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A 65yr old male patient presents with history of early morning bloody diarrhoea, Change in bowel habits, Intermittent Obstruction.Sometimes he had a feeling of incomplete evacuation and Tenesmus. There is no positive family history for any carcinoma.What will be the treatment of choice in this case:
|
CA rectum- MC site of large bowel malignancy- Usually seen in 5th - 6 decade- MC site of metastasis - Liver > lungs - Chemotherapy regimen- FOL FOX-IV* FOL - Folinic acid/ leucovorin* F- 5-FV (5-Flurouracil)* Ox- Oxaliplatin Clinical features- MC symptom - Bleeding PR- Early morning bloody diarrhea- Passage of bloody slime (no fecal matter) - Spurious diarrhea (every 2 to 3 hours, rectum is full with discharge from tumor, so patient passes like stool every 3 hours)- Tenesmus - Painful defecation with sensation of incomplete evacuation seen in lower pa of CA rectum- Back ache/ sciatica (sacral plexus involvement posteriorly)- Weight loss (liver metastasis) Investigations- Length of anal canal - 3cm- length of rectum - 14cm- For complete evaluation, the length of the instrument should be at least 17 cm Investigations Options available- PROCTOSCOPY- Sigmoidoscopy- Colonoscopy* Length of proctoscope - 10 cm* Rigid sigmoidoscope -25 cm* Flexible sigmoidoscope- 60cm* Colonoscope - 160 cm- Investigation of choice - Rigid sigmoidoscopy + biopsy- Colonoscopy is mandatory for adequate evaluation of whole colon and to rule out any synchronous polyp or synchronous malignancy* Synchronous- simultaneously* Metachronous- later after surgery- Viual colonoscopy (3D reconstruction colonoscopy using CT) * Advantage - can visualize outside of lumen also* Disadvantage - Biopsy of colon cannot be done- In head & neck malignancies & pelvic malignancies, overcrowding of nerves, blood vessels & soft tissues. So, IOC for staging of most of head and neck malignancy- MRI- For T- staging, investigation of choice- TRUS (Transrectal ultrasound)- Distantly lying nerve, lymph node, vessel cannot be differentiated as Sensitivity of ultrasound decrease if distance between probe & organ increase. - For lymph node staging, investigation of choice is - Endorectal MRI- Overall Best investigation for staging- MRI Treatment- Principle of treatment in CA Rectum* Stage I - Surgical resection* State II & III - Neoadjuvant chemoradiation followed by surgical resection (down stage the tumor & then surgery)* Stage IV - Neoadjuvant chemoradiation followed by palliation +- surgical excision - TOC- TOTAL MESORECTAL EXCISION* Given by Bill Heald* Significant length of bowel removal around the tumor* Removal of Surrounding tissues up to the plane between Mesorectum & Presacral Fascia known as HEALD'S HOLYPLANE - If CA rectum is located > 5 cm above Anal verge - Low Anterior Resection (LAR)- If CA rectum is located at or below 5 cm from anal verge - APR (Adomino Perineal resection) aka Mile's Procedure - In elderly patient >60 years with malignancy in sigmoid/ or proximal pa of rectum which is intraperitoneal - Haman's procedureHaman's procedure* Sigmoidectomy +Descending colostomy + Closure of rectal stump
| 1
|
Total mesorectal excision
|
Hamann's procedure
|
Anterior resection
|
Abdominoperineal resection
|
Surgery
|
Rectum and anal canal
|
63826197-0786-43c2-9c7e-5c4c471dc731
|
single
|
All of the following are included in "Five cleans" of CSSM programme, except -
|
Ans. is 'c' i.e., Clean perineum Cleans of safe delivery : o 'Five cleans' (practices) under strategies for elimination of neonatal tetanus include, Clean delivery surface Clean hands (of bih attendants) Clean cord cut (blade or instrument) Clean cord tie Clean cord stump (no applicant) o Sometimes these practices are called as '3 cleans': Clean delivery surface Clean hands Clean cord care (cut, tie and stump) o Suggested 'Seven cleans' include five cleans and Clean water, and Clean towel, for hand washing
| 3
|
Clean cord
|
Clean tie
|
Clean perineum
|
Clean room
|
Social & Preventive Medicine
| null |
03b4636b-8ac5-4351-961b-437a9930eec3
|
multi
|
Signs of placental separation are all except
|
There is apparent lengthening of cord with placental separation.
| 2
|
Gush of blood pervaginally
|
Apparent shortening of cord
|
Supra pubic bulge
|
Slight increase in height of uterus
|
Gynaecology & Obstetrics
| null |
547c831f-2cbf-447f-a7d9-c9d6ef268f7f
|
multi
|
The main cause of minimal change ds is:
|
Ans. is 'b' i.e., Loss of negative charge on membrane o Sialoproteins in the glomerular capillary wall are negatively charged, and studies with anionically charged and cationically charged dextrans indicate that the negative charges repel negatively charged substances in blood, with the result that filtration of anionic substances 4 nm in diameter is less than half that of neutral substances of the same size.o This probably explains why albumin, with an effective molecular diameter of approximately 7 nm, normally has a glomerular concentration only 0.2% of its plasma concentration rather than the higher concentration that would be expected on the basis of diameter alone; circulating albumin is negatively charged,o In certain kidney diseases, the negative charges on the basement membrane are lost even before there are noticeable changes in kidney histology, a condition referred to as minimal change nephropathy,o As a result of this loss of negative charges on the basement membranes, some of the lower-molecular-weight proteins, especially albumin, are filtered and appear in the urine, a condition known as proteinuria or albuminuria.
| 2
|
Increase in pore size
|
Loss of negative charge on membrane
|
Loss of cells
|
Decreased circulation
|
Physiology
|
Diuretics, Kidney Diseases
|
c7629450-a7e3-4aba-8dab-b56c15bc4592
|
single
|
A 45-year-old patient complains of pain in throat which is aggravated on swallowing and radiates to the ear and posterior part of tongue. The likely diagnosis is:
|
Glossopharyngeal nerve supplies base of tongue, tonsillar fossa and the ear. In glossopharyngeal neuralgia pain radiates to these areas and is precipitated by swallowing or yawning. It is relieved by anesthetizing the area.
| 2
|
Sluder's neuralgia
|
Glossopharyngeal neuralgia
|
Disorder of temporomandibular joint
|
Trigeminal neuralgia
|
ENT
|
Facial Nerve And Its Disorders
|
a013515d-1851-49e2-b776-cd6914a55e6f
|
multi
|
A mother is holding her newborn baby in the hospital bed just a few hours after giving bih. The mother becomes alarmed when her baby begins to have a difficulty in breathing and she rings for help. You arrive at the bedside and observe that the baby is in severe respiratory distress. A quick physical examination reveals that the baby has a barrel-shaped chest, a scaphoid-shaped abdomen, and absence of breath sounds on the left side. A chest radiograph reveals air/fluid containing bowel in the left-side hemithorax, no visible aerated lung on the left side, contralateral displacement of the hea and other mediastinal structures, compression of the contralateral lung, and reduced size of the abdomen. Which of the following is the most likely diagnosis?
|
This is a case of Congenital Diaphragmatic (Bochdalek) Hernia. Herniation of abdominal contents into the pleural cavity (usually left). Caused by a failure of the pleuroperitoneal membrane to develop or fuse with other components of the diaphragm. Affected neonates usually present in the first few hours of life with respiratory distress that may be mild or so severe as to be incompatible with life. Symptoms : Difficulty in breathing (neo-natal emergency) O/E -Barrel-shaped chest, Scaphoid-shaped abdomen, and absence of breath sounds on the left side CXR -Air/fluid containing bowel in the left-side hemithorax
| 4
|
Esophageal Hiatal hernia
|
Infantile Hyperophic Pyloric Stenosis
|
Tracheoesophageal fistula (TEF)
|
Congenital Diaphragmatic Hernia
|
Anatomy
|
Umblicial cord and diaphragm
|
b9581080-6726-41da-95d7-a695d9bc071b
|
single
|
A 28-year-old man presents with a new genital ulcer on his penis that is painless. He is sexually active and noticed the lesion 1 week ago. The ulcer is 1 cm in size, has an eroded base, and an indurated margin. Dark-field examination of the ulcer fluid confirmed the diagnosis.For the above patient, select the most likely infecting organism.
|
On dark-field examination, T pallidum (the spirochete that causes syphilis) is a thin, delicate organism with tapering ends and 6-14 spirals. When dark-field examination is not possible, direct fluorescent antibody tests are used.
| 3
|
toxoplasmosis
|
tetanus
|
syphilis
|
smallpox
|
Medicine
|
Infection
|
104f3f15-d729-4756-be87-6a21f5a0ebf0
|
multi
|
A HIV positive patient presents with cough for 10 days. Sputum culture by SDA reveals broad budding yeast, diagnosis:
|
In AIDS patients fungal infections by dimorphic fungi are more common. Of the following options all four other dimorphic fungi but the yeast stage with broad-based cells is seen only in blastomycosis histoplasma shows narrow base yeast cells. In coccidioidomycosis endospore, spherules are formed and in paracoccidioidomycosis, Mickey Mouse type of cells are seen.
| 2
|
Histoplasma capsulatum
|
Blastomycosis
|
Coccidiodomycosis
|
Paracoccidiomycosis
|
Microbiology
|
JIPMER 2018
|
21766122-395b-426f-9408-64c57c145ed0
|
single
|
Which of the following is known as the dangerous zone of the eye?
|
Ciliary body is called the dangerous area of eye Allergic theory is being postulated as the reaosn for calling it as dangerous area of eye. During trauma to eye when ciliary body is injured it exposes uveal pigments and excites plastic uveitis in the sound eye.
| 4
|
Sclera
|
Retina
|
Optic nerve
|
Ciliary body
|
Ophthalmology
|
Ocular Embryology& Anatomy
|
bf2deb5e-004a-495e-9a3b-1ba8377ea6a2
|
single
|
Laboratory findings in fat embolism consist of the following except -
|
Ans. is 'c' i.e., Hypercalcemia Fat embolismo Fat embolism means circulation of fat globule away from its site of origin,o When fat embolism causes symptoms it is called fat embolism syndrome.Causes of fat embolism :-1. Fracture of long bone (most common) - Blunt trauma6. Recent Corticosteroid administration2. Soft tissue trauma3. Bums4 Parenteral lipid infusion5. Sickle cell crisis7. Acute pancreatitis8. D.M.9. Liposuction10. Decompression sicknessPathogenesis of fat embolism syndromeo Fat is released from the marrow after trauma and enters the circulation by rupture of the marrow vascular sinusoids.o These fat droplets are deposited in pulmonary and brain vessels - Respiratory & neurological symptoms.Clinical manifestations of fat embolism syndromeo Classical triad of fat embolism syndrome is -l) Respiratory symptomsii) Neurological symptomsiii) Petechial rash- Dyspnoea, Tachypnoea, or even ARDS.- Confusion, disorientation.- In axilla, necko Other - Fever, tachycardia, Subconjuctival & retinal hemorrhages.Lab findingso Thrombocytopeniao Hypocalcemiao Fat microglobulinemia (not macroglobulinemia)o |ESRo Anemiao Hypoalbuminemiao Fat globules in urineo Hypoxemia
| 3
|
Thrombocytoenia
|
Fat globules in urine
|
Hypercalcemia
|
Anemia
|
Pathology
|
Miscellaneous (Blood Vessels)
|
295aa54f-e9b4-4195-b38d-f1ae0ac0ab75
|
multi
|
Ture about terminal bronchioles are all except ?
