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135
99d540ec-42f0-49ad-97cb-80732db7f32d
Which of the following diseases of the skin is the most likely to be associated with partial anodontia?
erythema multiformae
hereditary ectodermal dysplasia
keratosis follicularits
lichen Onus
1b
single
Ectodermal dysplasia is characterized by congenital dysplasia of ectodermaL structures, manifested as hypohidrosis (partial or complete absence of sweat glands) hypotrichosis and hypodontia or partial anodontia. Two types Hypohidrotic (Christ-Siemens-Touraine syndrome) most common type and includes dental manifestations. Hidrotic (Clouston syndrome)- no specific dental defects are seen.
Pathology
null
c6c67fbf-0828-44e5-8045-23e831a6fd99
Early neonatal sepsis occurs within (hours) -
8
12
36
72
3d
single
Ans. is 'd' i.e., 72 hours
Pediatrics
null
fb793de0-b15e-4ee3-90fe-c6304678bb08
Cylindrical dilatation of renal tubules is seen in -
Polycystic disease of kidney
Medullary cystic disease
Wilms tumour
Lipoid nephrosis
0a
single
null
Pathology
null
39fde928-8afe-4690-96a8-b4522aa58f2e
All the following are features of Tropical pulmonary eosinophilia except
Eosinophilia>3000/mm3
Microfilaria in blood
Paroxysmal cough and wheeze
Bilateral chest mottling and increased bronchivascular markings
1b
multi
In TPE Microfilaria are rapidly cleared from blood stream by the lungs . Thus, Microfilaria are sequestrated in the lungs . Ref Harrison 19th edition pg 1686-87
Anatomy
Respiratory system
a9395f17-d6de-46bc-9c1e-c1f527d410a3
Feilization occurs in which pa of the fallopian tube
Ampulla
Isthmus
Interstitial
Infundibular
0a
multi
REF : DUTTA OBG 9TH ED
Gynaecology & Obstetrics
All India exam
8f009fea-3837-4f02-9018-17bf2c35519e
Naturally occurring LA –
Cocaine
Lidocaine
Bupivacaine
Tetracaine
0a
multi
Cocaine is the only naturally occuring local anaesthetic, obtained from leaves of Erythroxylon coca.
Anaesthesia
null
9f949b71-ee37-4529-baae-71e8064b75c9
The dangerous paicle size causing pneumoconiosis varies from ?
100-150 m
50-100 m
10-50 m
1-5 m
3d
single
Ans. is 'd' i.e., 1-5 m Pneumoconiosis o Pneumoconiosis is an occupational lung disease caused by the inhalation of dust. o The development of pneumoconiosis depends on - (i) The amount of dust retained in the lungs and airways. (ii) The size, shape of the paicles --> The most dangerous paicle ranges from Ito 5 m in diameter because they may reach the terminal small airway and air sacs and settle in their linings. (iii) Paicle solubility and physiochemical reactivity. (iv) Additional effects of other irritants (e.g. concomitant smoking). Impoant pneumoconiosis o Cool worker's pneumoconiosis (CWP) --> Coal dust o Silicosis (grinder's disease) --> Silica dust o Asbestosis --> Asbestos dust o Beryliosis --> Berylium dust o Siderosis --> Iron dust o Byssinosis --> Cotton dust
Pathology
null
b52bcdad-1153-4599-8c15-68193a4b1492
An 6 cm simple ovarian cyst was identified in late pregnancy, what would be the best management ?:
Emergency laparotomy
Removal after after 6 weeks of puerperium
Removal early in the puerperium
Conservative as most tumors would subside
2c
single
Treatment of ovarian tumour in pregnancy depending on time of pregnancy: During pregnancy In an uncomplicated case, the best time of elective operation is b/w 14-18wks as chances of aboion are less and access to the pedicle is easy. But if the tumour is diagnosed beyond 36 weeks, tumour is removed early in puerperium. During labour If the tumour is above the presenting pa watchful expectancy is followed but if its impacted in pelvis, caesarian section should be done followed by removal of tumour in same setting. During puerperium The tumour should be removed as early in puerperium as possible because the longer is the wait for the surgery, there is more chance of having the tumor undergo a torsion
Gynaecology & Obstetrics
Obstetrics
a4c9e119-008f-4c91-9bcb-c06add1bbb87
Periodontal pack is least successful in the management of?
Splinting
Antimicrobial Properties
Hemostasis
Pain elimination
3d
single
null
Dental
null
2b5d18cc-493a-4017-8049-6c119d013591
Neovascularisation is seen in
Central vein obstruction
Central retinal aery obstruction
Branch retinal vein obstruction
All of the above.
0a
multi
A i.e. Central vein obstruction
Ophthalmology
null
60453595-5fc3-4ef2-870b-bfc940dc9197
A person present with cribriform plate fracture with CSF rhinorrhea. What will be immediate treatment?
Frequent blowing of nose
Plugging of nose with paraffin
Craniotomy
Antibiotics with wait for 7 days
3d
single
TREATMENT OF CSF RHINORRHEA Early cases of post-traumatic CSF rhinorrhoea can be managed by conservative measures such as bed rest, elevating the head of the bed, stool softeners, and avoidance of nose blowing, sneezing and straining. Prophylactic antibiotics can be used to prevent meningitis. Acetazolamide decreases CSF formation. These measures can be combined with lumbar drain if indicated. Surgical repair can be done by the following: 1. Neurosurgical intracranial approach. 2. Extradural approaches such as external ethmoidectomy for cribriform plate and ethmoid area, trans-septal sphenoidal approach for sphenoid and osteoplastic flap approach for frontal sinus leak. 3. Transnasal endoscopic approach. With the advent of endoscopic surgery for nose and sinuses, most of the leaks from the anterior cranial fossa and sphenoid sinus can be managed endoscopically with a success rate of 90% with first attempt. Principles of repair include: (a) Defining the sites of bony areas . It can be (i) Cribriform plate (ii) Lateral lamina close to anterior ethmoid aery (iii) Roof of ethmoid (iv) Frontal sinus leak (v) Sphenoid sinus (b) Preparation of graft site. (c) Underlay grafting of the fascia extradurally followed by placement of mucosa (as a free graft or pedicled flap) (d) If bony defect is larger than 2 cm, it is repaired with cailage (from nasal septum or auricular concha) followed by placement of mucosa. (e) Placement of surgicel and gelfoam fuher strengthens the area. This is followed by a high antibiotic smeared nasal pack. Sometimes fat from the thigh or abdomen is used to plug the defect in place of fascia graft. (f) Lumbar drain if CSF pressure is high. (g) Antibiotics CSF leak from frontal sinus often requires osteoplastic flap, operation and obliteration of the sinus with fat. Ref : ENT textbook by Dhingra 6th edition Pgno : 163-165
ENT
All India exam
df4d104e-8c20-43cc-bfc0-1277267d6a4a
Which of the following structures is least likely to be damaged during mandibular 3rd molar extraction
Lingual artery
Lingual nerve
Inferior alveolar nerve
Inferior alveolar artery
0a
single
null
Anatomy
null
24618e4e-33d6-4912-874c-0214a19b7447
A 60 yr old female with I-1/0 8 blood transfusion in 2 years. Her Hb- 60g/L, TLC-5800, platelet-3.4 lakhs, MCV 60, RBC-2.1 lakhs/mm3. He is having hypochromic microcytic anemia. Which investigation is not needed aEUR'
Evaluation for pulmonary hemosiderosis
Urinary hemosiderin
Bone marrow examination
G I endoscopy
0a
single
Evaluation for pulmonary hemosiderosis Anemia with low RBC count, microcytotosis and hypochromia point towards iron deficiency anemia. - "Bone marrow biopsy" in iron deficiency anemia demonstrates erythroid hyperplasia and micronormoblasts reaction. - Prussian blue staining of the bone marrow aspirate and smear and biopsy demonstrate absent of iron stores. The patient continue to have iron deficiency anemia despite the blood transfusions. - This suggests chronic blood loss leading to iron deficiency anemia. - Chronic blood loss can result .from GIT (melena hematemesis) pathology. - G.I. Endoscopy is done in these cases to rule out GIT pathway. Chronic blood loss may also result from hemolytic anemias. - "Hemosiderin in urine" is found in patients with intravascular hemolysis. - Most of the autoimmune hemolytic anemias cause extravascular hemolysis (urine hemosiderin is absent). - Intravascular hemolysis occurs in paroxysmal nocturnal hemoglobinuria. This leads to chronic iron deficiency anemia. - Hemosiderin is present in urine due to intravascular hemolysis. Urinary hemosiderin can differentiate b/w PNH and other autoimmune hemolytic anemias. Idiopathic pulmonary hemosiderosis - Idiopathic pulmonary hemosiderosis is a rare condition chaeracterized by repeated episodes of intraalveolar bleeding that lead to abnormal accumulation of iron as hemosiderin in alveolar macrophage and subsequent development of pulmonary fibrosis and anemia. - The clinical features are characterized by a triad of - Hemoptysis - Moderate to severe iron deficiency anemia. - Diffuse radiological abnormality Diagnosis in these cases is confirmed by - Iron stains of sputum aspiration of and biopsy. The patient in the question does not give any features that are suggestive of idiopathic pulmonary hemosiderosis. He does not require evaluation for pulmonary hemosiderosis.
