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Neural tube defect is an adverse effect of :
null
1
Valproate
Phenytoin
Diazoxide
None
Pharmacology
null
6316abad-e018-42b4-b9d7-b0b20e751322
multi
Which of the following is an example of precipitation reaction?
Precipitation is a method for detecting an antigen-antibody reaction. When antigen and antibody combine in the proper propoions, a visible precipitate is formed. Optimum antigen-antibody ratios can be produced by allowing one to diffuse into the other, most commonly through an agar matrix (immunodiffusion). Counterimmunoelectrophoresis (CIE) is a type of precipitation reaction where immunodiffusion carried out in an electrophoretic field. Both the speed and the sensitivity of immunodiffusion are improved by CIE. Ref: Ray C.G., Ryan K.J. (2010). Chapter 4. Principles of Laboratory Diagnosis of Infectious Diseases. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.
3
Widal Test
Coomb's Test
Counter Current immunoelectrophoresis
Weil-Felix Test
Microbiology
null
e0f43655-df98-48c9-81fa-9dd54f6190a3
single
Most common anomaly of upper urogenital tract is -
Ans. is 'a' i.e., Uretero pelvic junction stenosis o UPJ stenosis is most common abnormality in childhood and is more frequent in male children, characterised by narrowing usually on left side.o Overall, position & shape of kidney being most common one.o Horse shoe kidney is the most common and most frequently found renal abnormality among men.
1
Uretero pelvic junction stenosis
Ectopic uretheral opening
Ureterocele
Ectopic ureter
Pediatrics
Nephropathy
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single
Which of the following is not seen in papilledema: March 2009
Ans. D: Prominent optic disc margin Signs of papilledema: Early and mild Papilledema - Subtle gray peripapillary halo - Normal radial optic nerve head disrupted and nerve fibers accentuated by grayish opacity - Concentric folds of the retinochoroid Moderate Papilledema - Borders of optic disc become obscure - Disc margins are progressively elevated - Nerve head diameter increases - Major blood vessels leaving the disc are obscured Severe Papilledema - Optic Nerve head protrudes - Peripapillary halo demarcated Optic cup is obliterated Associated findings Loss of spontaneous retinal vein pulsations - Pulsations disappear at CSF Pressure > 250 mm water, Many normal patients lack venous pulsations (Unreliable sign) - Hyperemia - Retinal vessel touosity - Retinal hemorrhages - Retinal exudates - The radiating, oedematous folds around the macula take on the appearance of a macular star, usually incomplete and fan-shaped on the side towards the disc, while pluffy patches (cotton wool spots due to Nerve fiber infarctions) appear scattered throughout the posterior half of the fundus. - Optic Nerve pallor Papilledema shows a distended Optic Nerve sheath.
4
Marked venous engorgement
Elevation of optic disc
Cotton wool spots
Prominent optic disc margins
Ophthalmology
null
55a91596-924c-4110-8598-3df55624a477
single
Name of mumps vaccine is -
Ans. is 'a' i.e., Jeryl lynn VaccineStrainso RubellaRA27/3o MeaslesEdomonston Zagreb strain (most common) Schwarts strain Mortaten straino MumpsJeryll Lynn straino Chicken poxOKA strainoBCGDanish 1331o JENakavam strain (MC), Beizing P3 strain, SA 14-14-2o Yellow fever17 Do MalariaSPf.66,Pf25o HIVmvA (modified vaccinia ankara) rAAV (recombinant adeno associated viral) AIDSVAX Subunit vaccine strain
1
Jeryl Lynn
Edmonshon zagreb
Schw'atz
Moraten
Social & Preventive Medicine
Principles of Immunization and Vaccination
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single
Which of the following biochemical reaction is associated with substrate level phosphorylation?
Conversion of succinyl CoA to succinate is an example of substrate level phosphorylation in which a high energy phosphate is generated from the energy trapped in the thioester bond of succinyl CoA. Enzyme succinic thiokinase catalyses this step. In this reaction a molecule of GDP is phosphorylated into GTP and succinate is formed. GTP so formed is conveed into ATP by reacting with an ADP molecule. Ref: Lippincott's Biochemistry, 2nd Edition, Page 109; Textbook of Biochemistry By D M Vasudevan, 3rd Edition, Pages 75-77, 194, 204
3
Fumarate to malate
Succinate to fumarate
Succinyl CoA to Succinate
Acetoacetate to a-ketoglutarate
Biochemistry
null
173e9c95-3647-4436-9f2d-ff7bdbe64bd6
single
The sputum examination under DTP is done when the patient present with -
<p> Hemoptysis Sputum examination under TB programme is done when patient presents with -cough more than 2 weeks. -fever with an evening rise. -hemoptysis. -unexplained weight loss. -reduced appetite. Park&;s textbook of preventive and social medicine,K.Park,21st edition,page no:392, 22nd edition,page no:396. <\p>
3
Cough of 1-2 weeks duration
Persistent cough of 1-2 weeks duration
Hemoptysis
Chest pain
Social & Preventive Medicine
Communicable diseases
e0c41b18-03a7-46fc-903f-fd3996dc247a
single
Which one of the following is not an objective of trituration?
null
2
Remove oxides from powder particle surface
Keep the amount of gamma-1 or gamma-2 matrix crystals to maximum
Pulverize pellets into particles to aid in attack by mercury
Achieve a workable mass of amalgam in minimum time
Dental
null
02eeaa43-9961-4e34-a188-220d30dd5a49
single
Largest branch of veebral aery is
Anterior inferior cerebellar aery is a branch of Basilar aery
4
Anterior spinal
Posterior spinal
Anterior inferior cerebellar
Posterior inferior cerebellar
Anatomy
All India exam
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single
An orthopedician adducts the flexed hip and gently pushes the thigh posteriorly in an effort to dislocate the femoral head of a neonate. What is this maneuver called?
D i.e. Barlow testRef: Nelson, Textbook of Pediatrics, 20th edition, page 3274Developmental Dysplasia of the Hip (DDH)Ranges from simple acetabular dysplasia, acetabular dysplasia plus subluxation to dislocation of the hip joint.Two major groups:Typical (otherwise normal individuals without defined syndromes or genetic conditions); andTeratologic (with identifiable causes) - small, shallow acetabulum and a stiff hip joint at birth.1-1.5 of 1000 live births, multifactorial etiology, involving both genetic and intrauterine environmental factors.Marked geographic and racial variation (Positive family history 12-33% of affected patients).Common - female patients, left hip (maternal hormones such as relaxin, which increases ligamentous laxity) and delivered by cesarean section.High rate of association in tighter intrauterine space (oligohydramnios, large birth weight, and first pregnancy) which supports the "crowding phenomenon" theory.Untreated typical DDH have changes may include (hypertrophy of the lateral cartilage of the acetabulum (neolimbus formation), hypertrophy of the ligamentum teres, capsular laxity, hourglass constriction of the hip capsule and hypertrophy of the transverse acetabular ligament, and excess femoral anteversion).Clinical Findings:CharactersBarlow testOrtolani testIntroductionProvocative maneuver / assesses the potential for dislocation of a nondisplaced hipNonforced maneuver / reverse of Barlow test- attempt to reduce a dislocated hipMethodAdducts the flexed hip and gently pushes the thigh posteriorly in an effort to dislocate the femoral headGrasps the child's thigh between the thumb and index finger and, with the 4th and 5th fingers, lifts the greater trochanter while simultaneously abducting the hipPositive testThe hip will be felt to slide out of the acetabulum and while relaxing the proximal push, the hip can be felt to slip back into the acetabulumThe femoral head will slip into the socket with a delicate "clunk" that is palpable but usually not audible Hip click - high-pitched sensation (or sound) felt at the very end of abduction during testing for DDH with Barlow and Ortolani maneuvers (originate in the ligamentum teres or occasionally in the fascia lata or psoas tendon and do not indicate a significant hip abnormality).Hip clunk - which is felt as the hip goes in and out of joint (signifies hip abnormality).Infant (1 to 3 months of age ) - hip is no longer reducible, limited hip abduction (most reliable sign of a dislocated hip), apparent shortening of the thigh, proximal location of the greater trochanter, asymmetry of the gluteal or thigh folds and pistoning of the hip.Galeazzi sign (Shortening of the thigh): Placing both hips in 90 degrees of flexion and comparing the height of the knees, looking for asymmetry.Klisic testPlaces the 3rd finger over the greater trochanter and the index finger of the same hand on the anterior superior iliac spine.* Normal hip - an imaginary line drawn between the two fingers points to the umbilicus.* Dislocated hip - the trochanter is elevated, and the line projects halfway between the umbilicus and the pubis.Walking child-Limp (toe-walk on the affected side), a waddling gait, leg-length discrepancy, positive trendelenburg sign and excessive lordosis.Ultrasonographic Findings:In < 6 mo of age - acetabulum and proximal femur are cartilaginous and not visible on plain radiographs and are best visualized with ultrasonography,Dynamic assessment about the stability of the hip joint.Monitor acetabular development, particularly of infants in Pavlik harness treatment.Radiographic Findings:> 6 mo of age. Anteroposterior view of the pelvis - use of several classic lines drawn on itLineTypeLandmarksInterpretationHilgenreiner lineHorizontallineDrawn through the top of both triradiate cartilages (the clear area in the depth of the acetabulum).* Perpendicular to the Hilgenreiner line* Ossific nucleus of the femoral head should be located in the medial lower quadrant of the intersection of these two linesPerkins lineVerticallineThrough the most lateral ossified margin of the roof of the acetabulumShenton lineCurvedlineDrawn from the medial aspect of the femoral neck to the lower border of the superior pubic ramus* Line is a continuous contour - normal* Two separate arcs / "broken" - in DDHAcetabular indexAngleFormed between the Hilgenreiner line and a line drawn from the depth of the acetabular socket to the most lateral ossified margin of the roof of the acetabulum (angle measures the development of the osseous roof of the acetabulum)* Newborn, the acetabular index can be up to 40 degrees* By 4 months in the normal infant, it should be no more than 30 degreesIn older childCenter-edge angleAngleFormed at the juncture of the Perkins line and a line connecting the lateral margin of the acetabulum to the center of the femoral head* 6-13 years old, an angle >19 degrees - normal* >14 years and older, an angle >25 degrees - normal Treatment Goals: Obtain and maintain a concentric reduction of the femoral head within the acetabulum.AgeTreatment< 6 months of age* Triple diapers or abduction diapers no role.* Pavlik harness - In normal newborns with all degrees of hip dysplasia.* Other braces - von Rosen splint, Frejka pillow.* 1 and 6 mo of age - Pavlik harness (full-time basis for 6 weeks), hip instability resolves in 95% of cases.* 6 months of age, the failure rate for the Pavlik harness is >50% (increasingly active and crawling child).6 months to 2 years* Closed reductions under general anesthesia. And casting in human position of moderate flexion and abduction for 12 weeks.* The replaced by an abduction orthotic device for 2 months (until acetabular development is normal).* Failure to obtain a stable hip needs open reduction.Older than 2 years of age* Open reduction is usually necessary.Sequlae: Avascular necrosis of the Capital Femoral epiphysis (< 6 months of age), redislocation, residual subluxation, and acetabular dysplasia.
