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A 19 year old boy suffering from chronic schizophrenia is put on haloperidol in the dose of 20 mg/day. A week after the initiation of medication the patient shows restlessness, fidgety, irritability and cannot sit still in one place. The most appropriate treatment strategy is -
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Restlessness, fidgety, irritability and inability to sit still at one place in a patient, one week after initiation of antipsychotic (haloperidol) suggest the diagnosis of Akathisia.
"The first line drug for akathisia is most commonly a β-blocker".
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Psychiatry
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Addtion of beta blocker
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The size of periapical film used in adults is
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Radiology
| null |
31 x 41 mm
|
Pap smear of Lelawati 45-years female shows CIN grade III. Which of the following is the next step in management:
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Ans. is c, i.e. Colposcopy directed biopsyRef: CGDT 10th/ed, p837, 841; Harrison 17th/ed, p608; Williams Gynecology 1st/ed, p628, Table 29-6 William Gynae 3rd/ed, p629
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Gynaecology & Obstetrics
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Carcinoma Cervix
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Colposcopy directed biopsy
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Among the causes of rib notching are:
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Ans. All of the above
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Radiology
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All of the above
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A body is brought to you for autopsy. The suspected cause of death is drowning. Which of the following would you NOT expect to find in this body?
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In drowning the pupils are dilated. Findings in case of drowning are: 1) Fine froth from the mouth 2) Weeds clenched tightly in the hands 3) Water in stomach 5) Diatoms in brain and bone marrow 5) Dilated pupils 6) Cutis anserina 7) Paltauf haemorrhage Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 23, Page - 307.
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Forensic Medicine
| null |
Miosis
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Which of the following neurotransmitter is having only inhibitory action?
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GABA is the major inhibitory mediator in the brain and mediates both presynaptic and postsynaptic inhibition. GABA, which exists as -aminobutyrate in the body fluids, is formed by decarboxylation of glutamate by the enzymeglutamate decarboxylase (GAD), which is present in nerve endings in many pas of the brain. Glutamate is the main excitatory transmitter in the brain and spinal cord and has been calculated to be responsible for 75% of the excitatory transmission in the CNS. Glycine has both excitatory and inhibitory effects in the CNS. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 7. Neurotransmitters & Neuromodulators. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.
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Biochemistry
| null |
GABA
|
Virulence factors for meningococci -a) Capsuleb) Pili c) Endotoxind) Coagulasee) M. Protein
|
Virulence factor of Meningococcus:
Refer text (chapter review) for explanation:
Option d: Coagulase is a Virulence factor for Staphylococcus
Option e: M protein is a Virulence factor for Streptococcus.
Ref: Apurba Sastry’s Essentials of Medical Microbiology 1/e p236
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Microbiology
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abc
|
Vasopressin inhibited by:
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Ref: Goodman & Gillman, The pharmacological basis of therapeutics. 12th edition, Pg No. 708.Explanation:Lithium and Demeclocycline are the other drugs which inhibits the action of vasopressinLithium reduce the V2 receptor mediated stimulation of adenylyl cyclaseIt also increases PTH which is an antagonist of LithiumDemeclocycline decreases the antidiuretic response of vasopressinIndomethacin. Chlorpropamide and Carbamezapine are the drugs which enhances the actions of vasopressin.
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Pharmacology
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Endocrinology
|
Alcohol
|
Dislufiram acts by blocking
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DISULFIRAM is a DETERRANT which acts by blocking acetaldehyde dehydrogenase When acetaldehyde dehydrogenase is blocked there will be increased amount of acetaldehyde that acts on mast cells and results in release of histamine that in turn leads to allergic reaction. Thus when a patient on disulfiram takes alcohol there would be allergic reaction that prevents the patient from using the substance Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, Pg,No.625
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Psychiatry
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Symptoms and signs in psychiatry and classification
|
Acetaldehyde dehydrogenase
|
Duration of action of Lidocaine with adrenaline
|
Duration of action of lidocaine with adrenaline is 2-3 hours. Adrenaline enhances both speed and quality of block, It also prolong effect of lignocaine and reduce the peak blood level and toxicity by reducing the local blood supply duration of action of lidocaine whithout adrenaline is 30-90min
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Anaesthesia
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Regional anaesthesia
|
2-3 hours
|
Osmotic damage is operative in all of the following complications of diabetes mellitus EXCEPT
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Osmotic damage is inoperative in insulin- receptor deficiency. Insulin-receptor deficiency is the result of an increase in adipose, which down regulates receptor synthesis, and chronic elevation of glucose (glucose toxicity), which renders the receptors less receptive to insulin.
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Pathology
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Insulin receptor deficiency
|
Which of the following is the clinical feature of intermittent claudication?
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Intermittent claudication refers to pain in muscles of the lower extremity associated with walking and relieved by rest. The pain is a deep-seated ache usually in the calf muscle, which gradually progresses until the patient is compelled to stop walking. Relief of symptoms is not dependent upon sitting or other positional change. Ref: Rapp J.H., MacTagga J. (2010). Chapter 34. Aeries. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
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Surgery
| null |
Pain in leg only on exercise
|
Rate controlling enzyme of fatty acid synthesis
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Carboxylation of Acetyl CoA The first step in the fatty acid synthesis is the carboxylation of acetyl CoA to form malonyl CoA. The acetyl CoA carboxylase is not a pa of the multienzyme complex. But it is the rate-limiting enzyme. Biotin, a member of B complex vitamins, is necessary for this reaction (step 1 in Fig. 11.15). The enzyme is allosterically regulated, the major effectors being citrate (positive) and palmitoyl CoA (negative). The reaction is similar to carboxylation of pyruvate to form oxaloacetate. The elongation of the fatty acid occurs by addition of 2 carbon atoms at a time. But the 2-carbon units are added as 3-carbon, malonyl units. The whole reaction sequence occurs while the intermediates are bound to ACP (acyl carrier protein).Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 137
|
Biochemistry
|
Metabolism of lipid
|
Acetyl-CoA carboxylase
|
Which of the following is true of shoulder joint?
|
D i.e. Allows flexion, rotation & abduction * The three joints in shoulder complex are sternoclavicular, acromioclavicular, and gleno- humeral joints.* The glenohumeral joint is a synol ball and socket aiculation between the head of the humerus and glenoid cavity of scapula. It is the most impoant joint of shoulder complexQ. Movements at this joint includes flexion, extension, abduction, adduction, medial rotation, lateral rotation and circumductionQ.* Sternoclavicular & acromioclavicular joints allow movements in antero posterior and veical planes to gether with some axial rotation.* For every 3deg abduction of arm, a 2deg abduction occurs in the shoulder joint, and 1deg occurs by rotation of scapula. At about 120degof abduction, the greater tuberosity of humerus hits the lateral edge of the acromian. Movements of scapula include rotation and anteroposterior glidingQ
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Surgery
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Allows flexion, rotation and abduction
|
Goblet cells are present in
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The lumen of the trachea is lined with mucous membrane that consists of a lining epithelium and an underlying layer of connective tissue. The lining epithelium is pseudostratified ciliated columnar. It contains numerous goblet cells and basal cells that lie next to the basement membrane.Ref: Inderbir Singh&;s Textbook of Human Histology; Pg No: 230
|
Anatomy
|
General anatomy
|
Trachea
|
Fluoroqinolone with least oral bioavailability-
|
Ans. is 'a' i.e., Norfloxacin Pharmacokinetic characteristics and doses of fluoroquinolones C1PROFLNORFLPEFLOFLLEVOFLGEM1PRULIMOXI1. Oral bioavailability (%)60-8035-4590-10085-95-1007090852. Plasma protein binding (%)20-351520-30252555-7345403. Vo!, of distribution (L/kg)3-4221.51.3----24. Percent metabolized2025855-105->9070-805. Elimination t 1/2 (hr)3-54-68-145-88710-1210-156. Routes of administrationoral, i.v.oraloral, i.v.oral, i.v.oral, i.v.oraloraloral, i.v.7. Dose (mg): oral250-750(BD)400(BD)400(BD)200-400(BD)500(OD)320(OD)600(OD)400(OD): i.v.100-200--400200500 --400
|
Pharmacology
|
Quinolones
|
Norfloxacin
|
7-methyl guanosine is added as a cap on mRNA. This methyl group is donated by:
|
Capping is a post transcriptional modification. 7-methyl guanosine cap is added at the 5'end of mRNA by Guanylyl Transferase. Methyl group is donated by SAM (S-Adenosyl Methionine) by enzyme Guanine-7-Methyl Transferase, which occurs in cytoplasm (rest all post transcriptional modifications occur in nucleus). This cap facilitate initiation of translation and stabilize mRNA by preventing it from attack by 5' exonucleases. Cap is attached to 5' end of mRNA by an unusual 5' 5' triphosphate linkage.
