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bf83869b-611e-4bd1-945b-e97fab2a5272 | Block veebra type of scoliosis has the best prognosis. The progression is slow and it can be corrected easily, whereas unilateral thoracic unsegmented type carries worst prognosis. Ref: Ohopaedic Surgery Essentials in Pediatrics By Kathryn E. Cramer, Susan A. Scherl, 2004), Page 65; Campbell's Ohopaedics, 11th Edition, Page 2607. | Surgery | null | Progression of congenital scoliosis is least likely in which of the following veebra anomalies?
A. Fully segmented Hemiveebra
B. Wedge veebra
C. Block veebra
D. Unilateral unsegmented bar with Hemiveebra
| Block veebra |
d7bbec2a-afd0-4d2d-8f48-e5cf46d06737 | C. The proximal pa of the internal carotid aery is derived from aoic arch 3. | Anatomy | Pharyngeal Arches | The proximal pa of the internal carotid aery is derived from which of the following?
A. Aoic arch 1
B. Aoic arch 2
C. Aoic arch 3
D. Aoic arch 4
| Aoic arch 3 |
bd6f9ddf-7516-4542-a01f-de6fd005ecc4 | Option A: Atropine is a muscarinic receptor antagonist that is used to inhibit the effects of excessive vagal activation on the heart, which is manifested as sinus bradycardia and AV nodal block. Effect on contractility is negligible.
Option B: Decrease EDV decreases contractility by Frank Starling law.
Option D: Acidosis, hypercapnoea and hypoxia inhibit myocardium contractility.
Option C: This effect is known as Bowditch Effect (Myocardial tension increases with an increase in heart rate). | Physiology | null | Myocardial contractility is increased by:
A. Atropine
B. Decreased end diastolic volume
C. Increased heart rate from 70 to 150 beats/min
D. Reduced arterial pH to 7.3
| Increased heart rate from 70 to 150 beats/min |
420b4e91-20a6-4335-a3a9-6484081d3fce | Laryngeal papillomata These are rare benign tumours occurring mainly in children, but can also present in adults. They are most commonly found on the vocal folds, but may spread throughout the larynx and tracheobronchial airway (although this is less likely in adults). They are caused by papillomaviruses andneed repeated removal by carbon dioxide laser or microsurgery to maintain a reasonable voice and airway. These patients are best managed in specialist centres, with the appropriate expeise. Antiviral treatment is of doubtful value. Papilloma vaccination is, to date, of unproven benefit. Ref: Bailey and love 27th edition Pgno : 750 | Surgery | Head and neck | Laryngeal Papillomatosis is caused by
A. HPV
B. EBV
C. CMV
D. HSV
| HPV |
b75249fa-cad3-4620-a558-89265009270e | She has a statin-induced myopathy, with a creatine kinase level more than 10 times normal from rhabdomyolysis (myoglobin released from muscle can be detected by the urine dipstick). Statins are HMG-CoA reductase inhibitors that reduce endogenous cholesterol synthesis in the liver. Cholestyramine binds bile acids in the intestine and disrupts enterohepatic bile acid circulation to increase the conversion of cholesterol to bile acids in the liver. Clofibrate enhances uptake and oxidation of free fatty acids in muscle. Ezetimibe interferes with intestinal lipid absorption. Nicotinic acid inhibits the mobilization of peripheral free fatty acids to reduce hepatic triglyceride synthesis and secretion of VLDL. | Pathology | Peripheral Nerve & Skeletal Muscles | A 71-year-old woman is receiving a drug to lower her serum cholesterol. Over the past week, she has developed muscle pain and weakness unrelated to physical activity. On examination, she has diffuse but mild muscle tenderness. Laboratory studies show her serum creatine kinase is 2049 U/L and creatinine is 2 mg/dL. Urine dipstick analysis is positive for blood, without RBCs on urine microscopy. Which of the following drugs is most likely to produce her findings?
A. Cholestyramine
B. Clofibrate
C. Ezetimibe
D. Lovastatin
| Lovastatin |
bff96992-281c-4b17-bb5a-16c22a9c6fb1 | Manifestation of Conn's Syndrome (Primary Hyperaldosteronism) Clinical Laboratory Muscle weakness and fatigue (due to hypokalemia) Hypeension without edema Polyuria and polydipsia Hypokalemia Metabolic alkalosis Hypernatremia Increased Aldosterone Low renin | Surgery | Parathyroid and adrenal glands | A 50-year-old male presents with severe refractory hypeension, weakness, muscle cramps and hypokalemia, the most likely diagnosis is:
A. Hypoaldosteronism
B. Hyperaldosteronism
C. Cushing syndrome
D. Pheochromocytoma
| Hyperaldosteronism |
575096a1-0e36-47c4-82b8-c82b3067123f | Ans. C. Biotin. (Ref Harper's Biochemistry 27th/Ch. 44).Vitamin B7 (biotin):Function:-Cofactor for carboxylation enzymes (which add a l-carbon group):- Pyruvate carboxylase: pyruvate (3C)*oxaloacetate (4C).- Acetyl-CoA carboxylase: acetyl-CoA (2C)*malonyl-CoA (3C).- Propionyl-CoA carboxylase: propionyl-CoA (3C)*methylmalonyl-CoA (4C).- 3 methylerotoyl CoA = methyl glutaconyl CoADEFICIENCY: due to antibiotic overuse, ingestion of raw eggs (avidin in egg white AVIDLY binds to biotin).Ch by Dermatitis, alopecia, enteritis.VitaminsVITAMINENZYMES IN WHICH IT ACTS AS COENZYMESDEFICIENCY DISEASE1. Vit. B1 (Thiamine)# Pyruvate dehydrogenase complex# Oxidation decarboxylation of a-keto-acid# Transketolase reaction# Tryptophan pyrolase# Beri-Beri disease# Werinicke encephalopathy2. Vit. B2 (Riboflavin) (heart stable but light sensitive)# FMN and FAD are two coenzymes of this vit.# Constituent of cytochrome -c- reductase# Warburg-yellow enzyme# Fumarate dehydroganase# Cheilosis# Glossitis# Seborrheic3. Vit. B3 (Niacin)# NAD and NADP are it's active forms with operate as hydrogen and electron transfer agents# They are co-enzymes for various types of dehydrogenase like- Alcohol dehyrogenase- Lactate dehydrogenase- Malate dehydrogenase- Pyruvate dehydrogenasePellagra C/B 3 D's:- Diarrhea- Dermatitis- Dementia4. Vit. B6 (Pyridoxine) (In vit.B6 defi Kynureine levels rise, which is converted to xanthurneic acid - a reliable criteria for B6 defi)# Co-transaminase# Co-decarboxylase# Deaminase# Involved in synthesis of Co-A# Coenzyme for Kynureninase# Epileptiform convulsion in infants# Sideroblastic anemia# (It is used in Rx of oxalate stone of kidney and homocytinuria)5. Pantothenic acid# Active form is Co-A# Formation of Acetyl CoA# Formation of succinyl CoA# Oxidation of F. acids# Synthesis of F. acids# G.I symptoms# Changed sleep pattern# Easy fatigue# Burning foot syndrome6. Biotin# Carboxylase enzyme (carboxylation reaction)# Leiner's disease# Exfoliative dermatitis7. Vit. B12 (Cyanocobalamine)# To convert-Methyl malonyl CoA|Homocysteine methionine|Ribonucleotide|DeoxyribounuleotideMethyl malonyluriaHomocystinuriaPernicious anemiaSACD | Biochemistry | Vitamins and Minerals | Which of the following acts as a coenzyme in carboxylation reaction?
A. Riboflavin
B. Niacin
C. Biotin
D. Pantothenic acid
| Biotin |
cdc37ffe-1980-449e-b568-4e0087e5db66 | Answer is D (Explicit memory): Hippocampal lesions primarily affect Declarative or Explicit memory. The Hippocampus is essential to forming new memories for facts and general information (sementic memory) and also for life experiences (episodic memory). But the hippocampus does not appear to play a role in precedural memory, the kind of memory we draw upon while riding bike or using a tool Classification of Memory Based on Anatomy of Temporal Lobe system (Hippocampus) Declarative Memory or Explicit Memory (Episodic/Sementic Memory) Declarative memory also known as Explicit memory, is memory of events, places, facts and people and is dependent on the temporal lobe system (Hipppcampus) Declarative memory can be fuher divided into two classes. Episodic memory Sementic memory Refers to memory of Refers to memory or facts episodic events that that are no longer contain 'what"where' ascribable to any paicular `when' information occasion in life Lesions of the temporal lobe such as hippocampus are known to greatly impair patient's ability to learn new facts, concepts, vacobulary and knowledge about the world. Non-Declarative Memory or Implicit Memory (Procedural memory) Non-Declarative memory is also known as procedural memory and does not depend on the structural integrity of the temporal lobe system. Non-Declarative memory encompasses a variety of perceptual motor learning skills and mental operations Currently the brain regions involved in encoding procedural memory are not clear, atleast in humans (striatum may be engaged) | Medicine | null | Hippocampus lesion affects:
A. Implicit memory
B. Procedural memory
C. Non-declarative memory
D. Explicit memory
| Explicit memory |
eac11180-1b84-406c-ad5e-621a6e55751b | Ans. is 'd' i.e., Congenital syphilis Syphilic ahritis Syphilic ahritis may be seen in congenital or acquired syphilis. Congenital syphilis The joint may be affected early or late : ? Early congenital syphilis : - Osteochondritis in juxta-epiphyseal region results in breakdown of the bone and cailage. Late congenital syphilis : - Painless synovitis at pubey is called clutton's joint. Most comon site is knee followed by elbow, and often is bilateral Acquired syphilis Joint may be involved in the secondary or teiary stage. Secondary stage : - Transient polyahritis. Teiary stage : - Gummatous polyahritis, Chorcot's (neuropathic) joint | Surgery | null | Clutton's joint is seen in ?
A. Primary syphilis
B. Secondary syphilis
C. Teiory syphilis
D. Congenital syphilis
| Congenital syphilis |
1878bfda-cffe-4497-b35f-279517910270 | Weine recommends that the apexification procedure be completed in two appointments. After instrumentation, irrigation and drying of the canal during the first appointment, he advises sealing a sterile, dry, cotton pellet in the pulp chamber for 1 to 2 weeks. Placing a calcium hydroxide dressing in the canal is optional at the first appointment.
During the second appointment, the debridement procedures are repeated before the canal is filled with a thick paste of calcium hydroxide and CMCP or calcium hydroxide in a methylcellulose paste. Whether the tooth is filled in one or two appointments (or more) should be determined to a large extent by the clinical signs and symptoms present and to a lesser extent by operator convenience.
All signs and symptoms of active infection should be eliminated before the canal is filled with the treatment paste.
Absence of tenderness to percussion is an especially good sign before the canal is obturated.
Because of the wide-open access to periapical tissues, it is not always possible to maintain complete dryness in the root canal.
If the canal continues to weep but other signs of infection seem to be controlled after two or three appointments, the dentist may elect to proceed with the calcium hydroxide paste treatment. | Dental | null | For a tooth with open apex, treated with calcium hydroxide for apexification, the most reliable sign before obturation is:
A. Electric pulp testing
B. Thermal pulp testing
C. Tooth mobility
D. Tenderness on percussion
| Tenderness on percussion |
7761f18f-e3d2-4b86-b101-6e125ad78966 | Side effects are unpredictable and depend on the type of chemo drug a person is using. Illness, easy bruising or bleeding, and hair loss are some of the most common side effects. Other common side effects include: nausea and vomiting Ref Harrison 20th edition pg 563 | Medicine | Oncology | The most common side-effect of chemotherapy administration is -
A. Nausea
B. Alopecia
C. Myelosuppression
D. Renal dysfunction
| Nausea |
c55ac8e4-43ef-43c1-b37d-778ffb3cefef | Blood agar is an example of enriched media. Enriched media are cultural media that are enriched with whole or lysed blood, serum, special extracts, or nutrients to suppo the growth of those bacteria that cannot grow on the basal media. Other examples of enriched media are serum agar and chocolate agar. Selenite F broth is an enrichment media used for the isolation of Salmonella group of bacteria. Selective media are solid media which contain substances that slow or inhibit the growth of micro-organisms other than those for which media are devised. Eg Tellurite medium for diphtheria, Deoxycholate citrate agar for Shigella and Salmonella. Ref: Medical Lab Science: Theory & Practice By Ochei Et Al, page 586 | Microbiology | null | Blood agar is an example of:
A. Enrichment media
B. Enriched media
C. Nutrient media
D. Selective media
| Enriched media |
6fba02e9-82c9-4852-93ae-434154a7890f | Ans. (b) Evaluation of left atria and left Atrial appendage thrombusRef.: Harrison 19th ed. /270e-2* Trans-esophageal echocardiography is better than trans- thoracic echocardiography as it is better able to evaluate the left Atrial thrombus and left Atrial appendage. Therefore in patients of atrial fibrillation of long standing duration for evaluation of clots in left atrium, trans-esophageal echocardiography is done. | Medicine | Noninvasive Examination of the Heart | Trans-esophageal echocardiography is better over trans- thoracic echocardiography in?