|
Terminal bronchioles contain Clara cells which secrete a protein that lines the small air passages. Alveoli (alveolar sac) are lined by type 1 pneumocytes (95%) and type 2 pneumocytes (5%). Type 2 pneumocytes secrete surfactant and also helps in repair of alveoli after destruction of type- 1 pneumocytes. Pores of Kohn are present in alveolar wall to allow passage of bacteria and exudate between adjacent alveoli.Terminal bronchi contain maximum smooth muscle cells relative to wall thickness.Cailage is found in larynx, trachea and bronchi but not in bronchioles.Submucosal glands are paicularly numerous in medium-sized bronchi and disapperar in distal terminal bronchioles.
| 3
|
Absence of cailage
|
Presence of clara cells
|
Absence of smooth muscles
|
Absence of submucous glands
|
Anatomy
| null |
b41e33af-e20e-472e-a92f-1335563e214d
|
multi
|
A 6-month-baby presented with recurrent seizures and developmental delay. On examination there was alopecia and scaly skin rashes. Investigations revealed metabolic acidosis, elevated lactates & ketonuria. What could be the underlying enzyme deficiency?
|
Skin rashes with presence of ketones and metabolic acidosis are all features of Multiple carboxylase deficiency. Phenylalanine hydroxylase deficiency- microcephaly, hypopigmentation, musty body odour Glucose 6 phosphatase deficiency- doll like facies
| 3
|
Phenylalanine hydroxylase
|
Epimerase
|
Multiple carboxylase
|
Glucose 6 phosphatase
|
Pediatrics
|
Disorders of Amino acid Metabolism
|
265980c2-f382-474b-ad45-7d2ea39c6936
|
single
|
Differential diagnosis of panic disorder includes: a. Pheochromocytoma b. Myocardial infarction c. Mitral valve prolapse d. Depression e. Carcinoid syndrome
|
Common physical disorders that must be ruled out before the diagnosis of panic disorder is made include myocardial infarction angina pectoris mitral valve prolapse asthma pulmonary embolism pheo- chromocytoma carcinoid syndrome hypoglycemia hypehyroidism anaemia.
| 3
|
all of the above
|
a,b,c,d
|
a,b,c,e
|
a,c,d,e
|
Psychiatry
|
Neurotic, Stress Related and Somatoform Disorders
|
352818a5-b037-4e51-b1ba-235579dd7d39
|
multi
|
A patient diagnosed with depression on treatment came to emergency with altered sensorium seizures, palpitations and ECG showing sinus tachycardia. How do you treat this patient?
|
The above symptoms suggests of TCA toxicity in a patient of depression and NaHCO3 remains as the main stay of treating TCA toxicity and metabolic acidosis associated with it.
| 3
|
Aspirin + clopidogrel
|
IV Lorazepam
|
IV Sodium bicarbonate
|
IV Haloperidol
|
Psychiatry
| null |
9b710500-45ff-46fc-ae81-3dd6ed29caea
|
single
|
Patient presenting with pellagra, parkinsonism, convulsions, anemia and kidney stones has deficiency of
|
D i.e. Pyridoxal phosphate
| 4
|
Coenzyme A
|
FADH
|
Niacin
|
Pyridoxal phosphate
|
Biochemistry
| null |
28e1949a-442d-4257-97e1-895e355187a8
|
single
|
Drugs which is ACE inhibiton ?
|
Ans. is 'd' i.e., Fosinopril Drugs acting on RASACE inhibitorsRenin inhibitorsAngiotensin antagonists (Angiotensin receptor blockers or ARBs)o Captoprilo Enalaprilo Aliskireno Losartano Lisinoprilo Benazeprilo Remikireno Candesartano Ramiprilo Fosinoprilo Enakireno Irbesartano Trandoloprilo Imidapril o Valsartano Perindopril o Telmisartano All ACE inhibitors are prodrugs except captopri! and Lisinopril.Important points about ACE inhibitorso ACE inhibitors inhibit the enzyme kininase II or ACE.o Angiotensin converting enzyme is also involved in the metabolism of Bradykinin -Bradykinin level is increased, which is responsible for dry cough and angioedema produced by ACE inhibitors,o ACE inhibitors also potentiate the hypotensive action of exogenously administered bradykinin.o ACE inhibitors decreases BP by decreasing total peripheral resistance (A-II is a potent vasoconstrictor) - Both systolic and diastolic BP fall,o There is no effect on cardiac output.o Cardiovascular reflexes are not interfered with and there is little dilatation of capacitance vessels - Postural hypotension is not problem (But because of faster action of captopril an initial sharp fall in BP first dose hypotension may occur).o Reflex sympathetic stimulation does not occur despite vasodilatation - Can be used safely in patients with ischaemic heart disease. (Note - ACE inhibitors are the only vasodilators which do not reflexly activate sympathetic system).o All ACE inhibitor are prodrugs except captopril and lisinopril.o Captopril is shortest and fastest acting A CE inhibitor:o Captopril has maximum bioavailibily among ACE inhibitors,o Lisinopril is slowest acting.o Presence of food in stomach reduces the bioavailibility of captopril and Imidapril (not other ACE inhibitors).o Fosinopril is unique in being a phosphinate compound that is glucuronide conjugated and eliminated both by liver and kidney (only kidney is the mode of excretion for all other ACE inhibitors after metabolism in the liver).o ACE inhibitors are teratogenic - Contraindicated in pregnancy.o Acute renal failure is precipitated by ACE inhibitors in patients with bilateral renal artery stenosis - Contraindicated in these patients.
| 4
|
Losartan
|
Milrinone
|
Candesartan
|
Fosinopril
|
Pharmacology
|
ACE Inhibitors
|
0d6172c9-ced2-44bb-a6da-709cc0a6abc7
|
multi
|
Sin needle used to kill animals made of :
|
B i.e. Rati seeds
| 2
|
Dhatura seeds
|
Rati seeds
|
Lead peroxide
|
Arsenic
|
Forensic Medicine
| null |
1df3f2bd-2d8c-42ff-ac27-d6b73e900ade
|
single
|
Cyst form is found in -
|
Infection is acquired from pigs and other animal reservoirs or from human carriers. The infective form is the cyst, which is ingested in contaminated food or drink.excystment takes place in the small intestine and the liberated trophozoites reach the large intestine where they feed and multiply as lumen commensals. Infection is very often confined to the lumen and is asymptomatic. Clinical disease results only when the trophozoites burrow into the intestinal mucosa, set up colonies and initiate inflammatory reaction. This leads to mucosal ulcers and submucosal abscesses. resembling the lesions in amoebiasis. Clinically also, balantidiasis resembles amoebiasis, causing diarrhoea or frank dysentery with abdominal colic, tenesmus, nausea and vomiting. Occasionally there may occur intestinal perforation with peritonitis and rarely involvement of genital and urinary tracts TEXTBOOK OF MEDICAL PARASITOLOGY,CKJ PANIKER,6TH EDITION,PAGE NO111
| 2
|
Entamoeba fragilis
|
B.Coli
|
T. Vaginalis
|
T. Intestinalis
|
Microbiology
|
parasitology
|
655bef9d-6f6a-4113-9454-1d89fc61fcdc
|
single
|
Which one of the following conditions is associated with Kawasaki&;s syndrome?
|
Kawasaki disease is an acute, febrile, multisystem disease of children. Although the disease is generally benign and self-limited, it is associated with coronary aery aneurysms in approximately 25% of cases.There is typical intimal proliferation and infiltration of the vessel wall with mononuclear cells. Beadlike aneurysms and thromboses may be seen along the aery. Other manifestations include pericarditis, myocarditis, myocardial ischemia and infarction, and cardiomegaly. High-dose IV g-globulin (2 g/kg as a single infusion over 10 h) together with aspirin (100 mg/kg per day for 14 days followed by 3-5 mg/kg per day for several weeks) have been shown to be effective in reducing the prevalence of coronary aery abnormalities when administered early in the course of the disease. Surgery may be necessary for Kawasaki disease patients who have giant coronary aery aneurysms or other coronary complications. Surgical treatment most commonly includes thromboendaerectomy, thrombus clearing, aneurysmal reconstruction, and coronary aery bypass grafting.Ref: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 385 The Vasculitis Syndromes; Page no: 2193
| 3
|
Acute rheumatic fever
|
Pulseless disease
|
Coronary aery aneurysm
|
Systemic lupus erythematosus
|
Pediatrics
|
C.V.S
|
7127064c-afe7-4544-8703-455106284c54
|
single
|
Constrictive pericarditis is associated with each of the following except
|
Constrictive pericarditis is a condition in which the filling of the hea is limited by the compressive nature of the pericardium. The pericardium acts as a rigid shell around the hea, imposing continuous positive pressure. The filling is, therefore, compromised specifically in diastole when filling is at its maximum. This results in an early diastolic descent followed by a rise and plateau (dip and plateau or square root sign). There are several disease processes that have been attributed to constrictive pericarditis including rheumatic hea disease, radiation therapy, tuberculosis, and purulent pericarditis. Hypothyroidism, however, causes pericardial effusion
| 4
|
Radiation therapy for Hodgkins disease
|
Tuberculosis
|
Bacterial (purulent) pericarditis
|
Hypothyroidism
|
Medicine
| null |
467aa054-be84-4230-82c5-8295b4ac8da4
|
multi
|
A 30 year old female presented with unilateral breast cancer associated with axillary lymph node enlargement. Modified radical mastectomy was done, fuher treatment plan will be:
|
Chemotherapy in Carcinoma Breast: First generation regimen such as 6-monthly cycle of cyclophosphamide, methotrexate and 5-fluorouracil(CMF) will acheive a 25% reduction in the risk of relapse over a 10-12 year period. CMF is no longer considered adequate adjuvant chemotherapy. Modern regimens include an anthracycline (doxorubicin or epirubicin) and taxanes Effect of combining hormone and chemotherapy is additive although hormone therapy is staed after completion of chemotherapy to reduce side-effects. Most popular combinations were CMF & CAF (Cyclophosphamide, Adriamycin(Doxorubicin), and 5-flurouracil) In the united states, a combination of Adriamycin (doxorubicin) and cyclophosphide (AC) or Ac plus a taxane (docetaxel, paclitaxel) are likely to be used as polychemotherapy. For Her-2-positive breast cancer, adding trastuzumab to polychemotherapy is approved for use as a surgical adjuvant Anthracycline-containing combinations are significantly better than no treatment, single agent treatment or CMI Hormone Therapy in Breast carcinoma: Ovarian suppression or ablation: Bilateral oophorectomy Medically by LHRH agonist (Goserelin, Leuprolide) SERM: Tamoxifen & Raloxifen Aromatase inhibitors: Non-steroidal : Letrozole & Anastrozle Steroidal: Examestane Anti-estrogens: Fulvestrant Progestins: Megesterol & Medroxypregesterone acetate Ref: Sabiston 20th edition Pgno: 857
| 2
|
Observation and follow up
|
Adriamycin based chemotherapy followed by tamoxifen depending on estrogen/progesterone receptor status
|
Adriamycin based chemotherapy only
|
Tamoxifen only
|
Surgery
|
Endocrinology and breast
|
9ea68eb9-89ba-490c-99f5-18d0ed931072
|
single
|
During anaesthetic procedure, compression of cricoid cartilage –
| null | 2
|
Prevents spinal headache
|
Helps in preventing regurgitation
|
Aid in intubation
|
Help to relieve reflex bronchospasm
|
Anaesthesia
| null |
4fa14dbb-02b2-496c-8e92-c461b30d4ff3
|
single
|
Investigation of choice for diagnostic evaluation of hydrocephalus is a one month old child?
