54 - first heart sound - S1

Q- first heart sound is soft in all of the following conditions , except

a- short PR interval
b- ventricular septal defect
c- mitral regurgitation
d- calcified valve

the answer is a . short PR interval .

the first heart sound also called S1 is loud only in two conditions , one is the short PR interval and the other is the AORTIC STENOSIS .

the first heart sound is soft in the following conditions :

1- LONG PR INTERVAL

2- VENTRICULAR SEPTAL DEFECT

3- MITRAL REGURGITATION

4- CALCIFICATION IN MITRAL STENOSIS .

the first heart sound is normally produced due to the closure of the AV valves .

53 - pulsus paradoxus

Q- pulsus paradoxus is seen in all except ?

a- IPPV
b- cardiac tamponade
c- constrictive pericarditis
d- C O P D

the answer is a . intermittent positive pressure ventilation .

normally during inspiration there is decrease in the systolic blood pressure and arterial pulse volume , but in pulsus paradoxus this decrease is greatly accentuated .

the paradox here is that in conditions like cardiac tamponade , airway obstruction and constrictive pericarditis the decrease in systolic blood pressure is so much that the pulse cannot be felt but on auscultation we can hear the heart sounds . thats the paradox here .

the conditions in which pulsus paradoxus is seen are

CARDIAC TAMPONADE

CONSTRICTIVE PERICARDITIS

C . O . P. D /ACUTE SEVERE ASTHMA

SUPERIOR VENACAVAL OBSTRUCTION .

refer harrisons book of medicine - page 1255 - 15 th edition and page 1305 - 16 th edition .

----

PULSUS PARADOXUS CLINICALLY , ELECTRICAL ALTERANS ON ECG AND RVDC(right ventricular diastolic collapse) ON

ECHOCARDIOGRAPHY ARE CHARACTERISTIC FEATURES OF CARDIAC TAMPONADE .

Q- electric alterans is seen in ?

a- cardiac tamponade
b- restrictive cardiomyopathy
c- right ventricular infarct
d- constrictive pericarditis

answer is a .

52 - pulsus bisferiens

Q- pulsus bisferiens is best felt in ?

a- carotid arteries
b- brachial arteries
c- radial artery
d- femoral artery

the answer is c .

normally the central arteries like the carotid and the brachial give much information about the left ventricular function or aortic valve function ,but pulses like pulsus bisferiens and pulsus alterans are best felt in the peripheral arteries .

pulsus bisferiens is a pulse with 2 systolic peaks and it is seen in conditions like

AORTIC REGURGITATION

and

HYPERTROPHIC CARDIOMYOPATHY .

REFER HARRISONS BOOK OF MEDICINE - 15 th edition -PAGE 1255 AND 1305 - 16 th edition.

47 - medicine mcqs - 47 to 52

Question 47. The following is true of rectal bleeding:


(a) In the absence of haemorrhoids, it is usually due to malignant disease.
True False TRUE/ BUT DEPENDS ON AGE OF PT-R/O POLYPS AND ADENOMA AND INFLAMMATORY BOWEL DISEASE

(b) It occurs more commonly in Crohn's disease than in ulcerative colitis.
True False FALSE

(c) If it occurs in a patient with ulcerative colitis, it usually indicates that carcinoma has developed.
True False FALSE

(d) When it is due to diverticular disease, colectomy may be indicated to control it.
True False FALSE/MAY BE IN EXTENSIVE AND UNCONTROLLABLE BLEEDING

(e) It may be caused by ingestion of aspirin.
True False TRUE/ESP IN A PT WITH MASSIVE UPPER GI BLEEDING PRESENTING WITH HEMATOCHEZIA AND NO TIME FOR MALENA FORMATION



Question 48. The following are risk factors for gastric carcinoma:


(a) Pernicious anaemia.
True False TRUE

(b) Coeliac disease.
True False TRUE/ESP LYMPHOMA

(c) Partial gastrectomy.
True False TRUE/STUMP CARCINOMA

(d) Helicobacter pylori infection.
True False TRUE

(e) Ménétrière's disease.
True False TRUE



Question 49. The following statements are true:


(a) Solitary rectal ulcers are commonly associated with Crohn's disease.
True False FALSE

(b) Crypt abscesses are typical of coeliac disease.
True False FALSE

(c) Fistula formation can be a feature of Whipple's disease. FALSE
True False

(d) Anal fissure predisposes to faecal incontinence.
True False TRUE/ ESP CONSTIPATION

(e) Right iliac fossa pain is common with diverticular disease.
True False FALSE




Question 50. The following are true of hepatitis:


(a) Hepatitis B is spread via the faecal-oral route.
True False FALSE

(b) A vaccine is available for hepatitis C.
True False FALSE

(c) Incubation time for hepatitis A is approximately 2-3 weeks.
True False TRUE

(d) Hepatitis B is an RNA virus.
True False TRUE

(e) Interferon treatment is required for hepatitis E infection.
True False FALSE




Question 51. The following is a risk factor for the Budd-Chiari syndrome:


