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30cf8dfa-20d2-4e5a-9a11-68c31e72cc92
|
MC cause of gas gangrene is Cl. perfringens type A.
|
Microbiology
| null |
Most common organism responsible for gas gangrene is:
A. Clostridium perfringens
B. Clostridium difficile
C. Clostridium tetani
D. Clostridium botulism
|
Clostridium perfringens
|
dd4c1d2c-5af3-458b-90d9-cff5320b8ad9
|
Ans. B Arachnoid and pia materRef: Netter's Clinical Anatomy, 3rd ed. pg. 25* Meninx implies all three layers--dura, arachnoid and inner pia matter.* The dura mater is called pachymeninx.* The middle arachnoid and inner pia matter is called as leptomeninges.* The arachnoid does not follow the convolutions of brain and looks like a loose fitting sac. Multiple arachnoid granulations pass through subarachnoid space and blends with pia matter.
|
Anatomy
|
Neuroanatomy
|
Leptomeninges is formed by:
A. Dura mater and Arachnoid
B. Arachnoid and pia mater
C. Dura and pia mater
D. Dura, arachnoid and pia matter
|
Arachnoid and pia mater
|
55bad8d7-c10b-4355-913a-c8e1df1aeb81
|
Interleukin 1 (IL-1) is a thymocyte mitogen produced by activated macrophages as well as many other types of cells (e.g., monocytes, dendritic cells, Langerhans cells, neutrophils, microglial cells). It induces interleukin 2 production by the helper T cell, which initiates a cascade of immunoregulatory and inflammatory functions.
|
Surgery
|
Transplantation
|
In order to activate helper/inducer T (CD41) lymphocytes, macrophages release
A. Interleukin 1
B. Interleukin 2
C. Interleukin 3
D. Interleukin 4
|
Interleukin 1
|
ef448cfd-3116-4c26-8218-ff0534643d54
|
Ans. is 'a' i.e Lancefield classification Hemolytic Streptococci were classified by Lancefield, serologically into groups based on the nature of carbohydrate C antigen on the cell wallThese are known as Lancefield groups. Twenty of these have been classified from A-V without I and J.The other component of the streptococcal cell wall that are antigenic areM-Protein -It is the major virulence factor for the group A streptococcus. It inhibitsActivation of complementsPhagocytosis of the organism.Group A Streptococcus are further classified on the basis of M-protein. (approx. 80 serotypes based on M protein)T -Protein - No relation to virulenceR -Protein - No relation to virulence.
|
Microbiology
|
Bacteria
|
C-Carbohydrate in Streptococcus hemolyticus is important for:
A. Lancefield classification
B. Phagocytic inhibition
C. Toxin production
D. Haemolysis
|
Lancefield classification
|
a251ec18-3c16-47ad-bdc2-bc739fa8f506
|
Causes of pneumothorax: 1. Primary spontaneous: a)rupture of apical blebs b)smokers 2.secondary : a)copd and any other lung disease 3. Traumatics secondary to thoracentesis,central intravenous catheters 4.tension pneumothorax: during mechanical ventilation may cause decreased venous return and decreased cardiac output.
|
Medicine
|
Respiratory system
|
Sudden onset of cough followed by increased dyspnea is typical of-
A. Pneumothorax
B. Lobar pneumonia
C. Collapse of lung
D. Acute pleurisy
|
Pneumothorax
|
5dd38884-73ae-4535-9af5-391f5a3412c5
|
Testicular lymphatics drain into the retroperitoneal lymph nodes; the right primarily into the interaoocaval area, the left into the para-aoic area, both just below the renal vessels. Lymph nodes of the testis extend from T1 to L4 but are concentrated at the level of the renal hilum because of their common embryologic origin with the kidney. Ref: Cooper C.S., Joudi F.N., Williams R.D. (2010). Chapter 38. Urology. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
|
Anatomy
| null |
Which of the following lymph nodes receive lymphatic drainage from testes?
A. Internal iliac LN
B. Para aoic LN
C. Superior inguinal LN
D. Deep inguinal LN
|
Para aoic LN
|
a0908b8d-3a79-4e1b-a940-15b09c236c73
|
Measure of dispersion (Variation)
Absolute: Range, Quartile deviation, Mean deviation, standard deviation.
Relative: Co-efficient of range, co-efficient of quartile deviation, coefficient of mean deviation, co-efficient of variation.
|
Social & Preventive Medicine
| null |
Dispersion of data is measured by -a) Coefficient of correlationb) Rangec) Standard deviationd) Coefficient of variatione) Normal distribution curve
A. a
B. c
C. ac
D. bcd
|
bcd
|
b637fbe8-7aa7-49ab-b704-3643a178476f
|
A i.e. HemophiliaHemophilia A is a disorder of coagulation occurs due to deficiency or reduced activity of factor VIII.FeaturesHemophilia A (Classical hemophilia)Hemophilia B (Christmas disease)DefectDeficiency of coagulant subunit of factor VIII i.e. VIIICfactor VIII=VIIIC + VWFDeficiency of factor IXQPathway ofcoagulation affectedInstrinsic pathwayIntrinsic pathway
|
Physiology
| null |
Activity of factor VIII procoagulant is deficient in:
A. Haemophilia
B. Von Willibrand's disease
C. ITP
D. Sickle cell anemia
|
Haemophilia
|
814eac52-c475-40b8-8938-153fb365ee55
|
Phosphofructokinase (PFK) (step 3) of glycolysis is the most impoant rate-limiting enzyme for glycolysis pathway. ATP and citrate are the most impoant allosteric inhibitors. AMP acts as an allosteric activatorRef: DM Vasudevan, Page no: 98
|
Biochemistry
|
Enzymes
|
PKF-I Inhibitor
A. AMP
B. Citrate
C. Glucose 6 phosphate
D. Insulin
|
Citrate
|
5b7cdf1a-e3d5-4216-b0e0-c1004d24d1cc
|
The most important and the most common cause of venous thrombosis is vascular stasis, which often occurs with immobilization. Calcium is a cofactor in the coagulation pathway, but an increase in calcium has minimal effect on the coagulation process. Aspirin inhibits platelet function and limits thrombosis. Nitric oxide is a vasodilator and an inhibitor of platelet aggregation. Turbulent blood flow may promote thrombosis, but this risk factor is more common in fast-flowing arterial circulation.
|
Pathology
|
Hemodynamics
|
A 55-year-old woman following major abdominal surgery has had discomfort and swelling of her left leg for the past week. On physical examination, the leg is slightly difficult to move, and on palpation there is tenderness. A Doppler sonogram shows thrombosis of deep left leg veins. Which of the following mechanisms is most likely to contribute to her condition?
A. Hypercalcemia
B. Immobilization
C. Ingestion of aspirin
D. Nitric oxide release
|
Immobilization
|
825a9f90-2e84-4a3a-aadc-8f49d6452109
|
Alpha - thalassemia
People who do not produce enough alpha globin chain have alpha - thalassemia.
Alpha globin chain is made by four genes, each gene contributes to 25% of the a-globin chains.
The severity of a-thalassemia varies greatly depending on the number of α-globin genes affected -
I) Silent carrier state
Single α-globin gene is deleted.
These individuals are completely asymptomatic.
ii) α-thalassemia trait
Two α-globin genes are deleted
These individuals are asymptomatic with some red cell abnormalities like β-thalassemia minor.
iii) HbH disease
Three genes of the a-globin chain are deleted.
With only one gene, the synthesis of α-chain is markedly reduced and tetramers of excess β-globin called HbH, form.
HbH has an extremely high affinity for oxygen and therefore is not useful for oxygen exchange, leading to tissue hypoxia disproportionate to the level of haemoglobin.
Patients have moderate to severe anaemia that may require an occasional blood transfusion.
iv) Hydrops fetalis
Deletion of all four α-globin genes.
In the fetus, excess γ-globin chains form tetramers, known as haemoglobin harts.
Hemolgobin bart has such a high affinity for oxygen that it delivers almost no oxygen to tissues.
Most individuals die before or shortly after birth.
In utero blood transfusion have allowed the birth of children with hydrops fetalis who then require life long blood transfusions.
|
Pediatrics
| null |
In α–thalassemia –
A. Excess α–chain
B. No α–chain
C. Excess β–chain
D. No β–chain
|
No α–chain
|
3d2675c6-245e-40c1-8360-eac99a27b294
|
Psychoanalysis is based on the principle of free association, where the patient is asked to say whatever comes to mind.
|
Psychiatry
| null |
A fundamental technique used in psychoanalysis is -
A. Concentration
B. Hypnosis
C. Empathy
D. Free association
|
Free association
|
f841c602-c84c-4445-962c-0a98933d8c48
|
Emerging patterns for language behaviour from 1-5years of age 15months Jargon Follows simple commands May name a familiar object (e.g., ball) Responds to his/her name 18months 10 words (average) Names pictures Identifies 1 or more pas of the body 24months Puts 3 words together (subject, verb, object) 30months Refers to self by the pronoun "I" Knows full name 36months Knows age and sex Counts 3 objects correctly Repeats 3 numbers or a sentence of 6 syllables Most of the speech intelligible to strangers 48months Counts 4 pennies accurately Tells story 60months Names 4 colours Repeats sentence of 10 syllables Counts 10 pennies correctly Ref: Nelson paediatrics; Table 11-1
|
Pediatrics
|
Growth and development
|
In a child ,Most of the speech is intelligible to strangers by the age of ____________
A. 30 months
B. 36 months
C. 48 months
D. 60 months
|
36 months
|
299d8cfd-9750-499d-a8a5-e6bdf14db267
|
Ans. is 'a' i.e., Na+ Cl- synport inhibitor o Na+ absorption at different tubular sites.PT - 65-70%Asc. LH - 20-25%DT - 8-9%CD- 1-2%o Tubular absorption can be divided into four sites.Site I- Proximal tubuleo Four mechanisms of Na4 transport have been defined in this segment -1. Direct entry of Na4 along electrochemical gradient.2. Na+-K+ symport along with active reabsorption of glucose, aminoacids, organic anions and PO4 -33. Exchange with H+ by Na+ /H+ exchanger located in the luminal membrane of proximal tubule (PT) epithelial cells. The PT cells secrete H+ with the help of carbonic anhvdrase. H+ ion exchanges with Na+ present in tubular fluid through Na+-H+ exchanger (antiporter) and forms H2CO3 by combining with HCO3-. This H2CO3 is broken into H2O + CO2 by brush border carbonic anhydrase; both CO2 and H2O diffuse inside the cell and recombine to form H2CO3 with the help of intracellular carbonic anhydrase. This H2CO3 is the source of H+. The dissociated HCO3- in the cell is transported to cortical E.C.F. by basolateral membrane Na+-HCO3- symporter resulting in net reabsorption of NaHCO3.Carbonic anvdrase inhibitors (acetazoiamide) act predominantly in PCTand inhibit NaHCQ3 reabsorption.4. The disroportionately large HCO3-, acetate, PO4-3, passive driving forces for Cl- to diffuse through the paracellular pathway, particularly in the later PT. This takes Na+ and H2O along to maintain electrical neutrality and isotonicity; reabsorption in PT is isotonic.o Osmotic diuretics (mannitol) are solutes which are not absorbed in proximal tubule and therefore retain water:Site 11 Ascending limb of loop of Henleo The thick ascending limb can be distinguished into two distinct portion.Medullary portion lined by cuboidal cells.Cortical portion lined by flattened cells.o Both portions are relatively impermeable to water but absorb salt actively and thus dilute tubular fluid,o In the medullary portion a distinct luminal membrane carrier transports ions in ratio of Na+-K+-2Cl-. The sodium enters the cell is pumped to ECF by Na+ K+ ATPase at the basolateral membrane,o This Na+ -K+--2Cl= symport is inhibited by loop diuretics (eg-Furosemide)o In addition, a Na+-Cl- symporter moves Cl- down its electrochemical gradient into ECF and carries Na+ along.Site III - cortical diluting segment of loop of Henle and early DTo This segment is also impermeable to H2O and continues to absorb salt through Na+-Cl- symporter.o Thiazide diuretics act at this site.Site IV - late distal tubule and collecting ducto In late DT and CD, Na+ is actively reabsorbed; the cation-anion balance being maintained partly by passive Cl- diffusion and partly by secretion of K+ and H+.o Absorption of Na+ at this site occurs through a specific amiloride sensitive Na+ channel and is controlled to a large extent by aldosterone.o K+- sparing diuretics act at this site.o Collecting tubule is the most important site of K+ secretion by the kidney and the site at which virtually all diuretic induced changes in K+ balance occur - as K+ secretion occurs in exchange of Na+, higher the Na+ load in CD higher will be K+ excretion in urine - Diuretics which act on PCT (maximum absortion of Na+ occurs at PCT) like acetazolamide will cause maximum kaliuresis (K+ excretion in urine),o The principal cells are the major sites of Na+, K+, and water transport, and intercalated cells are the primary sites of H+ secretion.o The collecting tubule is also the site at which the final urine concentration is determined. ADH (vasopressin) controls the permeability of this segment to water by regulating the insertion of preformed wrater channels (aquaporin-2, AQP2) into the apical membrane via a G protein - coupled cAMP - mediated process.o ADH also stimulates the insertion of urea transporter UT1 molecules into the apical membranes of medullary collecting tubule cells. Urea concentration in the medulla plays an important role maintaining the high osmolarity of the medulla and in the concentration of urine.
