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Which of the following drugs is effective against pseudomonas infection?
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Polymyxin 8 and Colistin Polymyxin and colistin were obtained in the late 1940s from Bacillus polymyxa and B. colistinus respectively. They are active against gramnegative bacteria only; all except Proteus, Serratia and Neisseria are inhibited. Both have very similar range of activity, but colistin is more potent on Pseudomonas, Salmonella and Shigella. Mechanism of action They are rapidly acting bactericidal agents; have a detergent-like action on the cell membrane. They have high affinity for phospholipids: the peptide molecules (or their aggregates) orient between the phospholipid and protein films in gram-negative bacterial cell membrane causing membrane distoion or pseudopore formation. As a result ions, amino acids, etc. leak out. Sensitive bacteria take up more of the antibiotic. They may also inactivate the bacterial endotoxin. They exhibit synergism with many other AMAs by improving their penetration into the bacterial cell. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:734
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Pharmacology
|
Chemotherapy
|
Colistin
|
Infliximab ?
|
Ans. is 'c' i.e., Chimeric antibody against TNF alpha
|
Pharmacology
| null |
Chimeric antibody against TNF alpha
|
Alpha methyldopa primarily used for
|
Methyldopa was primarily used in the past but is now used widely for pregnancy induced hypeension. Refer katzung 11e p173
|
Pharmacology
|
Cardiovascular system
|
Pregnancy induced hypeension
|
Figure of 8 appearance is seen in
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Microbiology
| null |
Blastomycosis
|
A 22 year old woman developed small itchy wheals after physical exeion, walking in the sun, eating hot spicy food and when she was angry. The most likely diagnosis is:
|
D i.e. Cholinergic Uicaria
|
Skin
| null |
Cholinergic uicaria
|
All are features of Lobar pneumonia except
|
Consolidation in Lobar pneumonia in Non - segmental.
|
Medicine
| null |
Segmental consolidation
|
Frame shift mutation DOESN'T occur in multiples of:
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Ans: (b) 3Ref: Harper's Biochemistry 30th edn. / 417-18* Frame-shift mutations* The genetic code is read in form of triplets of nucleotides which are known as codons.* If one or two base pairs from the code are removed or inserted, the genetic code will be misread from that change onwards, because the genetic code is not punctuated. Therefore the amino acid sequence translated from the change onwards will be completely changed. This is known as frame shift mutation.* However if the removal /insertion happens in multiples of three, rest of the reading frame doesn't change and hence the amino acid sequence will not change.
|
Biochemistry
|
Molecular Genetics
|
3
|
Among the following, which one is considered as 'pathologic problem' while planning treatment in orthodontics?
|
Inadequate attached gingiva around crowded incisors indicates the possibility of tissue dehiscence developing when the teeth are aligned, especially with non-extraction (arch expansion) treatment.
proffit page 173
|
Dental
| null |
Minimal attached gingiva in lower anterior region
|
Best view for nasal bone ?
|
Ans. is 'a' i.e., Lateral
|
ENT
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Lateral
|
Which of the following is true regrading spinal cord and neuraxial blockade
|
Spinal cord ends at upper border of L3 in children , and at lower border of L1 in adults. The dural sac extends upto S3 in children and S2 in adults.
|
Anaesthesia
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Spinal anaesthesia is given below L3 level in children
|
Poorest prognosis in AML is seen in which cytogenetic abnormality -
| null |
Medicine
| null |
Monosomy 7
|
Mysthenia gravis is which type of hypersensitivity
| null |
Microbiology
| null |
Type II
|
All are seen in ARDS, except :
|
Answer is C (Hypercapnia): ARDS results in Type I Respiratory failure and is characterized by normal or low PaCO2 (Hypocapnia) and not Hypercapnia (see previous explanation on types of respiratory failure). ARDS (Acute Respiratory distress syndrome) ARDS is an acute form of lung injury characterized by: Increased permeability of alveolar capillary membrane. Diffuse alveolar damage. Accumulation of proteinaceous pulmonary edema (non cardiogenic pulmonary edema Q)
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Medicine
| null |
Hypercapnia
|
The highest E.S.R. is seen in following conditions except:
|
Polycythemia rubra
|
Pathology
| null |
Polycythemia rubra
|
Pit viper beongs to -
|
Ans. is 'd' i.e., Crotalidae o Poisonous snakes are divided into six families:Viperidae - Russell's viper, gaboon viper, saw scaled viper, puff adder. They are found in all parts of world except America.Crotalidae - Rattlesnakes, pigmy rattlesnakes, copperheads, pit viper & bush master. They are found in Asia and America.Elapidae - Cobras, kraits, mambas, tiger snake, death adder, copperhead snakes and coral snakes. They are found in all parts of world except Europe.Hydrophidae or sea snakes - All sea snakes are poisonous but they seldom bite.Colubridae - Boomslangs, bird snake of the African continent.Atractaspididae - African & Middle Eastern burrowing asps or stiletto snakes.
|
Forensic Medicine
|
Toxicology
|
Crotalidae
|
"Pointing index" is due to paralysis of:
|
Ans. is 'a' i.e. Median nerve Pointing index:On asking the pt. to make a fist, it is noticed that the index finger remains straight.This is d/t Paralysis of the flexor digitorum superficialis and that of lateral half of the flexor digitorum profundus muscle (to the index finger) in median nerve palsy at a level of proximal to elbow.*Some other related questions:* Wrist drop is seen in*-Radial nerve palsy* Foot drop is seen in*-Common peroneal nv palsy.Winging of the scapula*Claw hand(Main -en -griffe):-Long thoracic nerve palsy.* Partial claw hand*-Ulnar nerve palsy* Complete claw hand*-Ulnar +Median nerve palsy* Ape thumb deformity*-Median nerve palsy* Pointing index*-Median nerve palsy* Policeman's tip deformity*-Also k/a Erb's paralysis d/t injury in the region of the upper trunk of the brachial plexus.Nerve roots involved are mainly C5 & partly C6.
