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c7678a67-e905-42c6-ad81-0152b1d05398 | Hyalin emembrane disease presents as | Pulmonary edema | Hea failure | Acute respiratory distress syndrome | Pulmonary embolism | 2c
| single | In hyaline membrane disease the basic pathology is surfactant defeciency.surfactant is a lipoprotein containing phospholipids like phosphatydylcholine and phosphatydylglycerol. Surfactant is produced by type ll alveolar cells of lungs which helps to reduce surface tension in alveoli,in its absence surface tension increases and alveoli tend to collapse during expiration.During inspiration more negative pressure is needed to keep alveoli patent.There is inadequate oxygenation and increased work for breathing. Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:143, 7th edition | Pediatrics | Respiratory system |
a7c170cb-f607-4ed5-a8a0-c5ab803170f3 | Secondary active transport true is - | Occurs only in same direction | Occurs only in opposite direction | Uses ATP molecule | No carrier required | 2c
| multi | Ans. is 'c' i.e., Uses ATP molecule Active transporto As the name suggests active transport is active pumping of drug molecules through a membrane against concentration gradient by a molecular pump (carrier mediated), which requires energy to function.o So, active transport has following characteristics:Movement is against concentration gradientA molecular pump (carrier protein) is required.Energy' is requiredo On the basis of energy utilization, active transport is divided to:Primary- (Direct) active transporty Transporter (carrier protein) binds ATP directly and energy is obtained directly by the hydrolysis of ATP. These transporters (carrier protein) belong to the superfamily of ATP binding cassettee (ABC) transporters whose intracellular loops have ATPa.se activity.Examples are Na+K+ ATPase. H+-K+ ATPase, Ca+2 ATPaseSecondary (Indirect) active transportThe energy to pump one solute is derived from the downhill movement of another solute, i.e. In secondary active transport, molecules are moved through a membrane as a result of the diffusion of other substance.When both molecules move in the same direction it is called svmport (cotransport), e.g. Na+ -glucose transporter in the intestine. Na+ jodide transporter in thvroid-When molecules move in opposite directions, it is termed as antiport (exchange transport) e.g. Na+-Ca+2 exchanger in myocardium | Physiology | Transport Across Cell Membrane |
9bdd1eaf-3d9a-4ba7-8cb1-d43b15147e35 | Which muscleft is the chief mover of the mandible towards the left | Left medial pterygoid | Left lateral pterygoid | Right medial pterygoid | Right lateral pterygoid | 3d
| single | The formula method states that the right lateral pterygoid moves the mandible left, whereas the left lateral pterygoid moves the mandible right. | Physiology | All India exam |
06b406c0-501f-402c-996d-ac4ef86762d7 | Bilateral rib notching is seen in – | Coarctation of aorta | PDA | TAPVC | All of the above | 0a
| multi | Radiological features of COA
Reverse figure of '3' sign or double bulge sign or E sign on the left border of aortic shadow is formed by (above downward:- Prestenotic dilatation; coarctation itself (indentation); poststenotic dilatation.
Double aortic knuckle.
Dock's sign:- There is bilateral notching of inferior margins of 3-8 ribs. Rib notching is absent in the 1st & 2nd ribs because first and second intercostal arteries do not take part in the collateral circulation. Rib notching increases with age and after the age of 7 years, rib notching is present in almost all the cases. | Radiology | null |
44c41065-64ff-4b1e-a50f-5b32e027b9f5 | A gallstone gets impacted most commonly in which pa of common bile duct | Supra duodenal | Retro duodenal | Ampulla of vater | Common hepatic duct | 2c
| multi | Most gallstones pass out of body unnoticed, but some become lodged in the common bile duct, causing jaundice A frequent site of gallstone impaction is the ampulla of vater, where common channel meets the small intestine Blockage of the common channel by a gallstone can induce acute pancreatitis Ref: Internet sources | Anatomy | G.I.T |
585f4738-c9a0-4373-9d1c-0a052c1cf6fe | Which of the following is the order of activation after stimulation of Purkinje fibers is | Septum → Endocardium → Epicardium | Endocardium → Septum → Epicardium | Epicardium → Septum → Endocardium | Septum → Epicardium → Endocardium | 0a
| single | Order of depolarization in the heart.
- First- Left side of interventricular septum
- Moves to right across the mid-portion of the septum
- Apex of heart
- Along ventricular walls to AV groove (Endocardium to epicardium)
- Last- Posterobasal portion of the left ventricle, pulmonary conus, uppermost portion of the septum. | Physiology | null |
ae9e7059-d561-4b9f-a9f3-dfc9255ee7f0 | Bariatric surgical procedures include | Gastric Banding | Gastric Bypass | Biliopancreatic diversion | Ileal Transposition | 3d
| single | Treatment for Obesity includes * Dieting. * Exercise.and also the various modalities of surgery indicated is the following, * Veical banded gastroplasty. * Gastric bypass. * Laparoscopic gastroplasty or gastric bypass. * Jaw wiring. * Biliopancreatic diversion. * Jejuno-ileal bypass ref: SRB&;s manual of surgery, ed 3, pg no 90 | Surgery | G.I.T |
277d4bee-4c21-4c90-a9dd-3fb7b283bbbd | The colorless or transparent pit and fissure sealants are usually | Indicated only in case of rampant caries | Accepted even though retention is limited | Limited to buccal pits | Indicated only before six years of age | 1b
| multi | null | Dental | null |
6cf0f837-104f-4704-ad09-3df3cb4495c8 | Which one of the following factors is labelled as cytokine in the pathogenesis of systemic inflammatory response syndrome (SIRS) ? | Nitric oxide | Complements | Leukotrienes | Tumor Necrosis factor | 3d
| single | Ans. is 'd' i.e., Tumor Necrosis factor | Pathology | null |
96343aec-f5b4-4eef-8a25-eb597271b931 | Hypeonic urine is excreted due to absorption of water in: | Collecting ducts | DCT | Ascending pa of loop of Henley | Descending pa of loop of Henley | 0a
| single | A i.e. Collecting DuctOsmolality of urine depends on the action of vasopressin on the collecting ductsQ. Alteration in water metabolism by vasopressinUrine isotonic to plasmaGFR (ml/min)% of filteredwaterreabsorbedUrine volume(L/d)Urine concentration(mosm /kg H20)Gain /Loss of water inexcess of solute (L/d)12598.72.4290 Vasopressin present12599.70.51400Q (almost 5 timeof plasma)1.9 gainNo vasopressin (Diabetesinsipidus)12587.123.33020.9 loss | Physiology | null |
f648c5a5-db4a-40f2-8466-a55dd5529bac | Impotent female is having - | Gonadal dysgenesis | Hermaphrodits | Vaginismus | Absence of ovary | 2c
| single | Ref: Synopsis of Forensic medicine and Toxicology (Dr.K.S.Narayana Reddy) Pg 200 In females impotence is of an active nature , leading to vaganismus . vaginisumus is a spasmodic contraction of vagina due to hyperesthesia .it's a classical example of psychosomatic illness .anatomically, it may affect the perineal muscles exclusively or may felt as a constriction of the levator ani , right up to vaginal fornices .this a definite cramp like spasam of the adductor muscles .the vagainal hypersthesia stas at the vaginal introitus . the spastic contraction of the vaginal outlet is completely involuntary reflex, at vaginal penetration. In fully developed state, penetration by the penis is impossible.thus she becomes impontant. In case of Gonadal dysgenesis , Hermaphrodits and Absence of ovary ,it doesn't interfere with vaginal penetration and paicipation in coitus, those females are not impotent but may be infeile. | Forensic Medicine | Sexual offences and infanticide |
53a341e3-3696-4ab9-84be-b3c1a32c4cf2 | Which among the following causes Malta fever? | Treponema pallidum | Borrelia burgdorferi | Brucella melitensis | Pseudomonas aeruginosa | 2c
| multi | Brucellosis, also called Bang's disease, Crimean fever, Gibraltar fever, Malta fever, Maltese fever, Mediterranean fever, rock fever, or undulant fever. The infection is transmitted from animals to humans. Brucella abous (cattle), B suis (hogs), and B melitensis (goats) are the main agents. Transmission to humans occurs by contact with infected meat (slaughterhouse workers), placentae of infected animals (farmers, veterinarians), or ingestion of infected unpasteurized milk or cheese. The incubation period varies from a few days to several weeks. Brucellosis is a systemic infection that may become chronic. B. melitensis infections tend to be more severe and prolonged, whereas those caused by B. abous are more self-limited. After an incubation period of 1 to 3 weeks, nonspecific symptoms such as fever, chills, fatigue, malaise, anorexia, and weight loss occur. The onset can be acute or gradual. The undulating (rising-and-falling) fever pattern that gives the disease its name occurs in a minority of patients. The treatment of choice is tetracycline plus rifampin. Prevention of brucellosis involves pasteurization of milk, immunization of animals, and slaughtering of infected animals. There is no human vaccine. Ref: Levinson W. (2012). Chapter 20. Gram-Negative Rods Related to Animal Sources (Zoonotic Organisms). In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e. | Microbiology | null |