4
Galeazzi sign
Ortoloni test
Telescopic sign
Barlow test
Pediatrics
Musculo Skeletal Disorders
21900172-c8a3-4d27-a63d-2314f81180ca
multi
True statement regarding ectopic pregnancy:
If the serum beta hcg value is 1500 IU/L and an intrauterine pregnancy is not visualized in a TVS it is likely to be an ectopic .This is the level at which intrauterine gestational sac is seen and is called discriminatory zone (refer pgno:159 sheila 2 nd edition)
1
Serum progesterone >25 ng/ml exclude ectopic
p-hCG levels should be >1000 mlU/ml for earliest detection by TVS
p-hCG levels should be <1000 mlU/ml for earliest detection by TVS
Methotrexate is not used for treatment
Gynaecology & Obstetrics
General obstetrics
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multi
The Vitamin A activity of beta-carotene compared to that of retinol is?
Beta-Carotene (provitamin A): This is found in plant foods. lt is cleaved in the intestine to produce two moles of  retinal. ln humans, this conversion is inefficient, hence beta-carotene possesses about  one-sixth vitamin A activity compared to that of retinol. Reference: Satyanarayana- Biochemistry, 3rd edition, pg-119
3
2-Jan
4-Jan
6-Jan
8-Jan
Biochemistry
null
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single
Prinzmetal angina is-
null
3
Angina after extreme exertion
Caused due to atherosclerotic blockade
Caused due to spasm of artery
Calcium channel blockers not effective
Medicine
null
0043c505-6981-48a9-93d1-981bf8a8b272
single
Insulin causes all of the following except
Refer Katzung 11/e p 731 Insulin inhibits the formation of ketone bodies, therefore it's deficiency can result in diabetic ketoacidosis
4
Glycogenesis
Glycolysiis
Lipogenesis
Ketogenesis
Pharmacology
Endocrinology
19a2cadb-4995-4b8e-8068-0484bd4b09cf
multi
True statement about fatty acid:
C, B, > A i.e. (Hydrogenated vegetable oils contains Trans fatty acid; Biologically arachidonic acid is essential to life >Polyunsaturated FA is essential for membrane structure)
4
Polyunsaturated FA is essential for membrane structure
Biologically arachidonic acid is essential to life
Hydrogenated vegetable oils contains Trans fatty acid
All
Biochemistry
null
c82a5657-0e2f-48c1-b32c-fb52e34d41ca
multi
Which of the following can cause toxic megacolon in 36 year old lady?
The hallmarks of toxic megacolon (toxic colitis), a potentially lethal condition, are nonobstructive colonic dilatation larger than 6cm and signs of systemic toxicity. The impoant etiologies of toxic megacolon include the following inflammatory causes: Ulcerative colitis Crohn colitis Pseudomembranous colitis The complication of toxic megacolon is perforation, even in the absence of colonic dilatation.
3
Amoebic colitis
IBS
Ulcerative colitis
Viral diarrhea
Surgery
null
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single
Percentage of cold nodules that becomes malignant are?
ANSWER: (C) 20 %REF: Bailey and love 25th ed page 779See details of thyroid nodules in Surgery June 2011About 80% of discrete swellings are cold. The risk of malignancy is higher in "cold" lesions (20%) compared to "hot" or "warm" lesions (<5%).
3
5%
15%
20%
40%
Surgery
Evaluation of a Thyroid Nodule
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single
In a rural clinic, a 3 year old girl child is brought by her mother and is emaciated. Her Hb was 5g/ dl. The girls also had edema over her knees and ankle, with discrete rash on her knees, angles and elbows. The most likely worm infestation causing these manifestations is?
null
1
Hook worm
Round worm
Whip worm
Pin worm
Microbiology
null
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Long acting beta agonist used once a day:
Ans. C. IndacaterolRef: Katzung's Basic and Clinical Pharmacology 13th/ed, p340ExplanationAns. c. Indacaterol Ref: Katzung's Basic and Clinical Pharmacology 13th/ed, p340Explanationb agonistFeatures* Albuterol (salbutamol)* Terbutaline* Metaproterenol* Pirbuterol* Metered-dose inhalers* Bronchodilation is maximal within 15-30 minutes and persists for 3-4 hours.Frequent administrations required based on clinical status.* Can be given by nebulizer if using metered dose is not possible.* Albuterol and terbutaline are also available in tablet form (2 to 3 times daily) (option d), no added advantage therefore prescribed rarely. * Only terbutaline is available for subcutaneous injection; useful in severe asthma requiring emergency treatment when aerosolized therapy is not available or has been ineffective; CAUTION: Due to its longer duration of action cumulative effects may be seen after repeated injections.Bambuterol* It is prodrug of terbutaline.* Slowly hydorlyzed by pseudocholinesterase to release the active drug over a period of 24 hours.* Available in tablet form and given once daily.Long acting: Salme-Terol* Formoterol* Arformoterol* Carmoterol* Salmeterol a partial agonist and formoterol a full agonist.* Duration of action: 12 hours or more; used 2 times daily (options a,b,e).* In asthma should not be used as monotherapy; interact with inhaled corticosteroids to improve asthma control.Indacaterol* Ultra long acting p2 agonist; used once daily (Answer)* Approved for once daily long-term treatment of COPD and not for asthma and not for acute exacerbations of COPD.
3
Salmeterol
Formoterol
Indacaterol
Terbutaline
Pharmacology
Asthma
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Essential for tumor metastasis is-
Angiogenesis is the mechanism of formation of new blood vessels. It is very critical in establishing the metastasis at the new area. Basic Pathology, Robbins. Page no.: 194
1
Angiogenesis
Tumorogenesis
Apoptosis
Inhibition of Tyrosine kinase activity
Pathology
General pathology
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Large dose of EDTA are used in carbonic anhydrase enzyme inactivation. The mechanism by which EDTA act is -
Ans. is 'a' i.e., It chelates with metal ions of the enzyme o EDTA is a chelating agent and it has already been explained that chelating agent has legands (reactive groups) for metal binding. o These ligands of chelating agent bind to metal ions and cause chelation. o EDTA binds to zinc ion of carbonic anhydrase and this results in formation of ternary complex involving the enzyme, chelating agent and metal ions. The formation of ternary complex results in inactivation of enzyme.
