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c208136e-f01f-4dfd-9666-d6dfeadfd8c5
|
(Ref: Katzung, 14th ed. pg. 527)* Lithium is DOC in manic disorder.* DOC for prophylaxis of mania: Lithium* DOC for acute attack of mania: Sedative + Atypical antipsychotics* DOC for mania in pregnancy: Atypical antipsychotics* Side effect of lithium (Mn: LITTH)# L: LEUCOCYTOSIS# I: Insipidus diabetes# T: Tremors (MC side effect- Coarse tremor)# T: Teratogenic (Ebstein anomaly)# H: HypothyroidismTherapeutic Plasma concentration of Lithium* Acute mania: 0.8-1.4mEq/L* Prophylaxis: 0.5-0.8mEq/L* Toxic plasma cone level:>2mEq/L
|
Pharmacology
|
C.N.S
|
Ebstein anomaly is known teratogenic effect due to this drug:
A. Clozapine
B. Phenytoin
C. Lithium
D. Lamotrogine
|
Lithium
|
583294f9-4cc8-4b74-b445-6d38cd1fdfc3
|
Bleeding is the most common adverse effect of anticoagulants, antiplatelets and fibrinolytic agents. Bleeding can manifest as hemorrhagic stroke in pts. on fibrinolytics therapy such as- Alteplase, Retaplase, Streptokinase. C/I of Fibrinolytics :- H/O Hemorrhagic Stroke H/O NON Hemorrhagic Stroke (within 1yr) Suspicion of aoic dissection Marked hypeension (SBP>180mm Hg and DBP>110mm Hg) Active internal bleed (Excluding menses)
|
Pharmacology
|
Hematology
|
If a fibrinolytic drug is used for the treatment of acute myocardial infarction, the adverse effect most likely to occur is:
A. Acute renal failure
B. Development of antiplatelet antibodies
C. Encephalitis secondary to liver dysfunction
D. Hemorrhagic stroke
|
Hemorrhagic stroke
|
bcffe1d6-16f0-4ceb-a7d8-efbd80de1c5d
|
Most impoant indicator of successful neonatal resuscitation - Increase in hea rate.
|
Pediatrics
|
Neonatal Resuscitation
|
Most impoant indicator of successful neonatal resuscitation:
A. Color change
B. Improved air entry
C. Increase in hea rate
D. Bilateral chest movements
|
Increase in hea rate
|
2d70c5df-0049-460b-88c0-c88a581e657e
|
ANSWER: (A) LactobacilliREF: Shaw 13th ed p. 125"Lactobacillus or Doderlein's bacillus is the most common organism found in vagina"
|
Gynaecology & Obstetrics
|
Vigina
|
Anaerobic bacteria commonly found in cervix or vagina?
A. Lactobacilli
B. Gardnerella
C. Mobilincus
D. Clostridium
|
Lactobacilli
|
b5483b81-c60b-4e23-a5f9-66a27556d2d1
|
Strongest risk factors for molar pregnancy are age and prior history of molar pregnancy.
|
Gynaecology & Obstetrics
| null |
Which among the following is highest risk factor for molar pregnancy
A. Prior C-section
B. Hypertension in pregnancy
C. Advanced age
D. Diabetes in pregnancy
|
Advanced age
|
205aa6ee-1223-47f3-a1ff-7690eef22da4
|
Holt Oram Syndrome Patient have normal blood picture.
|
Pediatrics
| null |
NOT a feature of Holt Oram Syndrome is
A. Absent Radius
B. Atrial septal defect
C. Thrombocytopenia
D. Autosomal dominant inheritance
|
Thrombocytopenia
|
802f0634-768b-41fa-8db0-a21036a0135c
|
Triad of ipsilateral 6th nerve palsy, ipsilateral 7th nerve palsy and contralateral hemiparesis constitutes milard gubler syndrome.
|
Anatomy
| null |
Patient presents to casualty with sudden onset LMN facial palsy on right side and inability to abduct right eye. There is left sided hemiparesis. Whats your diagnosis?
A. Fovilles syndrome
B. Milard gubler syndrome
C. Ramsay hunt syndrome
D. Tolosa hunt syndrome
|
Milard gubler syndrome
|
3695ce48-9b9c-4155-9877-2e7866a7bc88
|
Burst suppression is an electroencephalography (EEG) pattern that is characterized by periods of high-voltage electrical activity alternating with periods of no activity in the brain. The pattern is found in patients with inactivated brain states, such as from general anesthesia, coma, or hypothermia EEG video monitoring demonstrates that clinical seizure manifestations may lag behind the sta of ictal EEG activity; bursts lasting less than 3 seconds are usually clinically silent. During the absence seizure, rhythmic eye blinks and mild clonic jerks may be present. As a seizure progresses, automatisms may be seen. Ref Harrison 20th edition pg 1543
|
Medicine
|
C.V.S
|
Burst EEG pattern is seen in?
A. Herpes simplex encephalitis
B. Absent seizures
C. Myoclonic epilepsy
D. SSPE
|
Absent seizures
|
e3fdfcda-450d-44fa-bbdf-244abb70e4c5
|
Most osteomas are asymptomatic and are found incidentally when imaging the sinuses either for sinonasal symptoms or for unrelated complaints. Osteomas are frequently seen elsewhere in the head and neck paicularly the mandible and outer table of the skull vault. There is a paicular frequency distribution within the paranasal sinuses: frontal sinuses: 80%; ethmoid air cells: ~15%; maxillary sinuses: ~5 %; sphenoid sinus: rare. Osteomas are most commonly seen in the frontal sinus followed in turn by those of ethmoid and maxillary. They may remain asymptomatic, being discovered incidentally on X rays. Treatment is indicated when they become symptomatic, causing obstruction to the sinus sodium, formation of a mucocele, pressure symptoms due to their growth in the orbit, nose or cranium. (Ref: Textbook of Diseases of ENT, PL Dhingra, 7th edition, pg no. 231)
|
ENT
|
Nose and paranasal sinuses
|
The most common site of osteoma is( REPEAT QUESTION)
A. Maxillary sinus
B. Ethmoidal sinus
C. Frontal sinus
D. Sphenoid sinus
|
Frontal sinus
|
a494bc66-0ed0-4340-8a17-a6434248e318
|
Ans. is 'b' i.e., Serum bile acid levels Obstetric cholestasis (also known as intrahepatic cholestasis of pregnancy or cholestasis of pregnancy) is a liver disease unique to pregnancy which presents with pruritus.Clinical featuresObstetric cholestasis most commonly presents in the third trimester (80% develop symptoms after 1st week).The pruritus is often severe and typically the palms of the hands and the soles of the feet are involved but the legs, thighs arms, backs, breasts and abdomen are also reported.The disease tends to recur in every pregnancy and so a part history of the condition is important.The disease is more common among multiple gestations.Other signs and symptoms of liver disease are not observed. Additional symptoms which may be reported in common with other forms of cholestasis are right upper quadrant pain, pale stools and dark urine.Changes in liver function in obstetric cholestasisThe most common abnormalities in liver function are:Increase in ALT (seen in 100% cases)Increase in AST (seen in 99% cases)Increase in bile acids (seen in 92%) cases)Elevated bilirubin (22%) of cases)Increased GGT (39% cases)Elevations in alkaline phosphatase are seen in cholestatic disease such as obstetric cholestasis as it is released from the damaged liver but because the enzyme is also released from the placenta in normal pregnancies, measurements are less helpful than outside the pregnancy.Serum bile acid test is the most accurate determinant of cholestasis of pregnancy.The problem with the bile acid test is that only a small number of labs around the world have the equipment necessary to perform it which can result in a considerable delay for women experiencing symptoms of the conditions.Liver biopsy in a case of obstetric cholestasis: -Liver biopsy demonstrates: -Acinar cholestasis with centrilobular bile staining and bile plugs in the canaliculi.Liver biopsy is the definitive diagnostic test of the disease.Postnatal course in obstetric cholestasisBiochemical abnormalities and pruritics in obsteric cholestasis persists until delivery following which resolution occurs.Pruritus is typically absent within 48 hour after delivery usually improved within 1 week.Liver function tests becomes normal within 6 weeks.Complications of obstetric cholestasisMeconium stained liquorPremature deliveryFetal distressPost-partum hemorrhageTreatment of obstetric cholestasis: -AntihistaminesChlorpheniramine can provide symptomatic relief in pruritus.Topical treatmentsIf the skin is well moisturized pruritus may be relieved.Ursodeoxycholic acidS-Adenosyl methionineDexamethasoneDexamethasone in high dose results in resolution of all pruritus cases and significant reduction in total bile acids and ALT.Vitamin KIn obstetric cholestasis there is malabsorption and subsequent deficiency of vitamin K. This will increase the risk of postpartum hemorrhage.Vitamin K injection is given to reduce the risk of PPH.
|
Gynaecology & Obstetrics
|
Hepatic, Biliary, and Pancreatic Disorders
|
Investigation of choice in cholestasis of pregnancy ?
A. Serum bilirubin levels
B. Serum bile acids levels
C. Serum alkaline phosphatase levels
D. Serum glutathiones transferase levels
|
Serum bile acids levels
|
780c5d75-8009-4c14-b9c0-d63c79a48abe
|
Half life of basiliximab is 7 days.Basiliximab* This is anti CD-25 antibody with higher affinity for the IL-2 receptor, but shoer plasma t 1/2 (1 week).* It is used to prevent renal and other transplant rejection reaction.* It can cause anaphylactic reactions and promote oppounistic infection.
|
Pharmacology
|
JIPMER 2019
|
Half-life of basiliximab is:-
A. 7 days
B. 7 hours
C. 15 days
D. 24 hours
|
7 days
|
6336772f-0a4c-44d3-96d5-ecabbdac91f2
|
Poiseuille-Hagen Formula
The relation between the flow in a long narrow tube, the viscosity of the fluid, and the radius of the tube is expressed mathematically in the Poiseuille-Hagen formula:
|
Unknown
| null |
Poiseuille’s hagen lawis
A. F = (PA–PB) × 3.14 × r4/8nl
B. F = (PA+PB) × 3.14 × r4/8nl
C. F = (PA/PB) × 3.14 × r4/8nl
D. F = (PA × PB) × 3.14 × r4/8nl
|
F = (PA–PB) × 3.14 × r4/8nl
|
55b33c8a-2a0d-497d-96d0-234641a7438c
|
Suspected lymph node may have metastases from the upper aerodigestive tract. Since no lesion is found on physical examination of head and neck, triple endoscopy would be justified next. Supravital staining helps in selecting the site of biopsy in a lesion. As no lesion is discovered, it will not be very useful.
|
ENT
|
Oral Cavity
|
A patient presented with a 3.5-cm size lymph node enlargement, which was hard and present in the submandibular region. Examination of the head and neck did not yield any lesion. Which of the following investigations should follow?