|
Pharmacology
|
Diuretic
|
Mechanism of action thiazide is -
A. Na+Cl- symport inhibitor
B. Na+K+ symport inhibitor
C. Carbonic anhydrase inhibitor
D. Osmotic diuresis
|
Na+Cl- symport inhibitor
|
35d0a42a-d478-4b81-b82a-8f3a12af0247
|
Of the markers listed, alpha-fetoprotein is the best marker for non-seminomatous germ cell tumors of the testes, such as this patient's yolk sac tumor. Alpha-fetoprotein is also a good marker for hepatocellular carcinomas. Bombesin is a marker for neuroblastoma, small cell carcinomas, gastric carcinomas, and pancreatic carcinomas. CEA (carcinoembryonic antigen) is a nonspecific marker, but has the advantage that it is produced by about 70% of colorectal and pancreatic cancers. It is also produced by some gastric and breast cancers. PSA (prostatic specific antigen) is a marker for prostatic carcinoma. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 17. Pathology of the Male and Female Reproductive Tract and Breast. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds),Pathology: The Big Picture.
|
Pathology
| null |
A 20 year old man has a testicular mass, which on orchiectomy shows a malignant tumor with yolk sac differentiation. Which of the following tumor markers would probably be most useful in monitoring the patient for recurrent or metastatic disease?
A. Alpha-fetoprotein
B. Bombesin
C. Carcinoembryonic antigen (CEA)
D. Prostate-specific antigen (PSA)
|
Alpha-fetoprotein
|
c5f160d7-ad62-4769-8001-073410928e83
|
Ref :Parks 23rd edition Prevalence = 10% So probability of selecting a person having DM = 10/100= 0.1 So probability of selecting 3 persons with diabetes = 0.1*0.1*0.1= 0.001
|
Social & Preventive Medicine
|
Biostatistics
|
If prevalence of diabetes is 10%, the probability that three people selected at random from the population will have diabetes is -
A. 0.01
B. 0.03
C. 0.001
D. 0.003
|
0.001
|
7c29b84b-4989-4235-8aef-f44626af5505
|
Ans. is 'b' i.e., IL-1 antagonist BIOLOGIC RESPONSE MODIFIER (BRMs)* Several recombinant proteins/monoclonal antibodies that bind and inhibit cytokines, especially TNFa or IL-1 have been used succesfully in autoimmune diseases like RA, IBD, psoriosis or scleroderma.A. TNF-a inhibitorsa. Etanercept# It is a recombinant fusion protein of TNF - receptor and Fc portion of human IgG1'# It is administered by S.C. injection.b. Infliximab# It is a chimeral monoclonol antibody which binds and neutralizes TNF-a.# It is given by i.v. route.# It is indicated in RA, psoriotic arthritis, Crohn's disease, Wegener's granulomatosis and sarcoidosis.c. Adalimumab# This recombinant monoclonal anti-TNF antibody.# It is administered by S.C. route.B. IL-1 antagonistAnakinra# It is a recombinant human IL-1 receptor antagonist.# It is less effective than TNF inhibitors.# It is administered by S.C. route.C. T-cell costimulatory blockersAbatacept# It is a fusion protein that combines the extracellular domain of the molecule CTLA4 (CD 154) with the Fc portion of a human immunoglobulin.# It interfere with the interactions between antigen presenting cells and T lymphocytes. Therefore, it affects early stages in the pathogenic cascade of event in RA.D. B-cell depletersRituximab# B-cells are inflammatory cells with multiple functions in the immune response. The depletion of B cells has been shown to be effective in reducing signs and symptoms of RA and in slowing radiographic progression.# Rituximab is a chimeric monoclonal antibody that binds to the CD20 molecule on the B cell surface leading to the removal of B cells from the circulation.
|
Pharmacology
|
Immunomodulator
|
Anakinra acts as-
A. IL-1 agonist
B. IL-1 antagonist
C. IL-2 agonist
D. IL-2 antagonist
|
IL-1 antagonist
|
8b3de15a-3c0f-4bcd-926f-26e05ca5cbb9
|
GLUT 3 is a protein channal for facilitated diffusion of glucose it is seen in neurons
|
Anatomy
|
General anatomy
|
GLUT3 is seen in
A. Liver
B. Neurons
C. Pancreas
D. Spleen
|
Neurons
|
8409ee38-1922-4ac9-9178-ba699e33e643
|
Ans. is 'c' i.e., Hypothyroidism o Lithium can cause hypokalemia.Side effects of lithium1) Neurological: - Tremor is the commonest side effect of lithium. Other CNS side effects are giddiness, ataxia, motor incordination, hyperreflexia, mental confusion, nystagmus.2) Renal: - Nephrogenic diabetes insipidus with polyuria & polydipsia. Amiloride is the DOC for Lithium induced nephrogenic DI.3) Cardiovascular: - Effects are similar to hypokalemia which causes arrhythmia. Most common ECG change is T wave depression.4) Endocrine: - Goitre, hypothyroidism.5) GIT: - Nausea, vomiting, diarrhoea, metallic test, abdominal pain.6) Dermatological: - Acneiform eruptions, papular eruption, exacerbation of psoriasis.7) Teratogenicity: - Ebstein's anomaly in fetus.
|
Pharmacology
|
C.N.S
|
Long term use of lithium causes -
A. Hypopituitarism
B. Diabetes mellitus
C. Hypothyroidism
D. Hyperthyroidism
|
Hypothyroidism
|
90dfac1f-008c-494a-8689-aaddf1cf65bf
|
Derealization: Sensation of changed reality or that one's surroundings have altered. Usually seen in schizophrenia, panic attacks, and dissociative disorders Depersonalization: Sensation of unreality concerning oneself, pas of oneself, or one's environment that occurs under extreme stress or fatigue. Seen in schizophrenia, depersonalization disorder, and schizotypal personality disorder Reference: P.923 7.3 Signs and Symptoms in Psychiatry
|
Psychiatry
|
All India exam
|
Derealisation and depersonalization are seen in which type of disorder
A. Dissociative disorder
B. Personality disorder
C. Mania
D. Somatoform disorder
|
Dissociative disorder
|
79a4d6e0-fb4d-4ac0-9560-7a9bd24a5280
|
60% REF: Ajay Yadav 2nd ed p.35 Equipment and oxygen delivered in % * Nasal canula - 44% * Venturi mask - 60% * Oxygen mask - 60% * Ventilators - 100%
|
Anaesthesia
| null |
Maximum 02 concentration attained in venture mask is?
A. 90%
B. 100%
C. 60%
D. 80%
|
60%
|
03d69442-1f89-4efa-9347-ddb1def69143
|
Ans. C Right hydropneumothoraxCXR shows lucent (black) lateral aspect of right hemithorax with air fluid level in it-s/o hydropneumothorax. An expiratory CXR better than an inspiratory CXR for a diagnosis of pneumothorax. CT Thorax is IOC for pneumo/hydro- pneumothorax.
|
Radiology
|
Respiratory System
|
Diagnosis is:
A. Right pneumothorax
B. Left pneumothorax
C. Right hydropneumothorax
D. Left hydropneumothorax
|
Right hydropneumothorax
|
d043a81d-0e43-4d69-9768-76634bf4f035
|
The HACEK groupinclude -Hemophilus parainfluenzae, Hemophilus aphrophilus, Actinobacillus (now Aggregatibacter) actinomycecomitans, Cardiobacterium hominis, Eikinella corrodens and Kingella kingae. These are gram negative pleomorphic bacilli which are capnophilic and have fastidious growth requirements. They do not grow on MacConkey and on blood agar, their colonies appear in 2-3 days. They are normal commensals of the oral cavity which can cause endocarditis following dental manipulations.
|
Microbiology
|
Systemic Bacteriology (Haemophilus, Yersinia, Spirochaetes, Ricketssia, Chlamydia, Mycoplasma and Miscellaneous Bacteria)
|
Which of the following is a not member of HACEK group-
A. Hemophilus aphrophilus
B. Acinetobacter
C. Cardiobacterium
D. Kingella
|
Acinetobacter
|
d17dff5c-128a-4cf9-8b55-8627d22be53f
|
Carbon monoxide (CO) is not considered a direct greenhouse gas, mostly because it does not absorb terrestrial thermal IR energy strongly enough. Reference: Global changes of planet Eah OECD, page no:48.
|
Social & Preventive Medicine
|
Environment and health
|
Which gas is NOT responsible for green house affect -
A. Carbon monoxide
B. Ozone
C. Nitrous oxide
D. Nitrogen
|
Carbon monoxide
|
0e63e51e-bc04-4e45-bd88-25ded5d59910
|
a. Echocardiography > c. X-ray cervical spine(Ref: Nelson's 20/e p 610-615, Ghai 8/e p 637-639)Congenital heart diseases are more common in Down syndrome (in 50%), than atlantoaxial instability (20%); so a preoperative echocardiogram is warranted, so that management of child can be planned accordingly.
