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Period of sickness benefit given under ESI Act
null
3
41 days
17 days
91 days
101 days
Social & Preventive Medicine
null
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The drug which is used for long term maintenance in opioid addiction
Ans. is 'd' i.e., Methadone Maintenance therapy for opioid addiction* Once detoxification phase is over (i.e., withdrawal symptoms have been managed), the patient is maintained on any of the following drugs to prevent relapse by reducing craving and preventing 'kick' or 'euphoria' produced by opioids (morphine or heroin). Drugs used are : -1. Methadone: - Reduces craving and 'kick/euphoria from morphine or heroin because their opioid receptors are already occupied.2. LAAM and buprenorphine: - Similarly reduce craving.3. Opioid antagonists (naltrexone): - Naltrexone can be used orally to assist in the rehabilitation of ex-opioid abusers who are fully withdrawn (otherwise it induces an acute withdrawal syndrome). Naltrexone prevents relapse by discouraging substance seeking behavior - If a patient, who is on naltrexone maintenance therapy, takes an opioid, there is no 'kick' or euphoria as opioid receptors are already blocked. Naltrexone can be used with clonidine as in detoxification.Treatment of opioid addiction* Treatment can be divided into : -A. Treatment of toxicity (overdose)# Overdose is a medical emergency and is treated with opioid antagonist to reverse the complications (respiratory depression) by antagonizing the action on opioid receptors. Intravenous naloxone is the antagonist of choice for morphine (heroin) poisoning. Oral naltrexone is used for maintenance therapy, once acute poisoning has been treated by iv naloxone. Intravenous nalmefene is another specific antagonist.B. Treatment of dependence# Treatment of dependence include medically supervised withdrawal and detoxification, followed by maintenance therapy.a. Detoxification* Detoxification process include abrupt withdrawal of opioid followed by management of the emergent withdrawal symptoms, i.e., treatment of withdrawal syndrome. Detoxification can be done by any of the following.i) Substitution of long-acting opioid agonism : - Methadone is the treatment of choice. Because of its agonistic activity on opioid receptors it suppresses withdrawal symptoms. L-alpha-acetyl-methadol/ Levomethyl (LAAM) is the other opioid agonist which was used for this purpose. However it is no longer in use because some patients developed prolonged QT intervals (torsades de points).ii) Substitution of partial agonist: - Buprenorphine can be used in place of methadone because of its partial agonistic activity on opioid receptor.iii) Substitution by a2 agonists : - Clonidine as a sympatholytic agent due to its agonistic action on central presynaptic a2 receptors which reduce nor-adrenergic activity. Therefore, clonidine reduces the adrenergic withdrawal symptoms. Lofexidine, another a2 agonist, is an alternative to clonidine.iv) Clonidine plus naltrexone: - A more rapid detoxification can occur when clonidine is used along with naltrexone. Naltrexone, when given in opioid dependent patient, causes withdrawal symptoms because of its antagonistic action. These can be treated with clonidine. The addition of short acting Benzodiazepine (lorazepam or oxazepam) and NSAIDs, will help to relieve withdrawal symptoms not covered by clonidine. It should be kept in mind that naltrexone should not be used alone for detoxification (to treat withdrawal syptoms) as it precipitates or worsens the withdrawal syndrome.v) Other drugs : - Dextropropoxyphene, diphenoxylateb. Maintenance therapy:- explained above
4
Naloxone
Nalorphine
Butarphanol
Methadione
Psychiatry
Substance Abuse
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DNA depended RNA synthesis is inhibited by:
Rifampicin
1
Rifampicin
Ethambutol
Colchicine
Chloromycetin
Pharmacology
null
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single
Which of the following statements regarding the flow of lymph from lower limb is true?
Normally. the fluid in lymph is massaged by muscle contractions of the organs and contraction of aerioles and venules, with which they are often associated which increases the flow through lymph vessels lacking valves and smooth muscle Thus by massaging foot lymph flow can be increased Ref: Ganong's Review of Medical Physiology Twenty-Third Edition Page No: 550
4
|ed with change from supine to standing position
|ed in increased capillary permeability
|ed in deep vein valve incompetence
|ed by massage of foot
Physiology
Cardiovascular system
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Contraindication of liver transplant?
