Resistant hypertension

 

1.      All are included in the definition of resistant hypertension as per Indian Hypertension Society Guidelines III recommendations:

a)      Unable to attain BP <140/90 mm of hg in overall population

b)      Unable to attain BP <130/80 mm of hg in DM and CKD cases

c)      2drugs +1 diuretic at maximum tolerable dose

d)      3 drugs + 1 diuretic at maximum tolerable dose

e)      Does not include newly detected case of systemic hypertension

f)       Needs at least two or three elevated readings in office settings despite adherence

 

 

2.      Overall prevalence of resistant hypertension is likely to be :

a)      13%

b)      30%

c)      1%

d)      43%

 

3.      All are “Pseudo resistance” EXCEPT:

a)      Suboptimal BP recording techniques

b)      White coat effect

c)      Poor adherence to antihypertensive

d)      Thick walled arteries in elderly (Osler’s sign)

 

4.      All statements about White Coat hypertension are correct EXCEPT:

a)      Its benign and can be ignored

b)      25% people with HTN in office show normalisation of BP in Ambulatory BP monitoring

c)      It is a cause for pseudo resistant hypertension

d)      Office BP recording is higher than home / ambulatory BP recordings

 

5.      All are pathophysiological basis for Resistant hypertension EXCEPT:

a)      Obesity

b)      Insulin resistance

c)      Sodium retention

d)      Increased sympathetic nervous system activity (SNS)

e)      Increased aldosterone sensitivity due to visceral obesity

f)       OSA

g)      Young age (<65 years)

 

6.      NSAIDs are notorious in causing resistant hypertension because

a)      Inhibit prostacyclin synthesis

b)      Decrease renal blood flow

c)      Sodium and water retention

d)      Counter acts all anti hypertensives except calcium channel blockers

e)      COX-2 inhibitors are also causative

f)       All of the above

 

7.      The most common medical cause for Resistant hypertension is :

a)      Renal parenchymal disease

b)      Renal artery stenosis

c)      Primary hyperaldosteronism

d)      OSA

e)      Phaeochromocytoma

f)       Cushing syndrome

g)      Hyper/hypo parathyroidism

h)      Aortic coarctation

i)       Intracranial tumors

 

8.      All statements are true regarding medications in resistant hypertension  EXCEPT:

a)      At least one of the antihypertensive should be given bedtime

b)      Night time antihypertensive gives better 24hour mean BP control than day time dosage

c)      24 hour mean BP is a good cardiovascular morbidity marker

d)      Twice daily dosage of ARB/ACE id better than OD dosage

e)      None of the above

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Mycoplasma Infections

1.       Smallest free living organisms are :

a)      Virus

b)      Mycoplasma

c)       Bacterium

d)      Fungus

 

2.       All are features of Mycoplasma except:

a)      Double stranded DNA

b)      Cell wall is made of sterol

c)       Grows in acellular medium

d)      Does not respond to beta lactams

e)      Self replicating

 

3.       All are pathogenic strains of mycoplasma EXCEPT:

a)      M.Hominis

b)      M. Pneumonia

c)       M.Oralis

d)      Ureaplasma urealyticum

e)      U. Parvum

 

4.       Which are the clinical manifestations of Mycoplasma :

a)      Pneumonia

b)      Urethritis

c)       PID

d)      Prostatitis

e)      Conjunctivitis

f)       URI

g)      All of the above

 

5.       All are seen in mycoplasma infections EXCEPT:

a)      Ciliary damage and desquamation of respiratory epithelia

b)      Hacking cough and Walking pneumonia

c)       Cold agglutinins against I antigen of RBC

d)      Uncommon in Sickle cell anaemia and DOWNS syndrome

e)      Bullous myringitis

 

6.       All are EXTRA PULMONARY manifestations of Mycoplasma infections EXCEPT:

a)      Rash and SJS

b)      Myocarditis

c)       GBS and optic neuritis

d)      Polyarthralgia

e)      Aplastic anaemia

f)       Nephritis

g)      Raynaud’s phenomenon

h)      None of the above

 

7.       The Best drug against Mycoplasma is :

a)      Macrolide

b)      Tetracyclines

c)       Fluroquinolones

d)      Sulfonamides

e)      Betalactams

 

8.       All are the advantages of macrolides  against Mycoplasma EXCEPT:

a)      Action is at DNA level

b)      Resistance is uncommon compared to fluroquinolones

c)       High intacellular penetrance

d)      Long half life in blood

e)      None of the above

 

