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"Onion-skin" fibrosis of bile duct is seen in
Pathology of Primary sclerosing cholangitis Cholangiocytea, epithelial cells that lines the bile duct are target cell of injury in PSC Histologic finding "Onion skin appearance" is pathognomic of PSC, but seen in <10% cases Involvement of large intrahepatic and extrahepatic duct distinguishes PSC from PBC Absence of the smallest intrahepatic ducts leading to a reduction in the branching of biliary tree (giving rise to pruned-tree appearance on direct cholangiography) Histologic changes in the same liver can be markedly varied from segment to segment at any given time Ref: Sabiston 20th edition Pgno :1508-1509
2
Primary biliary cirrhosis
Primary sclerosing cholangitis
Extrahepatic biliary fibrosis
Congenital hepatic fibrosis
Anatomy
G.I.T
47978c7d-8176-4c2c-bda2-ae6bbf235841
single
Cullen's sign -
Ans. is 'b' i.e., Bluish discolouration in the umbilicus Cullen's sign - Bluish discoloration at the umbilicus Grey Turner's sign - Bluish discoloration at the flanks Ct. Mnemonic: GF (Girl Friend) Cullens --> Umbilicus Grey Turner's --> Flanks
2
Bluish disclolouration of the flanks
Bluish disclolouration of the flanks
Migratory thrombophelebitis
Subcutaneous fat necrosis
Surgery
null
13a7ceee-27d9-46d6-bc59-25bd6089b19f
single
A 25-year-old woman sustains a deep, open laceration over her right forearm in a motorcycle accident. The wound is cleaned and sutured. Which of the following cell types mediates contraction of the wound to facilitate healing?
The myofibroblast is the cell responsible for wound contraction as well as the deforming pathologic process termed wound contracture. Myofibroblasts exe their contractile effects by forming syncytia,in this they are bound together by tight junctions. -Fibroblasts (choice B) tend to be solitary cells, surrounded by collagen fibers. -Endothelial cells (choice A) respond to growth factors and form capillaries, which are necessary for the delivery of nutrients and inflammatory cells. -Neither macrophages (choice C) mediate wound contraction.
4
Endothelial cells
Fibroblasts
Macrophages
Myofibroblasts
Pathology
Wound Healing
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single
A 27 year old sexually active male develops a vesicobullous lesion on the glans soon after taking tab paracetamol for fever. The lesion healed with hyper pigmentation. The most likely diagnosis is:
C ie Fixed drug eruption Fixed Drug Eruption - Adverse cutaneous drug reaction appearing soon after ingestions (from 30 min to 8-16 hours) of offending agent in previously sensitized individuals - Numerous drugs, including anti-inflammatory agents (eg salicylates, NSAID's including paracetamol), phenylhutazone, phenacetin and dapsone, sulfonamides, tetracycline & mefenamic acid may be responsible - Genital & perianal skin is the most commonly involved siteQ. Neveheless any site may be involved. - Most commonly lesions are solitaryQ but they may be multiple - Lesions evolve from macules to papules to vesicles & bullae and then erode. - Lesions heal by residual hyper-pigmentation Q - Usually asymptomaticQ but may be pruritic, painful, or burning (when eroded) - Lesions persist if drug is continued and resolve days to weeks after drug is discontinued - FDE occurs repeatedly at the same (ie fixed) site within hours, every time drug is taken and heal by residual grayish or slate colored hyperpigmentationQ. On rechallange, not only do the lesions recur in the same location, but also new lesions often reappears Challenge or provocation/Patch test can asceain etiology Herpes genitalis - Multiple, painful, bleeding non-indurated vesicles or ulcer with painful lymphadenopathyQ Pemphigus vulgaris Flaccid intraepidermal bullaeQ on upper pa of body in 40 - 60 years adult with mucosal involvement. Nikolsky sign positive, row of tomb stone & accantholysis presentQ Bechet's syndrome Multisystemic disorder with recurrent oral & genital ulcerations with ocular involvement - Recurrent apthous ulcerations are sine qua non for diagnosis Ulcers heal without leaving scars - Genital ulcers are less common and do not involve glans and urethra
3
Bechet's syndrome
Herpes genitalis
Fixed drug eruption
Pemphigus vulgaris
Skin
null
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multi
A patient suffering from AIDS presents with history of dyspnea and non- productive cough x-ray shows bilateral perihilar opacities without pleural effusion and lymphaden-opathy. Most probable etiological agent is :
D i.e. Pneumocystic carinii
4
Tuberculosis
CMV
Kaposis sarcoma
Pneumocystis carinii
Radiology
null
56c5fb3a-4287-409d-8260-cf2afdacec68
single
Which of the following is true about P. Falciparum -
P.falciparum Forms in peripheral blood-ring forms and gametocytes (crescent shaped) A) Most pathogenic B). No relapses in P.falciparum-exo-erythrocytic schizogony is absent C). Complications-pernicious malaria,black water fever D)pernicious malaria-1). Cerebral malaria-hyperpyrexia, coma,paralysis.Brain is congested.Capillaries of the brain are plugged with parasitised erythrocytes 2). Algid malaria-cold clammy skin leading to circulatory failure 3). Septicaemic malaria- high continuous fever with involvement of various organs Black water fever * Previously infected * Intravascular haemolysis fever and haemoglobinuria * Autoimmune mechanism * Bilious vomiting+prostration+black urine(refer pgno:60 baveja 3 rd edition)
2
James donts are seen
Accole forms are seen
Relapses are frequent
Longest incubation period
Microbiology
parasitology
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multi
The outer covering of diatom is made of ?
Ans. is 'b' i.e., Silicon The extracellular coat of diatoms has silica. Diatoms are unicellular algae, suspended in water. They have silicaceous cell wall (i.e. cell wall contains silica) which resist acid digestion and putrefaction. Only live body with a circulation can transpo diatoms form lung to brain, bone marrow, muscles etc. So, presence of diatoms in brain and bone marrow indicates death due to drowning. For detection of diatoms, bone marrow of long bones, e.g. femur, tibia, humerus or sternum is highly suitable and reliable. As diatoms resist acid digestion, to extract them acid digestion techinique is used. Diatoms test is negative in dead bodies thrown in water and in dry drowning. However, diatoms test is invalid, if deceased had drunk this water before submersion or species of diatoms do not match with specimen from the site of drowning
2
Magnesium
Silica
Hydrocarbons
null
Forensic Medicine
null
ff2f1fde-9356-4e89-9ed5-cc073b0a5557
multi
Which of the following is not a side effect of clozapine:
Ref: KDT 6/e p429 Clozapine and other atypical antipsychotic resulting weight gain.
4
Agranulocytosis
Seizures
Sialosis
Weight loss
Pharmacology
Central Nervous system
ffd1f9fc-0803-4016-af86-5721e1d0a726
single
Most cardiotoxic local anesthetic ?
Ans. is 'b' i.e., Bupivacaine
2
Procaine
Bupivacaine
Cocaine
Lidocaine
Anaesthesia
null
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single
True about DNA reconstruction technology
DNA phenotyping (fee-no-type-ing) is the process of predicting an organism's phenotype using only genetic information collected from genotyping or DNA sequencing. This term, also known as molecular photofitting, is primarily used to refer to the prediction of a person's physical appearance and/or biogeographic ancestry for forensic purposes.DNA phenotyping uses many of the same scientific methods as those being used for genetically-informed personalized medicine, in which drug responsiveness (pharmacogenomics) and medical outcomes are predicted from a patient's genetic information. Significant genetic variants associated with a paicular trait are discovered using a genome-wide association study (GWAS) approach, in which hundreds of thousands or millions of single-nucleotide polymorphisms (SNPs) are tested for their association with each trait of interest. Predictive modeling is then used to build a mathematical model for making trait predictions about new subjectsRef: https://en.wikipedia.org/wiki/DNA_phenotyping
1
Restriction endonucleases are involved
DNA ligase is used
Acid phosphatase is used
Reverse transcriptase needed
Biochemistry
Metabolism of nucleic acids
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multi
Purple coloured reamer is numbered:
null
2
8
10
15
30
Dental
null
8229551e-04a4-41e0-b45e-4499fb7c8c30
single
Which of the following antibodies is highly specific for systemic lupus erythematosus -
Ans. is 'a' i.e., Anti-Sm
1
Anti-Sm
Anti-RO-1
Anti-UIRNP
Anti-Centeromere
Medicine
SLE
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single
Which of the following artery supplies parathyroid glands?
