L right L hi guys today's a practice session for the forthcoming exams so let's just uh revise a couple of facts together I know that your efficiency is down because of all these news that keeps on happening and uh I thought instead of reinforcing that information what I should be doing is discuss some questions uh which would help you again make your reflexes become razor shop and uh I know that efficiency is lesser but then everybody's in the same boat so you just have to persist with me and uh your new CeX will gradually adapt to this environment your eyes will start going to the correct answers very soon and uh let's get this journey I mean you know you got nothing to lose man I mean that's anyway going to happen but we take it on the chin and we just focus on the core aspects that come uh I mean handling those Core Concepts or handling those core issues are the main job of a doctor so let's just focus on those as far as today is concerned and I'll just make you do some mcqs of the previously conducted fmg exam and I think that that would help you you know understand you know everything it is just our brain become super saturated with facts and that is when we think that but then we are able to perform so let me just check if I am online at the movement just give me a thumbs up with respect to the audio and the visual part and uh we can get started for today okay so give me a second and just give a quick thumbs up for the audio and the visual part so that uh I can just check that out okay you don't need to worry man you don't need to worry hi hi Dr Putin good to see you again so uh very good evening to everybody and I think I missed a couple of names in between but uh you don't need to worry I I got you right and I got your back as well so cool let's get started with the very first question a very simple and a straightforward one where he spoke about a 33y old woman what M objective is we I'm going to try and do in under one hour as many max number of questions I'll try to dedicate about one to one and a half minute for every McQ hi chef uh everybody I think I missed out a couple of names in between but uh I I'll keep on talking to you so great great CH a 33y old woman is being evaluated for excessive daytime sleepiness and forgetfulness which has been present for past one year so who better than a doctor who can understand you know sleep deprivation I think we all are going to go through that same stages forgetful is something let's now focus on the core aspect the body mass index in this particular case is 43 that means obesity and that makes it two two possibilities in this question one is going to be obstructive sleep apne and second is obesity hypoventilation syndrome now how to differentiate in this McQ there is no mention of any snoring episodes right or snoring episodes he's also not mentioning about any Epic episod and more importantly in obstructive SLE respiratory but in this question you can notice that the pco2 the patient is elevated which means that you just need to add two English words first is obesity body mass index is 43 plus the pco2 of the patient is elevated so very good guys I think everybody got this one correct the answer is obesity hypoventilation syndrome question question changeing epes then the answer of this question should be given as option number D the main clinching point for this msql say once again is that ABG of the patient is showing respiratory acidosis in patients who are suffering from obstructive at night but at daytime their pco2 values would be normal which is why I think everybody got this one correct so cool man I mean see your reflexes work and you have to understand that some things you know but questions they might modify the options also so that is my humble request to you that don't straight away jump to the answer and uh I anyway have had good answers for the first question uh narcolepsy will be having HLA dr2 positivity narcolepsy will be having increased daytime sleepiness but then obesity component goes against it and Central sleep apnea to whenever he sleeps it's a very rare disease no so I mean because obesity is given in a question we can rule out the remaining two options and the more appropriate answer here is option number a uh what is the golden Point yeah yeah doctor that's the point Black Panther in central sleep apnea every time the person will sleep try to sleep there would be a Associated hypoventilation on onine in fact you know when we were kids there used to be a story sh you understand okay I understand you know maybe you may not be very good with our Hindi words but then sh was that someu gave you know curse to a King that is anyway let's move on to the next one Central sleep apnea guys the key word is that person when he will sleep he will be having development of respiratory acidosis but here when he's awake he's having respiratory acidosis so that's the differential now let's understand the second Point all of the following will show hypokalemia except yes guys a quick voting at this particular point of time for this uh okay yeah yeah it's not a badua it's not a actually it's a curse you know they used to be like very educated and very I mean renowned people and if they used to get angry then they used to you know take it out on others okay uh the next question is about all are true about hypokalemia except so I think most guys are going to be getting it right again uh when it comes to RTA RTA 4 will always be having a hyper calmia because there is a impairment like you can see in the diagram here that enac will not be working and if epithelial sodium Channel resistance is present in the case then sodium and water will not be salt and water will not be absorbed and there would be inability to excrete potassium from the body and if potassium is not excreted we will be getting a hyper calmia but in all the remaining varieties we usually tend to get a hypokalemia component present and why D is having a hypokalemia because urro Sig because you're diverting the urine of the person into the colon so it's going to change the pH of the colon it's going to change the bacterial count to the colon and therefore there is a diarhea component present and diarhea always has a hypokalemia present so therefore the answer for this question is option number c the question can be asked vice versa also now that he can ask you which of the following will be he can make permutation combination so RTA 1 and two have hypog understandable but uromi why it has a hypokalemia because of the diarhea component and the reasons uh that I have explained to you oh great I am happy because I thought that I should make you guys cheer up you know I was getting so many messages tired it's a life so I pumped myself up guys and I thought that I'm going to motivate you guys to Doc you can try these questions if if you think that you were able to solve them cool I mean you try to do them in a limited time frame yri 10-year-old kid is blot with two we history of not feeding well excessive irritability next stiffness so it's going to be a case of menite is where there's a history of tuberculosis also present so we are focusing on those 50 odd questions that I'll be covering with you and we going to focus on um uh those core topics which are going to be asked okay so as far as tuberculosis is concerned uh there would be tubercular menitis where we have Rich Focus present quick voting guys there's going to be lymphocytosis exactly now there are two options for lymphocytosis and you have to pick up that the bacterial infection will always be having a low sugar and a high protein so the correct answer for this one is option number a and most of the time the protein value that would be given here would be in grams most of the time it would be like more than one gram per dilit so anyway I mean every time in an Indian exam you get lymphocytosis with a long-standing history like two week old history it cannot be a viral iology has to be tubercular so uh cool man answer is uh option number a for question number three and let's move on to the question number fourth for the next one uh yes yes questions actual exam then people are not able to solve them because of the pressure all that happens is how do you react to pressure questions are straightforward only diseases will remain the same in those circumstances only a cobweb coagulum may or may not be given right I mean not always would you be having a cobweb coagulum so the key word in this question is not cobweb coagulum it is lymphocytosis with low CSF sugar that's the main that you have to remember and uh Dr imperfect straw color CSF would never help you uh I mean don't use color of the CSF for any McQ the next one is a patient of lung cancer with breathlessness and lightheadedness and there is mention of bronchial breathing now in a lung cancer patient what I was thinking was that the patient would be having a plural Fusion but the lung cancer metas to the heart when the lung cancer will metas to the heart it will cause a malignant pericardial effusion that will squeeze the heart press on the heart and will cause a lung consolidation you see the answer to this question is not plural effusion because plural effusion will not be having a presence of bronchial breathing you also another you know dullness because plural effusion will always be having Stony dullness present I mean why the answer is not plural effusion because plural effusion in the McQ will always be having the word Stony dullness present plus in plural effusion you will not be having bronchial breath sounds it would be rather distant breath sounds that would be present and I think that what I'm teaching you at the movement is one of the core aspects that is always asked in your fmg exam so you just need to get used to this and since bronchial breathing is given therefore current explain the reason is that the cancer is metastasing to the heart and the heart is pressing on the lung and the pressure on the lung will contribute to lung consolidation and that is why bronchial breathing is present so the correct answer for this one is option number a why it is not constructive pericarditis because constructive pericarditis will always be po post tuberculosis