A. Evaluation of left ventricle
B. Evaluation of left atria and left Atrial appendage thrombus
C. Evaluation of Pericardial fluid
D. Evaluation of commissural fusion
| Evaluation of left atria and left Atrial appendage thrombus |
03c5fdbb-5e81-47bc-bc91-659aa076400f | C i.e. Persons tolerating high doses of As after taking arsenic in low doses at frequent intervals. | Forensic Medicine | null | Arsenophagists are :
A. Criminals using arsenic for homicidal purpose
B. Person using arsenic as aboion stick
C. Person who can tolerate high doses of arsenic after taking arsenic in low doses at frequent intervals
D. Persons using it as cattle poison
| Person who can tolerate high doses of arsenic after taking arsenic in low doses at frequent intervals |
6244829d-bb69-4a7e-88ce-4312ce13ec9d | Intubation is generally done with the help of endotracheal tube (ETT). The internal diameter of ETT used ranges between 3 and 8 mm depending on the age, sex, and size of nares of the patient. Potex north and south polar performed Rae tubes (RAE- right angled ETT) and flexo- metallic tubes are commonly used. Out of them, North Pole Rae tube is preferred in case of ankylosis patient due to the direction of the curve of ETT which favors its placement in restricted mouth opening as in case of ankylosis. | Surgery | null | Choice of intubation in Bilateral TMJ ankylosis for oral surgeries
A. North pole Rae tube
B. South Pole Rae tube
C. Tracheostomy
D. Cricothyrotomy
| North pole Rae tube |
979b9e3f-a25a-4cad-9c86-87c07e918e10 | Bleomycin This is a mixture of closely related glycopeptide antibiotics having potent antitumour activity. It chelates copper or iron, produces superoxide ions and intercalates between DNA strands-causes chain scission and inhibits repair . It is highly effective in testicular tumour and squamous cell carcinoma of skin, oral cavity, head and neck, genitourinary tract and esophagus; also useful in Hodgkin&;s lymphoma. Mucocutaneous toxicity and pulmonary fibrosis, but little myelosuppression are the special features. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:826,827 | Pharmacology | Chemotherapy | Which antineoplastic drug is a peptide?
A. Bleomycin
B. Aspaeme
C. Valinomycin
D. Dactinomycin
| Bleomycin |
9da57665-f190-436b-b1cf-8f93db470086 | Grievous Hu: S 320 IPC defines grievous hu and lists eight kinds of hu which it lables as "grievous". These clauses are not mutually exclusive for there can be injuries which may fall in more than one clause. However, the list is exhaustive in the sense that, the framers of the Code have used the term "only", while listing the type of hus which they designated as "grievous". This positively shows that the list is exhaustive and no hu outside the list given in S. 320 can be termed as 'grievous hu'. The following kinds of hu only are designated as "grievous" Emasculation. Permanent privation of the sight of either eye. Permanent privation of the hearing of either ear Privation of any member or joint. Destruction or permanent impairing of the powers of any member or joint. Permanent disfiguration of the head or face. Fracture or dislocation of a bone or tooth. Any hu which endangers life or which causes the sufferer to be during the space of twenty days in severe bodily pain or unable to follow his ordinary pursuits. Where injury was caused on the abdomen with a sharp edged weapon and the doctor had stated that the injury had penetrated the abdominal cavity but had not involved any vital organs/ impoant structures, but had just touched the stomach, it was held that the accused had caused only simple hu. Similarly, cutting of a tendon or a muscle does not make the injury fall under purview of any clauses of S 320 IPC. Ref: Dr. Dasari Harish, Prof & Head; Dr. K H Chavali, Assoc. prof; Dr. Amandeep Singh & Dr. Ajay Kr, Asst. Profs, Dept. Forensic Medicine & Toxicology, Government Medical College & Hospital, Sector 32, Chandigarh - 160030. | Forensic Medicine | null | Which of these is NOT a grievous hu under Sec 320 of the IPC?
A. Loss of teeth
B. Loss of hearing of one ear
C. Emasculation
D. Abdominal stab with or without organ damage
| Abdominal stab with or without organ damage |
cf8deac0-97c8-4aaf-87ce-1c4406bb98e7 | Ans. is 'd' i.e., Hereditary spherocytosis Osmotic fragility of Red blood cells.o Red blood cell osmotic fragility is the resistance of RBC hemolysis to osmotic changes,o Normally RBC maintains osmotic equilibrium with the surrounding medium i.e., with a serum that has 0[?]9% NaCl.o As the surrounding medium becomes hypotonic fluid will enter into the cell along the osmotic gradient, eventually, under very hypotonic conditions the cell will enlarge to capacity and rupture - Osmotic lysis,o Osmotic fragility is determined by measuring the degree of hemolysis in hypotonic saline.o The normal red cell begins to lyse at 0[?]5% NaCl and the hemolysis is complete at 0[?]3 NaCl.o Red blood cells osmotic fragility is considered to be increased if hemolysis occurs in a NaCl concentration > 0[?]5%.o Osmotic fragility is considered to be decreased if the hemolysis is not complete in a 0[?]3 % of NaCl.Increased osmotic fragilityDecreased osmotic fragility'o Hereditary spherocytosiso Hemolytic anemia (acquired immune)o Malariao Severe pyruvate kinase deficiencyo Hemolytic disease of newborno Iron deficiency anemiao Thalassemiao Liver diseaseo Reticulocytosiso Hemoglobinopathies, HbS, HbC | Unknown | null | Increased osmotic fragility is seen in -
A. Alpha thalasemia
B. Beta thalassemia
C. Sickle cell anemia
D. Hereditary spherocytosis
| Hereditary spherocytosis |
33501538-17d7-4600-b7e3-89a5b66f1a5a | Ref; GOODMAN& GILMAN'S The Pharmacological Basis of the Therapeutics 10th edition (page no; 245) Tolazoline is an alpha adrenergic antagonist. used as an aid in visualizing distal peripheral vessels during aeriography and a vasodilator in treating coronary aery stenosis during angio-procedures | Pharmacology | Autonomic nervous system | Tolazine is used as:
A. A thrombin inhibitor in perpheral angiography
B. A vasodilatol' in treating coronary aery stenosis during angio procedures
C. A vasoconstrictor in treatment of varices
D. antispasmodic during biliary spasm
| A vasodilatol' in treating coronary aery stenosis during angio procedures |
747645fc-c00a-4820-b0c3-86d51cecdccc | Ans. is d i.e., District o The various activities of Reproductive and child Health Programme (RCH) arc targeted at the district level. "The RCH programme is based on a di iThrential approach. Inputs in all the districts have not been kept uniform. While the care component are the same for all districts, the weaker districts will get more suppo and sophisticated facilities are proposed for relatively advaced districts. On the basis of cude bih rate and female literacy rate - all the districts have been divided into three categories 'A, B, & C' All the districts will be covered in a phased manner over a period of three years." | Social & Preventive Medicine | null | In Community Needs Assessment approach as pa of the Reproductive & Child Health programme, the targets for various health activities are set at the level of-
A. Community
B. Sub-centre
C. Primary health-centre
D. District
| District |
7cb87c84-7285-49ac-823d-cb91e1365f70 | Psoralen and many of its derivatives are naturally occurring tricyclic furocoumarins. The derivative most widely used in photochemotherapy is 8 - methoxypsoralen (8MOP, methoxsalen, xanthotoxin) which is principally of plant origin but it is available as a synthetic drug. 4, 5, 8-trimethyl psoralen (TMP, trioxsalen) is a synthetic compound which is less phototoxic after oral administration and is primarily used for the treatment of vitiligo. ijdvl journal of dermatology, psoralens. | Dental | miscellaneous | Psoralen-A is used in the treatment of -
A. Pemphigus
B. Vitiligo
C. Pityriasis alba
D. Icthyosis
| Vitiligo |
b3cc95bf-bf78-4acf-a402-a854385cbf48 | (a) Cricothyroid(Ref. Dhingra, 6th ed., 422)In Direct laryngoscopy we are visualising the cavity of the larynx from within so cricothyroid muscle or membrane which lie externally cannot be seen. | ENT | Anatomy of Larynx | In direct laryngoscopy which of the following cannot be visualized:
A. Cricothyroid
B. Lingual surface of epiglottis
C. Arytenoids
D. Pyriform fossa
| Cricothyroid |
6df5338d-98d8-41fd-9c6c-b7c9d1a763c7 | Ans. is 'd' i.e., Lateral epicondyle o The capsular ligament of the elbow joint is attached to the lower end along a line that reaches the upper limits of the radial and coronoid fossae anterioly; and of the olecranon fossa posteriorly; so that these fossae lie within the joint cavity.o Medially, the line of attachment passes between the medial epicondyle and the trochlea,o On the lateral side, it passes between the lateral epicondyle and the capitulum.Attachments of right humerus: Anterior viewAttachments of right humerus: Posterior view | Anatomy | Joints | Which of the following is not intracapsular -
A. Coronoid fossa
B. Radial fossa
C. Olecranon fossa
D. Lateral epicondyle
| Lateral epicondyle |
d122ac78-b9fe-435e-bc56-a8a673aa3ed3 | Ans. is 'a' i.e., Decreases phosphate level | Physiology | null | Action of parathormone on phosphate level ?
A. Decreases phosphate level
B. Increases phosphate level
C. No effect
D. Variable effect
| Decreases phosphate level |
2e226451-d296-4014-9c51-0ad4a7440a89 | To achieve the demographic goal of NRR 1 the couple protection rate (CPR) should have to be achieved by 60% far beyond the present level. The objective was to assess the contraceptive prevalence rate by different methods and to find out the correlation of different biosocial factors with the use of contraception. | Social & Preventive Medicine | null | For NRR to be 1, couple protection rate should be?
A. 20%
B. 40%
C. 60%
D. 80%
| 60% |
c0619822-c711-4fac-ac75-03673228070d | - Boundaries of anatomical snuff box
Anterior/ Lateral wall- Extensor pollicis brevis and abductor pollicis longus tendons.
Posterior/ medial wall- Extensor pollicis longus tendon
Floor- Styloid process of radius, trapezium,scaphoid and base of first metacarpal.
Roof- Skin, fascia, starting of cephalic vein, superficial branch of radial nerve.
