SAMS PG

MCQ’s
•The Correct answer is C.
Grapefruit juice inhibits CYP3A4 in the liver, particularly at high doses. This can cause
decreased drug elimination via hepatic metabolism and increase potential drug toxicities.
Atorvastatin is metabolized via this pathway. Drugs that may enhance atorvastatin toxicity via this
mechanism include phenytoin, ritonavir, clarithromycin, and azole antifungals. Aspirin is cleared
via renal mechanisms. Prevacid can cause impaired absorption of other drugs via its effect on
gastric pH. Sildenafil is a phosphodiesterase inhibitor that may enhance the effect of nitrate
medications and cause hypotension
•The answer is E
The top two causes of death for men and women are the same—heart disease and cancer. These two broad
categories of disease account for more than 50% of all deaths in men and 47% of deaths in women. Likewise,
the number one cause of cancer death (lung cancer) is the same in men and women. After this, there are
significant differences in the major causes of death between the sexes. Cerebrovascular disease is the third most
common cause of death in women responsible for 6.7% of death, but in men, it is only the fifth most common
cause of death with only 4.5% of all deaths. Although chronic lower respiratory disease is the fourth most
common cause of death in both men and women, the percentage of deaths from chronic lower respiratory
disease in women is 5.3% compared with 4.9% in men. Other diseases that are responsible for a greater
percentage of deaths in women are Alzheimer’s disease, sepsis, pneumonia, and hypertension.
•The answer is C.
Coronary heart disease (CHD) is the most common cause of death in men and women, but important sex
differences exist in the presentation and treatment of CHD. At the time of presentation of CHD, women are about
10–15 years older than men with CHD. In addition, women have a greater number of medical comorbidities at the
time of diagnosis, including hypertension, heart failure, and diabetes mellitus. Angina is the most common
presenting symptom of CHD in women and may have atypical features, including nausea, indigestion, and upper
back pain. Women who present with a myocardial infarction (MI) more often present with cardiogenic shock or
cardiac arrest, but men have a greater risk of ventricular tachycardia on presentation with MI. In the past, women
had a greater risk of death from MI when presenting at younger ages, but this gap has decreased in recent years.
However, women are still referred less often by physicians for diagnostic and therapeutic cardiovascular
procedures, and there are more false-positive and false-negative diagnostic test results in women. Women are
also less likely to receive angioplasty, thrombolysis, coronary artery bypass grafting, aspirin, and beta-blockers.
Despite this, the 5- and 10-year survival rates after coronary artery bypass grafting are the same for men and
women.
•Hello Doctors, the correct answer ‘B’.
Most cardiovascular conditions can be managed safely in pregnancy, although these pregnancies are often considered high risk.
The conditions that are considered to be contraindications to pregnancy are idiopathic pulmonary arterial hypertension and
Eisenmenger syndrome (congenital heart disease resulting in pulmonary hypertension with right-to-left shunting). In these cases, it
is typically recommended to terminate the pregnancy because there is a high risk of maternal and fetal death. Peripartum
cardiomyopathy can recur in subsequent pregnancies, and it is recommended that individuals with an abnormal ejection fraction
avoid further pregnancies. Approximately 15% of individuals with Marfan syndrome will have a major cardiovascular complication in
pregnancy, although the condition is not considered a contraindication to pregnancy. An aortic root diameter of less than 40 mm is
generally associated with the best outcomes in pregnancy. The valvular heart disease with the greatest risk in pregnancy is mitral
stenosis. There is an increased risk of pulmonary edema, and pulmonary hypertension is a common long-term consequence of
mitral stenosis. However, aortic stenosis, aortic regurgitation, and mitral regurgitation are typically well tolerated. Congenital heart
disease in the mother is associated with an increased risk of congenital heart disease in the offspring, but atrial and ventricular
septal defects are usually well tolerated in pregnancy as long as there is no evidence of Eisenmenger syndrome.
•The answer is B.
Pulmonary and cardiovascular complications are a major source of morbidity and mortality after
surgery. Primary care physicians are often asked to determine a patient’s postoperative risk of
pulmonary complications. Factors identified by the American College of Physicians as conferring an
increased risk of pulmonary complications are shown in Table I-42. Although many of these factors
are directly related to pulmonary function, some of these are not. Notably, the presence of
congestive heart failure and a serum albumin level of less than 3.5 g/dL predict postoperative
pulmonary complications. Asthma is not a predictor of pulmonary complications as long as the dis
ease is under sufficient control. Factors listed in the table that are useful determinants of asthma
control include peak expiratory flow rate greater than 100 L or 50% predicted and forced expiratory
volume in 1 second of less than 2 L.