417e4104-370f-4905-b3f8-ef4fc6fa06c6 | Rupture of the carotid artery in the neck region. Which of the following site pressure is applied | C3 vertebra | C4vertebr | C5 vertebra | C6 vertebra | 3d
| single | D. i.e. (C6 - vertebra ) (444 - Grey 14th)The bifurcation of the common carotid artery in to the internal and external carotid arteries can be palpated just beneath the anterior border of sterno cleidomastoid muscle at the level of the superior border of the thyroid cartilage. This is a convenient site to take the carotid pulse (748- Snell 8th) (C3 - C4 junction)The artery may be compressed against the prominent transverse process of the sixth cervical vertebra (chassaignac's tubercle) and above this level it is superficial and its pulsation can be easily fet (444 - Gray - anatomy 14th)* Best radiographic view for fracture of Cl C2 vertebra is odontoid view*** C7 has longest spinous process*** Subclavian Artery in patients with upper limb hemorrhage - compressed against the upper surface of the fist rib (third part of subclavian artery | Surgery | Neck |
56a13627-8079-42bd-8b35-83bf1db7ba86 | Daily maintanence fluid for a child weighing 10 kg is: | 1000 ml/day | 800 ml/day | 500 ml/day | 1200 ml/day | 0a
| single | Ref: Nelson's Textbook of Pediatrics. 19th Edition.Explanation:The Holliday-Segar MethodIn the Holliday-Segar Method, fluid and electrolyte requirements are empirically based on the caloric needs of the average hospital patient.The same formula is used for calculating calorie requirement as well as fluid requirementRelation of Body Weight to Maintenance fluidsFor each kilogram in this rangeDaily fluid requirement per kilogramFirst 1-10 kg100 ml/kg/dayNext 11 -20 kg50 ml/kg/dayFor >20 kg20 ml/kg/dayFor 10kg child. Maintanence fluid for 24 hours = 10 x 100 = 1000 ml/dayFor 15 kg child, Maintanence fluid for 24 hours = 10 x 100 + 5x 50 = 1250 ml/dayFor 25 kg child, Maintanence fluid for 24 hours = 10 x 100 + lOx 50 + 5x 20 = 1600 mL/day | Pediatrics | Maintenance and Replacement Therapy |
5773c439-9541-4cd5-8e6c-53ab01c956f9 | Soft markers on ultrasonography are helpful in diagnosing? | Fetal age | Chromosomal anomalies | Fetal size | Site of pregnancy | 1b
| single | Ans. is'b'i.e., Chromosomal anomaliesAntenatal soft ultrasound markers are fetal sonographic findings that are generally not abnormalities as such but are indicative of an increased age adjusted risk of an underlying fetal aneuploidic or some non chromosomal abnormalities. | Radiology | null |
b16bee91-a6ce-4cb0-8693-594f08525983 | Baby born to DM have following except : | Hypercalcemia | Hypokalemia | Hypoglycemia | Obesity | 0a
| multi | Ans. is a i.e. Hypercalcemia Neonatal complications of Maternal diabetes : Respiratory distress syndrome (RDS) Hypoglycaemiadeg Hypocalcemiadeg Hypomagnesemia Polycythemia Hyperbilirubinaemia Hyperviscosity syndrome Hyperophic cardiomyopathy Bih trauma - Erb's and Klumpke's paralysis and fractures of the clavicle and humerus due to large size Feeding problems. Late effects : Increased risk of diabetes in children if : If mother is diabetic Risk 1-3% If father is diabetic Risk 6% If both are diabetic - Risk 20% - Self Assessment & Review Obstetrics As far as Hypokalemia is concerned - It is not given anywhere that hypokalemia is seen in neonate of diabetic mother, but we all know that in neonate of diabetic mother hyperinsulinemia is seen. "Insulin causes potassium to shift in to the cells by Na' antipoer and Na' ATPase pump thereby lowers plasma potassium concentration". | Gynaecology & Obstetrics | null |
69a6eca9-4578-4c15-9463-7a6fd34527de | Oblitration of left cardiac shadow on PA view is due to: | Lingular lesion | Left hilar lymphadenopathy | Left lower lobe lesion | Left upper apical lobe lesion | 0a
| single | A i.e. Lingular lesion | Radiology | null |
7a8e50ea-20c0-428b-a647-c6e7a88a52e7 | There is spontaneous rupture of the Achilles tendon in an 18 year old male. It is most likely to be due to excess stress beyond - | Tendon strength | Bone strength | Muscle strength | Musculotendinous junction strength | 0a
| single | ACHILLES TENDON RUPTURE: A ripping or popping sensation is felt, and often heard, at the back of the heel. This most commonly occurs in spos requiring an explosive push-off: squash, badminton, football, tennis, netball. The patient will often repo having looked round to see who had hit them over the back of the heel, the pain and collapse are so sudden.The typical site for rupture is at the vascular watershed about 4 cm above the tendon inseion onto the calcaneum. The condition is often associated with poor muscle strength and flexibility, failure to warm up and stretch before spo, previous injury or tendinitis and coicosteroid injection. REF:Apley&;s system of ohopaedics - 9th edn - pg no 615. | Orthopaedics | Miscellaneous |
eea2dbf1-f892-49a2-81ae-28982b341d68 | A 10 month of child weighing 8kg has bitot spots in both eyes. Which of the following is the most appropriate schedule to prescribed vitamin A to this child - | 2 lakh units intramuscular (IM) on day 0, 14 | 1 lakh units IM on day 0,14 | 2 lakh units on day 0, 1 and 14 | 1 lakh units on day 0, 1 and 14 | 3d
| multi | Vitamin A deficiency treatment: Vitamin A on days 1,2 and 14 each Age >12 months - 200,000 IU Age 6-12 months - 100,000 IU for age 0-5 months - 50,000 IU Ref: Guidelines for the inpatient treatment of severely malnourished children, WHO Pgno : 23 | Social & Preventive Medicine | Nutrition and health |
7c3fde37-530b-47f8-a7f5-0afda36cbc40 | All of the following drugs alter calcium hemostasis except- | Flouride | Indomethacin | Mithramycin | Thiazides | 1b
| multi | drugs or Non hormonal substances altering calcium hemostasis are Calcium preparations Flouride Thiazides Bisphosphonates Vit D or Calcitriol Some antibiotics like mithramycin Ref - Harrisons internal medicine 20e p2945-2946 2911-12 | Medicine | Endocrinology |
d4e65def-0980-4653-b4c6-768bf74aeb9f | Epornithic is outbreak of disease among? | Animal | Birds | Reptiles | Human | 1b
| single | null | Dental | null |
816fe5df-b8b2-42d9-834a-e792aca7b59f | Which of the following is NOT an adverse effect of cyclosporine? | Hirsutism | Nephrotoxicity | Hypeension | Hypoglycemia | 3d
| single | (Ref: KDT 6/e p840) Cyclosporine causes hyper and not hypoglycemia | Pharmacology | Other topics and Adverse effects |
26ec59a9-b350-4626-bbe9-6f0e67dd8652 | Epithelium of cornea is | Stratified squamous non Keratinizing | Stratified squamous Keratinizing | Collumnar Keratinized | Collumnar non Keratinized | 0a
| single | A. i.e. Stratified Squamous non Keratinizing | Anatomy | null |
74d23164-78c6-4276-abb0-dd4af7b75e4b | Ligamentum teres is: | Remnant of ductus aeriosus | Remnant of umbilical vein | Remnant if ductus venosus | Remnant of umbilical aery | 1b
| single | After bih, the left umbilical vein are obliterated and forms the ligamentum teres hepatisLigamentum teresIt is the obliterated fibrous remnant of the left umbilical vein of the fetus.It originates at the umbilicus.It passes superiorly in the free margin of the falciform ligament.From the inferior margin of the liver, it may join the left branch of the poal vein or it may be in continuity with the ligamentum venosumOther fetal remnantsUmbilical aeries forms medial umbilical ligamentDuctus venosus forms ligamnetum venosusmDuctus aeriosus forms ligamnetum aeriosum | Anatomy | null |
61e76dc0-e702-4b85-a1d5-94bee40ff011 | Structures passing through obturator foramen are all except - | Obturator nerve | Obturator aery | Obturator vein | Internal pudendal vessels | 3d
| multi | Through the canal the obturator aery, obturator vein and obturator nerve pass out of the pelvis. | Anatomy | null |
8e15e1af-1fd1-4be8-aa64-af0cd7748572 | The Earliest sign of male pubey is | Pubic hair | Axillary hair | Hoarseness of voice | Testicular enlargement | 3d
| single | In boys, the first visible sign of pubey and hallmark of SMR2 is testicular enlargement, beginning as early as 9 1/2 years. This is followed by penile growth during SMR3. Peak growth occurs when testis volumes reach approximately 9-10 cm3 during SMR4. Under the influence of LH and testosterone, and prostate enlarges. The left testis normally is lower than the right. Some degree of breast hyperophy, typically bilateral, occurs in 40-65% of boys during SMR2-3 due to a relative excess of estrogenic stimulationIn girls, the first visible sign of pubey and the hallmark of SMR2 is the appearance of breast buds, between 8 and 12 years of age. Menses typically begins 2-2 1/2 years later, during SMR3-4 (median age, 12 years; normal range, 9-16 years), around the peak height velocity. Less obvious changes include enlargement of the ovaries, uterus, labia, and clitoris, and thickening of the endometrium and vaginal mucosa | Microbiology | All India exam |