A. Chest X-ray
B. Triple endoscopy
C. Supravital oral mucosa staining
D. Laryngoscopy
|
Triple endoscopy
|
a7bf373a-3372-495d-a53e-c12a9142f8d6
|
Hour glass stomach is caused due to cicatracia contraction of a saddle shaped ulcer at the lesser curvature.
|
Pathology
| null |
Hour glass deformity is seen in -
A. Carcinoma stomach
B. Peptic ulcer
C. Duodenal atresia
D. CHPS
|
Peptic ulcer
|
9775593b-66b1-44a6-8c02-cba3e6e4eee1
|
Ans. is 'd' i.e., Standard detion "Standard detion is most common and generally most appropriate measure of dispersion (variation)".
|
Social & Preventive Medicine
| null |
Most common detion used in social medicine is-
A. Mean
B. Range
C. Variance
D. Standard detion
|
Standard detion
|
072290c4-b911-42df-852d-bc92f95f1c68
|
(A) Ecchymosis # Complications of varicose vein surgery: Bruising and discomfort are common following removal of varices, especially where the veins were of very large diameter. However, the pain usually requires only mild analgesics.
|
Surgery
|
Miscellaneous
|
The Most common complication in varicose vein surgery is
A. Ecchymosis
B. Deep vein thrombosis
C. Recurrence of varicosity
D. Venous ulcer
|
Ecchymosis
|
e6becfc9-5431-4e30-8e64-b453a9e40d95
|
Ans. is 'a' i.e., Kegel's exercises o Kegels exercises are used to strengthen the pelvic floor muscles mainly pubococcygeal.o These exercises can thus be used to treat orgasmic difficulties and prevent genital prolapse.
|
Gynaecology & Obstetrics
|
Management
|
Females with orgasmic difficulties are advised following exercises to strengthen pubococcygealmuscles-
A. Kegel's exercises
B. Jacobson's stent on top
C. Keeping muscle up exercises
D. Johnsons exercises
|
Kegel's exercises
|
8007ba1f-1ff9-4c2a-b9b1-f21ffeda9732
|
This clinical scenario is typical for Wiskott-Aldrich syndrome. This is a sex-linked recessive disorder presenting with the triad of thrombocytopenia, eczema, and recurrent sinopulmonary infections. Serum IgM levels are low but IgG, IgA, and IgE levels are increased. Patients have a defective response to polysaccharide antigens, which is due to a cytoskeletal defect in T cells that inhibits their binding to B cells. A CD4/CD8 ratio of < 1.5:1 is the pattern seen in AIDS due to selective tropism of the CD4+ T-helper cell population. Cerebellar ataxia is pa of the ataxia-telangiectasia syndrome. The ataxia develops between age 2 and 5. The defect is associated with a DNA repair enzyme deficiency. Elevated platelet count and increased serum levels of IgG, IgA, and IgE is not associated with a paicular syndrome. Polyclonal gammopathies result in an increase in immunoglobulin of more than one class. This benign alteration is frequently seen in viral or bacterial infections. Thrombocythemia may be associated with a myeloproliferative syndrome or with a secondary reactive process. Ref: Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. (2013). Chapter 8. Immunology. In G.F. Brooks, K.C. Carroll, J.S. Butel, S.A. Morse, T.A. Mietzner (Eds), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.
|
Medicine
| null |
A 3 year old male presents with a skin rash and epistaxis. He has had several, severe sinopulmonary infections. A careful history reveals that his maternal uncle died of bleeding complications following an emergency cholecystectomy. What additional findings are likely in this case?
A. A CD4/CD8 ratio of < 1.5:1
B. Cerebellar ataxia
C. Elevated platelet count and high serum IgG, IgA, and IgE levels
D. Low platelet count and low serum IgM levels
|
Low platelet count and low serum IgM levels
|
a9fed167-929e-4a5a-a15d-863cb70919d8
|
Screening mammography: For screening purpose it is done after 40 years. Early screening is indicated when there is family history of carcinoma breast or histological risk factor. Mammography before 35 years of age is usually not done unless there is a suspicious lump or a strong family history. Screening is done in asymptomatic female where even cancer is suspected. Ref; (page no; 515) 5th edition of SRB&;S manual of Surgery.
|
Surgery
|
Endocrinology and breast
|
Age for regular mammography is
A. 20
B. 30
C. 40
D. 50
|
40
|
5ff73f66-7493-4d62-b776-9b6de7d5b4ad
|
Spine of the scapula lies at the level of T3 veebrae. Scapular spine is seen on the posterior surface of the scapula and it expands into a terminal process called acromion process. The scapulae overlie the posterior poion of the thoracic wall, and cover the upper seven ribs. The superior angle of scapula can be palpated at the T1 veebral level and the inferior angle lies at the level of T7 veebrae.
|
Anatomy
| null |
The spine of the scapula can be palpated at which of the following level of veebrae?
A. T 1
B. T 3
C. T 5
D. T 7
|
T 3
|
2438e28a-5db4-4f1e-bac9-b13a0567de8f
|
In the TCA cycle,Step 3. In the third step, isocitrate is oxidized and releases a molecule of carbon dioxide, leaving behind a five-carbon molecule--a-ketoglutarate. During this step, \text{NAD}^+NAD + N, A, D, sta superscript, plus, end superscript is reduced to form \text{NADH}NADHN, A, D, H. The enzyme catalyzing this step, isocitrate dehydrogenase, is impoant in regulating the speed of the citric acid cycle.Ref: DM Vasudevan, 6th edition, page no: 218
|
Biochemistry
|
Metabolism of carbohydrate
|
NAD acts as a cofactor for
A. Citrate synthetase
B. Isocitrate dehyrogenase
C. a ketoglutarate dehyrogenase
D. Malate dehydrogenase
|
Isocitrate dehyrogenase
|
f96ed7ff-a25e-4357-9306-6b77f1bf1f68
|
- Combined liver-pancreas procurement should be routine, even if the right hepatic aery arises from the superior mesenteric aery. - In this situation, since the transplanted liver is the life-saving organ, the proximal superior mesenteric aery should remain with the liver and the distal superior mesenteric aery supplying the head of the pancreas can be reconstructed on a Y-graft of iliac aery with the splenic aery. - Successful pancreas transplantation can be performed using donors who have previously undergone splenectomy; however, there should be no significant pancreatitis and no history of diabetes in the donor.
|
Surgery
|
Transplantation
|
Criteria for a pancreas donor include:
A. No history of diabetes
B. No liver donation
C. No replaced hepatic aery vessels arising from the superior mesenteric aery (SMA)
D. No previous splenectomy
|
No history of diabetes
|
b7d06c4c-1491-40b9-bb0e-9343e1dd98e8
|
Refer KDT 6/e p 868 Drug of choice for acute iron poisoning is desferroxamine, however it has to be admistered parentarally It is not effective by oral route In beta thalassemia major iron excess can result due to repeated blood transfusions and massive Hemolysis Cheating agent has to be admistered for long time OK this case
|
Pharmacology
|
Respiratory system
|
Indication for intramuscular iron therapy is
A. Oral desforaxamine
B. Oral deferiprone
C. Intramuscular EDTA
D. Oral succimer
|
Oral deferiprone
|
07666a33-5e16-4d46-a1f9-e8219a56054b
|
Jod Basedow Effect: Refers to induction of thyrotoxicosis by iodine in the form of dietary supplements or medication, especially especially in patients who are relatively iodide deficient. Treatment includes combination of antithyroid drugs and perchlorate paicularly in amiodarone-induced thyrotoxicosis. Ref: Harrison's Internal Medicine, 18th Edition, Pages 2914, 2917, 2927, 2928, 2930 and 2932, Chapter 341 ; Acute Endocrinology: From Cause to Consequence By Greet Van Den Berghe, Page 9 ; Werner and Ingbar's Tthe Thyroid : A Fundamental and Clinical Text, Volume 549 By Lewis E. Braverman, 9th Edition, Page 548 ; Textbook of Cardiovascular Medicine, Volume 355 By Eric J. Topol, 3rd Edition, Page 598.
|
Medicine
| null |
Which of the following refers to the occurrence of hypehyroidism following administration of supplemental iodine to subjects with endemic iodine deficiency goiter?
A. Jod-Basedow effect
B. Wolff-Chaikoff effect
C. Thyrotoxicosis Factitia
D. De Quervain's Thyroiditis
|
Jod-Basedow effect
|
632e3de5-908a-4af2-a33b-1595137fc78f
|
Seoli cells are elongated cells in the seminiferous tubules that ensheathe spermatogenic cells, providing a microenvironment that suppos spermiogenesis and spermatocytogenesis; they secrete androgen-binding protein and establish the blood-testis barrier by forming tight junctions with adjacent Seoli cells.Ref: Ganong&;s review of medical physiology; 24th edition; page no:-419
|
Physiology
|
Endocrinology
|
Seoli cells play a key role in which of the following process
A. Spermiogenesis
B. Testosterone secretion
C. Secretion of seminal fluid
D. Production of germ cells
|
Spermiogenesis
|
5c9aed55-2802-46ae-8f55-7c96528e5deb
|
(Silver nitrate solution): Ref: 164-65-P, 71-KHOPHTHALMIA - NEONATORUM: any discharge or even watering from the eyes in the first week of life should arouse suspion of ophthalmia neonatorum* Use of either 1% tetracycline ointment or 0.5% erythromycin ointment or 1% silver nitrate solution (Crede's method) into the eyes of the babies immediately after birth* Single injection of ceftriazone 50 mg/Kg IV or IV (not to exceed 125 mg) should be given to infants born to mothers with untreated gonococcal infections.
|
Ophthalmology
|
Conjuctiva
|
According to WHO, crede's method is applied for prophylactic use in ophthalmia neonatorum, is
A. Silver nitrate solution
B. Erythromycin ointment
C. Tetracycline ointment
D. Penicilline injection
|
Silver nitrate solution
|
91dc1d58-1676-468e-b070-c57d648e9f2c
|
Ans. is 'b' i.e., Start Category I ATT in first trimester * Tuberculosis during pregnancy should be diagnosed promptly and as early as possible. Late diagnosis and care is associated with 4-fold increase in obstetric morbidity and 9-fold increase in preterm labor.* Poor nutritional states, hypoproteinemia, anemia and associated medical conditions add to maternal morbidity and mortality.* True congenital TB is believed to be rare. A fetus can get TB infection either by hematogenous spread through umbilical vein or by ingestion or aspiration of infected amniotic fluid. The risk to neonate of getting TB infection shortly after birth is greater.* ATT should be started as soon as possible, as untreated disease is a hazard to the mother and fetus.* The regimens recommended for use in pregnancy are same as for the nonpregnant state except for withholding of streptomycin. Currently, an intermittent regimen (thrice weekly on alternate days) under the DOTS strategyof RNTCP is being increasingly used worldwide for pregnant women having TB.* None of the AKT drugs are teratogenic and AKT should be started as soon as the diagnosis is made. Sputum positive tuberculosis is category 1.
|
Gynaecology & Obstetrics
|
Miscellaneous (Gynae)
|
A 6-week pregnant lady is diagnosed with sputum positive TB. Best management is -
A. Wait for 2nd trimester to start ATT
B. Start Category I ATT in first trimester
C. Start Category II ATT in first trimester
D. Start Category III ATT in second trimester
|
Start Category I ATT in first trimester
|
17f47413-489c-456f-95a4-d5d794aa601d
|
SMALL BOWEL OBSTRUCTION - Adhesions secondary to previous surgery are the MC cause of SBO. - Causes: Adhesions (60%) > Malignant tumors (20%) >Hernia (10%) > Crohn's disease (5%)Q. - Primary colonic cancers (paicularly those arising from the cecum and ascending colon) may present as a SBO.
|
Surgery
|
Intestinal obstruction
|
Commonest cause of acute intestinal obstruction is:
A. Adhesions
B. Volvulus
C. Inguinal hernias
D. Internal hernias
|
Adhesions
|
8174ad90-afc8-4cc4-a906-87f9073a1f8b
|
Ans. is 'b' i.e., Predictability Screening test to be applied o The screening test to be applied should fulfil the following impoant criteria before it is considered suitable for screening : ? 1. Acceptability The test should be acceptable to the people at whom it is aimed. In general painful or embarrasing tests e.g., per rectal or vaginal examination are not likely to be acceptable. 2. Repeatability (reliability) Repeatability means, the test must give consistent results when it is repeated more than once on the same individual under same conditions. That means the results of test are precise (exact), So repeatability is some time called precision, reliability or reproducibility. 3. Validity (accuracy) Validity refers to what extent the test accurately measures which is purpos to measures. That means a valid test distinguish the people who have the disease from those who do not. Validity has components ---> Sensitivity and specificity.
