A man is found to be HLA B5-positive on typing.-

Discussion in 'MRCP Forum' started by Guest, May 26, 2006.

  1. Guest

    Guest Guest

    A man is found to be HLA B5-positive on typing. Which of the following diseases is most liekly associated with HLA B5?
    a) Dermatitis herpetiformis
    b) Behחet’s syndrome
    c) Grave’s disease
    d) Addison’s disease
    e) Sjצgren’s syndrome

    Your answer is B
    The correct answer is B
    Explanation
    HLA B5 plays an important role in the aetiology of Behcet's disease. The frequency of HLA B5 differs between racial groups and geographical regions. Ocular involvement, which could lead to serious complications, is a very important feature of Behcet's disease.

    Behחet’s syndrome is associated with HLA B5 positivity, as is polycystic kidney disease and ulcerative colitis. All the other stems mentioned in this question are associated with the B8-DR3 subtype, as are autoimmune hepatitis, idiopathic membranous glomerulonephritis, myasthenia gravis and systemic lupus erythematosus

    Combination. 943 Question number 2
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    A 52 year old white male is found to have some abnormalities in his peripheral blood smear. He has anti-intrinsic factor antibodies in his serum. He has a positive Schilling test. He is given a diagnosis of pernicious anemia. He is told that on his differential count, the abnormality was a shift to the right. What is a 'shift to the right'?
    a) increased number of white blood cells in the peripheral blood
    b) decreased number of white blood cells in the peripheral blood
    c) hypersegmented granulocytes present in the peripheral blood
    d) increased number of immature white blood cells in the peripheral blood
    e) increased number of immature red blood cells in the peripheral blood

    Your answer is D
    The correct answer is C
    Explanation
    Hypersegmented changes in the white blood cells is referred to as 'right shift'. This also indicates that there are few immature cells in the differential. A increased number of white blood cells in the peripheral blood (choice a) is called a leukocytosis A decreased number of white blood cells in the peripheral blood (choice b) is called a leukopenia. An increased number of immature white blood cells in the peripheral blood (choice d) is a left shift, or a shift to the left.An increased number of immature red blood cells in the peripheral blood (choice e) is a reticulocytosis

    Combination. 5802 Question number 3
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    A random controlled trial of acute asthma treatment was performed in the emergency department wherein patients were discharged with oral corticosteroids plus either budesonide (an inhaled corticosteroid) or placebo. The main outcome event was relapse, defined as an unscheduled visit for worsening asthma symptoms within 21 days of discharge. Of the 100 patients randomized to budesonide, 25 relapsed. Conversely, 50 of the 100 patients randomized to placebo relapsed.
    What is the ratio of the probability of an relapse in the treated group to the probability of relapse in the placebo group (odds ratio)
    a) 0.25
    b) 0.33
    c) 0.4
    d) 0.5
    e) 1

    You have not attempted this question.
    The correct answer is B
    Explanation
    As with the ARR, the OR has a number of synonymous terms, including relative odds and cross-product ratio.1 Other terms often incorrectly used synonymously with OR include relative risk (RR) and risk ratio. The OR is the ratio of the probability of an outcome event in one group (treatment or exposure) to the probability of the outcome event in the other group (control or non-exposure).2,3 The OR is a useful measure of treatment effect in RCTs and, as with the RR, the OR indicates that the outcome rate in the treatment group is more (OR > 1), the same (OR = 1), or less (OR < 1) than in the control group.6 In case control studies on etiology, the OR indicates the probability of exposure to causative agent given the outcome
    Many confuse relative risk and odds ratio. Unlike RR, the OR is not an accurate measure of risk. OR tends to slightly overestimate RR, but as the frequency of outcome events or disease incidence becomes smaller and approaches zero, the OR and RR will become increasingly equal. Thus for rare events, the OR is a good approximation of RR. We can also see from the OR formula where the term cross-product ratio comes from
    Odds Ratio = (25 x 50) / (50 x 75)
    Odds Ratio = 0.33

    Combination. 4711 Question number 4
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    Marfans syndrome is caused by mutations in which gene ?
    a) Elastin
    b) Fibrillin 1
    c) Fibrillin 2
    d) Laminin
    e) Collagen