028f43bb-c2b1-464f-b68f-a7fb7fb23772 | Mechanism of action of Tetanospasmin:- | Inhibition of GABA release | Inhibition cAMP | Inactivation of Ach receptors | Inhibition of cGMP | 0a
| single | Mechanism of action of Tetanospasmin is Inhibition of GABA release. C. tetani produces:- Tetanolysin:heat labile, oxygen labile hemolysin. It plays no role in the pathogenesis. Tetanospasmin or tetanus toxin (TT) : neurotoxin responsible for the pathogenesis of tetanus: - It is oxygen stable but heat labile; coded by plasmid. - Mechanism of action: Toxin acts pre-synaptically at the inhibitory neuron terminals and prevents release of inhibitory neurotransmitter GABA and glycine - leads to spastic muscle contraction. -Strychnine poisoning has a similar mechanism except that it acts post-synaptically. - BT (Botulinum Toxin) blocks the release of acetylcholine in neuromuscular junction, which leads to flaccid paralysis. Options 2, 3 4: Mechanism of Action of some impoant Bacterial Toxins: Heat Labile toxin of E.coli Increase cAMP Heat stable toxin of E.coli Increase cGMP Botulism toxin Inhibit release of acetylecholine from peripheral nerves Tetanus toxin Inhibit release of glycine and GABA at presynaptic terminals Diphtheria toxin Inhibit protein synthesis by inactivating EF 2 | Microbiology | Systemic Bacteriology (Gram Positive Bacilli, Gram Negative Bacilli) |
77e6d65a-1886-411c-a1af-801e8a9093ab | Characteristic radiological feature of fibrous dysplasia- | Thickened bone matrix | Coical erosion | Ground glass appearance | Bone enlargement | 2c
| single | Fibrous Dysplasia (FD) Asymptomatic, self-limiting developmental regional alteration of bone in which the normal architecture is replaced by fibrous tissue and nonfunctional trabeculae-like osseous tissue. It is self-limiting (thus it is not a true neoplasm) * Represents a group of disorders with variety of clinical patterns * Mutation in GNAS 1 gene Clinical forms of fibrous dysplasia of the jaws * Monostotic: localized to a single bone Juvenile and aggressive juvenile Adult * Polystotic: involves several bones Craniofacial McCune-Albright syndrome Jaffe syndrome ref " maheswari 9th ed | Orthopaedics | Tumors |
e0b70935-18c6-49e7-8824-a6cad57ceb32 | A 9-year-old girl presents for evaluation of regular vaginal bleeding. History reveals the thelarche at the age of 7 years and adrenarche at the age of 8 years. The most common cause of this condition in girls is: | Idiopathic | Gonadal tumors | McCune-Albright syndrome | Hypothyroidism | 0a
| single | Pubeal changes before the age of 8 years in girls and 9 years in boys are considered as Precocious pubey Most common cause of precocious pubey in girls - Idiopathic Others causes: Congenital lesions of the hypothalamus-pituitary Acquired lesions--trauma, infection, neoplasm-- tuberculosis (TB) meningitis in childhood Pa of a specific syndrome--McCuneAlbright (5%), von Recklinghausen's neurofibrobromatosis Endocrine/metabolic disorders | Gynaecology & Obstetrics | Pubeal Changes |
17e3f11a-a5ee-4eba-b79c-b2a4564376f5 | Frameshift mutation occurs due to: | Transition | Transversion | Inseion | Point mutation | 2c
| single | A frameshift mutation is caused by a deletion or inseion in a DNA sequence that shifts the way the sequence is read. | Pediatrics | Types of Genetic Disorders |
9be458de-2090-4e4e-b278-609654a475f5 | Not controlled directly by ACTH- | Glucocorticoids | Aldosterone | DHEA | Epinephrine | 3d
| single | Ans. is 'D' i.e., Epinephrine o The question is very simple. o Adrenocorticotropin hormone ( ACTH), as the name indicates, stimulate adrenal cortex. o Epinephrine is secreted by adrenal medulla other three hormones (given in question) are secreted by adrenl cortex, o ACTH has its main and most important effect on secretion of glucocorticoids (cortisol). o The effect on secretion of mineralocorticoids (aldosterone) and androgens (DHEA : dehydroepiandrosterone) in minimal (but some effect is there, which is not major regulatory mechanism). o It should be remembered that, though ACTH does not have a direct effect on epinephrine secretion, it increases epinephrine secretion indirectly as epinephrine secretion is dependent on cortisol. | Unknown | null |
123c16bf-9d44-44be-ac6e-b884207ef207 | True about berry-aneurysm is following except ? | Associated with familial syndrome | Most common site of rupture is apex which causes SAH | Wall contains smooth muscle fibroblasts | 90% occurs at ant. pa of circulation at branching point | 2c
| multi | Answer is 'c' i.e. Wall contains smooth muscle fibroblasts The wall of Berry aneurysm is made up of thickened hyalinized intima. The adventitia covering the sac is continuous with that of the parent aery. Berry aneurysm (or Saccular or congenital aneurysm) Are the most common type of intracranial aneurysm (other rarer type of aneurysms include atherosclerotic, mycotic, traumatic and dissecting aneurysms). About 90% of berry aneurysms occur in the anterior circulation and are found near the major aerial bifurcations. * Multiple aneurysms exist in 20% - 30% of cases, many at mirror sites bilaterally Etiology & Pathogenesis The etiology is unknown, the underlying congenital weakness of the wall is considered to be the cause. There is increased risk of berry aneurysms in following conditions : a) Autosomal Polycistic Kidney Ds. d) Marfans syndrome b) Ehlers-Danlos syndrome e) Fibromuscular dysplasia c) Neurofibromatosis type I f) Coarctation of aoa Predisposing factors a) Cigarette smoking b) Hypeension Rupture of aneurysm usually occurs at the apex (i.e. dome) of the sac, resulting in subarchnoid haemorrhage or intraparenchymal haemorrhage or both. Unruptured aneurysms are usually completely asymptomatic. | Surgery | null |
ea9a7b25-59ee-4f1b-b398-9afb7e6d7373 | Earliest clinical indicator of sodium loss is | Altered sensorium | Reduced skin turgor | Arrhythmia | Orthostatic hypertension | 0a
| single | Ans. a (Altered sensorium) (Ref. Harrison's - 18th/pg. Ch. 45).Hyponatremia may be due to water excess, diabetes, lipidemia etc. Drugs known to release ADH will cause dilutional hyponatremia include morphine, tricyclics, nicotine, NSAIDs, etc. The individual present with confusion, anorexia, lethargy and cramps. When sodium drops abruptly, seizures, hemiparesis and coma can develop.CLINICAL FEATURES OF HYPONATREMIA# The clinical manifestations of hyponatremia are related to osmotic water shift leading to increased ICF volume, specifically brain cell swelling or cerebral edema.# The symptoms are primarily neurologic.# Patients may be asymptomatic or complain of nausea and malaise.# As the plasma Na+ concentration falls, the symptoms progress to include headache, lethargy, confusion, and obtundation.# Stupor, seizures, and coma do not usually occur unless the plasma Na+ concentration falls acutely below 120 mmol/L or decreases rapidly.# Loss of Na+ and K+, followed by organic osmolytes, from brain cells decreases brain swelling due to secondary transcellular water shifts (from ICF to ECF).# The net effect is to minimize cerebral edema and its symptoms.Composition of World Health Organization Oral Rehydration Solution (ORS) A,BConstituentConcentration, mmol/LNa+90K+20Cl-80Citrate10Glucose110Also know:*SLADH is characterized by hypotonic hyponatremia with euvolemia. Low plasma osmolality (<280 mOsm/Kg) with high urine osmolality (>100-150 mOsm/Kg) in suspected patients is diagnostic.* Pneumonia, hyponatremia and diarrhea are almost classic for Legionella.* Under most physiologic conditions, sodium, urea, and glucose generate the osmotic pressure of blood. Plasma osmolality is calculated according to the following expression: Posm = 2Na+ + Glu + BUN (all in mmol/L), or, using conventional laboratory values in which glucose and BUN are expressed in milligrams per deciliter: Posm = 2Na+ + Glu/18 + BUN/2.8. The calculated and determined osmolality should agree within 10-15 mmol/kg H20. When the measured osmolality exceeds the calculated osmolality by >15-20 mmol/kg H20, one of two circumstances prevails. Either the serum sodium is spuriously low, as with hyperlipidemia or hyperproteinemia (pseudohyponatremia), or osmolytes other than sodium salts, glucose, or urea have accumulated in plasma. | Medicine | Fluid & Electrolyte |
25083369-e7e2-4946-b365-b397c1d70e4d | Feature(s) of Allergic conjunctivitis is/are all except: | Itching | Papillary'hyperplasia | Presence of abundant eosinophils in the discharge | Usually present throughout year | 3d
