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Minimum effective dose of Ethinyl estradiol in combination oral pills is
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Ans. is a i.e. 20p.g -intensive pharmacological research clinical trials conducted to minimise the adverse effects of estrogen without reducing the contraceptive efficacy, resulted in lowering the dose of oestrogen to a minimum of 20gg or even 15gg." Examples of pills with 20p.g estrogen : Femilon : Loette Estrogen (EE) = 2opg Estrogen (EE) = 20pg Progestin (Desogestrel) = 0.15mg Progestin (Levonorgestrel) = 0.1mg Benefits of Low dose OCP's Decreased risk of Thromboembolic events with low dose OCP's.deg Note : Thrombosis risk is apparent by 4 months after staing estrogen containing OC's and does not increase fuher with continued use. Risk is highest during the first year of useq Decreased risk of high blood pressure (as compared to traditional high dose OCP's) Minimum adverse effect on lipid profile Less complains of Nausea and vomiting (as these complications are related to Estrogen component). The beneficial effects and efficacy of low dose OCP's is similar to traditional high dose OCP's whereas side effects have decreased. Extra Edge : Once a month (long acting pill). Contains : Ouniestrol (long acting estrogen) + sho acting progestin.
|
Gynaecology & Obstetrics
| null |
20 pgm
|
A 65 year old elderly male has history of sweating and chest pain for last 24 hrs with the following ECG. Which of the following is not given in managing the patient?
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Ans. C. Thrombolytic therapyFirst let us diagnose the ECG; we need to know the following points:E.C.G changes in acute infarctionEarly acute phase (with - in hours)Fully evolved phaseOld infarction (resolution phase)Elevation of ST segmentPathological Q warePathogical Q waveTall wide (peaked) T waveElevated ST segment being to resolveT wave inverts.ST segment and T wave may be normalST segment elevation, unlike depression, will localize to the ECG lead of the affected myocardium. Note that 1mm of ST elevation in 2 contiguous leads is required to diagnose STEMI, however there are two major exceptions.a. Anterior STEMI requires 2mm of ST elevation in V2 and V3 in men > 40 years old or 1.5mm in women according to the ACC/AHA definition.b. Posterior STEMI frequently has ST depression in V1-V3 instead of elevation since the vectors are completely reversed. Hence, this is an ECG of anterior STEMI.In STEMI, thrombolysis or PCI (primary PCI) are effective methods to restore coronary blood flow and salvage myocardium within the first 12 h after onset of chest pain.ST elevation MI (STEMI) Immediate management:a. Nitratesb. Morphinec. Oxygend. AspirinStart adjunctive treatmenta. Beta blockers (IV)b. Nitroglycerine (IV)c. Heparin (IV)Reperfusion therapy is the definitive treatment of choice if patient present < 12 hours.a. Thrombolysis (Streptokinase)b. Early primary PCI
|
Medicine
|
C.V.S.
|
Thrombolytic therapy
|
Glomus tumor invading the veical pa of carotid canal. It is
|
Ans. is 'c' i.e., Type C2 Fisch classification The Fisch classification of glomus tumors is based on extension of the tumor to surrounding anatomic structures and is closely related to moality and morbidity. Type A :- Limited to middle ear cleft (glomus tympanicum). Type B :- Limited to tympanomastoid area with no involvement of infralabyrinthine compament. Type C :- Involving infralabrinthine compament extending upto petrous apex Type C1 :- Limited involvement of veical poion of carotid canal Type C2 :-Invading veical poion of carotid canal Type C3 :-Invasion of horizontal poion of carotid canal Type D Intracranial extension Type D1 Intracranial extension < 2 cm in diameter Type D2 :-Intracranial extension > 2 cm in diameter
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ENT
| null |
Type C2
|
Essential amino acids are A/E -
|
- essential aminoacid are the one that cannot be synthesised in the body corresponding to the needs. Thus need to be supplied through diet. - they are leucine, isoleucine, lysine, methionine, phenylalanine, threonine, valine, tryptophan and histidine. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:609 <\p>
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Social & Preventive Medicine
|
Nutrition and health
|
Proline
|
Ascospore is -
|
FUNGAL SPORES
Most fungi reproduce through the generation of spores
Fungi produce spores by two methods-
Sexual reproduction → Sexual spores
Asexual reproduction → Asexual spores
|
Microbiology
| null |
Sexual spore
|
In a neonate, cessation of breathing for 10 second with bradycardia is:
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a. Apnea(Ref: Nelson's 20/e p 849)Apnea in a newborn is defined as: cessation of respiration for 20 seconds with or without bradycardia and cyanosis or cessation of respiration for less than 20 seconds if it is associated with bradycardia or cyanosis.
|
Pediatrics
|
New Born Infants
|
Apnea
|
4 years old child having palpable abdominal mass & hypertension with sweating and diarrhea is due to -
|
Ans. is 'a' i.e., NeuroblastomaNeuroblastoma - (Ghai 7th/ep. 590)o M.C. Intraabd solid tumor in children,o M.C. site of primary tumor:# Adrenal gland (30%)o Paravertebral retroperitoneal (28%)o Metastasis usually skeletal (facial bone/skull).o May be associated with sweating, diarrhea, hypertension. Cerebellar sign, opsoclonus.Wilms Tumor (Nebroblastoma) - (Ghai 7th/ep. 591)o M.C. malignant tumor of kidney,o Present in early childhood,o Abdominal mass.o May have hematuria, hypertension, abd. pain, fever.PCKD - (Ghai 7th/e p. 471)o Infantile form & adult form,o Infantile-ARo Adult - ADTnt. with abdominal cystic mass.
|
Pediatrics
|
Neoplasms of the Kidney
|
Neuroblastoma
|
TRUE regarding chi square test is -
| null |
Social & Preventive Medicine
| null |
Measures the significance of difference between two proportion
|
''Sleep apnoea '' is defined as a temporary pause in breathing during sleep lasting at least-
|
Sleep OSAHS also may be diagnosed in the absence of symptoms if the AHI is above 15. Each episode of apnea or hypopnea represents a reduction in breathing for at least 10 sec Ref Harrison 19th edition pg 1723
|
Anatomy
|
Respiratory system
|
10 seconds
|
A 2-year-old unresponsive child came to casualty with history of fall from a height. On examination, he is responsive to verbal stimuli intermittently, respiratory rate is 30 per min, pulse 130 per min, spO2 is 94% and BP is 104/60 mm Hg. What should be the next step of management?
|
c. Start oxygen by face mask, immobilize cervical spine and transfer to a tertiary centre accompanied by doctor(Ref: Nelson's 20/e p 545-552)The best management in this case is to supplement O2 as there is hypoxia, to prevent further CNS injury; Cervical spine should be immobilized and the patient should be transferred to a tertiary centre accompanied by doctor.
|
Pediatrics
|
Central Nervous System
|
Start oxygen by face mask, immobilize cervical spine and transfer to a tertiary center accompanied by doctor
|
Most common cause of amoebic lung abscess is :
|
Answer is B (Direct spread from liver): An amoebic lung abscess is almost always secondary to spread from the liver. Extraintestinal infection by E. histolytica most often involves the liver. Fuher involvement most commonly leads to Amoebic lung abscess. Infact pleuropulmonary involvement (Lung): is the most frequent complication of Amoebic liver abscess. Remember: Most common cause of a lung abscess is - 'Aspiration'. However this holds true for pyogenic (bacterial lung abscess)
|
Medicine
| null |
Direct spread from liver
|
Muscle of neck with dual nerve supply
|
Digastric muscle Digastric has two bellies United by an intermediate tendon. NERVE SUPPLY; anterior belly by nerve to mylohyoid, facial nerve. ACTIONS; 1. Depresses mandible is opened widely or against resistance it is secondary to lateral pterygoid. 2. Elevates hyoid bone. Ref BDC volume 3;6th edition
|
Anatomy
|
Head and neck
|
Digastric
|
Patients on isoniazid which vitamin deficiency is more likely to be seen.