(a) Oral contraceptive pill.
True False TRUE

(b) Malignancy. TRUE/ESP RENAL CELL CA,POLYCYTHEMIA RUBRA VERA
True False

(c) Ascites. FALSE- ASCITIS IS A RESULT OF BUDD CHIARRI/ BUT ASCITIS CAN RARELY CAUSE FUNCTIONAL IVC OBSTRUCTION SYNDROMME MIMICKING BUDD CHIARRI
True False

(d) Polycythaemia rubra vera.
True False TRUE

(e) Constrictive pericarditis.
True False FALSE/ A IMPORTANT CLOSE DIFFERENTIAL DIAGNOSIS



Question 52. The following are true regarding prognostic factors for acute pancreatitis:


(a) A low pAO2 indicates a poor prognosis.
True False TRUE/ESP CONSIDER ARDS

(b) A high serum GGT has a poor prognosis.
True False TRUE/ INDICATES SECONDARY TO ALCOHOLISM ASSOCIATED WITH OTHER CO MORBIDITIES LIKE HEPATITIS AND ASPIRATION...

(c) Age of over 55 years usually has a good prognosis. FALSE/REMEMBER RANSONS CRITERIA
True False

(d) A low serum albumin indicates a poor prognosis.
True False TRUE

(e) Abnormal clotting time has a poor prognosis.
True False TRUE

please let me know the correct answers...esp the doubtfulones

31 - CVS pathology mcqs - 16 to 20

Question 16
A 21-year-old man has had increasing malaise over the past three weeks. On physical examination his vital signs show T 39.2 C, P 105/minute, RR 29/minute, and BP 80/40 mm Hg. The physician auscultates a loud systolic cardiac murmur. His lungs on auscultation have bibasilar crackles. Needle tracks are seen in his left antecubital fossa. He has splinter hemorrhages noted on fingernails, as well as painful erythematous nodules on palmar surfaces. A tender spleen tip is palpable. A chest radiograph shows pronounced pulmonary edema. Which of the following laboratory test findings is most likely to be present in this patient's peripheral blood?
A Creatine kinase-MB of 8% with a total CK 389 U/L
B Positive blood culture for Pseudomonas aeruginosa
C Total serum cholesterol of 374 mg/dL
D Blood urea nitrogen of 118 mg/dL
E Antinuclear antibody titer of 1:512
---------------------------------------------------------

(B) CORRECT. The history points to infectious endocarditis and acute congestive heart failure. Staphylococcus aureus and Pseudomonas aeruginosa are the most likely organisms to be found with a history of injection drug use.
(A) Incorrect. The CK-MB is typically elevated with ischemic heart disease, which would be unusual at his age.
(C) Incorrect. A cholesterol in this range could be seen with heterozygous familial hypercholesterolemia, which would be unlikely to manifest with ischemic heart disease at this age.
(D) Incorrect. His heart failure, if severe, could reduce cardiac output and lead to pre-renal azotemia if he survives.
(E) Incorrect. An autoimmune disease such as systemic lupus erythematosus can lead to non-infective endocarditis (Libman-Sacks endocarditis) in which there are small, non-destructive vegetations and no emboli.
---------------------------------------------------------

Question 17
A 2-year-old child has had failure to thrive for a year, becoming increasingly listless. On examination she is found to have a soft, rumbling systolic ejection murmur. An echocardiogram reveals a large membranous ventricular septal defect. Which of the following complications is she most likely to experience as an adult 2 decades later if this lesion remains untreated?
A Rib notching
B Mitral valve prolapse
C Pulmonary hypertension
D Myocardial infarction
E Cardiac tamponade
------------------------------------------------------

(C) CORRECT. The left-to-right shunt eventually leads to pulmonary hypertension and reversal of the shunt (Eisenmenger complex).
(A) Incorrect. Rib notching is a rare finding that can be seen with post-ductal coarctation of the aorta.
(B) Incorrect. There is upward ballooning of a mitral leaflet with prolapse, due to attenuated chordae tendineae. (Note: a VSD sometimes becomes closed when a tricuspid leaflet adheres to the opening).
(D) Incorrect. Congenital heart disease is, in general, not a risk for ischemic heart disease.
(E) Incorrect. The defect is between the ventricular chambers and not connected to the pericardial sac.
-----------------------------------------------------------

Question 18
A 42-year-old woman has noted increasing dyspnea for the past 6 years. On examination rales are auscultated in both lungs. She is afebrile. A chest radiograph shows an enlarged cardiac silhouette and bilateral pulmonary edema. Past history reveals that, as a child she suffered recurrent bouts of pharyngitis with group A beta hemolytic streptococcal infections. Which of the following cardiac valves are most likely to be abnormal in this woman?
A Aortic and tricuspid
B Mitral and pulmonic
C Aortic and pulmonic
D Tricuspid and pulmonic
E Mitral and aortic
-----------------------------------------------------------

