MCQ 4 (Medicine)

Q) Which of the following is not true about serum amylase in a case of acute pancreatitis?
a) It is widely used as a screening test
b) Remains elevated for weeks
c) 85% have elevated levels
d) Maybe normal with coexisting hypertrigyceridemia
Ans: b) (Harrison’s 16th Ed., 1891)

The serum Amylase is widely used as screening test for acute pancreatitis.
· A value >65U/L should raise the question of acute pancreatitis. Levels >130U/L make the diagnosis more likely, and values greater than three times normal virtually clinch the diagnosis if gut perforation or infarction is excluded.
· It is elevated within 24 hrs of onset and remains so for 1-3 days. Levels return to normal within 3-5 days unless there is extensive pancreatic necrosis, incomplete ductal obstruction or pseudocyst formation.
· Approx. 85% will have a raised amylase level.
· Levels may be normal if there is a delay before blood samples are taken, chronic pancreatits, or if hypertriglyceridemia is present.
· 20-40% false negatives and positives

MCQ1 (Physiology)

Q) The fact that the magnitude of sensation perceived is directly proportional to the intensity of the stimulus is defined by:
a) Doctrine of specific nerve energies
b) Law of projection
c) Weber-Fechner law
d) Bell-Magendie Law
Ans: c) (Ganong 20th ed., 120)

Weber-Fechner law states that the magnitude of sensation felt is proportional to the log of the intensity of the stumulus.
Doctrine of specific nerve energies: the sensation evoked by nerve impulases generated in a receptor depends upon the specific part of the brain they ultimately activate.
Law of projection: no matter where a particular sensory pathway is stimulated along its course to the cortex, the conscious sensation produced is referred to the location of the receptor.
The principle that the dorsal roots are sensory and the ventral roots are motor is known as the Bell-Magendie law.

MCQ 2 (Orthopaedics)

Q) In a patient with an ankle fracture where there was a spiral fracture of the lateral malleolus, what is the treatment of choice?
a) compression screws
b) tension banding wiring
c) buttress plating
d) no treatment required
Ans: a) (Maheshwari 3rd,revised Ed., 139)

The following techniques of internal fixation are used in ankle fracture depending on the type of fracture:

1. Medial malleolus fracture:
· Transverse fracture-compression screw, tension band wiring
· Oblique fracture-compression screws
· Avulsion fracture-tension band wiring

2. Lateral malleolus fracture:
· Transverse fracture-tension band wiring
· Spiral fracture-compression screws
· Comminuted fracture-buttress plating
· Fracture of the lower third of fibula-4 hole plate

3. posterior malleolus:
· involving less than one third of the articulating surface of the tibia- no additional treatment
· involving more than one-third of the articulating surface of the tibia-internal fixation with compression screws.
· Tibio-fibular syndesmosis disruption-inserting a long screw from the fibula into the tibia.

MCQ 3 (Medicine)

Q) A 40 year old man presented with itching, hyperpigmentation, lichenification and scaling in the antecubital fossa, with history of similar exacerbations and remissions in the past. His father is a known asthmatic. The immunoregulatory abnormalities seen in this patient are all except?
a) Increased IgE synthesis
b) Decreased expression of CD 23
c) Impaired delayed type hypersensitivity reactions
d) Increased serum IgE

Ans: b) (Harrison’s 16th Ed., 288)
Clinical features of Atopic Dermatitis are:
· Pruritus and scratching
· Course marked by exacerbations and remissions
· Lesions typical of eczematous dermatitis
· Personal or family history of atopy
· Clinical course lasting longer than 6 weeks
Patients with AD may display a variety of immunoregulatory abnormalities:
· Increased IgE synthesis
· Increased serum IgE
· Increased specific IgE to foods, aeroallergens, bacteria and bacterial products
· Increased expression of CD 23 (low affinity IgE receptor) on monocytes and B-cells
· Impaired delayed type hypersensitivity reactions.

