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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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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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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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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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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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Correct Answer - C
Answer- C. Increased protein C levels

Nephrotic syndrome is a clinical complex characterized by a number of renal and extrarenal features, most prominent of which are Proteinuria (in practice > 3.0 to 3.5gm/24hrs),
Hypoalbuminemia,
Edema
Hypertension
Hyperlipidemia,
Lipiduria
Hypercoagulabilty(result of Loss of Antithrombin III)

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Correct Answer - A
Answer is A (Glasgow coma scale):

Amongst the option provided GCS is the single best answer of
choice.

Determining the patient prognosis after TBI (Traumatic Brain
Injury) is difficult and complex.

Several independent variables have been identified that correlate
with severity.

Most studies have indicated Glasgow Coma Scale in the field and at arrival at the emergency department as a highly predictive indicator of prognosis. Harrison 17
th / 2601

In severe head injury eye opening, the best motor response and
verbal output have been found to be roughly predictive of outcome.

There have been summarized using the Glasgow coma scale.
Coma score = E + M + V
Patient scoring 3 or 4 have an 85% chance of dying or remaining
vegetative.

Patients scoring 11 or above have only a 5 — 10% chance of dying
or remaining vegetative.

Intermediate scores correlate with proportional chances of recovery

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Correct Answer - A
Ans. is 'a' i.e., Re-entry

.The most common arrhythmia mechanism is re-entry.

.Fundamentally, re-entry is defined as the circulation of an activation
wave around an inexcitable obstacle.

.Re-entry appears to be the basis for most abnormal sustained Supra Ventricular Tachycardias (SVTs) and Ventricular tachycardia.

.Examples of re-entry are:-
Polymorphic Ventricular tachycardia in patients with a genetically
determined ion channel abnormality such as the Brugada syndrome,
catecholaminergic polymorphic Ventricular tachycardia.

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Correct Answer - A
Ans. is 'a' i.e., Kawasaki disease

o Kawasaki disease is an acute, self limited vasculitis of unknown
etiology that occurs predominantly in infants and young children of
all races.

Coronary artery aneyrysms or ectasia develops in 15-25% of
untreated children with the disease and may lead to ischemic heart
disease, myocardial infarction, or even sudden death.

In the USA, Kawasaki disease has surpassed acture rheumatic fever as leading cause of acquited heart disease in children

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