Ans. (c) MetastasisRef: Sabiston 19th edition, Page 657* Contraindications for Liver transplant:# Metastatic liver disease# Poor cardio-pulmonary reserve# Systemic infections (HIV is not a contraindication now)# Porto pulmonary hypertension with pulmonary artery pressure >50mmHg # Hepatopulmonary syndrome when PaO2 does not show improvement with 100% oxygen.
3
Acute fulminant hepatic failure
Metabolic Disease
Metastasis
Primary liver malignancy
Surgery
Transplantation
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Meniscal injury occurs during:
Ref: Apley's System of Orthopaedics and Fractures, 8th ed.Explanation:Mechanism of injury to MeniscusDamage to the meniscus is due to rotational forces directed to a flexed knee (as may occur w-ith twisting sports) is the usual underlying mechanism of injury.A valgus force applied to a Hexed knee with the foot planted and the femur rotated externally can result in a lateral meniscus tear.A varus force applied to the flexed knee when the foot is planted and the femur rotated internally can result in a tear of the medial meniscus.Symptoms and SignsThe patient's chief complaints are usually knee pain and swellingAnother typical complaint i s joint locking, when the patient is unable to straighten the leg fully. This can be accompanied by a clicking feeling.A tear of the meniscus commonly follows a trauma which involves rotation of the knee while it was slightly bent.In meniscal tears, pressing on the joint line on the affected side typically produces tenderness.The McMurrav test involves pressing on the joint line while stressing the meniscus fusing flexion-extension movements and varus or valgus stress).Stein man n test (with the patient sitting) and the Apley grind test (a grinding maneuver while the patient lies prone and the knee is bent 90deg) also elicit painBending the knee (into hyperflexion if tolerable), and especially squatting, is typically a painful maneuver if the meniscus is tornThe Cooper's sign is a subjective symptom of pain in the affected knee when turning over in bed at night.Meniscal tear causes pain with a twisting motion of the knee as the meniscal fragment gets pinched, and the capsular attachment gets stretched causing the complaint of pain.
3
Rotation
Extension
Rotation and Flexion
Flexion
Orthopaedics
Knee Ligament Injuries
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Zero order kinetics is independent of ?
Ans. is 'a' i.e., Plasma concentration o Rate of elimination in zero order kinetics is independent of plasma concentration (see above explanation).
1
Plasma concentration
Clearance
Volume of distribution
Half life
Pharmacology
null
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Spinal shock is characterised by -a) Spasticityb) Wastingc) Sensory lossd) urinary retentione) Areflexia
null
4
abd
acd
bde
cde
Medicine
null
610f2d96-bf48-43c7-8e96-f8fe476d9609
single
Which of the following is true regarding non-competitive enzyme inhibition?
In case of non-competitive enzyme inhibition Vmax decreases and Km remains the same.
2
Vmax increases
Vmax decreases
Km increases
Km decreases
Biochemistry
null
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multi
Occipitofrontal is muscle is present in which layer of scalp:
Ans. A. Aponeurotic layerThe term scalp is applied to the soft tissues covering the vault of skull. It extends anteriorly up to the eyebrows (superciliary arches), posteriorly up to the superior nuchal lines, and laterally on each side up to superior temporal line. The scalp consists of five layers. From superficial to deep these are as follows:1. Skin. 2. Connective tissue (superficial fascia). 3. Aponeurosis (occipitofrontal is muscle and its aponeurosis). 4. Loose areolar tissue. 5. Pericranium.
1
Aponeurotic layer
Subaponeurotic layer
Dense connective tissue layer
Loose connective tissue layer
Anatomy
Head & Neck
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Gleason's staging is used in:
Ans: A (Ca prostate) Ref: Bailey & Love s Short Practice of Surgery, 25th Edition & Internet SourcesExplanation:The Gleason Grading SystemIt is used to help evaluate the prognosis of men with prostate cancer.It also predicts prognosis and helps guide therapy.Scoring based upon its microscopic appearance on histopathology.Cancers with a higher Gleason score are more aggressive and have a worse prognosis.The pathologist assigns a Gleason score based on the sum ot' two numbers:The first number is the grade of the most common tumor pattern.The second number is the grade of the second most common pattern.If there are three patterns the first number is the most common and the second is the one with the highest grade.