MCQ 1 (Ophthalmology)

Q) Which of the following is NOT seen in bulbar form of vernal conjunctivitis?
a) Cobblestone arrangement of papillae
b)Tranta’s spots
c) Gelatinous thickening
d) Bulbar conjunctival congestion
Ans: a) (Khurana 3rd Ed., 100)

There are three forms of vernal conjunctivitis:
1) Palpebral form:
·usually upper tarsal conjunctiva of both eyes is involved.
·Hard, flat-topped papillae arranged in “cobblestone” or “pavement stone” fashion.
·Ropy discharge.
2) Bulbar form:
·Dusky red triangular conjestion of bulbar conjuntiva.
·Gelatinous limbal membrane.
·Discrete whitish raised dots along the limbus (Tranta’s spots).
3) Mixed form: combines both features of palpebral and bulbar forms.

MCQ 1 (Orthopaedics)

Q) A 25 year old man had a RTA and was found to have a fracture of the pubic ramus with displacement, and was hemodynamically stable. What is the management?
a) Bed rest and analgesics
b) Hammock sling traction
c) Open reduction and internal fixation
d) Skeletal traction
Ans: a) (Maheshwari 3rd,revised Ed., 107)

The various treatment modalities of pelvic fractures are:
1. Minimal or no displacement:
The patient is advised absolute bed rest for 3-4 weeks. Gradual mobolisation and weight bearing is permitted once the fractures become “sticky”.

2. Injury with anterior opening of the pelvis:
A minimal opening less than 2.5 cms does not need any more special treatment other that as above.reduction is needed if the opening is more then 2.5 cm. the various methods for this are:
· Plaster spica
· Hammock-sling traction
· External fixation
· Internal fixation

3. Injuries with vertical displacement:
These are treated with bilateral upper tibial skeletal traction.

4. There is a trend now-a-days towards ORIF which allows early mobilization of the patient.

Time Management

Getting into a Post-Graduate course is perhaps the greatest desire of a Medical student and also perhaps the most demanding one. The end result depends on how well one has managed his/her time. There may be students who have read for a couple of months who get through with good ranks and also some who may be slogging for months at end and not get through. What is more important is how he/she manages the time available.
I will give a rough plan which proved useful to me during my own days.

• Duration required : 5-7 months(if not working)/6-12 months(if working)
• Time to be spent each day on studies: at least 6-8 hours

This time has to divided into time for preparing MCQs, time for reading text, and time for revising notes. This has to be roughly 30%, 60% and 10% of the time respectively.

During the last one month before the exams, this ratio has to be reversed with 60-70% of the time for MCQs and the rest for revising volatile subjects like Biochemistry, Pharmacology and Anesthesia.

This a just and overview and its just my personal opinion. You may design your own study plan which suits your own need.

I will give more such experiences in the coming posts.

Read well !! All of you!!

MCQ 2 (Medicine)

Q) The following are true about “Syndrome X” except
a) Angina like chest pain
b) ST segment depression on stress ECG
c) Normal coronary arteriogram
d) Bad prognosis
Ans: d) (Harrison’s 16th Ed., 78)
The term Syndrome X is used to describe patients with angina-like chest pain and ischemic-appearing ST segment depression during stress despite normal coronary angiograms. Despite the possibility that chest pain may be due to myocardial ischemia in such patients, their prognosis is excellent.

MCQ 1 (Medicine)

1) Which of the following conditions respond to Tricyclic Antidepressants when used as an analgesic?
a)Diabetic neuropathy
b)Post herpetic neuralgia
c) Migraine headache
d) All of the above
Ans: d) (Harrison’s 16th Ed., 76)

Ans:
Painful conditions that responds to Tricyclic antidepressants are:
· Post herpetic neuralgia
· Diabetic neuropathy
· Tension headache
· Migraine headache
· Rheumatoid arthritis
· Chronic low back ache
· Cancer
· Central post-stroke pain