|
Ans. (c) Vitamin B6Ref. KDT 6th ed. / 740-41* For patients who are on isoniazid; peripheral neuropathy is observed in 10-20% of patients given dosages greater than 5 mg/kg/d but is infrequently seen with the standard 300 mg adult dose.* Pyridoxine (Vit B6), 25-50 mg/d, is recommended for those with conditions predisposing to neuropathy, an adverse effect of isoniazid.* NOTE: Isoniazid as a single agent is also indicated for treatment of latent tuberculosis. The dosage is 300 mg/d (5 mg/kg/d) or 900 mg twice weekly for 9 months.
|
Pharmacology
|
Anti-Tuberculosis
|
Vitamin B6
|
Denominator of positive predictive value
|
Ans. c (Number of true positives + number of false positives) (Ref. Park PSM 22nd/pg. 131).TopicEquation SensitivitySensitivity =a--a+cSpecificitySpecificity =d-b+dPositive predictive valuePPV =a--a + b Negative predictive valueNPV =d--c+d Relative riskRR =a--a + b c--c+d Attribute riskAR =a--a+bc--c+dHardy-Weinberg equilibriumP2 + 2pq + q2 =1p + q = lThe positive predictive value. or precision rate, is the proportion of patients with positive test results who are correctly diagnosed. It is considered the physician's gold standard, as it reflects the probability that a positive test reflects the underlying condition being tested for.Related calculationsFalse positive rate (a) = FP/(FP +TN) = 18/(18+182) = 90% = 1 - specificityFalse negative rate (b) = FN/(TP+FN) =1 (2+1) = 33% = 1 - sensitivityPower =1 - bDefinition:PPV =Number of True Positives-----------------------------------------Number of true positives + Number of False Positives or, alternatively.PPV =(Sensitivity) (prevalence)----------------------------------(Sensitivity) (prevalence) + (1 - specificity) (1 - prevalence)The negative predictive value is the proportion of patients with negative test results who are correctly diagnosed.NPV =Number of True Negatives----------------------------------------Number of True Negatives + Number of False Negatives or alternatively.NPV =Specificity x (1 - prevalence)----------------------------------Specificity x (1 - prevalence) + ( 1 - sensitivity) x prevalence
|
Social & Preventive Medicine
|
Screening for Disease
|
Number of true positives + number of false positives
|
Superolateral boundary of axillary dissection is:
|
Axillary Node Clearance Axillary node clearance is defined as clearing of the axillary contents bounded by: Laterally: Axillary skin Posteriorly: Lattisimus dorsi, Teres major and subscapularis Superiorly: Lower border of axillary vein Anteriorly: Pectoralis muscle Medially: Chest wall
|
Surgery
|
Breast
|
Axillary vein
|
Which of the following has propensity to metastasize through lymph nodes ?
|
Ans. is 'a' i.e., Alveolar rhabdomyosarcoma
|
Pathology
| null |
Alveolar rhabdomyosarcoma
|
The rubber dam is approximately placed in
| null |
Dental
| null |
3-5 min
|
Which of the following is Tensor of the vocal cord
|
Intrinsic muscles of larynx They may act on vocal cords or laryngeal inlet. (a) Acting on vocal cords:- * Abductors:- Posterior cricoarytenoid * Adductors:- Lateral cricoarytenoid , Interarytenoid (transverse arytenoid), Thyroarytenoid (external pa) * Tensors:- Cricothyroid , Vocalis (internal pa of thyroarytenoid). Ref:- Dhingra; pg num:-283
|
ENT
|
Larynx
|
Cricothyroid
|
Rocker bottom foot is due to ?
|
Ans. is 'a' i.e., Overeatment of CTEV Rocker bottom foot Rocker bottom foot is a foot with a convex plantar surface with an apex of convexity at the talar head (normal plantar surface is concave). Causes of Rocker Bottom foot are :- Congenital veical talus Overcorrection of CTEV Improper correction of CTEV, i.e. forceful correction of equines by dorsiflexion before correction of adduction, varus and inversion. Edward's syndrome, Escobar syndrome, Ape's syndrome. Congenital veical talus may be associated with ahrogryposis, Prune belly syndrome, neurofibromatosis, and spinal muscular dystrophy
|
Surgery
| null |
Overeatment of CTEV
|
Hypoglycemia is defined as a blood glucose value of less than
|
Hypoglycemia is defined as a blood glucose value of less than 40 mg/ dl (plasma glucose of less than 45 mg/ dl). These babies should be screened for hypoglycemia at 2, 6, 12, 24, 48 and 72 hr after bih with reagent strips (dextrostix).Babies showing blood sugar value of less than 40 mg/ dl on reagent strip should be treated for hypoglycemia but should have confirmation of hypoglycemia by a lab test Appropriate for gestational age babies who are breastfeeding adequately do not require any screening for hypoglycemia.Ref: Paediatrics; O.P. Ghai; 8th edition; Page no: 179
|
Pediatrics
|
New born infants
|
40 mg/dl
|
Typhoid Vi polysaccharide vaccine is usually administered in children above the age of-
|
Ans. is 'c' i.e., 2 years o The Vi polysacchiride vaccine is licensed for individuals aged 2 years because it does not elicit immune response in children less than 2 years.
|
Pediatrics
| null |
2 years
|
Which parotid tumor spreads along nerve sheath ?
|
Adenoid cystic carcinoma has got high affinity for perineural spread(both axially and circumferentially;antegrade and retrograde fashion) along mandibular and maxillary divisions of trigeminal (common) and facial nerve .It infiltrates nerve more proximally for long distance. Tumor may reach Gasserian trigeminal ganglion ,pterygopalatine ganglion and cavernous sinus SRB,5th,417 .
|
Surgery
|
Head and neck
|
Adenoid cystic carcinoma
|
All are features of psychosis except -
|
Ans. is 'c' i.e., Preserved contact with reality Psychosiso Psychosis is a mental state involving the loss of contact with reality, causing deterioration of normal social functioning. The characteristic features of psychosis are : -Gross impairment in reality testing, i.e., loss of contact with reality.Marked disturbance in personality and behavior with impairment in social, interpersonal and occupational functioning.Marked impairment in judgement.Loss of insight (insight is an assessment of how aware the patient is of their own mental illness).Presence of characteristic symptoms like delusions and hallucinations, these are called psychotic symptoms.o The major psychosis are : -Organic psychotic disorders, e.g., Delirium, substance related psychosis, head trauma.Non-organic psychosesMajor psychoses : - Schizophrenia, mood disorders (depression, mania, bipolar).Other psychotic disorders (third psychosis): - Delusional disorders, acute and transient psychotic dis- orders, schizoaffective disorderNeurosiso Neurosis is a general term referring to mental distress that, unlike psychosis, does not prevent rational thought and daily functioning. Characteristic features are : -Symptoms cause subjective distress to the patient.Insight is present (symptoms are recognised as undesirable).The personality and behaviour are relatively preserved as is the judgement.The contact with reality is preserved.Absence of organic causative factor.o Important neurotic disorders are Anxiety disorders (Panic), Phobia (Phobic anxiety disorder), obsessive compulsive disorder, Dissociative conversion disorder.
|
Psychiatry
|
Schizophreniform Disorder
|
Preserved contact with reality
|
Hemoglobin does not bind with:
|
Hemoglobin Combines Reversibly With Oxygen.