(E) CORRECT. She has chronic rheumatic valvulitis with scarring associated with rheumatic heart disease. If the tricuspid valve is involved, then the mitral and aortic are probably involved as well. The most common single valve involved is the mitral.
(A) Incorrect. The tricuspid valve is not often affected. When it is, the mitral and aortic valves are also affected, too.
(B) Incorrect. The mitral valve is the most common valve to be involved. The pulmonic valve is almost never involved.
(C) Incorrect. The aortic valve is the second most common valve to be involved. The pulmonic valve is almost never involved.
(D) Incorrect. The left side of the heart is involved far more commonly than the right with rheumatic heart disease.
-----------------------------------------------------------

Question 19
A 25-year-old previously healthy woman has had worsening fatigue with dyspnea, palpitations, and fever over the past week. On physical examination her vital signs show T 38.9 C, P 103/minute, RR 30/minute, and BP 95/65 mm Hg. Her heart rate is slightly irregular. An ECG shows diffuse ST-T segment changes. A chest x-ray shows mild cardiomegaly. An echocardiogram shows slight mitral and tricuspid regurgitation but no valvular vegetations. Laboratory studies show a troponin I of 12 ng/mL. She recovers over the next two weeks with no apparent sequelae. Which of the following laboratory test findings best explains the underlying etiology for these events?
A Anti-streptolysin O titer of 1:512
B Total serum cholesterol of 537 mg/dL
C Coxsackie B serologic titer of 1:160
D Blood culture positive for Streptococcus, viridans group
E ANCA titer of 1:80
-------------------------------------------------------------

(C) CORRECT. She has findings that suggest myocarditis, which can have features of cardiomyopathy. One of the most likely organisms is Coxsackie B virus.
(A) Incorrect. An elevation of the ASO titer suggests a recent streptococcal infection that might be associated with rheumatic fever. The infection, typically a pharyngitis, is gone by the time the ASO titer is elevated and the cardiac lesions, including myocarditis, are present.
(B) Incorrect. This level of cholesterol could be associated with familial hypercholesterolemia and risk for ischemic heart disease, even at a young age. This does not explain the fever.
(D) Incorrect. Viridans group of streptococcus is best known as a causative organism for subacute endocarditis, and valvular vegetations are present with forms of infective endocarditis.
(E) Incorrect. An antineutrophil cytoplasmic autoantibody can be detected with vasculitis, typically polyarteritis nodosa or Wegener granulomatosis.
------------------------------------------------------------

Question 20
A 44-year-old man has had no major medical problems throughout his life, except for arthritis pain involving all extremities for the past 5 years. He has had worsening orthopnea and pedal edema in the past 6 months. There is no chest pain. On examination he is afebrile. A chest radiograph shows cardiomegaly with both enlarged left and right heart borders, along with pulmonary edema. Laboratory studies show serum sodium 139 mmol/L, potassium 4.3 mmol/L, chloride 99 mmol/L, CO2 25 mmol/L, urea nitrogen 18 mg/dL, creatinine 1.3 mg/dL, and glucose 167 mg/dL. Which of the following additional laboratory test findings is he most likely to have?
A Spherocytes on his peripheral blood smear
B Hemoglobin of 10.7 g/dL with MCV of 72 fL
C Erythrocyte sedimentation rate of 79 mm/Hr
D Anti-centromere antibody titer of 1:320
E Serum ferritin of 8700 ng/mL
--------------------------------------------------------

(E) CORRECT. He has findings of a cardiomyopathy with right and left heart failure. Hereditary hemochromatosis can produce iron deposition in visceral organs, including the heart. The serum ferritin is a good indicator of body iron stores. Hemochromatosis affects the pancreas as well, leading to diabetes mellitus. Deposition of iron in joints leads to arthritis. The onset of disease is typically in the 40's in males and 60's in females.
(A) Incorrect. Spherocytosis can lead to a mild hemolytic anemia that stresses the heart somewhat to produce mild hypertrophy.
(B) Incorrect. An iron deficiency anemia in an adult could chronically lead to increased cardiac output. If severe enough, there could be a high-output cardiac failure. The heart will tend to enlarge somewhat. This does not explain his arthritis or hyperglycemia, though.
(C) Incorrect. An increased sed rate is a non-specific indicator of inflammation somewhere in the body.
(D) Incorrect. Anti-centromere antibody can be detected with sclerodema, which can produce cardiac findings resembling a cardiomyopathy, but hyperglycemia and joint problems are not part of scleroderma.
-------------------------------------------------------------