Ans. B Inferior thyroid arteryRef: Gray's, 41sted. pg. 472* Both upper & lower parathyroid glands are supplied by the inferior thyroid arteryVascular Supply and Lymphatic Drainage of Parathyroid Gland* Inferior thyroid arteries provide primary blood supply to posterior aspect of thyroid gland and parathyroid glands (which are situated there in posterior aspect of thyroid gland).* Parathyroid veins drain into thyroid plexus of veins of thyroid gland & trachea.* Lymphatics drain with those of thyroid into deep cervical R lymph nodes & paratracheal lymph nodes.Innervations and Functions* Since the gland is hormonally regulated, the nerve supply is sympathetic vasomotor, vaso constrictor and not secreto motor.* Parathyroid activities regulated by variations in blood calcium level: It is inhibited by a rise in calcium levels and stimulated by a fall in calcium level.Extra Mile* The superior parathyroid glands usually lie at the level of inferior border of cricoids cartilage.* The inferior glands are usually within thyroid fascia 1 cm below the inferior thyroid arteries behind the lower poles.* Color of thyroid gland: deep red color* Color of parathyroid gland: Brownish yellow color
2
Superior thyroid artery
Inferior thyroid artery
Common carotid artery
Middle thyroid artery
Anatomy
Neuroanatomy
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single
The voice in a patient with bilateral abductor paralysis of larynx is:
Ans. is d i.e. normal or good voice Management Lateralization of cord by arytenoidectomy, endoscopic surgery, thyroplasty type II, cordectomy In emergency cases -Tracheostomy may be required Also know Generally patients with bilateral recurrent laryngeal nerve palsy have a recent history of thyroid surgery or rarely an advanced malignant thyroid tumor. Most common presentation-Development of stridor following URI Since the voice of the patient is normal\\it is diagnosed very late.
4
Puberuophonia
Phonasthenia
Dysphonia plicae ventricularis
Normal or good voice
ENT
null
f8dafdc2-6aca-44ed-8351-44a86a610492
single
Time interval between acute and persistent psychotic disease is ?
Ans. is `d' i.e., 1 months If symtoms are for less than 1 months, it is transient psychotic disorder and if there are for more than 1 months, it is persistent psychotic disorder (persistent delusional disorder). Note:- Diagnosic criteria for delusional disorder (Persistent delusion disorder) has different durations in DSM IV and ICD-10 :- According to DSM IV, symptoms (Non bizzare delusion) should be for > 1 months. According to ICD-10, Symptoms should be for > 3 months.
4
1 week
2 week
3 week
1 months
Psychiatry
null
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single
Which interleukin is needed for differentiation of eosinophils: September 2009
Ans. D: IL5
4
IL1
IL2
IL4
IL5
Physiology
null
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single
An injury to the shown area can lead to fracture of which bone (FMGE June 2019)
Anatomical snuff box: The given picture shows anatomical snuff box which is a depression formed at the posterolateral side of the wrist and metacarpal by the extensor tendons passing into the thumb. Base of the triangle is at the wrist and apex is directed into thumb. It is most apparent when thumb is extended. Boundaries: Lateral: Abductor pollicis longus and extensor pollicis brevis tendons. Medial :Extensor pollicis longus tendon Floor: Scaphoid and trapezium the distal ends of the tendons of the extensor carpi radialis longus and extensor carpi radialis brevis Scaphoid Fracture: The commonest carpal injury is a fracture across the waist of the scaphoid bone . It is uncommon to see other injuries. In approximately 10% of individuals, the scaphoid bone has a sole blood supply from the radial aery, which enters through the distal poion of the bone to supply the proximal poion. When a fracture occurs across the waist of the scaphoid, the proximal poion therefore undergoes avascular necrosis.
2
Lunate
Scaphoid
Hamate
Trapezium
Anatomy
FMGE 2019
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single
Injury to long thoracic nerve leads to
Injury to long thoracic nerve causes paralysis of serratus anterior muscle which clinically manifests as winging of scapula. The patient also finds difficulty in overhead abduction and touching the opposite shoulder. B D Chaurasia 7th edition Page no: 45
1
Winging of scapula
Pointing index
Claw hand
Wrist drop
Anatomy
Upper limb
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single
Drug of choice in dermatitis herpetiformis is:
Ans. (c) DapsoneRef. katzung 11th ed. /1468* Dermatitis herpetiformis is a chronic blistering skin condition, characterised by blisters filled with a watery fluid.* DH is neither related to nor caused by herpes virus: the name means that it is a skin inflammation having an appearance similar to herpes.* It characterized by intensely itchy, chronic papulovesicular eruptions, usually distributed symmetrically on extensor surfaces (buttocks, back of neck, scalp, elbows, knees, back, hairline, groin, or face).* Diagnosis is confirmed by a simple blood test for IgA antibodies, and by a skin biopsy in which the pattern of IgA deposits in the dermal papillae, revealed by direct immunofluorescence, distinguishes it from linear IgA bullous dermatosis and other forms of dermatitis.* Treatment: Dapsone is considered as drug of choice for DH.* In case of intolerance to dapsone, other drugs which can be used are: Colchicine, Tetracycline, Sulfapyridine.
3
Corticosteroids
Colchicine
Dapsone
Chloroquine
Pharmacology
Anti-Leprotic
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single
Which of the following is the preferred local anesthetic technique for hemophiliacs?
null
3
Nerve block
Supraperiosteal
Intraligamentary
Field block
Surgery
null
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single
A 35-year-old man is taken to the emergency depament because he is coughing up large volumes of blood. He does not have any history suggestive of exposure to tuberculosis, and a chest x-ray film does not show a mass lesion. Chest x-ray films performed on the day of admission and daily for the next several days show asymmetric densities in both lungs that vary in shape and position from film to film. Urinary screening shows hematuria and proteinuria, and the urinary sediment contains cellular and granular casts. Renal biopsy shows rapidly progressive glomerulonephritis with prominent epithelial cell crescents. The mechanism causing this patient's disease is closest to the mechanism underlying which of the following diseases?
This patient has Goodpasture syndrome, which is a rare, severe autoimmune disease in which antibodies directed against the basement membrane in pulmonary alveoli and renal glomeruli predispose for hemoptysis and progressive renal disease. These patients can die because of exsanguination, asphyxiation by blood, or renal failure. Aggressive immunosuppression coupled with management of complications may be lifesaving. Goodpasture disease is often cited as an example of a Type II hypersensitivity reaction, and a very similar pathologic mechanism produces the blistering disease bullous pemphigoid, in which antibodies are directed against the basement membrane region of the skin. The immunologic basis of Graves disease is stimulation of TSH receptors by anti-receptor antibodies. The immunologic basis of hereditary angioedema is inadequate C1 esterase inhibitor activity. The immunologic basis of rheumatoid ahritis is the presence of immune complexes within joints.
1
Bullous pemphigoid
Graves disease
Hereditary angioedema
Rheumatoid ahritis
Medicine
null
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multi
A povey-stricken mother suffering from active tuberculosis delivers a baby. Which one of the following advices would be the most appropriate in her case -
Ans. is 'b' i.e., Breast feeding and isoniazid administration o The best answer would have been --> Breast feeding + INH + BCG vaccination.
2
Breast feeding and BCG immunization
Breast feeding and isoniazid administration
Expressed breast milk and BCG immunization
Stop feeds and isoniazid administration
Pediatrics
null
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The sago spleen and lardaceous spleen are conditions seen in-
Amyloidosis of SpleenAmyloid deposition in the spleen, for some unknown reasons, may have one of the following two patterns:1. SAGO SPLEEN. The splenomegaly is not marked and cut surface shows characteristic translucent pale and waxy nodules resembling sago grains and hence the name.Microscopically, the amyloid deposits begin in the walls of the aerioles of the white pulp and may subsequently replace the follicles.2. LARDACEOUS SPLEEN. There is generally moderate to marked splenomegaly (weight up to 1 kg). Cut surface of the spleen shows map-like areas of amyloid (lardaceous-lard-like; lard means fat of pigs)Microscopically, the deposits involve the walls of splenic sinuses and the small aeries and in the connective tissue of the red pulp. Confirmation is by seeing Congophilia in Congo Red staining and demonstration of apple-green birefringence under polarising microscopy in the corresponding positive areas. HARSH MOHAN Textbook of pathology 6th edition pg no 90
4
Congestive splenomegaly
Autosplenectomy
Secondaries in spleen
Amyloidosis of the spleen
Pathology
miscellaneous
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All of the following characteristic pattern seen in Brown-Sequard syndrome; except:
Ans. c. Ipsilateral loss of pain and temperatureRef: Ganongs Review of Medical Physiology 25th Ed; Page No-172BROWN-SEQUARD SYNDROMEBrown-Sequard syndrome is caused by damage to one half of the spinal cord, resulting in paralysis and loss of proprioception on the same (or ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion.Hemisection of spinal cord. Findings:1. Ipsilateral loss of all sensation at level of lesion2. Ipsilateral LMN signs (e.g. flaccid paralysis) at level of lesion3. Ipsilateral UMN signs below level of lesion (due to corticospinal tract damage)4. Ipsilateral loss of proprioception, vibration, light (2-point discrimination) touch and tactile sense below level of lesion (due to dorsal column damage).5. Contralateral pain, temperature, and crude (non-discriminative) touch below level of lesion (due to spinothalamic tract damage)Note: If lesion occurs above T1, patient may present with ipsilateral Horner syndrome due to damage of oculosympathetic pathway.