Content- radial artery | Anatomy | null | Anatomical snuffbox contains -
A. Radial artery
B. Brachial artery
C. Ulnar artery
D. Interosseus artery
| Radial artery |
ee6fc4ea-8c0e-4a1d-9f32-695907a93213 | Cytodiagnosis is of most value in pemphigus and its various forms. Acantholysis is the loss of intercellular connections, such as desmosomes, resulting in loss of cohesion between keratinocytes, seen in diseases such as pemphigus vulgaris. It is absent in bullous pemphigoid, making it useful for differential diagnosis In bulbous pemphigoid, eosinophils are commonly seen. Ref Harrison 20th edition pg 1245 | Dental | All India exam | Tzank smear in a case of pemphigus vulgaris show
A. Acantholytic cells
B. Macrophages
C. Fibroblasts
D. Neutrophils
| Acantholytic cells |
9d1781ab-b8e5-45fd-9e7a-ca4a264a1fc6 | <p>International Lymphoma Study Group (Harris et al) proposed revised European -American classification of lymphoid neoplasms (REAL classification ) .This classification was based on the hypothesis that all forms of lymphoid malignancies represent malignant counterpas of normal population of immune cells present in the lymph node & bone marrow.</p><p>Harsh mohan textbook of pathology 6TH edition pg no 366.</p> | Medicine | Haematology | The classification proposed by the International Lymphoma Study Group for non - Hodgkin&;s lymphoma is known as -
A. Kiel classification
B. REAL classification
C. WHO classification
D. Rappapo classification
| REAL classification |
3b51bbf5-7b38-48c3-b605-3a6241c7274b | Syndrome of apparent mineralocoicoid excess is due to genetic deficiency of 11b-dehydrogenase-2, cause hypokalemia. Liddle's syndrome is caused by autosomal dominant gain-in-function mutations of ENaC subunits, cause hypokalemia. Loss of the transpo functions of the thick ascending loop of Henle and distal convoluted tubule nephron segments causes hereditary hypokalemic alkalosis, Bater's syndrome (BS) and Gitelman's syndrome (GS), respectively. Ref: Harrison 19e pg: 305 | Medicine | Fluid and electrolytes | 'Syndrome of apparent mineralocoicoid excess' is due to deficiency of
A. 11a--hydroxysteroid dehydrogenase
B. 11b--hydroxysteroid dehydrogenase
C. 12a--hydroxysteroid dehydrogenase
D. 12b--hydroxysteroid dehydrogenase
| 11b--hydroxysteroid dehydrogenase |
046006db-797a-46a9-a9ff-e778ffc04155 | Primaquine In contrast to other antimalarial drugs, primaquine is a poor erythrocytic schizontocide: has weak action on P. vivax, but blood forms of P. Jalciparum are totally insensitive. On the other hand, it is more active against the preerythrocytic stage of P. Jalciparum than that of P. vivax. Primaquine differs from all other available antimalarials in having a marked effect on primary as well as secondary tissue phases of the malarial parasite. It is highly active against gametocytes and hypnozoites. The mechanism of action of primaquine is not known. However, it is different from that of chloroquine. Though, resistance among P. vivax against primaquine can be induced, it is not a clinical problem. Essentials of medical pharmacology K D Tripathi Sixth edition Pg no 791 | Pharmacology | Chemotherapy | Radical cure of plasmodium vivax is by:
A. Chloroquine
B. Tetracycline
C. Primaquine
D. Aesunate
| Primaquine |
e40983b0-00ba-4f3a-9684-b45df6840c12 | The middle meningeal aery is the largest of the aeries supplying the dura mater. It is a branch of the maxillary aery and enters the cranium through the foramen spinosum. | Anatomy | null | The middle meningeal aery enters the cranium through the ?
A. Foramen spinosum
B. Foramen rotundum
C. Foramen magnum
D. Foramen ovale
| Foramen spinosum |
d1da5ed6-94a3-47d1-8235-9568dd91faf4 | In fibrous joints the bones are joined by fibrous tissue.these joints are either immovable or permit a slight dgree of movement these can be grouped following three subtypes 1 sutures :these are peculiar to skull and are immovable according to shapre of bony margins the sutures can be Schindylesis;between rostrum of sphenoid and upper border of vomer 2 gomphoses: A joint that binds the teeth to bony sockets (dental alveoli) in the maxillary bone and mandible. 3 syndesmoses :Slightly movable aiculations where the contiguous bony surfaces are united by an interosseous ligament, as in the inferior tibiofibular aiculation. Description Ref BD CHAURASIA S Handbook of General Anatomy Fouh edition Pg no 61 FIBROUS JOINTS | Anatomy | General anatomy | Sphenoid vomer joint is which type of joint?
A. Schindylesis
B. Gomphoses
C. Syndesmoses
D. Synchondrosis
| Schindylesis |
3294783f-447f-45cb-a636-afb8a59078b9 | Taxanes (paclitaxel and docetaxel) act by increasing the polymerization of tubulin whereas vinca alkaloids (vincristine, vinblastine and vinorelbine) cause inhibition of tubulin polymerization. Both of these drugs act by causing the disruption of mitosis and are active in M-phase of the cell cycle. | Pharmacology | null | Mechanism of action of paclitaxel is :
A. Topoisomerase inhibition
B. Increases the polymerization of tubulin
C. Inhibits protein synthesis
D. Alkylation of DNA
| Increases the polymerization of tubulin |
fbb8941a-acb2-4867-9054-95bb3f2d50fe | Ans. b. DecreasesFeto-placental perfusion assessed with Doppler ultrasound by three methods. Systolic versus end diastolic flow velocity (S/D flow) in the umbilical vessels, middle cerebral artery, and ductus venosus.UMBILICAL ARTERY DOPPLERThis test measures the ratio of systolic and diastolic blood flow in the umbilical artery.The umbilical circulation normally has low resistance, so significant diastolic blood flow is expected.The systolic/diastolic (S/D) ratio normally decreases throughout pregnancy.Umbilical artery S/D ratio is gestational age-dependent.The S/D ratio normally decreases from approximately 4.0 at 20 weeks to 2.0 at term, and it is generally less than 3.0 after 30 weeks.Because of downstream impedance to flow, more end-diastolic flow is observed at the placental cord insertion than at the fetal ventral wall. Thus, abnormalities such as absent or reversed end-diastolic flow will appear first at the fetal cord insertion site.This test is predictive of poor perinatal outcome only in IUGR foetuses.Non-reassuring findings, which may indicate need for delivery, are absent diastolic flow and reversed diastolic flow.Note:-This notch disappears at 24 weeks of pregnancy as the resistance of uterine artery decreases due to trophoblastic invasion. There is no diastolic notch in late second and third trimester. But if this diastolic notch persists beyond 24 weeks, it predicts that female will have PIH during this pregnancy.Extra MileUmbilical artery Doppler waveform patterns vs USG patternsNORMAL UMBILICAL ARTERY DIASTOLIC FLOWABSENT UMBILICAL ARTERY DIASTOLIC FLOWREVERSED UMBILICAL ARTERY DIASTOLIC FLOW | Gynaecology & Obstetrics | Physiology & Histology | During progression of labor S/D of umbilical artery ratio?
A. Increases
B. Decreases
C. Persistent diastolic notch
D. Constant
| Decreases |
6158307b-a942-4636-917b-f502310dffba | Ans. is 'c' i.e., Duodenal atresiao Most common cause of neonatal intestinal obstruction Meconium plug syndrome.o Second most common cause of neonatal intestinal obstruction Duodenal atresia.Impoant causes of intestinal obstruction in newbornMeconium plug syndrome o Duodenal atresia o Jujunoileal atresiaMalrotation of gut o Meconium ileusMeconium plug syndrome --> when meconium plug causes obstruction of colon. It is seen in Hirschsprung disease, maternal DM, maternal preeclampsia, prematurity, sepsis, hypothyroidism.Meconium Ileus --> when meconium plug obstruct ileum. It is seen in cystic fibrosis.Note ?o Intussusception is the most common cause of intestinal obstruction between 3 months and 6 year of age (not in neonate). | Pediatrics | null | Most common cause ofAcute Intestinal Obstruction in neonates is -
A. Jejuna! atresia
B. Malrotation
C. Duodenal atresia
D. Acute Intussusception
| Duodenal atresia |
fed2d236-0b62-4de1-9065-2fa829fecc92 | Specific gravity of the amniotic fluid is 1.010 Fluid is faintly alkaline It becomes highly hypotonic to maternal serum at term pregnancy Ref: Dutta Obs 9e pg 34. | Gynaecology & Obstetrics | General obstetrics | Specific gravity of amniotic fluid
A. 1.213
B. 1.01
C. 1.51
D. 1.1
| 1.01 |
fb8dc07b-dd13-4c4b-9f5f-7737812872fe | Branches of arch of aoa are :- i) Brachiocephalic trunk ii) Left common carotid aery iii) Left subclan aery Right common carotid aery and right subclan aery arise from brachiocephalic trunk (Brachiocephalic trunk divides into right common carotid and right subclan aeries). | Anatomy | null | Not a direct branch of arch of aoa ?
A. Left common carotid aery
B. Left subclan aery
C. Brachiocephalic trunk
D. Right common carotid aery
| Right common carotid aery |
07cc186e-078f-4eb5-82c8-d426261bb781 | Enolase requires Mg2++, and by removing magnesium ions, fluoride will irreversibly inhibit this enzyme. Thus fluoride will stop the whole glycolysis.Ref: DM Vasudevan, 7th edition, page no: 111 | Biochemistry | Metabolism of carbohydrate | Naf inhibits
A. Enolase
B. Glucokinase
C. Hexokinase
D. G-6 PD
| Enolase |
7b37ca1d-7166-46df-b411-06cea03ab88c | Ans. is 'c' i.e., Dissociative disorder Dissociative disordero The essential feature of the dissociative disorder is a disruption in the usually integrated functions of consciousness, memory, identity or perception of the environment Dissociative disorder areDissociative (psychogenic) amnesia It is the most common type of dissociative disorder. Dissociative amnesia is characterized by retrograde amnesia (inability to retrieve stored memories and events leading up to onset of amnesia) and absence of antegrade amnesia (inability to form new long term memories).Dissociative fugue A dissociative fugue may be present when a person impulsively wanders or travels away from home and upon arrival in the new location is unable to remember his/her past (i.e., amnesia for early life). There is loss of personal identity and the person assumes a new identity. There is absence of awareness of amnesia during fugue episode, i.e., Patient denies any memory loss during fugue state. On recovery there is amnesia for fugue episodes and recovery of memory of earlier life (i.e., before the episode of fugue).Dissociative identity disorder (multiple personality disorder) More than one personality appears to possess the individuals, Showing their characteristic behavior. At any instance behavior and memories of one personality is exhibited, patient then is unaware of the other's existance.Depersonalization disorder : - Feeling of detachment from self is referred to as depersonalization. Individuals with this disorder will report feeling as if they are living in a dream or watching themselves on movie screen i.e., feeling detached from self and as if one is an outside observer of oneself. People with this disorder feel like they are "going crazy" and they frequently become anxious and depressed.Dissociative disorders not otherwise specified :-These are the disorders that are characterized by dissociative response that do not meet diagnostic criteria for one of the other dissociative disorder. Important ones areDissociative Trance (Possession) disorders There is temporary exchange of person's personality by a new personality usually attributed to a spirit or divine power. Usually the person is aware of the existance of the other, i.e., possessor (unlike dissociative identity disorder).Ganser's syndrome : - Also known as syndrome of approximate answers. This is characterized by giving approximate answers together with a clouding of consciousness, and frequently accompanied by hallucinations and other dissociative, somatoform or conversion symptoms. | Psychiatry | Symptoms & Signs | Ganser syndrome is a feature of -
A. OCD
B. Conversion disorder
C. Dissociative disorder
D. Schizoid personality disorder
| Dissociative disorder |
33952ca2-8eef-48a7-8f81-f75e24ca0a23 | Ans. is'a'i.e., GemfibrozilGemfibrozilThis fibric acid derivative effectively lowers plasma TG level by enhancing breakdown and suppressing hepatic synthesis of TGs.Besides high efficacy in type III hyperlipoproteinemia, gemfibrozil has shown action in subjects with raised blood CH in addition.In the 'Helsinki Hea Study' men without known CAD treated with gemfibrozil had a 34% reduction in fatal and nonfatal MI, though overall moality was not affected.That these benefits extend to secondary prevention of coronary events in men with existing CAD and low HDL CH, has been demonstrated in another trial. | Pharmacology | null | Which of the following drugs can be used for secondary prevention of coronary aery disease?