1
Ca prostate
Ca bladder
Ca pancreas
Ca colon
Surgery
Prostate Cancer
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The distance between tympanic membrane and medial wall of middle ear at the level of centre is:
(d) 2mm(Ref. BD Chaurasia, Human Anatomy 6th ed., Vol 3, page 277)Part of the middle ear cavityDistance from lateral to medial wallEpitympanum6mm (widest)Mesotympanum (centre)2mm (narrowest)Hypotympanum4mm
4
3 mm
4 mm
6 mm
2 mm
ENT
Ear
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Dystrophic calcification occur in all except -(
Ans. is 'c' i.e., Normal kidney
3
Rheumatic hea disease
Lymph node
Normal kidney
Aneurysm
Pathology
null
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A patient with peptic ulcer disease undergone billroth 2 gastrectomy. Later the patient presented with postprandial pain. On endoscopy oedematous and inflamed gastric mucosa has been found. What is the preferred diagnosis
Reflex of duodenal juices into the stomach after billroth surgery e will cause inflamed gastric mucosa. Treatment of choice is roux en y gastrojejunostomy.
1
Alkaline gastritis
Dumping syndrome
Gastroparesis
None of the above
Surgery
null
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In muscle cells, resting membrane potential is equal to the isoelectric potential of
The isoelectric potential of Cl- is -70mV and of K+ is -90mV. According to ‘Ganong’ and ‘Principles of Medical Physiology’, the actual measured RMP of a nerve fibre is -70mV rather than the calculated value of -90mV. So in nerve fibres, the RMP is equal to or closer to the isoelectric potential of Cl-. Whereas in muscle cells, the RMP is -90mV, which is equal to the isoelectric potential of K+.
3
Na+
Cl-
K+
Mg++
Physiology
null
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Subcutaneous vaccine is -
Ans. is 'd' i.e. measles Mode of administration of vaccines* BCG* intradermal* OPV* oral* DPT* Intramuscular* Measles* subcutaneously
4
BCG
Polio
DPT
Measles
Social & Preventive Medicine
Principles of Immunization and Vaccination
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True about shigella dysentriae except -
Ans. is 'd' i.e., Produces mildest form of dysentry * Mildest form of dysentry is caused by Sh. Sonnei.
4
It invades colonic mucosa
It can cause HUS
Produces verocytotoxin
Produces mildest form of dysentry
Microbiology
null
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A female presented with a severe headache of sudden onset. On CT scan a diagnosis of subarachnoid hemorrhage is made. The most common cause of subarachnoid hemorrhage is :
Ans. is 'b' ie. Berry Aneurysm (Ref. : Harrison, 17/e pl726 (16/e, p 2387, 15/e, p 238))" Excluding head trauma the most common cause of SAH is rupture of a saccular aneurysma (Berry aneurysm or congenital aneurysm). "Berry aneurysms - also k/a as congenital aneurysm although they are not present at birth. There is however a congenital defect of the media of the artery, which becomes the site of aneurysm in later life.Common sites :Junction of the anterior communicating artery with the anterior cerebral artery* (MC).Junction of the post communicating artery with the 1C A* (Internal carotid artery)The bifurcation of MCA* (Middle carotid artery)
2
Middle meningeal artery
Berry aneurysm rupture
Basilar artery
Subdural venous sinuses
Unknown
null
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Pulsus paradoxus is seen in all except :
Answer is A (IPPV) Pulsus paradoxus is not a feature of IPPV. Pulsus paradoxus may be seen in association with cardiac tamponade, constrictive pericarditis (infrequent) and COPD. Causes of Pulsus Paradoxus 1. Clinical Disease States Cardiac Tamponade (common) Constrictive Pericarditis (Infrequent) Superior vena cava syndrome Obstructive Airway disease (Emphysema) Acute Asthma Pulmonary embolism Hypovolemic shock 2. In the absence of clincal disease Obesity Pregnancy What is Pulsus Paradoxus Normally the aerial pulse volume and aerial blood pressure decreases during inspiration and increases during expiration. Pulsus paradoxus is an aggravation of a normal process and hence also called pulses normalis aggregans. In pulses paradoxus the decrease in systolic aerial pressure during inspiration is accentuated. What then in the paradox: In patients with pericardial tamponade, airway obstruction or superior vena caval obstruction, the decrease in systolic aerial pressure may be so much that the peripheral pulse may completely disappear during inspiration. The paradox is that the hea sounds may still be heard on auscultation over the apex at a time when no pulse is palpable at the radial aery.
