cells injury
4. Reflux Nephropathy with proteinuria in the nephrotic range may be seen
in patients with Focal segmental Glomerulosclerosis
5. Wire loop lesions are often characteristic for Diffuse proliferative
glomerulonephritis (WHO class IV) class of lupus nephritis
6. Hypocomplementemia is seen a. PSGN, b. MPGN, c. Infective endocarditis,
d. SLE
7. Proliferative glomerular deposits in kidney are found in IgA nephropathy

Tubulointerstitial Diseases of The Kidney

1. Saturnine gout occur due to Lead Poisoning
2. Renal papillary necrosis is associated with Diabetes-mellitus
3. Crush injury leads to ARF
4. Salt losing nephritis is a feature of Interstitial nephritis
5. Hypertension is a less important finding in interstitial nephritis
 Rhabdomyolysis
1. Non oliguric renal failure is seen in Rhabdomyolysis
2. Tests
a. Blood tests show a raised CK.
b. Dark urine is +ve for blood on dipstick but without RBCs on
microscopy.
c. Confirmed by +ve urinary /serum myoglobin.
d. Hyperkalemia, Hyperphosphatemia, Hyperuricemia, Hypocalcemia,
Lactic Acidosis

RTA
1. Hyperkalemia occurs in Type IV RTA
2. Fanconi syndrome occurs in Type II RTA
3. Type 1 (Distal)
a. Features include rickets, or osteomalacia, due to buffering of H+ with
calcium in bone.
b. Nephrocalcinosis with renal calculi is a feature.
c. Urine citrate is reduced.
4. Type 2 (Proximal) RTA is due to a 'bicarbonate leak' a defect in HCO3
reabsorption in the proximal tubule resulting in excess HCO3 in the urine.

Barter Syndrome
1. Hypocalciuria occur in Gitelman
2. Hypertension occur in a. Liddle, b. Gordon syndrome
3. Hyperkalemia occur in Gordon syndrome

ADPKD
1. Adult polycystic kidney is inherited as Autosomaldominant
2. Berry Aneurysm in Circle of Willis is associated with adult polycystic kidney
disease
3. Hepatic Cyst is the most common extra renal involvement in ADPKD.
4. The neonatal kidney achieves concentrating ability equivalent to adult's
kidney by One year of age
 Rheumatology

Arthritis
1. Osteoarthritis is not an inflammatory arthritis.
2. HLA B5 is associated with Behcet.
3. Proximal interphalangeal, distal interphalangeal& 1st carpometacarpal joint
involvement and sparing of wrist is a feature of Osteoarthritis.
4. Least common site to be involved in osteoarthritis is Metacarpophalangeal
joint.
5. Heberden's arthropathy affects Distal interphalangeal joints.
6. Arthroscopic washout is the best treatment of a patients of Osteo arthritis
Aphrolan grade II.

Rheumatoid Arthritis
1. HLA most characteristically associated with Rheumatoid arthritis - HLA
DR4.
2. TNF-alpha is involved in the pathogeneses of RA.
3. Synovium is the initial site of disease in RA.
4. DIP joint least likely involved in RA.
Erosion radiological feature would help differentiate rheumatoid arthritis
;5-
with SLE.
>,6.; Cervical spine is most commonly affected Vertebral Joint in Rheumatoid
arthritis.
Ulnar deviation of fingers is Pathognomic of RA.
Hammer toe is seen in Rheumatoid arthritis.
Rheumatoid arthritis causes pleural effusion with low sugar.
Type of anemia seen in Rheumatoid arthritis is Normocytic normochromic
anaemia.
Rh factor is a Antibody.
11.
Rheumatoid factor is IgM.
12.
Rheumatoid factor in rheumatoid arthritis is important because RA factor
13.
is associated with bad prognosis.
Anti CCP is the most specific antibody for rheumatoid arthritis.
14-
ii Sclerosis is a X-ray finding in RA.
16. Leucocytosis is not a marker of active RA.
17. Hemophilia with Rheumatoid arthritis, analgesic of choice is
Acetaminophen.
18. Anakinra is the IL-1 Receptor antagonist.
19. Flupirtine is Analgesic.

