Deepak Marwah

Director
Medicine Buster Classes

CBS Publishers & Distributors Pvt Ltd

• New Delhi • Bengaluru • Chennai • Kochi • Kolkata • Lucknow • Mumbai
• Hyderabad • Jharkhand • Nagpur • Patna • Pune • Uttarakhand
 Preface
Dear Students,
It gives me immense pleasure to introduce you to the “One-Touch” series, which is a magical bundle of
highly organized notes that give you a laser-focused approach for real-life exam scenario to solve questions
having twisted/super-confusing options.
The book has been designed keeping in mind the fact that one needs an interesting and high-yield
colorful summary book which he/she would love to open in the morning to learn interesting facts and revise
the standard content.
I suggest that you finish the theory in the book in three to four days by reading 40-50 pages per day. Each
word should be imprinted in your brain, as it has been well said that doctors have a photographic memory. Next
attempt should be to scan all the PYQ papers (Latest Question Papers) of NEET, INICET and FMG for the last
3 years given in the book. Explanation of each of the papers is available free on my YouTube channel:
https://www.youtube.com/@DrMarwahLIVE. Keep the book with you and underline the keywords in stem
of each question as I discuss each of them. It will help you learn critical exclusion skills for the current exam
pattern.
The book contains multiple case scenarios that will be of help to you in your final year of medical college
as well. Remember! It is an era where you need precise data to be able to decide why, when, how, and what
to do in a case.
Keep Hammering!
 Deepak Marwah
 Contents
Preface ................................................................................................................................................................................................... iii

THEORY

1. Cardiology and Emergency Medicine

1. Cardiomyopathies.............................................................................................................................................................3
2. Integrated Pathology Slide Interpretation.............................................................................................................4
3. Therapeutics of Congestive Heart Failure ..............................................................................................................6
4. Summary of Important JVP Findings......................................................................................................................7
5. ECG Changes.......................................................................................................................................................................7
6. Causes of ST Depression.................................................................................................................................................8
7. Abnormal ECG Findings Compiled Together..........................................................................................................8
8. Heart Rate Determination............................................................................................................................................9
9. Accessory Pathway-Mediated Disorders.................................................................................................................9
10. ECG Rhythm Disorders...............................................................................................................................................10
11. Bradyarrythmias ..........................................................................................................................................................15
12. Hypokalemia ..................................................................................................................................................................17
13. Ischemic Heart Disease ...............................................................................................................................................18
14. Diseases of Pericardium..............................................................................................................................................21
15. Infective Endocarditis 2023 Update.....................................................................................................................23
16. Major Criteria.................................................................................................................................................................24
17. Minor Criteria.................................................................................................................................................................25
18. Rheumatic Fever............................................................................................................................................................25
19. Murmurs...........................................................................................................................................................................26
20. Aortic Dissection............................................................................................................................................................27
21. Hypertension...................................................................................................................................................................27
22. Congenital Heart Defects (CHDs)............................................................................................................................29
23. Coarctation of Aorta....................................................................................................................................................30
24. ACLS AHA 2020 Guidelines ....................................................................................................................................31
25. BAsic Life Support........................................................................................................................................................32

2. Neurology
1. Montage Recording Interpretation.........................................................................................................................33
2. Epilepsy..............................................................................................................................................................................34
3. CNS Infections ................................................................................................................................................................36
4. Lumbar Puncture .........................................................................................................................................................41
5. Neurocysticercosis..........................................................................................................................................................42
vi One Touch Medicine by Dr Deepak Marwah

6. Brain Tumor....................................................................................................................................................................43
7. Pediatric Brain Tumors...............................................................................................................................................44
8. Transient Ischemic Attack (TIA) ............................................................................................................................44
9. Clinical Features of Localized Cerebral Lesions..................................................................................................45
10. Neuroimaging Findings in Acute Ischemic Stroke ...........................................................................................46
11. Intracerebral Hemorrhage.........................................................................................................................................46
12. Stroke Syndromes by Vascular Territory............................................................................................................47
13. Distinct Clinical Syndromes Associated with Lacunar Infarcts...................................................................48
14. Other Causes of Intracranial Bleeding...................................................................................................................49
15. Headache...........................................................................................................................................................................51
16. Myasthenia Gravis.........................................................................................................................................................52
17. Channelopathies.............................................................................................................................................................54
18. Parkinsonism ..................................................................................................................................................................57