Pathology
null
8cbcdc81-71bc-4881-8c3b-97c543fdd8ee
Nitrates are not used in -
CCF
Esophageal spasm
Renal colic
Cyanide poisoning
2c
single
Ans. is 'c' i.e., Renal colic Uses of nitrates Angina pectoris MI CHF and acute LVF --> nitroglycerine i.v. can be used Act by decreasing preload (LV filling pressure). Biliary colic and esophageal spasm (achalasia cardia) Acute coronary syndrome (unstable angina and non-ST segment elevation Ml). Cyanide poisoning
Pharmacology
null
8cc53ec0-d0d1-4eda-9c89-760ff8dc0aef
Natural uncoupler is-
Thermogenin
2, 4-dinitrocresol
2, 4 Dinitrophenol
Oligomycin
0a
single
Ans. is 'a' i.e., Thermogenin o Amongst the given options, a, b and c are uncouplers. o However, only thermogenin, among these three is a natural (physiological) uncoupler. Uncouples o As the name suggests, these compounds block the coupling of oxidation with phosphorylation. These compounds allow the transfer or reducing equivalents in respirators chain but prevent the phosphorylation of ADP to ATPy by uncoupling the linkage between ETC and phosphorylation. Thus the energy instead of being trapped by phosphorylation is dissipated as heat. Uncouplers may be NaturalThermogenin, thyroxine Synthetic 2, 4-dinitrophenol (2, 4-DNP), 2, 4-dinitrocresol (2, 4-DNC), and CCCP (chlorocarbonylcyanidephenyl hydrazone).
Unknown
null
adc88ae1-8019-435a-a035-012c5bd315db
All of the following statements about hairy cell leukemia are true except:
Splenomegaly is conspicuous
Results from an expansion of neoplastic T-lymphocytes
Cells are positive for Taarate Resistant Acid phosphatase
The cells express CD25 consistently
1b
multi
Hairy cell leukemia is a type of B-cell leukemia. Clinical feature: Massive splenomegaly Increase chances of infections DIAGNOSIS 1. BLOOD Pancytopenia Phase contrast microscopy- Hairy projections Staining- TRAP 2. Immunophenotyping CD11 + CD25+ CD103 + Annexin A1 + ( Best marker) 3.BM examination BM aspiration - Dry tap BM biopsy- Honey comb appearance - Fried egg appearance
Pathology
Non Hodgkin Iymphoma
5b2ac300-6988-4cd6-9c6a-b0d860cacde1
A decrease in which of the following parameters will shift the O2 dissociation curve to the right?
pH
Paial pressure of CO2
2,3 DPG concentration
Temperature
0a
single
Left shift (high affinity for O2) Right shift (low affinity for O2) Temperature decrease increase 2.3-DPG decrease increase p(CO2) decrease increase p(CO) increase decrease pH (Bohr effect) increase (alkalosis) decrease (acidosis) Type of haemoglobin Fetal haemoglobin Adult haemoglobin
Physiology
null
048023a8-f2c4-43b0-ba35-af0c68424222
Kussumauls breathing
Metabolic alkalosis
Respiratory alkalosis
Respiratory acidosis
Metabolic acidosis
3d
single
Rapid,deep(Kussmaul) breathing usually implies metabolic acidosis but may also occur with pontomesencephalic lesions. Ref:Harrison's medicine -18th edition,page no:2251.
Medicine
Respiratory system
cdb53cc4-0c9c-410a-9cf0-c6bd71a0b51a
Dislocation of lens is seen in:
Trachoma
Diabetes mellitus
Homocystinuria
Turner's syndrome
2c
single
C i.e. Homocystinuria
Ophthalmology
null
59dfe863-d05e-4c2f-8878-56b1d45c3c50
Which of the following is not a prodrug-
Enalapril
Oxcarbazepine
Chloral hydrate
Diazepam
3d
single
Ans. is 'd' i.e., Diazepam Prodrug o Few drugs are inactive as such and need conversion in the body to one or more active metabolites. Such a drug is called a prodrug. Prodrug Levodopa Enalapril - Methyldopa Chloralhydrate Dipivefrine Oxcarbazepine Prednisone Bacampicillin Sulfasalazine Cyclophosphamide Mercaptopurine Fluorouracil Sulindac Azathioprine Coisone Benorilate Proguanil Zidovudin Terfenadine Prontosil
Pharmacology
null
6e9ea73b-13c6-4306-9945-0dbfcdfa071f
Cause of "bloody" vomitus in a neonate
Meckel's diveiculum
Intussusception
Malrotation
Cholecystitis
0a
single
Meckel&;s dieiculum may cause severe hemorrhage due to peptic ulceration. The blood is usually passed per rectum and is maroon in colour. it may cause bloody vomitus. Ref : BAILEY AND LOVE&;S SHO PRACTICE OF SURGERY,24 TH EDITION PG NO:1159
Pediatrics
Gastrointestinal tract
2a4e5373-4e3a-4156-acef-5b82acdb499e
Lancinating pain around the tonsils during eating is indicative of
Trigeminal neuralgia
Glossopharyngeal neuralgia
Facial neuralgia
None of the above
1b
multi
(B) Glossopharyngeal neuralgia # Nerve Supply of Tonsils:* Lesser palatine branches of sphenopalatine ganglion (CN V) and glossopharyngeal nerve provide sensory nerve supply.
ENT
Miscellaneous (E.N.T.)
3210905e-ac93-4b5a-b660-87a25bd223c9
Bird of Prey" sign is seen in the radiographic barium examination of:
Gastric volvulus
Intussusception
Sigmoid volvulus
Caeca! volvulus
2c
single
Sigmoid volvulus
Radiology
null
c3073526-26e4-4552-9050-a08cfd2af1d4
A 30-year-old woman sustained a traumatic blow to her right breast. Initially, there was a 3-cm contusion beneath the skin that resolved within 3 weeks, but she then felt a firm, painless lump that persisted below the site of the bruise 1 month later. What is the most likely diagnosis for this lump?
Abscess
Fat necrosis
Fibroadenoma
Inflammatory carcinoma
1b
multi
Fat necrosis is typically caused by trauma to the breast. The damaged, necrotic fat is phagocytosed by macrophages, which become lipid-laden. The lesion resolves as a collagenous scar within weeks to months. The firm scar can mammographically and grossly resemble a carcinoma. An abscess may form a palpable but painful mass lesion, and often from Staphylococcus aureus infection when localized. A fibroadenoma is a neoplasm, and tumors are not induced by trauma. Inflammatory carcinoma refers to dermal lymphatic invasion by an underlying breast carcinoma, giving a rough red-to-orange appearance to the skin. Sclerosing adenosis is a feature of fibrocystic changes, a common cause of nontraumatic breast lumps.
Pathology
Breast
14faae5c-8635-443b-8d1d-a91f31afd2e4
The basis of Korotkoff sound is
Aoic valve closure
Production of hea sound
Aerial turbulence
Aerial valve expansion
2c
single
The sounds of Korotkoff are produced by turbulent flow in the brachial aery. When the aery is narrowed by the cuff, the velocity of flow through the constriction exceeds the critical velocity and turbulent flow results.
Physiology
Cardiovascular system
1d05977f-576f-45e6-8022-3b5f062ef67d
Aganglionic segment is encountered in which part of colon in case of Hirchsprung's disease -
Distal to dilated segment
In whole colon
Proximal to dilated segment
In dilated segment
0a
single
Ans. is 'a' i.e., Distal to dilated segment "The major feature of Hirschsprung ds is an absence of ganglion cells in the neural plexus of the intestinal wall, together with hypertrophy of nerve trunks. The absence of ganglion cells gives rise to a contracted non-peristaltic segment with a dilated hypertrophied segment of normal colon above it ___ Bailey 24/e
Surgery
Colon, Rectum, and Anus - Diagnostic Evaluation
5e0265a0-3ff5-4f66-8792-5d562ae80cae
Estimation of the following hormones is useful while investigating a case of gynecomastia except-
Testosterone
Prolactin
Estradiol
Luteinising hormone
1b
multi
Gynecomastia refers to enlargement of the male breast. It is caused by excess estrogen action and is usually the result of an increased estrogen-to-androgen ratio. True gynecomastia is associated with glandular breast tissue that is >4 cm in diameter and often tender. Evaluation of a case of gynecomastia should include a careful drug history, measurement and examination of the testes, assessment of virilization, evaluation of liver function, and hormonal measurements including testosterone, estradiol, and androstenedione, LH, and hCG. Reference : page 2366 Harrison's Principles of Internal Medicine 19th edition .
Medicine
Endocrinology
6c7f7183-0070-4e46-a26c-9c57cb7d6623
Light requirement in watch manufacturing company is -
2000-3000 Lux
5000-10000 Lux
10000-20000 Lux
50000 Lux
0a
single
The recommended illumination (IES Code)in watch manufacturing company is 2000-3000 lux Rule of thumb is that the illumination must be 30 times higher the level at which ask can be just done. Parks textbook of preventive and social medicine.K Park. Edition 23.page no:741.table2.
Social & Preventive Medicine
Environment and health
e56cb61a-fff4-4f59-a5b9-3c3580aa7a44
Drug with membrane stabilizing activity is?