it is like post antitubercular treatment that there would be calcification around the heart there is no history of any TB given and numo thorax would either be like you know ventilator induced trauma barot trauma or it's going to be like a penetrating injury to the chest which is again not given in this question so the correct answer for this question is option number a that is cardiac tanard and let's now look at another question which has been asked where he said a person is diagnosed with pneumonia and is having increasing breathlessness he is then say that the percussion note is dull now when I read this question I'm thinking to myself stone stone needle and then he's also mentioning that the person is having decrease in sensitive breath sounds so what is happening in this particular Cas is that there is a development of a Paran pneumonic effusion Paran neonic effusion pneumonia or pneumonia plural effusion develop so every time we read about a presence of a pneumonia with a plural effusion it's a Paran pneumonic effusion in this case which is why the answer in this case is option number b or diagnose then the person will go into empa that is accumulation of pass in the plural space of the patient and that can cause a deteriation to quickly chat box comment that in a case of empa if you have to do a diagnostic thoracentesis you would be putting the needle in which intercostal space yes guys it's an it's an exodite exactly now let me know that if there's an empa you going to do a diagnostic thoracocentesis anyway so what is going to be the side we're going to put in the needle quick waiting for your answers yep lights criteria is useful for diagnosis this is going to be exuded what you have to understand is pneumonia is a trigger for development of a Paran numic Fusion that is why the answer is as I mentioned uh okay guys no no no it is not the fifth intercostal space thoros centesis I asked diagnostic thoros say is eth intercostal space c mistakes it is not the fifth intercostal space fifth intercostal space is where you will put the chest tube in this case first you will be demonstrating the P Now by first you will be demonstrating that there is a p in the plural space of the person so you will be doing a diagnostic thos enesis and after that you will be putting in a chest tube that chest tube will be put by you in the fifth intercostal space in the midaxillary line so if I was asking you that where are going to put a chest tube understandable but for Diagnostic thos cyesis it is eighth intercostal space try to do it as low as possible the learning point for you guys is after pneumonia if somebody's having a worsening in spite of giving antibiotics it could possibly be a paranemic effusion that can deteriorate into a complication called as empa second thing to be understood is lung cancer patients can be having cancer metastasing to the heart and that can cause a malignant pericardial Fusion that can again press on the lung and therefore this particular question was on on Evart sign so this was slightly a difficult one I don't anticipate that they should be asking this Evart sign in the exam but question number five is a very justified by but the point question number five four is difficult you know some medicine questions are going to be like that but then question number five that I am saying before you is going to be the one which is standard bread and butter that fmg exam question Paran neonic effusion then we come to the next one ABC D2 score includes all of the following parameters except so a is a of the patient B is blood pressure uh C is clinical history clinical features of stroke it's not a history of stroke it is clinical features of stroke like patient can be having a facial asymmetry there could be a arm weakness there could be speech deficits that is occurring in a person so that is why I mean uh yes guys waiting for your answers uh here and D would be for diabetes malus and duration so the correct answer for this one is history of stroke as I mentioned it is not history it is it is going to be features hisory of Str then it is called as Chad Chad S2 VSC score ORV it is used to decide the need for anti coagulation it is to use the need for oral anticoagulation in a case of atal fibrillation so the for anational fibrillation and second is abcd2 Spore which is used to decide ABCD Spore use guys quick answers in the comment box abcd2 score is used to decide what it is used to decide percentage of chances whether person will or will not develop stroke so chances of stroke development can be diagnosed by abcd2 score and the need for anticoagulation in atal fibrillation by Chad S2 VC score see guys I'm getting brilliant answers here I mean right straight away at the moment asked you know your subconscious brain will start registering those facts I mean your eyes will start going to the correct answer so try doing these questions with me and you are going to be just fine very good M1 Academy your answers were excellent excellent a 60-year-old man presents with a sudden onset right sided hemiparesis for the previous 3 hours the blood pressure is 200 by 100 the ncct head is shown in this case so since it's a case of stroke with elevated BP initially I thought I will have to lower the BP because 200 by 100 is going to be very very high but then in this question you can notice that there is a hyperdensity present already this particular case is having brain hemorrhage if there is a presence of brain h in a case then uh this tells me that I am not supposed to do thrombolysis the correct answer for this one very correctly picked up is option number a initially I thought I might have to go for BP control but then thrombolysis is absolutely contraindicated in a case of CNS bleeding because if I do thrombolysis in a case of Cs CNS bleeding it will increase the chances of this bleed so yes M1 Academy and other people you have given correct answer here and thrombolysis should be done within 4.5 hours what is the upper limit where we should be doing thrombolysis then answer is 6 hours and after six hours quickly comment chat in a case of stroke like suppose he says acute isic stroke in the first 6 hours then in the first six hours what I'm going to do is I will use thrombolysis in the patient that is I can be using elap place but if it's going to be after 6 hours and going up to 24 hours then in in those circumstances what is the intervention that is done yes upper limit is 6 hours manol yes jalam you right we do not give manitol in active CNS bleeding perfect Perfecto yes the answer is mechanical thrombectomy or instead of mechanical thrombectomy they can use an alternative term also now so the technical term that I expected you to answer here is called as EVT EVT would stand for endovascular therapy and endovascular I mean your answer is correct guys that is mechanical thrombectomy I just wanted to emphasize that because we doing brain angiography and then we are seeing where the clot is and then we are trying to destroy that we are trying to remove that clot in one piece using a retrievable stand so it is a mechanical throaty which is also called as endovascular therapy so cool guys that's a great answer there and then this was again a question which was I would say not I was not very happy with very he saidis this is like what a scenario that yeah black panther things will work things will work in your favor just just keep on applying those um uh you know lots of time English helps sometimes your subconscious uh perception will work but then your reflexes will work in this case so what we do in this case is usually the dose that we give would be 0.9 milligram per kilogram so it is 18 to 0.9 that is about 72 mgram dose and 72 M 10% would be given initially that is 7.2 he's not asking you how much is the total dose to be given he's saying how much is the initial dose so initial dose that we give in this case is 10% of the total calculated which will turn out to be 7.2 and the closest answer for that would be 8 mgram so I think we can not worry too much about questions like these and we can let them go don't bother about dosages Etc let's now handle the next question a 50-year-old man presents with involuntary hand movements the mov I read involuntary hand movements with the development of cognitive and emotional problems cognitive is telling me Alzheimer's but do we read about involuntary hand movements in Alzheimer's disease unlikely so I am uh I'm not happy with option number c in this question I'm waiting for your answers and then when it comes to parkinsonism yes it can be parkinsonism because there is even in parkinsonism there can be development of subcortical Dementia in the patient so yes I will be considering this differential plus minus in this case then fredrich Axia will have Axia so two options are off the discussion and we are left with two options here parkinsonism and Huntington Korea Now 50 years is a little early for parkinsonism usually parkinsonism would be developing in 60 years years of age and then there would be mention of Tremors there should be presence of Brady kyia I mean why the answer is not parkinsonism is because in this question the must have criteria for diagnosis of parkinsonism is not there and the must have criteria for diagnosis is Brady kyia not described in this question if he mentioned slowness if the same question was given and Brady kinesia guys because in the McQ if he will be putting Brady kinesia then the answer will change and will become option number a at the moment what because of the fact that you done this question earlier so you getting a correct answer here that is Huntington Foria which is a disorder of trinucleotide repeats and you were able to answer that correctly but because in the exam they can modify disease to there going to be four disorders like this only but what you have to do in the actual exam is evaluate the evaluation part is no mention of yes somebody mentioned rigidity mask like faces is not reliable what you need to FOC focus on is mainly trap trap would be Tremors then is rigidity ayia or brainia and postural instability and the must have criteria for diagnosis of parkinsonism Parkinson disease is Brady kinesia let's