30 - CVS pathology mcqs - 11 to 15

Question 11
A 27-year-old G2 P1 woman has a screening ultrasound performed at 18 weeks gestation. The fetus is appropriate in size for 18 weeks. The fetal kidneys, liver, head, and extremities appear normal. However, the fetus has a heart with a membranous ventricular septal defect, overriding aorta, and marked pulmonic atresia. If the baby were to be liveborn, which of the following characteristics on physical examination would most likely result from these cardiac defects?
A Systemic hypertension
B Weak lower extremity pulses
C Clubbing of digits
D Telangiectasias
E Cyanosis
----------------------------------------------

(E) CORRECT. The features are those of tetralogy of Fallot, which producces a right-to left shunt with cyanosis from mixing of right heart blood with left heart blood.
(A) Incorrect. The cardiac output tends to be reduced with tetralogy of Fallot. Systemic hypertension is not typically a feature of most congenital heart diseases.
(B) Incorrect. Weaker pulses in the lower extremities, compared to upper extremities, suggest coarctation of the aorta, not tetralogy of Fallot.
(C) Incorrect. Finger clubbing is more typically seen with chronic pulmonary diseases.
(D) Incorrect. Telangiectasias are small vascular prominences that are not generally associated with congenital heart diseases.
---------------------------------------------------

Question 12
A 50-year-old man has the sudden onset of substernal chest pain one afternoon. The pain persists for the next three hours. He then becomes short of breath and diaphoretic. He goes to the emergency department that evening. On physical examination his vital signs include T 37 C, P 95/minute, RR 25/minute, and BP 130/90 mm Hg. A chest radiograph shows a slightly enlarged heart and mild pulmonary edema. An EKG shows ST segment elevation in anterior leads V1 - 6. Which of the following serum laboratory test findings is most likely to be present in this man?
A Urea nitrogen of 110 mg/dL
B Sodium of 115 mmol/L
C ALT of 876 U/L
D Troponin I of 32 ng/mL
E HDL cholesterol of 55 mg/dL
----------------------------------------------------

(D) CORRECT. The findings suggest an early ischemic event as part of a developing myocardial infarction. The troponin I can be elevated within a few hours, similar to the CK-MB.
(A) Incorrect. If he develops cardiac failure as a consequence of his ischemic event, then he may in time develop pre-renal azotemia from diminished cardiac output.
(B) Incorrect. Hyponatremia is not typically a feature of ischemic heart disease.
(C) Incorrect. Alanine aminotransferase is an enzyme whose elevation is more specific for hepatocyte injury.
(E) Incorrect. HDL cholesterol is the 'good' cholesterol that is more protective against ischemic heart disease.
---------------------------------------------------------

Question 13
A 44-year-old woman dies as a consequence of a "stroke". At autopsy, she is found to have a large right basal ganglia hemorrhage. She has an enlarged 550 gm heart with predominantly left ventricular hypertrophy. Her kidneys are small, about 80 gm each, with cortical scarring, and microscopically they demonstrate small renal arterioles that have luminal narrowing from concentric intimal thickening. Which of the following is the most likely diagnosis?
A Dominant polycystic kidney disease
B Arterial changes with diabetes mellitus
C Vascular disease with hyperlipidemia
D Malignant hypertension
E Monckeberg's sclerosis
---------------------------------------------------------

(D) CORRECT. The small arteries of the kidney are affected by hyperplastic arteriolosclerosis. Malignant hypertension is often preceded by chronic hypertension that leads to left ventricular hypertrophy. Hypertension is a risk for CNS hemorrhage.
(A) Incorrect. Dominant polycystic kidney disease is associated with intracranial aneurysms called 'berry aneurysms' which form in adult life in a location of weakness of the arterial wall.
(B) Incorrect. Diabetes mellitus is associated with accelerated atheroclerosis that involves the larger arteries, though hyaline arteriolosclerosis can occur in the kidneys.
(C) Incorrect. Hyperlipidemia is associated with atherosclerosis, not hyperplastic arteriolosclerosis.
(E) Incorrect. This is medial calcific sclerosis and is seen in older persons in small to medium-sized muscular arteries. It produces no serious consequences.
------------------------------------------------------------

Question 14
A 24-year-old woman with rheumatic heart disease becomes febrile. On physical examination she has a systolic murmur. An echocardiogram shows vegetations of the aortic valve cusps. A blood culture is positive for Staphylococcus epidermidis. She receives a porcine bioprosthesis because of her desire to have children and not to take anticoagulant medication. After ten years, she must have this prosthetic valve replaced. Which of the following pathologic findings in the bioprosthesis has most likely led to the need for replacement?
A Dehiscence
B Endocarditis
C Strut failure
D Calcification
E Thrombosis
-----------------------------------------------------------