|
Orthopaedics
|
Peripheral Nerve Injuries
|
Median nerve
|
A 25 years old female comes to your clinic for evaluation of infertility. A hysterosalpingogram reveals Asherman's syndrome. What symptoms will the patient have?
|
Ans. is d, i.e. HypomenorrheaThe typical presenting symptom in adenomyosis is hypomenorrhea, i.e. less blood loss during menstruation.
|
Gynaecology & Obstetrics
|
Endometriosis and Infertility
|
Hypomenorrhea
|
Anticancer drug also used in RA, produces acrolein in urine that leads to hemorrhagic cystitis
|
Cyclophosphamide IMPOANT POINTS ON HEMORRHAGIC CYSTITIS: Drugs causing: Cyclophosphamide Ifosfamide Metabolite responsible: Acrolein - In Cyclophosphamide Chloracetaldehyde - In Ifosfamide Treatment: Mesna. Nitrogen mustards: 1. Cyclophosphamide: Powerful vesicant Prodrug - Activated by hepatic biotransformation to aldophosphamide. Acrolein - One of its degradation products. Responsible for hemorrhagic cystitis - Characteristic adverse effect. Use: DOC for Wegener's granulomatosis. Adverse effects: Hemorrhagic cystitis (Characteristic) - Treated by mercapto ethane sulfonic acid (mesna). May cause cardiac dysfunction, pulmonary toxicity & syndrome of inappropriate ADH secretion. 2. Ifosfamide: Produces chloracetaldehyde & acrolein as metabolites. Adverse effects: HIGHER risk of neurotoxicity & hemorrhagic cystitis. Chloracetaldehyde - Responsible for nephrotoxic.
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Pharmacology
| null |
Cyclophosphamide
|
Hyponasal voice is seen in all except
|
Causes of hyponasality are Common cold Nasal allergy Nasal polyp Nasal growth Adenoids Nasopharyngeal mass Familial speech pattern Habitual Ref: PL Dhingra; Textbook of EAR, NOSE and THROAT; edition 7; Page - 357
|
ENT
|
Larynx
|
Cleft palate
|
Filled sealants are better than unfilled due to:
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Dental
| null |
Low abrasion
|
Receptor for HIV?
|
Ans. (a) CD4
|
Microbiology
| null |
CD4
|
While doing thoracocentesis, it is advisable to introduce needle along:
|
A i.e. Upper border of rib:
|
Anatomy
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Upper border of the rib.
|
In circulatory biomechanics which of the following is true?
|
Ans. is 'c' i.e., Cardiac output is increased in anemia Cardiac output is increased in conditions which cause decrease in peripheral vascular resistance :- Exercise AV fistula or shunt Severe anemia Thyrotoxicosis Wet beri-beri About other options Blood viscosity is low in anemia and high in polycythemia.
|
Physiology
| null |
Cardiac output is increased in anemia
|
Local anesthetic that is not used topically is?
|
Bupivacaine REF: Miller 6th e p. 590 Topical ( surface ) anesthetics Not used as surface (topical) ) anesthetics * Lignocaine * Procaine * Tetracaine * Bupivacaine * Dibucaine * Mepivacaine * Prilocaine * Cocaine
|
Anaesthesia
| null |
Bupivacaine
|
Mycobacterium scrofulaceum which cause scrofula, belongs to which groups of atypical mycobacteria -
|
Ans. is 'b' i.e., Scotochromogens
|
Microbiology
| null |
Scotochromogens
|
Which of the following is best for transport of the newborn with maintenance of warm temperature –
|
"Preferably mother should accompany and baby can be transported in KlI4C position. Even father can provide KII/IC during transport if mother can not a company
|
Pediatrics
| null |
Kangaroo Mother Care (KMC)
|
cove sensitization is used for
|
In cove sensitization also called as imagined punishment, the individual who wants to quit alcohol will be asked to think about adverse consequences of taking alcohol like getting arrested for drunken driving or facing a accident underintoxicated state. He would be told to dream as if if he is drunk and lies intoxicated in the road and has to be brought back to the home by family members where he will be given lot of advice from neighbours and there would be a loss of respect. While these imagined exposure the patient feels bad and makes sure thet he should quit alcohol and his thoughts ahgainst alcohol increases. Ref.kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 845
|
Anatomy
|
Treatment in psychiatry
|
alcohol use
|
A 6 month old baby brought to emergency depament with features of cardiac failure. On examination, she found to have developmental delay and a large tongue. Echocardiography shows severe concentric LVH. The most probable diagnosis is:
|
The type of glycogen storage disease that primarily involves the hea is Pompe disease (GSD IIa) in which acid maltase, necessary for hydrolysis of the outer branches of glycogen, is absent. There is marked deposition of glycogen within the myocardium. Affected infants are well at bih, but symptoms of growth and developmental delay, feeding problems, and cardiac failure occur by the sixth month of life. Physical examination reveals generalized muscular weakness, a large tongue, and cardiomegaly without significant hea murmurs. Chest radiographs reveal cardiomegaly with or without pulmonary venous congestion. The ECG shows a sho PR interval and LVH with ST depression and T-wave inversion over the left precordial leads. Echocardiography shows severe concentric LVH. Children with Pompe disease usually die before age 1 year. Death may be sudden or result from progressive HF. Ref: Darst J.R., Collins K.K., Miyamoto S.D. (2012). Chapter 20. Cardiovascular Diseases. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
|
Pediatrics
| null |
Pompe disease
|
Which of the following complement components attaches to the crystallizable fragment of immunoglobulin M ?