|
Social & Preventive Medicine
| null |
The criteria for validity of a screening test are -
A. Accuracy
B. Predictability
C. Sensitivity & Specificity
D. Cost effectiveness
|
Predictability
|
503d8364-58ed-4605-9726-98f814409559
|
The middle cerebral aery is the largest terminal branch of the internal carotid aery and it runs laterally in the lateral cerebral sulcus of the brain.It supplies the entire lateral surface of the cerebral hemisphere except the narrow strip along the superomedial border extending from the frontal pole to the parieto-occipital sulcus(which is supplied by the anterior cerebral aery) and the occipital pole and inferior temporal gyrus (both of which are supplied by the posterior cerebral aery).
|
Anatomy
| null |
Aery supplying major pa of superolateral surface of brain is
A. Middle cerebral aery
B. Anterior cerebral aery
C. Posterior cerebral aery
D. Veebral aery
|
Middle cerebral aery
|
8cce8415-daa7-4079-a3a4-cd68f91c832d
|
ANSWER: (A) HOCMREF: Harrison's 17th ed chapter 227"Most HOCM patients demonstrate a double or triple apical precordial impulse and a fourth heart sound. Those with intraventricular pressure gradients may have a rapidly rising arterial pulse. The hallmark of HOCM is a systolic murmur, which is typically harsh, diamond-shaped, and usually begins well after the first heart sound. The murmur is best heard at the lower left sternal border as well as at the apex, where it is often more holosystolic and blowing in quality, no doubt due to the mitral regurgitation that usually accompanies HOCM"Some important points about apical impulse:Normal: visible in the midclavicular line at the fifth intercostal spaceHypokinetic:Hypovolumic shockCalcified mitral stenosisSchemic heart disease with failureMyxedemaCardiomyopathiesEmphysemaHyperkinetic: (Duration of impulse is normal, increased amplitude)Aortic regurgitationMitral regurgitationASDPDAHyperdynamic circulatory states like anemia 8c thyrotoxicosisHeaving apical impulse: Duration of apical impulse is more than one third of systole. It is seen inAortic stenosisCoarctation of aortaSystemic hypertensionTapping apical impulse: only seen in uncomplicated mitral stenosis characterized by hypokinetic apical impulse with palpable loud SI
|
Medicine
|
C.V.S.
|
Double apical impulse is seen in?
A. HOCM
B. Cardiac tamponade
C. Aortic regurgitation
D. Pulmonary hypertension
|
HOCM
|
ebb86720-905d-42e9-ae23-b852363cd97e
|
Monoclonal antibody against IL-6 : Tocilizumab
Monoclonal antibody against IL-6 receptor : Sarilumab
Both are approved for Rheumatoid arthritis.
|
Pharmacology
| null |
Tocilizumab used against Rheumatoid arthritis is a monoclonal antibody against :
A. Interleukin-6
B. Interleukin-6 receptor
C. Interleukin-5
D. Interleukin-5 receptor
|
Interleukin-6
|
dbe38f8b-26e8-4c5d-82a5-c2bfb32c8893
|
Ans. is 'd' i.e., Alanine o The major noncarbohydrate precursors (substrate) for gluconeogenesis are lactate, pyruvate, glycerol, glucogenic amino acids, propionate and intermediates of the citric acid cycle. All aminoacids, exceptfor leucine and lysine, are substrate for gluconeogenesis. Alanine is the most important gluconeogenic amino acid.
|
Biochemistry
|
Amino Acids Basics
|
Most important amino-acid substrate for gluconeogenesis -
A. Leucine
B. Lysine
C. Histidine
D. Alanine
|
Alanine
|
eb216a2d-ec98-4e03-8ac8-de3c93bc6d1b
|
Ans. (d) Bilious vomitingRef: Sabiston 20th Edition, Page 1212Complications of Gastric Surgeries:* Dumping syndrome* Afferent loop syndrome* Efferent loop syndrome* Malabsorption syndrome (Anemia, hypocalcemia, B12 deficiency)* Alkaline reflux gastritis* Bile reflux gastritis* Gastric atony* Duodenal stump blow out.
|
Surgery
|
Stomach & Duodenum
|
A 66 year old female is posted for subtotal gastrectomy for adenocarcinoma. The important procedure related complication:
A. Pneumothorax
B. Constipation
C. Hemolytic anemia
D. Bilious vomiting
|
Bilious vomiting
|
444facf5-0bce-4548-821d-0cb8af2f2d15
|
Ans. is 'd' i.e., InhibinLeydig cells have receptors for LH and secrete androgens, i.e. Testosterone, dihydrotestosterone (DHT), androstenedione, and dehydroepiandrosterone (DHEA).Seoli cells have receptors for FSH and secrete ABP, inhibin and MIS. seoli cells also have receptor for testosterone.
|
Physiology
| null |
Seoli cells secrete ?
A. Testosterone
B. Androgen
C. FSH
D. Inhibin
|
Inhibin
|
bc380d98-aad4-4e01-b466-fcbe853412c4
|
Ans. C: Sigmond Freud Psychoanalysis/Freudian psychology is a body of ideas developed by Austrian physician Sigmund Freud and continued by others. It is primarily devoted to the study of human psychological functioning and behavior, although it can also be applied to societies. Psychoanalysis has three applications: A method of investigation of the mind and the way one thinks; A systematized set of theories about human behavior; A method of treatment of psychological or emotional illness.
|
Psychiatry
| null |
The term 'psychoanalysis' is associated with: March 2009
A. John Broadus Watson
B. Carl Gustav Jung
C. Sigmond Freud
D. Wilhelm Reich
|
Sigmond Freud
|
4d34f71e-b4cb-4b2f-b4ef-bc96bf049113
|
Gracilis is a muscle of Medial compartment
|
Anatomy
| null |
Muscle not included in Anterior compartment of thigh
A. lliacus
B. Sartorius
C. Gracilis
D. Rectus femoris
|
Gracilis
|
52a0c3ef-8f2d-4999-8ed8-77de7d59982d
|
Ziemann dots in RBC-PL Malaria Schaffner dots in RBC- Pl vivax Accola rings-falciparum Ref: D.R. Arora. Medical parasitology 4th ed pg 108
|
Microbiology
|
parasitology
|
Ziemann's dots in RBC are seen in infection with
A. Pl vivax
B. Pl falciparum
C. Pl malaria
D. Pl ovale
|
Pl malaria
|
bacf14d5-2ae8-4c46-99eb-fd6fd4156d1e
|
phase 1 reactions- oxidation, reduction, cyclization, decyclization and hydrolysis Phase II reactions: 1. Glucuronidation 2. Acetylation 3. Glutathione conjugation 4. Glycine conjugation 5. Sulfation 6. Methylation 7. Water conjugation Reference: Katzung Pharmacology; 13th edition; Chapter 4; Drug Biotransformation
|
Pharmacology
|
General anatomy
|
Which of the following is not an example of Phase II drug metabolic reaction?
A. Acetylation
B. Sulfation
C. Decyclization
D. Methylation
|
Decyclization
|
c22d1d78-a64e-4066-b2cf-376bf07bdf62
|
Diagnosis of menopause is from classical symptom of hot flush (50%) confirmed by elevated FSH levels to more than 100 mlU/ml and serum estradiol < 20 pg/ml.
|
Gynaecology & Obstetrics
| null |
The cutoff point of serum estrogen level for the diagnosis of ovarian failure:
A. 10 pg/ml
B. 20 pg/ml
C. 30 pg/ml
D. 40 pg/ml
|
20 pg/ml
|
21410650-b6bf-4c3f-8bb0-007d0fa6b98b
|
Ans. C: 294 days The normal duration of pregnancy is approximately 37 to 42 weeks, with the estimated due date at 40 weeks or 280 days from the first day of the last menstrual period. A postterm pregnancy/prolonged pregnancy/post maturity is one that has extended beyond 2 weeks of the expected date of delivery (beyond 294 days). Nearly 10 percent of pregnancies are postterm.
|
Gynaecology & Obstetrics
| null |
Post term pregnancy is the pregnancy which continues beyond: September 2006
A. 274 days
B. 284 days
C. 294 days
D. 304 days
|
294 days
|
facfee90-11e8-4ce2-a5c0-82710b5261d7
|
(b) Source: GAS 797, 879, 1018, 1020, 1022; GA 487, 518, 525 The nasal polyp also involved the maxillary sinus, located immediately laterally to the nasal cavity. The sphenoid sinus, located posterosuperiorly to the nasopharynx, is unlikely to be affected by a nasal polyp. The ethmoidal sinuses, located medially to the orbit and lateral to the nasal cavity, are also unlikely to be affected by a nasal polyp, although this possibility cannot be ruled out. The frontal sinuses located superomedially to the eyes are unlikely to be affected by the nasal polyp. The frontonasal ducts, the communication between the frontal sinus and the nasal cavity, are also unlikely to be affected.
|
Anatomy
|
Head & Neck
|
A 45-year-old man is admitted to the hospital with breathing problems. During physical examination the patient shows signs of airway obstruction. A CT scan examination reveals a nasal polyp obstructing the airway. Drainage from which of the following structures is also obstructed?
A. Sphenoid sinus
B. Maxillary sinus
C. Ethmoidal sinus
D. Frontal sinus
|
Maxillary sinus
|
4b27fc61-89bb-44bb-a286-ccb418622a3d
|
Ans. B. BRCA 1. (Ref. Bailey and Love 26th/pg. 817)The BRCA1 gene has been associated with an increased incidence of breast (and ovarian) cancer and is located on the long arm of chromosome 17 (17q). The gene frequency in the population is approximately 0.0006. It does, however, occur with greater frequency in certain populations such as Ashkenazi Jews, in whom there is often a common (founder) mutation. BRCA2 .is located on chromosome 13q and there is an association with male breast cancer. Women who are thought to be gene carri- ers may be offered breast screening (and ovarian screening in the case of BRCA1, which is known to impart a 50 % lifetime risk of ovarian cancer), usually as part of a research programme, or genetic counselling and mutation analysis. Those who prove to be 'gene positive' have a 50-80 % risk of developing breast cancer, predominantly while premenopausal. Many opt for prophylactic mastectomy.GeneChromosomeAssociated tumourRb12qRetionablastoma, osteosarcomaBRCA-l and 217q, 13qBreast and ovarian cancerAPC5Colonic cancerP5317qMost human cancers, Li-Fraumeni syndromeHereditary cancer occurs in multiple family members due to germline mutations in high-risk genes which are inherited in autosomal dominant pattern. BRCA1 and BRCA2 are two major high-risk genes associated with hereditary breast cancer.Likelihood of genetic mutation with family history.No. of family cases <50 years oldBRCA1 (%)BRCA2 (%)243317134413355544BRCA1 is also associated with ovarian and, to a lesser extent, colorectal and prostate cancer. bBRCA2 is associated with familial male breast cancer.Genetics of breast cancer.The majority of breast cancers are sporadic, occur randomly, and carry somatic genetic alterations. Hereditary cancer occurs in multiple family members due to germline mutations in high-risk genes which are inherited in autosomal dominant pattern. BRCA1 and BRCA2 are two major high-risk genes associated with hereditary breast cancer. Mutations in CHEK2 contribute to a substantial fraction of familial breast cancer. Carriers of TP53 mutations develop Li-Fraumeni syndrome and are at high risk of developing early onset breast cancer, but these mutations are very rare. Susceptibility alleles in other genes, such as PTEN, ATM, STK11/LKB1, and MSH2/MLH1 are also very rare causes of breast cancer. ~ Devita.
|
Surgery
|
Breast
|
Gene associated with autosomal dominant breast cancer?
A. PTEN and KAI
B. BRCA 1 and 2
C. APC
D. P53
|
BRCA 1 and 2
|
53357344-ac6c-4f51-b325-c57ef0148986
|
Ans-A Trichomonas VaginalisThe image shows the presence of the anaerobic flagellated protozoan parasite, which causes vaginitis in women with the development of greenish malodorous discharge.
|
Unknown
| null |
A 35-year-old lady presents with vaginal discharge. Smears from vaginal discharge show presence of?