    Your answer is B
    The correct answer is B
    Explanation
    Marfan syndrome is caused by mutations in the fibrillin-1 (FBN1) gene located on chromosome 15q21.1. The gene encodes the glycoprotein fibrillin, a major building block of microfibrils, which constitute the structural components of the suspensory ligament of the lens and serve as substrates for elastin in the aorta and other connective tissues. Abnormalities involving microfibrils weaken the aortic wall. Progressive aortic dilatation and eventual aortic dissection occur because of tension caused by left ventricular ejection impulses. Likewise, deficient fibrillin deposition leads to reduced structural integrity of the lens zonules, ligaments, lung airways, and spinal dura. Production of abnormal fibrillin-1 monomers from the mutated gene disrupts the multimerization of fibrillin-1 and prevents microfibril formation. This pathogenetic mechanism has been termed dominant-negative because the mutant fibrillin-1 disrupts microfibril formation even though normal fibrillin is being encoded on the other fibrillin gene. This proposed mechanism is evinced by the fact that cultured skin fibroblasts from patients with Marfan syndrome produce greatly diminished and abnormal microfibrils. Laminins are the major noncollagenous components of basement membranes and mediate cell adhesion, growth migration, and differentiation.

    Combination. 5734 Question number 5
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    The patient is unable to distinguish the difference between a hot and cold test tube simultaneously applied to the ulnar side of the right hand and arm and the left leg. This deficit is in the same distribution as the pain deficit noted when testing sharp sensation. Pain and temperature sensation are tests for the
    a) corticospinal tract
    b) spinothalamic tract
    c) the reticular formation of the brainstem
    d) the hypothalamus
    e) central vestibular connections

    Your answer is D
    The correct answer is B
    Explanation
    The patient is unable to distinguish the difference between a hot and cold test tube simultaneously applied to the ulnar side of the right hand and arm and the left leg. This deficit is in the same distribution as the pain deficit noted when testing sharp sensation. Pain and temperature sensation are tests for spinothalamic tract function

    Combination. 4829 Question number 6
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    Chronic myeloid leukemia is the result of
    a) hybrid gene BCR-ABL
    b) mutation of DPC4 gene
    c) Mutation of p21 gene
    d) Mutation of Rb gene
    e) Mutation of p53 gene

    Your answer is A
    The correct answer is A
    Explanation
    The Ph chromosome is the result of a translocation or exchange of genetic materialbetween the long arms of chromosomes 9 and 22 . This exchange brings together two genes: the BCR (breakpoint cluster region) gene on chromosome 22 and the proto-oncogene ABL (Ableson leukemia virus) on chromosome 9. The resulting hybrid gene BCR-ABL codes for a fusion protein with tyrosine kinase activity, which activates signal transduction pathways, leading to uncontrolled cell growth

    Combination. 1194 Question number 7
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    A patient with a throat infection has a blood agar culture of his throat swab performed. The type of hemolytic reaction displayed on the blood agar is described as being beta-hemolytic. This means :
    a) there is complete lysis of red cells surrounding the colony
    b) there is partial lysis of red cells surrounding the colony
    c) the patient is infected with Group B streptococci
    d) there is hemolyis of red blood cells in a helical pattern
    e) there is evidence of hemolysis of B-lymphocytes

    Your answer is C
    The correct answer is A
    Explanation
    Throat culture has been used as the gold standard for determining the presence of streptococci in a throat infection.

    The type of hemolytic reaction displayed on blood agar has long been used to classify the streptococci. Beta -hemolysis is associated with complete lysis of red cells surrounding the colony, whereas alpha-hemolysis is a partial or "green" hemolysis associated with reduction of red cell hemoglobin. Nonhemolytic colonies have been termed gamma-hemolytic. Hemolysis is affected by the species and age of red cells, as well as by other properties of the base medium. Group A streptococci are nearly always beta-hemolytic; related Group B can manifest alpha, beta or gamma hemolysis. Most strains of S. pneumoniae are alpha-hemolytic but can cause -hemolysis during anaerobic incubation.
    The Lancefield procedure is the gold standard for identifying Streptococcal Group Antigens. It requires a pure culture of beta-hemolytic streptococci and standardized grouping antisera, and it is the most complex GAS identification procedure, with a minimum of 48 hours between swabbing the throat and identification of the bacteria. Beta-hemolytic streptococci are subdivided into groups A-D, F, and G using antibodies against the heat- and acid-stable carbohydrate antigens in their cell walls.
    Beta -hemolysis is associated with complete lysis of red cells surrounding the colony
    Colonies of Streptococcus pyogenes on blood agar exhibiting beta (clear) hemolysis.




