Cause of HYPERkalemia: Acidosis Or K-sparing diuretics?

Causes of hyperkalemia?

A. Potassium sparing diuretics
B. Acidosis
C. Hyperaldosteronism
D. Vomiting
E. Anorexia Nervosa

Answer: I am sure that you'll be confused between TWO options (Option A or Option B). All others three options cause HYPOkalemia so they are OUT.
Now the correct answer is Option A (K+-sparing diuretics) but you want to know the reason that why Acidosis is WRONG?

Well! There are some conditions where you get HYPOKalemia (instead of HYPERkalemia) with Acidosis - Diarrhea is a perfect example (Metabolic Acidosis + HYPOkalemia)

Another example is Renal Tubular Acidosis (ONLY type I & II)
In both type I & type II we have Acidosis PLUS Hypokalemia
In Type IV Renal Tubular Acidosis - Acidosis PLUS HYPERkalemia.

Intercostal muscle OR Intercostal Membrane?

Q: Need inserted at 5th intercostal space on left of sternum pierces, which structure will be damage FIRST?

A. Internal intercostal muscle

B. External intercostal membrane
C. Left atrium
D. Left lung
E. Left Ventricle

Answer: If they give you such questions (Needle pierces JUST Left or Right of the sternum) then ALWAYS select "External intercostal membrane"

REMEMBER: JUST LEFT or RIGHT

If they give you some specific distance from Sternum (lets suppose Left to the sternum in mid-clavicular line) then DON'T select External intercostal membrane.

Q 2: Need inserted at 5th intercostal space on left of sternum pierces, which structure will be damage FIRST?

A. Internal intercostal muscle

B. Internal intercostal membrane

C. Left atrium
D. Left lung
E. Left Ventricle

Answer: See here option B is INTERNAL (NOT External) intercostal membrane so selecting option B is wrong. Here correct answer would be Internal intercostal muscle (Option A). Internal intercostal membrane is on POSTERIOR side (External is on ANTERIOR)

To understand this whole concept check this picture (taken from Gray's Anatomy Student Ed)

Iron deficiency is best diagnosed by

Q1: Iron deficiency anemia is best diagnosed by?
A) increased TIBC
B) Serum ferritin

Q2: Iron deficiency anemia is best diagnosed by?
A) increased tibc
B) Serum ferritin
C) Bone Marrow Biposy

Answer 1: A
Answer 2: C

Explanation: I know, I know, You'll say why not B for Question 1? and you may give "Goljan" Reference.
Read carefully the options. In option A we have Increased TBIC & in option B we have "just" Serum Ferritin (Low or High? we have No idea)
Remember that Ferritin is acute phase reactant and can be INcreased in ANY Infectious process. (Just for Info in Adult onset Still's disease we will have High Ferritin - 3 times to NORMAL level) 
LOW Ferritin is HIGHLY Specific for iron deficiency anemia.
Also keep in mind "ONLY microcytic anemia with HIGH Total iron Binding Capicity (TIBC) is Fe deficiency anemia."
Now for Question 1 Selecting simple option B (S. Ferritin) will be WRONG. Correct answer will be Increased TIBC.

The Most Accurate Test for Iron deficiency anemia is "Bone Marrow Biopsy".


Just for practice One more question:

Q1: Iron deficiency anemia is best diagnosed by?
A) increased TIBC
B) Low Serum ferritin

Answer: B

Coagulative Necrosis in T.B or Gangrene

Coagulative Necrosis is seen in...

A.TB
B. Pyogenic infections
C.all infractions
D.gangrene
E.brain

Answer: A

Explanation: Yes! I know I know, T.B & Caseous Necrosis thing. Actually Caseous is variant of Coagulative Necrosis that's why here the correct answer is T.B (a)
Why NOT Gangrene?
We have TWO types of Gangrenes (a) Gas (b) Wet
Gas Gangrene is related to Coagulative while Wet Gangrene is related with Liquifective Necrosis.
Here in question we have generalized term "Gangrene" which can be BOTH - either Gas or Wet.

Unlikely cause of Acute fulminant Hepatitis in Pregnant lady

A young female with pregnancy developed nausea vomiting and jaundice suddenly she died which is most unlikely in this patient?

A. HAV 
B. Hep B 
C. Hep C
D. Hep D 
E. . Hep E

Answer: C (Hepatitis C)

Explanation: ALL Hepatitis viruses can cause  Acute fulminant hepatitis EXCEPT Hepatitis C. The given presentations are HIGHLY suggestive of Fulminant hepatitis and the Least likely or most Unlikely cause will be Hepatitis C.

Low MCV & MCH with NORMAL Iron studies

Q: Young female with low MCV and MCH but normal Fe and TIBC, most likely test to make Diagnosis? 

A. bone marrow aspiration
B. Hb A2
C. Retic count


Answer: B


Explanation: Microcytic Anemia With NORMAL Iron studies (Serum Iron, TIBC, Ferritin etc) = Thalassemia.

Hb electropheresis is the Next best Investigation.

Most important component of shock

Q: Most important component of shock is?? 


a) Hypotension 
b) Tachycardia 
c) Tissue hypoxia
d) Temperature 


Answer: C

Explanation: By definition shock is inadequate tissue perfusion, which is just ANOTHER way of saying "Tissue Hypoxia".

Which ONE is NOT a Carcinogenic Virus?

Question: One of the following is not an oncogenic virus?

a.EBV
b. Hep B
c.Hep D
d.herpes virus
e. HPV

Answer: C

Remember: 

If Hep D and Herpes are in options SELECT Hep D.
If Hep D and HSV in options SELECT HSV.

Herpes --> family of 8 viruses (Including HHV8 and EBV - BOTH are carcinogenic)