1
It chelates with the metal ions of the enzyme
It combines with the substrate and reacts with the enzyme
Combines with the substrate and doesn't react with the enzyme
Enzyme-EDTA complex can not be attached to substrate
Pharmacology
null
68ffc131-c9b4-4bf2-93a7-5f3eb14f9ec6
single
Drug contraindicated in hyperiglyceridemia
Bile acid binding resins like cholestyramine causes increase in triglycerides and are thus contraindicated in patients with hyperiglyceridemia due to risk of development of pancreatitis. Statins - decrease LDL and increase HDL Niacin - decrease LDL and triglyceride, maximum increase in HDL Fibrates - decrease triglyceride, decrease LDL.
4
Fibrates
Simvastatin
Niacin
Cholestyramine
Pharmacology
Hypeension, Arrhythmias, Dyslipidemia
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Culture media for transport of stools in suspected case of shigellosis -
Ans. is 'd' i.e., Buffered glycorol salineOrganismTransport mediaStreptococcus pyogenesPike's mediumNeisseriaStuart's medium, Amies mediumFor stool specimenBuffered glycerol saline, Carly-Blair, Stuart mediumSalmonella, ShigellaSach's buffered glycerol salineV choleraeVR medium, Cary-Blair medium, Autoclaved sea waterBordetellaModified Stuart's, Mischulow's charcol agar
4
Deoxycholate medium
Blood agar
Nutrient broth
Buffered glycerol saline
Microbiology
Enterobecteriaceae
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All are true about SLE in pregnancy except?
Increased anti Ro and La implies high risk of congenital hea block. Anti Ro antibody can be transmitted transplacentally and can lead to complete hea block leading to neonatal lupus. Steroids can be given in pregnancy as they fall in category A with no evidence of teratogenicity. But a placental enzyme 11 dehydrogenase deactivates glucocoicoids. Presence of anti-cardiolipin antibody and anti beta 2 glycoprotein antibody can lead to uterine aery or venous thrombosis leading to recurrent aboions. Most women can tolerate pregnancy without flare but it can worsen in some requiring aggressive treatment. All autoimmune diseases can worsen in pregnancy except rheumatoid ahritis.
1
Increased anti Ro and La implies low risk for congenital hea block
Steroids can be continued in pregnancy
Recurrent aboions
Disease may worsen during pregnancy
Medicine
Systemic Lupus Erythematous
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An orbital tumor has the following characteristics: Retrobulbar location within the muscle cone, well defined capsule, presents with slowly progressive proptosis, easily resectable, occurs most commonly in the 2" to 4th decade. The diagnosis is:
Cavernous hemangioma Cavernous hemangioma is the most common benign, intraconal tumor in adults. Hemangiopericytoma is also retro bulbar intraconal lesion. found in adults but is a rare tumor. Moreover owing to its tendency to invade the adjacent tissues, its margins are less distinct than cavernous hemangioma. Rest 2 options i.e. Dermoid and Capillary hemangiomas are primarily extraconal lesions. Cavernous hemangioma Cavernous hemangioma is the most common orbital vascular tumor in adults. Patients are typically middle aged (2nd to 4th decade) Present with slowly progressive painless proptosis Mostly its intraconal (>80%) but may also be extraconal. Cavernous hetnangiomas possess a distinct fibrous pseudo capsule and therefore on CT and MR appear well defined masses. Cavernous hemangioma is easily resectable as it is: - well encapsulated - does not have a prominent aerial supply (in contrast to capillary hemangioma) Capillary hemangioma Capillary hemangiomas occur primarily in infants. The tumor often increases in size for 6 to 10 months and then gradually involutes. Mostly extraconal, commonly occur in superior nasal quadrant. Capillary hemangiomas in and around the orbit may have an aerial supply from either the external carotid or internal carotid aeries. These tumors are capable of profuse bleeding. On CT and MR these lesions appear fairly well marginated to poorly marginated. Hemangiopericytomas Hemangiopericytomas are rare, slow growing vascular neoplasms that arise from the pericytes of Zimmermann, which normally envelop capillaries. About 50% cases are malignant. On CT and MR the orbital hemangiopericytoma, in contrast to cavernous hemangioma, appear less distint owing to its tendency to invade the surrounding tissues. Angiography may differentiate the tumors from cavernous hemangioma, meningioma, and schwannoma. - Hemangiopericytomas usually have an early florid blush - Cavernous hemangiomas show late minor pooling of contrast, or often appear as avascular masses - Meningiomas may show multiple tumor vessels and a late blush - Schwannomas may show no tumor blush. Dermoid Dermoid and epidermoids are the most frequent development cysts of the orbit. They result from the inclusion of ectodermal elements during closure of the neural tube. The dermoid contains one or more dermal adnexal structures such as sebaceous glands and hair folliclels. Dermoids are extraconal lesions. mostly located at the superior temporal quadrant of the orbit. On CT or MR demonstration offat within the lesion is almost diagnostic of dermoid.
4
Hemangiopericytoma
Dermoid
Capillary hemangioma
Cavernous hemangioma
Ophthalmology
null
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Cillia can transport radiolabelled particle in antrum with:
Cilia can transport radiolabeled particles an average of 6mm/min, with a range of 1-20mm/min. Thus this transport can clear inhaled particles from nasal cavity in 10-20 min.
3
1-20dm/min
20-30mm/sec
1-20mm/ min.
20-30mm/min
Surgery
null
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Following can lead to osteomalacia EXCEPT-
Calcium is the most abundant cation in the body and powerful homeostatic mechanisms control circulating ionised calcium levels . The WHO's dietary guidelines for calcium differ between countries, with higher intakes usually recommended in places with higher fracture prevalence. Between 20% and 30% of calcium in the diet is absorbed, depending on vitamin D status and food source. Calcium requirements depend on phosphorus intakes, with an optimum molar ratio (Ca:P) of 1 : 1. Excessive phosphorus intakes (e.g. 1-1.5 g/day) with a Ca:P of 1 : 3 have been shown to cause hypocalcaemia and secondary hyperparathyroidism Calcium absorption may be impaired in vitamin D deficiency and in malabsorption secondary to small intestinal disease. Calcium deficiency causes impaired bone mineralisation and can lead to osteomalacia in adults. Too much calcium can lead to constipation, and toxicity has been observed in 'milk-alkali syndrome' Ref Harrison 20th edition pg 78
2
Vit D deficiency
Phosphorus deficiency in diet
Gastrectomy
Lack of exposure to sunlight
Medicine
Nutrition
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All the following inflammatory mediators are derived from the cells except
. Kinins
1
Kinins
Cytokines
Histamine
Leukotriene
Pathology
null
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Investigation of choice for subdural hemorrhage is?
Ans. (b) NCCTRef Appendix-81 for "Traumatic intracranial hemotomas
2
Angiography
NCCT
CECT
MRI
Radiology
Brain Imaging: Anatomy, Trauma, and Tumors
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Hydatid disease of liver is caused by -
The larval stage is present in the animals including man,giving rise to hydatid cyst.Sheep ,pigs,cattle ,horse ,goat and man may act as intermediate host. Hydatid cyst involve liver , lung,brain,hea,kidney,spleen,bone,musclesetc. Liver is the commonest site and right lobe is frequently involved.The disease remains symptomless for many years.Chronic abdominal discomfo may be present in case of liver cyst.Cyst in the lungs are asympotomatic but may cause cough , breathlessness or chest pain (refer pgno:107 baveja 3 rd edition,panikers textbook of Medical parasitology 8th edition page 131)
2
Strongyloides
Echinococcus granulosus
Taenia solium
Trichinella spiralis
Microbiology
parasitology
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A 30-year-old man has had cramping abdominal pain and bloody diarrhea for the past 4 days. On physical examination, there is diffuse tenderness on palpation of the abdomen. Bowel sounds are present. There are no masses and no organomegaly. A stool culture is positive for Shigella flexneri. The episode resolves spontaneously within 1 week after onset. Six weeks later, he has increasingly severe lower back pain. Physical examination now shows stiffness of the lumbar spine and tenderness of the sacroiliac joints. He is treated with nonsteroidal anti-inflammatory agents. Two months later, the back pain recurs, and he complains of redness of the right eye and blurred vision. Serologic testing for which of the following is most likely to be positive in this patient?
This patient developed enteritis-associated arthritis affecting the lumbar and sacroiliac joints several weeks after Shigella dysentery. He subsequently developed conjunctivitis and, most likely, uveitis. This symptom complex is a classic representation of a cluster of related disorders called seronegative spondyloarthropathies. This cluster includes ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and enteropathic arthritis (as in this case). A common feature is a very strong association with the HLA-B27 genotype. Despite some similarities with rheumatoid arthritis, these patients invariably have a negative test result for rheumatoid factor. Urethritis caused by Chlamydia trachomatis can trigger reactive arthritis, another form of seronegative spondyloarthropathy. Such infection precedes the onset of arthritis, however. There is no relationship between infection with Borrelia burgdorferi, the causative agent of Lyme disease, and reactive arthritis in individuals testing positive for HLA-B27. Similarly, Epstein-Barr virus infection is not a trigger for these disorders.