| multi | Ans: D (UsuaIly..) SIMPLE ALLERGIC CONJUNCTIVITISIt is a mild, non-specific allergic conjunctivitis characterized by itching, hyperaemia and mild papillary response. Basically, it is an acute or subacute urticarial reaction.EtiologyIt is seen in following forms:Hay fever conjunctivitis. It is commonly associated with hay fever (allergic rhinitis). The common allergens are pollens, grass and animal dandruff.Seasonal allergic conjunctivitis (SAC). SAC is a response to seasonal allergens such as grass pollens. It is of very common occurrence,Perennial allergic conjunctivitis (PAC) is a response to perennial allergens such as house dust and mite. It is not so common, results. However, a trial may be given in recurrent cases.PathologyPathological features of simple allergic conjunctivitis comprise vascular, cellular and conjunctival responses.Vascular response is characterised by sudden and extreme vasodilation and increased permeability of vessels leading to exudation.Cellular response is in the form of conjunctival Infiltration and exudation in the discharge of eosinophils, plasma cells and mast cells producing histamine and histamine-like substances.Conjunctival response is in the form of boggy swelling of conjunctiva followed by increased connective tissue formation and mild papillary hyperplasia.Clinical PictureSymptoms include intense itching and burning sensation in the eyes associated with watery discharge and mild photophobia.Signs (a) Hyperaemia and chemosis which give a swollen juicy appearance to the conjunctiva, (b) Conjunctiva may also show mild papillary reaction, (c) Oedema of lids.DiagnosisDiagnosis is made from : (1) typical symptoms and signs; (2) normal conjunctival flora; and (3) presence of abundant eosinophils in the discharge.TreatmentElimination of allergens if possible.Local palliative measures which provide immediate relief include:Vasoconstrictors like adrenaline, ephedrine, and naphazoline.Sodium cromoglycate drops are very effective in preventing recurrent atopic cases.Steroid eye drops should be avoided. However, these may be prescribed for short duration in severe and non- responsive patients.Systemic antihistaminic drugs are useful in acute cases with marked itching.Desensitization has been tried without much rewardingFig: (Khurana): Differentiating features of common types of conjunctivitis BacterialViralAllergicChlamydial(A) CLINICAL SIGNS 1. CongestionMarkedModerateMild to moderateModerate2. Chemosis+++- +-3. Subconjunctival haemorrhages++---4. DischargePurulent or mucopurulentWateryRopy/wateiyMucopurulent5. Papillae+-+++6. Follicles-+-++7. Pseudomembrane++--8.Pannus--- (Exceptvernai)+9. Pre-auricular lymph nodes+++-+(B) CYT0L0G1CAL FEATURES 1. Neutrophils++ (Early)-+2. Eosinophils--+-3. Lymphocytes-+-+4. Plasma cells---+5. Multi nuclear cells-+--6. Inclusion bodies: Cytoplasmic-+(Pox)-+Nuclear-+ (Herpes)--7. Micro-organisms+--- | Ophthalmology | Inflammations of Conjunctiva - Allergic and Granulomatous |
5e209771-0870-4a23-b611-4794943e09ee | The combination of alcohol and disulfiram results in nausea and hypotension as a result of accumulation of: | Acetaldehyde | Acetate | Methanol | NADH | 0a
| single | Disulfiram is an aldehyde dehydrogenase inhibitor that can be used for de-addiction of chronic alcoholics. Due to inhibition of aldehyde dehydrogenase, there is accumulation of acetaldehyde that leads to several distressing symptoms (which strengthens the resolution of a person to quit alcohol). | Pharmacology | Opioids and Alcohols |
b4afbb19-5fc2-4132-b313-e161bfcfcd8d | Possible contra indications for periapical surgery are | Controlled diabetis mellitus | The danger of damage to adjacent structures | A history of rheumatic fever | Congenital heart disease | 1b
| single | null | Dental | null |
9f75e88c-67f6-4533-b44c-accea21dd2a7 | Lymph node biopsy of an AIDS patient shows: March 2009 | Wahin-Finkeldey cells | Marked follicular hyperplasia | 'Moth-eaten appearance' | All of the above | 3d
| multi | Ans. D: All of the above Histopathology of HIV Florid reactive hyperplasia-may be: - Collections of monocytoid B cells in sinuses - Neutrophils - Features of dermatopathic lymphadenopathy Often reactive germinal centers show 'follicle lysis':i.e. invagination of mantle lymphocytes into germinal centers associated with: - Disruption of centers ('moth-eaten appearance') - Distinctive clustering of large follicular center cells resulting appearance termed explosive follicular hyperplasia Occasional polykaryocytes: - Wahin-Finkeldey cells - May be multinucleated form of follicular dendritic cell Electron microscopy: - Sometimes prominent follicular dendritic cells exhibit alterations of their fine processes Interfollicular tissue may show prominent vascular proliferation: vague resemblance to Castleman's disease - These areas and subcapsular region may reveal earliest signs of Kaposi's sarcoma - Sometimes advanced lymphocyte depletion: may be abnormal (regressively transformed) germinal centers | Pathology | null |
3d5df235-057d-4847-a5fc-53bf46beb4a3 | In oesophageal ca which Neoadjuvant chemotherapy is used - | Cisplatin | Cyclophosphamide | Doxorubicin | Methotrexate | 0a
| single | Sabiston writes-"Since its introduction in 1980, cisplatin has emerged as the cornerstone of combination therapy in esophageal cancer.
As a single agent, it has a response rate of 25% to 30%. Given in combination with 5-fluorouracil, a response rate of 50% may be achieved, and this is an established chemotherapeutic regimen for esophageal cancer." | Surgery | null |
f05f06d5-0b70-4174-821b-d645b11ba239 | Choriocarcinoma commonly metastasize to:
a.Brain
b. Lung
c. Vagina
d. Ovary
e. Cervix | ab | bc | cd | de | 1b
| single | Most common sites of metastases in choriocarcinoma are:
Lung (80%) > Vagina (30%) > Pelvis (20%) > Liver (10%) and Brain (10%) | Gynaecology & Obstetrics | null |
6bb751f8-dfa4-4e0c-93ec-0e69682ad4be | In burns least useful is | Normal saline | Blood | Dextran | Ringer lactate | 1b
| single | We know that Ringer's lactate is the preferred agent during initial 24 hrs. Nasogastric intubation is done to decrease the risk of emesis and possible aspiration (as parlytic ileus develops in a pt. with significant burn) Dextran is a colloid and can be used in 2nd 24 hrs., however albumin is the preferred and most widely used colloid. Blood has also role in burn patient. The need for Blood replacement is significant in extensive burns. Besides injury to red blood cells and their decreased half-life resulting in their early destruction, many patients may be anaemic. Hence, repeated and frequent transmission to maintain a hematocrit around 35% is necessary. Ref Bailey and love 27e p625 , Srb`s manual of surgery p133 | Anatomy | General anatomy |
29a8fcef-cac1-4c7a-82e0-9dcdc89c64cd | Alpha 1 antitrypsin deficiency is associated with- | Panacinar-emphysema | Centriacinar-emphysema | Paraseptal-emphysema | Irregular-emphysema | 0a
| single | Ans. is 'a' i.e., Panacinar-emphysema Pathogenesis of Emphysemao The most accepted theory in the pathogenesis of emphysema is protease - antiprotease mechanism which is responsible in the pathogenesis of two common forms of emphysema, i.e. centriacinar and panacinar.o The alveolar wall destruction results from an imbalance between proteases (mainly elastase) and antiproteases in the lung.o Proteases (elastase) cause destruction of alveolar wall, while antiproteases prevent this damage,o a1 antitrypsin is the major antiprotease (antieiastase) secreted by neutrophils during inflammation.A. Pathogenesis of panacinar emphysemao Panacinar emphysema is associated with congenital deficiency of a1.-antitrypsin.o This results in unchecked overactivity of neutrophil elastase that causes destruction of alveolar wall,o As a,-antitrypsin is deficient throughout the acinus, the acini are uniformly involved from the respiratoiy bronchiole to the terminal blind alveoli.o Neutrophils are the major cells in the pathogenesis of panacinar emphysemaB. Pathogenesis of centriacinar emphysemao Centriacinar emphysema is associated with smoking.o Nicotine acts as a direct chemoattractant for neutrophils and macrophages,o So, in centriacinar emphysema, both neutrophils and macrophages play central role,o Smoking enhances activity of neutrophil and macrophage elastase.o Macrophage elastase is not inhibited by a1-antitrypsin and indeed can proteolvticallv digest this antiprotease,o Beside protease - antiprotease mechanism, oxidant - antioxidant imbalance also plays an important role in the pathogenesis of smoking related emphysema.o Normally, the lung contains a healthy complement of antioxidants (superoxide dismutase, glutathione),o Tobacco smoke contains abundant reactive oxygen species (free radicals) which deplete these antioxidant mechanisms.o Free radicals cause tissue damage as well as they inactivate a(-antitrypsin, resulting in functional a,- antitrypsin deficiency even in patients without enzyme deficiency. | Pathology | Obstructive Lung Diseases |
f7652f76-c01f-4db7-8803-eda1f5917a6e | Blocking out undercuts in cavity preparation for CAD/CAM inlay is carried out by: | Dentist after final cavity preparation stage | Laboratory technician before wax pattern preparation | The system automatically during the optical impression | Dentist in the wax preparation | 0a
| multi | null | Dental | null |
68253f41-6d3a-4763-bceb-9e175bd19218 | Sternocleidomastoid is supplied by all of the following aeries, EXCEPT? | Occipital | Posterior auricular | Thyrocervical trunk | Superior thyroid | 1b