1
IPPV
COPD
Cardiac Temponade
Constrictive pericarditis
Medicine
null
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The following are characteristic of autism except ___________
Autistic disorder:- Pervasive developmental disorders. Also called autistic spectrum disorders, cluster of syndromes that share marked abnormalities in the development of social and communicative skills. Symptoms: Qualitative impairment in social interaction as manifested by two of the following- impairment in use of multiple non verbal behaviors( eye gaze, facial expression, body postures) , failure to develop peer relationships, lack of sharing of enjoyment, lack of social or emotional reciprocity. Qualitative impairment in communication in at least one of the following areas- delay or total lack of spoken languages, marked impairment in the ability to initiate or sustain a conversation with others, stereotyped or repetitive use if languages and lack of varied spontaneous play. Restricted repetitive and stereotyped patterns of behaviors, interests, and activities as manifested by preoccupation with one or more restricted patterns of interests; inflexible adherence to nonfunctional routines or rituals ; repetitive motor mannerisms( such as rocking, hand flipping, finger flicking) and preoccupation with pas of objects. Intelligence is variable. Reference: GHAI Essential pediatrics, 8th edition
1
Onset after 6 years of age
Repetitive behaviour
Delayed language development
Severe deficit in social interaction
Pediatrics
Growth and development
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Which among the following is not an RNA virus?
Ans: b (hepatitis B) Ref:Ananthanarayan, 7 p. 547Among the hepatitis virus only DNA virus is hepatitis B virus (Hepadna virus). Just go through theFeatureHAVHBVHCVHDVHEVAgentSSRNA icosahedral,capsid unenvelopedDSRNAComplex structure envelopedSSRNA envelopedSS defective virus envelopedSSRNA unenvelopedClassificationPicoma virus(enterovirus typelll)Hepadna virusFlaviUnknowncalcivirusTransmissionfaecooralparentralparentralparentralfaecooralIP15-45 days(2-6 weeks)30-180 days(2-6 mon)30-90 days 1-3 mon30-50 days 1-2 mon50-60 days 1/2 - 2 monthOnsetacuteinsiduousinsiduousinsiduousacuteIllnessmildOcc. severemoderateOcc. severeMild except in pregnancy (fulminant in 40 %)Carrier statenilcommonpresentNil(only with HBV)niloncogenicityNilyesyesnilNilSpecific Rx.Ig & vaccineIg& vaccinenilHBV vaccineNil
2
Hepatits A
Hepatitis B
Hepatitis C
Hepatitis D
Microbiology
Virology
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An old man enters the hospital with myocardial infarction and a severe ventricular arrhythmia. The antiarrhythmic drug chosen has a narrow therapeutic window. The minimum toxic plasma concentration is 1.5 times the minimum therapeutic plasma concentration. The half life is 6 hrs. It is essential to maintain the plasma concentration above the minimum therapeutic level to prevent a possible lethal arrhythmia. Of the following, the most appropriate dosing regimen would be
null
4
Once a day
Twice a day
Four times a day
Constant intravenous infusion
Pharmacology
null
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The most common indication for tracheostomy is:
Historically, the main indication for a tracheostomy was to bypass upper airway obstruction caused by a foreign body or infection, paicularly diphtheria. Nowadays upper airway obstruction is the least common indicator for tracheostomy. Almost two thirds of tracheostomies are currently performed on intubated intensive care patients, mainly to aid removal of secretions from the distal tracheobronchial tree and to facilitate weaning from distal tracheobronchial tree in acute respiratory failure and prolonged ventilation
2
Laryngeal diphtheria
Foreign body aspiration
Carcinoma
Asthma
ENT
null
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Absolute contraindication of OCP's is:
null
1
Breast cancer
Mentally ill
Migraine
Fibroid
Gynaecology & Obstetrics
null
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Epicritic perception of pain occurs at the level of
null
2
Thalamus
Area 3, 1, 2
Areas 5, 7
Pulvinar
Physiology
null
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A 35-year-old man comes to the physician because of a lump in his neck. Examination shows a thyroid nodule, Laboratory studies show serum calcitonin is elevated, and serum calcium is normal Despite high serum calcitonin levels, which of the following mechanisms best explains the normal calcium levels in this patient?
