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e5e50625-979e-49bb-80b6-16b36181be5b | Complex IV: Cyt-c Oxidase The system functions: * As proton pump * Catalyses transfer of electrons to molecular O2 to form H2O. This is the terminal component of ETC. It catalyses the transfer of electrons from Cyt-c to molecular O2 Cyt-a, Cu++ ions and Cyt-a3.Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition, page no: 142 | Biochemistry | Respiratory chain | Which complex of ETC reacts directly with O2?
A. I
B. II
C. III
D. IV
| IV |
ac3b92d2-4bd5-43c3-a99c-a2bd848854a2 | WHO : Established in 1945. Constitution came into force on 7th April 1948. Hence, 7th April is WORLD HEALTH DAY. Head quaers is located in GENEVA. WHD 2018,2019 Theme is Universal health coverage. WHO's most impoant single function is to promote and suppo national health policy development and the development of comprehensive national health programmes. Other Works of WHO - Prevention and control of specific diseases, Family health, Environment health, Health statistics, Health literature & Information, Biomedical research, Cooperation with other organizations. | Social & Preventive Medicine | International health agencies | The most impoant single function of World Health Organization is?
A. Prevention and control of specific diseases
B. Development of comprehensive health services
C. Health literature & Information
D. Biomedical research
| Development of comprehensive health services |
9b2e70e7-0a88-4b1c-a685-ec6b90479c08 | Sciatic notch index is a trait used for differentiating sex by measuring sciatic notch. Formula is, Sciatic notch index = (width of sciatic notch/depth of sciatic notch) * 100 It is normally 4-5 in males and 5-6 in females Ref: Essentials of Forensic Medicine and Toxicology by Narayan Reddy, 27th edition, Page 56. | Forensic Medicine | null | Which of the following is determined by measuring sciatic notch index in a skeleton?
A. Determination of age
B. Identification of sex
C. Determination of race
D. Cause of death
| Identification of sex |
42b4b80b-41a7-4bf9-920c-770c85df12e3 | Ans. C: AstheniaSigns of Cerebellar DisordersAtaxia, Reeling, wide-based gait- decomposition of movements, Inability to correctly sequence fine, coordinated actsDysahria-Inability to aiculate words correctly, with slurring and inappropriate phrasingDysdiadochokinesia-Inability to perform rapid alternating movementsDysmetria-Inability to control range of movementHypotonia-Decreased muscle toneNystagmus-Involuntary, rapid oscillation of the eyeballs in a horizontal, veical, or rotary direction, with the fast component maximal toward the side of the cerebellar lesionScanning speech-Slow enunciation with a tendency to hesitate at the beginning of a word or syllableTremor-Rhythmic, alternating, oscillatory movement of a limb as it approaches a target (intention tremor) or of proximal musculature when fixed posture or weight bearing is attempted (postural tremor)Asthenia: (Weakness/Lack of energy and strength/Loss of strength). It is a prominent pa of myasthenia gravis | Anatomy | null | Not involved in damage to cerebellum:March 2010
A. Posture
B. Equilibrium
C. Asthenia
D. Tone
| Asthenia |
580d99ef-2c6f-44af-b9c8-ce96c9b84c27 | Ans. is 'a' i.e., Thumb metacarpophalangeal joint ulnar collateral ligament ruptureo Injury to the thumb metacarpophalangeal joint ulnar collateral ligament is commonly referred to as gamekeeper thumb orskierfs thumb, although the original "gamekeeper" description (Campbell, 1955) referred to an attritional ulnar collat- eral ligament injury.o Snow skiing accidents and falls on an outstretched hand with forceful radial and palmar abduction of the thumb are the usual causes. | Orthopaedics | Injuries of the Wrist | Game keepers thumb is -
A. Thumb metacarpophalangeal joint ulnar collateral ligament rupture
B. Thumb metacarpophalangeal joint radial collateral ligament rupture
C. Thumb interphalangeal joint ulnar collateral ligament rupture
D. Thumb interphalangeal joint radial collateral ligament rupture
| Thumb metacarpophalangeal joint ulnar collateral ligament rupture |
5b9a5111-52cd-44ba-bd87-41c60ba0442d | Ans. is 'a' i.e., Left lateral rectus paralysis | Ophthalmology | null | Right esotropia is evident with ?
A. Left lateral rectus paralysis
B. Right lateral rectus paralysis
C. Left medial rectus paralysis
D. Right medial rectus paralysis
| Left lateral rectus paralysis |
0a9c1b39-d2b6-442b-ab22-b9b8b5994052 | Ans. is 'c' i.e., Leucine o Jowar (Sorghum) contains excess of leucine which can cause niacine deficiency and pellagra. | Social & Preventive Medicine | null | Sorghum contains excess of
A. Lycine
B. Arginine
C. Leucine
D. Histidine
| Leucine |
153a3722-ab45-4240-943f-203bd93b68de | Ref: Pal GK. Transport across Cel! membrane. In: Textbook of medical physiology. 2""' ed. Abuja publishing house. 2011: 4: 32,33.Explanation:Permeability of substances across the membrane is decided by1. Lipid - solubility2. Molecular size3. Charge of the molecule4. Temperature5. Distribution of channels in the membrane6. Pressure gradientSimple and passive diffusion are passive transport and energy is not do not require utilization of metabolic energy (ATP) | Physiology | Nervous System | Transport of molecules in simple diffusion is not determined by:
A. ATP usage
B. Size of molecule
C. Lipid solubility
D. Number of channels
| ATP usage |
ea090ecc-a122-4016-927f-71c7205c3450 | Ans. is 'a' i.e., Atrial contraction JUGULAR VENOUS PULSEa waveIt is the positive presystolic wave produced by right atrial contraction.x descenta wave is followed by the negative systolic wave the x ' descent. The x descent is produced due to atrial relaxation. The atrial relaxation is produced as a result of ventricular contraction.c waveThe x descent is interrupted by second positive wave the 'c' wave. It is produced by bulging of the tricuspid valve into the right atrium during R V isoivolumetric contraction.vwaveIt is the positive systolic wave. It result from increase in the blood volume in the venacava during systole, when the tricuspid valve is closed.y descentFollowing the "v wave " this is a negative descending limb referred to as they descent or diastolic collapse. It is due to tricuspid valve opening and rapid inflow of blood into the right ventricle.So there areThree visible major positive waves (a.c and v) andTwo negative waves (x and y). | Physiology | Heart, Circulation, and Blood | A wave in JVP is due to-
A. Atrial contraction
B. Ventricular filling
C. Atrial filling
D. Bulging of tricuspid valve in right atrium
| Atrial contraction |
f606b723-bf31-4390-a1e7-c95d86c0e0c6 | The first modern halogenated volatile anesthetic, halothane, was introduced in 1955. Clinical exposure to halothane is associated with two distinct types of hepatic injury. Subclinical hepatotoxicity occurs in 20% of adults who receive halothane. It is characterized by mild postoperative elevations in alanine aminotransferase and aspaate aminotransferase, but is reversible and innocuous. Anaerobic halothane reduction by CYP2A6 to a 2-chloro-1,1,1-trifluoroethyl radical is thought to mediate this mild hepatic injury. The fulminant form of hepatotoxicity, commonly known as halothane hepatitis, It is characterized by elevated alanine aminotransferase, aspaate aminotransferase, bilirubin, and alkaline phosphatase levels, and massive hepatic necrosis following the administration of halothane. Halothane hepatitis is rare (1 in 5000 to 35,000 administrations in adults), but is fatal in 50% to 75% of these cases. Because of the potential for fatal hepatitis, halothane is no longer used in adult patients in many countries. Halothane hepatitis is caused by a hypersensitivity reaction associated with the oxidative metabolism of halothane. The highly reactive trifluoroacetyl chloride metabolite of halothane oxidation can react with nearby liver proteins. In most patients who developed hepatic necrosis after halothane anesthesia, antibodies against TFA-modified proteins were detected, suggesting that the hepatic damage is linked to an immune response against the modified protein, which acts as a neoantigen. Accordingly, patients who develop halothane hepatitis often have a history of prior exposures to halothane or other volatile anesthetics, together with symptoms suggestive of immune reactivity, such as fever, rash, ahralgia, and eosinophilia. A current hypothesis is that TFA-protein adducts induce a cytotoxic T cell reaction in sensitized individuals, which leads to liver damage. However, the immune responses observed in halothane hepatitis might not mediate liver injury. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e | Anaesthesia | General anaesthesia | A patient after giving inhalational anaestheia developed fulminant hepatitis, patient was exposed to same drug previously. Which is the drug
A. Halothane
B. N20
C. Enflurane
D. Isoflurane
| Halothane |
cfef5f66-0d0e-4d7d-83b6-cee52c15910a | Ans. is b, i.e. Distended neck veinsRef. Williams Obs. 22/e, p 1019, 23/e, p 960, Dutta Obs. 7/e, p 275Many of the physiological adaptations of normal pregnancy and physical findings resemble heart disease symptoms and signs, making the diagnosis of heart disease more difficult.For example, in normal pregnancy, functional systolic heart murmurs are quite common; respiratory efforts is accentuated, at times suggesting dyspnea and edema in the lower extremities usually develops after midpregnancy.It is important not to diagnose heart disease during pregnancy when none exists, and at the same time not to fail to detect and appropriately treat heart disease when it dose exist.Clinical indicators of Heart disease during Pregnancy: Metcalfes criteria for Heart disease in pregnancySymptomsClinical findings* Progressive dyspnea or orthopnea* Nocturnal cough* Hemoptysis* Syncope with exertion* Chest pain related to effort or emotion* Symptoms of pulmonary hypertension* Cyanosis* Clubbing of fingers* Persistent neck vein distension* Systolic murmur greater than grade 3* Diastolic murmur* Cardiomegaly* Persistent arrhythmia* Persistently split second sound* Criteria for pulmonary hypertensionNote: In question 3 - exertional dyspnea, and pedal edema are seen normally during pregnancy and do not indicate heart disease. During pregnancy due to relaxation of the smooth muscles of the arteries by the progesterone, blood pressure decreases (Ref. Dutta 7/e, p 53) i.e. systemic hypotension normally occurs during pregnancy.Distended neck veins are suggestive of heart disease in pregnancy and are not a normal physiological condition. | Gynaecology & Obstetrics | Medical & Surgical Illness Complication Pregnancy | Which of the following features indicates the presence of heart disease in pregnancy and which is not seen in normal pregnancy?
A. Exertional dyspnea
B. Distended neck veins
C. Systemic hypotension
D. Pedal edema
| Distended neck veins |
00194855-6308-40eb-84cb-eb9399229b02 | Alvimopan is a peripheral opioid antagonist used against opioid induced constipation. | Pharmacology | null | Which of the following is preferred in treating opioid induced constipation
A. Linaclotide
B. Lubipristone
C. Alvimopan
D. Prucalopride
| Alvimopan |
a065a49e-e112-417c-ae77-ae228b1ff9fb | Distant Direct Ophthalmoscopy Distance at which DDO performed is 25cm done with direct ophthalmoscope. contains light source viewing window. Normally red glow seen Interpretations Red glow= healthy retina Grey glow = Retinal Detachment No glow = vitreous haemorrhage Black spot in centre = cataract or corneal opacity GOLD STANDARD FOR LOCATING SUBLUXATED LENS: DDO | Ophthalmology | Optics and Errors of Refraction | Distance of distant direct ophthalmoscopy:
A. 25 cms
B. 50 cms
C. 75 cms
D. 100 cms
| 25 cms |
938eb4c6-bcfe-4103-83e3-554508dd0b7e | Ans. (a) Two different speciesType of TestApproachAcute toxicityDefined as dose that is lethal in approximately 50% of animals and is maximum tolerated dose.It requires usually two species, two routes, single dose.Subacute toxicityIt requires three doses and two species. 4 weeks to 3 months may be necessary prior to clinical trial.Chronic toxicityIt is done in Rodent and non-rodent species for 6 months or longer.Required when drug is intended to be used in humans for prolonged periods.Usually run concurrently with clinical trial.Carcinogenic potentialTwo years, two species.It is Required when drug is intended to be used in humans for prolonged periods.Mutagenic potentialEffects on genetic stability and mutations in bacteria (Ames test) or mammalian cells in cultureInvestigative toxicologyDetermine sequence and mechanisms of toxic action. Discover the genes, proteins, pathways involved. Develop new methods for assessing toxicity. | Pharmacology | Clinical Trials | For knowing the acute adverse effects of a drug, the drug micro doses should be tested on:
A. Two different species
B. On rabbit, one rodent
C. Two rabbits
D. Two rodents
| Two different species |
1d11bdbb-06a3-4c9d-95fd-89b964b591aa | Ans. is 'b' i.e. pulmonary embolism Ref: Miller's anesthesia 5th/e p1276First what is end tidal CO2The air exhaled during normal respiration initially consists of the dead space. Then a mixture of dead space air plus alveolar air comes out. The air coming out at the end consists purely of alveolar air.Measurement of concentration of gases in this alveolar air is useful for analysis. The CO2 concentration in the last 10ml. of tidal volume is known as end tidal CO2In pulmonary embolism the blood supply to certain parts of the lung is cut off due to the emboli in circulation. This reduces the exchange of gases between the alveoli and pulmonary capillaries, as a result the cone, of CO2 in alveolar air decreases (CO2 is carried from tissues to the lung by blood and is transferred to the alveoli in exchange of O2). The decrease in alveolar CO2 will lead to decrease in end tidal CO2.Other conditions in which end tidal CO2 decreasesIncrease in dead space (decrease in end tidal CO2 in pulmonary embolism can be explained by this also. Pulmonary embolism causes increase in physiological dead space hence decreases the end tidal CO2)HyperventilationMalignant hyperthermia. | Surgery | Heart & Pericardium | A patient undergoing surgery suddenly develops hypotension. The monitor shows that the end tidal CO2 has decreased abruptly by 155mm Hg. What is the probable diagnosis?