3. Endocrinology
1. Diabetes Mellitus.............................................................................................................................................................58
2. Diseases of Adrenal Cortex and Medulla..............................................................................................................60
3. Thyroid Gland.................................................................................................................................................................61
4. Multiple Endocrine Neoplasia (MEN)......................................................................................................................62

4. ABG Analysis
1. Effect of Extra Heparin on ABG Sample..............................................................................................................64
2. ABG HACKS.....................................................................................................................................................................64
3. How to Calculate the Level of Compensation in Respiratory Acidosis and
Respiratory Alkalosis? .................................................................................................................................................65
4. MMRC Grading of Dyspnea: Modified Medical Research Council Grading of
Dyspnea for COPD Patients.......................................................................................................................................65
5. Anion Gap.........................................................................................................................................................................67

5. Pulmonology and Spirometry

1. Pneumothorax ...............................................................................................................................................................70
2. Pleural Effusion .............................................................................................................................................................71
3. Hydropneumothorax ...................................................................................................................................................72
4. Pneumonia........................................................................................................................................................................72
5. Pulmonary Embolism ..................................................................................................................................................74
6. Fat Embolism Syndrome ...........................................................................................................................................75
7. Spirometry Interpretation.........................................................................................................................................75
8. Diffusion Capacity of Lung.........................................................................................................................................78
9. Pulmonary Capacity.....................................................................................................................................................78
10. Tuberculosis......................................................................................................................................................................78
11. Asthma Severity ...........................................................................................................................................................78
12. Air Embolism .................................................................................................................................................................80
13. Bronchiectasis..................................................................................................................................................................80
14. Cystic Fibrosis..................................................................................................................................................................81
 CONTENTS vii

15. Respiratory Failure........................................................................................................................................................82

16. Acute Respiratory Distress Syndrome (ARDS)..................................................................................................83
17. Interstitial Lung Disease (ILD)..................................................................................................................................84

6. Nephrology and Electrolytes

1. Nephrotic Syndrome....................................................................................................................................................87
2. Hematuria and Nephritic Syndrome.....................................................................................................................88
3. Hyponatremia.................................................................................................................................................................88
4. Hypernatremia................................................................................................................................................................89
5. Disorders of Phosphate Metabolism........................................................................................................................89

7. Hepatology
1. Important Scoring Patterns in Liver Disease.....................................................................................................91
2. Acute Liver Failure........................................................................................................................................................91
3. Hepatitis B........................................................................................................................................................................92
4. Hepatitis C........................................................................................................................................................................93
5. Hepatitis D........................................................................................................................................................................94
6. Hepatitis A and E..........................................................................................................................................................94
7. Extrahepatic Manifestations of Hepatitis B and Hepatitis C Viruses........................................................94
8. Incidence of Fulminant Hepatic Failure and Chronic Hepatitis with Hepatotropic Viruses.............95
9. Autoimmune Hepatitis.................................................................................................................................................95
10. Alcoholic Liver Disease.................................................................................................................................................95
11. Non-Alcoholic Fatty Liver Disease...........................................................................................................................95
12. Causes of Cirrhosis..........................................................................................................................................................96