null
3
Concurrent parathyroid adenoma
Concurrent parathyroid hyperplasia
High levels of calcitonin down reQulates its receptor
Increase in PTH in response to hypocalcemia
Medicine
null
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single
Aflatoxin is produced by the fungus?
Aflatoxin is a mycotoxin that is produced by the fungi Aspergillus flavus and Aspergillus parasiticus. Exposure to aflatoxin can cause hepatic necrosis later progressing to cirrhosis. It also acts as a carcinogen and can produce hepatocellular carcinoma.
1
Aspergillus flavus
Aspergillus fumigatus
Aspergillus niger
Penicillium marneffei
Microbiology
Mycology
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Ram Prashad is admitted to Guru Teg Bahadur Hospital with respiratory infection for which antibiotic tobramycin is ordered. The clearance and Vd of tobramycin in him are 160 ml/min and 40 L, respectively. If you wish to give Ram Prashad an intravenous loading dose to achieve the therapeutic plasma concentration of 4 mg/L rapidly, how much should be given?
Loading dose = Vd x target plasma cone. = 40 L x 4 mg/L = 160 mg Clearance plays no role in the determination of loading dose. It is given to confuse you.
4
0.1 mg
10 mg
115.2 mg
160 mg
Pharmacology
null
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Extra cervical rib usually compresses which pa of brachial plexus -
THORACIC OUTLET SYNDROME Neurological and vascular symptoms and signs in the upper limbs may be produced by compression of the LOWER TRUNK of the brachial plexus (C8 and T1) and subclan vessels between the clavicle and the first rib. The subclan aery and lower brachial trunk pass through a triangle based on the first rib and bordered by scalenus anterior and medius. These neurovascular structures are made taut when the shoulders are braced back and the arms held tightly to the sides; an extra rib (or its fibrous equivalent extending from a large costal process), or an anomalous scalene muscle, exaggerates this effect by forcing the vessel and nerve upwards. REF:Apley&;s system of ohopaedics- 9th edn - pg no 292.
4
Lateral cord
Upper trunk
Middle trunk
Lower trunk
Orthopaedics
Miscellaneous
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The following structure does not pass through flexor retinaculum
FLEXOR RETINACULUM Carpel tunnel.Transverse carpal ligament. Strong fibrous band which bridges anterior concavity of carpus and conves it into osseofibrous tunnel called carpal tunnel for the passage of flexor tendons of the digits. Rectangular.Formed due to thickening of deep fascia in front of carpal bones. Attachments: medial-pisiform, hook of hamate.Lateral-tubercle of scaphoid and crest of trapezium. Structures passing superficial to flexor retinaculum:-(medial to lateral)1. Ulnar nerve 2. Ulnar aery 3. Posterior cutaneous branch of ulnar nerve.4. Tendon of palmaris longus.5. Palmar cutaneous branch of median nerve.6. Superficial palmar branch of radial aery. Structures passing deep to flexor retinaculum:-1. Tendon of FDS2. Tendon of FDP 3. Tendon of FPL.4. median nerve. Ulnar bursa-tendons of FDS&FDP.Radial bursa- tendon of flexor pollicis Flexor carpi radialis pass through separate canal. CARPAL TUNNEL SYNDROME:-Injury to median nerve in carpal tunnel.Causes:-Tenosynovitis of flexor tendons.MyxedemaRetention of fluid in pregnancy Fracture dislocation of lunate bone.Osteoahritis of wrist. Symptoms:-1. Feeling of burning pain or " pins & needles " along lateral 3 and half digits especially at night.2. Weakness of thenar muscles.3. No sensory loss over thenar eminence.4. Ape thumb deformity if left untreated.5. Positive phalens abd tinel's sign.Phalen' sign-flexion of both wrists against each other for one minute reproduces the symptoms.Tinel's sign- percussion over flexor retinaculum reproduces symptoms. MNEMONIC structures passing deep to flexor retinaculum:" SPM fuLLy Boring Flexor digitorum Superficialis tendon, flexor digitorum Profundus tendon, Median nerve, flexor poLLicis longus , Bursae - radial and ulnar. {Reference: vishram singh, page no.196,} Figure:9.15,page no:113,BD chaurasia , 6th edition,upper limb & thorax.
