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All of the following are features of tonic pupil, EXCEPT:
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Tonic pupil results from damage to ciliary ganglion or sho ciliary nerves. Features of tonic pupil: Reaction to light is absent and to near reflex is very slow and tonic Accommodative paresis is present Affected pupil is larger It is generally unilateral Cholinergic supersensitivity of the denervated muscle occurs. Association of tonic pupil with absent deep tendon reflexes in the lower extremities is called Adie's tonic pupil. Ref: Textbook of Ophthalmology edited by Sunita Agarwal, page 305.
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Ophthalmology
| null |
It is caused by damage to oculomotor nerve
|
Spinal cord ends at lower border of which vertebra in adults -
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Ans. is 'b' i.e., Li o Spinal cord begins at foramen magnum and, in adults, ends at the lower border of LI. Structure Extends up to # Adult spinal cord # Infant spinal cord Lower border of L1 or upper border of L2 Upper border of L3 vertebrae # Filum terminate # Pia mater Tip of the coccyx # Dural sheath # Subdural space # Subarachnoid space S2 vertebra
|
Unknown
| null |
L1
|
Carboxypenicillins true is all except -
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Ans. is 'a' l.e., Nephrotoxic Carboxvpeniciilins - Carbenicillin:o It is active against pseudomonas and indole positive proteus.o Klebsiella and gram positive cocci are unaffected by ito It is neither penicillinase resistant nor acid resistant,o It is inactive orally and is rapily excreted in urine in 1 hr.o At high doses it can cause bleeding by interfering with platelet function due to perturbation of agonists receptors on platelet surface.# Carbenicillin indanyl is an orally active ester of carbenicillin, used for treatment of UTI caused by pseudomonas and proteus.
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Pharmacology
|
Penicillin & Cephalosporin
|
Nephrotoxic
|
Which among the following parotid tumor spreads through neural sheath
|
Adenoid cystic carcinoma, which has a propensity for neural invasion, is the second most common malignancy in adults. Skip lesions along nerves are common and can lead to treatment failures because of the difficulty in treating the full extent of invasion. Adenoid cystic carcinomas have a high incidence of distant metastasis but display indolent growth. It is not uncommon for patients to experience lengthy survival despite the presence of disseminated disease." - Schwaz 8/e "Treatment consists of removal of the gross tumor with radiation therapy for the microscopic disease that is assumed to exist at the periphery of the tumor."
|
Surgery
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Head and neck
|
Adenocystic ca
|
All of the following are branches of maxillary artery except
|
Ascending pharyngeal artery is branch of external cartotid artery.
|
Anatomy
| null |
Ascending pharyngeal artery
|
Unilateral proptosis and bilateral 6th nerve palsy are seen in?
|
Cavernous sinus thrombosis is usually a unilateral condition which caused rapid unilateral proptosis. The 6th nerve passes through the cavernous sinus, So bilateral 6th nerve palsy is seen. Later 3rd and 4th nerves are also involved. Clinical features of cavernous sinus thrombosis: Onset of cavernous sinus thrombosis is abrupt with chills and rigors. The patient is acutely ill. Eyelids get swollen with chemosis and proptosis of the eyeball. Cranial nerves 3,4 and 6 which are related to the sinus get involved individually and sequentially causing total ophthalmoplegia. The pupil becomes dilated and fixed, optic disc shows congestion and oedema with diminution of vision. Sensation in the distribution of ophthalmic division of trigeminal nerve is diminished. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 226)
|
ENT
|
Nose and paranasal sinuses
|
Cavernous sinus thrombosis
|
The best approach to prevent congenital anomalies in infants of diabetic mothers is to?
|
.
|
Pharmacology
|
All India exam
|
Maintain periconceptional tight control of maternal blood glucose levels
|
Eight year girl presented by her mother with sexual precocity. She may have the following disorder:
|
McCune-Albright syndrome (MAS) is classically manifested as a triad of irregular cafe au lait spots, fibrous dysplasia of long bones with cysts, and precocious pubey (sexual precocity). This is a sporadic disorder caused by somatic (postzygotic) activating mutations in the GSalpha subunit that links G protein-coupled receptors to intracellular signaling pathways. Precocious pubey may be central or incomplete. Other clinical manifestations include, Hypehyroidism Adrenal nodules with Cushing syndrome Acromegaly Hyperprolactinemia Hyperparathyroidism Hypophosphatemic hyperphosphaturic rickets Autonomous endogenous-functioning ovarian cysts (in girls) Must know: Causes of Precocious Pubeal Development: Central (GnRH-dependent) precocious pubey: Idiopathic Central nervous system abnormalities Acquired--abscess, chemotherapy, radiation, surgical trauma Congenital--arachnoid cyst, hydrocephalus, hypothalamic hamaoma, septo-optic dysplasia, suprasellar cyst Tumors--astrocytoma, craniopharyngioma, glioma Peripheral (GnRH-independent) precocious pubey: Congenital adrenal hyperplasia Adrenal tumors McCune-Albright syndrome Familial male-limited gonadotropin independent precocious pubey Gonadal tumors Exogenous estrogen--oral (contraceptive pills) or topical Ovarian cysts (females) HCG-secreting tumors (eg, hepatoblastomas, choriocarcinomas) (males) Ref: Styne D. (2011). Chapter 15. Pubey. In D.G. Gardner, D. Shoback (Eds), Greenspan's Basic & Clinical Endocrinology, 9e.
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Pediatrics
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McCune Albright syndrome
|
Hinchey classification is used for perforations of colon secondary to -
|
Ans. is 'c' i.e., Diverticulitis * Hinchey Classification is used to describe perforations of the colon due to diverticulitis.* The Hinchey classification - proposed by Hinchey et al. in 1979 classifies a colonic perforation due to diverticular disease.* The classification is I-IV:i) Hinchey I - localised abscess (para-colonic)ii) Hinchey II - pelvic abscessiii) Hinchey III - purulent peritonitis (the presence of pus in the abdominal cavity)iv) Hinchey IV - feculent peritonitis. (Intestinal perforation allowing feces into abdominal cavity)* The Hinchey classification is useful as it guides surgeons as to how conservative they can be in emergency surgery. Recent studies have shown with anything up to a Hinchey III, a laparoscopic wash-out is a safe procedure avoiding the need for a laparotomy and stoma formation.
|
Surgery
|
Small & Large Intestine
|
Diverticulitis
|
The first laboratory test that becomes abnormal in acute hepatocellular failure is:
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Answer is A (Prothrombin time (PT)): An increased prothrombin time is the most frequently observed first laboratory test suggesting the possibility of hepatocellular failure. Early liver failure may be suspected based on isolated prolongation of the Prothrombin Time (PT). Patients with early hepatocellular failure may present with isolated prolongation of PT Prolonged PT is an early sensitive indicator of hepatic synthetic dysfunction due to the sho half life offactor VII (2-6 hours) vvhich the failing liver cannot maintain. APTT is prolonged after PT in Liver Disease. Albumin has a long half life of about 20 days and hence reduced albumin will manifest only after 20 days of onset of Reduced synthetic function of Liver. Increased aerial ammonia is also a sign of acute liver failure, however increased aerial ammonia is primarily vieved as an impoant factor in the development of hepatic encephalopathy. 'Patient with liver disease may have only a prolonged PT (normal APTT and thrombin time) reflecting a decrease in factor VII which is the. first to be reduced in liver disorders because of its sho half life of 2-6 hours' 'Factor Vila is an essential enzyme in the extrinsic pathway of coagulation. The pathway is evaluated by PT. Because factor VII has the shoest half life of the procoagulant proteins, patient with early liver disease may present with an isolated prolonged PT' - Hematology / Oncology Secrets / 82 `Increased Prothrombin Time has a high prognostic value, paicularly for patients with acute hepatocellular failure. An abnormal prothrombin lime with confirmed prolongation of more than 5-6 seconds above control is the single laboratory test that draws attention to the possibility of the development offlummant hepatic necrosis (acute hepato cellular failure) in the course of acute viral hepatitis. Such a prolonged prothrombin time often precedes by days the manifestations of liver failure' - Schiff's Disease of the Liver 1011/52 'Most coagulation factors are produced in the liver (except VWF) and development of liver disease may result in prolongation of both PT and APTT. However because factor VII (Extrinsic pathway; measured by PT) has the shoest half life amongst all vitamin K dependent factor. PT will be the first to be prolonged. Development of Liver disease will lead to deficiency offactor VII first and initial prolongation of only the Prothrombin Time. With fuher deterioration of liver function both the PT and APTT will be prolonged' - 'Clinical Anesthesia' by stoelting (Lippincott Williams) 2009/396
|
Medicine
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Prothrombin time (PT)
|
A 42-year-old woman with benign ovarian tumor presents with ascites and breathlessness. CXR is performed. The clinical diagnosis is?