Nadolol
Atenolol
Carvedilol
Oxprenolol
3d
single
ANSWER: (D) OxprenololREF: KDT 6 th edition page 140Membrane stabilizing activity (in propanolol, oxprenolol, acebutolol). This activity is claimed to contribute to the antiarrhythmic action, but appears to be significant only at high doses
Pharmacology
Anti Adrenergic System
ff3a70fa-0334-470c-a272-a0ba8d65e408
Which of the following statement is/are true of all paramyxoviruses -a) They contain a single standed RNA genome of negative polarityb) Envelope is derived from the host cells plasma membranec) They have a cytoplasmic site of replicationd) They enter the body by the respiratory route
acd
abcd
abc
ab
1b
multi
Paramyxoviruses are negative sense single stranded Enveloped RNA viruses Site of riboncleoprotein synthesis is cytoplasm and envelop is derived from host cell plasma membrane They are important pathogens of infants and children and responsible for major part of acute respiratory infections and Infection is acquired by respiratory route
Microbiology
null
14bb9049-9498-4c54-a58d-00d280a2689b
Venous congestion of liver affects ?
Midzone
Perihepatic zone
Centrilobular zone
All the above
2c
multi
Ans. is 'c' i.e., Centrilobular zoneNutmeg liver or chronic passive congestion or Congestive hepatopathy :?Chronic passive congestion is liver dysfunction due to venous congestion, usually right sided cardiac dysfunction (right sided cardiac decompenstion).When there is right sided cardiac decompensation, the blood being dammed back in the IVC and hepatic veins. o This results in increase venous pressure and passive congestion of centrilobular region and hemorrhagic necrosis of centrilobular region.The liver takes on a variegated mottled appearance, reflecting hemorrhage and necrosis in the centrilobular region, known as 'nutmeg liver'.
Pathology
null
a7df9fa1-ff7a-40c3-a634-ebeb48fa45ea
In alcohol withdrawal which is not seen -
Seizure
Blackout
Coarse tremor
Hallucination
1b
multi
Blackout occurs during acute intoxication (not during withdrawal). All the other options can occur in alcohol withdrawal.
Psychiatry
null
e49e563a-e976-4592-8762-c5f83f274e0a
Pitting of nails is seen in – a) Lichen planusb) Psoriasisc) Pemphigusd) Arsenic poisoning
ab
a
ad
bc
0a
single
null
Dental
null
3fe063ec-fd78-48d6-8d8f-8709cbd7eb41
A triphasic withdrawal syndrome follows an abrupt discontinuation of ______ use.
Alcohol
LSD
Heroin
Cocaine
3d
single
Cocaine use produces a mild physical, but a strong psychic dependence. A triphasic withdrawal syndrome follows an abrupt discontinuation of chronic cocaine use. Signs and symptoms : In the early phase (crash phase, 9 h to 4 days), there is anorexia, depression, agitation, excessive craving, hypersomnia, fatigue and exhaustion which is followed by normal mood, anxiety and anhedonia (next 4-7 days). In third phase (extinction phase, after 7-10 days), there are no withdrawal symptoms, but increased vulnerability to relapse. Treatment : Bromocriptine and amantadine are useful in reducing cocaine craving. Gabapentin is being used in adult addicts.
Forensic Medicine
Drug Abuse
67fce0c1-0aa2-43f1-8ca8-e7ce08bc1de6
Lamivudine is given when?
HBeAg positive
HBeAg negative
ALT >_ 2 ULN
Viral DNA> 10(square) copies
2c
single
Lamivudine belongs to the set of antiviral agents effective against hepatitis B virus infection. Given case repos on liver injuries after ceain antiviral agent treatments, this study examined the effects of lamivudine on alanine aminotransferase (ALT) and total bilirubin (TB) using a medical system database Ref Harrison20th edition pg 2675 Lamivudine has been used for treatment of chronic hepatitis B at a lower dose than for treatment of HIV/AIDS. It improves the seroconversion of e-antigen positive hepatitis B and also improves histology staging of the liver. Long-term use of lamivudine leads to emergence of a resistant hepatitis B virus (YMDD) mutant. Despite this, lamivudine is still used widely as it is well tolerated Lamivudine, commonly called 3TC, is an antiretroviral medication used to prevent and treat HIV/AIDS. It is also used to treat chronic hepatitis B when other options are not possible.It is effective against both HIV-1 and HIV-2.It is typically used in combination with other antiretrovirals such as zidovudine and abacavir. Lamivudine may be included as pa of post-exposure prevention in those who have been potentially exposed to HIV. Lamivudine is taken by mouth as a liquid or tablet HIV, high level resistance is associated with the M184V/I mutation in the reverse transcriptase gene as repoed by Raymond Schinazi's group at Emory University. GlaxoSmithKline claimed that the M184V mutation reduces "viral fitness", because of the finding that continued lamivudine treatment causes the HIV viral load to rebound but at a much lower level, and that withdrawal of lamivudine results in a higher viral load rebound with rapid loss of the M184V mutation; GSK therefore argued that there may be benefit in continuing lamivudine treatment even in the presence of high level resistance, because the resistant virus is "less fit". The COLATE study has suggested that there is no benefit to continuing lamivudine treatment in patients with lamivudine resistance. A better explanation of the data is that lamivudine continues to have a paial anti-viral effect even in the presence of the M184V mutation. In hepatitis B, lamivudine resistance was first described in the YMDD (tyrosine-methionine-aspaate-aspaate) locus of the HBV reverse transcriptase gene. The HBV reverse transcriptase gene is 344 amino acids long and occupies codons 349 to 692 on the viral genome. The most commonly encountered resistance mutations are M204V/I/S. The change in amino acid sequence from YMDD to YIDD results in a 3.2 fold reduction in the error rate of the reverse transcriptase, which correlates with a significant growth disadvantage of the virus. Other resistance mutations are L80V/I, V173L and L180M Ref Davidson 23rd edition pg 768
Medicine
C.N.S
f2af87c0-d31e-4c49-9204-e9ef8e357d5b
In PML, all of the following are seen except :
Retinoic acid is used in treatment
15/17 translocation
CD 15/34 both seen in same cell
Associated with DIVC
2c
multi
Answer is C (CD15 / 34 both seen in same cell) Acute promyelocytic Leukaemia (PML : FAB M3) * This is a type of Acute Myeloid Leukaemia (AML) and has been classified as the M3 category according to the FAB morphological classification.9 * It constitutes 5 - 10% of all AML (Robbin's / Ghai) Pathological characteristic of PML * It is characterized by the chromosomal translocation 1(15;17)Q - CMDT * t(1 5;17) translocation produces a fusion gene ( PML-RAR }involving the Retinoic Acid Receptor gene and Promyelocytic Leukemia (PML) gene. This PML - RaR fusion protein tends to suppress gene transcription and blocks differentiation of cells. This block can be overcome with pharmacological doses of retinoic acid (Harrrison). * Most cells are hypergranularQ promyelocytes often with many Auer rods per cell. Presentation characteristic / Specific features of PML * Patients of PML are younger (median age 35 - 40 years) - Robbin's * Incidence of Disseminated Intravascular Coagulation (DIVC) is high in patient with PML. -Robbin's DIC may occur with any subgroup of AML but is especially common in acute PML (M3)-Ghai Treatment specific to PML subject All-Trans Retinoic Acid (ATRA/Tretinoin) * The treatment of patient with PML has been dramatically improved by the use of All - Trans - Retinoic acid. This agent is an analog of vitamin A that leads to terminal differentiation of occult promyelocytic leukemia cells. - CMDT * Remission in PML is induced by All - Trans-Retinoic acid as a single agent -Ghai Arsenic Trioxide Arsenic Trioxide produces meaningful response in upto 85% of patients refractory to tretinoin
Medicine
null
68e386ea-93eb-4376-963c-36093e9ab192
All the following are true of Paget disease Except
It affects elderly individuals
It may be monostotic or polyostotic
There is an imbalance between osteoblastic and osteoclastic activity
Deformed long bones result from coical bone thinning
3d
multi
Paget disease is a disorder of unknown origin, which occurs in older people and involves either a single bone or several bones. It is not associated with systemic metabolic disturbances, and some pas of the skeleton are always spared. The bones show marked thickening, owing to excessive osteoblastic and reduced osteoclastic activity. Although only a few persons suffering from Paget disease develop sarcoma of bone, in adults the disease remains an impoant predisposing condition for this tumor in long bones. The skull and veebrae are viually never the sites of secondary osteogenic sarcomas. Ref: Maheshwari 6e pg 317.