3
Ipsilateral weakness
Ipsilateral loss of position and vibration
Ipsilateral loss of pain and temperature
Contralateral loss of pain and temperature
Physiology
Nervous System
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Mandibular 1st molar has:
null
2
2 roots and 2 canals
2 roots and 3 canals
3 roots and 3 canals
3 roots and 4 canals
Dental
null
697c8087-a7e8-487f-b3b3-07eb7c4d0f51
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In simple hanging, the knot comes to rest at the: September 2009
Ans. C: Angle of mandible In most hanging deaths, the ligature and ligature mark lie above the thyroid prominence, with a point of suspension usually behind one ear. Frontal knots are unusual. The appearance of the ligature mark varies with the type of ligature used and with the physical characteristics of the individual neck. Soft broad ligatures may not leave any recognizable marks. In most cases, the ligature does not completely encii le the neck.
3
Occiput
Chin
Angle of mandible
Below the cheek
Forensic Medicine
null
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single
Injury of common peroneal nerve at the lateral aspect of head of fibula results in all of the following except -
Common peroneal nerve injury may result in -  Foot drop -  Weakness of dorsiflexion -  Inability to extend the toes. -  Loss of eversion -  Sensory loss Anterior side of leg Lateral side of leg Dorsum of foot and toes (including medial side of big toe) Common peroneal nerve injury does not affect -  Sensation on lateral border of foot (Supplied by Sural nerve) -  Sensation on medial border of foot (Supplied by saphenous nerve) -  Ankle reflex
3
Weakness of ankle dorsi-flexion
Foot drop
Loss of ankle reflex
Sensory impairment on lateral aspect of leg extending to the dorsum of foot
Anatomy
null
aab2fe18-065e-46d1-8157-caea468b2d71
multi
Which of following antibody is pentameric -
Ans. is 'a' i.e., IgM * Ig M is a pentameric immunoglobulin with five, four - peptide subunits.* The subunits are joined together by J chain.Remember* J chain is found in IgA and IgM.Also know* I think the following information requires some specific mention here-# There may be confusion about the status of momomer and dimer when applied to antibody as each molecule of an antibody is a dimer of two identical heavy and light chains.# But, the terms monomer , dimer or pentamer are used in context to how many molecules of same class of antibody are bound together-i) IgG is not found to bound to other IgG - Monomerii) IgA is bound to another IgA - Dimeriii) IgM binds four other IgM - Pentamer
1
IgM
IgG
IgA
IgD
Microbiology
Immunology
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single
Pelkan's spur is seen in?
Severe vitamin C deficiency causes scurvy. The usual age of onset is 6 to 18 months. Pseudoparalysis is commonly seen. Hemorrhages occur under the periosteum of long bones. Gum bleeds are common. Costochondral junctions become prominent and appears sharp and angular. Scorbutic rosary is attributed to the separation of epiphysis of ribs and backward displacement of sternum. Diagnosis is based on radiological features. Bone assumes a ground glass appearance with a pencil thin coex. Metaphyses demonstrates a zone of well calcified cailage referred to as white line of frenkel. Pelkan's spur is one of the radiological lines seen in scurvy. It is a bone spur from the lateral border of metaphysis. Epiphyseal centers of ossification are surrounded by a white ring called Weinberger's sign. Ref: Textbook of Ohopedics, 4th Edition By John Ebnezar, Page 539; O.P.Ghai, 6th Ed, Page 127.
3
Rickets
Hypopituitarism
Scurvy
Hypothyroidism
Pediatrics
null
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single
Which of the following is NOT a content of the axilla:
Contents of axillaAxillary aery and its branchesAxillary vein and its tributariesInfraclavicular pa of brachial plexusFive groups of axillary lymph nodes and the associated lymphaticsThe long thoracic and intercostobrachial nerveAxillary fat and areolar tissue in which the other contents are embeddedLymph nodes of axilla are very impoant from pathological point of view because breast cancer in female spread to these lymph nodes readily.
3
Axillary vessels
Axillary tail of the breast
Roots of brachial plexus
Intercostobrachial nerve
Anatomy
null
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What is a Baker's Cyst -
Ans. is 'c' i.e., Cyst over the popliteal fossa Baker's Cvsto A Baker's cyst, also known as a popliteal cyst, is a benign swelling of the semimembranosus or more rarely some othersynovial bursa found behind the knee joint.o Diagnosis is by examination. A Baker's cyst is easier to see from behind with the patient standing with knees fully extended. It is most easily palpated (felt) with the knee partially flexed. Diagnosis is confirmed by ultrasonography, although if needed and there is no suspicion of a popliteal artery aneurysm then aspiration of synovial fluid from the cyst may be undertaken with care. An MRI image can reveal presence of a Baker's cysto Baker's cysts usually require no treatment unless they are symptomatico Surgical excision is reserved for cysts that cause a great amount of discomfort to the patient.
3
Gluteal Abscess
Cyst on the posterior aspect of the thigh
Cyst over the popliteal fossa
Swelling of the bursa of semiteninosus and gracilis
Surgery
Orthopedics
76d21c33-d9d2-4d54-9cd7-05f02415217a
single
Inability to suck on a straw may indicate lesion of which nerve?
The orbicularis oris muscle encircles the opening of the mouth and helps to bring the lips together to keep the mouth closed. Pursing of mouth is due to orbicularis oris inseed into lips and angle of mouth supplied by VII nerve.The muscles of facial expression are innervated by branches of the facial nerve (VII). After emerging from the stylomastoid foramen, the facial nerve lies within the substance of the parotid gland. Here, it gives off its five terminal branches: (1) The temporal branch courses up to the scalp to innervate the occipito frontalis and orbicularis oculi muscles. (2) The zygomatic branch courses across the cheek to innervate the orbicularis oculi muscle. (3) The buccal branch travels with the parotid duct and innervates the buccinator and orbicularis oris muscles, and also muscles that act on the nose and upper lip. (4) The mandibular branch innervates the orbicularis oris muscle and other muscles that act on the lower lip. (5) The cervical branch courses down to the neck and innervates the platysma muscle. Ref: Dhillon N. (2012). Chapter 1. Anatomy. In A.K. Lalwani (Ed), CURRENT Diagnosis & Treatment in Otolaryngology--Head & Neck Surgery, 3e.
3
II
V
VII
IX
Anatomy
null
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single
Emile Durkheim is linked with work on which condition is psychiatry
Durkheim's theory: first major contribution to the study of social and cultural influences on suicide was made by french sociologist Emile Durkheim. He divided suicides into three social categories- Egoistic, Altruistic amd Anomic. Ref: Synopsis of Psychiatry, 11e, pg 766.
1
Suicide
Obsessive compulsive disorder
Anxiety disorder
Schizophrenia
Psychiatry
Cognitive development and defence mechanism
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single
Glycosylated haemoglobin reflects the mean blood glucose level of previous
null
3
15 days
1 month
3 months
6 months
Social & Preventive Medicine
null
80645cce-f833-482e-8ec7-41f98bd443a2
single
Which one of the following statements truly represents Bell's paralysis?
(c) Bell's palsy is idiopathic LMN palsy of facial nerve causing ipsilateral paralysis of face.(Ref. Scott Brown, 6th ed., 1400)Ipsilateral Facial nerve paralysis and contralateral Hemiparesis along with ipsilateral VI nerve palsy constitutes Millard Gubler syndrome. It is a form of "crossed hemiplegia," as the paralysis of muscles controlled by the facial nerve occurs on the same side as the lesion, while the hemiplegia of muscles below the neck occurs on the opposite side from the lesionIn Bell's palsy facial palsy may be associated with other cranial nerve neuropathies which are Vth, VIIIth, IXth and Xth.Facial nerve paralysis with uveitis and parotid enlargement constitutes Heerfordt's syndrome.
3
Facial nerve paralysis and contralateral Hemiparesis
Combined paralysis of the facial, trigeminal and abducens nerves
Idiopathic ipsilateral paralysis of the facial nerve
Facial nerve paralysis with uveitis and parotid enlargement
ENT
Facial Nerve And Its Disorders
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multi
In a specimen of kidney, fibrinoid necrosis is seen and onion peel appearance is also present. Most probable pathology is:
Histological alterations characterizing blood vessels in malignant hypeension. ? Hyperplastic aeriosclerosis Fibrinoid necrosis of aerioles: Onion-skinning (concentrically arranged smooth muscle with collagen).