| multi | The Sternocleidomastoid muscle flap is used in reconstructive surgery of the neck. The exact knowledge of its blood supply helps to minimize the risk of flap necrosis after transposition.Blood supply of Sternocleidomastoid: Upper third - supplied by branches of the occipital aery. Middle third - supplied by a branch of the superior thyroid aery.Lower third - supplied by a branch arising from the suprascapular aery. (Suprascapular aery is a branch of thyrocervical trunk). | Anatomy | null |
ef6b0423-eef2-448a-b53e-55703fe4f3aa | Stereognosis will be lost in the lesion of: | Fasciculus gracilis | Fasciculus cuneatus | Anterior spinothalamic tract | Lateral spinothalamic tract | 1b
| single | Stereognosis is the ability to identify an object by its touch, texture. The object is placed in hands and is identified without seeing it. Fine touch sensation from the upper limb is carried toward coex in fasciculus cuneatus. The tract also carries the finer aspects of touch. Perception of touch occurs in the somatosensory coex I (areas 3, 1, 2); analysis and interpretation of the touch is done in the somatosensory coex II (areas 5, 7). | Physiology | Sensory System |
cd71f884-ffdb-46f4-8db5-aa0e38de8533 | Lateral boundary of cubital fossa is formed by: | Brachioradialis | Pronator teres | Brachialis | Biceps | 0a
| single | Brachioradialis Boundaries of cubital fossa- Laterally - Medial border of brachioradialis. Medially - Lateral border of pronator teres. Base - It is directed upwards, and is represented by an imaginary line joining the front of two epicondyles of the humerus. Apex - It is directed downwards, and is formed by the area where brachioradialis crosses the pronator teres muscle. Ref: Gray&;s anatomy text book of anatomy BD chaurasia 21st Ed. | Anatomy | All India exam |
fefe8db3-8264-40cd-8dc9-7b0582bd9f97 | Second gas effect is seen with - | Ether | Nitrous oxide | Desflurane | Sevoflurane | 1b
| single | Ans. is 'b' i.e., Nitrous oxide Second gas effecto If another inhalation agent is (eg Halothane) is being given at the same time with N2O2 it also will be delivered to lung from the cylinder (due to negative intraalveolar pressure).Also Remembero Concentration effect and secondary gas effect - during inductiono Diffusion hypoxia - during recovering.o All these occur with N2O only (Xenon also causes these effects). | Anaesthesia | Miscellaneous General Anesthesia |
3212e9bf-f1d3-4e32-a9b9-c994ace14cd5 | Elastic cartilage is present in- | Thyroid cartilage | Epiglottis | Cricoid | Arytenoid cartilage | 1b
| single | null | Anatomy | null |
7620f0a6-a7e6-4573-b525-e0849f7a25d2 | Example of electrical synapse: | Tight junction | Gap junctions | Anchoring junction | Neuromuscular junction | 1b
| single | (Refer: Ganong’s Review of Medical Physiology, 24th edition, pg no: 43-44)
Intercellular junctions
Connects the cell membranes of the neighboring cells also known as junctional complexes | Unknown | null |
0bcedcd4-53d6-43d4-88a7-b86dbb81f923 | All are medically important streptococci except - | Strep. pyogenes | Strep. agalactiae | Strep. equisimilis | Strep. salivarius | 3d
| multi | STREPTOCOCCI
Streptococci are gram-positive, nonmotile, non-spore-forming, catalase & oxidase negative medically important bacteria.
Many organisms of streptococcus genus cause human diseases. | Microbiology | null |
01e98aca-d792-4dd7-bc9a-eb0fc8eb402f | True about meningiomas- | More common in men | 50% are malignant | 95% cure rate following treatment | Arise from arachnoid layer | 2c
| multi | Meningiomas are predominantly benign tumors that arise from arachnoid meningothelial cells. They usually occur in adults and are often attached to the dura. Meningiomas may be found along any of the external surfaces of the brain as well as within the ventricular system, where they arise from the stromal arachnoid cells of the choroid plexus.They usually come to attention because of vague nonlocalizing symptoms, or with focal findings referable to compression of the adjacent brain. Most meningiomas are easily separable from the underlying brain. Meningiomas (WHO grade I/IV) grow as well-defined dura-based masses that may compress the brain but do notinvade it. Among the varied histologic patterns are syncytial, named for whorled clusters of cells without visible cell membranes that sit in tight groups; fibroblastic, with elongated cells and abundant collagen deposition between them; transitional, which shares features of the syncytial and fibroblastic types; psammomatous, with numerous psammoma bodies ; and secretary, with gland-like PAS-positive eosinophilic secretions known as pseudopsammoma bodies. Atypical meningiomas (WHO grade II/IV) are recognized by the presence of ceain histologic features (prominent nucleoli, increased cellularity, pattern-less growth), and often have a higher mitotic rate. These tumors demonstrate more aggressive local growth and a higher rate of recurrence; they may require therapy in addition to surgery. Anaplastic (malignant) meningiomas (WHO grade III/IV) are highly aggressive tumors that may resemble a high-grade sarcoma or carcinoma, although there usually is some histologic evidence of a meningothelial cell origin. | Pathology | Nervous system |
31117f1b-6870-4655-bd34-9f166f70b54f | A 52-year-old alcoholic notices a skin rash on his chest, and also has symptoms of diarrhea and abdominal pain. On examination, he has a scaly and pigmented rash on the sun-exposed areas of his skin, the abdomen is soft, and his short-term memory is impaired. He has dermatitis, diarrhea, and dementia syndrome.For the patient with vitamin deficiency or excess, select the most likely diagnosis | niacin | thiamine | pyridoxine | vitamin C | 0a
| single | Diarrhea, dementia, and dermatitis are the classic triad for pellagra (niacin deficiency). The diagnosis is based on clinical suspicion and response to therapy, and can be confirmed by demonstrating low levels of the urinary metabolites 2-methylnicotinamide and 2-pyridone. Small doses of niacin (10 mg/day) with adequate dietary tryptophan will cure pellagra secondary to nutritional deficiency. | Medicine | Endocrinology |
c82b8e71-5dd0-4fee-94d5-c146ba0fc50d | The transmembrane adhesive molecules present in hemi desmosomes which specifically binds to basal lamina glycoprotein laminin are | integrin α6-β4 | the catenins desmoplakin | cadherins desmoglein | α and β catenin | 0a
| multi | null | Biochemistry | null |
fa36b805-79a7-432e-88e1-7406b87aa473 | Tarsometatarsal amputation and Intertarsal amputation known as respectively, | Lisfranc and Pirogoff | Lisfranc and Chopart | Chopart and Lisfranc | Chopart and Pirogoff | 1b
| single | null | Orthopaedics | null |
d93522e3-8ae1-451e-a688-daec2e5dfe08 | A 19-year-old man presents to the clinic complaining of early fatigue and muscle cramps while playing sports. He is fine when walking or doing less intense levels of work. On physical examination, he appears well and the vital signs are normal. Muscle bulk, tone and strength in the proximal muscles are normal. There is no muscle fatigue with repetitive arm grip exercises. After an exercise stress test, his serum creatine kinase (CK) is elevated and lactate level is normal. Which of the following is the most likely diagnosis? | Gaucher disease | Tay-Sachs disease | McArdle disease (glycogen storage disease) | hemochromatosis | 2c
| single | There are many types of glycogen storage diseases, each caused by a different enzymatic abnormality. The best-known types of glycogen storage disease are those that have hepatic hypoglycemic pathophysiology (eg, von Gierke disease) or those that have muscle energy pathophysiology (McArdle disease). InMcArdle' symptoms usually develop in adulthood, and it is marked by cramps and muscle injury with strenuous exercise, but not with usual activities. Gaucher and Tay-Sachs disease are lysosomal storage diseases. | Medicine | Endocrinology |
a3716633-52bb-4b96-a5ce-68f5406639eb | A 36-year-old lady presents with a 20 yrs duration fluctuant and translucent swelling on right side of her neck. No other history available. No other findings on examination of neck. What is the most probable diagnosis? | Lymph cyst | Lymph node | Colloid nodule | Cold abscess | 0a
| single | The only swelling among the 4 options which will show translucency is Lymph cyst. | Surgery | All India exam |
52beca06-66a5-495d-a2bf-5f9d73b57e06 | Tumorogenesis in aging is due to - | Telomerase reactivation | Telomerase inactivation | Increased apoptosis | Suppression of proto-oncogenes | 0a
| single | After a fixed number of divisions, normal cells becomes arrested in a terminally nondividing state.
How does the normal cells count their divisions i.e. How, do the cells find out that now they do'nt need to divide further.
Cells achieve this through telomer shortening
Telomers are short repeated sequences of DNA present at the linear ends of chromosome that are important for ensuring complete replication of chromosome ends.