|
Ans. b (Ultrasonography). (Ref. Grainger Radiology, 4th/2469; Refer Q. No. 17 of Radiology of MH'2002).RADIOLOGICAL PROCEDURE/ TOOLPRIME INDICATIONSIVP/IVU# Renal tuberculosis# Renal anomaliesOesophagography# TO fistula (Water-soluble contrast study)# Motility disorders (initial evaluation)# DysphagiaHysterosalpingography (Postmenstrual-preovulatoryperiod)# Infertility0# Congenital uterine anomalies# Tubal blockUrethrography# PU Valves (MCU)# VUR (MCU)# Trauma# StrictureUltrasound# Hydrocephalus in infants0# Thyroid nodule# Initial evaluation of Rotator cuff injury/ subacromial bursitis/ bicipital tendinitis0# Synovial cysts# Pleural/ Pericardial effusion0# First investigation done for Acute abdomen and obstructive jaundice0# Congenital Hypertrophic Pyloric Stenosis & Intussuception0# Gallstones0# Initial evaluation of focal liver lesions# Initial evaluation of blunt trauma abdomen (FAST protocol) 0# Free fluid in abdomen0# Cystic hygroma# Prostatic pathologies (TRUS)# Seminal vesicle pathologies (TRUS)# Staging of early rectal/pancreatic head malignancies (EUS)# Neuroectodermal pancreatic tumors-insulinoma & gastrinoma (EUS)# Scrotal pathologies# Developmental dysplasia of Hip0# Ectopic pregnancy (TVS) 0MRI# Investigation of choice for all brain tumors (CEMRI) 0# Chronic subarachnoid hemorrhage (MRI-FLAIR) 0# Sensitive most for ischemic stroke (DWMRI) 0# In perinatal asphyxia , neurological damage can be predicted by MRI# The best investigation for parameningeal rhabdomyosarcoma0# Best choice to radiologically evaluate a posterior fossa tumor0# Gadolinium enhanced MRI is investigation of choice for vestibular schwannoma.0# First investigation of choice for spinal cord tumor0# Investigation of choice for multiple sclerosis (all white matter diseases)0# Ideal test to detect bone metastasis to only spine. (For all other bones - metastasis : bone scan)0# Imaging of pancoast's tumor ( superior sulcus tumor )deg# Imaging of posterior mediastinal masses# Investigation of choice in traumatic paraplegia0# Investigation of choice for evaluation of suspected Perthes disease and acute osteomyelitis.0# In a 40 year old female patient on long term steroid therapy presents with recent onset of severe pain in the right hip. Imaging modality of choice for this patient is MRI.# Investigation of choice for a pregnant lady with upper abdominal mass# The most sensitive and specific investigation for renal artery stenosis.# Investigation of choice in aortic dissection0# Best diagnosis for dissecting aorta (aortic dissection).# MoyaMoya disease (MRA)
| 2
|
X-ray skull
|
Ultrasonography
|
CT scan
|
MRI
|
Radiology
|
Nervous System
|
9e3d3ec9-c4b9-40d1-8fc6-50333f8ec44a
|
single
|
Nitrates are not used in?
|
C; renal colic
| 3
|
CHF
|
Cyanide poisioning
|
renal colic
|
Esophageal spasm
|
Pharmacology
| null |
8f9167d0-5350-40a9-8eb8-8f470d46f2e4
|
single
|
Which of the following leukemia almost never develops after radiation?
|
Ref: Robbin's Pathology, 9th ed. pg. 324-325Cancers associated with radiation:* ALL, AML, CML* Thyroid cancer* Breast cancer* Lung cancer* Bladder, ovarian cancerCancers not seen with radiation:* CLL* Hodgkin's lymphoma* Prostate cancer, testis cancer and cervical cancer
| 4
|
Acute myeloblastic leukemia
|
Chronic myeloid leukemia
|
Acute lymphoblastic leukemia
|
Chronic lymphocytic leukemia
|
Pathology
|
Hemodynamics
|
1c099a36-e339-4477-84ab-5fbce6ad51ab
|
single
|
Radiological factors indicating an unstable pelvis are all except
|
ref : maheswari 9th ed
| 4
|
Posterior sacroiliac complex displacement by > 1 cm
|
Avulsion fracture of sacral or ischial end of the sacrospinous ligament
|
Avulsion fractures of the L5 transverse process
|
Isolated disruption of pubic symphysis with pubic diastasis of 2 cm.
|
Orthopaedics
|
Pelvis and Hip injuries
|
0e0df40e-4618-46b9-994c-6f3072d38356
|
multi
|
Which of the following probably triggers the onset of labour?
|
Ans: a (ACTH in fetus) Ref: Ganong, 22nd ed, p. 451This also is a direct pick from self study MCQs (Chap 23 Q. 17)Mechanism responsible for onset of labour:| Circulatory estrogens due to increase in circulatory DHEAS.So |' gap junction - |' uterine contractions.| GRH by fetal hypothalamus - |' circulatory ACTH - | cortisol leading to maturation of respiratory system.(Thus in a sense fetus picks the time to be bom by | GRH & ACTH secretion)
| 1
|
ACTH in fetus
|
ACTH in mother
|
Oxytocin
|
Prostaglandin
|
Physiology
|
Endocrinology and Reproduction
|
2531380d-f56b-446a-b9c8-a413b7a51f71
|
single
|
Unilateral high stepping gait is seen in
|
Steppage gait (High stepping, Neuropathic gait) is a form of gait abnormality characterised by foot drop or ankle equinus due to loss of dorsiflexion. The foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking Conditions associated with a steppage gait Edit Foot drop Charcot-Marie-Tooth disease Polio Multiple sclerosis Syphilis Guillain-Barre syndrome Spinal disc herniation Anterior Compament Muscle Atrophy Deep fibular nerve Injury Spondylolisthesis Slipped Femoral Epiphysis ALS/PLS Ref Harrison20th edition pg 2445
| 1
|
L5 radiculopathy
|
Distal radiculopathy
|
Cauda equina syndrome
| null |
Medicine
|
C.N.S
|
fd6c4231-a3f8-4267-8715-fe400bbbc936
|
multi
|
Axial reduction in a posterior three quarter crown imparts:
| null | 4
|
Retention and Resistance
|
Structural durability
|
Periodontal preservation
|
All of the above
|
Dental
| null |
1e71131e-b083-44a9-b9f1-6bd7d8554ddc
|
multi
|
Increase in MCHC is associated with
|
Ans is 'd' i.e. Hereditary spherocystosis Mean cell hemoglobin concentration (MCHC) is the average concentration of hemoglobin in a given volume of packed red blood cells, expressed in grams per deciliter. Normal value is 33-37 gm/dlMCHC is increased in hereditary spherocytosis, not because of increased hemoglobin, but due to decerase volume of spherocytes.MCHC is decreased in microcytic hypochromic anemia(iron deficiency anemia & anemia of chronic disease).MCHC remains normal in megaloblastic anemia.
| 4
|
Iron deficiency anemia
|
Megaloblastic anemia
|
Anemia of chronic disease
|
Hereditary spherocystosis
|
Pathology
| null |
66368898-071e-4c01-bed8-935f06005929
|
single
|
All are true about facial colliculus EXCEPT
|
Facial colliculus is present on the dorsal aspect of lower (not upper) pons. It is raised by axons of facial nerve (internal genu) It is located in the floor of fouh ventricle. Abducent nucleus (6th N. ) lies deep to it.
| 4
|
Raised by axons of facial nerve (internal genu)
|
Abducent nucleus lies deep to it
|
Located at the floor of fouh ventricle
|
Present on the dorsal aspect of upper pons
|
Anatomy
|
Neuroanatomy, Head and Neck
|
e016fb1d-a614-4248-918a-4621388558d5
|
multi
|
In a 2 months old infant undergoing surgery for biliary atresia, you would avoid one of the following anaesthetic –
|
The child with biliary atresia will have hepatic dysfunction.
Sevoflurane, thiopentone and propofol are safe in liver disease.
Halothane is not contraindicated in pre-existing liver :-
"There is no compelling evidence associated with worsening of pre-existing liver disease".
─Morgan
"Pre-existing liver disease unrelated to halothane is not a contraindication to the use of halothane".
—Lee 13th/e 143
Though not a contraindication, halothane should be avoided in liver disease -
"Potentialy hepatotoxic drug should be avoided".