A. Gemfibrozil
B. Colestipol
C. Temisaan
D. Vitamin E
| Gemfibrozil |
2bea30b9-bcfa-4ed4-8657-a528bf894fa5 | Dinitrophenol (DNP) a potent uncoupler is amphipathic and increase the permeability of the lipoid inner mitochondrial membrane to protons (H+), thus reducing the electrochemical potential and sho-circuiting the ATP synthase. In this way, oxidation can proceed without phosphorylation.Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition, page no: 146 | Biochemistry | Respiratory chain | Uncoupler in ETC
A. H2S
B. Antimycin a
C. 2, 4-dinitrophenol
D. Barbiturates
| 2, 4-dinitrophenol |
7b31f5af-d70f-41b5-98ab-e4d25af7d339 | A membrane is seen over the tonsil in this child with swelling of neck: suggestive of Diphtheria. Diphtheria typically follows an incubation period of 2-5 days. - Infection is slower in onset with less local discomfo often resembling a typical viral upper respiratory infection (URI) - Localized or coalescing pseudo membrane in diphtheria extends beyond the tonsils, on to the soft palate and is diy grey in colour. It is characterized by the formation of a dense, gray debris layer composed of a mixture of dead cells, fibrin, RBCs, WBCs, and organisms - It is adherent, and its removal leaves a bleeding surface. - Urine may show albumin. - Smear and culture of throat swab will reveal corynebacterium diphtheriae | Pediatrics | Impoant Bacterial Diseases in Children | A 5-year-old unimmunised child presented with sore throat & swelling of neck. On examination of throat, the following was seen. What is the most probable causative organism?
A. Streptococcus pyogenes
B. Mycobacterium tuberculosis
C. Staphylococcus aureus
D. Corynebacterium diphtheriae
| Corynebacterium diphtheriae |
3c13e5c2-6db6-4c53-bb07-c67f5dc9d027 | Ans: D (Health.....) HEALTH PROMOTION Park 23rd/ 43# It is process of enabling people to increase control over & to improve health# The well known interventions in this area are: health education, environmental modification, nutritional interventions & life style & behavioural changes # Health education: This is one of the most cost-effective interventionsEnvironmental modification: A comprehensive approach to health promotion requires environmental modifications, such as provision of safe water, installation of sanitary' latrines, control of insects & rodents, improvement of housing etcNutritional interventions : These comprises food distributions & nutrition improvement of vulnerable groups, child feeding programmes, food fortifications & nutritional education# Life style & behavioural changes:Specific protection Park 23rd/ 43To avoid disease altogether is the ideal but this is possible only in a limited number of cases.The following are some of the currently available interventions aimed at specific protectionImmunizationUse of specific n utrien tsChemoprophylaxisProtection against occupational hazardsProtection against accidentProtection from carcinogenAvoidance from allergenThe control of specific hazards in the general environment e,g air pollution, noise controlControl of consumer product quality & safety of foods, drugs, cosmetics etcEarly Diagnosis &Treatment Park23rd/ 43# These are main interventions of disease control# Though notas effective & economical as primary prevention may be critically important in reducing in high morbidity & mortality in certain disease such as essential hypertension, cancer cervix & breast cancer. For many others such as T.B, leprosy, & STD, early diagnosis & treatment are the only mode of interventions# Mass treatment approach is used in the control of certain diseases viz. yaws, pinta, bejel, trachoma & filaria | Social & Preventive Medicine | Health Education & Communication | Health promotion includes:
A. PAS smear
B. Mass treatment
C. Immunization
D. Health education
| Health education |
e5c69dcf-bdbd-42d3-a3de-6ac770aa9c26 | Nevus sebaceous appears usually on the scalp. Made of extra sebaceous glands in the skin. It stas as a flat pink or orange plaque (slightly raised area). Hair does not grow in a nevus sebaceous. During adolescence, they can become very bumpy and wa- like. A nevus sebaceous does not go away on its own. T/t: Surgery Sebaceous hyperplasia: Enlarged sebaceous glands seen on the forehead or cheeks of the middle-aged and elderly. Aplasia cutis: Congenital absence of skin, with or without the absence of underlying structures such as bone. It most commonly affects the scalp. | Dental | Naevi and vessel related disorders | A 12 year old girl presents with a yellowish "bihmark" on the scalp. Her mother repos that the lesion has progressively become thicker and way. She is asymptomatic but they are concern regarding the cosmetic appearance. Which is the most likely diagnosis?
A. Sebaceous hyperplasia
B. Congenital was
C. Nevus sebaceous
D. Aplasia cutis
| Nevus sebaceous |
a0c7e108-ee1e-44b1-95ec-0cffe25e7fbd | A i.e. ImipramineAdverse effects ofTCAsl. Anticholinergic - Dry mouth, bad taste, urinary retention, blurred vision, palpitation, constiPation.2. Sedation, mental confusion, weakness.3. Increased appetite and veigfit gain.4. Sweating andfinc tremer.5. Decreased seizure threshold (clomipramine, maprotiline & bupropion).6. Postural hypotension > Marimum by amitripSline - Goodman & Gillman 11/e p. 4j3.7. Cardiac arrythmia; Maximum by amitriptyline and dosulpin. | Psychiatry | null | Antidepressant drug used in nocturnal eneuresis is:
A. Imipramine
B. Fluoxetine
C. Trazdone
D. Sealine
| Imipramine |
288a504b-52f0-41f2-8081-366707a88dfc | Iron poisoning
Ingestion of a number of ferrous sulphate tablets may cause acute iron poisoning.
Clinical features
Severe vomiting
GI bleeding
Diarrhea
There may be severe shock, hepatic & renal failure
Treatment of Iron poisoning
Because iron is radio-opaque abdominal radiography may confirm the ingestion. Repeat radiograph may help with assessment of the efficiency of gastric decontamination methods.
Ipecac-induce emesis may be used to remove tablets from the stomach.
Gastric lavage is not recommended in children because of its inefficiency.
Activated charcoal does not adsorb iron and should not be used.
Whole bowel irrigation may be of benefit.
If tablets adhere to gastric mucosa, removal by endoscopy.
Desferrioxamine is a specific shelter of iron and is the antidote of choice. | Pediatrics | null | Iron poisoning in 4 year child, R X includes –a) Stomach lavageb) Desferrioxamine IV 100 mgc) X–ray abdomend) Blood transfusion
A. a
B. c
C. ac
D. bc
| bc |
6db68f02-eea8-488a-8ee3-07c61f640df1 | Ans. is 'b' i.e., Gaping Gaping is more when the skin is cut across the Langer's line. Incised wound It is a clean cut through the tissues (usually, skin and subcutaneous tissue), caused by sharp-edged object. which is longer than its depts, when the weapon is struck or pressed and drawn across the body pa, i.e., there is pressure and friction. examples of sharp edged object are knife, blade, razor, scalpel, sword, chopper etc. The characteristic feature of incised wound are : - Length is the greatest dimension (most impoant) Hair, hair bulb, nerve and vessels are cut --> bleeding is profuse as vessels are cut. Width of injury is more than the thickness of blade, due to gaping of wound. Langer's line of skin determines gaping : gaping is more when cut is across these lines Margins are eveed, clear, and clean cut Clean incised wounds heal by primary intention, whereas diy, infected or large wounds heal by secondary intention, with scar formation. Hesitation cuts (Tentative cuts or trial cuts) are characteristic features of suicidal attempt. Incised wound on nose, ear and genital are usually homicidal and are inflicted on account of jealously or revenge in case of adultery, causing disfiguration | Forensic Medicine | null | In deep incised wounds, Langer's lines determine?
A. Direction
B. Gaping
C. Shelving
D. Healing
| Gaping |
abc7c799-13bb-4c93-aa5c-8cec6d7c85f8 | Chronic bronchitis: Follicular bronchiolitis: Desquamative pneumonitis: Chemical pneumonitis One type of COPD Inflammed bronchial tubes produce lots of mucus Leads to coughing and difficulty breathing Cigarette smoking is the most common cause Known as hyperplasia of the BALT ( Bronchial associated lymphoid tissue) Characterized by the development of lymphoid follicles with germinal centers in the walls of small airways. Idiopathic interstitial pneumonia Elevated level of macrophages Name derived from the former belief that these macrophages were pneumocytes that had desquamated Inflammation of the lungs ( or ) breathing difficulty due to inhaling chemical fumes Inhaled substance include: Chlorine gas Grain and feilizer dust Fumes from pesticides | Pathology | Obstructive Lung Disease | Which of the following is seen in COPD?
A. Chronic bronchitis
B. Follicular bronchiolitis
C. Desqumative pneumonitis
D. Chemical pneumonitis
| Chronic bronchitis |
edb3331e-9e85-44c4-bf4d-16d6b7acad0d | Ans. is `d.' i.e., Parainfluenza virus Croup (Laryngotracheobronchitis) Laryngotracheobronchitis is the most common infectious cause of obstruction in children usually occurring between the ages of 6 months and 3 years. Male children (boys) are characteristically more frequently involved than females (girls) Etiology It is a viral infection most frequently caused by Parainfluenza virus Pathology The most characteristic pathological feature is edema formation in the subglottic area The loose areolar tissue in the subglottic area swells up and causes predominant signs of upper airway obstruction. Presentation Gradual onset with a prodrome of upper respiratory symptoms Hoarseness and barking cough (croupy cough) Stridor (initially inspiratory than biphasic) Fever is usually low grade (or absent) although may occasionally be high grade Droolings is characteristically absent and there is no dysphagia (seen in epiglottitis) Imaging (X ray) Symmetric 'steeple' or 'funnel shaped' narrowing of the subglottic region (steeple sign) Hypopharyngeal widening or distension Normal epiglottis and aryepiglottic folds Treatment Mild symptoms (barking cough but no stridor at rest) Suppoive therapy alone with humified oxygen, oral hydration and minimal handling. Moderate symptoms (barking cough with stridor at rest) Active intervention with humified oxygen, Nebulized racemic epinephrine and glucocoicoids (steroids). Severe symptoms (impending respiratory failure) Require an aificial airway (Intubation with endotracheal tube or tracheostomy may be required). Antibiotics are not routinely indicated in the treatment of Acute Laryngotracheobronchitis. Their use is limited if there is evidence of secondary bacterial infection. | ENT | null | Most common cause of Croup ?
A. H influenza
B. S pneumoniae
C. Influenza virus
D. Parainfluenza virus
| Parainfluenza virus |
5d10159b-1c13-4072-97de-b058a048178f | A branchial cyst probably develops from the vestigial remnants of the second branchial cleft, is usually lined by squamous epithelium, and contains thick, turbid fluid full of cholesterol crystals. The cyst usually presents in the upper neck in early or middle adulthood and is found at the junction of the upper third and middle third of the sternomastoid muscle at its anterior border. It is a fluctuant swelling that may transilluminate and is often soft in its early stages so that it may be difficult to palpate. If the cyst becomes infected it becomes erythematous and tender and, on occasions, it may be difficult to differentiate from a tuberculous abscess. Ultrasound and fine-needle aspiration both aid diagnosis and treatment is by complete excision, which is best undeaken when the lesion is quiescent. Although the anterior aspect of the cyst is easy to dissect, it may pass backwards and upwards through the bifurcation of the common carotid. Bailey & Love,5th,727 | Surgery | Head and neck | Commonest treatment of Branchial cyst
A. Cystectomy
B. Aspiration
C. Excision
D. Nothing done
| Excision |
bb1e8876-00d9-4bc5-8e31-85618130b522 | Etomidate causes adrenal gland suppression. It inhibits an enzyme 11 beta hydroxylase on essential enzyme for coisol synthesis. Etomidate has the highest incidence (40%) of post operative nausea and vomiting (PONV) among the intravenous anesthetics. Propofol has antiemetic propeies thereby reducing PONV. Other potential adverse effects of etomidate: Adrenocoical suppression Myoclonus Seizure precipitation Pain on injection | Anaesthesia | Intravenous Anesthetic Agents | Transient acute adrenal insufficiency is seen with which of the following drug.