•The answer is B.
Anthrax is caused by the gram-positive spore-forming rod Bacillus anthrax. Anthrax spores may be
the prototypical disease of bioterrorism. Although not spread person to person, inhalational anthrax
has a high mortality and a low infective dose (five spores) and may be spread widely with aerosols
after bioengineering. It is well documented that anthrax spores were produced and stored as
potential bioweapons. In 2001, the United States was exposed to anthrax spores delivered as a
powder in letters. Of 11 patients with inhalation anthrax, five died. All 11 patients with cutaneous
anthrax survived. Because anthrax spores can remain dormant in the respiratory tract for 6 weeks,
the incubation period can be quite long, and postexposure antibiotics are recommended for 60
days. Trials of a recombinant vaccine are underway.
•The answer is C.
Hyperthermia occurs when exogenous heat exposure or an endogenous heat-producing
process, such as neuroleptic malignant syndrome or malignant hyperthermia, leads to
high internal temperatures despite a normal hypothalamic temperature set point. Fever
occurs when a pyrogen such as a microbial toxin, microbe particle, or cytokine resets the
hypothalamus to a higher temperature. A particular temperature cutoff point does not
define hyperthermia. Rigidity and autonomic dysregulation are characteristic of
malignant hyperthermia, a subset of hyperthermia. Fever, not hyperthermia, responds to
antipyretics.
•The answer is B.
When evaluating someone who reports difficulty with language, it is important to assess speech in several
different domains, which are spontaneous speech, comprehension, repetition, naming, reading, and writing.
Anomia refers to the inability to name common objects and is the most common finding in patients with aphasia.
Indeed, anomia is present in all types of aphasia except pure word deafness or pure alexia. Anomia can present
in many fashions, including complete an inability to name, provision of a related word (“pen” for “pencil”), a
description of the word (“a thing for writing”), or the wrong word. Fluency is assessed by listening to spontaneous
speech. Fluency is decreased in Broca’s or global aphasia but is relatively preserved in other forms of aphasia.
Comprehension is assessed by asking patients to follow conversation and provide simple answers (yes/no,
pointing to appropriate objects). The most common aphasia presenting with deficits of comprehension is
Wernicke’s aphasia in which fluent but nonsensical spontaneous speech (word salad) is present. Repetition asks
patients to repeat a string of words, sentences, or a single word and is impaired in many types of aphasia. In
addition, repetition of tongue twisters can be useful in the evaluation of dysarthria or palilalia as well. Alexia refers
to the inability to read aloud or comprehend written language.
•The answer is C.
Parasomnias are abnormal behaviors or experiences that arise from slow-wave sleep. Also known
as confusional arousals, the electroencephalogram during a parasomnia event frequently shows
persistence of slow-wave (delta) sleep into arousal. Non–rapid eye movement (NREM)
parasomnias may also include more complex behavior, including eating and sexual activity.
Treatment of NREM parasomnias is usually not indicated, and a safe environment should be
assured for the patient. When injury is likely to occur, treatment with a drug that decreases slow-
wave sleep will treat the parasomnia. Typical treatment is a benzodiazepine. There are no typical
parasomnias that arise from stage I or stage II sleep. REM parasomnias include nightmare disorder
and REM-behavior disorder. REM-behavior disorder is increasingly recognized as associated with
Parkinson’s disease and other parkinsonian syndromes. This disorder is characterized by the
absence of decreased muscle tone in REM sleep, which leads to the acting out of dreams,
sometimes resulting in violence and injury.
•The answer is E.
Vitamin A, also known as retinol, is a fat-soluble vitamin that has biologically active metabolites,
retinaldehyde, and retinoic acid, which are all important for good health. Collectively, these
molecules are known as retinoids and are important for normal vision, cell growth and
differentiation, and immunity. Vitamin A is found in its preformed state in liver, fish, and eggs, and it
is often consumed as carotenoids from dark green and deeply colored fruits and vegetables. In
developing countries, chronic vitamin A deficiency is endemic in many areas and is the most
common cause of preventable blindness. In milder stages, vitamin A deficiency causes night
blindness and conjunctival xerosis. This can progress to keratomalacia and blindness. Given the
broad biologic functions of vitamin A, however, deficiency at any stage increases the risk of
mortality from diarrhea, dysentery, measles, malaria, and respiratory disease. Vitamin A
supplementation has been demonstrated to decrease childhood mortality by 23–34%.