Carbon monoxide (CO) combines with hemoglobin at the same point on the hemoglobin molecule as does O2 ; it can therefore displace O2 from the hemoglobin.
CO2 reacts directly with amine radicals of the hemoglobin molecule to form the compound carbaminohemoglobin (CO2 Hgb).
This combination of CO2 and hemoglobin is a reversible reaction that occurs with a loose bond, so the CO2 is easily released into the alveoli, where the PCO2 is lower than in the pulmonary capillaries.
Reference: : Guyton physiology pg no 532,535
|
Medicine
| null |
HCN
|
All of the following are haemoproteins, EXCEPT:
|
Haemoproteins:- A haemoprotein or heme protein, is a protein that contains a heme prosthetic group. Heme containing proteins: Hemoglobin Myoglobin Cytochromes (ETC Components) Heme containing enzymes Catalase Peroxidase Tryptophan dioxygenase/Tryptophan pyrrolase Few more examples:- Cytoglobin Neuroglobin SolubleGuanylyl cyclase NADPH oxidase Nitric oxide synthase (NOS)
|
Biochemistry
|
HAEM synth and porphyrias
|
Adenylate kinase
|
What is true regarding byssinosis?
|
Byssinosis - due to cotton dust exposure - presents with Monday Chest tightness which resolves with cessation of cotton dust exposure. - Byssinosis presents as hypersensitivity pneumonitis with the honey-comb lung. - Lymphocytes and not eosinophils are present in bronchoalveolar lavage of hypersensitivity pneumonitis patients.
|
Medicine
|
Interstitial Lung Disease
|
Dyspnea resolves after cessation of exposure
|
Within the RBC, hypoxia stimulates glycolysis by which of the following regulating pathways ?
| null |
Physiology
| null |
Hypoxia stimulates release of all Glycolytic enzymes from band 3 on RBC membrane
|
Which one can have more than one value
|
In a central tendancy of distribution :
Mean is the best measure.
Mode is most frequently occuring value in the given distribution.
Mode may be bimodal or trimodal.
Mode = 3 mediam - 2 mean.
|
Social & Preventive Medicine
| null |
Mode
|
In magil circuit airflow is -
|
In Magills it fresh gas flow is equal to minute volume. In Bains co-axial system or type D ,fresh air flow required to prevent rebreathing is 1.6minute volume
|
Anaesthesia
|
Anaesthetic equipments
|
equal to M.V.
|
In hilum of right lung which of the following is the uppermost structure
|
Right lung(above downwards) Epaerial bronchus Pulmonary aery Hypaerial bronchus Inferior pulmonary vein Left lung Pulmonary aery Bronchus Inferior pulmonary vein <img src=" /> Ref. BD Chaurasia volume 1 page 226
|
Anatomy
|
Thorax
|
Bronchus
|
In a patient with mitral stenosis, disappearance of Loud S1 is associated with all except
|
ANS. DConditions associated with dulling of SI (disappearance of loud SI) in patient with mitral stenosis:1. Calcified mitral valve2. Aortic regurgitation (AR)3. Mitral regurgitation (MR)Absence of presystolic accentuation in mitral stenosis:1. Atrial fibrillation2. Presence of MR3. Flabby left atrium4. Atrial septal defect (ASD)5. After surgery6. Junctional rhythm.
|
Medicine
|
C.V.S.
|
Mild mitral stenosis
|
Nikolsky's sign is positive in
| null |
Dental
| null |
Pemphigus
|
In basic model of Nuclear family life, the phase of family life cycle beginning with birth of last child and ending with leaving of home of first child is known as?
|
Ans. c (Complete extension) (Ref. Park Textbook of PSM 22nd/pg.635)A family is a primary unit in all socities. Familes are not constant. A normal family-cycle is generally conceived as having six phases as follows:BASIC MODEL OF NUCLEAR FAMILY LIFE CYCLE Phase of family cycleCharacterizing EventsNo.DescriptionBeginning of phaseEnd of phaseIFormationMarriageBirth of 1st childIIExtensionBirth of 1st childBirth of last childIIIComplete extensionBirth of last child1st child leaves homeIVContraction1st child leaves homeLast child has left home of parentsVCompleted contractionLast child has left home of parents1st spouse diesVIDissolution1st spouse diesDeath of survivor (Extinction)
|
Social & Preventive Medicine
|
Demography and Family Planning
|
Complete extension
|
Dofetilide belong to?
|
Ibutilide, dofetilide, sotalol, amiodarone are class 3 agents they are potassium channel blockers- they r broad spectrum antiarrhythmic agents they increase QT interval
|
Pharmacology
|
Cardiovascular system
|
Class III antiarrythmic
|
A young girl presents with abdominal pain and a recent change in bowel habit, with passage of mucus in stool. There is no associated blood in stool and symptoms are increased with stress. The most likely diagnosis is:
|
IBS is a disorder for which no pathognomonic abnormalities are identified. Females are more commonly affected. People of all age groups are affected, but most have the onset of symptoms before 45 years. Patients usually presents with recurrent lower abdominal pain, abdominal bloating and altered bowel habits. Stool is accompanied by large amount of mucus, Bleeding is not a feature. Symptoms occur at times of stress or emotion. Ref: Harrison's principles of internal medicine 18th edition, Chapter 296; Current medical diagnosis and treatment 2012, Chapter 35; Current medical diagnosis and treatment 2012, Chapter 15.
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Medicine
| null |
Irritable bowel syndrome
|
The main types of muscle cells are
| null |
Physiology
| null |
All of the above
|
Retraction of scapula at sternoclavicular joint is done by:
|
Retraction means moving backward of scapula at sternoclavicular joint. It is done by the following muscles: Trapezius Rhomboid major Rhomboid minor. Subscapularis helps in medial rotation of humerus. Serratus anterior helps in protraction of scapula. Supraspinatus helps in adduction.
|
Anatomy
|
Upper limb bones and muscles (proximal region) & Scapular movements
|
Trapezius
|
Which of the following factors of balanced occlusion is given by the patient?
|
Condylar guidance
Definition: The mechanical form located in the upper posterior region of an articulator that controls movement of its mobile member (GPT8).
Condylar guide inclination: The angle formed by the inclination of a condylar guide control surface of an articulator and a specified reference plane (GPT8).
This is the mandibular guidance generated by the condyles traversing the contours of the glenoid fossa.
It is duplicated in the articulator. The extent of duplication depends on the articulator’s capability, whether it is semi-adjustable or fully adjustable.
Protrusive condylar guidance is obtained using protrusive records,while the lateral condylar guidance is obtained using Hanau’s formula or lateral records
It is designated as an inclination or angle – condylar guidance angle or inclination – and is expressed in degrees.
This is the only factor that is obtained from the patient and is not under the dentist’s control.
A shallow condylar guidance will cause less posterior tooth separation in protrusion and requires teeth with shorter cusps and flatter fossa to achieve balanced occlusion, than a steep guidance.