A. Etomidate
B. Propofol
C. Thiopentone
D. Ketamine
| Etomidate |
9f11e268-f221-40a7-877c-6d7bf873aa66 | Amorphous densities in mitochondria Ref , Robbins 7/e p41-2 ,9/ep42 | Anatomy | General anatomy | Ultra structure finding of irreversible injury
A. Ribosomal detachment from endoplasmic reticulum
B. Amorphous densities in mitochondria
C. Formation of phagolysosomes
D. Cell swelling
| Amorphous densities in mitochondria |
b25e95f0-40e7-4b5a-aa94-55a547d5ca1f | Vitamin D can be synthesized endogenously in the skin with exposure to ultraviolet (UV) light. Together, vitamin D and calcium help build and maintain growing bone. Exercise helps build bone mass, which protects against osteoporosis later in life, particularly in women. Renal function is not greatly affected by the environment. There are some deleterious effects on the eye (cataracts) and the skin (cancer, elastosis) from increased exposure to UV radiation in sunlight. Increased air pollution in many cities has led to an increased incidence of pulmonary diseases, and children are particularly at risk. | Pathology | Environment & Nutritional Pathology | In a study of lifestyle influences on health, investigators observe that sending children outside to play instead of letting them sit for hours in front of the television can have long-term health benefits. Which of the following tissues is most likely to be in better condition by middle age from this lifestyle change?
A. Bone fractures
B. Ocular cataracts
C. Urinary tract calculi
D. Pulmonary emphysema
| Bone fractures |
ad1bca5c-d47b-4db6-ba81-8a44243e1d66 | Ans. is 'd' i.e., Methadone Maintenance therapy for opioid addiction* Once detoxification phase is over (i.e., withdrawal symptoms have been managed), the patient is maintained on any of the following drugs to prevent relapse by reducing craving and preventing 'kick' or 'euphoria' produced by opioids (morphine or heroin). Drugs used are : -1. Methadone: - Reduces craving and 'kick/euphoria from morphine or heroin because their opioid receptors are already occupied.2. LAAM and buprenorphine: - Similarly reduce craving.3. Opioid antagonists (naltrexone): - Naltrexone can be used orally to assist in the rehabilitation of ex-opioid abusers who are fully withdrawn (otherwise it induces an acute withdrawal syndrome). Naltrexone prevents relapse by discouraging substance seeking behavior - If a patient, who is on naltrexone maintenance therapy, takes an opioid, there is no 'kick' or euphoria as opioid receptors are already blocked. Naltrexone can be used with clonidine as in detoxification.Treatment of opioid addiction* Treatment can be divided into : -A. Treatment of toxicity (overdose)# Overdose is a medical emergency and is treated with opioid antagonist to reverse the complications (respiratory depression) by antagonizing the action on opioid receptors. Intravenous naloxone is the antagonist of choice for morphine (heroin) poisoning. Oral naltrexone is used for maintenance therapy, once acute poisoning has been treated by iv naloxone. Intravenous nalmefene is another specific antagonist.B. Treatment of dependence# Treatment of dependence include medically supervised withdrawal and detoxification, followed by maintenance therapy.a. Detoxification* Detoxification process include abrupt withdrawal of opioid followed by management of the emergent withdrawal symptoms, i.e., treatment of withdrawal syndrome. Detoxification can be done by any of the following.i) Substitution of long-acting opioid agonism : - Methadone is the treatment of choice. Because of its agonistic activity on opioid receptors it suppresses withdrawal symptoms. L-alpha-acetyl-methadol/ Levomethyl (LAAM) is the other opioid agonist which was used for this purpose. However it is no longer in use because some patients developed prolonged QT intervals (torsades de points).ii) Substitution of partial agonist: - Buprenorphine can be used in place of methadone because of its partial agonistic activity on opioid receptor.iii) Substitution by a2 agonists : - Clonidine as a sympatholytic agent due to its agonistic action on central presynaptic a2 receptors which reduce nor-adrenergic activity. Therefore, clonidine reduces the adrenergic withdrawal symptoms. Lofexidine, another a2 agonist, is an alternative to clonidine.iv) Clonidine plus naltrexone: - A more rapid detoxification can occur when clonidine is used along with naltrexone. Naltrexone, when given in opioid dependent patient, causes withdrawal symptoms because of its antagonistic action. These can be treated with clonidine. The addition of short acting Benzodiazepine (lorazepam or oxazepam) and NSAIDs, will help to relieve withdrawal symptoms not covered by clonidine. It should be kept in mind that naltrexone should not be used alone for detoxification (to treat withdrawal syptoms) as it precipitates or worsens the withdrawal syndrome.v) Other drugs : - Dextropropoxyphene, diphenoxylateb. Maintenance therapy:- explained above | Psychiatry | Substance Abuse | The drug which is used for long term maintenance in opioid addiction
A. Naloxone
B. Nalorphine
C. Butarphanol
D. Methadione
| Methadione |
2b5946ed-dbdc-47b7-a409-f9f279b13e23 | Ans. (c) MetastasisRef: Sabiston 19th edition, Page 657* Contraindications for Liver transplant:# Metastatic liver disease# Poor cardio-pulmonary reserve# Systemic infections (HIV is not a contraindication now)# Porto pulmonary hypertension with pulmonary artery pressure >50mmHg # Hepatopulmonary syndrome when PaO2 does not show improvement with 100% oxygen. | Surgery | Transplantation | Contraindication of liver transplant?
A. Acute fulminant hepatic failure
B. Metabolic Disease
C. Metastasis
D. Primary liver malignancy
| Metastasis |
306616e8-402c-420a-a4ef-d442e779c972 | Ref: Apley's System of Orthopaedics and Fractures, 8th ed.Explanation:Mechanism of injury to MeniscusDamage to the meniscus is due to rotational forces directed to a flexed knee (as may occur w-ith twisting sports) is the usual underlying mechanism of injury.A valgus force applied to a Hexed knee with the foot planted and the femur rotated externally can result in a lateral meniscus tear.A varus force applied to the flexed knee when the foot is planted and the femur rotated internally can result in a tear of the medial meniscus.Symptoms and SignsThe patient's chief complaints are usually knee pain and swellingAnother typical complaint i s joint locking, when the patient is unable to straighten the leg fully. This can be accompanied by a clicking feeling.A tear of the meniscus commonly follows a trauma which involves rotation of the knee while it was slightly bent.In meniscal tears, pressing on the joint line on the affected side typically produces tenderness.The McMurrav test involves pressing on the joint line while stressing the meniscus fusing flexion-extension movements and varus or valgus stress).Stein man n test (with the patient sitting) and the Apley grind test (a grinding maneuver while the patient lies prone and the knee is bent 90deg) also elicit painBending the knee (into hyperflexion if tolerable), and especially squatting, is typically a painful maneuver if the meniscus is tornThe Cooper's sign is a subjective symptom of pain in the affected knee when turning over in bed at night.Meniscal tear causes pain with a twisting motion of the knee as the meniscal fragment gets pinched, and the capsular attachment gets stretched causing the complaint of pain. | Orthopaedics | Knee Ligament Injuries | Meniscal injury occurs during:
A. Rotation
B. Extension
C. Rotation and Flexion
D. Flexion
| Rotation and Flexion |
e297ae54-65c4-4d73-9330-b27a20545aaa | Ans. is 'a' i.e., Plasma concentration o Rate of elimination in zero order kinetics is independent of plasma concentration (see above explanation). | Pharmacology | null | Zero order kinetics is independent of ?
A. Plasma concentration
B. Clearance
C. Volume of distribution
D. Half life
| Plasma concentration |
fbb17b41-708d-493b-8ee2-4403261f01ab | Ans. A. Aponeurotic layerThe term scalp is applied to the soft tissues covering the vault of skull. It extends anteriorly up to the eyebrows (superciliary arches), posteriorly up to the superior nuchal lines, and laterally on each side up to superior temporal line. The scalp consists of five layers. From superficial to deep these are as follows:1. Skin. 2. Connective tissue (superficial fascia). 3. Aponeurosis (occipitofrontal is muscle and its aponeurosis). 4. Loose areolar tissue. 5. Pericranium. | Anatomy | Head & Neck | Occipitofrontal is muscle is present in which layer of scalp:
A. Aponeurotic layer
B. Subaponeurotic layer
C. Dense connective tissue layer
D. Loose connective tissue layer
| Aponeurotic layer |
7304abd1-d146-4143-ae01-8d102ae7b5fb | Ans: A (Ca prostate) Ref: Bailey & Love s Short Practice of Surgery, 25th Edition & Internet SourcesExplanation:The Gleason Grading SystemIt is used to help evaluate the prognosis of men with prostate cancer.It also predicts prognosis and helps guide therapy.Scoring based upon its microscopic appearance on histopathology.Cancers with a higher Gleason score are more aggressive and have a worse prognosis.The pathologist assigns a Gleason score based on the sum ot' two numbers:The first number is the grade of the most common tumor pattern.The second number is the grade of the second most common pattern.If there are three patterns the first number is the most common and the second is the one with the highest grade. | Surgery | Prostate Cancer | Gleason's staging is used in:
A. Ca prostate
B. Ca bladder
C. Ca pancreas
D. Ca colon
| Ca prostate |
e3bbb17f-e7e4-4b6c-ac2a-6ae6f10deb50 | The isoelectric potential of Cl- is -70mV and of K+ is -90mV.
According to ‘Ganong’ and ‘Principles of Medical Physiology’, the actual measured RMP of a nerve fibre is -70mV rather than the calculated value of -90mV.
So in nerve fibres, the RMP is equal to or closer to the isoelectric potential of Cl-.
Whereas in muscle cells, the RMP is -90mV, which is equal to the isoelectric potential of K+. | Physiology | null | In muscle cells, resting membrane potential is equal to the isoelectric potential of
A. Na+
B. Cl-
C. K+
D. Mg++
| K+ |
0436a661-0888-4f34-855d-d105eb49cd49 | Ans. is 'd' i.e. measles Mode of administration of vaccines* BCG* intradermal* OPV* oral* DPT* Intramuscular* Measles* subcutaneously | Social & Preventive Medicine | Principles of Immunization and Vaccination | Subcutaneous vaccine is -
A. BCG
B. Polio
C. DPT
D. Measles
| Measles |
5f099f2b-0b6c-4995-9181-70369c47206b | Ans. is 'b' ie. Berry Aneurysm (Ref. : Harrison, 17/e pl726 (16/e, p 2387, 15/e, p 238))" Excluding head trauma the most common cause of SAH is rupture of a saccular aneurysma (Berry aneurysm or congenital aneurysm). "Berry aneurysms - also k/a as congenital aneurysm although they are not present at birth. There is however a congenital defect of the media of the artery, which becomes the site of aneurysm in later life.Common sites :Junction of the anterior communicating artery with the anterior cerebral artery* (MC).Junction of the post communicating artery with the 1C A* (Internal carotid artery)The bifurcation of MCA* (Middle carotid artery) | Unknown | null | A female presented with a severe headache of sudden onset. On CT scan a diagnosis of subarachnoid hemorrhage is made. The most common cause of subarachnoid hemorrhage is :
A. Middle meningeal artery
B. Berry aneurysm rupture
C. Basilar artery
D. Subdural venous sinuses
| Berry aneurysm rupture |
6185a27a-a703-48e7-b947-f36509811a86 | Ans: b (hepatitis B) Ref:Ananthanarayan, 7 p. 547Among the hepatitis virus only DNA virus is hepatitis B virus (Hepadna virus). Just go through theFeatureHAVHBVHCVHDVHEVAgentSSRNA icosahedral,capsid unenvelopedDSRNAComplex structure envelopedSSRNA envelopedSS defective virus envelopedSSRNA unenvelopedClassificationPicoma virus(enterovirus typelll)Hepadna virusFlaviUnknowncalcivirusTransmissionfaecooralparentralparentralparentralfaecooralIP15-45 days(2-6 weeks)30-180 days(2-6 mon)30-90 days 1-3 mon30-50 days 1-2 mon50-60 days 1/2 - 2 monthOnsetacuteinsiduousinsiduousinsiduousacuteIllnessmildOcc. severemoderateOcc. severeMild except in pregnancy (fulminant in 40 %)Carrier statenilcommonpresentNil(only with HBV)niloncogenicityNilyesyesnilNilSpecific Rx.Ig & vaccineIg& vaccinenilHBV vaccineNil | Microbiology | Virology | Which among the following is not an RNA virus?