A. Hypothermia
B. Pulmonary embolism
C. Massive fluid deficit
D. Myocardial depression due to anaesthetic agent
| Pulmonary embolism |
8eb0eb03-69ac-42b8-8627-c3be71dae47d | C i.e. Congenital diaphragmatic hernia Left sided & whole lung involvementQ points towards diagnosis of Congenital diaphragmatic hernia, Cong. cystic .adenomatoid malformation (CCAM) and Congenital lobar emphysema all can present with multicystic Contralateral mediastinal shift & respiratory distress. | Radiology | null | A new born baby with acute respiratory distress on day 1. X Ray chest PA view showed neumerous gas luscencies in entire left hemithorax, most likely diagnosis is
A. Congenital lobar Emphysema
B. Pneumatocoel hernia
C. Congenital diaphragmatic hernia
D. Congenital lung cyst
| Congenital diaphragmatic hernia |
e438d2da-1b4e-4ccd-acd2-ce913579c7bf | Diagnostic markers GISTs and cajal cells express c-KIT (also known as CD117) and CD34. Most useful diagnostic marker is c-KIT and immunohistochemically detected in 95% of gastric GISTs GENERAL AND SYSTEMIC PATHOLOGY RAMDAS NAYAK FIRST EDITION PAGE 390 | Pathology | G.I.T | Best marker for GIST is
A. CD117
B. DOG 1
C. CD 34
D. CD 43
| CD117 |
618c87f7-7a3d-4dd1-88fb-b2ec732fbc78 | ALP is a nonspecific enzyme which hydrolyzes aliphatic, aromatic or heterocyclic compounds. the pH optimum for the enzyme reaction is between 9 and 10.it is activated by magnesium and manganese. zinc is a constituent ion of ALP.Ref: DM Vasudevan Biochemistry, page no: 305 | Biochemistry | Enzymes | Alkaline phosphatase contains
A. Cobalt
B. Zinc
C. Iron
D. Copper
| Zinc |
66fb9bee-4d05-4508-9644-f1704b5f4f03 | Answer is B (Reduced Total RBC distribution width Microcytic Hypochromic Anemias are typically associated with a Normal or High Red Cell Distribution Width Condition Test (normal values) Iron deficiency Thalassemia Sideroblastic anemia Anemia of chronic disease Smear Microcytic (MCV<80) Microcytic hypochromic Microcytic hypochromic Microcytic hypochromic Normocytic normochromic > Micro/hypochromic (but Micro/Hypo may be present) Serum iron (50-150n/d1) Low (<30) Normal Normal .1. (<50) TIBC (300-360 ug/dl) High (>360) Normal Normal (Chandrasoma Taylor) ,i, (<300) % Saturation (30-50%) < 10 (J') N or Ted (30-80) N or "I' (30-80) 4, (10-20) Ferritin (R/1) (50-200 ug/L) < 15 (fed) T (50-300) T (50-300) Normal or T (30-200) Hemoglobin pattern Normal Abnormal Normal Normal Free Erythrocyte Protporphrin Ted Normal Ted Ted RDW Ted Normal Normal Normal | Medicine | null | Which of the following is not expected in a case of Microcytic Hypochromic Anemia:
A. Reduced serum Iron
B. Reduced Total RBC distribution Width
C. Normal Ferritin levels
D. Increased TIBC
| Reduced Total RBC distribution Width |
bc3daeab-d3a7-4da7-b4d2-8549093e342e | The respiratory tract is a common portal of entry to such airborne organisms as M. tuberculosis. This is why respiratory precautions must be taken when patients are harboring viable M. tuberculosis. The GI tract is usually infected from ingestion of contaminated food or water (Shigella, Salmonella, and Campylobacter) or by an alteration of the normal microbial flora such as with C. difficile disease. The genital tract may become infected either by sexual contact or by alteration of the genital environment, as often occurs with yeast infections. Several bacteria such as N. gonorrhoeae, Chlamydia, and T. pallidum are transmitted by direct sexual contact with infected partners. | Microbiology | Bacteria | A college student is surprised one morning by painful urination and a cream-colored exudate. Any person who acquires the gram-negative microbe that causes this infection is most likely to have acquired it via which of the following?
A. GI tract
B. Genitourinary tract
C. Nasal tract
D. Respiratory tract
| Genitourinary tract |
4537a3b3-80d0-40ea-b854-f79adc170116 | Valproate is the most teratogenic, phenytoin also isn't safe. Phenobarbitone, lamotrigine, topiramate are relatively safe drugs but 4mg folic acid is required per day. Ref: KD Tripathi 8th ed. | Pharmacology | Central Nervous system | Most teratogenic in pregnancy
A. Phenytoin
B. Valproate
C. Barbiturate
D. Ethosuximide
| Valproate |
b1c76634-d18f-4664-b008-c40c4e8badc2 | Jejunum [Ref: Oxford textbook of medicine: Sections 18-33, Volume 3 By David A. Warrell 2005/e p6431 Oxford textbook of medicine writes- "The syndrome stigmata are obvious with multiple pigmented spots on the lips and buccal mucosa, and multiple benign hamaomatous polyps throughout the gastrointestinal tract, most frequently affecting the jejunum." Peutz-Jeghers syndrome is an autosomal dominant syndrome characterized by the combination of hamaomatous polyps of the intestinal tract and hyperpigmentation of the buccal mucosa, lips, and digits. The syndrome is associated with an increased (2%-10%) risk for cancer of the intestinal tract, with cancers repoed throughout the intestinal tract, from the stomach to the rectum. There is also an increased risk for extraintestinal malignancies, including cancer of the breast, ovary, cervix, fallopian tubes, thyroid, lung, gallbladder, bile ducts, pancreas, and testicles. | Surgery | null | . Peutz Jeghers polyps present most commonly in
A. Rectum
B. Colon
C. Esophagus
D. Jejunum
| Jejunum |
3afb4faf-3ac8-4476-84f9-f782557b0d57 | ANSWER: (B) Heimlich maneuverREF: Dhingras 4th ed p. 257Management of Laryngeal foreign body:A large bolus of food/ foreign body obstructed above the cords may make the patient totally aphonic, unable to cry for help. He may die of asphyxia unless immediate first aid measures are taken.H eimlichJs maneuvers: S udden thrust dire cte d up wards and backwards, b elo w the epigastrium, squeezes the air from the lungs, sufficient to dislodge a foreign body.Cricothyrotomy or emergency tracheostomy should be done if Heimlich's maneuvers fails.Once acute respiratory emergency is over, foreign body can be removed by direct laryngoscopy or by laryngofissure, if found impactedManagement of Tracheal and bronchial foreign bodies:Bronchoscopy under general anesthesia. Emergency removal of these foreign bodies is not indicated unless there is airway obstruction or they are of the vegetable nature (e.g. seeds) and likely to swell up. Methods to remove tracheobronchial foreign body:Conventional rigid bronchoscopy.Rigid bronchoscopy with telescopic aid.Bronchoscopy with C-arm fluoroscopy.Use of Dormia basket or Fogartys balloon for rounded objects.Tracheostomy first and then bronchoscopy through the tracheostome.Thoracotomy and bronchotomy for peripheral foreign bodies.Flexible fiber optic bronchoscopy in selected adult patients. | Anaesthesia | Fundamental Concepts | For foreign body causing sudden choking, most appropriate first line of management is?
A. Tracheostomy
B. Heimlich maneuver
C. Airway insertion
D. Laryngoscopy
| Heimlich maneuver |
adafe901-7ce4-42e8-bfbc-2c8a4fa71ad4 | Human Hb exists in a number of types which differ slightly in the structure of their globin moiety. HbA2 is minor Hb in the adult red cell with structural formula alpha 2 delta 2.Alpha with 141 aminoacid and delta with 146 aminoacids.It is present in very small amounts at bih and reaches adult level during first year of life. Increases in some types of thalasssaemia and occasionally occurs in megaloblastic anaemia.It may be reduced in iron deficiency anaemia. Alpha 2 beta 2 is HbA Alpha 2 gamma 2 is HbF(foetal Hb) Beta 2 gamma 2 doesnot exsist But zeta 2 gamma 2 is embryonic Hb - poland Ref:de Gruchy's Clinical hematology in medical practice 6th adapted edition.Page no.121 Ref Robbins 9/e pg 422 | Pathology | Haematology | HbA2 is -
A. Alhpa2Beta2
B. Alpha 2 Gamma 2
C. Beta 2 Gamma 2
D. Alpha 2 Delta 2
| Alpha 2 Delta 2 |
de3c73c2-d346-4637-8f1a-768b3f43ca78 | Malignant mesothelioma of pleura
Malignant mesothelioma in the thorax arise from either the visceral or the parietal pleura.
It is associated with exposure to asbestos.
Simian virus 40 (SV40) viral DNA has also been associated with malignant mesothelioma.
Morphology
Malignant mesothelioma is a diffuse lesion that spreads widely in the pleural surface and is usually associated with extensive pleural effusion and direct invasion of thoracic structures.
Malignant mesothelioma may be of following types, depending on the type of mesothelial cells that is present in the tumor.
1. Epithelioid type
Mesothelial cells develop as epithelium like lining cells.
Consists of cuboidal, columnar or flattened cells forming tubular or papillary structures.
Epithelioid type of mesothelioma resembles adenocarcinoma of lung and can be differentiated from it by following featurs:-
Positive staining for mucopolysaccharide.
Lack of staining for carcinoembryonic antigen (CEA).
Strong staining for keratin.
Positive staining for calretinin, wilms' tumor 1 susceptibility gene product, cytokeratin 5/6, mesothelin and thrombomodulin.
Presence of long microvilli and abundant tonofilaments but absent microvillous rootlets and lamellar bodies.
2. Sarcomatoid (mesenchymal type)
Mesothelial cells develop as mesenchymal stromal cells.
They appear as spindle cell sarcoma, resembling fibrosarcoma.