A. Trichomonas
B. Entamoeba Histiolytica
C. Toxoplasma
D. Giardia
|
Trichomonas
|
650debb1-0bee-4a55-a072-7f549690d93c
|
Decreased size of paracoical areas of lymph nodes is expected as this child has DiGeorge Syndrome. DiGeorge Syndrome: Deficient CMI is seen due to aplasia of thymus and hence deficiency of T cells. This leads to paracoical areas of lymph nodes and periaeriolar sheaths of the spleen being reduced in size. B cells are usually not affected. Clinical Features of DiGeorge Syndrome - DiGeorge syndrome is a cellular immunodeficiency disorder caused by the deletion of a small segment of chromosome 22 (22q11) leading to a developmental defect involving the endodermal derivatives of the third and fouh pharyngeal pouches. (Thymus and parathyroid glands) The clinical features can be remembered with the mnemonic - CATCH C - Cardiac defects A - Abnormal facies T - Thymic aplasia C - Cleft palate H - Hypocalcemia Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition
|
Microbiology
|
Immunology
|
A mother brings her 1 year old child to the hospital with complaints that he turns blue while breastfeeding. It resolves when he assumes a squatting position. On examination, a cleft palate is seen. Labs show hypocalcemia. Which of the following abnormalities are expected to be seen in the lymphoid organs?
A. Decreased size of periaeriolar lymphoid sheath of spleen
B. Increased size of spleenic follicles
C. Increased size of para coical areas of lymph nodes
D. Decreased size of germinal centres of lymph nodes
|
Decreased size of periaeriolar lymphoid sheath of spleen
|
20911c3b-6e7d-415d-822f-7165f1e27074
|
The Austin Flint murmur of chronic severe AR is a low-pitched mid to late apical diastolic murmur that sometimes can be confused with MS. The Austin Flint murmur typically decreases in intensity after exposure to vasodilators, whereas the murmur of MS may be accompanied by an opening snap and also may increase in intensity after vasodilators because of the associated increase in cardiac output.
|
Medicine
| null |
Austin flint murmur is seen in cases of
A. Aortic stenosis
B. Aortic regurgitation
C. Hypertrophic obstructive cardiac myopathy
D. Ventricular stenosis
|
Aortic regurgitation
|
904f526a-6a9f-4e49-a7a5-d6bbbf449dde
|
Ans. is 'b' i.e., Cafe-au-lait spots o About 25-33% of patients with a pheochromocytoma or paraganglioma have an inherited syndrome.# Neurofibromatosis type 1 (NF1) was the first described pheochromocytoma-associated syndrome.o The NF1 gene functions as a tumor suppressor by regulating the Ras signaling cascade. Classic features of neurofibromatosis include:# Multiple neurofibromas# Cafe au lait spots# Axillary freckling of the skin# Lisch nodules of the iris.o Pheochromocytomas occur in only about 1% of these patients and are located predominantly in the adrenals.
|
Medicine
|
Endocrinology
|
Pheochromocytoma is associated with -
A. Vitiligo
B. Cafe-au-lait spots
C. Ash leaf amelanotic macusles
D. Acanthosis Nigricans
|
Cafe-au-lait spots
|
2472904e-ec5a-425e-82c3-7970030122dd
|
The structural and functional damage of brain-stem may be diagnosed depending upon the following observations: Dilated fixed pupils, not responding to sharp changes in intensity of incident light. Absence of motor responses within the cranial nerve distribution on painful stimulation. Absence of corneal reflexes. Absence of vestibulo-ocular reflexes. Absence of gag reflex or reflex response to bronchial stimulation by a suction-catheter passed down the trachea. Absence of spontaneous breathing. Ref : Krishnan vij Textbook of Forensic medicine and Toxicology 5th edtion ; pg no - 75
|
Forensic Medicine
|
All India exam
|
Not a feature of brain death
A. Complete apnea
B. Absent Pupillary reflex
C. Absence deep tendon reflex
D. Hea rate un-responsive to atropine
|
Hea rate un-responsive to atropine
|
b0665dd4-9301-45ba-842b-de34ba80abcf
|
A patient with severely decreased sperm counts and a normal Karyotype is offered testing for microdeletion of Y chromosome.
|
Gynaecology & Obstetrics
| null |
Testing for microdeletion of Y-chromosome is offered for which patient with a normal Karyotype
A. Sperm concentration of 2 million/ml
B. Semen volume of 2 ml
C. Presence of fructose in semen
D. Normal morphology sperms >4%
|
Sperm concentration of 2 million/ml
|
cadf8a35-bbee-49b9-a54c-b855ae257161
|
Ans. (b) ProlineRef: Harper's Biochemistry, 30th ed. pg. 141, 298-99* Proline is the amino acid which changes the conformation of the alpha helix in collagen due to the nature of proline having a cyclical structure. It also forms the ends of the beta sheets in the secondary structures.
|
Biochemistry
|
Proteins and Amino Acids
|
What changes the conformation of alpha helix in collagen
A. Methionine
B. Proline
C. Alanine
D. Tyrosine
|
Proline
|
80c83132-0c7b-452d-8218-757339c85c3d
|
Disturbance of biological functions is common with depression, with insomnia (or sometimes increased sleep), loss of appetite and weight (or sometimes hyperphagia and weight gain), and loss of sexual drive. When the disturbance is severe, it is called as melancholia ( somatic syndrome) The somatic syndrome in depression is characterised by: a. A significant decrease in appetite or weight b. Early morning awakening, at least 2 (or more) hours before the usual time of awakening c. Diurnal variation, with depression being worst in the morning d. Pervasive loss of interest and loss of reactivity to pleasurable stimuli e. Psychomotor agitation or retardation. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.72
|
Psychiatry
|
Mood disorders
|
Disruption or disorganization of biological rhythm is observed in
A. Schizophrenia
B. Anxiety
C. Depression
D. Mania
|
Depression
|
bb9e9fc3-46aa-409a-bd4e-b18725e775d0
|
The paramesonephric ducts remain rudimentary in the maleThe greater pa of each duct eventually disappearsThe cranial end of each duct persists as a small rounded body attached to the testis(appendix of testis)It has been considered that the prostatic utricle represents the uterovaginal canalRef: Inderbir Singh&;s Human embryology; Tenth edition; Pg 300
|
Anatomy
|
General anatomy
|
Paramesonephric duct in males remains as
A. Prostatic utricle
B. Prostatic uretha
C. Colliculus seminalis
D. Ejaculatory duct
|
Prostatic utricle
|
1a5c58ea-02c5-444a-be0f-3a8d582b190b
|
The superior mesenteric artery arises from the aorta, deep to the neck of the pancreas, then crosses the uncinate process and third part of the duodenum. An uncinate tumor can cause compression of the superior mesenteric artery. The common hepatic artery arises superior to the body of the pancreas and is unlikely to be affected by a tumor in the uncinate region of the pancreas. The cystic artery and vein, supplying the gallbladder, are also superior to the pancreas. The inferior mesenteric artery arises at the level of L3, which is thus situated deep to and inferior to the head of the pancreas. The portal vein, formed by the confluence of the superior mesenteric vein and splenic vein, passes deep to the neck of the pancreas.
|
Anatomy
|
Abdomen & Pelvis
|
A 45-year-old woman is admitted to the emergency department with a complaint of severe abdominal pain. CT scan and MRI examinations reveal a tumor of the head of the pancreas involving the uncinate process. Which of the following vessels is most likely to be occluded?
A. Common hepatic artery
B. Cystic artery and vein
C. Superior mesenteric artery
D. Inferior mesenteric artery
|
Superior mesenteric artery
|
7f1aea67-72b4-4833-94ff-f4562c59933a
|
Ans. C. Gouta. Acute gout causing swelling, erythema and extreme pain and tenderness of the first metatarsophalangeal joint.b. This is also known as Podagra- Colchicine and indomethacin are the drug of choice in this acute attack.
|
Medicine
|
Immunology and Rheumatology
|
A 35-year-old man presents with following problem. Most likely diagnosis?
A. Cellulitis
B. Deep vein thrombosis
C. Gout
D. PAN
|
Gout
|
4d06b572-fb1a-46a0-903d-6a439ad69c8a
|
Extrapyramidal side effects of antipsychotics
Extrapyramidal side effects are the major dose limiting side effects of antipsychotics.
Maximum extrapyramidal side effects are seen with haloperidol.
Least extrapyramidal side effects are seen with clozapine (amongst all antipsychotics).
Among typical antipsychotics, thioridazine has least extrapyromidal side effects (EPS).
Amongst atypical antipsychotics, resperidone has maximum tendency to cause EPS.
Different syndromes are : Parkinsonism, acute muscular dystonia, akathisia, malignant neuroleptic syndrome, tardive dyskinesia, rabbit syndrome.