2
Hyaline degeneration
Hyperplastic aeriosclerosis
Glomerulosclerosis
Fibrillary glomerulonephritis
Pathology
Basic Concepts
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single
All of the following conditions are associated with an early systolic murmur, EXCEPT:
Aoic stenosis
1
Aoic stenosis
Tricuspid regurgitation
Papillary muscle dysfunction
Small ventricular septal defect
Medicine
null
1665705e-1152-4511-9e8e-251d30b0eca1
multi
SI unit of Radioactivity is
SI unit - Becquerel Old unit - Curie
2
Curie
Becquerel
Roentgen
Sievert
Radiology
null
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single
All require hospitalization except
null
1
5% burns in children
10% scalds in children
Electrocution
15% deep burns in adults
Surgery
null
b0a81f73-5fc2-4e40-8c7c-80b90262dfb7
multi
SA node acts as a pacemaker of the hea because of the fact that it:
The sinoatrial (SA) node normally displays the highest intrinsic rate. All other pacemakers are referred to as subsidiary or latent pacemakers because they take over the function of initiating excitation of the hea only when the SA node is unable to generate impulses or when these impulses fail to propagate. There is a hierarchy of intrinsic rates of subsidiary pacemakers that have normal automaticity: atrial pacemakers have faster intrinsic rates than AV junctional pacemakers, and AV junctional pacemakers have faster rates than ventricular pacemakers. Ref: Chen P., Antzelevitch C. (2011). Chapter 38. Mechanisms of Cardiac Arrhythmias and Conduction Disturbances. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e.
4
Is capable in generating impulses spontaneously
Has rich sympathetic innervations
Has poor cholinergic innervations
Generates impulses at the highest rate
Physiology
null
308b8f00-75b5-491b-9a84-ed68ece4dc46
single
A 62-year-old diabetic patient presented with a history of progressive right-sided weakness of one-month duration. The patient was also having speech difficulty. Fundus examination showed papilledema. Two months ago, she also had a fall in her bathroom and struck her head against a wall. The most likely clinical diagnosis is -
null
4
Alzheimer's disease
Left parietal glioma
Left MCA territory stroke
Left chronic subdural haematoma
Medicine
null
53da0711-5b1c-4729-829f-0790bb8daec8
multi
Which of the following is Calcivirus-
Hepatitis A → Picorna Viridae (Single Stranded RNA) Hepatitis B → Hepadna Viridae (Double stranded circular DNA)* Hepatitic C → Flavivirus (single stranded RNA) Hepatitis D → Incomplete RNA virus (causes infection only in presence of Hepatitis B virus) Hepatitis E → Calcivirus (Single stranded RNA
1
Hepatitis E
Hepatitis B
Hepatitis C
Hepatitis A
Microbiology
null
181d5cc0-a2b7-4302-a539-a966c913bee7
single
Not seen in children is
Seminoma, the most common GCT in adults, does not occur before 5 years of age. seminoma is considered a postpubeal tumor.
4
Neuroblastoma
Retinoblastoma
Hepatoblastoma
Seminoma
Pathology
Pediatrics, environment and nutrition
c7fa5b72-9f2e-4eaa-a848-8063beac2f7f
single
Which group of anticancer drugs temozolomide belong to :
Temozolomide is an alkylating agent that can be given orally.
1
Oral alkylating agent
Antitumor Antibiotic
Antimetabolite
Mitotic Spindle Inhibitor
Pharmacology
null
a88e7708-0106-45eb-a8aa-0189856b0793
single
A patient with traumatic paraplegia due to injury of the thoracic cord of 'T3 level' is observed to have blood pressure f 210/120. What should be the initial management?
Traumatic paraplegia is caused by a lesion of the spinal cord which occurs after a trauma, e.g. veebral fracture causing a puncture to the spinal cord. Any injury of the spinal cord may result in a condition known as autonomic dysreflexia (AD).. Autonomic dysreflexia can cause systolic blood pressure readings to increase by 20-40 mmHg. , this condition couples dangerously high blood pressure with decreased hea rates.nefidipine can be used for high blood preassures Ref Harrison20th edition pg 2378
3
Subcutaneous LMWH
Steroids
Nifedipine
Normal saline / Dextrose
Medicine
C.N.S
7a031a5a-48f3-4cdd-854b-3aca92473144
single
The drug found to be beneficial in amyotrophic lateral sclerosis is :
null
1
Riluzole
Methylprednisolone
Hydroxyurea
None of the above
Pharmacology
null
6b9c613b-b314-46d0-a352-857979c26821
multi
All are true of the genetic code except ?
C i.e. Punctuation
3
Degenerate
Universal
Punctuation
Non overlapping
Biochemistry
null
093038dd-d6c1-49d9-864c-843be04a944f
multi
Therapeutic levels of lithium (in mecill) in a patient of acute mania is:
null
2
0.4–0.8
0.8–1.2
1.2–1.6
1.6–2.0
Pharmacology
null
880cc1ef-f8fc-45c0-a4fb-ce5fe81be66e
single
Wrong statement is -
Maize is deficent in in tryptophan and lysine. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 579
4
Pulses are deficent in methionine
Cerels are deficient in lysine
Wheat deficient in threonine
Maize is deficient in tryptophan & leucine
Social & Preventive Medicine
Nutrition and health
95265c95-9b0d-4b64-9fcf-2643b72e48aa
multi
Psammoma bodies are found in which of the following organs?
Histologically, with the usual hematoxylin and eosin stain, calcium salts have a basophilic, amorphous granular, sometimes clumped appearance. They can be intracellular, extracellular, or in both locations. In the course of time, heterotopic bone may be formed in the focus of calcification. On occasion single necrotic cells may constitute seed crystals that become encrusted by the mineral deposits. The progressive acquisition of outer layers may create lamellated configurations, called psammoma bodies because of their resemblance to grains of sand. Some types of papillary cancers (e.g., thyroid) are apt to develop psammoma bodies. Ref: Robbins, 8th edition, Chapter 1.
4
Stomach
Hea
Lungs
Thyroid
Pathology
null
cf5faa3c-4e8b-4cbd-a52b-0d5aeed4fd62
single
Preload is increased by -
Ans. is 'a' i.e.. Increase blood volume Preload (Degree of ventricular filling during diastole)o Cardiac preload is represented by volume of venous blood that distends the ventricle, i.e., venous return determines the preload. An increase in preload, i.e., increase in venous return results in a higher end-diastolic volumeQ (PreloadQ).o This results in stretching of myocardial fiber and this increase in length of myofibril increases the strength of cardiac contraction in accordance with the Frank-Starling law or Starling's law of the hearto According to Starling's lawr, greater the initial length of muscle fiber, greater is the force of contraction,o The initial length of muscle fiber (length of fiber at the initiation of contraction/systole) refers to length of the fiber at the end of the diastole, i.e., end-diastolic fiber length.o Thus, the factors which improve venous return increase the cardiac output by increasing end-diastolic ventricular volume and length, i.e.. preload,o Opposite is true for factors which decrease venous return.| Stroke volume| Stroke volumeFactors Increasing end-diastolic ventricular muscle fiber length (Factors increasing venous return or preload)Factors decreasing end-diastolic ventricular muscle fiber length (Factors decreasing venous return or preload)o Increased total blood volumeQo Decreased total blood volumeo Increased venous toneQo Decreased venous toneo Increased pumping action of skeletal muscleo Decreased pumping action of skeletal muscleso Increased negative intrathoracic pressureQ (e.g. inspiration)o Less negative or positive intrathoracic pressure (expiration)o Sitting or standingQ (venous pooling of blood)o Lying down from sitting or standing position o Sympathatic discharge causing decrease in venous capacitance by decreasing venous compliance
1
Increased blood volume
Increased total peripheral resistance
Standing
Sitting
Physiology
Circulation: Cardiac Output, Venous Return
dc5090a9-0718-41b0-b0af-d1cb3fb44f75
single
Hanifin & Rajke is the diagnostic criteria for
Ans. is 'a' i.e., Atopic dermatitis Hanifin and Rajka criteria is for diagnosis of atopic dermatitis. Diagnostic criteria (Hanifin and Rajka) Based mainly on clinical experience Major criteria Family history of atopy Chronicity Pruritus Typical morphology and distribution Minor criteria Dry skin Chelitis Elevated edge Dennie's line/dennie morgan fold (infra orbital fold) White dermographism Peripheral eosinophillia Immediate (type i) hypersensivity Facial pallor, orbital darkening Food intolerance Conjunctivitis (recurrent), keratoconus, cataract Pityriasis alba Hand dermatitis Recurrent infections At least 3 major or 2 major plus 2 minor criteria are necessary for diagnosis
1
Atopic dermatitis
Contact dermatitis
Uicaria
Erythroderma
Skin
null
3d537990-81ce-473b-9a8d-f5098b32131c
single
Nerve affected in trendenlenberg test is ?