|
Ans. is 'c' i.e., Clqrs Only IgM and IgG activate or fix complement the classic pathway. Of the IgGs, only IgG subclasses 1, 2 and 3 fix complement; IgG4 does not.CI, which is bound to a site in the Fc region, is composed of three proteins: Clq, CI r and Cls. Clq is an aggregate of polypeptides that bind to the Fc poion of IgG and IgM.The antibody-antigen immune complex bound to CI activates C I s, which cleaves C4 and C2 to form C4b2b. The latter is an active C3 convease, which cleaves C3 molecules into two fragments: C3a and C3b.
|
Microbiology
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Clqrs
|
All of the folowing opens into middle meatus except:
|
Superior Meatus The superior meatus lies below the superior concha. It receives the openings of the posterior ethmoid sinuses.Middle MeatusThe middle meatus lies below the middle concha. It has a rounded swelling called the bulla ethmoidalis that is formed by the middle ethmoidal air sinuses, which open on its upper border.A curved opening, the hiatus semilunaris, lies just below the bulla. The maxillary sinus opens into the middle meatus through the hiatus semilunaris.The opening of the frontal air sinus is seen in the anterior pa of the hiatus semilunarisInferior MeatusThe inferior meatus is below and lateral to the inferior nasal concha; the nasolacrimal duct opens into this meatus under cover of the anterior pa of the inferior concha.
|
Anatomy
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Posterior ethmoid sinuses
|
RPD is indicated in all except
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Dental
| null |
Multiple edentulous spaces
|
Which of the following instruments is shown below?
|
Ans. (d) Slit lamp biomicroscope.
|
Ophthalmology
|
Techniques of Ocular Examination and Diagnostic Tests
|
Slit lamp biomicroscope
|
About cushing syndrome, true Is -
|
most cases the cause is bilateral adrenal hyperplasia due to hyper secretion of pituitary ACTH or ectopic production of ACTH by a non pituitary source ( Harrison 17 pg 2255)
|
Medicine
|
Endocrinology
|
ACTH secretion is the commonest cause
|
Best test for Small intestine malabsorption of carbohydrates is :
|
Answer is C (D-xylose test) D-xylose absorption test is the most commonly employed test for carbohydrate absorption - Harrison An endoscopic mucosal biopsy is the more specific test and is now considered essential. As endoscopic small intestinal biopsy' is not provided in the options 'D-xylose test' is the answer of the choke Evaluation of small intestine malabsorption of carbohydrates due to altered small intestinal mucosal function Urinary D-xylose test Non invasive test of choice Endoscopic mucosal biopsy Test of choice / preferred test `The ease of obtaining a mucosal biopsy of the small intestine by endoscopy and the false negative rate of the Dxylose test have led to its diminished use. When small intestinal disease is suspected, a small intestinal biopsy should be performed' - Harrison
|
Medicine
| null |
D-Xylose test
|
A Thirty five year old female has proximal weakness of muscles, ptosis and easy fatigability. The most sensitive test to suggest the diagnosis is -
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Medicine
| null |
Single fiber EMG
|
String sign is a radiological feature of -
|
String sign → Congenital hypertrophic pyloric stenosis, Ileocecal tuberculosis.
String sign of Kantor → Crohn's disease
String of bead sign → Small bowel obstruction
|
Radiology
| null |
Ileocecal tuberculosis
|
Alarm system (a reminder technique for digit sucking in mature children) was developed by:
|
Norton and Gellin developed 3 alarm system.
|
Dental
| null |
Norton and Gellin
|
Which level of prolactin definitely suggest hyperprolactinemia?
|
Elevations in prolactin may cause amenorrhea or galactorrhea. Amenorrhea without galactorrhea is associated with hyperprolactinemia in approximately 15% of women. In patients with both galactorrhea and amenorrhea, approximately two-thirds will have hyperprolactinemia; of those, approximately one-third will have a pituitary adenoma. In more than one-third of women with hyperprolactinemia, a radiologic abnormality consistent with a microadenoma (<1 cm) is found. Normal Prolactin levels Males: 2-20 ng/mL Females (non-pregnant): 2-30 ng/mL Pregnant females: 10-200 ng/mL A prolactin level of more than 200 ng/mL is usually due to a pituitary tumour and requires pituitary evaluation
|
Gynaecology & Obstetrics
|
Normal Menstruation, Abnormal Menstruation, Menopausal Physiology and forsight of conception
|
200 ng/mL
|
Bulge sign in knee joint is seen after how much fluid accumulation-
|
BULGE TEST is a useful method of testing when there is very little fluid in the joint.Usually occurs in medial meniscal injury. It can detect even 30 ml of fluid accumulation. After squeezing any fluid out of the suprapatellar pouch,the medial compament is emptied by pressing on the inner aspect of the joint; that hand is lifted away and the lateral side is sharply compressed-a distinct ripple is seen on the flattened medial surface as fluid is shunted across. REF:APLEY'S 9TH EDITION PAGE NO.550
|
Orthopaedics
|
Thigh, Knee,Leg,Foot & Ankle injuries
|
< 30 ml
|
An 11-year-old boy was brought to the pediatric OPD with multiple abscesses over his face, chest, and back. The child has a history of recurrentrespiratory infections. On examination, he has atopic excoriating skin and multiple cold abscesses on his back. What is the most probable diagnosis?
