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Drugs of choice for the treatment of neurocysticercosis are :

Pharmacology

Albendazole and praziquantel

In ACLS which drug can be given following ventricular fibrillation after cardiac arrest other than epinephrine?

V-Fib or VF is the most common rhythm that occurs immediately after cardiac arrest. In this rhythm, the hea beats with rapid, erratic electrical impulses. Treatment: * Shock / Defibrillation: every 2 minutes in a single one shock, successive, shockable increments * 200 joules - Followed by immediate CPR for 2 minutes / give and circulate a drug(s) * 300 joules - Followed by immediate CPR for 2 minutes / give and circulate a drug(s) * 360 joules - Followed by immediate CPR for 2 minutes / give and circulate a drug(s) * Drugs : * Give Epinephrine 1mg of a 1:10,000 solu,on every 3 to 5 minutes * Give either: * Amiodarone : 300mg first dose / 150mg second dose at 3 to 5 minutes increments. Lidocaine: First dose: 1mg/kg or 1.5 mg/kg. Can repeat it at half the original dose up to a total of 3 mg/kg REF : BAILEY AND LOVE 27TH ED

Surgery

All India exam

Amiodarone

Gas gangrene is due to

The alpha-toxin is produced by all types of Clostridium perfringens and most abundantly by type A strains. This is the most impoant toxin biologically and is responsible for the profound toxemia of gas gangrene. It is lethal, dermonecrotic and hemolytic. It is phospholipids which, in the presence of calcium and magnesium ions, splits lecithin into phosphorylcholine and diglyceride. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 259

Microbiology

Bacteriology

Alpha toxin

Which drug causes osteoporosis on long-term use

Ans. is 'c' i.e., GnRH analogues Drugs causing osteoporosis : o Glucocoicoids o Cytotoxic drugs o Excessive alcohol intake o Excessive thyroxine o Heparin o Cyclosporine o Anticonvulsants o Aluminum o GnRH agonist o Lithium

Pharmacology

GnRH analogues

Fletcher's medium containing Rabbit serum is used for ?

Ans. is 'c' i.e., Leptospira Media for the culture of leptospirae usually contain either rabbit serum (Flatcher medium, stua broth) or bovine serum albumin (EMJH medium plus long - chain fatty acids and vitamins (B1 & B12).

Microbiology

Leptospira

A blood stained discharge from the nipple indicates -

"Bloody discharge is more suggestive of cancer but is usually caused by a benign papilloma in the duct." - CSDT "Intraductal papilloma is the most common cause of bloody nipple discharge." — Schwartz 7/e p 553 Also, remember Nipple discharge is suggestive of cancer if it is spontaneous, unilateral, localized to a single duct, occurs in women age 40 years or more, is bloody, or is associated with a mass. Nipple discharge is suggestive of a benign condition if it is bilateral or multiductal in origin, occurs in women age 39 years or less, or is milky or blue-green in colour.

Surgery

Duct papilloma

The following separation technique depends on the molecular size of the protein

Answer is C Size-exclusion--or gel filtration--chromatography separates proteins based on their Stokes radius, the radius of the sphere they occupy as they tumble in a solution. The stokes radius is a function of molecular mass and shape. When rapidly tumbling, an elongated protein occupies a larger effective volume than a spherical protein of the same mass. Size-exclusion chromatography employs porous beads. Ref: Harper's Illustrated Biochemistry, 30E (2015) Pg No 27. in Ion Exchanege chromatography ,Cation-exchange solid phases contain covalently bound, negatively charged functional groups. Examples include strongly acidic groups, such as sulfonate ions, or weakly acidic groups, such as carboxyl or carboxymethyl . Immobilized enzymes have been chemically bonded to adsorbents, such as (1) microcrystalline cellulose,(2) diethylaminoethyl (DEAE) cellulose, (3) carboxymethyl cellulose, and (4) agarose. Ref: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 5E Pg no 308 and 375 Iso Electric focussing is based on electric field and pH. Ionic buffers called ampholytes and an applied electric field are used to generate a pH gradient within a polyacrylamide matrix. Applied proteins migrate until they reach the region of the matrix where the pH matches their isoelectric point (pI). Ref: Harper's Illustrated Biochemistry, 30E (2015) Pg No 29.

Biochemistry

Structure and function of protein

Gel filtration chromatography

Stimulation of which of the following nerves cause improvement in mood?

2 Advanced treatment options for depression: Vagus Nerve Stimulation: A number of clinical studies have shown that vagus nerve stimulation (VNS) has antidepressant effects in patients with depression resistant to four or more treatments. Improvement with VNS result in enhanced neurocognitive function in many patients. VNS appears to be most effective in patients with low to moderate antidepressant resistance. Response rates usually range from 30-40%, and long-term VNS treatment appears to be associated with sustained symptomatic improvement. VNS is also known to improve mood in depressed patients with epilepsy. Transcranial Magnetic Stimulation: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive and easily tolerated method of altering coical physiology. Clinical studies suppo an antidepressant effect of high-frequency rTMS administered to the left PFC; however, antidepressive efficacy is not consistent, and where efficacy is demonstrated, degree of clinical improvement appears to be small. The absence of psychosis, and younger age may be predictors of treatment success. Low frequency TMS to the right PFC also has shown promise. Repetitive TMS may be useful in augmenting or hastening the response of antidepressant drugs in patients with major depressive disorder. Ref: Loosen P.T., Shelton R.C. (2008). Chapter 18. Mood Disorders. In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.

