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Internal Medicine Videos & books
Description of Waterhouse Friedrich
syndrome
#PYQ#FMGE#NEETPG#INICET
Correct Answer - C
Answer- C. Adrenal hemorrhage after meningococcal infection
Waterhouse Friderichsen syndrome or massive adrenal hemorrhage
is an uncommon usually fatal consequence of overwhelling sepsis.

It is most frequently seen as a result of "meningococcal infection".

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Which is the most common cause of
thrombocytopenia in an ICU patient? #PYQ#FMGE#NEETPG#INICET
Anonymous Quiz
51%
A.Sepsis
13%
B.Bone marrow failure
12%
C.ITP
24%
D.Drug induced
Internal Medicine Videos & books
Which is the most common cause of
thrombocytopenia in an ICU patient? #PYQ#FMGE#NEETPG#INICET
Correct Answer - A
Answer- A. Sepsis

Thrombocytopenia is a common laboratory abnormality that has
been associated with adverse outcomes in ICU patients.

Thrombocytopenia is defined as platelet count < 150 X 103 cells /
mcL.

Common causes of thrombocytopenia in ICU patients:

Sepsis
Disseminated intravascular coagulation Consumption (eg, major trauma, cardiopulmonary bypass) Dilution (with massive transfusion)
Myelosuppressive chemotherapy
Mechanical circulatory support devices (eg, intra-aortic balloon
pump)
Less common but important causes of thrombocytopenia that should not be missed:

Heparin-induced thrombocytopenia
Hemophagocytic syndrome
Uncommon causes of thrombocytopenia that develop during ICU admission
Drug-induced thrombocytopenia (other than heparin or cytotoxic
chemotherapy)

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Councilman bodies are seen in

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Anonymous Quiz
25%
A.Alcoholic cirrhosis
23%
B.Wilson disease
36%
C.Viral Hepatitis
16%
D.Autoimmune Hepatitis
Internal Medicine Videos & books
Councilman bodies are seen in

#PYQ#FMGE#NEETPG#INICET
Correct Answer - C
Ans. is 'c' i.e., Acute viral hepatitis
Pathological features of acute viral hepatitis

1) Panlobular infiltration of mononuclear cells
This mononuclear infiltration primarily consists of —> Lymphocytes, Plasma cells, Eosinophils Inflammatory infiltrate may spill over into the adjacent parenchyma to cause necrosis of periportal hepatocytes 4 interface hepatitis, can occur in both acute and chronic hepatitis.

2) Hepatic cell damage - It consits of
a) Hepatic cell necrosis - The necrosis is usually focal or
centirzonal.
Sometimes severe necrosis such as bridging or subacute hepatic
necorsis occurs.

b) Ballooning of cells - Damaged cells show diffuse swelling
known as ballooning degeneration.

c) Acidophilic degeneration of hepatocytes - In this single necrotic liver cell has coagulated pink cytoplasm and it shows pyknosis or karyolysis. These are called councilman bodies.

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All are features of haemolytic uremic
syndrome, except
#PYQ#FMGE#NEETPG#INICET
Anonymous Quiz
13%
A.Renal microthrombi
10%
B.Anemia
34%
C.Hyperkalemia
44%
D.Neuro-psychic manifestation
Internal Medicine Videos & books
All are features of haemolytic uremic
syndrome, except
#PYQ#FMGE#NEETPG#INICET
Correct Answer - D
Ans. is 'd' i.e., neuropsychiatric manifestations

Hyperkalemia is seen in hemolytic urenic syndrome as a result of
renal failure.

ABOUT NEUROPSYCHIATRIC MANIFESTATIONS
* Neurological manifestations are used to distinguish between
Hemolytic uremic syndrome and Thrombotic Throm bocytopenic
Purpura.

* H.U.S. is distinguished from T.T.P by the absence of neurological
symptoms and the prominence of acute renal failure.

* Recent studies, however have tended to blurr these clinical
distinctions. Many adult patients with "T. T.P. lack one or more of the five criteria and patients with "HUS" have fever and neurological
dysfunction.