1
Ulnar N
Median N
Flexor digitorum profundus
Flexor digitorum superficialis
Anatomy
Upper limb
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To diagnosis foetal wellbeing of foetus, most reliable method -(UPSC 97)
To get started, sit with your feet up or lie on your side. Count each of your baby'smovements as one kick, and count until you reach 10 kicks or movements. Most of the time it will take less than a half-hour, but it could take as long as two hours. Log your recorded times into a Count the Kicks chart. The lecithin-sphingomyelin ratio (aka L-S or L/S ratio) is a test of fetal amniotic fluid to assess for fetal lung immaturity. Lungs require surfactant, a soap-like substance, to lower the surface pressure of the alveoli in the lungs. Human placental lactogen (hPL), also called human chorionic somatomammotropin (HCS), is a polypeptide placentalhormone, the human form of placental lactogen (chorionic somatomammotropin). Its structure and function are similar to those of human growth hormone. It modifies the metabolic state of the mother during pregnancy to facilitate the energy supply of the fetus. hPL has anti-insulin properties. hPL is a hormone secreted by the syncytiotrophoblast during pregnancy. Like human growth hormone, hPL is encoded by genes on chromosome 17q22-24. HPL is present only during pregnancy, with maternal serum levels rising in relation to the growth of the fetus and placenta. Maximum levels are reached near term, typically to 5-7 mg/L. Higher levels are noted in patients with multiple gestation. Little hPL enters the fetal circulation. Its biological half-life is 15 minutes.
4
L:S ratio
HPL levels
Kick test
Ultrasound
Gynaecology & Obstetrics
Diagnosis in Obstetrics
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Drug commonly used against enteric fever are all except-
Aminoglycosides are not given for enteric fever
1
Amikacin
Ciprofloxacin
Ceftriaxone
Azithromycin
Microbiology
null
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Hiatus semilunaris is present in?
Middle meatus: Uncinate process is a hook-like structure running in from anterosuperior to the posteroinferior direction in the middle meatus. It&;s postero superior border is sharp and runs parallel to the anterior border of bulla ethmoidalis. This gap between the two is called hiatus semilunaris .it is two-dimensional space of 1-2 mm width. (Ref: Diseases of Ear, Nose and Throat and head and neck surgery, Dhingra 7th edition, Pg no. 150)
2
Superior meatus
Middle meatus
Inferior meatus
Spheno-ethmoidal recess
ENT
Nose and paranasal sinuses
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After an incised wound, new collagen fibrils are seen along with a thick layer of growing epithelium. The approximate age of the wound is:
The approximate age of the wound in an incised wound, when new collagen fibrils are seen along with a thick layer of growing epithelium is 4-5 days.
1
4-5 days
About 1 week
12-24 hours
24-72 hours
Pathology
null
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Shoest skull diameter: March 2013
Ans. D i.e. Bimastoid Fetal skull Shoest diameter of fetal skull: Bimastoid (7.5 cm) Largest diameter of fetal skull: Mentoveical (14 cm)
4
Biparietal
Mentoveical
Bitemporal
Bimastoid
Gynaecology & Obstetrics
null
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Regarding yaws, all are true except -
Yaws is a chronic contagious non veneral disease. Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 359
2
Caused by T. Peenue
Sexually transmitted
Croos active antibodies with syphilis
Drug of choice is penicillin
Social & Preventive Medicine
Communicable diseases
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Surgery for undescended testis is recommended at what age?
Optimum age for surgery in case of undescended testis is 6 months. The surgical procedure done is called orchidopexy. Earlier intervention (Six months of age) should be considered in order to theoretically prevent the complications of crytorchidism that may be manifested before 1 year of age. Ref: Sabiston 20th Ed. ; Schwaz 11th Ed.
1
6 months
12 months
24 months
36 months
Surgery
All India exam
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Subepidermal bistreing is seen in all except ?