|
Biochemistry
|
Transcription
|
S-Adenosyl methionine (SAM)
|
All are the Complication of CVP line except
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Complications of CVP are air embolism, thromboembolism; cardiac arrhythmias; Pneumothorax; hemothorax; Chylothorax; Cardiac tamponade; Sepsis; Trauma to the phrenic nerve, Carotid artery (can cause pseudoaneurysm) & brachial plexus.
|
Anaesthesia
| null |
Airway injury
|
Increased 5 Hydroxy-Indole-acetic acid in urine is seen in:
|
Carcinoid tumors are neuroendocrine tumors of Argentaffin cells that secrete serotonin. 5 Hydroxy-Indole-acetic acid(5-HIAA) is a metabolites of Tryptophan/Serotonin that is clasically elevated in typical carcinoid tumors. Urinary excretion of HIAA is diagnostic test for identification of Carcinoid tumors. Carcinoid Tumors: Carcinoid tumors are neuroendocrine tumors of Argentaffin cells that secrete excess serotonin. Ordinarily only 1% of total tryptophan is conveed to serotonin but in carcinoid tumors 50-60% of available tryptophan is conveed to serotonin. The diagnosis of carcinoid syndrome relies on measurement of urinary or plasma serotonin or its metabolites in the urine. Serotonin is typically degraded to 5-HIAA (Hydroxy-indole acetic acid) in presence of monoamine oxidase(MAO) and is excreted in urine. In carcinoid syndrome large amounts of 5-HIAA is formed and is excreted in urine Carcinoid Syndromes may fuher be divided into Typical Carcinoid Syndromes and atypical carcinoid syndromes depending on the metabolites raise in urine and blood. Typical carcinoid syndrome: Elevated levels of Plasma serotonin Elevated levels of urinary (5HIAA) Atypical Carcinoid Syndrome: Plasma serotonin levels are normal Plasma and urinary levels of 5HTP are increased (Urinary 5HIAA may be normal or midly elevated) Ref: Harper
|
Biochemistry
|
Metabolism of protein and amino acid
|
Carcinoid syndrome
|
The most severe form of respiratory complication in influenza virus infection is:
|
Primary influenza viral pneumonia is the least common but most severe of the pneumonic complications. The most common bacterial pathogens causing secondary bacterial pneumonia are Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae. Ref:Harrisons Principles of Internal Medicine, 18th Edition, Page 1496
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Medicine
| null |
Primary viral pneumonia
|
Binary (secondary) exposure to an antigen results in sudden increase in -
|
Secondary response: the response to subsequent stimuli with the same antigen. Usually 100-1000 times more than primary response. IgG is responsible for the secondary response. Reference: Anathanarayan & paniker's 9th edition, pg no:146 <\p>
|
Microbiology
|
Immunology
|
IgG
|
Leprosy involves all except
|
Uterus Uterus is the least likely site of involvement in Leprosy "Although Leprosy rarely involves the female genital tract, the ovary is the most commonly involved gynaecological site" - Blaustein's Pathology of the Female Genital Tract "There is little or no involvement of the female genital tract. 3 The repoed incidence of involvement of the ovary ranges from none or very litile,63.73'141 to almost half (47%) of cases."- International Journal of Dermatology: Visceral leprosy, Andria M. Klioze MD The above mentioned aicle has classified visceral organs into 3 categories: Uterus Uterus is the least likely site of involvement in Leprosy "Although Leprosy rarely involves the female genital tract, the ovary is the most commonly involved gynaecological site" - Blaustein's Pathology of the Female Genital Tract "There is little or no involvement of the female genital tract. 3 The repoed incidence of involvement of the ovary ranges from none or very litile,63.73'141 to almost half (47%) of cases."- International Journal of Dermatology: Visceral leprosy, Andria M. Klioze MD The above mentioned aicle has classified visceral organs into 3 categories: Organs with significant degree of infiltration or dysfunction Skin yes Peripheral nerves asopharynx arynx Kidney Liver esticles Organs with mild to moderate degree of infiltration or dysfunction Tongue Autonomic nervous system Spleen Bone marrow Adrenals Bone Lymph nodes Joints Peripheral vasculature Organs with none or minimal degree of infiltration or dysfunction Brain Striated muscle Cerebellum Ureter Leptomeninges Bladder Spinal cord Urethra Pancreas Prostate Lungs Seminal vesicles Hea External genitalia Great vessels Breasts Gallbladder Vagina Pancreas Uterus Esophagus Ovaries Stomach Thyroid gland Small intestine Parathyroid gland Large intestine Pituitary gland Striated muscle Pineal gland So according to this aicle both uterus and ovaries are none or minimally involved. Now this aicle fuher describes leprosy involvement of each and every organ system in detail. Under its description of Female reproductive system the aicle describes involvement of only ovary and does not even mention uterus. The exact lines are quoted below: 'There is little or no involvement of the female genital tract. The repoed incidence of involvement of the ovary ranges from none or very little, to almost half (47%) of cases. Menarche, menstruation, feility, and menopause do not seem to be affected." So to summarize: we have 2 Reference clearly stating that female genital tract is very rarely involved, and if there is any involvement, ovary is the most common genital organ to be involved.
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Social & Preventive Medicine
| null |
Uterus
|
Refractive condition of the eye at bih is:
|
A i.e. Hypermetropia of 2 D
|
Ophthalmology
| null |
Hypermetropia of 2 D
|
Incidence of Pneumocystis jiroveci pneumonia has declined in recent times due to which of the following?
|
Answer- C. Use of combination APneumocystis pneumonia (PCP), once the hallmark of AIDS, has dramatically declined in incidence following the development of effective prophylactic regimens and the widespread use of cA.
|
Medicine
| null |
Use of combination A
|
True about bacteriophage -
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Ans. is 'd' i.e., All of the above Bacteriophage (phage)o Bacteriophages are viruses that infect bacteria.o Phages play an important role in the transmission of genetic information between bacteria by the process of transduction.o The presence of phage genome integrated with bacterial chromosome confer bacteria certain properties by a process known as phage conversion.o Phages have been used as cloning vectors in genetic manipulation.Life cvcle of bacteriophageo Bacteriophage exhibit two types of life-cycleVirulent or lyticReplication of phage inside bacteria leads to lysis of bacteria.Temperate or nonlvtic cyclePhage DNA becomes integrated with the bacterial chromosome and multiplies synchronously with host DNA.Integrated phage genome is known as prophage.This process of integration is called as lysogeny.Bacteria harbouring prophage are called as lysogenic bacteria.The prophage confers certain new properties on lysogenic bacterium - Lysogenic conversion or phage conversionThis is due to synthesis of new proteins that are coded for by the prophage DNA.Example is Lysogenic conversion in diphtheria bacilli, which acquire toxigenicity (virulence) by lysogenisation with the beta phage.A lysogenic bacterium is resistant to reinfection by the same or related phages i.e., Superinfection immunity'.