|
Pediatrics
|
Genetics And Genetic Disorders
|
A Down syndrome patient is posted for surgery, the necessary preoperative investigation to be done is:
A. Echocardiography
B. CT brain
C. X-ray cervical spine
D. USG abdomen
|
Echocardiography
|
6037664e-806c-4099-825b-114efe3af62a
|
Oxytocin is a nanopeptide synthesised by supraoptic and paraventricular nuclei of hypothalamus. It is rapidly metabolised and degraded by oxytocinase and hence has a half life of 3 - 4 minutes and a duration of action of approximately 20 minutes. (DC Sutta TB of obstetrics 8th edtn pg 573)
|
Gynaecology & Obstetrics
|
Abnormal labor
|
Half-life biological of oxytocin:
A. 2-3 min
B. 3-4 min
C. 5-6 min
D. 7-8 min
|
3-4 min
|
e8475697-940f-47ef-91ed-fc8905922603
|
The femur ossifies from five centres: in the shaft, head, greater and lesser trochanters and the distal end. Other than the clavicle, it is the first long bone to ossify.
|
Anatomy
| null |
Number of ossification centres in femur is:
A. 2
B. 4
C. 5
D. 7
|
5
|
3ac64cd3-3d21-4078-995a-f52056daf11c
|
Ans. is 'b' i.e. posterior dislocation of hip Be sure of the answer, we have been taught this in the clinics.Shortening of the limb is seen in: (in decreasing order)Post dislocation of hip (maximum) shaft femur Intertrochanteric neck femur
|
Orthopaedics
|
Fracture Neck of Femur
|
Maximum shortening of limbs occur in
A. Trochantric femur
B. Post dislocation of hip
C. neck femur
D. Anterior dislocation of hip
|
Post dislocation of hip
|
2b937e1d-c1a1-4364-9313-63a2ff374ac4
|
Stereotactic radiosurgery means delivery of precise high dose radiation in a single fraction to intracranial targetsReference: Eric J Hall Textbook of Radiobiology for Radiologist; 5th edition
|
Radiology
|
Radiotherapy
|
Stereotactic radiosurgery is a form of
A. Radiotherapy
B. Cryosurgery
C. Neurosurgery intervention
D. Embolisation and radiofrequency ablation
|
Radiotherapy
|
6d8023fe-7a66-445c-9c74-8f012d3a027e
|
Ans. is 'b' i.e., Grievous This patient had permanent vision loss as it was corrected by surgery (corneal transplant). Permanent loss of sight of either eye is grievous hu. Injuries can be classified as 1. A simple injury is one which is neither extensive nor serious, and which would heal rapidly without leaving any permanent deformity or disfiguration. 2. A grievous injury is one (i) Which is extensive or serious (ii) Which does not heal rapidly, and (iii) Which leaves a permanent deformity or disfiguration. Section 320 IPC defines following injuries as grievous. Emasculation (cutting of the penis, castration; or causing loss of power of erection due to spinal injury). Permanent privation of the sight of either eye. Permanent privation of the hearing of either ear. Privation of any member (pa, organ, limb) or joint. Destruction or permanent impairing of powers of any member or joint. Permanent disfiguration of head or face. Fracture or dislocation of a bone or a tooth. Any hu which endangerous life or which causes the sufferer to be, during the space of twenty days in severe bodily pain, or unable to follow his daily routine. Section 319 IPC defines hu as bodily pain, disease, or infirmity, caused to any person. Grievous hu is a cognisable offence for which a police officer can arrest a person without a warrant from magistrate. 3. Dangerous injury is a variety of grievous injury. It is an injury whichposes an immediate danger to life and is fatal in absence of surgical aid, e.g. gun shot wounds, compound skull fracture, trauma to large blood vessel or rupture of internal organ like spleen.
|
Forensic Medicine
| null |
In a patient of unilateral loss of vision, the patient had injury to opposite eye leading to corneal opacification. The patient was operated by corneal grafting, he could see clearly again with one eye. The injury is said to be
A. Simple
B. Grievous
C. Dangerous
D. Hazardous
|
Simple
|
8324181b-2cf3-4cef-ac98-a66bd9b7437d
|
When a person moves to a standing position, blood pools in the leg veins, causing decreased venous return to the hea, decreased cardiac output, and decreased aerial pressure. The baroreceptors detect the decrease in aerial pressure, and the vasomotor center is activated to increase sympathetic outflow and decrease parasympathetic outflow. There is an increase in hea rate (resulting in a decreased PR interval), contractility, and total peripheral resistance (TPR). Because both hea rate and contractility are increased, cardiac output will increase toward normal
|
Physiology
|
Cardiac Output
|
When a person moves from a supine position to a standing position, which of the following compensatory changes occurs?
A. Decreased hea rate
B. Increased contractility
C. Decreased total peripheral resistance (TPR)
D. Decreased cardiac output
|
Increased contractility
|
05bef95b-9727-4485-9cc2-3b0173d78cab
|
Ans. (a) Proline to hydroxyprolineRef: Harpers Biochemistry, 30th ed. pg. 47, 562* Ascorbic acid is needed for a variety of biosynthetic pathways, by accelerating hydroxylation and amidation reactions.* In the synthesis of collagen, ascorbic acid is required as a cofactor for following enzymes:# Prolyl hydroxylase# Lysyl hydroxylase* These two enzymes are responsible for the hydroxylation of the proline and lysine amino acids in collagen.* Remember, Hydroxyproline and hydroxylysine are important for stabilizing collagen by cross-linking the propeptides in collagen.* Clinical effects if there is defective collagen fibrillogenesis:# Impaired wound healing.# Impaired bone bormation# Abnormal bleeding due to fragile capillaries.
|
Biochemistry
|
Proteins and Amino Acids
|
Vitamin C is necessary in the formation of collagen. It is required for the conversion of:
A. Proline to hydroxyproline
B. Beta-carotene to vitamin A
C. Glutamate to gamma-carboxyglutamate
D. Pyridoxine to pyridoxal phosphate
|
Proline to hydroxyproline
|
1d2dce7c-2dfb-49df-abf0-7f2de7327354
|
Pigmented villonodular synovitis (PVNS) is a benign proliferative condition affecting synol membranes of joints, bursae or tendons resulting from synol proliferation with villous and nodular projections and haemosiderin deposition. PVNS is most commonly mono aicular mainly involving Knee joint
|
Radiology
|
Musculoskeletal Radiology
|
Pigmented Villonodular synovitis most commonly involves?
A. Shoulder
B. Knee
C. Hip
D. Ankle
|
Knee
|
8f905234-66fd-494d-93fd-75a8758c06ff
|
Due to narrowing of the airway it resembles the steeple of the church. It is a characteric x ray finding for croup/ acute laryngo tracheo bronchitis. Croup is a viral infection, most common causative agent is parainfluenza virus C/F fever, malaise, respiratory distress, barking cough, stridor Rx: Mild case Dexamethasone i/m single dose Mild- moderate Dexamethasone single dose + nebulized epinephrine, suppoive care No role of antibiotics Acute epiglottitis shows thumb sign On direct inspection we see cherry red epiglottis (red swollen epiglottis). Most common causative agent is streptococcus (previously it was H. influenzas but with availability of H. influenzae vaccine, it is streptococcus) It is bacterial infection for the child is much more sick C/F High grade fever, drooling of saliva, respiratory distress Rx along with respiratory suppo we give antibiotics Treatment of choice-> IV 3 generation Cephalosporins Ceftriaxone
|
Pediatrics
|
JIPMER 2018
|
Steeple sign is seen in?
A. Influenza infection
B. Croup
C. Laryngomalacia
D. Acute epiglottitis
|
Croup
|
0845ede5-148a-4682-9147-e2aa842d679a
|
Liver transplant is becoming popular for cirrhosis with varices. It is ideal, final and best. But donor availability and cost is the problem. If patient is for ohotopic liver transplantation (OLT), open shunt surgeries should not be done as liver hilum should be kept virgin for effective transplantation. TIPSS can be done as a bridge in such patients. Ref: SRB&;s manual of surgery,3 rd ed, pg no 555
|
Surgery
|
G.I.T
|
In ohotropic liver transplantation, which is the best way to get bile drainage in donor&;s liver
A. Donor bile duct with recipient bile duct or Roux en Y choledochojejunostomy
B. Donor bile duct with duodenum of recipient
C. Donor bile duct with jejunum of recipient
D. External drainage for few days followed by choledochojejunostomy
|
Donor bile duct with recipient bile duct or Roux en Y choledochojejunostomy
|
e73848fa-8f45-4725-be6c-60b1d28f059d
|
Vitamin C. Vitamin C (ascorbic acid) is a powerful, biologic reducing agent that is necessary for the hydroxylation of proline residues in collagen. Most of the clinical features associated with vitamin C deficiency (scurvy) are caused by the formation of an abnormal collagen that lacks tensile strength. Patients with vitamin C deficiency exhibit poor wound healing. Dehiscence (bursting open) of previously healed wounds may also occur. None of the other choices are required for collagen assembly.Diagnosis: Wound healing
|
Pathology
|
Inflammation & Repair
|
A 25-year-old woman sustains a deep, open laceration over her right forearm in a motorcycle accident. The wound is cleaned and sutured. During the next 3 months, the wound heals with formation of a linear scar. Which of the following nutritional factors is required for proper collagen assembly in the scar tissue of the patient?
A. Folic acid
B. Thiamine
C. Vitamin A
D. Vitamin C
|
Vitamin C
|
80a09353-3b8b-4e4b-84c1-5c426d9881ee
|
Ans. is 'a' i.e., DuodenumAlmost all iron absorption occurs in the duodenum.
|
Physiology
| null |
Iron absorption takes place in which pa of intestine?
A. Duodenum
B. Ileum
C. Jejunum
D. Colon
|
Duodenum
|
60d464f6-ed63-46ff-be03-54a620d61088
|
C i.e. Fracture dislocation of upper cervical
|
Forensic Medicine
| null |
Death of judicial hanging is because of :
A. Vasovagal shock
B. Occlusion of airway
C. Fracture disclocation of upper cervical veebra
D. Coma
|
Fracture disclocation of upper cervical veebra
|
b0a7408e-7d90-4663-a44c-c6eb704134ea
|
The patient in the question following A has blood in the urethral meatus and a palpable abdominal mass both of which indicate the presence of injury to membranous urethra. Injury to membranous urethra occur following fracture of pelvis or avulsion of symphysis pubis. Rupture usually occur at the junction of membranous and prostatic urethra. Ref: Current Surgical Diagnosis & Treatment, Gerard M. Dohey, Page 1030-32; Undergraduate Surgery By A.K. Nan page 671.
|
Surgery
| null |
A patient is brought to the hospital with history of A 8 hours back. A few drops of blood were noted at the external urethral meatus. He has not passed urine and his bladder is palpable per abdomen. What is the probable diagnosis?