—Lee 55
| 2
|
Thiopentone
|
Halothane
|
Propofol
|
Sevoflurane
|
Anaesthesia
| null |
472bbab1-f249-4be0-989b-dcf546e51e7f
|
single
|
A reflex that if once appears, never disappears is:
|
Parachute reflex is a reflex that if once appears, never disappears.
| 2
|
Moro's Reflex
|
Parachute reflex
|
Symmetric Tonic neck reflex
|
Asymmetric Tonic neck reflex
|
Pediatrics
|
Impoant Terminologies and Primitive Neonatal reflexes
|
26e3c0cd-5a21-4f71-b171-b4bf1d7dd318
|
single
|
A person's electrocardiogram (ECG) has no P wave, but has a normal QRS complex and a normal T wave. Therefore, his pacemaker is located in the
|
The absent P wave indicates that the atrium is not depolarizing. Therefore, the pacemaker cannot be in the sinoatrial (SA) node. Because the QRS and T waves are normal, depolarization and repolarization of the ventricle must be proceeding in the normal sequence. This situation can occur if the pacemaker is located in the atrioventricular (AV) node. If the pacemaker were located in the bundle of His or in the Purkinje system, the ventricles would activate in an abnormal sequence (depending on the exact location of the pacemaker) and the QRS wave would have an abnormal configuration. Ventricular muscle does not have pacemaker propeies.
| 2
|
Sinoatrial (SA) node
|
Atrioventricular (AV) node
|
Bundle of His
|
Purkinje system
|
Physiology
|
ECG
|
399e64ba-228d-458c-8d3b-fa0f80ca17e6
|
single
|
Lupus erythematosus is
| null | 3
|
Reactive Lesion
|
Degenerative condition
|
Autoimrnune disorder
|
Neoplastic condition
|
Pathology
| null |
1bba7b43-2937-4d8a-8068-d3ffbac35172
|
single
|
Neuro-physiological defects present in right lobe involvement all, except -
| null | 3
|
Visuo-spatial defect
|
Anosognosia
|
Dyscalculia
|
Dysgraphia
|
Medicine
| null |
169d9fb6-5f67-49ce-bd13-cd876236a18e
|
multi
|
Identity '1' in the illustration depicting compliance of lungs:
|
Ans. A. InspirationThe illustration shows a Pressure-volume curve of the lung during inspiration and expiration.
| 1
|
Inspiration
|
Expiration
|
Inspiration Air filled
|
Expiration air filled
|
Physiology
|
Respiratory System
|
331fc2a4-e458-4102-9fb7-fc57a6844171
|
single
|
One side weakness, On NCCT No hemorrhage seen, BP is 160/100 what you should do as clinician?
|
- One sided weakness indicates stroke. Stroke - IOC for stroke - NCCT - IOC for acute infarct / ischemic stroke is MRI (Diffusion weighted MRI) NCCT Hyperdense Hypodense / normal Haemorrhagic stroke Ischemic stroke / acute infarct - If MRI cannot be done and ischemic stroke is suspected: Sta thrombolytics. - BP should not be managed unless more than 180/110- ONLY aspirin is proven to be useful as an antiplatelet in the management of acute infarcts.
| 3
|
Manage BP
|
Do Nothing
|
Thrombolytics
|
Aspirin plus Clopidogril
|
Radiology
|
CT SCAN
|
6408aa02-d2dc-4a4a-a2a4-36df98679935
|
single
|
Most common histological subtype of cancer endometrium is :
|
Histologically most of the endometrial cancers are Adenocarcinomas Hence they are called endometriod adenocarcinoma About 10-15% are Papillary serous Clear cell Adenosquamous Pure squamous Ref : Shaw Gynecology 17e pg 434.
| 4
|
Mucinous carcinoma
|
Clear cell carcinoma
|
Squamous cell carcinoma
|
Endometrioid adenocarcinoma
|
Gynaecology & Obstetrics
|
Gynaecological oncology
|
3ccd8240-0bb6-4d8e-8a79-a7d48fb80853
|
single
|
Kocher Langenbeck approach for emergency acetabular fixation is done in all Except -
|
Morel - Lavalle lesion is a localized area of subcutaneous fat necrosis over the lateral aspect of hip caused by same trauma that causes the acetabular fracture. The operation through it has been a/w a higher (12%) rate of postoperative infection, wound dehiscence and healing by secondary intention. The presence of a significant Morel-Lavallee lesion can be suspected by hypermobility of the skin and subcutaneous tissue in the affected area from the shear-type separation of the subcutaneous tissue from the underlying fascia lata. Alternatively, some fractures can be treated through ilioinguinal approach, thus avoiding the affected area.
Therefore, In the presence of Morel-Lavalle lesion posterior kocher langenbeck approach is avoided.
| 4
|
Open fracture
|
Progressive sciatic nerve injury
|
Recurrent dislocation inspite of closed reduction and traction
|
Morel - Lavallee lesion
|
Orthopaedics
| null |
d7e8732b-1447-4b97-860a-eb466effe4f0
|
multi
|
Lateral umbilical fold of Peritoneum is produced by?
|
Ans.is 'c' i.e., Inferior epigastric vesselsUmbilical folds are reflections of the parietal peritoneum that are raised from the body wall by underlying structures.A median umbilical fold :Covers median umbilical ligament (a remnant of urachus).Two medial umbilical folds :Cover medial umbilical ligaments (remnants of distal pa of obliterated umbilical aery).Two lateral umbilical folds :Cover inferior epigastric vessel.
| 3
|
Median umbilical ligament
|
Medial umbilical ligament
|
Inferior epigastric vessels
|
None of the above
|
Anatomy
| null |
db5b6e2d-f724-45ca-bd40-0e485387d200
|
multi
|
Which myxovirus does not have hemagglutinin and neuraminidase but have membrane fusion protein -
|
Ans. is 'c' i.e., RSV RSV does not posses hemagglutinin or neuraminidase. The viral envelope has two glycoproteins? i) G protein - By which virus attaches to cell surface ii) F- protein ( Fusion protein ) - which bring about fusion between viral and host cell membranes. It is also responsible for cell to cell fusion, which leads to characteristic syncytial formation.
| 3
|
Measles
|
Parainfluenza
|
RSV
|
Influenza
|
Microbiology
| null |
3f1ddc6e-b3cc-45b3-8cec-9a30cab67553
|
single
|
Which of the following increases BMR ?newe
|
Ans. is 'c' i.e., Ingestion of foodFactors affecting BMR BMR (RMR) represents tissue metabolic activity. Hence BMR is affected by any factor which alters cellular metabolic activity and energy expenditure.i) Factors increasing BMR :- Early age (infancy and childhood), male sex, pregnancy, lactation, recent ingestion of food, (especially proteins), Cold or very hot (uncomfoable) environment, Fever, Hormones (thyroxine, catecholamines, growth hormone), muscular exercise (exeion), Smoking, Caffine, Stress and emotional hyperactivity, and person with tall thin built.ii) Factors decreasing BMR :- Advanced age (adult and old age), female sex, fasting, starvation, (up to 40% decrease in prolonged starvation), malnutrition, hot (comfoable) climate, obesity, sleep, and person with sho obese built.
| 3
|
Starvation
|
Obesity
|
Ingestion of food
|
Sleep
|
Physiology
| null |
8a961904-97ab-4c31-8d70-a2e194b2208f
|
single
|
Superior orbital fissure syndrome includes-
| null | 1
|
3, 4, 5, 6 cranial nerves
|
3, 2, 4, 5 cranial nerves
|
2, 6, 3 cranial nerves
|
2, 5, 6 cranial nerves
|
Anatomy
| null |
b50364ac-73f5-463c-9b95-3c0466f347a7
|
single
|
The following is used for testing absorption in intestine -
|
D-xylose absorption test is used to check how well your intestines are absorbing a simple sugar called D-xylose. From the results of the test, your doctor can infer how well your body is absorbing nutrients. D-xylose is a simple sugar that occurs naturally in many plant foods. Ref Davidson edition23rd pg 822
| 1
|
Xylose
|
Sucrose
|
Fructose
|
Maltose
|
Medicine
|
G.I.T
|
a7fe8261-2319-4cc1-ad38-9442e6c9f980
|
single
|
Lymphoreticular system doesnot includes -
|
Lymphoreticular system include lymphoid & reticular components, with clearly demarcated function. The lymphoid cells lymphocytes & plasma cells are primarly concerned with specific immune response. The phagocytic cells, forming pa of the reticuloendothelial system are primarly concerned with the scavenger functions Reff: Ananthanarayanan & Paniker's textbook of microbiology 9th edition pg: 128
| 3
|
T-cells
|
B-cells
|
Platelets
|
Macropahges
|
Microbiology
|
Immunology
|
11a3f6a4-0607-49ea-a972-44516d16c745
|
single
|
Reverse transcription involves
|
Generally, the genes are made up of DNA . Usually , DNA dependent RNA polymerase transfers the information of DNA to mRNA . But Retrovirus group , RNA acts as a template Based on this RNA , the enzyme , RNA dependent DNA polymerase or reverse transcriptase will make a new DNA strand. Reference : DM.VASUDEVAN.TEXTBOOK SEVENTH EDITION ; PAGE NO : 593.
| 1
|
RNA dependent DNA synthesis
|
DNA dependent RNA synthesis
|
DNA dependent DNA synthesis
|
RNA dependent RNA synthesis
|
Biochemistry
|
Metabolism of nucleic acids
|
4b0d870c-db7c-472f-a6c7-fa7feeb883e2
|
single
|
All of the following may occur in Down's syndrome except
|
congenital or acquired hypothyroidism,brush field spots in iris,and ventricular septal defect IS seen in a case with down syndrome.
Undescended testis is not a feature.
| 2
|
Hypothyroidism
|
Undescended testis
|
Ventricular septal defect
|
Brushfield's spots
|
Pediatrics
| null |
1d74419c-460a-4fdb-8fc6-ee82a71af155
|
multi
|
Phospholipase A2 act on:
|
Ans: d. Phosphatidyl-inositolPhospholipases hydrolyze the phosphodiester bonds of phosphoglycerides, with each enzyme cleaving the phospholipid at a specific site.Phospholipases release molecules that can serve as messengers (for example, DAG and IP3), or that are the substrates for synthesis of messengers (for example, arachidonic acid.Phospholipases are responsible not only for degrading phospholipids, but also for "remodeling" them. For example, phospholipases Al and A2 remove specific fatty acids from membrane-bound phospholipids; these can be replaced with alternative fatty acids using fatty acyl CoA transferase.
| 4
|
Phosphoglyceric acid
|
Phosphate
|
Ca+
|
Phosphatidyl-inositol
|
Biochemistry
| null |
aa3cb2b7-ea24-4415-8b82-888d83628e61
|
single
|
The most impoant cause of the death in septic shock is-
|
Hypotension is the most common cause of death in septic shock Cardiac output is decreased in septic shock, leading to hypotension Ref: Sabiston 20th edition Pgno :554
| 2
|
Renal failure
|
Cardiac failure
|
Respiratory failure
|
DIC
|
Anatomy
|
General anatomy
|
ce90a42a-d2c0-4545-b1a0-7c3c638d7d34
|
single
|
Any child with caries before_________ years is called ECC:
| null | 4
|
2 years
|
3 years
|
5 years
|
6 years
|
Dental
| null |
1ce30319-6954-453a-8a98-849f4e05026f
|
multi
|
Osteoporosis is caused by all, except -
|
Oestradiol is used to prevent osteoporosis.