|
Microbiology
|
Virology
|
All of the above
|
Male with history of bilateral undescended testis
|
Male with bilateral undescended testis (especially intra-abdominal testes) are usually sterile. To optimise spermatogenesis the testis needs to be in the scrotum below body temperature at a young age. Incompletely descended testes are often macroscopically normal in early childhood but by pubey the testis is poorly developed, gradually atrophies. The epithelial elements are immature histologically and by late pubey irreversible destructive changes halt spermatogenesis and limit the production of androgens leading to sterility.Malignant transformation in undescended testis is 20 times more common than normally descended testis. Pathophysiology include gubernacular dysfunction, lack of gonadotrophin, lack of 'calcitonin gene related peptide'(CGRP) , familial , altered hypothalamo-pituitary-gonadal axis, deficiency of mullerian inhibiting substance, Prune-Belly syndrome. These patients also require psychological intervention. Reference : page77 and 1377 Bailey and Love's sho practice of surgery 25th edition and page1079 SRB's manual of surgery 5th edition
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Surgery
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Urology
|
Is likely going to be sterile
|
Caries, all are true except:
| null |
Pathology
| null |
Lactobacillus is main causative organism in plaque
|
Factor which is associated both with exposure and disease is called -
|
Ans. is 'a' i.e., Confounding factor
|
Social & Preventive Medicine
| null |
Confounding factor
|
. Urinary cytology is a useful screening test for the dignosis of -
| null |
Surgery
| null |
Urothelial carcinoma
|
According to Tanner stages of development, which is the first sign of pubey in females?
|
GnRH stimulates secretion of LH and FSH which causes the ovary to produce estrogens. Subsequently changes of pubey occur including breast development (thelarche), development of pubic and axillary hair (pubarche), the growth spu (peak height velocity), and onset of menstruation (menarche). Thelarche (breast development) is the first sign of pubey (Tanner stage B2). It usually begins between 8 and 10 years of age and is associated with increased estrogen production. Pubarche (development of pubic and axillary hair) is the second stage in maturation and typically occurs between 11 and 12 years of age. Axillary hair usually appears after the growth of pubic hair is complete. Menarche (onset of menstruation) usually occurs 2-3 years after thelarche at an average age of 11-13 years. Initial cycles are often anovulatory and irregular. Ref: Blueprints Obstetrics & Gynecology By Tamara L. Callahan, Aaron B Caughey, Aaron B Caughey, M.D., 2008, Page 212 ; Obstetrics and Gynaecology at a Glance By Errol R. Norwitz, John O. Schorge, 2010, Page 49 ; Nelson Textbook of Paediatrics 17th edition page 1882
|
Pediatrics
| null |
Thelarche
|
Best disinfectant for endoscopes is: (D. REPEAT 2012)
|
Ref: Russel, Hugo and Ay tiff e's Principles and Practice of Disinfection, Preservation and Sterilization, 4th edition, Page 568Explanation:Activated 2% alkaline glutaraldehyde is used for decontaminating flexible endoscopes.Advantageso Relatively non-corrosiveo Will kill spores with prolonged exposure (3- 10 hours).Disadvantageso Toxic.o Irritant.Possible alternatives:o Orthophthalaldehyde (OPA) peracetic acid.o Chlorine dioxide (ClO2) products (such as Tristel).o Superoxidized water (Sterilox).Advantages of these newer agents are - rapidly sporicidal, mycohactericidal and viricidal.BUT remember - No agent is clearly superior to the others and a thorough assessment needs to be performed before an alternative agent is chosen.Commonly Used DisinfectantsDisinfectantUseActive againstEthyl alcohol*Skin antisepticsBactcncidal but not sporicidalIsopropylalcohol* Disinfection of suture material* Clinical thermometersBactericidal but not sporicidalMethyl alcohol* Cabinets * IncubatorsActive against bacteria and fungal sporesFormaldehyde* OT fumigationBactericidal, Spori cidal and VirucidalGlutaraldehyde* Bronchoscopes* Endoscopes* CystoscopesBactericidal, Spori cidal andVirucidal (less toxic/ irritant)Hypochlorite* Blood spillBactericidal, Spori cidal and VirucidalChlorhexidine* Treatment of woundsBactericidal, Mod erate Sporicidal and VirucidalEthylene oxide* Heart lung machines* Respirators* Dental equipmentBactericidal, Spori cidal and Virucidal i highly penetrating gas)
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Microbiology
|
Sterilization and Disinfection
|
Glutaraldehyde
|
Wahin's tumor is found in
|
It is a benign tumour that occurs only in parotid ,usually in the lower pole. SRB,25th,415
|
Surgery
|
Head and neck
|
Salivary gland
|
Accidental injury of the ureter during abdominal operation should be managed by all except:
|
Surgeries for ureteric fistula:
• Bladder flap procedure (modified Boari–Ocker–Blad)
• Ureteroneocystostomy
• Implantation into the bladder
Note: End to end anastomosis may lead to stricture formation.
Colonic transplantation results in recurrent pyelonephritis and hyperchloremic acidosis.
|
Gynaecology & Obstetrics
| null |
Colonic implantation
|
Which is not a branch of anterior division of internal iliac aery ?
|
Branches of anterior division of internal iliac aery are :(i) Superior vesical(ii) Middle rectal(iii) Inferior vesical (in males),(iv) Internal pudendal, (v) Vaginal (in females),(vi) Uterine (in females)(vii) Obturator(viii) Inferior gluteal.Branches of posterior division are : (i) Iliolumbar, (ii) Lateral sacral, and (iii) Superior gluteal.
|
Anatomy
| null |
Iliolumbar
|
Migratory superficial thrombophlebitis is seen in -
|
Ans. is 'a' i.e., Carcinoma pancreas
|
Pathology
| null |
Carcinoma pancreas
|
Most common surgical cause of obstructive jaundice-
|
Ans. is 'd' i.e., CBD stones o Most common surgical cause of obstructive jaundice is choledocholithiasiso Stone disease is the most common cause of obstructive jaundice. Gallstones may pass through the CBD and cause obstruction and symptoms of biliary colic and cholecystitis. Larger stones can become lodged in the CBD and cause complete obstruction, with increased intraductal pressure throughout the biliary tree. Mirizzi syndrome is the presence of a stone impacted in the cystic duct or the gallbladder neck, causing inflammation and external compression of the common hepatic duct and thus biliary obstruction.
|
Surgery
|
Gallstone Disease
|
CBD stones
|
Most common cyanotic heart disease -
|
Ans. is 'a' i.e., TOF Tetroiogy of falloto Cyanonic heart disease (MC).o Defect in infundibular septum leads to :Pulmonary stenosis.VSD (Not ASD)Dextroposition and overriding of aorta.Right ventricular hypertrophy (NOT LVH).o Pink TOF (Acyanotic TOF) when PS is mild to moderate, balanced shunt across the VSD, pt does not have cyanosis.
|
Pediatrics
|
Cyanotic Congenital Heart Disease
|
TOF
|
Wilm's tumor associated with all except -
|
Ans. is 'd' i.e., Digeorge syndrome o Wilnvs tumour is associated with three groups of congenital malformations,o The risk of Wilm's tumour is increased in these conditions,o These are -o WAGR syndrome - It consists of# Aniridia# Genital anomalies# Mental retardationThe risk of Wilnvs tumour is increased by 33% in this syndrome,o Denys - Drash syndrome - It consists ofGonadal dysgenesis (male pseudohermaphroditism)Nephropathy leading to renal failure.Majority of patients with this syndrome have renal failure,o Beckwith - Wiedeman syndrome - It consists of# Enlargement of body organso Hemihypertrophy# Renal medullary cysts.o Abnormal large cells in adrenal cortex.
|
Pathology
|
Histo Pathology
|
Digeorge syndrome
|
Indomethacin causes:
|
a. Closure of ductus in premature neonate(Ref: Nelson's 20/e p 2197)Indomethacin, a Prostaglandin inhibitor is used in medical closure of Ductus arteriosus in preterm neonates with PDA.
|
Pediatrics
|
C.V.S.