Psychiatry

Vagus Nerve

Not true about experimental study

Experimental epidemiology meant the study of epidemics among colonies of experimental animals such as rats and mice ( refer pg: 80, park 23 rd edition)

Social & Preventive Medicine

Epidemiology

Unethical to use in animal

All of the following are used to assess the nutritional status of an individual, except -

Serum immunoglobulin is not a measure to assess the nutritional status. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 586

Social & Preventive Medicine

Nutrition and health

Serum immunoglobulin

Transesophageal echocardiogram (TEE) is preferred to Trans-thoracic echocardiogram (TTE) in:

Answer is D (Evaluation of Left Atrial Appendage Thrombi) Trans-esophageal echocardiogram (TEE) is preferred to Trans-thoracic echocardiogram (TTE) for smaller, atrial and posterior masses such as the Left Atrial Appendage Thrombi. TTE is the standard test for the noninvasive evaluation of pericardial disease. Identification of vegetations on tricuspid valves is no better overall by TEE than by TEE (as the tricuspid valve is equidistant from the chest wall and the esophagus). Very anterior masses, Such as left ventricular apical thrombi, are equally well and, far more easily imaged by TTE. Trans-esophageal echocardiogram (TEE) vs. Trans-thoracic echocardiogram (TTE) Trans-esophageal Echocardiography (TEE) is generally more sensitive than Trans-thoracic Echocardiography (TTE) and provides a unique window for high resolution imaging of posterior structures of the hea paicularly the left atrium, mitral valve and aoa. TEE is however an invasive and more expensive procedure and hence its indications must be weighed against these factors and TTE remains the initial investigation of choice for most situations. However if a high clinical index of suspicion remains after a negative or non-diagnostic transthoracic study, Trans-esophageal echocardiography should be considered. Situations in which Trans-esophageal echocardiography should be performed as the initial test of choice include Those patients in whom image quality on chest wall imaging is unacceptable. Those with prosthetic valves, and Those in whom complications such as abscess formation are suspected on clinical rounds.

Medicine

Evaluation of Left Atrial Appendage Thrombi

Child with h/o hypopigmented macule on back, infantile spasm and delayed milestone has

C i.e. Tuberous sclerosis

Skin

Tuberous sclerosis

Diuretic causing impaired glucose tolerance is ?

Ans. is'd'i.e., ThiazideRef KDT &/e p. 567; Katung If le p. 261Diuretics causing hyperglycemia are loop diuretics (furosemide) and thiazide diuretics.

Pharmacology

Thiazide

Causes of community-acquired native valve endocarditis are

Streptococcus viridans is a group which normally resides in the mouth and upper respiratory tract and is alpha hemolytic. In persons with pre-existing cardiac lesions, they may cause bacterial endocarditis, Streptococcus sanguis being most often responsible. Following tooth extraction or dental procedures, they cause transient bacteremia and get implanted on damaged or prosthetic valves or in congenitally diseased hea and grow to form vegetation. Streptococcus mutans is also a member of viridans group which causes endocarditis in individuals with risk factors ( dental extraction in people with damaged valves). Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 220

Microbiology

Bacteriology

Streptocccus viridians

Which of the following is the mechanism of action of methyl dopa?

So, both the Methyl dopa & clonidine are used as Anti- hypeensive drugs. KEY POINTS ABOUT METHYL DOPA It's a prodrug DOC in pregnancy induced hypeension (but if both Labetalol and Methyl dopa are given in option mark Labetalol as the drug of choice S/E of Methyl Dopa - Hemolytic Anemia

Pharmacology

Sympathetic System

Agonism of alpha 2 receptors

Rickettsial pox is caused by ?

Rickettsial pox caused by R.akari Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 316

Social & Preventive Medicine

Communicable diseases

Rickettsia akari

Elements of primary health care include all except:

Elements of Primary Health Care:  E - Health Education (health problem & control).  L - Locally Endemic disease (prevention & control).  E - Essential drugs.  M - MCH (Maternal & Child Health) including FP.  E - EPI (Immunization against 6 Vaccine Preventable Diseases).  N - Nutrition/ food supply.  T - Treatment of common illness & injury.  S - Safe water supply & Sanitation.

Dental

Referral services

A newborn presenting with intestinal obstruction showed on abdominal X-ray, multiple air fluid levels. The diagnosis is not likely to be -

Ans- A Question ask -The diagnosis is not likely to be

Radiology

Abdominal Radiography

Pyloric obstruction

Both hepatic and renal failures can be

D i.e. All Both hepatic and renal failure can be caused by Paracetamol, Carbon tetrachloride, Arsenic, CuSO4, & Mushroom poisoningQ

Forensic Medicine

All

Cause of hydrocele in infants

Surgery

Patent processus vaginalis

In which type of poisonings is gastric lavage contraindicated?

Ans. C. Corrosive acid poisoningGastric Lavage is contraindicated when patients havea. Corrosive substance poisoningb. Convulsion (strychnine, tetanus)c. Comad. Volatile poisons (kerosene)e. Hypothermiaf. patients at risk of gastrointestinal hemorrhage or perforation.g. aluminum phosphide poisoning

Pharmacology

Miscellaneous (Pharmacology)

Corrosive acid poisoning

True about atopic dermatitis are all except -

Mica like scales are characteristic of pityriasis lichenoidis chronica(PLC) Pruritus,scratching and Xe rosins are the features of atopic dermatitis. Ref Harrison20th edition pg 2341

Dental

Dermatitis

Mica like scales

A disease that produces decreased inhibitory input to the internal segment of the globus pallidus should have what effect on the motor area of the cerebral coex

The decrease in inhibition of globus pallidus internus will make its signals more strong.Globus pallidus internus inhibits thalamus. so inhibition of thalamus increases.Thalamus have an excitatory effect on motor coex, this signal is decreased as thalamus is inhibited.