Orthopaedics
Avascular necrosis and osteochondroses
e9d6073f-fd8c-412d-af06-73e51f2cd262
True about keratoconus are all of the following except: September 2005
Can be seen in Down's syndrome
It manifests just after bih
Munson sign is characteristic
Corneal transplantation is needed in severe cases
1b
multi
Ans. B: It manifests just after bih Keratoconus is frequently due to a congenital weakness of the cornea, though it manifests itself after pubey. However it can occur secondarily following trauma or Down's syndrome. Keratoconus is divided into mild, moderate, and advanced. Mild keratoconus - External and corneal signs are often absent or minimal. - A history of multiple inadequate spectacle corrections of one or both eyes may be noted and may include oblique astigmatism on refraction as well as moderate-to-high myopia. - Irregularly astigmatic keratometry values (egg-shaped), not necessarily on the steep side of normal (approximately 45 diopters (D)), are consistent with diagnosis. Diagnosis can be confirmed with computer-assisted videokeratography, which may reveal corneal inferior steepening (approximately 80% of keratoconus cases), central corneal astigmatic steepening (approximately 15% of keratoconus cases), or even bilateral temporal steepening (extremely rare). Diagnosis may also be aided by applying a diagnostic rigid contact lens with its base curve equal to the flat keratometry value. One observes a typical nipple pattern by use of sodium fluorescein dye in the underlying tear film. Moderate keratoconus One or more corneal signs of keratoconus are often present. Enhanced appearance of the corneal nerves is noted. Approximately 40% of eyes in patients with moderate keratoconus develop Vogt striae (fine-stress lines) in the deep stroma. Approximately 50% develop the deposition of iron in the basal epithelial cells in a (often paial) ring shape at the base of the conical protrusion called the Fleischer ring. Approximately 20% develop corneal scarring. Superficial corneal scarring can be fibular, nebular, or nodular. Deep stromal scarring may occur, perhaps representing resolved mini-hydrops events. Some patients show scarring at the level of the Descemet membrane (posterior limiting lamina), consistent in appearance with posterior polymorphous corneal dystrophy. Paraxial (usually inferior to the pupil) stromal thinning may be appreciated. Keratometry values typically increase to 45-52 D. Distoion of the retinoscopy and direct ophthalmoscope red pupillary reflex may allow observation of "scissoring" or an inferior distoion termed the oil drop sign. The Munson sign is noted when, upon downgaze, a "V" shape is noted in the cornea's profile against the lower lid margin, an accentuation of the conical shape of the modest to advanced keratoconus cornea. Advanced keratoconus This often results in keratometry values greater than 52 D and enhancement of all corneal signs, symptoms, and visual loss/distoion. Vogt striae are seen in approximately 60% of eyes, and Fleischer ring and/or scarring are seen in approximately 70% of eyes. Acute corneal hydrops can occur. Treatment: In the early stages, vision may be improved with spectacles but contact lens are more beneficial as they eliminate the irregular corneal curvature. If the disease progresses and the cone hydrated, the most satisfactory treatment is corneal transplantation.
Ophthalmology
null
2db106ce-b897-42ee-9a27-426ad09ebd9b
Vaccines prepared by embryonated hen's egg are:
Measles
Rabies
Rubella
Varicella
1b
single
Ans. (b) Rabies Vaccine that grows in embryonated eggs: Influenza Yellow fever (17 D strain) Rabies (Flury strain) Mumps Varicella vaccine growns in chick embryo fibroblast culture. Rubella - RA 27/3 vaccine produced in human diploid fibroblast. No eggs culture vaccine of measles are produced. All are tissue culture vaccine, either chick embryo or human diploid cell line.
Microbiology
null
9e70a91a-f0b2-4df5-bc7a-baad4eb234f1
How does the distal nephron differ functionally from the proximal tubule?
The distal nephron has a more negative intraluminal potential than the proximal tubule.
The distal nephron is less responsive to aldosterone than the proximal tubule.
The distal nephron is more permeable to hydrogen ion than the proximal tubule.
The distal nephron secretes more hydrogen ion than the proximal tubule does.
0a
multi
Proximal and distal convoluted tubule The site of action of acetazolamide is the proximal convoluted tubule and the site of action of the thiazides is the distal convoluted tubule. The distal nephron has a negative luminal potential because it is poorly permeable to negatively charged ions. Therefore, when Na+ is reabsorbed, negatively charged ions, primarily Cl-, lag behind, producing a negative intraluminal potential. Although a similar situation occurs in the proximal tubule, the proximal tubule has a higher permeability to Cl- and, therefore, does not develop as large a negative intraluminal potential. The distal nephron is less permeable to hydrogen than the proximal tubule. Aldosterone increases Na+ reabsorption from the distal nephron but has no effect on the proximal tubule. K+ is reabsorbed from the proximal tubule and secreted by the distal nephron. Although the amount of H+ excreted each day is determined by the amount of H+ secreted into the distal nephron, Proximal tubule secretes much more H+ than the distal nephron. However, almost all of the H+ secreted in the proximal tubule is reabsorbed in association with the reabsorption of HCO3-
Physiology
Excretory System (Kidney, Bladder) Acid-Base Balance
c8c28ce0-6826-4d8f-ab49-9831ff2d4cd5
Which is the commonest abdominal mass in neonate -
Wilm's tumor
Polycystic kidney
Neuroblastoma
Rhabdomyosarcoma
2c
single
Ans. is 'c' i.e., Neuroblastoma The commonest intra-abdominal tumor in first two years of life Neuroblastoma The commonest intra-abdominal tumor between 2"d to 5th year of life - Wihn's tumor The commonest intra-abdominal tumor in children (no age specification) Neuroblastoma (Wilm's tumor is the second most common abdominal tumor in children) Remember: The commonest cause of abdominal mass in Newborn is : Multiple dysplastic kidneys (if neoplasm or tumor has not been mentioned when asking for the commonest intra-abdominal mass, the answer will be multiple dysplastic kidneys)
Pediatrics
null
1b5e262d-5de9-4bba-9be3-700742a17b82
Mode Is:
Arthimetic average of the values
Most frequently occurring observations
Middle observation when arranged in ascending or descending order
Adding all values and then dividing by number of values
1b
multi
null
Dental
null
25bb124e-1c6e-4c60-b8a2-640a5ba80f2f
A patient gets tingling when his bed light is flashed suddenly. Which type of hallucination is this :
Hypnagogic hallucinations
Hypnopompic hallucinations
Reflex hallucinations
Functional hallucinations
2c
multi
"Example of reflex hallucination : when the light flashes the patient gets tingling sensation".
Psychiatry
null
80727211-e047-437d-99f1-69d8221d13e4
Which of the following amino acids is most responsible for the buffering capacity of hemoglobin and other proteins?
Arginine
Aspaic acid
Glutamic acid
Histidine
3d
single
Remember that a buffer is most effective when its pKa is within the pH range of the surrounding medium. Histidine is the only amino acid with good buffering capacity at physiologic pH. The imidazole side chain of histidine has a pKa around 6.0 and can reversibly donate and accept protons at physiologic pH. Arginine and lysine are basic amino acids with pKa's of 12.5 and 10.5, respectively; at physiologic pH both will behave as bases and accept protons. Aspaic acid and glutamic acid are acidic amino acids with pKa's of approximately 4; at physiologic pH they will behave as acids and donate protons. Ref: Rodwell V.W. (2011). Chapter 30. Conversion of Amino Acids to Specialized Products. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.
Biochemistry
null
ccc6c882-5c84-44df-af69-a50d0a6d14f2
Which of the following is NOT associated with elevation Right hemi-diaphragm:
Amebic abscess
Pyogenic abscess
Cholecystitis
Sub diaphragmatic abscess
2c
single
Ans. (c) CholecystitisCholecystitis is inflammation of gall bladder wall.Radiological evaluation does not show elevation of right hemidiaphragm in these cases.AMOEBIC LIVER ABSCESS* Chest radiographs are abnormal in the majority of patients with amebic hepatic abscesses. Findings include elevation of the right hemi-diaphragm, right pleural effusion, atelectasis in the region of the base of the right lung, and a right pleural effusion.PYOGENIC LIVER ABSCESS* Chest radiographs are abnormal in half of patients with pyogenic liver abscesses, reflecting an underlying inflammatory process. The most frequent findings include a right pleural effusion, elevation of the right hemi-diaphragm, and atelectasisIn case of subdiaphragmatic abscess also, there is elevation of right hemi-diaphragm.
Surgery
Miscellaneous
67b9dd5a-cc76-4ca3-b129-4b2a9dc05a4c
All of the following drugs are useful in the treatment of a patient with acute bronchial asthma except
Ipratropium
Salbutamol
Montelukast
Hydrocortisone
2c
multi
null
Medicine
null
4d79e291-8a7b-4f4e-aba6-4e1123ba0d21
Mydriasis is/are caused by:
Homer syndrome
Neurosyphilis
Organophosphorus poisoning
Atropine
3d
single
D i.e. Atropine Pinpoint pupils are seen in - 'Car Chlor Or Mor' i.e. Carbolic acid, Chloral hydrate, Organophosphorus, Morphine (opiate)Q and 'New Horn' i.e. neurosyphilis/tabes dorsalis (spinal miosis or small, irregular Argyll Robeson pupil) and Horner's syndrome. Atropine and cocaine cause mydriasisQ Barbiturate poisoning 1/t constricted & reacting pupils which dilate during terminal asphyxiaQ
Forensic Medicine
null
b8404abb-8c0c-464e-9720-0393fd0e4963
Which of the following techniques use piezoelectric crystals -
Ultrasonography
X-ray diffraction
NMR imaging
Xeroradiography
0a
single
Ans. is 'a' i.e., Ultrasonography o Ultrasonography is based on piezoelectric effect.o MRI is based on gyeromagneticproperty of proton (H+).Ultrasonography (USG) / Ultrasoundo USG is performed with the pulse-echo technique. By the virtue of piezoelectric effect in the ultrasound probe (or transducer), electric energy is converted to sound energy that is transmitted into patient's tissues. The US transducer (probe) then becomes a receiver, detecting echo of sound energy reflected from tissue.o The US transducer (probe) then becomes a receiver, detecting echo of sound energy reflected from tissue.o The ultrasound transducer uses the principle or property of piezoelectricity.o Quartz is a naturally occuring peizoelectric material.o Currently, Lead Zirconate titanate (PZT) is the most widely used material in the ultrasound tranducer/probes
Radiology
Ultrasonography, CT, and MRI
23637300-9b66-4e37-bfac-6dcd82e06399
A patient with hypeension is also having aoic dissection. Anti-hypeensive agent of choice is: September 2008
Sodium nitroprusside
Reserpine
Pindolol
Nifedipine
0a
single
Ans. A: Sodium Nitroprusside Antihypeensive therapy in acute aoic dissection aims specifically to lessen pulsatile load or aoic stress, in order to retard the propagation of the dissection and prevent aoic rupture. The goals of treatment are to prevent myocardial ischemia, decrease left ventricular afterload, decrease myocardial oxygen consumption, and prevent rupture and bleeding from suture lines Nitroprusside is a potent direct aerial and venous dilator, acting through release of nitric oxide. It has a rapid onset of action, and a shoer half-life and thus is given in the form of continuous infusion. The hypotensive effects of nitroprusside can be unpredictable because it simultaneously causes potent venodilatation and peripheral aerial vasodilatation. This is especially the case for patients with severe left ventricular hyperophy and preload-dependent diastolic dysfunction. It has been shown to cause coronary steal; it can cause a significant reflex tachycardia, and it can decrease oxygen circulation. It is photosensitive, so it requires special handling. Its most serious adverse effect is in the form of cyanide toxicity, which occurs due to accumulation of its metabolites thiocyanate/ cyanide and its clinical presentation may vary leading to difficulty in diagnosis. Thus, it is recommended that this drug be used only when other intravenous antihypeensive agents are not available
Pharmacology
null
1d798a72-cfe5-4375-8458-29c156bcadab
The parietal peritoneum covering the inferior surface of the diaphragm transits its sensory information via the phrenic nerve. In the case of peritonitis in the parietal peritoneum on the inferior surface of the diaphragm, pain may be referred through which of the following nerves?