3. Mixed type (Biphasic type)
Contains both epithelioid and sarcomatoid patterns. | Pathology | null | Pleural mesothelioma is associated with-
A. Asbestosis
B. Berylliosis
C. Silicosis
D. Bagassosis
| Asbestosis |
31c0700b-5517-4e59-94aa-662fbfe01cf2 | - Vitamin B12/Cyanocobalamine is only obtainable through animal sources, therefore strict vegetarians develop B12 deficiency. - Vit B12 deficiency leads to :- Megaloblastic anemia Peripheral neuritis SCDSC Infeility Atrophic glossitis Peripheral neuropathy. | Social & Preventive Medicine | Vitamins and Nutritional Deficiencies | Vitamin for which only animal source is available is:-
A. Vitamin B1
B. Vitamin B2
C. Vitamin B12
D. Vitamin C
| Vitamin B12 |
a2c4c5a0-1839-4f36-9e5f-63d4312a3b61 | Ans.c (Sphingomyelinase) (Ref. Harper Biochemistry, 26th ed. 203; Table 24-1; OP Ghai 6th ed. 542, 616) SphingolipidosesInheritanceEnzyme DeficientCNS InvolvementVisceral Involvement1Fabry diseaseXLRAlpha-Galactosidase_+2Krabbe's diseaseARBeta-Galactosidase++3Farber diseaseARCeramidase+/--4Gaucher diseaseARBeta-Glucosidase+/-+5Metachromatic leukodystrophyARSulfatide sulfatase+-6Niemann-pick diseaseARSphigomyelinase++7Tay-sachs diseaseARHexosaminidase A+-8Sandhoff diseaseARHexosaminidase A,B++# NIEMANN-PICK DISEASE- Due to deficiency of sphingomyelinase- Stored material = sphingomyelin- C/f:* Enlarged liver and spleen,* Mental retardation,* Cherry-red spots,* Foam cells in blood,* Pulmonary infiltrates.# GAUCHER'S DISEASE- Due to deficiency of Acid b-Glucosidase- Stored material = Glucosylceramide- C/f:* Enlarged liver and spleen,* MR,* Erosion of long bones (Pathological of bones)* Foam cells in blood.# VON-GIERKE'S DISEASE (Type I - glycogenosis)- Due to deficiency of glu-6-phosphatase- C/f:* Growth retardation,* Liver and kidney enlarged due to increased glycogen content,* Hypoglycemia,* Hyperuricemia,* Hyper lipidemia, and* Lactate acidosis.Selected Lysosomal Storage DiseasesDisorderEnzyme Deficiency Stored MaterialInheritanceNeurologicLiver Spleen Enlarg- mentSkeletal DysplasiaOphthalmo- logicUnique featuresMucopolysaccharidoses (MPS)MPSIHHurleralpha-L-Iduro- nidase Dermatan sulfate Heparan sulfateARMental retardation Mental retardation None++++ + + +Corneal cloudingCoarse facies; cardiovascular involvement; joint stiffnessMPS II, HunterIduronate sulfataseDermatan sulfate Heparan sulfateX-linkedMental retardation, less in mild form++++ + + +Retinal degenera- tion, no corneal cloudingCoarse facies; cardiovascular involvement; joint stiffness; distinctive pebbly skin lesionsMPS III A, Sanfilippo AHeparan-N- sulfataseHeparan sulfateARSevere mental retardation++NoneMild coarse faciesMPS III B, Sanfilippo BN-Acetyl-a- glucosaminidaseHeparan sulfateARSevere mental retardation++NoneMild coarse faciesMPS III C, Sanfilippo CAcetyl-CoA: a- glucosaminide N-acetyltrans- feraseHeparan sulfateARSevere mental retardation++NoneMild coarse faciesMPS IIID, Sanfilippo DN-Acetylglucosa- mine-6-sulfate sulfataseHeparan sulfateARSevere mental retardation++NoneMild coarse faciesMPS IV A, MorquioN-Acetylgalacto- samine-6-sulfate sulfataseKeratan sulfate Chondroitin-6 sulfateARNone++ + + +Corneal cloudingDistinctive skeletal deformity; odontoid hypoplasia; aortic valve diseaseMPS VI B, Morquiob-Galactosidase ARNone+-+ + + + MPS VI,Maroteaux- LamyArylsulfatase BDermatan sulfateARNone+++ + + +Corneal cloudingCoarse facies; valvular heart diseaseMPS VIIb-GlucuronidaseDermatan sulfate Heparan sulfateARMental retardation, absent in some adults++++++Corneal cloudingCoarse facies; vascular involvement; hydrops fetalis in neonatal formGM2 GangliosidosesTay-Sachs diseaseb-Hexosamini- dase AGM2 gangliosidesARMental retardation; seizures; later juvenile formNoneNoneCherry red spot in infantile formMacro-cephaly; hyperacusis in infantile formSandhoff's- diseaseb-Hexosamini- dases A and BGM2 gangliosidesARMental retardation; seizures+++-Cherry red spotMacro-cephaly; hyperacusis Neutral GlycosphingolipidosesFabry'sDiseasea-Galactosi- dase AGlobotriaosyl- ceramideX-linkedPainfulAcropares- thesiasNoneNoneCorneal dystrophy, vascular lesionsCutaneous angiokeratomas; hypo- hydrosisGaucher's diseaseAcid b-glucosi- daseGlucosyl- ceramideARNone+ + + ++ + + +NoneAdult form highly variableGaucher's cells in bone marrow; cytopenias++++++++Eye movements+++ + + ++ + + + Niemann- Pick disease A and BSphingomye - linaseSphingo- myelinARMental retardation; seizures+ + + +None Osteopo- rosisMacular degenerationPulmonary infiltrates Lung failure Foam cells in bone marrowLeukodystrophiesKrabbe's diseaseGalactosyl- ceramidaseGalactosy-IceramideGalactosyls- phingosineARMental retardationNoneNoneNoneWhite matter globoid cellsMetachro- matic leukody - strophyArylsulfatase ACerebroside sulfateARMental retardation; dementia; and psychosis in adultNoneNoneOptic atrophyGait abnormalities in late infantile formMultiple sulfatase deficiencyActive site cysteine to C-a formylglycineconverting enzymeSulfatides; mucopoly - saccharidesARMental retardation+++Retinal degenerationAbsent activity of ail known cellular sulfatasesDisorders of Neutral LipidsWolman's diseaseAcid lysosomal lipaseCholesteryl esters; triglyceridesARMild mental retardation+++NoneNoneAdrenal calcificationCholesteryl ester storage diseaseAcid lysosomal lipaseCholesteryl estersARNoneHepato - megalyNoneNoneFatty liver disease; cirrhosisFarber's diseaseAcid ceramidaseCeramideAROccasional mental retardation+NoneMacular degenerationArthropathy, subcutaneous nodulesDisorders of GlycogenPompe's diseaseAcid a-glucosidaseGlycogenARNeuromuscular+-NoneNoneMyocar-diopathy | Biochemistry | Carbohydrates | Which of the following enzymes is deficient in Niemann- Pick disease?
A. Aryl sulfatase
B. Glucose-6-phosphatase
C. Sphingomyelinase
D. Beta glucosidase
| Sphingomyelinase |
cee7dbb4-251c-4918-b77c-191f8973ebc7 | Agglutination test:-insoluble antigen +antibody=clumps. Principle-When sera containingantibodies are mixed with antigen coated red cells, the antibody globulin coats the surface of the erythrocytes,though they are not agglutinated. When such erythrocytes coated with the antibody globulin are washednfree of all unattached protein and treated with a rabbitantiserum against human gamma globulin (antiglobulin or Coombs serum), the cells are agglutinated example:- 1. Coombs test (antiglobulin test or anti-Rh antibody test) is an agglutination test. The direct Coombs test is used to detect antibodies that are stuck to the surface of red blood cells. this. These antibodies sometimes destroy red blood cells and cause anemia. this in done for fetal ab(in vivo test) The indirect Coombs test looks for free-flowing antibodies against ceain red blood cells. It is is most often done to determine if you may have a reaction to a blood transfusion. done for detecting Maternal Ab(in vitro test) | Microbiology | Immunology Pa 1 (Immune Response, Antigen-Antibody Reactions, Hypersensitivity, Structure of Immune System, Immunodeficiency Disorders) | Coombs test is
A. Precipitation test
B. Agglutination test
C. CFT
D. Neutrilization test
| Agglutination test |
c0dc18dd-7d50-4b8a-ab7a-b6232880ef66 | - zoonoses have been defined as those disease and infection which are naturally transmitted between veebrate animals and man. - hydatid disease is a zoonotic disease of man . It is caused in man by the metacystode stage of the canine intestinal tapeworm, Echinococcus. The adult worms are found in dogs and other carnivores. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:276, 303 <\p> | Social & Preventive Medicine | Communicable diseases | Which of the following is a zoonotic disease -
A. Hydatid cyst
B. Malaria
C. Filariasis
D. Dengue fever
| Hydatid cyst |
7ee5751f-d2fc-4dc0-8432-ca16c6e68499 | Chromosome 21 [Ref: www.ihop netorgiunipub/ihopigi92248.htmll Transpo of folate compounds Folk acid transpo * Chromosome location ----> 21 q 223. * Gene name --> SLCI9AI solute carrier family 19 (folate transpoer), member * Gene product/function --> Transpoer for the iniake of folate. Transpo of folate occurs by novel mechanism called potocytosis which functionally couples three components namely the folate receptor, the folate transpoer and v-type h+ pump. * Alleles _> A 80G single nucleotide polymorphism | Pathology | null | Gene for folate carrier protein located on ?
A. Chromosome 10
B. Chromosome 5
C. Chromosome 21
D. Chromosome 9
| Chromosome 21 |
ecaae7ce-199c-4370-b258-db301154f392 | Ans. is 'd' i.e Reopen immediately Post tonsillectomy haemorrhages can be of two types :Primary or reactionary- occurs with in a few hrs of the operation (by definition within 24 hrs)Secondary haemorrhage- usually seen between 5th to 10th post - op dayIt is due to infection.*MxPrimary - return to the operation theatre where the bleeding vessel is ligated under anesthesia.Secondary - Patient should be readmitted to hospital;An appropriate dose of morphine for adults or heroin for children is injectedA course of systemic antibiotics.Bleeding vessel is searched and ligated if the conservative methods fail which is not common.Remember:MC vessel responsible for post tonsillectomy haemorrhage*- Palatine vein {also called as external palatine vein) | ENT | Ear | Ramu, 15 yrs of age presents with haemorrhage 5 hrs after tonsillectomy. Treatment of choice is
A. External gauze packing
B. Antibiotics & mouth wash
C. Irrigation with saline
D. Reopen immediately
| Reopen immediately |
9efa91c8-449e-4e66-8465-9ec409dbe165 | Sunray (sunburst) appearance and Codmans triangle ***typical freatures of Osteosarcoma ***may also be seen in Ewings sarcoma, osteomyelitis onion peel apperacne ***typical feature of Ewings sarcoma ***May also be seen in Osteosarcoma, and osteomyelitis Refer Maheshwari 9th/e p 240. | Anatomy | null | 7 years old child presents with a lesion in upper tibia. X ray shows radioluscent area with Codmans triangle and Sunray appearance. Diagnosis is
A. Ewing sarcoma
B. Osteosarcoma
C. Osteoid Osteoma
D. Chondrosarcoma
| Osteosarcoma |
f6a0fc8b-8811-490b-9736-9265a4aa2d7d | Ans. C: Breached basement membrane Carcinoma in situ (CIS) is an early form of carcinoma. When dysplastic changes are marked and involves the entire thickness of the epithelium but the leasion remains confined by the basement membrane, it is referred to as carcinoma in situ. Once the tumour cells breach the basement membrane, the tumour is said to be invasive. For example, carcinoma in situ of the skin, also called Bowen's disease, is the accumulation of neoplastic epidermal cells within the epidermis only. For this reason, CIS will usually not form a tumour. Rather, the lesion is flat (in the skin, cervix, etc) or follows the existing architecture of the organ (in the breast, lung, etc). Some CIS, however, form tumours, for example colon polyps or papillary cancer of the bladder as well as some CIS of the breast (more properly called Ductal Carcinoma in situ). Many forms of invasive carcinoma originate from a CIS lesion. Therefore, CIS is considered a precursor or incipient form of cancer that may, if left untreated long enough, transform into a malignant neoplasm. These terms are related since they represent the three steps of the progression toward cancer: Dysplasia is the earliest form of pre-cancerous lesion recognizable in a biopsy Dysplasia can be low grade or high grade. The risk of low-grade dysplasia transforming into cancer is low. Carcinoma in situ is synonymous with high-grade dysplasia in most organs. The risk of transforming into cancer is high. Invasive carcinoma, commonly called cancer, is the final step in this sequence. | Pathology | null | Invasive carcinoma differs from carcinoma in situ by: March 2005
A. Abnormal nuclear morphology
B. Pleomorphism
C. Breached basement membrane
D. Mitoses
| Breached basement membrane |
