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Which of the following opioid analgesic acts primarily through K opioid receptors?
(Ref: KDT 6/e p464, 465) Pentazocine can cause dysphoric reactions (hallucinations) by stimulating the K receptors.
1
Pentazocine
Methadone
Buprenorphine
Pethidine
Anatomy
Other topics and Adverse effects
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Kappa statistics is used to measure
null
1
Inter examiner validity
Correlation
Regression
Proportion
Dental
null
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single
Which of the following is not a component of Glasgow Coma Scale?
Ans. is 'c' i.e. pupil size
3
Eye opening
Motor response
Pupil size
Verbal response
Surgery
null
8068717f-962e-4012-9a31-263500b618e0
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Form the normal bacterial flora of the conjunctiva
Ans. Corynebacterium xerosis
1
Corynebacterium xerosis
E. Coli
Streptococci
All of the above
Ophthalmology
null
a2841be9-4b54-4065-9373-98b9919af87b
multi
Hypoceruloplasminimia is associated with which abnormality?
(A) Menkes disease # Deficiency or Lower-than-normal ceruloplasmin levels may indicate the following:> Wilson disease copper storage disease)> Menkes disease (Menkes kinky hair syndrome) (rare - UK incidence 1/100,000)> Overdose of Vitamin C> Copper deficiency> Aceruloplasminemia> Excess or Greater-than-normal ceruloplasmin levels may indicate or be noticed in: copper toxicity / zinc deficiency pregnancy oral contraceptive pill use lymphoma acute and chronic inflammation (it is an acute-phase reactant) rheumatoid arthritis Angina Alzheimer's disease Schizophrenia Obsessive-compulsive disorder
1
Menkes disease
Alzheimer's disease
Schizophrenia
Obsessive-compulsive disorder
Psychiatry
Miscellaneous
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According to triage patient having visible bleeding should be treated in:
null
1
Emergency.
Delayed.
Minimal treatment.
No treatment.
Surgery
null
4a161c38-60e3-4902-8e9b-a09997c19b0d
single
Apart from plasmodium, which of the following can infect RBCs in "ring forms"?
Ans. a (Babesia microti). (Ref. Harrison's, Principles of Internal Medicine, 16th ed., pg1232)Babesiosis (B. microti)# Babesiosis is a worldwide protozoan disease of animals that is transmitted by ticks; humans are infected incidentally and initially develop a nonspecific febrile illness that can lead to hemolytic anemia.# Babesia organisms enter RBCs and resemble malarial parasites morphologically, posing a diagnostic problem.# Ixodid (hard-bodied) ticks, in particular Ixodes scapularis (/. dammini) and I. ricinus, are the vectors of the parasite. Transfusions are another source of babesiosis.# The incubation period for B. microti infection is 1 to 4 weeks.# Immunosuppressed patients, splenectomized individuals, and the elderly have the most severe illness.# The clinical presentation varies widely and resembles malaria or rickettsiosis; symptoms and signs include a gradual onset of irregular fever, chills, sweating, muscle pain, and fatigue. Mild hepatosplenomegaly and mild hemolytic anemia may develop, but a rash is not present.# Giemsa-stained thick and thin blood films examined for small intraerythrocytic parasites. b. microti appears as a small ring form resembling P. falciparum.# Unlike infection with Plasmodium, however, Babesia does not cause the production of pigment in parasites, nor are schizonts or gametocytes formed.# A species-specific polymerase chain reaction test using the RNA gene has been used to show parasite persistence when the blood smear is negative.# Treatment of Babesiosis:OrganismAdultsBabesia microtiAtovaquone 750 mg bid PO plus azithromycin 600 mg/ d PO or clindamycin 1200 mg bid IV.Babesia divergens and other Babesia species, including MO-1,WA-1, and CA-1Quinine 650 mg tid PO plus clindamycin 1200 mg bid IV (or 600 mg tid PO) plus atovaquone 750 mg bid POo
1
Babesia microti
Tyrpanosomas
Schistosomia
Microfilaria
Microbiology
Parasitology
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Following clostridia are saccharolytic except ?
Ans. is 'b' i.e., Sporogenes . Clostridia may break down carbohydrate for energy (sacchrolytic) or break down protein for energy (proteolytic) or both. Different clostridia have different pattern :- . Both proteolytic and saccharolytic - Predominating proteolytic --> CL sporogenes, Cl botulinum A .B.F., Cl. bifermentans, Cl. histolyticum - Predominating saccharolytic Cl. perfringens, Cl. novyi, CL septicum, Cl. difficile. . Only proteolytic (not saccharolytic) --> Cl. tetani . Only saccharolytic (not proteolytic) --> Cl. botulinum C.D.E. . Neither proteolytic nor saccharolytic --> Cl. cochlearum.
2
Welchii
Sporogenes
Septicum
Oedematiens
Microbiology
null
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A 32-year-old primi gravida presents with DVT. There is history of 2 episodes of DVT in the past and was diagnosed to have antiphospoholipid antibody. Next step in management is:
Ans: B (Aspirin and heparin) Ref: Maternal-Fetal Medicine edited by Mary E. D'Alton. pg: 10-14 and DC Dutta's Textbook of Obstetrics. 7th edition, pg: 343 Explanation: "ACOG 2005 guidelines recommends low dos aspirin t5-80 mg orally per day along with unfractionated heparin 5000 unit subcutaneously twice daily. The therapy is begun with diagnosis of pregnancy and continued till delivery." Ref: The American Congress of Obstetricians and Gynecologists (ACOG) Guidelines 'Therapy for patients with positive antiphospholipid antibodies and with thrombophilias is low dose aspirin (50 mg a day). When there is history of previous thrombotic event heparin (5000IU, sc twice daily) is the drug of choice. Low molecular weight heparin in also effective."Ref: Dutta's Obstetries ANTI PHOSPHOLIPID ANTIBODY SYNDROME Autoimmune disorder characterized by circulating antibodies against membrane phospholipid. Antiphospholipid Antibodies o Abs against Cardioitpin - aCL. o Abs against beta 2 glycoprotein 1 - B2GP1. o Lupus anticoagulant - LAC. o Abs against phospholipids and cholesterol. Clinical Features o Recurrent pregnancy loss, o Coombs positive hemolytic anemia and thrombocytopenia. o Pre-eclampsia, o IUGR. o Recurrent Thrombosis (Superficial and deep vein thrombosis; Cerebral venous thrombosis; Retinal vein thrombosis). o Raised intracranial tension, o Livedo retiuclaris. o Libman sacks endocarditis. o Premature atherosclerosis. Diagnosis: o Lupus anticoagulant is an unidentified antibody causing increase of phospholipid dependent coagulation tests { aPTT, Russel viper venom test) by binding to prothrombin activator complex. o In vivo, LAC causes thrombosis. o Specific antiphospholipid antibodies measured by ELISA, o It is associated with anticoagulatnt activity in-vitro and procoagulant activity in-vivo. Differential Diagnosis o SLE. o 10 - 30% women with SLE have APLA antibodies, o 60 - 90% women with APS have ANA antibodies. Complications: * Maternal o Recurrent pregnancy loss o Thrombosis o Thrombocytopenia o PROM o Preeclampsia Drug side-effects: (Aspirin, Heparin and Prednisolone) o Hemorrhage o Osteoporosis o Fractures o Cataracts o Infection o Adrenal suppression. Fetal o Prematurity o Placental abruption o IUGR o Stillbirth Treatment General Measures o Low dose aspirin (60-100 mg) + Prophylactic Heparin - Current treatment of choice. Alternative Options o Low dose Aspirin + Prednisolone (40 - 60 mg daily), o Heparin and Prednisolone should not be given together due to increased risk of osteoporosis, c Treatment should be initiated early in pregnancy and continued to delivery. o Regular fetal testing for growth. o Elective delivery at 39 - 40 weeks. o WARFARIN contraindicated in pregnancy.
2
Aspirin alone
Aspirin and heparin
LMWH
Warfarin for 6 months
Unknown
null
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Iridocorneal endothelial syndrome is associated with –
Iridocorneal endothelial (ICE) syndrome is characterized by abnormal corneal endothelium which causes :- Iris atrophy, Secondary angle closure glaucoma in association with characteristic peripheral anterior synechiae, Corneal edema. Option 'c' may cause confusion here. You should keep in mind that in iridocorneal endothelial syndrome, collagen deposition occurs on the posterior surface of Descemet's membrane (not in the Descemet's membrane).
1
Progressive atrophy of iris stroma
Bilateral stromal edema of iris & cornea
Deposition of collagen in Descemet's membrane
Deposition of glycosaminoglycan in Descemet's membrane
Ophthalmology
null
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An elderly man complains of ear pain. During evaluation, the physician asks if the patient has tinnitus. What is tinnitus?
Tinnitus is the perception of abnormal noise in the ear or head. It is usually attributed to a sensory loss; pulsatile tinnitus occurs with conductive hearing loss and is due to carotid pulsations becoming more apparent.
1
A subjective sensation of noise in the head
A complication of chronic metal ingestion
An audible cardiac murmur
Dizziness with sounds
Surgery
Nervous System
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A 6 year old child with IQ of 50. Which of the following can the child do?
IQ is defined by as the mental age divided by the chronological age multiplied by 100. In this case, a child of 6 years of age with an IQ of 50%, means that his mental age is that of a 3 year old child. At 3 years of age, a child can identify two colours. Ref: Essential paediatrics by OP Ghai, 6th edition, Page 543.