|
From the above clinical history and examination, the most probable diagnosis is Hyper IgE syndrome (Job's syndrome). It is an autosomal dominant primary immunodeficiency disease caused by a mutation of STAT3 gene. Neutrophils do not generate an immune response, probably due to a defect in chemotaxis. Patients present with recurrent staphylococcal skin abscesses, recurrent lung infections (pneumatoceles), eczema, eosinophilia and high serum levels of lgE. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition
|
Microbiology
|
Immunology
|
Hyper IgE syndrome
|
Material used in verterbroplasty is :
|
Ans. is 'd' i.e. Polymethyl methacrylate Vertebroplasty and kyphoplasty are interventional radiologic procedures for the treatment of the intense pain refractory to medical management or bracing caused by vertebral compression fracture associated with osteoporosis, tumors, and trauma.Vertebroplasty and kyphoplasty involve intraosseous injection of acrylic cement- polymethyl methacrylate under local anesthesia and fluoroscopic guidance.Pain reduction or elimination is immediate, and the risk of complications is low. Neither vertebroplasty nor kyphoplasty are intended for the treatment of intervertebral disc disease or arthritis.Vertebroplasty may also be applied prophylactically to an at-risk vertebra between 2 other abnormal vertebrae.Vertebroplasty does not restore the height of the compressed vertebral body. A related procedure, kyphoplasty, is intended to restore lost height by inflating a balloon pump within and between the fracture fragments prior to the infusion of the cement. Both procedures result in similar relief of pain due to vertebral compression fractures.The risks of the procedure are low and include extravasation of cement into the epidural space causing myelopathy, or fatal pulmonary embolism from extension of cement into paraspinous veins.
|
Orthopaedics
|
Management In Orthopedics
|
Polymethyl methacrylate
|
All of the following are false regarding Vacuum assisted closure Except -
|
VACUUM ASSISTED CLOSURE/NEGATIVE PRESSURE WOUND THERAPY(NPWT) NPWT promotes wound healing by applying a vacuum through a special sealed dressing. Continued vacuum draws out the fluid (interstitial fluid) from wound and increase blood flow to the area. As a result, bacterial counts decrease and cell proliferation increases, thereby creating a suitable bed for graft or flap cover. Intermittent negative pressure of -125 mm Hg appears to hasten debridement and formation of granulation tissue in chronic wounds and ulcers. Contraindications for NPWT Use Malignancy in the wound Untreated osteomyelitis Non-enteric & unexplored fistula Necrotic tissue with eschar
|
Surgery
|
General Surgery
|
Due to negative pressure , bacterial counts decrease and cell proliferation increases in the wound.
|
Which of the following is not found in cerebral palsy?
|
Cerebral palsy is a static encephalopathy and a disorder of posture and movement often associated with seizures and deficit in the motor, language, and social milestones due to insult to the developing brain.MICROCEPHALY is a feature of cerebral palsy because of insult to the developing brain.DYSTONIC CP is associated with hypotoniaEXTRAPYRAMIDAL CP is associated with ataxiaCerebral palsy is an upper motor neuron disease characterized by rigidity.Flaccid paralysis is a feature of lower motor neuron disease. Hence flaccid paralysis not a feature of cerebral palsy.Spastic cerebral palsy is the common type( 65%)Spastic CP - prognosis for normal intellectual development is good compared to other types of cerebral palsy.BIH ASPHYXIA accounts for only 8 -10% of cerebral palsy.
|
Pediatrics
|
All India exam
|
Flaccid paralysis
|
When observations are made before and after the exposure to the factor, it is -
|
Ref:Parks 23rd edition pg 852 Tests of significance: Qualitative: Chi- square : 2 or more than 2 groups Mc Nemar test : 1 group. ( before and after intervention) Quantitative: Paired T test: 1 group Student T test/ unpaired T test: 2 groups Anova: more than 2 groups.
|
Social & Preventive Medicine
|
Biostatistics
|
Paired T-Test
|
The symmetrical radiopacities marked with arrow are most likely:
|
On periapical radiographs of the mandibular central incisors, the mental ridge (protuberance) may occasionally be seen as two radiopaque lines sweeping bilaterally forward and upward toward the midline. They are of variable width and density and may be found to extend from low in the premolar area on each side up to the midline, where they lie just inferior to or are superimposed on the mandibular incisor roots. The image of the mental ridge is most prominent when the beam is directed parallel with the surface of the mental tubercle (as when using the bisecting-angle technique).
Ref: White and Pharoah, pg- 145
|
Radiology
| null |
Mental ridges
|
An absent kidney is found in
|
About 1 in 1400 people have a single kidney. Sometimes a ureter and renal pelvis are present with no kidney. The contralateral kidney is typically hyperophied. Reference: page 1282 Bailey and Love's sho practice of surgery 26th edition ( note : according to 27th edition Complete absence of one kidney occurs in 1 in 500-1000 bihs )
|
Surgery
|
Urology
|
1:1400 individuals
|
A 50 years old male presents with massive splenomegaly. His differential diagnosis will include all, except
|
Diseases Associated with massive splenmegaly.
Chronic myclogenous leukemia
Gaucher's disease
Lymphomas
Chronic lymphocytic leukemia
Hairy cell leukemia
Sarcoidosis
Myelofibrosis with myeloid metaplasia
Autoimmune hemolytic anemia
Polycythemia vera
Diffuse splenic human giomatosis
|
Pathology
| null |
Aplastic anemia
|
For cast restorations the cavity wall should have a taper of
| null |
Dental
| null |
2-5 degree
|
All of the following statements regarding nasolabial cyst are TRUE, EXCEPT:
|
Nasolabial cyst are common developmental cyst arising outside the bone in the nasolabial fold below the alae nasi. It usually affects women in their 4th to 5th decade. Microscopically the cyst is lined by non cililated pseudostratified columnar epithelium. Complete surgical excision is the treatment of choice.
|
ENT
| null |
Arises from odontoid epithelium
|
Darrier's sign is seen in -
|
Ans. is 'b' i.e., Urticaria pigmentosao Urticaria pigmentosa is a familial cutaneous disorder characterised by generalised distribution of red brown macules,o Each lesion represents a collection of mast cells in the dermis with hyperpigmentation of overlying epidermis,o The most characteristic features is that these lesions urticate on scratching.o Light scratching with the point of forceps or rounded tip of a pen or even rubbing causes these mast cells to degranulate leading to localized urticaria (become red swollen and enlarged) - Darrier's Sign Extensive release of histamine from mast cell degranulation may result in - Headache, flushing diarrhea and pruritis.