Physiology

General physiology

Decreased excitatory output from the thalamus to the coex

Kernicterus is invariably associated with

Inherited Unconjugated HyperbilirubinemiaCrigler Najjar Type - 1 Crigler Najjar Type - 2Persistence of unconjugated bilirubin > 20mg/dl after 1st week in the absence of hemolysis suggests CN-1.KERNICTERUS -usual UDPGT activity reduced.Autosomal recessive.Rx - Phototherapy.Heme oxygenase inhibition by metalloporphyrin therapy.Cure - ohotropic liver transplantation.Can be differentiated from CN1 by marked decrease in serum bilirubin with phenobarbitone.KERNICTERUS -unusual.Inducible phenobarbitone response on UGTA1 promoter.Orlistat intestinal lipase inhibitor reduces bilirubin in both CN-1 & CN -2Inherited Conjugated HyperbilirubinemiaDubin Johnson syndrome Rotor syndrome Absent MRP2 protein - multiple drug resistant protein is responsible defectCholangiography fails to visualize gall bladderTotal urinary coproporphyrin is normal||| coproporphyrin 1 excretion||| coproporphyrin 3 excretionX ray -Gall bladder abnormalLiver histology-Black pigment.Additional deficiency of organic anion uptakeTotal urinary coproporphyrin is increasedX ray gall bladder - normalNo black pigment(Refer: Nelson's Textbook of Paediatrics, 19thedition, pg no:604)

Pathology

All India exam

Crigler-Najjar syndrome type-I

The most appropriate technique for mammography is:

Ans. (b) Medio lateral oblique viewRef: Harrison 19th ed. / 525There are numerous mammography views that can broadly be split into two groups* Standard views- Medio-Lateral, Medio-lateral oblique, Craniocaudal* Supplementary views - Additional information or problem solving# The mediolateral oblique (MLO) view is one of standard mammographic views. It is the most important projection as it allows to depict most breast tissue.# The Mediolateral view loses significant tissue volume in the upper outer quadrant of the breast where statistically the most breast cancers are found. By doing an MLO view you get extra tissue without extra exposure.

Radiology

Plain Film Radiography, Fluoroscopy, and Tomosynthesis

Medial lateral oblique view

In microcornea, diameter of cornea is less than:

Ans. 10 mm

Ophthalmology

10 mm

A 3-week-female infant is brought for ambiguous genitalia and hyperpigmentation of skin. She has hyponatremia and hyperkalemia. Which one of the following is the most likely diagnosis?

a. 21 hydroxylase deficiency(Ref: Nelson's 20/e p 2227-2729, Ghai 8/e p 525)The given clinical scenario of ambiguous genitalia, hyperpigmentation and electrolyte disturbances suggest a diagnosis of CAH due to 21 hydroxylase deficiency.Features Seen in Adrenal Enzyme Deficiency17-a-hydroxylase11-b hydroxylase21 hydroxylase and 3b-HSDSalt retention and hypertensionFeminization of maleSalt retention and hypertensionVirilization of femalePrecocious puberty in maleSalt losingVirilization of femalePrecocious puberty in male

Pediatrics

Endocrinology

21 hydroxylase deficiency

Death of a person due to compressing of neck by another person is:

Ans. b (Throttling). (Ref. Textbook of FMT by Parikh 6th ed. 3.53)Throttlingis defined as a form of strangulation effected by hand, and is therefore often called manual strangulation.Mugging (choke-hold)When strangulation is effected by compressing the victim's neck against forearm.GarrotingVictim is attacked from back without warning and strangulated by throwing ligature over the neck and tightening it quickly. It was the mode of execution in Spain, Portugal and Turkey.BansdolaNeck is compressed between two sticks or hard objects, usually bamboo, one being placed across the throat in front and another behind. It is practiced in north India.

Forensic Medicine

Asphyxial Deaths

Throttling

A 2-year-old child with severe dehydration has sudden-onset Gross Hematuria with a unilateral flank mass. The most likely diagnosis is

Pediatrics

Renal vein thrombosis

Infection with herpes simplex virus, a common human pathogen, is best described by which of the following statements?

The initial infection by herpes simplex virus is often inapparent and occurs through a break in the skin or mucous membranes, such as in the eye, throat, or genitals. Latent infection often persists at the initial site despite high antibody titers. Recurrent disease can be triggered by temperature change, emotional distress, and hormonal factors. Type 1 herpes simplex virus is usually, but not exclusively, associated with ocular and oral lesions; type 2 is usually, but not exclusively, associated with genital and anal lesions. Type 2 infection is more common. In addition to mucocutaneous infections, the CNS and occasionally visceral organs can be involved.