1
Identify colours
Read a sentence
Ride a bicycle
Copy a triangle
Pediatrics
null
99dafc79-4384-4222-bb13-bdbf56f7d5be
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In fracture surgical neck of humerus, the following nerve injury is common:
A i.e. Axillary
1
Axillary
Radial
Ulnar
Median
Surgery
null
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Not an indication for blood transfusion
Indications for Blood Transfusion  To correct anemia due to blood loss and to combat postpartum hemorrhage Patient with severe anemia seen in later months of pregnancy (beyond 36 weeks) Refractory anemia: Anemia not responding to either oral or parenteral therapy in spite of correct treatment Associated infection
1
Moderate anemia at 24-30 weeks
Severe anemia at 36 weeks
Blood loss anemia
Refractory anemia
Gynaecology & Obstetrics
null
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Trans-placental spread is least associated with?
HSV infection may be acquired in utero, during the birth process, or during the neonatal period. Intrauterine and postpartum infections occur infrequently. Most cases of neonatal herpes result from maternal infection and transmission, usually during passage through a contaminated infected birth canal of a mother with asymptomatic genital herpes.
1
HSV
Rubella
HBV
HIV
Pediatrics
null
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Ovum is released due to
Ovulation-the discharge of a secondary oocyte from the Graafian follicle; in an adult woman, this normally occurs at intervals of about28 days and alternates between the two ovaries. As a rule, only one secondary oocyte is produced, but occasionally ovulation produces two or more; if more than one subsequently become feilized, the result may be multiple bihs, such as twinsEstrogen levels peak towards the end of the follicular phase. This causes a surge in levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This lasts from 24 to 36 hours, and results in the rupture of the ovarian follicles, causing the oocyte to be released from the ovary the oviduct.Ref: Ganong&;s review of medical physiology; 24th edition
2
FSH
LH
Prolactin
HCG
Physiology
Endocrinology
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Sholy after the administration of an inhalational anesthetic and succinylcholine for intubation prior to an elective inguinal hernia repair in a 10-year-old boy, he becomes markedly febrile, displays a tachycardia of 160, and his urine changes color to a dark red. Which of the following is the most appropriate treatment at this time?
The cause of malignant hypehermia is unknown, but it is associated with inhalational anesthetic agents and succinylcholine. It may develop in an otherwise healthy person who has tolerated previous surgery without incident. It should be suspected in the presence of a history of unexplained fever, muscle or connective tissue disorder, or a positive family history (evidence suggests an autosomal dominant inheritance pattern). In addition to fever during anesthesia, the syndrome includes tachycardia, increased O2 consumption, increased CO2 production, increased serum K+ , myoglobinuria, and acidosis. Rigidity rather than relaxation following succinylcholine injection may be the first clue to its presence. Treatment of malignant hypehermia should include prompt conclusion of the operative procedure and cessation of anesthesia, hyperventilation with 100% O2 , and administration of intravenous dantrolene. The urine should be alkalinized to protect the kidneys from myoglobin precipitation. If reoperation is necessary, the physician should premedicate heavily, alkalinize the urine, and avoid depolarizing agents such as succinylcholine. Pretreatment for 24 hours with dantrolene is helpful; it is thought to act directly on muscle fiber to attenuate calcium release.
4
Complete the procedure but pretreat with dantrolene prior to future elective surgery.
Administer inhalational anesthetic agents.
Administer succinylcholine
Hyperventilate with 100% O2 .
Anaesthesia
Miscellaneous
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single
A gastric biopsy is performed on a patient with suspected graft-versus-host disease following bone marrow transplantation. The biopsy demonstrates many isolated dying epithelial cells in crypts showing fragmented, hyperchromatic nuclei and small discrete blebs containing both cytoplasm and nuclear fragments. The biopsy proves which of the following?
The changes described are those of apoptosis, which is a form of programmed cell death. Apoptosis can be seen in a variety of settings. In this case, it is occurring in the context of graft-versus-host disease, which is mediated by CD8+ and CD4+ cells. Apoptosis also occurs during embryogenesis, during hormone-dependent involution in the adult (eg, during menstruation), during rapid proliferation of cell populations (eg, intestinal crypt epithelia), and in the immune system (e.g., in developing thymus). It can also occur after duct obstruction in organs such as pancreas and during some viral diseases. The hallmark of this programmed method of cell death is the fragmentation of the cell with formation of cytoplasmic blebs and apoptotic bodies that are phagocytized by other healthy cells. Caseous necrosis, such as is seen in tuberculosis, shows necrotic, amorphous granular debris surrounded by a granulomatous response. Coagulative necrosis, such as is seen in myocardial infarction, shows coagulated, anuclear cell "ghosts." Gangrenous necrosis is a commonly used surgical term (eg, in diabetic feet) that does not have a precise pathologic counterpa.
1
Apoptosis
Caseous necrosis
Coagulative necrosis
Gangrenous necrosis
Pathology
null
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Varenicline is used in
Varenicline is a prescription medication used to treat smoking addiction. This medication is the first approved nicotinic receptor paial agonist. Specifically, varenicline is a paial agonist of the alpha4/beta2 subtype of the nicotinic acetylcholine receptor Ref Davidson 23rd edition pg 578
4
Pulmonary hemosiderosis
Sleep apnea
Anti-trypsin deficiency
Nicotine dependency
Medicine
Respiratory system
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Cyst seen in vagina are all except:
Ans: A (Nebothian cyst) Ref: Shows Textbook of Gynecology 15th ed pg 136Explanation:VAGINAL CYSTSVaginal cysts are rare and are located more commonly in anterior vaginal wallGartner's cystArises from remnants of mesonephric ductLies in anterolateral aspect of vaginal wallSmall cyst is asymptomaticLarge cyst causes dyspareuniaLarge symptomatic cysts requires excisionInclusion cystSeen in lower end of vagina on its posterior surface.It is caused by tags of mucosa embedding inside the scar that later forms a cystBartholin cyst--Extends into vaginaEndonietriotic cystBluish bulge in posterior fornix.It is treated with either danazol or surgical excisionA Nabothian Cyst lor Nabothian Follicle)It is a mucus-filled cyst on the surface of the cervix.They are most often caused when stratified squamous epithelium of the ectocervix grows over the simple columnar epithelium of the endocervix (Metaplasia).This tissue growth can block the cervical crypts, trapping cervical mucus inside the crypts.
1
Nebothian cyst
Gartner's cyst
Bartholin's cyst
Inclusion cyst
Gynaecology & Obstetrics
Miscellaneous (Obs)
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Features of achalsia cardia are all of the following except: March 2009
Ans. C: Rat-tail deformity and filling defect on barium study Dysphagia is the most common presenting symptom in patients with achalasia. The ingestion of either solids or liquids can result in dysphagia. Emotional stress and the ingestion of cold liquids are well-known exacerbating or precipitating factors. 80-90% of patients with achalasia experience spontaneous regurgitation of undigested food from the esophagus during the course of the disease. Features of achalasia depicted at barium study under fluoroscopic guidance include the following: Failure of peristalsis to clear the esophagus of barium with the patient in the recumbent position Antegrade and retrograde motion of barium in the esophagus secondary to uncoordinated, nonpropulsive, teiary contractions Pooling or stasis of barium in the esophagus when the esophagus has become atonic or noncontractile (which occurs late in the course of disease) LES relaxation that is incomplete and not coordinated with esophageal contraction Dilation of the esophageal body, which is typically maximal in the distal esophagus Tapering of the barium column at the unrelaxed LES, resulting in the bird beak sign
3
Regurgitant vomiting
Elongated and dilated esophagus
Rat-tail deformity and filling defect on barium study
Increased difficulty in swallowing
Surgery
null
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A 6 year old girl presents with Recurrent E.coli infection in urine. Ultrasound of abdomen shows Hydroureter and Hydronephrosis. Micturating cysto – urethrogram shows filling defect in urinary bladder. The likely diagnosis is –
IVP in ureterocele usually shows a round filling defect, sometimes large, in the bladder corresponding to the ureterocele, and characteristic finding of duplication of the collecting system (ureteroceles are nearly always associated with ureteral duplication) Ureterocele : Is a cystic dilatation of the terminal ureter, and is obstructive because of a pinpoint ureteral orifice. It is more common in females Affected children often are discovered by prenatal sonography or during an investigation of UTI (IVP) Treatment : o transurethral incision of ureterocele : effectively relieves the obstruction but it may result in V.U.R. necessitating ureteral reimplantation later, or ' open excision of ureterocele and reimplantation 'as primary management'. About other options An isolated VUR or Duplication of ureter do not explain the filing defect in the bladder. Sacrococcygeal Teratoma : The most common presentation here is with an abnormal, obvious protruding mass from the sacral area. Out of the 4 varieties known, only Type IV which contributes 9.8 % ie entirely pre-sacral and not visible externally (90.8% tumors are visible externally). Bladder and Rectum may be displaced anteriorly but a filling defect is not characteristic as in ureterocele. Ureters may be partially obstructed resulting in hydro-ureter and hydronephrosis.
4
Sacrococcygeal Teratoma
Vesicoureteric Reflux – grade II
Duplication of Ureter
Ureterocele
Pediatrics
null
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Orchidopexy is done in cases of undescended testes at the age of
Ans. is 'a' i.e. Infancy Campbell's Urology writes - "Definitive treatment of an undescended testis should take place between 6 and 12 months of age. Because spontaneous descent occurs in most boys by 3 months of age and uncommonly thereafter, earlier interventions should be considered in order to theoretically prevent the complication of cryptorchidism that may be manifested before 1 yr. of age".