|
Closure of ductus in premature neonate
|
All of the following are seen in retinitis pigmentosa except: September 2009
|
Ans. A: Prominent retinal vessels The condition is abiotrophic in nature (premature senility and death of tissue) and genetically determined. Autosomal recessive is the most common and is very severe. Autosomal dominant is benign and is symptomatic only in adult life. X-linked recessive is least common. It is also a very severe form. Degeneration of rods commences near the equator. Macular region is not affected until late in the disease. The symptoms of retinitis pigmentosa are characteristic, the most prominent being defective vision in the dusk (night blindness/nyctalopia). It is due to degeneration of rods, which are primarily responsible for vision in low illumination. The visual field show concentric reduction. In early cases a paial or complete annular/ring scotoma is found. As the disease progresses the field becomes gradually smaller until at last it is reduced to a restricted area around the fixation point (tubular vision).Hence person has difficulty in moving about. Initially the equatorial region is affected. Ophthalmoscopic findings in the affected zones shows the retina studded with small, jet black spots resembling bone corpuscles with a spidery outline. The retinal pigment epithelium becomes transparent so that the choroid vessels become visible and the fundus appears tessellated or tigroid. The retinal veins, never the aeries, often have a sheath of pigment for pa of their course. The retinal vessels becomes extremely attenuated and thread like. The disc exhibits the characteristics of primary optic atrophy. It is pale and have a wax like yellowish appearance and is often termed as 'consecutive optic atrophy' (Ganglion cells destroyed with degeneration of the axial cylinders and optic nerve is known as consecutive atrophy). Ocular associations of retinitis pigmentosa are myopia, chronic simple glaucoma. Systemic associations of retinitis pigmentosa are in the form of various syndromes: Laurence - Moon - Biedl syndrome - obesity, hypogonadism, polydactyly and mental retardation. Usher's syndrome - deaf mutism. Secondary retinitis pigmentosa due to infections like syphilis, mumps, German measles (rubella) and due to drug like chloroquine must be differentiated from primary retinitis pigmentosa. Treatment: is unsatisfactory Vasodilators - nicotinic acid. High doses of Vitamin A.
|
Ophthalmology
| null |
Prominent retinal vessels
|
All is true about Pecquet duct EXCEPT
|
Thoracic duct, aka duct pecquet, is the largest lymphatic vessel in the body. it Crosses from right to left at level of T5 It extends from the lower border of T12 as a continuation of the cisterna chyli. Enters thorax through the aoic opening of diaphragm along with the aoa & azygous veins. It ascends through the posterior mediastinum till T5, where it crosses from right to left side. It then courses through superior mediastinum along the left edge of esophagus and reaches the neck. In the neck it arches laterally at level of transverse process of C7. It descends in front of the 1st pa of subclan aery & ends by opening into the angle of junction between the L. subclan & L. jugular veins
|
Anatomy
|
Thorax- wall and Bronchopulmonary segment
|
Crosses from right to left at level of T8
|
Which of the following is the most specific test for Rheumatoid arthritis
|
Ans. is 'a' i.e. Anti-ccp antibody Rheumatoid factor is an autoantibody, usually IgM directed against the Fc region of IgG.Despite its name, rheumatoid factor is not specific for rheumatoid arthritis, it can also be seen in wide range of autoimmune disorders, inflammatory disease and chronic infections. *Anticitrullinated peptide antibody test (Anti ccp) test is more specific than rheumatoid factor for diagnosis of rheumatoid arthritis, It may be positive very early in the course of the disease.Oxford Journal of medicine states "Anti-cyclic citrullinate peptide (anti-ccp) antibody testing is particularly useful in the diagnosis of rheumatoid arthritis with high specificity, present early in the disease process and has ability to identify patients who are likely to have severe disease and irreversible damage. Anti ccp antibodies have not been found at a significant frequency in other diseases to date and are more specific than Rheumatoid factor for detecting rheumatoid arthritisAlso knowDiagnosis of Rheumatoid arthritisThere is no single sign, symptom or test result that allows the definitive diagnosis of rheumatoid arthritis.Instead, the diagnosis is based on a consideration of many factors, including the presence of characteristic signs and symptoms of rheumatoid arthritis, the results of laboratory tests, and the result of X-rays.The diagnosis of R. A. is based on the presence of at least four of the following criteria :Morning stiffness that lasts at least one hour and that has been present for at least six weeks.Swelling of at least three or more joints for 6 weeks.Swelling of the wrist, metacarpophalangeal (MCP), or proximal interphalangeal (I.T.P.) joints for at least six weeks.Swelling of the same joint on both sides of the bodyChanges in hand X-rays that are characteristic of rheumatoid arthritisRheumatoid nodules of the skin.Rheumatoid factor found in the blood.
|
Medicine
|
Rheumatoid Arthritis
|
Anti-ccp antibody
|
Pheochromocytoma secretes?
|
ANSWER: (D) AllREF: Harrison's Internal Medicine > Chapter 337. PheochromocytomaSee previous question"Pheochromocytomas and paragangliomas synthesize and store catecholamines, which include norepinephrine (noradrenaline), epinephrine (adrenaline), and dopamine"
|
Surgery
|
Physiology and Pathophysiology - Primary Hyperparathyroidism
|
All
|
Trauma to breast causes which type of necrosis -
|
Ans. is 'd' i.e., Fat necrosis Fat necrosisFat necrosis may be of two types : -Enzymatic fat necrosiso This is due to the action of lipase on adipose tissue,o It occurs most frequently in acute pancreatitis due to leakage of lipase,o Depending on the severity of acute pancreatitis, fat necrosis may occur in : -Adipose tissue contiguous to patter ease, i. e., retroperitoneal fat.Adipose tissue in the anterior mediastinum.Bone marrowOmental and abdominal fatNonenzymatic or Traumatic fat necrosiso Occurs due to traumao Is seen in the subcutaneous tissue of breast, thigh, and abdomen.
|
Unknown
| null |
Fat necrosis
|
Which of the following is the best way of preventing development of deep vein thrombosis (DVT) in post-operative period?
|
Ans is 'c' i.e. Prophylactic Heparin Patients are at increased risk for developing venous thromboembolism after:Major abdominal surgery Major orthopaedic surgery has sustained, major trauma has prolonged immobility (>3 days)These patients need some form of prophylaxis. The prophylaxis can be mechanical or pharmacological.Prophylaxis for DVT Mechanical prophylaxis includes: i: ' ' ' - V, .V? 'Early ambulation **Pneumatic compression devices **It is the simplest method of prophylaxis It acts by activating the calf pump mechanism It is the most common method of prophylaxisPneumatic compresses prevents the stasis by periodically compressing the calvesPharmacological prophylaxis includes: Use of unfractionated heparin * Use of fractionated low molecular * weight heparin *Now being replaced by fractionated low molecular weight hepatin Better efficacy than unfractionated heparin No laboratory monitoring is necessaryComparison of low molecular weight heparin (LMWH) with mechanical prophylaxis demonstrates superiority of low molecular weight heparin (LMWH) in reduction of the development of venous thromboembolic disease.Prospective trials evaluating LMWH in head injured and trauma patients have also proven safety of LMWH with no increase in intracranial bleeding or major bleeding at other sites. In addition, LMWH shows significant reduction in the development of venous thromboembolism compared to other methods.In short, LMWH should be considered the optimal method of prophylaxis in moderate and high risk patients.Even the traditional reluctance to use heparin in high risk groups such as the multiply injured trauma patient and the injured patient must be reexamined, given the efficacy and safety profile of LMWH in multiple prospective trials.
|
Surgery
|
Chronic Venous Insufficiency
|
Prophylactic heparin
|
A 40-year-old male comes to emergency with altered level of consciousness. On Examination, His BP 210/ 152 and has severe papilledema. Which of the following drug should be given by intravenous infusion and acts GPCR and is very sho acting?
|
Patient is likely having hypeensive emergency. All the drugs given in options except metoprolol can be used to control hypeensive emergencies. Fenoldopam Used in hypeensive emergencies Act on D1 receptors which are G protein coupled receptors. Very sho acting drug and must be given by intravenous infusion (being a catecholamine, not effective orally) Nitroprusside and hydralazine acts by releasing NO, which acts on intracellular guanyl cyclase. These do not act on GPCRs
|
Pharmacology
|
Hypeension, Arrhythmias, Dyslipidemia
|
Fenoldopam
|
First drug of choice in a patient with Diabetes mellitus and concomitant hypertension?