move on to the 10th one which of the following jvp findings is expected to be seen in a patient with muffled heart sounds hypotension and a raised jvp because he has mentioned muffled heart sounds we are understanding that he's talking about cardiac tampon the M I pick up the word cardiac I just have to look for a steep X and A absent y descent and therefore the answer in this question will turn out to be option number B somebody asked me treatment of Huntington pora well you should be answering it no it is a disorder of extra dopamine in the brain so I am giving everybody else an opportunity to answer uh this young doctor can you tell me a dopamine depleter that will be used here yes the answer for the question number 10 is option number B but in the excess of dopamine aspect which I'm mentioned superiorly yes can I have an answer can you tell me a dopamine depleter that we use for Huntington koria we are not going to use lopa because it will cause deteriation of the case so yes a bit of spelling mistakes there but still people did mention there it's a dopamine depleter that we going to be using here and the dopamine depleter that would be used is tetrabenazine so answer to this question is going to be given as option number uh uh answer to this question ninth is D and the 10th one is B and let's do some more questions here a 45-year-old man is brought to the hospital with complaints of suddenly not making any sense while speaking and uh using nonsensical grammar though he can speak Qui quickly he could communicate effectively prior to this he says which of the following defect is present in this patient so I mean the the basic concept is yeah yeah you were right guys now brought to the hospital by it unlikely to be motor Aphasia because motor Aphasia would be a feature of broas area getting damaged so the answer to this question cannot be option number a because it is motor Aphasia means that broa area is getting affected and in this case broa area is not affected enomic Aphasia is a feature of metabolic incopy like if a person is having ammonia intoxication if a person is having uremic incopy so metabolic en sopath causes enomic Aphasia that is difficulty of naming an object so answer cannot be B and between option number C and D in this case yes the concept is that area of brain which is damaged in this patient is because nonsensical grammar nonsensical grammar means jargon speech so all you have to pick up is the key word in this question as people are doing at the moment because patient he's speaking those random words so it is jargon speech and that is why the answer to this question would be given as fluent Aphasia and why is not conduction aphasia because conduction Aphasia he will be able to understand but he'll not be able to repeat conduction epia refrigerator understand but he cannot repeat those words so he just repeated some words in Parts there so conduction aasia due to damage to Aros FAS and this is to be answered if there is a problem with repetition and what they've done in your exam is that they've given all these permutation combinations so I want you to remember four mcqs from this particular McQ first and foremost if he says if he says that he's having difficulty in naming a object like you showed him a mobile phone and you said what is it and he's he's like staring at your face he knows it's a mobile phone but it's taking a while for him to speak out that would be enomic aasia difficulty naming an object plus there would be mention of Al failure liver failure in a person so in the setting of liver failure renal failure anomic Aphasia comes in if he says that he can he can understand everything but he cannot repeat that is conduction epia but here that Ison speech so that is ver area damage that is fluent Aphasia yes exactly a you are right it's a word salad that's an alternative term for jargon speech let's move on to the next one it says scissoring gate will be occurring due to increase ing of which of the following nerve in fact you know scissoring gate you you tend to read about scissoring gate in patients who are going to be having cerebral pulsy neologism is again you know something I would say terms uh that can be present even in schizophrenia so uh I mean instead of saying neologism it's Jaron speech and words spelled which are more appropriate now cerebral pulsy is what I'm talking about and in cereal py there is going to be adductor spasm present and the adductor spasm the adductor Magnus muscle is going to be supplied by the opor nerve so the correct answer for this one is option number c option number B again has been asked in the exam inferior glal nerve that is luring it body move that is laring gate wadling gate wadling gate is what you see with respect to dislocation of hip joint or you you could be seeing a wadling gate or you could be having a wadling gate with patients of D muscular destrophy but lurching it is where inferior gluteal nerve is damaged and if it is superior Glu nerve then this is again an McQ of your exam I'm just going to move up my slide Superior glal nerve damage is seen with trendin burgade in fact this trendelburg sign again has been asked in your exam that the pelvis of the patient will drop on which side like you can see gluteus medius on one particular side is weak then the pelvis drop would be on the contal side in the person and that normally they love to ask about tranberg sign in the exam so I always used to ask my students to remember tranberg sign due to weakness of gluteus medius and this is the nerve that gets involved in this case is the superior glal nerve uh I mean this is what I always ask students to remember but then he just you know pushed up the game by a few notches and he changed the question into aductor spasm of scissoring that is seen in cerebral pulsy and the answer would be given as op toetal nerve so what you need to remember is yes it should be going to the opposite side you perfectly right and you uh there are three mcqs that we covering here like we covered four mcqs in question number 11 we are covering three mcqs in question number 12 that is going to be like op toor nerve adductor spasm then is inferior glal nerve that is lurching gate and then Superior gluteal nerve that's going to be uh related to Trend Lumber gate then is a very easy question on dialysis dementia person is undergoing recurrent hemodialysis so what's going to be accumulated in the brain is AB to amloid and a related McQ for you guys IET Associated amloid precursor protein this would be seen with respect to which other the following yes guys uh I a is IET Associated precursor protein this would be seen with respect to diabetes mellitus two questions which are covered here a beta 2 e beta to everybody knows Alzheimer's disease so that's never an association or problem but then a beta 2 is going to be dialysis dementia and ilet assciated aoid protein or a precursor protein getting deposited is with respect to diabetes meitus the next question is on Gan bar syndrome traditionally in Gan bar syndrome he asked the cause that is compilo Janai or zika virus but today he's asking us that which antibody would be responsible that the antibody which is present here is called as anti gm1 antibody he's not even asking us the name of the antibod saying it will be which class the logic is the logic is in Gan bar syndrome the progression of paralysis can be sometimes over 12 hours the whole body of the patient will become paralyzed in some cases the paralysis might go up to or might slowly go up to 4 weeks that is 28 days so the message here is because we are talking about large number of days so that is why the antibody in this case would be imunoglobulin gclass uh guys the answer to this question white is turning out to be a is primarily because of the fact that anti- gm1 antibody which is responsible for the dation of the spinal cord antibody it can cause a fast progression over hours but it can cause progression over days also so then it's not going to be IG it's going to be imunoglobulin G Class of antibody so the correct answer for this one is going to be given as option number a and yeah there is a sparing of urinary bladder in gulin bar syndrome we move to the next one where says which are the following is correct about wolf Parkinson White syndrome this is a condition where we read about bundle of C there is to be a fast conduction in this particular case but the PJ interval of this condition is perfectly normal yes it is Brighton criteria Bish Pria you're right so the point is that in wpw syndrome what happens is PR intervals comp reload and the reason for that broadness is inter myosite conduction which is going to be relatively slower than the pering fiber so the correct answer for for this particular question would be option number B uh here the trick in the McQ is it is not a short PR interval it is a uh I mean it is written short PJ interval short PJ interval is seen in cousin brother of wolf Parkinson White syndrome and the cousin brother of wool Parkinson White syndrome please comment in the chat box I would like everybody to do that commenting which condition do we read about James mundle yes guys second answer in which condition do you get James bundle yeah PR is short QRS is Broad bundle of C is going to be wpw which condition do you read James bundle test 10 seconds on man yeah Delta wave is a good pickup point for wpw where the P will end and that's when there would be a broad RS complex so that's a Delta wave that would be coming up so that's understandable okay okay that is cousin brother of wpw is called as L gong leine syndrome so no problem spelling isues LG LGL is L gong Levine syndrome L gong line syndrome the cousin brother where we have James bundle would be the one where there would be a presence of a short PR interval so a quick practice here that I would like you to go through I mean if you listen through my videos in prepladder I have emphasized this point repeatedly that wpw and LGL is like a hard favorite with fmg examiner I don't know why are they asking it but they have been asking this this for large number of years so be very thorough with these topics go through it either in Rapid revision or you can go through