|
Psychiatry
| null |
Extrapyramidal side effects of antipsychotics -a) Dystoniab) Akathisiac) Seizuresd) Diarrheae) Parkinsonism
A. abc
B. bcd
C. abe
D. acd
|
abe
|
3b40b5c2-df3d-4b66-9db6-d55e9574b592
|
Ans. c. CTEV (Ref: Apley's 9/e p291, 591-594; Turek's 6/e p658-661; Campbell's 11/e p1474-1475)The most probable diagnosis in a newborn child with inverted foot in whom the dorsum of the foot cannot touch the anterior tibia is CTEV.Congenital Talipes EquinoVarus (CTEV):Congenital deformity involving one foot or both.Affected foot appears rotated internally at the ankle.As heels are rotated internally patient is not able to touch tibia by dorsum of his foot.Congenital Vertical Talus (CVT):It is irreducible dorsal dislocation of the navicular on the talus with a fixed talo-navieular complex.CVT is a common cause of rigid flat foot, which can be isolated, or can occur with chromosomal abnormalities, myeloarthropathies (myelomeningocele) and neurologic disorders.Clinically talar head is prominent medially, sole is convex, forefoot is abducted and dorsiflexed, and the hind foot is equinovalgusSole of foot has a rocker-bottom (convex) deformityPatients demonstrate peg-leg gait (awkward gait with limited forefoot push off)Arthrogryposis Multiplex Congenita:Rare congenital disorder that is characterized by multiple joint contractures and can include muscle weakness and fibrosis.It is a non-progressive disease.The disease derives its name from Greek, literally meaning 'curved or hooked joints'.Cerebral Palsy:Includes the group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement.Divided into four major classifications to describe different movement impairments; also reflect the areas of the brain that are damaged.The four major classifications are:Spastic: MC type (70-80%)Ataxic: Caused by damage to the cerebellum (10%)Athetoid/dyskinetic: Mixed muscle tone, trouble holding in an upright, steady position for sitting or walking; often show involuntary motions.Hypotonic: Patients have musculature that is limp, and can move only a little or not at all.Congenital Talipes EquinoVarus (CTEV)/Club FootCongenital deformity involving one foot or both.Affected foot appears rotated internally at the ankle.As heels are rotated internally patient is not able to touch tibia by dorsum of his foot.CTE-V is classified into 2 groups: Postural TEV and Structural TEV.Incidence: 1 in 1,000 live births: More common in malesEtiology and Associated Anomalies:Idiopathic (MC)Q; Secondary club footSecondary club foot* Neurological disorders and neural tube defectsQ (myelomeningocele and spinal dysraphism)* Paralytic disorder (due to muscular imbalance) as polio. spina bifidaQ, myelodysplasia, and Freidreich's ataxia* Arthrogryposis multiplexaQ* Larsen syndrome* Freeman-Sheldon (Mobius) syndrome* Diasirophic dwarfism* Sacral agenesis, tibial deficiency, constriction rings and amniotic bands* Fetal alcohol syndrome* Down's syndrome Deformities affecting joints of the foot in CTEV* Inversion at subtalar jointQ* Adduction at talonavicular jointQ* Equinus at ankle jointQ"InAdEquate" for Inversion, Adduction and EquinusQ.Screening Methods:The foot of a newborn child normally can be dorsiflexed until the dorsal surface of foot touches the anterior aspect of shin of tibiaQ.It is a useful screening method for detecting the milder cases of CTEV, in which the foot cannot touch anterior tibia.Clinical Presentation:Classical appearance of CTEV is small size foot and small heel with characteristic CAVE deformity (Cavus, Adduction, Varus, Equinus) i.e. heel in equinuis with foot inverted on end of tibia giving the foot an upside down club appearance.Inability to bring the foot in opposite directions to deformity.Deep skin creases on medial side of foot and back of heel.Outer side of foot is convex and contains bony prominences (e.g. head of talus) and dimples.Prognosis:Prognosis of non-idiopathic syndromic club foot is generally worse than that for an idiopathic club foot, although there are certain exceptions like Down's syndrome or Larsen's syndrome: in which because of significant ligamentous laxity underlying the syndrome itself, correction may be achieved with non-operative treatment.Management of CTEVConservative managementOperative management* Clubfoot always requires treatment, which should begin at birthQ.* Manipulation should be frequently repeated, and after manipulation some form of splint or cast must be usedQ.* In the first month of life, manipulation should be repeated 6 times at each nappy change and adhesive strapping which maintains the correctionQ.* In place of strapping, splintage (Dennis Brown Splint) and even casting usually at one-week interval in the first month of lifeQ can also be used.* In infants >1 month, corrective manipulations and above knee cast (from toe to groin) is applied for 2 weeks.* Delaying surgery is suitable for severe, rigid deformities; for less severe cases it may be preferable to operate at around 6 months of ageQ.* Posteromedial soft tissue release is best done at 6 months-3 yearsQ.* Triple arthrodesis is necessary for recurrent or persistent club foot deformity in older children (chronic cases)Q. It is best done at 10-12 years of age when foot growth is completeQ. Pseudoarthrosis (most commonly of talonavicular joint) is commonest complicationQ.Kite's MethodPonseti Method (Method of choice)6 months-3 yearsPosteromedial soft tissue releaseOrder of correction of deformity:* Adduction of forefoot* Inversion (varus) of heel / hind foot and inversion (supination) of fore /mid foot* Equinus (plantar flexion) of ankleOrder of correction of deformity:* Cavus* Adductus* Varus* Equinus4-10 yearsRevision of soft tissue release together with shortening of lateral side of foot by:* Lichtblau's Procedure (<6 years)* Even-Dillwyn Procedure (>6 years)>10-12 yearsTriple arthrodesisQ
|
Orthopaedics
|
Lower Limb and Foot & Ankle Problems
|
A newborn child presents with inverted foot and the dorsum of the foot cannot touch the anterior tibia. The most probable diagnosis is:
A. Congenital vertical talus
B. Arthrogryposis Multiplex
C. CTEV
D. Cerebral palsy
|
CTEV
|
7d499d38-8956-41d8-841b-e7440b64d4c8
|
Ans. is 'b' i.e., Progesterone o Ovulation mav be inferred bv measuring the basal body temperature throuehout the menstrual cycle.o Temperature recordings are done on a chart and sustained upward shift of temperature (0.3degrees F for three days) infers that progesterone is being synthesized and released into circulation as a result of ovulation.Test Time ObservationTest for documenting ovulation1. Basal body tempThroughout cycleBiphasic pattern2. Cervical mucusDay 12 - 14 Day 21 -23Cervical mucus is clear watery, stretchabilitv present, derming present Cervical mucus is thick, viscid, tack present, feming absent3. Vaginal cytologyDay 12 - 14Estrogen dominated smears-efear, discrete comifined, polygonal, superficial cells (predominant cells)Day 21-23Progesterone dominanted smear - containing dirty, predominantly intermediate (Navicular) cells4. Endometrial biopsyDay 24 - 26Secretory' endometrium (confirming ovulation)5. Serum progesteroneD8 and D21D - 8 < 1 ng/mi D - 21 > 6 5 ng/ml6. Foil icular monitoringD10- D14Follicle is measured by USG7. LaparoscopySecretory phaseRecent corpus luteum is directly seen
|
Gynaecology & Obstetrics
|
Pathology of Conception
|
Increase in body temp during ovulation is by -
A. Estrogen
B. Progesterone
C. LH
D. FSH
|
Progesterone
|
823d0894-30c4-41d8-b93d-5734139f18d3
|
Lumph nodes are the most common site of extrapulmonary TB. Associated pulmonary disease is present in fewer than 50% of cases. The diagnosis is established by fine needle aspiration biopsy. Cultures are positive in 70- 80%. In descending order of frequency, the extrapulmonary sites most commonly involved in TB are the lymph nodes, pleura, genitourinary tract, bones and joints, meninges, peritoneum and pericardium. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition
|
Microbiology
|
Bacteriology
|
A middle aged man came with fever 2 weeks. He also complains of occasional night sweats and has significant weight loss. BAL was done, in which MTB was not detected. Extra pulmonary TB is suspected. Which of the following sites is most likely affected?
A. Skeletal system
B. Gastrointestinal tract
C. Lymph nodes
D. Genito urinary tract
|
Lymph nodes
|
cb7ae32c-5d79-4d98-932f-885cb393d2a9
|
.HYPERBARIC OXYGEN It is administration of oxygen 1 or 2 atmospheres above the atmospheric pressure in a compression chamber. It increases the aerial oxygen saturation so that oxygen perfusion of tissues will be increased.Indications 1. Carbon monoxide poisoning. 2. Tetanus, gas gangrene infections. 3. Bedsores, frostbites, necrotising fasciitis. 4. Drenching in paralytic ileus to reduce the nitrogen gas in distended bowel. 5. As a radiosensitizer in the treatment of cancer. ref:SRB&;s manual of surgery,ed 3,pg no 98
|
Surgery
|
Urology
|
Ohobaric oxygen is used in
A. Carbon monoxide poisoning
B. Ventilation failure
C. Anaerobic infection
D. Gangrene
|
Carbon monoxide poisoning
|
432370b8-e674-4ca1-b21f-b8b15f5c1089
|
Ans. is 'b' i.e., ParacetamolParacetamolo It does not possess anti - inflammatory activity because it is ineffective in the presence of peroxides generated at the site of inflammation.o It produces very little GI toxicity and can be administered in patients intolerant to other NSAIDs.
|
Pharmacology
|
Prostaglandins
|
NSAIDS with least anti inflammatory' action -
A. Indomethacin
B. Paracetamol
C. Ketorolac
D. Ibuprofen
|
Paracetamol
|
32790a09-f519-4c46-9354-5bb020b75db3
|
Ans. C: Propofol Benzodiazepines, e.g. diazepam, lorazepam and midazolam, are widely used as sedative agents in the ICU. Diazepam use has become less common as newer shoer-acting benzodiazepines have become available. Lorazepam is more potent than midazolam and, because of its low lipid solubility, crosses the blood-brain barrier more slowly, delaying its onset of action and prolonging the sedative effect. Hence, it is recommended for longer-term sedation while midazolam is preferred for sho-term sedation Propofol, another frequently used sedative agent, resembles midazolam in terms of pharmacological profile. Midazolam and propofol have similar efficacy and safety in sedating various groups of critically ill patients. Midazolam is, however, cheaper than propofol Neveheless, propofol, when used as a sedative in mechanically ventilated patients, is associated with shoer weaning times and hence, while midazolam may be cheaper, the overall cost-benefit analysis taking into account duration of mechanical ventilation and ICU stay may in fact be better with propofol.
|
Anaesthesia
| null |
Drug of choice for sedation of a patient in ICU is: September 2009, March 2013 (a)
A. Diazepam
B. Lorazepam
C. Propofol
D. Alprazolam
|
Propofol
|
b42e0068-f0a8-4d38-b7f2-a68b8ce48286
|
Ans. is 'a' i.e., Failure of obliteration of second branchial cleft Brachial Cyst* A branchial cleft cyst is a congenital epithelial cyst that arises on the lateral part of the neck usually due to failure of obliteration of the second branchial cleft in embryonic development. Less commonly, the cysts can develop from the first, third, or fourth clefts.* The cyst, usually presents as a smooth, slowly enlarging lateral neck mass that may increase in size after an upper respiratory tract infection.* Treatment is generally conservative.
|
Anatomy
|
Embryology
|
Branchial cyst arises due to-
A. Failure of obliteration of second branchial cleft
B. Persistance of urachus
C. Thymus
D. Thyroglossal tract
|
Failure of obliteration of second branchial cleft
|
2c3b3748-4455-49f6-bbfd-c93177fde53f
|
Ans. (b) PleuritisRef: Harrisons Principle of Internal Medicine 20th Ed; Page No- 2520Most Common Complication in SLE* Cutaneous Manifestations:# The most common acute SLE rash: Butterfly" rash# Most common chronic dermatitis in lupus: Discoid lupus erythematosus (DLE)* Vascular Occlusions: Myocardial infarctions are primarily manifestations of accelerated atherosclerosis.* Pulmonary manifestation: Pleuritis with or without pleural effusion.* Cardiac manifestations: Pericarditis.* Hematologic Manifestations: Anemia* Renal Manifestations: Nephritis* CNS Manifestations: The most common manifestation of diffuse CNS lupus is cognitive dysfunction, including difficulties with memory and reasoning.NoteOther pulmonary Complications* Pulmonary infiltrates are seen active SLE and it is very difficult to distinguish from infection on imaging studies.* Interstitial inflammation is a life-threatening pulmonary manifestation leading to fibrosis, shrinking lung syndrome, and intra-alveolar hemorrhage.* Pulmonary arterial hypertension occurs in a small proportion of SLE patients.Cardiac complications* More serious cardiac manifestations are myocarditis and fibrinous endocarditis of Libman-Sacks.* A patient has SLE if four or more of these 11 criteria are present at any time.Diagnostic criteria for SLEMucocutaneous signs (each counts as one)* Malar rash* Photosensitivity rash* Oral ulcers rash* Discoid rashArthritisPresent in 90 percent of patients; non-erosiveCardiac & PulmonaryPericarditis, myocarditis, Pleuritis (most common pulmonary finding), pleural effusion, pneumonitis, pulmonary HypertensionHematologic (Any blood involvement counts as 1 criteria)Hemolytic anemia, leukopenia, lymphopenia, thrombocytopeniaRenalIt benign from Proteinuria >0.5g/ day to end stage renal disease; such as:- Cellular casts, Glomerulonephritis, azotemia, pyuria, uremia, HTNCerebralSeizures, psychosis (may be subtle), meningitis TIA, cerebrovascular accidentSerology* ANA. It is 95 % sensitive but not specific; almost all patients with SLE have elevated serum ANA levels.* Anti-ds DNA (60-70%) or anti-Sm (Smith) (10-20%). The presence of either of these is diagnostic of SLE--very specific (but obviously not sensitive)NoteEach of the serologic abnormalities counts as 1 criterion. Hence, if the person has joint pain, a rash, and both an ANA and DS DNA, that patient would have 4 criteria.Points to RememberDiagnostic Test for SLE* Best initial test: ANA* Most specific test: Anti-DS DNA (60-70%) or anti-Sm (Smith) (10-20%)..* Rule of thumb- ANA positivity is a must in SLE diagnosis.* ANA negativity twice rules out SLE. Even though ANA positivity cannot confirm SLE - negativity can rule out.Note* There is no ANA negative SLE. But there is ANA negative scleroderma* Also Drug induced lupus - secondary to Quinidine/ Minocycline tends to be ANA negative.