A. Urethral injury
B. Rupture of bladder
C. Anuria due to hypovolemia
D. Ureteral injury with extravasation of urine into the retro peritoneum
|
Urethral injury
|
73932e61-37db-4a4a-bd3a-5148d1e7f783
|
[A) (IgE) (161-AN 7th) (202-206-CP)Type of reactionClinical syndromeMediatorsType I - IgE1. Anaphylaxis2. Atopy P.K. reactionIgE, histamine and other pharmacological agents
|
Microbiology
|
Immunology
|
Type I hypersensitivity, the mediator is:
A. IgE
B. IgE
C. IgM
D. IgC
|
IgE
|
2fe954c6-2b59-4c56-8b05-bf28760b450f
|
BMI stands for the Body Mass Index which is used to predict weight for the respective height. It is defined as the weight in kilograms divided by the square of height in metres and is expressed as kg/m2. A value of BMI > 30 is classified as obesity and a BMI of > 40 is classified under class III obesity. A BMI > 20 up to 30 will include those who are pre-obese and the overweight. Ref: Park's Textbook of Preventive and Social Medicine 19th Edition; Pages 332 - 335; 515.
|
Social & Preventive Medicine
| null |
What should be the value of BMI for it to be classified as obesity?
A. > 50
B. > 40
C. > 30
D. > 20
|
> 30
|
503a073d-2e67-42ac-8b0d-c1df37328865
|
Ans. is 'd' i.e., Splenic Branches of coeliac trunkThe coeliac trunk is only about 1.25 cm long and it ends by divided into its three terminal branches :?1) Left gastric aery :- It is the smallest branch of coeliac trunk. It ends by anastomosing with right gastric aery. It gives off :a) Two or three esophageal branches.b) Number of gastric branches.2) Common hepatic aery :- It runs to the right behind lesser sac and enters the free right border of lesser omentum and then run upwards as proper hepatic aery, in front of poal vein and to the left of bile duct. After reaching the poa hepatis it terminates by dividing into right and left hepatic branches. It gives of following branches :a) Gastroduodenal aery :- It terminates by dividing into right gastroepiploic aery and superior pancreaticoduodenal aery.b) Right gastric aery.c) Cystic aery :- It is a branch of right hepatic aery.3) Splenic aery :- It is the largest branch of coeliac trunk. It runs horizontally to the left along upper border of pancreas and has touous course. It crosses left suprarenal gland and left kidney to enter the linorenal ligament through which it reaches the hilum of spleen where it divides into 5-7 splenic (hilar) branches. It gives off :a) Numerous pancreatic brnaches :- These supply body and tail of pancreas. One of the pancreatic branches is large and is called aeria pancreatic magna. Another large branch is called aeria caudae pancreatis.b) Sho gastric anteries :- Run in gastrosplenic ligament and supply the fundus of stomach.c) Left gastroepiploic aery :- It anastomoses with right gastroepiploic aery and supplies stomach and greater omentum.d) Posterior gastric aery :- It is an inconsistent branch and supplies posterior body and fundus of stomach.
|
Anatomy
| null |
Aeria pancreatic magna is a branch of which aery ?
A. Left gastric
B. Right gastric
C. Common hepatic
D. Splenic
|
Splenic
|
9d4bc6ea-ddb5-45e1-960a-fefc8ce1fc41
|
Hypervolemia leads to low plasma renin. Low renin measurements differentiate primary from secondary, hyperreninemic forms of hyperaldosteronism seen in renovascular hypeension, coarctation of the aoa, renin-secreting neoplasms, or diuretic therapy Ref Davidson 23rd edition pg 486
|
Medicine
|
C.V.S
|
Low renin ls seen In A/E-
A. Essential hypeension
B. Conn's syndrome
C. Renovascular hypeension
D. Liddle syndrome
|
Renovascular hypeension
|
64945c85-2750-4ff7-8e6a-8174bb7c7738
|
Ans. is 'c' i.e., SCC * Squamous cell carcinoma is by far the most malignant tumor of the larynx and hypopharynx.
|
Pathology
|
Neoplasia
|
Most common type of hypopharyngeal carcinoma is?
A. Adenocarcinoma
B. Lymphoma
C. SCC
D. Neuro-endocrine tumor
|
SCC
|
789013ee-9d00-43db-93cd-37ec2d192be3
|
Ans. is 'd' i.e., Rheumatic carditis o Cardiac failure causes cardiomegaly o MC cause of cardiac failure in children (elder than infants) is rheumatic fever and rheumatic hea disease.
|
Pediatrics
| null |
Commonest cause of enlarged cardiac shadow in X-ray of a child is -
A. PDA
B. Coarctation of Aoa
C. Pericarditis
D. Rheumatic carditis
|
Rheumatic carditis
|
26782fc1-239a-4a57-a5ce-81354186abfb
|
(D) Laryngeal cancer[?]High tracheostomy is done above the level of thyroid isthmus (isthmus lies against II, III and IV tracheal rings). It violates the 1st ring of trachea. Tracheostomy at this site can cause perichondritis of the cricoid cartilage and subglottic stenosis and is always avoided. Only indication for high tracheostomy is carcinoma of larynx because in such cases, total larynx anyway would ultimately be removed and a fresh tracheostoma made in a clean area lower down.[?]Low tracheostomy is done below the level of isthmus. Trachea is deep at this level and close to several large vessels; also there are difficulties with tracheostomy tube which impinges on suprasternal notch.Indications of tracheostomy:1. Upper respiratory tract obstruction; Laryngeal, supralaryngeal, and tracheal causes. (Causes of stridor)2. Lower respiratory tract obstruction: (Secretory obstruction, Wet lung syndrome).Only indication for high tracheostomy is carcinoma of larynx because in such cases total larynx airway would ultimately be removed and a fresh tracheostoma made in a clean area. TRACHEOTOMY INDICATIONSCauseExamplesCongenitalSubglottic or upper tracheal stenosis, laryngeal web, laryngeal & vallecular cysts, tracheoesophageal anomalies or haemangioma of the larynxTRACHEOTOMY INDICATIONSCauseExamplesCongenitalSubglottic or upper tracheal stenosis, laryngeal web, laryngeal & vallecular cysts, tracheoesophageal anomalies or haemangioma of the larynxInfectiveAcute epiglottitis, laryngotracheobronchitis, diaphtheria or Ludwig's angina.MalignancyAdvanced tumours of larynx, pharynx or upper trachea presenting with stridorTraumaGunshot and knife wounds to the neck, inhalation of steam or smoke, swallowing of corrosive fluidVocal cord paralysisPost operative complication of thyroidectomy, cardiac or oesophageal surgery, bulbar palsy.Foreign bodySwallowed or inhaled object lodged in upper airway causing stridor.Other Options[?]Vocal Cord Palsy:Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds.Bilateral VFP (BVFP) is characterized by inspiratory dyspnea due to narrowing of the airway at the glottic level with both vocal folds assuming a paramedian position.The primary objective of intervention for BVFP is to relieve patients' dyspnea.Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy.[?]Tracheomalacia:Indications for tracheostomy in Tracheomalacia are severe symptoms, failure of conservative therapy, and proximal or diffuse tracheomalacia.Indications for aortopexy are dying spells or reflex apnea, recurrent pneumonia, intermittent respiratory obstruction, and inability to extubate airway in an infant who is intubated..[?]Foreign Body:Occasionally, open surgical intervention in the form of tracheostomy, thoracotomy and bronchotomy and/or pulmonary resection is needed for removal of foreign bodies.[?]General indications for Tracheostomy:Include the following: Congenital anomaly (E.g, laryngeal hypoplasia, vascular web) Upper airway foreign body that cannot be dislodged with Heimlich and basic cardiac life support maneuvers. Supraglottic or glottic pathologic condition (E.g, infection, neoplasm, bilateral vocal cord paralysis).
|
ENT
|
Larynx
|
High tracheostomy is done in which one of the following condition?
A. Vocal cord palsy
B. Tracheomalacia
C. Foreign body
D. Laryngeal cancer
|
Laryngeal cancer
|
6a4772cb-3809-4a6d-9ab0-0ac89bd26a5a
|
Ans. is 'b' i.e., Meconium aspiration o Most common cause of respiratory distress in a term or post-term neonate -4 Meconium aspiration. o Most common cause of respiratory distress in a preterm infant --> hyaline membrane disease.
|
Pediatrics
| null |
Most common cause of respiratory distress after bih in first 24 hours is -
A. Neonatal sepsis
B. Meconium aspiration
C. Bacterial pneumonia
D. Air embolism
|
Meconium aspiration
|
5b48523f-cccd-4cfe-aa31-0603426d9c5b
|
Given scenario suggests Gaucher disease Gaucher disease is the most common lysosomal storage disorder with a defect of lysosomal enzyme acid b glucosidase. Gaucher cells are lipid laden macrophages that show a characteristic histologic appearance of "wrinkled tissue paper" of cytoplasm.
|
Pediatrics
|
Lysosomal Storage Diseases
|
Bone marrow examination of a 2 year old child with massive splenomegaly and pancytopenia showed cells with wrinkled paper appearance of cytoplasm. What could be the possible diagnosis?
A. Niemann Pick disease
B. Gaucher disease
C. Acute Leukemia
D. Hereditary spherocytosis
|
Gaucher disease
|
12324900-2e30-4a44-b907-708356b653a4
|
Restless leg syndrome / Ekbom syndrome. Sensorimotor disorder, commonly seen in 5-15% of the population. Affects females and after 40 years. 4 salient diagnostic features being: Urge to move limbs, commonly associated with premonitory sensory discomfo Motor restlessness Relief by activity Evening/Night worsening Pathophysiological explanations or mechanisms attributed are: Dysregulation of dopamine transmission Intracellular iron dysregulation. This can be objectively substantiated by decreased CSF ferritin and prohepcidin (Intracellular regulatory protein for iron) levels.
|
Psychiatry
|
Substance Related and Addictive Disorders
|
Ekbom syndrome is:-
A. Narcolepsy
B. Restless leg syndrome
C. Pica
D. Delusion of nihilism
|
Restless leg syndrome
|
26c9d98f-d399-4488-b452-c5bfabfa62f6
|
One tablet of iron containing 100mg of elemental iron is given daily. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 594
|
Social & Preventive Medicine
|
Nutrition and health
|
Elemental iron supplementation in Iron deficiency anemia is -
A. 300-400 mg
B. 150-200 mg
C. 100-150 mg
D. <100 mg
|
100-150 mg
|
ef4212cd-fc0d-46ad-b33d-d1f5899b5657
|
Ans. is `b' i.e., Pendrin Pendred syndrome or Pendred disease :? Pendred syndrome or Pendred disease is a genetic disorder leading to congenital bilateral (both sides) sensorineural hearing loss and goitre with occasional hypothyroidism. It has been linked to mutations in the PDSgene, which codes for the pendrin protein (solute carrier family 26, member 4, SLC26A4). The gene is located on the long arm of chromosome 7 (7q31). It is an autosomal recessive disorder.
|
Pathology
| null |
Pendred syndrome due to mutation of ?