1
Infancy
1-2 yrs
5 yrs
Puberty
Surgery
Miscellaneous (Testis & Scrotum)
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A 45 year old woman develops abdominal and pelvic discomfo. Physical examination reveals a large mass in the right lower quadrant, which is surgically resected. The mass consists of a large (25 cm) cystic sac containing thick mucinous fluid within a thin wall. On careful inspection, the pathologist finds an area of increased thickness in the cyst wall, which is sampled for histology. Microscopically, the tumor appears to be composed mostly of a single layer of nonciliated columnar cells arranged in papillary projections. The thickened area, however, displays stratification of epithelial cells, increased cytologic atypia, and high mitotic activity. Neveheless, no stromal invasion is found. Which of the following is the most likely diagnosis?
Classification of ovarian tumors, like testicular tumors, is based on putative cell of origin. Thus, ovarian tumors can be divided into neoplasms of germ cells,surface epithelium, or stromal origin. Two thirds of all ovarian neoplasms derive from the surface (coelomic) epithelium. These cystic tumors may contain clear serous fluid or turbid mucinous fluid. Depending on whether a tumor is benign or malignant, surface epithelium tumors can be differentiated into serous cystadenoma or cystadenocarcinoma, and mucinous cystadenoma or cystadenocarcinoma. Borderline tumors are intermediate cases in which the epithelial lining shows malignant features (cytologic atypia and architectural disorganization) in the absence of stromal invasion. Thus, microscopic features of the ovarian tumor in this case are consistent with a borderline mucinous tumor. Mucinous cystadenocarcinoma shows obvious signs of malignancy, including foci of invasion of the stroma within the cystic wall. Mucinous cystadenoma is a cystic tumor with a mucin-rich fluid content. The epithelial lining is similar to intestinal or cervical epithelium, ie, a single layer of columnar cells with apical mucin and no cilia. Serous cystadenocarcinoma is the most frequent malignant ovarian tumor. Its epithelial lining is composed of columnar cells showing atypia and crowding. By definition, stromal invasion is present. Ref: Levy G., Purcell K. (2013). Chapter 50. Premalignant & Malignant Disorders of the Ovaries & Oviducts. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.
1
Borderline mucinous tumor
Mucinous cystadenocarcinoma
Mucinous cystadenoma
Serous cystadenocarcinoma
Gynaecology & Obstetrics
null
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multi
A man is brought to casualty who met with A. He sustained multiple rib fractures with paradoxical movement of chest. Management is
Ventilator suppo with IPPV(intermittent positive pressure ventilation) is the treatment of choice.Assisted ventilation is required for several days until the chest wall stabilises.If ventilator suppo is required for more than 10 days,then tracheostomy is done to prevent laryngeal stenosis which can occur due to prolonged endotracheal intubation. Reference:SRB's manual of surgery,5th edition,page no:1116.
4
Tracheostomy
Consult cardiothoracic surgeon
Strapping
Intermittent positive pressure ventilation
Surgery
Cardio thoracic surgery
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The hookworm thrives on ?
Ans. is 'b' i.e., Plasma Hook worms Ancylostoma duodenale - Old world hookworm Nector americanus - New world hook worm Habitat - Small intestine (Jejunum > duodenum > Ileum) Infective form - Filariform larva Mode of infection - Penetration of skin Plasma forms the main source of nourishment for hookworm, the red blood cells pass out from the worm practically unchanged into the lumen of host's intestine.
2
Whole blood
Plasma
Serum
RBC
Microbiology
null
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single
Which of the following penicillins has the best gram negative spectrum?
null
2
Methicillin
Ampicillin
Penicillin V
Cefixime
Pharmacology
null
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single
Eminectomy is done for treatment of:
null
2
TMJ ankylosis
TMJ dislocation
Coronoid fracture
All of the above
Surgery
null
ac331422-2134-43a3-bf9d-60d4c273ec09
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Which of the following is a RNA virus?
null
1
Measles virus
Herpes virus
Papaya virus
Adeno virus
Microbiology
null
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Following drugs are the first choice in treating patients with candidiasis except-
Ans. is "d' i.e., Caspofungin Choice of drugs for systemic mycosesDiseaseDrugs1st Choice2nd Choice1) Candidiasisoral/vaginal / cutameous deep / invasive AMB/VORIAMB/VORIHRFLU/CAS/POSA2. CryptococcosisAMB/+-5-FCFLU3. HistoplasmosisITR/AMBFLU4. CoccidioidomycosisAMB/FLUITR.'KTZ5. BlastomycosisITR/AMBKTZ/FLU6. Sporotrichosis (disseminated)AMBHR7. ParacoccidioidomycosisHRAMB8. AspergillosisVORI/AMBITRCAS/POSA9. MucomycosisAMBPOSA10. ChromomycosisHRTERPOSA AMB - Amphotericin B;ITR - Itraconazole;CAS - Caspogungin;5-FC-Flucvtosine;NYS-Nystatin;POSA- Posaconazole;KTZ - Ketoconazote;CLO - Clotrimazole;TER - TerbinafineFLU - Fluconazole;Vori - Voriconazole;
4
Fluconazole
Nystatin
Amphotericin B
Caspofungin
Pharmacology
Anti-Fungal
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All of the following are anti HIV agents except ?
Ans. is 'b' i.e., Acyclovir
2
Ritonavir
Acyclovir
Didanosine
Zidovudine
Pharmacology
null
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multi
Which one of the following drugs of abuse is most typically associated with the illustrated complication??
Answer C. CocainePerforation of the nasal septum and palate are well recognized complications of intranasal cocaine use.
3
Ketamine
Heroin
Cocaine
Phencyclidine
Medicine
Drugs
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multi
Most common symptom associated with adult OCD?
(a) Pathological doubt, Ref: Complete review of psychiatry by Dr. Prashant Agrawal, ed.,, 2018, ch- 7, pg. 164 Explanation: Variable % Obsessions (N=200) Contamination 45 Pathological doubt 42 Somatic 36 Need for symmetry 31 Aggressive 28 Sexual 26 Other 13 Multiple obsessions 60 Compulsions (N=200) Checking 63 Washing 50 Counting 36 Need to ask for confess 31 Symmetry and precision 28 Hoarding 18 Multiple compulsions 48
1
Pathological doubt
Need for symmetry
Sexual
Aggressive
Psychiatry
Mood Disorders
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Pralidoxime acts by -
Ans. is 'a' i.e., Reactivating cholinesterase enzyme o Pralidoxime is most commonly used cholinesterase reactivater.OXIMESo Oximes 1 Pralidoxime 2-PAM, obidoxime and diacetyl-monoxime (DAM)J are used in organophosphatepoisoning.o Oximes acts by reactivating cholinesterase enzyme.o Mechanism of actionIn organophosphate poisoning esteratic site of cholinesterase is phosphorylated and anionic site is free.Phosphorylated cholinesterase reacts very slowly with water.However, if more reactive OH groups in the form of oximes are provided, reactivation occurs more than a million time faster.Oximes attach to anionic site and provide more reactive OH groups.Oximes are ineffective in Carbamates poisoning.Pralidoxime is contraindicated in carbamates poisoning, because not only it does not reactivate carbamylated enzyme, it has weak anti-chE activity of its own.Remembero Obidoxime is more potent than pralidoxime.o Pralidoxime and obidoxime are lipid insoluble, while diacetyl-monoxime (DAM) is lipid soluble so it can cross EBB and regenerate AChE in brain.o Atropine is used in both organophosphate and carbamate anticholinesterase poisoning.
1
Reactivating cholinesterase enzyme
Promoting synthesis of cholinesterase
Promoting synthesis of acetylcholine
Direct action on cholinergic receptors
Pharmacology
Cholinergic System
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Malignant cells in urine cytology are most commonly seen in
Ans. c (Urothelial carcinoma). (Ref. Harrison's Medicine 17th ed. 555)# Urothelial malignancy classically shows polychronotropism & multicentricity.# In urothelial or transitional carcinoma of renal pelvis or ureter, the examination of urine for malignant cells is positive and even may indicate whether tumor is well or poorly differentiated.# There is evidence that those with poorly differentited tumors do better if they have a short course of radiotherapy before surgery.# It is hence useful to obtain cells from tumor/urine by sampling a brush or catheter passes up the ureter under radiological control.
3
Renal cell carcinoma
Prostate carcinoma
Urothelial carcinoma
Bladder carcinoma
Surgery
Urinary Tract
fab52be2-1236-4ac4-b40f-95a9b9fd37dd
single
Drug of choice for mushroom poisoning is :
null
1
Atropine.
Solefenacin.
Oxybutynin.
Tolterodine.
Pharmacology
null
64e1a4a3-6e42-4b4a-a305-02547ef5dba6
single
Surya kant is prescribed with first generation antihistaminic. He should be advised to avoid:
Ans. A. Driving motor cycleFirst generation antihistaminic like promethazine, diphenhydramine crosses the blood brain barrier and have higher incidence of sedation. Another property of these drugs is that they show anticholinergic side effects. Due to this patient is asked not to drive any vehicle.