8. Rheumatology
1. Systemic Lupus Erythematosus ........................................................................................................................... 102
2. Antiphospholipid Antibody Syndrome (APLAS)............................................................................................. 104
3. Autoantibodies in SLE............................................................................................................................................... 105
4. Scleroderma (Systemic Sclerosis)......................................................................................................................... 105
5. Mixed Connective Tissue Disorder........................................................................................................................ 105
6. Sjögren’s Syndrome/Sicca Syndrome................................................................................................................. 106
7. Behcet’s Syndrome..................................................................................................................................................... 106
8. Dermatomyositis......................................................................................................................................................... 107
9. Polymyositis................................................................................................................................................................... 107
10. Arthritis......................................................................................................................................................................... 107
11. Sarcoidosis..................................................................................................................................................................... 110
12. Vasculitis......................................................................................................................................................................... 111
13. Giant Cell Arteritis.................................................................................................................................................... 111
14. Takayasu’s Arteritis................................................................................................................................................... 112
15. Polyarteritis Nodosa (PAN)..................................................................................................................................... 112
16. Kawasaki Disease......................................................................................................................................................... 113
17. Granulomatosis with Angiitis (Formerly Called Wegener’s Granulomatosis)...................................... 113
18. Henöch-Schonlein Purpura (HSP)....................................................................................................................... 113
viii One Touch Medicine by Dr Deepak Marwah

9. Gastroenterology
1. Entire Gut in Case based Scenarios..................................................................................................................... 118

10. Hematology Scenarios

1. How to Identify Various Transfusion Reactions?............................................................................................ 122
2. Granulocytes Concentrate....................................................................................................................................... 124
3. Spot Diagnosis in Hematology............................................................................................................................... 127

11. Miscellaneous Case Scenarios

LATEST QUESTION PAPERS

NEET PG 2023.............................................................................................................................................................................. 133
NEET PG 2022.............................................................................................................................................................................. 136
NEET PG 2021.............................................................................................................................................................................. 140
INI-CET November 2023........................................................................................................................................................... 144
INI-CET May 2023....................................................................................................................................................................... 148
INI-CET November 2022........................................................................................................................................................... 150
INI-CET May 2022....................................................................................................................................................................... 156
INI-CET November 2021........................................................................................................................................................... 161
INI-CET July 2021....................................................................................................................................................................... 164
FMGE January 2023................................................................................................................................................................... 169
FMGE July 2023........................................................................................................................................................................... 173
FMGE June 2022.......................................................................................................................................................................... 177
FMGE December 2021................................................................................................................................................................ 180
THEORY
 THEORY 3

1. CARDIOLOGY AND EMERGENCY MEDICINE

CARDIOMYOPATHIES

HCM DCM RCM (Rarest subtype)

Leading Autosomal dominant 1. Toxin-induced: Alcohol
Mnemonic: ACE_SIR
Cause MYH7 Gene on 2. Sequalae of viral myocarditis
• Amyloidosis (MC)
chromosome 14 3. Titin gene mutation
• Carcinoid syndrome
4. Duchenne muscular dystrophy
• Endomyocardial
HOCM is a subtype fibroelastosis
that has LV outflow • Sarcoidosis
tract obstruction • Scleroderma
called subvalvular
• Iron excess/
aortic stenosis.
Hemochromatosis
• Radiation-induced

Gross
specimen

Banana-shaped Thinned out walls of all the Notice the grossly enlarged
Cavity of left ventricle chambers. left and right atria which
Predominant diastolic appear to be bigger than size
malfunction as LV of ventricles
cavity size is smaller
due to asymmetrical
septal hypertrophy.
Increased thickness
of free wall of left
ventricle.
Pulse Pulsus bisferiens Dicrotic pulse Normal to low volume
Heart sounds Narrow split S2 Not useful for diagnosis as S3 and S4 both heard called
Reverse split S2 functional MR and TR are summation gallop
S4 present concomitantly

Murmur Ejection systolic Pansystolic murmur due to Not relevant

murmur due to MR and TR.
subvalvular aortic
stenosis
Effect of Louder Softer __
Valsalva on All murmurs decrease
murmur with valsalva,
standing and amyl
nitrate inhalation
except HOCM which
becomes louder
Contd...
4 One Touch Medicine by Dr Deepak Marwah

HCM DCM RCM (Rarest subtype)

Echocardio- Increased thickness of Reduced thickness of all chambers Enlarged atria chambers with
graphic free wall of heart with hypokinesia stiff noncompliant ventricles.
findings Systolic anterior Dilatation of mitral and tricuspid Square root wave sign
movement of mitral annulus which is also a cardiac
valve catheterization finding.
Intervention Implantable Implantable cardioverter Implantable cardioverter
to prevent cardioverter defibrillator defibrillator.
sudden death defibrillator
Drugs used Propranolol and Low dose of diuretics Low dose of diuretics plus
disopyramide warfarin as fibrosis in heart
wall causes clot formation
that can embolize to the
brain.