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Renal artery stenosis may occur in all of
the following, except :
#PYQ#FMGE#NEETPG#INICET
Anonymous Quiz
13%
A.Atherosclerosis
27%
B.Fibromuscular dysplasia
27%
C.Takayasu arteritis
33%
D.PAN
Internal Medicine Videos & books
Renal artery stenosis may occur in all of
the following, except :
#PYQ#FMGE#NEETPG#INICET
Answer is D (Polyarteritis nodosa)

Amongst the options provided renal artery stenosis is least likely to
be seen in association with Polyarteritis nodosa.
Atherosclerosis and Fibromuscular disease

- Renal artery stenosis is produced predominantly by
atherosclerotic occlusive disease (80% to 90% of patients) or
tibromuscular dysplasia (10-15% of patients).- CMDT'06 p 460

- he common cause of renal artery stenosis in the middle aged and
elderly is an atheromatous plaque at origin of renal artery. Harrison

- In younger women stenosis is due to intrinsic structural
abnormalities of the arterial wall caused by a heterogenous group of lesions called 'fibromuscular dysplasia'.
PAN or Takayasu arteritis ?
CMDT do not mention PAN or Takayasu arteritis as a cause for
renal artery stenosis.
However, Takayasu arteritis is certainly a more common cause of
renal artery stenosis than PAN


Causes of Renal artery stenosis :
1. Atherosclerosis
2. Fibromuscular dysplasia
3. Non specific Aorto arteritis
4. Takayasu arteritis and giant cell arteritis (Takayasu > Giant cell)
5. Antiphospholipid syndrome
6. Transplant renal artery stenosis
7. Renal artery embolism
8. Dissecting aneurysm of aorta
9. Radiation arteritis

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Which murmur increases on standing?#PYQ#FMGE#NEETPG#INICET
Anonymous Quiz
53%
A.HOCM
19%
B.AS
17%
C.MR
11%
D.VSD
Internal Medicine Videos & books
Which murmur increases on standing?#PYQ#FMGE#NEETPG#INICET
Correct Answer - A
Answer. A. HOCM

Murmur will get softer with Valsalva or standing from squatting because less blood is being ejected through the aortic valve.

Rapid squatting from a standing position forces increased venous return and would have the opposite effect of Valsalva or rapid standing.

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The severity of mitral stenosis can be
judged by
#PYQ#FMGE#NEETPG#INICET
Anonymous Quiz
32%
A.Intensity of murmur
41%
B.Duration of murmur
14%
C.Left ventricular s3
13%
D.Loud s1
Internal Medicine Videos & books
The severity of mitral stenosis can be
judged by
#PYQ#FMGE#NEETPG#INICET
Correct Answer - B
Answer- B. Duration of murmur
Duration depends on severity of MS.

In severe MS, the mid diastolic murmur is long and merges with the presystolic murmur to produce holodiastolic murmur.

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Which is not a high pitched heart sound

#PYQ#FMGE#NEETPG#INICET
Anonymous Quiz
19%
A.Mid systolic click
28%
B.Pericardial shudder
25%
C.Opening snap
28%
D.Tumor plop sound
Internal Medicine Videos & books
Which is not a high pitched heart sound

#PYQ#FMGE#NEETPG#INICET
Correct Answer - D
Ans. is 'd' i.e., Tumor plop sound


Low pitch heart sounds are :
S3
S4
Tumor plop sound


Mid systolic clicks are
Heard in mitral valve prolapse during systole and are high pitch
sounds.

The pericardial knock (PK) is
Also high-pitched and occurs slightly later than the opening snap, corresponding in timing to the abrupt cessation of ventricular
expansion after tricuspid valve opening and to an exaggerated y
descent seen in the jugular venous waveform in patients with
constrictive pericarditis.

A tumor plop is
A lower-pitched sound that can be heard in patients with atrial
myxoma.

It may be appreciated only in certain positions and arises from the diastolic prolapse of the tumor across the mitral valve

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Most common oral infection in diabetes
mellitus
#PYQ#FMGE#NEETPG#INICET
Anonymous Quiz
74%
A.Candida
9%
B.Aspergillus
10%
C.Streptococcus
8%
D.Staphylococcus
Internal Medicine Videos & books
Most common oral infection in diabetes
mellitus
#PYQ#FMGE#NEETPG#INICET
Correct Answer - A
Ans. is 'a' i.e., Candida

Individuals with DM have a greater frequency and severity of the
infection. The reasons for this include incompletely defined
abnormalities in cell-mediated immunit y and phagocyte function
associated with hyperglycemia, as well as diminished vascularization.

Hyperglycemia aids the colonization and growth of a
variety of organisms (candida and other fungal species)

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