4
Borrelia burgdorferi
Chlamydia trachomatis
Epstein-Barr virus
HLA-B27
Pathology
Osteology
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Radiolucent periapical lesions have the following except
The features of periapical inflammatory lesions vary depending on the time course of the lesion. More chronic lesions may show lytic (radiolucent) or sclerotic (radiopaque) changes, or both. The lamina dura around the apex of the tooth usually is lost.  In most instances, the periphery of periapical inflammatory lesions is ill defined, showing a gradual transition from the surrounding normal trabecular pattern into the abnormal bone pattern of the lesion. In chronic cases, the new bone formation may result in a very dense sclerotic region of bone, obscuring individual trabeculae.    Oral radiology ; White and Pharaoh 7th edition page no 316-317
3
Absence of lamina dura
Hanging drop of oil effect
Opaque diffuse appearance
No movement on cone shift
Radiology
null
a3f66cbc-7ab6-452f-89c9-6cd2f11a0289
multi
Biological value of proteins refers to the
null
1
Proteins efficiency ratio
Proteins biologic value
Protein energy ratio
Calorific value
Biochemistry
null
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single
All are risk factors for preterm delivery except :
Absence of fetal fibronectin at < 37 weeks
1
Absence of fetal fibronectin at < 37 weeks
Previous history of preterm baby
Asymptomatic cervical dilatation
Chylamydial infection of genital tract
Gynaecology & Obstetrics
null
6e03305d-8eb7-4eed-ac9e-1e7185e28458
multi
Antitumor activity is shown by all except -
Ananthanarayanan and Paniker's textbook of microbiology 9th edition. cytotoxic T cells can kill and lyse target cells carrying new or foreign antigens including tumor,allograft and virus infected cells. Natural killer cells are natural defence against virus infected and malignant mutant cells. activated macrophages secrete a number of biologically active substances including hydrolytic enzymes , TNF , Colony stimulating factor and IL 1. This they have tumor cytotoxicity..
3
Cytotoxic T lymphocytes
Natural killer cells
Basophils
Macrophages
Pathology
General pathology
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multi
Immunoglobulins are produced by -
Immunoglobulin (Ig),is a large, Y-shaped protein produced mainly by plasma cells that is used by the immune systema Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:94
2
Macrophages
B-cells
T-cells
NK-cells
Microbiology
Immunology
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single
Single most important feature to diagnose fetal aneuploidy:
Ans: (a) Increased nuchal translucencyRef: Current Progress in Obstetrics and Gynecology, John Stud, Volume Page 17Ultrasound markers of fetal aneuploidy:Nuchal translucency is the single most powerful tool. More than 3 mm needs evaluationAbsence of nasal boneAbsence or reversal of flow in the ductus venosus on DopplerTricuspid regurgitationIncrease in frontomaxillary angle more than 85 deg
1
Increased nuchal translucency
Absent nasal bone
Cystic hygroma
Abnormal ductus venosus flow
Gynaecology & Obstetrics
Physiology & Histology
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single
Ponderal's index for "small for gestational age" child: March 2013
Ans. B i.e. Less than 2 Ponderal Index (for neonates) Calculated as Weight in gm X 100/ (length in cm)3 A child with ponderal index 3.0 or more can be considered overweight but in some conditions such as in maternal smoking, reduced length may also be implicated. An index between 2.5 and 3.0 is considered normal, Between 2.0 and 2.5 marginal, and A child with this index less than 2.0 is classified as small for gestational age (SGA).
2
Less than 1
Less than 2
Less than 3
Less than 4
Pediatrics
null
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multi
Earnest Klein has classified habits into
null
2
Compulsive and non-compulsive habits
Intentional and non-intentional habits
Primary and secondary habits
Pressure and non-pressure habits
Dental
null
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single
Suspended animation is seen with -a) Electrocutionb) Strangulation hangingc) Drowningd) Burn
null
4
a
bc
ad
ac
Forensic Medicine
null
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single
According to European laryngeal Society, Subligamental cordectomy is classified as
Subligamental cordectomy is classified as Type II Excision of vocal cord after splitting the larynx (cordectomy laryngofissure) Ref: PL Dhingra; Textbook of EAR, NOSE and THROAT; edition 6; page no 310
2
Type I
Type II
Type III
Type IV
ENT
Larynx
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Infeility can be defined as: UP 11; KCET 13
Ans. Not conceiving after 1 year of unprotected intercourse
3
Not conceiving after 3 years of marriage
Not conceiving after 2 years of unprotected intercourse
Not conceiving after 1 year of unprotected intercourse
Not conceiving after 1 year of marriage
Forensic Medicine
null
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The commonest cause of primary amenorrhea with ambiguous genitalia in a female with 46XX chromosome :
A i.e. 21- hydroxylase deficiencyClassic 21 - hydroxylase deficiency is most common cause of ambiguous genitalia in new born (virilization) and primary amenorrheaQ. i.e. Pseudohermaphroditism of female childPrimary amenorrhea with VirilizationQ in females is in:- 21 - hydroxylase deficiency- 11 - Hydroxylase deficiencyTypesMain function ofenzymeMineralococoid(M)Glucocoicoid(G)AndrogenFeatures21- OH-deficiencyGlucocoicoid &Mineralocoicoidproduction U"l'* HypotensionQ(salt losing virilization)* VirilizationQ in females* Precocious pubey in femalesQ.11 hydroxylase-deficiencyGlucocoicoidproductionT.1.1,T* HypeensionQ* VirilizationQ in females* Precocious pubey in femalesQ.17- hydroxylasedeficiencyGlucocoicoid &Androgen production'1'.1,14* Male hermaphroditeQ* Primary atnenorrhea infemalesQ.* HypeensionQ3 - p-hydroxylasedeficiencyMineralcoicoid &glucocoicoidproduction..1,.1,T* Male hermaphrodite.
1
21 hydroxylase def.
17 hydroxylase def.
11 hydroxylase def.
Desmolase hydrolase def
Physiology
null
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While going for oxidation in the mitochondria, free fatty acid are transpoed by:
Free fatty acids (FFA)-also called unesterified (UFA) or nonesterified (NEFA) fatty acids--are fatty acids that are in the unesterified state. In plasma, longer chain FFA are combined with albumin, and in the cell they are attached to a fatty acid binding protein. Shoer chain fatty acids are more water-soluble and exist as the unionized acid or as a fatty acid anion. Ref: Botham K.M., Mayes P.A. (2011). Chapter 22. Oxidation of Fatty Acids: Ketogenesis. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.
2
None of the above
Albumin
Globulins
Chylomicrons
Biochemistry
null
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multi
Sepsis of index finger will spread to?
Ans. a (Thenar).Deep thenar space infection occurs in the potential space between the palmar aponeurosis and the fascia overlying adductor policis, which contains not only the flexor pollicis longus tendon plus the neurovascular (NV) bundles to the thumb, but also the NV bundle on the radial side of the index plus the flexor tendons of the index. Therefore, a deep thenar space infection can involve both the thumb and the index finger.The pollical sheath extends distally almost to its insertion, and that part of the common sheath for the little finger usually does likewise. The ring, middle, and index fingers are provided with digital sheaths that usually extend proximally no further than the necks of their metacarpal bones, leaving a gap of 1 to 3 cm below the common sheath. Hence infection of the synovial sheaths of the thumb or little finger may spread along tendon sheaths readily into the palm and even into the forearm.Also remember:Hypothenar musclesMuscle Origin Insertion InnervationActionAbductor digiti minimi Pisiform}Medial side of}} Abducts little fingerFlexor digiti minimi brevis}Hooks of hamate}proximal phalanxDeep branch of ulnarFlexes little fingerOpponens digiti minimi Front of 5th metacarpal Draws 5th metacarpal forwardPalmaris brevis Medial border of palmar aponeurosis Skin on medial side of hand Superficialbranch of ulnarDeepens hollow of palm & protects ulnar nerve & arteryThenar MusclesMuscles Origin Insertion InnervationActionAbductor pollicis brevis}Flexor ratinaculum}Lateral sesamoid &} Abducts thumb Flexes thumbFlexor pollicis brevis}& tubercle of trapezium}base of proximal phalanx}Recurrent branch of medianRotates 1st metacarpalOpponens pollicis Lateral side of 1st metacarpal- mediallyAdductor pollicis Capitate, trapezoid, base of 2nd metacarpal {oblique head) & front of 3rd metacarpal (transverse head) Medial sesamoid & base of proximal phalanx Deep branch of ulnarAdducts thumb
1
Thenar
Mid-palmar
Hypothenar
All of the above
Anatomy
Upper Extremity
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Spherocytosis of RBC is a common feature in -
null
1
G6PD deficiency
Sickle cell anemia
CML
All
Pathology
null
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multi
Defective chromosome associated with De-George syndrome is -
Ans. is 'd' i.e., 22 This syndrome encompasses a spectrum of disorders that result from a small deletion of band q 11.2 on long arm of chromosome 22. Clinical features are considered to represent two different disorders :-1) Di George syndromeThese patients have thymic hypoplasia with resultant T-cell immunodeficiency.Other features include parathyroid hypoplasia (causing hypocalcemia), cardiac malformations & facial anomalies.TBX-1 gene (a T-box transcription factor) is most closely associated with this syndrome.The target of TBX-1 include PAX 9, a gene that controls the development of the palate, parathyroid and thymus.2) Veto cardio facial sndromeThis syndrome is characterized by facial dysmorphism (prominant nose, retrognathia), cleft palate, cardiovascular anomalies, and learning disabilities.