794cd01b-d91f-47b9-9302-3daf81d48770 | Mucomycosis is an oppounistic infection which is, common in diabetics, presenting with blackish nasal discharge. | ENT | null | A 40 year old diabetic presents with blackish nasal discharge and a mass in the nose, likely diagnosis is:
A. Mucormycosis
B. Actinomycosis
C. Rhinosporiodosis
D. Histoplasmosis
| Mucormycosis |
5196b904-bd40-4ddd-82a9-b10feb0b0fb7 | Somatostatin receptor scintigraphy helps in improved visualization of neuroendocrine tumors. Octreoscan utilizes a somatostatin analogue In 111 labelled diethylenetriamine penta-acetic acid octreotide to visualize somatostatin receptor-positive tumors. When compared to CT or MRI octreoscan detects additional metastasis in about 1/3rd of patients. Other nuclear scintigraphy techniques used are: MIBG: It is absorbed by carcinoid tumor cells. Iodine labelled MIBG has an overall sensitivity of 55 to 70% in detecting NETs. Although it is less sensitive than octreoscan, its advantage is that it can be used in patients who are treated by long acting octreotide. Ref: Jakob J.A., Contreras C.M., Odisio B.C., Gupta S., Abdalla E.K., Yao J.C. (2011). Chapter 23. Neuroendocrine Tumors. In H.M. Kantarjian, R.A. Wolff, C.A. Koller (Eds), The MD Anderson Manual of Medical Oncology, 2e. | Radiology | null | Neuroendocrine tumors (NET) can be best detected by:
A. PET scan
B. HRCT scan
C. MRI
D. Radionuclide scan
| Radionuclide scan |
9fc266e8-395c-4382-953c-d44a91acf98c | Ans. is 'c' i.e., Tubulo-glomerular feedback Autoregulation of GFRThe GFR is normally well autoregulated in the range of 70-180 mm Hg of systemic pressure. Feedback mechanisms intrinsic to the kidney normally keep the renal blood flow and GFR relatively constant, despite marked changes in aerial blood pressure. The relative constancy of GFR and renal blood flow is referred to as autoregulation. The primary function of autoregulation in other tissues (other than kidneys) is to maintain the delivery of oxygen and nutrient at a normal level and to remove the waste products of metabolism, despite changes in aerial pressure. In the kidneys, the non-nal blood flow is much higher than that required for these functions. the major function of autoregulation in the kidney is to maintain a relatively constant GFR and to allow precise control of renal excretion of water and solutes.There are two plausible hypotheses for explaining the autoregulation of GFR (i) Tubuloglomerular feedback hypothesis, and (ii) Myogenic hypothesis.Tubulo-glomerular feedbackTo perform the function of autoregulation, the kidneys have a feedback mechanism that links changes in sodium chloride concentration at the macula densa with the control of renal aeriolar resistance. This feedback helps to ensure a relative constant delivery of sodium chloride to the distal tubule and helps prevent spurious fluctuations in renal excretion that would otherwise occur.The tubuloglomerular feedback mechanism has two components that act together to control GFR : - i) An afferent aeriolar feedback mechanism (usually this component is referred to as tubuloglomerular feedback, and ii) An efferent aeriolar feedback mechanism. These feedback mechanisms depend on the juxtaglomerular apparatus which consists of : (i) Macula densa, i.e., specialized epithelium of distal tubule where it comes in contact with afferent aeriole, (ii) Juxtaglomerular cells, i.e., modified smooth muscle cells of afferent aeriole, and iii) Lacis cells.Afferent aeriolar feedback mechanism : - Decrease in renal aeriolar pressure causes decrease in GFR and as a result low NaCI is delivered to distal tubules. This is sensed by macula densa and the signal is transmitted to afferent aerioles which causes decreased resistance of afferent aerioles. Decreased afferent aeriolar resistance increases glomerular hydrostatic pressure and therefore GFR. The transmitter involves is adenosine which causes opening of Ca*2 channels.Efferent aeriolar feedback mechanism : - Decreases GFR causes delivery of less NaCl to distal tubule, which is sensed by macula densa cells and the signal is transmitted to juxtaglomerular (JG) cells which secrete renin. As a result renin angiotensin system is activated and there is generation of angiotensin II which causes constriction of efferent aeriole. This results in increased glomerular capillary hydrostatic pressure and increased GFR.Opposite occurs when there is increase aerial pressure and increased GFR. Increased NaCl is delivered to the macula densa which causes constriction of afferent aeriole and decrease,: renin by JG cells with decreased efferent aeriole resistance.It would be wise to know about glomerulotubular balance, which may be confused by tubuloglomerular feedback.Glomerulotubular balance : - Tubular reabsorption in proximal tubules is load-dependent, i.e., when the GFR increase, the reabsorption of the filtrate in the proximal tubule increases propoionately. It occurs because tubular reabsorption is flow-limited. Because of glomerulotubular balance, the urinary Na+ output does not increase massively when the GFR increases.Myogenic AutoregulationAfferent aerioles constrict in response to augmented blood pressure. Aeriolar constriction restores GFR to normal levels. Possibly, stretching of aerioles leads to the opening of stretch - sensitive Ca+2 channels on aeriolar smooth muscle cells resulting in a Ca+ influx that causes the cells to contract. | Physiology | null | With increased flow to loop of Henle, decreased in GFR is by ?
A. Countercurrent exchanger
B. Glomerulotubular balance
C. Tubulo-glomerular feedback
D. Countercurrent multiplier
| Tubulo-glomerular feedback |
e2995392-383d-4293-b05d-0e01e24cb42c | Answer is C (Lower 1/3rd) The most common site of adenocarcinoma esophagus is the lower 1/3rd of esophagus Esophageal Adenocarcinoma invariably arises from Barret's esophagus (Barret's ulcer) which is characteristically located in the distal esophagus around the gastroesophageal junction. | Medicine | null | The most common site of esophageal adenocarcinoma is:
A. Upper 1/3rd
B. Middle 1/3rd
C. Lower 1/3rd
D. Upper 2/3rd
| Lower 1/3rd |
ec007111-1f1e-44f4-a9d3-87953ed0ab57 | ANSWER: (A) Type IREF: APPENDIX-21 below for "HYPERSENSITIVITY REACTIONS"Wheal-and-flare reaction: (Stedman s Medical Dictionary)The characteristic immediate reaction to an injected allergen in a skin test, in which an irregular blanched wheal, appears surrounded by an area of redness. Also called as wheal and erythema reaction. APPENDIX - 21Hypersessitivity ReactionsTYPE 1:Allergy/Atopy/' AnaphylaxisTrue AnaphylaxisFree Ag - fixed IgE (on mast cell)Wheal and Flare reaction Casoni s test, anaphylaxis, prusnitz kunster reaction, Theobald smith phenomenon, Schultz dale phenomenon, Atopic dermatitis, Pseudoanaphylaxis (Anaphylactoid reaction)Free Ag - direct degranulation of mast cell (not IgE mediated)Iodine-containing radio contrast (me), aspirin and muscle reiaxants, morphineTYPE 2:AntibodydependentcytotoxichypersensitivityFree Ab - fixed AgIgM IgG/ComplementmediatedAutoimmune hemolytic anemiaHemolytic disease of the newborn (erythroblastosis fetalis)Autoimmune thrombocytopenic purpuraGoodpasture's syndrome: Pemphigus vulgarisBullous pemphigoid; Acute rheumatic feverPernicious anemia: Myasthenia gravis; Graves' diseaseADCC- antibody- dependent cell-mediated cytotoxicityAcute & chronic transplant rejectionTYPE 3: Immune complexFree Ag+ Free Ab - Immune complexSerum sicknessArthus reactionSystemic lupus erythematosus (SLE)Immunoglobulin therapyHyperacute graft rejectionAcute necrotizing vasculitisPolyarteritis nodosa Post streptococcal glomerulonephritisShick s testTYPE 4: Delayedhypersensitivity,cell-mediated,antibody-independentAg -T cell mediated (CD4/CD8)Delayed: CD4mediated .contact & tuberculin types with in 72 hours, Granulomatous type; 21-28 days]Contact dermatitis; Mantoux (tuberculin) testLepromin testChronic transplant rejectionMultiple sclerosisPhlyctenular keratoconjunctivitisJones mote reaction (cutaneous basophilic hypersensitivity)Direct cell toxicity:CD8 mediatedPerforin dependent killingFas-FasL dependent killingAlso know: Graft rejection is type 4 hypersensitivity unless type is provided. (Most of the MCQ guides have quoted this falsely)HyperacuteType 3AcuteType 4 >2 (both if provided)Acute cellular rejection = type 4 (better prognosis) Acute vascular rejection = type 2ChronicType 2 | Microbiology | Immunology | Wheal and Flare reaction is which type of Hypersensitivity?
A. Type I
B. Type II
C. Type III
D. Type IV
| Type I |
ce5578d7-703c-4f47-afcf-43064ce75f6c | Pancreatic juice contains lipase, colipase, phospholipase A & B Colipase: Facilitates the action of lipase Prevents inactivation of lipase by bile salts | Physiology | Gastrointestinal System | Colipase acts with:
A. Lipoprotein lipase
B. Pancreatic lipase
C. Gastric lipase
D. Salivary lipase
| Pancreatic lipase |
8e2cd6c4-717b-44c4-8962-3df7bb54273e | Adult Hb- 50% saturation at PO2 of 26mmHg.
1mmHg= 0.133 KPa
26mmHg= 0.133 X 26 = 3.45 | Physiology | null | The normal value of P50 on the oxyhaemoglobin dissociation curve in an adult is
A. 1.8 kPa
B. 2.7 kPa
C. 3.6 kPa
D. 4.5 kPa
| 3.6 kPa |
d6cb4741-0918-4056-9783-976d80ae9124 | The classical features of acute appendicitis begin with poorly localised colicky abdominal pain.Central abdominal pain is associated with anorexia, nausea and usually one or two episodes of vomiting that follow the onset of pain (Murphy). Anorexia is a useful and constant clinical feature, paicularly in children. The patient often gives a history of similar discomfo that settled spontaneously. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1207,1208 | Surgery | G.I.T | Confirmation of appendicitis
A. Clinical examination
B. USG abdomen
C. X-ray abdomen
D. Raised TLC\/DLC
| Clinical examination |
f6d5364f-40a1-4ce8-8070-c22653c5b8f0 | There are 4 phases of a clinical trial. Once the drug is released into market pharmacovigilance is done - comes under phase 4 of drug trial to asses the safety, cost effectiveness of the drug once marketed Ref: K.D.Tripati.7th ed. Pg 82-83 | Pharmacology | General pharmacology | The postmarketing trial comes under
A. Phase 1 clinical trial
B. Preclinical trial
C. Phase 3 clinical trial
D. Phase 4 clinical trial
| Phase 4 clinical trial |
e659e4f4-cd09-4a55-a982-dfa8e6ce4dd7 | Ref, Robbins 8/ep27,9/ep56 Apoptotic cells express phosphatidylserine in the outer layers of their plasma membrane.This phospholipids move out from the inner layer where it is recognised by number of receptors on the phagocytes. | Anatomy | General anatomy | Annerix V on non permeable cell is indicative of
A. Apoptosis
B. Necrosis
C. Cell entering replication phase
D. Cell cycle arrest
| Apoptosis |
619d5b7e-cfe3-4c57-9b61-767ee954319e | Ans. B: CT scan Contrast CT is the imaging method of choice for delineating pancreas as well as demonstrating necrotizing pancreatitis and many of the complications of acute pancreatitis (e.g. pancreatic pseudocyst) Accuracy of contrast CT >90% when there is more than 30% glandular necrosis Presence of pancreatic necrosis is a good marker of prognosis. However in early stages routine contrast CT is of little value in the critically ill. Administration of contrast may increase risk of renal failure | Surgery | null | Investigation of choice for Acute pancreatitis: September 2005 & 2006
A. X-ray abdomen
B. CT scan
C. USG
D. ERCP
| CT scan |
003545bb-ce46-4e13-bfb1-c38579ad9fcf | Mitochondrial pyruvate carboxylase catalyzes the carboxylation of pyruvate to oxaloacetate, an ATP- requiring reaction in which the vitamin biotin is the coenzyme.
Biotin binds CO2 from bicarbonate as carboxybiotin prior to the addition of the CO2 to pyruvate.
The resultant oxaloacetate is reduced to malate, exported from the mitochondrion into the cytosol and there oxidized back to oxaloacetate.