Microbiology

Virology

It can be reactivated by emotional disturbances or prolonged exposure to sunlight

Increase is Pauwel's angle indicate -

*The more the angle, the more unstable is the fracture, and worse the prognosis. Ref: Maheshwari 9th/e p.132,133& 4th/e p.129

Orthopaedics

Pelvis and Hip injuries

More chances of displacement

Investigation of choice of diphtheria carrier is -

Ans. is 'a' i.e., Throat Swab Culture Carriers can be detected only by cultural methods --> Swabs are taken from nose and throat and it is examined by cultural methods for Diphtheria bacilli

Microbiology

Throat Swab Culture

An anatomic structure which has a worm-hole radiolucency is characteristic of

Radiology

Nutrient canal

Ergot alkaloid commonly used to prevent postpartum hemorrhage is :

Methylergometrine (methergine) is administered during delivery of anterior shoulder to prevent postpartum hemorrhage.

Pharmacology

Methylergometrine

True about hyperkalemia -

Classically, the electrocardiographic manifestations in hyperkalemia progress from tall peaked T waves (5.5-6.5 mM), to a loss of P waves (6.5-7.5 mM) to a widened QRS complex (7.0-8.0 mM), and, ultimately, a to a sine wave pattern (>8.0 mM). However, these changes are notoriously insensitive, paicularly in patients with chronic kidney disease or end-stage renal disease. ( ref: harrisons principles of internal medicine, 19E page 310)

Medicine

Fluid and electrolytes

ECG is diagnostic

With couinaud's segment nomenclature, which one the following segments of liver has an independent vascularization

Segment I is the caudate lobe and is situated posterior l and it may receive its supply from both the right and the left branches of poal vein. It contains one or more hepatic veins which drain directly into the IVC Ref: Sabiston 20th edition Pgno : 1422

Anatomy

G.I.T

Segment I

All are usuful in acute appendicitis except -

Surgery

Purgation

The mechanism of action of surfactant is

Ans. is 'd' i.e. Breaks the structure of water in the alveoli The water molecules on the surface of water (at air-water interphase) have an especially strong attraction for one another. This results in the water surface to contract producing surface tension.Thus the water molecules lining the alveoli produce an elastic contractile force due to surface tension which causes the alveoli to collapse.This surface tension force of water molecules is broken by surfactant (a mixture of phospholipids, proteins and ions, most important phospholipid of which is dipalmitoylphosphatidyl-choline-DPCC). It is secreted by type II alveolar epithelial cells and lines the alveoli.The phospholipid molecules have a hydrophilic head and two parallel hydrophobic 'tails'. Thus only head part of the molecule dissolves in the fluid lining the alveolar surface and the hydrophobic tails face the alveolar lumen. This new surface thus formed of the surfactant has a significantly reduced surface tension than the water molecules.By reducing the surface tension, surfactant serves two purposes:Prevents the alveoli from collapsingPrevents pulmonary edema.

Physiology

Functional Anatomy - Respiratory System

Breaks the structure of water in the alveoli

Cell lining of common bile duct is :

Ans. 4. Simple columnar > 3. Simple cuboidal Cell lining of common bile duct is simple columnar epithelium, it may be cuboidal at the proximal region. The Intrahepatic ducts, cystic duct, and the common bile duct are lined by tall columnar epithelium. Ducts are usually lined by simple cuboidal epithelium, which differentiates to form the secretory and duct poions of glands. Stratified cuboidal epithelium protects areas such as the ducts of sweat glands, mammary glands, and salivary glands. At locations like common bile duct, the ducts may be lined by columnar epithelium.

Anatomy

Epithelial tissue

Simple columnar

In tetany the increased membrane excitability is caused by:

Membrane excitability is related to the ease with which depolarization opens Na+ channels. The opening of the Na+ channel in response to depolarization is, in pa, related to the extracellular Ca2+ concentration; the lower the extracellular Ca2+ concentration, the easier it is for Na + channels to open when the membrane depolarizes. Hyperventilation (lowering aerial CO2 tension) decreases extracellular Ca+ concentration by increasing aerial pH. When pH rises, H+ is released from plasma proteins in exchange for Ca and ionized Ca+ concentration decreases.

Surgery

Depolarization of the nerve and muscle membranes

Which of the following is true regarding cardiac MRI

Ans. is 'b' i.e., Viable myocardium can be differentiated from infarcted myocardium.Infarcted myocardium appears hypointense on T1-MRI and hyperintense on T2-MRIViable myocardium can be easily differentiated from infarcted tissue.Prosthetic hea valves are a relative contraindications for MRI.Multislice CT is a better modality than cardiac MRI for the non invasive assessment of coronary aeries.

Radiology

Viable myocardium can be differentiated from infarcted myocardium

Day light factor in living room should he?

Ans. is 'a' i.e., 8%

Social & Preventive Medicine

8%

Cathelicidins are rich in which of the following amino acid?

Microbial killing can also occur through the action of other substances in leukocyte granules. Cationic arginine-rich granule peptides that are toxic to microbes; cathelicidins is present in leukocyte granules. Ref: Robbins 8th edition, Chapter 2.

Pathology

Arginine

Neonate triangular cord sign on USG is seen in –

Triangular cord sign is seen in biliary ateria due to fibrosis.

Radiology

Biliary atresia

Peyronie's disease affects the -

Ans. is 'd' i.e., Penis

Surgery

Penis

A 67-year-old man with an 18-year history of type 2 diabetes mellitus presents for a routine physical examination. His temperature is 36.9 C (98.5 F), his blood pressure is 158/98 mm Hg and his pulse is 82/minute and regular. On examination, the physician notes a non tender, pulsatile, mass in the mid-abdomen. A plain abdominal x-ray film with the patient in the lateral position reveals spotty calcification of a markedly dilated abdominal aoic walI. Which of the following physiologic observations helps to account for the fact that 75% of the aneurysms of this patient's type are found in the abdomen and only 25% principally involve the thorax?