A
B
C
D
3d
single
Ans. D. Supraclavicular nervesThe phrenic nerve consists of contributions from spinal nerve levels C3 to 5.Therefore, when sensory information comes from the parietal peritoneum on the inferior diaphragmatic surface, it may refer through spinal nerves at the same levels.a. Supraclavicular nerve shares levels with the C3 and C4 levels.b. The greater and lesser occipital nerves both originate at the C2 level.c. Great auricular nerve root value is C2, C3
Anatomy
Abdomen & Pelvis
3f4b03b8-c4fb-4192-9861-ec70b6ade393
Operation of choice in GERD is
Highly selective vagotomy
Fundoplication
Hellers myotomy
Gastrectomy
1b
single
Operations for GORD are based on the creation of an intra-abdominal segment of oesophagus, crural repair and some form of wrap of the upper stomach (fundoplication) around the intra-abdominal oesophagus.Nissen fundoplication is one of the commoner procedures done.Ref: Bailey and Love 27e pg: 1078
Surgery
G.I.T
f4873d26-d753-4048-bbe1-64d8649eb261
Non immunized susceptible diphtheria contacts should receive:
Erythromycin
Penicillin and diphtheria antitoxin
Penicillin, diphtheria antitoxin and DPT vaccine
No treatment is required
2c
single
Non immunized contacts should receive prophylactic penicillin or erythromycin. They should also be given 1000 to 2000 units of antitoxin and actively immunized against diphtheria. Ref: Park 21st edition, page 151.
Social & Preventive Medicine
null
b26f9e12-8ccc-4167-8993-772c0c0474d2
In emergency tracheostomy following structures are damaged except:
Isthmus of thyroid
Inferior thyoid vein
Inferior thyroid aery
Thyroid ima
2c
multi
Structures which lie below the midline viz. isthmus of thyroid and thyroid ima aery can be damaged in emergency tracheostomy. Inferior thyroid veins emerge at the lower border of the isthmus form a plexus in front of the trachea and drains into brachiocephalic vein can be damaged during tracheostomy but inferior thyroid aery, a branch of thyrocervical trunk of subclan aery lies laterally away from midline and can thus escape injury.
ENT
null
dc937900-30c6-4d2f-bc61-c0ef53433063
Intrinsic factor is required for absorption of ?
Folic acid
Vitamin B12
Vitamin B
Vitamin B2
1b
single
Ans. is 'b' i.e., Vitamin B12
Physiology
null
cb1b8cdc-6739-46ea-9ee2-0b98f038a538
After a normal prenatal period, a lady developed sudden HTN and bleeding from all places. Diagnosis is:
DIC
Aplastic anemia
ITP
APLA
0a
multi
(A) DIC# Disseminated Intravascular Coagulation (DIC), also known as disseminated intravascular coagulopathy or less commonly as consumptive coagulopathy, is a pathological process characterized by the widespread activation of the clotting cascade that results in the formation of blood clots in the small blood vessels throughout the body. This leads to compromise of tissue blood flow and can ultimately lead to multiple organ damage. In addition, as the coagulation process consumes clotting factors and platelets, normal clotting is disrupted and severe bleeding can occur from various sites.> DIC can occur in the following conditions: Solid tumors and blood cancers (particularly acute promyelocytic leukemia) Obstetric complications: abruptio placentae, pre-eclampsia or eclampsia, amniotic fluid embolism, retained intrauterine fetal demise, septic abortion, post partum haemorrhage Massive tissue injury: severe trauma, burns, hyperthermia, rhabdomyolysis, extensive surgery Sepsis or Severe infection of any kind (infections by nearly all microorganisms can cause DIC, though bacterial infections are the most common): bacterial (Gram-negative and Gram-positive sepsis), viral, fungal, or protozoan infections Transfusion reactions (i.e., ABO incompatibility haemolytic reactions) Severe allergic or toxic reactions (i.e. snake or viper venom) Giant haemangiomas (Kasabach-Merritt syndrome) Large aortic aneurysms> Liver disease, HELLP syndrome, thrombotic thrombocytopenic purpura/Haemolytic uremic syndrome, and malignant hypertension may mimic DIC but do not occur via the same pathways.
Gynaecology & Obstetrics
Miscellaneous (Obs)
65934f28-68d3-447f-b328-b5c56b393fae
Which of the following is the best test to diagnose bleeding in DIC?
Increased PT
Increased aPTT
Decreased fibrinogen
Increased fibrin degradation products
3d
single
Fibrin degradation product (FDP) is the best test to diagnose bleeding in DIC. D-Dimer assay is for screening | PT & | aPTT seen in a lot of conditions - so not best.
Medicine
Platelet & Coagulation disorders
536aa21e-dde9-4e75-b75a-648a9b27589b
Chlorhexidine as a root canal irrigant is
Active against gram +ve , gram –ve bacterias and to some extent Virus with lipid envelop.
Normally used at 2% conc
A poly biguinide
All of the above
3d
multi
null
Dental
null
4e6f7dc8-11e3-485c-ab6e-e41e1a3f7827
Inferior border of scapula lies at the level of which rib?
5th
6th
7th
8th
2c
single
ANSWER: (C) 7thREF: Gray's Anatomy 40th Ed Ch: 49Indirect repeat Anatomy 2012 Session II, 2013 Session 1The inferior angle overlies the seventh rib or intercostal space and T7
Anatomy
Back, Deltoid, and Scapular Region
ea2bbbfd-ccc8-4e13-b0a9-db56da9d2a2d
Most common complication of acute pancreatitis is -
Pancreatic abscess
Pseudocyst
Phlegmon
Pleural effusion
1b
single
null
Medicine
null
17df7825-4359-4de9-a6e6-ed584940a378
Marble bone disease, characterized by increase in bone density is due to mutation in the gene encoding:
Carbonic Anhydrase I
Carbonic Anhydrase II
Carbonic Anhydrase III
Carbonic Anhydrase IV
1b
single
Ans. B. Carbonic Anhydrase IIIn osteoporosis, also called as marble bone disease there is increased bone density. It is due to mutation in gene encodingcarbonic anhydrase II enzyme. The deficiency of this enzyme in osteoclasts leads to inability of bone resorption.
Biochemistry
Enzymes
8054db28-aa2d-437f-80ff-2d215980d73f
Cidex is
Gluteraldehyde
Alcohol
A phenolic compound
A caustic agent
0a
single
null
Surgery
null
88bf9f8a-9d38-4433-ac15-c0a7ba58bdd2
Hemorrhagic fever is caused by -
West-Mile fever
Sandfly fever
Ebola virus
All of the above
2c
multi
kyasanur forest disease a hemorrhagic fever found in Karnataka. It is an arboviral disease. a new arbovirus genetically related to RSS isolated REF:ANANTHANARYANAN TEXTBOOK OF MICROBIOLOGY 9EDITION PGNO.524
Microbiology
Virology
f7db0acd-0dca-450d-9cba-055e84d41c5f
Initial stage of clinical union of bone is equivalent to
Callus formation with woven bone
Woven bone Formation
Haematoma formation
Calcification formation only
0a
multi
The first signs of union are seen in stage of hard callus formation A. Clinical sign:fracture is no more mobile B. Radilogical sign :callus is seen on X ray *hard callus is immature woven bone* Ref: Maheshwari 9th/e p 12
Orthopaedics
Anatomy and physiology of bone and fracture healing
33e7cae5-5277-43b0-8a2b-1f9ef1355d87
A two-year-old child presents with persistent diarrhea, acidic stools and presence of one percent of reducing substance in the fresh stools. What is the most probable diagnosis?