Key Concept:
Biotin is the co-enzyme for pyruvate carboxylase which carboxylates pyruvate into oxaloacetate
Ref : Harper’s illustrated biochemistry, 31st edition. | Biochemistry | null | Biotin is required for the activity of
A. Pyruvate carboxylase
B. Lactate dehydrogenase
C. Succinate thiokinase
D. Phosphohexose isomerase
| Pyruvate carboxylase |
370ffe78-4184-4183-b468-aa0d534314f5 | - ECL cells lie in deep recesses of oxyntic glands & is associated with parietal cells of glands - Under influence of gastrin (secreted by G-cells), ECL cells release Histamine directly to deep oxyntic gland. Then histamine acts quickly to stimulate Hcl secretion Parietal cell / oxyntic cell: - Present in body of stomach & secrete Hcl & intrinsic factor (B12 vit absorption) - PH of this acid is about 0.8 (3 million times > PH of aerial blood) - Main driving force of Hcl secretion | Hydrogen-potassium pump (H+ - K+ adenosine triphosphatase ) - HCL secretion is under regulation of Endocrine = gastrin Neurocrine = Vagus (Ach) Paracrine = ECL (Histamine) - Chief / peptic cells Secrete large quantities of pepsinogen | Physiology | FMGE 2018 | Histamine is secreted by:
A. Enterochromaffin cell
B. Parietal cell
C. Oxyntic cell
D. Chief cell
| Enterochromaffin cell |
81e1e9d8-2af8-44b4-9953-721d0899e5b6 | Drugs which do not form active metabolite- S- sho acting T- temazepam O-oxazepam L-lorazepam E- estazolam | Pharmacology | Sedative-Hypnotics and Parkinsonism | Which of the following drug does not form active metabolite ?
A. Flunitrazepam
B. Diazepam
C. Oxazepam
D. Nitrazepam
| Oxazepam |
bd416545-b5e9-47fd-8739-f610831e0843 | (Ref: Khurana 6th/e p.176 & 4th/e p.150; Yanoff 3rd/e p.815; Ocular pathology by Yanoff 6th/e p.57) Clinical features Acute bacterial endophthalmitis occurs within 7 days of operation and is characterized by severe ocular pain, redness, lacrimation, photophobia and marked loss of vision. | Anatomy | General anatomy | Which of the following is not a clinical feature of Endophthalmitis?
A. Vitritis
B. Corneal edema
C. Hypopyon
D. Cranial nerve palsies
| Cranial nerve palsies |
84299061-ecb0-4a12-9d0b-edf7e104776c | A fouh sound can sometimes be heard immediately before the first sound when atrial pressure is high or the ventricle is stiff in conditions such as ventricular hyperophy. It is due to ventricular filling and is rarely heard in normal adults.Ref: Ganong&;s Review of medical physiology 25th edition. Page: 542 | Physiology | Cardiovascular system | Fouh hea sound is caused by
A. Closure of AV valves
B. Closure of semilunar valves
C. Rapid ventricular filling
D. Atrial contraction
| Atrial contraction |
b7b2827b-e9b0-47f8-a722-4eae639b0a55 | Other early changes in mitral stenosis include prominence of the main pulmonary arteries and backward displacement of the esophagus. CXR changes are caused by enlargement of the left atrium. Severe disease can cause pulmonary congestion (Kerley B lines) and enlargement of the right ventricle, right atrium, and superior vena cava. | Medicine | C.V.S. | A 37-year-old woman presents with shortness of breath on exertion. She has a past history of rheumatic fever as a child. On cardiac auscultation, there is a loud S1 and a mid-to-late low-pitched diastolic murmur. You suspect she has mitral stenosis. Which of the following findings is most likely to be seen on the CXR in someone with mitral stenosis?
A. general enlargement of the heart
B. Kerley B lines
C. attenuation of pulmonary arteries
D. straightening of the left heart border
| straightening of the left heart border |
32686767-e538-4a99-9ef6-596cddd265f0 | Streptococcal toxic shock syndrome is caused by pyrogenic exotoxin. Pyrogenic exotoxin (erythrogenic, shock, scarlatinal toxin): the primary effect of the toxin is induction of fever and so it was renamed streptococcal pyrogenic exotoxin (SPE). 3 types of SPE are identified- A, B, C. Types A and C are coded by bacteriophage genes while type B gene is chromosomal. SPE is superantigens, T cell mitogens that induce a massive release of inflammatory cytokines, causing fever, shock and tissue damage. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 213 | Microbiology | Bacteriology | Toxin involved in the streptococcal toxic shock syndrome is
A. Pyrogenic toxin
B. Erythrogenic toxin
C. Hemolysin
D. Neurotoxin
| Pyrogenic toxin |
959dcb0f-019b-41e5-86e0-8494d379a863 | Ans. is 'b' i.e., Continue the drug in same dose Valproic acid has the risk of fetal malformations during the first trimester of pregnancy. This patient has normal level II scan at 5 months of pregnancy so the risk period of valproate is already over and valproate is the drug of choice in juvenile myoclonic epilepsy. Thus the drug shoud be continued in the same doses. | Gynaecology & Obstetrics | null | Patient of juvenile myoclonic epilepsy on valproate comes to you at 5 months of pregnancy with level H scan normal what will you advise?
A. Change the drug
B. Continue the drug in same dose
C. Decrease the dose of drug
D. Increase the dose of drug
| Continue the drug in same dose |
3edf33ed-9f4a-4ff4-9c58-48bed7c31217 | The catheter penetrated the jugular vein and traumatized the lung parenchyma damaging the lung tissues leading to PNEUMOTHORAX OPTION B - Takes time to form septicemia OPTION C: MCC of ARDS is Sepsis so, not related to question OPTION D: In Infective Endaeritis fever develops and not respiratory distress | Medicine | Pneumothorax | On putting an internal jugular vein catheter, a patient has developed sudden onset severe respiratory distress. Clinical diagnosis is?
A. Pneumothorax
B. Sepsis
C. ARDS
D. Infective endaeritis
| Pneumothorax |
7bc6dbbd-4b58-43ee-a497-7f502632f7e0 | Bulimia nervosa * Gender==== more common in females * Age=======adolescence * Comorbidity=== depression and social phobia * Duration====3 months * Criteria= * Binge eating at least once a week for 3 months * Uses laxatives, diuretics, self-induced vomiting * Association= * Impulsive behaviors * increased interest in sex * They may be of normal weight * Less secretive * Mood disorders * Complication * Electrolyte abnormalities * Hypokalemia * Hypochloremia alkalosis * Russel's sign==== as these patients uses their fingers to be stick out in the throat and vomit, there is a lesion in meta carpo phalangeal joints. * Drugs * Carbamazepine * MAOI * SSRI Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 509 | Anatomy | Treatment in psychiatry | duration criteria for bulimia nervosa is
A. 3 months
B. 5 months
C. 4 months
D. 6 months
| 3 months |
cadc02cf-5a43-4b45-a7c5-c71f5ea92c8b | The veins of pericardium drains into svc, pierced anteriorly . Ref - BDC 6th edition vol 1 pg 272 | Anatomy | Thorax | The veins of the pericardium drain into
A. Superior vena cava
B. Inferior vena cava
C. Azygos vein
D. Left brachiocephalic vein
| Superior vena cava |
d922dd6c-be1e-40ef-81b4-0a8bdbcb9b74 | Infection is caused by Actinomyces israelii, a grampositive anaerobe. It may be associated in IUCD users more with noncopper devices. | Gynaecology & Obstetrics | Genital Tract Infections (Too hot to handle!) | Actinomyces pelvic infection is most associated with?
A. STDs
B. Unsafe aboions
C. Immuno - compromised patients
D. IUCD users.
| IUCD users. |
3c7c7d15-8b23-4bfc-8e99-e5beb8abe0d2 | Ans. is 'b' i.e., Nose * To detect MRSA carrier Nasal swab is taken.* S. aureus is part of normal human flora. The anterior nares is the most frequent site of human colonization although the skin (especially when damaged), vagina, axilla, perineum and oropharynx may also be colonized. | Microbiology | Bacteria | MRSA carrier status is diagnosed by taking sample swab from -
A. Skin
B. Nose
C. Oral cavity
D. Perineum
| Nose |
19a3f2fe-c35a-491d-be17-711c04ba4683 | (A) Elevated Creatine kinase # Laboratory abnormalities of NMS:> Elevated serum CK -- Laboratory findings often reflect the clinical manifestations of NMS with more severe rigidity leading to more profound creatine kinase (CK) elevation.> In NMS, CK is typically more than 1000 IU/L and can be as high as 100,000 IU/L.> Normal CK can be seen if rigidity is not clearly well developed, particularly early in the onset of the syndrome.> Elevated CK, particularly in the mild to moderate range, is not specific for NMS and is often seen in patients with acute and chronic psychosis due to intramuscular injections and physical restraints, and sometimes without specific explanation.> CK levels greater than 1000 IU/L, however, are probably more specific for NMS, and the degree of CK elevation correlates with disease severity and prognosis.> Other-- Other laboratory abnormalities are common but nonspecific.> A consistent laboratory finding is leukocytosis, with a white blood cell count typically 10,000 to 40,000/mm3 . A left shift may be present.> Mild elevations of lactate dehydrogenase, alkaline phosphatase, & liver transaminases are common.> Electrolyte abnormalities - Hypocalcemia, Hypomagnesemia, Hypo & Hypernatremia, Hyperkalemia, & Metabolic Acidosis are frequently observed.> Myoglobinuric acute renal failure can result from rhabdomyolysis.> Low serum iron concentration (mean 5.71 pmol/L; normal 11 to 32 pmol/L) is commonly seen in NMS patients and is a sensitive (92 to 100 percent) but not specific marker for NMS among acutely ill psychiatric patients> Investigations FBC often shows leukocytosis. U&Es may show metabolic disturbance due to acidosis or renal failure. Hypocalcaemia is a frequent association. Arterial blood sample to assess acid-base balance. LFTs may show elevated transaminases and lactate dehydrogenase (LDH) of muscle origin. CK is usually elevated. Urine myoglobin should be checked. Coagulation studies (particularly prothrombin time, activated partial thromboplastin time and international normalised ratio (INR)) should be checked (to detect coagulopathy). A urinary drug screen should be performed (particularly for salicylates, cocaine and amfetamines). If sepsis is suspected then blood and other relevant cultures should be taken.> Imaging may be indicated: CXR should be considered if sepsis is suspected. CT scan of the head, in order to exclude other diagnoses. Lumbar puncture may be required to exclude other diagnoses (particularly where there is fever and altered mental status). There are no significant cerebrospinal fluid (CSF) findings in neuroleptic malignant syndrome (NMS) other than raised protein. | Psychiatry | Miscellaneous | The specific laboratory finding often reflect the clinical manifestations of Neuroleptic Malignant Syndrome (NMS) is
A. Elevated Creatine kinase
B. Hypocalcemia
C. Increased Alkaline phosphatase
D. Leukocytosis
| Elevated Creatine kinase |
b7ef7a7e-91f1-4f40-9e9c-00432e395cd0 | Ans. is 'b' i.e., Oval window Perilymph fistula In this condition, perilymph leaks into the middle ear through the oval or round window. Perilymphatic fistula (so positive fistula test) may occur due to a defect in one of three locations : 1. Oval - window (most common site) Stapedectomy surgery (for otosclerosis) Head trauma or Barotrauma (Pressure injury) Acoustic trauma 2. Round window (rupture of round window membrane) Barotrauma :- SCUBA diving, airplane pressurization Congenital malformations (mondini dysplasia) 3. Otic capsule Another possible location for a fistula is in the bone of the ear (the otic capsule). This is a rare condition where the bone between the ear and brain area is missing or thin, causing symptoms very similar to that of round or oval window fistula. Causes are :- Superior canal dehiscence syndrome Cholesteotoma Fenestration surgery (surgically created window in horizontal SCC) Erosion of Horizontal (lateral) SCC due to any cause Temporal bone fracture Micro fissure | ENT | null | Most common site of perilymph fistula ?