it in the main section P but I can assure you the fact that I mean LGL or wpw directly indirectly it can be present in some questions or like you know PJ interval PR interval or any standard informations that they love to ask so just go through keep on practicing questions with me keep I mean keep persisting moving to the next one a 40-year-old woman presents with difficulty eating due to uh persistent dry mouth and uh dry mouth is one of the key words in this question dry eyes is also there so I am talking about uh exocrine glands being affected like crimeal glands liary glands getting affected that is by Dental cares be because the saliva has a bactericidal property and in these circumstances the movement we pick up that there's a dry I dry mouth yes perfect comments started coming I'm still waiting most guys are comments are giving are coming correct it would be esjan syndrome in the case so sarcosis per se will always be presenting with a female and she'll be having breathing difficulty she'll be having bilateral higher lymphadenopathy so as such I don't think so that there would be any problems vagous gitosis I'll discuss subsequently and then mixed connected tossue disorder we'll be having features of SLE as well as of Scleroderma as well as a polymyositis and can be therefore ruled out in this particular question I think everybody did correct as Jan syndrome would be having dry eyes and dry mouth no no not a leathery skin leathery skin is a feature that is seen with Scleroderma but at the moment the topic that we studying is sjer and again if you go through the rapid revision section in prepl that I have spoken uh you will notice that the rat section is like very precise but it's very high yield so in case you are having any issues in solving it please go through that section once again so that you can get those core uh diseases right yes the antibodies which are found in sjan syndrome would be SSA and SSB antibody but if he says what is the investigation of choice then it is not an antibody the investigational choice for these patients would be a salivary gland biopsy now if I take a biopsy from pared glad of sub I might create a fista so therefore what we do in these patients is we take a biopsy from lips Min Sal yeah okay let's not butter you know something you you went out and you had a pizza right a cheese B Pizza so you'll start salivating in your mouth so what's going to happen is there's going to be saliva accumulation and that saliva accumulation is going to be because minor salivary glands would also be working so what we're going to do in this patient is labial biopsy and this labial biopsy will help us identify the damage to the minor salivary glands in the patient yes yoges you right the best way for diagnosis in this particular case is a labal biopsy cromier antibody is going to be seen with Crest syndrome no no dog centrom antibody doctor is seen with Crest syndrome and shers test is obviously one of the test which is going to be like seen before diagnosis or dry eyes but it is not a diagnostic test so okay okay so let's not focus on piz let's focus on the job at St okay the answer to this question is option number c s Jan syndrome is not diagnosed on the basis of antibodies as jran syndrome would be diagnosed on basis of a labial biopsy H yes so I mean I just adore the facts that you come up okay 70y old man presents with low back pain and Progressive p in your fmg exam or need PG exam every time they give you a man with low back pain 70 years of age either think prostate cancer or think of multiple Myoma these are two simple thoughts that you need to have he's telling you kft is DED then he's also telling me that uh GMA globulins are disproportionately elevated I mean the Albin globulin ratio in this patient is what he's talking about about that alamin is normal but gamma globulin is elevated I mean the M he says about gamma globulin he's talking about multiple Myoma and suppose you could not pick this up you could have picked up this word that is multiple litic Legions present in this case and the moment you read about multiple litic Legions the answer for this case would be plasma cells that is multiple Myoma would be the correct answer to this question so great guys great going tell me the investigation of choice for this condition and we move on to the next one what is the ioc for diagnosis of multiple [Music] yeah crab is going to be like the Myoma defining events here what is the investigation of choice for this condition I'm waiting for your answers we get passed out lesions lighting lesions in the pelvis in the in the vertebra the most common site where we get these litic lesions is not going to be the skull the commonest site is the pelvis so yep Vishnu prya mentioned it correctly there the multiple Myoma fat would be having bone marrow biopsy as the investigation of choice and no no doctor it's not serum electroforesis Serum electroforesis is a screening test for this condition investigational choice in hematological disorders always has to be bone marrow studies so that you can do cytogenetic evaluation you can do full flowetry on them so we'll do a bone marrow biopsy and then we can run I mean specialized test on them so the main test for diagnosis of this condition is going to be answered by you as bone marrow biopsy and the screening test that we do is serum electroforesis Serum benston protura is not a reliable way for diagnosis there are three things guys only three things here crab that is one second unit to remember screening test that is going to be the main finding of serum electr fores is showing a m Spike and then bone marrow biopsy showing 10% plasma cells that is all you need to do and you sorted for this disorder and the drug of choices lenalidomide and steroids and bom that's a protome inhibitor if you did not remember the the drugs there do practice it subsequently lenalidomide I'm not writing it because we're going through questions lenalidomide dexamethasone and bom is the drug that we'll be using Okay moving to the next one a patient had a road traffic accident he's brought with bradic cardia with elevated BP now what is bradic cardian elevated BP telling me it is Cushings reflex and because in this chap the G CS of the patient is eight less than eight it means that he's also going into a development of raise ICP and coma there are two informations which are given in this question one is that there is a elevated intal pressure why because of pushings reflex and second is the patient is going into a coma and because the patient is coma to I need to secure the airway because the first and the foremost thing in anybody who cannot protect his Airway is to intubate and prevent microaspiration of saliva so uh yeah yeah it would be available doctor it would be available yes so we'll have to intubate and go ahead we will not be giving uh in these patients straightaway manitol because I first want to see is he having active cus bleeding or not because in acus bleeding we do not give manitol to the case uh moving to the next one he's talking about a patient with pedal edema and then there is raise jvp till the mandible I mean ultra high elevated jvp and there's an atis also so these findings are telling me which side of the heart is involved the right side pelema is a feature of right heart failure raise jvp is a feature of right heart failure aitis is a feature right heart failure and he's not even asking you that it is left or right heart failure he's just asking what is the answer in this case that would be CC failure why would you not like to answer renal failure because renal failure would not be having presence of aide T no that goes against it and this is not a brain injury because all cardiovascular findings are given liver failure will contribute to Pedal and will contribute to a but then liver failure causing rise jbp is not there suppose in this McQ now I'll use a different color suppose in this multiple choice question the only information that was given was pedal Adema and he was mentioning atis in aent if only two green things are given in the question then answer is liver failure if he says just pedal EMA and atis then you will say liver failure if you're having a pedal edema atis and raise jvp then you will say cardiac failure in the case so absolutely right the jvp finding would would uh would be making it DOC people got this wrong in the actual exam you know ji people messed it up so it is just that because we go through it our eyes see what our brain knows now that is what I'm trying to teach you that why you have to practice this don't Focus that you know the answer to this question what you have to understand is that very good moving to the 20th one calcitonin is a marker for which type of malignancy that would be fol cancer and I can assure you that about a large number of questions are like questions you to ensure that you get at least 100 of them correct EAS and then among those plus minus another 60 70 and you are through okay okay yeah calcitonin would be for medary Caro thyroid got carried away medary carcino thyroid follicular thyroid can would be having a hematogenous spread you are right answer would be option number c AAL next is about a patient who 60 year of age he's bedridden and he develops a sudden onet breathlessness and chest pain CTP is given CTP is showing a big big clots bang in the middle of the pulmonary artery and he's saying that which of the following non-invasive modality will be used to diagnose this particular condition so if he says that it's going to be a 60-year-old bedridden patient who's having chest pain CT was done and there's a huge plot in the pulm artery of this patient then I need to basically find the iology because the diagnosis of this patient is pulm embolism and because the diagnosis of this case is PE that is pulm embolism what I need to do is I need to find the iology where did the clot come from he's saying look at the question noninvasive Imaging modality the word is Imaging modality so the answer will not be a d dier essay because D dier essay is a screening test for this condition is asking me Imaging modality that would be that the cause of this is deep V thrombosis and for