A. Hepatits A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
| Hepatitis B |
5e745d6b-e03c-43e0-a20c-46c7d5a7e313 | Historically, the main indication for a tracheostomy was to bypass upper airway obstruction caused by a foreign body or infection, paicularly diphtheria. Nowadays upper airway obstruction is the least common indicator for tracheostomy. Almost two thirds of tracheostomies are currently performed on intubated intensive care patients, mainly to aid removal of secretions from the distal tracheobronchial tree and to facilitate weaning from distal tracheobronchial tree in acute respiratory failure and prolonged ventilation | ENT | null | The most common indication for tracheostomy is:
A. Laryngeal diphtheria
B. Foreign body aspiration
C. Carcinoma
D. Asthma
| Foreign body aspiration |
0d5dede3-bc48-4bfb-bc7b-01e5cbdf29e1 | Aflatoxin is a mycotoxin that is produced by the fungi Aspergillus flavus and Aspergillus parasiticus. Exposure to aflatoxin can cause hepatic necrosis later progressing to cirrhosis. It also acts as a carcinogen and can produce hepatocellular carcinoma. | Microbiology | Mycology | Aflatoxin is produced by the fungus?
A. Aspergillus flavus
B. Aspergillus fumigatus
C. Aspergillus niger
D. Penicillium marneffei
| Aspergillus flavus |
f0b1a64c-3784-4deb-9b6c-10b0ef6eb573 | Loading dose = Vd x target plasma cone.
= 40 L x 4 mg/L
= 160 mg
Clearance plays no role in the determination of loading dose. It is given to confuse you. | Pharmacology | null | Ram Prashad is admitted to Guru Teg Bahadur Hospital with respiratory infection for which antibiotic tobramycin is ordered. The clearance and Vd of tobramycin in him are 160 ml/min and 40 L, respectively. If you wish to give Ram Prashad an intravenous loading dose to achieve the therapeutic plasma concentration of 4 mg/L rapidly, how much should be given?
A. 0.1 mg
B. 10 mg
C. 115.2 mg
D. 160 mg
| 160 mg |
6c9ebdc7-8d66-4b68-982a-761223c5de66 | FLEXOR RETINACULUM Carpel tunnel.Transverse carpal ligament. Strong fibrous band which bridges anterior concavity of carpus and conves it into osseofibrous tunnel called carpal tunnel for the passage of flexor tendons of the digits. Rectangular.Formed due to thickening of deep fascia in front of carpal bones. Attachments: medial-pisiform, hook of hamate.Lateral-tubercle of scaphoid and crest of trapezium. Structures passing superficial to flexor retinaculum:-(medial to lateral)1. Ulnar nerve 2. Ulnar aery 3. Posterior cutaneous branch of ulnar nerve.4. Tendon of palmaris longus.5. Palmar cutaneous branch of median nerve.6. Superficial palmar branch of radial aery. Structures passing deep to flexor retinaculum:-1. Tendon of FDS2. Tendon of FDP 3. Tendon of FPL.4. median nerve. Ulnar bursa-tendons of FDS&FDP.Radial bursa- tendon of flexor pollicis Flexor carpi radialis pass through separate canal. CARPAL TUNNEL SYNDROME:-Injury to median nerve in carpal tunnel.Causes:-Tenosynovitis of flexor tendons.MyxedemaRetention of fluid in pregnancy Fracture dislocation of lunate bone.Osteoahritis of wrist. Symptoms:-1. Feeling of burning pain or " pins & needles " along lateral 3 and half digits especially at night.2. Weakness of thenar muscles.3. No sensory loss over thenar eminence.4. Ape thumb deformity if left untreated.5. Positive phalens abd tinel's sign.Phalen' sign-flexion of both wrists against each other for one minute reproduces the symptoms.Tinel's sign- percussion over flexor retinaculum reproduces symptoms. MNEMONIC structures passing deep to flexor retinaculum:" SPM fuLLy Boring Flexor digitorum Superficialis tendon, flexor digitorum Profundus tendon, Median nerve, flexor poLLicis longus , Bursae - radial and ulnar. {Reference: vishram singh, page no.196,} Figure:9.15,page no:113,BD chaurasia , 6th edition,upper limb & thorax. | Anatomy | Upper limb | The following structure does not pass through flexor retinaculum
A. Ulnar N
B. Median N
C. Flexor digitorum profundus
D. Flexor digitorum superficialis
| Ulnar N |
43b33cf4-1938-4285-b9a1-6068a19e1bd7 | To get started, sit with your feet up or lie on your side. Count each of your baby'smovements as one kick, and count until you reach 10 kicks or movements. Most of the time it will take less than a half-hour, but it could take as long as two hours. Log your recorded times into a Count the Kicks chart. The lecithin-sphingomyelin ratio (aka L-S or L/S ratio) is a test of fetal amniotic fluid to assess for fetal lung immaturity. Lungs require surfactant, a soap-like substance, to lower the surface pressure of the alveoli in the lungs. Human placental lactogen (hPL), also called human chorionic somatomammotropin (HCS), is a polypeptide placentalhormone, the human form of placental lactogen (chorionic somatomammotropin). Its structure and function are similar to those of human growth hormone. It modifies the metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus. hPL has anti-insulin properties. hPL is a hormone secreted by the syncytiotrophoblast during pregnancy. Like human growth hormone, hPL is encoded by genes on chromosome 17q22-24. HPL is present only during pregnancy, with maternal serum levels rising in relation to the growth of the fetus and placenta. Maximum levels are reached near term, typically to 5-7 mg/L. Higher levels are noted in patients with multiple gestation. Little hPL enters the fetal circulation. Its biological half-life is 15 minutes. | Gynaecology & Obstetrics | Diagnosis in Obstetrics | To diagnosis foetal wellbeing of foetus, most reliable method -(UPSC 97)
A. L:S ratio
B. HPL levels
C. Kick test
D. Ultrasound
| Ultrasound |
19dbb51a-75ee-4e72-b26c-711d85a582f7 | Middle meatus: Uncinate process is a hook-like structure running in from anterosuperior to the posteroinferior direction in the middle meatus. It&;s postero superior border is sharp and runs parallel to the anterior border of bulla ethmoidalis. This gap between the two is called hiatus semilunaris .it is two-dimensional space of 1-2 mm width. (Ref: Diseases of Ear, Nose and Throat and head and neck surgery, Dhingra 7th edition, Pg no. 150) | ENT | Nose and paranasal sinuses | Hiatus semilunaris is present in?
A. Superior meatus
B. Middle meatus
C. Inferior meatus
D. Spheno-ethmoidal recess
| Middle meatus |
3c6ced6c-0e79-4933-a349-ffc7a598cd5a | The approximate age of the wound in an incised wound, when new collagen fibrils are seen along with a thick layer of growing epithelium is 4-5 days. | Pathology | null | After an incised wound, new collagen fibrils are seen along with a thick layer of growing epithelium. The approximate age of the wound is:
A. 4-5 days
B. About 1 week
C. 12-24 hours
D. 24-72 hours
| 4-5 days |
5288c03d-1e35-419b-8b16-dcd64ae7138c | Ans. D i.e. Bimastoid Fetal skull Shoest diameter of fetal skull: Bimastoid (7.5 cm) Largest diameter of fetal skull: Mentoveical (14 cm) | Gynaecology & Obstetrics | null | Shoest skull diameter: March 2013
A. Biparietal
B. Mentoveical
C. Bitemporal
D. Bimastoid
| Bimastoid |
d52c957e-e1ae-48cc-8e0d-2f8732fc08ee | Optimum age for surgery in case of undescended testis is 6 months. The surgical procedure done is called orchidopexy. Earlier intervention (Six months of age) should be considered in order to theoretically prevent the complications of crytorchidism that may be manifested before 1 year of age. Ref: Sabiston 20th Ed. ; Schwaz 11th Ed. | Surgery | All India exam | Surgery for undescended testis is recommended at what age?
A. 6 months
B. 12 months
C. 24 months
D. 36 months
| 6 months |
170029ac-2a8e-43a6-ad55-e31059a55b20 | Hebephrenic schizophrenia Key Symptoms: Disorganized speech, behavior (often silly/ shallow) and flat or inappropriate affect Order of prognosis from good to bad in Schizophrenia: Catatonic > Paranoid > Undifferentiated > Hebephrenic > Simple Reference: Oxford Handbook of psychiatry; 3rd edition; Chapter 6; Schizophrenia and related psychoses | Psychiatry | Schizophrenia and other psychotic disorders | Schizophrenia with the worst prognosis
A. Catatonic
B. Paranoid
C. Hebephrenic
D. Undifferentiated
| Hebephrenic |
94eba4f1-7251-4f74-bf7e-0ad3423fde77 | Most endodontic rotary systems are used in the speed range of 300-350 RPM. Light speed is ued at 1200 rpm | Dental | null | Ideal speed for most rotary NiTi Instrument is
A. 300-350 rpm
B. 350-500 rpm
C. 500-600 rpm
D. 100-200 rpm
| 300-350 rpm |
2deca00a-f289-4105-931d-8d2019b354c2 | Ans. a (MCU). (Ref. Sutton Radiology 7th ed. 1017, 1061)- MCU is IOC for PU valve and VUR.Posterior urethral valves (PUV)# Varying degree of chronic urethral obstruction due to fusion and prominence of plicae colliculi, normal concentric folds of urethra.# Usually located in posterior urethra just distal to the level verumontanum.c;# It is the most common cause of severe obstructive uropathy in infants and children.# MCU is 'gold standard' in diagnosis of PUV.# Rx: Cystoscopic fulguration of the valves.Three types of PUV are described : | Radiology | Genito Urinary System | Investigation of choice for Posterior urethral valves:
A. Micturating Cystourethrography (MCU)
B. Ultrasound
C. Intravenous Pyelography
D. Retrograde urethrography
| Micturating Cystourethrography (MCU) |
1e4aa405-24ac-4dc2-abad-ebcd47e977d0 | Vaginal pH: newborn infant -4.5 to 7 pubey -alkaline to acidic reproductive age -4 to 5.5 pregnancy -3.5 to 4.5 post menopausal -6 to 8 Acidity of vagina is because of doderlein's bacilli. It is a rod-shaped gram-positive bacillus which grows anaerobically on acid media. It appears in the vagina 3-4 days after bih and disappears after 10-14 days. It appears again at pubey and disappears after menopause. Its function is to conve glycogen present in vaginal mucosa into lactic acid so that the vaginal PH is maintained towards acidic side, which prevents other pathogenic organisms from invading the vagina. Ref: D.C Dutta's Textbook of GynaecologyPg no:7,6th edition | Gynaecology & Obstetrics | Anatomy of the female genital tract | Vaginal defence is lost:
A. Within 10 days of bih
B. After 10 days of bih
C. During pregnancy
D. At pubey
| After 10 days of bih |
6ed275d2-a711-461f-beb1-aca540311498 | The right border of the hea is approximately 1 to 2 cm to the right of the right border of the sternum; therefore, the knife probably did not hit the hea. The middle lobe of the right lung extends from the level of the fouh costochondral junction to the level of the fifth intercostal space. The middle lobe is most likely at the level of the fouh intercostal space. | Anatomy | Thorax | A patient sustains a knife wound through the right fouh intercostals space, 2 cm to the right of the sternum. The area most likely penetrated by the knife is the
A. Right upper lobe of the lung
B. Right middle lobe of the lung
C. Right lower lobe of the lung
D. Right atrium of the hea
| Right middle lobe of the lung |
b7d9688e-4eb7-4d3a-ae88-01e1ac397d54 | Ans. B: Ring Finger Dupuytren's contracture is more common among people with diabetes, alcoholism, or epilepsy. Dupuytren contracture, a disease of the palmar fascia, results in the thickening and shoening of fibrous bands in the hands and fingers. The ring finger is the one affected most commonly. It is usually limited to the medial three fingers. This disease entity belongs to the group of fibromatoses that include plantar fibromatosis (Ledderhose disease), penile fibromatosis (Peyronie disease), and fibromatosis of the dorsal proximal interphalangeal (PIP) joints (Garrod nodes or knuckle pads). | Surgery | null | Duputryens contracture commonly affects: September 2005