Ans:D. i.e. Pemphigus Causes of Subepidermal Blistering includes :Bullous pemphigoid, dermatitis herpetiformis, erythema multiforme, TEN, friction blisters.Causes of Intraepidermal Blistering includes :Acute eczema, varicella, herpes simplex, pemphigus
4
Pemphigus vulgaris
Dermatitis herpetiformis
Toxic epidermal necrolysis
Pemphigus
Skin
null
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Palmer's sign is pregnancy refers to (8-12 weeks):
Rhythmic contractions of uterus
1
Rhythmic contractions of uterus
Pulsations in the lateral fornix
Discoloration of vagina
null
Gynaecology & Obstetrics
null
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Schizophrenia with the worst prognosis
Hebephrenic schizophrenia Key Symptoms: Disorganized speech, behavior (often silly/ shallow) and flat or inappropriate affect Order of prognosis from good to bad in Schizophrenia: Catatonic > Paranoid > Undifferentiated > Hebephrenic > Simple Reference: Oxford Handbook of psychiatry; 3rd edition; Chapter 6; Schizophrenia and related psychoses
3
Catatonic
Paranoid
Hebephrenic
Undifferentiated
Psychiatry
Schizophrenia and other psychotic disorders
170029ac-2a8e-43a6-ad55-e31059a55b20
single
Most common type of schizophrenia
D i.e. Paranoid
4
Simple
Hebephrenic
Catatonic
Paranoid
Psychiatry
null
1fa5ede1-d052-468a-8027-150d486cb0cc
single
The drug most likely to be responsible for acute pancreatitis is :
null
1
Didanosine
Ketoconazole
Saquinavir
Zidovudine
Pharmacology
null
ab2a8fc4-5d06-4a45-95f9-bc98aed2b916
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Ideal speed for most rotary NiTi Instrument is
Most endodontic rotary systems are used in the speed range of 300-350 RPM. Light speed is ued at 1200 rpm
1
300-350 rpm
350-500 rpm
500-600 rpm
100-200 rpm
Dental
null
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Investigation of choice for Posterior urethral valves:
Ans. a (MCU). (Ref. Sutton Radiology 7th ed. 1017, 1061)- MCU is IOC for PU valve and VUR.Posterior urethral valves (PUV)# Varying degree of chronic urethral obstruction due to fusion and prominence of plicae colliculi, normal concentric folds of urethra.# Usually located in posterior urethra just distal to the level verumontanum.c;# It is the most common cause of severe obstructive uropathy in infants and children.# MCU is 'gold standard' in diagnosis of PUV.# Rx: Cystoscopic fulguration of the valves.Three types of PUV are described :
1
Micturating Cystourethrography (MCU)
Ultrasound
Intravenous Pyelography
Retrograde urethrography
Radiology
Genito Urinary System
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A 25-year-old man is involved in an automobile accident with resultant injuries including bilateral closed femur fractures, left pulmonary contusion, and closed head injury. On post-injury day 4, significant upper gastrointestinal hemorrhage begins. Endoscopic examination reveals an area of confluent ulceration with bleeding in the gastric fundus. Endoscopic hemostasis fails. Appropriate immediate management includes:
Initial effos to control gastric hemorrhage consist of gastric lavage using warmed saline. Lavage serves to fragment existing clots and to remove any pooled blood, reducing fibrinolysis at bleeding sites. Over 80% of patients who present with upper gastrointestinal hemorrhage stop bleeding using this approach. Definitive treatment of ongoing acute active stress bleeding by antacids is largely unsuccessful. Administration of H2-receptor blocking agents once active gastrointestinal bleeding has commenced is also usually ineffective as a definitive form of therapy. The endoscope has become the preferred therapeutic as well as diagnostic instrument with electrocautery and laser photocoagulation capabilities. If endoscopic therapy fails, angiography offers an additional means for the control of bleeding by selective infusion of vasopressin into the splanchnic circulation the left gastric aery. Vasopressin is administered by continuous infusion through the catheter at a rate of 0.2 to 0.4 IU/min for a maximum of 48 to 72 hours. About 10% to 20% of patients with acute stress ulcers continue to bleed or have recurrent bleeding despite these measures. In these patients, total gastrectomy has a moality ranging from 17% to 100%. In general, operative moality rates for acute stress-induced hemorrhage range from 30% to 60% regardless of the surgical procedure undeaken.