Ans. is 'a' i.e., Superior gluteal nerve
1
Superior gluteal nerve
Inferior gluteal nerve
Obturator nerve
Pudendal nerve
Surgery
null
2de9693c-515e-4152-a229-5e6c96848186
single
Following predispose to the high risk of vulvovaginal candidiasis except
Several potential risk factors have been described, including the recent use of antibiotics and oral contraceptives, the presence of diabetes mellitus, dietary practices, gastrointestinal colonization by the organism, clothing and sanitary protection practices, sexual communicability of the organism, and HIV, DM, Ref ganong's review of medical physiology 25e 498
2
HIV
Hypeension
Pregnancy
DM
Physiology
All India exam
9f822821-43a4-4366-836e-648ac297e054
multi
A 71-year-old woman comes to the office with a history of headaches, fatigue, and weight loss for 3 months. The headaches are new for her, and usually not very severe. Her jaw also hurts when she is chewing food. Two days prior, she had briefly lost partial vision in her left eye. There were no other neurologic symptoms at the time. On examination, her neck is supple to flexion, fundi and neurologic examinations are normal. She is started on prednisone 60 mg/day and a biopsy is performed to confirm the diagnosis. Which of the following is the most likely change seen on the biopsy to confirm the diagnosis?
Temporal artery biopsy is required for definitive diagnosis of giant cell arteritis, because of the relatively nonspecific nature of the presenting symptoms, signs, and routine laboratory tests. The arteritis can be segmental, however, and great care must be taken in the pathologic assessment.
2
immune complex deposition
arteritis with giant cells
lymphocytic infiltration
type II muscle fiber atrophy
Medicine
C.N.S.
dc98be1c-09bb-4063-b2f1-690f2c2ea3e9
multi
The muzzle velocity of given firearm is
The revolver, which tends to have a low muzzle velocity of 150 m/s, is a sho barreled weapon with its ammunition held in a metal drum, which rotates each time the trigger is released.The muzzle velocity of pistols varies between 300 and 360 m/s.The rifle is a long-barreled shoulder weapon capable of firing bullets with velocities up to 1500 m/s.
1
150 m/s
300 m/s
360 m/s
1500 m/s
Microbiology
All India exam
6350ebdb-0759-4056-bce0-bd35dc9f5943
single
MAC stands for?
Ans. is 'a' i.e., Minimum alveolar concentration Minimal alveolar concentration (MAC)* Most important measure of potency is minimal alveolar concentration (MAC). MAC is the lowest concentration of the anesthetic in pulmonary alveoli needed to produce immobility in response to a painful stimulus (surgical incision) in 50% individuals. Higher the MAC, less potent the anesthetic agent.* Methoxyflurane has minimum MAC (0.16%) - The most potent inhalational agent.* N2O has maximum MAC (105) - The least potent inhalational agent.* Order of potency in decreasing order (MAC in increasing order): -* Methoxyflurane (MAC = 0.16 %) > Trilene (MAC = 0.2%) > Halothane (MAC = 0.74%) > Chloroform (MAC = 0.8 %) > Isoflurane (MAC = 1.15 %) > Enflurane (MAC = 1.68%) > Ether (MAC = 1.92 %) > Sevoflurane (MAC = 2.0 %)> Desflurane (MAC = 6.0%) > Cyclopropane (MAC = 9.2%) > N20 (MAC 104%).Factor affecting MAC1. Age: - Young age increases and old age decreases MAC.2. Alcohol: - Chronic intoxication increases and acute intoxication decreases MAC.3. Temperature: - Both hypothermia and hyperthermia decrease MAC.4. Electrolyte: - Hypercalcemia, Hypermagnesemia & Hyponatremia decrease. Whereas hypernatremia increases MAC.5. Anemia : - Decrease MAC6. Hypoxia (pO2 < 40), and hypercarbia (pCO2 > 95) decrease MAC.7. Pregnancy: - Decreases MAC8. Drugs: -A. Decreasing MAC - Local anaesthetics (except cocaine) Opioids, Ketamine, Barbiturates, Benzodiazepines, Verapamil, Lithium, Sympatholytics (Methyldopa, reserpine, Clonidine, Dexmedetomidine), Chronic amphetamine use.B. Increasing MAC: - Acute amphetamine intake, Cocaine, ephedrine.
1
Minimum alveolar concentration
Minimal analgesic concentration
Minimal anesthetic concentration
Maximum alveolar concentration
Anaesthesia
Fundamental Concepts
4407a8cd-6210-4bb0-a016-085ab9eeb310
single
Acute onset of blurred vision and absent pupillary response with rapidly progressive descending muscular weakness manifesting as quadriparesis in an afebrile 20 year old male with preserved sensorium is -
Ans. is tb' i.e., Botulism Remember these important points about Botulismo Acute onset of weakness in muscles innervated by cranial nerve with prominent bulbar palsy (4D's) i.e. -# Diplopia# Dysphonia# Dysphagia# Dysarthriao Descending symmetrical weakness occurs often leading to weakness,o Sensory' abnormalities are absent because only motor and autonomic nerves affected.o Mental function not affected o Afebrileo Absent pupillaty reflexes
2
Porphyria
Botulism
Polio
Diphtheria
Medicine
Toxicology
ccb4670b-95d4-4b9c-879e-bd30a72c7e4f
single
All are affected in Graft-Versus host reaction
• GVHD affects skin (earliest organ), intestine and liver • Lungs are not affected in GVHD. For details see text.
4
Skin
GIT
Liver
Lung
Pathology
null
6740e137-8c0f-46d6-b638-bddd76af3cf6
multi
Vitamin D is maximum in -
Cod liver oil But overall Richest source is Halibut liver oil Ref: Park 25th edition Pgno : 653
4
Milk
Fish fat
Eggs
Cod liver oil
Social & Preventive Medicine
Nutrition and health
eb92f25f-29ec-4931-b26b-e76816b33c70
single
All of the following drugs are used in emergency management of acute hyperkalemia except:
Treatment of Hyperkalemia: IV Ca gluconate Insulin drip Salbutamol/ nebulization IV Furosemide Hemodialysis
4
Calcium gluconate
Salbutamol
Glucose-Insulin
Intravenous magnesium sulphate
Pharmacology
Hypeension, Arrhythmias, Dyslipidemia
768ac204-670b-4707-899d-e030964e00ee
multi
A female presents with significant blood loss due to post-partum haemorrhage (PPH). What would be the shock index (HR/systolic BP)?
Shock index = heartrate/systolic BP Normal = 0.5–0.7 If it becomes 0.9–1.1 it indicates massive blood loss and need for intensive resuscitation.
4
0.3-0.5
0.5-0.7
0.7-0.9
0.9-1.1
Gynaecology & Obstetrics
null
075c6aab-1ef0-43c9-926f-7770b3ed4507
single
Subnuclear cytoplasmic vacuolization is seen in which stage of menstural cycle ?
Ans. is 'c' i.e., Secretory phaseSubnuclear cytoplasmic vacuolization is seen in early secretory phase.Histological features in secretory phasei) Basal location of gland cell nuclei (Post-ovulation day 5-6 and later in cycle).ii) Subnuclear cytoplasmic vacuolization (early secretory phase).iii) Serated glandular configration or "Saw-tooth appearance" (mid-secretory phase).iv) Periaeriolar predecidual rection (mid-secretory phase).
3
Proliferative phase
During mensturation
Secretory phase
null
Physiology
null
4551e60a-c5c8-4827-a768-bebabf6cd36b
multi
what is the root value of phrenic nerve?
* Phrenic nerve (C3,C4,C5)- It descends in front of scalenus anterior muscle . * Descends down to enters thorax where it lies between subclan vein(in front) and subclan aery lies behind it . * Fuher it descends in front of hilum of the lungs (whereas vagus nerve descends behind the hilum of lungs) * It is mixed nerve sensory and motor.(both motor and sensory to diaphragm)
1
C3,4,5
C2,3,4
C4,5,6
C5,6,7
Anatomy
Bronchopulmonary Segments, Embryonic veins
6a772c13-d3fa-4854-a2a2-b7aa1bc1f431
single
Antibiotics are indicated in which type of psoriasis?
Ref: Rook's Textbook of DermatologyExplanation:Guttate psoriasis (Eruptive psoriasis)Presents as shower of small psoriatic lesions, appearing more or less generally over the body, particularly in children and young adults, after acute streptococcal infections.Guttate psoriasis is classically triggered by a bacterial infection, usually an upper respiratory tract infection.Guttate psoriasis will most resolve, but may turn chronic remitting and relapsing psoriasis vulgaris.Because of a streptococcal etiology, antibiotic therapy is warranted.