Key Concept:
Out of the five factors of balanced occlusion, only condylar guidance is recorded from the patient by the means of protrusive records.
|
Dental
| null |
Condylar guidance
|
Elek's gel precipitation test is for -
|
Ans. is 'b' i.e., Diphtheria
|
Microbiology
| null |
Diphtheria
|
A patient with hea failure developed recurrent sustained monomorphic vt .Treatment is/are -
|
Sustained monomorphic VT associated with nonischemic cardiomyopathy is usually due to scar-related reentry. On cardiac MR imaging, scars are detectable as areas of delayed gadolinium enhancement and are more often intramural or sub-epicardial in location as compared with patients with prior MI. Any cardiomyopathic process can cause scars and VT, but cardiac sarcoidosis, Chagas disease, and cardiomyopathy due to Lamin A/C mutations are paicularly associated with monomorphic VT . An ICD is usually indicated with additional drugs or catheter ablation for control of recurrent VT. Harrison 20thed pg 1758
|
Medicine
|
C.V.S
|
Intracardiac Defibrilator
|
In multibacillary leprosy, the follow-up examination after adquate Rx should be done early for -
| null |
Social & Preventive Medicine
| null |
5 years
|
All are true about meningiomas except -
|
Ans. is 'c' i.e.. They are attached to pia matterMeningiomas are amont the most frequent primary brain tumors.o Although most meningiomas ae benign, their location in the central nervous system can cause serious morbidity or mortality.Clinical presentationo Meningiomas can arise anywhere from the dura most commonly within the skull and at sites of dural reflection (Falx cerebri, fentorium cerebelli, venous sinuses). Other less common sites include the optic nerve sheath and choroid plexus; approximately 10 percent arise in the spine. Very rarely, menningiomas can arise at extradural sites.o Symptoms from a mengioma are determined by the location of the mass and by the time course over which the tumor develops.o Meningioma frequently are extremely slow growing and often are asymptomatic.Asymptomatic tumorso Many meningiomas are asymptomatic or minimally symtomatic, and are discovered incidentlally on a neutroimaging study or at autopsy.Seizureso Seizures are present preoperatively in 25 to 40 percent of patients who are diagnosed with an intracranial meningioma.Focal findingso Characteristic focal deficits are caused by tumors in specific locations.MeningiomaVisual changesHearing lossMental statusExtremityObstructiveSpontaneous changesweaknesshydrocephalyhemorrhage
|
Medicine
|
Tumors of Nervous System
|
They are attached to pia mater
|
Serum sickness is which type of hypersensitivity reaction?
|
Ans. c (Type III). (Textbook of Microbiology by Ananthnarayan, 6th ed., 155)HYPERSENSITIVITY ReactionsTypeMechanismE.g.Hints to rememeberType I(Anaphylactic and Atopic)Antigen cross -links IgE on presensitized mast cells and basophils, causing of vasoactive amines (i.e., histamine) release.- Anaphylaxis,- Asthma,- Hives- Local wheal and flareFirst and fast (anaphylaxis)Type I, II, and III are all antibody mediated.Type II Cytotoxic(antibody mediated)Antibody mediatedIgM, IgG bind to antigen on "enemy" cell, leading to lysis (by complement) or phagocytosis.- Autoimmune Hemolytic anemia,- Rh disease,- Good pasture's syndrome,- Rheumatic fever,- Grave's disease,- Bullous pemphigoid,- Myasthenia gravis,- ITP.Cy-2-toxic.Antibody and complement lead to membrane attack complex (MAC).Type IIIC-ComplementImmune complexImmune complex-- activate complement, which attracts neutrophils; neutrophils release lysosomal enzymes,- PAN,. Immune complex GN, SLE, rheumatoid arthritis.- Serum sickness--antibodies to the foreign proteins are produced (takes 5 days). Immune complexes form and are deposited in membranes, where they fix complement (leads to tissue damage).More common than Arthus reaction.- Arthus reaction--fntraderma! Injection of antigen induces antibodies, which from antigen-antibody complexes in the skin, causing edema, necrosis and activation of complement.Imagine an immune complex as 3 things stuck together; antigen antibody- complementType IVDelayed(cell mediated)Delayed (T cell mediated) type - sensitized T lymphocytes encounter antigen and then release lymphokines (leads to able by macrophage activation).- 4T's -- T lymphocytes,- Transplant reactions,- TB skin tests,- Touching (contact dermatitis). Hypersensitivity pneumonitis (farmer's lung) by Thermophilic actinomycetes....as per Harrison's 17th ed.4th and last - delayed.
|
Pathology
|
Immunity
|
Type III
|
While discharging a patient of meningitis due to H. influenzae the essential step you will do -
|
Ans. is 'c' i.e., Bilateral evoked auditory response o Nontypable H. influenzae is one of the three most common causes of childhood otitis media.o The other two beingStreptococcus pneumoniae andMoraxella catarrhaliso The diagnosis is made by pneumatic otoscopyAn etiologic diagnosis, although not routinely sought, can be established by tympanocentesis and culture of m iddle-ear fluid.o A diagnosis of otitis media is based on theDetection by pneumonic otoscopy of fluid in the middle ear andBilateral evoked auditory response
|
Medicine
|
Meningitis and Encephalitis
|
Bilateral evoked auditory response
|
Tonsillectomy following peritonsilar abscess is done after weeks -
|
Ans- C 6-8 weeks Ref. Turner 7 Oth/ed p 86; Head and Neck Surgery by Chris DeSouza Vol 2 p 7583 a. Friends, Dhingra and Turner have a different opinions on this one. b. According to Turner 10th/ed p 86-'The tonsils should be removed 6-8 weeks following a Quinsy." c. According to Dhingra 6th/ed p 265-'Tonsils are removed 4-6 weeks following an attack of Quinsy." d. According to Head and Neck Surgery- e. Quinsy - "Most people would practise interval tonsillectomy for these patients, deferring surgery for 6 weeks following resolution of an attack." - Head and Neck Surgery by Chris de Souza Vol 2 p 7583
|
Unknown
| null |
8-Jun
|
Aspirin triad is?
|
ANSWER: (C) Sampter's syndromeREF: With textIn 1922 Widal et al. recognized the additional association of nasal polyposis with aspirin sensitivity and asthma. This became commonly known as "aspirin triad." Following studies by Samter and Beers in the late 1960s, aspirin triad was commonly referred to as Samter's triad. (Ref: Head & Neck Surgery--otolaryngology - Volume 1 by Byron J. Bailey, Jonas T. Johnson, Shawm D. Newlands 4th ed Page 396)"36% of the patients with aspirin intolerance may show polypi. Sampter's triad consists of nasal polypi, asthma and aspirin intolerance* (Ref: Dhingra 4th ed page 162)
|
ENT
|
Nasal Polyposis
|
Sampter's syndrome
|
All the following are Derivatives of Dorsal mesogastrium except
|
The derivatives of Dorsal mesogastrium are:(1) The greater or caudal pa of the dorsal mesogastrium becomes greatly elongated and forms the greater omentum.(2) The spleen develops in relation to the cranial pa of the dorsal mesogastrium and divides it into dorsal and ventral pas. The ventral pa forms the gastrosplenic ligament while the dorsal pa forms the lienorenal ligament. (3) The cranial most pa of the dorsal mesogastrium forms the gastrophrenic ligament. The ventral mesogastrium forms the falciform ligament.Reference: Chaurasia Volume II; 7th edition; Page no: 270
|
Anatomy
|
General anatomy
|
Falciform Ligament
|
Peripheral resistance is best indicated by:
|
Ans. a. Diastolic blood pressure Aerial hypeension is the result of abnormal flow/resistance relationships. Resistance to outflow consists of different components: the systolic component is the one generated by conductance vessels, whereas the diastolic component consists of peripheral resistance, which regulates peripheral blood supply due to the run-off of conductance vessels during left ventricular diastole. Thus, an increase in systemic resistance results in a rise in diastolic blood pressure. If the elasticity of conductance vessels decreases, diastolic run-off also decreases and diastolic blood pressure goes down. When this loss of elasticity occurs, the ejection force cannot be anymore offset by aerial distension, the pulse wave velocity increases and reflex waves to the hea arrive earlier, causing the systolic blood pressure to augment. Such an augmentation, together with decreasing diastolic blood pressure results in an enhancement of the pulse pressure. When the stroke volume is normal, an increase in pulse pressure is, therefore, a marker of altered conductance. However, if, due to loss of elasticity of the conductance aeries diastolic blood pressure goes down, increasing systolic pressure also protects against a decrease in mean pressure. Indeed, in conditions of elevated pulse pressure, the mean pressure can be normal or high, indicating that when evaluating blood pressure all components should be taken into consideration. A high systolic blood pressure associated with a normal mean blood pressure is suggestive of a normal peripheral resistance.'Diastolic PressureSystolic pressure is peak pressure reached during systole, similarly, diastolic pressure refers to lowest pressure during diastole.Diastolic blood pressure is an index to peripheral resistance.Elasticity of aoa and large aeries is mainly responsible for origin and maintenance of diastolic pressure (by Windkessel elastic recoil effect).Because the elasticity is higher in younger subjects, diastolic pressure is maintained and pulse pressure is narrow.Because the elasticity is lower in old persons, diastolic pressure is decreased and pulse pressure is widened.
