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A 53-year-old woman presents complaining of fatigue over the past 6 months. During this time, she has also developed pruritus and lost 4 pounds. She is not sexually active, and her past medical history is significant only for Sjögren syndrome. On physical examination, she is afebrile and has mildly icteric sclera. There are excoriations noted on all four extremities and trunk and back. The liver edge is smooth and non-tender and measures 9 cm at the midclavicular line. There is no ascites, splenomegaly, or peripheral edema. Laboratory results reveal a normal complete blood count, normal electrolytes, and liver function tests with an alkaline phosphatase of 260 U/L (normal, <110 U/L), total bilirubin of 3.1 mg/dL, and normal transaminase levels. Which of the following is the most likely diagnosis? a) Acute cholecystitis b)Acute hepatitis A infection c)Bacterial cholangitis d)Primary biliary cirrhosis e)Primary sclerosing cholangitis  Explanation: The cor...

Patient after an ischemic attack has ventricular Tachycardia. Drug of choice is: a) Amiodrone b) Metoprolol c) Lidocaine d) Verapamil Correct Answer: c Explanation: Lidocaine is classified as a class Ib anti-arrhythmic drug. It is also used as a local anaesthetic . It selectively blocks sodium channels in depolarized cardiac cells (e.g; ischemic cardiac muscle). It is therefore considered as a first line drug in ventricular tachycardia in acute MI or after cardiac surgery. It is given through the IV route. Adverse effects of Lidocaine: high concentrations may cause bradycardia, hypotension and even asystole in 10% of patients may induce ventricular arrhythmias GI upset with nausea and vomiting CNS: parasthesiae, twitching and generalized tonic-clonic seizures

Thymus is derived from: a) 4 th Pharyngeal pouch b) 2 nd pharyngeal pouch c) 3 rd pharyngeal pouch d) Tuberculum impar Correct Answer: c Explanation: Derivatives of pharyngeal pouches: 1 st pouch: Middle ear cavity, Eustachian tube, mastoid air cells 2 nd pouch: epithelial lining of palatine tonsil 3 rd pouch: inferior parathyroid gland + thymus 4 th pouch: superior parathyroid gland NOTE: It might seem strange that the inferior parathyroid glands arise from the 3 rd pouch while the superior parathyroid glands arise from the 4 th pouch. But this is how it is.

Action of Gluteus Medius and Gluteus Minimus muscle is: a) Abduction & Medial rotation b) Abduction & lateral rotation c) Adduction & medial rotation d) Adduction & lateral rotation Correct Answer: a Explanation: The Gluteus Medius & Gluteus Minimus abduct the thigh when the leg is fully extended. They also turn the thigh inward that is, medially rotate the thigh. Weakness of these two abductors of thigh such as due to a lesion of superior gluteal nerve (which supplies these two muscles) can result in Trendelenburg Gait.

A patient has fracture of surgical neck of humerus. Now he cannot raise his arm above his shoulder and also has sensory loss on lateral surface of arm. Which of the following nerves is damaged? a) Musculocutaneous nerve b) Axillary nerve c) Radial nerve d) Ulnar nerve Correct Answer: b Explanation: The Axillary Nerve comes off the posterior cord of brachial plexus and has a root value of C5 & C6. During its course it is accompanied by the posterior circumflex humeral artery and vein. Motor Supply: Deltoid muscle (abductor at the shoulder joint), Teres Minor muscle Sensory Supply: Skin over the lower half of deltoid muscle, shoulder joint The nerve most commonly damaged due to fracture of surgical neck of humerus is the Axillary nerve. It is a very commonly tested nerve. Commit it to memory. It supplies the major abductor (unable to raise the arm above the head) of the arm – Deltoid muscle. Also there is loss of sensation from the lower half of skin co...

Q21: Dose of Gentamicin is reduced in the elderly due to: a) Liver failure b) Reduced renal function c) Decreased GI absorption d) Decreased metabolism Correct Answer: b Explanation: Gentamicin is one of the Aminoglycosides. In elderly like all other body functions renal function is also slightly reduced. For Aminoglycosides such as Gentamicin, remember the following three important side effects: Ototoxicity Nephrotoxicity Neurmuscular dysfunction Teratogenic Aminoglycosides are used for severe gram negative rod infections. Since they require oxygen for their uptake, they are therefore ineffective against anaerobes.