Other causes of osteoporosis have been discussed before.
| 2
|
Corticosteroid
|
Oestradiol
|
Methotrexate
|
Chronic heparin therapy
|
Pathology
| null |
cc3243fe-381e-47d9-afe5-bb8c91bf3720
|
multi
|
Patellar tendon bearing P.O.P. cast is indicated in the following fracture:
|
Patellar tendon bearing cast is indicated in fracture shaft of tibia (closed fracture). With good alignment it unites within 6 weeks in the case of children and 16 - 20 weeks in adults. Ref: Essential Ohopedics By J Maheswari, 2nd Edition, Page 133; Rockwood and Green's 'Fractures in Adult', 4th Edition, Page 163
| 2
|
Patella
|
Tibia
|
Medial malleolus
|
Femur
|
Surgery
| null |
e4c0369b-0d11-4163-9b5d-8afe28f1f24b
|
multi
|
The presence of large quantities of unabsorbed solutes in the renal tubule causes an increase in urine volume this is called
|
Diuresis due to a high concentration of osmotically active substances in the renal tubules (for example, urea, sodium sulfate), which limit the reabsorption of water.Ref: Ganong&;s review of medical physiology; 24th edition; page no; 689
| 1
|
Osmotic diuresis
|
Osmotic natriuresis
|
Water intoxication
|
Water diuresis
|
Physiology
|
Renal physiology
|
4c6561e9-cf72-470f-8121-579158828361
|
multi
|
Increased gastric acid secretion occurs in
|
Gastric ulcersTYPELOCATIONACID LEVELI60%Lesser curve at incisuraLow to normalII15%Gastric body with duodenal ulcerIncreasedIII20%Prepyloric IncreasedIVLess than 10%High on lesser curveNormalVAnywhereNormal, NSAID-inducedSome ulcers may appear on the greater curvature of the stomach,but the incidence is less than 5%Sabiston 20e pg: 1233
| 2
|
Type I gastric ulcer
|
Type III gastric ulcer
|
Type IV gastric ulcer
|
Type V gastric ulcer
|
Surgery
|
G.I.T
|
ef3b03e4-a3ca-435b-ba9b-4ab5ab3c9c85
|
single
|
Name the muscle forming pelvic diaphragm?
|
Ans. is 'c' i.e., Levator aniThe muscles given in question are of pelvic diaphragm and urogenital diaphragm.Pelvic diaphragm The pelvic floor is formed by 'pelvic diaphragm' which consists of levator ani and coccygeus. The pelvic diaphragm separates the perineum below from pelvis above.Pelvic diaphragm is traversed by urethra, anal canal and in females vagina.Urogenital diaphragm It is a musculo-fascial paition across the pubic arch and separates the pelvic cavity from anterior pa of pelvic outlet.It consists of two muscles (sphincter urethrae and deep transverse perinei, also called transversus pernei profundus), and two fasciae (Inferior fascia of urogenital diaphragm, also called perineal membrane and superior fascia of urogenital diphragm).Both muscules of urogenital diaphragm are supplied by muscular branches of perineal nerve, a branch of pudendal nerve.Structures piercing the urogenital diaphragm are urethra and in female vagina (behind urethra).
| 3
|
Deep transverse perinei
|
Sphincter urethrae
|
Levator ani
|
None od the above
|
Anatomy
| null |
13b07b1b-dd7a-4df9-968e-27e62ad26210
|
multi
|
Most serious side effects of amphotericin B:
|
Ref: Sharma & Sharma 3rd ed. P 783Adverse Drug reactions of Amphotericin B* The most common, most serious and long term side effect of amphotericin B is Nephrotoxicity (renal tubular necrosis)* This nephrotoxicity presents with hypokalemia, hypomagnesemia secondary to renal tubular acidosis, azotemia and even irreversible damage if the dose exceeds 5g.# In order to prevent the nephrotoxicity, prior hydration with 1L of normal saline is recommended.# Liposomal preparation has lesser risk of nephrotoxicity* Hypochromic normocytic anemia is common and thrombocytopenia and leukopenia although less common but has been noted.* Intrathecal administration: Arachnoiditis and seizure* Hepatic impairment and Jaundice* Infusion related toxicity (chills, tachypnea, fever, vomiting, hypotension, anaphylaxis)
| 2
|
Hepatic damage
|
Renal damage
|
Cardiotoxicity
|
Hypochromic anemia
|
Pharmacology
|
Anti Microbial
|
ab23ae6a-7291-47de-b49b-bd4fd084058f
|
single
|
Most common aerial thrombosis related manifestations in antiphospholipid antibody syndrome is:
|
Aerial thrombosis and related consequences in APLA syndrome: Stroke-20%, TIA-11 %, Myocardial ischemia-10% Amaurosis fugax-7% Ref: Harrisons principles of internal medicine, 18th edition, Page 2737
| 1
|
Stroke
|
Transient ischemic attacks
|
Myocardial ischemia
|
Amaurosis fugax
|
Medicine
| null |
7103a1ec-9946-441c-8334-423d5a75f594
|
single
|
Fluoride level permissible in drinking water ?
|
Ans. is 'd' i.e., 1.5 mg/L The recommended level of fluoride in drinking water in the country is accepted as 0.5 to 0.8 mg/ Liter. -Park o Maximum permissible limit is 1.5 mg/Lit. Guidelines of for drinking water Colour < 15 true colour units (TCU) Turbidity < 1 nephlometric turbidity units (NTU) Hardness < 100 - 300 mg/litre calcium ion o pH: 6.5-8.5 Total dissolved solids (TDS) < 600 mg/litre Chloride 200 - 600 mg/L H,S < 0.05 mg/L Iron < 0.3 mg/L Sodium < 200 mg/L Sulphate < 250 mg/L Zinc < 4 mg/L NH3 <1.50 mg/L Fluorine < 1.5 mg/L (0.5 - 0.8 mg/L : Optimum level) Nitrates < 50 mg/litre Nitrites < 3 mg/litre Gross alpha radiological activity < 0.1 Bq/litre Gross beta radiological activity < 1.0 Bq/litre Zero pathogenic microorganisms Zero infectious viruses Absence of pathogenic protozoa and infective stages of helminthes Dissolved 02 has indirect effect, level is not specified.
| 4
|
< 0.5 mg/L
|
0.5-0.8 mg/L
|
1 mg/L
|
1.5 mg/L
|
Social & Preventive Medicine
| null |
61333696-341d-4d61-a70c-797ddae6727d
|
single
|
Alcohol is found in all except :
|
Alcoholic group is found in Glucocerebrosides, Sphingomyelin, Lecithin except for DHA. DHA (Docosa Hexaenoic Acid) 22C fatty acid with 6 double bonds. No alcohol is present Glucocerebrosides & Sphingomyelin contains Sphingosine alcohol. Lecithin contains Glycerol alcohol.
| 2
|
Glucocerebroside
|
DHA (Docosa Hexaenoic Acid)
|
Lecithin
|
Sphingomyelin
|
Biochemistry
|
Chemistry of Lipids
|
50765667-b4fc-48ab-af1a-98da1b8746ed
|
multi
|
Joint NOT involved in Rheumatoid Arthritis:
|
Ans. (a) D.I.PRef: Maheshwari 5th ed. 1287* Rheumatoid arthritis characteristically causes swelling of small joints in the hand like the P.I.P, M.C.P and the wrist joint bilaterally.* Isolated D.I.P joint involvement is seen in psoriatic arthropathy.* D.I.P joint involvement is also seen with osteo-arthritis but the involvement is with pain at the base of thumb. Knee joint is the commonest joint involved in these patients.
| 1
|
D.I.P
|
P.I.P
|
M.C.
|
Wrist
|
Orthopaedics
|
Rheumatoid Arthritis
|
f0e5992e-79a7-4b0e-982d-cb35a55d9786
|
single
|
Mody false is -
|
Ans. is 'd' i.e., Insulin dependent Maturity onset diabetes of the young (MODY) o This is characterized by non-insulin dependent diabetes mellitusQ o The usual age of onset is 25 years or youngerQ o Patients are nonobese and their hyperglycemia is due to impaired glucose induced secretion of insulinQ. o It generally responds well to low doses of oral hypoglycemic agentsQ. Tvpe II diabetes mellitus - o In this type of diabetes obesity, insulin resistance and relative insulin deficiency are key findings. Insulin secretion is usually sufficient to prevent ketosis under basal conditions, o It is common in obese individuals but can occur in non obese too. o The diabetes is usually controlled with oral hypoglycemic agentsQ (insulin is usually not required). So. How to differentiate between MODYand diabetes mellitus type II ???. Diagnostic criteria for the diagnosis of MODY include : o Not insulin-dependent - sho wn by absence of insulin treatment 5 years after diagnosis or significant C-peptide in a patient on insulin treatment. o Rarely obese (obesity is not required for the development of diabetes). o Early diagnosis of diabetes - before age 25 years in at least one and ideally two family members. o Autosomal dominant inheritance i.e. vertical transmission of diabetes through at least two generations (ideally three generation), with a similar phenotype in cousins or second cousins. o Diabetes results from b-cell dysfunction (insulin levels are often in the normal range, though inappropriately low for the degree of hyperglycemia). Type I Type II Mody Age of onset Predominantly young Predominantly middle to old age Predominantly yound (usually < 25 years) Family history Not significant (ucommon) Significant (Positive) Inheritance is Polygenic/Heteroaenous Vertical transmission through successive generations is not essential for diagnosis Signi ficant (Positive) Inheritance is Monoeenic/Autosomal dominant Vertical transmission through at least two successivegeneration (ideally three) is essential for diagnosis Risk of ketoacidosis High Low (uncommon) Low (uncommon ) Insulin dependence Insulin dependent Non insulin dependent Non insulin dependent Obesity Uncommon (may be present) Common (may be absent) Uncommon (may be present) Pathophysiology b cells dysfunction (Autoantibodies against b cells) No insulin resistance bcell dysfunction Insulin resistance b cell dysfunction No insulin resistance Fasting 'C' pcptide/insulin Low High Low
| 4
|
Age <25 years
|
Impaired secretion of insulin
|
Responds to sulfonylureas
|
Insulin dependent
|
Medicine
|
Diabites & Inappropriate Antidiuretic Hormone
|
3d79ea96-adfd-4e79-8aaa-12ca93909a6f
|
multi
|
All are true regarding disinfectants except ?