|
Ans. d. ACE inhibitors (Ref. Harrison's Internal medicine 17th edition, p. 1558; 16th edition, p. 1479)Antihypertensive therapy:Primary (essential) hypertensionDiuretics, ACE inhibitors, angiotensin li receptor blockers (ARBs), calcium channel blockers.Hypertension with CHFDiuretics, ACE inhibitors/ARBs, b-blockers (compensated CHF), aldosterone antagonists, p-blockers must be used cautiously in decompensated CHF and are contraindicated in cardiogenic shock.Hypertension with diabetes mellitusACE inhibitors/ARBs. Calcium channel blockers, diuretics, b-blockers, a-blockers.ACE inhibitors/ARBs are protective against diabetic nephropathy.ACE INHIBITORS AND DM# No adverse effect on glucose and lipid metabolism# No depression / sexual dysfunction# Lower intraglomerular pressure & retards diabetic nephropathy by 50%ACE INHIBITORSMECHANISMCLINICAL USETOXICITYCaptopril, enalapril, lisinopril.loss of feedback inhibition.Inhibition of ACE also prevents inactivation of bradykinin, a potent vasodilator.Hypertension, CHF, proteinuria, diabetic nephropathy. Prevent unfavorable heart remodeling as a result of chronic hypertension.Cough, Angioedema (contraindicated in Cl esterase inhibitor deficiency), Teratogen (fetal renal malformations), | Creatinine (|GFR),Hyperkalemia, and Hypotension. Avoid in bilateral renal artery stenosis, because ACE inhibitors will further |GFR -renal failure. Also remember:
|
Medicine
|
Endocrinology
|
ACE inhibitors
|
"Risk ratio" is utilized to calculate the-
|
Relative risk is the ratio of the incidence among exposed and the incidence among non exposed. In the example, RR of lung cancer = 10/1 = 10 Some authors use the term risk ratio to refer to relative risk. The larger the relative risk the greater the strength of association between the suspected factor and disease Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 86
|
Social & Preventive Medicine
|
Epidemiology
|
Relative risk
|
In hypogonadotropic hypogonadism?
|
- LH and FSH are decreased in hypogonadotropic hypogonadism. Hypogonadotropic hypogonadism: - Reversible - if its d/t to Chronic systemic illness (CKD, Chronic liver Disease) Severe malnutrition Endocrine causes (hypothyroidism, type 1 DM) - Permanent if its d/t Isolated delayed pubey - Genetic mutations - KAL 1 (Kallmann Syndrome), GnRH Receptor, DAX -1 gene - Syndromes- Prader Willi Syndrome, Laurence Moon Syndrome MPHD (multiple pituitary hormone disease) - Injury - Infiltration by tumors- Langerhan cell histiocytosis - Genetic - PROP1,LH - Malformations - Trauma
|
Pediatrics
|
Disorders of Pubey
|
Both LH and FSH decreased
|
Delusion is a disorder of:
|
Ans. is 'a' Thinking Cognition (Thought) Disorders are -Schizophrenia*Obsessive compulsive neurosis*Delusions* & phobias*Also rememberHallucinations are disorder of - perception*
|
Psychiatry
|
Organic Mental Disorder
|
Thinking
|
Which is not true about cephalohaematoma?:
|
Not limited by sutures
|
Gynaecology & Obstetrics
| null |
Not limited by sutures
|
All are seen in PTSD; post-traumatic stress disorder EXCEPT:
|
Vivid dreams REF: Kaplan & Sadock's Synopsis of Psychiatry: 10th Edition, page 615"The principal clinical features of PTSD are painful re-experiencing of the event, a pattern of avoidance and emotional numbing, and fairly constant hyper arousal. Patients may also describe dissociative states and panic attacks, and illusions and hallucinations may be present"
|
Psychiatry
| null |
Vivid dreams
|
For refraction in a hypermetropic child, which is the best drug -
|
Ans. (b) Atropine ointmentRef: Parson's 22/e, p. 79Atropine ointment (1%) is the cycloplegic of choice for refraction in a young child.
|
Ophthalmology
|
Elementary Optics
|
Atropine ointment
|
Increased Radio - isotope uptake is seen in
| null |
Orthopaedics
| null |
Pseudoarthrosis
|
A 69-year-old man with a history of chronic obstructive pulmonary disease/chronic bronchitis is admitted with increasing sputum production, fever, chills, and decreased O2 saturation. His chest x-ray shows a left lower lobe nonhomogeneous opacity. He is treated with IV antibiotics and improves. On the fouh hospital day, prior to discharge, CXR is repeated and the radiologist repos that there is no change as compared to the admission x-ray. Chest x-rays are shown.What will you do next?
|
This chest x-ray shows an ill-defined, patchy opacity in the left middle and left lower zones. Incomplete consolidation with air bronchogram is seen. The left hea border is clear, but the silhouette of the left diaphragm is lost. This is consistent with the left lower pneumonia. This patient with chronic obstructive pulmonary disease has left lower lobe pneumonia. The clinical history suggests that the patient improved on the fouh hospital day of treatment. Chest x-ray improvement usually lags behind and does not temporally correspond with clinical change. In this case the patient is improving and therefore the best option is to discharge the patient on continued antibiotics. There is no indication for either deferring the discharge or resuming IV antibiotics on the basis of a nonresolving x-ray at this stage. Bronchoscopy for drainage would not be indicated, and obtaining a CT scan would not alter the treatment or management plan at this stage.
|
Radiology
|
Respiratory system
|
Discharge the patient on oral antibiotics
|
The average length of a full term child will be about -
|
The average length in full term mature child is between 48-52 cms.
|
Forensic Medicine
| null |
50 cms
|
Which of the following are used for calculation of fluid replacement in burns
|
Parkland regime : It is commonly used . 4ml/%burn/kg body weight / 24 hours . Maximum percentage considered is 50%. volume is given in first year hours, rest given in 16 hours. Muir and Burclay regime : For colloid after 12-24 hours %burns x kg body weight /2 = 1 ration Three rations given in 12 hours . Two rations in second 12 hours . One ration in third 12 hours . Evan's formula : In first 24 hours : Normal saline 1ml/kg/%burns Colloids 1ml/kg/%burns 5% dextrose in water , 2000 ml in adult . In second 24 hours : Half of the volume used in first 24 hours . Ref - Srb's manual of surgery 5/e p133
|
Anatomy
|
General anatomy
|
All the above
|
Simple random sampling-
|
.
|
Social & Preventive Medicine
|
Biostatistics
|
Haphazard collection of ceain number for a sample
|
A 70-year-old diabetic and hypeensive patient was being investigated for angina and a coronary angiogram was performed. Two days later, he developed fever and abdominal discomfo and dyspnea and a mottled skin rash. His great toe appeared black. His BP increased to 180/100. His creatinine was found to have risen from a pre-angiography level of 1.2 to 3.6 mg/dl. He has eosinophilia. Which one of the following statements is TRUE regarding this condition?
|
Diabetes and angina both point to atherosclerosis. In patients undergoing angiography, catheterization can lead to embolism of a vulnerable atherosclerotic plaque in descending aoa downstream to renal aeries leading to an atheroembolic kidney disease. The symptoms of diabetic patient developed after angiography and since atherosclerotic lesion can involve the aoa, the atheroembolic event would explain the events. Presence of eosinophilia and mottling of toes and reduced kidney function confirm the diagnosis as Atheroembolic kidney disease. Hence Choice D is the answer. Lab findings include Rising serum creatinine Transient eosinophilia Elevated sedimentation rate Hypocomplementemia Definitive diagnosis by doing kidney biopsy:- Microvessel obstruction with cholesterol crystals that leave a cleft in the vessel. Contrast-induced nephropathy can occur in diabetics with chronic kidney disease. However rash, toe discoloration with the sudden rise of creatinine and eosinophilia are not seen in contrast-induced nephropathy. Hence choice B is ruled out Choice A is ruled out as it prevents contrast-induced nephropathy Choice C is ruled as out as heparin will not manage cholesterol embolism
|
Medicine
|
Chronic Kidney Disease & Diabetic Nephropathy
|
Kidney biopsy will show micro-vessel occlusion with a cleft in the vessel
|
Periplasmic space is seen in ?
|
Ans. is 'b' i.e., Gram negative bacteria Periplasmic space is a narrow space between cytoplasmic membrane (plasma membrane) and cell wall. Periplasmic space has been more frequently and better recorded in gram-negative bacteria as compared to gram-negative. "At present most gram positive bacteria are thought to have only periplasm, but not periplasmic space".