A. Baillin
B. Pendrin
C. Fibrillin
D. Reticulin
|
Pendrin
|
7b81040c-9388-452c-95e8-c7de8bc5a321
|
Freeze-drying--technically known as lyophilization or cryodesiccation--is a dehydration process typically used to preserve a perishable material or make the material more convenient for transpo.Viruses can be preserved by storage at subfreezing temperatures, and some may withstand lyophilization and can thus be preserved in the dry state at 4degC or even at room temperature
|
Microbiology
|
general microbiology
|
Lyophilization means
A. Sterilizations
B. Freeze drying
C. Burning to ashes
D. Exposure to formation
|
Freeze drying
|
84b0180b-3089-44ff-af7d-78564b578248
|
The retropubic space (of Retzius) is the extraperitoneal space between the pubic symphysis and the bladder. A needle placed over the pubic bone, through the body wall, and into the space of Retzius will enter the full bladder but avoids entry into the peritoneum and there is little risk of damaging major organs or vessels. Entry through the ischioanal fossa would not provide a direct route to the bladder. With entry through the superficial perineal cleft, perineal body, and deep perineal pouch there is a high risk of damaging important structures.
|
Anatomy
|
Abdomen & Pelvis
|
A 62-year-old man is admitted to the emergency department due to increasing difficulty in urinating over a period of several months. Physical examination reveals prostatic hypertrophy. After several unsuccessful attempts to catheterize the penile urethra, the urologist orders drainage of the urinary bladder by the least invasive procedure, avoiding entry into the peritoneal cavity or the injury of any major vessels or organs. Which of the following spaces needs to be traversed by the needle to reach the bladder?
A. Ischioanal fossa
B. Perineal body
C. Retropubic space (of Retzius)
D. Superficial perineal cleft
|
Retropubic space (of Retzius)
|
ca9932e7-fb48-48c2-b4ce-fc0684b3ee23
|
Specificity is the ability of a test to identify correctly those who do not have the disease, that is, the percentage of "true negatives" among those not diseased. In the above question, there are 600 true negatives among 800 who are not diseased. Hence, the specificity is (600/800)x100 = 75 per cent. Ref: Park's Textbook Of Preventive And Social Medicine, By K. Park, 19th Edition, Pages 118, 119.
|
Social & Preventive Medicine
| null |
Calculate the specificity of the screening test: Screening test results Diseased Not diseased Total Positive 400 200 600 Negative 100 600 700 Total 500 800 1300
A. 70 per cent
B. 75 per cent
C. 80 per cent
D. 85 per cent
|
75 per cent
|
159473c0-b695-46e2-bf05-4acb948fd90c
|
Ans. D. Anorexia nervosaAnorexia nervosa is an eating disorder, characterized by low weight, food restriction, fear of gaining weight, and a strong desire to be thin. Many people with anorexia see themselves as overweight even though they are, in fact, underweight. They often deny that they have a problem with low weight. They weigh themselves frequently, eat small amounts, and only eat certain foods. Some will exercise excessively, force themselves to vomit, or use laxatives to produce weight loss. Complications may include osteoporosis, infertility, and heart damage--among others. Women will often stop having menstrual periods. It is seen more in males than females.
|
Psychiatry
|
Child Psychiatry
|
Among the following disorders which is not seen more in males than females?
A. Autism
B. Conduct disorder
C. Oppositional defiant disorder
D. Anorexia Nervosa
|
Anorexia Nervosa
|
84ab63c5-c08c-40b4-9efd-d310be66ec4f
|
OCPs are contraindicated in patient on enzyme-inducing drugs like rifampicin, and antiepileptic except sodium valproate. Rifampicin induces cytochrome 450 ,increasing the hepatic hydroxlation of estrogen by which there is a fourfold increase in its metabolism. This causes clearance and deceased effect of estrogen. Reference: Shaw's textbook of Gynaecology 17th edition,page 265.
|
Gynaecology & Obstetrics
|
Contraception
|
OCP's are contraindicated in women receiving which of the following drug ?
A. Rifampicin
B. Ethambutol
C. Streptomycin
D. Pyrazinamide
|
Rifampicin
|
053f73df-b721-450d-8818-463fb7118169
|
Classification criteria for Psoriatic ahritis is used in the diagnosis of psoriatic ahropathy Refer : maheswari 9th ed
|
Orthopaedics
|
Joint disorders
|
CASPAR criteria is used in diagnosis
A. Psoriatic ahritis
B. Rheumatoid ahritis
C. Ankylosing spondylitis
D. Reactive Synovitis
|
Psoriatic ahritis
|
d101e7c4-1e2f-43d4-af77-b0e044a4207a
|
Ketamine has multiple effects throughout the central nervous system, and it is well recognized to inhibit N-methyl-D-aspaate (NMDA) channels and neuronal hyperpolarization-activated cationic (HCN1) channels. Ref: Morgan & Mikhail's clinical anesthesiology 6e
|
Anaesthesia
|
General anaesthesia
|
Ketamine acts an which receptor
A. GABAA
B. GABAB
C. NMDA
D. Glutamate
|
NMDA
|
85087c1e-da65-4197-9c52-18ecdd39bfba
|
Addition of nucleotides requires a free OH group on the 3' end of the DNA strand The Sanger method of DNA sequencing is also known as chain termination sequencing. In this method, DNA strands are synthesized in the presence of a low concentration of dideoxynucleosides (ddNTPs) in addition to deoxynucleosides (dNTPs). Incorporation of a dNTP allows synthesis to continue as there is a free 3'-OH group for addition of the next nucleotide. Incorporation of a ddNTP terminates synthesis of the DNA strand as there is no free 3-OH group for addition of the next nucleotide. In Sanger sequencing, four reactions (A, C, T, and G) are run, each containing the appropriate ddNTP. The mixture of DNA strands generated in each reaction includes strands that are terminated at each given nucleotide (e.g., the A reaction contains DNA strands terminated at each A). The four reactions are run adjacent to one another on an acrylamide gel to separate the strands by size. The sequence of the DNA is determined by reading the order of the terminated chains going up the gel.
|
Surgery
| null |
DNA sequencing by the Sanger method takes advantage of which propey of DNA synthesis to generate a sequencing ladder?
A. Addition of nucleotides requires a free OH group on the 3' end of the DNA strand
B. DNA has a free 5' phosphoryl group
C. DNA polymerase has proofreading capabilities
D. Nucleotides are linked by phosphodiester bonds
|
Addition of nucleotides requires a free OH group on the 3' end of the DNA strand
|
d6417bdc-3438-43df-bb1a-d5fa664c57a4
|
Septum secundum Grows down from theroof of the common atrium(primitive atrium)toward the atrioventricular endocardial cushions. Present on the right side of the septum primum. Contains foramen ovale for the pasage of blood from RA to LA. Note =Order of hea tube on day 21 from caudal to cranial Sinus venosus Atrium Ventricle Bulbus cordis Truncus aeriosus
|
Anatomy
|
CVS Embryology
|
Septum secundum arises from:
A. Bulbus cordis
B. Primitive ventricle
C. Primitive atrium
D. Sinus venosus
|
Primitive atrium
|
1c7222d5-8536-4b29-9d2a-fdaf8f802c08
|
Most common-paranoid Best prognosis-catatonic Worst prognosis-simple Personality deterioration-hebephrenic Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 365-370
|
Psychiatry
|
Schizophrenia and other psychotic disorders
|
Most common type of schizophrenia is
A. Paranoid
B. Catatonic
C. Hebephrenic
D. Simple
|
Paranoid
|
7f550afd-6824-420f-b20f-e9e0efd38004
|
Ans. C. Log phase1. Max. size in lag phase2. Max. active, dividing, smaller cells with uniform staining in log phase3. Speculation, exotoxin production & antibiotic production occurs in stationary phase4. Involutional forms in phase of decline.
|
Microbiology
|
General
|
The rationale for giving prophylactic antibiotics at the beginning of a surgical procedure can be thought of as an attempt to prevent the bacteria from entering which of the following growth phases?
A. Death phase
B. Lag phase
C. Log phase
D. Phase of decline
|
Log phase
|
3e8b63d4-ebc8-4ddc-ac90-134456f12a05
|
The microscopic appearance also undergoes a characteristic sequence of changes . Typical features of coagulative necrosis become detectable within 4 to 12 hours of infarction. "Wavy fibers" also can be present at the edges of an infarct. Light microscopic features in 1-3 days include: Coagulation necrosis with loss of nuclei and striations; interstitial infiltrate of neutrophils. (Robbins basic pathology,9th edition.pg no.380)
|
Pathology
|
Cardiovascular system
|
Cells seen in MI at 48 hours are
A. polymorphs
B. Fibroblasts
C. Lymphocytes
D. Macrophages
|
polymorphs
|
db8d2e6d-3d98-4ca1-a145-aa1cf7e2d3b8
|
Several inhibitory synapses are located directly on the axon hillock and initial axon segment. This location provides especially powerful inhibition because it has the direct effect of increasing the threshold for excitation at the very point where the action potential is normally generated.Ref: Guyton; 13th edition; Chapter 46; Organization of the Nervous System, Basic Functions of Synapses, and Neurotransmitters
|
Physiology
|
General physiology
|
Initiation of impulse stas in
A. Axon
B. Axon hillock and initial segment
C. Cell body
D. Dendritic tree
|
Axon hillock and initial segment
|
62e51b76-fdc6-48c0-88b2-c61205df7320
|
Radionuclides react with hydroxyapatite and the pattern of uptake is seen on the bone scan. Strontium-89, Samarium-153, Phosphorus -32, Rhenium-186, Tin -117m emit beta particles with a mean range between 0.2 to 3 mm, minimising toxicity to the surrounding tissues.
Technetium 99m emits gamma radiations and is used as a diagnostic tool in medical sciences.
|
Radiology
| null |
Which of the following emits gamma radiations only?
A. Strontium 89
B. Technetium 99m
C. Phosphorus 32
D. Tin 117m
|
Technetium 99m
|
46926575-ed47-4299-b3a4-63b7386f5804
|
Human copper deficiency diseases of importance are hepatotenticular degeneration (Wilson’s disease) and Menke’s syndrome (Steely-or-Kinky hair syndrome).
|
Pathology
| null |
Which among the following is not a copper deficiency disease:
A. Hunter's disease.
B. Wilson's disease.
C. Menke's syndrome.
D. Hepatolenticular degeneration.
|
Hunter's disease.
|
c1b6770d-1ada-4143-8a4b-d35e84d3f314
|
Chronic granulomatous disease (CGD) has a defective NADPH oxidase activity with recurrent infection and granuloma formation affecting gastrointestinal or genitourinary tract. CGD can be diagnosed with the following tests:
Nitroblue-tetrazolium (NBT) test: It is negative in chronic granulomatous disease and positive in normal individuals. This test depends upon the direct reduction of NBT by superoxide free radical to form an insoluble formazan. This test is simple to perform and gives rapid results, but only tells whether or not there is a problem with the PHOX enzymes, not how much they are affected.