    Combination. 6440 Question number 8
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    The presence of Anti-Jo-1 autoantibodies is most specific for :
    a) polymyositis
    b) ankylosing sponylitis
    c) SLE
    d) CREST sydrome
    e) Sjogren's Syndrome

    Your answer is A
    The correct answer is A
    Explanation
    Anti-Jo-1 autoantibodies were originally described as precipitating autoantibodies in sera of patients with polymyositis. It was later realized that the anti-Jo-1 antibodies were specific for patients with polymyositis. The target for the anti-Jo-1 antibodies was one of a family of distinct cellular enzymes, the aminoacyl t-RNA synthetases .
    The presence of autoantibodies against the Jo-1 antigen has been reported in up to 23% of polymyositis patients by immunodiffusion . Anti-Jo-1 antibodies are almost completely specific for myositis, being more common in polymyositis than dermato-myositis, and rare in children . The presence of anti-Jo-1 antibodies defines a distinct group of polymyositis patients with interstitial disease, arthritis, and fevers.

    Combination. 5745 Question number 9
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    A patient has muscular weakness which is found to be secondary to autoantibodies to postsynaptic nicotinic acetylcholine receptors (anti-AChRs) at the neuromuscular junction.
    How likely is a patient with a thymoma to have these smptoms and clinical features?

    a) >90%
    b) 70-90%
    c) 30-70%
    d) 20-30%
    e) <20%

    Your answer is C
    The correct answer is C
    Explanation
    As many as 50% of patients with thymoma have MG, and approximately 15% of patients with MG have thymoma

    MG is caused by autoantibodies to postsynaptic nicotinic acetylcholine receptors (anti-AChRs) at the neuromuscular junction, causing weakness of skeletal muscles. Some patients with thymoma-associated MG have an inflammatory myopathy of striated and cardiac muscles. Cardiac myositis may cause heart failure, cardiac arrhythmia, and sudden death

    Combination. 5741 Question number 10
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    undergoing prostatic surgery under subarachnoid anaesthesia received midazolam for intraoperative sedation . After receiving intravenous midazolam he suffers from respiratory arrest. Which is the most appropriate choice of emergency treatment?
    a) Naloxone
    b) Diazepam
    c) Dantrolene
    d) Flumazenil
    e) Neostigmine

    Your answer is D
    The correct answer is D
    Explanation
    Anexate, or Flumazenil, an imidazobenzodiazepine, is a benzodiazepine antagonist which blocks the central effects of agents that act via the benzodiazepine receptor, by competitive inhibition. The antagonism is specific, since in animal experiments the effects of compounds which have no affinity for the benzodiazepine receptor (e.g., barbiturates, meprobamate, ethanol, GABA-mimetics, and adenosine receptor agonists) were not affected by flumazenil.

    For the complete or partial reversal of the central sedative effects of benzodiazepines. It may therefore be used in anesthesia and intensive care in the following situations: termination of general anesthesia induced and/or maintained with benzodiazepines, reversal of benzodiazepine sedation in short diagnostic and therapeutic procedures, for the diagnosis and/or management of deliberate or accidental benzodiazepine overdosage.

    Combination. 6369 Question number 11
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    according to Vaughan Williams Classification of antiarrhythmic Drugs, which class would bretylium be in ?
    a) class 1A
    b) class 1B
    c) class 1C
    d) class II
    e) class IV

    Your answer is C
    The correct answer is D
    Explanation
    Class II
    - decrease potential for arrhythmias to develop in response to catecholamines
    - eg bretylium: blocks release of sympathetic transmitters
    - beta blockers: competitive antagonists and also block possible arrhythmogenic effect of cAMP
    - indirect blockade of Ca channel opening by attenuating adrenergic activation

    Combination. 936 Question number 12
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    A 72 year old man homeless man dies in suspicious circumstances and an autopsy is performed. On autopsy there was evidence of discrete areas of epithelioid macrophages in his lungs, approximately 1 mm in diameter. The area is surrounded by lymphocytes. There are other areas that are much larger that contain multinucleated giant cells. Which of the following can lead to this response?
    a) pneumococcus
    b) Mycobacteria
    c) salmonella
    d) Shigella
    e) Clostridium tetani

    Your answer is B
    The correct answer is B
    Explanation
    The inflammatory response described is granulomatous inflammation. Mycobacteria are one of the causes of a granulomatous immune response. Choices (a), (c), (d) and (e) are incorrect because infection with any of these agents does not elicit granuloma formation.

