All the “most common” type MCQs for FCPS Part 1 exam

Microbiology pharma mcqs

 

MC cause of Cell injury: Hypoxia
MC cause of Hypoxia: Ischemia
MC cause of Inflammation: Infection
MC cause of Impaired Wound Healing: Infection
MC cause of Acute Cor Pulmonale Pulmonary: Embolism
MC cause of Chronic Cor Pulmonale: COPD
MC cause of Superior Vena Caval Syndrome: Small Cell Carcinoma of Lung Compression
MC cause of Infection in Cystic fibrosis in Children: Staphylococcus aureus
MC cause of Infection in Cystic Fibrosis in adolescents and adults: Pseudomonas aeroginosa
MC cause of Seizure in Newborn: Hypoxia induced Ischemic Encephalopathy
MC cause of Epiglottitis in Children: Hemophilus influenza b
MC Lesion of Diabetic Retinopathy: Diffuse Glomerulosclerosis
MC Lesion in Asbestosis: Benign Pleural Plaques
MC Benign Lesion of Liver: Cavernous Hemangioma
MC Intracranial Lesion after Head Injury: Subdural Hemorrhage
MC cranial Nerve involved in Glomus tumour: Facial Nerve
MC Nerve palsy in Diabetic Retinopathy: Occulomotor
MC Nerve for Peripheral stimulation (Supramaximal Stimulation): Ulnar Nerve (Volar side of Wrist)
MC Nerve involved in Leprosy: 1st Posterior Tibial Nerve 2nd Ulnar Nerve
MC Nerve leading to Abscess: Ulnar Nerve
MC Nerve injured in anterior dislocation of shoulder: Circumflex branch of axillary nerve
MC Nerve injured in Fracture neck of Humerus: Axillary nerve
MC Nerve injured in Lunate Dislocation: Median Nerve
MC Nerve injured in Fracture medial epicondyle of Humerus: Ulnar nerve
MC Nerve injured in Supracondylar fracture of Humerus: 1st Anterior Interosseous Nerve 2nd Median Nerve 3rd Radial Nerve
MC Nerve injured in Forearm fractures especially Monteggia fracture: Posterior interosseous Nerve
MC Nerve involved in Perilunate dislocation: Median Nerve
MC Nerve injured in Posterior Dislocation of Hip: Sciatic nerve
MC Nerve injured in McBurney’s Incision: Iliohypogastric Nerve
MC Nerve involved in Thoracic outlet Syndrome: Ulnar Nerve
MC Nerve affected by Plexiform Neurofibroma: Trigeminal Nerve
MC Nerve injury in Postpartum Female: Common Peroneal Nerve
MC Route of Lead Intoxication: Inhalation
MC Occupational Cancer: Skin(Squamous cell carcinoma)
MC Mental Disorder causing death: Alzheimer’s and Other Dementia
MC Infection of Streptococcus pneumonia: Otitis Media
MC Gram Positive organism causing meningitis: Streptococcus pneumonia
MC Gram Negative organism causing meningitis: Neisseria meningitides
MC Source of Meningococcal meningitides: Carrier
MC Legionella causing Human disease: Legionella Pneumophilia
MC Diagnostic test in Lymphogranulorum venerum: Cell Culture
MC Infection Complicating Organ Transplantation: CMV
MC Genital Lesion in HIV patient: Herpes
MC organ affected in Amoebic Colitis: Caecum
MC organ affected in Visceral Leishmaniasis: Spleen
MC Diagnostic specimen for Visceral Leishmaniasis: Spleen
MC Parasitic Infection of CNS: Cysticercosis
MC Congenital Lesion complicated by Infective Endocarditis: VSD
MC association of Right sided aortic arch Tetrology of Fallot
MC condition associated with Coarctation of Aorta: Bicuspid Aortic Valve
MC Rheumatic Valvular Disease: Mitral Regurgitation
MC Renal Vein Thrombosis seen in Membranous Glomerulonephritis
MC Ectopic Ureter associated with: Dysuria
MC Symptomatic CNS infection in Neonates Rubella,HSV
MC Virus causing Diarrhoea in Infants: Rota Virus
MC Biochemical abnormality in Congenital Hypertrophic Pyloric Stenosis: Hypokalemic Hypochloremic Metabolic alkalosis with Paradoxical aciduria
MC Carcinoma of Breast: Intraductal Carcinoma
MC cells damaged during Hypoxia: Neurons
MC Thyroid carcinoma: Papillary
MC Thyroid carcinoma after radiation Papillary
MC etilogical agent for Lung Abscess: Anaerobic bacteria
MC Chronic Occupational disease in world: Silicosis
MC Renal Stones: Calcium Oxalate
MC CNS Herniation: Transtentorial Herniation
MC Demyelinating Disease: Multiple Sclerosis
MC mutated gene in Human cancer: P53