Dihydrorhodamine (DHR) test: In this test, the whole blood is stained with DHR, incubated and stimulated produce superoxide radicals which reduce DHR to rhodamine in cells with normal function.
Cytochrome C reduction assay is an advanced test that tells physicians how much superoxide a patient’s phagocytes can produce.
|
Pathology
| null |
In which of the following conditions is negative nitroblue tetrazolium dye test result seen?
A. Tuberculosis
B. Chronic granulomatous disease
C. Severe combined Immunodeficiency
D. DiGeorge syndrome
|
Chronic granulomatous disease
|
20c45c69-43ca-4fa0-863e-61536f22934b
|
The classic postmoem feature of Acute Arsenic poisoning is Red velvety stomach. The mucous membrane is covered with tenacious mucus often tinged with blood, and is swollen and red in appearance. The distribution is usually patchy and corresponds to the deposits of paicles of arsenic, around which the inflammatory changes are evident. Ulceration or erosions may be found, especially at the pyloric end. Submucous petechial haemorrhages are often seen. Another impoant postmoem feature of Arsenic poisoning is that Rigor mois lasts longer than usual.
|
Forensic Medicine
|
Toxicology - 2
|
Red velvety stomach is seen in?
A. Lead
B. Arsenic
C. Copper
D. Mercury
|
Arsenic
|
5a6dad5d-15f1-46ed-ab44-99dfa1009a3d
|
Hemodynamic instability is the most pressing indication for operative treatment in a patient with splenic injury. In all other situations listed a trial of nonoperative management may be continued.
|
Surgery
|
Spleen
|
Which of the following is a contraindication to nonoperative management of splenic injury?
A. Prior hematologic disorder
B. HIV-positive patient
C. Hemodynamic instability
D. Multiple other solid-organ injuries
|
Hemodynamic instability
|
c7a0adfc-66e3-428e-9d05-394a7ae19359
|
Luftsichel sign is a sickle shaped lucency of air seen On Chest Radiographs, Seen in Left Upper lobe collapse with Compensatory Left Lower lobe hyperinflation.
|
Radiology
|
Respiratory Radiology
|
Luftsichel sign is seen in
A. Right upper lobe collapse
B. Right middle lobe collapse
C. Left upper lobe collapse
D. Left lower lobe collapse
|
Left upper lobe collapse
|
a70d2851-0982-4f7f-a282-50c275abfd2e
|
TETRACYCLINES These are a class of antibiotics having a nucleus of four cyclic rings. Mechanism of action The tetracyclines a :- c primarily bacteriostatic; inhibit protein synthe:"i&; by binding to 305 ribosomes in susceptible organism. Subsequent to such binding, attachmer. : o f aminoacyl-t-RNA to the mRNA-ribosomc complex is interferred with. A ntimicrobial spectrum When originally introduced, tetracyclines inhibited practically all tvpes of pathogenic microorganisms except fungi and viruses; hence the name &;broad-spectrum antibiotic&;. However, promiscous and often indiscriminate use has gradually narrowed the field of their usefulness. 1. Cocci: All gram-positive and gram-negative cocci were originally sensitive, but now many Strep. pyogenes, Staph. aureus and enterococci have become resistant. Responsiveness of Strep. pneumoniae has decreased somewhat. Tetracyclines (especially minocycline) are now active against few N. gonorrhoeae and N. meningitidis. 2. Most gram-positive bacilli, e.g. Clostridia and other anaerobes, Listeria, Corynebacteria, Propionibacterium acnes, B. anthracis are inhibited but not Mycobacteria, except some atypical ones. 3. Sensitive gram-negative bacilli are-H. ducreyi, Calymmatobacterium granulomatis, V. cholerae, Yersinia pestis, Y. enterocolitica, Campylobacter, Helicobacter pylori, Brucella, Pasteurella multocida, F. tularensis and many anaerobes; some H. influenzae have become insensitive. Enterobacteriaceae are now largely resistant. Notable bacilli that are not inhibited are Pseudomonas aeruginosa, Proteus, Klebsiella, Salmonella typhi and many Bact. fragilis. MIC against anaerobes is relatively higher. 4. Spirochetes, including T. pallidum and Borrelia are quite sensitive. 5. All rickettsiae (typhus, etc.) and chlamydiae are highly sensitive. 6. Mycoplasma and Actinomyces are moderately sensitive. 7. Entamoeba histolytica and Plasmodia are inhibited at high concentrations. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:710,711,712
|
Pharmacology
|
Chemotherapy
|
Drug effective against pseudomonas is:
A. Penicillin G
B. Gentamicin
C. Tetracycline
D. Chloramphenicol
|
Tetracycline
|
6918d99b-4554-4849-b584-41fb0dcfe642
|
Secretion inhibitors:These are fastest acting anti thyroid drugs. NaI KI Lugol iodine Thyroid peroxidase inhibitor Carbimazole/Methimazole Propylthiouracil Thiocyanate is Na+I+sympoer (NIS) inhibitor. Highly toxic Not used clinically
|
Pharmacology
|
Pituitary-Hypothalmic System and Thyroid
|
Fastest acting anti-thyroid drug is
A. Sodium Iodide
B. Propyl thiouracil
C. Methimazole
D. Thiocyanate
|
Sodium Iodide
|
863ffc62-397e-4a42-aa00-169a3a43cd47
|
Ans. is 'a' i.e., Zenkers diverticulum Treatment of zenker's diverticulum* Treatment is excision of pouch and cricopharyngealmyotomy. This is done through cervical approach.* Dohlman'sprocedure: - The partition wall bewteen the oesophagus and the pouch is divided by diathermy through an endoscope. This is done in poor risk debilitated patients.* Endoscopic laser treatmentIt is similar to Dohlman's procedure. Partition between the pouch and oesophagus is divided by CO2 laser using operating microscope.
|
Surgery
|
Oesophagus
|
Dohlmans procedure is used for -
A. Zenkers diverticulum
B. Carcinoma esophagus
C. Carcinoma larynx
D. Nasal carcinoma
|
Zenkers diverticulum
|
c4078f89-29ea-4214-913e-0b5db8df7d22
|
Many different species of fungi are found to involve the paranasal sinuses, the more common being the Aspergillus, Alternaria, Mucor or Rhizopus. "Most common type of fungal infection of nose and parsnasal sinuses are due to Aspergillus, Aspergillus fumigatus, Aspergillus niger and Aspergillus flavus"
|
Microbiology
|
Mycology
|
Which of the following is the most common etiological agent in paranasal sinus mycoses?
A. Aspergillus spp
B. Histoplasma
C. Conidiobolus coronatus
D. Candida albicans
|
Aspergillus spp
|
2a5fe12a-8ed0-43d4-87a4-a254747db84d
|
Ans. is 'c' i.e., Plasma cells o Gamma globulins (immunoglobulins) are synthesized by plasma cells.Plasma cellso Plasma cells are the antibody secreting cellso On contact with its appropriate antigen, the mature B cell undergoes clonal proliferation. The majority of activated B cells are transformed into plasma cells and secrete antibodies,o Plasma cells make an antibody of a single specificity, of a single immunoglobulin class and allotype.and of a single light chain type only. An exception is seen in the primary antibody response, when a plasma cell producing Ig M initially, may later be switched to Ig G production.o While plasma cell is the best antibody producing cell, lymphocytes, lymphoblasts and transitional cells may also synthesise Ig to some extent.
|
Microbiology
|
Immunity
|
Gama globulins are synthesized in -
A. Liver
B. Lung
C. Plasma cells
D. Spleen
|
Plasma cells
|
b8427883-c96c-4a17-a041-707d2e021937
|
IMAGE : SPADE LIKE DEFORMITY OF HANDS: Seen in ACROMEGALY Screening test done: IGF -1 IOC: Glucose challenge test (GCT) Treatment: Surgery (Transphenoidal Resection) If recurrence seen: PEGVISOMANT
|
Medicine
|
Disorders of pituitary gland
|
Which of these tests is the first to be performed in a patient with the following presentation?
A. ABG sampling
B. IGF- 1 levels
C. RA factor
D. HLA- B27 levels
|
IGF- 1 levels
|
1986196e-869c-41c0-a4fe-0bf8b993bc87
|
PROKINETIC DRUGS ACh is the main excitatory neurotransmitter in the GIT. Cholinergic neurons contain excitatory (5-HT4) as well as inhibitory (5HT3, D2) presynaptic receptors. Thus D2 and 5HT3 antagonists and 5 HT4 agonists will increase the release of ACh and stimulate the GI motility. Metoclopramide possesses central as well as peripheral D2 blocking action. Central D2 blocking action is responsible for its antiemetic effects. Domperidone is a D2 receptor antagonist and cannot cross blood brain barrier. It is mainly used as an antiemetic (less efficacious than metoclopramide) drug and is devoid of extrapyramidal and hyperprolactinemic adverse effects. Cisapride, mosapride, renzapride, prucalopride and tegaserod are 5-HT4 agonistic drugs with no action on D2 receptors (no antiemetic propey). These drugs increase whole GI motility including colon.
|
Pharmacology
|
Gastro-Intestinal Tract
|
Which of the following is a prokinetic drug with no dopamine antagonism?
A. Chlorpromazine
B. Metoclopramide
C. Domperidone
D. Mosapride
|
Mosapride
|
62300684-3991-4bca-be05-8b43c0dbd535
|
Ans. b. PTEN mutationRef: Robbins and Cotran Pathologic Basis of Disease 9th Ed; Page No-291Tumor suppressor genes and associated with syndromesGeneProteinFunctionFamilial syndromesPTCHPatchedInhibitor of Hedgehog signalingGorlin syndrome (basal cell carcinoma, medulloblastoma, several benign tumors)PTENPhosphatase and tensin homologueInhibitor of PI3K/AKT signalingCowden syndrome (variety of benign skin, Gl, and CNS growths; breast, endometrial, and thyroid carcinoma)STK11Liver kinase B1 (LKB1) or STK11Activator of AMPK family of kinases; suppresses cell growth when cell nutrient and energy levels are lowPeutz-Jeghers syndrome (Gl polyps, Gl cancers, pancreatic carcinoma and other carcinomas)SMAD4SMAD4Component of the TGFP signaling pathway, repressors of MYC and CDK4 expression, inducers of CDK inhibitor expressionJuvenile polyposis, pancreatic carcinoma
|
Pathology
|
Neoplasia
|
Which of the following mutation seen in Cowden syndrome?