|
Medicine
|
Respiratory
|
Most common pulmonary manifestation of SLE:
A. Shrinking Lung
B. Pleuritis
C. Intra alveolar hemorrhage.
D. Interstitial inflammation
|
Pleuritis
|
29735677-15e7-4b29-ae79-ab2ddeda079c
|
Ans. a. P. falciparum (Ref: Robbins 9/e p390, 8/e p387)Person having heterozygous sickle cell trait is protected from infection of P. falciparum."People who are heterozygous for the sickle cell trait (HbS) become infected with P. falciparum, but they are less likely to die from infectionQ. The HbS trait causes the parasites to grow poorly or die because of the low oxygen concentrationsQ."- Robbins 8/e p387Host Resistance to PlasmodiumTwo general mechanisms of host resistance to Plasmodium:Inherited alterations in red cells make people resistant to PlasmodiumQ.Repeated or prolonged exposure to Plasmodium species stimulates an immune response that reduces the severity of the illness caused by malariaQ.People who are heterozygous for the sickle cell trait (HbS) become infected with P. falciparum, but they are less likely to die from infectionQ.The HbS trait causes the parasites to grow poorly or die because of the low oxygen concentrationsQ.The geographic distribution of the HbS trait is similar to that of P. falciparumQ, suggesting evolutionary selection of the HbS trait in people by the parasite.HbC, another common hemoglobin mutation, also protects against severe malaria by reducing parasite proliferationQ.People can also be resistant to malaria due to the absence of proteins to which the parasites bindQ.P. vivax enters red cells by binding to the Duffy blood group antigenQ.Many Africans, including most Gambians, are not susceptible to infection by P. sivax because they do not have the Duffy antigenQ.Antibodies and T lymphocytes specific for Plasmodium reduce disease manifestations.Cytotoxic lymphocytes may also be important in resistance to P. falciparum.In the given image, irregularly shaped large rings and trophozoites are seen with enlarged erythrocytes, which are the characteristic features of Plasmodium vivax.Examination of Blood Films for Malaria ParasiteMalaria parasites pass through a number of developmental stages. In all stages, however, the specific parts of the parasite will stain a specific colour.Parts of parasiteStaining characteristicChromatin (parasite nucleus)* Usually round in shape & stains a deep red.Cytoplasm* Blue, although shade of blue may vary between malaria species.Recognition of a Malarial Parasite* Malaria parasite takes up Giemsa stain in a special way in both thick & thin blood films. Blood Smears of PlasmodiumFeaturesP. falciparumP. vivaxP, malariaeP. ovaleFeatures of red cellsSizeAll sizes/ normalLarge (young) paleSmall (Old), normalLarge (young)ShapeRound, may be crenatedRound or ovalRoundRound or pear- shaped fimbriatedStipplingMaurer's cleftsQ Large;red up to 20 Basophilic stippling +-Schuffner's dotsQ;numerous small redNone, Occasionally Zieman's dotsQSchuffner's dots, James dotQFeatures of ParasiteRing (early trophozoite)Threadlike, multiple infections, double chromatin dots form accoleQThickerQCompactQCompactQMature/Late trophozoites (amoeboid form)Absent/ occasionally seenAmeboid may fill cell-- More regular, smaller, Band formQLess ameboid &smaller than those of P vivaxDiagnostic keys Gametocyte, multiple rings, double chromatin dots, accoie forms, heavy infectionQSchizont, large RBCs, amoeboid formsQSchizont, small RBCs, band formsQSchizont and large RBCs; pear-shaped, fimbriated RBCsQ Characteristics of plasmodium species infecting HumansCharacteristicP. falciparumP. vivaxP. ovaleP. malariaeIncubation period12 days (shortest) Q14 days14 days30 days (longest) QDuration of erythrocytic cycle (hours)48 (malignant tertian malaria) Q48 (benign tertian malaria)50 (ovale tertian malaria)72 (Guatran malaria) QRed cell preferenceYounger cellsQ (but can invade cells of all ages), >2% of RBC infectedQRed cells upto 14 days oldQ, <1% of RBC infectedReticulocytesQOlder cellsQMorphologyUsually only ring forms, banana shaped gametocytesQIrregularly shaped large rings and trophozoites; enlarged erythrocytes; Schuffner's dotsQInfected erythrocytes enlarged and oval with tufted endsQ; Schuffners dotsSand ofrectangular formsof trophozoites commonPigmentBlackQYellow-brownQDark brownQBrown-blackQRelapse (hypnozoits or exo- erythrocytic schizogony)NoYesQYesQNo
|
Pathology
|
Hemolytic anemia
|
Person having heterozygous sickle cell trait is protected from infection of:
A. P. falciparum
B. P. vivax
C. Pneumococcus
D. Salmonella
|
P. falciparum
|
1bc4f6ce-6b4d-4798-8dfb-c6b95f196b07
|
prolactinoma stimulate pituitary causing excessive milk secretion and it also inhibit GnRH causing decreased FSH &LH level causing secondary amenorrhea (Harrison 17 pg 2206)
|
Medicine
|
Endocrinology
|
A 30 year ols woman presented with secondary amenorrhoea for 3 years along with galactorrhea. The most likely cause of her symptoms would be -
A. Craniopharyngioma
B. Prolactinoma
C. Meningioma
D. Sub-arachnoid haemorrhage
|
Prolactinoma
|
7baca24a-b67a-471a-9f9e-79ada427357f
|
Ans. is 'b' i.e., Sho arm of chromosomes 6 o HLA complex of genes is located on the sho arm of chromosome 6.
|
Pathology
| null |
HLA is present on -
A. Sho term of chromosomes 3
B. Sho arm of chromosomes 6
C. Long arm of chromosomes 3
D. Long arm of chromosomes 6
|
Sho arm of chromosomes 6
|
e72a3615-f212-4a79-a0f4-87aba20c0cc4
|
In social phobia, among the antidepressants, SSRIs are currently drugs of choice, with paroxetine being the most widely used drug. Other SSRIs, such as fluoxetine and seraline are also equally effective. Fluoxetine has the advantage of a longer half-life. Other antidepressants such as imipramine (TCA) and phenelzine (MAOI), are also helpful in treating the panic attacks associated with phobias, thereby decreasing the distress. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 95
|
Psychiatry
|
Pharmacotherapy in psychiatry
|
SSRI is first-line treatment for
A. OCD
B. Panic disorder
C. Social phobia
D. Post traumatic stress disorder
|
Social phobia
|
d2017687-25a0-4272-907f-a1e0863c11a9
|
In general, weight bearing lower limb joints are affected more commonly than upper limb joints.
However, No textbook has mentioned which is the commonest joint : knee or hip.
According to me it is knee because of following facts :-
I have seen hardly one or two cases of primary OA of hip; while, I have seen hundreds of cases of Primary OA of knee in my OPD. At least 4 to 5 patients of primary OA of knee comes daily to my OPD.
"OA commonly affects the knee joint" —Ebnezar
"OA of hip is second in frequency to the knee joint" —Ebnezar
|
Orthopaedics
| null |
The most common site of primary osteoarthrosis is -
A. Hip joint
B. Knee joint
C. Ankle joint
D. Shoulder joint
|
Knee joint
|
9e74ea99-cd9a-47e7-bd03-95c4f99b8d59
|
Perls' stain (Prussian-Blue Reaction) is to demonstrate Ferric salts in tissues. These are seen as iron granules in bone marrow macrophages, erythroblasts (Sideroblasts) and erythrocytes (Siderocytes) in blood films and haemosiderin in spun urine.
|
Biochemistry
| null |
Perl's stain or prussion blue test is for:
A. Bilirubin
B. Calcium
C. Hemosiderin
D. Glycogen
|
Hemosiderin
|
96624c60-6cfb-41f7-94ce-d9ce6c565e73
|
Secondary haemorrhage (occur from 3rd day onwards (5th to 10th day higher chances) due to sloughing of aeries caused by infection). It is the result of sepsis and premature separation of membrane. Ref : ENT textbook by Dhingra 6th edition Pgno : 430
|
ENT
|
All India exam
|
Secondary hemorrhage is after how many days of tonsillectomy
A. Within 6 hrs of operation
B. Within 24 hrs of operation
C. Within 3 weeks of operation
D. Within 3 months of operation
|
Within 3 weeks of operation
|
20255e67-c1c7-4d28-9aab-16c70c500d0b
|
Ans. is 'c' i.e., Vesicouretrial reflux induced pyelonephritis The small scarred kidney in childhood;. Risdon RA] `Reflux nephropathy is now a generally accepted term to describe small scarred kidneys discovered during childhood; it recognises the close association between this renal lesion and vesicoureteric reflux (VUR)'. Renal scarring is most commonly a result of chronic pyogenic injection of the kidney or chronic pyelonephritis. Chronic pyelonephritis occurs only in patients with major anatomic abnormalities, such as obstructive uropathy, struvite calculi or, most commonly, VUR (in 30 to 45% of young children with symptomatic UTI).
|
Pediatrics
| null |
The most common cuase of renal scarring in a 3 year old child is -
A. Trauma
B. Tuberculosis
C. Vesicoureteral reflux induced pyelonephritis
D. Interstitial nephritis
|
Vesicoureteral reflux induced pyelonephritis
|
dab67c26-3707-4de5-8b91-30e60c3eafeb
|
Intact limiting membrane with inflammation confined to portal area is seen in chronic persistent hepatitis.
|
Pathology
| null |
In chronic inflammation confined to the portal tract with intact limiting membrane and normal lobular parenchyma, the histopathological diagnosis would be -
A. Active hepatitis
B. Chronic active hepatitis
C. Chronic persistent hepatitis
D. Acoholic heaptitis
|
Chronic persistent hepatitis
|
238d76d9-837c-407e-8399-952a3cf3d851
|
D. Immunoglobulins and hepatitis-B-vaccine(Ref: Nelson's 20/e p 1942-1952)"Infants born to HbsAg positive mothers should receive both Hep B Ig and Hep B vaccine at separate sites within 12 hours of birth, followed by 2nd and 3rd dose of vaccine at 1 and 6 months.
|
Pediatrics
|
Gastro Intestinal System
|
A neonate born to infected hepatitis-B mother, should be treated with:
A. Isolation
B. Immunoglobulins
C. Hepatitis-B-vaccine
D. Immunoglobulins and hepatitis-B-vaccine
|
Immunoglobulins and hepatitis-B-vaccine
|
f7aab564-8873-4d84-be7b-bc8381a4cc8c
|
Ans. is 'd' i.e., More than one outcomes can be studied
|
Social & Preventive Medicine
| null |
Advantage of coho study ?
A. Involves fewer number of subjects
B. Inexpensive
C. Suitable for rare disease
D. More than one outcomes can be studied
|
More than one outcomes can be studied
|
6455f1b0-0aee-4ff5-8448-7b4f1ecdb05a
|
Answer-A. Lacunar ligamentIt is also called Gimbernat's ligament.From the medial end, deep fibres curve horizontally backward to the medial side of pectin pubis forming lacunar ligament.This ligament is trainagular in shape, with the apex attached to the pubic tubercle.Its sharp lateral edge forms the medial boundary of the femoral canal, which is the site of production of femoral hernia.
|
Surgery
| null |
Ligament of Cooper, used in the surgery for femoral hernia repair, is formed by which of the extentions of inguinal ligament?
