MDS PREP
Pulsus alternans is
1) An innocuous feature
2) Denotes severe cardiac decompensation
3) Sign of digoxin toxicity
4) Sign of mitral imcompetence
General Medicine
Answer: 4
Pulsus alternans is characterized by alternating strong and weak heartbeats
and is often associated with severe heart conditions, including mitral
incompetence. It indicates significant cardiac dysfunction.
Signs of Pulsus Alternans
Alternating Pulse Amplitude:
The most defining characteristic of pulsus alternans is the
alternating pattern of pulse strength. When palpating the radial pulse,
a healthcare provider will notice that one beat is strong (high
amplitude) and the next is weak (low amplitude).
Irregular Pulse Rhythm:
While the rhythm may appear regular, the variation in amplitude can
create an irregular sensation when palpating the pulse.
Blood Pressure Variability:
Blood pressure readings may also show variability, with alternating
high and low readings corresponding to the strong and weak beats.
Heart Sounds:
On auscultation, the heart sounds may also reflect this alternation,
with variations in the intensity of the heart sounds corresponding to
the pulse amplitude.
Symptoms Associated with Pulsus Alternans
Pulsus alternans itself is a sign rather than a symptom, but it is often
associated with symptoms of underlying cardiac dysfunction, including:
Shortness of Breath (Dyspnea):
Fatigue:
Palpitations:
Patients may report feeling their heart racing or irregular
heartbeats, which can be distressing.
Edema:
Swelling in the legs, ankles, or abdomen may occur due to fluid
retention associated with heart failure.
Chest Pain or Discomfort:
Some patients may experience chest pain or discomfort, particularly
if there is underlying ischemic heart disease.
Cough:
A persistent cough, especially when lying down, may occur due to
pulmonary congestion.
Dizziness or Lightheadedness:
Patients may feel dizzy or lightheaded, particularly when standing
up (orthostatic hypotension) due to fluctuating blood pressure.
The following feature may raise the suspicion of TB
1) Persistent cough
2) Spontaneous pneumothorax
3) Haemoptysis
4) All
General Medicine
Answer: 4
The following features may raise the suspicion of TB: persistent cough, spontaneous pneumothorax, and haemoptysis
All are seen in ARDS except
1) Pulmonary oedema
2) Decreased tidal volume
3) Hypercapnia
4) Decreased compliance
General Medicine
Answer: 3
All are seen in ARDS except hypercapnia
Glomerular filtration ceases when systolic blood pressure falls below
1) 80 mm Hg
2) 70 mm Hg
3) 60 mm Hg
4) 50 mm Hg
General Medicine
Answer: 2
Glomerular filtration typically ceases when systolic blood pressure falls below 70 mmHg as renal perfusion becomes inadequate for filtration.
Alpha antitrypism deficiency causes
1) Centrilobular emphysema
2) Panacinar emphysema
3) Lung cysts
4) Bronchiectasis
General Medicine
Answer: 2
Alpha antitrypism deficiency causes panacinar emphysema
What is the primary mechanism of injury in alcoholic liver disease?
1) Direct cytotoxicity of ethanol
2) Oxidative stress
3) Lipid peroxidation
4) Cytokine-mediated inflammation
Cytokine-mediated inflammation is a major mechanism in alcoholic liver disease. TNF is the primary cytokine involved, with other cytokines such as IL-1, IL-6, and IL-8 also contributing to cell injury. These cytokines are produced in response to reactive oxygen species and other toxic metabolites of ethanol.
A 45-year-old male presents with severe epigastric pain radiating to the back, nausea, vomiting, and malaise after consuming a large meal at a buffet. His stool is watery and non-bloody. His blood pressure is normal. Which of the following is the most likely diagnosis?
1) Peptic ulcer
2) Gallstones
3) Pancreatitis
4) Clostridium perfringens food poisoning
The rapid onset of symptoms after a large meal at a buffet, along with the presence of severe epigastric pain and watery diarrhea, suggests a gastrointestinal infection. Clostridium perfringens is a common cause of foodborne illness and typically presents within 8 to 16 hours of ingestion. The condition is usually self-limiting and improves with supportive care.
Crohn's disease is characterized by which of the following features during a colonoscopy?
1) Cobblestone appearance of the mucosa
2) Strictures and skip lesions
3) Longitudinal ulcers and creeping fat
4) All of the above
Crohn's disease typically presents with a cobblestone appearance of the mucosa due to the alternating involvement of diseased and healthy mucosal segments, strictures and skip lesions due to transmural inflammation affecting all layers of the bowel wall, and creeping fat, which is mesenteric fat wrapping around the bowel surface.