|
Ans. is 'c'i.e., Ethylene oxide is intermediate disinfectant Phenols do not require organic matter to act, rather they are slowly and paly deactivated by organic matter. Organic matter tends to absorb phenol and lowers the concentrationu available to kill microorganism. Do not get confused with the answer of previous question; phenols are not readily inactivated by organic matter, they are inactivated slowly and paly. . Ethylene oxide gas is a high level disinfectant ( not intermediate). . Gluteraldehyde has sporicidal activity and hypochlorite (chlorine) has virucidal activity. . Option 'c' requires detailed explanation. Categories of effective potency . Sterilants :- are capable of completely eliminating or destroying in all forms of microbial life, including spores. . Disinfectants :- Destroy some, but not necessarily all organisms. The category is fuher divided into subcategories:- i) High level disinfectants :- In their usual concentration and contact period, they destroy all microorganisms, with exception of high number of bacterial spores ( small number of spores can be destroyed). It is woh noting that at higher concentrations and prolonged contact period, high level disinfectant can act as steriliant, i.e. can kill high numbers of spores as well. Examples are :-2% gluteraldehyde, 8% formaldehyde, 6-10% hydrogen peroxide and ethylene oxide gas. ii) Intermediate level disinfectants :- Inactivate even resistant organisms such as mycobacterium tuberculosis as well as vegetative bacteria, most viruses and most fungi, but do not necessarily kill bacterial spores. Examples are :-0.5% iodine, 70-90% ethanol and isopropanol, chlorine compounds (hypochlorite), some phenolic compounds and iodophor based disinfectants. iii) Low level disinfectants :- kill most bacteria, some viruses and some fungi, but cannot be relied on to kill resistant microorganisms such as tubercular bacilli or bacterial spores. Examples are :- quaerly ammonium compounds, mercurials,some phenolic compounds and iodophores. Note:- the disinfectant levels of iodophors (iodines) and phenolic compounds may be classified as intermediate or low depending on the concentration employed. Levels of disinfectant Activity Level of activity Bacteria Spores Fungi Viruses Vegetative Tubercular Lipid medium size Nonlipid & Small High Intermediate Low + + + + + - + - _ + + + + + + + -
| 3
|
Gluteraldehyde is sporicidal
|
Hypochlorites are virucidal
|
Ethylene oxide is intermediate disinfectant
|
All
|
Microbiology
| null |
6c9209ae-b5e7-498f-bd2b-c2f61280bbbe
|
multi
|
In ectopic pregnancy all are useful for diagnosis except
|
Ans) d (Flat abdomen) Ref Williams 22nd ed pg 259All except flat abdomen are useful for diagnosing ectopic pregnancy.Ectopic pregnancyCommonest site - AmpullaCommonest cause - PID (Salpingitis)Other causes - IUCD (Progestasert)- Tubal surgery- Adhesion following pelvic surgery- ARTPrevious ectopic -10% chance of recurrent ectopicModes of termination of tubal pregnancy--- Tubal abortion (most common)- Tubal rupture- Tubal mole- Continuation of pregnancyUterus in ectopic - Decidua without Chorionic villusArias- Stella reaction - Typical adenomatous change of endometrial glandsTubal mptureMost common in isthmic regionIsthmic mpture - 6-8wksAmpullary mpture - 8-12 wksInterstitial mpture - 16wksTriad- AmenorrhoeaAbdominal pain - Most constant feature of triadVaginal bleedingOther symptoms - Nausea, vomiting, fainting attacksInvestigation of choice - TVSAbsence of intrauterine pregnancy with a positive pregnancy testFluid in pouch of douglasAdnexial mass clearly separated from ovaryRarely cardiac pulsationOthers - beta HCG, laparoscopy, D & CS. progesterone>25mg/ml- Intra uterine <5mg/ml- AbnormalStudiford criteria - Primary abdominal pregnancySpiegelberg criteria - Ovarian pregnancyPaalman and Me Elin criteria- Cervical pregnancyDmgs used - Methotrexate KC1 Hyperosmolar glucose Ru-486. Indication for Methotrexate in ectopic pregnancy(1) Patient haemodynamically stable(2) Tubal diameter <4cm without cardiac activities(3) Beta-HCG levelSurgery - Linear salpingostomy- Linear salpingotomy- Salpingectomy- Milking of tube
| 4
|
Culdocentesis
|
USG
|
Beta HCG
|
Flat abdomen
|
Gynaecology & Obstetrics
|
Miscellaneous (Gynae)
|
baa93d98-71a7-4848-a418-cbe4b80e0ac3
|
multi
|
Which of the following types of hyperiglyceridemia is associated with an increase in chylomicron and VLDL remnants?
|
Frederickson's classification of hyperlipoproteinemias Type III Lipoprotein fraction elevated: Broad beta VLDL Chylomicrons It is very rare. It is due to increased levels of LDL and IDL. Beta lipoprotein floats on ultra-centrifugation and a broad beta band is observed on electrophoresisRef: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 299, Table 25.4
| 3
|
Type I
|
Type IIa
|
Type III
|
Type IV
|
Biochemistry
|
Metabolism of lipid
|
826bf9d3-e73a-4566-b326-4e0304a061fd
|
single
|
Which of the following muscles adducts the vocal cords?
|
Lateral cricoarytenoid. The oblique and transverse arytenoids and thyroartenoid also adduct the vocal folds. The posterior cricoarytenoids abducts the vocal cords. The cricothyroid muscle raises the cricoid cartilage and tenses the vocal cords.
| 1
|
Lateral cricoarytenoid.
|
Posterior cricoarytenoid.
|
Cricothyroid.
|
Vocalis.
|
Anatomy
| null |
0cd022b2-a8dd-41e9-93c7-bc80cd29213b
|
single
|
Exclusive breastfeeding is at least until –
|
Exclusive breastfeeding: The baby should be given only breast Milk and nothing else (not even water) for the first 6 months of life. Weaning should be started by 6 months of age with semisolid food, in addition to continuing breastfeeding.
The WHO recommends exclusive breastfeeding for the first six months of life and then breastfeeding up to two years or more. ___ Internet
Complementary feeding means giving the child other nutritious foods in addition to breast milk. Breastfeeding is sufficient food for the first 6 months. Thereafter, concentrated energy-dense complementary foods are essential in order to maintain an adequate velocity of growth for the infant.
| 2
|
4 month
|
6 month
|
8 month
|
10 month
|
Pediatrics
| null |
d934265b-e659-47f4-b51e-3791bae825bc
|
single
|
Hyaluronic acid is present in
|
Vitreous is composed of water, collagen and hyaluronic acid. Vitreous Humour. Vitreous humor is the fluid-like gel, composed of approximately 98-99% water with trace amounts of hyaluronic acid, glucose, anions, cations, ions, and collagen, located in the posterior chambers of the eyes Reference: khurana 6th edition pg 567
| 2
|
Lens
|
Vitreous humour
|
Blood vessels
|
cornea
|
Ophthalmology
|
Anatomy, Development and clinical examination
|
ac6a1fc1-a55e-4e36-a5b3-ce6e2504256d
|
single
|
All of the following statements about primary Gouty ahritisare true, Except
|
In over 90% of patients, the main abnormality is reduced uric acidexcretion by the kidney, which is genetically determined. Impaired renal excretion of urate also accounts for the occurrence of hyperuricaemia in chronic renal failure, and for hyperuricaemia associated with thiazide diuretic therapy . The prevalence of gout is approximately 1-2%, with a greater than 5 : 1 male preponderance. Gout has become progressively more common over recent years in affluent societies due to the increased prevalence of obesity and metabolic syndrome . Ref Davidsons 23e p1013
| 1
|
90% of cases are caused by over production of uric acid
|
Uric acid levels may be normal at the time of an acute attack
|
Men are more commonly affected than women (Male> Females)
|
Definitive diagnosis requires aspiration of synol fluid
|
Medicine
|
Immune system
|
785c6a63-7d63-407c-a50d-adaba54076ca
|
multi
|
All are features of hypernephroma except:
|
RENAL CELL CARCINOMA (AKA gravitz tumor, hypernephroma, internist's tumor, radiologist's tumor) - More common in males, in 6th and 7th decade - Tumor usually involve upper pole Most common site of distant metastasis are lungs (cannon ball deposits and pulsatile osteolytic secondaries in bone>liver>brain) Characteristic feature of RCC is tendency to invade renal vein
| 2
|
May invade renal vein
|
Lower pole involvement
|
More common in males
|
Cannon ball secondaries are seen
|
Surgery
|
Kidney and ureter
|
14f5d8f0-86f5-4d01-bdda-76a697f18d7a
|
multi
|
Oral glucose tolerance test in children is done with
|
Ideal weight of the glucose taken for glucose tolerance test for children are 1.75gm/kg glucose . Obtain a fasting blood sugar level, then administer an oral glucose load (2 g/kg for children aged < 3 y, 1.75 g/kg for children aged 3-10 y , or 75 g for children aged >10 y). Check the blood glucose concentration again after 2 hours. A fasting whole-blood glucose level higher than 120 mg/dL (6.7 mmol/L) or a 2-hour value higher than 200 mg/dL (11 mmol/L) indicates diabetes. However, mild elevations may not indicate diabetes when the patient has no symptoms and no diabetes-related antibodies. Reference: GHAI Essential pediatrics, 8th edition
| 2
|
1.5 gm/kg glucose
|
1.75 gm/kg glucose
|
2 gm/kg glucose
|
2.5 gm/kg glucose
|
Pediatrics
|
Endocrinology
|
aa3af173-4296-4a04-84f4-6b67814329be
|
single
|
<img alt="" src=" />Which is not a feature of Netheon Syndrome
|
This autosomal recessive disorder is characterized by ichthyosis (usually ichthyosis linearis circumflexa but occasionally the lamellar or congenital ichthyosiform erythroderma types), trichorrhexis invaginata and other hair shaft anomalies, and atopic diathesis. Mutations in the gene SPINK 5, which encodes a serine protease inhibitor, have been identified in patients with Netheon syndrome. causes: *Netheon syndrome is an autosomal recessive disorder associated with mutations in the SPINK5 gene, which encodes the serine protease inhibitor lympho-epithelial Kazal-type-related inhibitor (LEKTI). These mutations result in a dysfunctional protein that has a reduced capacity to inhibit serine proteases expressed in the skin. Potential endogenous targets of LEKTI include KLK5, KLK7 and KLK14. These enzymes are involved in various aspects of epidermal remodelling, including desquamation, PAR-2 activation and degradation of lipid hydrolases, suggesting a potential mechanism for the development of atopic manifestations characteristic of Netheon syndrome. *Disease severity is determined by the level of LEKTI expression and, consequently, serine protease activity. Complete SPINK5 gene deletions have been linked to severe cases, while mutations which induce alternate splicing or create premature stop codons may lead to varying levels of severit.Fuhermore, LEKTI-knockout mice exhibit a phenotype similar to Netheon syndrome in humans Ref Harrison 20th edition pg 1234
| 1
|
Autosomal dominant
|
Ichthyosis
|
Very sho hair
|
Erythroderma
|
Dental
|
miscellaneous
|
64904a0b-7e9b-4020-9057-83d1321457b1
|
single
|
A young woman presents with delayed cycles and abnormal growth of hair on face. On USG ovaries are normal. What is the most probable diagnosis?