|
Ans. A Meigs syndromeRef: CMDT 2019 page 323* The CXR shows presence of right sided pleural effusion along with history of ascites and a benign ovarian tumor. This a triad seen in Meigs syndrome.* Choice B is seen in post MI patients* Choice C leads to acute onset ascites and right upper quadrant pain* Choice D leads to obstructive jaundice and cachexia.
|
Physiology
|
Misc.
|
Meigs syndrome
|
The sensitivity of uterine musculature is
|
Progesterone reduces muscle excitability by increasing calcium binding, thereby reducing free intracellular calcium. Oestrogen has the opposite effect and increases myometrial excitability.Refer page no 106 of Textbook of obstetrics, Sheila Balakrishnan, 2 nd edition.
|
Gynaecology & Obstetrics
|
General obstetrics
|
Enhanced by estrogen and Inhibited by progesterone
|
A patient with hypersplenism underwent splenectomy. The most probable oppounistic infection in this patient after the procedure is:
|
The most serious consequence of splenectomy is increased susceptibility to bacterial infections, paicularly those with capsules such as Streptococcus pneumoniae, Haemophilus influenzae, and some gram-negative enteric organisms. Patients under age 20 years are paicularly susceptible to overwhelming sepsis with S. pneumoniae. The case-fatality rate for pneumococcal sepsis in splenectomized patients is 50-80%. Ref: Henry P.H., Longo D.L. (2012). Chapter 59. Enlargement of Lymph Nodes and Spleen. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
|
Surgery
| null |
Pneumococci
|
A female is admitted in the ICU with the symptoms of GBS. She is getting these symptoms for the third time during few weeks. Nerve biopsy reveals onion-bulb appearance. What can be the MOST probable diagnosis?
|
Chronic inflammatory demyelinating polyneuropathy (CIDP):An acute-onset form of CIDP should be considered when GBS deteriorates >9 weeks after onset or relapses at least three times.This neuropathy shares many features with the common demyelinating form of GBS, including elevated CSF protein levels and the Edx findings of acquired demyelination.The CSF is usually acellular with an elevated protein level.Biopsy typically reveals little inflammation and onion-bulb changes (imbricated layers of attenuated Schwann cell processes surrounding an axon) that result from recurrent demyelination and remyelination.CIDP responds to glucocoicoids, whereas GBS does not. Ref: Amato A.A., Hauser S.L. (2012). Chapter 385. Guillain-Barre Syndrome and Other Immune-Mediated Neuropathies. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
|
Pathology
| null |
Chronic inflammatory demyelinating polyneuropathy
|
Paranasal polyp CT view?
|
Ans. is 'a' i.e., Coronal Both coronal and axial view are used, but coronal views are best to study paranasal sinus polyps.
|
ENT
| null |
Corona!
|
You are presented with a patient having a diffuse swelling in the neck bilaterally below the chin region. Intra orally the Lower molar is infected on left side
Incision is made for drainage at?
| null |
Surgery
| null |
All of the above
|
Biochemical oxygen demand is calculated to know ----- wastes -
|
Biochemical oxygen demand is an impoant test done on sewage. It is defined as the amount of oxygen adsorbed by a sample of sewage during a specified period, generally 5 days, at a specified temperature for the aerobic destruction or use of organic matter by living organisms. If BOD more than 300mg/L - strong sewage Less than 100mg/L - weak sewage Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 823
|
Social & Preventive Medicine
|
Environment and health
|
Organic
|
Corneal endothelial counting is done by?
|
Ans. (c) Specular microscopeRef : Yanoff 3/d, p 83
|
Ophthalmology
|
Cornea
|
Specular microscope
|
Macrophage, granuloma, erythrophagocytosis are found in
|
Ans. is 'c' i.e., Regional ileitisThere is confusion between option c & d because macrophage and granuloma are seen in crohn's disease (Regional ileitis), while erythrophagocytosis is seen in typhoid fever.o Regional Ileitis or crohn's disease has the histological features of transmural inflammatory cell infiltrate consisting of chronic inflammatory cells (lymphocytes, plasma cells & macrophges) which is the classical microscopic feature. Noncaseating, sarcoid like granulomas are present in all the layers of the affected bowel wall in 60% of cases & may even be seen in the regional lymph nodes. There is also patchy ulceration of the mucosa which may take the form of deep fissures, widening of submucosa due to edema & foci of lymphoid aggregates,o In typhoid fever, there is hyperemia, edema and cellular proliferation consisting of phagocytic histiocytes, lymphocytes & plasma cells. There is phagocytosis of RBC --> erythrophagocytosis.
|
Pathology
| null |
Regional ileitis
|
Which of the following is an optically inactive amino acid?
|
Optical properties: All the amino acids except glycine possess optical isomers due to the presence of asymmetric carbon atom.
Ref: Satyanarayan 3rd edition page no: 49
|
Biochemistry
| null |
Glycine
|
Percentiles divides the data into _____ equal pas
|
A percentile (or a centile) is a measure used in statistics indicating the value below which a given percentage of observations in a group of observations falls. There is no standard definition of percentile,. however all definitions yield similar results when the number of observations is very large and the probability distribution is continuous. In the limit, as the sample size approaches infinity, the 100pth percentile (0<p<1) approximates the inverse of the cumulative distribution function (CDF) thus formed, evaluated at p, as p approximates the CDF. This can be seen as a consequence of the Glivenko-Cantelli theorem. Ref : https://en.m.wikipedia.org/wiki/Percentile
|
Social & Preventive Medicine
|
Biostatistics
|
100
|
Most common site involved in genital TB -
|
Ans. is 'a' i.e., Fallopian tubes Genital tuberculosiso Almost always a secondary infectiono Most common route of spread is hematogenous.o Most common site is bilateral fallopian tubes, (in fallopian tubes most common part affected is ampulla and most common pathology encountered is endosalpingitis).o Most common in 20 - 30 years age groupo Infertility is the most common symptom.Site of genital tuberculosis% involvementFallopian Tubes90-100Uterus50-60Ovaries20-30Vagina/ vulva1-2
|
Gynaecology & Obstetrics
|
Tuberculosis of the Genital Tract
|
Fallopian tubes
|
Lateral dislocation of patella is prevented by
|
The lateral border provides inseion to vastus lateralis in its upper one-third or half. The medial border provides inseion to the vastus medialis in its upper two-thirds or more. Ref : B D Chaurasia's Humsn Anatomy , seventh edition , volume 2 , pg, no. 22
|
Anatomy
|
Lower limb
|
Vastus medialis
|
Posterior cutaneous nerve of thigh supplies skin overlying:
|
A i.e. Medial aspect of thigh; B i.e. Posteroinferior aspect of buttock; C i.e. Scrotum
|
Anatomy
| null |
All
|
Post operative radiotherapy in breast is given for?
|
Ans. is 'c' i.e. To prevent recurrence
|
Surgery
| null |
To prevent recurrence
|
Wilson’s disease is?
|
Wilson’s disease is an autosomal recessive disorder.