|
Anatomy
| null |
Diastolic blood pressure
|
Gas gangrene is caused by all except?
|
Ans. is 'd' i.e., Cl. sporogenes
|
Microbiology
| null |
Cl. sporogenes
|
Vogt's striae shown below are seen in:
|
Ans. (b) Keratoconus.
|
Ophthalmology
|
Ecstatic Conditions of Cornea
|
Keratoconus
|
All of the following statements about the control of micturition are true except:
|
Micturition is initiated by activation of afferent sensory fibers located in the wall of the bladder; these fibers sense the degree of stretch of the bladder wall. In addition, these sensory fibers travel back to the spinal cord via sacral dorsal roots. The sensory information that reaches the spinal cord also travels to the micturition center in the rostral pons. When sensory activity to the micturition center is sufficient, a command is sent to the sacral spinal cord, leading to activation of parasympathetic fibers. The parasympathetic fibers travel to the bladder via the pelvic nerve. Activation of these fibers leads to bladder contraction. Destruction of the sacral dorsal roots (as occurs with tabes dorsalis) abolishes the reflex because sensory afferent fibers no longer send signals back to the spinal cord.
A spinal cord injury at L1 is well above the sacral region where the micturition reflex originates. How ever, the central nervous system (CNS) plays an important role in facilitating or inhibiting the micturition reflex, and this function is lost with spinal cord injury. Although some patients with spinal cord injury can still elicit a micturition response (e.g., stroking of the skin in the genital region), the bladder in these patients has increased muscle tone and fails to empty completely. As the bladder becomes more and more distended, an involuntary micturition reflex can occur. However, the CNS can keep urine from being voided under these circumstances by maintaining a constant tonic contraction of the external sphincter. This contraction is accomplished through continued activation of so matic nerves that travel in the pudendal nerve from the sacral spinal cord to the external sphincter. The point at which an urge to void first occurs corresponds to a bladder volume of approximately 150 ml. However, bladder volume can increase more than twofold before involuntary micturition occurs. At 400 ml a marked sense of fullness is present. Parasympathetic fibers originating in the sacral spinal cord innervate the body of the bladder, and it is activation of these fibers that leads to bladder contraction.
|
Unknown
| null |
An individual with destruction of the sacral dorsal roots can still have a micturition reflex
|
Drug of choice for a case of uncomplicated cystitis -
|
Ans. is 'd' i.e.. Fosfomycin[Ref: OBJECTIVE: To determine the drug of choice for the treatment of uncomplicated cystitis. METHOD: Drug selection was performed by means of the so-called 'system of objectified judgment analysis' (SOJA) method by a working group of 11 persons. The following selection criteria were used: pharmacokinetics, interactions, the probability of hitting (the probability that the microorganism is sensitive to the antibiotic), development of resistance, specific use in urinary tract infections, efficacy, side effects, dosage-frequency, duration of treatment, cost and documentation. The following drugs were included in the study: amoxicillin (with or without clavulanic acid), nitrofurantoin, sulfamethizole, trimethoprim, co-trimoxazole, ciprofloxacin, norfloxacin, ofloxacin and fosfomycin trometamol. RESULTS: Fosfomycin and nitrofurantoin slow release showed the highest scores. The main selection criteria that determined the selection of a drug were especially specific use in urinary tract infections, development of resistance, the probability of hitting and cost. CONCLUSION: Fosfomycin and nitrofurantoin slow release best fulfill the requirements for drugs in the treatment of uncomplicated cystitis. No comparative studies have been performed with the 3-day treatment of uncomplicated cystitis with nitrofurantoin slow release or with trimethoprim. Fluoroquinolones play no important part in the treatment of uncomplicated cystitis, mainly because of the risk of development of resistance.
|
Unknown
| null |
Fosfomycin
|
Mucosa is involved in –
|
Diseases involving oral mucosa :- Lichen plaints, Pemphigus, Infections (Candida, Secondary syphilis, HSV), Leucoplakia, Erythema multiforme, Peutz Jegher syndrome, Aphthous ulcers, Bechet's disease, squamous cell carcinoma
|
Dental
| null |
Lichen planus
|
Glucose alanine cycle is impoant in:
|
In the fasting state, there is a considerable output of alanine from skeletal muscle, far in excess of its concentration in the muscle proteins that are being catabolized. It is formed by transamination of pyruvate produced by glycolysis of muscle glycogen, and is expoed to the liver, where, after transamination back to pyruvate, it is a substrate for gluconeogenesis. Ref: Harper 28th edition, chapter 20.
|
Biochemistry
| null |
Muscle
|
Lord's and Jaboulay's operation is done for
|
These operations are done for hydrocele .Lord's operation or plication is suitable when the sac is small, thin walled and contains clear fluid. Here tunica is bunched into a 'ruff' at its attachment to the testis by using a series of multiple interrupted chromic catgut sutures to plicate the redundant tunica vaginalis, so as to make the sac to form fibrous tissue. Jaboulay's procedure - Eversion of the sac following paial excision with placement of the testis in a pouch prepared by dissection in the fascial planes of the scrotum.Reference : page 1072 SRB's manual of surgery 5th edition and page 1382 Bailey and Love's sho practice of surgery 25th edition
|
Surgery
|
Urology
|
Hydrocele
|
Which of the following is not a function of aqueous humor?
|
It provides nutrition to the cornea and lens and not the retina. Functions of aqueous humor: Maintenance of IOP Nutrition to lens and cornea Maintaining transparency of eye Clearing the eye of toxins
|
Ophthalmology
|
Glaucoma
|
Providing nutrition to retina
|
Painful ulcers over genitalia are caused by –
| null |
Dental
| null |
Chancroid
|
Trichotillomania-
|
Ans. is 'c' i.e., Compulsive hair pulling o As there is no organic or behavioral disorders, this girl is suffering with impulse control disorder of compulsive hair pulling, known as Trichotillomania.Impulse control disordero These disorders are characterized by failure to resist an impulsive behavior that may be harmful to self or others. There may be a feeling of release of tension by doing the act and a feeling of guilt after the act is over.Important impulse control disorder are : -Pyromania (Pathological fire setting)Kleptomania (Pathological stealing)Trichotillomania (Compulsive hair pulling)Pathological gamblingIntermittent explosive disorderImpulse control disorder not otherwise specifiedOniomania (Compulsion to shop/buying)Internet compulsion (Internet addiction)Cellular or Mobile phone compulsionCompulsive sexual behavior (sexual addiction).
|
Psychiatry
|
Mood Disorders
|
Compulsive hair pulling
|
Inositic acid is biological precursor of ?
|
C i.e., Adenylic & guanylic acid
|
Biochemistry
| null |
Adenylic acid and guanylic acid
|
Geographic lytic lesions in the vault of the skull with bevelled edges are seen with:
|
Ans. Eosinophilic granuloma
|
Radiology
| null |
Eosinophilic granuloma
|
Which enzyme level is tested in thiamine deficiency?