|
Skin
|
General
|
Urticaria pigmentosa
|
Melatonin is secreted by parenchymal cells of pineal gland. Fever causes:
|
Thermoregulatory centre to shift to new level
|
Physiology
| null |
Thermoregulatory centre to shift to new level
|
Which of the metabolic abnormality is seen in multiple myeloma?
| null |
Pathology
| null |
Hypercalcemia
|
An adult presented with hematemesis and upper abdominal pain. Endoscopy revealed a growth at the pyloric antrum of the stomach. CT scan showed growth involving the pyloric antrum without infiltration or invasion into surrounding structures and no evidence of distant metastasis. At laparotomy neoplastic growth was observed to involve the posterior wall of the stomach and the pancreas extending 6cm up to the tail of the pancreas. What will be the most appropriate surgical management
|
Palliative procedures like palliative paial gastrectomy, anterior gastrojejunostomy, Devine's exclusion procedure, luminal stenting in proximal inoperable growths, chemotherapy are used in inoperable cases. * In early carcinoma proper lymph nodal clearance is impoant. Antrectomy is also called as hemi-gastrectomy. Removal of 60-75% stomach is called a paial gastrectomy. Removal of more than 80% of the stomach is called a subtotal gastrectomy. Distal pancreatectomy or central pancreatectomy or total pancreatectomy for cystadenocarcinoma of pancreas depending on the extent and size of a tumour . Ref: SRB&;s manual of surgery,3 rd ed, pg no 636
|
Surgery
|
G.I.T
|
Paial gastrectomy + Distal pancreatectomy
|
Which of the following is an anti-coagulant for atrial fibrillation in a patient with prior history of stroke, with reduced risk of haemorrhage?
|
Anticoagulants are the treatment of choice in patients with atrial fibrillation and prior stroke or transient ischemic attack (TIA). Vitamin K antagonists such as warfarin have long been the mainstay of therapy, but a new set of anticoagulants has emerged as a reasonable alternative that may indeed prove to have better efficacy and a reduced risk of hemorrhage. Apixaban is one such oral direct factor Xa inhibitor; it was recently shown to be likely more effective compared with warfarin in the Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation (ARISTOTLE) trial. Clopidogrel combined with aspirin was more effective than aspirin alone in preventing vascular events, principally stroke, but increases the risk of major bleeding. Ref: 1. Easton JD et al. Apixaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: A subgroup analysis of the ARISTOTLE trial. Lancet Neurol 2012;11:503. 2. Smith W.S., English J.D., Johnston S.C. (2012). Chapter 370. Cerebrovascular Diseases. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
|
Medicine
| null |
Apixaban
|
The cause of oedema in nephritic syndrome
|
Robbins page no p922 Glomerular diseases presenting with a nephritic syn- drome are often characterized by inflammation in the glomeruli. The nephritic patient usually presents with hematuria, red cell casts in the urine, azotemia, oliguria, and mild to moderate hypeension. Proteinuria and edema are common, but these are not as severe as those encountered in the nephrotic syndrome, discussed later. The acute nephritic syndrome may occur in such multi- system diseases as SLE and microscopic polyangiitis.
|
Pathology
|
Urinary tract
|
Sodium and water retention
|
Triple assessment for carcinoma breast includes :
|
Triple assessment comprises of :
Clinical examination (palpation).
Radiological imaging (mammography or USG).
Pathological assessment (Biopsy or cytology).
|
Radiology
| null |
Clinical examination, mammography, biopsy/cytology
|
EC O157:H7, shiga toxin-producing strain of E. coli can be distinguished from other strains of E.coli by using the following medium:
|
Shiga toxin-producing E coli (STEC) are named for the cytotoxic toxins they produce. There are at least two antigenic forms of the toxin referred to as Shiga-like toxin 1 and Shiga-like toxin 2. STEC has been associated with, Hemorrhagic colitis Severe diarrhea Hemolytic uremic syndrome resulting acute renal failure Microangiopathic hemolytic anemia Thrombocytopenia Of the E coli serotypes that produce Shiga toxin, O157:H7 is the most common. STEC O157:H7 does not use sorbitol, unlike most other E coli, and is negative (clear colonies) on sorbitol MacConkey agar (sorbitol is used instead of lactose); which serves as an impoant criterion that distinguishes it from other strains of E. coli. O157:H7 strains also are negative on MUG tests. Many of the non-O157 serotypes may be sorbitol positive when grown in culture. Ref: Brooks G.F. (2013). Chapter 15. Enteric Gram-Negative Rods (Enterobacteriaceae). In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.
|
Microbiology
| null |
Sorbitol
|
Amylin is secreted by which cell of pancreas?
|
Amylin, or islet amyloid polypeptide (IAPP), is a 37-residue peptide hormone. It is cosecreted with insulin from the pancreatic b-cells in the ratio of approximately 100:1.Ref: Ganong&;s review of medical physiology 23rd edition Page no: 315
|
Physiology
|
G.I.T
|
Beta cells
|
Putrefaction process is delayed by :
|
Carbolic acid delays the process of putrefaction.