Autosomal recessive disorders
1) Metabolic - Cystic fibrosis, Phenyl ketonuria, Galactosemia, Homocystinuria, Lysosomal
storage dis, al- antitrypsin deficiency, Wilson disease, Hemochromatosis, Glycogen storage disorders
2) Hematological - Sickle cell anemia, Thalassemias
3) Endocrine - Congenital adrenal hyperplasia (some variants), Albinism
4) Skeletal - EDS (some variants) Alkaptonuria
5) Nervous -Friedreich ataxia, Spinal muscular atrophy, Neurogenic muscular atrophies, Ataxia
Telegiectasia.
|
Pathology
| null |
AR
|
Most common type of hyppospadias is?
|
Ans. (a) GlandularRef. Bailey & Love 24th edp 1389
|
Surgery
|
Anatomy (Urethra & Penis)
|
Glandular
|
Which of the following therapy is known to stimulate progenitor megakaryocytes and used in Rx of Cancer Chemotherapy-Induced Thrombocytopenia?
|
IL-11 (oprelvekin) is approved for use in the setting of expected thrombocytopenia, but its effects on platelet counts are small, and it is associated with side effects such as headache, fever, malaise, syncope, cardiac arrhythmias, and fluid retention.
|
Pathology
|
All India exam
|
IL-11
|
The reward or pleasure center is present in
| null |
Physiology
| null |
Ventral tegmental area
|
Sumoylation of histones proteins is associated with
|
Sumoylation of histones is associated with Transcription repression Histone post-translational modifications & their role: Post-translational modifications Role Acetylation of histones H3 and H4 Activation or inactivation of gene transcription Acetylation of core histones Chromosomal assembly during DNA replication Phosphorylation of histone H1 Condensation of chromosomes during the replication cycle ADP-ribosylation of histone DNA repair Methylation of histone Activation and repression of gene transcription Mono-ubiquitylation Gene activation, repression, and heterochromatic gene silencing Sumoylation of histones Transcription repression
|
Biochemistry
|
Basics of DNA
|
Transcription repression
|
Treatment of choice for scabies in an infant < 6 months is?
|
Ans. is 'c' i.e., Permathrin Treatment of scabies in children* Topical permethrin (5% cream) is a safe and effective scabicide in children. It is recommended as a first-line therapy for patients older than 2 months of age. Because there are theoretical concerns regarding percutaneous absorption of permethrin in inf ants younger than 2 months of age, guidelines recommend 7% sulfur preparation instead of permethrin.* Gamma benzene hexachloride 1% lotion (lindane) is recommended as second-line therapy for scabies in children. But it should be used with caution in children younger than 2 years of age as systemic absorption in children can cause neurotoxicity. It should not be applied over face and scalp* Ivermectin is not approved for use in children younger than 5 years.* Crotamiton 10% cream is approved by the US Food and Drug Administration for treatment of scabies in adults, but there is very little research on its use in children.Note - permethrin is the DOC for scabies in infants older than 2 years, pregnant & nursing female.
|
Skin
|
Scabies
|
Permathrin
|
Beaded margin of eyelid is seen in
|
Lipoid proteinosis is a rare, recessively inherited disorder, characterized by infiltration of the skin, oral cavity and larynx. Patients with this genodermatosis can usually be recognized instantly because of husky voice, inability to protrude tongue and thickened eyelids.
|
Ophthalmology
|
Diseases of orbit, Lids and lacrimal apparatus
|
Lipoid proteinosis
|
Best way to diagnose gall bladder stones: March 2007
|
Ans. A: USG In Europe and USA 80% of the stones are cholesterol or mixed type. In Asia, 80% of the stones are pigment stones On the basis of their contents, gallstones can be subdivided into the two following types: Cholesterol stones are usually green, but are sometimes white or yellow in color. They are made primarily of cholesterol. Pigment stones are small, dark stones made of bilirubin and calcium salts that are found in bile. Risk factors for pigment stones include hemolytic anemia, cirrhosis, biliary tract infections, and hereditary blood cell disorders, such as sickle cell anemia and spherocytosis. Mixed stones-most of these are a mixture of cholesterol and calcium salts. Because of their calcium content, they can often be visualized radiographically. Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts. Besides a high concentration of cholesterol, two other factors seem to be impoant in causing gallstones: The first factor is how often and how well the gallbladder contracts; incomplete and infrequent emptying of the gallbladder may cause the bile to become overconcentrated and contribute to gallstone formation. The second factor is the presence of proteins in the liver and bile that either promote or inhibit cholesterol crystallization into gallstones. Increased levels of the hormone estrogen as a result of pregnancy, hormone therapy, or the use of combined (estrogen-containing) forms of hormonal contraception, may increase cholesterol levels in bile and also decrease gallbladder movement, resulting in gallstone formation. It is most common for a person to have gall stones if (s)he falls under the four F's: Fat, Female, (nearing) Foy, Feile. A diagnosis of gallstone is based on the history and physical examination with confirmatory radiological studies like USG Cholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid. Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphincterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP).
|
Surgery
| null |
USG
|
Vascular repair to be done in which Gustilo Anderson type?
|
Ans. is 'a' i.e., Mc Treatment of Open Fractures Gustilo's classification of open fractures : Type I Small clean puncture wound with/ without protruded bone spike. Low energy non-comminuted fracture(low energy trauma). Little soft tissue injury with no crushing. Type II More than 1 cm long wound. Moderate soft tissue damage and crushing. Low to moderate energy trauma with moderate comminution. Type III Large laceration, skin flap, crushing. IIIA: fractured bone can be adequately covered by soft tissue despite laceration. IIIB: extensive periosteal stripping and fracture cover is not possible without use of local or distant flaps. IIIC: associated aerial injury that needs to be repaired regardless of the amount of other soft tissue damage.
|
Surgery
| null |
Inc
|
You have been directed by a class - I judicial magistrate to provide "Compos mentis". "Compos mentis" is associated with which of the following?
|
A judicial magistrate is the optimal person to record a dying declaration, but before recording the statement the doctor should ceify that the person is conscious and his mental faculties are normal. This is called "compos mentis". Also know S.32 IEA deals with dying declaration Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 21, Page - 9.
|
Forensic Medicine
| null |
Dying declaration
|
The difference in molecular weight between Phenylalanine & Tyrosine is by :
|
Usually students tend to mark 17 as the answer. Phenylalanine gets conveed to Tyrosine by enzyme Phenylalanine Hydroxylase. Most Hydroxylases are Mono-oxygenases i.e. EC No. 1. In hydroxylation reactions, only one oxygen atom from the molecular oxygen is added because H was already present in the phenylalanine. So, change in molecular weight is by 16 and NOT 17. Extra Information: Phenylalanine is an essential amino acid and its only role in the body is to give rise to tyrosine.