4
7
15
17
22
Pathology
null
267e7535-dabf-4ff2-9ebf-04da0201aedf
single
all are true about s1 except
CHARACTERISTICS OF S1 Normally heard as fused single hea sound Medium to High Frequency Low Pitched Best heard with diaphragm M1 louder than T1 M1 best heard at apex T1 best heard at Left LSB Splitting can be heard in Expiration and L-LSB ref : harrisons 21st ed
3
lower frequency than s2
caused by closure of mitral valve
heard at the end of ventricular systole
better heard with diaphragm of stethescope
Medicine
All India exam
b875cad7-bec7-49ca-9cc2-76451f3f6717
multi
Central dot sign is seen in
"central dot" sign: enhancing dots within the dilated intrahepatic bile ducts, representing poal radicles (seen in CT).
3
Primary sclerosing cholangitis
Liver Hamaoma
Caroli's disease
Polycystic liver disease
Surgery
G.I.T
fcde14ea-557e-4cb0-b76b-612c6bd8a847
single
Which of the following is/are an example(s) of non-Mendelian inheritance?
Single-Gene Disorders with Non classic Inheritance. -This group of disorders can be classified into four categories: Diseases caused by trinucleotide-repeat mutations Disorders caused by mutations in mitochondrial genes Disorders associated with genomic imprinting Disorders associated with gonadal mosaicism
4
Genomic imprinting
Uniparental disomy
Mitochondrial inheritance
All of the above
Pathology
Introduction
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multi
The period of training for a village health guide is -
After selection village health guide undergoes a sho training in primary health care.The training is arranged in nearby health center,subcenter or any other suitable place for the duration of 200 hours ,spread over a period of 3 months.During training period they receive a stipend of Rs 200 per month (refer pgno:902 park 23rd edition)
2
1 month
3 months
6 months
12 months
Social & Preventive Medicine
Health care of community & international health
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single
Which of the following minerals does not act as prosthetic group in enzymes?
null
4
Copper
Cobalt
Selenium
Manganese
Biochemistry
null
07144811-37a0-4e2f-9ec5-140606e88a64
single
A 50 year old man presents with paresthesia. Hb = 6.8 gms/dl. Peripheral smear shows macrocytes and neutrophis with hypersegmented nuclei. Endoscopy reveals atroghic gastritis. Which of the following deficiency is more likely?
above clinical features point towards Vit B12 deficiency due to Pernicious anemia. Pernicious anemia -Type II Hypersensitivityin which ABs are formedagainst intrinsic factorthus inhibits the binding of IF+B12. Intrinsic factor deficiency-Malabsorption of vitamin B12 - Megaloblastic anemia /Pernicious anemia
2
Fotate deficiency
Vitamin B12 deficiency
Riboliavan deficiency
Fotate deficiency
Physiology
NEET Jan 2020
bb4074ae-1c8d-4a32-b221-873eaba4900b
single
Which of the following is a stage of intuitive thought appearance in jean-Piaget scheme :
C i.e. Preoperational stage
3
Senosorimotor
Concrete
Preoperational stage
Formal operations stage
Psychiatry
null
9f1e7890-c902-4f64-8379-bc27b4a6640b
single
Normal IOP is range is ____________
null
3
10 - 15 mmHg
5 - 10 mmHg
11 - 21 mmHg
9 - 25 mmHg
Ophthalmology
null
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single
An expectant mother feels quickening at :
In second trimester the pregnant women feels much better ,the nausea vomiting and bladder frequency is almost gone She slowly stas feeling growing uterus per abdomen Of interest and excitement to her is the very first perception of foetal movement called quickening felt at around 18 weeks in a primigravida and 16 -18 wks in a multigravida (refer pgno:90 Sheila 2 nd edition)
2
12-14 weeks
16-20 weeks
26 weeks
24-28 weeks
Gynaecology & Obstetrics
General obstetrics
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single
Renal transplantation, in which mother acts as a donor of one kidney to her son is an example of
Ans. is 'c' i.e., Allograft Transplantation terminologyAutograft:Tissue transplanted from one part of the body to another in the same individual.Also called an autotransplant.Isograft:Is a graft of tissue between two individuals who are genetically identical (i.e. monozygotic twins). Transplant rejection between two such individuals virtually never occurs.Allograft:An organ or tissue transplanted from one individual to another.
3
Autograft
Heterograft
Allograft
Xenograft
Surgery
Transplantation
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multi
Giving commission to other doctor is -
null
1
Dichotomy
Covering
Professional secrecy
Professional neglect
Forensic Medicine
null
16946f6b-bae0-4dbd-a61d-66b4cfb8def6
single
All of the following statements about Zenker's diveiculum are true Except:
Ans is D i.e. Out pouching of the anterior pharyngeal wall, just above the cricopharyngeus muscle Zenker's diveiculum is out pouching of the posterior pharyngeal wall, where pharyngeal mucosa herniates through the Killian's dehiscence (the weak area between the upper oblique fibres and the lower horizontal fibres of the inferior constrictor muscle). Zenker's diveiculum is an acquired diveiculum and not a congenital diveiculum. It's a false diveiculum as it does not contain all the anatomic layers of the oesophageal wall. Barium swallows are diagnostic. Lateral views are essential as these are posterior outpouchings.
4
Acquired diveiculum
Lateral X-rays on Barium swallow are often diagnostic
False Diveiculum
Out pouching of the anterior pharyngeal wall, just above the cricopharyngeus muscle
Surgery
null
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multi
The administration of succinylcholine to a paraplegic patient led to appearance of dysarrythmias, conduction abnormalities and finally cardiac arrest. The most likely cause is :
null
2
Hypercalcemia
Hyperkalemia
Anaphylaxis
Hypermagnesemia
Pharmacology
null
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multi
The blood pressure measured by a sphygmomanometer
At the point at which systolic pressure in the aery just exceeds the cuff pressure, a spu of blood passes through with each heabeat and, synchronously with each beat, a tapping sound is heard below the cuff.Ref: Ganong&;s Review of Medical Physiology 25th Edition. Page: 577
2
Is lower than the intraaerial pressure
Is higher than the intraaerial pressure
Is same as the intraaerial pressure
Is the same with different cuff sizes
Physiology
Cardiovascular system
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single
A decrease in basal metabolic rate (BMR) is seen in which of the conditions?
Obesity by definition is an increase in the amount of adipose tissue mass or fat mass. Adipose tissue is relatively ine from a metabolic rate. Basal metabolic rate depends on the amount of metabolically active tissue or the lean body mass. An obese individual has higher propoion of fat relative to lean body mass than a non- obese individual with the same weight, and hence a lower basal metabolic rate. Ref: Understanding Nutrition By Ellie Whitney, Eleanor Noss Whitney, Sharon Rady Rolfes, Page 246; Biochemistry By Debajyoti Das, Page 570.
1
Obesity
Hypehyroidism
Feeding
Exercise
Physiology
null
77ec9a20-6182-4caf-9b12-a79941858aca
single
Patient with fixed dilated pupil, with iris atrophy and secondary glaucoma after penetrating keratoplasty is suggestive of.