It consists of many arrays of TTAGGG repeats at tellninal of 3' ending strand. It confers stability to chromosomes. With each successive division there is some shortening of the telomers.
Once the telomers are shortened beyond a certain point the ends of the chromosome are seen as broken i1 NA, which signals cell cycle arrest.
The broken NA leads to activation of p53 dependent cell cycle check points causing proliferative arrest or apoptosis.
Thus telomere shortening functions as a clock that counts cell division.
How do the germ cells keep on dividing throughout their life???
In germ cells telomere shortening is prevented by the sustained function of the enzyme telomerase.
Telomerase is a reverse transcriptase and is responsible for telomer synthesis and maintaining the length of telomer.
It is RNA dependent DNA polymerase. It has one segment that is complimentary to TTAGGG repeat and is used as template for the replication of telomeric sequence.
This enzyme is absent from most somatic cells and hence they suffer progressive loss of telomers and they exit the cell cycle. Telomerase is present in Germ cells thus explaining the ability of these cells to self replicate extensively. If loss of telomere is the basis of finite life span then how do cancer cells continue to divide actively????
In cancer cells telomerase activity is reactivated. Telomerase activity has been detected in more than 90% of human tumours.
Thus telomerase activity and maintenance of telomere length are essential for the replicative potential in cancer cells. | Pathology | null |
84cd88f1-d037-468b-8b70-fa356ed0c34d | All are true regarding typhoid ulcer EXCEPT: September 2012 | Ileum is the common site | Bleeding is common | Stricture is usual and causes obstruction | Perforation is common | 2c
| multi | C i.e. Stricture is common and causes obstruction Typhoid ulcers Longitudinal, Ulceration of Peyer's patches, Stricture is rare | Medicine | null |
b721ac62-bfa3-43fb-8dfd-5d0f6dfc22a9 | All are true regarding paroxysmal nocturnal haemoglobinuria, except- | Haemosiderinuria | Pancytopenia | Increased alkaline phosphatase | Cellular marrow | 2c
| multi | null | Medicine | null |
89eba139-5884-4de5-a7a2-866a0ce50614 | The lesion listed below that would most likely pursue a benign course is :- | Vaginal adenosis | Adenomyosis | Extramammary Paget's disease | Endometrial hyperplasia | 1b
| single | Adenomyosis is a benign condition characterised by the presence of benign endometrial glands and stroma within the myometrium, Common cause of diffuse uterine enlargement and menstrual irregularities. Vaginal adenosis is a DES-related precursor lesion for clear cell adenocarcinoma. Extrammary paget's disease is an intraepithelial adenocarcinoma. Endometrial hyperplasia is a precursor lesion of endometrial carcinoma. | Gynaecology & Obstetrics | Endometriosis & H |
10f67894-3496-4aca-8b89-bdb3df1aab17 | Chromophobe variant of renal cell carcinoma is associated with - | VHL gene mutations | Trisomy of 7 and 17 (+7, +17) | 3 p deletions (3p-) | Monosomy of 1 and Y (-1, -Y) | 3d
| single | null | Pathology | null |
76205fac-06be-44e5-ac70-a42c5942d456 | Canakinumab is a monoclonal antibody against: | IL-1 | IL-2 | IL-5 | IL-6 | 0a
| single | Canakinumab and Anakinra are IL-1 inhibitors used in the treatment of gout. | Pharmacology | null |
d5050f74-0d57-41a2-8b48-42b4337dc4ac | Minimum amount of GI bleed to cause malena is | 10 ml | 40 ml | 60 ml | 115 ml | 2c
| single | Melaena refers to the passage of typical black, tarry coloured foul smelling stool. It signifies upper GI bleed. At least 50-60 ml bleeding should be there to cause melaena. Reference : page 834 SRB's manual of surgery 5th edition | Surgery | Urology |
7db23073-08bb-4054-82aa-760e55108a90 | Sympathetic innervation of heart is by - | T1-T3 | T1 - T5 | c) T3-T7 | L1 - L5 | 1b
| single | Ans. is 'b' i.e., T1- T5 * Parasympathetic supply to heart - Vagus.* ympathetic supply to heart - T1- T5Innervation of Heart* Innervations of heart are :-A) Sympathetic innervation of heart:# All parts of the heart (SA node, atria, AV node and ventricles) recieve sympathetic innervations.# The sympathetic innervation on right side is distributed primarily to the SA node, while on the left side is distributed primarily to the AV node.# Sympathetic fibers are mostly distributed to the epicarium.# Sympathetic discharge has following effects :i) Positive ionotropic (Increase in force of contraction).ii) Positive chromotropic (Increased heart rate).iii) Positive dromotropic (Increased conduction).iv) Positive bathmotropic (increased automaticity).v) Decreased refractory period of all types of cardiac cells. -# The main neurotransmitter is nor-adrenaline.B) Parasympathetic innervation of heart:# Parasympathetic fibers to the heart reach through the vagus nerve.# The right vagus is distributed mainly to SA node while the left vagus mainly innervates the AV node. Vagal fibers are mostly endocardial in distribution.# Vagal stimulation has following effects :i) Negative chronotropic (decreased heart rate).ii) Negative dromotropic (decreased conduction).iii) Increased refractory period of all types of cardiac cells.# But vagal stimulation does not have a negative inotropic effect because vagal (parasympathetic) fibers do not innervate the myocardial cells of the ventricles in sufficient numbers; there is slight decrease in force contraction of atria only.# Major neurotransmitter is acetylcholine. | Physiology | Heart, Circulation, and Blood |
4cb65fc3-bef3-411c-a2bb-0da0c2245cf7 | All of the following can induce methemoglobinemia EXCEPT: | Nitroglycerine | Procaine | Prilocaine | Phenytoin | 3d
| multi | Drugs that may cause Methemoglobinemia includes- nitrates derivatives (nitrates salt, nitroglycerin), nitrites derivatives (nitroprusside, amyl nitrite, nitric oxide), sulfonamides, dapsone, phenacetin, phenazopyridine, local anesthetics such as prilocaine, topical anesthetics such as Emla cream, benzocaine etc Essential of medical pharmacology Sixth edition-KD Tripathi Page:405,406 | Pharmacology | Other topics and Adverse effects |
819a9b25-36f0-41d0-a409-8289d976f067 | Kamli Rani, 75-years -old woman present with post myocardial infarction after 6 weeks mild CHF. There was past H/O neck surgery for parathyroid adenoma 5 years ago, ECG shows slow atrial fibrillation. Serum Ca2+ 13.0 mg/L and urinary Ca2+ is 300 mg/24 hr. On examination there is small mass in the Para tracheal position behind the right clavicle. Appropriate management at this time is: | Repeat neck surgery | Treatment with technetium-99 | Observation and repeat serum Ca2+ in two months | Ultrasound-guided alcohol injection of the mass | 3d
| multi | Patient is a case of recurrent hyperparathyroidism, as she was operated previously for parathyroid adenoma. In the setting of recent myocardial infarction, CHF and atrial fibrillation, any operation carries a high risk. Ultrasound-guided alcohol injection in the mass is preferred in this setting. | Surgery | Parathyroid and adrenal glands |
1c1952d1-508c-4dfa-ab1a-bdcd6b9061b6 | True regarding multiple myeloma is all, EXCEPT- | Bone pain | Lytic lesions | Increased alkaline phosphatase | Tarterate resistance, acid phosphatase positive | 2c
| multi | null | Medicine | null |
674ba9bc-b118-45db-8112-040b2b84f2d8 | All are true for transplanted kidney except | Humoral antibody responsible for rejection | CMI is responsible for rejection | Previous blood transfusion | HLA identity similarity seen in 1:100 people | 3d
| multi | Answer- D. HLA identity similarity seen in 1:100 peopleWithin any paicular family, sibling's have a 7:4 chance of being HLA identical. In contrast among unrelatedpeople, the probabilities of HLA identity in several thousand depending upon phenotype involved' It is due to the fact thatHLA complex is inherited intact as two haplotypes. | Medicine | null |
a23d6bed-8155-46ef-916b-10886fc17537 | Non-coding RNAs are | siRNA | miRNA | tRNA | mRNA | 0a
| single | A non-coding RNA (ncRNA) is a functional RNA molecule that is transcribed from DNA but not translated into proteins. Epigenetic related ncRNAs include miRNA, siRNA, piRNA, and lncRNA. In general, ncRNAs function to regulate gene expression at the transcriptional and post-transcriptional level. | Biochemistry | Metabolism of nucleic acids |
d6b7eda2-1233-413c-a589-6dd7473ae5c3 | 'Brush burns' are synonymous with | Graze abrasion | Scalds | Electrical injury | Injury by a brush | 0a
| single | Ans. a (Graze abrasion) (Ref. Reddy FMT 23rd ed. 145)ABRASIONS (GRAZES, SCRATCHES, BRUSH BURNS)# Loss/crushing of outer skin layer due to impact with a rough surface- Tangential impact produces a moving abrasion:* Indicates direction.* Trace material (e.g., grit).- Direct impact produces an imprint abrasion:* Pattern of causative object.# All abrasions reflect site of impact (contact bruises).# Assessment of age difficult.# Postmortem abrasion - Brown, leathery. | Forensic Medicine | Injuries by Blunt Force |
26aa4dc2-bdc4-4b45-aa89-1d65bff8fc46 | Cervical cone biopsy in a case of carcinoma cervix causes all, except : | Bleeding | Cervical stenosis | Infection | Spread of malignancy | 3d
| multi | Ans. is d i.e. Spread of malignancy Complications of Cone biopsy are : Hemorrhagedeg Sepsis (infection)deg Cervical stenosisdeg Pregnancy complications which include : Mid trimester aboionsdeg Preterm labourdeg -- Cervical dystociadeg Also Know : Cone biopsy should be done under general anaesthesia. The cone should include the entire outer margin and the endocervical lining but internal OS is spared. 1 A small cone is preferred in younger women to avoid pregnancy complications. | Gynaecology & Obstetrics | null |