|
Idiopathic hirsutism is hrisutism in absence of any adrenal or ovarian tumor and normal serum levels of androgens. This is only 25 % of al the cases of hirsutism, and not the commonest! The most common cause of hyperandrogenism and hirsutism is PCOS. There are only two major criteria for the diagnosis of PCOS: anovulation and the presence of hyperandrogenism as established by clinical or laboratory means. Revised criteria (2 out of 3) 1. Oligo ovulation or anovulation 2. Clinical and/or biochemical signs of hyperandrogenism 3. Polycystic ovaries and exclusion of other etiologies (congenital adrenal hyperplasia, androgen-secreting tumors, Cushing's syndrome) From Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop These features alone are sufficient for the diagnosis in the absence of other pathologies accounting for hyperandrogenism (i.e., AOAH, or ovarian neoplasm, Cushing syndrome) or anovulation (i.e., hypogonadotropic or hypergonadotropic disorders, hyperprolactinemia, thyroid disease). Please note that presence of polycystic ovaries on USG is not necessary nor sufficient for diagnosis of PCOD
| 2
|
Idiopathic hirsutism
|
PCOD
|
Testestrone screting tumor
|
Adrenal hyperplasia
|
Gynaecology & Obstetrics
|
Polycystic Ovarian Syndrome
|
e334bea4-d412-459f-8c01-d8b391102dc9
|
single
|
All of the following are features of Friadreich's Ataxia, Except:
|
Answer is D (Extensor plantar with brisk lower limb reflexes): Friedreich's Ataxia, is characteristically associated with an extensor plantar response but absent lower limb reflexes. Lower limb reflexes are characteristically absent (in most patients) and not brisk. Cardiomyopathy is a common association seen in up to 90% of patients Diabetes mellitus may be associated in up to 25% of cases Progressive ataxia is the most common presenting symptom.
| 4
|
Prograssive Ataxia is the most common presentation
|
Cardiomyopathy is a common association
|
Diabetes mellitus may be associated
|
Extensor plantar with brisk lower limb reflexes.
|
Medicine
| null |
cc63fd13-ab98-42ce-85fe-ee00e4891f85
|
multi
|
Treatment of choice in a young patient with primary dysmenorrhea is: March 2011
|
Ans. D: Symptomatic Therapy for primary dysmenorrhoea consists of measure to relieve pain and to suppress ovulation if the woman desires contraception additionally Surgery is indicated if medical measures fail to provide relief and in women with secondary dysmenorrhoea to treat the underlying pelvic pathology
| 4
|
Presacral neurectomy
|
Dilatation
|
Hysterectomy
|
Symptomatic
|
Gynaecology & Obstetrics
| null |
62a89265-19b0-406a-8bfe-c73c6b46aa86
|
single
|
Carcinoma, which has predilection for metastasis to hands and feet bones: March 2007
|
Ans. B: Bronchus In adults, the metastatic lesions generally occur in the axial skeleton and other sites with residual red marrow, although the lesions may be found anywhere in the skeletal system. Common sites for metastases are the veebrae, pelvis, proximal pas of the femur, ribs, proximal pa of the humerus, and skull. Ceain carcinomas may have a predilection for paicular skeletal sites. For example, metastases to the bones of the hands and feet are rare, but 500/0 of hand metastases originate from lung neoplasms Primary tumors arising from the pelvis have a predilection for spread to the lumbosacral spine.
| 2
|
Prostate
|
Bronchus
|
Pelvis
|
Breast
|
Pathology
| null |
648264e4-195b-4d90-9cca-5de934d01e08
|
single
|
All except one is true regarding minimum alveolar concentration
|
Rate of induction depends on Blood gas partition coefficient.
| 2
|
Lower the MAC, higher the potency
|
Rate of induction depends on MAC
|
Nitrous oxide has MAC value of 104 and thus is least potent
|
Methoxy flurane has lowest MAC value
|
Anaesthesia
| null |
cba217e1-c5e9-41c6-a2e2-b2d7d6f80133
|
multi
|
"Double bubble sign" seen in
|
(Annular pancreas) (1120, 1198-LB) (1137-B & L 25th)Annular pancreas - in which a ring of pancreatic tissue from the head of the pancreas surrounds the descending duodenum X-ray shows a dilated stomach and proximal duodenum (double bubble sign) and little or no air in the rest of the small bowel.Congenital duodenal obstruction - causes of duodenal obstruction are atresia, mucosal web, annular pancreas, preduodenal portal vein and peritoneal bands {Ladd's bands) from malrotations - shows - "double bubble sign" (1316-CSDT 11th)
| 1
|
Annular pancreas
|
Ureterocele
|
Hypertrophic pyloric stenosis
|
Wilm's tumour
|
Surgery
|
Pancreas
|
01008fec-3ae8-4f2a-afcf-e496d8bcd61b
|
single
|
A 2 years old child is brought to the emergency with history of fever and vomiting. On examination he has neck rigidity. The CSF examination shows polymorphs more that 2000/m1 protein 100 mg/dl and glucose 10mg/d1. The Gram stain shows the presence of Gram negative coccobacilli. The culture shows growth of bacteria only on chocolate agar and not on blood agar. The caustive agent is ?
|
Ans. is 'b' i.e., Haemophilus influenzae . The impoant clues in this question are ? The organism is gram negative coccobacilli. It grows only on chocolate agar and not on blood agar. Causing meningitis in children. . Haemophilus influenzae : - Gram negative Coccobacilli - Can not grow in blood agar because utilization of V factor (NAD or NADP) is limited by the presence of serum NADase. - Grows well on chocolate agar (blood agar which is heated up to 70-80degC) because, on heating extra X and V factors are liberated from the lysed red cells. - Is a common cause of meningitis in children. About other options - N. Meningitis . It occur as diplococci (not coccobacilli) . It can grow on blood agar. - Legionella pneumophilia . Does not cause meningitis. - Bramanhella catarrhalis . It occur as diplococci (not coccobacilli) . It can grow on blood agar.
| 2
|
Neisseria meningitides
|
Haemophilus influenzae
|
Branhamella catarrhalis
|
Legionella pneumophila
|
Microbiology
| null |
0241258d-0b31-4ba5-a06b-9461ac02a07a
|
single
|
Upper Lid Retractors include ?
|
Ans. is 'd' i.e., Levator palpabrae superioris & muller muscleo The levator palpebrae superioris is the important upper eye lid retractor. Injury or weakness to this muscle leads to ptosis.o This muscle is supplied by occulomotor (3rd) nerve.o Deep part of the elevator muscle is the Muller's muscle, which is sympathetically innvervated.o In hyperthyroidism, sensitization of the Muller muscle leads to upper eyelid retraction and pseudoproptosis,o On the other hand, in Horner's syndrome loss of this muscle action leads to ptosis.o The capsulopalpebral fascia assists in lower eyelid retraction and coordinates with eyeball movement. It arises as an extension of the inferior rectus and inserts into the lower edge of the lower tarsus and the adjacent orbital septum.
| 4
|
Muller muscle and superior rectus
|
Levator palpabrae superioris and superior oblique
|
Superior oblique and superior rectus
|
Levator palpabrae superioris & muller muscle
|
Ophthalmology
|
Anatomy
|
6375395f-12ce-4cea-8472-1f9c378e37c6
|
single
|
What is the chance of having Homocystinuria if only one parent is affected and the other is normal?
|
Homocystinuria is autosomal recesive disorder.If one parent is affected and the other is normal,none of the children will be affected.
| 2
|
25%
|
0%
|
50%
|
75%
|
Pathology
| null |
566f1757-63ae-4380-9639-eba01bf19906
|
single
|
Fish mouth stenosis in rheumatic hea disease is due to which of the following mechanisms?
|
Fish mouth stenosis in RHD is manifestation of Chronic RHD involving mitral valve which is due to calcification and fibrosis bridging across valvular commissures. RHD is viually the only cause of mitral stenosis. Acute and chronic rheumatic hea disease. A) Acute rheumatic mitral valvulitis superimposed on chronic rheumatic hea disease. Small vegetations (verrucae) are visible along the line of closure of the mitral valve leaflet (arrows). Previous episodes of rheumatic valvulitis have caused fibrous thickening and fusion of the chordae tendineae. B) Microscopic appearance of an Aschoff body in a patient with acute rheumatic carditis. The myocardium exhibits a circumscribed nodule of mixed mononuclear inflammatory cells with associated necrosis; within the inflammation, large activated macrophages show prominent nucleoli, as well as chromatin condensed into long, wavy ribbons (caterpillar cells; arrows). C/D). Mitral stenosis with diffuse fibrous thickening and distoion of the valve leaflets and commissural fusion (arrows, C), and thickening of the chordae tendineae (D). Note neovascularization of anterior mitral leaflet (arrow, D). E). Surgically resected specimen of rheumatic aoic stenosis, demonstrating thickening and distoion of the cusps with commissural fusion. Comparison of the four major forms of vegetative endocarditis. The rheumatic fever phase of rheumatic hea disease (RHD) is marked by small, way vegetations along the lines of closure of the valve leaflets. Infective endocarditis (IE) is characterized by large, irregular masses on the valve cusps that can extend onto the chordae. Nonbacterial thrombotic endocarditis (NBTE) typically exhibits small, bland vegetations, usually attached at the line of closure. One or many may be present. Libman-Sacks endocarditis (LSE) has small or medium-sized vegetations on either or both sides of the valve leaflets.
| 1
|
Calcification and fibrosis bridging across valvular commissures
|
Fibrinoid necrosis
|
Acute inflammation leading to valvular damage
|
Myxomatous degeneration of the valve
|
Pathology
|
NEET 2019
|
cfee4081-6c1b-4211-8d6b-93881f154da2
|
single
|
After endodontic therapy has been perfomed on a
mandibular molar with both periodontal bifurcation involvement and bifurcation caries:
| null | 1
|
Hemisection
|
Fenestration
|
Root amputation
|
Apical curettage
|
Dental
| null |
9427821c-2d17-4d28-9580-3acd5458e6e9
|
multi
|
The major cells seen in gingiva are
| null | 1
|
Fibro blast
|
Odontoblasts
|
Cementoblasts
|
Merkel cells
|
Dental
| null |
5cceb700-d1e7-4f7b-b25f-65ce55b824ac
|
single
|
A patient complaints of breathlessness following a trauma, Trachea shifted to opposite side, Resonant percussion note seen with absent Breath sounds. On inseion of ICD- False statement is
|
Inseing a Chest Drain Site of Inseion: - Triangle of Safety Boundaries: - * Anterior to mid axillary line * Above level of nipple * Below and Lateral to Pectoralis Major * This usually gets inseed in 5th ICS level. Steps in ICD Inseion: - * Meticulous Sterility maintained. * Inse Local Anaesthesia up to Pleura. * Sharp dissection to Cut only the Skin. * Blunt Dissection using Aery Forceps through the muscles- Intercostal and Serratus anterior. * Oblique tract is made so that the parietal pleura is tunnelled to avoid leakage of air. * Drain in cases of Haemothorax and Pneumothorax should aim the Apex * Drain for Empyema and Pleural effusion should be at Base * Drain should pass at the upper edge of the rib to avoid injury to neurovascular bundle. * Don't apply any clamp in Drain as it may be forgotten to be removed. * Don't apply suction also. * Bubbling drain must never be clamped. * Check the drain location by a Chest X ray. Ref:- Bailey and Love 27th Edition; Pg num:- 920
| 3
|
Direction of inseion is posterior and superior
|
Inseion area must be palpated digitally to confirm the position
|
Inseed into the 4th or 5th ICS along the scapular line
|
Done in Upper pa of Lower Rib to avoid vessel and nerve injury
|
Surgery
|
Vascular surgery
|
87283cd0-3f8d-42c3-8bb0-09ece70d989e
|
multi
|
True about spermatids
|
Spermatid is the haploid male gametes that results from division of secondary spermatocytes . as a result of meiosis, each spermatid contains only half of the genetic material present in the original primary spermatocyte., spermatids spermiogenesis to form the spermatozoa, they undergo no cell division. Ref: Gray's 39e/p-210-220
| 2
|
Derived from primary spermatocyte
|
Derived from secondary spermatocyte
|
Undergoes mitotic division
|
Undergoes meiotic division
|
Anatomy
|
General anatomy
|
aeec64b3-68d0-487e-947d-5f2db1f2fef1
|
multi
|
Anti infective vitamin is –
|
Functions of Vit A
Vitamin A is essential for -
I.Normal vision
Retinol is necessory for functioning of retina.