|
Thiamine (vitamin B1) Deficiency It is assessed by Erythrocyte transketolase activity. Thiamine (Vitamin B1) is the marker for transketolase enzyme -which is involved in HMP pathway (in RBCs) Activity of Transketolase is measured (not the quantity).
|
Biochemistry
|
FMGE 2019
|
Transketolase
|
The measure of variability indicating how many standard detions, an observation is above or below the mean is
|
A z-score is the number of standard detions from the mean. The coefficient of variation (CV) is a measure of relative variability. It is the ratio of the standard detion to the mean. Ref : Park 23rd edition Pgno : 849
|
Social & Preventive Medicine
|
Non communicable diseases
|
Z score
|
A Down syndrome child is mentally retarded. All cytogenetic abnormalities may occurs except?
|
Ans is 'a' i.e., Deleted 21
|
Pediatrics
| null |
Deleted 21
|
Hydatidiform mole is associated with :
|
Theca lutein cysts
|
Gynaecology & Obstetrics
| null |
Theca lutein cysts
|
A 24-year-old P2+0 woman presents to the emergency department complaining of pain in her right breast. The patient is postpartum day 10 from an uncomplicated spontaneous vaginal delivery at 42 weeks. She reports no difficulty breast-feeding for the first several days postpartum, but states that for the past week her daughter has had difficulty latching on. Three days ago her right nipple became dry and cracked, and since yesterday it has become increasingly swollen and painful. Her temperature is 38.3°C (101°F). Her right nipple and areola are warm, swollen, red, and tender. There is no fluctuance or induration, and no pus can be expressed from the nipple.
|
A postpartum lady coming with H/o pain in breast and fever and nipples being warm, red, swollen, with no induration, fluctuance and no pus extruding from them - leaves no doubt that the patient is having mastitis. As discussed in question 9, mastitis is not a contraindication for breast feeding. She should continue feeding from both the breasts.
|
Gynaecology & Obstetrics
| null |
Continue breast feeding from both the breasts
|
A 65-year-old male is having a swelling on the back of lower thigh. On investigation it was found to be a high grade liposarcoma of 5 cm in size. Best management is:
|
Ans. B. Wide local excisionExplanationLiposarcoma is one of the types of soft tissue sarcoma (STS). Liposarcoma is the most frequent STS subtype and represents 45% of all retroperitoneal sarcoma. It is composed of three histologicvarieties (listed in order of decreasing frequency):Well-differentiated and dedifferentiated liposarcoma,Pleomorphic liposarcoma, andMyxoid/round cell liposarcoma.Well differentiated and dedifferentiated liposarcomas more typically arise from the retroper- itoneum versus the extremities, whereas the inverse is true for pleomorphic and myxoid/round cell liposarcoma.Mainstay of treatment for STS is surgery.Algorithm for STS management is as follows:
|
Surgery
|
Plastic & Reconstructive Surgery
|
Wide local excision
|
Preganglionic supply to the submandibular gland is
|
The sensory root is from the lingual nerve. It is suspended by two roots of lingual nerve.The sympathetic root is from the sympathetic plexus around the facial aery. This plexus contains postganglionic fibers from the superior cervical ganglion of the sympathetic trunk. These fibers pass express through the ganglion and are vasomotor to the submandibular glandThe secretomotor root is from superior salivatory nucleus through nervous intermedius chords tympani which is a branch of cranial nerve VII. Chorda tympani joins lingual nerve. The parasympathetic fibers get relayed in the submandibular ganglion.Ref: BD Chaurasia; volume 3; 6th edition; Page no: 308
|
Anatomy
|
Head and neck
|
Superior salivary nucleus
|
Phycomycosis is also called
| null |
Pathology
| null |
Mucormycosis
|
Skin biopsy in leprosy is characterized by –
|
In indeterminate leprosy, there is perivascular and Periappendageal infiltrate of lymphocytes.
In lepromatous leprosy large number of lepra bacill are seen in dermal infiltrate around appendages (periappandgeal).
|
Dental
| null |
All of the above
|
Most commonly used measure of central tendency-
|
Ans. is 'a' i.e., Mean * The commonly used statistical average (measures of central tendency) are (i) Arithmetic mean, (ii) Median and (iii) Mode.Arithmetic mean* It is the most commonly used statistical average. It is obtained by sum of all the values divided by total number of values.Mean =[?]x----e* The major disadvantage of mean is that it may be unduly influenced by abnormal high or low values in the distribution.Median* It is the middle most value in a distribution arranged in ascending or descending order. If there are two values in the middle, instead of one, the median is worked out by taking the average of two middle values.* The main advantage of median is that it is not affected by abnormal high or low values (unlike mean). Therefore, median is used in skewed distribution (distribution which is skewed/deviated due to small number of very high or low values).Mode* It is the most frequently occuring value in a distribution. If there are two most frequent values, there are two modes and the distribution is called 'bimodal distribution In bimodal distribution the mode is the average of two modes.* For bimodal distributionMode = (3 x median) - (2 x mean)* Mode is the central tendency which is least affected by extreme values or skewness (But median is the preferred central tendency in skewed distribution).
|
Social & Preventive Medicine
|
Biostatistics
|
Mean
|
All of the following are pre-malignant except:
|
Ans. c. Peutz-Jegher's syndrome
|
Surgery
| null |
Peutz-Jegher's syndrome
|
Condition not associated with bronchiectasis is?
|
Ans. is 'b' i.e., Lung Cancer * Important complications of bronchiectasis are massive hemoptysis, purulent pericarditis, lung abscess, empyema, amyloidosis, metastatic abscess (in brain, bones etc) , and cor pulmonale. It is not a premalignant condition.
|
Pathology
|
Respiration
|
Lung cancer
|
Lateral medullary syndrome or Wallenberg syndrome involves all, EXCEPT:
|
Ipsilateral cranial nerve involvement (spinal tract of Vth cranial nerve and IX, X, XI cranial nerve) is seen in Wallenberg syndrome. Clinical manifestations of involvement of these cranial nerves are, loss of taste from the posterior third of the tongue (nuclei or fibers of CN IX and X) and reduced corneal reflex, from damage to the descending spinal tract and nucleus of CN V. Ref: Clinical Medicine Made Easy By TV. Devarajan, 2008, Page 213 ; Harrison's Internal Medicine 17th ed Chapter 364 ; Cerebrovascular Diseases, Brainstemdisorders by Peter P Urban, Louis R Caplan page 205-207.
|
Medicine
| null |
12th cranial nerve
|
Maximum equilibrium potential is for -
|
Ans. is 'b' i.e., K+
|
Physiology
| null |
K+
|
Amitryptyline is a
| null |
Pharmacology
| null |
Tricyclic antidepressant
|
Commonly used FNAC needle gauge -
| null |
Pathology
| null |
22-26
|
The sensitive period for tetracycline induced discolouration in the permanent maxillary mandibular incisors and canines is
| null |
Pathology
| null |
3 months postpartum to 7th year of Life
|
A 40 year old male had multiple blisters over the trunk & Extremities. Direct immuno fluoresce studies showed linear IgG deposits along the basement membrane, which of the following is the most likely diagnosis –
|
IgG deposits along basement membrane occurs only in bullous pemphigoid, amongst the given options.