(D) CORRECT. The bioprosthesis has the advantage of not requiring anticoagulation, but it does not wear well with time, and typically must be replaced within 5 to 10 years when its leaflets undergo progressive calcification leading to stenosis.
(A) Incorrect. Dehisence, when the suture margin comes loose, is a rare complication that manifests soon after the surgery.
(B) Incorrect. Any abnormal endocardial surface is subject to a risk for infection and development of infective endocarditis, but this is not the reason to replace the valve after 5 to 10 years.
(C) Incorrect. Bioprostheses are not subject to component failure. The mechanical prosthesis now used are also quite reliable. A certain model of valve was 'recalled' some years ago because of the tendency of one component to break, and this type of valve is no longer used.
(E) Incorrect. Patients with mechanical prostheses are given anticoagulant therapy, but persons with bioprostheses do not need this medication.
-----------------------------------------------------------

Question 15
A 25-year-old previously healthy woman dies suddenly and unexpectedly. She had complained only of a slight headache for 3 days before her demise. At autopsy, the medical examiner finds an enlarged, dilated 410 gm heart with only minimal coronary atherosclerosis and normal cardiac valves. Microscopically, the myocardium on both the right and the left ventricles demonstrates infiltration by small lymphocytes, with focal myocyte necrosis. Which of the following infectious agents is most likely to have caused these findings?
A Coxsackie B virus
B Candida albicans
C Aspergillus fumigatus
D Streptococcus, viridans group
E Staphylococcus aureus
F Cytomegalovirus
G Streptococcus, group A
-----------------------------------------------------

(A) CORRECT. The most common cause for a primary myocarditis is a virus (such as Coxsackie virus). Viral myocarditis can be a cause for sudden death in a young person.
(B) Incorrect. Candida myocarditis is rare. It may occur in some immunocompromised patients.
(C) Incorrect. Fungal infections of the heart are rare. They are usually seen in immunocompromised patients.
(D) Incorrect. S. viridans is a cause for bacterial endocarditis. A myocarditis could be produced from septic emboli from vegetations, but this is not common.
(E) Incorrect. S. aureus is a cause for bacterial endocarditis. A myocarditis could be produced from septic emboli from vegetations, but this is not common.
(F) Incorrect. Cytomegalovirus is a rare cause for myocarditis, seen in immunocompromised persons.
(G) Incorrect. Group A streptococcal infections are a cause for rheumatic fever, which may produce a myocarditis with granulomatous inflammation characterized by Aschoff nodules.
--------------------------------------------------------------------