Increased blood pressure is a strong risk factor for atherosclerosis, and humans pay a price for their erect sitting and standing postures. In these postures, the abdominal aoa experiences the weight of a column of blood added to the pressure produced by the hea. In the supine posture, the pressures in the thoracic and abdominal aoa are similar. So, if an average daily pressure is taken, the abdominal aoa tends to have a significantly higher pressure than does the thoracic aoa. Diastolic pressure is actually greater in the thoracic aoa compared to the abdominal aoa in the supine position. However, the systolic blood pressure is greater in the abdominal aoa. A negative intrathoracic pressure would tend to increase transmural pressure across the wall of the thoracic aoa, and thereby increase wall tension and promote the development of aneurysms. Blood flow in the abdominal aoa is less than that in the thoracic aoa, because some blood leaves the aoa through its thoracic branches. Ref: Creager M.A., Loscalzo J. (2012). Chapter 248. Diseases of the Aoa. 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.

Physiology

The average blood pressure in the abdominal aoa is higher than that in the thoracic aoa

Most important from of carbon-dioxide transport in the blood

The route by which most of the carbon dioxide is carried in the bloodstream. Once dissolved in the blood plasma, carbon dioxide combines with water to form carbonic acid, which immediately ionizes into hydrogen and bicarbonate ions. The bicarbonate ions serve as part of the alkaline reserve.

Physiology

As bicarbonates

A 45 year old comes with symptoms of septic ahritis. What will be the most common cause in this patient?

Staphylococcus aureus is the most common (about 90%) organism isolated in septic ahritis in adults. In neonates joint sepsis is caused by S. aureus with group B streptococci being the next most common. In young children aged 2 months to 2 years, S. aureus, Streptococcus and Haemophilus influenza in an decreasing order. In young adults, S. aureus and N. gonorrhoeae are the most common organisms causing joint sepsis. In elderly people, S.aureus causes infection. Gram negative septic ahritis may occur in patients with sickle cell anemia.

Surgery

Staphylococcus aureus

Which of the following therapeutic index (T.I.) values represent the greatest safety profile for a drug?

Although factors such as idiosyncratic reactions or allergic reactions can contribute to the overall safety profile of a drug, the therapeutic index gives a reliable indication of the drugs safety margin if other considerations are assumed to be equal. The therapeutic index represents the ratio between the median lethal dose (LD50) and the median effective dose ( ED50) of a drug. This calculation of LD50/ DD50 generates an index that is the therapeutic window between the dose that produces the desired effect and the dose that results in toxic effects. Like all indices, the T.I. is dimensionless since the dose units, usually express in "mg-kg ", cancel each other. The therapeutic index conveniently represents the safety merger of a drug. The greater the therapeutic ratio, or spread, between the ED50 and LD50, the greater the drug safety. Therefore a T.I. of one thousand represents a drug with a far greater safety profile than a drug with a T.I. of two. Ref: Von Zastrow M. (2012). Chapter 2. Drug Receptors & Pharmacodynamics. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical Pharmacology, 12e.

Pharmacology

1,000

Mechanism of analgesia is by

The degree to which a person reacts to pain varies tremendously. This variation results paly from a capability of the brain itself to suppress input of pain signals to thenervous system by activating a pain control system called an analgesia system. The analgesia system consists of three major components: (1) The periaqueductal gray and periventricular areas of the mesencephalon and upper pons surround the aqueduct of Sylvius and poions of the third and fouh ventricles. Neurons from these areas send signals to (2) the raphe magnus nucleus, a thin midline nucleus located in the lower pons and upper medulla, and the nucleus reticularis paragigantocellularis, located laterally in the medulla. From these nuclei, second-order signals are transmitted down the dorsolateral columns in the spinal cord to (3) a pain inhibitory complex located in the dorsal horns of the spinal cord. At this point, the analgesia signals can block the pain before it is relayed to the brain. Ref: guyton and hall textbook of medical physiology 12 edition page number:698,699,700

Physiology

Nervous system

Nocioeptin stimulation

Investigation of choice in a pregnant lady at 16 weeks of pregnancy with past H/0 delivering a baby with Downs syndrome:

Dual marker and Triple marker tests are screening tests and since the patient here already has a past history of Downs syndrome fetus, she is at an increased risk of having an aneuploid fetus again, so it is advisable to undergo a diagnostic procedure rather than a screening test. Fetal chromosomes can be assessed only on amniocentesis and chorionic villous sampling But CVS is best done between 10 to 13 weeks of gestation and amniocentesis is best done between 16 to 18 weeks of pregnancy

Gynaecology & Obstetrics

Diagnosis of Pregnancy

Amniocentesis

Collection duct has which cells

Ans. (a) Principal and intercalated(Ref: Ganong, 25th ed/p.672)Colleting duct is made up of two types of cell: principal cells (P cells) and intercalated cells (I cells)

Physiology

Kidneys and Body Fluids

Principal and intercalated

In case of Gow-Gates technique the target area is

Surgery

Neck of condyle

In a population of 200 people with normal distribution. How many people would be included in 1 SD

Ans. a. 136

Social & Preventive Medicine

136

If the prevalence of a disease in a population increases, the predictive value of a positive test ?

Ans. is 'a' i.e., Increases

Social & Preventive Medicine

Increases

Which of the following is TRUE differential cause of referred otalgia?