identifying deep V thrombosis I will be using a ultrasound or a Doppler so the correct answer for this one is option number D and it is a saddle embolus moving to question number 22 a 23y old patient he has presented today to a hospital and uh in this particular case what you're noticing is that there is a history of smokey urine I mean that's the key word in the question Smokey urine which is telling us about hematuria uh there are 20 uh dysmorphic rbcs and then he mentions about no bacteria being noted with the protein Ura so the diagnosis of this patient based on hematuria cannot be minimal chain disease and bladder calculi but along with bladder calculi I mean bladder calculi will contribute to a painful hematuria in bladder calculi will always have renal colic I mean the main my point is there is no information given of suggestive of renal colic uh another feature I can say is that there is a protein U also given in this case which again tells me that it it's the parim of the kidney that gets involved and why is not a UTI because he's saying no bacteria are noted so between B and D the correct answer for this one let me just check what you guys have answered but this would be acute Glon nephritis yes yes yes yes it would be acute Glon nephritis and isomorphic rbcs in a bladder calculi is again something that would help you I mean the key word in this questions are two one is going to be dysmorphic RBC dysmorphic RBC every time you read that word no dismorphic RBC it means that it is a glomerular bleeding just remember that point straight on every time you read about dysmorphic red blood cells it's always going to be a presentation of glomular bleeding in a patient so RBC is present in psdn absolutely right let's move to the next one a elderly patient presents with the history of op hypertension and diabetes valitus and is on multiple drugs which criteria are used to avoid the use of certain drugs it was a question based on exclusion Dukes criteria is for infective endocarditis then we have Jones criteria that is for romatic heart disease lights criteria are for plural effusion so I'll just write P PF that is a plural effusion and by exclusion the correct answer for this one would be option number a in fact let me just write down plural Fusion a little better in case the nodes get circulated subsequently so if it is going to be plural effusion for lights criteria to differentiate whether it is a transudate and exudate and the correct answer is a then was a question on stroke this is a sensory stroke it's called as thalamic dejerine Lucy syndrome Thalamus is getting affected so patient will be saying I feel as if somebody has put acid over half of my body or somebody has put burning water over my body in those circumstances when we are going to be having like you know acid present acid being poured patient I feel as if you know somebody has poured acid over my body that is neuropathic pain so the question is simply regarding what is which is for I mean which of these will not be useful for evaluation of neuropathic pain so neuropathic pain Gaben I'm amalin use TCA would basically mean amitryptiline and then cannabis is now legal in Canada Cannabis is legal in certain countries for cancer pain and pain of pain which is neuropath I in nature to G the people are allowed to you know cultivate and keep a certain amount of cannabis I mean cannabis plants so that they can you know get if they are having a cancer cancer patient in their family or somebody suffering from an intractable pain so like cannabinoids are again on the correct answer for this one is analgesics analgesics do not work for management of any neuropathic pain a condition which Salman Khan suffers from that is what I read on media was trial neuralgia tell me the drug of choice for trial neuralgia guys what is the preferred drug for management a quick comment here with respect to trigeminal neuralgia do for trial neuralgia okay doc thanks for that invite for Australia Tri oralia would be yes yes the Drago choice in those circumstances would be caropines answer to that would be uh cbz aripine and we use that exactly exactly caropine is the first best answer we use governmentin along with that we might even use valporate in this cases but caropine is the first line answer in those cases moving to the next one 25th for today look at your speed man you're doing great today so on the which of the following will help in making a definitive diagnosis of bronchial asthma I'm not going to diagnose on history in a scenario faor Den B medicine asthma does not have any CT chest findings so there's going to be only two possibilities either an osculatory finding or fv1 change asthma is a reversible air disorder the diagnosis of reversibility is change in the value of Fe V1 so the correct answer for this one would be option number B Fe V1 showing an increment of 15% the cut off is actually 12% so because of the fact that F1 value is increasing that means person is responding to your treatment then was a very interesting question in which he had mentioned regarding infective endocarditis he asked you to calculate the minor Dukes criteria in this question so try to read this question with me fast over 30 seconds everybody now focus on the screen 20 R male who an IV drug user so IV drug user is a minor criteria then he's having fever for last one week that is again a minor criteria then he's mentioning spots on fun he did not say Rod spots anything he just said spots on funders examination so he's talking about Rod spots so there are three minor new criteria present in this case and therefore the correct answer for this one would be option number D and he can obviously change the options in the question and I mean uh you will have to count the minor criteria in this case the most important thing is fever predisposition predisposition can be IV drug use predisposition can be rheumatic fever it can be cardiomyopathy of any iology it could be dileted hypertrophic structural heart disease congenital heart disease any structural B any structural heart disease is a predisposition for development of infective endocarditis so answer to 26 is option number D and let's now look at question number 27 where we have already discussed this so I'll just Mark the answer there any change of FB Beyond 12% is asthma less than 12% is COPD and 12% exact is a asthma COPD overlap we move to the next one where he said uh which of the following uh okay 30-year-old female is having recurrent episodes he says uh this lady she's having recurrent episodes of epistaxis and along with that there is a perennial running nose she's also having a cola color urine so two involvements there there's blood from the nose and blood in the urine and then is's also talking blood in the urine and uh he's saying multiple Cavit lesions in the lungs of the case so because in this case upper respirat tract is involved lower respir tract is involved and then kidney is also involved in this case how do I know respir tract involvement epistaxis how do I know kidney involvement that would be Cola color urine and lower respirat tract involvement is's mentioning regarding hemoptisis and multiple cavitary lesions so if I combine all this the diagnosis of this condition is granulomatosis with polyangitis and the main test for diagnosis of this condition is C anchor every time you read about lung involvement plus kidney involvement plus upper respir tract because if you read only about lung involvement on if suppose in this McQ there was only involvement of hemoptisis with Uria good pasture but if you're going to be getting three things present here like the ones that I've explained at the movement then you will say it is vaganos Grom matosis and the answer would be option number c next is again a very interesting one that is a pregnant lady is having excessive bleeding after a delivery and her husband is saying that recently she had about couple of years ago she had a dental extraction and then she again had excessive bleeding uh then he given a coagulogram report but even if you're not able to solve this quag report though I'll give you a hack for this also you should be able to solve this question because every time you read about excessive bleeding first you think in terms of Hemophilia but hemophilia is seen in boys it would be seen in a boy at one year two year of age with excessive bruising so I can in this particular question rule out uh especially option number a and option number B Because hemophilia a and hemophilia B would be seen in from the gender perspective in a male patient as far as deficiency of factor 7 is concerned lots of time it could be congenital but then could be due to liver disease also I mean lots of time Factor 7 gets affected in liver disease and how am I ruling out Factor 7even also is based on the fact that proin time in this condition is normal whereas whenever liver is involved Prothrombin time will always be dered the correct answer for this one is one vber and disease now listen to how to interpret the quag in 30 seconds one vibrant Factor one vibrant factor is responsible for helping in interlinking between the platelet function one is one vbr one vibrant factor helps in addition of the platelets to the wall of the blood vessels second it also stabilizes factor8 factor8 is a component of the intrinsic step of clotting so first and foremost you should know the functions of one vibrant Factor uh 15 seconds done listen to it carefully it is responsible for controlling the platelet add it's it's responsible for platelet addition that is one it it helps in sticking of the uh platelet to the wall of the blood vessel and second it prolongs the activity of factor eight that is intrinsic factor activated partial thrombo blast in time or one vibrant factor is missing then none of these functions would be done and the platal addition will not occur so bleeding time will be more and it will not be able to prolong the half life of factor eight so apt will also be increased so every time you read a report in which these two factors are increased because of the fact that van willbrand is responsible for controlling both of these processes and therefore the interpretation is option number D