Systemic Lupus Erythematosus

1. Polyserositis is seen in SLE
2. Procainamide causes SLE.
3. In SLE, characteristic kidney lesion is Wire loop lesions.
4. Wire loop lesions are often characteristic diffuse proliferative
glomerulonephritis (WHO class IV) class of lupus nephritis.
5. Shrinking lung is a feature of SLE.
6. Autoimmune destruction of platelet is seen in SLE.
7. Carpet tack sign is seen in SLE.
8. In APLA, BT & PT are normal but PTT is increased.
9. Thrombocytosis is not associated with an Anti-phospholipid syndrome.
10. Anti beta 2 glycoprotein antibody is used for diagnosis of antiphospholipid
antibody syndrome.
11. ANA is the most sensitive test for SLE.
12. Anti ds DNA ab is specific test for SLE.
13. Anti - Ro (SS- A) antibody is associated with subacute cutaneous lupus.
14. Anti ribosomal P antibody is associated with psychosis or depression due to
CNS SLE.
15. Best marker for drug induced lupus is Anti histone antibodies.
16. U1 RNP antibodies is most important in a diagnosis of Mixed Connective
tissue disorder.
17. Sapporo criteria is used for Anti phospholipid syndrome.

Spondylo - Arthrosis
1. Ankylosing spondylitis in associated with HLA-B27.
2. Sacroiliitis is the earliest joint involved in ankylosing spondylitis.
3. The Schober test is done for Ankylosing Spondylitis.
4. Bamboo spine is seen in Ankylosing Spondylitis.
5. Treatment of choice in seronegative spondyl-arthritis is Indomethacin
6. Subcutaneous nodules are not seen in Reiter's syndrome.
7. Chlamydia most commonly causes reactive arthritis.
8. Reiter's disease can occur in epidemic form.
9. Circinate balanitis is seen in Reiter's disease.
10. Sausage dactylitis is seen in Reiter's disease.
11. Keratoderma blennorrhagica is seen in Reiter's disease.
12. Patrick test is done for Sacroiliitis.

Systemic Sclerosis
1. Sudden renal failure occurs in PSS.
2. Anti centromere antibodies are most commonly associated with CREST
syndrome.
3. Bosentan is used to treat Raynaud's phenomena.
4. Hypothyroidism occurs in Scleroderma.

Sjogren syndrome
1. Commonest cause of secondary Sjogren's syndrome is RA.
2. Alpha fodrin antibodies are present in Sjogren's syndrome.
3. Focus score is use in the diagnosis of Sjogren's syndrome.
4. Schirmer's test is done to diagnose Sjogrensyndrome.

Behcet's Syndrome
1. Recurrent Bilateral Hypopyon formation associated with thrombophlebitis
is most consistent with Behcet's syndrome.
2. Pathergy test is done for Behcet's syndrome.
3. Thalidomide is used to treat Behcet's syndrome.

Crystals deposit disease

1. Gout is a disorder of Purine metabolism.
2. Allopurinol is not used in treatment of acute gout.
3. Most specific test for gout is Raised uric acid in synovial fluid of joint.
4. Martel's or G'sign is seen in Gout.
5. Benzbromarone is used in gout because it is Uricosuric.
6. Tienilic acid is the only diuretic that can be used in Gout.
7. Febuxostat is a Xanthine oxidase inhibitor and is used in the treatment of
 Gout.
8. Rasburicase is used in the treatment of Gout.
9. Small joints affected is not seen in pseudogout.
10. Hemochromatosis causes pseudogout.
11. Knee is the most common joint involved in pseudogout.

Vasculitis
1. ANCA is sensitive and specific for Idiopathic crescentic glomerulonephritis.
2. C-ANCA Positivity is specific for Wegener's granulomatosis.
3. c-ANCA positivity indicates, antibody formed against Proteinase 3.
4. p-ANCA is characteristic for Microscopic polyangiitis.
5. Headache is the most frequent presenting symptoms in patients with Giant
cell arteritis.
6. The investigation of choice for diagnosis of Giant cell Arteritis is Temporal
Artery biopsy.
7. Biopsy in PAN shows Necrotizing arteritis.
8. Kawasaki disease is common cause of Vasculitis in children.
9. Kawasaki disease is associated with coronary artery aneurysm.
10. The treatment of choice for Kawasaki disease is Immunoglobulins.
11. Intravenous immunoglobulin is given in a. Kawasaki disease, b. GB
syndrome, c. Myasthenia gravis.
12. Cavitating lesion in lung is seen in Wegner's granulomatosis.
13. Churg Strauss diseases manifest as asthma.
14. A characteristic of Henoch - Schonlein Purpura Blood in stool.
15. Henoch - Schonlein purpura is characterized by the deposition
IgAimmunoglobulin around the vessels.
16. Hypersensitive vasculitis involves Post capillary venules.