Ans. d. Urrets Zavalia syndrome A fixed dilated pupil following penetrating keratoplasty is a well recognized if rare postoperative complication. The mydriasis following penetrating keratoplasty was first described by Castroviejo but it was Urrets-Zavalia who first published his observations on a series of six cases and suggested an association of fixed dilated pupil, iris atrophy. and secondary glaucoma. The pupil can become abnormally dilated following penetrating keratoplasty for keratoconus, paicularly if dilating drops are used. In addition to the pupil and iris abnormalities, Urrets-Zavalia also described other features__ iris ectropion, pigment dispersion, anterior subcapsular cataract and posterior synechiae. Urrets Zavalia Syndrome Urrets Zavalia Syndrome is characterized by triad of: Secondary glaucoma + Iris atrophy + Fixed dilated pupil') Urrets-Zavalia syndrome (UZS) consists of a fixed dilated pupil associated with iris atrophy. It is a poorly understood complication following penetrating keratoplasty for keratoconus. Posner Shlossman syndrome It is also called as glaucomatocyclitic crisis. Episodic unilateral mild anterior uveitis, photophobia, reduced vision and colored rings around lights (from secondary corneal edema Benedict's Syndrome If red nucleus is involved, tremors and jerky movements occur in contralateral side of the body. This condition combined with ipsilateral 3rd nerve paralysis is called as Benedict's syndrome. McKusick-Kaufmann Syndrome McKusick-Kaufman syndrome: A rare genetic disorder characterized by hydrometrocolpos (fluid buildup in vagina and uterus), extra fingers and congenital hea defects
4
Benedict's syndrome
Posner-Shlossman syndrome
Kaufmann's syndrome
Urrets Zavalia syndrome
Ophthalmology
null
86371fc4-0956-4adc-a97c-234f1495b167
single
Which of the following is not used for emergency contraception?
Emergency contraception should be given within 72 hours of unprotected sex. They interfere with postovulatory events which normally results in pregnancy and therefore known as incentives - As the most common method and drug is - levonorgestrel with success rate of 95 %.the tablets can be offered up to 120 hours. however, sooner the tablets taken after intercourse is more effective and most effective method is IUCD as it is given by the doctor itself to inject the IUCD and the failure rate is 0.1% Mifepristone is a steroid for progesterone receptor. It does not prevent feilization but by blocking the action of progesterone on the endometrium, it causes sloughing and shedding of decidua and prevents implanatation. Danazol is contraceptive drug it is anti - estrogenic in nature but it is not the best drug because of the failure rate chance of this drug and if mother is having female fetus it can cause virilization of unborn female child.
4
Mifepristone
IUCD
Levonorgestrel
Danazol
Gynaecology & Obstetrics
JIPMER 2018
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single
About first order kinetics,true statement is
Clearance is variable in zero-order kinetics because a constant amount of the drug is eliminated per unit time, but it is constant in first-order kinetics, because the amount of drug eliminated per unit time changes with the concentration of drug in the blood Ref-KDT 6/e p32
1
Clearance remains constant
Fixed amount of drug is eliminated
Half life increases with dose
Decreases clearance with increased dose
Anatomy
General anatomy
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multi
True statement about streptococcus faecalis ?
Ans. is 'a' i.e., Growns in 6.5% Nacl solution
1
Growns in 6.5% Nacl solution
Are lactose fermenter
Easily destroyed at 60 C for 30 minutes
Classified on the basis of teichoic acid of cell wall
Microbiology
null
19148abf-9095-4144-a1b1-fc185870b621
multi
In national vector borne disease control program which disease is not included?
Ans. (b) Yellow feverRef. K. Park 21sted./380* The National Vector Borne Disease Control Programme (NVBDCP) is implemented for the prevention and control of vector borne diseases such as: Malaria, Filariasis, kala-azar, Japanese encephalitis, Dengue and Chikunguniya.* Yellow fever is NOT a part of NVBDCP.
2
Malaria
Yellow fever
Japanese encephalitis
Kala azar
Social & Preventive Medicine
Health Programmes in India
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single
Last pa of the hea to be repolarised is:
Depolarization occurs from apex to base & endocardium to epicardium; Repolarization occurs from base to apex & epicardium to endocardium Last to depolarize are: Base of LV (epicardium) Pulmonary conus. Upper most pa of interventricular septum. Last to repolarise: Apex endocardium
2
Apical epicardium
Apical endocardium
Epicardium of the base of LV
Endocardium of the base of LV
Physiology
Conducting System of Hea
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single
Hassal's corpuscles are seen in:
Hasal's corpuscles/thymic corpuscles are structures found in the medulla of the human thymus, formed from type VI epithelial reticular cells.They are named for Ahur Hill Hassall, who discovered them in 1849.
1
Thymus
Spleen
Bone marrow
Lymph node
Anatomy
null
68780356-f951-4925-ae8e-68f0315520b7
single
At the altitude of 6500 meters, the atmospheric pressure is 347 mmHg. What is the inspired PO2.
According to law of paial pressures : Pressure exeed by a gas in a mixture is directly propoional to its concentration in the mixture. In inspired gases; 20 % = O2 78% = N2 PH2O = 47 mmHg (air humidified with inspiration) =347 - 47 = 300 mmHg = gaseous component
2
73 mm Hg
63 mm Hg
53 mm Hg
83 mm Hg
Physiology
Respiratory System Pa 2
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single
Management of medulloblastoma in 1.5 year old. What is not done in curative therapy?
. Treatment consist of relief of raised intracranial pressure,establishment of pathological diagnosis,removal of beningn tumors,decompressive surgeries for malignant tumor,shunt surgeries to drain CSF_ventriculo peritonial shunt or ventriculo atrial shunt,radiotherapy ,chemotherapy-temozolamide (Ref;SRB's Manual of Surgery,5th edition,pg no. 1105)
1
Open surgery with leaving the tumour margins
Chemotherapy
Total cranial spinal irradination
VP shunt for the obstructive hydrocephalus
Surgery
Trauma
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single
Sandfly can fly upto –
null
1
50 yards
100 yards
200 yards
300 yard
Social & Preventive Medicine
null
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single
A middle aged female repoed with dull diffuse progressive headache of 2 months duration associated with episodes of vomiting and blurred vision at times. Cough increases the headache.Likely patient has
A space-occupying lesion of the brain is usually due to malignancy but it can be caused by other pathology such as an abscess or a haematoma. Almost half of intracerebral tumours are primary but the rest have originated outside the CNS and are metastases Features of a headache indicating a high risk of a space-occupying lesion of the brain or idiopathic intracranial hypeension include: A new headache with features suggestive of raised intracranial pressure, including papilloedema, vomiting, posture-related headache, or headache waking the patient from sleep Ref Harrison20th edition pg 2456
2
Vascular headache
Intracranial space occupying lesion
Intracerebral hemorrhage
Acute pyogenic meningitis
Medicine
C.N.S
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single
Porcelain jacket crowns are contraindicated in
null
4
Hypoplastic teeth
Excessive horizontal overlap
Decay is extensive but pulp is vital
Excessive vertical overlap with little horizontal overlap
Dental
null
2fca93ab-33f1-4502-9bda-3bd7721040d2
single
Which is not secreted by stomach?
Gastric lipase is an acidic lipase secreted by the gastric chief cells in the fundic mucosa in the stomach. It is a weak fat-splitting enzyme. Pepsinogen is secreted by the chief cells of main gastric glands which are found in the body & fundus of stomach. It is a proteolytic enzyme. HCl is secreted by the parietal cells of main gastric glands found in body & fundus of stomach. It paicipates in the breakdown of protein, provides an optimal pH for action of pepsin & hinders the growth of pathogenic bacteria. Ref: Medical Physiology, Indu Khurana
4
Lipase
Pepsinogens
HCI
None
Physiology
G.I.T
c7ca2e8c-b647-4426-b965-e095dda2593b
multi
Which of the following is an alternative to methadone for maintenance treatment of opiate dependence
The withdrawal symptoms can be managed by one of the following methods: 1. Use of substitution drugs such as methadone 2. Clonidine is a a2 agonist that acts by inhibiting norepinephrine release at presynaptic a2 receptors. 3. Naltrexone with Clonidine: Naltrexone is an orally available narcotic antagonist which, when given to an opioid-dependent individual, causes withdrawal symptoms. These symptoms are managed with the addition of clonidine for 10-14 days after which clonidine is withdrawn and the patient has continued on naltrexone alone. 4. Other Drugs: The other detoxification agents include LAAM ( Levo-alpha-acetyl-Metha dol), propoxyphene, diphenoxylate, buprenorphine (long-acting synthetic paial m-agonist which can be administered sublingually), and lofexidine (a2 agonist, similar to clonidine). In paicular, Buprenorphine has recently been used widely for detoxification as well as for maintenance treatment in many pas of the World. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 44
3
Diazepam
Chlordiazepoxide
Buprenorphine
Dextropropoxyphene
Psychiatry
Substance abuse
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single
The MOST likely site of lesion in a patient with Wernicke's hemianopic pupil is:
Wernicke's hemianopic pupil indicates lesion in the optic tract. In this condition light reflex is absent when light is thrown on temporal half of the retina of the affected side and nasal half of retina of the opposite side. In this condition light reflex is present when light is thrown on nasal half of affected side and temporal half of affected side. This patient also has homonymous hemianopia. Ref: Textbook of Ophthalmology edited by Sunita Agarwal, page 304.