    Combination. 5713 Question number 13
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    A young female patient has just been diagnosed with a first acute exerbation of Crohns disease. What is the medication of choice for inducing and maintaining remission in this patient?
    a) Azathioprine
    b) cyclosporin
    c) 5-aminosalicylic acid
    d) 5-ASA agents
    e) Anti-TNF

    Your answer is A
    The correct answer is C
    Explanation
    Mesalamine (5-aminosalicylic acid), the active moiety of sulfasalazine, is available in several oral formulations designed to release in various segments of the small bowel and colon. It is especially useful in patients who are intolerant of sulfasalazine. In doses of up to 4 g/day, mesalamine is effective for inducing and maintaining remission and is showing considerable promise for inhibiting postoperative recurrence.

    Most people are first treated with drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs.

    Sulfasalazine is one of the oldest treatments for inflammatory bowel disease. The sulfa part of the compound attached to the active 5-ASA fragment prevents the medication from being absorbed in the proximal intestine, thereby allowing the 5-ASA fragment to be delivered to the colon. When colonic bacteria split the molecule, the 5-ASA compound is liberated.

    Sulfasalazine has proved to be somewhat effective in treating Crohns disease in the large bowel but not in the small bowel. The drug has been supplanted for the most part by forms of 5-ASA that do not contain sulfa but are protected by a wax matrix that delays the release of the drug until it reaches the distal small bowel or the colon. Because these new varieties do not contain the sulfa moiety, they produce fewer adverse effects, but they are more expensive. Balsalazide, a new 5-ASA medication, consists of 5-ASA linked to a nonsulfa fragment that liberates the 5-ASA portion in the colon. The 5-ASA compounds have not been effective in maintaining either surgically or medically induced remission.

    Patients who do not benefit from it or who cannot tolerate it may be put on other mesalamine-containing drugs, generally known as 5-ASA agents, such as Asacol, Dipentum, or Pentasa. Possible side effects of mesalamine preparations include nausea, vomiting, heartburn, diarrhea, and headache.

    Some patients take corticosteroids to control inflammation. These drugs are the most effective for active Crohns disease, but they can cause serious side effects, including greater susceptibility to infection.

    Although steroids have been shown time and again to be effective in inducing clinical remission in patients who have active Crohns disease, they are not effective in maintaining the remission. All steroid agents also produce adverse effects, specifically osteonecrosis of the hip, which are a considerable medicolegal concern for the prescribing practitioner. In addition, steroid therapy does not modify the disease-that is, the drugs do not significantly reduce or eliminate lesions in the bowel. Budesonide, a steroid metabolized on its first pass through the liver, has been tried and may have a role, but it is no panacea.

    Drugs that suppress the immune system are also used to treat Crohns disease. Most commonly prescribed are 6-mercaptopurine and a related drug, azathioprine. Immunosuppressive agents work by blocking the immune reaction that contributes to inflammation. These drugs may cause side effects like nausea, vomiting, and diarrhea and may lower a person s resistance to infection. When patients are treated with a combination of corticosteroids and immunosuppressive drugs, the dose of corticosteriods can eventually be lowered. Some studies suggest that immunosuppressive drugs may enhance the effectiveness of corticosteroids.

    Azathioprine, or its metabolite 6-mercaptopurine, has been demonstrated in several studies to be effective in maintaining remission of Crohns disease. Although initial concerns about carcinogenic effects associated with azathioprine in clinical practice have not been substantiated, its delayed onset of action (approximately three months, on average) makes it unsuitable as a single-drug therapy for active Crohns disease. Methotrexate is not used as often, but as a remission-inducing agent, it provides a similar effect, at least in patients whose remission was induced with steroids and methotrexate.

    Finally, early results from trials of infliximab, an antitumor necrosis factor antibody, have indicated that it can maintain remission in patients who used the drug to induce the remission.

