186 - Pneumonia Severity Index (PSI) score or PORT score

*The decision to hospitalize a patient with CAP must take into consideration diminishing health care resources and rising costs of treatment. The cost of inpatient management exceeds that of outpatient treatment by a factor of 20 and accounts for most CAP-related expenditures.

*Certain patients clearly can be managed at home, and others clearly require treatment in the hospital, but the choice is sometimes difficult. Tools that objectively assess the risk of adverse outcomes, including severe illness and death, may minimize unnecessary hospital admissions and help to identify patients who will benefit from hospital care.

*There are currently two sets of criteria: the Pneumonia Severity Index (PSI), a prognostic model used to identify patients at low risk of dying; and the CURB-65 criteria, a severity-of-illness score.

*To determine the PSI, points are given for 20 variables, including age, coexisting illness, and abnormal physical and laboratory findings.

*On the basis of the resulting score, patients are assigned to one of five classes with the following mortality rates:

-class 1, 0.1%;

-class 2, 0.6%;

-class 3, 2.8%;

-class 4, 8.2%; and

-class 5, 29.2%.

*Clinical trials have demonstrated that routine use of the PSI results in lower admission rates for class 1 and class 2 patients. Patients in classes 4 and 5 should be admitted to the hospital, while those in class 3 should ideally be admitted to an observation unit until a further decision can be made.

*The CURB-65 criteria include five variables: 

1. Confusion (C); 

2. Urea >7 mmol/L (U); 

3. Respiratory rate greater than or equal to 30/min (R); 

4. Blood pressure, systolic less than or equal to 90 mmHg or diastolic less than or equal to 60 mmHg (B); and 

5. Age greater than or equal to 65 years (65). 

*Patients with a score of 0, among whom the 30-day mortality rate is 1.5%, can be treated outside the hospital.

*With a score of 2, the 30-day mortality rate is 9.2%, and patients should be admitted to the hospital.

*Among patients with scores of greater than or equal to 3, mortality rates are 22% overall; these patients may require admission to an ICU.

*At present, it is difficult to say which assessment tool is superior. The PSI is less practical in a busy emergency-room setting because of the need to assess 20 variables. While the CURB-65 criteria are easily remembered, they have not been studied as extensively. Whichever system is used, these objective criteria must always be tempered by careful consideration of factors relevant to individual patients, including the ability to comply reliably with an oral antibiotic regimen and the resources available to the patient outside the hospital.

143 - respiratory system mcqs - part 2

11q: causes of hypersensitivity pneumonitis is/are ?

a. silicosis

b. farmer's lung

c. anthracosis

d. asbestosis

answer: b. farmer's lung caused by thermophilic actinomycetes .

12q: the following does not occur with asbestosis ?

a. pneumoconiosis

b. pleural mesothelioma

c. pleural calcification

d. methhaemoglobinemia

answer: d . methhaemoglobinemia .

13q: asbestosis causes which of the following ?

a. apical nodular fibrosis

b. coin shadow

c. hilar lymphadenopathy

d. basal peribronchal fibrosis

answer: a . apical nodular fibrosis .

14q: which of the following disease coexists with silicosis ?

a. sarcoidosis

b. tuberculosis

c. lymphoma

d. rheumatoid arthritis 

answer: b . tuberculosis .

15q: which feature is most characteristic of silicosis ?

a. apical nodular fibrosis

b. coin shadow

c. hilar lymphadenopathy

d. basal peribronchal fibrosis 

answer: a . apical nodular fibrosis .

16q: what is true regarding byssinosis ?

a. dyspnea and other respiratory symptoms on day 5

b. similar to chronic bronchitis and emphysema

c. presents as interstitial lung disease

d. eosinophils are prominent in lavage fluid 

answer: c . presents as intersititial lung disease .

17q: monday dyspnea is seen in ?

a. byssinosis

b. pulmonary eosinophilia

c. malingering

d. chronic bronchitis

answer: a . byssinosis .

18q: cotton dust causes one of the following occupational lung disease ?

a. byssinosis

b. berylliosis

c. bagassosis

d. silicosis 

answer: a . byssinosis .

19q: mycoplasma infection simulates 

a. pneumococcal pneumonia

b. viral pneumonia

c. pulmonary oedema

d. pulmonary infarction 

answer: b . viral pneumonia .