|
Microbiology
| null |
Gram negative bacteria
|
Intrinsic factor is secreted by-
|
Ans. is 'b' i.e., Parietal cells In stomach* Parietal cells (oxyntic cells) secrete - HC1 and intrinsic factor of castle.* Chief cells (zymogen or peptic cells) secrete - Pepsinogen.* G cells secrete - Gastrin* D cells secrete - Somatostatin* ECL cells secrete - Histamine
|
Physiology
|
G.I.T.
|
Parietal cells
|
Regarding the lipid or liposomal formulations of amphotericin B, which of the following statments is accurate?
|
(Ref: KDT 6/e p758) Newer liposomal preparations of amphotericin B have the following features: Less chances of nephrotoxicity and infusin related reactions Lesser uptake in the tissues like kidney More expensive Similar in efficacy and antifungal spectrum as conventional preparations
|
Pharmacology
|
Chemotherapy
|
They may decrease the nephrotoxicity of amphotericin B
|
A 75 year old female with a long history of cigarette smoking is found to have a small tumor at the periphery of her right upper lobe. Initially, the tumor was believed to be a Stage I carcinoma (T1 NO MO), but after surgery it is found to be Stage II (T1 N1 MO). What is found at surgery that changed the staging?
|
Although it is nearly impossible to memorize the staging rules for all the different kinds of tumors, there are several basic principles common to all. The TNM stage of a tumor is determined by the tumor size and extent (T for tumor), lymph node involvement (N for nodes), and metastasis (M for metastasis). N0 always means no lymph nodes are involved. An NI lesion has positive nodes, and only 2nd choice, positive bronchial lymph nodes, changes the patient's nodal status. Involvement of the chest wall is a feature of tumor size and extent-thus, it is a component of the T in TNM-staging. T2 lesions involve the chest wall. Histological features of the tumor, such as small cell morphology , are not considered in tumor stage, but rather in tumor grade. Small cell tumors are considered high-grade carcinomas. Tumor extending to the carina reflects the tumor size and extent-thus, it is a component of the T in TNM-staging: T3 lesions involve the carina . Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 4. Neoplasia. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture.
|
Pathology
| null |
Positive bronchial lymph nodes
|
Arch of aorta is derived from:
|
Ans. D 4th pharyngeal archRef: Gray's Anatomy, 4V ed. pg. 607DERIVATIVES OF THE PHARYNGEAL ARCHESArch numberArch nameEmbryonic cartilageCartilage derivativeMuscleNerveArtery1MandibularQuadrate Meckel'sIncusMalleusAnterior ligament of malleus Spine of sphenoidSphenomandibular ligamentGenial tubercle of mandibleTensor tympani Muscles of mastication MylohyoidAnterior belly of digastricTensor veli palatineTrigeminal (V)Mandibular divisionFirst aortic arch artery (transitory)2HyoidReichert's* Stapes* Styloid process of temporal bone* Styloid process of temporal bone* Stylohyoid ligament* Lesser horn and upper part of body of hyoid bone*Stapedius* Stylohyoid muscle* Facial muscles, include.# Buccinator# Platysma# Posterior belly digastricFacial (VII)Stapedial artery (transitory)3Third Greater horn and lower part of body of hyoid boneStylopharyngeusGlossopharyngeal (IX)Common carotid artery4Fourth Thyroid cartilageCorniculate cartilageCuneiform cartilagePharyngeal and extrinsic laryngeal muscles, levator veli palatiniVagus (X)Pharyngeal branch* Proximal part of subclavian artery on the right* Arch of aorta between origins of left common carotid and left subclavian arteries6Sixth Arytenoid cartilagesIntrinsic laryngeal musclesVagus (X)Recurrent laryngeal branchPart between the pulmonary trunk and dorsal aorta becomes ductus arteriosus on left, disappears on right
|
Anatomy
|
Embryology
|
4th pharyngeal arch
|
Difference between reversible and irreversible reaction is
|
C i.e. Work done
|
Biochemistry
| null |
Work done
|
Which of the following is not a component of SIRS?
|
Ans. b. Urine output < lml/kg/hour
|
Medicine
| null |
Urine output < lml/kg/hour
|
Provision of total beds at PHC & CHC is:-
|
- There are no beds at Sub-center level.
|
Social & Preventive Medicine
|
Rural & Urban Health Centres, Workers, Norms
|
PHC 4-6, CHC 30
|
The MOST frequently implicated antibiotic among the causes of DILI is:
|
Amoxicillin-clavulanic acid causes inflammatory cholestasis. It is the most common cause of antibiotic induced DILI. Other examples of drugs causing Inflammatory cholestasis are Phenothiazine Oxacillin Erythromycin oleate Ref: Harrison, Edition-18, Page 2561
|
Pharmacology
| null |
Amoxicillin -clavulanic acid
|
Which of the following is the "Least Common" complication of measles ?
| null |
Microbiology
| null |
SSPE
|
Decrease in weight for height indicates?
|
Decrease in weight for height indicates Acute malnutrition Decrease in height for age indicates chronic malnutrition.
|
Pediatrics
|
Malnutrition
|
Acute malnutrition
|
SMILE is
|
SMILE is bladeless Flapless LASIK Types of LASIK *Conventional LASIK: The LASIK flap is made by microkeratome blade and then EXCIMER laser is used for stromal ablation *Epi LASIK or Photorefractive Keratectomy: Laser ablation is done after removal of epithelium without the creation of flap *SMILE- is small incision lenticular extraction , a new technique in lasik using femtolaser. No Flap is made and it is bladeless. *I lasik: bladeless lasik. Creation of Flap is by Femtolaser LASIK procedure
|
Ophthalmology
|
Cornea
|
Bladeless Flapless LASIK
|
True about pediatric tracheostomy – a) Most common early complication is subcutaneous emphysemab) 3rd & 4th tracheal rings are incisedc) Easy to remove the tracheostomy tubed) Complete tracheal ring is removede) Moisturing of orifice should be done
|
Pediatric treacheostomy
In most of the cases tracheostomy is performed with general anesthesia and the patient intubated and paralyzed.
Neck is extended.
A horizontal incision is made halfway between the cricoid cartilage and the sternal notch.
Subcutaneous fat and tissues are reflected, and deep cervical facia, is cut to expose thyroid isthmus.
A vertical cut is given in 2-3 or 3-4 rings in midline and no part of the tracheal wall is removed.
The endotracheal tube is withdrawn and a suitable size tracheostomy tube is simultaneously inserted.
Post-operatively neck & chest radiograph are obtained to evaluate the position of the tube and to identify the subcutaneous emphysema & pneumothorax that could have developed as complication.
Tube must be cleaned at frequent intervals.
Patient should be nursed in and atmosphere of moist air.
|
Pediatrics
| null |
abe
|
Indications for exchange transfusion are all except –
|
Cord bilirubin 5 or more is an indication.