A. Lacunar ligament
B. Pectineal ligament
C. Ilioinguinal ligament
D. Reflected pa of inguinal ligament
|
Lacunar ligament
|
2f2b9b1e-61f7-45cb-a653-76e70b1b4583
|
Ref Robbins 9/e p371 Mantoux test is simply able to predict the presence or absent of cell mediated immunity against the tubercular antigens .it cannot differentiate between infection and disease Negative mantoux test just indicates that the individual has not been exposed to tuberculin bacilli
|
Anatomy
|
General anatomy
|
Mantoux test reading of less than 5mm indicates
A. Tuberculosis infection
B. Disseminated TB
C. Susceptiblity to TB
D. Immunity to TB
|
Disseminated TB
|
701efbf3-bf83-4797-87c8-3200c6632e1c
|
Ans. is 'd' i.e., Riboflavin VitaminCoenzymeFunction as coenzymeEntity transferredThiamine (Vit B1)Thiamine pyrophosphate (TPP)Oxidative decarboxylation and transketolase reactionHydroxy-ethylRiboflavin (Vit B2)Flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN)Oxidation and reduction reactionHydrogen atomsNiacinNicotinamide adenine dinucleotide (NAD+) and nicotinamide adenine dinucleotide phosphate (NADP+)Oxidation and reduction reactionHydride ion (H-)Pyridoxin Q (Vit B6)Pvridoxal phosphate (PLP)Transamination, deamination, decarboxylation of amino acidsAmino groupBiotin QBiocytinCarboxylation reaction QCarbon dioxideFolic acid QTetrahydrofolate (THF)Carrier of one carbon group (other than CO2)One carbon groupPentothenic acid QCoenzyme A QAcyl carrierAcyl groupCyanocobalamine QMethylcobalamine and DeoxyadenosylcobalamineTransfer of H2 group and isomerizationAlkyl group or hydrogen atom
|
Biochemistry
|
Vitamins
|
Which Vitamin is involved in Redox reactions -
A. Pyridoxin
B. Biotin
C. Folic acid
D. Riboflavin
|
Riboflavin
|
d9f99fbc-bebb-4db3-abff-ba9db4b085a6
|
Wahin's tumor Is the second most common benign tumor of the parotid gland (1st is pleomorphic adenoma). It consists of both epithelial and lymphoid elements thus known as adenolymphoma (probably arises from remnants of parotid tissue trapped in lymphnodes within the parotid gland). Also known as papillary cystadenoma lymphomatosum. The tumor arises only in the parotid gland. Almost always arises in the lower poion of the parotid gland overlying the angle of mandible. Common in males. (Occurs most often in older white men) Age : 5th to 7th decade. Association is seen with smoking. Bilaterality is seen in 10% cases. Its well encapsulated, extremely slow growing tumor, never turns malignant. A peculiar feature of Wahins tumor is that it shows 'hot' spot in 99' Tc-peechnate scan. Other tumors of the parotid show 'cold' spot (Oncocytomas another benign parotid tumor also shows hot spot). (Because of the high mitochondrial content within oncocytes, the oncocyte-rich Wahin tumor and Oncocytomas incorporate technetium Tc 99m and appear as hot spots on radionuclide scans.) Also remember Godwin's tumor - Benign lymphoepithelial tumor of the parotid gland. Most salivary gland tumors are benign. However remember that the smaller the salivary gland, the higher is the chance of the tumor being malignant. Parotid gland - 80% benign Submandibular, Sublingual - 50% benign, 50% malignant Minor salivary glands - 25% benign, 75% malignant
|
Surgery
|
Head and neck
|
A Wahin's tumour is
A. An adenolymphoma of parotid gland
B. A pleomorphic adenoma of parotid
C. A carcinoma of the parotid
D. A carcinoma of submandibular salivary gland
|
An adenolymphoma of parotid gland
|
977df036-1eb8-4de2-badd-0a23b59e225b
|
Natural Killer CellsThe function of NK cells is to destroy irreversibly stressed and abnormal cells, such as virus-infected cells and tumor cells. NK cells make up approximately 5% to 10% of peripheral blood lymphocytes. They do not express TCRs or Ig.NK cells are endowed with the ability to kill a variety of virus-infected cells and tumor cells, without prior exposure to or activation by these microbes or tumors.Two cell surface molecules, CD16 and CD56, are commonly used to identify NK cells. CD16 is an Fc receptor for IgG, and it confers on NK cells the ability to lyse IgG-coated target cells. This phenomenon is known as antibody-dependent cell-mediated cytotoxicity (ADCC). The function of CD56 isnot known.Ref: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 6; Diseases of the Immune System
|
Microbiology
|
Immunology
|
Natural killer cells
A. Belongs to B-cell lineage
B. Belongs to T-cell lineage
C. Display cytotoxic effect on tumor cell
D. Requires previous antigen exposure for activation
|
Display cytotoxic effect on tumor cell
|
557d6593-08fc-4abf-aa48-5a4ddbd9e594
|
Ans. is 'a' i.e., 10 years o The longest life span is of CuT380A: 10 years.IUDsLife spanFirst generation:Lippe's loop (obsolete)--Second generationCopper-T--CuT-200-B4 yrCuT-2003yrCuT-220C--Nova-T5 yrMultiload - 2503 yr3755 yrCuT-3 80A10 yrThird generationProgestasert1 yrLNG-20 (Mirena)5 yr (Ref: Novak p263; Note that Park mentions the life span of mirena to be 10 yrs)
|
Gynaecology & Obstetrics
|
Non-Hormonal - Intrauterine Devices
|
Life span of CuT 380 A is -
A. 10 years
B. 8 years
C. 4 years
D. 5 years
|
10 years
|
d5bb73ad-1472-4bc4-9a31-8e0abab3e418
|
Ans. is 'c' i.e., Temporal lobe involvement Pathology of Herpex simplex encephalitis:o Herpes simplex infection has a prediliction for the involvement of Temporal lobe.o The lesions in HSV encephalitis are intense hemorrhagic necrosis of the inferior and medial temporal lobe and the mediorbital part of frontal lobes.o The temporal lobe lesions are usually b/L but not symmetrical.o The distribution of the lesion is so characteristic that the diagnosis can be made by gross inspection or by their location and appearance on imaging studies.o In the acute stages of the disease, intranuclear eosinophilic inclusions are found in neurons and glial cells in addition to the usual microscopic abnormalities of acute encephalitis and hemorrhagic necrosis.C.S.F examination# Increased C.S.F pressure# Pleocytosis, cells are mostly lymphocytes# Red cells sometimes numbering in thousands and xantho chromia are found refecting the hemorrhagic nature of the brain lesions.# Protein content is increased in most cases.# Slight reduction of glucose.o Herpes simplex encephalitis is characterized bv "focal neurological symptoms"o Over 90% patients will have one of the following symptoms offocal neurological deficit, plus fever -# Focal cranial nerve deficits# Hemiparesis# Dysphasia# Aphasia# Ataxia# Focal seizure# Altered mentation and level of consciousnesso Most common area involved in herpes simplex encephalitis is "Temporal lobe"# Temporal lobe abnormalities on brain imaging are considered strong evidence for herpes simplex encephalitis.# Temporal lobe lesions are predominantly unilateral.# Most sensitive and specific investigation for HSV-1 encephalitic is MRI# In contrast, cranial CT scans have only 50% sensitivity and that too early in the disease.EEG findings in HSV-jencephalitis# Focal electroencephalogram (EEG) findings occur in >80% of cases typically showing prominent intermittent high amplitude slow waves (delta and theta slowing) and occasionally continuous "periodic lateralized epileptiform discharges ".
|
Medicine
|
Infection
|
Herpes simplex infection can lead to?
A. Frontal lobe infarction
B. Parietal lobe infarction
C. Temporal lobe involvement
D. Occipital neuralgia
|
Temporal lobe involvement
|
31608513-c271-49e8-b833-7a55d2d1ab75
|
Ans. is 'a' i.e., 350 gmCarbohydrate store of body is approximately 350 grams (70 grams hepatic glycogen and 280 grams muscle glycogen).
|
Social & Preventive Medicine
| null |
Corbohydrate reserve of human body
A. 350 gm
B. 600 gm
C. 950 gm
D. 1500 gm
|
350 gm
|
802b5bec-215a-462d-b053-62c0e5af3894
|
Meningeal involvement is pronounced at the base of the brain, paresis of cranial nerves (ocular nerves in paicular) is a frequent finding. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 1348
|
Medicine
| null |
Which cranial nerve is commonly involved in meningeal tuberculosis infection?
A. 7th nerve
B. 8th nerve
C. Ocular nerve
D. Oculomotor nerve
|
Ocular nerve
|
3de7ebb7-c191-4ea9-bbac-4a23d3b6025c
|
Cytochromes P450 (CYPs) are a family of enzymes containing heme as a cofactor that function as monooxygenases. In mammals, these proteins oxidize steroids, fatty acids, and xenobiotics, and are impoant for the clearance of various compounds, as well as for hormone synthesis and breakdown Ref: guyton and hall textbook of medical physiology 12 edition page number:20,21,22
|
Physiology
|
Endocrinology
|
Cytochrome P450 is identified to 11-ss hydroxylase is known as
A. CYMA-IB
B. CYPA-2B
C. CYPA-3B
D. CYPA-4B
|
CYPA-2B
|
7183c715-5517-42cb-84bd-47d08d1d36ab
|
Ans. is 'a' i.e., Pagets disease Paget's disease o Paget s disease is characterized by increased bone turnover and enlargement and thickening of the bone the internal architecture is abnormal and the bone is usually brittle, o Primary defect is in osteolastic. o It is marked by regions of furious osteolastic bone resorption which is followed by a period of hectis bone formation. The net effect is gain in bone mass. o It has the following three stages Initial osteocytic stage Mixed osteoclast osteoblastic stage Burned out quiescent osteosclerotic stage o Following complications can occur in Paget's Increased risk of development of sarcomas (osteosarcoma chondrosarcoma) Fractures in weight bearing bones Osteoarthritis High output cardiac failure Cranial nerve compression Otoscleosis
|
Unknown
| null |
Premalignant bone lesion among the following is -
A. Pagets disease
B. Osteoid osteoma
C. Osteochondroma
D. Enchondroma
|
Pagets disease
|
afc9a7aa-ea95-4bda-adef-6c0c157909bd
|
There are two types of stratified squamous epithelia: nonkeratinized and keratinized. Nonkeratinized epithelium exhibits live surface cells and covers moist cavities such as the mouth, pharynx, esophagus, vagina, and anal canal. Keratinized epithelium lines the external surfaces of the body.
|
Anatomy
| null |
Which among the following is the epithelial lining of vagina?
A. Stratified squamous non-keratinized
B. Columnar
C. Stratified squamous keratinized
D. Cuboidal
|
Stratified squamous non-keratinized
|
5d79dffd-dde1-4967-bc9d-0910b7926218
|
One of the main causes of death is hypeensive renal crisis, characterised by rapidly developing malignant hypeension and renal failure. Hypeensive renal crisis is much more likely to occur in DCSS than in LCSS, and in patients with topoisomerase 1 antibodies. Hypeension should be treated aggressively with ACE inhibitors, even if renal impairment is present. DAVIDSON&;S 22nd EDITION;PAGE NO 1113
|
Medicine
|
Immune system
|
Drug of choice for hypeension crises in systemic sclerosis is
A. Beta blocker
B. Losaan
C. ACE inhibitor
D. Nitrates
|
ACE inhibitor
|
3b909ad5-c40f-4013-85df-1a402a8b9fc4
|
- There are 3 groups of ethmoidal air sinuses Anterior Middle Posterior - Posterior ethmoidal sinus is opening in lateral wall of the nose. - Lateral wall of the nose has 3 elevations called superior, middle & inferior turbinates / conchae - Under each turbinate, there is space called meatus called superior, middle & inferior meatus - Posterior ethmoidal sinus is opening in superior meatus - Anterior & middle sinus is opening in middle meatus - Middle meatus have hiatus semilunaris At front of hiatus semilunaris frontal air sinus opens The anterior, middle ethmoidal sinus respectively Maxillary sinus opens slightly posterior; In the region of hiatus semilunaris in middle meatus - Naso-lacrimal duct opens in the inferior meatus on Anterior aspect - Inferior turbinate is largest turbinate & its meatus is largest meatus - Eustachian tube opens behind inferior turbinate in lateral wall of nasopharynx
|
Anatomy
|
JIPMER 2019
|
Posterior ethmoidal sinus drains into (JIPMER May 2019)
A. Spheno-ethmoidal recess
B. Superior meatus
C. Middle meatus
D. Inferior meatus
|
Superior meatus
|
6a2008ad-90b7-46ec-8b01-422d1cd3ad8e
|
The hypoglossal nerve innervates the muscles of the tongue and is therefore directly involved in alteration of shape and movement of the tongue. A lesion in this nerve would cause deviation of the tongue toward the injured side, which could be observed upon protrusion of the tongue. The genioglossus is the major muscle involved in protrusion of the tongue. The genioglossus muscles arise from the inside of the mandible and pass posteriorly to insert into the deep aspect of the tongue. When the genioglossi contract, they pull the tongue forward, and out of the mouth, in protrusion. If one genioglossus is paralyzed, it acts like a brake on one side of the tongue when the tongue is pulled forward, causing the tip of the tongue to point to the nonmoving side. The styloglossus muscle is responsible for retraction and elevation of the tongue.
|
Anatomy
|
Head & Neck
|
A 56-year-old man is diagnosed with an extradural tumor in the posterior cranial fossa. When the patient protruded his tongue during physical examination, the tongue deviated to the right. Which of the following muscles and nerves are most likely injured?
