Poststreptococcal (or postinfectious) glomerulonephritis (PSGN) refers to acute glomerularinflammation that results from a preceding infection with nephritogenic strains of streptococci. Clinical features: Approx. 50% of cases remain asymptomatic. Nephritic syndrome Hematuria: tea- or cola-colored urine Hypertension: can lead to headaches Edema; may be associated with dyspnea and neurologic symptoms (e.g., seizures) Oliguria Influenza-like symptoms Flank pain

SA node is the pacemaker of the heart. Located in the right atrium adjacent to the opening of the superior vena cava. Composed of specialized pacemaker cells that spontaneously generate action potentials, which are converted to electrical impulses that are conducted to the myocardium through a specialized pathway, which results in myocardial contraction. Generates impulses at the rate of ~ 60–100/min in adults. __________________________________ __________________________________

The typical murmur of aortic stenosis is a high-pitched, "diamond shaped" crescendo-decrescendo, midsystolic ejection murmur heard best at the right upper sternal border radiating to the neck and carotid arterial

The ECG findings of an acute inferior myocardial infarction include the following: ST segment elevation in the inferior leads (II, III and aVF) Reciprocal ST segment depression in the lateral and/or high lateral pertension or aortic stenosis

key: B Explanation: Long Thoracic nerve injury and Winging of Scapula: Patients with injury of the long thoracic nerve are unable to move their arm above the head as the long thoracic nerve is responsible for the movement of the arm above 90 degrees.

Key: A Explanation: Case of Myositis Ossificans. Definition: Extra-osseous nonneoplastic growth of new bone.Most often in response to localized trauma.Soft tissue and muscle ossification (heterotopic ossification) can occur congenitally or after tissue or joint injuries or surgery. Etiology: Post-traumatic, Neurogenic: after nerve injuries, meningitis, and spinal cord injuries, Chronic degenerative disease (e.g., in ankylosing spondylitis), Muscle overuse (e.g., in athletes). Clinical features: restriction of movement, muscle stiffness Diagnostics: X-RAYS. Radiological findings: periarticular soft tissue calcifications.Laboratory findings: ↑ alkaline phosphatase.Positive scintigraphy. Treatment: radiotherapy, possibly surgery.Alternative: postoperative administration of NSAID (indomethacin) __________________________________

Key: A EXPLANATION: NSAIDs (eg: Diclofenac) are the drug of choice in most patients with acute gout who do not have underlying health problems. Key Features: Usually Monoarthritis - Acute severe pain with overlying erythema, decreased range of motion, swelling, warmth, fever. Diagnosis: Gold Standard - Synovial fluid analysis - needle-shaped Monosodium Urate Crystals that are negatively birefringent. Treatment: NSAIDs, corticosteroids or colchicine are treatment options in acute gout.The choice is based primarily on whether the patient has any concomitant health problems (eg, renal insufficiency or peptic ulcer disease). NOTE: Although colchicine was once the treatment of choice for acute gout, it is now less commonly used than NSAIDs because of its narrow therapeutic window and risk of toxicity. NOTE: Starting therapy to control hyperuricemia e.g Allopurinol, during an acute attack may intensify and prolong the attack. _________________________________

Key: A EXPLANATION: Otosclerosis: Otosclerosis is a condition in which there's abnormal bone growth inside the ear. It's a fairly common cause of hearing loss in young adults.

Key → A

Key: A Explanation: The deep peroneal nerve innervates the anterior muscles of the leg by traveling deep to the peroneus longus. This nerve supplies the tibialis anterior, extensor digitorum longus, peroneus tertius, and extensor hallucis longus. These muscles control foot dorsiflexion and toe extension. __________________________________

Key: A Explanation: Esophageal atresia: A congenital defect in which the upper esophagus is not connected to the lower esophagus and ends blindly instead, so the fetus is unable to swallow amniotic fluid that's why polyhydramnios occur. 

Key: C Explanation ●Pheochromocytoma is most commonly an adrenal medullary mass and manifests with episodic bouts of hypertension, diaphoresis, headaches, tachycardia, and palpitations, as seen in this patient.