Marfan's syndrome
1. Root of aorta is the site of Aortic aneurysm in Marfan syndrome.
2. Ghent criteria is used to diagnose Marfan syndrome.
3. Most important differential diagnosis of Marfan syndrome is
Homocystinuria.
 Hematology

Anemia
1. Thalassemia is associated with microcytic hypochromic anemia.
2. Elevated serum ferritin, serum iron and increase transferrin saturation are
most consistent with the diagnosis of Hemochromatosis.
3. Spherocytes are seen in Autoimmune hemolysis.
4. Fragmented RBCs are seen inHUS.
5. Howell-Jolly bodies are seen in Post splenectomy.
6. Hb level at birth is 20 gm%.
7. Soft Systolic murmur is a feature of anemia.

Iron deficiency anemia (IDA)

1. Increased TIBC, decreased serum ferritin is diagnostic of iron deficiency
anemia.
2. The earliest sign of iron deficiency anaemia Decrease in serum ferritin
level.
3. In iron deficiency anemia Bone marrow iron is decreased earlier than
serum iron.
4. Most sensitive and specific test for diagnosis of iron deficiency is Serum
ferritin levels.

Macrocytic anemia
1. Megaloblastic anemia in blind loop syndrome is due to bacterial
overgrowth.
2. Type of anaemia caused by lleocaecale TB is Megaloblastic.
3. Deficiency of the 'intrinsic factor of Castle' causes Pernicious anemia.
4. MCH is high & MCHC is normal in pernicious anemia.
5. Hypokalemia can occur in the treatment of pernicious anemia.
6. Megaloblastic anemia due to folic acid deficiency is commonly due to
Inadequate dietary intake.
7. Folate Deficiency occurs in Celiacdisease.
8. Thiamine deficiency lead to lactic acidosis.
Aplastic anemia
1. Pancytopenia with cellular marrow is seen in PNH.

Anaemia of Chronic Diseases (AOCD)

1. In chronic inflammatory anemia: Serum iron 4- S. ferritin T and transferrin
saturation
2. In Anemia of chronic disease normocyticnormochromicanemia. Decreased
serum iron and TIBC.
3. Transferrin saturation is Serum iron / TIBC X 100.

Sideroblastic anemias
1. Sideroblasticanaemia is seen in Hypothyroid.
2. Sideroblasticanaemia is caused by INH.
3. In Sideroblastic anaemia transferrin saturation is increase.
4. Treatment of sideroblastic anemia is Pyridoxine.
5. Pearson syndrome is Congenital sideroblastic anemia.

Hemolytic anemic
1. Cold autoimmune hemolysis is associated with Donath Landsteiner
antibody.
2. Autoimmune hemolytic anemia is seen in CLL.
3. Coombs positive hemolytic anemia associated with SLE.
4. Low serum haptoglobin in hemolysis masked by burns.
5. Hemolysis is most likely occur in Army soldier due to prolong March.
6. Spur cell anemia is seen in Alcoholic liver disease.

Hereditary Spherocytosis (HS)

1. Osmotic fragility is increased in Hereditary spherocytosis.
2. Decreased osmotic fragility is seen in Thalassemia.
3. Aplastic anemia in hereditary spherocytosis can be precipitated by Parvo
virus.
4. Splenectomy is useful in Hereditary spherocytosis.
PNH
1. A stem cell disorder affecting all the three cell line (Platelets, RBCs and
leucocytes) is Paroxysmal nocturnal hemoglobinemia.
2. Chronic Hemolysis from PNH is associated with iron deficiency.
3. Increased LDH is seen in PNH.
4. HAM test is based upon acidic medium.
5. Flow cytometry test is gold standard to diagnose a case of PNH.
6. Most common cause of death in PNH is Venous thrombosis.
7. Prophylactic treatment of PNH is Eculizumab.