1
Guttate
Pustular
Chronic plaque psoriasis
Erythrodermic psoriasis.
Skin
Psoriasis
3a2f6c05-c606-48c0-9e66-cef8629b45a7
single
A patient has Bullous Lesion; on Tzank smear -
Ans-BTzank smearo It is done for vesiculobullous disorders.o A small, early, uninfected lesion should ideally be selected. The roof of the blister is removed with scissors, and the base of the blister gently scraped with a blunt scalpel so as not to produce bleeding. The material obtained is spread thinly on a glass slide.o It shows acantholytic cells (rounded cells with a relatively large nucleus and a condensed cytoplasm) e g: pemphigus gp of disorders.o Multinucleated giant cells nad ballooning degeneration is a characteristic of herpes simplest, herpes zoster and varicella infection.
2
Langerhans ceils are seen
Acantholysis
Leucocytosis
The absence of melanin pigment
Unknown
null
ae1fabce-4c79-470a-adac-4250080d5761
single
Which of the following has propensity to metastasize through lymph nodes -
Alveolar rhabdomyosarcoma is a type of rhabdomyosarcoma characterized by its appearance, which is similar to the alveoli of the lungs. It can be associated with a fusion protein between PAX3 and FKHR (now known as FOXO1). It can also be associated with PAX7-FKHR.Alveolar rhabdomyosarcoma (ARMS) typically affects all age groups equally. It makes up a larger poion of RMS in older children and teens than in younger children (because ERMS is less common at older ages). ARMS most often occurs in large muscles of the trunk, arms, and legs. The cells of ARMS look like the normal muscle cells seen in a 10-week-old fetus. ARMS tends to grow faster than ERMS and usually requires more intense treatment.
1
Alveolar rhabdomyosarcoma
Osteosarcoma
Both
null
Pathology
General pathology
1e6f0f44-24d6-4489-bb68-ce87af037ecc
multi
Key symptom in alcohol withdrawal syndrome is:
Ans: C. TremorsKey symptom - Tremor.Withdrawal SyndromesSubstanceFeaturesOpioidYawningdeg, Insomnia, Dysphoric moodWater loss from different orificesdeg (Lacrimationdeg, sweatingdeg, diarrheadeg, vomiting, Increased vitalsdeg (BP, Pulse, RR, Temperature)degPupillary dilation, piloerectiondegAlcoholHang over (MC)degHallucinationsdeg (usually auditory) and illusionsdegInsomniadegTremors/Seizures (Alcoholic seizures/Rum fits): Classic signDelirium tremens:Occurs within 5 daysdeg of complete or significant abstinencedeg from heavy alcohol Recovery occurs within 7 daysCharacteristic features are clouding of consciousnessdeg, disorientationdeg, hallucinations (mostly visual and auditory)deg, illusiondeg, autonomic disturbancesdeg, agitationdeg and insomniadeg.CocaineIncreased or decreased Sleep (hypersomniadeg or insomnia) Psychomotor activityVivid unpleasant dreamsdegIncreased apetite and fatigue
3
Sleep disturbance
Visual hallucinations
Tremors
Delirium
Psychiatry
null
3a069379-2b20-4c7e-8392-1c8c61dfa9ce
multi
Which of the following is not used as hemostatic agent during furcation repair?
null
2
Ca(OH)2
Ferric sulphate
Calcium sulphate
Collagen
Dental
null
7bcc73e5-49fb-44cd-ad92-0097c9769dc0
single
Bonded retainers are popular in which area of dentition?
null
1
Lower anteriors
Lower posteriors
Upper anteriors
Upper posteriors
Dental
null
15563c94-f3b0-44c5-87d4-54f9cdfd3d2b
single
Figure of 8 in chest X-ray is seen in –
Snowman's sign or figure of 8 sign is seen in supracardiac TAPVC.
2
Ebstein anomaly
Total anomalous pulmonary venous connection (TAPVC)
Tetrology of fallot
Transposition of great vessels
Radiology
null
694d3e8f-b57c-405d-89e6-8e1fcb4f2ba7
multi
Parafollicular 'C' cells develop from:
C. i.e. Ultimobronchial body
3
Parafollicular 'C' cells develop from:
Second branchial cleft
Ultimobranchial body
Third branchial pouch
Anatomy
null
a37df1c3-204e-4341-abf3-fb23433d0438
single
AMPLE history includes all of the following except;
AMPLE history is a useful mnemonic for this purpose: Allergies Medications currently used Past illnesses/Pregnancy Last meal Events/Environment related to the injury
2
Allergy.
Personal history.
Last meal.
Medication
Surgery
null
1b8960e0-a53c-434d-bbdc-c8b0efbe02c6
multi
Which of the following enzymes require Vitamin C for their activity?
Vitamin C plays the role of a coenzyme in hydroxylation of proline and lysine while protocollagen is converted to collagen  (i.e.  post-translational modification). The hydroxylation reaction is catalysed by lysyl hydroxylase  (for  lysine)  and prolyl  hydroxylase (for  proline).
1
Procollagen proline hydroxylase
Procollagen amino peptidase
Procollagen carboxyl peptidase
Lysyl oxidase
Biochemistry
null
d6c0c080-55a0-49db-bfcb-acc26dfa26f8
single
The mechanism of action of cephalosporin is:
Ans: A (Interferes with cell wall synthesis) Ref: Goodman & Gilmans The Pharmacological Basis of Therapeutics, 12th ed, 2011. Pg 1479, 1493: Basic and Clinical Pharmacology by Katzung, 2012, 12th ed, Pg 792Explanation:Cephalosporin inhibits bacterial cell wall synthesis.Its mechanism of action is similar to penicillin as both are beta lactams.Bacterial ceil wall plays a major role in the growth and development of bacteria.Peptidoglycan. a component of bacterial cell wall owing to its cross-linked structure offers strength to the cell wall.Peptidoglycan is composed of N-acetyl- glucosamine and N-acetylmuramic acid with cross-linking.A five amino acid peptide known as pentapeptide is linked to N-acetylmuramic acid and this peptide terminates as D-alanyl-D- alanine.Penicillin Binding Protein (PBP) removes terminal alanine from D-alanyl -D-alanine and forms cross link with the adjacent peptide, thus enhancing cell wall rigidity.Beta lactam antibiotics are structurally similar to D-alanyl -D-alanine, and hence covalently bind to PBP, resulting in inhibition of transpeptidation reaction w hich is essential for the removal of D-alanine from D-alanyl-D- alanine.As peptidoglycan synthesis is inhibited by cephalosporins as any other beta lactams, the bacterial cell dies. However cell death is maximum when the cells are actively growing and synthesizing cell wall.
1
Interferes with cell wall synthesis
Inhibition ol DNA gyrase
Inhibition of protein synthesis
Inhibition of DMA polymerase
Pharmacology
Penicillin & Cephalosporin
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multi
Reduced FEV 1, Normal FVC and FEV 1/FVC ratio less than 0.7 .which is reversible with bronchodilator s is consistent with
In Asthma FEV1(forced expiratory volume in 1 second), FVC(forced vital capacity, is the total volume exhaled), FEV1/FVC decreases. To daignose Asthma: Compatible clinical history plus either : 1)FEV1>12% increase following administration of a bronchodilator or glucocoicoids. 2)FEV1>15% decrease after 6min of exercise 3)>20% diurnal variation on >3days in a weeks on PEF(peak expiratory volume). Reference : Davison, 23rd Edition, page no : 569,555
1
Bronchial Asthma
Hypersensitivity penumonitis
Sarcoidosis
Polyaeritis nodosa
Medicine
Respiratory system
ef888510-5f56-4297-8a12-28f3fc3b0371
single
A patient married for 3 years, unable to conceive, has regular menstrual cyclesHusbands semen analysis is normal and so is his hormonal profile What is the right time in menstrual cycle to do endometrial biopsy for infeility:-
Endometrial biopsy is best done on 21st - 23rd day of the cycle. Evidences of secretory activity of the endometrial glands in the second half of the cycle give not only the diagnosis of ovulation but can predict the functional integrity of the corpus luteum. Luteal Phase Defect- Lag of 2 to 4 days in observed/expected secretory changes. Recognized as cause of infeility.
3
12-14 days
17-19 days
20-22 days
3-5 days
Gynaecology & Obstetrics
Normal Menstruation, Abnormal Menstruation, Menopausal Physiology and forsight of conception
1c6a56ac-46fd-451b-ac07-7a3364abb2e8
single
Which of the following is not a feature of RPGN?