from the lab report which is given this is the lab report you need to remember this is the only there are only two lab reports you need to remember I'll write the two one two of them before you as well one you need to remember lab report for cases uh in fact let's just practice it here I mean the lab report that you need to remember the parameters are bleeding time let's do it Fast Pro thring time and activated partial thrombo blasting time bleeding time is related to platelets I'll take just the 30 seconds into it guys so don't lose patience focus on this prothrombine time is related to the extrinsic step of clotting that is Factor five and seven so I'll write numbers also 5 seven and activated partial thrombol blast in time is related to Intrinsic step of clotting like clotting factor eight and N now suppose suppose in a case he gives you says a boy who's having joint bleeding like ankle bleeding or knee joint bleeding hemophilia hemophilia is a disease of factor8 deficiency so what you will notice in the McQ will be that bleeding time will be normal proing time will be normal because if factor 8 is deficient only AP will be DED so if they give you a report in which BT and if they give you an McQ where two things are elevated AP as well as bleeding time then you will say one will disease I'll say that once again try to remember it here and right now if he gives you an McQ where only APD is deranged don't even get into the full form if APD activated partial thrombol P time is deranged hemophilia but if it is going to be two things that are deranged that's BD and apdt then it's going to be one vant disease that we're trying to focus in this particular question so great guys very very good answers that you guys have given me here and now we are going to focus on a question on sodium correction because it is a female so what you will do is you will multiply the weight of this patient by 0.5 and then you will be putting the desired value what is the desired value I want to upgrade sodium to 140 the actual sodium in this patient is only 120 so it is a one step multiplication the formula is total body water how do you calculate the total body water you have to multiply weight into 0.5 when it comes to a female patient you have to multiply weight by 0 six if it is going to be a male patient and then it's going to be desired value DV means desired value minus whatever is the actual value actual value given in the question is 120 so it's a one step multiplication that would be 20 into 20 that would be 400 let me just check how many of you got this one correct cool yes yes yes so I had very good answers there let's move on to the next one here a 37y old woman presents with record episodes of pain and pressure sensation behind her ey a very neglected question not discussed on any platform but we are discussing it here I mean most of the time it's it's neglected it's an opal SL medicine kind of an overlap where he's talking about pain pre pain and pressure sensation behind the eye initially I thought it could be a question on glucoma but then he says intermittent proptosis and this proptosis AR prominent and that is versen due to vola maneuver that means there are some dileted veins which are pushing the eyeball anly therefore the diagnosis in this case would be given as orbital vares let me just check out how many of you got this one correct oh okay okay so I had multiple answers there see dermoid will not dermoid will not change with valsava maneuver dermoid is like a is like a firm firm nodule no so it's it's not going to change in consistency hi Dr dopamine good to hear from you dermoid is not going to change with consistency of or it's not going to change with wsava maneuver orbital metastasis well again the point is wsava maneuver means there has to be some connection with the Venus system so I can rule out B and C because they're not related to the vascular connections I'm left with varices and ktic cavernous fistula now how does caroticocavernous fistula present it will present with what is called as pulsating proptosis pulsating proptosis would mean that every time the koted artery will beat now the eyeball of the patient will also beat in case if you check on a prepl channel on Instagram we had just posted a video just a couple of days back and it the person was having eyeball K pulation children but every time the heart is beating you will notice that even when the heart is beating in a patient there is going to be pulsation of the eyeball that is ktic cavernous fistula that is a communication between the koted artery and the cavernous sinus of the patient so there are two mcqs which are to be remembered for this one here one is pulsating proptosis pulsating proptosis is is corresponding to the pulsation of the koted artery of the patient it is not related to vaba maneuver every time there's going to be a Wella maneuver that is present it means connection with the Venus system maneuver related then it means it is connected to the Venus system especially with respect to the options that I have currently described there before you and another another Point why it is not ktic cavernous fistula is that the trigger for K cavernous fistula is infection of the the dangerous area of the face the trigger is infection of the dangerous area of the face and in this case I mean there is no infection of the dangerous area of the phas so that is why the answer to this question will work out to be option number a let's move on to the next one what can be given to a patient of celx pro so we cannot give suji because suji is going to be MAA and MAA is going to be made for wheat only so that is ruled out similarly we would not like to give oats and wheat because they belong to that bro category so the only plausible explanation in this case is poha or Pula that can be given to a patient which is rice based idly the best answer in the McQ would be quinua if it is not kinoa then another thing we can be giving is maze to the patient if not Maze We can be giving bajra so preference of order would be Quin M bajra me that's the first priority and then is going to be rice based diet which still has a bit of gluten but among among the options that were given here this was the best one that we could have given okay let's move to 33 elderly patient presents with focal Caesar and CT shows multiple ring enhancing granulomas the moment you read multiple ring anouncing granas either it is going to be neuros syy soses or it's going to be tuberculomas which are seen as a complication of tubercular menitis uh because the cases or the options which are given here are like anti-helminthic treatment anti-edema Caesar control so uh the it goes in favor of like more in favor of neuros system circuses and in all cases of neuros cytic circuses in the first 24 hours we do not give anti-helmintic drugs if we will give antih helic drugs in the first 24 hours it will worsen the cerebral edema of the case it will cause more development of Caesar in this case so we first give only steroids for 40 to 72 hours let the swelling in the brain subside and that is when we can be giving albendazol with pres quental for management of this case so the correct answer for question number 33 is option number D let just check out what you guys answered there okay okay the correct answer for this one guys is which is not to be given in the next 24 hours yep yep I had a a answer there as well we are going to he it it's a not question now which of the following is not to be given the question is not what is to be given in the next 24 hours if he's saying what is not to be given it is anti- helenic treatment of the case rest everything is fine I mean we'll give steroids we'll give antiedema treatment that is steroids and then Cesar control will be done so the correct answer for this one is option number D I'll just highlight the this with a color appropriately the question was not like if he was question was like what will you give first in the patient then it is going to be answered as option number a otherwise yeah neuros cytic sosis is by tenia Solium it's caused by the lar it's actually caused by The larva right that is C cusis cellus okay so the answer to this question is option number D and let's move on to 34 now a patient is being taken to the hospital for anaphylaxis and uh in a fully equipped ambulance after a honey beasting he says which of the following is correct about this management so I will have to select options where they give parentral IM Adin to the patient because in anapilis the veins will be dileted and therefore because of histamine release I'll not be able to get an IV excess in patients of anaphalis there is also presence of lingal Edema because of the lingal edema component you will not be able to intubate the patient so option number D can be ruled out because you cannot intubate you would not like to give IV treatment at this moment because you cannot secure an excess it is intramuscular and it is repeated shots till the patient reaches the hospital the correct answer for this one is option number B let's see guys okay yes yes this one is right okay uh live life king size that's the M man don't worry don't worry you you have to operate on subconscious memory subconscious memory always works in fact that's the main message we have 15 mcqs more to go I would like you to focus with me for next 15 minutes atmost amount of concentration and listen to the aspects that has say before you right everybody's in the same board so I'll say this once again I know that at this point of time all of you would be feeling the pressure and you would be is saying that my efficiency is lesser and I'm not able to remember things hi Santos and uh then comes the fact that everybody is in the same boat so that you have to persist with me you have to ensure that your new cortex is going to help you in getting to the right answer it comes with practice as you're doing with me at the moment I mean you are getting the correct answers that's okay I mean that's a part and parcel of the game so next we focus on giant v waves that would be seen in either he will say giant v wve or he will be saying giant CV wave that would be for a case of triped regurgitation in