Key C Explanation: STEMI: Gold standard is ECG in first 6 hours best investigation is troponin T(highly sensitive). Immediate intervention: Percutaneous intervention(PCI)

Key: B Explanation: PCOS is characterized by hyperandrogenism. Lab shows raised levels of testosterone and Androstenedione. Management : Lifestyle modification by decreasing BMI. Recommendations for all patients Target BMI < 25 kg/m2 (can reduce estrone production in the adipose tissue) Patients not planning to conceive For patients who do not wish to conceive, the therapeutic goals are to control menstrual irregularities and hyperandrogenism, treat comorbidities, and improve quality of life. Combined oral contraceptives (COCs) [8] first-line Additional benefits ↓ Endometrial hyperplasia → ↓ risk of endometrial carcinoma ↓ Menstrual bleeding ↓ Acne Treatment of hirsutism Patients planning to conceive : Letrozole: first-line therapy for ovulation induction Exogenous gonadotropins: The low-dose regimen is the second-line treatment for ovulation induction. Metformin Can be used as second-line monotherapy for fertility treatment. Combination with clomiphene may increase pregnancy rates, especially in obese women. _______________________________

Key: C Explanation: Cushing syndrome: There is excessive production of cortisol. It’s caused by both endogenous or exogenous corticosteroids. Clinical features: Obesity, Hirsutism and acne, Stretch marks, Hyperpigmentation, Moon face and Buffalo hump, raised BP, hypernatremia Best initial test: 24 hours urinary cortisol _______________________________

Key: A Explanation: Bradykinin causes pain by directly stimulating primary sensory neurons and provoking the release of substance P, neurokinin, and calcitonin gene-related peptides. Its bronchoconstrictor effect has been linked to asthma and rhinitis. __________________________________

Key: C Explanation: Key Features- age>40 Neurological manifestation (tremors, dystonia, dysarthria), Cirrhosis, Hepatic encephalopathy, and Psychiatric issues. Keyser Fleischer's ring- Copper accumulation in Descemet membrane of cornea (1–2 mm wide, green-brown rings in the periphery of the iris) Management- with pencillamine or trientrine __________________________________

key: A Explanation Glaucoma is defined as Optic disc atrophy with characteristic cupping, usually with elevated intraocular pressure (IOP) and progressive peripheral visual field loss if untreated. Open-angle glaucoma has a greater incidence rate in older people, Black people, and patients with a family history of the condition. It is painless. Primary—cause unclear. Secondary—blocked trabecular meshwork from WBCs (eg, uveitis), RBCs (eg, vitreous hemorrhage), retinal elements (eg, retinal detachment) Treatment of open-angle glaucoma Indicated in all patients diagnosed with open-angle glaucoma (even if asymptomatic) Options include medical therapy, laser surgery, and open surgery Topical prostaglandins are most effective and usually used initially; other drugs (with a different mechanism) may be added if topical prostaglandins are unsuccessful. __________________________________

__________________________________ Key: A __________________________________

Key: C Explanation: Definition of Infective Endocarditis: Microbial infection of endothelium of heart . ⦁ Most common cause is Streptococcus viridans. ⦁ Most common involved valve is Mitral Valve. ⦁ . Most accurate diagnostic test is Blood Culture. Diagnosed on the basis of Modified Dukes criteria. Treatment: ⦁ For Acute bacterial endocarditis : Vancomycin and Gentamicin. ⦁ For Subacute bacterial endocarditis : Ceftriaxone and Gentamicin. ⦁

Key: E Explanation: Mitral stenosis is the most common valvular complication of rheumatic fever. Etiology: Most commonly due to rheumatic fever Examination findings: ⦁ Diastolic murmur heard best at the 5th left intercostal space at the midclavicular line (the apex) Opening snap ⦁ Delayed rumbling mid-to-late diastolic murmur (interval between S2 and OS correlates with severity,Often a late (and highly specific) sequelae of rheumatic fever. Chronic MS can result in pulmonary congestion/hypertension and LA dilation Ž atrial fibrillation Diagnosis: ⦁ Transthoracic echocardiography (TTE) ⦁ TTE is the most important test for diagnosing and guiding the treatment of mitral stenosis. Treatment: ⦁ Interventional management: Percutaneous mitral valve balloon commissurotomy (PMBC

Key: B Explanation: Aortic Stenosis Clinical Features; Dyspnea (typically exertional), Angina pectoris,Dizziness and syncope, in infants: wheezing and difficulty feeding Harsh crescendo-decrescendo (diamond-shaped), late systolic ejection murmur that radiates bilaterally to the carotids Best heard in the 2nd right intercostal space Diagnosis:ECG, Chest X ray, Cardiac Catheterization. Coronary Angiography Treatment;Prophylactic antibiotics Aortic valve replacement (AVR) and repairsk: botulinum toxin injection in LES, nitrates, calcium channel blocker __________________________________