c7adea89-80f3-4715-950a-4b0b133f8e84 | A 57-year-old man arrives at the emergency room complaining of weakness, fatigue, and intermittent fever that has recurred for several weeks. The patient had a cardiac valvular prosthesis implanted 5 years ago. Blood cultures grew ceain gram-positive cocci on which catalase and coagulase test were done. The gram-positive organisms failed to ferment mannitol, and their growth was inhibited by novobiocin. CATALASE TEST SLIDE COAGULASE TEST Lesions seen on skin What is the most likely infectious agent? | Staphylococcus aureus | Staphylococcus epidermidis | Staphylococcus saprophyticus | Streptococcus viridans | 1b
| single | Physical examination reveals petechiae (pinpoint, nonraised, purplish red spots caused by intradermal hemorrhage) on the chest and stomach. Catalase-positive and coagulase negative The patient is probably suffering from bacterial endocarditis caused by S. epidermidis infection of the prosthetic hea valve. S. epidermidis Coagulase-negative organism Unable to ferment mannitol Sensitive to novobiocin Resistant to penicillin. Patients with congenital hea malformations, acquired valvular defects (for example, rheumatic hea disease), prosthetic valves, and previous bacterial endocarditis show an increased incidence of bacterial endocarditis. Intravenous drug users also have a high risk for infection. S. viridans can be ruled out, because streptococci are catalase negative, which is a feature that distinguishes them from catalase-positive staphylococci. S. aureus is coagulase positive so it is ruled out. S. saprophyticus is coagulase negative but resistant to novobiocin, hence also ruled out here | Unknown | Integrated QBank |
960f67e6-cd35-43c6-bf3b-44ba3785af10 | A patient aged 63 years, is diagnosed to have severe aplastic anemia. HLA compatible sibling is available. The best option of treatment is : | Anti-thymocyte globulin followed by cyclosporine | A conventional bone marrow transplantation from the HLA identical sibling | A non-myeloablative bone marrow transplantation from the HLA identical sibling | Cyclosporine | 0a
| multi | Answer is A (Antithymocyte globulin followed by cyclosporine) Tor adults over age 50 years or those without HLA matched siblings, the treatment of choice for severe Aplastic anemia is immunosupression with antithymocyte globulin (A TG) plus Cvclosporine' | Medicine | null |
2f9d014b-5875-4c85-ada4-dca4a72536bc | Cobblestone appearance is seen in | Spring Catarrh | Viral conjunctivitis | Bacterial conjunctivitis | Phlyctenular conjunctivitis | 0a
| single | Cobblestone appearance is severe papillary hyperplasia in upper palpebral conjunctiva Refer: Khurana 6th edition page number 73 | Ophthalmology | Conjunctiva |
a9f58246-3b51-4e63-b200-9835291680fb | Not a molecular motor: | Kinesin | Dynein | Actin | Myosin | 2c
| single | Motor proteins: Molecular motors include the proteins: myosin kinesin dynein They move along a track- microtubules or microfilaments - and pull larger structures such as vesicles, fibers, or paicles. Such movement can be used for intracellular transpo or movement of the cell's entire framework. | Physiology | Cell Membrane and transpo protiens |
80f82d62-6060-40e7-b938-25b666f14fb5 | True about anaplastic thyroid carcinoma:a) Common in elderlyb) Well encapsulatedc) Will not invade surrounding structuresd) Distant metastasis commone) Some degree of differentiation to Papillary and Follicular types seen | acd | bde | ade | ad | 2c
| multi | About option 'e' Schwartz writes:
"On gross inspection, anaplastic tumors are firm and whitish in appearance. Microscopically, sheets of cells with marked heterogeneity are seen. Cells may be spindle-shaped, polygonal, or large, multinucleated cells. Foci of more differentiated thyroid tumors, either follicular or papillary, may be seen, suggesting that anaplastic tumors arise from more well-differentiated tumors." | Surgery | null |
bb7d33b9-1146-4450-ac8d-a4a4bce3b612 | Recommended Dietary allowance in pregnancy are - | +100-300 cal | 35 mg Iron | 4 mg folic acid | 2500 mg Mg | 1b
| multi | Requirements in pregnancy Pregnancy Proteins +23 g/day Calcium 1200 mg/day Iron 35 mg/day Vitamin A 800mcg/day Ref: Park 25th edition Pgno : 674 | Social & Preventive Medicine | Nutrition and health |
d526af5d-44c1-459a-912b-52f2b4fe4133 | Which of the following is not a feature of chronic tonsillitis? | Fever | Halitosis | Recurrent attacks of sore throat | Choking spells at night | 0a
| single | Ans. is 'a' i.e., Fever(ref Dhingra 6h/e p. 258]Fever is a symptom in case of acute tonsillitis, not chronic tonsillitis.Chronic tonsillitis is characterized by:- Recurrent attacks of sore throat or acute tonsillitis. | ENT | null |
b0547567-2eb8-46d4-94d8-9ffc26815626 | Which of the following muscle relaxants causes maximal pain on injection – | Succinyl choline | Vecuronium | Rocuronium | Cistracurium | 2c
| single | Pain during injection is an important and common feature of Rocuronium Injection. | Anaesthesia | null |
9daacfb7-a6aa-44d6-80f5-3baa2aed36b7 | Steroids are indicated in all of the following forms of tuberculosis except: | Meningitis | Pericarditis | Ileo-caecal tuberculosis | Adrenal involvement | 2c
| multi | Steroids are contraindicated in intestinal tuberculosis because silent perforation can occur. (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 778) | Pharmacology | Endocrinology |
880012d6-4c05-45e8-bd94-202a37fd4853 | Which of the following is false about viral thyroditis? | Self limiting | Painful | Initial hypothyroid state | Raised ESR | 2c
| multi | Viral thyroditis has initial hyperthroid state due to release of harmones due to gland destruction. | Surgery | null |
e249f58e-839d-4d08-99e9-0e0186145e4f | Expansible pulsating secondary metastasis is a feature of | Basal cell carcinoma | Renal cell carcinoma | Osteogenic sarcoma | Carcinoma prostate | 1b
| single | B i.e. Renal Cell carcinoma | Radiology | null |
5a787da9-6f9a-429c-bbc0-cb0833505608 | Most common cause of bleeding for massive hemothorax in blunt trauma to chest is from | Intercostal vessels | Bronchial vessels | Pulmonary vessels | Internal mammary aery | 0a
| single | Answer- A. Intercostal vesselsThe most common cause of massive haemothorax in blunt injury to chest is continuing bleeding from torn intercostal vexels or occasionallyfrom the internal mammary aety. | Surgery | null |
e2925cfa-68ad-4684-a46b-f978223f9ba2 | The main clinical significance of sliding type hiatus hernia is: | Propensity for GERD | High risk of barrett's esophagus | High chance for dieulafoy's lesion | Dysphagia is common | 0a
| single | Four types of hiatus hernia are present. Type I, or sliding hiatal hernia comprising at least 95% of total. Pathology is the weakening of the phrenoesophageal ligament attaching the gastroesophageal junction to the diaphragm at the hiatus. Incidence of sliding hernias increases with Age and conceptually, results from wear and tear Intraabdominal pressure Hereditary factors The main significance of sliding hernias is the propensity of affected individuals to have GERD. Ref: Harrison, E-18, P- 2429 | Medicine | null |
ccb6a62f-b594-4b96-bf14-c5ebe0e8fe9e | The fascia of Denonvilliers - | Membranous layer of fascia of the thigh | Perirenal fascia | Fascia between the rectal ampulla and the prostate and the seminal vesicles | Posterior layer of perirenal fascia | 2c
| single | The posterior surface of prostate is separated from the rectum by the fascia of Denonvilliers which is the obliterated rectovesical pouch of the peritoneum. | Anatomy | null |
01c89b56-ee99-4991-8fa3-5b4ec90acde9 | How many items are there in Mini mental state examination (MMSE)? | 10 | 15 | 20 | 30 | 3d
| single | Ans.D.30ExplanationMMSE or Folstein test is a simplified form of routine cognitive status examination. It is routinely used to track improvement and deterioration. It includes following points:Orientation to time-5Orientation to place-5Registration-3Attention and calculation-5Recall-3Language-2Repetition-1Complex commands-6Total score-30, score less than 24 indicates cognitive impairment. | Psychiatry | Organic Mental Disorder |
4675b934-a3b4-4e43-a644-8a3e1d414aea | Accidental from a needle stick, an unknown quantity of blood from an AIDS patient is injected into a nurse, lab reports of the patient show CD4 count 20/microL and a viral RNA load of more than 10^7copies/ml. What action should be taken regarding the treatment of the nurse | Monitor the nurse's blood to determine whether HIV transmission has occurred or not. | Treat with full doses of zidovudine for 2weeks. | Add acyclovir to the 4weeks zidovudine regimen | Administer zidovudine with lamivudine for 4weeks. | 3d
| single | null | Pharmacology | null |
c7ee6295-44cc-4b0d-812c-f8d0b373fea7 | According to Lecompte (1987), the following are the recommendations for topical application of high potency fluoride products EXCEPT- | No more than 2 g of gel per tray or approximately 40% of tray capacity should be dispensed. | The use of a saliva ejector during the procedure is recommended. | Following the procedure, the patient should be instructed not to expectorate. | When utilizing custom individually fitted trays, utilize only 5-10 drops of products per tray. | 2c
| multi | According to Lecompte (1987), the following are the recommendations for topical application of high potency fluoride products:
1. No more than 2 g of gel per tray or approximately 40 % of tray capacity should be dispensed. Even more conservative amounts should be considered for small children.