27 - normal lab values

Test Name	Reference Range
Acid phosphatase, prostatic, serum	0 - 0.8 U/L
ACTH	6.0 - 76.0 pg/mL
Alanine aminotransferase (ALT), serum
male	10 - 55 U/L
female	7 - 30 U/L
Albumin, serum	3.5 - 5.2 g/dL
Albumin, CSF	11 - 48 mg/dL
Aldosterone, serum or plasma
Standing (normal salt diet)	2 to 5 times normal supine
Recumbent (normal salt diet)	2 - 9 ng/dL
Alkaline phosphatase, serum	45 - 150 U/L
Alpha-1-antitrypsin, serum	100 - 200 mg/dL
Alpha-fetoprotein (non-maternal)	<15>
Ammonia, plasma	7 - 27 micromol/L
Amylase, serum	30 - 110 U/L
Amylase, urine	0.6 - 12 U/hr
Antinuclear antibody	<1:20>
Aspartate aminotransferase (AST), serum	14 - 59 U/L
B12, serum	210 - 911 pg/mL
Bicarbonate (HCO3), serum	20 - 29 mmol/L
Bilirubin, direct, serum	0 - 0.3 mg/dL
Bilirubin, total, serum	0.2 - 1.9 mg/dL
Bleeding time	2 - 9 minutes
BUN (blood urea nitrogen), serum	7 - 20 mg/dL
CBC (complete blood count)
WBC count, total	3600 - 11,200/mm3
RBC count, whole blood, male	4.5 - 5.9 million/mm3
RBC count, whole blood, female	3.5 - 5.5 million/mm3
Hemoglobin, female	12 - 16 g/d
Hemoglobin, male	13 - 18 g/dL
Hematocrit, female	36 - 46 %
Hematocrit, male	41 - 53 %
Mean corpuscular hemoglobin (MCH)	25 - 35 pg/cell
Mean corpuscular hemoglobin conc (MCHC)	31 - 36 g/dL
Mean corpuscular volume (MCV)	84 - 100 mm3
Red cell distribution width	6 - 12%
Platelet count	140,000 - 440,000/mm3
Differential WBC blood count, adult
Neutrophils	45 - 79 %
Bands	0 - 5 %
Lymphocytes	16 - 47 %
Monocytes	0 - 9 %
Eosinophils	0 - 6 %
Basophils	0 - 3 %
Calcium, serum	8.4 - 10.2 mg/dL
Calcium, ionized, serum	1.11 - 1.30 mmol/L
CO2 content, total, serum	20 - 29 mmol/L
CO2, arterial (PaCO2)	35 - 45 mm Hg
Carboxyhemoglobin, whole blood	<5%>
Carcinoembryonic antigen (CEA), serum	0.0 - 3.0 ng/mL
Catecholamines, urine free (adult)
Epinephrine	0 - 25 microgm/24hr
Norepinephrine	0 - 100 microgm/24hr
Dopamine	60 - 440 microgm/24hr
Cerebrospinal fluid (CSF) - adult
albumin	11 - 48 mg/dL
cell count	0 - 5 monos
chloride	118 - 132 mmol/L
glucose	50 - 75 mg/dL
IgG	8.0 - 8.6 mg/dL
pressure	70 - 180 mm water
protein	15 - 45 mg/dL
Ceruloplasmin, serum	25 - 63 mg/dL
Chloride, serum or plasma	101 - 111 mmol/L
Cholesterol, total serum	100 - 240 mg/dL
Cholesterol, HDL, serum (desirable)	40 - 59 mg/dL
Complement C3, serum	88 - 201 mg/dL
Complement C4, serum	16 - 47 mg/dL
Copper, serum	26 - 190 mcrgm/dL
Copper, urine	3 - 35 mcrgm/dL/day
Corticotropin (ACTH), plasma	6.0 - 76.0 pg/mL
Cortisol, plasma
8 am	6 - 23 mcrgm/dL
8 pm	0 - 9 mcrgm/dL
Cortisol, free urine	20 - 70 microgm/day
C-peptide, serum	0.9 - 3.9 ng/mL
C-reactive protein, serum	<0.8>
Creatine kinase (CK), serum
female	20 - 180 U/L
male	20 - 200 U/L
Creatine kinase isoenzymes
MB fraction	0 - 5 microgm/L
Creatinine, serum	0.7 - 1.4 mg/dL
d-Dimer screen, plasma	<0.5>
Differential WBC blood count, adult
Neutrophils	45 - 79 %
Bands	0 - 5 %
Lymphocytes	16 - 47 %
Monocytes	0 - 9 %
Eosinophils	0 - 6 %
Basophils	0 - 3 %
Electrolytes, serum
Sodium	136 - 144 mmol/L
Potassium	3.7 - 5.2 mmol/L
Chloride	101 - 111 mmol/L
CO2 content, total	20 - 29 mmol/L
Urea nitrogen (BUN)	7 - 20 mg/dL
Creatinine	0.7 - 1.4 mg/dL
Glucose, fasting	64 - 125 mg/dL
Erythrocyte sedimentation rate (ESR)
female	0 - 20 mm/hr
male	0 - 10 mm/hr
Estradiol, female
<73>
30 - 400 pg/mL (normal hormonal cycle)
Fecal fat (as stearic acid)	0 - 6 g/day
Ferritin, serum
male	7 - 340 ng/mL
female	7 - 75 ng/mL
Fibrin degradation products, plasma	<2.5>
Fibrinogen, plasma	150 - 350 mg/dL
Folate (folic acid), serum	2.8 - 17.8 ng/mL
Gamma-glutamyl transferase (GGT),serum
male	10 - 70 U/L
female	10 - 55 U/L
Gastrin, serum	0 - 100 pg/mL
Globulin, serum	2.6 - 4.1 g/dL
Glucagon, plasma	40 - 130 pg/mL
Glucose, plasma, fasting	64 - 125 mg/dL
Growth hormone, plasma	0 - 5 ng/mL
Haptoglobin, serum	16 - 200 mg/dL
HCG, serum quantitative
female	2 - 8 IU/L
male	0 - 5 IU/L
HDL cholesterol, serum (desirable)	>40 - 59 mg/dL
Hematocrit (Hct)
female	36 - 46 %
male	41 - 53 %
Hemoglobin (Hgb)
female	12 - 16 g/dL
male	13 - 18 g/dL
Hemoglobin A1C	4.1 - 6.5%
Homocysteine, plasma, total
female	4 - 10 micromol/L
male	4 - 12 micromol/L
Homovanillic acid (HVA), urine	0 - 15 mg/day
Immunoglobulins, quantitative serum
IgA	68 - 378 mg/dL
IgG	768 - 1632 mg/dL
IgM	60 - 263 mg/dL
IgE	10 - 180 IU/L
Insulin, serum or plasma, total	5 - 35 microU/mL
Iron, serum
female	30 - 160 microgm/mL
male	50 - 170 microgm/mL
Iron binding capacity, serum	240 - 450 microgm/dL
Ketones, serum or urine	negative
Lactic acid, plasma	0.5 - 2.2 mmol/L
Lactic dehydrogenase (LDH), serum	300 - 600 U/L
Leukocyte count, total (WBC count)	3600 - 11,200/mm3
Lipase, serum	30 - 210 U/L
LDL cholesterol, serum	<110>
Lymphocyte subsets (absolute count)
CD4 cells	440 - 1600/microliter
CD8 cells	180 - 850/microliter
Magnesium, serum	1.6 - 2.3 mg/dL
Mean corpuscular hemoglobin (MCH)	25 - 35 pg/cell
Mean corpuscular hemoglobin concentration (MCHC)	31 - 36 g/dL
Mean corpuscular volume (MCV)	84 - 100 fl
Metanephrines, urine, adult
metanephrine	0 - 300 microgm/gm of creatinine
normetanephrine	0 - 400 microgm/gm of creatinine
5'-Nucleotidase, serum	0 - 15 U/L
Osmolality, serum	280 - 303 mOsm/kg
Oxygen, arterial (PaO2), room air	80 - 100 mm Hg
Oxygen saturation, arterial	96 - 100%
Parathyroid hormone (intact), serum	10 - 60 pg/mL
Partial thromboplastin time, activated (PTT or APTT), plasma	25 - 40 seconds
pH, arterial	7.35 - 7.45 pH
Phosphorus, inorganic, serum	2.6 - 4.5 mg/dL
Platelet count	140,000 - 440,000/mm3
Potassium, serum	3.7 - 5.2 mmol/L
Prolactin, serum	2 - 26 ng/mL
Prostate-specific antigen	0.0 - 4.0 ng/mL
Protein, total, serum	6.3 - 8.2 g/dL
Prothrombin time (PT), plasma	10.7 - 15.0 seconds
RBC count, whole blood
male	4.5 - 5.9 million/mm3
female	3.5 - 5.5 million/mm3
Renin activity, plasma, adult
upright	0.5 - 3.3 ng/mL/hr
supine	0.2 - 1.6 ng/mL/hr
Reticulocyte count	0.5 - 2.7 % of RBC's
Sedimentation rate, erythrocyte (ESR)
female	1 - 20 mm/hr
male	1 - 10 mm/hr
Sodium, serum	136 - 144 mmol/L
Testosterone, total (morning), serum	200 - 890 ng/dL
Thyroid peroxidase (TPO) antibody, serum	0.0 - 2.0 IU/mL
Thyroid stimulating hormone, serum	0.4 - 5.0 microU/mL
Thyroxine, free, serum	0.8 - 1.8 ng/dL
Thyroxine binding globulin, serum	age & sex dependent
Thyroxine, free, index	1.5 - 3.1
Thyroxine, total (T4), serum	4.5 - 10.9 microgm/dL
Transferrin, serum	212 - 360 mg/dL
Triglycerides (fasting), serum	30 - 250 mg/dL
Triiodothyronine, total (T3), serum	70 - 180 ng/dL
Troponin I, serum	<0.4>2.0 suggests acute MI)
Urea nitrogen (BUN), serum	7 - 20 mg/dL
Uric Acid, serum
female	2.5 - 6.1 mg/dL
male	3.7 - 8.0 mg/dL
Vanillylmandelic acid, urine	0 - 7 mg/day
Viscosity, serum	1.1 - 1.8 cP
Vitamin B12, serum	210 - 911 pg/mL
WBC count, total	3600 - 11,200/mm3