1
Driving motor cycle
Consuming cheese
Physical exercise
All of the above
Pharmacology
Miscellaneous (Pharmacology)
317c6251-f5b1-4b02-8baa-947e91e1d59f
multi
Pivot shift test is positive with
Ans. a (Anterior cruciate ligament tear) (Ref. Adam's orthopedics 11th/pg, 315-325)Knee Joint Injuries1Normal range of motion# Flexion: 135 degrees# Extension: 0 to 10 degrees above horizontal plane2Patellar apprehension test# Evaluates for patella subluxation3Anterior cruciate ligament (ACL) stability tests# Lachman test (most sensitive) - done with the knee flexed at 20deg.# Anterior drawer test- done with the knee flexed at 20deg.# Pivot shift test (Macintosh Test)4Posterior Cruciate Ligament (PCL) Tests# Knee posterior drawer test# PCL sulcus test# PCL sag test5Collateral ligament evaluation# Knee valgus stress test (Medial collateral ligament)# Knee varus stress test (Lateral collateral ligament)6Meniscus evaluation# McMurray's test# Apley's compression test and apley's distraction test# Bounce Test7Pivot test# Patient lies in lateral decubitus position,# Affected knee extended, affected tibia internally rotated, and examiner applies valgus stress to knee (push from lateral side) and tries to flex knee,# If clunk felt at 30 degrees knee flexion, the test is said positive test for ACL rupture.
1
Anterior cruciate ligament tear
Posterior cruciate ligament tear
Medial meniscus injury
Lateral meniscus injury
Orthopaedics
Injuries Around the Thigh & Knee
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single
Antidepressant drug used in nocturnal eneuresis is -
Drugs used in nocturnal enuresis are imipramine and desmopressine.
1
Imipramine
Fluoxetine
Trazdone
Sertaline
Psychiatry
null
b512d30c-b34d-48fe-a7ac-bc6346f0b8b3
single
A pregnant lady at 32 weeks of gestation presents with a BP of 160/110 mmHg, proteinuria with retinal haemorrhage. What is the definitive treatment of choice in this patient?
This patient is showing features of severe hypeension which is an indication for delivery. Induction of labour is the definitive treatment of choice which is most preferable. In order to prevent the onset of seizures magnesium sulfate prophylaxis should be given. Features of severe pre eclampsia are: BP > 160/110 >- 3 + proteinuria Presence of headache, visual disturbances, upper abdominal pain, oliguria and convulsion Elevated levels of serum creatinine, serum transaminase or presence of thrombocytopenia Fetal growth restriction Pulmonary edema Ref: Anantharaman P., Schmidt R.J., Holley J.L. (2009). Chapter 55. Pregnancy & Renal Disease. Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 34.
4
Ritodrine
Nifedipine
Magnesium sulphates
Termination of pregnancy
Gynaecology & Obstetrics
null
f0548c9a-9604-49d4-9507-39c7b55820d3
single
Which is not a component of APGAR Score –
null
4
Colour of the body
Muscle tone
Heart rate/minutes
Respiratory rate per minute
Pediatrics
null
cf641071-6dbd-4872-b895-c2a6cacf6688
single
Chromosome in which centromere is close to one end which result in short arm being very short is which type of chromosome?
Ans. d (Acrocentric). (Ref. Cell & Molecular Biology by DeRobertis, 7th /pg. 348)CHROMOSOMES# The entire genetic information contained in the genes is packaged in the chromosomes. All the somatic cells of an individual organism contain the same number of chromosomes.# Genes are arranged linearly on the chromosomes and their positions on the normal chromosome in relation to other genes on same chromosome are fixed. This position is called locus.# Genes occupying the same locus on a pair of chromosomes are called alleles.Structure of chromosomes:# Chromosomes are long structures with a constriction at point along its length-called centromere.# The ends of the chromosomes are called telomeres. These give stability to the chromosome. In the absence of telomeres, chromosomes become unstable and tend to break until joined to a telomere. An enzyme telomerase maintains the length of the telomeric sequences. Cell aging is controlled by telomerase enzyme. (AI 2003)# It has the structure for the attachment of chromosome to the spindle fibers called the Kinetochore.Depending on the location of the centromere on the chromosome, they are classified as: Type of chromosomeComments1.MetacentricThe centromere is in the centre of the chromosome so that the chromosome has two equal arms.2.Sub-metacentricCentromeres are away from the center so that the arms are unequal in size (one arm shorter than other).3.TelocentricCentromere is at the extreme end of replicating chromosome, so that chromosome consists of only one arm.4.AcrocentricCentromere is almost at the tip (one end) of the chromosome, so that one arm is much longer than other. BANDING TECHNIQUES# Techniques using dyes such as quinacrine, or giemsa after trypsin or heat treatment are called banding techniques. The banding pattern is specific for each chromosome, and seen in both members of a pair.# Bands seen with quinacrine, a fluorescent dye, are called Q-bands.# Banding seen with giemsa stain is called G-banding (The most extensively used technique)# Mitotic cells are essential for chromosome studies. In human body, mitosis occurs in:- Bone marrow, Intestinal mucosa, Skin and Gonads.# However, biopsies are difficult to obtain and sufficient number of dividing cells are not available.# The blood lymphocytes can be stimulated to divide in culture (appropriate medium) and easy to obtain.# Small skin biopsies can be obtained and the fibroblasts grown in culture.# Lymphocyte culture: Treatment of peripheral blood lymphocytes with substances such as Phytohemagluttinin (PHA) or Concanavalin A (Con A) stimulates the T lymphocytes to transform into lymphoblasts and undergo 3-4 rounds of mitotic divisions.# Sources of human cells for cytogenetic studies (analysis of human karyotypes) are:- Fibroblasts- Amniotic cells- Cells of chorionic villi.For detailed studies on the human chromosome mitotic cells are arrested in metaphase.The metaphase chromosomes are in a highly condensed state.
4
Metacentric
Submetacentric
Telocentric
Acrocentic
Anatomy
General
3761d425-1996-4438-b8ee-dc77c1e16d81
single
Which among the following is a mechanism of action of colchicine?
Colchicine is known to suppress many immune functions in the setting of crystal induced ahritis by 1. decreasing neutrophil chemotaxis 2. decreasing neutrophil adhesion 3. decreasing release of multiple inflammatory mediators 4. decreasing phagocytosis of urate crystals by neutrophils. Mechanism: Colchicine binds to tubulin and causing its depolymerization. This disrupts the mobility of granulocytes thereby decreasing its migration to the affected area. It also blocks cell division by binding to mitotic spindles. Uses: Colchicine is used in the treatment of acute gouty attacks as well as chronic gout. It is neither uricosuric nor an analgesic agent but it relieves pain in acute attacks of gout. It does not prevent progression of gout to acute gouty ahritis, but it has a suppressive, prophylactic effect that reduces the frequency of acute attacks and relieves pain. Ref: Applied Pharmacology By Stan K. Bardal, page 298, Pharmacology edited by Michelle A. Clark, page 546.
1
Suppression of immunity
Increase in uric acid excretion
Decrease in uric acid synthesis
None of the above
Pharmacology
null
52326d02-8302-4436-be24-ea5a5f44d82b
multi
Bollinger bodies are seen in -
null
3
Chickenpox
Cowpox
Fowlpox
Smallpox
Microbiology
null
870d7455-f9a8-4e98-9576-0886fd889ee7
multi
About Kawasaki disease all are true, EXCEPT:
Suppurative lymphadenopathy
4
Mucocutaneous lesions
Coronary aery is involved
Seen in children
Suppurative lymphadenopathy
Medicine
null
d1869c29-3776-4ff6-85b8-34120edf484b
multi
Which of the following is a L-type calcium channel blocker:
Ans. (d) All of the aboveRef. KDT 6th ed. / 528Types of Calcium Channel Blocker L-Type (long lasting current)T-type (transient current)N-Type (neuronal)Locations and function* Excitation -contraction coupling in cardiac and smooth muscle* SA, A-V node: conductivity* Endocrine cell: Hormone release* Neurons: transmitter release* Sa node- pacemaker activity* "T" current and repetitive spikes in thalamic and other neurons* Endocrine cells hormone release* Certain arteries constriction* Only on Neurons in CNS, sympathetic and myenteric plexuses transmitter releaseBlocker (drugs)Amlodipines, Nifedipine, diltiazem, verapamilMibefradil, flunarizine, ethosuximideo- conotoxin
4
Nifedipines
Amlodipines
Diltiazem
All of the above
Pharmacology
Anti-Hypertensive
6f9e2805-85d6-47e9-934d-03b202f130b2
multi
Male to male transmission is seen in -
Robbins basic pathology 9th edition page no 218,Heading=Transmission patterns of single-gene disorders Disorders of autosomal dominant inheritance are manifested in the heterozygous state, so atleast one parent in an index case usually is affected, both males and females are affected, both males and females are affected, and both can transmit the condition
1
Autosomal dominant diseases
Autosomal recessive
X-linked dominant
Mitochondrial disease
Pathology
General pathology
bafc4838-ff95-4fac-bf18-7522993b43cf
single
Sputum from one patient is disinfected immediately following expectoration, this is known as:
Ans: a (Concurrent) Ref: Park, 19th ed, p. 108Sterilization is the process of destroying all life including spores.Disinfection- is the killing of infectious agents outside the body by direct exposure to chemical or physical agents.Types of disinfection:a) Concurrent disinfection- It is the application of disinfective measures as soon as possible after the discharge of infectious material from the body of infected person, or after the soiling of articles with such infectious discharges, e.g.. disinfection of urine, faeces, vomit, contaminated linen, cloth hands, dressings, aprons, throughout the course of illness.b) Terminal disinfection- It is the application of disinfective measures after the patient has been removed by death or to hospitals or has ceased to be a source of infection. Terminal disinfection is now scarcely practiced; terminal cleaning is considered adequate, alongwith airing and sunning of rooms, furnitures.c) Precurrent or prophylactic disinfection- Disinfection of water by chlorine, pasteurization of milk and hand washing are examples.
