Q.1 MCQ Answers (20×1 = 20 marks)

1) 25-year-old female with decreased weight, sweating, tremor, pulse 120/min, BP 160/60, exophthalmos

• Answer: A - Graves disease
• Classic hyperthyroidism triad: weight loss, tachycardia, exophthalmos (Graves' is the only cause with exophthalmos due to TSH receptor antibodies)

2) 55-year-old male with polyuria, polydipsia, polyphagia - Diabetes Mellitus. Long-term glucose control investigation:

• HbA1c reflects average blood glucose over 2-3 months. Blood sugar fasting/random only reflect current levels.

3) 75-year-old male with difficulty in movement, rigidity, resting tremor, festinant gait - which brain part involved?

• Parkinson's disease: loss of dopaminergic neurons in substantia nigra (part of basal ganglia)

4) 55-year-old post-menopausal woman - blood investigation for hormonal analysis. Finding seen:

• Post-menopause: ovarian failure → loss of negative feedback → ↑ FSH and ↑ LH. LH is specifically elevated.

5) 75-year-old male - Rinne's test positive in right ear, bone conduction better in left. Patient has:

• Wait - Rinne's test: in conductive deafness, BC > AC (Rinne negative). If bone conduction is better in the opposite (left) ear on Weber's test, the right ear has conductive deafness.
• Answer: B - Right ear conductive deafness

6) 20-year-old female with Turner syndrome. Number of Barr bodies:

• Turner syndrome: 45, XO. Barr bodies = number of X chromosomes - 1 = 1 - 1 = Zero

7) 25-year-old male with loss of pain, vibration, and position sense. Identify condition:

• With loss of pain + vibration + position sense together affecting spinothalamic and dorsal column tracts - likely Tabes dorsalis (B)
• Answer: B - Tabes dorsalis (syphilitic dorsal column + pain pathway damage)

8) 20-year-old male with fatigue, weakness, and diplopia - identify condition:

• Diplopia + fatiguable weakness = classic Myasthenia gravis (autoimmune, anti-AChR antibodies)

9) 60-year-old male develops non-fluent speech after stroke; lesion location:

• Non-fluent (expressive) aphasia → Broca's area (inferior frontal gyrus)
• Answer: A - Broca's area

10) 45-year-old male with morning headache, excessive daytime sleepiness, difficulty maintaining posture while eating - which part of cerebellum affected?

• Postural control and truncal ataxia → Flocculonodular lobe (vestibulocerebellum)
• Answer: A - Flocculonodular lobe

11) In pituitary adenoma, bitemporal hemianopia is seen. This is due to lesion in:

• Pituitary tumor compresses the optic chiasm → bitemporal hemianopia (loss of nasal fibers crossing at chiasm)

12) 15-year-old female brought in emergency with morning headache and excessive daytime sleepiness (brought by husband - likely Narcolepsy/Kleine-Levin):

• Morning headache + excessive daytime sleepiness = Narcolepsy (orexin/hypocretin deficiency)

13) EEG recorded while solving mathematical problems - type of wave:

• Beta waves (13-30 Hz): active mental concentration, problem solving, alert/focused state

14) In left dorsal column pathway lesion, sensation lost from left side below lesion:

• Left dorsal column lesion → loss of vibration and proprioception on the same (left) side
• Answer: D - Vibration

15) Aldosterone escape is due to:

• Aldosterone escape mechanism involves ANP (atrial natriuretic peptide) and increased GFR
• Answer: A - Atrial natriuretic factor (ANF)

Summary Table

Q   | Answer
----|--------------------------------
1   | A - Graves' disease
2   | D - HbA1c
3   | A - Substantia nigra
4   | C - LH
5   | B - Right ear conductive deafness
6   | A - Zero
7   | B - Tabes dorsalis
8   | A - Myasthenia gravis
9   | A - Broca's area
10  | A - Flocculonodular lobe
11  | C - Optic chiasm
12  | A - Narcolepsy
13  | B - Beta waves
14  | D - Vibration
15  | A - Atrial natriuretic factor