2. Because patient may have the need to swallow during a 4 minute topical application procedure, the use of a saliva ejector during the procedure is recommended.
3. Following the 4 minutes application procedure, the patient should be instructed to expectorate thoroughly for from 30 sec to one minute, regardless of whether high speed suction is utilized or not. Expectoration is probably the single most effective way of reducing orally retained fluoride.
4. When utilizing custom individually fitted trays for patients requiring daily or weekly application of a high fluoride concentration product, utilize only 5-10 drops of products per tray. | Dental | null |
99eb3e35-77af-4842-9dcc-9ae2848b0c35 | Ion required for exocytosis is - | Potassium | Sodium | Calcium | Magnesium | 2c
| single | (C) (Calcium) (4.8 Ganong 24th edition, 18 A.K. Jain 5th)Exocytosis is the Ca^ dependant process.Exocytosis: here-substances secreted by the cell are trapped within vesicles or granules which fuse with the cell membrane and release their contents to the ECF. This leaves the contents of the vesicles or granules outside the cell and cell membrane intact.It requires Ca++ and energy. Hormones, digestive enzymes and synaptic transmitters are examples of substances transported out of the cell by this process.Endocytosis: includes phagocytosis, pinocytosis, clathrin mediated endocytosis, caveolate-dependant uptakeand nonclathrin/noncaveolae endocytosis. | Physiology | General |
839b70fc-6778-4230-ac13-606644372991 | Essential radiological feature of acute mastoiditis is: | Temporal bone pneumatization | Clouding of air cells of mastoid | Rarefaction of petrous bone | Thickening of temporal bone | 1b
| single | (b) Clouding of air cells of mastoid(Ref. Cummings, 6th ed., 2161)X-ray mastoid and CT scan shows clouding of air cells because of the collection of exudates in them. Later on mastoid pneumatisation is lost and a single mastoid cavity may be seen. | ENT | Disorders of Middle Ear (Otitis Media) |
fa356e3a-10cb-4328-bd52-e620a4e8a96f | All the following are features of Wilson's disease except: | Increased copper content in liver | Increased ceruloplasmin | Mental changes | Features of chronic active hepatitis | 1b
| multi | Answer is B (Increased Ceruloplasmin) In Wilson's disease, Ceruloplasmin levels are decreased (not increased). In Wilson's disease excess Cu saturates liver and spills in the plasma thereby decreasing ceruloplasinin levels. | Medicine | null |
ba3dd484-9b7a-4191-a89e-6781123128fd | Pelvic exentration is known as ? | Miles Operation | Lyods operation | Finch operation | Brunshwings operation | 3d
| single | Ans. is 'd' i.e., Brunschwig's operation | Surgery | null |
e6d36baf-03dc-4540-ab0b-04d024965d01 | Seen in a fresh dead body, which of the following features is suggestive of antemortem drowning? | Fine leathery forth | Thick mucoid forth | Blood stained forth | Any of the above | 0a
| multi | null | Forensic Medicine | null |
d789db86-4538-4026-b7ec-60eb0f3e3adb | What is the latest reference to body length in ICD-10 to call it perinatal moality rate? | 28cm | 30cm | 35cm | 38cm | 2c
| multi | parks textbook of preventive and social medicine 23rd edition * ninth revision of international classification of diseases (ICD) added that :(1) babies choosen for inclusion in perinatal statistics should be tjose above a minimum bih weight ie1000g at bih. (2)if bihweight is not available ,a gestational period of atleast 28weeks should be used if (1)&(2)is not available ,body length of atleast 35cm should be used . | Social & Preventive Medicine | obstetrics,pediatrics and geriatrics |
afacac97-e3bd-4087-9e9f-86b2e7ae423e | Palpatory thud audible slap is seen in: | Tracheal foreign body | Bronchial foregion body | Laryngeal foreign body | None | 0a
| multi | A foreign body in trachea may move up and down the trachea between the carnia and the undersurface of vocal cords causing "audible slap" and "palpatory thud." | ENT | null |
389655ed-2195-42ee-b7f3-089e44fc83e5 | An example for primary prevention of dental diseases is: | Scaling & polishing and filling | Extractions, RCT and periodontal surgeries | Wearing gloves and sterilization of the instruments | Replacements of Lost teeth and orthodontic treatments | 2c
| single | null | Dental | null |
d5c564e6-36c1-42b4-834b-04cdfd549f85 | Pseudogestational sac is seen in | Missed aboion | Threatened aboion | Inevitable aboion | Ectopic pregnancy | 3d
| single | The gestational sac --an anechoic fluid collection that represents the exocoelomic cavity--may be seen by 4.5 weeks.A caveat is that a gestational sac may appear similar to other intrauterine fluid accumulations--the so-called pseudogestational sac. This pseudosac may be seen with ectopic pregnancy and is easier to exclude once a yolk sac is seen. Typically, the yolk sac is visible by 5.5 weeks and with a mean gestational-sac diameter of 10 mm. Thus, the diagnosis of a uterine pregnancy should be made cautiously if the yolk sac is not yet seen.Ref: William&;s Obstetrics; 24th edition; chapter 19 | Gynaecology & Obstetrics | General obstetrics |
25f981b1-3ecc-43c0-a40e-89937631579b | A 50 years old patient presented to the skin OPD with erythematous scaly plaques over trunk and extremities for last l0 years. Lesions are occasionally itchy. There is history of remission and relapse with exacerbation during winters. Most likely diagnosis is? | Lichen planus | Psoriasis vulgaris | Pityriasis rosea | Seborrhic dermatitis | 1b
| multi | Ans: B. Psoriasis vulgaris(Ref: Neena Khanna 4'h/e p. 40-48; Roxburg lVh/e p. 128-42; Venkataram 1"'/e p. 491)Psoriasis (psoriasis vulgaris):Psoriasis is chronic dermatosis characterized by unpredictable course of remission and relapse and presence of well defined silvery white scaly papules and plaques on erythematous base.Aggravated in winter.Lesions are mildly pruritic or non-pruritic. | Skin | null |
d1de0120-8da1-4be8-80bf-98b1ce91e234 | Child with primary amenorrhoea with negative progesterone challenge test but positive combined progesterone and estrogen test. Diagnosis may be : | Mullerian agenesis | PCOSD | Asherman syndrome | Prolactinoma | 3d
| multi | Ans. is d i.e. Prolactinoma This child is presenting with - Primary amenorrhea with : Negative progesterone challenge test - which rules out PCOD - (otherwise too, PCOD is a cause of secondary amenorrhea). When next step was done i.e., estrogen, progesterone combined test - It comes out to be positive i.e., compament I system (uterus, endometrium and outflow tract) is normal if properly stimulated by estrogen which rules out mullerian agenesis and ashermann syndrome. Positive estrogen progesterone combined test means the defect is in the production of estrogen i.e., either ovaries, pitutary or hypothalmus. So from the given options we have to look for a cause which involves either of the above sites. which in this case is prolactinoma. | Gynaecology & Obstetrics | null |
94d3ba3e-a852-45a0-a71f-f07be92a41b2 | The average whey/casein ratio in breast milk is: | 60:40:00 | 80:20:00 | 0.888888889 | 40:60 | 0a
| single | a. 60:40(Ref: Nelson's 20/e p 286-290, Ghai 8/e p 150-161)Human milk contains two types of proteins 60% is: whey and 40% is casein; helps in quick & easy digestion. | Pediatrics | Nutrition |
a49da66e-2ce3-491c-8cb7-5d7e93bb830c | All of the following agents act by intracellular receptors EXCEPT: | Thyroid hormones | Vitamin D | Insulin | Steroids | 2c
| multi | The insulin receptor is located at outer membrane Pg.no.261KD TRIPATHI SEVENTH EDITION | Pharmacology | General pharmacology |
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