Otalgia can occur as a symptom of carcinoma on the base of tongue, pharynx or larynx. Ear receives nerve supply from 4 cranial nerves such as trigeminal, facial, glossopharyngeal and vagus; and from two branches of cervical plexus called C2 (lesser occipital) and C2 and C3 (greater auricular), pain maybe referred from these remote areas. Facial nerve refers pain to the external ear canal and post auricular region. Second and third cervical nerves refer pain to the postauricular and mastoid regions. Trigeminal referred otalgia arise from lesions involving the oral cavity and floor of mouth, teeth, mandible, temporomandibular joint, palate and pre auricular skin. Glossopharyngeal referred otalgia arise from the tonsil, base of the tongue, soft palate, nasopharynx, Eustachian tube and pharynx. Vagal referred otalgia arise from the hypopharynx, larynx and trachea. Differential causes of referred otalgia includes migraine, TMJ syndrome, cervical myalgia, fibromyalgia, dental abscess, head and neck malignancy (neoplasm of nasopharynx, sinus, tonsil, base of tongue, hypopharynx), temporal aeritis, inflammatory sinusitis, carotidynia, trigeminal neuralgia, glossopharyngeal neuralgia and GERD.

ENT

All of the above

Child with generalized petechiae. CSF shows gram negative diplococci. Treatment

Most patients (70-80%) presenting with fever and petechiae have defined or presumed viral infections, which are often caused by enteroviruses or adenovirus. Parvovirus B19 may also be responsible for many cases of fever and generalized petechiae inchildren. Reference: GHAI Essential pediatrics, 8th edition

Pediatrics

Central Nervous system

IV Ceftriaxone

Glasgow coma scale includes all except

Surgery

Swallowing reflex

An elderly couple living in a very cold apament turned on the oven, opened the oven door, and went to sleep. The next morning, the neighbors found the couple dead. The direct mechanism by which death was caused most likely involves which of the following?

The scenario described in the question stem is unfounately not at all uncommon. The open oven door is a tip-off that carbon monoxide was involved. Carbon monoxide has a very high affinity for hemoglobin, and binds, nearly irreversibly, to it in such a manner that oxygen cannot bind, drastically decreasing the oxygen-carrying capacity of the blood. Carbon monoxide also causes the oxygen-hemoglobin dissociation curve to shift to the left, making oxygen more difficult to unload. Traditionally, patients with carbon monoxide poisoning have been described as having "cherry red" blood and, consequently, skin, but this change is somewhat unreliable in real life. The 1st and 3rd Choices list secondary changes that are commonly observed in injured cells, no matter what the cause of the injury. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 32. Cardiovascular Regulatory Mechanisms. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.

Physiology

Decreased oxygen-carrying capacity of blood

Pulp core contains

Dental

All of the above

Cholinesterase is seen in venom of: DNB 08

Ans. Elapids

Forensic Medicine

Elapids

The following are the components of apgar score except

*Apgar score is an objective method of evaluating the newborn&;s condition. It includes Hea rate, Respiratory effo, Muscle tone, Reflex irritability and Color. *It is generally performed at 1min and again at 5 min after bih. Reference : page 127 Ghai Essential Pediatrics 9 th edition

Pediatrics

New born infants

Respiratory rate

Anaesthetic agent causing hallucination is

Ans. is 'a' i.e. Ketamine Ketamine is an analogue of phencyclidine and therefore it causes hallucinations.Facts you must always remember about Ketamine.It causes Dissociative Anaesthesia *It causes sympathetic stimulation which leads to* Cardiac stimulation-increase O2 demand** Bronchodilation-it is anaesthetic of choice for Bronchial Asthma* Increase all pressure*-B.P. I.C.T. I.O.P.* It causes muscular rigidity* It increases salivation so Atropine is always given with it*

Anaesthesia

Anesthesia for Neurologic & Psychiatric Diseases

Ketamine

When is surgery not done in cases of Ulcerative Colitis?

Surgical indications for ulcerative colitis: Urgent Non-urgent: Fulminant colitis Toxic megacolon Perforation Massive hemorrhage Acute colonic obstruction Colon cancer Medically refractory disease Unacceptable medication related toxicity Dysplasia Suspected ca Ulcerative colitis Crohn's disease MC pa involved is Rectum(colon) MC is terminal ileum (mouth to anus) Hallmark is pseudo polyp Fistula More prone for malignancy Less prone that ulcerative colitis Mucosa and submucosa involved Transmural involvement Complications: Hemorrhage Toxic megacolon Fistula Abscess Obstruction Perforation Lead pipe colon String of Kantor Surgery can be done DOC is sulphasalazine Surgery is of no use DOC is sulphasalazine

Medicine

Inflammatory Bowel Disease

Refractory fistula

In contrast to heparin, enoxaparin:

Enoxaprin is a LMW heparin. It does not require monitoring. Both heparin as well as enoxaprin do not cross placenta and are not teratogenic.

Pharmacology

Hematology

Can be used without monitoring the patient's aPTT

Cigar body is seen in -

Cigar shaped yeast cells are seen in sporothrix schenkii which is a dimorphic fungus. at 37 degree C - it is yeast at 25 degree C - it is mold Flower like sporulation appearance is seen in mould form of the sporothrix Sporotrichosis ( Rose gardener's disease)

Microbiology

Mycology

Sporotrichosis

Tooth whitening strip is

Dental

H2O2

Ultrasound frequency used for diagnostic purposes in obstetrics :

A i.e. 1-20 MHz

Radiology

1-20 MHz

Disseminated intravascular coagulation is present in all except -

Ans: A

Unknown

Prolonged pregnancy

What is ligament of lockwood related to

Ans. (c) OrbitRef: Khurana Anatomy 2/e, p. 493It is a fascial expansion of the extraocular muscles formed by fusion of sheaths of MR, IR, LR, IO extending from the posterior lacrimal crest to the lateral orbital margin.