INTEGRATED PATHOLOGY SLIDE INTERPRETATION

Pathology slide Interpretation

Notice the myocardial disarray with Y-shaped branching. Totally
disorganized myocytes arranged in haphazard fashion to each other
is diagnostic of hypertrophic cardiomyopathy.

Notice the Ninja star nucleus in myocytes that occurs due to titin
Mutation in cases of Dilated cardiomyopathy.

Notice the pink hyaline deposit in upper part of entire slide interspersed
between myocytes seen in cases of restrictive cardiomyopathy.

Notice the Fibrofatty deposition between cardiac myocytes which is

seen in cases of arrhythmogenic right ventricular dysplasia.

Notice the diffuse infiltration of mononuclear cells in entire slide

suggestive of myocarditis due to viral etiology.
 THEORY 5

ONE-LINERS

Leading cause of sudden nocturnal death in Brugada syndrome

Southeast Asian male with ECG showing ST SCN5A Sodium channel defect
elevation of Cove pattern
Two types of ST elevation pattern seen are Coved
pattern and saddleback pattern.

Leading cause of sudden cardiac death with Arrhythmogenic right ventricular dysplasia. It has
ECG showing epsilon wave fibrofatty deposition in RV epicardium.

Leading cause of sudden death in young guy Hypertrophic cardiomyopathy

doing gym workout

Leading cause of death in MI Ventricular fibrillation/pulseless ventricular

tachycardia. More common in the first hour of MI
which is called Golden period.

Leading cause of death in MI after 24 hours of Cardiogenic shock/pump failure

admission and treatment

Leading cause of sudden death in alcoholic who Holiday heart syndrome due to atrial fibrillation
on admission had absent P waves on ECG

Sudden death of wife after coming back from Broken heart syndrome/takotsubo cardiomyopathy
cremation of husband who died in morning (Intense emotional trauma causing surge of
catecholamines that cause myocardial damage and
cardiogenic shock)

MC arrhythmia seen POST MI Ventricular fibrillation/pulseless ventricular tachycardia

MC sustained arrhythmia in clinical practice Atrial fibrillation

Most dangerous bradyarrhythmia Mobitz II heart block

6 One Touch Medicine by Dr Deepak Marwah

THERAPEUTICS OF CONGESTIVE HEART FAILURE

Acute pulmonary edema HFrEF: EF <40%

• ACEI/ARB (Major mortality reducing drug)
• Carvedilol (start with lowest dose and do
not give if pulmonary edema is present)
• Spironolactone
• ARNI
• SGLT2 inhibitors, like Empagliflozin

Bat wing pulmonary edema

Mnemonic: LMNOP
• Lasix/Furosemide
• Morphine
• Nitrates
• Oxygen using NIV
• Positioning with head-end elevation and feet
lower
• Control of Hypertensive crisis using NTG/
Nicardipine
• Flash pulmonary edema is seen in Renal artery
stenosis and needs ACEI plus CCB or PTRA with
stenting

Efficacy of drugs causing progressive decline in mortality in CHF

8 One Touch Medicine by Dr Deepak Marwah

CAUSES OF ST DEPRESSION

1. Chronic stable angina/Hibernating myocardium/

Reversible Ischemia
2. Subendocardial ischemia (LVH due to Hypertension
that increases demand but supply remains the same)
3. Hypokalemia
4. Digoxin* (Hockey stick sign or reverse tick sign)

MC arrythmia seen with digoxin toxicty Ventricular Bigeminy

Hockey stick sign on MRI head: Variant Creutzfeldt Jacob disease

*Digoxin induced bradycardia is managed with Atropine and if required Transcutaneous external pacemaker. Specific
treatment is digoxin specific Antibodies called digibind.