Cystic fibrosis
Lactose intolerance
Rotavirus induced diarrhea
Intestinal tuberculosis
1b
single
Presence of acidic stools with reducing substance positive, suggests a diagnosis of lactose intolerance.
Pediatrics
Disorders of Gastrointestinal System Including Diarrhea
d07da705-f903-4f1a-8828-f88fae64228a
Drug of choice for mycoplasma pneumonia is
Penicillin
Tetracycline
Cefuroxime
Erythromycin
3d
single
Treatment options for acute M.pneumoniae infection include macrolides (e.g., oral azithromycin, 500 mg on day 1, then 250 mg/d on days 2-5), tetracyclines (e.g., oral doxycycline, 100 mg twice daily for 10-14 days), and respira-tory fluoroquinolones Ref Davidson edition23rd pg 585
Anatomy
Respiratory system
5820af2b-4075-4cb0-8ef7-d868f487391f
A 6 year old female patient complains of pain due to a decayed lower right 2nd molar. During the treatment, patient becomes uncooperative and throws a tantrum. The dentist then asks the mother to step out of the operatory, after which the child begins to cooperate. The example demonstrated by the dentist falls under which type of conditioning, as described by Skinner?
Positive reinforcement
Negative reinforcement
Omission
Punishment
2c
multi
Omission (also called time-out), involves removal of a pleasant stimulus after a particular response. For example, if a child who throws a temper tantrum has his favorite toy taken away for a short time as a consequence of this behavior, the probability of similar misbehavior is decreased.
Dental
null
c222240e-3b33-4f5d-a035-e3c708f87453
Desks provided with table top to prevent neck problems in an example of
Primordial prevention
Secondary prevention
Specific protection
Disability limitation
2c
single
Specific protection comes under Primary prevention. It prevents risk factor from progressing to disease. Ref : Park&;s Textbook of Preventive and Social Medicine; 23rd edition; Page 42
Social & Preventive Medicine
Concept of health and disease
128af4d6-c3e4-48e0-a0cc-5c082fe78995
Glutamine synthetase is a -
Isomerase
Ligase
Lyase
Transferase
1b
single
Ans. is 4b' i.e., Ligase /Ref Essential of biochemsitry p. 186]o All synthases are ligases.o All digestive enzymes are hydrolases.o Lyases are:DecarboxylasesAldolasesHydratasesEnolaseFumaraseArginosucinaseEnzyme classImportant enzymesOxidoreductaseOxidases, Dehydrogenases, Hydroperoxidases, (catalase, peroxidase), oxygenases.TransferaseAmino transferase or transaminase, e.g., SGOT (AST) and SGPT (ALT), kinases (HexokinaseQ glucokinase, pyruvate kinase etc), Transketolases, transaldolases, transcarboxylases.HydrolasesAll digestive enzymes (Pepsin, trypsin, lipases, esterases), lysosomal enzymes, urease, and phosphataseLyasesDecarboxylasesQ, aldolases, hydratases, enolase, fumaraseQ, ArginosuccinaseIsomerasesRacemases, epimerases. cis- trans- isomerases, mutasesLigasesSynthatasesQ, Carboxylases, DMA ligase
Biochemistry
Amino Acid Metabolism
45bf6850-35e9-466a-aeaa-b85c3423b7c2
Which of the following is not an accepted method of randomization-
Computer drawn randomization
Odd/even day hospital admission
Lottery
Random number table
1b
single
Ans. is 'b' i.e., Odd/even day hospital admission Methods of Randomization o Randomization is accomplished in a number of classic ways 1. Lottery method Suppose 10 patients are to be put in a control group or the trial group out of 100 available. The serial numbers of patients are noted on 100 cards and then shuffled well. The cards are drawn one by one and thus patients are allocated into trial and control groups. 2. Table of Random Numbers Published tables of Random numbers are used. This is considered to be the best method of randomization. A computer program is used for randomization o Randomization methods , which may at first seem reasonable (odd-even day randomization or daytime-nighttime convenience randomization), may actually suppo bias, paicularly if the study is open-label or the operator or subject are not blinded as to the nature of the intervention. For example, if the study involves a procedure such as wound irrigation and the patients are randomized to have wounds irrigated with sterile saline on even days and tap water on odd days, a patient may present on an even day and the treating clinical investigator may elect not to enroll the patient in the study or to break the randomization, because they "just think that this paicular wound needs saline irrigation." This is a very common error in otherwise well-designed clinical studies.
Social & Preventive Medicine
null
4ad04b23-b54c-4899-b245-1f0f020dc71b
A 23 year old profession footballer sufferd a twisting injury to his right ankle. On examination there is a lot of swelling around the medial malleolus but xray doesn't show any fracture. The structure injured could be -
Deltoid Ligament
Anterior talofibular ligament
Spring ligament
Tendo Achilles
0a
multi
Answer- A. Deltoid LigamentDeltoid ligament injuries involve the deltoid ligament that forms the medial pa of the anHe joint.It attaches the medial malleolus to multiple tarsal bones.It occurs due to eversion and/orpronation injury, or can be associated with lateral ankle fractures.
Surgery
null
de8e87a0-bd91-47b5-85a2-54c7de8ec2c5
Von Willebrand&;s factor is synthesized in which one of the following -
Vascular endothelium
Macrophages
Liver
Eosinophils
0a
single
The Von willebrand factor is synthesized in the endothelial cells ,megakaryocytes and platelets While the principal site of synthesis of factor VIII is the liver Reference :textbook of Pathology ,7th edition ,Author: Harsha Mohan, page number 314.
Pathology
Haematology
5004bc72-a76c-481a-a5ea-b5d2609651b5
Persistence of Moro's reflex is abnormal beyond the age of –
3rd month
4th month
5th month
6th month
3d
single
"In a normal infant, the Moro's reflex begins to fade at three months of age and gradually disappears at 4-6 months. When it persists beyond 6 months it indicates a delay in CNS development." ---------- Tachdjian "Moro's reflex disappears by six months in a normal infant." ------------ Ghai
Pediatrics
null
7e58514a-4721-4f0c-adfe-c6e334d47aec
Which of the following statements regarding live vaccines is false
Two live vaccines cannot be administered simultaneously
Booster doses are not required when live vaccines are administered
Single dose gives lfe long immunity
Live vaccine contains both major and minor antigens
0a
multi
When 2 live vaccines are required they should be given either simultaneously at different sites or with an interval of at least 3 weeks.In case of live vaccines,protection is generally achieved with a single dose of vaccine (refer pgno:103 park 23 rd edition)
Social & Preventive Medicine
Epidemiology
86ac2881-be7e-4ad6-87bf-f793f6e39f01
All are alkylating agents, except ?
5-FU
Melphalan
Cyclophosphamide
Chlorambucil
0a
multi
Ans. is 'a' i.e., 5 Fluorouracil
Pharmacology
null
6f63a8e7-577e-4d6c-9be0-c23f4537574c
True about VSD are all except -
Left to right shunt
Pansystolic mormor
Reverse spitting of S2
Left atrial hyperophy
2c
multi
Ans. is 'c' i.e., Reverse spliting of S2 Hemodynamics of VSD o A VSD results in shunting of oxygenated blood from left to right because left ventricle has more pressure than right Left to right shunt. o Blood flow from left to right ventricle due to high pressure gradient --> Pansystolic murmur and systolic thrill. o Because left ventricle stas contracting before Right ventricle, pansystolic murmur stas early --> Masking of SI. o This pressure gradient is maintained throughout the systole pansystolic murmur lasts long --> Masking of S2. o Towards the end of systole, the declining left ventricular pressure becomes lower than aoic Early closure of A2. o Left to right shunt occurs during systole at a time when the right ventricle is also contracting, therefore left to right shunt streams to pulmonary aery more or less directly --> No volume overload --> Right ventricle size remains normal. Increased blood flow through pulmonary valve --> Pulmonary ejection systolic murmur and delay & accentuated P2. o Early closure of A2 and delayed closure of P2 cause --> Widely split S2 (But this is usually masked by pansystolic murmur). o Larger volume reaches the left atrium -3 Left atrial hyperophy o Increased blood flow through mitral valve -3 Accentuated Si (But it is masked by pansystolic murmur) and delayed diastolic murmur. Note : o Ejection systolic murmur of pulmonary valve can not be separated from pansystolic murmur. o The effect of ejection systolic murmur is a selective transmission of pansystolic murmur to the upper left sternal border (pulmonary valve area) In this area ejection characteristic of this murmur can be recognized since it does not mask the aoic component of S2. For the same reason second hea sound (S2) can be heard in the pulmonary area where it is not masked by pansystolic murmur.
Pediatrics
null
3b86072f-bafb-44ab-b878-e6f08a4cd7c9
The most common causative organism for external otitis in adults is:
Streptococcus viridans
Staphylococcus epidermidis
Pseudomonas aeruginosa
E. coli
2c
single
Otitis externa is an inflammatory and infectious process of the external auditory canal. Pseudomonas aeruginosa and Staphylococcus aureus are the most commonly isolated organisms. Less commonly isolated organisms include Proteus species, Staphylococcus epidermidis, diphtheroids, and Escherichia coli.