    Infliximab, the first treatment approved specifically for Crohns disease, is an anti-tumor necrosis factor (TNF) substance. Infliximab may be used for the treatment of moderate to severe Crohns disease that does not respond to standard therapies (mesalamine substances, corticosteroids, immunosuppressive agents) and for the treatment of open, draining fistulas.

    Infliximab is a chimeric, part human (75%), part murine (25%), genetically engineered antibody designed to fight tumor necrosis factor, and is the latest advance in the treatment of Crohns disease and has generated a lot of excitement.

    Infliximab binds to tumor necrosis factor, causing it to become biologically inactive, and decreases the number of T-cells in the intestinal lamina propria as well.

    TNF is a protein produced by the immune system that may cause the inflammation associated with Crohns disease. Anti-TNF removes TNF from the bloodstream before it reaches the intestines, thereby preventing inflammation. Investigators will continue to study patients taking infliximab to determine its long-term safety and efficacy.

    Antibiotics are used to treat bacterial overgrowth in the small intestine caused by stricture, fistulas, or prior surgery. For this common problem use one or more of the following antibiotics: ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole.

    Study results from 20 years ago have demonstrated metronidazole usefulness in the temporary healing of perianal Crohns disease. A more recent study found that in the treatment of mild to moderate Crohns disease, ciprofloxacin at 1 gm/day was as effective as mesalamine at 4 gm/day. Further studies are ongoing, but antibiotics seem to be a reasonable alternative to steroids and are better tolerated.

    Diarrhea and crampy abdominal pain are often relieved when the inflammation subsides, but additional medication may also be necessary. Several antidiarrheal agents could be used, including diphenoxylate, loperamide, and codeine. Patients who are dehydrated because of diarrhea will be treated with fluids and electrolytes.

    Combination. 6380 Question number 14
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    Nonselective beta blocker possessing quinidine-like membrane stabilizing effects.
    a) labetalol
    b) acebutolol
    c) sotalol
    d) esmolol
    e) butorphanol

    Your answer is B
    The correct answer is A
    Explanation
    Beta-blockers, such as propranolol, labetalol, and pindolol, can have membrane stabilizing effects (eg, quinidinelike effects, Vaughan-Williams class I antiarrhythmic effects). This property, usually not evident with therapeutic doses, may significantly contribute to toxicity by prolonging QRS duration and impairing cardiac conduction. Seizures are more commonly observed in the drugs with quinidinelike membrane stabilizing effects.

    Combination. 5757 Question number 15
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    A group of physicians are evaluating patients with ARDS and specifically wish to exclude patients with elevated hydrostatic pressures.
    Which of the following would be most suitable to exclude such patients?
    a) extravascular lung water
    b) Procalcitonin
    c) endotoxin activity assay
    d) popolysaccharide binding protein
    e) inducible nitric oxide synthase

    Your answer is D
    The correct answer is A
    Explanation
    There is evidence that ARDS patients often experience increases in hydrostatic pressure at some time during their course of ARDS, despite the clinical consensus definition of ARDS specifically excluding patients with elevated hydrostatic pressures.

    Outcomes for ARDS patients may be improved if they achieve negative fluid balance or reductions in hydrostatic pressure.

    Perhaps the best level of evidence to date comes from a trial of patients with pulmonary artery catheters in place who were randomized to a fluid restrictive strategy guided by measures of extravascular lung water (EVLW)

    Combination. 1184 Question number 16
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    What specific part of the eye is mainly responsible for acute vision ?
    a) zonnule of Zinn
    b) limbus
    c) optic disc
    d) macula
    e) fovea

    Your answer is E
    The correct answer is E
    Explanation
    The fovea lies slightly below and to one side of the optic disk. It is found in the centre of a shallow depression or pit (the macula). Only cones are present at the fovea, which is an area approximately 0.2 mm in diameter: all other parts of the retina including blood vessels are pushed aside. The cones here have individual connections with the bipolar and ganglion cells, hence the fovea gives us our most sensitive and acute vision.