A. Round window
B. Oval window
C. Otic capsule
D. Attic
| Oval window |
9547e546-1bf9-48dd-996f-36cae7879724 | Ans. b. Macular cones (Ref: Yanoff and Duker 4/e p460)Multifocal ERG is useful to assess the function of macular cones.Multifocal ERG (mfERG)The multifocal ERG (mfERG) has supplanted focal ERG testing and records multiple local ERG responses elicited from the central 40--50 degrees of the retina under light- adapted conditions.These responses are then displayed individually so that abnormal spatial variations can be localized to their corresponding areas in the macula, perimacula, or remaining posterior pole.Clinically, mfERG testing is most useful to assess macuiar function in patients with unexplained or central loss of vision who may have a normal full-field ERG.The mfERG can aid in the diagnosis of macular diseases including Stargardt's dystrophy, cone dystrophy, occult macular dystrophy, and hydroxychloroquine toxicity.Ring ratio analysis of mfERGs provides a quantitative measure that can be helpful in early detection of diseases that cause dysfunction in the pericentral macula, such as in hydroxychloroquine toxicity.Fig. 23: Typical electroretinogram showing a, b and c waves. The dip in the lower line indicates the point of stimulationElectroretinogram (ERG)In ERG, changes in the resting potential of the eye, induced by the stimulation of the eye with a light stimulus, are measured.In the normal dark-adapted eye, after a fleeting early receptor potential, three components are seen:Negative a-wave* Possibly representing the activity of the rods and conesQPositive (composite) b-wave* Arising in the inner retinal layers: and, with strong stimuli, a secondary rise in potentialQc-wave* Related not to visual processes but to retinal metabolism, associated particularly with the pigmentary epitheliumQ.The ERG measures a global response and essentially gives an indication of the activity of the entire retina, that is, of the rods and cones and their immediate connections.The rod response is selectively tested in the dark-adapted state with a blue light stimulus (scotopic ERG).The cones are tested in bright light (photopic ERG) or with a flickering light stimulus of >20 Hz, which is higher than the critical fusion frequency of rods.The pattern ERG indicates the activity of the central macular region and its corresponding nerve connections: it is used to diagnose early glaucomatous damage.ERG (Normal ERG is biphasic)Extinguished ERG* Advanced retinitis pigmentosa. CRAO. complete old retinal detachment, advanced siderosisSubnormal ERG* Early retinitis pigmentosa, large area of retina is not functioningNegative ERG* Gross disturbances of retinal circulationPattern ERG* Indicates activity of central macular regionMultifocal ERG* For disorders of central retina/fovea | Ophthalmology | Techniques of Ocular Examination and Diagnostic Tests | Multifocal ERG is useful to assess the function of:
A. Rods
B. Macular cones
C. Ganglion ceils
D. Retinal pigment epithelium
| Macular cones |
e0ca5a07-a1ad-499c-a92d-719a7ff1af01 | Image 1 ⇒ Rachitic rosary
Image 2 ⇒ Widening of wrists | Pediatrics | null | A mother brings her child to clinic with short stature. On examination following physical findings are seen. Doctor advises for the below investigations. Calcium - Normal, Phosphorous - Increased, PTH - Increased, Alvaline Phosphatase - Increased. What is the most probable diagnosis
A. Chronic renal failure
B. Vitamin D deficiency rickets, type 1
C. Vitamin D deficiency rickets, type 2
D. Hypophasphatemic rickets
| Chronic renal failure |
40da2f5d-f108-4af3-9506-d3f7601b0fe3 | - Given clinical features are suggestive of Acromegaly; which is d/t increased growth hormone, produced by pituitary adenomas. - C/F of Acromegaly: Enlargement of terminal poions of extremities & jaw Headaches and visual disturbances d/t compression on optic chiasma. Menstrual irregularities in women Diabetes mellitus. 1/3rd have hypeension. Hypercalciuria & renal stones in 1/5th of patients - Somatotroph adenoma that arises in a child or adolescent before the epiphyses close results in gigantism. | Pathology | Miscellaneous | A 48-year-old man presents with recurrent headaches and ahritic pain in his knees of 9 months in duration. He notes that his head size has recently increased. Physical examination reveals a blood pressure of 170/100 mm Hg. The patient is observed to have coarse facial features and a goiter. Urinalysis reveals glucosuria and hypercalciuria. Which of the following is the most likely explanation for this patient's clinical presentation?
A. Excess growth hormone secretion
B. Excess parathyroid hormone secretion
C. Excess prolactin secretion
D. Hypersecretion of bone morphogenetic protein
| Excess growth hormone secretion |
2fa86d31-9e49-4c20-937b-32076858232f | Ans is "C" i.e. measurement of catecholamine This patient is having MEN syndrome more specifically MEN type 2, which includes. Medullary carcinoma of thyroid and Pheochromocytoma Headache and flushing are manifestation of pheochromocytoma which can be diagnosed by measuring catecholamine level in urine or blood. | Surgery | null | A patient presented with headache and flushing. He has a family history of his relative having died of a thyroid tumour. The investigation that would be required for this patient would be -
A. Chest X-ray
B. Measurement of 5 HIAA
C. Measurement of catecholamine
D. Intravenous pyelography
| Measurement of catecholamine |
c69cc126-c7a0-41c8-8af5-f75304717cf0 | The chief causes of severe sustained hypeension identified included chronic glomerulonephritis , obstructive uropathy , reflux nephropathy , thrombotic microangiopathy and renovascular disease . ref:Harrison&;s principles of internal medicine,ed 18,pg no | Medicine | C.V.S | Commonest cause of sustained severe hypeension in children
A. Endocrine causes
B. Coarctation of aoa
C. Renal parenlchyma disease
D. Pheochromocytoma
| Renal parenlchyma disease |
499329d9-56d9-46a9-a1f7-6ec582d00e17 | - The most appropriate course of management in this case would be Conservative management - CECT | Depending upon the findings proceed for surgery | Surgery | Spleen | A 30-year-old person met with a roadside accident. On admission his pulse rate was 120/minute, BP was 100/60 mmHg. USG examination revealed laceration of the lower pole of spleen and hemoperitoneum. He was resuscitated with blood and fluid. Two hours later, his pulse was 84/ minute and BP was 120/70 mm Hg. The most appropriate course of management in this case would be:
A. Exploring the patient followed by splenectomy
B. Exploring the patient followed by excision of the lower pole of spleen
C. Splenorrhaphy
D. Continuation of conservative treatment under close monitoring system and subsequent surgery if fuher indicated
| Continuation of conservative treatment under close monitoring system and subsequent surgery if fuher indicated |
28c5b41d-647a-4d80-b7a7-57101527b9e1 | It is caused most commonly by staphylococcus aureus Refer Maheshwari 6th/e p 168 | Anatomy | Skeletal infections | Acute osteomyelitis is caused by
A. Staphylococcus aureus
B. Actinomyces bovis
C. Nocardia asteroids
D. Borelia vincenti
| Staphylococcus aureus |
fbfe94fd-4d9f-479b-8706-30fb86812353 | Synergists: It refers to the muscles having the same primary action in the same eye; e.g., 1) superior rectus and inferior oblique of the same eye act as synergistic elevators. 2) Inferior rectus and superior oblique of the same eye act as synergistic depressors. Ref:- A K KHURANA; pg num:-316 | Ophthalmology | Ocular motility and squint | Left superior oblique and left inferior rectus are
A. Yoke muscles
B. Antagonists
C. Agonists
D. Synergists
| Synergists |
feb9bb74-76f4-4e9f-8787-cf02d9df7ef9 | PID resulting in salpingitis is an important cause of infertility.
Infertility from PID can occur due to following organisms:
a. Chlamydia
b. Gonorrhea
c. Tuberculosis
d. Mycoplasma (Specifically ureoplasma)
Certain Infections cause Intrauterine synechiae or asherman syndrome thus leading to infertility like:
e. Schistosoma | Gynaecology & Obstetrics | null | Common causes of infertility are:a) Chlamydiab) Gonorroheac) Mycoplasmad) Pneumococcus
A. ab
B. bc
C. acd
D. abc
| abc |
6f35c93b-84f3-4802-8dd3-599e079a43f8 | Retinoschisis does not need active treatment as compared to retinal detachement Retinoschisis : * Term is used to describe splitting of inner retinal layers(intra neurosensory layer). * Can be acquired or juvenile X linked congenital retinoschisis * Absolute scotoma is seen as a clinical feature * Beaten metal appearance is seen over elevated retinal surface * Does not require active treatment * Inferotemporal location is most common * Laser will blanch retinoschis but not a retinal detachment * OCT is the investigation of choice to diagnose * May be seen in cases of pathological myopia | Ophthalmology | Retina | Which of the following is not a feature of retinoschisis
A. Splitting of inner retinal layers
B. Require active treatment
C. Caweel maculopathy is seen
D. May be seen in patients of high myopia
| Require active treatment |
47b9f3d0-ffa3-482e-a2b3-0faa40035ccf | Preformed antibodies will cause hyperacute rejection.
T cells will cause acute rejection. | Surgery | null | Hyperacute rejection of transplant is due to
A. T cell mediated
B. B cell mediated
C. Preformed antibodies
D. Macrophage mediated injury
| Preformed antibodies |
133afa25-e1c7-4dff-b24d-704c36c90531 | Factor V mutation also called as leiden's mutation Leiden's mutation is characterized by substitution of amino acid at the position 506 Arginine at this position is replaced by glutamine Protein C and S inhibit the activity of Factor V and VIII In Factor V mutation, Factor V gets resistant to the action of protein C and S, then Factor V won't get inhibited, which is responsible for causing higher risk of development of thrombosis Inheritable causes of hypercoagulability Factor V mutation (commonest) Mutation in the activity of homocysteine Mutation in the activity of prothrombin gene | Pathology | NEET 2018 | Factor V mutation is commonly associated with:-
A. Hemahrosis
B. Hematemesis
C. Thrombosis
D. Epistaxis
| Thrombosis |
dc257320-ca6a-442d-b303-257341cba7de | Ans. is 'a' i.e., Modified macrophages Pathologic Features of Acute Rheumatic Fever Aschoff bodies focal inflammatory lesions seen in acute rheumatic fever consisting of foci of T lymphocytes, occasional plasma cells, and plump activated macrophages. These activated macrophages called Anitschkow cells (pathognomonic for Rheumatic Fever) have abundant cytoplasm and central round-to- ovoid nuclei (occasionally binucleate) in which the chromatin condenses into a central, slender, wavy ribbon (hence also called "caterpillar cells"). Pancarditis - During acute RF, diffuse inflammation and Aschoff bodies may be found in any of the three layers of the hea, resulting in pericarditis, myocarditis, or endocarditis Verrucae are small (1 to 2 mm) vegetations overlying necrotic foci and along the lines of closure of valves. o MacCallum plaques are irregularly thickened subendocardial lesions usually in the left atrium. o Mitral stenosis - Fish Mouth or Button - Hole stenosis. | Pathology | null | Antischkow cells are ?
A. Modified macrophages
B. Modified neutrophils
C. Modified B cells
D. Modified RBCs
| Modified macrophages |
c4da5418-3479-4210-9b2e-638e3340e758 | MIDAS Questionnaire is used for assessment of disability in migraine Disease Scores Migraine Disability Assessment Score MIDAS Screening tool for Dementia MMSE Used for Diabetic Retinopathy study ETDRS Used in Multiple Sclerosis EDSS | Medicine | Headache And Migraine | Which of the following is used to assess disability in migraine?
A. MIDAS
B. MMSE
C. EDSS
D. ETDRS
| MIDAS |
1fb01b5f-161c-4ca9-9ada-435fee39d519 | Answer- D. 4The alpha-thalassemias are caused by inherited deletions that result in reduced or absent synthesis of alpha-globin chains.Normally, there are four alpha-globin genes. | Pathology | null | In a-thalassemia, Hb Bas is said when number of gene loci affected is:
A. 1
B. 2
C. 3
D. 4
| 4 |
8fbc2341-0392-4065-bb10-067bb070786b | Four bump heaMS/MR Due to left atrial appendage enlargementGlassy hea on ECHOAmyloidosisDouble Cardiac shadow, Double density sign, Bedford signLeft Atrial EnlargementDock&;s sign, E-Sign, Figure of 3 sign, Reversed E sign, Inveed 3 signCoarctation of the aoaDouble aoic knuckleAoic dissectionJughandle appearancePrimary pulmonary hypeensionMaladie de Roger effectsmall VSDHilar dance (Pulmonary plethora)ASDBox-shaped heaTricuspid atresiaWater bottle / Flask shaped hea / Leather bottle / Pear shaped / money bag hea/Purse like hea/Epicardial fat pad signPericardial effusionCoeur en Sabot ie., Boot shaped heaTetrology of heaSpade-like deformity on ECHOAtypical HOCMEgg in Cup appearance, Square root signConstrictive PericarditisInveed moustache signMitral stenosisEgg on side appearance, Egg shaped hea, Egg in StringD-Transposition of great aeries (D-TGA)Convex left hea borderL-TGAGround glass ventricular septumHyperophic Obstructive Cardiomyopathy (HOCM)Straight left upper cardiac borderEbstein&;s anomalyConcave main pulmonary segment and right aoic archPersistent TruncusAeriosusSnowman sign, Figure of 8 sign, Cottage loaf signTotal Anomalous Pulmonary Venous Connection (TAPVC)Gooseneck signAtrio-ventricular septal defectTubular heaEmphysemaStag antler / Hands up signCCFSchimitar sign / Turkish sword appearanceCongenital venolobar syndromeSitting duck signpersistent TruncusAeriosusYin Yang SignPseudoaneurysmSmall hea signTension PneumopericardiumHigh attenuating Crescent signImpending rupture of an abdominal aoic aneurysmDraped Aoa signContained rupture of an abdominal aoic aneurysm(Ref: Problem Solving in Radiology: Cardiovascular Imaging by SuhnyAbbara and SanjeevaKalva) | Radiology | All India exam | The ground glass ventricular septum is seen in
A. TOF
B. HOCM
C. TGA
D. CHF
| HOCM |
2b914563-e45e-4c5b-a956-898049c68022 | "The highest grade tumor of astrocytoma, known as glioblastoma, has a histologic appearance similar to anaplastic astrocytoma with the additional features of necrosis and vascular or endothelial cell proliferation and pseudo-palisading nuclei."