ENT
null
9b010130-0fa2-4f72-be34-28fc5a00335f
Insulin is secreted along with the following molecule in a 1: 1 ratio:
Pancreatic polypeptide
Glucagon
GLP-1
C- peptide
3d
single
D i.e. C - PeptideInsulin has two interchain (A7 - B7, & A20 - B19) and one intrachain (A6 - All) disulfide bridges with in AB hetrodimeric structureQ.Insulin is synthesized as pre-pro-hormone (MW 11, 500), which makes it difficult to synthesize insulin in laboratory even after synthesizing A, B chains. This pre prohormone is directed by hydrophobic 23 aminoacid pre or leader sequence into cisternae of endoplasmic retinaculum, which is then removed to form 9000 MW proinsulin.Staing from amino terminal, the chain sequenc of proinsulin is.
Physiology
null
1dbdf7c2-95d8-41a0-9d5d-641e2666be8e
A 20 year old boy c/o hearing of voices, aggressive behavior since 2 days. He has fever since 2 days. When asked to his family, they says that he has been muttering to self and gesticulating. There is no h/o of psychiatric illness. Likely diagnosis is
Dementia
Acute psychosis
Delirium
Delusional disorder
1b
single
Acute psychosis ??? [Ref: Kaplan and Saddock synopsis of Psychiatry 10/e p 516-5171We are unable to reach a conclusive diagnosis with the information provided in the question.Acute onset, presence of fever, no history of psychiatric illness suggests delirium.But, the diagnosis of delirium cannot be made definitively in the absence of disorientation.In the question there is no definite comment on orientation of the patient.May be, that suggests, the patient is not disoriented.Acute onset, presence of perceptual disturbances (hallucination and other symptoms point towards acute psychosis.But acute psychosis seems unlikely because:-- Absence of cognitive dysfunction or thought disorders.- Absence of H/o psychiatric illness or substance abuse disorders.Psychotic disorders cannot be diagnosed only in the presence of perceptual disturbances. Some disorder in cognitive dysfunction or thought disorders is also required.May be this is a case of acute transient psychosis- These disorders do not give the classical manifestations of psychotic disorders.- They are characterized by the predominance of perceptual disturbances, and they do not fulfil the criteria of psychotic disorders.Acute and Transient Psychotic disordersA large number of psychiatrists especially from the developing countries like India, repoed that many patients developed an acute psychotic disorder that neither followed the course of schizophrenia nor resembled mood disorders in the clinical picture and usually had a better prognosis than schizophrenia.Acute and transient psychosis as a descriptive entity was recognized only with the advent of 1CD-10 in 1992. Where it is included under psychotic disorder.- The key features that characterize the disorder are an -- acute within (2 weeks) onset in all the cases presence of typical syndrome which are described as rapidly changing variables, polymorphic states and typical schizophrenic symptoms evidence ,for associated acute stress in a substantial number of cases and complete recovery in most cases within 2-3 months.A pa from these criteria ICD-10 also provides diagnostic guide- lines which include- Not meeting the criteria for manic or depressive episodes although the affective symptoms may be prominent - Absence of organic causation although perplexity confusion and inattention may he present. - Absence of obvious intoxication by drugs or alcohol.It is evident that ICD 10 intends to "clearly differentiate" the concept of acute transient psychosis .from those of affective psychosis, organic psychosis and drug induced psychosis.This is the point which is creating doubt in our minds.The ICD wants to clearly differentiate it from organic psychosis.- The boy presents with "fever" therefore the organic cause for the psychosis cannot be ruled out. - May be the psychosis is due to fever (some C.N.S. infection)- If fever had not been mentioned the diagnosis would have been clear. But the presence of fever prevents us from diagnosing this as acute transient psychosis.- The correct option would have been "organic psychosis" or "psychosis due to general medical condition". - Acute psychosis cannot be diagnosed without addressing the organic basis of the disease.Four subtypes of acute transient psychosis are described in ICD 10 -Acute polymorphic psychotic disorder without symptoms of schizo- phrenia - Acute polymorphic psychotic disorders with symptoms (?f schizo- phrenia - Acute schizophrenia like psychotic disorder- Acute predominantly delusional psychotic disorderOverall, duration of total episode should not exceed 3 months and that .for schizophrenic symptoms should not exceed 1 month. There is provision for change of diagnosis to schizophrenia.
Psychiatry
null
9954aebd-4d12-4239-b332-29e6ca333eef
The most impoant prognostic factor in breast carcinoma is
Histological grade of the tumor
Stage of the tumor at the time of diagnosis
Status of estrogen and progesterone receptors
Over expression of p-53 tumour suppressor gene
1b
single
Stage I and II has got better prognosis. Spread to axillary nodes is the most impoant prognostic indicator. Age: Younger the age worser the prognosis. Sex: Carcinoma male breast has got worser prognosis compared to female breast. Because of early spread in carcinoma male breast. Atrophic scirrhous has got best prognosis. Medullary carcinoma has got better prognosis than scirrhous carcinoma because of lymphocytic infi ltration. Invasive carcinoma has got worser prognosis. Inflammatory carcinoma breast has worst prognosis. Ref; (page no;559 ) 5th edition of SRB&;S manual of Surgery
Surgery
Endocrinology and breast
9d2b0404-9a26-4240-9d2c-08067145d4ff
Which of the following is associated with > 20% risk of chromosomal anomalies?
Omphalocele
Gastroschisis
Cleft lip
Spina bifida
0a
single
Omphalocele is a midline abdominal wall defect. The abdominal viscera (commonly liver and bowel) are contained within a sac composed of peritoneum and amnion from which the umbilical cord arises at the apex and center. When the defect is less than 4 cm, it is termed a hernia of the umbilical cord; when greater than 10 cm, it is termed a giant omphalocele. Associated abnormalities occur in 30-70% of infants and include, in descending order of frequency, Chromosomal abnormalities (trisomy 13, 18, 21) Congenital hea disease (tetralogy of Fallot, atrial septal defect) Beckwith-Wiedemann syndrome (large-for-gestational-age baby; hyperinsulinism; visceromegaly of kidneys, adrenal glands, and pancreas; macroglossia; hepatorenal tumors; cloacal extrophy) Pentalogy of Cantrell Prune belly syndrome (absent abdominal wall muscles, genitourinary abnormalities, cryptorchidism) Ref: Albanese C.T., Sylvester K.G. (2010). Chapter 43. Pediatric Surgery. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
Pathology
null
164960d2-bd93-4fbe-9720-22f492db5fd1
Features of SLE include all of the following except -
Recurent abortion
Sterility
Coomb's positive hemolytic anemia
Psychosis
1b
multi
null
Medicine
null
e51b039a-7a08-4747-b23b-eba9f6545ce8
Multiple myeloma most common part involved is-
Bone marrow
Cortex of bone
Metaphyses
Epiphyses
0a
single
Ans. is 'a' i.e., Bone marrow Multiple mveiomao Multiple myeloma is a plasma cell neoplasm characterized by involvement of the skeleton at multiple sites,o Plasma cells proliferate abnormally and the proliferated plasma cells infiltrate various organs, particularly bone marrow, but can also spread to lymph nodes and extranodal sites like skin,o The proliferation and survival of myeloma cells are dependent on several cytokines, IL-h Is particularly important.o The neoplastic plasma cells secrete abnormally large amounts of immunoglobulin.o The immunoglobulin secreted by neoplastic plasma cells are quiet different form the immunoglobulin normally present in the blood.o The normal immunoglobulin consists of two heavy and two lights chains molecules and the production of both chain is tightly balanced.o The immunoglobulin secreted in this condition may be : -Isolated light chain or heasy chain.May be an intact antibody molecule of any heavy chain subclass.May be an altered antibody or fragment.
Pathology
Multiple Myeloma
fd402e68-4e81-47ba-9f86-a2e0c1e21b76
All are the causes of neovascular glaucoma except:
Intraocular tumour
Central retinal vein occlusion
Diabetic retinopathy
Central serous retinopathy
3d
multi
Ans. Central serous retinopathy
Ophthalmology
null
54b2ddac-2be4-4be7-b7b0-84610278bbf2
False about Corona viruses?
Corona viruses are non-enveloped
Spreads by coughing and sneezing
Most of them infect animals and birds
Human infection is rare
0a
multi
Corona viruses are enveloped.