Regeneration of rhodopsin during dark light is vit A dependent --> vit A deficiency causes defective dark adaptation.
2. Anti-infective
Vitamin A is necessary for integrity of epithelial tissues that resist invasion by pathogens.
Vitamin A has some role in immune response.
3. Anticancer effect
Beta-carotene has antioxidant property —> by virtue of this action it reduces the incidence of lung, breast, oral, esophageal and bladder cancers.
4. Skeletal - growth
Vitamin A supports skeletal growth.
| 2
|
Vitamin B6
|
Vitamin A
|
Vitamin D
|
Vitamin C
|
Pediatrics
| null |
cffefd7a-cdda-4fac-85e9-1f10de832592
|
single
|
All the following is a method of sewage disposal except
|
OTHER METHODS OF Sewage DISPOSAL. (a) Sea outfall (b) River outfall (c) Land treatment (d) Oxidation ponds (e) Oxidation ditches. Ref: Park 25th edition Pgno : 800
| 4
|
River outfall
|
Land treatment
|
Oxidation ponds
|
Bangalore method
|
Social & Preventive Medicine
|
Environment and health
|
754e1838-ca41-487a-9e36-1f937018e426
|
multi
|
Snowstorm appearance in Ultrasound is seen in:
|
Explanation:On ultrasound, the Hydatiform mole resembles a bunch of grapes ('cluster of grapes" or ''honeycombed uterus" or "snow-storm appearance) (See table below) Partial and Complete Hydatiform Mole PARTIAL MOLECOMPLETE MOLEFetus, Fetal vessels, PlacentaPresentAbsentKaryotype69 XXY (triploid)46 XXHydropic changesFocalMarkedMalignant potentialRare1 5-20%Ultrasound featuresFocal cystic spaces in placentaFetus and placenta are seenTransverse diameter of uterus increasesSnowstorm appearance
| 1
|
Hydatiform mole
|
Twins
|
Hydronephrosis
|
Downs syndrome in fetus
|
Radiology
|
Obstetrical Ultrasonography in the Second Trimester
|
4047c095-f550-4e89-bf0c-659ce3af0840
|
single
|
Warfarin acts by
|
Ans. is 'a' i.e., Inhibition of Vitamin K epoxide reductase
| 1
|
Inhibition of Vitamin K epoxide reductase
|
Inhibition of gamma glutamyl carboxylase
|
Activation of Vitamin K epoxide reductase
|
Activation of gamma glutamyl carboxylase
|
Pharmacology
| null |
ac0d14a0-074e-4fdb-a149-c7cd2fe3d4fb
|
single
|
Eversion occurs at which joint:
|
Ans. A. subtalarInversion and eversion refer to movements that tilt the sole of the foot away from (eversion) or towards (inversion) the midline of the body. This movement occurs at subtalar joint. Eversion is the movement of the sole of the foot away from the median plane. Inversion is the movement of the sole towards the median plane.Inversion of the foot is produced by tibialis anterior & tibialis posterior. Eversion of the foot is produced by Peroneus longus & brevis.
| 1
|
Subtalar
|
Ankle
|
Metatarsophalangeal
|
Interphalangeal
|
Anatomy
|
Lower Extremity
|
3497fe30-1729-46a5-aae1-5c49ee87b87e
|
single
|
Which of the following is not a broad spectrum antibiotic
| null | 4
|
Tetracycline
|
Chloramphenicol
|
Doxycycline
|
Penicillin G
|
Pharmacology
| null |
07f7a724-a035-4e7b-a1ed-bde5214d320c
|
single
|
Wavelength of Nd: YAG laser
|
Ans. (d) 1064 nmRef: Khurana 6/e, p. 461Wavelength of laser is measured in nm and Nd:YAG Laser is 1064 nm. Nd:YAG Laser is used for posterior capsulotomy and peripheral iridotomy.
| 4
|
1040 nm
|
1040 mm
|
1064 cm
|
1064 nm
|
Ophthalmology
|
Lens
|
ca3eccbb-6cf8-486f-b844-a69144eafefc
|
single
|
F plasmid of high frequency recombination is
|
Hfr Conjugation: F factor being a plasmid, is always Extra-chromosomal It may integrate with bacterial chromosome and behave as episome. Such donor cells are able to transfer chromosomal DNA to recipient cells with high frequency in comparison to F+ cells, therefore, named as Hfr cells (high frequency of recombination). During conjugation of Hfr cell with an F- cell, only few chromosomal genes along with only a pa of the F factor get transferred. Hence, F- recipient cells do not become F+ cells.
| 1
|
Extrachromosomal
|
Chromosomal
|
Mesosome
|
Ribosomes
|
Microbiology
|
General Microbiology Pa 1 (History, Microscopy, Stains and Structure and Physiology of Bacteria)
|
68e3c6e9-528a-4f68-a94f-a13a64b4070c
|
single
|
True about Chest radiographs of children with foreign body aspiration is:
|
Ans. B. May show Hyperinflation of one lung field.The hallmark of an aspirated foreign body is a lung volume that does not change during the respiratory cycle. Due to the check valve mechanism, where air enters the bronchus around the foreign body but cannot exit, the affected lung will usually appear overinflated and hyperlucent, with concomitant rib flaring and a depressed ipsilateral hemidiaphragm. The chest X-ray will be normal in 35% (range 30-40%) of patients, unilateral emphysema or atelectasis are the most common findings; only uncommonly will a radio-opaque foreign body be demonstrated.
| 2
|
Always abnormal
|
May show hyperinflation of one lung field
|
Always show antibody
|
Will always present with pneumothorax
|
Pediatrics
|
Respiratory System
|
9126af70-3bbe-4886-ac3f-93a9a6efe576
|
multi
|
All are secreted in the stomach except?
|
Gastrin produced by G cells in the pyloric gland is absorbed into the blood and carried to the oxyntic glands where it stimulates the parietal cells strongly to secrete hcl. And secretin is synthesized and secreted by S cells of duodenum (GANONG'S REVIEW OF MEDICAL PHYSIOLOGY)
| 1
|
Secretin
|
Hcl
|
Intrinsic factor
|
Mucous
|
Physiology
|
General physiology
|
8c94eed5-e1f9-4ab6-8bb0-31273e0d9345
|
multi
|
All of the following statements about nateglinide are true except ?
|
Sulfonylureas, nateglinide and repaglinide act by inhibiting ATP sensitive K channels and thus resulting in the release of insulin.
Like insulin, all of these drugs can cause hypoglycemia. However, nateglinide therapy produces fewer episodes of hypoglycemia as compared to other oral insulin secretagogue.
Nateglinide and repaglinide are short-acting and thus can reduce post-prandial hyperglycemia.
| 3
|
Decreases postprandial hyperglycemia
|
Hypoglycemia is less common than with sulfonylureas
|
It decreases insulin resistance
|
It acts by releasing insulin
|
Pharmacology
| null |
da60995e-6dff-4b5a-8bd3-c8215d9ca2e6
|
multi
|
This segment of jejunum shows a nodular lesion located in the submucosa. Upon histological examination, the tumor was composed of uniform round cells arranged in trabeculae, with a "salt-and-pepper" chromatin pattern. Electron microscopic studies revealed secretory granules, and immunohistochemical stains were positive for serotonin. Which of the following parameters correlates best with the metastatic potential of this tumor?
|
The tumor in the picture is a carcinoid. This neoplasm derives from the neuroendocrine cells of the intestinal epithelium and often retains the capacity to produce hormonal substances, such as serotonin, gastrin, somatostatin, etc. The architectural arrangement is variable, although trabecular and insular patterns are the most common. Carcinoid tumors may be found throughout the intestinal canal, as well as in the bronchial tree and other organs. Location and size are the most impoant predictor of their metastatic potential. Carcinoids of the appendix and cecum (the most frequent) only rarely metastasize to the liver. Carcinoids of the stomach, ileum and colon have a high metastatic propensity, especially if they are larger than 2 cm in main diameter. Neither architectural pattern nor cell pleomorphism is a good predictor of the malignant potential of carcinoid tumors. In general, this rule applies to most of endocrine tumors, in which histologic features and biologic behavior do not often correlate with one another. In other words, a tumor that shows relatively bland cells may undergo metastatic spread, while tumors with more anaplastic features may behave in a benign fashion. Hormonal production is common in carcinoids, but does not often lead to a clinical syndrome nor does it correlate with metastatic potential.
| 4
|
Architectural pattern
|
Cell pleomorphism
|
Hormonal production
|
Site and size
|
Pathology
| null |
ee776b0c-5211-425b-8a8d-add3cbf35b8e
|
single
|
Figure of 8 in chest X-ray -
|
Ans. is 'a' i.e., Supracardiac TAPVC o Tertralogy of fallot- boot shaped hearto Transposition of great vessel- egg on sideo TPVC (supracardioe) - snownan or figure of 8 configuration
| 1
|
Supracardiac TAPVC
|
Tetralogy of fallot
|
TGA
|
None of above
|
Pediatrics
|
Cyanotic Congenital Heart Disease
|
e4c6b7e8-453f-4288-b57f-cd13b7f91faf
|
multi
|
Regarding propofol which One of the following is false
|
Propofol also possesses significant antiemetic activity with small (sub hypnotic) doses (i.e., 10 mg in adults). The median concentration of propofol with an antiemetic effect was 343 ng/mL, which also causes a mild sedative effect. This concentration can be achieved by an initial dose of propofol infusion of 10 to 20 mg followed by 10 mg/kg/minute. Propofol used as a maintenance anesthetic during breast surgical procedures was more effective than 4 mg of ondansetron given as prophylaxis in preventing postoperative nausea and vomiting (PONV). Propofol as an infusion of 1 mg/kg/hour (17 mg/kg/minute) also has provided excellent antiemetic action after anticancer chemotherapy. Ref: Miller's anesthesia 8th edition
| 2
|
it is used as an intravenous induction agent
|
It causes severe vomiting
|
It is painful on injecting intravenously
|
It has no muscle relaxant propey
|
Anaesthesia
|
General anaesthesia
|
02c01137-65d2-4b02-9c60-999bc4f045d2
|
multi
|
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