|
Biochemistry
|
Phenylalanine and Tyrosine metabolism Detail
|
16
|
Amphotericin-B is obtained from:
|
POLYENE ANTI BIOTICS The name polyene is derived from their highly double-bonded structure. Amphotericin B is described as the prototype. Amphotericin B (AMB): It is obtained from Streptomyces nodosus ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:757
|
Pharmacology
|
Chemotherapy
|
Streptomyces nodosus
|
Cavitary lesions are chacteristically seen in
|
Ans bLung involvement typically appears as multiple, b/L nodular cavitary infil-trate. Biopsy almost invariably shows typical necrotizing granulomatous vasculitis of small arteries and veins together with granuloma formation. WG is a distinct clinicopathological entity characterised by a granuloma-tous vasculitis of upper and lower resptract together with glomerulone-phritis. In addition variable degree of disseminated vasculitis involving both small arteries and veins may occur.Glomerulo nephritis may evolve to rapidly progressive crecentic glomeru-lonephritisIn contrast to others glomerulo nephritis evidence of immunocomplex depo-sition is not found in renal lesions of WegenersWegeners granulomatosis C/F - Kidney- GlomerulonephritisEnt- sinusitis, nasal discharge, otitis media, hearing loss, sub glottis stenosisLung- Pulmonary infiltrates, nodules, hemoptysis, pleuritis Eyes - conjunctivitis, dacrocystitis, scleritis, proptosis, visual loss. Others- arthralgia, fever, cough, skin lesions, wt loss, peripheral neuropa-thyLab- increased ESR. mild anemia, leukocytosis, mild hyper gamma globulinemia (particularly class IgA), mildly elevated RA factor. 90% have positive antiproteinase-3 ANCARx* cyclophosphamide induction for severe disease.* glucocorticoid gives symptomatic relief with little effect on ultimate outcome.Best is combining cyclophophamide and glucocorticoid.* In immediate life threatening conditions glucocorticoid + cyclo. For remission- 3-6m followed by methotrexate/ azathioprine for maintenance.
|
Medicine
|
Respiratory
|
Wegeners granulomatosis
|
28-year-old pregnant lady comes to the ER with headache, blurring of vision and vomiting. On examination, her BP is 195/150 mm Hg, ankle edema present, urinary proteinuria present. On inquiry, she is primi and it is 23 weeks of gestation. All on a sudden, she develops convulsion. Intravenous magnesium sulphate is introduced immediately and she recovers smoothly. During discharge, which of the following medication will be justified?
|
Answer: b) MetoprololMethyldopa is still the drug of choice for many obstetricians in pregnancy, because extensive experience has shown that it does not harm the fetus.Nifedipine is also used in pregnancy, but it is kept in second class. Nifedipine can reduce BP immediately and it is unpredictable even sometimes large enough to cause cerebral ischemia.Beta blockers can cause growth retardation in first and second trimester. It can be used in last trimester in combination with hydralazine to combat the unpleasant tachycardia.ACE-inhibitors and ARBs (i.e. - Losartan, Olmesartan) are absolutely contraindicated during pregnancy, where they cause fetal death, typically mid-trimester.
|
Gynaecology & Obstetrics
|
Miscellaneous (Gynae)
|
Metoproplof
|
Which of the following is the most common postoperative complication related to intubation: March 2011
|
Ans. C: Sore throat Sore throat (pharyngitis, laryngitis) is the most common post-operative complication of intubation It usually subsides within 2-3 days without any treatment
|
Anaesthesia
| null |
Sore throat
|
Which one of the follwing is the ECG hallmark of hypothermia-
|
ECG Changes in Hypothermia Hypothermia may produce the following ECG abnormalities: Bradyarrhythmias (see below) Osborne Waves (= J waves) Prolonged PR, QRS and QT intervals Shivering aefact Ventricular ectopic Cardiac arrest due to VT, VF or asystole Ref Harrison 20th edition pg 1445
|
Medicine
|
C.V.S
|
Osborne J wave
|
In Guinea worm prophylaxis, all are true, except ?
|
Ans. is 'c' i.e., Mass t/t with mebendazole o No drug is suitable for effective mass treatment of Dracunculiasis. o The drugs effective for t/t of cases of Dracunculiasis Niridazole Mebendazoel Metronidazole
|
Social & Preventive Medicine
| null |
Mass treatment with Mebendazole
|
A 20-year-old young girl, presents with history of rapidly developing hirsutism and amenorrhea with change in voice. To establish a diagnosis you would like to proceed with which of the following tests in blood:
| null |
Gynaecology & Obstetrics
| null |
Testosterone
|
Cross bite is a
| null |
Dental
| null |
Bucco lingual malocclusion
|
Which of the following drugs should not be used in a setting of severe hypertension in elderly on empirical basis ?
| null |
Medicine
| null |
Prazosin
|
Apocrine mode of secretion is classically seen in _______ glands?
|
Apocrine mode of secretion is seen in Mammary gland Modes of Secretion of exocrine glands can be classified as - Merocrine Apocrine Holocrine
|
Dental
|
Disorders of sebaceous and sweat glands
|
Mammary
|
Areas of carcinoma of oral mucosa can be identified by staining with:
|
Toluidine Blue Toluidine blue is a basic metachromatic dye with high affinity for acidic tissue components, thereby staining tissues rich in DNA and RNAQ. Wide applications both as vital staining in living tissues and as a special stain used in vivo to identify dysplasia and carcinoma of the oral cavityQ.
|
Surgery
|
Oral cavity
|
2% toluidine blue
|
Syndrome x not found in
|
(D) (Weight loss) (1992-95-H 18th)* Syndrome X is much more common in patients who are obese.Metabolic' syndrome (syndrome X) or Insulin resistance syndrome (805- Davidson 22nd)* DM type II* Hypertension* Dyslipidaemia * Over weight/obesity* Central adiposity is a key feature of the syndrome* Sedentary life style* Aging 50 years* Coronary heart disease* Lipodystrophy* Glucose intoleranceOther ossociated conditions1. Non alcoholic fatty liver disease2. Hyperuricemia3. Polycystic ovary syndrome4. Obstructive sleep apnea
|
Medicine
|
Endocrinology
|
Weight loss
|
Trisomy of which chromosome is associated with uterine fibroids?
|
Fibroids are monoclonal and about 40% have chromosomal abnormalities that include translocations between chromosomes 12 and 14, deletions of chromosome 7, and trisomy of chromosome 12.Cellular, atypical, and large fibroids are most likely to show chromosomal abnormalities.Ref: Berek and Novak&;s Gynecology; 15th edition; Chapter 15
|
Gynaecology & Obstetrics
|
Uterine fibroid
|
Trisomy 12
|
What percentage of the blood flow to the liver is supplied by the hepatic aery -
|
Ans. is 'b' i.e., 20 %
|
Surgery
| null |
20%
|
Arsenic is useful in treatment of
|
Refer Harrison 17th/389 AS2O3 promote the differentition of APL cells and promote apoptosis by upregulating the genes involved in apoptosis. It is used for the treatment of acute promyelocytic leukemia
|
Pharmacology
|
Chemotherapy
|
Acute promyelocytic leukemia
|
Defective hepatic conjugation is seen in all the following except -
|
Ans. is 'd' i.e., Novobiocin therapy
|
Pediatrics
| null |
Novobiocin therapy
|
Lumbar plexus is situated in
|
Ans. b (Posterior portion of psoas) (Ref. BDC anatomy Vol. II 3rd ed., 278)LUMBAR PLEXUS# The lumbar plexus lies in the posterior part of the substance of the PSOAS MAJOR muscle.# It is formed by the ventral rami of the upper 4 lumbar nerves.Its branches include:- Ilioinguinal nerve (L1)- Lateral cutaneous nerve of the thigh (L2, L3 dorsal divisions)- Lumbosacral trunk (L4, 5; ventral trunk)- Genitofemoral nerve (L1, L2, ventral divisions)- Obturator nerve (L2, 3, 4; dorsal divisions)- Femoral nerve (L2, 3, 4; dorsal divisions)- Iliohypogastric nerve (L1)Branches of the lumbar plexusNerveSegmentMuscleMotionSensationIliohypogastricT12 -L1# Inter oblique# External oblique# Transversus abdominusAnterior abdominal wall# Inferior abdominal wall# Upper lateral quadrant of buttockIlioinguinalL1Internal obliqueAnterior abdominal wall# Internal medial inguinal ligament# GenitaliaGenitofemoralL1-L2CremasterTesticular# Inferior medial inguinal ligament# Spermatic cordLateral femoral cutaneousL2-L3 # Anterior, lateral and posterior aspect of thighFemoral Nerve1. Anterior division L2-L4# Sartorius,# Pectineus# Medial aspect of lower thigh# Adduction of thigh# Anterior medial skin of thigh2. Posterior division Quadriceps# Knee extension# Patellar movement# Anterior thigh hip and kneeObturator nerve1. Anterior division L2-L4# Gracilis# Adductor longus# Adductor brevis# PectineusThigh adduction# Posterior medial thigh# Medial knee# Hip2. Posterior division # Adductor magnus# Obturator externusThigh adduction with lateral hip rotationKnee
|
Anatomy
|
Nerves of Abdomen
|
Posterior portion of psoas
|
A patient has a goiter associated with high plasma levels of both TRH and TSH. Her hea rate is elevated. This patient most likely has which condition?