MC mutation in Hereditary Spherocytosis: Ankyrin
MC mutation in Hereditary Elliptocytosis: Spectrin
MC Congenitally absent muscle in Humans: Pectoralis Major
MC weakened muscle in Osteoarthritis: Quadriceps
MC fractured bone in carpus: Scaphoid
MC Injured organ in Blunt injury abdomen: Spleen
MC Hereditary blood coagulation disorder: Factor V Leiden
MC virus associated with Transfusion Hepatitis: HCV
MC Source of Hemorrhage in Duodenal Ulcer (Arterial): Gastroduodenal Artery
MC Lobe involved in Carcinoma Prostate: Posterior Lobe
MC Zone involved in Carcinoma Prostate: Peripheral Zone
MC Node involved in Ca Prostate Metastasis: Obturator Node
MC Congenital Deformity of Urethra: Hypospadiasis
MC Cancer in Burn Scar: Squamous Cell Carcinoma
MC Origin of Melanoma: Junctional Melanocytes
MC Clinical Pattern of Basal cell carcinoma: Nodular
MC Infection in Dry Wound in Burns: Pseudomonas
MC side of Unilateral Cleft Lip: Left
MC Salivary Gland to get Stones: Submandibular Gland
MC Type of Inflammation: Catarrhal
MC Type of Hemoglobinopathy in World: Thalassemia
MC Type of mutation causing β-Thalassemia: Splicing mutation
MC type of AML: M2
MC type of AML in Down’s Syndrome: M7
MC Type of Ca Penis: Squamous Cell Carcinoma
MC Type of Malignant Melanoma: Superficial Spreading Type
MC cause of Acute Adrenocortical Insufficiency: Abrupt withdrawal of Corticosteroids
MC cause of SIADH: Ectopic ADH by Small Cell Cancer
MC cause of Hyperaldosteronism: Conn’s Syndrome (Adrenocortical Adenoma-Left sided MC)
MC cause of Thyrotoxicosis: Grave’s Disease
MC cause of Hypothyroidism in Iodine Sufficient areas of the world: Autoimmune Hypothyroidism (Hashimoto’s Thyroiditis)
MC cause of Primary Hyperparathyroidism: Parathyroid Adenoma
MC cause of Secondary Hyperparathyroidism: Renal Failure
MC cause of Hypoparathyroidism: Surgical Removal of Parathyroid Gland
MC cause of Panhypopituitarism: Pituitary adenoma
MC cause of Cushing’s Syndrome: Administration of Exogenous Corticosteroids
MC cause of Congenital Adrenal Hyperplasia: 21α Hydroxylase Deficiency
MC cause of Right Heart Failure: Left Heart Failure
MC cause of Ascending Aorta Aneurysm: Hypertension
MC cause of Secondary Raynaud Phenomenon: Systemic Sclerosis
MC cause of Acute bacterial Endocarditis: Staphylococcus aureus
MC cause of Subacute Endocarditis: α Hemolytic Streptococci(Viridans)
MC cause of Prosthetic Valve Endocarditis: Staphylococcus epidermidis(Coagulase negative
MC cause of endocarditis in IV drug users: Staphylococcus aureus
MC cause of Bleeding during Tonsillectomy: Paratonsillar Vein
MC cause of arterial bleeding during Tonsillectomy: Tonsillar Branch of Facial Artery
MC cause of Left Recurrent Laryngeal Nerve Palsy: Ca Bronchus
MC cause of Right Recurrent Laryngeal Nerve Palsy: Thyroid Surgery
MC bacterial cause of Pustule: Streptococcus pyogenes
MC cause of Cellulitis: Streptococcus pyogenes
MC cause of Lobar Pneumonia: Streptococcus pnemoniae
MC cause of Bronchopneumonia: Staphylococcus aureus
MC cause of Otitis Media: Streptococcus pneumonia
MC cause of Septicaemia in Asplenic patient: Streptococcus pneumonia
MC cause of gas gangrene: Clostridium perfringens(A type)
MC cause of actinomycosis: Actinomyces Israeli
MC cause of mycetoma: Fungi
MC cause of UTI: E.coli
MC cause of Catheter associated UTI: E.coli
MC cause of Intraabdominal Abscess: E.coli
MC cause of Acute Bacterial Peritonitis: 1st E.coli 2nd Klebsiella
MC cause of Salmonella gastroenteritis: Salmonella typhimurum
MC bacterial cause of Traveller’s Diarrhoea: ETEC
MC viral cause of Traveller’s Diarrhoea: Rota virus
MC parasitic cause of Traveller’s Diarrhoea: Giardia
MC cause of Pyrexia of Unknown Origin: Mycobacterium tuberculosis
MC cause of Blood stained nipple discharge: Intraductal Papilloma
MC cause of Adenomatoid cancer: Follicular Carcinoma
MC cause of Thyroiditis: Hashimoto’s Thyroiditis
MC cause of Esophagitis: Esophageal Reflux
MC cause of Esophageal Perforation: Instrumentation