Sickle Cell Anemia

1. The primary defect which leads to sickle cell anemia is Replacement of
glutamate by valine in B-chain of HbA.
2. Splenomegaly is not seen in a chronic case of Sickle cell anemia.
3. Commonest acute presentation of sickle cell anaemia is bone pain.
4. Crew haircut appearance in X-rays skull and Gandy gamma bodies are seen
in Sickle cell anemia.
5. Sickle cell trait is protective against Plasmodium infection.

Thalassemia
1. In Beta thalassemia, there is decrease in beta chain, increase in alpha chain.
2. The most common mutations in Beta thalassemia involves lntron-1.
3. HbH is characterized by deletion of three alpha chain genes.
4. Cause of alpha thalassemia deletion of alpha genes.
5. Diagnosis of beta Thalassemia is best established by Hb electrophoresis.
6. NESTROFT test used as screening test in beta thalassemia.
7. Hair on end appearance in X-rays skull is seen in thalassemia.
8. In thalassemia Ineffective erythropoiesis and hemolysis occurs.

G6PD deficiency
1. Oestrogen doesn't cause hemolysis in G6PD deficiency.
2. Heinz bodies are seen in G6PD deficiency
Bone marrow transplantation
1. Herpes simplex is the earliest infection to occur in BMT.
2. After BMT interstitial pneumonitis occurs at Seven week.

Porphyria
1. Porphyria is AD
2. Hepatitis C is associated withPorphyriaCutanea tarda.
3. Hepatoma is associated withPorphyriaCutanea tarda.

Myeloproliferativedisorders
1. Gaisbock syndrome occurs in Dehydration.
2. Arterial oxygen tension <90% on room air can differentiate primary
polycythemia from secondary polycythemia.
3. Tumor associated with polycythemia is Cerebellar hemangioblastoma,
Hepatoma, Renal Cell Carcinoma.
4. Erythropoietin level is not increased in polycythemia vera.
5. Severe infection is not commonly seen in Polycythemia.
6. Presence of JAK2 mutation is an essential (Major) criteria for diagnosis of
polycythemia vera.
7. Peripheral smear with increased neutrophils, basophils, eosinophils, and
platelets is highly suggestive of Chronic myelogenous leukemia.
8. Size of spleen is a criteria of prognosis in CML.
9. Leukocyte alkaline phosphate is decreased in CML.
10. Drug of choice for chronic myeloid Leukemia is Imatinib
11. Best Rx for CML is allogenic BMT.
12. Hemoglobin F is raised in Juvenile chronic myeloid leukemia.
13. Priapism is seen in bite by Spanish fly.
14. Giant platelet are seen in Myelofibrosis
15. Extra medullary hemopoiesis occurs in Myelofibrosis

Hairy cell leukaemia

1. 'Hairy cell leukemia' is a Neoplastic proliferation of B. cells.
2. Treatment of choice in hairy cell leukemia is Cladribine.
 3. Abscopal effect is related to radiation to Spleen.

Chronic Lymphocytic Leukemia (CLL)

1. Rituximab is used for the treatment of CLL.

Multiple myeloma
1. Bence Jones protein are derived from Gamma chains.
2. Commonest site of lytic lesion, in multiple myeloma is Vertebral column.
3. Russell bodies is seen in Multiple Myeloma.
4. Lytic bone lesions is a minor criteria for diagnosis of multiple myeloma.
5. Bone scan is not useful investigation in multiple myeloma.
6. Elevated alkaline phosphatase is not a feature of multiple myeloma.
7. High ESR is seen in Multiple myeloma.
8. Best marker for poor prognosis of the disease is Beta 2 micro globulin.
9. Bortezomib is used in the treatment of MM.
10. Franklin's disease is associated with Gamma heavy chain disease.
11. Plasmacytoid lymphoma is associated with IgM.