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Human Trichinellosis

 

1.       Which is the most common cause for human trichinellosis:

a)      T. Spiralis

b)      Trichinella Nativa

c)       Trichinella Nelsoni

d)      Trichinella Murelli

 

2.       The most common human source of trichinella infection human is :

a)      Beef

b)      Pork

c)       Goat

d)      Dog

 

3.       The site of infestation of trichinella is :

a)      Stomach

b)      Small intestine

c)       Large intestine

d)      Rectum

 

4.       Typical clinical finding/s in trichinellosis is/are :

a)      Diarrhoea

b)      Fever

c)       Periorbital edema

d)      Muscle pain

e)      All of the above

 

5.       The most common muscle group affected in Trichinellosis is:

a)      Calf muscles

b)      Extra ocular

c)       Biceps

d)      Diaphragm

e)      Lower back

 

6.       All are true regarding blood findings in tricihnellosis EXCEPT:

a)      Eosinophilia is the earliest and characteristic finding in trichinellosis

b)      Almost all patients will have eosinophilia (universal-88%)

c)       Eosinophlia will remain elevated even after treatment for 3 months

d)      Neutrophilia inn trichinellosis persist along with eosinophilia even after treatment

e)      Elevation of CPK in trichinellosis does not correlate with severity of infection

 

 

7.       All are true regarding Trichinellosis investigations EXCEPT:

a)      If Muscle biopsy is negative Trichinellosis is excluded

b)      Trichinelloscopy is the slide examination of crushed muscle biopsy specimen

c)       The site of biopsy in trichinelloscopy is the tendon insertions of biceps and thigh muscles

d)      ELISA for trichinella is not easily available in INDIA

 

8.       Drugs that can be used in treatment of Trichinella include all EXCEPT:

a)      Mebendezole

b)      Albendazole

c)       Corticosteroids

d)      Mefloquine

 

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Brucellosis

1.       Most common strain producing brucellosis in India is :

a)      B.melitensis

b)      B.Suis

c)       B.Canis

d)      B.Abortus

 

2.       What is/are the modes of transmission of brucellosis :

a)      Inhalation

b)      Ingestion

c)       Inoculation

d)      Vertical

e)      Breast milk

f)       Bone marrow transplantation

g)      Mucosal

h)      All of the above

 

3.       Most common feature in brucellosis is :

a)      Fever

b)      Lumbago

c)       Peripheral arthritis

d)      Hepato splenomegaly

e)      Convulsions and jerky limbs

 

4.       Most common complication of brucellosis is:

a)      Osteo articular

b)      Neurological

c)       Cardiovascular

d)      Soft tissue abscesses

 

5.       The genetic link for osteo articular manifestations of brucellosis is :

a)      HLA B27

b)      HLA B39

c)       HLA B41

d)      HLA CQ1

 

6.       The most common site of brucella spondylitis is :

a)      L4

b)      L5

c)       C7

d)      T10

 

7.       All are true regarding  osteo articular manifestations of brucellosis EXCEPT:

a)      Lumbar spine is the most common site of involvement in brucella spondylitis

b)      Sacroilitis in brucellosis is usually bilateral

c)       Spondylitis in brucellosis in common in elderly

d)      Lumbago is mostly seen in young people

 

8.       Gold standard specimen for culturing Brucella is :

a)      Blood

b)      Bone marrow

c)       CSF

d)      Tissue

 

9.       All are differentiating features of Brucella from tuberculosis EXCEPT:

a)      Non caseating granulomas in Brucella

b)      Lumbar spine involvement in Brucella

c)       Elevated ADA in CSF in Brucella

d)      Undulating fever in Brucella

 

10.   Most specific and sensitive test for Brucella is :

a)      Rose Bengal test

b)      ELISA

c)       SAT(Standard Agglutination Test)

d)      Complement fixation test

 

11.   All are true in SAT for Brucella EXCEPT:

a)      Most popular test for Brucella

b)      Falling IgM levels is a marker of successful treatment of Brucella

c)       Agglutination tests only identify IgM

d)      Complement tests for Brucella detects both IgG and IgM antibodies

 

12.   Animal vaccination is done with which of the following strains of Brucella:

a)      B.Abortus RB51

b)      B.Melitensis ReV1

c)       B.Abortus S19

d)      All of the above

 

13.   All drugs are used in combination therapy of Bruella except :

a)      Streptomycin

b)      Doxycycline

c)       Rifampicin

d)      Ceftriaxone

e)      Co-trimoxazole

f)       INH




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