Most important facts about HIV asked in FCPS Part 1

🔹Most common severe ocular complication of AIDS → CMV retinitis

🔹Most common cause of T.B. in HIV → Mycobacterium tuberculosis

🔹Most common cause of C.N.S. infection in AIDS → Toxoplasmosis

🔹Most common cause of seizures in HIV → Toxoplasmosis

🔹Most common cause of meningitis in HIV → Cryptococcus

🔹Most common fungal infection in AIDS → Candida

🔹Most common cause of oral ulcer in AIDS → Candida

🔹Most common viral infection in AIDS → HSV

🔹Most common cause of genital lesion in AIDS → HSV

🔹Commonest helminthic infection in AIDS → Strongyloides stercoralis

🔹Most common cause of diarrhoea in AIDS → Cryptosporidium

🔹Most common cause of pneumonia in AIDS → Pneumococcus

🔹HIV infects most commonly→ CD4 cells+Helper cells

🔹HIV infects characteristically→ CD4 cells+Macrophages

🔹Most common late CNS complication of HIV is→Dementia

🔹The most common, or “classical”, type of HIV-associated nephropathy is
→collapsing variant of focal segmental glomerulosclerosis (FSGS)

Best Diagnostic Tests For Anemias (For Exams)

anemias

BEST DIAGNOSTIC TESTS FOR ANEMIAS

NOTE: This post covers many controversial Exam MCQs.

*Iron deficiency anemia =====> Dec ferritin (not “increased TIBC”)

*Thalesemia =====> Hb Electrophoresis

* Lead Poisoning =====> Lead level Blood+Urine

* B12 Def =====> Increase methylmalonic acid

* Folate def =====> RBCs Folate levels (not “blood folate levels”)

* Pernicious Anemia =====> Antibodies against intrinsic factor

* PNH =====> flow ctyometry

* Sickle Cell =====> Hb electrophoresis

* G6PD def =====> RBC enzyme essay

* pyruvate kinase disease =====> Rbc enzyme assay

* Aplastic anemia =====> Bone marrow examination

* Hemolytic anemia =====> Decreased haptoglobin (not “increased reticulocytosis”)

Important Cardiac Markers Tested In Exam MCQs

cardiac markers

Most Important Points About Cardiac Markers Tested In Exam

Cardiac markers is one of the most important as well as the most confusing topic for exam. The following points will clear many controversial MCQs.

1. Myoglobin first comes and first goes (rises first, disappears first). This means that:

A. Myoglobin is the earliest cardiac marker to appear after MI.

B. The investigation of choice within first hour of MI is ECG, followed by myoglobin. (ECG is always the investigation of first choice for myocardial infarction regardless of time).