CASE SCENARIO 1

Boy with recurrent syncopal events at rest. ECG is ECG shows heart rate of 50 bpm. PR interval is
shown below. Diagnosis is? short and delta wave is seen. Diagnosis is Wolf
Parkinson white syndrome.

CASE SCENARIO 2

Boy is noticed to have agonal rhythm by father early Cove pattern is diagnostic of Brugada syndrome
morning at 5 am and is rushed to ER. ECG shows which is a Sodium channel (SCN5A defect)
coved ST segment in lead V2 and V3. Diagnosis?

CASE SCENARIO 3

Sudden death in a boy while dancing at a marriage Hypertrophic cardiomyopathy

party. He had multiple syncopal events in past. Family
history of sudden death in sibling during rock climbing.
Diagnosis?

ABNORMAL ECG FINDINGS COMPILED TOGETHER

P wave Absent: Atrial fibrillation

abnormalities Variable size: Multifocal atrial tachycardia (commonly seen in COPD patients)
P Mitrale: Mitral stenosis due to left atrial enlargement
P pulmonale: Seen due to pulmonary artery hypertension
Pseudo-P Pulmonale: Seen in hypokalemia
PR interval Short
• Wolff-Parkinson-White syndrome
• Lown-Ganong-Levine syndrome
Contd…
26 One Touch Medicine by Dr Deepak Marwah

MURMURS

Early diastolic murmurs Mid diastolic murmurs

Mnemonic: GAP Mnemonic: CAM

• Graham steel murmur • Carey Coombs murmur
• Aortic regurgitation (Mild) • Austin flint murmur of severe AR
• Pulmonic regurgitation (Mild) • Mitral stenosis
(Schematic above has red marking showing
opening snap followed by low pitch mid diastolic
murmur and Presystolic murmur)

Continuous murmurs Ejection systolic murmurs Late systolic murmur

• Coarctation of aorta Mnemonic: PASS Mitral valve prolapse

• Patent ductus arteriosus • Pulmonic stenosis Pansystolic murmur
• Peripheral pulmonic stenosis • Aortic stenosis
• Mammary souffle • Subaortic stenosis/HCM
(physiological finding in
pregnancy)
• Venous hum

• Mitral regurgitation
• Tricuspid regurgitation
• VSD
64 One Touch Medicine by Dr Deepak Marwah

4. ABG ANALYSIS
EFFECT OF EXTRA HEPARIN ON ABG SAMPLE

pH = falls as heparin is acidic

pCO2 = falls due to dilution
HCO3 = falls due to acidic nature
Always expel air bubbles. Do not bend the needle but put a rubber stopper at distal end of needle to avoid
false elevation of pO2. Sample should be put in ice if it is not being analyzed in next 10 minutes.

ABG HACKS

Mnemonic
ROME: Respiratory problem causes pH and pCO2 to move in Opposite direction and Metabolic problem
causes pH and pC02 to move in Equivalent/same direction

pH pCO2 HCO3 Interpretation

Low Low Low Metabolic acidosis
High High High Metabolic alkalosis
Low High High Respiratory acidosis
High Low Low Respiratory alkalosis

CASE SCENARIO 37

Parameters Values Interpretation

pH 7.25 pH is low and pCO2 is low implying metabolic problem. Low bicarbonate
seals it as metabolic acidosis. Expected pCO2 by modified winter formula is
pC02 25
same as actual pCO2 value implying compensation process is working.
HCO3 10 Partially compensated metabolic acidosis
OR primary metabolic acidosis with compensatory respiratory alkalosis.

