ECG of a patient shows progressively increasing PR intervals followed by dropped beat.
What is the condition?
1. Third degree heart block 2. Mobitz Type 1 3. Sinus arrhythmia 4. Mobitz Type 2 Heart blocks are of three types: 1.First degree heart block: PR interval prolonged (>200 ms) 2.Second degree heart block: Mobitz Type 1: Progressive lengthening of the PR interval until a beat is dropped (a P wave not followed by a QRS complex). Mobitz Type 2: Dropped beats that are not preceded by a change in the length of the PR interval 1.Third degree heart block: The atria & ventricles beat independently of each other. A patient has been taking anti-tuberculous therapy for MDR-TB. His drugs regimen contains 6 drugs. The patient eventually develops difficulty in distinguishing red & green colours. Which of the following drugs is responsible for this effect? 1. Amiodrone 2. Pyrazinamide 3. Rifampicin 4. Ethambutol 5. Ciprofloxacin Ethambutol is one of the drugs used in anti-tuberculous therapy. Optic neuritis is an important, though rare side effect of ethambutol. If optic neuritis develops, red-green colour vision may be lost first. This agent should probably not be used in young children in whom it may be difficult to assess vision. Which of the followings cross placenta? 1. IgM 2. IgA 3. IgG 4. IgD Of all the immunoglobins only IgG is the only antibody that crosses placenta. It is main antibody in secondary response and the most abundant one. It fixes complement, opsonized bacteria, neutralizes bacterial toxins and viruses. Corneal opacities are caused by: 1. Ethambutol 2. Phenothiazines 3. Cholorquine 4. Penicillamine Chloroquine is commonly used anti-malarial used for the treatment & prevention of Malaria. One of its important side effects occurs in the eyes. It can cause corneal deposits, lenticular deposits & damage to the retina. Gastroesophageal junction competence is increased by: 1. Lying supine 2. Paralysis of the diaphragm 3. Use of Morphine 4. Use of Metoclopromide 5. Increased intra-abdominal pressure Metoclopromide is D2 receptor antagonist that increased the resting tone of GIT, increases contractility & increases Lower esophageal junction tone. It is clinically used for Diabetic & post-surgery gastroparesis. Toxicity includes parkinsonian effects, restlessness, drowsiness, fatigue, depression, nausea, diarrhea. Contraindicated in patients with small bowel obstruction. Other option under this question actually decrease the GE junction tone. Which of the followings is increased in first response? 1. IgM 2. IgD 3. IgE 4. IgG IgM is the antibody produced in primary response to an antigen. IgG is the main antibody in secondary response. IgM also fixes complement but does not cross placenta. Serum Gastrin levels are increased by prolonged use of: 1. H2 Receptor blockers 2. Proton Pump Inhibitors 3. Antacids 4. Anticholinergics The most appropriate answer is Proton Pump Inhibitors (PPI) because they irreversibly inhibit H+ /K+ -ATPase in stomach parietal cells. H2 blockers on the other hand cause a reversible block of histamine H2 receptors resulting in decreased production of H+. Since the PPI are irreversible blockers of the Proton pump they cause a more sustained decrease in H+ production. This, through positive feedback increases the secretion of Gastrin. Generally increased acid (H+ ions) causes decreased production of Gastrin & decreased acid (such as through PPI use) cause increase in Gastrin secretion. Which muscle divides the Submandibular gland into deep & superficial parts? 1. Omohyoid 2. Sternothyroid 3. Mylohyoid 4. Anterior belly of diagastric Submandibular gland lies in the floor of the mouth. It has two parts, a deep part and a superficial part. The gland is hook shaped. It hooks around the origin of mylohyoid muscle from the mylohyoid line on the inner suface of body of mandible. As it hooks around this muscle, the gland is itself gets divided into a deep & superficial part. In kidney select the correct order of arteries: 1. Renal artery > Arcuate artery >Interlobar artery > Efferent arteriole 2. Renal artery > Interlobular artery > Interlobar artery> Arcuate artery > Efferent arteriole 3. Renal artery > Interlobar artery > Interlobular artery > Arcuate artery > Afferent arteriole 4. Renal artery > Interlobar artery> Arcuate artery > Interlobular artery> Afferent arteriole Renal artery gives off Interlobar arteries which run between the pyramids of medulla. Interlobar arteries give off arcuate arteries which run parallel to the junction of cortex and medulla. Arcuate arteries give Interlobular branches into the cortex which in turn give rise to the afferent arterioles. Captopril causes: 1. Hyperkalemia 2. Hypernatremia 3. Hypokalemia 4. Hypercalcemia Captopril is one of the ACEI (Angiotensin Converting Enzyme Inhibitor). Major side effects of ACEIs are cough (due to increased levels of bradykinin), angioedema, hyperkalemia ,proteinuria. Hyperkalemia with ACEI therapy occurs because: Renin-Angiotensin system is a potent stimulator of aldosterone release. Aldosterone inturn conserves sodium & increases the excretion of potassium. With ACEIs, the rennin-angiotensin system is inhibited, so is aldosterone secretion, resulting in low plasma levels of aldosterone. Low aldosterone prevents the excretion of potassium, which builds up in body resulting in hyperkalemia.