A. PTCH mutation
B. PTEN mutation
C. STK11 mutation
D. SMAD4 mutation
|
PTEN mutation
|
5b13ac7b-536c-430d-96fc-72fb942965ba
|
Lens has a special carrier system for the Ascorbic acid which is a major oxidant in the lens This carrier system is mediated by myoinositol Refer: AK Khurana 6th edition
|
Ophthalmology
|
Lens
|
Transpo of Ascorbic acid to lenses done by
A. Myoinositol
B. Choline
C. Taurine
D. Na/K ATPase
|
Myoinositol
|
36d5588e-dc12-48a9-ad0b-9d16041e7178
|
Wood's lamp is used in Tinea capitis, Erythrasma, vitiligo, albinism, Leprosy, Tuberous sclerosis, Pseudomonas infection, Porphyria, Tinea versicolor.
|
Dental
| null |
Woods lamp used in diagnosis of – a) P. versicolorb) Vitiligoc) Porphyriad) Psoriasise) Lichen planus
A. abc
B. bc
C. acd
D. bcd
|
abc
|
5209c440-7367-40e8-95ee-770d46c073ad
|
Oral contraceptives produce an intrahepatic cholestasis that is unpredictable (not related to the dose). The incidence of liver cell adenomas is also increased as a result of oral contraceptive use. These vascular tumors have a tendency to rupture during pregnancy, particularly those in a subcapsular location.
A purported increase in the incidence of focal nodular hyperplasia (FNH) is associated with oral contraceptive use. Grossly, FNH is characterized by a poorly encapsulated nodule that has a lighter color than the surrounding hepatic parenchyma. On cut section, a centrally located stellate scar radiates out to the periphery of the lesion. Microscopically, the hepatocytes between the scar tissue are normal.
A slightly increased risk for hepatocellular carcinoma is another effect of birth control pills on the liver.
Oral contraceptives are not associated with drug-induced hepatitis with fatty change, cholangiocarcinoma, cavernous hemangiomas, or fulminant hepatic failure.
|
Unknown
| null |
Which of the following liver disorders is a compli¬cation associated with oral contraceptives?
A. Drug-induced hepatitis with fatty change
B. Cholangiocarcinoma
C. Cavernous hemangiomas
D. Intrahepatic cholestasis
|
Intrahepatic cholestasis
|
2a1993a5-29ea-4a2c-8386-3c6f2faa5a42
|
Ref. Guyton. 13th edition. Page. 96
Myasthenia gravis is an autoimmune disease characterized by autoantibodies against the acetylcholine (ACh) receptor of the neuromuscular junction, result- ing in muscular weakness predominantly affecting the facial muscles. Females are affected more frequently than males.
Extra ocular muscle weakness may lead to ptosis and diplopia; the weakness worsens with repeated contractions.
Respiratory muscle involvement may lead to death.
There is an association with thymic hyperplasia and thymomas.
Treatment is anticholinesterase agents, steroids, and thymectomy.
|
Unknown
| null |
Which receptors are blocked in Myasthenia Gravis.
A. Ach receptors
B. Calcium receptors
C. Sodium receptors
D. Opioid receptors
|
Ach receptors
|
78eeb919-124b-47d6-9f5a-1ecb5e7c2145
|
ERB’S PARALYSIS
One region of upper trunk (C# CfQ of the brachial plexus is called Erb's point where six nerves meet,
Injury at this point results in Erb’s paralysis.
The injury is due to undue separation of the head from the shoulder; which may be seen in : -
i. Birth injury
ii. Fall on the shoulder
iii. During Anesthesia
Clinical features of Erb’s palsv
A. Muscles paralysed: Mainly biceps brachii, deltoid, branchialis and brachioradialis. Partly supraspinatus, infraspinatus and supinator.
B. Deformity (position of the limb)
i. Arm : Hanges by the side; it is adducted and medially rotated
ii. Forearm : Extended and pronated
The deformity is known as “policeman's tip hand’ or ‘porter’s tip hand’.
C. Disability : The following movements are lost.
Abduction and lateral rotation of the arm (shoulder),
Flexion and supination of the forearm,
Biceps and supinator jerks are lost.
Sensations are lost over a small area over the lower part of the deltoid.
KLUMPKE’S PARALYSIS
Site of injury : Lower trunk of the brachial plexus
Cause of injury: Undue abduction of the arm, as in clutching something with the hands after a fall from a height, or sometimes in birth injury,
Nerve roots involved : - Mainly T1 and partly C8.
Muscles paralysed
i. Intrinsic muscles of the hand (T1).
ii. Ulnar flexors of the wrist and fingers (C8)
iii. Deformity (position of the hand). Claw hand due to the unopposed action of the long flexors and extensors of the fingers. In a claw hand there is hyperextension at the metacarpophalangeal joints and flexion at the interphalangeal joints.
Disability
i. Claw hand
ii. Cutaneous anaesthesia and analgesia in a narrow' zone along the ulnar border of the forearm and hand.
iii. Homer’s syndrome if T1 is injured proximal to white ramus communicans to first thoracic sympathetic ganglion. There is ptosis, miosis, anhydrosis, enophthalmos, and loss of ciliospinal
reflex-may be associated. (This is because of injury to sympathetic fibres to the head and neck that leave the spinal cord through nerve T1).
iv. Vasomotor changes : The skin area with sensory loss is warmer due to arteriolar dilation. It is also drier due to the absence of sweating as there is loss of sympathetic activity.
v. Trophic changes : Long standing case of paralysis leads to dry and scaly skin. The nails crack easily with atrophy of the pulp of fingers.
|
Anatomy
| null |
Klumpke’s paralysis affect-
A. C3C6
B. C 6 C7
C. C 8T1
D. C4C5
|
C 8T1
|
b3d41006-7d06-4d57-a69c-5f4524cacd27
|
Ans. is 'a' i.e., Methotrexate o Folate antagonists which are used as anticancer cancer drugs :- (i) Methotrexate; (ii) Premetrexate
|
Pharmacology
| null |
Antifolate cancer drug are -
A. Methotrexate
B. Azathioprine
C. Cycl osporin
D. Vincristine
|
Methotrexate
|
7b222138-7c69-4421-8605-b5459405ba1f
|
This is the history of neurocysticercosis due to T. solium. Common name for this parasite is pork tapeworm or armed tapeworm. The intermediate host is pig, while human can act as both definitive and intermediate host. When humans act as intermediate host, it causes neurocysticercosis, which is the most common parasitic infection of CNS in our country. The laboratory diagnosis is by biopsy of the tissue containing cysticerci or demonstration of antibodies in the patient's serum by ELISA.
|
Surgery
| null |
A 42-year-old man is brought to you after suffering a grand mal seizure. There is no history of recent illness, fever, headache, seizures, or head trauma. Neurologic exam shows the patient to be ale and oriented. No focal abnormalities are noted. A CT scan of the head reveals multiple punctate calcifications, and two enhancing cystic lesions with surrounding edema. Most likely diagnosis?
A. Amebiasis
B. Cytomegalovirus infection
C. Echinococcosis
D. Neurocysticercosis
|
Neurocysticercosis
|
f68f7dc8-4f78-45d8-89f6-0694af53410f
|
Ans. is 'b' i.e., Liver In fetus hematopoiesis occurs in three anatomic stages. Mesoblastic stage Hepatitis stage Myeloid stage o This stage of hematopoiesis begins between 10th and 14th days of gestation o It occurs in the extraembryonic structures principally in the yolk sac. o This stage of hematopoiesis essentially ceases by 10-12 week of gestation. o By 6-8 weeks of gestation, the liver replaces the yolk sac as primary site of gestation. o Hematopoiesis occurs in the liver throughout the remainder of the gestation and the liver remains the predominant hematopoietic organ,. till 20-24 weeks of the gestation. o After this the hematopoiesis begins to decrease in liver and in full term infant hepatic hematopoiesis is seen only in widely scattered small foci which soon become inactive after bih. o Hematopoiesis in the marrow stas by 4th month of gestation. o By bih, marrow throughout the skeleton is hematopoietically active and viually the sole source of blood cells. Hematopoiesis after bih Upto pubey Hematopoiesis occurs throughout the skeleton After pubey Only the veebrae, ribs, sternum, skull, pelvis and proximal epiphyseal regions of the (By the age of 18) humerus and femur retain red marrow, the remaining marrow becomes yellow, fatty an inactive. Thus, in adults only about half of the marrow space is active in hematopoiesis.
|
Pediatrics
| null |
Which organ is the primary site of hematopoiesis in the fetus before midpregnancy -
A. Bone
B. Liver
C. Spleen
D. Lung
|
Liver
|
d55cfe49-6bb0-4493-b624-f44d4597a80e
|
Medical care OPD services- 4 hours in the morning and 2 hours in the afternoon/evening 24 hour emergency services Referral services Inpatient services-6 beds (refer pgno:905 park 23rd edition)
|
Social & Preventive Medicine
|
Health care of community & international health
|
No of inpatient beds in PHC ?
A. 6
B. 10
C. 20
D. 25
|
6
|
45ff5c4b-8d4a-474e-b402-4bae82738fa1
|
Ans-A i.e., the Transepithelial nasal potential difference Diagnosis of cystic fibrosis Sweat chloride testingThe sweat test is the standard approach to diagnosis.The diagnosis is made by elevated sodium and chloride level in the sweat > 60 meq/l.Two tests on different days are required for accurate diagnosis.A normal sweat chloride does not exclude the diagnosis.Genotyping and other tests such as measurement of nasal membrane potential difference, the pancreatic function should be done if there is high clinical suspicion of cystic fibrosis.Nasal potential differenceMeasurement of nasal transepithelial potential difference in vivo can be a useful adjunct in the diagnosis of cystic fibrosis.Individuals with cystic fibrosis demonstrate a significantly more negative baseline nasal potential difference, with the topical application of amiloride there is a loss of this potential difference.The nasal potential difference is a sensitive test of electrolyte transport (CFTR) function that can be used to support or refute a diagnosis of cystic fibrosis.Genetic analysisCystic fibrosis is an autosomal recessive disorder.It is caused due to a defect in CFTR (Cystic fibrosis transmembrane conductance regulator) protein.Cystic fibrosis is associated with a large number of mutations.More than 1500 CFTR polymorphisms are associated with cystic fibrosis syndrome.The most prevalent mutation of CFTR is the deletion of a single phenylalanine residue at amino acid A508This mutation is responsible for high incidence of cystic fibrosis in northern European populations.Approximately 50% of individuals with CF who are of northern European ancestry are homozygous for A508 and > 70% carry at least one A508 gene. The remainder of patients has an extensive array of mutation, none of which has the prevalence of more than several percents.Testing for cystic fibrosis mutation was not possible because of the large no. of mutations associated with the disease.Now day's commercial laboratories test for 30-80 of the most common CFTR mutations.This testing identifies > 90% of individuals who carry 2 CF mutations.Nowhere it is mentioned in the texts that testing only for A508 is enough for diagnosis.Detection of at least 2 CF mutations is necessary for making the diagnosis of cystic fibrosis.The patient has features of cystic fibrosis but sweat chloride levels are normal.To diagnose cystic fibrosis in this patient, another laboratory evidence demonstrating CFTR dysfunction is required.This can be done by two methods :-Demonstrating abnormal potential differenceDemonstrating abnormal CF mutations.But the diagnostic criteria for cystic fibrosis requires.Demonstration of two CF mutations (demonstration of single abnormal F508 mutation is not enough)So we are left with abnormal nasal potential difference.It is an established laboratory evidence for CFTR dysfunction and is accepted as a diagnostic criteria to establish the diagnosis of cystic fibrosis.