A. Little finger
B. Ring finger
C. Middle finger
D. Index finger
| Ring finger |
ba7c2757-ee9a-4c98-bfa1-acef6adfa8b6 | Patients with veebral aery occlusion may present as posterior inferior cerebellar aery syndrome with cerebellar and brainstem signs such as dysahria, iplsilateral limb ataxia, veigo, nystagmus, ipsilateral Horner's syndrome, ipsilateral loss of pain and temperature of face, ipsilateral pharyngeal and laryngeal paralysis, contralateral loss of pain and temperature in limbs and trunk. Occlusion of stem of middle cerebral aery results in contralateral hemiplegia, contralateral hemianopia, contralateral hemianesthesia, aphasia, contralateral neglect and dressing difficulties. Occlusion of ACA, distal to anterior communicating aery result in contralateral leg weakness, contralateral leg sensory loss and urinary incontinence. Occlusion of ACA proximal to ACCA result in bilateral leg weakness, sensory loss, urinary incontinence, and frontal release signs. Ref: Laboratory Medicine in Psychiatry and Behavioral Science By Sandra A. Jacobson page 567. | Medicine | null | Hemiparesis is NOT a feature of:
A. Carotid aery occlusion
B. MCA occlusion
C. AC A occlusion
D. Veebral aery occlusion
| Veebral aery occlusion |
2914f119-98dd-4c93-ac21-88e91f6c0480 | Ans. is 'a' i.e., CO2 washout PDA in preterm neonate o In previous explanations I have explained that chances of spontaneous closure of PDA are higher in premature infants as there is no structural abnormality. However, you should keep in mind that this fact is true when we are comparing the spontaneous closure of PDA between term and pre-term neonate. Overall, the percentage of spontaneous closure of PDA in preterm neonate is very low. To avoid confusion, I am explaining following facts in brief:? 1) Normal neonate :- Ductus aeriosus closes functionally within about 15 hours of bih. 2) PDA in term (mature) neonate :- The persistence of ductus aeriosus beyond 24 hours after bih is considered as PDA in term neonate. Spontaneous closure of PDA does not usually occur because PDA results from structural abnormality. 3) PDA in pre-term (pre-mature) neonate :- The ductus aeriosus in pre-term neonate is not as responsive to increased oxygen content as it is in term neonate. However, there is no structural abnormality. i) Chances of spontaneous closure are very less (compared to normal term neonate). ii)Chances of spontaneous closure are more than the term-neonate with PDA. However, in premature neonate, where hypoxic pulmonary disease is commonplace, the ductus being sensitive to hypoxia, remains open. o So, it is very unlikely that spontaneous closure of PDA will occur in pre-term neonate. But chances are more when compared to term neonate with PDA (not normal term neonate in which ductus aeriosus closes within 15 hours of bih). Manifestations of PDA in pre-term neonate 1) Apnea for unexplained reasons in an infant recovering from RDS; 2) A hyperdynamic precordium, bounding peripheral pulses, wide pulse pressure, and a continuous or systolic murmur with or without extension into diastole or an apical diastolic murmur, multiple clicks resembling the shaking of dice; 3) Carbon dioxide retention; 4) Increasing oxygen dependence; 5) X-ray evidence of cardiomegaly and increased pulmonary vascular markings; and 6) Hepatomegaly o Increased pulmonary blood flow and compromised ventricular function accompanying dropping pulmonary resistance in the setting of a PDA is a significant risk factor for pulmonary hemorrhage. o The greatest risk factor for NEC is prematurity. Any etiology which leads on to hemodynamic or hypoxic insult predisposes to NEC. PDA is common in preterm infants and it definitely causes hemodynamic stress and is a risk factor for development of NEC. | Pediatrics | null | Preterm baby with PDA, which is the least likely findings?
A. CO2 washout
B. Bounding pulses
C. Pulmonary hemorrhage
D. Necrotising enterocolitis
| CO2 washout |
561f6314-6a70-44a7-9b05-4b60f7201797 | (A) (Open neural tube defects) (1998 - Nelson 19th)* Failure of closure of the neural tube allows excretion of fetal substances (a-fetoprotein , acetylecholinesterase) into the amniotic fluid, serving as biochemical and markers of a neural tube defects (NTD).* Prenatal screening of maternal serum of AFP in the 16th - 18th week gestation is an effective method for identifying pregnancies at risk for features with NTDA in utero.* Risk factor for neural tube defects (william obs)i) Family history of NTD-First degree relative 2 - 3% Autosomal dominant or Autosomal recessive - 20 - 3% times highter.ii) Exposure to certain environmental agents, malnutrition.iii) Diabetes (Hyper glycemia/Matemal obesity).iv) Hyperthermiav) Drugs - valproic acid, carbamazepine, Aminopterin and isotretinoin (Anacephaly or encephalocele)vi) Genetic syndrome with known recurrence risk Meckel - Gruber, Roberts - SC, Phocomelia, Jarco Levin and HARDE syndrome.vii) Trisomy 13 and 18 and Triploidy all have 1% recurrence risk.* Major NTDs include - spina bifida occulta, meningocele, myelomeningocele, encephalocele, anencephaly, caudal regression syndrome, dermal sinus, tethered cord, syringomyelia, diastematomyelia and lipoma involving the conus medullaris and / or filum terminale and the rare condition anencephaly.Prevention - The U.S. Public health service has recommended that all women of child bearing age and who are capable of becoming pregnant take 0.4 mg folic acid daily.* Nuchal translucency is used for screening of Down syndrome in antenatal USG** | Pediatrics | Miscellaneous | Increased acetylcholinesterase in amniotic fluid indicates -
A. Open neural tube defects
B. Oesophageal atresia
C. Down syndrome
D. Edwards syndrome
| Open neural tube defects |
35cd4faf-f262-4883-9836-4de77f1a505b | Given scenario suggests diagnosis of Chondromalacia patellae Plica syndrome- anterior knee pain, clicking, clunking, and a popping sensation on patellofemoral loading activity such as squatting Patellofemoral ahritis will be seen at a later age and will have pain in all movements of knee. Bipaite patella is congenital fragmentation of patella and is usually asymptomatic. | Orthopaedics | Neuromuscular disorders | 15/F complains of anterior knee pain, increased on climbing stairs and getting up after prolonged sitting. Diagnosis is:
A. Chondromalacia patellae
B. Bipaite patellae
C. Plica syndrome
D. Patellofemoral ahritis
| Chondromalacia patellae |
d8d33903-6c01-46eb-926f-8903350eae35 | Reffered pain to ear: Benign ulcers or malignant lesions of the base of tongue tonsil pillars palate Ref: Dhingra 7e pg 435. | ENT | Ear | Which of the following pain is not referred to ear
A. Pharynx
B. Teeth
C. Angle of TM joint
D. Vestibule of nose
| Vestibule of nose |
91fc0a8a-7251-4962-823f-afb03cdf85ec | Ans. (a) Lesser cornuRef: Inderbir Singh's Embroyology, 7th ed. /119-120Lesser cornu of hyoid is derived from 2nd branchial arch.1st Branchial arch2nd Branchial arch3rd Branchial arch4th Branchial arch6th Branchial arch* Malleus and Incus* Maxilla* Mandible* Muscle of mastication* Stapes* Upper half of body of hyoid* Lesser cornu of hyoid* Muscle of facial expression* Lower part of body of hyoid* Greater cornu of hyoid* Thymus* Stylopharyngeus* Upper thyroid cartilage* Cricothyroid muscle* Lower half of thyroid cartilage* Arytenoid, Cuneiform, Corniculate cartilage* All intrinsic laryngeal muscle except cricothyroidNerve: Mandibular branch of CN 5thFacial NerveGlossopharyngeal nerveVagus + Superior Laryngeal nerveVagus + Recurrent laryngeal nerve | ENT | Larynx | Which of these is not a derivative of 3rd pharyngeal/ branchial arch:
A. Lesser cornu
B. Greater cornu
C. Stylopharyngeus
D. Lower hyoid
| Lesser cornu |
69cda036-fe20-4d53-be80-5e563c9122f2 | Ans. is 'a' i.e., Ketoconazole Pityriasis versicolor (Tinea versicolor) Tinea versicolor is a misnomer as it is not caused by dermatophyte; Pityriasis versicolor is more appropriate term. It is caused by a nondermatophyte fungus called Pityrosporum ovale (Malasezia furfur). It usually affects young adults. Clinical features There are multiple small scaly hypopigmented macules (macules may be hyperpigmented also). Scaling is furfuraceous or rice powder like. Macules sta around the hair follicles and then merge with each other to form large areas. Affects trunk and shoulders (mainly chest and back). There may be loosening of scales with finger nails -4 Coupled onle or stroke of nail. Lesions are recurrent in nature (may reappear after treatment). Diagnosis of P.versicolor Examination of scales in 10% KOH shows sho hyphae and round spores (Sphagetti and meat ball appearance). Wood's lamp shows apple green fluorescence (blue-green fluorescence). Skin surface biopsy --) A cyanoacrylate adhesive (crazy glue) is used to remove the layer of stratum corneum on glass slide and then stained with PAS reagent. Treatment of P.versicolor Systemic agents : - Systemic azoles provide a convenient therapeutic option. Drugs used are ketoconazole, Fluconazole or intraconazole. Topical antifungals :- Topical antifungals used are : - i. Azoles --> Clotrimazole, econazole, Miconazole, Ketoconazole. ii. Others --> Selenium Sulfide, Sodium thiosulphate, whield's ointment (3% salicylic acid + 6% Benzoic acid). | Skin | null | The following drug is effective in treatment of ptyriasis versicolor ?
A. Ketoconazole
B. Metronidazole
C. Griseofulvin
D. Chloroquine
| Ketoconazole |
5a21646a-c5db-4e8d-b73b-8fc2d46f2fd6 | Hypoxia is O2 deficiency at the tissue level. Traditionally, hypoxia has been divided into four types.Type of hypoxiaSignificanceHypoxic hypoxia The PO2 of the aerial blood is reduced.Anemic hypoxia The aerial PO2 is normal but the amount of hemoglobin available to carry O2 is reducedStagnant hypoxia The blood flow to a tissue is so low that adequate O2 is not delivered to it despite a normal PO2 and hemoglobin concentrationHistotoxic hypoxia The amount of O, delivered to a tissue is adequate. But, because of the action of a toxic agent, the tissue cells cannot make use of the O2 supplied to them.Effects of hypoxia on cellsHypoxia causes the production of transcription factors (hypoxia-inducible factors; HIFs). In hypoxic cells, the subunits dimerize with subunits, and the dimers activate genes that produce angiogenic factors and erythropoietin.(Refer: Ganong&;s Review of Medical physiology 24th edition,pg no: 649,653) | Anatomy | All India exam | Hypoxia due to the slowing of circulation is seen in which of the following?
A. Anemic hypoxia
B. Histotoxic hypoxia
C. Hypoxic hypoxia
D. Stagnant hypoxia
| Stagnant hypoxia |
fbafe949-e281-4310-bfab-53fe65e85921 | Option A & C ruled out as SAH presents with Nuchal rigidity. Option B- Sudden neck flexion causes shooting pain in the back which is feature of TABES DORSALIS. HIT test is a bedside technique used to diagnose reduction in vestibular function in one ear vs. the other. HINTS exam (Head Impulse, Nystagmus and Test for Skew Detion) can be used to differentiate acute continuous veigo. The 3 components of the HINTS exam include: HINTS Test Reassuring Finding Head Impulse Test Abnormal (corrective saccade) Nystagmus Unidirectional, horizontal Test of Skew No skew detion | Medicine | Headache And Migraine | (HIT)Head impulse test is used to diagnose?