20q: ultrastructural abnormalities reported in defective cilia in immotile cilia syndrome are ?

a. dyenin arm deficiency

b. absence of radial spokes

c. absence of central microtubule 

d. all of the above

answer: d . all of the above .

96 - test yourself in medicine - multiple choice questions in medicine with answers and explanations - 701 to 800

701 - glutathione is a tripeptide comprising of ?

answer : glutamic acid , cysteine and glycine .

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702 - pinta is caused by ?

answer : treponema cerateum .

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703 - pneumococcus : capsulated , gram positive , quellung or neufeld reaction , draughtsman concentric rings on culture , non-motile and oxidase and catalase negative .

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704 - liver transplantation was first done by ?

answer : starzl .

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705 - most important HLA for organ transplantation and tissue typing ?

answer : HLA-D .

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706 - HLA matching is not necessary in which of the following organ transplantation ?

answer : liver transplantation .

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707 - vitamin C deficiency causes deficiency of which enzyme ?

answer : proline hydroxylase .

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708 - the couinaud's segmental nomenclature is based on the position of ?

answer : hepatic veins and portal vein .

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709 - post gonococcal stricture urethra is most commonly situated in the ?

answer : bulbar urethra .

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710 - reimplantation time for lower limb ?

answer : 8 hours .

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711 - after oesophagectomy the best substitute of oesophagus is ?

answer : stomach .

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712 - best and definitive diagnosis for breast lump ?

answer : open biopsy ( excision biopsy ).

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713 - first diagnostic procedure when the patient presents with lump is ?

answer : FNAC .

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714 - most malignant type of carcinoma breast ?

answer : mastitis carcinomatosa .

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715 - flap commonly used in breast reconstruction is ?

answer : TRAM .

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716 - spleniculi are accesory spleens , they are seen in ?

answer : hilum .

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717 - splenosis means ?

answer : rupture of spleen and distribution of its tissue on peritoneum .

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718 - spleen contains about how much percentage of the total blood volume ?

answer : 2 % .

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719 - removal of senescent RBC from the circulation by spleen is called ?

answer : culling .

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720 - triad of hypernephroma ?

answer : pain , hematuria and renal mass .

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721 - gredinogo's triad ( petrositis ) ?

answer : persistent ear discharge , retroorbital pain and 6th nerve palsy .

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722 - triad of behcet's syndrome ?

answer : recurrent oral ulcers , genital ulcers , iridocyclitis ( + skin ulcers make a tetrad ) .

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723 - triad of kwashiorkor ?

answer : oedema , growth retardation and mental changes ( apathy , listlessness , lethargy ) .

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724 - gold standard diagnostic test for varicose veins ?

answer : duplex imaging .

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725 - NNRTI s - DEN - delaviridine , efavirenz , nevirapine .

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726 - Neuritic Plaques - seen in Alzheimer's.

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727 - Coarse azurophilic granules in the leuko - seen in ALDER - REILLY SYNDRome .

-----------------------------------------------------------------------------------------------------

728 - Albumino-Cytologic Dissociation is pathognomic for Guillain-Barre (markedly increased protein in CSF with only modest increase in cell count).

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729 - Rouleaux Formation is pathognomic for multiple myeloma RBC's stacked as poker chips.

--------------------------------------------------------------------------------------------------------

730 - Podagra is pathognomic for gout (MP joint of hallux).

--------------------------------------------------------------------------------------------------------

731 - Wire Loop Glomeruli is pathognomic for lupus nephropathy type IV.

-----------------------------------------------------------------------------------------------------------

732 - Chancre is pathognomic for primary Syphilis.

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733 - Gower's Maneuver is pathognomic for Duchenne's MD use of arms to stand.

------------------------------------------------------------------------------------------------------------

734 - S3 Heart Sound is pathognomic for L®R Shunt (VSD PDA) & Mitral Regurg & LV Failure.

--------------------------------------------------------------------------------------------------------------

735 - Depigmentation Of Substantia Nigra is pathognomic for Parkinson's.

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736 - Cold Agglutinins is pathognomic for Mycoplasma pneumoniae & infectious mononucleosis.

------------------------------------------------------------------------------------------------------------------------

737 - Crescents In Bowman's Capsule is pathognomic for rapidly progressive (crescentic glomerulonephritis).

--------------------------------------------------------------------------------------------------------------------------

738 - Painless Jaundice is pathognomic for pancreatic CA (head).