2
Optic nerve
Optic tract
Optic chiasma
Optic radiation
Ophthalmology
null
59d21cbf-5c87-4bf8-aeb7-1c8389af7f22
single
Use of oral contraceptives increases the risk of which cancer -
Ans. is 'c' i.e., breast * Important adverse effects of OCPs are: (1) Nausea, vomiting, headache (worsening of migraine), (2) breakthrough bleeding, (3) mastalgia, (4) weight gain, (5) acne and hirsutism, (6) cholasma and pruritis, (7) carbohydrate intolerance, (8) leg vein and pulmonary thrombosis, (9) coronary and cerebral thrombosis (MI & stroke), (10) hypertension, (11) increased risk of breast and cervical carcinoma, (12) benign hepatoma, (13) gall stones, (14) precipitation of acute intermittent porphyria.
3
Colon
Ovary
Breast
All of the above
Gynaecology & Obstetrics
Miscellaneous (Gynae)
7d5c1319-4421-4cb6-b1c6-2437bb30cfe4
multi
Most common location of accessory spleen
Accessory spleen, in other words supernumerary spleens, splenunculi, or splenules, results from the failure of fusion of the primordial splenic buds in the dorsal mesogastrium during the fifth week of fetal life. Incidence of accessory spleen in the population is 10%-30% of patients in autopsy series and 16% of patients undergoing contrast enhanced abdominal CT. Although the most common location for an accessory spleen is splenic hilum (75%) and pancreatic tail (25%) , it can occur anywhere in the abdomen including gastrosplenic or splenorenal ligaments, wall of stomach or bowel , greater omentum or the mesentery, and even in the pelvis and scrotum. Accessory spleen usually measures 1 cm in diameter, but its size varies from a few milimeters to centimeters. Also the number of accessory spleens can vary from one to six . Accessory spleens are usually incidentally detected and asymptomatic, but in case of unexpected locations, accessory spleen can be of clinical impoance. Ref - radiologyassistant.com
1
Hilum of spleen
Greater omentum
Lesser omentum
Duodenum
Anatomy
Abdomen and pelvis
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Leaving (or forgetting) an instrument or sponge in the abdomen of the patient during a surgery and closing operation is:
Ans. d (Criminal negligence). (Ref. Textbook of FMT by Parikh 6th ed. 1.46)Contributory negligencea common law defence to a claim or action. It applies to a situation where a plaintiff claimant has, through their own negligence, caused or contributed to the injury they suffered. For example where a pedestrian crosses a road carelessly and is hit by a driver who is also driving carelessly.Comparative negligencea system of apportioning recovery for a tort based on a comparison of the plaintiff's negligence with the defendant's. It contrasts with the doctrine of contributory negligence, which disallows recovery by a plaintiff whose actions in some way, however small, contributed to the tort.Criminal negligencedefined as careless, inattentive, neglectful, willfully blind, or in the case of gross negligence what would have been reckless in any other defendant. For example, leaving (or forgetting) an instrument or sponge in the abdomen of the patient during a surgery and closing the operation contributes to criminal negligence.Corporate manslaughtera term for an act of homicide committed by a company. In general, a legal person is in the same position as a natural person, and may be convicted for committing virtually all offences, under English criminal law. The Court of Appeal confirmed in one of the cases following the disaster that a company can in principle omit manslaughter, although all defendants in that case were acquitted
4
Contributory negligence
Civil
Corporate negligence
Criminal negligence
Forensic Medicine
Law & Medicine, Identification, Autopsy & Burn
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In a pregnant female, there is decreased requirement of the spinal anaesthetic agent because of all of the following except –
A smaller dose of local anaesthetic is nedded to produce the same level of neuraxial block in pregnant women compared with nonpregnant women. The causes may be :- Compression of the inferior vena cava by the pregnant uterus causes "distension or engorgment" of the epidural venous plexus. This decreases the volume of the epidural space and also the volume of the CSF per spinal segment. Therefore a given dose of epidural or intrathecal local anaesthetic will produce a greater degree of demiatomal involvement. Pregnant women exhibit increase susceptibility to local anaesthetics. Apex of lumbar lordosis cauded to thoracic kyphosis is reduced in supine position. This may enhance the cephalad spread of CSF.
1
Exaggerated lumbar lordosis
Decreased volume of subarachnoid space
Engorgement of epidural veins
Increased sensitivity of the nerves to anaesthetic agent
Anaesthesia
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True statement regarding upper GI bleeds:
UPPER GI BLEED: Bleeding up to Lig. of Treitz M/c cause- Non-variceal peptic ulcer bleeding Causes of upper gastrointestinal bleeding Condition % Ulcers 60 Oesophageal 6 Gastric 21 Duodenal 33 Erosions 26 Oesophageal 13 Gastric 9 Duodenal 4 Mallory-Weiss tear 4 Oesophageal varices 4 Tumour 0.5 Vascular lesions, e.g. Dieulafoy's disease 0.5 Others 5 Risk stratification system for UPPER GI BLEEDS: - Help to identify the patients at higher risk of major bleeding or death (facilitate patient triage) Commonly used scoring systems: - Rockall score -takes account of endoscopic findings, most useful - Blatchford score -during initial assessment, does not require endoscopic data. Commonly Used Risk Stratification Systems for Upper GI Bleeds Blatchford Score (PUSH + Melena/Syncope + Cardiac/Hepatic Dysfunction) Rockall & Baylor Score (CASDE) PulseQ Blood Urea nitrogenQ Systolic BPQ HemoglobinQ Presence of MelenaQ, SyncopeQ, HepaticQ or Cardiac dysfunctionQ Comorbid diseaseQ (cardia, hepatic, renal, or disseminated) * AgeQ (<60 years, 60-79 years >80 years) ShockQ (systolic BP <100 mm Hg. HR >100 beats/min) Diagnosis at the time of endoscopy (Mallory-Weiss non-malignant lesions, or malignant lesions) Endoscopic Stigmata of recent bleedQ
3
It is bleeding up to ampulla of Vater
Most common cause is variceal bleeding
Rockall-Baylor scoring is used for risk stratification
Most common management is endoscopic banding
Surgery
NEET 2018
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All of the following are seen in Lichen planus except?
Granular cell layer is absent in psoriasis where as Lichen planus is characterized by Hypergranulosis. Necrotic / apoptotic keratinocytes are called as "colloid / civatte bodies" and spaces left at the dermo - epidermal junction are termed as "Max - joseph spaces".Both are seen due to autoimmune destruction of basal keratinocytes,classical of lichen planus.
4
Max - Joseph spaces
Civatte or colloid bodies
Koebner's phenomenon
Absent granular cell layer
Dental
null
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In human body the action of surfactant is done by
null
3
Sugar and salt
Soap and water
Lipid and protein
Base and lipid
Physiology
null
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Noonan syndrome is characterized by all except
Coarctation  of aorta  is not the cardiovascular manifestation  in Noonan syndrome.
4
Hypertrophic cardiomyopathy
Dysplastic pulmonary stenosis
Pectus excavatum
Coarctation of aorta
Medicine
null
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Pain Assessment Tool is best done by
(B) TachycardiaPAT - Pain Assessment ToolParameters012Posture/tone ExtendedDigits widespreadShoulders raised off bedFlexed and/or tenseFists clenchedTrunk guardingLimbs drawn to midlineHead and shoulder resist posturingCryNo YesWhen disturbedDoesn't settle after handlingLoudWhimperingWhiningSleep patternRelaxed Agirated or withdrawnWakes with startleEasily wokenRestlessSquirmingNo clear sleep/wake patternEye aversion "shut out"Expression FrownShallow furrowsEyes lightly closedGrimaceDeep furrowsEyes tightly closedPupils dilatedColorPink, well perfused Pale/dusky/flushed, Palmar swearingRespirations TachypneaArt restApneaAt rest or with handlingHeart rate TachycardiaAt restFluctuatingSpontaneous or at restOxygen saturationNormal Desaturation with or without handlingBlood pressureNormal Hypo-/hypertension at restNurse's perceptionNo pain perceived by me I think the baby is in painNote: Infants are assessed and scores obtained every 2 to 4 hours. An infant with a score > 5 requires comfort measures; >10 requires analgesia dose adjustment# Pain causes stress. The endocrine system reacts by releasing an excessive amount of hormones, ultimately resulting in carbohydrate, protein, and fat catabolism (destruction); poor glucose use; and other harmful effects. This reaction combined with inflammatory processes can produce weight loss, tachycardia, increased respiratory rate, fever, shock, and death. Unrelieved pain prolongs the stress response, adversely affecting the patient's recovery.> Cardiovascular system responds to stress of pain by activating the sympathetic nervous system, which produces a variety of unwanted effects.> In the postoperative period, these include hypercoagulation and increased heart rate, blood pressure, cardiac work load, and oxygen demand.> Aggressive pain control is required to reduce these effects and prevent thromboembolic complications.> Cardiac morbidity is the primary cause of death after anesthesia and surgery
2
Ask patient
Tachycardia
Tachypnea
Bradypnea
Anaesthesia
Miscellaneous
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Most fatal amoebic encephalitis is caused by ?