Peritonitis, ansarca, sepsis enhances the process of putrefaction.
|
Forensic Medicine
| null |
Carbolic acid
|
Initial preferred investigation for thyroid nodule is:
|
Initial investigation done in STN is thyroid function test(TFT) Investigation of choice in STN for diagnosis is FNAC Solitary Thyroid Nodule: Initial investigation done in STN is thyroid function test (TFT) If TFT is raised, next investigation is thyroid scan , (For hot nodules, RAI ablation or surgery is done; For warm or cold nodules follow-up or surgery) If TFT is normal, USG is done (Aspiration in cystic lesion, FNAC for solid or heterogenous lesions) Investigationn of choice in STN for diagnosis is FNAC. Ref: Sabiston 20th edition Pgno: 890
|
Surgery
|
Endocrinology and breast
|
Thyroid function test
|
Longest fetal diameter:
|
Ans is d, i.e. MentoverticalFetal diameters-AP diameters are always longer than Transverse diameter of fetal head.Longest diameter is-Mentovertical diameter (14 cms) followed by submentovertical diameter.
|
Gynaecology & Obstetrics
|
Fetal Skull and Maternal Pelvis
|
Mentovertical
|
Which of the following is an impoant distinguishing characteristic of H. pylori as compared to Campylobacter species?
|
Both Campylobacter and Helicobacter Belong to the family Campylobacteriaceae. Both are GNspiral-shaped or comma-shaped bacteria. Catalase and oxidase positive. Urease however, is produced only by Helicobacter.
|
Microbiology
|
Systemic Bacteriology (Haemophilus, Yersinia, Spirochaetes, Ricketssia, Chlamydia, Mycoplasma and Miscellaneous Bacteria)
|
Urease production
|
True about Hepatocellular Carcinoma ?
|
Ans. is 'c' i.e. HBV predisposes Most common cancers in the world are --> Lung > Breast > Colorectal. As already stated before, HCC presents quite late and thus only 15-20% cancers are resectable. Most patients with unresectable lesions die within a year after diagnosis.
|
Surgery
| null |
HBV predisposes
|
From A drugs which acts through inhibition of integrase activity of virus ?
|
Ans. is 'a' i.e., Raltegravir
|
Pharmacology
| null |
Raltegravir
|
A 33 yr /M has history of A, now complaints of pain left hip. On examination there is Flexion, External Rotation of left lower limb is present. There is 7 cm shoening of left lower limb, there is a gluteal mass felt which moves with the movement of femoral shaft, most probable diagnosis could be?
|
Anterior dislocation is ruled out because it will have Flexion Abduction External Rotation with lengthening and anterior femoral head (Mass that moves with femur shaft is femur head). Central dislocation is ruled out because it will have shoening and femur head palpable on per rectal examination. Posterior dislocation will have Flexion Adduction and internal rotation with shoening and gluteal femoral head. Pipkins type IV: Shoening and gluteal mass with atypical features Type I: Femoral head fracture caudal to fovea centralis. Type II: Femoral head fracture cephalad to the fovea. Type III: Femoral head fracture associated with femoral neck fracture. Type IV: Type I, II or III with associated acetabular fracture.
|
Orthopaedics
|
Pelvis and Hip Injury
|
Pipkin's type 4 fracture
|
C-reactive proteins are -
|
Ans. is 'b' i.e., Beta-1 globulin C-reactive is a nonspecific inflammatory acute phase protein. It is a beta globulin which is produced in the liver.
|
Microbiology
| null |
Beta-1 globulin
|
Wood's lamp is made up of -
|
Wood's Lamp It is a low intensity ultraviolet light(360nm) emitted by a high pressure mercury lamp fitted with a special filter made up of 9% nickel oxide and silica.
|
Dental
|
Fungal infections
|
9% nickel oxide with barium silicate
|
In carcinoid syndrome, the ap of hea mostly affected is:
|
Answer is B (Inflow tract of RV) The most commonly involved valve in, carcinoid syndrome is tricuspid valve which forms the inflow tract of Right ventricle. Most commonly involved pa of hea : Inflow tract of RV (Tricuspid valve) Second most commonly involved pa of hea : Outflow tract of RV (Pulmonic valve)
|
Medicine
| null |
Inflow tract of RV
|
Forceps used for maxillary fracture disimpaction
| null |
Surgery
| null |
Rowe's
|
Premature atherosclerosis causing death is seen in:
|
Fabry's disease is an X-linked dominant disorder. Angiokeratoma corporis diffusum is another name for it. Neuropathy usually stas in the childhood. It is overshadowed by complications arising from the associated premature atherosclerosis that lead to death by the fifth decade of life. ALSO KNOW: Fabry's disease is caused by mutations in the Alpha -galactosidase gene. There will be accumulation of ceramide trihexoside in nerves and blood vessels. Enzyme replacement therapy with alpha galactosidase B may be useful in the early stages. Ref: Harrison, Edition-18, Page-3456
|
Medicine
| null |
Fabry's disease
|
Pharmacovigilance means:
|
Pharmacovigilance has been defined by the WHO as the ''science and activities relating to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems'' The information generated by pharmacovigilance is useful in educating doctors about the adverse drug reaction and in the official regulation of drug use Ref; KD Tripathi Pharmacology 7th edition (page no:82)
|
Pharmacology
|
General pharmacology
|
Monitoring of drug safety
|
When the black band of a CPITN probe is completely visible while in gingival sulcus, it means
| null |
Dental
| null |
The individual has calculus and needs scaling and oral hygiene instructions
|
Ligament of poupart is
|
Ligament of poupart is another name for Inguinal ligament
|
Anatomy
| null |
Inguinal ligament
|
Individuals with alcoholic cirrhosis of the liver may develop severe hepatotoxicity after doses of acetaminophen that are not toxic to individuals with normal liver function. This increased sensitivity to acetaminophen's toxicity is due to :
| null |
Pharmacology
| null |
Decreased hepatocellular stores of glutathione
|
The chromosomal complement of a primary oocyte is-
|
Ans- (C) Primary oocyte
|
Gynaecology & Obstetrics
|
Obstetrical Anatomy
|
46XX
|
Most affernt fibers from the lateral geniculate nucleus terminate in the primary visual coex is:
|
Most fibers from the lateral geniculate nucleus (LGN) end in layer 4 of the primary visual coex. Ref: Ganong's Review of Medical Physiology, 22nd Edition, Page 161; Berne and Levy Physiology, 5th Edition, Page 129.