|
A hypothalamic tumor secreting large amounts of TRH would stimulate the pituitary gland to secrete increased amounts of TSH. As a result, the secretion of thyroid hormones would increase, which would result in an elevated hea rate. In comparison, a patient with either a pituitary tumor secreting large amounts of TSH or Graves' disease would have low plasma levels of TRH because of feedback. Both TRH and TSH levels would be elevated in an endemic goiter, but the hea rate would be depressed because of the low rate of T4 secretion.
|
Physiology
|
Endocrine System
|
A hypothalamic tumor secreting large amounts of TRH
|
Which of the following statement about the primary lymphedema is NOT TRUE?
|
Primary Lymphedema: It has been generally been classified on the basis of the age of onset and presence of familial clustering. Primary lymphedema with onset before the age first year (with in two year according to L & B) of life is called is called congenital. The familial version of congenital lymphedema is known as Milroy's disease and is inherited as a dominant trait. Primary lymphedema with onset between the age of 1 and 35 years (b/w 2-35 according to L& B) is called lymphedema praecox. The familial version of familial praecox is known as Meige's disease. Primary lymphedema with onset after the age of 35 years is called lymphedema tarda. The primary lymphedema are relatively uncommon, occurring in 1 of every 10,000 individuals. The most common form of primary of lymphedema is praecox, which accounts for about 80% of the patients. Congetital and tarda lymphedemas each account for the remaining 10%. Lymphangiosarcoma is rare tumor that develops as a complications of long-standing ( usually more than 10 years) lymphedemas. Clinically, patients present with acute worsening of the edema and appearance of subcutaneous nodules that have a propensity towards hemorrhage and ulceration. The tumor can be treated, as other sarcomas, with preoperative chemotherapy and radiation followed by surgical excision, which usually takes the form of radical amputation. Overall, the tumour has a poor prognosis. Ref: L & B 25/e, page 949-50 ; Sabiston 18/e, page 2021-25
|
Surgery
| null |
Lymphangiosarcoma never occurs
|
WHO recommended tetanus toxoid dose/s to prevent maternal and neonatal tetanus for a pregnant woman whose previous immunization status is not known is/are -
|
Ans. is 'b' i.e., 2 * Guidelines recommeded for prevention of neonatal tetanus are:-1) Training of birth attendants to provide clean delivery. Clean delivery mainly concentrates on three things:i) Hand (of attendant)ii) Delivery surfaceiii) Cord3 cleans5 cleans7 cleans (proposed under RCH+III)Clean HandClean HandsClean HandsClean TowelClean waterClean delivery surfaceClean delivery surfaceClean delivery surfaceClean cord careClean cord cut/bladeClean cord tieClean cord stump (no applicant)Clean cord cut/bladeClean cord tieClean cord stump (no applicant)2) Administration of tetanus-toxoid to pregnant women. Two dose of tetanus toxoid (one at early pregnancy and 2nd one month later) is given in unimmunized pregnant women; whereas only one booster dose is given in immunized pregnant female.3) Administration of tetanus toxoid to all women of child bearing age in areas where incidence of neonatal tetanus is high and coverage of antenatal care is low.4) Administration of antitoxin to unprotected neonates within 6 hours of birth.
|
Medicine
|
Infection
|
2
|
EGFR antagonist, Cetuximab is used in cases of
|
Cetuximab and pemtumomab are directed against the epidermal growth factor receptor (EGFR), a transmembrane glycoprotein involved in signaling pathways affecting growth and proliferation of tumor cells. Both cetuximab and pemtumomab, when given alone, have been shown to benefit a small propoion of previously treated patients
|
Surgery
|
All India exam
|
Palliative treatment of head and neck cancer
|
The Mechel's diverticulum is situated within about cm from the ileocecal valve -
| null |
Surgery
| null |
60
|
The sodium gradient across the nerve cell membrane IS:
|
The sodium- potassium pump uses the energy contained in ATP to maintain the sodium gradient across the membrane. The sodium gradient, in turn, is used to transport other substances across the membrane. For example, the NaCa exchanger uses the energy in the sodium gradient to help maintain the low intracellular calcium required for normal cell function. Although sodium enters the cell during an action potential, the quantity of sodium is so small that no significant change in intracellular sodium concentration occurs. Because the sodium transference is so low, the sodium equilibrium potential is not an important determinant of' the resting membrane potential.
|
Unknown
| null |
Used as a source of energy for the transport of other ions
|
Late hyperglycemia in pregnancy is associated with:
|
“Hyperglycemia at the time of conception results in enhanced rates of spontaneous abortion and major congenital malformations. Hyperglycemia in later pregnancy increases the risk for macrosomia, hypocalcemia, polycythemia, respiratory difficulties, cardiomyopathy, and congestive heart failure.”
COGDT 10/e, p 316
Macrosomia:
Fetal macrosomia is defined by ACOG as fetal birth weight is > 4500 g.
Macrosomic fetuses have extensive fat deposits on the shoulder and trunk which is associated with increased incidence of shoulder dystocia.
Organ which is not affected in macrosomia is brain.
Control of postparandial blood sugar levels is very important for preventing macrosomia.
For diagnosing macrosomia: USG is performed every 4 weeks, starting at 20 weeks of gestation.
First sign of developing macrosomia is: increase in abdominal circumference more than other measurements.
Management : If wt of fetus is > 4.5 kg in diabetic mothers or > 5 kg in non diabetic mothers–section is recommended.
|
Gynaecology & Obstetrics
| null |
Macrosomia
|
A male 45 year old presents to the clinic for general routine checkup. The patient is hypertensive and diabetic and is on medication. General examination reveals RBS levels 180 mg/dl and elevated levels of HDL. Which of the following is not true regarding the lipoprotein levels of the patient?
|
HDL concentrations vary reciprocally with plasma triacylglycerol concentrations and directly with the activity of lipoprotein lipase. This may be due to surplus surface constituents, eg, phospholipid and apo A-I, being released during hydrolysis of chylomicrons and VLDL and contributing toward the formation of preβ-HDL and discoidal HDL. HDL2 concentrations are inversely related to the incidence of atherosclerosis, possibly because they reflect the efficiency of reverse cholesterol transport. HDLc (HDL1) is found in the blood of diet-induced hypercholesterolemic animals. It is rich in cholesterol, and its sole apolipoprotein is apo E. It appears that all plasma lipoproteins are interrelated components of one or more metabolic cycles that together are responsible for the complex process of plasma lipid transport.