C. The investigation of choice within first two hours of MI is ECG, followed by myoglobin.

 

cardiac markers

 

2. Myoglobin has the highest sensitivity but has the lowest specificity.

3. LDH is called “lazy enzyme” because it comes late, and goes late (rises after 24 hours and remains till 14 days).

4. Trop-I has the greatest specificity. That’s why it is the “GOLD STANDARD” test for MI.

5. “CKMB” is useful for confirmation of reinfarction as this enzyme disappears after 72 hours of MI. So, if a patient comes after 72 hours of initial infarction, and you are suspecting a reinfarction, go for “CKMB”.

6. When do the enzymes disappear?

– Myoglobin disappears after 24 to 48 hours.

– CKMB disappears after 72 hours.

– Trop I disappears after 7 – 10 days.

– LDH disappears after 14 days.

Scenerio 1: CKMB of patient is normal. Trop-I is raised. He is 3 – 10 days post MI patient.

Scenerio 2: CKMB and trop – I of patient are normal. LDH is raised. He is 10 – 14 days post-MI patient.

Hepatitis B Markers Made Easy

  1. HBsAG: Surface antigen
  • Positive in:
  1. Acute infection (first marker to rise)
  2. Chronic infection (> 6 months)

hepatit

  1. HBsAB (IgG): Surface antibody
  • It represents victory; victory can be achieved in two ways:
  1. Resolved acute infection
  2. Immunization

 

3. HBcAB: Core antibody

  1. IgM appears during “acute” phase and persists during “window” phase (the only marker +ve during “window” phae)
  2. IgM converts entirely to IgG after 6 months. So IgG is +ve in:

    A. Resolved acute infection
    B. Chronic infection

NOTE: HBsAG is protective but HBcAB is not.

 

  1. HBeAG:
  • It results from breakdown of core antigen from infected liver cells and is, therefore, marker of infectivity (i.e,. patient can transmit infection to others).

Mnemonic: ”e” for envelope – Envelope is used for sending letters to others

Most important points about hepatitis tested on exams

hepatitis
Most important points about hepatitis which are frequently tested on exams
 
These points should be on your finger tips; expect at least one MCQ from these points.
 
(1) HDV has the highest mortality rate at 20%
 
(2) HAV is mot common, both in general population and in pregnant women. But HEV is most common in far flung areas.
 
(3) HEV is most lethal in pregnancy
 
(4) HAV is acute only; does not cause death.
 
(5) HCV has the highest chronicity (cirrhosis) rate (but the most common cause of cirrhosis is alcohol, followed by HCV). The chronicity rate of: HCV > HBV > HAV
 
(6) HBV is the most carcinogenic hepatitis (Other types of hepatitis increase the risk of hepatocellular carcinoma by causing cirrhosis; but HBV is directly carcinogenic even without prior cirrhosis)
 
(7) Both HAV and HEV are epidemic as both are transmitted via oro-fecal route; HAV clasiccaly infects “travelers”
 
(8) The most common hepatitis which spreads via blood transfusion is “HCV” (Mnemonic: Patients can not “C” [see] HCV virus in the blood which is being transfused to them).
 
(9) HBV is the most common type of hepatitis transmitted from mother to the baby.
 
Don’t forget to share with your friends.

Aortic Stenosis

aortic stenosis

Aortic Stenosis

 

Etiology

 

  • Overall, most common cause Calcification

 

(1) Calcification (normal ageing)

 

  • Most common cause in older patients > 65 years

 

(2) Bicuspid aortic valve

 

  • Most common cause in younger patients < 65 years

  • Normal aortic valve is tricuspid (the only bicuspid valve is mitral valve); bicuspid aortic valve may be stenotic due to cusp fusion.

 

(3) William’s syndrome (supravalvular stenosis)

 

  • A congenital fibrous diaphragm is present above the aortic valve.

 

C:\Users\ayyan\Desktop\williams.jpg

 

(4) HOCM (subvalvular stenosis)

 

(5) Rheumatic heart disease

 

  • RHD may result in aortic valve stenosis due to cusp fusion.

 

 

Assessing the severity

 

Severity of AS is assessed by:

 

  • Valve area

  • Pressure gradient across the valve

 

  • Normal valve area = 3 – 4 cm2{cm} ^ {2}

  • Normal valve gradient < 5 mmHg

 

 

Severity of aortic stenosis

Severity valve area (cm2{cm} ^ {2})

Mean gradient (mmHg)

Mild

1.5 - 3

< 25

Moderate

1.0 – 1.5

25 - 50

Severe

< 1.0

> 50

Critical

< 0.7

> 80

 

 

Symptoms

 

The classic triad of AS is:

 

(1) Angina (exertional)

Angina occurs due to 3 reasons:

 

  • Oxygen demand due to LVH

  • Coronary perfusion due to stenosis and C.O

  • In 50% of AS patients above the age of 35 years, angina occurs due to coexisting CAD.