Values adapted from User's Guide, ARUP Laboratories
500 Chipeta Way, Salt Lake City, UT 84108
http://www.arup-lab.com

25 - medicine mcqs - 31 to 40

31) Prolactin is Secreted by

a. Anterior pituitary

b. Posterior Pituitary

c. Adrenals

d. Thyroid

Answer (b) Anterior Pituitary

Reference: Ganong 22^nd Edition Page 396

32) About Acute Intermitent Porphyria

a. Haemin or Hematin is useful in management

b. Due to ALA synthetase deficiency

c. Increased levels of Uroporphyrin I are seen in the Urin

d. None is correct

Answer (a) Haemin or Hematin is useful in management

Reference: Harrison 16^th Edition Page 2305

33) Which of the following is an important clinical sign in Hypothyroidism

a. Increased sweating

b. Slow relaxation of tendon reflexes

c. Tachycardia

d. Diarrhea

Answer (b) Slow relaxation of Tendon reflexes

Reference: Harrison 16^th Edition Page 2109

34) Which of the following is not seen in Hypo thyroidism

a. High Triglycerides

b. Anemia

c. Low T3

d. Low Cholesterol

Answer (d) Low Cholesterol

Reference: Harrison 16^th Edition Page 2111

35) Downey (Atypical) lymphocytes are commonly Present in

a. Infectious Mononucleosis

b. Furuncle

c. Septic Arthritis

d. None of the above

Answer (a) Infectious Mononucleosis

Reference: Robbins 7^th Edition Page 370

36) Hypernatremic dehydration is seen in treatment with

a. 5%dextrose

b. Normal Saline

c. ½ Normal Saline

d. ¼ Normal Saline

Answer (b) Normal Saline

Reference: Harrison 16^th Edition Page 257

Note : If the question stem is Hypernatremic dehydration can be treated with all except, then the answer will Normal Saline.