|
Pediatrics
| null |
Cord bilirubin < 5 mg/100 ml
|
Xavier and yogender stay in the same hostel of same university. Xavier develops infection due to group B meningococcus. After few days yogender develops infection due to Group C meningococcus. All of the following are true statements except -
|
Park&;s texbook of Preventive and Social Medicine 23rd edition Page no: 166 Currently available meningococcal vaccines include polysaccharide vaccines and polysaccharide-protein conjugate vaccines. Both vaccines are available against meaningococci of serogroup A, C, W135 and Y
|
Social & Preventive Medicine
|
Communicable diseases
|
Vaccine prophylaxis of contacts of xavier
|
Phage typing is widely usde for the intraspecies classification of one of the following bateria -
|
Phages that lyse all the members of genus salmonella species, Bacillus anthracis, and subspecies classical Vibrio cholera. The most impoant application of phage typing is for intraspecies typing of bacteria as in the phage typing of S.typhi and staphylococci. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:459
|
Microbiology
|
Virology
|
Staphylococci
|
A Patient presents with pain in Meta-Tarso-Phalangeal joints and is a known case of chronic renal failure. This is due to accumulation of:
|
Ans. b. Uric acid (Ref: Harrison 19/e p2233, 18/e p2837)The underlying basis of gouty arthritis is increased serum uric acid level.Most common joint involved in gout: Meta-Tarso-Phalangeal jointsQPrecipitation of monosodium urate crystalsQ into the joints is the underlying basis for these urate crystals is increased total body urate levels.Diagnosis in a 40 years old man, who presents with acute onset pain and swelling of left great toe and punched out lesion of phalanx and overhanging edges on X-ray is gout. (AIIMS November 2013 repeat)Gout is a metabolic disease that most often affects middle- aged to elderly men and postmenopausal women. It results from an increased body pool of urate with hyperuricemia. It typically is characterized by episodic acute and chronic arthritis caused by deposition of MSU crystals in joints and connective tissue tophi and the risk for deposition in kidney interstitium or uric acid nephrolithiasis. Usually, only one joint is affected initially and the metatarsophalangeal joint of the first toe is the most commonly involved joint. '- Harrison 18/e p2837'Radiographic Features of Gout: Early in the disease radiographic studies may only confirm clinically evident swelling. Cystic changes, well-defined erosions with sclerotic margins (often with overhanging bony edges), and soft tissue masses are characteristic features of advanced chronic tophaceous gout. Ultrasound, CT and MRI are being studied and are likely to become more sensitive for early changes. - Harrison 18/e p2837'Tophi appear as characteristic punched-out cysts or deep erosions in the para-articular bone ends. These excavations are larger and slightly further from the joint margin than the typical rheumatoid erosions. This punched out lesion in gouty arthritis is called Martel's sign, G sign or rat-bite erosion.''Gout: X-ray of feet demonstrated soft tissue swelling, cystic changes, and well-defined 'punched-out' type lytic lesions with sclerotic margins and overhanging bony edges (Martel's sign, G sign or rat-bite erosion). ''Most common joint involved in gout: Meta-Tarso-Phalangeal jointsQ.'GoutA disorder of purine metabolism characterized by hyperuricemia, deposition of monosodium urate-monohydrate crystals in Joints and per-articular tissuesQ and recurrent attacks of acute synovitis.Late changes include cartilage degeneration, renal dysfunction and uric acid urolithiasisMC joint involved in gout: Meta-Tarso-Phalangeal jointsQThe underlying basis of gouty arthritis is increased serum uric acid levelQSerum urate levels >7 mg/dL is defined as hyperuricemiaEpidemiology:Commoner in CaucasiansMore common in menQ, age >30 yearsQStereotype patient is obese, hypertensive and fond of alcohol and may be nudged into an attack by uncontrolled administration of diuretics or aspirinQPathology:Precipitation of monosodium urate crystalsQ into the joints is the underlying basis for these urate crystals is increased total body urate levels.Tophi are nodular deposits of monosodium urate monohydrate crystals, with an associated foreign body reaction.Pathognomonic hallmark of gout: TophiQTophi evolve from repeated precipitation of urate crystals during attackClinical Feature:Acute attack is sudden onset of severe joint pain that lasts for a week or two.Usually comes out of blue but may be precipitated by minor trauma, illness, unaccustomed exercise, alcohol, ACTCH, steroid withdrawal, hypouricemic therapy and drugs.Diagnosis:Definitive diagnosis is made by examination of synovial fluid or tophaceous material with polarized light microscopy and identifying monosodium urate crystals.Crystals have following characteristicsDuring attack: Intracellular and needle shapedQAfter the attack: Extracellular and bluntedQX-ray changes in GoutX-ray of feet demonstrated soft tissue swelling, cystic changes, and well-defined 'punched- out' type lytic lesions with sclerotic margins and overhanging bony edges (Martel's sign, G sign or rat-bite erosion)Q.Treatment of GoutAnti-inflammatoryHypouricemicsXanthine oxidase inhibitors* Mainstay of treatment during acute attack is administration of anti-inflammatory drugs such as colchicine, NSAIDs (except aspirin) or glucocorticoidsQ* Probenecid or sulfinpyrazone can be used if renal function is normal.* Allopurinol, a xanthine oxidase inhibitorQ is usually preferred.These drugs should never be started in acute attack, and they should always be covered by an anti inflammatory preparations or colchicine; otherwise they may actually precipitate an acute attackQ.In chronic tophaceous gout and in all patients with renal complications, allopurinol is drug of choiceQ.
|
Medicine
|
Immunology and Rheumatology
|
Uric acid
|
In breast, Copper's ligament extends from subcutaneous tissue to
|
B. i.e. Pectoral fascia Strands of fibrous tissue (forming the suspensory ligament of Cooper) connect the dermis of overlying skin to the ducts of breast (mammary gland) and pectoral fasciaQ. These suppo mammary gland lobule and help to maintain the protuberence of young breast. They also cause pitting of oedematons skin that results from malignant involvement of dermal lymphatics (peaud' orange) and dimpling of skin d/t fibrosis associated with ceain breast carcinomas.The fibrous stroma forms septa known as suspensory ligaments of cooper, which anchor the dermis of skin and gland to superficial pectoral fasciaQSuperficial pectoral fascia has two layers;- Superficial layer - Camper's fascia which contain mammary gland and?- Deep layer scarpa's fascia upto which Cooper's ligament extend
|
Anatomy
| null |
Pectoral fascia
|
Coarctation of Aoa is most commonly associated wtth-
|
Coarctation occurs in ~7% of patients with congenital hea disease, is more common in males than females, and is paicularly frequent in patients with gonadal dysgenesis (e.g., Turner syndrome). Clinical manifestations depend on the site and extent of obstruction and the presence of associated cardiac anomalies; most commonly a bicuspid aoic valve. Circle of Willis aneurysms may occur in up to 10%, and pose a high risk of sudden rupture and death. ( Harrison&;s principle of internal medicine,18th edition,pg no. 1925)
|
Medicine
|
C.V.S
|
Bicuspid Aoic valve
|
Which prevents plasminogen activators?
|
Ans. is 'b' i.e., Aminocaproic acid o Epsilon amino caproic acid (EACA) competitively inhibits plasminogen activation.
|
Pharmacology
| null |
Aminocaproic acid
|
Commonest cardiac lesion in tuberous sclerosis is
|
Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome with a high incidence of sporadic cases and variable clinical expression. It has an estimated frequency of 1/6000. Major manifestations of TSC include skin lesions in more than 95%, autism and seizures in 85%, kidney disease in 60%, mental retardation in 50%, and cardiac rhabdomyoma in 50%.Mental retardation and autism are more in TSC patients who presents with generalized seizures including infantile spasms in the first 2 years of life. Reference: GHAI Essential pediatrics, 8th edition
|
Pediatrics
|
Genetic and genetic disorders
|
Rhabdomyoma
|
DNA fingerprinting is based on possessing in DNA of:
|
Ans. B. Variable number tandem repeatDNA Finger printingThe use of normal genetic variation in the DNA (SNP or VNTR or RFLP) to establish a unique pattern of DNA fragments for an individual.This is also called DNA Profiling.Most commonly used is VNTR or repeat length polymorphism.The process of DNA finger printing was invented by Alec Jeffreys in 1985.Primer is needed
|
Biochemistry
|
Molecular Biology Techniques
|
Variable number tandem repeat
|
Ekbom's syndrome is seen in
|
Ekbom's syndrome or Delusional parasitosis is seen in cocaine intoxication where patient feels a sensation of insects crawling over the body.