1
Concurrent
Pre current
Recurrent
Terminal
Social & Preventive Medicine
Communicable Diseases
5783b99d-68d8-43db-8877-c1357e81888d
single
'Sequestration' is best defined as:
Ans. B. A piece of dead bone surrounded by infected tissue (Ref. Maheshwari ortho 3rd/pg.l60)Maheshwari orthopaedics 3rd/pg. 160...."Sequestrum is a piece of dead bone, surrounded by infected granulation tissue trying to 'eat' the Sequestrum away"CHRONIC OSTEOMYELITISPresents in 3 forms:A. Chronic osteomyelitis secondary to acute osteomyelitisB. Garre's osteomyelitisC. Brodie's abscessA. Chronic osteomyelitis secondary to acute osteomyelitis# Key radiological feature is Sequestrum ( a feature of chronic osteomyelitis) which appears denser than surrounding normal bone because decalcification which occurs in normal bones does not occur here. The granulation tissue surrounding the sequestrum gives rise to a radiolucent zone around it. A sequestrum may be visible in soft-tissues.# Involucrum is the dense sclerotic bone overlying a sequestrum. There may be some holes in involucrum for the pus to drain out and these holes are called cloacae. The bony cavities are lined by infected granulation tissue. Involucrum and cloacae are often visible.- Chronic osteomyelitis is commonest complication of acute osteomyelitis.- A chronic discharging sinus is the commonest presenting symptom.- The lower end of femur is commonest site of chronic osteomyelitis.B. Garre's osteomyelitis# Sclerosing non-suppurative chronic osteomyelitis.0# Begins with acute local pain, swelling and pyrexia.# Fever subsides but fusiform osseous enlragment persists.# Tenderness on deep palpation.# No discharging sinus.# Shaft of femur or tibia are the commonest sites affected.# Importance lies in differentiating it from bone tumors which present with similar features e.g. Ewing's sarcoma and osteosarcoma.# Rx: Acute symptoms subside with rest and broad spectrum antibiotics and Some times making a gutter or holes in the affected bone brings relief in pain.C. Brodie's abscess# Special osteomyelitis in which body defense mechanism have been able to contain the infection so as to create a chronic bone abscess containing pus/jelly-like granulation tissue surrounded by a zone of sclerosis.# Age: 1 - 20 yrs.# A deep boring pain is predominant symptom, which may become worse at night & relived by rest.# Occasionally, there may be transient effusion in the adjacent joint during exacerbation.# Examination may reveal tenedemess and thickening of bone.# Common sites: Upper end of the tibia and Lower end of femur# Usually located at metaphysis# X-ray rCircular or oval translucent area surrounded by a zone of sclerosis.# Rx: Surgical evacuation and curettage under antibiotic cover and If the cavity is large it is packed with cancellous bone chips.
2
A piece of dead bone
A piece of dead bone surrounded by infected tissue
A piece of bone with poor vascularity
None of the above
Orthopaedics
Infection of Bones & Joints
37465750-3029-43ee-8553-183f8aa34f5c
multi
Dose of Rabies immunoglobulin is?
Anti rabies serum is given in class III bites (Single or multiple transdermal bites or scratches, licks on broken skin, Contamination of mucous membranes with aalvia, exposure to bats) It is found to prolong the incubation period. Passive immunization in rabies may be given by : Horse Anti-rabies serum : 40 IU/kg body wt (upto max 3000 units), infiltrated in the wound, & the rest given IM Human Rabies Immunoglobulin : (preferred) 20 IU/kg body wt infiltrated in the wound, & the rest given i.m.
3
10 IU/Kg body weight
15 IU/kg body weight
20 IU/kg body weight
25 IU/kg body weight
Unknown
null
9d65ee9b-e380-4fa0-8108-195f071bf656
single
Progressive cognitive impairment is Alzheimer's disease is characterized by
Memory impairment is typically an early and prominent feature in dementia, especially in dementias involving the coex, such as dementia of the Alzheimer's type. Early in the course of dementia, memory impairment is mild and usually most marked for recent events. As the course of dementia progresses, memory impairment becomes severe, and only the earliest learned information (e.g., a person's place of bih) is retained. Reference: Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 11th Edition, page 712.
2
Nominal aphasia
Recent memory loss
No behavioral abnormalities
All
Psychiatry
Organic mental disorders
48b32cb1-8b7a-4797-9274-e8697ab08c01
multi
Mesothelioma is most commonly caused by?
Ans. (a) AsbestosisRef: Harrison 19th ed. /1689* Working with asbestos is the most common risk factor for mesothelioma.* Indeed, the relationship between asbestos and mesothelioma is so strong that many consider mesothelioma a "signal" or "sentinel" tumor.* In rare cases, mesothelioma has also been associated with irradiation of the chest or abdomen, intrapleural thorium dioxide (thorotrast) as a contrast medium, and inhalation of other fibrous silicates, such as erionite.
1
Asbestosis
Silicosis
Anthracosis
Coal workers pneumoconiosis
Medicine
Pneumoconiosis
ac378e3c-74c8-48d7-ac19-bce3885d4312
single
The following rosette cataract is seen with
null
2
Steroid induced cataract
Traumatic cataract
Syndermatotic cataract
Rose thorn injury to lens
Ophthalmology
null
1eefadf6-c0eb-44cd-8281-d04adeb68264
single
Which of the following is true about typhoid?
Convalescent carriers excrete the bacilli for 6-8 weeks.Persons who excrete the bacilli for more than a year after a clinical attack are called chronic carriers.In chronic carriers, the organism persists in the gallbladder. Vi antibodies are present in about 80% 0f chronic carriersFecal carriers are more frequent than urinary carriers. The chronic urinary carrier state is often associated with some abnormality of the urinary tract.Ampicillin or amoxicillin + Probenecid for 6 weeks achieve eradication in 70% of chronic carriersPark 23e pg: 236
2
Fecal carriers are less common
Vi antibodies are present in about 80% of chronic carriers
Gall bladder usually not involved in carrier state
Tetracycline is the DOC for carriers
Social & Preventive Medicine
Communicable diseases
7da0a3c4-316b-40e7-9a91-241483ab4691
multi
A 5 yr. old male child has multiple hyperpigmented macules over the trunk. On rubbing the lesion with rounded end of pen, he developed urticarial wheal, confined to border of lesion, most likely diagnosis is:
Ans. C. Urticaria pigmentosa* It is urticaria pigmentosa.* It is cutaneous mastocytosis presenting with pigmented lesions.* On rubbing the lesions mast cells degranulate releasing histamine.* This produces the wheal and flare of the lesion. It is known as Darier's sign.Epidermal acantholysis in mid epidermis with "dilapidated or crumbling brick wall" appearance. Darier's disease is associated with ATP2A2 defect
3
Fixed drug eruption
Lichen planus
Urticaria pigmentosa
Urticarial vasculitis
Skin
Miscellaneous
9f8dcde7-4ab4-4390-8ecc-387c17e340ce
single
Long term control of diabetes is assessed by
Ans. D i.e. HbA1c
4
Random blood sugar
Microalbuminuria/ creatinine ratio
HbA2
HbA1c
Medicine
null
5e58e064-06c9-44f7-8a4b-f79b38a6adf0
single
Primary open-angle glaucoma is associated with all of the following except:
Ans. Pars planitis
4
Diabetes mellitus
Myopia
Hypehyroidism
Pars planitis
Ophthalmology
null
7a7f5bfe-c812-4fae-8b19-927825035080
multi
Direction of water jet while doing syringing of ear should be:
In syringing (done to remove impacted wax) pinna is pulled upwards and backwards and a stream of water from the ear syringe is directed along the posterosuperior wall of the meatus.
2
Anteroinferior
Posterosuperior
Anterosuperior
Posteroinferior
ENT
null
b0dbf3bb-0859-4668-82ef-9d12ec3333b6
single
Biological value is maximum of:
Egg
1
Egg
Milk
Soyabean
Pulses
Social & Preventive Medicine
null
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single
Among the given hormones which are stored the longest in a cell
Hormone Supply Stored in CellSteroids and 1,25(OH)2-D3NoneCatecholamines and PTHHoursInsulin DaysT3 and T4WeeksRef: Harper; 30th edition; Pg:515
2
Insulin
T3
PTH
Testosterone
Biochemistry
Structure and function of protein
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single
The most common effect of colchicine which is dose limiting is :
null
1
Diarrhea
Dyspepsia
Retinal damage
Loss of taste sensation
Pharmacology
null
96d171c3-ed59-4539-9f65-2991a015773a
single
Not a feature of Treacher-Collins syndrome:
Ans. D. Mongoloid slant of palpable fissureMandibulofacial dysostosis is also known as Franceschetti-Klein syndrome or Treacher-Collins syndrome.Important features are as under:MicrognathiaColobomas of lower eyelidSunken cheek bonesBlind fistulas between the angles of mouth and earsDeformed pinnasAtypical hair growth extending towards cheekReceding chinLarge mouthFacial cleftsDeafnessAnti-mongoloid palpable fissureHypoplasia of mid face and zygomatic bone
4
Deafness
Colobomas of lower eyelid
Hypoplasia of zygomatic bone
Mongoloid slant of palpable fissure
Pediatrics
Genetics And Genetic Disorders
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single
Most potent stimulator of NaiveT-cells -
Question repeated
1
Mature dentritic cells
Follicular dentritic cells
Macrophages
B-cell
Pathology
General pathology
9dacd22c-982f-4023-a8df-4a2b7a46a0b8
single
Layers of the scalp include all of the following except-
Ans. is 'b' i.e., Adventitious layer Layers of scalp have been explained in NEET Dec.-16
2
Galea aponeurotica
Adventitious layer
Skin
Pericranium
Anatomy
Head & Neck
45ca83ff-dc48-49a8-9d42-7ac346189b18
multi
Which of the following adverse effects characteristically associated with methysergide ?
null
2
Pulmonary hypertension
Retroperitoneal fibrosis
Hepatotoxicity
Ischemic heart disease
Pharmacology
null
e8b96f11-a402-4f70-9684-d0ba21a935a4
multi
Binge eating disorder is characterized by ?