Lymphoma
1. The subtype of Hodgkin's disease, which is histologically distinct from all
the other subtypes, is Lymphocyte predominant.
2. Cells characteristic of Hodgkin's disease are Reed-Sternberg cells.
3. The lymphocytic and Histiocytic variant of Reed Sternberg cell is seen in
Lymphocyte predominant Hodgkin's disease.
4. Hodgkin's lymphoma of the nodular subtype is associated with Lacunar
cells.
5. Most common type of Hodgkin's lymphoma is Nodular sclerosis.
6. Most common type of Hodgkin's lymphoma in India is Mixed cellularity.
7. Best prognostic type of Hodgkin's lymphoma is Lymphocytic predominant.
8. Classical markers for Hodgkin's disease is CD 15 and CD 30.
9. The paraneoplastic syndrome associated with Hodgkin's disease is
cerebellar degenerative disease.
10. Treatment for Hodgkin stage IA is Radiotherapy.
Non-Hodgkin's Lymphoma
1. The classification proposed by the International Lymphoma Study Group
for non-Hodgkin's lymphoma is known as REAL classification.
2. Angiocentric lymphoma is not a B-cell neoplasm.
3. Most malignant form of NHL is Burkitt lymphoma.
4. In Burkitt's lymphoma, translocation seen is 8 -14 translocation.
5. Translocation t (2- 8) is associated with Burkitt lymphoma.
6. Epstein-Barr virus can lead to non-Hodgkin lymphoma.

Acute Leukemia
1. The marker for B lymphocyte is CD 19.
2. MPO is marker specific for myeloid lineage.
3. CD3is a pan-T lymphocyte marker.
4. Memory T cells can be identified by using the CD45RO marker.
5. Paroxysmal cold hemoglobinuria is not a preleukemic condition.
6. The most common type of ALL is Pre B cell ALL.
7. L-asparaginase is particularly used in ALL leukemia.
8. Treatment of choice in intracranial ALL is Intrathecal methotrexate.
9. In ALL methotrexate is administered for CNS prophylaxis.
10. Poor prognostic factor for ALL is t(9;22) t(4;ll).
11. Poor prognosis in AML is indicated by Monosomy 7.
12. Arsenic is used in treatment of Acute promyelocytic leukemia.

Bleeding disorder
1. Converging point of both pathways in coagulation is at Stuart factor X.
2. Factor VII deficiency may present with isolated prolongation of
prothrombin time (PT).
3. Platelet function may be assessed by Platelet adhesion Assays.
4. A patient is on aspirin, Prolonged BT will occur.
5. Feature of hemorrhagic disease of new born is Prolonged prothrombin
time.
6. P.T. is most likely to be increased in Vit. K deficiency.
Platelet Disorders
1. Normal platelet counts and prolonged Bleeding time is the finding in
functional defect in platelets.
2. The presence of small sized platelets on the peripheral smear is
characteristic of Wiskott Aldrich syndrome.
3. Thrombocytopenia is not seen in H.S. purpura.
4. Cause of ITP is antibody to platelets.
5. Bleeding time is abnormally prolonged in ITP.
6. Platelet transfusion is not indicated in immunogenic thrombocytopenia.

HUS & TTP

1. MicroangiopathicHemolyticanemia is seen in a). TTP, b). Microscopic
polyangiitis, c). Anti-phospholipid syndrome.

Hemophilia
1. The commonest mode of inheritance of Von Willebrand's disease
autosomal dominant.
2. Bleeding time is used to differentiate hemophilia A from von Willebrand
disease.
3. In a case of hemophilia, spontaneous bleeding occur when serum factor VIII
level is below 1%.

Disseminated Intravascular Coagulation (DIC)

1. DIC is commonly seen in M3 AML.
2. The most sensitive test for DIC is Serum levels of fibrin degradation
products (FDP).
3. Increased FDP, prolonged PT, reduced Platelets is the finding seen in DIC.

Hypercoagulable States
1. Predisposing factor for arterial thrombosis a). Protein S deficiency, b).
Protein C deficiency, c). Homocystinemia.
2. Hypercoagulability due to defective factor V gene is called Leiden mutation.
3. Most common inherited thrombotic disorder is factor V Leiden mutation.
4. A Female with recurrent abortions, pain in calves, It is most likely due to
deficiency of Protein C.

Blood Transfusion
1. Blood components products are a). Platelets, b). Fresh frozen plasma , c).
Leukocyte depleted RBC.
2. Most Common blood transfusion reaction is- Febrile nonhemolytic
transfusion reaction.

DRUGS
1. Clopidogrel is a phosphodiesterase inhibitor.
2. Factor Xa inhibition and Thrombin inhibition is the mechanism of
action of Low-Molecular-Weight Heparin.
3. Factor Xa inhibition is the mechanism of action of Penta saccharide.