Key: A Clinical features Marfan syndrome Cardiovascular ⦁ Aortic disease ⦁ Caused by aortic necrosis (cystic medial degeneration) → weakening of the elastic artery ⦁ Manifestations include: ⦁ Aortic aneurysm ⦁ Thoracic or abdominal aortic aneurysm ⦁ Aortic root dilation: aneurysm of the proximal thoracic aorta ⦁ Aortic regurgitation ⦁ Aortic dissection (typically of the thoracic aorta) ⦁ Mitral valve prolapse ⦁ Berry aneurysms: rupture leads to subarachnoid hemorrhage __________________________________

Key: B Introduction ⦁ Clinical definition ⦁ blood clot in the deep veins, typically of the lower extremities ⦁ Associated conditions ⦁ pulmonary embolism Risk factors ⦁ immobility ⦁ hospitalization ⦁ surgery A) thrombophilia ⦁ malignancy ⦁ trauma ⦁ state of elevated estrogen Presentation ⦁ Symptoms ⦁ lower extremity pain and swelling ⦁ Physical exam ⦁ examination of the affected extremity ⦁ redness ⦁ warmth ⦁ Homan sign ⦁ calf tenderness with passive dorsiflexion of the foot ⦁ however, this is not a very useful sign ⦁ shortness of breath may indicate pulmonary embolism __________________________________

Key: D Explanation: The term somatostatin was originally applied to the 14-aminoacid cyclic peptide that is secreted by the hypothalamus and that inhibits the production of growth hormone from the anterior pituitary gland.  Somatostatin is now known to be secreted from other parts of the central nervous system and from pancreatic delta cells.  Somatostatin secreted from pancreatic "delta cells" decreases the secretion of secretin, cholecystokinin, glucagon, insulin, and gastrin.  Somatostatinomas are rare pancreatic islet cell tumors that arise from delta cells.  Patients with somatostatinomas present with hyperglycemia or hypoglycemia, steatorrhea (excessive fat in the feces), and gallbladder stones.  Gallbladder stones form because of poor gallbladder contractility, which is secondary to inhibition of cholecystokinin release. Secretin (A) Regulate gastric acidand bicarbonate. Glucogan(B) increase blood glucose by breaking glycogens. Gastrin(C) increase HCL secretion,gastric motility and enhance gastric mucosal growth. __________________________________

Key: A Explanation ⦁ During prolonged fasting, ketone body levels rise significantly and are able to contribute almost 60% of the brain's energy requirement, thereby replacing glucose as the main fuel . Biochem

Key: A Explanation: Hypoglycemia does not occur in type 2 diabetes unless the patient is on insulin therapy or taking other diabetes medication. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over time, insulin production decreases, resulting in T2DM

Key: B Explanation: Glycosylated hemoglobin levels between 5.7%-6.4% are considered as pre-diabetes. The hemoglobin A1c (glycated hemoglobin, glycosylated hemoglobin, HbA1c, or A1c) test is used to evaluate a person’s level of glucose control. Diabetes mellitus ≥ 6.5% Prediabetes 5.7–6.4% Normal _______________________________

Key B Explanation: DM type-2 has a life-threatening complication called HHS( Glucose > 600 mg/dL) if left untreated. _______________________________

Key: B Guillain-Barré syndrome Mechanism Immune-mediated polyneuropathy due to cross-reacting antibodies (molecular mimicry) Triggering events Campylobacterjejuni   Viral illness (e.g., HIV, upper respiratory viral illness) Trauma/surgery Vaccinations Pathology Endoneurial inflammation Segmental demyelination & axon damage Manifestations Symmetric, progressive muscle weakness Depressed deep tendon reflexes Paresthesias; back pain Respiratory compromise

Key: B Explanation: Primary syphilis: painless ulcer with non-exudative base and painless lymphadenopathy Secondary syphilis: Condyloma lata, hepatitis, Rash on palms and soles, Patchy hair loss Tertiary syphilis: Gummas, Neurosyphilis, Aortitis

Key: A Explanation: Sodium-glucose co-transporter 2 inhibitors such as Canagliflozin, dapagliflozin, empagliflozin block reabsorption of glucose in proximal convoluted tubule. Its side effects are Glucosuria (UTIs, vulvovaginal candidiasis), dehydration (orthostatic hypotension), weight loss. __________________________________

Key: D Explanation : In insulin-dependent diabetics, beta-blockers can prolong, enhance, or alter the symptoms of hypoglycemia, while hyperglycemia appears to be the major risk in noninsulin-dependent diabetics. Beta-blockers can potentially increase blood glucose concentrations and antagonize the action of oral hypoglycemic drugs. __________________________________