    Combination. 802 Question number 17
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    A patient suffering from hemochromatosis classically presents with the following triad:
    a) micro-nodular liver cirrhosis, iron deficiency anemia & diabetes mellitus
    b) micro-nodular liver cirrhosis, diabetes mellitus & bronze pigmentation of skin
    c) diabetes mellitus, sickle cell anemia, bronze pigmentation of skin
    d) micro-nodular liver cirrhosis, diabetes mellitus & sickle cell anemia
    e) micro-nodular liver cirrhosis, Kayser-Fleischer rings & diabetes mellitus

    Your answer is B
    The correct answer is B
    Explanation
    Hemochromatosis is a condition caused by excessive iron accumulation in the body most of which is deposited in the parenchymal cells of various organs particularly liver and pancreas. The excess iron deposition in the parenchymal cells of various organs leads to dysfunction and ultimate failure of these organs. The organs most commonly affected are the liver and the pancreas. Liver undergoes micro-nodular cirrhosis due deposition of iron in the periportal hepatocytes and in pericanalicular lysosomes. Bile duct epithelium and kupffer cell pigmentation is less marked. Pancreas becomes intensely pigmented, has interstitial fibrosis and parenchymal atrophy. Iron deposits are found in both acinar and islet cells. This responsible for pancreatic failure and development of diabetes mellitus. The intensity of iron staining in the pancreatic islets correlates with occurrence and severity of diabetes. Bronze pigmentation of skin is due to the deposition of iron in the dermal macrophages and fibroblasts.So as per the above explanation a person suffering from hemochromatosis will present with a triad of micro-nodular liver cirrhosis, diabetes mellitus and bronze pigmentation of the skin. therefore the correct answer is B A,C,& D are not the correct answers because anemia-- sickle cell or iron deficiency is not a manifestation of hemochromatosis E is also incorrect because Kayser-Fleischer ring is seen in Wilson's disease and not in hemochromatosis.

    Combination. 5777 Question number 18
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    The HLA-DR3 antigen has been strongly associated with celiac disease.
    Which chromosome is this antigen found on?
    a) chromosome 3
    b) chromosome 6
    c) chromosome 15
    d) chromosome 16
    e) chromosome 21

    Your answer is B
    The correct answer is B
    Explanation
    Human immune-response, D-related antigen encoded by the D locus on chromosome 6 and found on lymphoid cells. It is in linkage disequilibrium with HLA-A1 and HLA-B8. The HLA-DR3 antigen is strongly associated with celiac disease, Grave's disease, dermatitis herpetiformis, early-age onset myasthenia gravis, systemic lupus erythematosus, juvenile diabetes, and opportunistic infections in AIDS.

    Combination. 6115 Question number 19
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    a drug that may cause pericarditis
    a) Sulphonylureas
    b) Metformin
    c) phenytoin
    d) Meglitinides
    e) Alpha-glucosidase inhibitor

    Your answer is D
    The correct answer is C
    Explanation
    a number of drugs may cause pericarditis, including hydralazine, procainamide, phenytoin, dantrolene, phenylbutazone, isoniazid, and the anthracycline class of chemotherapeutic agents.

    Combination. 5758 Question number 20
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    A group of physicians are exploring toxic shock.
    Which is the major gram-negative bacterial cell wall toxin that triggers septic shock ?

    a) amino acid
    b) cell membrane
    c) periplasmic space
    d) lipopolysaccharide
    e) phospholipid

    Your answer is D
    The correct answer is D
    Explanation
    Endotoxin, or lipopolysaccharide (LPS), is the major gram-negative bacterial cell wall toxin that triggers septic shock . Gram-negative endotoxin is shed from the membrane of rapidly proliferating bacteria, and enhanced release into the blood is associated with antibiotic use

    Endotoxin is also translocated through the gut after periods of hypotension often associated with cardiopulmonary bypass or hypovolemic shock
  2. Guest

    Guest Guest

    Thanks for the Qs.
    Really appreciate it.
  3. Guest

    Guest Guest

    the question is good...thanks
  4. Guest

    Guest Guest

    thnkx for good ques.
    only one thing i want to say plz when u post questions, post answers in next post or in same post but after some space so that thinking process(that all we wana gain by practicing)doesnt stop in the way when u catch a glimpse of answer right under options.at least my mind get stuck.;)
    it was just a friendly request
    thanx for ur contribution
    regards
  5. Guest

    Guest Guest

    Thanks , You are so kind ....I am preparing now so they are so useful ...Again thanksssss

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