|
Psychiatry
| null |
Cocaine intoxication
|
Stain with parasite having charcot-laden crystals but no pus cells
|
Ans. is 'c' i.e., E. histolytica Fecal finding in amoebiasis are :- i) Positive test for heme. ii) Paucity (lack) of neutrophils (pus cells). iii) Presence of amebic cysts or trophozoites iv) Charcot-leyden crystals. Remember Charcot leyden crystals are seen in E. histolytica 3. Ascaris pneumonia Whip worm (Trichuris) 4. Bronchial asthma
|
Microbiology
| null |
E. histolytica
|
A 57-year-old boy has been diagnosed to have posterior superior retraction pocket cholesteatoma. All would constitute part of the management, except -
|
Ans-DMyringoplasty consists of closing a 'central perforation' in the tympanic membrane in the 'tubotympanic type' or 'safe type' of chronic suppurative otitis media. It is not indicated in the unsafe or dangerous type of otitis media with posterosuperior attic perforation.The patient in question is a case of the dangerous or unsafe type of CSOM as Signified by the presence of posterosuperior retraction pocket cholesteatoma.The mainstay in the treatment of this type of CSOM is surgery.- The primary aim is to remove the disease and render the ear safe.A secondary aim is to preserve or reconstruct hearing, but never at the cost of the primary aim.(Mastoid exploration) is the operation of choice.Tympanoplasty: forms part of the secondary aim to reconstruct hearing after a primary mastoid exploration.- Dangerous type CSOM is associated with a perforation in the attic or posterosuperior region of T.M. along with the variable extent of destruction of ossicles and other middle ear contents. Reconstruction of hearing in this type of CSOM thus requires the variable extent of ossicular reconstruction besides closure of perforation.Audiometry forms an important step in the evaluation of disease process preoperatively.Although myringoplasty also forms a type of tympanoplasty its use is limited to closure of a perforation in the parts tensa of tympanic membrane which is seen in safe type CSOM.
|
Unknown
| null |
Myringoplasty
|
Procedure of choice for ptosis in Horner's syndrome?
|
Procedure of choice of ptosis in Horner syndrome: Fasanella Servat or Mullerectomy in case of good levator action Superior Tarsal muscle or Muller's muscle is the that is responsible for keeping the upper lid in a raised position after the LPS raises it. It is supplied by the sympathetic system. Hence it is involved in patient's with Horner's Syndrome. As levator remains intact, the degree of ptosis is mild - hence paial ptosis in patients with Horner's Syndrome
|
Ophthalmology
|
Neuro Ophthalmology
|
Fasanella Servat
|
Thymoma can be associated with all, except -
| null |
Medicine
| null |
Hypergammaglobulinemia
|
Dose of i.v. adrenaline in term infant is during neonatal resuscitation -
|
Ans. is c i.e., 0.1-0.3 mUkg in 1:10,000 Dose or adrenlaine ? 0.1 ml/kg to 0.3 inlikg diluted (1: I0,000) Routs : (1) Intravenous (umbilical vein) or (2) Endotracheal Indication ? HR < 60/min after 30 sec. of positive pressure ventilation & chest compression
|
Pediatrics
| null |
0.1-0.3 ml/kg in 1:10,000
|
Crash in cocaine means
|
Cocaine Cocaine is a stimulant which increases dopamine. It is available as a powder which is inhaled by nasal route called as SNOING. It can also be used as IV route * Cardiovascular adverse effects * MI * Arrhythmia * SIDS if mother exposed during pregnancy POST COCAINE DEPRESSION is alled CRASH * TREATMENT * dopamine agonists * Disulfiram Desipramine Ref.kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no.672
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Anatomy
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Substance abuse
|
post cocaine use depression
|
Double bubble appearance is seen in:
|
Ans. B. Duodenal atresiaThe double bubble sign is seen in infants and represents dilatation of the proximal duodenum and stomach. It is seen in both radiographs and ultrasound, and can be identified antenatally The finding is typically pathologic, and implies either duodenal atresia, duodenal web, annular pancreas, and on occasion midgut volvulus, a distinction that requires close clinical correlation and, in most cases, surgical intervention.
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Pediatrics
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Stomach and Intestines
|
Duodenal atresia
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A 65-year-old man, with a 45-pack-per-year history of smoking, presents with hematuria and flank pain. He reports no fever, chills, or dysuria, but he has lost 15 lb. On examination the abdomen is soft, no mass is felt, and there is no flank tenderness on percussion. His hemoglobin (Hb) is 18.5 g/dL, and his liver enzymes are normal. A CT scan of the abdomen reveals a mass in the left kidney with involvement of the renal vein. Which of the following is the most likely diagnosis?
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Age, history of smoking, and polycythemia in a patient with hematuria strongly suggests a renal cell carcinoma. The elevated hemoglobin represents increased erythropoietin production and is not related to prognosis. Involvement along the renal vein and metastases to the lung is also characteristic of renal cell carcinoma. Elevated liver enzymes and weight loss can represent nonmetastatic effects of malignancy and can reverse with resection. Almost half of patients will have a palpable abdominal mass on presentation. The CT of the thorax is a useful test because three-quarters of those with metastatic disease will have lung metastases.
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Medicine
|
Oncology
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renal cell carcinoma
|
CREST syndrome is an autoimmune condition which is associated with atrophy and fibrosis of the oesophageal musculature resulting in dysphagia and reflux-type symptoms. Which of the following is not a feature of CREST syndrome?
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The scleroderma spectrum of disorders are a group of connective tissue diseases inclusive of localized scleroderma (affects skin only), Raynaud's (vasospastic involvement of the fingers) and systemic sclerosis which is itself divided into diffuse cutaneous systemic sclerosis (DCSS) and limited cutaneous systemic sclerosis (also known as CREST syndrome). The two conditions vary in their symptom pattern and onset, but both involve the internal organ systems, including the renal tract and lungs (causing failure and pulmonary fibrosis). Skin involvement in DCSS is severe and widespread, but organ involvement is maximal at around 3 years and then typically improves. In CREST skin involvement is confined to the face and extremities; however, organ involvement tends to be progressive and more severe. CREST syndrome is typified by the following features: Calcinosis, Raynaud's, esophageal disorders, sclerodactyly and telangiectasia. Diagnosis is clinical and backed by identification of ceain auto-antibodies. Anti-nuclear antibodies are usually present, anti-Scl-70 is positive in 40% of scleroderma, the presence of anti-centromere antibody occurs in 80%-90% of CREST and is suggestive of the diagnosis. However, auto-antibody testing is non-specific, and either antibody or both antibodies may occur in both conditions.
|
Surgery
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Esophagus
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Erythematous malar rash
|
Assay for lipid peroxidation is:
|
Free radical measurement can be done by : FOX assay - (Ferrous oxidation in Xylenol) Estimation of Dialdehydes (e.g. MDA- Malon dialdehyde) Pentane and methane measurement in exhaled air
|
Biochemistry
|
Miscellaneous
|
FOX assay
|
In Duchenne's muscular dystrophy, which muscle is not involved :
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Ans. is 'b' & 'd' Vastus medialis and infraspinatus (Ref. O.P. Ghai, 5/e, p 425; Harrison, 17/e p 2682, 2683 & 16/e, p 2528 (15/e, p 2530)).
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Medicine
|
C.N.S.
|
Vastus medialis
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Best pontic for maxillary posterior teeth is:
| null |
Dental
| null |
Trupontic
|
Niemann-Pick disease is?
|
Ans. is 'a' i.e., AR All lysosomal storage disease are autosomal recessive, except Hunter syndrome and Fabry's disease, both of them are X-linked recessive.
|
Pathology
| null |
AR
|
Characteristics of BENIGN tumour of lung in X-ray is
|
Central, concentric, laminar, popcorn or homogeneous (diffuse) calcification is seen in benign lesions.
|
Radiology
| null |
Concentric dense calcification
|
A 20 year old primigravida is admitted with full term pregnancy and labour pain. At 4 am she goes into active phase of labour with 4 cm cervical dilatation. Membranes rupture during p/V examinatin showing clear liquor. A repeat PN examination after 4 hours of good uterine contraction reveals a cervical dilatation of 5 cm. What should be the next step in management :
|
Reassess for occipito posterior position and cephalopelvic dispropoion
|
Gynaecology & Obstetrics
| null |
Reassess for occipito posterior position and cephalopelvic dispropoion
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Angle between FH plane & occlusal plane is
| null |
Dental
| null |
10°
|
Which of the following muscle is derivative of 1st arch:
|
Tensor tympani muscle develops in the first pharyngeal arch. Stylopharyngeus develops in 3rd arch. Platysma develops in 2nd arch. Cricothyroid develops in 4th arch.
|
Anatomy
|
Pharyngeal Arches
|
Tensor tympani
|
Treatment of Acute lymphangitis requires ?
|
Ans. is 'a' i.e., Antibiotic and rest
|
Surgery
| null |
Antibiotic and rest
|
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