Patients with RPGN presents with features of glomerulonephritis such as hematuria, edema and hypeension in association with a rapidly progressive loss of renal function. When untreated these patients rapidly develop end stage renal disease and death can occur within weeks to months. Reference: Robbins Pathologic Basis of Disease, 6th Edition, Page 951
4
Oliguria
Edema
Hypeension
Rapid recovery
Medicine
null
786921b8-a941-4eb0-8c38-ebbf097c2bf9
single
Bed strength at CHC:
Community Health Centre (CHC) Secondary level of health care. Located for population of 1,20,000 in plains. Located for population of 80,000 in hilly areas. Staff at CHC : 46-52 Acts as referral unit for 4 PHCS. Bed strength : 30
3
6-Apr
10
30
50
Social & Preventive Medicine
null
28e8ae2f-b81b-4c7f-a9d8-f65ad9df49b8
single
Most common cytochrome associated with metabolism of drugs is ?
Ans. is 'a' i.e., CYP3A4/5 Cyp 3 A 4/5 carryout biotransformation of largest number (nearly 50%) of drugs.
1
CYP3A4/5
CYP2D6
CYP2C8/9
CYP2Cl.9
Pharmacology
null
51af9d9e-1ad2-442b-9aa6-0b88d289a079
single
Which premolar resembles a canine
Mandibular 1st premolar resembles canine from buccal aspect and it has almost rudimentary lingual cusp which further makes it canine alike.
2
Maxillary 1st premolar
Mandibular 1st premolar
Maxillary 2nd premolar
Mandibular 2nd premolar
Dental
null
1d20c2ee-2f93-4cf3-9ebb-3c5d8117abf6
single
The alveoli are normally kept dry by the:-
Surfactant is a mixture of dipalmitoyl phosphatidyl choline, other proteins & lipids. Role in keeping alveoli dry :- 1. The lipids in the alveolus 2. In the absence of surfactant, the unopposed surface tension in the alveoli would produce a force that greatly ors transudation of fluid from blood into alveoli. Note Factors increasing surfactant synthesis: Factors decreasing surfactant synthesis: Glucocoicoids Thyroxine Stretching of lungs in infancy Beta adrenergic agonist Calcium Smoking Long term inhalation of 100% oxygen Occlusion of main bronchus/pulmonary aery
2
Macrophages
Surfactant
Negative intrapleural pressure
High pCO2 in the alveoli
Physiology
Respiratory System Pa 1
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multi
In which of the following, virus is shed in stool?
Herpangina: Respiratory viral shedding can persist for up to 3 weeks and in the stool for up to 8 weeks. Patients are most contagious at this stage. Influenza: People with flu can spread it to others up to about 6 feet away. Most experts think that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk.  Varicella (Chickenpox): Chickenpox is transmitted from person to person by directly touching the blisters, saliva or mucus of an infected person. Smallpox:  They spread the virus when they coughed or sneezed and droplets from their nose or mouth spread to other people. They remained contagious until their last smallpox scab fell off.
1
Herpangina
Influenza
Varicella
Smallpox
Microbiology
null
f481dd2a-ab51-4602-b993-7063d6816e9c
multi
Which of the following clinical signs is not associated with acute appendicitis?
Ans. c (Cullen's sign) (Ref. Bailey and Love 26th/pg. 1203; box 71.4)Signs to elicit in appendicitisClinical signs of Acute Pancreatitis# Pointing sign# Cullen's sign# Rovsing's sign# Grey Turner's sign# Psoas sign# Fox sign# Obturator sign ACUTE APPENDICITIS# Acute appendicitis is relatively rare in infants, and becomes increasingly common in childhood and early adult life, reaching a peak incidence in the teens and early 20s.# The incidence of appendicitis is equal amongst males and females before puberty. In teenagers and young adults the male: female ratio increases to 3:2 at the age of 25 years; thereafter the greater incidence in males declines.# Aetiology- Some form of luminal obstruction by either a faecolith or stricture is found in the majority of cases.- The incidental finding of a faecolith is a relative indication for prophylactic appendicectomy.- Intestinal parasites, particularly Oxyuris vermicularis (syn. pinworm), can proliferate in the appendix and occlude the lumen.Clinical signs --Clinical examination{best for diagnosis)The diagnosis of appendicitis rests more on thorough clinical examination of the abdomen than on any aspect of the history or laboratory investigation.Cardinal features# unwell patient with low grade pyrexia, localised tenderness, guarding and rebound tenderness.The pointing sign# The patient is then asked to point to where the pain began and to where it moved.McBurney's tenderness# Muscle guarding over the point of maximum tenderness, classically McBurney point.Rebound tenderness# Palpation in LTF causes pain in RIFRovsing's sign# Deep palpation of the left iliac fossa may cause pain in the right iliac fossa.Psoas sign# Occasionally an inflamed appendix lies on the psoas muscle and the patient, often a young adult, will lie with the right hip flexed for pain relief.Obturator test(Zachary Cope)# Spasm of the obturator internus is sometimes demonstrable when hip is flexed and internally rotated. If inflamed appendix is in contact with obturator internus, this maneuvre will cause pain in hypogastrium.Cutaneous hyperaesthesia# Cutaneous hyperesthesia may be demo in the right iliac fossa, but is rarely of diagnostic value.Special features. according to ageInfants# Appendicitis is relatively rare in infants under 36 months of age.# diagnosis is often delayed and thus the incidence of perforation and post-op morbidity is considerably higher.# Diffuse peritonitis can develop rapidly due to the underdeveloped greater omentum.Children# It is rare to find a child with appendicitis who has not vomited.# Children with appendicitis usually have complete aversion to food.# In addition, they do not sleep and bowel sounds are completely absent in early stages.The elderly# Gangrene and perforation occur much more frequently in elderly patients.# Elderly patients with lax abdominal walls or obesity may harbour a gangrenous appendix with little evidence of it, and the clinical picture may simulate subacute intestinal obstruction.# These features with coincident medical conditions produce a much higher mortality for acute appendicitis in elderly.The obese# Obesity can obscure and diminish all the local signs of acute appendicitis.# Delay in diagnosis coupled with the technical difficulty of operating in the obese make it wiser to consider operating through a midline abdominal incision.Pregnancy# Appendicitis is the most common extrauterine acute abdominal condition in pregnancv with a frequency of from one in 1500 to one in 2000 pregnancies.# As pregnancy develops during the second and third trimesters, the caecum and appendix are progressively pushed to the right upper quadrant of the abdomen.# Foetal loss occurs in 3-5% of cases, increasing to 20% if perforation is found at operation.
3
Pointing sign
Rovsing's sign
Cullen's sign
Obturator sign
Surgery
Vermiform Appendix
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Rapid fluid resuscitation of the hypovolemic patient after abdominal trauma is significantly enhanced by which of the following?
Rapid fluid administration is often the key to successful trauma resuscitation. Some of the important factors affecting the rate of fluid resuscitation include the diameter of the intravenous tubing, the size and length of the venous cannulae, the fluid viscosity, and the site of administration. According to Poiseuille's law, flow is proportional to the fourth power of the radius of a catheter and inversely proportional to its length. Therefore, the shorter a catheter and the larger its diameter, the faster one can infuse a solution through it. Central venous placement alone does not assure rapid flow. Importantly, the diameter of the intravenous tubing employed may be the rate-determining factor in fluid delivery: blood-infusion tubing allows twice the flow of standard intravenous tubing and should be used when rapid fluid resuscitation is needed. Any patient who is suspected of having a major abdominal injury should immediately have at least two short, large-bore (16-gauge or larger) intravenous cannulae placed in peripheral veins. Longer, smaller catheters, such as standard 18-gauge central venous catheters, may take more time to place and will have lower flow rates. Once fluid resuscitation is under way, one may elect to place an 8- or 9-French pulmonary artery catheter-introducer via a central venous approach for further volume administration, as well as for measurement of central venous pressure or for Swan-Ganz catheter insertion. Lower-extremity venous cannulae, placed by saphenous vein cutdown or percutaneously into the femoral veins, are no longer advised as primary access for patients with abdominal trauma, since possible disruption of iliac veins or the inferior vena cava will render volume infusion ineffective. Studies have demonstrated that the flow rate of cold whole blood is roughly two-thirds that of whole blood at room temperature. Diluting and warming the blood by "piggybacking" it into infusion lines that are delivering crystalloid will decrease the blood's viscosity, enhance flow, and minimize hypothermia.
4
Placement of long 18-gauge subclavian vein catheters
Placement of percutaneous femoral vein catheters
Bilateral saphenous vein cutdowns
Placement of short, large-bore percutaneous peripheral intravenous catheters
Surgery
Trauma
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A 16 year old girl was brought to the psychiatric emergency after she slashed her wrist in an attempt to commit suicide. On enquiry her father revealed that she had made several such attempts of wrist slashing in the past, mostly in response to tril fights in her house. Fuher she had marked fluctuations in her mood with a pervasive pattern of unable interpersonal relationship. The most probable diagnosis is:
A i.e. Borderline Personality DisorderSchizophrenia can easily be ruled out by absence of disorganized speech, disorganized behaviour (or catatonia), delusions, hallucinations, & negative symptoms (ex blunt affect) for more than 6 months & leading to social / occupational dysfunction.