Expected pCO2 = HCO3 plus 15 = 10 + 15 = 25 mm Hg. Since expected and actual pCO2 are matching
it implies compensation is working.
96 One Touch Medicine by Dr Deepak Marwah

RECENT ADVANCES Clinical Features of Compensated Cirrhosis

Non-alcoholic fatty liver disease 1. Spider nevi/angioma seen in SVC distribution
• Non-alcoholic fatty liver disease leads to 2. Palmar erythema
macro-vesicular steatosis (Reye’s syndrome 3. Dupuytren’s contracture (begins in ring finger)
leads to microvascular steatosis). 4. Clubbing of nails
• Most patients are asymptomatic or complain 5. Gynecomastia
of right upper quadrant pain.
6. Testis atrophy/hypogonadism
• Antinuclear antibodies with elevated serum
ferritin levels.
• Percutaneous liver biopsy is not recommended.
• BARD score: Serum bilirubin, AST/ALT
>0.8 and diabetes mellitus has 96% negative
predictive value.
• 7–10% weight loss and exercise. Both aerobic
exercise and resistance training improve muscle
insulin sensitivity. Stains in patients with
dyslipidemia and NAFLD show benefit. Previous
approaches like metformin, thiazolidinediones,
pentoxifylline and ursodeoxycholic acid have
marked side effects.
• Liver transplantation is done in appropriate cases.

CASE SCENARIO 49

A 40-year-old patient of grade II steatohepatitis

of liver presents with regular intake of 2-3 alcohol
drinks daily and has BMI of 29. What will be the
most appropriate advice to the patient?
a. Lifestyle modification + regular exercise
b. Lifestyle modification + vitamin E
Ursodeoxycholic acid
c. Lifestyle modification + Pioglitazone
d. Lifestyle modification
The patient has alcoholic hepatitis and is
overweight. Exercise plus lifestyle modification is
best recommended for this case. Options b and c 3. Cardiac Cirrhosis
are used in NASH but are not FDA approved.
• Cardiac cirrhosis/congestive hepatopathy leads
CAUSES OF CIRRHOSIS to NUTMEG LIVER.
• This occurs due to venous congestion, usually due
1. NAFLD to cardiac dysfunction like cor pulmonale.
2. Alcoholic cirrhosis • This congestion will stimulate hepatic stellate
cells, which will initiate fibrosis leading to
EXTRA MILE regressed liver size.
Mallory hyaline bodies are seen in: (Mnemonic: I
will break alcoholic status) RECENT ADVANCES
Ultrasound elastography
• Intestinal bypass surgery
• Wilson disease Elastographic techniques based on shear waves
generated by the acoustic beam are used for early
• Biliary cirrhosis
detection of cirrhosis and have the advantage of
• Alcoholic hepatitis
being noninvasive, in comparison to liver biopsy.
• Steatosis
 THEORY 129

11. MISCELLANEOUS CASE SCENARIOS

CASE SCENARIO 70 CASE SCENARIO 71

A 15-year-old child with dystonia, dysarthria and A 20-year-old guy doing regular gym workouts
poor school performance is found to have the following and eating good diet presents with severe sensory
finding on ophthalmological evaluation. Which of the neuropathy with dysesthesia in glove and stocking
following is correct about this presentation? pattern and ataxia. He eats both veg and non-
veg items with some unknown supplements. Which
of the following is likely to be responsible for this
presentation?
a. B1 b. B6
c. B9 d. B12
The patient is having features of vitamin B
6 toxicity due to his supplements leading to
sensory neuropathy with dysesthesias and sensory
ataxia. NCS reveals reduced Sensory nerve action
potentials.
Ans. (b) B6

a. Defect in P type ATPase protein that transports CASE SCENARIO 72

copper into bile
A 30-year-old man is having foamy urine for past few
b. Defect in P type ATPase protein that transports
days. On work up, massive proteinuria is found and
copper to basal ganglia
kidney biopsy was done as serum creatinine was rising
c. Defect in P type ATPase that causes excess
progressively. Electron microscopy shows extensive foot
transports copper across cell membranes
process obliteration, mesangial sclerosis with increased
d. Defect in P type ATP ase that causes inhibition
matrix and collapsed glomerular loops. Diagnosis?
of copper across cell membranes