Reference: HARPERS ILLUSTRATED BIOCHEMISTRY30th ed Page no 259
|
Biochemistry
| null |
Directly related to the incidence of atherosclerosis
|
Which of the following organelle plays a pivotal role in apoptotic pathways?
|
Mitochondria are essential in controlling specific apoptosis pathways. The redistribution of cytochrome c, as well as apoptosis-inducing factor (AIF), from mitochondria during apoptosis leads to the activation of a cascade of intracellular proteases known as caspases. Ref: Beal M.F., Hauser S.L. (2012). Chapter 366. Biology of Neurologic Diseases. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
|
Pathology
| null |
Mitochondria
|
What is net reproduction rate?
| null |
Social & Preventive Medicine
| null |
No. of female children a newborn girl has in her life time taking into account mortality
|
Raised serum level of lipoprotein-a is a predictor of -
|
Ans. is 'c' i.e., Atherosclerosis Lipoprotein - (a) o Lp (a) is a lipoprotein similar to LDL in lipid and protein composition, but it contains an additional protein called apolipoprotein (a). o Elevated level of Lp (a) is associated with increased risk of atherosclerosis. o How does Lp (a) increase the risk of atherosclerosis ? In atherosclerosis, there is hypercoagulability and hypofibrinolysis due to associated inflammation (remind you-atherosclerosis is a chronic inflammatory condition). So there is consistent doposition of fibrin. Lp (a) has close homology to plasminogen and it competes with plosminogen for binding on the surface of endothelium. This result in reduced generation of plasmin from plasminogen --> Inhibition of endogenous fibrinolytic system. This enhances fuher fibrin deposition. In addition, Lp (a) is accumulated in atherosclerotic lesions. So, Lp (a) causes impaired cell surface fibrinolysis and progressive atherosclerosis.
|
Pathology
| null |
Atherosclerosis
|
Best time for surgery of Undescended testis is:
|
Management: Orchidopexy, Ideal time: 6-12 months of age. (Best time is 6 months) Types of Orchiopexy 1. Fowler-Stephens orchidopexy 2. Microvascular testicular autotransplanatation (Best results) 3. Ladd and Gross orchidopexy 4. Ombridanne's orchidopexy 5. Placing testis in Daos pouch 6. Keetley-Torek orchidopexy Diagnostic Laparoscopy IOC for 'non-palpable' UDT. Vas and testicular aery is traced in Pelvis. Blind ended Vas doesn't conclude the absence of testis, whereas Blind ended testicular aery is a definitive investigation for an absence of testis. Laparoscopy is also useful in lap. Assisted orchidopexy
|
Surgery
|
Testis and scrotum
|
6 months of age
|
IFN-a and IFN-b are produced by the virus-infected cell due to the interaction of virus nucleic acid with which of the following?
|
Following virus entry into a cell, the virus initiates replication and the viral nucleic acid interacts with specific microbial sensors (TLR3, TLR7, TLR 9, RIG-1, and MDA-5). This interaction triggers cellular production of IFN that is secreted from the infected cell.Jawetz 27e pg: 130
|
Microbiology
|
Immunology
|
TLR pathway
|
Incubation period of staphylococcal food poisoning is:
|
Ans.is 'a' i.e., 4-6 hours (Ref: Ananthanarayan, 9th/e, p. 202 and 8th/e, p. 198)* Incubation period of staphylococcal food poisoning is 1-6 hours.* Toxin can be detected by ELISA, Latex agglutination test and toxin gene detection by PCR.
|
Microbiology
|
Bacteria
|
4-6 hrs
|
Mammography can be used in -
| null |
Radiology
| null |
Early breast carcinoma
|
All of the statements regarding progesterone only pill are true, except
|
Failure rate of combined OCP is 0.2/100 women years, whereas failure rate of progesterone only pill is about 0.5 - 2 per 100 women years of use. Progesterone only pill acts by thickening cervical mucous, causing atrophy of endometrium or by inhibiting ovulation.
|
Gynaecology & Obstetrics
| null |
Failure rate is the same as combined OCP
|
False about TGA
|
Patient with comlete TGA with intact ventricular septum will be cyanotic at bih. TGA may be associated with VSD. Patient may develop CHF within Weeks. Arotic stenosis is not a feature of TGA. Ref: Ghai essential of pediatrics, eighth edition, p.no:425
|
Pediatrics
|
C.V.S
|
AS
|
Roopa Devi, a 65-year-old female with ovarian cancer is being treated with cisplatin-bassed chemotherapy. All of the following are used to limit the toxicity of cisplatin except:
|
(Ref: Harrison 18th/697) The patient de3scribed in the question has hemorrhagic cystitis caused by drugs like cyclophospamide or ifosfamide is caused by the urinary excretion of the toxic metabolite acrolein. This can be prevented by aggressive hydration, bladder irrigation, and administration of mesna, a sulfhydryl compound that binds acrolein in the urine.
|
Pharmacology
|
Other topics and Adverse effects
|
N-acetylcysteine
|
Wermer's syndrome (multiple endocrine neoplasia type I) is characterised by all of the following except-
|
MEN type 1 (MEN 1), which is also referred to as Wermer's syndrome, is characterized by the triad of tumors involving the parathyroids, pancreatic islets (gastrinomas, insulinomas, nonfunctioning and PPoma, glucagonoma, VIPoma) and anterior pituitary (prolactinoma, somatotrophinoma, coicotropinoma, nonfunctioning). Reference : page 2335-36 Harrison's Principles of Internal Medicine 19th edition
|
Medicine
|
Endocrinology
|
Phaeochromocytoma
|
Which of the following is the meaning of 'Corpus delicti' in forensic medicine?
|
The Corpus delicti (the body of offence or the essence of crime) means, the facts of any criminal offence, i.e., murder. The main pa of corpus delicti is the establishment of identity of the dead body, and identification of violence in a paicular way, at a paicular time and place, by the person or persons charged with a crime and none other. Ref: Essentials of Forensic Medicine and Toxicology by K S Narayan Reddy, 27th edition, Page 52.
|
Forensic Medicine
| null |
Essence of crime
|
Unit of absorbed dose of radiation -
|
Ans. is 'c' i.e., Grayo 100 Rad is equal to 1 gray or 1 rad is equal to 0[?]01 gray.Quantity measuredOld unitNew (SI) unit RadioactivityCurieBecquerel1 curie = 3[?]7 x 1010 Becquerel1 Becquerel = 2[?]7 x 10-11 curieRadiation exposureRoentgenColumb/cm Absorbed doseRadGray (Gy)100 rad = 1 Gray1 rad = 0[?]01 GrayDose equivalentRemSievert (Sv)100 Rem = 1 Sievert1 Rem = 0[?]01 Sievert
|
Radiology
|
Radiation Dose and Safety Considerations in Imaging
|
Gray
|
Which of the following is Climber's muscle -
|
Ans. is 'b' i.e., Lattissimus Dorsi o Lattissimus Dorsi is sometimes referred as the 'Climber's muscles' as it comes in visible action in climbing up the trees, so also in swimming and rowing.Special nameMuscleBoxers muscleSerratus anteriorTailer's muscleSartoriusRider's muscleAdductors of thighClimber's muscleLattissimus dorsiGuthrie's muscleWilson's muscleSphincter urethraeShawl muscleCowl muscleTrapeziusLaughing or Smiling muscleCoder's muscleZygomaticus majorCorrugator supercilliToynbee's muscleTensor tympaniThelle's muscleSuperficial transverse perinea
|
Anatomy
|
Thorax
|
Lattissimus Dorsi
|
Which one of the following neurological conditions is not inherited in autosomal dominant pattern
|
Friedreich ataxia Gene :FXN,locus:9q21.1 ; protein :frataxin; repeat GAA; normal: 7-34 ; Disease :34-80 (pre); >100 (full) Friedreich ataxia is an inherited condition that affects the nervous system and causes movement problems.This condition is caused by mutations in the FXN gene and is inherited in an autosomal recessive pattern Ref Robbins 9/e pg 168
|
Medicine
|
Genetics
|
Friedreich's ataxia
|
Subtype of leprosy with maximum number of TH -1 cells -
|
Ans. is 'a' i.e., TT TT --4. Max. no. of CD4 - T cells (TH -1) 11, --II. Max. no. of CD8 - T cells
|
Microbiology
| null |
TT
|
Which among the following is bile esculin positive and shows growth in 6.5% sodium chloride?