|
Dental
| null |
Bullous pemphigoid
|
Allergic rhinitis is which type of hypersensitivity-
|
Ans. is 'a' i.e., Type -1 Pathogenesis of allergic rhinitiso Allergic rhinitis is a type I hypersensitivityIt occurs in two phases:-1) Initial response/Acute or early phase# After first antigen exposure, this antigen is presented to CD-4 helper T cells (TH, type) by antigen presenting cells. These primed TH, cells release IL-4 that acts on B-cells to form Ig E specific for that particular antigen. The antigen specific Ig E antibodies then bind to the surface receptors of mast cells and basophils. The process from first antigen exposure to the coating of mast cells by Ig E acts as sensitization (prior sensitization) and first exposure is also called priming or sensitizing exposure (dose). Subsequent exposure (shocking dose) to same antigen then results in activation of mast cells and basophils with release of inflammatory mediators : -i) Histamine (most important)ii) Hepariniii) Leukotriens (B4, C4> D4)iv) PGD2v) PAFvi) Cytokines (IL-1, 3, 4, 5, 6; INF)vii) Eosinophil chemolactic factor (ECF)viii) Neutrophil chemolactic factor (NCF)The release of these mediators result in : -Increased vascular permeability and vasodilatation which result in tissue edema - Nasal blockage and sneezing.Smooth muscle spasm - BronchoconstrictionHyperactivity of glands - RhinorrheaRecruitment of inflammatory cells.2) Late phase responseRecruited inflammatory cells of initial phase amplify and sustain the inflammatory response without additional exposure to the triggered antigen. PAF is the most important mediator in initiation of late phase response. Eosinophils are particularly important cells among the recruited cells which also include neutrophils, basophils, monocytes and T-cells. It causes symptoms like nasal congestion and post nasal drip.
|
ENT
|
Rhinitis
|
Type -1
|
Myasthenia gravis is associated with
|
Some 60%of Myasthenia gravis are associated with a peculiar reactive hyperplasia of intrathymic B cells and another 20%are associated with thymoma, a tumor of thymic epithelial cells. Robbins basic pathology 9th edition page no 800,heading =Myasthenia gravis Option 4 is correct
|
Pathology
|
Breast
|
Thymoma
|
Red degeneration most commonly occurs in
|
Ans. is 'b' i.e. 2nd Trimester Red degeneration of the myomasRed degeneration of uterine myomas develops most frequently during pregnancy. It typically occurs during 2nd trimester (20-22) weeks of pregnancy.During red degeneration, the myomas become tense, tender and causes severe abdominal pain with constitutional upset and fever.Although the patient is febrile with moderate Leucocytosis and raised E.S.R., the condition is an aseptic one.It needs to be differentiated from appendicitis, twisted ovarian cyst, pyelitis and accidental hemorrhage.During the red degeneration, the tumour itself assumes a peculiar purple red colour and develops a fishy odour. If the tumour is carefully examined, some of the large veins in the capsule and the small vessels in the substance of the tumour will be found thrombosed. The discoloration is possibly caused by diffusion of blood pigments from thrombosed vessels.Conservative treatment with analgesia, reassurance and supportive therapy is almost always adequate.Also knowAnother complication of myoma which is seen during pregnancy is torsion of the myoma.Torsion of the myoma is also characterized by acute abdominal pain with point tenderness over the site of leiomyoma.Conservative t/t is adequate.
|
Gynaecology & Obstetrics
|
Clinical Features, Diagnosis, and Pathology
|
2nd trimester
|
Which one of the following is a conjugated vaccine-
|
Ans. is 'c' i.e., Hemophillus influenzae HIB PRP vaccine (conjugate vaccine) is available for H. influenzae type b. o Currently no vaccine is available for non typable strains.
|
Pediatrics
| null |
Hemophilius influenza
|
Echoencephalography is most useful in detecting:
|
Ans. Ventricular dilatation
|
Radiology
| null |
Ventricular dilatation
|
Vidian neurectomy is done in?
|
Ans. (b) Vasomotor rhinitisRef: Dhingra's 4th ed p-160
|
ENT
|
Rhinitis
|
Vasomotor rhinitis
|
Vasanti 45 years, was brought to casualty with abnormal movements which induced persistent detion of neck to right side. One day before she was prescribed Haloperidol 5mg three times daily from the psychiatry OPD. She also had an alternation with her husband recently. Which of the following is the most likely cause for her symptoms.
|
C i.e. Acute drug dystonia
|
Psychiatry
| null |
Acute drug dystonia
|
Which of the following statistics should be adjusted for age to allow comparisons -
|
Crude Mortality Rate (Crude Death Rate) is not a correct parameter to compare death rates of two populations since each population is likely to have different age compositions. Age adjustment or Age standardization is required to compare crude death rates from two different populations.
Infant Mortality Rate; Perinatal Mortality rate; and Age Specific Fertility Rate all compare populations within a narrow/similar age range and hence these statistics do not require to be adjusted for age.
|
Social & Preventive Medicine
| null |
Crude mortality rate
|
In postmenopausal women, estrogen is metabolized mostly into
|
.
|
Pathology
|
All India exam
|
Estrone
|
Pain-sensitive intracranial structure is
|
Intracranial structures sensitive to pain are scalp, anponeurotica, duramater around venous sinuses & vessels, falx & tentorium cerebri, cranial venous sinuses, some arteries. Intracranial structures insensitive to pain are brain parenchyma, ventricular ependyma, duramater over convexity of skull, piameter, pial veins, arachnoidmater and choroids plexus.
|
Physiology
| null |
Duramater
|
Auer rods are seen in:
|
Some of the commonly employed cytochemical stains, as an aid to classify the type of acute leukemia, are-
Myeloperoxidase: positive in immature myeloid cells containing granules and Auer rods but negative in M0 myeloblasts.
Sudan black: Positive in immature cells in AML.
Periodic acid Schiff (PAS): Positive in immature lymphoid cells and in erythroleukemia (M6).
Non-specific esterase (NSE): Positive in monocytic series (M4 and M5).
Acid phosphatase: Focal positivity in leukemic blasts in ALL and diffuse reaction in monocytic cells (M4 and M5).
|
Pathology
| null |
Acute myeloid leukemia.
|
A 5-day-old male infant is diagnosed with Hirschsprung disease. CT scan examination reveals an abnormally dilated colon. Which of the following is the most likely embryologic mechanism responsible for Hirschsprung disease?
|
Congenital megacolon (Hirschsprung disease) results from the failure of neural crest cells to migrate into the walls of the colon. Incomplete separation of the cloaca would result in anal agenesis either with or without the presence of a fistula. The failure of recanalization of the colon results in rectal atresia, wherein both the anal canal and rectum exist but are not connected due to incomplete canalization or no recanalization. Defective rotation of the hindgut can cause volvulus or twisting of its contents. Oligohydramnios is a deficiency of amniotic fluid, which can cause pulmonary hypoplasia but would not cause Hirschsprung disease.
|
Anatomy
|
Abdomen & Pelvis
|
Failure of neural crest cells to migrate into the walls of the colon
|
Winging of the scapula is seen in injury to which nerve?
|
Ans. is 'a' i.e., Long thoracic nerve of Bell * Winging of scapula is caused most commonly by serratus anterior palsy. This is typically caused by damage to long thoracic nerve (nerve to serratus anterior).