 

(2) SOB (exertional)

 

SOB/orthopnea/PND occurs due to both:

 

  • Systolic failure (dilated ventricles due to high pressure - ​​ dilated cardiomyopathy)

  • Diastolic failure (LVH - Hypertrophic cardiomyopathy)

 

(C) Syncope (on exertion)

 

 

Examination

 

GENERAL PHYSICAL EXAMINATION

 

(1) CAROTID PULSE

 

  • “Low volume” and “slowly rising pulse” called slow rising pulse.

 

C:\Users\ayyan\Desktop\pulse.jpg

(2) PULSE PRESSURE

  • Narrow (because systolic pressure decreases due to C.O

 

PulsePressure=SystolicDiastolic↓ Pulse Pressure= ↓ Systolic -Diastolic

 

C:\Users\ayyan\Desktop\Untitled.jpg

 

  • Vs. aortic regurgitation, in which pulse pressure becomes wide (due to increased cardiac out resulting in increased systolic pressure)

 

(3) JVP

 

Prominent “a” wave – This is due to reduced compliance of right ventricle which is due to:

 

  • Hypertrophy of ventricular septum

  • Pulmonary hypertension

 

“a” WAVE

 

PRODUCED BY

 

a” wave is produced by “atrial contraction” (late ventricular diastole).

 

C:\Users\ayyan\Desktop\JVP.jpg

 

PROMINENT “a” WAVE

 

“a” wave will be prominent whenever atrial pressure increases:

 

  • Pulmonary hypertension ​​ (any disease causing left sided heart failure)

  • Pulmonary stenosis

  • HOCM

  • Tricuspid stenosis

 

All these conditions causes: RV pressure RA pressure Prominent “a” wave

ABSENT “a” WAVE

 

  • Atrial fibrillation

 

 

 

 

 ​​​​ CVS examination

 

PALPATION

 

(1) APEX BEAT

  • Site: Not displaced (The concentric hypertrophy, in contrast to, dilatation, does not produce cardiomegaly)

  • Character: Heaving (forceful – Due to LVH)

 

CONCENTRIC LVH (hypertrophic cardiomyopathy)

 

  • Concentric hypertrophy is a hypertrophic growth of a hollow organ without overall enlargement, in which the walls of the organ are thickened and its capacity or volume is diminished.

  • LV mass” as well as “wall thickness” increases; but wall thickness increases on the inside of ventricular wall; so:

.

 

  • Ventricular cavity size decreases, and

  • Cardiomegaly does not occur (apex beat not displaced)

 

  • The center of the circle remains in the center.

  • It is caused by volume overload (aortic regurgitation, mitral regurgitation, septal defects, pregnancy)

 

C:\Users\ayyan\Desktop\hypertrophy.jpg

 

 

Eccentric LVH (dilated cardiomyopathy)

 

  • LV mass” increases but “wall thickness” remains normal or decreased.

.

 

  • But ventricular cavity size increases, so

  • Cardiomegaly occurs (apex beat displaced)

 

  • The center of circle is in the periphery of the circle.

  • It is caused by pressure overload (aortic stenosis, HOCM, HTN)

 

 

 

Eccentric hypertrophy

Concentric hypertrophy

LV mass

Increased

Increased

LV wall thickness

Normal or decreased

Increased

 

(but on the inside, so no cardiomegaly – Apex beat not displaced)

Cavity

Dilated

 

(Results in cardiomegaly – Displaced apex beat))

Normal

Type of heart failure

Systolic

 

(Dilated cardiomyopathy)

Diastolic

 

(Hypertrophic cardiomyopathy)

 

Added sounds

  • S3 (Increased early diastolic filling into compliant dilated ventricle)

 

  • S4 (Hypertrophy limits diastolic filling)

 

S4

Causes

Increase in left ventricular volume ​​ (and pressure):

 

  • Valvular regurgitations (Aortic regurgitation + Mitral regurgitation

  • Septal defects

  • Pregnancy

Chronic pressure overload

 

  • Aortic stenosis

  • HOCM

  • HTN

 

(2) SYSTOLIC THRILL

  • At aortic area

 

AUSCULTATION

 

HEART SOUNDS

 

(1) S2:

  • Soft”:

 

  • REASON: Calcified aortic valve is immobile A2 is not audible; only P2 is audible Soft S2

  • SEVERE AS: When S2 is not audible, it can be concluded that AS is severe.