1
Borderline personality disorder
Major depression
Histrionic personality disorder
Adjustment disorder
Psychiatry
null
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True about active immunity
When B cells and T cells are activated by a pathogen, memory B-cells and T- cells develop, and the primary immune response results. Throughout the lifetime of an animal these memory cells will "remember" each specific pathogen encountered, and are able to mount a strong secondary response, if the pathogen is detected again. Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg.no. : 81-84
3
Less effective
Can be given in immunodeficient state
Immunological memory present
No lag period
Microbiology
Immunology
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Vasopressin decreases the volume of urine primarily by causing :
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4
Decrease in glomerular filtration rate
Decrease in renal blood flow
Decrease in water permeability of descending limb of loop of Henle
Increase in water permeability of collecting duct cells
Pharmacology
null
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All of the following cell types undergo cell division, EXCEPT:
Myocyte cell division in the human hea ceases a few weeks after bih. Thereafter, enlargement of the hea is as a result of cell hyperophy or the laying down of collagen in the extracellular space. DNA turnover is almost undetectable except in pathologic states. Approximately 20% of myocytes in the human hea have two nuclei, so that cell separation, rather than mitosis, could bring about a small increase in the total cell number. Ref: Francis G.S., Tang W., Walsh R.A. (2011). Chapter 26. Pathophysiology of Hea Failure. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e.
2
Pericyte
Cardiac muscle cell
Smooth muscle cell
Satellite cell of skeletal muscle
Physiology
null
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1st Symptom to go with treatment of schizophrenia
C i.e. Auditory hallucinations
3
Apathy
Anhedonia
Auditory hallucination
Paucity of thoughts
Psychiatry
null
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Louis Pasteur is associated with all except -
The development of microbiology as a scientific discipline dates from Louis pasteur (1822-95). He introduced techniques of sterilisation and developed the steam sterilizer,Hot air oven and auto clave. He also established the differing growth needs of different bacteria and contributed to the knowledge of anthrax,chicken cholera and hydrophobia. An accidental observation that chicken cholera bacillus cultures left on the branch for several weeks lost their pathogenic propey but retained their ability to protect the birds against subsequent infection by them,led to the discovery of the process of attenuation and the development of live vaccine. He attenuated cultures of the anthrax bacillus by incubation at high temperature and proved that inoculation of such cultures in animals induced specific protection aganist anthrax. It was pasteur who coined the term vaccine for such prophylactic preparation to commemorate the first of such preparations,namely cowpox employed by Edward Jenner for protection against small pox Ref :Ananthanarayan & paniker's textbook of microbiology 9th edition page no 3
1
Vaccination of small pox
Germ theory
Pasteurization
Vaccination of rabies
Microbiology
general microbiology
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In post-term pregnancy, there is increased risk of all except
Post maturity DOES NOT put mother at risk.Increased morbidity may occur due to hazards of induction. Post term pregnancy causes an increased risk of placental insufficiency due to placental ageing,meconium aspiration and intracranial hemorrhage. (TB of obstetrics DC DUTTA 8th edition pg 374)
1
Postpaum hemorrhage
Meconium aspiration syndrome
Intracranial hemorrhage
Placental insufficiency leading to fetal hypoxia
Gynaecology & Obstetrics
Abnormal labor
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According to AJCC 8th edition, staging of 2 cm size pancreatic cancer if it involves poal vein in:
8th AJCC(2017) TNM Classification of Pancreatic cancer Tis Carcinoma in situ T1 Tumor limited to pancreas upto 2 cm in greatest dimension T1a : Tumor <= 0.5 cm in greatest dimension T1B: Tumor > 0.5 cm but <= 1 cm in greatest dimension T1c : Tumor > 1 cm but <= 2 cm in greatest dimension T2 Tumor limited to pancreas > 2-4 cm in greatest dimension T3 Tumor > 4 cm in greatest dimension T4 Tumor involves Coeliac axis, superior mesenteric aery and / or common hepatic aery N1 Metastasis in 1-2 regional LN N2 Metatasis in 4 or more regional LN M1 Distant metatasis Stage 0 Stage IA Stage IB Stage IIA Stage IIB Stage III Stage IV Tis N0 M0 T1 N0 M0 T2 N0 M0 T1-T3 N1 Mo T1-T3 N2 M0T4 AnyN M0 T1-T3 N2 M0T4 Any N M0 Any T AnyN M1 Involvement of veins does not change the staging. Size of 2cm pancreatic cancer is under T1 according to TNM staging.
1
T1
T2
T3
T4
Surgery
Pancreas
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The following are related to fetal erythropoiesis except :
Primitive hematopoiesis and vasculogenesis first occur in the yolk sac followed by liver and finally bone marrow, leading to the production of blood and vessels respectively Blood islands, clusters of primitive erythrocytes surrounded by endothelial cells, arise from the extraembryonic mesoderm in the yolk sac Hematopoiesis (formation and development of various types of blood cells) begins in the liver during the sixth week The first erythrocytes released into the fetal circulation are nucleated and macrocytic Hemoglobin content of fetal blood rises to approximately 12 g/dL at midpregnancy and to 18 g/dL at term Because of their large size, fetal erythrocytes have a sho lifespan, which progressively lengthens to approximately 90 days at term Erythropoiesis is controlled primarily by fetal erythropoietin because maternal erythropoietin does not cross the placenta Fetal blood is first produced in the yolk sac, where hemoglobins Gower 1, Gower 2, and Poland are made Erythropoiesis then moves to the liver, where fetal hemoglobin F is produced When hemopoiesis finally moves to the bone marrow, adult type hemoglobin A appears in fetal red blood cells and is present in progressively greater amounts as the fetus matures The final adult version of the a chain is produced exclusively by 6 weeks. After this, there are no functional alternative versions Reference: William's Obstetrics; 24th edition; Chapter 7
1
In the embryonic phase, the erythropoiesis is first demonstrated in the spleen
By 20th week, the liver becomes the major site of erythropoiesis
Near term, the bone marrow becomes the major site of erythropoiesis
At term 75-80% of haemoglobin is fetal type (HbF)
Gynaecology & Obstetrics
General obstetrics
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First clinical sign of Vitamin - A deficiency is:
All the ocular manifestations of Vitamin - A deficiency are collectively known as 'Xerophthalmia' (Dry Eye). - Xerophthalmia is most common in children aged 1-3 years. 'First clinical sign' of Vitamin - A deficiency: Conjunctival xerosis . 'First clinical symptom' of Vitamin - A deficiency: Night blindness. Conjunctival xerosis in Xerophtalmia - characteristic appearance of emerging like sand banks at receding tide. 'Bitot's Spots' are triangular, pearly-white or yellowish, foamy spots on bulbar conjunctiva, on either side of cornea ( temporal > nasal).
2
Night blindness
Conjunctival xerosis
Bitot's spots
Keratomalacia
Social & Preventive Medicine
Vitamins and Nutritional Deficiencies
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Most common cause of umbilicus does not separate at age of 2 years
Ans. is 'b' i.e., Leukocyte adhesion deficiency
2
Raspbery tumour
Leukocyte adhesion deficiency
Patent urachus
Umblical granuloma
Surgery
null
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The drug of choice for prevention of seizures in a patient with severe preeclampsia is :
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2
Phenytoin
Magnesium sulphate
Diazepam
Nifedipine
Pharmacology
null
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Left bundle branch block (LBBB) on ECG can suddenly develop in all of the following except
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3
Acute MI
Ashman syndrome
Hypokalemia
Hyperlcalernia
Medicine
null
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Various factors are involved in inflammation. Which among the following is NOT a mediator of inflammation?
Tumour necrosis factor, interferon, prostaglandins are mediators of inflammation. The protein MPO is a marker of azurophil granules. MPO reacts with H2O2, formed by the NADPH oxidase, and increases the toxic potential of this oxidant. Through oxidation of chloride, tyrosine, and nitrite, the H2O2-MPO system induces formation of hypochlorous acid (HOCl), other chlorination products, tyrosine radicals, and reactive nitrogen intermediates, all of which can attack the surface membrane of microorganisms. Ref: Borregaard N., Boxer L.A. (2010). Chapter 66. Disorders of Neutrophil Function. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds), Williams Hematology, 8e.
3
Tumour Necrosis Factor (TNF)
Interferon
Myeloperoxidase
Prostaglandins
Pathology
null
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In Against-the-rule astigmatism:
Ans. Horizontal meridian is more curved than the veical
2
Veical meridian is more curved than the horizontal
Horizontal meridian is more curved than the veical
Both meridia are equally curved
None of the above
Ophthalmology
null
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