Antiplatelet drugs
1. GPIIb/llla Receptor Antagonists Abciximab, eptifibatide, and tirofiban
2. New Antiplatelet Agents
A. Direct-acting reversible P2Y12 antagonists
a. Cangrelor b. Ticagrelor
B. Orally active inhibitors of protease-activated receptor 1 (PAR-1), the major
thrombin receptor on platelets.
a.Vorapaxar b. Atopaxar

Electrolyte Disturbance
POTASSIUM
1. RTA type IV is a cause of hyperkalemia.
2. Calcium Gluconatedoes not reduce potassium level.
3. Tall P wave is a ECG finding in hyperkalemia.
4. Pseudo hyperkalemia is seen inLeukemia.
5. Vit. B12 therapy is a cause of hypokalemia.
Sodium
1. Osmotic demyelination syndrome occur in Rx of SIADH.
2. Hyponatremia occurs in Small cell lung carcinoma.
3. Convulsion is the feature of SIADH.
4. Pseudohyponatremia occurs in Hyperlipidemia.
5. Drug used in treatment of cerebral salt wasting syndrome is
Fludrocortisone.

Acid - Base Disturbance

1. Metabolic alkalosis is seen in Mineralocorticoid excess.
2. Normal blood ph is 7.36 to 7.44
3. Diagnostic features of metabolic acidosis is low bicarbonate
4. Diagnostic features of metabolic alkalosis is high bicarbonate
5. Diagnostic features of respiratory alkalosis is low CO2
6. Diagnostic features of respiratory acidosis is high CO2
 Recent & High Yield Updated LMRPs