|
- Enterococcus faecalis can- - Resist 6.5% NaCL - Resist 40% bile - Temperature of >55o C They are bile esculin positive. Bile esculin agar is used to culture. Black coloured colonies are seen. In gram staining, Spectacle like appearance is present
|
Microbiology
|
JIPMER 2019
|
Enterococcus faecalis
|
A 40-year-old man has been bothered by oral candidiasis, fever, and diarrhea for the past year. On physical examination, he has muscle wasting. His weight is 70% of normal for his height and age. He has generalized nontender lymphadenopathy, but no hepatosplenomegaly. He developed three irregular, 1- to 2-cm, reddish-purple, nodular skin lesions on his forearm in the past 3 months. Laboratory findings show hemoglobin, 12.2 g/dL; hematocrit, 36.5%; MCV, 85 mm3; platelet count, 188,000/ mm3; and WBC count, 2460/ mm3 with 82% segmented neutrophils, 4% bands, 6% lymphocytes, 6% monocytes, and 2% eosinophils. Infection with which of the following organisms is most likely to produce these findings?
|
The reddish-purple lesions are typical of Kaposi sarcoma in a patient with wasting syndrome, oral thrush, and lymphopenia characteristic of HIV infection with AIDS. Hepatitis C virus is unlikely to produce skin lesions or lymphopenia of this degree. Herpes simplex virus infections may be seen more frequently in HIV infection, but the lesions are typically vesicular and are located in the perioral or perianal regions. Hansen disease, caused by Mycobacterium leprae infection, may produce a faint reddish rash that fades, followed by hypopigmentation or anesthesia of affected skin and sometimes nodular deforming lesions developing over years. Staphylococcal skin infections tend to produce localized abscesses, such as furuncles and boils. Streptococcal skin infections may manifest as abscesses or as cellulitis.
|
Pathology
|
Infectious Disease
|
HIV
|
In a right-handed person, which of the following signs is not a characteristic feature of occlusion in the right middle cerebral aery?
|
Middle cerebral aery syndrome is a condition whereby the blood supply from the middle cerebral aery (MCA) is restricted, leading to a reduction of the function of the poions of the brain supplied by that vessel: the lateral aspects of frontal, temporal and parietal lobes, the corona radiata, globus pallidus, caudate and putamen. The MCA is the most common site for the occurrence of ischemic stroke. Depending upon the location and severity of the occlusion, signs and symptoms may vary within the population affected with MCA syndrome. More distal blockages tend to produce milder deficits due to more extensive branching of the aery and less ischemic response. In contrast, the most proximal occlusions result in widespread effects that can lead to significant cerebral edema, increased intracranial pressure, loss of consciousness and could even be fatal. In such occasions, mannitol (osmotic diuretic) or hypeonic saline are given to draw fluid out of the edematous cerebrum to minimise secondary injury. Hypeonic saline is better than mannitol, as mannitol being a diuretic will decrease the mean aerial pressure and since cerebral perfusion is mean aerial pressure minus intracranial pressure, mannitol will also cause a decrease in cerebral perfusion. Contralateral hemiparesis and hemisensory loss of the face, upper and lower extremities is the most common presentation of MCA syndrome. Lower extremity function is more spared than that of the faciobrachial region.The majority of the primary motor and somatosensory coices are supplied by the MCA and the coical homunculus can, therefore, be used to localize the defects more precisely. Middle cerebral aery lesions mostly affect the dominant hemisphere i.e. the left cerebral hemisphere Ref Harrison20th edition pg 2456
|
Medicine
|
C.N.S
|
Left hemiplegia with aphasia
|
A 56 year old female is brought to casualty with acute narrow angle glaucoma. She has severe pain in her eye and it spreads. The radiation of pain in acute narrow angle glaucoma is in the distribution of:
|
Acute primary angle glaucoma: It occurs due to a sudden total angle closure leading to severe rise in intraocular pressure (IOP). Typically acute attack is characterized by sudden onset of very severe pain in the eye which radiates along the branches of 5th nerve. Nausea, vomiting and prostrations are frequently associated with pain. Ref: Comprehensive Ophthalmology by A K Khurana, 4th edition, Page 229.
|
Ophthalmology
| null |
V nerve
|
Which among the following is not true about otosclerosis?
|
Otosclerosis- Enchondral bone conve to spongy bone (Fissula ante fenestrum is mc site )- Conductive Hearing loss- Paracusis willsi - patient hear better in noisy - Eustachian tube is normal- Carha's notch - dip at 2000hz
|
ENT
|
JIPMER 2019
|
Eustachian tube is always abnormal
|
Organic cause for erectile dysfunction is most commonly: March 2009
|
Ans. B: Vascular ED is essentially a vascular disease. It is often associated with other vascular diseases and conditions such as diabetes, hypeension, and coronary aery disease. Other conditions associated with ED include neurologic disorders, endocrinopathies, benign prostatic hyperplasia, and depression. Conditions associated with reduced nerve and endothelium function, such as aging, hypeension, smoking, hypercholesterolemia, and diabetes, alter the balance between contraction and relaxation factors. These conditions cause circulatory and structural changes in penile tissues, resulting in aerial insufficiency and defective smooth muscle relaxation. In some patients, sexual dysfunction may be the presenting symptom of these disorders. Additionally, ED is often an adverse effect of many commonly prescribed medications. Some psychotropic drugs and antihypeensive agents are associated with ED.
|
Psychiatry
| null |
Vascular
|
A 44 yr old female presented with bony pain.On general examination hepatospleenomegaly was observed.Biopsy from spleen shows crumpled tissue paper appearance.Which of the following product is likely to have accumulated?
|
GAUCHER DISEASE: It is one of the most common lysosomal storage diseases There are 3 clinical subtypes delineated by the absence or presence and progression of neurologic manifestations: type 1 or the adult, nonneuronopathic form; type 2, the infantile or acute neuronopathic form; and type 3, the juvenile or subacute neuronopathic form. All are autosomal recessive traits. Clinical manifestations : Thrombocytopenia & its manifestation *Anemia & its manifestation * Hepatomegaly with or without elevated liver function test results *Splenomegaly *Bone pain. *Pulmonary involvement *Growth retardation Erlenmeyer flask deformity of the distal femur Gaucher disease should be considered in the differential diagnosis of patients with unexplained organomegaly, who bruise easily, have bone pain, or have a combination of these conditions The pathologic hallmark of Gaucher disease is the Gaucher cell in the reticuloendothelial system, paicularly in the bone marrow. Treatment: Enzyme replacement therapy. The efficacy of enzyme replacement therapy with mannose-terminated recombinant human acid b- glucosidase has definitively been demonstrated. Reference: Harpers illustrated biochemistry 30th edition
|
Biochemistry
|
Metabolism of carbohydrate
|
Glucocerebroside
|
Mitochondria] DNA inheritance is transmitted from: UP 10
|
Ans. Mother
|
Forensic Medicine
| null |
Mother
|
Pseudouridine found in
|
Pseudouridine (abbreted by the Greek letter psi- Ps) is an isomer of the nucleoside uridine in which the uracil is attached a carbon-carbon instead of a nitrogen-carbon glycosidic bond. It is the most prevalent of the over one hundred different modified nucleosides found in RNA. Ps is found in all species and in many classes of RNA. Ref-Harpers illustrated biochemistry 30/e p649
|
Biochemistry
|
Metabolism of nucleic acids
|
tRNA
|
False about the phenomenon illustrated below is:
|
Diffuse radiolucent areas with ill-defined borders may be apparent radiographically on the mesial or distal aspects of teeth in the cervical regions between the edge of the enamel cap and the crest of the alveolar ridge (The gap between the CEJ and the alveolar bone crest contains dentin only). This phenomenon, called cervical burnout, is caused by the normal configuration of the affected teeth, which results in decreased X-ray absorption in the areas in question. Close inspection reveals intact edges of the proximal surfaces. The perception of these radiolucent areas results from the contrast with the adjacent, relatively opaque enamel and alveolar bone. Such radiolucencies should be anticipated in almost all teeth and should not be confused with root surface caries, which frequently have a similar appearance.