|
Anatomy
|
Upper Extremity
|
Long thoracic nerve of Bell
|
A 16-year-old boy suffering from drug abuse presents with cross-over of sensory perceptions, such that, sounds can be seen and colors can be heard. Which of the following is the most likely agents responsible for drug abuse:
|
B i.e. (LSD) - Lysergic acid diethylamide (LSD) has potent psychedelic & hallucinogenic effects and produce a variety of bizarre and offer conflicting perceptual and mood changes, including visual illusions, synesthesias (reflex hllucination = sensory modalities cross over) extreme lability of moodQ. and sometimes bad trip (panic episode). It also produces tachycardia, hypeension, pupillary dilation, tremor, and hyperpyrexia. Phencyclidine (PCP) or angel dust, a NMDA receptor blocker, is widely used in veterinary medicine to briefly immobilize large animals (dissociative anesthesia). It produces agitation, excitement, impaired motor coordination, dysahria and analgesia at low doses; whereas signs of intoxication include horizontal or veical nystagmus, flushing, diaphoresis, and hyperacusis; higher doses (5-10 mg) produce profuse salivation , vomiting, myoclonus, fever, stupur, coma, convulsions, opisthotonus and decerebrate posturing. Behavioral changes include distoion of body image, disorganization of thinking, and feeling of estrangementQ - Flunitrazepam (Rohypnol), a benzodiazepine used for insomnia has strong hypotic, anxiolytic and amnesia producing effects. It is also k/a date - rape drug or roofies and overdose can be treated with flumazenil. GHB (Gamma hydroxy butyric acid = Xyrem) is FDA approved treatment for narcopepsy with abuse potential producing euphoria & disinhibition. GABAB antagonists can reverse its sedating effects and opioid antagonists (naloxone, naltrexone) can attenuate GHB effects on dopamine release.
|
Psychiatry
| null |
LSD
|
Monoclonal antibody used in Head and neck cancer is:-
|
Drug Mechanism of action Uses Pembrolizumab Monoclonal antibody against PD 1 * Multiple myeloma * Non small cell lung cancer * Head and neck cancer * Any cancer containing mismatch repair Trastuzumab Monoclonal antibody against her-2/neu Breast cancer, gastroesophageal junction cancer Rituximab Monoclonal antibody against CD20 Non hodgkin's lymphoma(NHL), chronic lymphocytic leukemia(CLL) Ocrelizumab Monoclonal antibody against CD20 Primary progressive multiple sclerosis(PPMS)
|
Pharmacology
|
Targeted Anticancer Drugs and Immunosuppressants
|
Pembrolizumab
|
Numerator in negative predictive value -
|
Ans. is 'c' i.e., True negative o The results of a screening test can be arranged in following table : -Screening test resultsDiagnosisTotalDiseasedNot diseasedPositiveNegativeTrue positive (a)False negative (c)False positive (b)True negative (d)a + bc + dTotala + cb + d From this table following measure can be obtained : -i) Sensitivityo It is the percentage of diseased people that wrho are diagnosed as having disease,o Total number of diseased people = True positive + False negative.o Number of people (among diseased people) diagnosed as having disease = True positives,o So, percentage of truely diagnosed people : -Number of true positiveSensitivity = ---------------------------------------------------------------------------------Number of true positives - Number of false negative.Specificityo It is the percentage of healthy people who are identified as healthy.o Total number of healthy people = True negatives + False positiveso Number of healthy people who are identified as healthy = True negatives,o So, percentage of true healthy people : -Number of true negativesSpecificity = ------------------------------------------------------------------------------------Number of true negative + number of false positives.Predictive valve of a positive test (positive predictive value of secreening test)o It is the percentage of truely diseased people among those who show positive test results,o Total number of people showing positive test results = True positive + False positiveo Numbers of truely diseased people showing positive test = true positive,o So, the percentage of truely diseased people : -True positivePositive predictive value = ------------------------------------------------------------------------True positive + False positiveiv) Predictive value of a negative of test (negative predictive value)o It is the percentage of healthy people among those who show negative test results,o Total number of people showing negative test results = True negative + False negativeo Number of healthy people showing negative test = True negativeo So, percentage of healthy people showing negative results.True negativeNegative predictive value = ---------------------------------------------------------------------------True negative +- False negative
|
Social & Preventive Medicine
|
Screening for Disease
|
True negative
|
Which one of the following agents / drugs is of no value in the post operative care of the hemophilic patient?
| null |
Pharmacology
| null |
Clopidogrel
|
Increased BP & decreased heart rate is seen in
|
Raised intracranial pressure initiates Cushing’s reflex. Cushing’s reflex leads to a rise in arterial pressure, which restores the blood supply to the brain. At the same time, the raised BP causes reflex Bradycardia through the baroreceptors.
|
Physiology
| null |
Raised intracranial pressure
|
Ether is still used as a general anaesthetic in lndia, specially in peripheral hospitals because:
|
(Ref: KDT 6/e p371) Ether is the only complete anaesthetic agent. It is highly inflammable and explosive. It has good analgesic and muscle relaxant action. It can be delivered by open method. It is a pungent smelling liquid. Induction of anaesthesia with ether is quite slow. All the four stages can be seen.
|
Pharmacology
|
Other topics and Adverse effects
|
It is cheap and can be administered without anaesthetic machine
|
A patient presents 12 hours following a Myocardial infarction. Which of the following enzymes will be elevated at this period -
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Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:184 Cardiac Enzymes a. CPK-MB: This cardiac isoenzyme stas rising within 4-6 hrs after development of acute MI, peaks during the 2nd day (4 fold rise) and disappears in 2-3 days. Other causes of total CK elevation: 1. Skeletal diseases - Polymyositis, Muscle dystrophy, Myopathies 2. Electrical cardioversion 3. Skeletal muscle damage - trauma, convulsions, immobilisation 4. Hypothyroidism 5. Stroke 6. Surgery b. AST: Stas rising on the 1st day, peaks in 2-3 days (3 fold rise) and disappears by 3rd day. c. LDH1: Stas rising by second day, peaks around 3- 4 days ( 3 fold rise) and disappears in 10 days. d. Troponin T: Cardiac troponin T is a regulatory contractile protein not normally found in blood. Its detection in the circulation has been shown to be a sensitive and specific marker for myocardial cell damage. Troponin T and I reach a reliable diagnostic level in plasma by 12-16 hrs, maximal activity by 24-32 hrs, returns to normal in 10-12 days. Troponin I : 0-0.4 ng/ml Troponin T: 0-0.1 ng/ml Cardiac troponins are detected in the serum by using monoclonal antibodies. These antibodies have negligible cross reactivity to skeletal muscle. Cardiac troponins I and T sta to rise within 3-4 hours after myocardial infarction and remain raised for 4-10 daysOther causes of elevated cardiac troponins: Cardiac causes: * Cardiac contusion/surgery * Myocarditis * Cardiomyopathy * Hea failure * Cardioversion * Percutaneous coronary intervention * Cardiac amyloidosis * Radiofrequency ablation * Supraventricular tachycardia * Post-cardiac transplantation Non-cardiac causes: * Primary pulmonary hypeension * Pulmonary embolism * Cerebrovascular stroke * High dose chemotherapy * Sepsis and septic shock * Renal failure * Critically ill patients * Scorpion envenomation * Ultra-endurance exercise (marathon) e. Myoglobin It is increased within 2 hrs of onset of symptoms and remains increased for at least 7-12 hrs. Normal level is 20-100 mg/L.
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Medicine
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C.V.S
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Creatinine phosphokinase
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IPC 314 deals with ?
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Ans. is 'b' i.e., Death of patient caused by miscarriage Offences related to aboion and child bih 312 , 313, 314 and 315 IPC : For causing voluntary miscarriage (criminal aboion). 312 IPC : Causing miscarriage with consent (3 years of imprisonment +- fine). 313 IPC : Causing miscarriage without consent of lady (10 years of imprisonment which can extend up to life +- fine). 314 IPC : Death of patient caused by miscarriage (10 years of imprisonment + fine). 315 IPC : Death of child during miscarriage (10 years imprisonment + fine). 316 IPC : Death of quick unborn child by act amouting to culpable homicide (10 years imprisonment + fine). 317 IPC : Abandoning a child (7 years imprisonment +- fine). 318 IPC : Concealment of bih by secret disposal of dead body (2 years imprisonment + fine).
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Forensic Medicine
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Death of patient caused by miscarriage
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Which of the following is long acting insulin?
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Medicine
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Insulin Glargine
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