  • Reverse splitting of S2:

 

  • REASON: Delayed closure of aortic valve due to AS → P2 occurs earlier than A2 → Reverse splitting of S2

(2) S4:

 

  • Due to LVH

 

MURMUR (EJECTION – SYSTOLIC)

 

Radiation:

 

  • Carotid artery: The ejection systolic murmur of HOCM does not radiate to neck which helps in differentiating it from murmur of AS.

  • Apex: Murmur of MR at apex is “pansystolic” while that of AS is ejection-systolic.

 

C:\Users\ayyan\Desktop\e964ee6d8bd13247e6118bfaa0e7ea79.jpg

 

Maneuvers:

 

  • Valsalva, standing, hand grip: Murmur decreases due to transvalvular flow

  • Squatting, leg raise: Murmur increases due to transvalvular flow

 

Duration:

  • Longer the murmur, severe is aortic stenosis.

 

Intensity:

  • Intensity of murmur typically increases as the disease progresses.

  • However, in very severe aortic stenosis, cardiac output decreases; as a result, the murmur becomes “softer” or “disappears”. Therefore, intensity of murmur is not a good indicator of disease severity.

 

 

Investigations

 

TTE TEE Cardiac catheterization

 

(1) CXR:

  • Normal (concentric hypertrophy – no cardiomegaly)

 

(2) ECG

  • LVH

 

(3) Echo:

 

​​ Echo can determine:

 

  • Valve area

  • Pressure gradient

 

(4) Cardiac catherization

 

Cardiac catherization is indicated in three conditions:

 

  • Measure gradient: Rarely, cardiac catherization is indicated to measure gradient if echocardiography is unable to determine whether severe aortic stenosis is present or not.

 

  • Angina: Cardiac catherization is indicated when it is suspected that the angina of aortic stenosis may be due to coexisting CAD (50% of aortic stenosis patients older than 35 years of age have CAD).

  • AVR: Angiography should be done before AVR, so that CABG, if indicated, can be performed during the procedure of valve replacement.

 

Treatment

 

(1) ASYMPTOMATIC

 

  • Mild to moderate AS: If the patient is asymptomatic, and AS is not severe, just observe the patient is the general rule.

  • Severe AS: AVR is indicated

 

​​ (2) SYMPTOMATIC

 

  • Medical treatment is not effective.

  • Development of any of the three symptoms is indication for AVR.

 

(A) MEDICAL TREATMENT

  • BETA BLOCKERS: Can be used for angina (but may cause hypotension)

  • ACE INHIBITORS, DIGOXIN, NITRATES: Just like HOCM, these drugs are relatively contraindicated.

 

 

 

Drug

Indication

ACE inhibitors

Symptomatic systolic failure

Digoxin

Decreased EF

Nitrates

Angina

 

 

 

 

 

(B) Surgical treatment

 

(i) AVR

C:\Users\ayyan\Desktop\hqdefault.jpg

INDICATIONS:

 

  • Symptomatic patients (any of the three symptoms)

  • Asymptomatic but severe AS (i.e; valvular gradient > 50 mmHg or valve area < 0.7)

  • Patients undergoing CABG or any other heart surgery

 

 

 

 

C:\Users\ayyan\Desktop\Image_201510071501_10068.jpg

 

(II) BALOON VALVULOPLASTY

 

Definition: It is widening of stenotic aortic valve using a balloon catheter inside the valve.

 

INDICATION: Patients with “critical” aortic stenosis who are not fit for AVR.

 

NOTE: Baloon valvuloplasty is not routinely done because “calcified” aortic stenosis does not respond very well to balloon valvuloplasty.

 

 

TAGS: aortic stenosis murmur radiation causes signs symptoms listen murmur location aortic stenosis treatment