Wilson Menke

ATP 7B protein defect ATP 7A protein defect

due to defect in Copper-transporting
chromosome 13 P-type ATPase which
Copper transporting uses the energy arising
ATP ase is located from ATP hydrolysis
in the trans-Golgi to transport copper
network of the liver across cell membranes.
and brain and balances
the copper level in
the body by excreting a. Membranous glomerulopathy
excess copper into bile b. Focal segmental glomerulosclerosis
and plasma c. Minimal change disease
d. Post-infectious glomerulonephritis
Ans. (a) Defect in P type ATPase protein that Key words are foot process obliteration, mesangial
transports copper into bile sclerosis with increased matrix and collapsed
glomerular loops in an adult patient which point
to diagnosis of FSGS.
Ans. (b) Focal segmental glomerulosclerosis
Latest Question Papers

→ NEET PG 2023 → INI-CET MAY 2022

→ NEET PG 2022 → INI-CET NOVEMBER 2021

→ NEET PG 2021 → INI-CET JULY 2021

→ INI-CET NOVEMBER 2023 → FMGE JANUARY 2023

→ INI-CET MAY 2023 → FMGE JULY 2023

→ INI-CET NOVEMBER 2022 → FMGE JUNE 2022

→ FMGE DECEMBER 2021
 LATEST QUESTION PAPERS 133

5. A 60-year-old man with a history of smoking

NEET PG 2023
presented with pain in the right arm. There is
1. A 30-year-old patient presents with BP of also evidence of ptosis and Horner’s syndrome.
160/110 mm Hg and on CT head subarachnoid Chest X-ray is given below. What is the
hemorrhage is detected. What is the next step diagnosis?
in the management of this patient?
a. Nimodipine
b. Conventional angiography for aneurysm
c. Urgent surgical intervention
d. IV mannitol

Ans. b. Conventional angiography for aneurysm

2. Which murmur is shown below?

a. MR b. AS a. Right upper lobe pneumonia

c. MS d. AR b. Lung aspergilloma

Ans. a. MR c. Pancoast tumor

d. SVC obstruction
3. A patient presents with chest pain radiating
to interscapular pain, with BP in left arm = Ans. c. Pancoast tumor
160/110 mm Hg and right arm = 110/70
mm Hg. CXR shows widening of mediastinum. 6. A 65-year-old patient who occasionally takes
What is the diagnosis? alcohol and is on aspirin therapy for 4 years
is having epigastric pain in the abdomen with
a. Pulmonary embolism b. Aortic dissection
hematemesis and melena. What is the likely
c. Esophageal rupture d. Myocardial rupture
diagnosis?
Ans. b. Aortic dissection a. PUD
b. Mallory Weiss
4. A 10-year-old boy, weight of 30 kg is admitted c. Boerhaave syndrome
with features of severe dehydration, nausea d. Variceal bleed
and vomiting. Urine sugar is 3+, urine ketones
3+ and RBS = 500 mg/dL. ABG shows pH of Ans. a. PUD
7.1 with HCO3 = 7 mmol/L. Serum potassium
is 3.5 mEq/L. Next line of management as per 7. Patient is surgically treated for pituitary
ISPAD guidelines is? tumor. He is now having polyuria with high
a. 10 mL/kg of IV fluids and 0.1 U/kg/hr serum osmolarity. Which of the following is
bolus   correct about treatment of this patient?
b. 10 mL/kg of IV fluids and after one hour a. Arginine vasopressin life-long basis
of fluids 0.1 U/kg/hr of insulin b. Arginine vasopressin for 2 weeks
c. 20 mL/kg of IV fluids with 0.1 U/kg/hr of c. Vaptans for life-long basis
insulin bolus d. Thiazides for 2 weeks
d. 20 mL/kg of IV fluids and after one hour
of fluids 0.1 U/kg/hr of insulin Ans. b. Arginine vasopressin for 2 weeks

Ans. b. 10 mL/kg of IV fluids and after one Majority of cases develop transient diabetes insipidus
hour of fluids 0.1 U/kg/hr of insulin post pituitory surgery