|
Unknown
| null |
In a child with respiratory distress, failure to thrive. His sweat chloride levels were estimated at 35 meq/L and 41 meq/L. What is next best test to do cystic fibrosis for diagnosis -
A. Nasal transmembrane potential difference
B. DNA analysis AF 508 mutation
C. CT chest
D. 72-hour fecal fat estimation
|
Nasal transmembrane potential difference
|
d1368a71-758f-4ae0-8067-a5fd7ba9b0a0
|
Ans. is 'c' i.e., 7a-hydroxylase o About half of the cholesterol in the body is ultimately metabolized to bile acids.o The primary bile acids are synthesized from cholesterol in liver. These are cholic acid and chenodeoxycholic acid.o Rate limiting enzyme in primary bile acids synthesis is 7a- hydroxylase (cholesterol 7a - hydroxylase).o This enzyme is inhibited by bile acids and induced by cholesterol.o Thyroid hormones induce transcription of 7a-hvdroxylase, thus in patients with hypothyroidism plasma cholesterol tends to rise (because of inhibition of 7a-hydroxyiase which in turn inhibits conversion of cholesterol to bile acids).
|
Unknown
| null |
Rate limiting enzyme in bile acid synthesis -
A. Desmolase
B. 21a-hydroxylase
C. 7a-hydroxylase
D. 12a-hydroxylase
|
7a-hydroxylase
|
0cd8c3d9-5be8-43b1-8ac8-398bafa94f97
|
Complications of PCNL (percutaneous nephrolithotomy) include sepsis, renal hemorrhage, renal collecting system injury, and damage to adjacent organs and viscera, Haematoma, Hematuria, colonic perforation. Hydrothorax or pneumothorax is related to the level of percutanous access . incidence are less than 0.5% below the 12th rib , 4.6% above the 12th rib and 24.6% above 11th rib ref :- Campbell - walsh urology 11th edition . chapter 8 . pg no 179 Bailey and Love 27th edition , chapter 76 , pg no 1409
|
Surgery
|
Urology
|
What complication should one expect when PCNL is done through 11th intercostal space
A. Hydrothorax
B. Hematuria
C. Damage to colon
D. Remnant fragments
|
Hydrothorax
|
c00a1262-555a-4da9-9909-6637bd8fda86
|
Urobilinogen is formed from degradation of bile pigments by bacterial action. In case of obstruction to bile flow as happens in cholelithiasis or any kind of biliary obstruction,There will be no urobilinogen in urine. So, No formation of stercobilinogen and the patient passes clay colored stools. Option analysis: Hemolysis produces a lot of urobilinogen which is excreted in urine - option a and c are excluded. In hepatocellular jaundice, urobilinogen can be normal or reduced. The question specifically uses the word "absent" - options c is also excluded. Parameter Pre-hepatic Hepatocellular Obstructive Basic mechanism of raised bilirubin Hemolysis defective uptake, conjugation and excretion of bilirubin by hepatocytes defective excretion of bile due to the obstruction of biliary tract Type of serum bilirubin raised mainly unconjugated unconjugated + conjugated mainly conjugated (>50%) Urine bilirubin absent present present Urine urobilinogen present present absent Prototype example Hemolytic anaemia viral hepatitis common bile duct stone Prothrombin time normal abnormal; that is n't corrected by vitamin K inj. abnormal; that is corrected by the vitamin K inj. Additional features features of hemolysis on peripheral blood smear, reticuloytosis, low Hb, low haptoglobin Marked rise of serum ALT and ALP Marked rise of serum ALP (>3 times)
|
Biochemistry
|
HAEM synth and porphyrias
|
Hyperbilirubinemia with the absence of urobilinogen in urine is seen in:
A. G6PD enzyme deficiency
B. Cirrhosis of liver
C. Paroxysmal Nocturnal Hemoglobinuria
D. Obstruction of the common bile duct
|
Obstruction of the common bile duct
|
c91f1dc0-3222-474f-a6a7-f1f2e1b453a5
|
Moality estimates for ARDS range from 26 to 44%.Moality in ARDS is largely attributable to nonpulmonary causes,with sepsis and nonpulmonary organ failure accounting for >80% of deaths.Increasing age,chronic liver disease,cirrhosis,chronic alcohol abuse,chronic immunosuppression,sepsis,chronic renal disease,any nonpulmonary Organ failure have been linked to increased ARDS moality. Ref:Harrison's disease-18th edition,page no:2209/
|
Medicine
|
Respiratory system
|
The commonest of death in ARDS is
A. Hypoxemia
B. Hypotension
C. Non-pulmonary organ failure
D. Respiratory failure
|
Non-pulmonary organ failure
|
322fd003-f2bd-42f5-8632-fa862982abfd
|
Trench method sanitary landfill with depth of 2 m (6 feet ), it is estimated that one acre of land per year will be required for 10,000 population. Trench method is also known as Below Ground Landfill. Collected Waste is disposed inside excavated trench and is covered-up with a layer of soil. This method is suitable only for small quantity of waste.
|
Social & Preventive Medicine
|
NEET 2019
|
For the population of 10000, Trench method sanitary landfill pit of depth 2m is to be constructed. How much area is required per year?
A. 1 acre
B. 2 acres
C. 3 acres
D. 4 acres
|
1 acre
|
9ccdedd7-51d5-4b3b-ab78-bf3cfa041894
|
Ans:D i.e. Isoflurane. CARDIAC EFFECTS OF ANESTHETIC AGENTS :Anticholinergic agents - Atropine/glycopyrrolate: will cause an increase in hea rate, contractility, cardiac output and myocardial oxygen consumption. Often there will be no changein blood pressure and a decrease in right atrial pressure.Thiopental - BarbiturateReduction in blood pressure - peripheral vasodilation is the main action. Compensatory rise in hea rate - barorecptor response. Commonly associated with ventricular arrhythmias .BenzodiazepinesMidazolam and diazepam: Cause little or no direct myocardial depressant effects.Hypnotics- Etomidate: no direct myocardial depression. Safe to use with cardiac, critical and septic patients. .Mu opioids- Fentanyl is a pure mu agonist causes dose dependant bradycardia (increase in vagal tone). Mixed agonist/antagonist agents= Buprenorphine: a paial mu agonist/antagonist. Slow onset of action, duration of 6-8 hours. Cardiovascular depression and respiratory depression not as profound as pure mu agonists. Butorphanol: paial agonist/antagonist. Similar to buprenorphine in cardiovascular/respiratory effects. Dissociative Agents:Ketamine- Hea rate and aerial pressure increase due to an increase in sympathetic tone .Inhalational Anesthetics: Isoflurane and sevoflurane preserved cardiac index, and isoflurane and fentanyl-midazolam preserved myocardial contractility at baseline levels in this group of patients with congenital hea disease. Halothane depressed cardiac index and myocardial contractility.
|
Anaesthesia
| null |
Least effect on myocardial contractility
A. Ether
B. Halothane
C. Trilene
D. Isoflurane
|
Isoflurane
|
fae5e0b6-6b01-4a7b-ab5e-cc9eb4d737fd
|
Ans. B. Alpha 2Stimulation of alpha 2 present on ciliary muscle helps in reduction of aqueous humor. This mechanism is utilized in treatment of glaucoma by apraclonidine, brimonidine. Answer is B
|
Pharmacology
|
A.N.S.
|
Receptor responsible for decrease in aqueous humor formation:
A. Beta 1
B. Alpha 2
C. M2
D. Beta 2
|
Alpha 2
|
12205881-7f4a-4e37-a44f-924ddb00a6ba
|
Ans: a. Hydrolase enzyme [Ref Harper 30th/638-39, 29th/589, 599, 600; Lippincott 6th/163-64JThe mucopolysaccharidoses are hereditary diseases caused by a deficiency of any one of the lysosomal hydrolases normally involved in the degradation of heparan sulfate and/or dermatan sulfateThey are progressive disorders characterized by accumulation of glycosaminoglycans in various tissues, causing a range of symptoms, such as skeletal and extracellular matrix deformities, and mental retardation.Children who are homozygous for any one of these diseases are apparently normal at bih, then gradually deteriorate. In severe cases, death occurs in childhood.Diagnosis is confirmed by measuring the patient's cellular level of the lysosomal hydrolases. Bone marrow and cord blood transplants have been used to treat Hurler and Hunter syndrome
|
Biochemistry
| null |
Mucopolysacchidosis, which is a lysosomal storage disease, occurs due to abnormality in:
A. Hydrolase enzyme
B. Dehydorgenase enzyme
C. Lipase enzyme
D. Phosphatase
|
Hydrolase enzyme
|
b45a3224-b19a-4e6c-9bd6-86644c00842e
|
Ans. (c) Exploratory laparotomy.Image shows Chest X-ray with central trachea and increased bronchovascular markings. The Right lung shows clear presence of gas under diaphragm and needs an exploratory laparotomy.
|
Radiology
|
Imaging of Interstitial Lung Disease
|
CXR of a patient is shown. What is the next investigation to be done in the patient?
A. Ventilation perfusion scan
B. Bronchoalveolar lavage
C. Exploratory laparotomy
D. High resolution CT scan
|
Exploratory laparotomy
|
9c4f0eee-b4f9-4c18-874c-47310705fa6e
|
Superantigens are ceain protein molecules such as staphylococcal enterotoxin, that stimulate large numbers of T cells irrespective of antigenic specificity. This leads to an excessive and dysregulated immune response with release of cytokines such as interleukin-1,2 and tumor necrosis factor and interferon gamma. Reference : Anathanarayan & paniker's 9th edition, pg no:90,203 <\p>
|
Microbiology
|
Immunology
|
Super antigen acts through?
A. IL-3
B. IL-6
C. IFN-Gamma
D. IL_1 & TNF
|
IL_1 & TNF
|
35eb2f0c-f128-424f-943c-94de9df3f947
|
All other options have decreased platelet count except Henoch Schonlein purpura. Henoch-Schonlein purpura is a systemic syndrome involving the skin (purpuric rash), gastrointestinal tract (abdominal pain), and joints (ahritis). skin manifestations in HSP are due to small vessel vasculitis and platelet count is normal. Wiskott-Aldrich syndrome is an X-linked disease characterized by thrombocytopenia, eczema, and a marked vulnerability to recurrent infection that results in early death. The platelets are small and are reduced in number .
|
Pathology
|
Platelet
|
Normal platelet count is found in:
A. Wiskott Aldrich syndrome
B. Henoch Schonlein purpura
C. Immune thrombocytopenia
D. Dengue fever
|
Henoch Schonlein purpura
|
122e0ed1-80ca-4683-b9f1-4e70ae18534b
|
Answer- B. EOG Arden index is related to ElectrooculographyInterpretation of results:- Results of EOG are interpreted by finding out the Arden ratio as follows :Normal curve values are 185 or above.Subnormal curve values are less than 150.Flat curve values are less than 125.
|
Ophthalmology
| null |
Arden index is related to -
A. ERG
B. EOG
C. VER
D. Perimetry
|
EOG
|
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