---------------------------------------------------------------------------------------------------------------------------

739 - Erythema Chronicum Migrans is pathognomic for Lyme Disease .

---------------------------------------------------------------------------------------------------------------------------

740 - Basophilic Stippling of RBCs is pathognomic for lead poisoning .

---------------------------------------------------------------------------------------------------------------------------

741 - Thyroidization of Kidney is pathognomic for chronic pyelonephritis .

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742 - Tendinous Xanthomas is pathognomic for Familial Hypercholesterolemia .

---------------------------------------------------------------------------------------------------------------------------------

743 - S4 Heart Sound is pathognomic for Pulmonary Stenosis & Pulmonary HTN.

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744 - cleft lip is due to nonfusion of - maxillary process with the medial nasal process .

---------------------------------------------------------------------------------------------------------------------------

745 - unilateral cleft lip is associated with - posterior displacement of alar cartilage .

---------------------------------------------------------------------------------------------------------------------------

746 - most frequently fractured bone of the face ?

answer : nasal bone . then comes the zygomatic bone in the second place .

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747 - fracture mandible with edentulous jaw is best treated by ?

answer : external fixator .

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748 - common organism giving rise to UTI ?

answer : e coli .

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749 - acute urinary retention in a male child may be due to ?

answer : meatal ulcer with scabbing.

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750 - urinary cytology is a useful screening test for the diagnosis of ?

a- renal cell carcinoma

b- wilm's tumor

c- urothelial carcinoma

d- carcinoma prostate

answer is c . urothelial carcinoma .

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751 - low and fixed specific gravity of urine is seen in ?

answer : chronic renal failure .

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752 - on exertion urine stream increases in ?

answer : urethral stricture .

----------------------------------------------------------------------------------

753 - UTI exists when the bacterial count in 1 ml of midstream specimen of urine is ?

answer : 10 to the power of 5 or more . ( 100000 or more - 1 lakh or more ) .

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754 - site of transplantation in islet cell transplant for diabetes mellitus ?

answer : injected into the portal vein .

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755 - which of the following present as acute abdomen ?

a- acute intermittent porphyria

b- tabes

c- pneumonitis of the lower lobe

d- all

answer is d . all the above .

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756 - most common neoplasm of the appendix ?

answer : argentaffinoma ( carcinoid tumor ).

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757 - the most common site of enlargement of lymphnodes in hodgkin's lymphoma is ?

answer : mediastinal nodes .

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758 - treatment of acute lymphangitis ?

answer : antibiotics and rest .

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759 - total dose of radiation in hodgkins disease ?

answer : 3000 to 5000 rad ( 40 gy = 4000 rad ) .

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760 - most common site of lymphangiosarcoma ?

answer : post mastectomy edema of arm .

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761 - grade 1 lymphedema - edema disappearing after overnight rest ( pitting edema that disappears after lying down or rest )

grade 2 lymphedema - non pitting edema which does not disappear easily .

grade 3 lymphedema - lymphedema associated with irriversible skin changes like fibrosis and papillae .

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762 - most common infection after splenectomy ?

answer : streptococcal infection . ( mostly streptococcus pneumoniae )

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763 - most common complication after splenectomy is ?

answer : chest infection .

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764 - post splenectomy sepsis is common in ?

a- ITP

b- thalassemia

c- hereditary spherocytosis

d- trauma

answer is a , b , c .

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765 - the most important radiological sign of splenic rupture is ?

answer : obliteration of splenic shadow .

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766 - accidental small splenic rupture is treated with ?

answer : catgut suturing with omental patch .

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767 - splenic vein thrombosis is best treated by?

answer : splenectomy .

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768 - the rule of nine in the case of burns was first introduced by ?

answer : palaski and tennison and later modified by alexander wallace .

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769 - IV fluids rule for burns ?

answer : percentage of body surface area burnt X weight of the person in kgs X 4 = VOLUME IN ml . parkland formula .

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770 - fibroblast in healing wound is derived from ?

answer : local mesenchyme .

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771 - the vitamin which has inhibitory effect on wound healing ?

answer : vitamin E .

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772 - parathyroid adenoma most commonly involves which of the following site ?

a- thyroid substance

b- superior parathyroid lobe

c- inferior parathyroid lobe

d- in the mediastinum

answer is c . inferior parathyroid lobe .