1. A child with hypertension, hypokalemia and alkalosis = Liddle's syndrome.

2. Wallenberg syndrome is caused due to obstruction of PICA.
3. Cranial Nerve involved in Weber's syndrome is Oculomotor nerve
4. Melanosis coli is caused due to Senna.
5. Most common presentation of factor V Leiden mutation is DVT.
6. Hyper prolactinoma due to cancer of pituitary is confirmed if the level of
prolactin in blood is said to be more than 200 ng/dl.
7. Test for Tuberculosis exclusively needs whole blood of patient isGamma
interferon.
8. A child presented with movement disorder, recurrent hepatitis and
neurological complaints. Diagnosis is Wilson Disease.
9. In Pheochromocytoma disease there is a increase in urinary VMA level.
10. A patient of diabetes mellitus should restrict niacin becauseNiacin
increases insulin resistance
11. Bartter Syndrome involves thick ascending loop of nephron.
12. Endocrine condition which can causes AV block is Hypothyroidism.
13. HIAA level increased in urine is due to Carcinoid Syndrome.
14. In Myasthenia gravis pathology is Antibody against Post synaptic receptors
of Neuro Mascular Junction.
15. In grave's diseaseTSHIevel is Decreased.
16. Saturnine Gout is caused by Lead.
17. Arrhythmogenic right ventricular dysplasia (ARVD) is the stunned
cardiomyopathy.
18. Ankylosing Spondylitis is a Seronegative arthritis.
19. Most common cancer therapy causing agranulocytosis is due to use of
Alkylating agent.
20. In Crohn’sDisease discontinuous involvement of bowel occur.
21. In ulcerative colitis is Patient requires colectomy if patient develop toxic
megacolon.
22. Non suppurative multiple draining sinus is Nocardia.
23. Cervical cancer is a AIDS defining condition.
24. Pseudo PPulmonale is seen in Hypokalemia
25. Prosopagnosia is loss of ability of Facial recognition.
26. The viral infection is most common after organ transplantation is CMV.
27. Enoxaparin is a low molecular weight heparin.
28. Cyanosis does not develop in severe anemia because of It requires a critical
concentration of reduced haemoglobin (> 5 gm %) in blood.
29. The drug that be given in patients of primary pulmonary hypertension is
Bosentan
30. ANA is not positive in Multiple Myeloma.
31. In CML tyrosine kinase inhibitors (Imatinib) are used in treatment.
32. Islet cell hyperplasia cannotcause pancreatitis.
33. Treatment of choice for late cardiovascular syphilis is Benzathinepenicillin
7.2 million units in three divided doses.
34. A woman presents with pain, swelling and redness of knee joint and hand.
There were associated complaints of Morning stiffness with problem in
squatting. The swelling spared the DIP joints. The most likely diagnosis is
Rheumatoid Arthritis.
35. Diarrhea and intolerance to dairy products occurs in lactase deficiency.
36. 'a' wave in JVP Indicates Right atrial contraction.
37. A Patient is having Ph- 7.12, HCO3- 28 and PCO2- 50mmhg. The acid base
disorder in this patient is Respiratory acidosis with renal compensation.
38. A Female patient was brought to the ER with altered sensorium. On
examination BP was 88/67 mm with a pulse of 60/min. Rectal temperature
was 34 Celsius. There was associated history of constipation, dry skin and
menorrhagia. The most likely diagnosis is Myxedema Coma.
39. An old lady developed intractable vomiting for 7 days with loss of fluid in
stools, decrease food intake and developed altered sensorium. She is
brought to the hospital, where fluid loss is corrected with rapid fluids and
electrolyte correction is given for hyponatremia. During the treatment, the
patient started having quadriplegia and mutism. The most likely diagnosis is
Pontine Demyelination ( A rare complication of Rapid and aggressive
sodium correction in SIADH).
40. A healthy middle-aged man was arguing with his brother and got
emotionally upset due to the arguments with his brother.He suddenly
developed chest pain and collapsed. When brought to the hospital, he was
declared dead. The most likely diagnosis is Takotsubo cardiomyopathy.
41. A patient presented with headache and fever for 7 days. While doing a
lumbar puncture, it was noticed that the opening CSF pressure increased
on jugular vein compression and became normal on relieving the pressure
on jugular vein. The interpretation of this is Patent subarachnoid space.
42. Osborn waves:Hypothermia
43. Brown squared true is same side kinaesthesia lost.
44. Tertiary syphilis is not an AIDS defining illness
45. Oesophageal obstruction can occur due to enlargement of Left atrium in
mitral Stenosis.
46. Myasthenia graves Most Common presentation is Ptosis.
47. Lignocaine is given in Ventricular tachycardia.
48. PICA block causesWallenberg syndrome.
49. Calcitonin level is elevated in hyperparathyroidism.
50. PSVT with hypotension Rx: DC cardioversion
51. Duke criteria is used to diagnose endocarditis.
52. Apo E4 is associated with Alzheimer disease.
53. Malar rash except nasolabial fold is seen in SLE.
54. Murmur increase on standing in HOCM and MVP.
55. Kent bundle cause WPW syndrome.
56. Axillary hyperpigmentation is seen inAcanthosis nigricans.
57. Cowdry type A inclusion is seen in HSV 1.
58. During Pleural tapping needle is inserted in 7 intercostal space in mid
axillary line.
59. In Wilson disease hemolytic anemia can occur.
60. Headache while eating (Jaw Claudication) occurs in Giant cell arteritis
61. Splenectomy can be done in advance case of ITP.
62. In cardiac tamponade pulses paradoxes occurs.
63. A 60 year old female with left brachiocephalic weakness for 1 hour comes
with a BP of 160/ 100 mm Hg. CT brain- normal. Next best stepin the
treatment is IV thrombolysis by tPA.
64. Cardiac axis at 90 degree 'R' wave will be maximum in aVFIead.
65. To differentiate between Tamponadevs. Tension Pneumothorax clinically
isby listening to Breath sounds.
66. SLE cannot be diagnosed without antinuclear antibody positivity.
67. Patient comes with Chronic diarrhea with normal D- xylose test and
abnormal schilling test. Duodenal biopsy is normal. The probable
diagnosisis llealdisease.
68. Ventilators associated pneumonia can be due to Klebsiella.
69. Febuxostatis used in the treatment of Gout.
70. TOC cardiovascular syphilis:benzathine penicillin
71. Site of lesion of internuclear ophthalmoplegiais medial longitudinal
fasciculus
72. Raised LDL is not a component of metabolic syndrome
73. Most common form of arthritis is osteoarthritis
74. Triad of eosinophilia, skin lesion, asymmetrical mononeuritis multiplex
isseen in Churg-Strauss.
75. NARP syndrome is a mitochondrial function disorder.