|
Physiology
| null |
Layer 4
|
A 40 year old male brought to the emergency room with a stab injury to the chest.On examination pt is found to be hemodynamically stable. The neck veins are engorged and the hea sounds are muffled .The following statements are true for this pt except -
|
Pericardial tamponade Pericardial tamponade must be differentiated from tension pneumothorax in the shocked patient with distented neck veins It is most commonly the result of penetrating trauma. Characterized by Beck's Triad (MDH) : Muffled hea sounds, distended neck veins & Hypotension Diagnosis Chest X-Ray : Enlarged hea shadow Echocardiography : ECHO is diagnostic showing fluid in the pericardial sac. Central line : Rising central venous pressure Treatment Needle pericardiocentesis can buy enough time to move to the operating room. Treatment of choice : Surgical pericardiotomy Ref: Sabiston 20th edition Pgno :1678
|
Surgery
|
Trauma
|
Emergency thoracotomy should be done
|
Nagler's reaction is shown by ?
| null |
Microbiology
| null |
Clostridium welchii
|
Using a lens of +14D, magnification of fundus of an emmetropic eye in indirect ophthalmoscopy is: March 2013 (e)
|
Ans. D i.e. 5 times
|
Ophthalmology
| null |
25 times
|
The characteristic feature of catatonic schizophrenia is
|
(D) All of the above
|
Psychiatry
|
Miscellaneous
|
All of the above
|
A diabetic with orbital cellulitis and maxillary sinusitis shows hyaline, narrow, septate and ranching hyphae with invasion of the blood vessels fungus on microscopy. Which is the causative fungus ?
|
Ans. is 'c' i.e., Aspergillus Diagnosis of Aspergillus infection: o Histologic examination of affected tissue reveals either infarction, with invasion of blood vessels by many fungal hvphae, or acute necrosis, with limited inflammation and hyphae. o Aspergillus hyphae are hyaline, narrow, and septate, with branching at 45deg: no yeast forms are present in infected tissue. o Hyphae can be seen in cytology or microscopy preparations, which therefore provide a rapid means of presumptive diagnosis.
|
ENT
|
Head & Neck Infections
|
Aspergillus
|
Partogram is used to -
|
Ans: D
|
Unknown
| null |
Assess the progress of labour
|
Mcdonald stitch is applied in the following conditions except:
|
Contraindications to Circlage operation:
Intra uterine infection
Ruptured membranes
H/o vaginal bleeding
Severe uterine irritability
Cervical dilatation > 4 cm
|
Gynaecology & Obstetrics
| null |
Placenta previa
|
In early stages, how is acute alveolar abscess is diagnosed:
|
PDL widening can be the method for diagnosing the acute alveolar abscess in early stage, while chronic alveolar abscess presents as more distinct radiographic lesion.
|
Dental
| null |
PDL widening.
|
Specific reason to disallow the sample for culture -
|
Sample brought in formalin are not allowed for culture,as it may loose it's characteristic propeies specific to that organism. Ref ananthnarayana and panikers microbiology textbook
|
Microbiology
|
general microbiology
|
Sample brought in formalin
|
The spirometer can estimate all the following except
|
The total lung capacity (TLC), about 6,000 mL, is the maximum amount of air that can fill the lungs (TLC = TV + IRV + ERV + RV Ref: guyton and hall textbook of medical physiology 12 edition page number:326,327,328
|
Physiology
|
Respiratory system
|
Total lung capacity
|
Epidural anaesthesia decrease risk of – a) Headacheb) Hypotensionc) Meningitisd) Arachnoiditis
|
As dura is not punctured in epidural anesthesia, chances of postdural puncture headache, meningitis and arachnoiditis are less.
|
Anaesthesia
| null |
acd
|
Gamma Carboxylation of what requires vitamin K
|
Biochemical functions of Vitamin K The functions of vitamin K are concerned with blood clotting process. lt brings about the post- translational (after protein biosynthesis in the cell) modification of ceain blood clotting factors. The clotting factors ll (prothrombin), Vil, lX and X are synthesized as inactive precursors (zymogens) in the liver. Vitamin K acts as a coenzyme for the carboxylation of glutamic acid residues present in the proteins and this reaction is catalysed by a carboxylase (microsomal). lt involves the conversion of glutamate (Clu) to y-carboxyglutamate (Gla) and requires vitamin K, O2 and COz. The formation of y-carboxyglutamate is inhibited by dicumarol, an anticoagulant found in spoilt sweet clover. Warfarin is a synthetic analogue that can inhibit vitamin K action Vitamin K is also required for the carboxylation of glutamic acid residues of osteocalcin, a calcium binding protein present in the bone. The mechanism of carboxylation is not fully understood. lt is known that a 2,3-epoxide derivative of vitamin K is formed as. an intermediate during the course of the reaction. Dicumarol inhibits the enzyme (reductase) that conves epoxide to active vitamin K. Ref : Biochemistry by U. Satyanarayana 3rd edition Pgno : 130
|
Biochemistry
|
All India exam
|
Glutamic Acid
|
Which of the following is not an anti androgenic drug ?
|
Ans. is 'd' i.e., Cypionate
|
Pharmacology
| null |
Cypionate
|
12 years old male presented with intensely itchy grouped vesicles on buttock, trunk and scalp. On exposure to wheat they exaggerate. Diagnosis is -
|
Ans is 'b' i.e. Dermatitis herpetiformis o Among given options only dermatitis herpetiformis is a gluten sensitivity disorder and aggravates on on eating gluten (wheat, rye, barley).Other features in favour of diagnosis areo Intense itching (characteristic feature)o Distribution of lesion - buttock, trunk and scalpo Age group - DH is commonly seen in 2nd to 3rd decade.o Has been explained in previous sessions.