Ans. is 'b' i.e., Naeglaria . Amongst the given options Naeglaria and Acanthamoeba cause amoebic encephalitis. " The prognosis of Naeglaria encephalitis is uniformaly poor, most patients die within a week."---Harrison "Acanthamoeba encephalitis follows a more indolent course."----- Harrison . So, amongst the given options Naeglaria causes most fatal amoebic encephalitis .
2
E.histolytica
Naeglaria
E. dispar
Acanthamoeba
Microbiology
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In an adult, the hyoid bone is seen at which of the following level of the cervical veebrae?
The hyoid bone is found at the level of third cervical veebrae in adults. It is situated above the thyroid cailage in the anterior wall of the hypopharynx in relation to the base of the tongue. It is made up of a body, bilateral greater cornua and bilateral lesser cornua. It is a sesamoid bone and is suspended in between the supra hyoid and infra hyoid musculature and is therefore responsible for the concavity between the chin and the anterior neck. The body is convex from side to side. At either end of the body on its upper surface is a small tubercle called lesser cornu. It is the point of attachment of medial end of middle constrictor muscle and stylohyoid ligament.
2
C2
C3
C4
C5
Unknown
null
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Which of the following statements about Von-Hippel Lindau syndrome is true
Harrison's principles of internal medicine 17th edition. *In VHL somatic mutation of normal allele leads to retinal angiomas, CNS hemangioblastoma,pheochromocytomas and multicentric clear cysts,hemangiomas and adenomas of kidney
2
Multiple tumors are rarely seen
craniospinal hemangioblastomas are common
Superatentorial lesions are common
Tumors of Schwann cells are common
Medicine
C.N.S
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Which of the following statement regarding measurement of BP with sphygmomanometer versus intra aerial pressure measurements is true?
The measurement of aerial pressure using a sphygmomanometer bag with a standard arm cuff is subject to inaccuracy leading to falsely high aerial pressure readings. Using sphygmomanometer blood flow is detected. The accuracy of blood pressure measurement is affected by the cuff size. Inadequate cuff size result in falsely elevated blood pressure reading. A large cuff size result in falsely low reading. Ref: Medicine for Anaesthetists By Michael Douglas Vickers, Ian Power, Ppage 285; Critical Care Study Guide: Text and Review By Gerard J. Criner, Page 157.
2
It is less than intravascular pressure
It is more than intravascular pressure
It is equal to intravascular pressure
It depends upon blood flow
Physiology
null
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The earliest sign of iron deficiency anaemia -
<p>Plasma ferritin is a measure of iron stores in tissues & is the single test to confirm iron deficiency .It is a very specific test. In the course of development of anaemia, firstly storage iron(ferritin) depletion occurs during which iron reserves are lost without compromise of the iron supply for erythropoiesis.</p><p>Plasma iron & total iron binding capacity(TIBC) are measures of iron availability ;hence they are affected by many factors besides iron stores.Plasma iron has a diurnal & day -to-day variation & becomes very low in acute phase response .</p>
2
Increase in iron binding capacity
Decrease in serum ferritin level
Deorease in serum iron level
All the above
Medicine
Haematology
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Most potent bronchodilator among inhalational anesthetic agents is
Effect of inhalational agents on respiratory systemAll inhalational agents are bronchodilators -Halothane cause maximum bronchodilatation. The inhalational agent of choice in asthmatics (intravenous anaesthtic of choice is ketamine).All inhalational agents cause respiratory depression to some extent - Maximum depression of respiration is seen with enflurane, on the other hand, maximum inhibition of ventilator response to increased CO2 and hypoxia is caused by halothaneAll inhalational agents vasodilate pulmonary vascular bed by blunting the hypoxic pulmonary vasoconstriction (HPV) response. Halothane has maximum effect: Isoflurane, Enflurane, desflurane, sevoflurane have similar effect.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 167 - 169)
3
Isoflurane
Sevoflurane
Halothane
Desflurane
Anaesthesia
All India exam
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Compared to the other antidepressant drugs miazapin has the distinct ability to act as an antagonist of:
Ref: KDT 8th ed Miazapine blocks presynaptic [?]2 receptors on NA and 5-HT neurons. This increases the release of both NA and 5-HT. It also inhibits 5-HT2 and 5-HT3 receptors.
3
Beta receptors
D2 receptors
Alpha 2 receptors
5-HT receptors
Pharmacology
Central Nervous system
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Primary sites of lymphocyte production are
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1
Bone marrow and Thymus
Spleen and Lymph nodes
Lymph nodes and mucosa associated lymphoid tissue
Spleen and mucosa associated lymphoid tissue
Physiology
null
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All is true about von Hippel Lindau syndrome except:
C i.e. Tumors of Schwann cells are common Von Hippel-Lindau (VHL) syndrome is associated with multiple hemangioblastomasQ of infratentorial craniospinal axis, retina and pancreas. Supratentorial HB are uncommonQ.
3
Hemangioblastomas seen in craniospinal axis
Multiple tumors common
Tumors of Schwann cells are common
Supratentorial lesions are uncommon
Radiology
null
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Nucleus ambiguus is composed of:
Ans. C. 9,10,11 cranial nerve nucleusCells in nucleus ambiguus contain motor neurons associated with three cranial nerves (rostral pole = C.N. IX = glossopharyngeal; middle part = C.N. X = vagus; caudal pole = C.N. XI = spino accessory). Axons arising from nucleus ambiguus pass laterally and slightly ventrally to exit the medulla just dorsal to the inferior olive. These axons then course with the three cranial nerves IX (glossopharyngeal), X (vagus) and XI (spino accessory) to innervate the striated muscles of the soft palate, pharynx, larynx, and upper part of the esophagus.
3
7,9,10 cranial nerve nucleus
7,9,11 cranial nerve nucleus
9,10,11 cranial nerve nucleus
7,10,11 cranial nerve nucleus
Anatomy
Neuroanatomy
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At what age a child's height is expected to be 100 cm?
ANSWER: (C) 4 yearsREF: Essence of Paediatrics Prof. MR Khan 4th ed page 59, Clinical Pediatrics by D. N. Chatterjee page 18 A simple rough formula for calculation height from 2-14 years is:Height in inches = (2.5 x age in years) + 30* Thus the expected height at 4 year of age = (2.5 x 4) + 30 = 40 inches* As 1 inch = 2.5 cm, 40 inches = 100 cm
3
2 years
3 years
4 years
5 years
Pediatrics
Assessment of Growth
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True about mesenteric vein thrombosis ?
Answer is 'd' i.e. Surgery can lead to sho-bowel syndrome Peritoneal signs are present in less than half the cases. Any length of bowel may be involved depending on the level and extent of thrombosis. Resection of the nonble bowel along with its mesentry is the treatment of choice. Heparin is given in all cases and along with bowel rest and fluid resuscitation is sufficient in patients without bowel infarction, but I am not sure whether it should be termed tit of choice.
4
Peritoneal signs are always present
Invariably involves long length of bowel
I.V. Heparin is the treatment of choice
Surgery can lead to sho-bowel syndrome
Surgery
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Dysphagia caused by in Plummer Vinson Syndrome is due to
(Web) (1024-25-LB) (737, 1043-B &L 25th)Plummer-Vinson Syndrome (Brown-Kelly Paterson syndrome or sideropenic dysphagia)* Young women with iron deficiency anaemia and dysphagia referred high in the neck.* The dysphagia was said to be caused by spasm or a web in the post-cricoid area. The patients were said to have an increased tendency to post-cricoid cancer.* Web certainly occurs in the upper oesophagus. More recently it has been noted that there is often a patch of heterotopic gastric mucosa in the upper oesophagus (probably congenital)* Complications - ulceration, stricture and adenocarcinoma
2
Stenosis
Web
Stricture
Ulceration
Surgery
Oesophagus
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Most common cause of ectopic ACTH production-
Ans. is 'c' i.e.. Small cell carcinoma lungo Ectopic ACTHproduction accounts for 10-20% cases of cushings syndromeo Small cell lung carcinoma (SCLC) is by far the most common causes of ectopic ACTH.# If accounts for more than 50%cases of cushings syndrome due to ectopic ACTH production.Other carcinomas associatedThymic carcinoid (15%)Islet cell tumour (10%)Bronchial carcinoid (10%)Other carcinoids (5%)Pheochromocytoma (2%)
3
Renal cell carcinoma
Hepatocellular carcinoma
Small cell carcinoma lung
Pheochromacytoma
Medicine
Adrenal
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