Glioblastoma is type of infiltrating astrocytoma (Classified as Grade 4).
Necrosis in glioblastoma often results in a SERPENTINE pattern in areas of hyper-cellularity.
Tumor cells collect along the edges of the necrotic regions, producing histologic pattern referred to as pseudopalisading pattern.
GLIOMAS
Gliomas are tumors of the brain parenchyma that histologically resemble different types of glial cells. The major types of tumor in this category are:
a. Astrocytomas
b. Oligodendrogliomas
c. Ependymomas.
ASTROCYTOMAS
Two major categories of astrocytoma, infiltrating and non-infiltrating types.
Infiltrating astrocytomas account for about 80% of adult primary brain tumors.
They are most frequent in the fourth through sixth decades.
They are usually found in the cerebral hemispheres.
The most common presenting signs and symptoms are seizures, headaches and focal neurologic deficits related to the anatomic site of involvement.
Infiltrating astrocytomas show a spectrum of histologic differentiation that correlates well with clinical course and outcome.
Based on the degree of differentiation, they are classified into four groups:
Pilocytic astrocytoma - Grade I - Most common
Astrocytoma - Grade 2
Anaplastic astrocytoma - Grade 3
Glioblastoma multiforme - Grade 4 - Least differentiated
PILOCYTIC ASTROCYTOMA
Pilocytic astrocytomas are relatively benign tumors, often cystic, that typically occur in children and young adults.
They are usually located in the cerebellum; also in the floor and walls of the third ventricle, the optic nerves, and occasionally the cerebral hemispheres.
A pilocytic astrocytoma is often cystic, with a mural nodule in the wall of the cyst; if solid, it is usually well circumscribed.
The tumor is composed of areas with bipolar cells with long, thin “'hairlike” processes that are GFAP positive: Rosenthal fibers, eosinophilic granular bodies, and microcysts are often present.
Necrosis and mitoses are absent.
OLIGODENDROGLIOMAS
These tumors constitute about 5% to 15% of gliomas and are most common in the fourth and fifth decades.
Patients may have had several years of neurologic complaints, often including seizures. The lesions are found mostly in the cerebral hemispheres, with a predilection for white matter.
Oligodendrogliomas are infiltrative tumors that form gelatinous, gray masses, and may show cysts, focal hemorrhage and calcification.
On microscopic examination, the tumor is composed of sheets of regular cells with spherical nuclei containing finely granular chromatin (similar to normal oligodendrocytes) surrounded by a clear halo of cytoplasm.
The tumor typically contains a delicate network of anastomosing capillaries. Calcification, present in as many as 90% of these tumors, ranges from microscopic foci to massive depositions.
With increasing cell density, nuclear anaplasia, increased mitotic activity and necrosis, the tumor becomes higher grade (anaplastic oligodendroglioma.)
Patients with oligodendrogliomas have a better prognosis than do patients with astrocytomas.
Current treatment with surgery, chemotherapy, and radiotherapy yields an average survival of 5 to 10 years.
Patients with anaplastic oligodendroglioma have a worse prognosis.
EPENDYMOMAS
Ependymomas most often arise next to the ependyma-lined ventricular system, including the central canal of the spinal cord.
In the first two decades of life, they typically occur near the fourth ventricle and constitute 5% to 10% of the primary brain tumors in this age group.
In adults, the spinal cord is their most common location; tumors in this site are particularly frequent in the setting of neurofibromatosis type 2.
Because ependymomas usually grow within the ventricles. CSF dissemination is a common occurrence.
In the fourth ventricle, ependymomas are typically solid or papillary masses extending from the floor of the ventricle.
These tumors are composed of cells with regular, round to oval nuclei with abundant granular chromatin.
Between the nuclei there is a variably dense fibrillary background.
Tumor cells may form round or elongated structures (rosettes, canals) that resemble the embryologic ependymal canal, with long, delicate processes extending into a lumen. More frequently present are perivascular pseudo-rosettes in which tumor cells are arranged around vessels with an intervening zone consisting of thin ependymal processes directed toward the wall of the vessel.
Anaplastic ependymomas show increased cell density, high mitotic rates, necrosis and less evident ependymal differentiation.
The clinical outcome for completely resected supratentorial and spinal ependymomas is better than for those in the posterior fossa. | Pathology | null | "Pseudopalisading" arrangement of malignant cells is characteristic of:
A. Glioblastoma
B. Ependymoma
C. Oligodendroglioma
D. Medulloblastoma
| Glioblastoma |
9ff1b39e-3523-4c43-aeb4-2e8190f093bd | Acute laryngotracheobronchitis or croup is a viral infection caused by parainfluenza type 1, 2, and sometimes 3. The critical area involved is subglottic larynx producing oedema with stridor and respiratory distress. X-ray (PA view) larynx shows typical "steeple sign" but X-rays are avoided as any manipulation may precipitate acute obstruction. Ref: PL Dhingra 7th edition of Ear, Nose and Throat; Pg no 328 | ENT | Larynx | Steeple sign is seen in
A. Croup
B. Acute epiglottitis
C. Laryngomalacia
D. Quinsy
| Croup |
5ff1c598-70b9-41c8-a40d-7b1c13390466 | VHL gene mutation is associated with neurocutaneous syndrome Von - Hipple - Lindau disease. It is associated with Hemangioblastomas, cysts, Renal cell carcinoma. | Pathology | null | VHL gene is located on?
A. 3q
B. 3p
C. 5p
D. 5q
| 3p |
521095cd-26b7-45ad-b688-2d2355415336 | Dermatomyositis a. Heliotrope erythema and oedema of the periorbital skin are seen in dermatomyositis, b. Dermatomyositis is a well established cutaneous marker of interval malignancy. c. About 10% of all patients of dermatomyositis have an underlying malignancy. d. The most common malignancies associated with dermatomyositis are Lung, Ovary, breast, GIT and lymphoprol iterative disorders. | Physiology | All India exam | 'Heliotrope rash' over face is seen in
A. Systemic sclerosis
B. Dermatomyositis
C. Systemic lupus erythematosus
D. Rheumatoid ahritis
| Dermatomyositis |
6e1702ad-dfeb-4274-95de-052628a319d6 | Ans. B. Adenomatous polyp.. (Ref. Robbin's pathology 8th/pg. 618)Robbin's pathology 8th/pg. 618....."Adenomas are neoplastic polyps that range from small, often pedunculated, tumors to large lesions that are usually sessile. Incidence of adenomas in the small intestine is very low compared to those arise in the colon.The prevalence of colonic adenomas is 20% to 30% before age 40, rising to 40% to 50% after age 60. Males and females are affected equally. There is familial predisposition to sporadic adenomas, accounting for about a fourfold greater risk for adenomas among first-degree relatives, and also a fourfold greater risk of colorectal carcinoma in any person with adenomas"Polyps of the Large Intestine.TypeHistologic DiagnosisNeoplasticAdenomaTubular adenoma (adenomatous polyp)Tubulovillous adenoma (villoglandular adenoma)Villous adenoma (villous papilloma)CarcinomaHamartomasJuvenile polypPeutz-Jeghers polypInflammatoryInflammatory polyp (pseudopolyp) Benign lymphoid polypUnclassifiedHyperplastic polypMiscellaneousLipoma, leiomyoma, carcinoid# Inflammatory polyps have no malignant potential. Cancer developing in asso with hamartomas is rare.# Hyperplastic polyps are not neoplastic and therefore do not become malignant.# Juvenile polyps- are hamartomatous proliferations, mainly of lamina propria, enclosing widely spaced, dilated cystic glands.- They occur most frequently in children younger than 5 years old but also are found in adults of any age; in the latter group they may be called retention polyps.- Irrespective of terminology, the lesions are usually large in children (1-3 cm in diameter) but smaller in adults; they are rounded, smooth, or slightly lobulated and sometimes have a stalk as long as 2 cm.- In general, they occur singly and in the rectum, and being hamartomatous have no malignant potential.- Juvenile polyps may be the source of rectal bleeding and in some cases become twisted on their stalks to undergo painful infarction.# Syndromes of juvenile polyposis have been defined:# (1) Juvenile polyposis syndrome: (1/100,000 population): (juvenile polyposis and ectodermal lesions).# (2) Bannayan-Riley-Ruvalcaba syndrome: (juvenile polyposis and macrocephaly and genital hyperpigmentation), and# (3) Cowden's disease (juvenile polyposis and facial trichilemmomas, thyroid goiter and cancer, and breast cancer).# (4). Although juvenile polyps are hamartomas with a low malignant potential, the risk of GI cancer is increased in familial juvenile polyposis patients and their relatives. The lifetime risk of colorectal cancer with juvenile polyposis syndrome is 30-60%. Furthermore, hamartomas can coexist with adenomas, and one must not assume that a polyp is a hamartoma without proof. Colonoscopic excision is performed for large or symptomatic (bleeding, intussusception) lesions. Some juvenile polyps autoamputate. Colectomy is required in patients with familial juvenile polyposis.# Peutz-Jeghers syndrome- is an uncommon autosomal dominant disease (1/200,000 population) in which multiple hamartomatous polyps appear in the stomach, small bowel, and colon.- There is melanotic pigmentation of skin and mucous membranes, especially about lips and gums.- Until recently the Peutz-Jeghers hamartomas were thought to be without malignant potential, but adenomatous changes and the development of malignancy have been described.- The lifetime risk of colorectal cancer has been reported to be 39%.- Polyps are generally removed only if symptomatic, but patients should undergo continued surveillance. Carcinoma also develops at an increased rate in other tissues, eg, stomach, duodenum, pancreas, small intestine, and breast. | Pathology | G.I.T. | Colonic Polyp that has maximum chance of malignant change?
A. Hyperplastic polyp
B. Adenomatous polyp
C. Juvenile polyp
D. Polyp of Peutzeger syndrome
| Adenomatous polyp |
96c23a4f-3ee1-41ea-91b8-79bdb6ce6df3 | If multiple myeloma occurs as a solitary lesion it is known as Plasmacytoma
Age gp is 6th-7th decade, Rare before 40yrs of age
So the lytic lesion in a 13 yrs old boy cannot be a plasmacytoma | Orthopaedics | null | 13, years old boy, the LEAST common cause of proximal lytic lesion of the head of the femur is -
A. Plasmacytoma
B. Metastasis
C. Histiocytosis
D. Bone tumour
| Plasmacytoma |
f8227ae2-5dc5-4922-b2fa-e27fb5306691 | Suvorexant MOA : Orexin 1 and 2 receptors inhibitor Orexin antagonist enhance REM and non-REM sleep. Suvorexant decreases sleep onset latency Dose : 10-mg dose within 30 min of going to bed S/E : Daytime somnolence | Pharmacology | Sedative-Hypnotics and Parkinsonism | Which orexin receptor antagonist is approved for treatment of insomnia ?