|
Radiology
| null |
None of the above
|
Coarctation of aoa is most commonly associated with -
|
Ans. is 'c' i.e., Bicuspid aoic valve o 98% of coarctation of aoa is Juxta-ductal (at the origin of ductus aeriosus just below the origin of subclan aery). o Bicuspid aoic valve is associated in more than 70% of patients. o It is also associated with : ----> PDA, VSD, ASD, TGA, Hypoplastic left hea o It is the most common CHD seen in Turner syndrome.
|
Pediatrics
| null |
Bicuspid aoic valve
|
A 45 yrs old male came to the psychiatric OPD complaining of continuous, dull, non-progressive headache for the last 8 years. The patient has seen numerous neurologists in the belief that he has a brain tumor even though all his investigations have been normal. The patient insisted that he had a brain tumor and requested yet another workup. Psychiatric evaluation reveals disease conviction in the background of normal investigations. The most probable diagnosis is
|
Hypochondriasis:- This disorder is characterized by a preoccupation with the fear of having, or the idea that one has one or more serious physical illnesses. The preoccupation persists despite normal investigation results as well as doctors reassurances. It is impoant to differentiate hypochondriasis from somatization disorder. The emphasis in hypochondriasis is on the diagnosis whereas the emphasis in somatization disorder is on the symptoms. Also, hypochondriasis must be differentiated from delusional disorder (somatic type). In patients with hypochondriasis the belief is not as fixed as it is in delusional disorder. The patient with hypochondriasis may doubt his belief atleast for sho-term, after a normal investigation or medical reassurance. In contrast in delusional disorder, the belief is fixed and totally unshakeable. Ref:- Psychiatry by Sandeep Govil; pg num:-164
|
Psychiatry
|
Somatoform disorders
|
Hypochondriasis
|
Basic laboratory service is not available at PHC for which disease -
|
Ans. is 'd' i.e., Leprosy Basic laboratory services at PHCRoutine urine, stool and blood tests.Bleeding time, clotting time.Diagnosis of RTI/STDs with wet mounting, Grama stain, etc.Sputum testing for tuberculosis (if designated as a microscopy center under RNTCP).Blood smear examination for malarial parasite.Rapid tests for pregnancy.RPR test for Svphilis/YAWS surveillance.Rapid diagnostic tests for typhoid (Typhi Dot) and malaria.Raid test kit for faecal contamination of water.Estimation of chlorine level of water using orthotoludine reagent.
|
Social & Preventive Medicine
|
Community Healthcare
|
Leprosy
|
Tourniquet test is used for monitoring patients with?
|
The tourniquet test is a pa of WHO case definition for dengue. It is a market for capillary fragility Procedure of Tourniquet test 1) Take the BP, example 120/80 2) Inflate cuff to midway between SBP and DBP (120+80/2)=100mm Hg and maintain for 5 minutes. 3) Reduce the cuff pressure and wait for 2 minutes 4) Count the petechiae below antecubital fossa. A positive test is >10 or more petechiae per square inch
|
Medicine
|
viral infection
|
Dengue fever
|
Most common site of salivary gland tumor is?
|
Ans. is 'a' i.e., Parotid salivary gland * Most common salivary gland tumor - Pleomorphic adenoma (mixed tumor).* Site of Pleomorphic adenoma - Parotid > Submandibular > minor salivary glands
|
Pathology
|
Neoplasia
|
Parotid salivary gland
|
A pregnant woman with a family history of fragile X syndrome undergoes prenatal testing of her fetus. PCR analysis to amplify the appropriate region of the FMR1 gene is attempted using DNA from amniotic fluid cells, but no amplified products are obtained. Which of the following is the most appropriate next step?
|
Failure to find amplified product by PCR analysis in such a case could mean that the fetus is not affected, or that there is a full mutation that is too large to be detected by PCR. The next logical step is a Southern blot analysis of genomic DNA from fetal cells. Routine karyotyping of the amniotic fluid cells is much less sensitive than a Southern blot analysis. Karyotyping of the unaffected father cannot provide information about the status of the FMR1 gene in the fetus because amplification of the trinucleotide occurs during oogenesis. For the same reason, PCR analysis of the mother's FMR1 gene is of no value.
|
Pathology
|
Genetics
|
Southern blot analysis of DNA from the amniotic fluid cells
|
Fracture of the proximal humerus in an elderly patient is best treated by?
|
Fracture Proximal Humerus MC fracture in osteoporotic postmenopausal women Classification of fracture - Neer classification Complications - Axillary nerve injury, Shoulder stiffness & Malunion, AVN of the humeral head Treatment Undisplaced - Immobilization in a sling (Cuff & Collar or Triangular sling) x 4 weeksDisplaced & Unstable - Closed reduction & internal fixation with percutaneous pinning or nailing(Refer: Watson Jones Textbook of Ohopedics & Trauma, 6thedition, pg no: 536-538)
|
Orthopaedics
|
All India exam
|
Open reduction internal fixation
|
Scrambled egg appearance is seen in -
|
Ans. is 'c' i.e., Pancreatic carcinoma
|
Surgery
| null |
Pancreatic carcinoma
|
Ohobaric oxygen is used in:-
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Ans is 'a' i.e., CO Poisoning Ohobaric Oxygen - 100% oxygen at atmospheric pressure. Ohobaric oxygen is used in CO poisoning. It reduces the half life of carboxyhemoglobin complex. About use of hyperbaric oxygen in CO poisoning. - Although hyperbaric oxygen therapy is often recommended for patients with coma, syncope, seizures, and cardiovascular instability, for those who do not respond to ohobaric oxygen therapy, recent data suggest that it is no more effective than ohobaric oxygen therapy -
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Surgery
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CO poisoning
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Skin manifestations of PCOS are all except
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Ans. is c, i.e. Seborrheic dermatitisRef: Jeffcoates 9th/ed, p467Skin manifestations of PCOS are:* Acne* Hirsutism* Alopecia (androgenic alopecia)* Acanthosis nigricans
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Gynaecology & Obstetrics
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Disorders in Menstruation
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Seborrheic dermatitis
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Drug used for acute severe asthma is
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Magnesium produce broncho dilatationRef:Harrison 17th ed Pg 1605
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Pharmacology
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All India exam
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MGS04
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Macula densa in kidney is located in relation to ?
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B i.e. DCT
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Physiology
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DCT
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A young male after sudden unconsciousness following an episode of seizure.ori awakening, finds that both of his arms were adducted and internally rotated. The most probable diagnosis i
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Ans. b. Posterior dislocation Posterior Dislocation of Shoulder is caused by indirect force producing marked internal rotation and adduction, most commonly during a fit, convulsions or an electric shock Posterior Dislocation of Shoulder Mechanism of injury: Indirect force producing marked internal rotation and adductionQ most commonly during a fit, convulsions or an electric shockQ Clinical Presentation: Diagnosis is frequently misseddeg, patient may have normal contour of shoulder The classical clinical feature is arm is held in medial rotation and is locked in that positiondeg and the examiner cannot externally rotate it. Diagnosis: X-Ray: Due to medial rotation, head looks abnormal (electric bulb sign)deg and it stands away somewhat from glenoid fossa (empty glenoid sign)Q
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Surgery
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Posterior dislocation
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