fact TripIt regurgitation is answer to three mcqs TripIt regurgitation is going to be uh first of I mean scenario where we get TI as an answer is absent X descent and after that we get a CV wave or giant v wve and then we get is what is called as a steep y descent so three mcqs strike is spit regurgitation must know m CQ is absent a wave of atrial fibrillation every time there's a irregularly irregular pulse an absent a wave that's going to be always answered as atal fibrillation okay let's move to the next one 60-year-old patient is on bed rest for 10 days he's having breathing difficulty and chest pain he says what is the best investigation so uh doctor I okay fine well I'm going to be having multiple more sessions and I'm going to keep on giving these list but these 50 topics that I'm teaching at the moment 50 is the count to today I'm on 35th at the moment all these topics are must know for you guys okay we are having a patient with palmary embolism how do I know palmary embolism if somebody is going to be on a bed rest for 10 days then immobilization is a risk factor for development of deep wi thrombosis that will be causing clots to go up into the brain and he says which of the following is the best investigation for this case the answer would be a ctpa a CT palmary angiography is best way to demonstrate a saddle Ulus that could be developed in in this patient yes correct if the question said screening test then the answer would have been option number D like if he said what is the initial test to be done then this would be D dimer okay moving to 37 a child presents with fever for last 14 days with neck rigidity because there's a fever there is a neck rigidity so I'm thinking of a CNS infection uh you can notice that in this case the CSF sugar is 5050 and the blood sugar is 100 so if I divide this uh then the ratio will become about 0.5 normal CSF sugar normal CSF sugar is always more than 0.6 what I mean by 0.6 is it is always more than 60% of the blood sugar value in this case the CSF sugar is less proteins are elevated and then is also giving me some evidence there right the evidence is with respect to low bar involvement then there is a higher lymph FL enlargement there is a lob involvement which is present here so in those circumstances what I'll do in this case is think in terms of tubercolosis as I've said mononuclear cells monuclear cells would mean lymphocytes if it was polymorphonuclear cells I would have thought in neutrophils even in Tubac menitis initially there can be neutrophils but later they're replaced by lymphocytes even in tubular menitis initially there is going to be neutrophils and then they're going to be replaced by lymphocytes and the protein in this patient is super super elevated so that is why the answer for this is tubercular itis now the only thing that you need to remember is if they give you a short history and sugar is normal then answer it as viral menitis if they give you turbid CSF it is going to be bacal menitis three scenarios only turbate CSF polynuclear cells bacal menitis if it is going to be lymphocytosis with normal CSO sugar viral and if it is going to be grossly elevated proteins like in this case lymphocytes present then it is tubular where will be giving at to these patients with steroids steroids would be given for 6 weeks a patient presents with dist neck WIS that increase on inspiration what is he trying to tell you here he's trying to tell you regarding kolen he's trying to tell you regarding kol sign kol sign is distended neck veins that increase on inspiration the question can be correct by this statement only then he's talking about regular pulse is noted with disappears on deep inspiration that pulse that disappears on inspiration is pulses paradoxes so when you're going to go through these questions what you're going to notice is that there are two information that are given in this question kol sign and pulsus paradoxes and that would help you understand I mean you could solve the question from the first line itself then that this is going to be a case of constructive pericarditis I mean every time we have pulsus Paradox tampon May or constructive pericard May and in this case we are having pulses paradoxes with kol sign if we do not have kol sign Tempo not along with you know a crashing of the blood pressure but this is constrictive pericardia is due to the information that is mentioned here so cool guys great answers pulm or hypertension will always be having a loud P2 not described there trusper stenosis will always be having a mid diastolic murmur iotic regurgitation will be having a early diastolic murmur so there's no mention of murmur in this case in and that is the reason why A and B can be ruled out okay a patient had acute dentry and then there's a bilateral entering cgia uh the pain perception proception are preserved at the movement so it's like a pre dominant motor paralysis and predominant motor paralysis after a about of dentry would always be answered by you as Gan bar syndrome so this I think was a easy one let me just check why it is not transfers mtis because pain and proprioception in the case is being preserved yes this is GBS yes guys keep the comments on keep the comments on try to give correct answers in the shortest possible time and always before answering look at the key key word in the question and check out whether that matches with me or not that is what the session is for you need to see whether your eyes are locking onto those words that my eyes are locking so that we are on syn and I want you to get these reflexes going okay six-year-old child presents with a one day history of uh highr fever loss of consciousness palor and upgoing planter upgoing planter basically means Babinski S upgoing Planter basically means insky sign in this patient and along with this he's also saying presence of hypoglycemia so I'm waiting for your answers the key word in the question is fever of one day presence of palor because there is a hemolysis and there is upper motor neuron signs which are also given in this case given that we talking about a babinsky sign it means a CNS lesion it is a it's a CNS either it's an infection or it is an incopy and the pecularity of this CNS infection is that it is causing hemolysis I think the movement aay hemolysis you should be able to pick it up that this is a parasite that would be inside the rbcs that is why it is destroying the rbcs and that is why the answer for this one is cerebral malaria very good guys I think uh you guys just got it spot on uh why this is not menitis because there is no mention of any nucal rigidity I mean I cannot say menitis without nucal rigidity I cannot say menitis without Lumber puncture findings and I'll not be getting a paler with the hypoglycemia this is because the the reason why the answer is why there is a hypoglycemia is because the malarial parasite is living inside the rbcs now so it will consume more sugar and when it is going to consume more sugar it's going to result in development of it's going to cause deteriation of the patient in a sense that one of the leading reasons why patients of cerebral malaria will die is because of the fact that they are going to uh they are they are going to die because of hypoglycemia because the parasite will increase the RBC production uh see you have to Focus not on the correct answers you have to focus on whether you're picking up the correct words in the question that is the objective of this session okay elaboration for this question 40 uh okay one day history of fever in India is always to be thought of as cerebral malaria till Prov otherwise that's the shortest summary that I can say one day history of fever in India with altered sensorium either it is heat stroke or it is terrible malaria Lula or it's going to be cereal malaria and malaria will always contribute to hemolysis it will always contribute to hypoglycemia which is why the answer is C then the leading cause of death in diabetic keto acidosis is going to be cerebral edema this is a repeat question that I think everybody was able to pick up and if he says what is the complication of treatment or diabetic keto acidosis then on treatment you could be having a hypokalemia coming up that's uh I mean hypokalemia is usually a complication on treatment because when you will be giving insulin drip to this patient on presentation also I mean because of vomiting hypokalemia can be present in these cases then is which of the following is not present in Q sofa score that is sequential organ failure assessment score so Q sofa score talks about one breathing issues in a patient I mean the vital organs are affected lungs are affected so respiratory rate is increased because the brain circulation is affected the GCS will be affected because the heart will be affected the BP will also be low but lactate option number a of this question is going to be a feature which is useful for diagnosis of sepsis it is a criteria for diagnosis of serum lactate is always increas in sepsis but at the moment what we're trying to check out is components of the sequential organ failure assessments for which are respirate GCS and systolic blood pressure then was regarding systemic fungal infections that is invasive fungal infections so invasive fungal infections would always be seen in those cases where there's going to be compromise of immunity and one immunity can be affected is because of neutropenia another cause why immunity less is because of steroid usage so I'm left between two options indwelling urine catheter and vascular surgery if you're going to put a catheter in somebody it's again going to increase the risk of either bacterial or a fungal infections so indwelling urinary catheter is also risk factor for invasive fungal infections in fact in lot of time at covid times we were having problems with candida Oris quand candada Oris has no treatment candada alans can be treated no but candada Oris has no definitive treatment most most cases I mean we we give aino kind but in spite of that mungin for example but most cases die so I mean this is a superbug which has evolved over all these years and uh if you look at the data the correct answer for this would be option number