Ophthalmology

Orbit

Orbit

Why is a child abler to breathe and suckle at the same time

High placed larynx A baby can suck milk into mouth and because of its palate its mouth is separated from its nasal cavity so white it is sucking in milk it can also breathe through its nose. When the infant has to swallow the soft palate rapidly moves upward to close off the hack of the nasal air tube. At the same time, the epiglottis closes off the larynx and guides the milk into the esophagus (food tube). Because of these factors infants can breath and swallow in quick succession. - Its lumen is sho and. funnel shaped and dispropoionately narrower than that of adult. - It lies higher in the neck than the adult larynx. -It rest the upper border of the infant epiglottis is at the level of the second or third cervical veebrae. - When larynx is elevated it reaches the level of first cervical veebrae. - This high position enables an infant to use its nasal airway to breathe while sucking.

Anatomy

High placed larynx

Fatty liver with hepatomegaly is seen in:

OPTION B: Metabolic syndrome - Obesity - Fatty liver Option A: Marasmus do not have hepatomegaly rather kwashiorkor will have hepatomegaly Option C: Wilson disease leads to Cirrhosis Option D: Nutmeg liver leads to Cirrhosis Best test for fatty liver = Gamma GGT Alcoholic liver disease + fatty liver - Best Test - SGOT / SGPT Ratio more than 2

Medicine

FMGE 2017

Metabolic syndrome

Prognosis for carcinoma rectum is best assessed by -

No effect on Prognosis: Tumor size and duration of symptoms. Tumor size and configuration (endophytic, exophytic, annular) do not carry any prognostic significance in colorectal carcinoma.

Surgery

Histological grading

In the stage of Grey hepatization -

Pathological changes of bacterial pneumonia A. Lobar pneumonia Large confluent area of the lung or entire lobes is consolidated. The lower lobes are affected most commonly. There are four stages of the inflammatory response (Laennec's stages) - 1. Stage of congestion (initial phase) The affected lobe is enlarged, heavy, dark red and congested. Cut surface exudes blood-stained frothy fluid. There are dilatation and congestion of alveolar capillaries. There are few neutrophils and numerous bacteria in the alveolar fluid. 2. Stage of red hepatization (early consolidation) The term hepatization refers to the liver-like consistency of the affected lobe on cut section. The affected lobe is red and firm. The edema fluid of preceding stage is replaced by strands of fibrin. There is marked cellular exudate of neutrophils with extravasation of red cells. 3. Stage of gray hepatization (late consolidation) The affected lobe is grayish brown, firm and dry. The fibrin strand are dense and more numerous. There is progressive disintigration of red cells and neutrophils. The macrophages begin to appear in the exudate. The organisms are less numerous and appear as degenerated forms. 4. Resolution The previously solid and fibrinous constituent is liquefied by enzymatic action. Granular and fragmented strands of fibrin in the alveolar spaces are seen due to progressive enzymatic digestion. There is progressive removal of fluid content as well as cellular exudate from the air spaces, resulting in restoration of normal lung parenchyma with areation. B. Bronchopneumonia Patchy areas of red or grey consolidation, more often multilobar and frequently bilateral and basal (lower zones) because of tendency of secretions to gravitate into lower lobes. There is suppurative exudate, consisting chiefly neutrophils, filling bronchi, bronchioles and adjacent alveolar spaces. Alveolar septa thicken due to congested capillaries and leucocytic infiltration.

Pathology

Accumulation of fibrin

True about carcinoma larynx -

ENT

Glottis is most common site

A child presents with ascending flaccid paralysis. There is subsequent respiratory muscle involvement. CSF examination shows albuminocytological dissociation. Treatment of choice is :

Answer is D (I.V. Immunoglobins): The characteristic clinical presentation and CSF finding lead us to the diagnosis of GBS Either high does intravenous immunoglobulins or plasmapharesis can be initiated as they are equally effective. -- Harrison 's Glucocoicoids have not been found to be effective in GBS - Harrisons Steroids do not reduce the duration but may increase the risk of infection and worsen the problem. Steroids should be considered contraindicated in the treatment of GB syndrome - API 6th/ 835

Medicine

I.V. immunoglobins

Which of the following is true in respect to the ciliary ganglion?

Afferent fibers from the iris and cornea pass through the ciliary ganglion.

Anatomy

Afferent fibers from the iris and cornea pass through the ganglion

Aplastic anemia in hereditary spherocytosis precipitated by-

Answer is A (Parvovirus) Aplastic crisis is usually triggered by an acute parvovirus infection.

Medicine

Parvo virus

Howell-Jolly bodies are seen in-

Howell Jolly bodies are purple nuclear remnants ,usually found singly, and are larger than basophilic stippling.They are present in megaloblastic anemia & after splenectomy.Reference :Harsh Mohan Textbook of pathology sixth edition pg no 293.

Medicine

Haematology

Postsplenectomy

Which of the following is not seen in hereditary spherocytosis -

Medicine

Direct Coombs test + ve

All act by inhibiting call wall synthesis except ?