Microbiology
null
8341990b-1d42-4707-bb74-b154e0cde6d9
Copper sulfate poisoning manifests with
High anion gap acidosis
Rhabdomyolysis
Acute hemolysis
Peripheral neuropathy
2c
single
COPPER Poisonous Compounds: (1) Copper sulphate (blue vitriol) occurs in large, blue crystals. (2) Copper subacetate (verdigris), occurs in bluish-green masses or powder. Signs and Symptoms: Increased salivation, burning pain in the stomach with colicky abdominal pain, thirst, nausea, eructations and repeated vomiting. The vomited matter is blue or green. There is diarrhoea with much straining; motions are liquid and brown but not bloody. Oliguria, haematuria, albuminuria, acidosis and uraemia may occur. In severe cases haemolysis,haemoglobinuria, methaemoglobinaemia, jaundice, pancreatitis and cramps of legs or spasms and convulsions occur. The breathing is difficult, cold perspiration and severe headache occur. In some cases, paralysis of limbs is followed by drowsiness, insensibility, coma and death due to shock. Later deaths occur due to hepatic or renal failure or both. Ref:- k s narayan reddy; pg num:-547
Forensic Medicine
Poisoning
41c5ee5c-1991-4635-9440-79789fec69c6
Which of the following enzyme is associated with the conversion of androgen to oestrogen in a growing ovarian follicle is:
Aromatase
5 alpha reductase
Desmolase
Isomerase
0a
single
Aromatase enzyme: In a normal ovary, LH acts on the theca interstitial stromal cells, whereas FSH acts on granulosa cells. In response to LH the thecal cells secretes androgen, and the produced androsendione is conveed in the granulosa cells to estrogen by the action of aromatase enzyme. Ref: Physiology By James N. Pasley 2nd Edition, Page 145 ; Androgens in health and disease By William J. Bremne Page 84 ; Pade approximation and its applications: Diagnosis and management of PCOS, Issue 765, By Luc Wuytack, Page 107
Physiology
null
7b604476-4102-416b-9f7d-66bb7638d4b0
All of the following may occur in Noonan syndrome except:
Hypertrophic cardiomyopathy
Cryptorchidism
Infertility in females
Autosomal dominant transmission
2c
multi
c. Infertility in females(Ref: Nelson's 20/e p 2744-2746, Ghai 8/e p 640-641)Turner syndromeNoonan syndromeKaryotype 45, XOKaryotype normalInfertileFertile but delayed pubertySeen only in femalesMay be seen in males or femalesIntelligence normalIntellectual disability present
Pediatrics
Genetics And Genetic Disorders
bc72e7e6-c3c0-4fbb-8e0c-f15345d6ed38
Gas gangrene is caused by all except
Cl. Histolyticum
Cl. novyi
Cl. septicum
Cl. Sporogenes
3d
multi
Gas gangrene is rapidly spreading, edematous myonecrosis occurring characteristically in association with a severe wound of extensive muscle mass contaminated by pathogenic clostridia. Most frequently encountered is clostridium perfringes. Also caused by clostridium novyi, Clostridium septicum and clostridium histolyticum. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 261
Microbiology
Bacteriology
ca582da5-7d80-4d47-b237-ba7288ff469e
60 yrs old, air in biliary tree, colicky abdominal pain hyper-peristaltic abdominal sounds diagnosis -
Gall stone ileus
Hemobilia
Cholangitis
Pneumobilia
0a
multi
Answer- A. Gall stone ileusPresence in air in biliary tract along with sign of intestinal obstruction is characteristic of gall stone ileus.
Surgery
null
59359832-dffc-423d-9110-8674a1b05501
The term applied when it is doubtful whether there will be space for all the teeth in mixed dentition analysis is:
Space maintenance
Space regaining
Space supervision
None of the above
2c
multi
Space supervision  It is a term applied when it is doubtful, according to the mixed dentition analysis, whether there will be room for all the teeth. Prognosis for supervision is always questionable, where as prognosis is always good for regaining space and for space maintenance. Space supervision cases are those that will have a better chance of getting through the mixed dentition with clinical guidance than they will without. Handbook of orthodontics  Moyers 4th Ed P-364
Dental
null
952e0805-cb2b-4be6-b884-76f7ce6d779d
Absence seizures are seen in:
Grand mal epilepsy
Myoclonic epilepsy
Petitmal epilepsy
Hyperkinetic child
2c
single
Ans. is 'c' Petit mal epilepsy "Absence seizures or (Petit mal epilepsy is characterized by sudden, brief lapses of unconsciousness without loss of postural control line seizures typically lasts for only seconds, consciousness return as suddenly it was lost, and there is no postictal confusion.Absence seizures are usually accompanied by subtle, bilateral signs such as rapid blinking of eyelids, chewing movements or small amplitude clonic movements of the hand"
Medicine
Seizures and Epilepsy
6c6287a7-09db-40a2-a97f-1b0b0becd01e
Which of the following enzymes contain manganese as its cofactor?
LDH
Arginase
Hexokinase
DNA polymerase
1b
single
Manganese: Cofactor for enzymes, e.g., arginase, pyruvate carboxylase. Enzymes that require a metal ion cofactor are termed metal-activated enzymes to distinguish them from the metalloenzymes for which bound metal ions serve as prosthetic groups. Reference-Satyanarayana Pg- 405
Biochemistry
null
4824b433-8a71-40d8-871a-d7b2229c5ae8
Ergometrine is not used for initiation of labour because -
Show onset of action
Fetal hypoxia
Increases blood pressure
Act on D2 receptors to cause vomiting
1b
single
Ans. is 'b' i.e., Fetal hypoxia
Pharmacology
null
8ac9640d-d878-4003-8341-2eea055157f8
A 60-year-old man presents to the emergency department with chest pain described as retrosternal chest pressure radiating to the jaw. The symptoms started at rest and coming and going, but never lasting more than 15 minutes. He has a prior history of hypertension and smokes 1 pack/day. He is currently chest-pain free and on physical examination the blood pressure is 156/88 mmHg, pulse 88/min, and O2 saturation 98%. The heart and lung examination is normal.His ECG shows ST-segment depression in leads V1 to V4 that is new, and the first set of cardiac enzymes is negative. He is diagnosed with unstable angina pectoris, admitted to a monitored unit, and started on low molecular weight heparin, aspirin, nitroglycerin, and beta- adrenergic blockers. He continues to have ongoing chest pain symptoms. Which of the following is the most appropriate next step in management?
IV streptokinase
coronary angiography
exercise testing
oral aspirin
1b
multi
A period of 24-48 hours is usually allowed to attempt medical therapy. Cardiac catheterization and angiography may be followed by bypass surgery or angioplasty. For those who do settle down, some form of subsequent risk stratification (e.g., exercise ECG) is indicated.
Medicine
C.V.S.
996a33c2-e56e-4942-b088-96020426e714
Which of the following manifestations is not a clinical manifestation of parvovirus infection?
Erythema infectiosum
Polyarthropathy
Pure Red Cell aplasia
Tropical sprue
3d
single
null
Medicine
null
693c6ab0-7a33-49fc-abaf-8731995974d7
Which one of the following statements about the gap junction is true?
It extends as a zone around the apical perimeter of adjacent cells.
It possesses dense plaques composed in pa of desmoplakins.
It permits the passage of ions from one cell to an adjacent cell.
Its adhesion is dependent upon calcium ions.
2c
multi
The gap junction channel regulates the passage of ions and small molecules from cell to cell, excluding those having a molecular weight greater than 1200 Da. The tight junction is the zone of adhesion around the apical perimeter of adjacent cells. The other statements are characteristics of desmosomes.
Anatomy
Cailage tissue & cell junctions
6786e788-bea2-408e-b675-6c9778e62f2d
The muscle responsible for falsetto voice of puber phonia is
Vocalis
Thyroarytenoid
Posterior cricoarytenoid
Cricothyroid
3d
multi
Cricothyroid is the main tensor responsible for the falsetto voice in puberphonia. There is hyperkinetic function and spasm of cricothyroid muscle. Ref:- TB of ENT Hazarika; pg num:- 636
ENT
Larynx
91070341-4d37-4cf1-a45a-3b5146fd2a8b
The virus, which spreads by both hermatogenous and neural route is -
Rabies virus
Varicella zoster virus
Poliovirus
E.B. Virus
2c
multi
The virus multiplies initially in the epithelial cells of the alimentary canal and the lymohatic tissues from tonsil to peyer's patches. It then spreads to the rwgiinal lymoh node and enters blood stream. Direct neural transmission ti the CNS may also occur. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:486
Microbiology
Virology
5d0a032c-1b73-405b-af2f-4a612432f97f
The esophagus crosses the diaphragm at the level of:
T8
T9
T10
T11
2c
single
The oesophagus is a muscular tube 25 cm (10 in) long, which connects the pharynx to the stomach. It begins in the neck, level with the lower border of the cricoid cailage and the sixth cervical veebra. It descends largely anterior to the veebral column through the superior and posterior mediastina, passes through the diaphragm, level with the tenth thoracic veebra, and ends at the gastric cardiac orifice level with the eleventh thoracic veebra.
Anatomy
null
dd28e798-60e9-40a6-83d8-d418b9ab909e
Constriction of the afferent aeriole to the kidney glomerulus results in:
Reduction of glomerular filtration rate and decreased urinary output
Increased urine output
Increased glomerular filtration rate and no change in urine output.
Decreased urine output
0a
single
The kidney is innervated primarily by the sympathetic nervous system, and as such, regulates the contraction of the smooth muscle surrounding the afferent and efferent aerioles of the glomerulus. Sympathetic stimulation to the efferent glomerular aerioles causes their constriction and increases the filtration rate, leading to an increase in urinary output. Similarly, with the loss of sympathetic innervation, such as due to sympathectomy of the kidney, relaxation of tone of the afferent aeriole occurs and the filtration rate increases, which results in an increased urine output. Decreased urine output may result from the constriction of the afferent aerioles, leading to a decrease in glomerular filtration rate. Also Know: Factors affecting the GFR: Changes in renal blood flow Changes in glomerular capillary hydrostatic pressure Changes in systemic blood pressure Afferent or efferent aeriolar constriction Changes in hydrostatic pressure in Bowman's capsule Ureteral obstruction Edema of kidney inside tight renal capsule Changes in concentration of plasma proteins: dehydration, hypoproteinemia, etc (minor factors) Changes in Kf Changes in glomerular capillary permeability Changes in effective filtration surface area Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 37. Renal Function & Micturition. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.
Physiology
null