a now you're going to comment in the chat box and I would like at least 100 people to comment what is the blood test that you do for diagnosis of invasive fungal infection yes please comment on what is the blood test that is done for diagnosis of IFI inv fungal infection can be diagnosed by because I will do a cyos dear okay but that cyos D dear report will take like you know maybe days to come and weeks to come so I need to be like more proactive I need to do a test which will help me diagnose systemic fungal infection on the same day itself so I'm waiting for your answers there what is the best test that you would be writing for a invasive fungal infection exactly I think ronuk was the first one to mention there that is beta 13 glucan test if I do a beta 13 glucan test it would help me diagnose a invasive fungal infection early and then is the nimonic which I think U uh Dr pry would have already discussed so I don't need to say that that is capap and capap would be standing for like cryptococcus then uh capap in fact much more important that would be Canada then is aspergilus and then is pumos cytis Jes so candida aspergilus and pyus jov there are three infections where this particular test would be positive so the correct answer for this one is a and then he says which drug will decrease mortality in heart failure among the options which are given here the answer is metop perol the word of caution is I want you to listen now carefully if you have to select between A and B then the first selection will be for a it is a Inhibitors and ARB which is the major mortality reducing drug in heart failure uh most guys who SP I spoke to they said sir there was no AC inhibitor in the options that is why the answer is B every time you're treating chronic congestive heart failure every time you're treating a patient of chronic heart failure you give a plus b if both A and B are in the options you will Mark as option number a in this particular case because it is not given that is why the answer to this one is option number B so six more to go for today and we'll be sorted he says select the correct components of child puug score in child pu score bil Rubin and proin time are standard comp components you just need to pick up the Three A's what are the three A's albumin albumin Las atis and because ammonia will rise axis in a patient or asterixis will cause incopy they are being satisfied in this particular case b Rubin and INR blue b Rubin or you can just write BP B Rubin and proin timer components of all liver scource the extra things are three a it is BP and then it is Three A's that is Albin asitis and asteris Asis is written as incopy which helps us in nailing the diagnosis then was a long stem question this I spent a lot of time on you know interacting with people who had cleared the exam that this was a smoker with highr fever confusion with diarrhea so initially I thought this question is on lung cancer because every time you read a smoker and then you are reading about confusion cuffs you I thought like it's a case which is related to lung cancer and maybe he's having uh some paraneoplastic manifestation which could be explaining maybe development of confusion diarhea then he said the X-ray of this patient shows bilateral infiltrates now lung cancer will not have bilateral infiltrat so it has to be some lung infection on sputum gr stain no organisms were detected because the organism that we're going to discuss here is not going to stain very well with gr stain and the most important finding that was given in this question in the workup was that the sodium values were low normal sodium in the body is like about 135 to 145 it is 126 so the organism that has hypon and contribute to atypical amonia is liop liop it causes sad s ad will cause more water in the body more water in the body will cause dilution and the dilution is the responsib dilution is the one which is causing this hyponatremia this is again a h favorite of your examiner UIC hyponatremia must know causes of UIC hyponatremia is what I'm going to write before you I mean they have asked this ubic hyponatremia large number of of times most of the time the question that used to come in the past for UIC hyponatremia used to be ectopic ectopic antidiuretic hormone production with lung cancer so one I want you to remember o cell cancer of the lung can contribute to UIC hyponatremia and development of Caesar and confusion the second important cause for UIC hyponatremia is what we have discussed at the moment that is lious disease which is also called as Lian mopa I mean though I have discussed even Beyond this I've talked about uh cerebral toxoplasmosis entis menitis among other causes for ubic hyponatremia but the most important one that you need to remember are these two either liop or o cell cancer contribute to siadh and contribute to UIC hyponatremia so correct answer for this one is option number B we have three more to go which of the following is a cause of exudative plural effusion then exod means inflammation and inflammation would be present in which of the following yes guys can I have answers there which of the following would be causing a exud plural effusion because if I say anything else the answer will become obvious uh this sadh is opposite of diabetes Inus no diabetes insipidus is Ulta of s yes exud is rheumatoid arthritis the correct answer for this one is RA romat arthritis is the autoimun disorder no all autoimun disorders are inflammatory and inflammatory would mean that it would be exudative moving to 48 he said a child is having recurrent lung infections with thicken sputum and x-ray shows bronchial wall thickening that could be bronis the key word is Toria and along with that lung infections you have to combine the two in a child the answer for this cannot be alpha 1 anpin deficiency because alpha 1 anpin deficiency will be causing liver ceris along with sosis it will also be causing micma so it is not a lung infection if I was mentioning fosis Alpha Anin Highline membrane disease is seen in pre-term babies malabsorption syndrome looks like the first answer to this question but uh because there's the lung infection also given that changes the entire thing in malabsorption it is not going to have present with recurrent lung infections it's going to be cystic fibrosis that is mucoviscidosis where we have delion of phy alanine at 508 putation at 508 position on the cftr protein and as a result of it the the manifestations that will occur in this case would be of thick secretions that is mucoviscidosis the answer to this one is option number a moving to the second last uh this is a repeat a 70-year-old man has presented with hip pain and back pain hemoglobin is less calcium is elevated creatinin he's telling me about crab crab would be calcium is elevated renal failure by renal failure creatinine is 2.5 then there's an anemia component present and there is litic lesions that can also be seen in the pelvis of this person they can be seen even in the head of the femur of this patient as well so considering that we are seeing litic lesions we are showing a bone maroby showing positive cells the diagnosis is right in front of you that would be multiple Myoma and I think this was one of the easy questions I've already told you the investigation of choice for this is a bone marob biopsy screening test is serum electroforesis let's move on to the last one for today and uh 20-year-old patient presents with upper respir tract infection and there's a periorbital edema with rbcs in the urine the protein is about 800 milligram of protein per gram of urinary creatinin normally report normally report that is less than 30 migam of Alin per gram of urinary creatinin but in this case it is only going to be 800 milligram plus he's also mentioning C3 to be less so he's talking about nephritic syndrome because C3 L it is always going to be nephritic as a presentation it is unlikely to be nephrotic because nephrotic will not present with development of hematuria then is good pasture which will have a combination of hopus is than Uria so I am left between C versus D in fact A and C to same so the correct one for this one would be psgn that is post strepto coal globon nephritis so yes guys I think you you got this you got this one correct as well and we are sorted for today's discussion so I'm going to see you again tomorrow to get your rhythm going and tomorrow we're going to discuss some mcqs from surgery so please read that up as a topic and I think that you guys are uh going to rock the scene once again so it is just an efficiency building exercise that I'm trying to do since my inbox with full with lot of messages I thought I should come live and discuss this so uh thank you so much guys in case of any queries yep let me know if I miss something in the chat you can uh send me an email at Marva medicine gmail.com vomiting uh doc I could not understand your query doc uh I mean that vomiting mentioned whilea so you have to drop me a mail at maram medicine gmail.com I'll just ch key in my email ID as well so I can understand that better so thank you guys it was just see is 50 me say I think most of you would have got about 45 correct 4 because these are all previous year questions so you should get them sorted and uh get do this practice and I'm going to see you again same time so we're going to do these sessions for a couple of days so that I can just get you guys into the group as well and for those of you for need PG yes I'm going to be taking session subsequently as well I think the date would come soon and then we can go ahead with our routine sessions as well so daily questions 150 in the morning questions that is all that is required I will be coming tomorrow need PG sessions are on on the cards uh give me two three days more and let me just get done with these fmg exam sessions and for those of you who if have are sitting for n PG in 50 out of 50 L right I mean you have to get a 100% score in this I will be conducting Dr manohar so give me some time another two three days let me get these guys into the group and I I got your back right so thank you so much guys bye-bye take care God BL bless you and uh we are ending the live session now