Ans. C. ObesityBinge eating disorder (BED) is characterized by insatiable cravings that can occur any time day or night, usually secretive, and filled with shame.There are no comPensatory mechanisms associated with the binge to get rid of calories, so individulas with BED are more likely to be overweight or obese, while patients with bulimia nervosa may be underweight, normal weight.
3
Normal weight
Weight loss
Obesity
Self induced vomiting
Psychiatry
null
f9e0dd56-435f-4f22-aae9-ee8dea11f162
single
Anemia of chronic disease is characterised by
(Ref: Robbins 8/e p662) Anemia of chronic disease- Impaired red cell production associated with any chronic diseases that would be infectious/inflammatory/neoplastic. Chronic diseases produce a cytokine “IL-6” that increases the production of hepcidin from liver.  Hepcidin inhibits ferroportin function in macrophages and reduces the transfer of iron from storage pool to developing erythroid precursors in bone marrow. So the patient develop anemia irrespective of increased amount of iron in macrophages. Laboratory findings- Increased ferritin (storage iron), Low serum iron  and reduced total iron binding capacity. Whereas in iron deficiency anemia, the patient will have decreased ferritin, lowserum iron and high iron binding capacity.
3
Increased sideroblast
Increased TIBC
Increased bone marrow iron
Increased protoporphyrin
Unknown
null
b8930b48-32e6-4700-9951-bd12426ad066
single
Choose the true statement about mit DNA:
Ans. D. It codes for less than 20% of the proteins involved in respiratory chainIn ETC there are around 67 subunits, out it 13 proteins are coded by Mit DNA, which comes around 19%.Mitochondrial DNA has high mutation rate almost 5 to 10 times that of nuclear DNA.It has 16,569 bpMitochondrial DNA has maternal inheritance
4
Few mutation compared to nuclear DNA
It has 3x109 base pairs
It receives 23 chromosomes from each parent
It codes for less than 20% of the proteins involved in respiratory chain
Biochemistry
Molecular Genetics
629939d5-2989-485c-8051-7ec91f016bf0
multi
Cataract in newborn is:
Ans. Zonular
1
Zonular
Coronary
Snowflake
Coical
Ophthalmology
null
672c4c46-5bef-420f-bd74-77a5e0141f13
single
Drug of choice for treatment of type 2 Brittle Asthma is -
Ans. is 'd' i.e., Subcutaneous epinephrine o Brittle asthma is a type of asthma distinguishable from other forms by recurrent, severe attacks.o There are two subtypes divided by symptoms: Type 1 and Type 2, depending on the stability of the patient's maximum speed of expiration, or peak expiratory flow rate (PEFR).o Brittle asthma is one of the "unstable" subtypes of "difficult asthma", a term used to characterize the less than 5% of asthma cases that do not respond to maximal inhaled treatment, including high doses of corticosteroids combined with additional therapies such as long-acting beta-2 agonists.o Oxford Textbook of Medicine distinguishes type 1 brittle asthma by# "persistent daily chaotic variability in peak flow (usually greater than 40 per cent diurnal variation in PEFR more than 50 per cent of the time)",o While type 2 is identified by# "sporadic sudden falls in PEFR against a background of usually well-controlled asthma with normal or near normal lung function".o In both types, patients are subject to recurrent, severe attacks.o Individuals with type 1 suffer chronic attacks in spite of ongoing medical therapy, while those with type 2 experience sudden, acute and even potentially life-threatening attacks even though otherwise their asthma seems well managed.
4
b-adrenergic agonist
Inhaled corticosteroids
Antileukotrines DM
Subcutaneous epinephrine
Medicine
Asthma
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single
A 22-year-old woman is admitted to the hospital because of right-hand anaesthesia, that developed after an argument with her brother. She is in good spirits and seems unconcerned about her problem. There is no history of physical trauma. The neurologic examination is negative EXCEPT for reduced sensitivity to pain in a glove-like distribution over the right hand. Her entire family is in attendance and is expressing great concern and attentiveness. She ignores her brother and seems unaware of the chronic jealousy and rivalry described by her family. The most likely diagnosis is
(D) Conversion disorder # Conversion disorder is characterized by symptoms or deficits of die voluntary motor or sensory functions dial cannot be explained by neurological or other medical conditions.> These symptoms are precipitated by psychological conflicts.> Term 'Hysteria' was used in die nineteenth century (and die first versions of die DSM) to describe syndromes similar to conversion disorder.> It is not a legitimate diagnostic term anymore and it has a negative connotation in general use.> Patients with body dysmorphic disorder are preoccupied wide in-existent or wry minor physical imperfections, often at a delusional level.> Patients with brain tumors present with motor, behavioral and neuropsychiatry symptoms dial vary depending on the localization of die tumors.> Patient's lack of anxiety and apparent lack of awareness of the conflicts with her brother are classic findings In conversion disorder and they are described as called "Primary gains."> This term refers to the use of physical symptoms to express a conflict, emotion, or desire with-in allowing it to enter the patient's consciousness.> Patient's enjoyment other family's attention is a form of "Secondary gain." Secondary gains, being experienced as plea sur- able, reinforce the symptoms.> There is no such dying as "Tertiary gain."> Suppression is a mature defense mechanism and consists of a voluntary decision to put a disturbing thought temporarily o.it of the conscious mind.> "indifference reaction" is associated with right hemispheric lesions and consists of symptoms of indifference toward failures and physical difficulties and lack of interest in family and friends.
4
Body dysmorphic disorder
Histrionic personality disorder
Parietal brain tumor
Conversion disorder
Pharmacology
Miscellaneous (Pharmacology)
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multi
A person following a road-traffic accident presented in emergency with laceration of inguinal region. On examination there was swelling of inguinal region and distal pulsation was felt; internal iliac artery was normal, common iliac and external femoral artery was normal but common femoral vein is transected. Treatment of choice is -
null
1
Vein repair with continuity
Sclerotherapy
Ligation of femoral artery and vein
Amputation below knee
Surgery
null
ab7779d0-18c3-4d45-a732-33612120f24c
single
A patient with ASD has the murmur similar to mitral regurgitation and left axis detion of 40 degrees. He is likely having:
Presence of pansystolic murmur of mitral regurgitation in a patient with ASD suggests the presence of ostium primum defect with cleft mitral leaflet or a floppy mitral valve with mitral valve prolapse. ECG shows right axis detion in ASD, and extreme left axis detion in ostium primum ASD. Clinical presentation of ostium primum is similar to ostium secundum except that there may be a mitral systolic murmur due to MR and ECG shows left axis detion. Ref: Pediatrics: A Concise Text By SK Kabra, RN Srivastava, 2010, Page 135
4
TGA
Ostium secondum
Ostium primum
Floppy mitral valve
Pediatrics
null
163ec7af-ce59-46da-afb3-4429b44ae682
single
GLUT 4 is present in -
Ans. is 'c' i.e., Cardiac muscle* GLUT4 transporters mediate insulin dependent glucose uptake in skeletal muscle, cardiac muscle and adipose tissue
3
Endothelium
Liver
Cardiac muscle
Lens
Biochemistry
Carbohydrates
545927bc-c9c0-48c5-98a4-855a6e901674
single
Which is the best test to detect pulmonary embolism
CTPA is the first-line diagnostic test. It has the advantage of visualising the distribution and extent of the emboli or highlighting an alternative diagnosis, such as consolidation, pneumothorax or aoic dissection. The sensitivity of CT scanning may be increased by simultaneous visualisation of the femoraland popliteal veins, although this is not widely practised. As the contrast media may be nephrotoxic, care should be taken in patients with renal impairment, and CTPA avoided in those with a history of allergy to iodinated contrast media. In these cases, either V/Q scanning or ventilation/perfusion single photon emission computed tomography (V/Q SPECT) may be considered Ref Davidson edition23rd pg 620
4
D dimer assay
MRI
Ventilation Perfusion scan
CT with IV contrast
Medicine
Respiratory system
e06652e3-5225-4e8b-ace7-cf5b9a12a29e
single
A 54-year-old clerk complains of having had dysphagia for 15 years. The clinical diagnosis of achalasia is confirmed by a barium study. What is TRUE in this condition?