A. Right hypoglossal nerve and right genioglossus
B. Left hypoglossal nerve and left genioglossus
C. Right hyoglossus and left styloglossus
D. Right geniohyoid and first cervical nerve
|
Right hypoglossal nerve and right genioglossus
|
5f9056e8-2364-4f13-926e-7853c4a561f0
|
Ans. is 'b' i.e., Catalase test(Ref: Ananthanarayan, 9th/e, p. 200 and 8th/e, p. 196)* Coagulase test is used to differentiate the different species of staphylococci (staph, aureus, staph, epidermidis).* Catalase test is used to differentiate staphylococci from streptococci.* Coagulase test cannot be used to differentiate streptococci from staphylococci because certain species of staphylococci are coagulase negative (coagulase negative staphylococci) as streptococci.
|
Microbiology
|
Bacteria
|
Staphylococcus differs from streptococcus by:
A. Coagulase test
B. Catalase test
C. Phosphatase
D. Gram negative
|
Catalase test
|
df20a02a-2444-4503-9a36-722ccedbe7eb
|
Ans. is 'a' i.e., Scabies Vesicobullous lesion in an infant can be seen in Scabies Infantile eczema Seborrheic dermatitis The clincher here is involvement of palms and soles. This is a characteristic feature of scabies in infants * Differential diagnosis Scabies Infantile eczema Characteristic distribution: Lesions present on palms, soles and genitalia Spares palms and soles Burrows present. Absent Typical lesions in a family member May have atopic diathesis in family H/O asthma not relevant History of Asthma Infantile Seborrheic dermatitis Infantile eczema Begin in infants <3 months In infants > 3 months Asymptomatic Extremely itchy Scalp, major flexures (axillae, groins) Face, other parts of the body Family or personal history of atopy. Also, know, In scabies in adults, the scalp, face, palms, and soles are characteristically spared, but in infants scalp, face, palms, and soles are typically involved.
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Unknown
| null |
A 6-month old infant presented with multiple papules and exudative lesions on the face, scalp, trunk and few vesicles on the palms and soles for 2 weeks. His mother had a history of itchy lesions.The most likely diagnosis is :
A. Scabies
B. Infantile eczema
C. Infantile seborrhoeic dermatitis
D. Impetigo contagiosa
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Scabies
|
8d8e32be-d0b8-4cce-b382-d65d00d3ebad
|
Ans: A (Mycobacterium Gordonae) M. Marinum & M. Kansasii are photochromogenes while M. intracellulare & M. avium are non-photochromogenes.Scotochromogens# M, Gordonae (formely M.aquae) - Often found in tap water (hence called 'the tap water scotochromogen), is a common contaminant in clinical specimens and a rare cause of pulmonary disease.# M. Scrofulaceum - It is principally associated with scrofula or cervical lymphadenopathy, but also cause pulmonary disease.# M, szulgai - An uncommon cause of pulmonary disease & bursitis. It is a scotochromogen when incubated at 37degC but a photochromogen at 25degC.Table (Greenwood): Principal types of opportunist mycobacterial disease in man and the usual causative agentsDiseaseUsual causative agentLymphadenopathyM. avium complexM. scrofuiaceumSkin lesions Post-trauma abscessesM. chelonaeM. fortuitumM.terraeSwimming pool granulomaM. marinumBuruli ulcerM. ulceransPulmonary diseaseM avium complexM. kansasiiM. xenopiM. malmoenseDisseminated disease AIDS-relatedM. avium complexM. genevenseNon-AIDS-relatedM. avium complexM. chelanae A typical = Nontuberculous = Paratubercle Mycobacterium = MOTTClassified into four group by Runyon | | | | |1. PhntnchroiiiogenesProduce no pigment in dark & yellow orange pigment when exposed to light.i M.SimiaeQii M. AsiaticumQiii M. kansasiiQiv M. MarinumQ 2. Scotochromogenes: Form yellow-orange red colonies even in the darki. M. ScrofulaceumQii M.Szulagaiiii. M. GordonaeQ 3. NonphotochromogenesDo not form pigment even on exposure to lighti M. AviumQii M. XenopiQiii M. UlceransQiv M. JntracellulareQv M.Matmoensevi M. Shinshuensevii M. Paratuberculosisviii M. Sylvaticumix M. Lepraemuriumx M. terraexi M. Nonchromogenicumxii M. trivialexiii M. Haemophiiumxiv M. Genevense 4. Rapid growers: Thevare capable of rapid growth, colonies appearing within seven days of incubation at 37deg C or 25deg C.i M. ChelonaeQii M. ForuitumQiii M. SmegmatisQiv M. fiavescensQv M. VaccaeQ
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Microbiology
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Bacteria
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Scotochromogens are: (PGI Dec 2008)
A. Mycobacterium Gordonae
B. Mycobacterium Marinum
C. Mycobacterium Intracellulare
D. Mycobacterium avium
|
Mycobacterium Gordonae
|
eee95682-65f1-4f9b-887b-96bcad4b41ac
|
Ans. is 'a' i.e., Physiological anemia o Physiologic Anemia of InfancyHemoglobin drops to low point at age 6 to 8 weeksErythropoietin nadir drops HemoglobinTerm Infants: Hemoglobin drops to 9-11 g/dlPreterm Infants: Hemoglobin drops to 7-9 g/dlo No work-up or treatment unless Hemoglobin lower than expected Other point -# Hemoglobin g/dl cut off-. (WHO/UNU-1996)# 6mo-5yr <11.0;5-11 yr. - 11.5;# 12-13 yr -12.0g/dl; Men - 13.0# Women Non-pregnant - 12.0;Pregnant -11.0
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Pediatrics
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Anemias of Inadequate Production
|
Child of 6 weeks with Hemoglobin of 10 gm% pale on examination, diagnosis is -
A. Physiological anemia
B. Pathological anemia
C. Thalassemia
D. Iron dificiency anemia
|
Physiological anemia
|
f61646b1-e81a-4592-990d-968991f1b156
|
For the antemortem diagnosis of rabies, viral antigens can be demonstrated in the corneal smear, skin biopsy from the face or neck or saliva.
|
Microbiology
| null |
A 15 year old girl was admitted to the infectious disease hospital with a provisional diagnosis of rabies. The most suitable clinical sample that can confirm the antemortem diagnosis is-
A. Serum for anti-rabies IgG antibody
B. Corneal impression smear for immunofluorescence stain
C. CSF sample for viral culture
D. Giemsa stain on smear prepared from salivary secretions
|
Corneal impression smear for immunofluorescence stain
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a9fe12f7-57f8-4f2d-90d0-55426043e20d
|
Ans. is'b'i.e.,0.7 mSvScreening mammography and radiation A screening mammogram is an X-ray of the breast tissue for women without any breast symptoms.It uses low doses of radiation (about 0.7mSv for 4 X-rays).
|
Radiology
| null |
Amount of radiation used in mammography -
A. 0.5 mSv
B. 0.7 mSv
C. 0.9 mSv
D. 1 mSv
|
0.7 mSv
|
c02c97aa-cb2d-403d-909c-efcc2d5851f8
|
The structure that lies lateral to distal radial tubercle are: Tendons of Extensor carpi radialis brevis and longus. Distal radial tubercle (Lister's tubercle) is located at the distal dorsal aspect of the radius It is a bony prominence that can be easily palpated. Function: It acts as a pulley for the Extensor Pollicis Longus tendon, changing it's mechanical direction of action.
|
Anatomy
|
Muscles of arm and forearm region & Cubital fossa
|
The structure that lies lateral to distal radial tubercle
A. Extensor pollicis longus
B. Extensor carpi radialis longus
C. Brachioradialis
D. Extensor carpi ulnaris
|
Extensor carpi radialis longus
|
d2dc91ad-da8a-4713-9f51-8499aef5a8f3
|
Diffusion-weighted MRIDiffusion-weighted MRI detects cytotoxic edema in just a few hours of infarction.
|
Radiology
| null |
Best imaging study for the earliest diagnosis of cerebral infarct-
A. FLAIR MRI
B. Non-contrast CT
C. CECT
D. Diffusion-weighted MRI
|
Diffusion-weighted MRI
|
6de209bb-4110-403b-9938-375289db82ec
|
Night blindness (nyctalopia) is one of the earliest symptoms of vitamin A deficiency. Severe deficiency of vitamin A leads to xerophthalmia. This is characterized by dryness in conjunctiva and cornea, and keratinization of epithelial cells. In certain areas of conjunctiva, white triangular plaques known as Bitot's spots are seen.
Satyanarayana- Biochemistry, 3rd edition, pg-123
|
Biochemistry
| null |
A 40 year old male patient complains of diminished vision during night and dryness of eyes. Patient gives history of recurrent bacterial infections. Ophthalmic examination reveals white triangular plaques on conjunctiva. This patient is suffering from deficiency of:
A. Vitamin D
B. Vitamin B
C. Vitamin A
D. Vitamin C
|
Vitamin A
|
053485fa-4a38-44a1-b70a-687af2906c74
|
Reversal of the reaction catalyzed by pyruvate kinase in glycolysis involves two endothermic reactions. Mitochondrial pyruvate carboxylase catalyzes the carboxylation of pyruvate to oxaloacetate, Key Gluconeogenic Enzymes 1. Pyruvate carboxylase.Pyruvate Carboxylase Reaction Pyruvate in the cytoplasm enters the mitochondria. Then, carboxylation of pyruvate to oxaloacetate is catalysed by a mitochondrial enzyme, pyruvate carboxylase (Fig. 9.24). It needs the co-enzymes biotin and ATP.Ref: DM Vasudevan, 7th edition, Chapter 9
|
Biochemistry
|
Metabolism of carbohydrate
|
Which helps in the production of more glucose?
A. Pyruvate kinase
B. Pyruvate carboxylase
C. PDH
D. Pyruvate decarboxylase
|
Pyruvate carboxylase
|
cae21cc5-b191-4ee9-8fbe-d3f083837659
|
Rapidly progressive glomerulonephritis may occur in association with the five diseases mentioned and also with periaeritis (polyaeritis) nodosa, Wegener's granulomatosis, and essential cryoglobulinemia. Some cases arise without a known antecedent disease (idiopathic). Although the prognosis is poor in all types of rapidly progressive glomerulonephritis, post streptococcal disease has a better prognosis than the other types, and up to 50% of patients may recover sufficient renal function to avoid chronic dialysis or transplantation. Ref: Wyatt C., Kemp W.L., Moos P.J., Burns D.K., Brown T.G. (2008). Chapter 16. Pathology of the Kidney and Bladder. In C. Wyatt, W.L. Kemp, P.J. Moos, D.K. Burns, T.G. Brown (Eds), Pathology: The Big Picture.
|
Pathology
| null |
The prognosis is best in rapidly progressive (crescentic) glomerulonephritis associated with:
A. Poststreptococcal glomerulonephritis
B. Systemic lupus erythematosus (SLE)
C. Henoch-Schoenlein purpura
D. Polyaeritis nodosa
|
Poststreptococcal glomerulonephritis
|
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