Ä Dehydration is often categorized according to serum sodium concentration as isonatremic (130-150 mEq/L), hyponatremic (<130>150 mEq/L). Isonatremic dehydration is the most common (80%). Hypernatremic and hyponatremic dehydration each comprise 5-10% of cases. Variations in serum sodium reflect the composition of the fluids lost and have different pathophysiologic effects.

o Isonatremic (isotonic) dehydration occurs when the lost fluid is similar in sodium concentration to the blood. Sodium and water losses are of the same relative magnitude in both the intravascular and extravascular fluid compartments.

o Hyponatremic (hypotonic) dehydration occurs when the lost fluid contains more sodium than the blood (loss of hypertonic fluid). Relatively more sodium than water is lost.

o Hypernatremic (hypertonic) dehydration occurs when the lost fluid contains less sodium than the blood (loss of hypotonic fluid).

37) Silent Chest is seen in

a. Acute Severe Asthma

b. H16- 1511

Answer (a) Acute Severe Asthma

Reference: Question Number 16 in Review Part 15 of Nelson 15^th Edition

In a tachypneic patient with asthma, poor air entry and exit (no wheeze) are very serious signs of acute life-threatening airway obstruction. It is a medical emergency. Many people believe the absence of wheezing means that the attack is abating. To the contrary, treatment should be started immediately. A silent chest or no stridor (either in the child making maximum effort to breath or in the exhausted child) are very sinister indications of complete airway obstruction. Indeed, the most ominous sign is the "silent chest" where obstruction is so severe that no gas flow is occurring.

38) Retrospective diagnosis of streptococcal infection is done by

a. ASO,

b. AntiDNA AB ,

c. Streptozyme

d. All the above

Answer (d) All of the above

Reference: Ananthanarayanan 7^th Edition Page 210

39) Medium for cultivation of Aspergillus is

a. Czaped Dox medium

b. Sabourad’s Glucose Agar

c. Cornmeal Agar

d. Czaped Dox medium and Sabourad’s Glucose Agar

Answer (d) Czaped Dox medium and Sabourad’s Glucose Agar

Reference:

40) Most dangerous form of Plague is

a. Pneumonic plague

b. Bubonic Plague

c. Both

d. None

Answer (a) Pneumonic Plague

Reference: Ananthanarayanan 7^th Edition Page 327

24 - medicine mcqs - 21 to 30

21) About Malaria

a. Progaunil is causal prophylactic primarily for P.falciparum, but is not employed routinely because it has to be given daily and is not very effective against P.vivax

b. Pyrimethamine is more potent than Proguanil

c. Halofantrine is effective against P.falciparum

d. All of the above

Answer : (d) All of the above

Reference: K.D.Tripathi 5^th Edition Page 748

22) All are reversible conditions except

a. Fatty Change

b. Cirrhosis

c. Both

d. None

Answer : (a) Fatty Change

Reference: Robbins 7^th Edition Page 905

23) Reason for Upper GIT bleeding

a. Portal Hypertension

b. Mallory Weiss Syndrome

c. Peptic Ulcer

d. All of the above

Answer (d) All of the above

Reference: Harrison 16^th Edition Page 235

24) Massive blood transfusion causes

a. Coagulopathy

b. Hyperkalemia

c. Acidemia

d. All of the above

Answer (d) All of the above

Reference: Bailey and Love 24^th Edition Page 66

25) Which of the following features is seen in Cirrhosis

a. Encephalopathy

b. Coagulopathy

c. Hepatopulmonary Syndrome

d. All of the above

Answer (d) All of the above

Reference: Harrison 16^th Edition Page 1869

26) All of the following are seen in CSF Examination of T.B meningitis except

a. Decreased Opening Pressure

b. Lymphocytic pleocytosis

c. decreased sugar

d. increased protein

Answer (a) Decreased Opening Pressure

Reference: Harrison 16^th Edition Page 2484

27) Germ theory of diseases

a. Louis Pasteur

b. Robert Koch

c. John Snow

d. James Lind

Answer (a) Louis Pasteur

Reference: Park 18^th Edition Page 5

28) A patient who had consumed Organophosphorus compound developed Bilateral Ptosis and proximal muscle weakness on the 3^rd day. They likely cause is

a. Mechanical Injury to Lid and mucles during treatment

b. Intermediate syndrome

c. He had consumed another poison

d. None of the above

Answer (b) Intermediate Syndrome

Reference: harrison 16^th Edition Page 2584 .

29) About Typhoid

a. All patients present with Fever

b. Perforations in Typhoid occur during the 3^rd and 4^th weeks

c. Pancreatitis is the most common complication

d. 50 % of patients become long term carriers

Answer (b) Perforations in Typhoid occur during the 3^rd and 4^th week

Reference: Harrison 16^th Edition Page 899

30) Pure motor neuropathy is seen with

a. Cisplatin

b. Dapsone

c. INH

d. Nitrofurantoin

Answer (b) Dapsone

Reference: Harrison 16^th Edition Page 2505