Dysphagia in esophageal achalasia is described as paradoxical in that it is more pronounced for liquids than solids. There are numerous reports of an increased incidence of carcinoma in achalasia, ranging from 3% to 10%. In 1975, Belsey reported a 10%. incidence in 81 patients in whom symptoms tended to occur at a younger age. Recurrent lung infections from aspiration of esophageal contents are a troublesome complication. The treatment is surgical myotomy or endoscopic dilatation.
1
The most common symptom is dysphagia.
In the early stages, dysphagia is more pronounced for solids than liquids
The incidence of sarcoma is increased.
Recurrent pulmonary infections are rare.
Surgery
Stomach & Duodenum
106bb8c1-7fb2-40fb-8ac2-327f733b2492
multi
Uveitis is caused by all except:
Ans. Klebsiella
4
T.B.
Staphylococcus
Streptococcus
Klebsiella
Ophthalmology
null
dfd75847-f4df-40bb-ab84-fcb5038fefe3
multi
Which of the following is false regarding plasmid
Plasmids contain their own signals for replication and can replicate independently.
4
Circular genetic material
Double stranded DNA
Extra chromosomal
Synchronised with chromosomal multiplication
Biochemistry
null
5cc9e218-a6f9-4ce9-acf2-f69baddbac40
multi
Commonest cause of right ventricular failure is ?
Ans. is 'd' i.e., Left ventricular failureRight sided hea failureo Most common cause of right sided hea failure is left sided hea failure, i.e. right hea failure occurs as a consequence of left hea failure because left hea failure increases pressure in pulmonary circulation that produces an increased burden on the right side of the hea.o Left sided hea failure --> is pulmonary circulation pressure T burden to right atrium and ventricle -4 right sided hea failure.o Isolated right-sided hea failure most often occurs with chronic severe pulmonary hypeension and thus is called Cor-pulmonale.o Dilatation and hyperopy are confined to right atrium and ventricle.o The major morphological and clinical effects of pure right sided hea failure differ from those of left-sided hea failure because pulmonary congestion is minimal, while there is increased pressure and congestion in systemic veins and poal venous system. That results in ?l. Peripheral edema of dependent poion, especially ankle (pedal) and pretibial edema is a hallmark of right sided hea failure. Generalized massive edema may occur --> An asarca.Hepatic enlargement with centrilobular necrosis that may progress to cirrhosis --> Cardiac cirrhosis.Congestive splenomegaly.Pleural effusion (in contrast to left sided hea failure where pulmonary edema occurs).Pericardial effusion.Ascitieso Pulmonary edema is associated with LVF whereas pleural effusion is associated with RVF.
4
Corpulmonale
Pulmonary involvement
Endomyocardial fibrosis
Left ventricular failure
Pathology
null
eadf0100-f37f-4bd3-af71-f15226951a7c
single
Which of the following anti-histaminie has very less cholinergic side effects?
Loratidine is a second generation anti-histamine which has lesser sedation and cholinergic side effects.
4
Promethazine
Chlorpheniramine
Hydroxyzine
Loratidine
Pharmacology
null
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single
following are decomposition changes except
Decomposition changes Discoloration: greenish discoloration of right iliac fossa due to sulphmethemoglobin, marbling, discoloration under surface of liver, staining of aoa, blackish discoloration of skin is due to formation of ferric sulphide. Distension: abdomen, breasts, penis, scrotum, face bloated, eyes budget out from sockets, gas rigidity, crepitus felt on soft tissues due to gas formation. Discharge: purging, fecal discharge, postmoem delivery of fetus. Detachment: peeling of skin, loosening of tissues, hair. Degloving: of hands and feet. Degradation: anatomy integrity of tissues and organs will be lost, softening. Dissolution: liquefaction of tissue and organs. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 33
4
Discoloration
Discharge
Degloving
Dilatation
Forensic Medicine
Death and postmortem changes
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multi
A 31 year old female patient complaints of bilateral impairment of hearing for the past 5 years. On examination, tympanic membrane is normal and audiogram shows a bilateral conductive deafness. Impedance audiometry shows normal curve and acoustic reflexes are absent. All of the following constitute pa of its treatment, EXCEPT:
The patient is showing features of otosclerosis. It is a condition due to new spongy bone formation. About 50% of the cases may have a positive family history and deafness stas between the age of 20-30 years. Non surgical treatment of otosclerosis includes use of hearing aid and sodium fluoride. Use of high doses of sodium fluoride is thought to increase the remineralization of otospongotic foci. It has been repoed to stabilize progressive inner ear hearing loss and tinnitus. Surgical treatment of choice is stapedectomy.
1
Gentamicin
Hearing aid
Stapedectomy
Sodium fluoride
ENT
null
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multi
A 43-yrs-old female patients, who has sustained a head injury in a fall, has significant problems wit memory. Her brain injury is most likely to the
The area of the brain most closely associated with memory is the temporal lobe, paicularly the hippocampus. PE presents with a syncopal episode up to 15 percent of the time. Altered mental status and generalized seizures may also be the presenting complaint, especially in the elderly. The most common presenting symptoms are chest pain and dyspnea (up to 85 percent); anxiety occurs in more than 50 percent of PE patients. Tachypnea (RR > 16) is seen in more than 98 percent of all cases, and tachycardia (resting HR > 100) is seen in up to 44 percent of all patients. Other signs are variable. The risk for embolism from proximal DVT is highest in the first week of its formation.
1
Temporal lobe
Frontal lobe
Parietal lobe
Occipital lobe
Surgery
null
698b9d08-8ac1-42eb-bf13-8515cca5f63d
multi
Antidote for ethylene glycol poisoning is/are: a) Methyl violet b) Fluconazole c) Fomepizole d) Ethyl alcohol
null
2
ac
cd
ad
bc
Pharmacology
null
1ee618bb-4cf0-470a-8895-0eaec35f9975
single
Which among the following is not a beta lactamase resistant Penicillin?
Ans. is 'b' i.e., Carbenicillin
2
Methicillin
Carbenicillin
Nafcillin
Oxacillin
Pharmacology
null
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single
Class IV Kennedy Classification is:
The following is the Kennedy classification: Class I: Bilateral edentulous areas located posterior to the natural teeth. Class II: A unilateral edentulous area located posterior to the remaining natural teeth. Class III: A unilateral edentulous are with natural teeth remaining both anterior and posterior to it. Class IV: A single, but bilateral (crossing the midline), edentulous area located anterior to the remaining natural teeth. Ref: McCrackens Removable Partial Denture Ed 13th Pg 17
4
Bilateral edentulous area located posterior to the remaining natural teeth.
Unilateral edentulous area located posterior to the remaining natural teeth.
Unilateral edentulous area with natural teeth remaining both anterior to the remaining natural teeth and posterior to it.
A single but bilateral (crossing the midline) edentulous area located anterior to the remaining natural teeth.
Dental
null
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multi
Earliest fetal anomaly to be detected by USG :
Anencephaly
2
Hydrocephalous
Anencephaly
Achondroplasia
Spina bifida
Gynaecology & Obstetrics
null
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single
A 54-year-old male nonsmoker is seen with complaints of a flulike illness. Initial symptomatic treatment is provided. Two days later, he returns, as he is still not feeling well. His primary physician prescribes a macrolide along with the symptomatic treatment. After 5 days of this treatment, the patient says he is running a fever and has increasing fatigue, weakness, and cough. He also complains of pain in the right wrist with some difficulty in motion. He has left groin pain and is unable to walk more than a few steps. On physical exam, vital signs are: pulse 110 bpm; temperature 102degF; respirations 24/min; blood pressure 10/68 mm Hg. He looks weak and says he has lost about 8 lb in the last 10 days. Peinent findings: lung exam reveals area of egophony, and E to A changes in the left anterior and posterior lung field. The patient has swelling with some areas of skin sloughing in the right wrist and tenderness with limitation of movement in the left groin area. Laboratory data: Hb 11 g/dL; Hct 33%; WBCs 16.0/uL; differential 90% segmented neutrophils; BUN 42 mg/dL; creatinine 1.1 mg/dL; sodium 142 mEq/L; potassium 3.4 mEq/L. ABGs on room air: pH 7.45, PCO2 34 mm Hg; PO2 65 mm Hg. CXR is shown.Associated findings may include all of the following except?
This x-ray shows a nonhomogeneous airspace density in the left middle and lower zones with areas of incomplete consolidation and evolving pneumatocele formation. The left diaphragm is raised and the trachea appears shifted to the left, suggesting loss of volume of the left lung. There is minimal blunting of the left costophrenic angle, suggesting a left pleural effu-sion. This CXR is consistent with the left lower lobe necrotizing pneumonia with loss of volume, which can be seen in staphylococcal pneumonia. The prodrome of a flulike illness and the development of pneumonia along with multisystem involvement suggest a bacteremic process. Both staphylococcal and pneumococcal pneumonia can produce this picture. However, the signs of the loss of volume in the left lung along with the necrotizing airspace disease or pneumatoceles suggest that this is more likely staphylococcal pneumonia. Associated conditions include septic ahritis, endocarditis, and brain abscess. Reye syndrome is unlikely in an adult and is not an applicable choice here.
