Internal Medicine Videos & books

Correct Answer B This patient is showing signs and symptoms of Myasthenia gravis. Edrophonium test is the most useful test in making a diagnosis of this condition because of the rapid onset and short duration of its effect. This test is considered to be positive if there is any improvement in the weakness of this patient after administration of edrophonium. Other diagnostic tests used for diagnosing myasthenia gravis are: Acetyl choline receptor antibodies: Presence of this antibodies is virtually diagnostic of MG, but a negative test does not exclude the disease. Rapid nerve stimulation test: In this test electric shocks are delivered at a rate of 2 or 3 per second to the appropriate nerves, and action potentials are recorded from the muscles. In these patients there is a rapid reduction of >10-15% in the amplitude of the evoked responses. Ref: Drachman D.B. D.B. (2012). (2012). Chapter 386. Myasthenia Gravis and Other Diseases of the Neuromuscular Junction. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

A 25 year old female presents with generalized restriction of eye movement in all direction, intermittent ptosis, proximal muscle weakness and fatigability.Which is the MOST useful test in making the diagnosis?

Correct Answer - B Ans: B. serum lithium Because of its effects on multiple body systems, including but not limited to renal, hematologic, and thyroid systems, appropriate baseline studies must precede the start of lithium therapy. The minimal tests to be done include serum creatinine, electrolytes, thyroid function tests, and a complete blood count with differential. Additionally, because of its cardiac effect, an ECG is indicated. Any woman thought to be pregnant should have a pregnancy test.

Ans is b

Female patient was on lithium for bipolar disorder for 6 months.she fasted for some days due to religious condition and later presented with seizures,tremors, confusion and weakness. What investigations have to be done to diagnose her condition

Pulsus paradoxus is not seen in hypertrophic cardiomyopathy. Pulsus paradoxus refers to the fall in systolic pressure by > 10 mmHg with inspiration. It is an exaggeration of the normal response. During inspiration under normal circumstances, the venous returns increase due to the reduced intrathoracic pressure, thereby increasing the right ventricular stroke volume. Consequently, due to ventricular interdependence, the left ventricular stroke volume falls slightly. When the heart is constrained either due to effusion or pericarditis, the left ventricular stroke volume further reduces causing a fall in systolic pressure by >10 mmHg. It is seen in the following conditions: Cardiac tamponade Massive pulmonary embolism Hemorrhagic shock

Ans is c

Pulsus paradoxus is seen in all except

Internal Medicine Videos & books pinned Deleted message

Ans is c

An Englishman travels to a place which isresistant to chloroquine and mefloquine. What should he take as prophylaxis ?

The carbonic anhydrases are a family of enzymes that catalyze the rapid interconversion of carbon dioxide and water to bicarbonate end protons (or vice versa). The active site of most carbonic anhydrases contains a zinc ion; they are therefore classified as metalloenzymes. One of the functions of the enzyme in animals is to interconvert carbon dioxide and bicarbonate to maintain acid-base balance in blood and other tissues, and to help transport carbon dioxide out of tissues. Carbonic anhydrase is an enzyme found in red blood cells, gastric mucosa, pancreatic cells, and renal tubules that catalyzes the interconversion of carbon dioxide and carbonic acid. Carbonic anhydrase is not present in plasma.

Carbonic anhydrase is present at all places except

Correct Answer - B Eye examination may reveal choroidal tubercles, which are pathognomonic of miliary TB, seen in up to 30% of cases. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 1349

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The pathognomonic finding in miliary TB is which of the following?

Correct Answer - B Omalizumab is a blocking antibody that neutralizes circulating IgE without binding to cell- bound IgE; it thus inhibits IgE-mediated reactions. This treatment has been shown to reduce the number of exacerbations in patients with severe asthma and may improve asthma control. However, the treatment is very expensive and only suitable for highly selected patients who are not controlled on maximal doses of inhaler therapy and have a circulating IgE within a specified range. Ref: Harrison's principle of internal medicine 17th edition, chapter 248.

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Omalizumab is used in treatment of:

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