|
Skin
|
Eosinophilic Dermatoses
|
Dermatitis herpetiformis
|
Causes of a painless limp in infancy includes:
|
Painless Limp Painful Limp 1-3 years age group: DDH Cerebral palsy Muscular dystrophy Infantile coxa vara 4-10 years age: Limb length discrepancy Poliomyelitis Legg Calve Pehes disease Slipped capital femoral epiphysis Osteochondritis dissecans -Lateral surface of medial femoral condyle Ahritis/Synovitis/Osteomyelitis
|
Orthopaedics
|
Pediatric Ohopedics
|
All of the above
|
Functions of plasmin are all except-
|
Ans. is 'd' i.e., Stabilization of fibrin * Plasmin is a proteolytic enzyme which belongs to serine protease family.* Its function are:-i) Fibrinolysis by break down of fibrin - It is the major function.ii) Activation of Collagenaseiii) Break down of matrix proteins (fibrin, fibronectin, thrombospondin, laminin) and von Willebrand factor.* These effects are responsible for role of plasmin in embryogenesis, wound healing, angiogenesis and tumor growth & dissemination.* Plasmin released as zymogen (inactive) form, i.e. plasminogen from liver. In circulation, plasminogen is converted into active plasmin by tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), Kallikrein and Hageman factor (factor XII).
|
Physiology
|
Heart, Circulation, and Blood
|
Stabilization of fibrin
|
What is the extent of spinal cord in an adult?
|
Ans. is 'a' i.e., Lower border of LI * Spinal cord begins at foramen magnum and, in adults, ends at lower border of LI.StructureExtends uptoAdult spinal cordInfant spinal cordLower border of L} or upper border of L2Upper border of L3 vertebraeFilum terminalePiamaterTip of coccyxDural sheathSubdural spaceSub arachnoid spaceS2 vertebra
|
Anatomy
|
Neuroanatomy
|
Lower border of L1
|
Which of the following are common physiological problems in neonates:
|
Ans. D. All of the aboveNeonates may have minor physiological peculiarities which are of no serious consequences. These include(i) Regurgitation of milk (most neonates take out small amount of curdled milk soon after feed. Child is usually active and vomitus is never yellow or green colour)(ii) Transitional stools: It is the transition from meconium to the yellow homogenous stool of a breastfed infant and is physiological(iii) Erythema toxicum: The rash usually appears on 2nd or 3rd day of life. It is scattering of erythema macules, papules and even vesicles. It occurs commonly over trunk, face and extremities and palms and soles are spared.(iv) Mongolian spots: They are pigmented lesions found at birth. The area most commonly involved is the lumbosacral region, but occasionally in the upper back, arms, buttocks and legs may be involved.(v) Neonatal Jaundice: Jaundice is common physical finding (manifesting as yellowness of the skin of the face) when serum bilirubin exceeds 5mg/dl during the first week of life. As the degree of jaundice increases, there is cephalocaudal progression. Jaundice should be considering non - physiological if it has appeared within 24 hours of age, stains palms or soles or persists beyond 10-14 days.
|
Pediatrics
|
New Born Infants
|
All of the above
|
The following is a marker of acute hepatitis B infection-
|
HBV-DNA can be measured by PCR in the blood. Viral loads are usually in excess of 105 copies/mL in the presence of active viral replication, as indicated by the presence of e antigen. In contrast, in individuals with low viral replication, who are HBsAg- and anti-HBe-positive, viral loads are less than 105 copies/mL. The exception is in patients who have a mutation in the pre-core protein, which means they cannot secrete e antigen into serum . Such individuals will be anti-HBe-positive but have a high viral load and often evidence of chronic hepatitis. These mutations are common in the Far East, and those patients affected are classified as having e antigen-negative chronic hepatitis. They respond differently to antiviral drugs from those with classical e antigen-positive chronic hepatitis. Measurement of viral load is impoant in monitoring antiviral therapy and identifying patients with pre-core mutants. Specific HBV genotypes (A-H) can also be identified using PCR. In some settings, these may be useful in guiding therapy, as genotype A tends to respond better to pegylated interferon-alfa compared to genotypes C and D. Ref Davidson edition23rd pg 875
|
Medicine
|
G.I.T
|
DNA polymerase
|
Binding of gp 120 causes:
|
Ans. b. Facilitation of co-receptor
|
Microbiology
| null |
Facilitation of co-receptor
|
Following is not a variety of entropion ?
|
Ans. is 'a' i.e., Pathological
|
Ophthalmology
| null |
Pathological
|
Tendon Xanthomas are seen in
| null |
Medicine
| null |
Familial hyper cholesterolemia
|
All or none law refers to:
|
Action potential
|
Physiology
| null |
Action potential
|
If a biochemical test gives the same reading for a sample on repeated testing, it is inferred that the measurement is:
|
Criteria of screening test
Acceptability – The test should be acceptable to population to which it is going to be applied.
Repeatability (reliability, precision, reproducibility) – The test must give consistent results when repeated more than once on the same individual or material under the same condition.
Validity (accuracy) – It refers to what extent the test accurately measures which it purports to measure. (it means it expresses the ability of a test to separate or distinguish those who have the disease from those who do not). Accuracy refers to closeness with which measured values agree with “true” value.
It has two components:
i. Sensitivity – Ability of test of identify correctly all those who have disease.
ii. Specificity – Ability to test to identify correctly all those who do not have disease.
So, if test gives the same reading for a sample on repeated testing means test is precise (i.e., reliable, reproducible, repeatable).
|
Dental
| null |
Precise
|
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