4
Septic ahritis
Endocarditis
Brain abscess
Reye syndrome
Radiology
Respiratory system
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multi
Subclan steal syndrome is due to
Subclan steal syndrome refers to steno-occlusive disease of the proximal subclan aery with retrograde flow in the ipsilateral veebral aery and associated cerebral ischaemic symptoms.CausesClinical presentationIpsilateral upper limbNeurological, radiationCongenital Weak or absent pulseDecreased blood pressure (>20 mmHg)Arm claudication (rare due to collateral perfusion)DizzinessVeigoSyncopeAtaxiaVisual changesDysahriaWeaknessSensory disturbancesRadiographic featuresUltrasoundCT angiographyMR angiographyRetrograde flow in ipsilateral veebral aeryEarly changes prior to reversal of flow: decreased velocity, biphasic flow (in veebral aery)Changes can be augmented with arm exercise or inflation of BP cuff above systolic pressureProximal subclan aery usually can't be seen well enough to assessDistal subclan aery shows parvus-tardus waveform and monophasic waveformSubclan aery stenosis or occlusion easily identifiedDelayed enhancement of ipsilateral veebral aeryDirection of flow in veebral aery cannot be determinedOther intracranial or extracranial cerebral vascular lesions can be identifiedSubclan aery stenosis or occlusion easily identifiedDelayed enhancement of ipsilateral veebral aeryRetrograde direction of flow in ipsilateral veebral aeryOther intracranial or extracranial cerebral vascular lesions can also be identifiedTreatmentEndovascular: angioplasty & stent inseionSurgical: bypass surgery
2
Blockage of first pa of subclan aery
Blockage of second pa of subclan aery
Blockage of third pa of subclan aery
Thrombosis of subclan vein
Pathology
All India exam
e94ea92f-3d1b-4f02-949c-e37f05e38d4f
single
GABA is produced from:
Glutamate
3
Alanine
Glycine
Glutamate
Glutamine
Physiology
null
81f3ce8d-ce5d-4da1-a6b3-b8228d4856ce
single
Palpatory thud, an audible snap is seen in
A foreign body in trachea may move up and down the trachea between the carnia and the undersurface of vocal cords causing "audible slap" and "palpatory thud&;.Symptoms and signs of foreign bodies at different levelsSite of foreign bodiesSymptoms and signsLarynxChoking, Cyanosis, Complete obstruction leading to death* Paial obstruction: stridor, hoarseness, cough, respiratory difficultyTrachea* Choking, stridor, wheeze, cough, palpatory thud, audible slap* Cough, wheeze and diminished air entry to lung forms a "triad"Bronchi Respiratory distress with swelling of the foreign body* Lung collapse, emphysema, pneumonitis, bronchiectasis or lung abscess are late featuresRef: Hazarika; 3rd ed; Pg 651
1
Tracheal foreign body
Bronchial foreign body
Laryngeal foreign body
Foreign body in ear
ENT
Larynx
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single
A drug used in LUMINATE programme for non-infectious uveitis is –
Voclosporin is an immunomodulatory drug which inhibits the enzyme calcineurin. The chemical structure of voclosporin is similar to cyclosporine with a difference in one amino acid, leading to superior calcineurin inhibition and less variability in plasma concentration. The LUMINATE (Lux Uveitis Multicenter Investigation of a New Approach to Treatment) clinical development programme was initiated in 2007 by Lux Biosciences Inc to assess the safety and efficacy of Voclosporin for the treatment, maintenance, and control of all form of non-infectious uveitis. The aim of the LUMINATE programme was to ensure that voclosporin would become the first Corticosteroid-sparing agent to be approved by the US Food and Drug Administration for non-infectious uveitis.
2
Cyclosporine
Voclosporin
Methotrexate
Infliximab
Ophthalmology
null
d1a4d2e7-43f2-4634-b991-f4938c88cebb
single
Average of length of maxillary cuspid is:
null
1
26 mm
33 mm
21 mm
18 mm
Dental
null
57815d37-3ae7-417d-ad46-4eccf10f80d5
single
The nerve root blocked in pudendal block is
Pudendal nerve block : Pudendal nerve arises from S2,3,4. Doesn't relieve the pain of labor Cause perineal analgesia and relaxation Ref: Dutta Obs 9e pg 480.
3
L 1,2,3
L 2,3
S 2,3,4
S 4
Gynaecology & Obstetrics
General obstetrics
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single
A 45 year old male , known case of diabetes mellitus from last 15 years ,presents with Diabetic ketoacidosis . What shall be the initial line of management?
Diabetic ketoacidosis (DKA) is a problem that affects people with diabetes . It occurs when the body stas breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic. Initial management is - 0.9% saline Treatment of choice - Insulin drip The use of 3% saline is not indicated because the patient has no neurologic deficits * Intracellular potassium shift out of cells in acidosis and cause a normal or even elevated potassium level but with improvement in the acidosis, it rapidly falls. (Insulin shifts potassium into intracellular compament thus resulting in fall of serum Potassium levels) Therefore, potassium repletion is critical.
3
3 % saline
5% dextrose
0.9 % saline
Colloids
Medicine
DNB 2018
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multi
All of the following are true regarding pilonidal sinus except: September 2009
Ans. A: Seen predominantly in women Pilonidal disease is described back as far as 1833, when Mayo described a hair-containing cyst located just below the coccyx. Hodge coined the term "pilonidal" from its Latin origins in 1880. Pilonidal disease describes a spectrum of clinical presentations, ranging from asymptomatic hair-containing cysts and sinuses to large symptomatic abscesses of the sacrococcygeal region that have some tendency to recur Pilonidal disease involves loose hair and skin and perineal flora. Risk factors for pilonidal disease include male gender, hirsute individuals, Caucasians, sitting occupations, existence of a deep natal cleft, and presence of hair within the natal cleft. A common affliction amongst the military, it has been referred to as 'jeep disease'. Family history is seen in 38% of patients with pilonidal disease. Obesity is a risk factor for recurrent disease.
1
Seen predominantly in women
Occurs only in sacrococcygeal region
tendency for recurrence
Obesity is a risk factor
Surgery
null
c3738a59-7894-4e55-9854-efe08aedc855
multi
Fever & hemorrhagic rash are seen in ail except:
Ans: D (Sand,.) [Ref: Ananthanarayan 8th/514.518-19; Harrison 18th/l50,1629; Medical microbiology by Greenwood 16 th /4961The viral HF syndrome is a constellation of findings based on vascular instability and decreased vascular integrity. An assault, direct or indirect, on the microvasculature leads to increased permeability and (particularly when platelet function is decreased) to actual disruption and local hemorrhage"Dengue (breakbone fever) Q is a mosquito-borne infection caused by a flavivirus that is characterized by fever, severe headache, muscle and joint pain, nausea and vomiting, eye pain, and rash"-Harrison 18th/1632"Lassa fever: The disease is characterized by very high fever, mouth ulcers, severe muscle aches, skin rash with hemorrhages, pneumonia, and heart and kidney damage"- Harrison 18th/1628Viral hemorrhagic feverArboviruses and arenavirusesPetechial rash Residence in or travel to endemic areas or other virus exposureTriad of fever, shock, hemorrhage from mucosa or gastrointestinal tractTable (Harrison 18th/1629): Viral Hemorrhagic Fever (HF) Syndromes and Their DistributionDiseaseIncubation Period, DaysCase-Infection RatioCase-Fatality Rate, %Geographic RangeTarget PopulationLasso fever-5-16Mild infections probably common15West AfricaAll ages, both sexesRift Valley fever2-5~1:100a~50Sub-Saharan Africa, Madagascar. EgyptAll ages, both sexes; more often diagnosed in men; preexisting liver disease may predisposeCrimean-Congo HF3-12>1:515-30Africa, Middle East, Turkey, Balkans, southern region of former Soviet Union, western ChinaAll ages, both sexes: men more exposed in some settingsYellow fever3-61:2-1:2020Africa, South AmericaAh ages, both sexes; adults more exposed in jungle setting; preexisting flavivirus immunity may cross-protectDengue HF/dengue shock syndrome2-7Nonimmune, 1:10,000; heterologous immune, 1:100<1 with supportive treatmentTropics and subtropics worldwidePredominantly children: previous heterologous dengue infection predisposes to HF
4
Dengu fever
Lassa fever
Rift Valley fever
Sand fly fever
Microbiology
Virology
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multi
Argentaffin cells in the GIT produce
Their granules contain a chemical called serotonin, which stimulates smooth muscle contractions.
4
Gastrin
Pepsin
HCl
None of the above
Anatomy
Systemic histology
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multi
A 46-year-old man has a swelling in the scrotum. It shows clear transillumination anterior to the testis when a light is applied to the scrotum in a dark room. This physical exam is most consistent with?
In adults, this is diagnostic, but in children, transillumination is also seen in an indirect inguinal hernia. As epididymal cyst may transilluminate but is posterior to the testis.
3
Cyst of the epididymis
Torsion of testis
Hydrocele
Direct inguinal hernia
Surgery
Urethra & Penis
3c372938-0d3a-43c0-a2ae-4e6d55a8f27f
single
A 35-year patient recalls episodes where he smells a pungent odor, becomes sweaty and loses consciousness. His family member says while unconscious he was having facial twitching with lip-smacking movements. What is the most probable diagnosis?
The patient is exhibiting focal seizures which are accompanied by transient impairment of patient's ability to maintain normal contact with environment. Chewing, lip smacking, swallowing or picking movements of hands are called Automatism. Full recovery after the episode range from seconds to an hour. Due to involvement of temporal lobe, patient was having an abnormal olfactory sense before the episode.
1
Focal seizures
Hysteria
Atonic seizures
Myoclonic seizures
Medicine
Epilepsy and EEG
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multi