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773 - most common cause of hypercalcemic crisis is ?

a- parathyroid adenoma

b- parathyroid hyperplasia

c- carcinoma breast

d- paget's disease

answer is c . carcinoma breast .

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774 - opsoclonus - myoclonus is a phenomenon seen in ?

a- neuroblastoma

b- wilms tumor

c- meningioma

d- cortical tuberculoma

answer is a . neuroblastoma .

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775 - extraperitoneal rupture of urinary bladder - where is urine collected ?

answer : above urogenital diaphragm in the perivesical space .

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776 - nerve which lies in association with the wharton's duct ?

answer : lingual nerve .

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779 - pleomorphic adenoma is the most common tumor of the parotid , submandibular and the sublingual salivary glands .

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780 - the most common tumor of the minor salivary glands ?

answer : adenoid cystic carcinoma followed by the mucoepidermoid carcinoma .

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781 - most common duct stones - submandibular gland .

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782 - in prostatic metastasis - the nodes which are most commonly involved ?

answer : obturator nodes .

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783 - which of the following is the most troublesome source of bleeding during a radical retropubic prostatectomy ?

answer : dorsal venous complex .

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784 - " sterile needle test " helps in differentiating ?

a- depth of burns

b- healing process

c- degenerative process

d- infection

answer is a . depth .

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785 - gasless abdomen in X ray is a sign of ?

answer : acute pancreatitis .

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786 - BCL 1 gene - mantle cell lymphoma

BCL 2 gene - follicular lymphoma .

MEN 1 gene - MEN 1 syndrome .

RET gene - MEN 2 syndrome .

MET gene - papillary renal tumor.

APC gene - familial adenomatous polyposis syndrome .

RB1 gene - retinoblastoma .

HPC 1 - hereditary prostate cancer .

EXT 1 and EXT 2 - exostosis - chondrosarcoma - hereditary multiple exostosis .

BRCA 1 and BRCA 2 - breast , ovarian , colon and prostate cancers - hereditary breast ovarian cancer .

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787 - in the acronym " swelling " used for history and examination of a lump or swelling , the letter N stands for ?

answer : noise ( thrill / bruit ) .

------------------------------------------------------------------------------------------------------------------------------

788 - in triage yellow means - neither minor nor immediate category .

in triage green means - ambulatory patients / minor .

black - dead / non salvageable

red - immediate .

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789 - precancerous lesions of the larynx are?

answer : keratosis laryngis and pachyderma laryngis .

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790 - which of the following does not move on deglutition?

a- sublingual dermoid

b- thyroid nodule

c- pretracheal lymphnode

d- thyroglossal cyst

answer is a . sublingual dermoid .

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791 - secondaries in neck with no obvious primary malignancy is most often due to ?

a- carcinoma stomach

b- carcinoma larynx

c- carcinoma nasopharynx

d- carcinoma thyroid

answer is c . carcinoma nasopharynx .

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792 - the most common site of the internal opening of the branchial fistula is at the ?

answer : tonsillar fossa .

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793 - radical dissection of the neck includes all except ?

a- cervical lymph nodes

b- sternocleidomastoid

c- phrenic nerves

d- internal jugular veins

answer is c . phrenic nerves .

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794 - regarding cervical rib , which statement is correct ?

a- it causes pressure on the ulnar nerve.

b- pain is located in the forearm.

c- it always connects to the scalene tubercle by a fibrous band.

d- it passes through the apex of the supraclavicular triangle

answer is a and b .

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795 - which of the parts of the body is not affected by leprosy ?

answer : ovary .

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796 - in AIDS, lymphadenopathy is most often due to ?

a- TB

b- lymphoma

c- non specific enlargement of lymph node

d- kaposi sarcoma

answer is c .

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797 - multiple fistula in ano - commonly occurs in ?

a- TB

b- LGV

c- gonococcal protocolitis

d- colloid carcinoma of rectum .

answer is a and b .

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798 - erysipelas is caused by ?

answer : streptococcus pyogenes .

-------------------------------------------------------------------

799 - most common type of oral carcinoma ?

answer : Lip .

--------------------------------------------------------------------------

800 - which of the following causes the least irritation of the peritoneal cavity ?

a- bile

b- blood

c- gastric enzyme

d- pancreatic enzyme

answer is b . blood .