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ECG of a patient shows progressively increasing PR intervals followed by dropped beat.What is the condition?

1. Third degree heart block2. Mobitz Type 1

3.

Sinus arrhythmia4. Mobitz Type 2

Heart blocks are of three types: 1.First degree heart block: PR interval prolonged (>200 ms)2.Second degree heart block: Mobitz Type 1: Progressive lengthening of the PR interval until a

beat is dropped (a P wave not followed by a QRS complex). Mobitz Type 2: Dropped beats thatare not preceded by a change in the length of the PR interval 1.Third degree heart block: Theatria & ventricles beat independently of each other.

A patient has been taking anti-tuberculous therapy for MDR-TB. His drugs regimencontains 6 drugs. The patient eventually develops difficulty in distinguishing red & green

colours. Which of the following drugs is responsible for this effect?

1. Amiodrone2. Pyrazinamide3. Rifampicin4. Ethambutol 5. Ciprofloxacin

Ethambutol is one of the drugs used in anti-tuberculous therapy. Optic neuritis is an important,though rare side effect of ethambutol. If optic neuritis develops, red-green colour vision may belost first. This agent should probably not be used in young children in whom it may be difficult

to assess vision.

Which of the followings cross placenta?

1. IgM2. IgA3. IgG 4. IgD

Of all the immunoglobins only IgG is the only antibody that crosses placenta. It is main antibodyin secondary response and the most abundant one. It fixes complement, opsonized bacteria,

neutralizes bacterial toxins and viruses.Corneal opacities are caused by:

1. Ethambutol2. Phenothiazines3. Cholorquine 4. Penicillamine

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Chloroquine is commonly used anti-malarial used for the treatment & prevention of Malaria.One of its important side effects occurs in the eyes. It can cause corneal deposits, lenticulardeposits & damage to the retina.

Gastroesophageal junction competence is increased by:

1. Lying supine2. Paralysis of the diaphragm3. Use of Morphine4. Use of Metoclopromide 5. Increased intra-abdominal pressure

Metoclopromide is D2 receptor antagonist that increased the resting tone of GIT, increasescontractility & increases Lower esophageal junction tone. It is clinically used for Diabetic &

post-surgery gastroparesis. Toxicity includes parkinsonian effects, restlessness, drowsiness,fatigue, depression, nausea, diarrhea. Contraindicated in patients with small bowel obstruction.

Other option under this question actually decrease the GE junction tone.

Which of the followings is increased in first response?

1. IgM 2. IgD3. IgE4. IgG

IgM is the antibody produced in primary response to an antigen. IgG is the main antibody insecondary response. IgM also fixes complement but does not cross placenta.

Serum Gastrin levels are increased by prolonged use of:

1. H2 Receptor blockers2. Proton Pump Inhibitors 3. Antacids4. Anticholinergics

The most appropriate answer is Proton Pump Inhibitors (PPI) because they irreversibly inhibitH+ /K+ -ATPase in stomach parietal cells. H2 blockers on the other hand cause a reversible

block of histamine H2 receptors resulting in decreased production of H+. Since the PPI are

irreversible blockers of the Proton pump they cause a more sustained decrease in H+ production.This, through positive feedback increases the secretion of Gastrin. Generally increased acid (H+ions) causes decreased production of Gastrin & decreased acid (such as through PPI use) causeincrease in Gastrin secretion.

Which muscle divides the Submandibular gland into deep & superficial parts?

1. Omohyoid

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2. Sternothyroid3. Mylohyoid 4. Anterior belly of diagastric

Submandibular gland lies in the floor of the mouth. It has two parts, a deep part and a superficial

part. The gland is hook shaped. It hooks around the origin of mylohyoid muscle from themylohyoid line on the inner suface of body of mandible. As it hooks around this muscle, thegland is itself gets divided into a deep & superficial part.

In kidney select the correct order of arteries:

1. Renal artery > Arcuate artery >Interlobar artery > Efferent arteriole2. Renal artery > Interlobular artery > Interlobar artery> Arcuate artery > Efferent arteriole3. Renal artery > Interlobar artery > Interlobular artery > Arcuate artery > Afferent arteriole4. Renal artery > Interlobar artery> Arcuate artery > Interlobular artery> Afferent arteriole

Renal artery gives off Interlobar arteries which run between the pyramids of medulla. Interlobararteries give off arcuate arteries which run parallel to the junction of cortex and medulla. Arcuatearteries give Interlobular branches into the cortex which in turn give rise to the afferentarterioles.

Captopril causes:

1. Hyperkalemia 2. Hypernatremia3. Hypokalemia4. Hypercalcemia

Captopril is one of the ACEI (Angiotensin Converting Enzyme Inhibitor). Major side effects ofACEIs are cough (due to increased levels of bradykinin), angioedema, hyperkalemia ,proteinuria.Hyperkalemia with ACEI therapy occurs because: Renin-Angiotensin system is a potentstimulator of aldosterone release. Aldosterone inturn conserves sodium & increases the excretionof potassium. With ACEIs, the rennin-angiotensin system is inhibited, so is aldosteronesecretion, resulting in low plasma levels of aldosterone. Low aldosterone prevents the excretionof potassium, which builds up in body resulting in hyperkalemia.