Ans. is 'd' i.e., Pramlinitide

Pharmacology

Bacitracin

A mother brings her 10 year old son to OPD because of a history of medullary carcinoma of thyroid in his father and grandparents. There are no findings on physical examination. Which of the following tests you would perform?

Most cases of medullary thyroid carcinomas (MTC) are sporadic. But 25% occur in inherited syndromes such as familial medullary thyroid cancer and MEN types 2A and 2B. These occur due to germline mutations in the RET protooncogene. MEN2A consists of Medullary thyroid cancer, Pheochromocytoma and Primary hyperparathyroidism. MEN 2B consists of MTC, Pheochromocytoma, Mucosal neuromas, Gangliomas, and aMarfan-like habitus. Any patient with MEN 2A or MEN 2B may develop medullary carcinoma at a very young age and therefore should be followed carefully for pheochromocytoma with urine VMA, for hyperparathyroidism with serum calcium, and for medullary carcinoma with serum calcitonin.

Surgery

Parathyroid and adrenal glands

Urine vanillylmandelic acid (VMA) level

Immunoglobulins are secreted by:

Microbiology

Plasma cells

Molybdenum is a constituent of:

Molybdenum containing enzymes include aldehyde oxidase, sulfite oxidase and xanthine oxidase.

Biochemistry

Xanthine oxidase

Regarding propofol, which one of the following is false :

Pharmacology

It causes severe vomiting

Which one of the following serum levels would help in distinguishing an acute liver disease from chronic liver disease

Answer- D. AlbuminSerum albumin has a long half life 15-20 days with approximately 4% degraded per day

Medicine

Albumin

True about optic nerve glioma

Optic Nerve Glioma *Can cause gradual, painless, unilateral Proptosis *a/w Neurofibromatosis 1 *Mainly affect children (1-10 year) *Have characteristic fusiform enlargement of optic nerve Optic Nerve Glioma - Fusiform Enlargement of optic nerve - Nerve is not seen separately from the mass

Ophthalmology

Squint

Unilateral proptosis

Which of the following types of leukemia is administered prophylactic methotrexate for CNS prophylaxis –

Pediatrics

ALL

Serum alkaline phosphate is not rassed in ?

Ans. is 'c' i.e., Multiple Myeloma

Pathology

Multiple myeloma

Golden S sign is seen in:

Ans. (a) Bronchogenic carcinoma with collapse of lung* The Golden S sign (reverse S sign of Golden.) is seen in PA chest radiographs with right upper lobe collapse.* It is caused by a central mass obstructing the upper lobe bronchus and should raise suspicion of a primary bronchogenic carcinoma.* The right upper lobe appears dense and shifts medially and upwards with a central mass expanding the hilum. The combination of two changes together form a reverse S shane.

Radiology

Imaging of Lung Nodules and Masses

Bronchogenic carcinoma with collapse of lung

Anterior belly of digastric is supplied by:

Anatomy

Branch of mandibular nerve/ Mylohyoid nerve

Which of the following is a mineralocoicoid antagonist ?

Ans. is 'a' i.e., Spironolactone

Pharmacology

Spironolactone

A male 25 years old presents to the dental clinic with a black spot. He also gives the history of previous dental treatments of other teeth as well and wants gold to be filled in his tooth. On examination, it is revealed that 16 no. tooth has pit and fissure caries. Which preparation is used for retention in this restoration?

Skirts.   Skirts are preparation features used in cast gold restorations that extend the preparation around some, if not all, of the line angles of the tooth. When properly prepared, skirts provide additional, opposing vertical walls that increase retention of the restoration. The placement of skirts also enables increased resistance to fracture by allowing the envelopment of the remaining compromised tooth structure with the restorative material. Sturdevant operative dentistry  7th  E D I T I O N, Page No:131

Dental

Skirts

Eichosapentaenoic acid is present in

Dental

Fish oil

First pathological change apparent in Nephrotic syndrome is

Most forms of primary GN and many of the secondary glomerular diseases in human beings have immunologic pathogenesis. This view is largely based on immunofluorescence studies of GN in humans which have revealed glomerular deposits of immunoglobulins and complement in patterns that closely resemble those of experimental models. The consequences of injury at different sites within the glomerulus in various glomerular diseases can be assessed when compared with the normal physiologic role of the main cells involved i.e. endothelial, mesangial, visceral epithelial, and parietal epithelial cells as well as of the GBM as summed up in Table 22.8.<\p> text book of pathology harshmohan 6th edition page 662

Pathology

Urinary tract

Thickening of the glomerular capillary wall and effacement of podocyte foot processes

Well known Zadek's procedure is:

Ans. (b) Resection of complete nail with part of nail bed* Zadek's procedure is the surgical correction of ingrowing toe nail.* Removal of complete nail with part of nail bed.

Surgery

Plastic & Reconstructive Surgery

Resection of complete nail with part of nail bed

Features of secondary syphilis are/is a) Condyloma accuminata b) Condyloma lata c) Mulberry/moon molar d) Lesions over palms/sales

Medicine

bd

Gillmore needle is used for

Dental

Evaluating the setting time of plaster of paris

In cystoid macular edema fluid collects in the macular region at the level of

Ans. Outer plexiform layer

Ophthalmology

Outer plexiform layer

Unna boot is used for treatment of:

Unna boot is used for the varicose vein ulcers.

Orthopaedics

Lower Limb Traumatology

Varicose ulcers