A. Suvorexant
B. Doxepin
C. Ritanserin
D. Agomelatine
| Suvorexant |
2c2932a5-7d82-451b-9734-67a5c7499fa1 | Methods to induce or augment labor are contraindicated by most conditions that preclude spontaneous labor or delivery. The few maternal contraindications are related toPrior uterine incisionType contracted or distoed pelvic anatomy,Abnormally implanted placentas, and Uncommon conditions such as active genital herpes infection or cervical cancer. Fetal factors include Appreciable macrosomiaSevere hydrocephalusMalpresentationNonreassuring fetal statusRef: Willaim&;s Obstetrics; 25th edition | Gynaecology & Obstetrics | General obstetrics | Contraindication of induction of labour among the following is
A. Contracted pelvis
B. Bad obstetrical history
C. Diabetes
D. Hea disease
| Contracted pelvis |
63bf9364-0226-4f29-9b77-de17ef6e2c7d | Ans. D: CPDMnemonic for FORCEPS:Favourable head position and station Open os (fully dilated)Ruptured membranesContractions present and Consent Engaged head, Empty bladderPelvimetry-no major CPDStirrups, lithotomy positionThe following are contraindications to forceps-assisted vaginal deliveries:Any contraindication to vaginal delivery.Refusal of the patient to verbally consent to the procedureCervix not fully dilated or retractedInability to determine the presentation and fetal head positionInadequate pelvic sizeConfirmed cephalopelvic dispropoionUnsuccessful trial of vacuum extraction (relative contraindication)Absence of adequate anesthesia/analgesiaInadequate facilities and suppo staffInexperienced operator | Gynaecology & Obstetrics | null | Contraindication for applying forceps: March 2009
A. Crowning of head
B. Head station +1
C. Maternal cardiac disease
D. CPD
| CPD |
fa74cf8e-6c89-4000-8191-4b335f9376ad | Phenomena resulting from lymphatic obstruction in advanced breast cancer
1. Peaud* orange Peau d' orange is due to cutaneous lymphatic edema, where the infiltrated skin is tethered by the sweat ducts, it cannot swell, leading to an appearance like orange skin. Occasionally it may be seen in a chronic abscess.
2. Cancer-en-cuirasse Is infiltration of the skin with carcinoma
3. Lymphangiosarcoma It’s a rare complication of lymphodema with an onset many years following the treatment.
It takes the form of multiple subcutaneous nodules in the upper limb and must be distinguished from recurrent carcinoma of the breast. | Surgery | null | Peau d’orange appearance is due to -
A. Intra-epithelial cancer
B. Sub-epidermal cancer
C. Lymphatic permeation
D. Vascular embolization
| Lymphatic permeation |
9e918ba4-23b3-4379-a5f6-b40516007d6b | Calcium gluconate is used to decrease potassium toxicity along with insulin. Calcium chloride is 2nd choiceRef: | Pharmacology | General pharmacology | Which of the following drug is used for hyperkalemia?
A. Calcium gluconate
B. Glucagon
C. Sodium phosphate
D. Chloride salts
| Calcium gluconate |
ec337e61-0883-4ab3-aa51-636b30ac89aa | Ans. is 'c' i.e., Head trauma Purtscher retinopathyo Occurrence of bilateral patches of retinal whitening and hemorrhage around the optic disc in patients who suffered massive head trauma was first described by Purtscher and is called Purtscher retinopathy. | Ophthalmology | Traumatic Lesions | Purtscher retinopathy is seen in patients with -
A. Complication of chronic pancreatitis
B. Occlusion of anterior retinal artery
C. Head trauma
D. Diabetes mellitus
| Head trauma |
08fb0113-f430-4445-84a9-ef0072bfa834 | Ans.B.)12-24 hours Ovulation occurs 34 to 36 hours after the onset of the LH surge and about 10 to 12 hours after the LH peak. | Physiology | null | LH peak occurs how many hours before ovulation ?
A. 36-48 hrs.
B. 12-24 hrs.
C. 48-72 hrs.
D. 72-96 hrs.
| 36-48 hrs. |
92b70865-b201-4d25-972f-ef3079cb038a | Ans. is 'd' i.e., Standardized moality rate Special incidence rates i) Attack rate (case rate) ii) Secondary attack rate iii) Hospital admission rate | Social & Preventive Medicine | null | Which one of the following is not a special incidence rate-
A. Attack rate
B. Secondary attack rate
C. Hospital admission rate
D. Standardized moality rate
| Standardized moality rate |
b7cc4806-cb5d-4a00-a4ca-75b265265fe0 | Answer- C. PCOSRotterdam criteriaTwo of the following three criteria are required :Oligo/anovulationHyperandrogenismClinical (hirsutism or less commonly male pattern alopecia) orBiochemical (raised FAI or free testosterone)Polycystic ovaries on ultrasound | Surgery | null | Rotterdam criteria are used to evaluate -
A. CA Breast
B. Aberrations in normal development and involution
C. PCOS
D. CA Cervix
| PCOS |
e3f23718-cc7c-4369-be21-2e85ecc4ea1c | Neonatal complications Respiratory distress syndrome Hypoglycemia Polycythemia Hyperbilirubinemia Hyperviscosity Cardiomyopathy Bih trauma Reference: Textbook of Obstetrics; Sheila Balakrishnan, 2nd edition; Page no: 241 | Gynaecology & Obstetrics | Medical, surgical and gynaecological illness complicating pregnancy | Not a feature of diabetes mellitus in pregnancy
A. Postdatism
B. Hydramnios
C. Neonatal hyperglycemia
D. congenital defect
| Neonatal hyperglycemia |
93638f2d-6b25-4fe9-8cd1-39fe7f952d3c | Ans: C Akathasia is the complication. It's the most common extrapyramidal side effect to develop due to use of antipsychotics. it appears within hoursto weeks of starting anti psychotics. Doc is propranolol. | Psychiatry | Pharmacotherapy Management of Children and Adolescents | A19 year old boy suffering from chronic schizophrenia is put on haloperidol in the dose of 20 mg/day. A week after the initiation of medication the patient shows restlessness, fidgety, irritability and cannot sit still at one place. The most appropriate treatment strategy is -
A. Increase in the dose of haloperidol
B. Addition of anticholinergic drug
C. Addtion of beta blocker
D. Adding another antipsychotic drug
| Addtion of beta blocker |
7f0eec99-88fd-47d3-b64e-bca0955c5bef | Answer- C. Steroid1. Medical treatmentPrednisolone (steroid) is the drug of choice and is staed at initial visit. Initiation of therapy during first 24 hours of symptom confers a higher likelihood of recovery.Antiviral therapy (Acyclovir) is a newer adjunct in treating acute facial palsy of viral origin (both Bell's palsy and Ramsay hunt syndrome).Most surgeons these days advocate combination of steroids and antiviral drugs. | ENT | null | Evidence based therapy of Bell's palsy include(s):
A. Facial nerve massage
B. Facial nerve stimulation
C. Steroid
D. Acyclovir
| Steroid |
e4e4ee27-43e5-4bf5-bced-77043682864d | Ans. is 'a' i.e., Hypertension Minimal change disease (lipoid nephrosis)* Minimal Change Disease is the most common cause of Nephrotic syndrome in children.* Edema and Selective proteinuria are features of nephrotic syndrome. Fever may be present on account of increased susceptibility to infection.* Minimal change disease prsents with insidious onset of nephrotic syndrome in children below 6 years of age.* Hypertension is not a feature of nephrotic syndrome and is rare in Minimal change disease. Hematuria (a finding of nephritic syndrome) is also rare.* Pathological findings include :1. Light microscopy - No abnormality2. Electron microscopy - Obliteration (loss) and fusion of foot processes of epithelial cells.3. Immunofluorescence - No deposits of immune reactants4. Serum complements - Normal levels* Urine shows lipid cast, hyaline cast, no RBC or WBC.* Minimal change disease has very good prognosis with excellent response to steroids. | Pediatrics | Kidney | Which of the following is not a feature of Minimal change disease?
A. Hypertension
B. Edema
C. Proteinuria
D. Responsive to steroid therapy
| Hypertension |
30c19d4b-e9df-4e14-8042-20cde472edb9 | Secretions of stomach
- HCl- Parietal cells/ Oxyntic cells
- The intrinsic factor of Castle- Parietal cells/ Oxyntic cells
- Pepsinogen- Chief cells/ Peptic cells
- Gastrin- G cells
- Somatostatin- D cells
- Histamine- ECL cells | Physiology | null | The intrinsic factor of the castle is secreted by which of the following cells in gastric glands
A. Chief cells
B. Parietal cells
C. Enterochromaffin cells
D. B cells
| Parietal cells |
392035ee-0139-4c6e-adea-e4497e6a152f | Ans. is 'd' i.e., Methoxyflurne Methoxyflurane It was most potent inhalation agent (least MAC), but not used not (now Halothane is most potent). o It should not be used in closed circuit (reacts with rubber tubing of the losed circuit). It has slowest onset & recovery (however now ether has slowest onset & recovery as methoxyflurane is not used). o Boiling point is more than water (104degC). Intrarenal metabolism of methoxyflurane and subsequent intrarenal production of fluoride ion is the significant cause of methoxyflurane renal toxicity. It can cause high output renal failure and hepatotoxicity | Anaesthesia | null | Which anaesthetic is contraindicated in renal failure?
A. Isoflurane
B. Desflurane
C. Halothane
D. Methoxyflurne
| Methoxyflurne |
4c5512af-79f6-4aae-ab4c-a59134c9926f | Ans. C: Ketamine Ketamine is classified as an NMDA (N-methyl-D-aspaate) receptor antagonist, and at high, fully anesthetic level doses, ketamine has also been found to bind to opioid (mu) receptors and sigma receptors. Like other drugs of this class such as tiletamine and phencyclidine (PCP), it induces a state referred to as "dissociative anaesthesia" and is used as a recreational drug. Ketamine has a wide range of effects in humans, including analgesia, anaesthesia, hallucinations, elevated blood pressure, and bronchodilation. It is primarily used for the induction and maintenance of general anaesthesia, usually in combination with some sedative drug. Ketamine is usually injected intravenously or intramuscularly, but it is also effective when insufflated, smoked, or taken orally. When used at anaesthetic doses, it will usually stimulate rather than depress the circulatory system, so I/ V anaesthetic of choice for shock. Ketainine produces a dissociative state, characterised by a sense of detachment from one's physical body and the external world which is known as depersonalization and derealization. At sufficiently high doses users may experience what is coined the "K-hole", a state of dissociation whose effects are thought to mimic the phenomenology of schizophrenia. | Anaesthesia | null | Anaesthetic of choice in asthma patients: March 2007
A. Halothane
B. Thipentone
C. Ketamine
D. Feanyl
| Ketamine |
bcff1006-1f49-4150-84f5-cc8eb13844db | ARSENIC * Copper arsenite - sheele&;s green * Copper acetoarsenite - paris green * Permissible limits of arsenic in ground water - 0.05mg/L * The gastroenteric type of poisoning resembles cholera * Greatest quantity is seen in - liver * Red velvety appearance of mucosa of stomach * Most affected pa of the stomach - pylorus * Subendocardial petechial hemorrhages of the ventricle is typical of arsenic poisoning (also found in phosphorus, barium, mercury and in cases of heat stroke and acute infectious disease e.g. influenza) * Rigor mois lasts longer than usual, Delays putrefaction Ref ; Narayana reddy 33rd ed. | Forensic Medicine | All India exam | Arsenic poisoning presents with symptoms mimicking
A. Cholera
B. Dhatura poisoning
C. Barbiturates poisoniong
D. Morphine poisoning
| Cholera |
b33ee74b-ac01-4a85-bfcf-35d373786287 | According to Rook and Colleagues the extra corporeal photochernotherapy for drug resistant pemphigus vulgaris include administration of 8-methoxypsoralen followed by exposure of peripheral blood to ultraviolet radiation. It is also used for vitiligo and graft versus host disease. | Pathology | null | Psoralane Ultra Violet A (PUVA) therapy is advised in
A. Pemphigus vulgaris
B. Apthous ulcers
C. Carcinoma in situ
D. ANUG
| Pemphigus vulgaris |
ab76263d-6370-40df-9edb-dd57f42b313b | An ectopic thyroid gland can be located anywhere from the base of the tongue to the mediastinum. It often results in the failure of descent resulting in either a linginal thyroid or ectopic thyroid in the midline of the neck. The so called lateral aberrant thyroid is usually a metastasis from papillary carcinoma of the thyroid.Angioneurotic edema is an acute allergic reaction, which causes a sudden swelling of the whole tongue with airway obstruction. | Surgery | Neck | A 5-year-old girl presents with difficulty breathing. On examination, of the oral cavity a 3 cm mass is found in the midline on the posterior aspect of the tongue. The most likely diagnosis is:
A. Lingual tonsil
B. Lingual thyroid
C. Foreign body stuck to the tongue
D. Dermoid
| Lingual thyroid |
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