A. Subarachnoid haemorrhage
B. Lhermite sign
C. Nuchal rigidity
D. Vestibular disease
| Vestibular disease |
1544dd2d-cc15-4352-9bb3-002524216a59 | Ans. is 'c' i.e., Healed disease Prognosis of Pott's paraplegia Good Poor Degree Paial (only sensory or motor) Complete paraplegia (grade IV) Duration Shoer Longer (> 12 months) Type Early (acute) onset Late (chronic) onset Speed of onset Slow (insidious) Rapid (sudden) Age Younger Old General condition Good Poor Veebral disease Active Healed Kyphotic deformity < 600 > 60deg Cord on MRI Normal Myelomalacia or syringomyelia Preoperative Wet lesion Dry lesion | Surgery | null | Poor prognostic indicator of Pott's paraplegia
A. Early onset
B. Active disease
C. Healed disease
D. Wet lesion
| Healed disease |
82e657d9-2911-4d2e-a004-b0a4c480a741 | Ans. is 'a' i.e., Superior analgesic and inferior hypnotic I mg of methadone can be substituted for 4 mg of morphine. Methadone is less hypnotic than morphine (sedative action is less intense). | Pharmacology | null | As compared to morphine, methadone is -
A. Superior analgesic and inferior hypnotic
B. Superior hypnotic and inferior analgesic
C. Superior analgesic and superior hypnotic
D. Inferior analgenic and inferior hypnotic
| Superior analgesic and inferior hypnotic |
aafd05ba-1121-4f53-b1cf-44ec4c586daa | Pergolide, ergot derivative, directly stimulates both D1 and D2 receptors. It has been widely used for parkinsonism but is no longer available because its use has been associated with the development of valvular hea disease.Reference: Katzung Pharmacology; 13th edition; Chapter 28; Pharmacologic Management of Parkinsonism & Other Movement Disorders | Pharmacology | Central Nervous system | Antiparkinson's drug known to cause cardiac valvular fibrosis is
A. Levodopa
B. Ropinirole
C. Pramipexole
D. Pergolide
| Pergolide |
368161c1-15ef-4d0b-986c-ff62ca444eb4 | Ans. a. Fasudil (Ref: Katzung 11/e p203; Harrison 19/e p1590, 18/e p2011)Fasudil is a Rho kinase inhibitor leading to vasodilatation.FasudilRho kinase (protein kinase)-Vasocontrictor signalFasudil is a Rho kinase inhibitorQ leading to vasodilatation.New Anti-Anginal DrugsFasudilRho kinase inhibitorQTrimeiazidine* Metabolic modulatorsIvabardine* Direct bradycardic agentDedanonoate* Protein kinase G facilitatorGlybenclamide* Sulphonyl ureasOther New Anti-Anginaf DrugsThiazolidinedionesVasopeptidase inhibitorsNitric oxide donors (L-arginine)CapsaicinAmilorideRanolazine (Harrison 19/e p1590, 18/e p2011)MOA: Reduced contractility , due to blockade of late Na+ current that facilitates Ca2+ entry via Na+-Ca2+ exchanger, thus prevents CaJ- overloadQNicorandil (Harrison 19/e p1590, 18/e p2011)K' channel opener - reduction of free intracellular Ca2 | Pharmacology | Anti-Anginal | Which of the following is a Rho kinase inhibitor? (AIIMS November.2013. May 2013. November 2012)
A. Fasudil
B. Ranolazine
C. Amiloride
D. Nicorandil
| Fasudil |
9d4a8b6b-e3fc-4eac-92bb-08cc589c7b54 | Phase Unit of study Purpose PRECLINICAL PHASE Lab experiments Animals Pretesting CLINICAL PHASE Typical No. of patients Phase 0 Healthy human volunteers Micro - dosing Phase I Healthy human volunteers Safety and non - toxicity profile 10 to 30 usually healthy volunteers Phase II Patients Effectiveness Fewer than 100 Phase III Patients Comparison with existing drugs Hundreds or thousands Phase IV Patients Long term side effects Many thousands | Social & Preventive Medicine | RCT, Trials | Efficacy of new drug A is compared with an existing drug B in:
A. Clinical trial phase I
B. Clinical trial phase II
C. Clinical trial phase III
D. Clinical trial phase IV
| Clinical trial phase III |
01e7819e-9e1f-45a9-9efb-47c58351c08b | Answer: c) Assistant Sessions court (KS NARAYAN REDDY 33rd ED P-7)COURTS OF LAWCourtImprisonmentFineSupreme courtAny sentenceAny amount of fineHigh courtAny sentence authorized by lawAny amount of fineSessions courtAny sentence authorized by law (but death sentence must be confirmed by High court)Any amount of fineAssistant sessions court10 years imprisonmentAny amount of fineChief Judicial magistrateChief Metropolitan Magistrate7 years imprisonmentAny amount of fineFirst class Judicial magistrateMetropolitan Magistrate3 years imprisonment10000 rupeesSecond class judicial magistrate1 year imprisonment5000 rupees | Forensic Medicine | Law & Medicine, Identification, Autopsy & Burn | The court which can sentence imprisonment for a maximum of 10 years
A. Chief Judicial Magistrate
B. First class Judicial Magistrate
C. Assistant Sessions court
D. Additional Sessions court
| Assistant Sessions court |
a9e6e097-c028-439a-ae33-13d34946a4c3 | Postoperative nausea and vomiting is most common in women, young people, and patients who have received opioids during surgery. Surprisingly, perhaps the one advantage of smoking is that smokers tend to have less postoperative nausea and vomiting than nonsmokers. Similarly, the incidence of postoperative nausea and vomiting is lower in the geriatric population. | Anaesthesia | Preoperative assessment and monitoring in anaesthesia | Which of the following is the most significant risk factor for postoperative nausea and vomiting
A. Female gender
B. Smoking
C. Age over 60 years
D. Surgery on the breast
| Female gender |
be6a8fe5-fe54-4dc5-85b7-35be03560c68 | Ans is 'a' i.e. Certain min. amount of reduced Hb should be present o Cyanosis is a blue coloration of the skin and mucous membranes due to the presence of >5g/dl reduced hemoglobin in blood vessels near the skin surface. Now since in anemia the total amount of hemoglobin is decreased, the amount of reduced Hb to produce Cyanosis is not sufficient. | Pathology | Misc. (R.B.C) | There is no cyanosis in severe anemia because -
A. Certain min. amount of reduced Hb should be present
B. In anemia, O2 saturation increases
C. Hypoxia stimulates erythropoietin production
D. O2 hemoglobin curve shifts to right
| Certain min. amount of reduced Hb should be present |
0fff791e-7073-496c-8af2-e92d78482a2d | GIANT CELL AERITIS Headache, scalp tenderness, visual symptoms, jaw claudication, or throat pain The temporal aery is usually normal on physical examination but may be nodular, enlarged, tender, or pulseless Blindness Results from occlusive aeritis of the posterior ciliary branch of the ophthalmic aery Ischemic optic neuropathy may produce no funduscopic findings for the first 24-48 hours after the onset of blindness Asymmetry of pulses in the arms, a murmur of aoic regurgitation, or bruits heard near the clavicle resulting from subclan aery stenoses identify an affected aoa or its major branches Foy percent of patients with giant cell aeritis have nonclassic symptoms at presentation, primarily respiratory tract problems (most frequently dry cough), mononeuritis multiplex (most frequently with painful paralysis of a shoulder), or fever of unknown origin The fever can be as high as 40degC and is frequently associated with rigors and sweats Unexplained head or neck pain in an older patient may signal the presence of giant cell aeritis Diagnosis An elevated ESR, with a median result of about 65 mm/h, occurs in more than 90% of patients with polymyalgia rheumatica or giant cell aeritis Magnetic resonance angiography or CT angiography establishes the diagnosis by demonstrating long stretches of narrowing of the subclan and axillary aeries Imaging of the temporal aery with ultrasound, MRI, or CT angiography can sometimes obte the need for biopsy Temporal aery biopsy -Diagnostic findings of giant cell aeritis may still be present 2 weeks (or even considerably longer) after staing coicosteroids . TREATMENT The urgency of early diagnosis and treatment in giant cell aeritis relates to the prevention of blindness When a patient has symptoms and findings suggestive of temporal aeritis, therapy with prednisone, 60 mg daily orally, is initiated immediately Prednisone should be continued in a dosage of 60 mg/day for 1-2 months before tapering Intravenous pulse methylprednisolone (eg, 1 g/day for 3 days) may help patients with visual loss and may increase chance of remission; however, data suppoing this recommendation are preliminary Low-dose aspirin (~81 mg/day orally) may reduce the risk of visual loss or stroke and should be added to prednisone Tocilizumab, an anti-interleukin-6 receptor monoclonal antibody Phase 2 clinical trials have shown that patients initially treated withtocilizumaband prednisone were able to be tapered off prednisone faster than those who were treated with prednisone alone After 1 year of treatment,tocilizumabachieves coicosteroid-free remission in approximately 50% of patients | Medicine | JIPMER 2019 | A 65 year old lady underwent mastectomy for Carcinoma breast. Later she developed frontal headache, pain in temple region and around eye. Her ESR is 55 mm/hour. What is the most probable diagnosis?
A. Cavernous sinus thrombosis
B. Meningeal metastasis
C. Frontal sinusitis
D. Giant cell aeritis
| Giant cell aeritis |
496ee96f-286c-4796-8490-20abc3e6f333 | A continuous murmur is predicated on a pressure gradient that persists between two cardiac chambers or blood vessels across systole and diastole.The murmurs
typically begin in systole, envelop the second heart sound (S 2 ), and continue through some portion of diastole.
They can often be difficult to distinguish from individual systolic and diastolic murmurs in patients with mixed valvular heart disease.
The classic example of a continuous murmur is that associated with a patent ductus arteriosus, which usually is heard in the second or third interspace at a slight distance from the sternal border. Other causes of a continuous murmur include a ruptured sinus of Valsalva aneurysm with creation of an aortic–right atrial or right ventricular fistula, a coronary or great vessel arteriovenous fistula, and an arteriovenous fistula constructed to provide dialysis access. | Medicine | null | Continuous murmur is present in
A. cardiomyopathy
B. MS
C. PDA
D. cardiac tamponade
| PDA |
999fea48-cf9d-495e-82de-dc137ae28888 | Endonuclease Exonuclease Cut in between the DNA sequence Cut from the sides either from 5' or from 3' side Cut ds DNA Cut ss & ds DNA | Biochemistry | Basics of DNA | Function of endonucleases:-
A. Cut DNA at specific DNA sequences
B. Enhancers
C. To find out antibiotic resistances
D. To point out the coding regions
| Cut DNA at specific DNA sequences |
9e7fc1f1-55b9-433b-8ccf-23e740cd68d4 | .In adults surgical management includes * It includes herniotomy, i.e. excision of hernial sac and herniorrhaphy (strengthening of the posterior wall of inguinal canal either by repair or mesh). Precipitating causes should be treated first, like TURP for BPH, dilatation of stricture urethra, treatment of chronic bronchitis. Patient is advised to avoid smoking. * Hernioplasty is the present choice (ideal) for all inguinal and groin hernias. Mesh is placed either onlay (over conjoint tendon to inguinal ligament) or inlay (in preperitoneal space). Polypropylene mesh is used. Herniotomy is done prior to mesh placement. TEP (Totally extraperitoneal laparoscopic preperitoneal mesh repair) is preferred method. ref:SRB&;s manual of surgery,ed 3,pg no 686 | Surgery | Urology | Which is a clean surgery
A. Hernia surgery
B. Gastric surgery
C. Cholecystectomy
D. Rectal surgery
| Hernia surgery |
9a6541ad-5180-499d-8a89-1cc8a796cefb | Folic acid plays a role in synthesis of nucleic acids. It is needed for normal development of blood cells in the marrow. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 620 | Social & Preventive Medicine | Nutrition and health | Which of the following drugs is supposed to prevent congenital neural tube defects -
A. Thiamine
B. Riboflavin
C. Folic acid
D. Pyridoxine
| Folic acid |
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