3
Lavage of gastric contents with iced saline
Urgent total gastrectomy
Selective aerial infusion of vasopressin the left gastric aery
Inseion of Sangstaken-Blakemore balloon
Surgery
Stomach & Duodenum
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Triangular relation of Elbow is maintained in
D i.e. Supracondylar fracture
4
Fracture ulna
Anterior dislocation of Elbow
Posterior dislocation of Elbow
Supracondylar fracture
Surgery
null
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Vaginal defence is lost:
Vaginal pH: newborn infant -4.5 to 7 pubey -alkaline to acidic reproductive age -4 to 5.5 pregnancy -3.5 to 4.5 post menopausal -6 to 8 Acidity of vagina is because of doderlein's bacilli. It is a rod-shaped gram-positive bacillus which grows anaerobically on acid media. It appears in the vagina 3-4 days after bih and disappears after 10-14 days. It appears again at pubey and disappears after menopause. Its function is to conve glycogen present in vaginal mucosa into lactic acid so that the vaginal PH is maintained towards acidic side, which prevents other pathogenic organisms from invading the vagina. Ref: D.C Dutta's Textbook of GynaecologyPg no:7,6th edition
2
Within 10 days of bih
After 10 days of bih
During pregnancy
At pubey
Gynaecology & Obstetrics
Anatomy of the female genital tract
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Primary health centre was proposed under:
Bhore committee in 1946 gave the concept of primary health care centre as a basic health care unit. Ref: Park 22nd edition pg: 800.
2
Srivastava committee
Bhore committee
Kaar Singh committee
None of the above
Social & Preventive Medicine
null
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Natural habitat of Schistosoma (blood flukes) ?
Ans. is 'd' i.e., All of the above
4
Veins of the urinary bladder
Poal & pelvic veins
Vesical plexuses
All of the above
Microbiology
null
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A patient sustains a knife wound through the right fouh intercostals space, 2 cm to the right of the sternum. The area most likely penetrated by the knife is the
The right border of the hea is approximately 1 to 2 cm to the right of the right border of the sternum; therefore, the knife probably did not hit the hea. The middle lobe of the right lung extends from the level of the fouh costochondral junction to the level of the fifth intercostal space. The middle lobe is most likely at the level of the fouh intercostal space.
2
Right upper lobe of the lung
Right middle lobe of the lung
Right lower lobe of the lung
Right atrium of the hea
Anatomy
Thorax
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Duputryens contracture commonly affects: September 2005
Ans. B: Ring Finger Dupuytren's contracture is more common among people with diabetes, alcoholism, or epilepsy. Dupuytren contracture, a disease of the palmar fascia, results in the thickening and shoening of fibrous bands in the hands and fingers. The ring finger is the one affected most commonly. It is usually limited to the medial three fingers. This disease entity belongs to the group of fibromatoses that include plantar fibromatosis (Ledderhose disease), penile fibromatosis (Peyronie disease), and fibromatosis of the dorsal proximal interphalangeal (PIP) joints (Garrod nodes or knuckle pads).
2
Little finger
Ring finger
Middle finger
Index finger
Surgery
null
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Hemiparesis is NOT a feature of:
Patients with veebral aery occlusion may present as posterior inferior cerebellar aery syndrome with cerebellar and brainstem signs such as dysahria, iplsilateral limb ataxia, veigo, nystagmus, ipsilateral Horner's syndrome, ipsilateral loss of pain and temperature of face, ipsilateral pharyngeal and laryngeal paralysis, contralateral loss of pain and temperature in limbs and trunk. Occlusion of stem of middle cerebral aery results in contralateral hemiplegia, contralateral hemianopia, contralateral hemianesthesia, aphasia, contralateral neglect and dressing difficulties. Occlusion of ACA, distal to anterior communicating aery result in contralateral leg weakness, contralateral leg sensory loss and urinary incontinence. Occlusion of ACA proximal to ACCA result in bilateral leg weakness, sensory loss, urinary incontinence, and frontal release signs. Ref: Laboratory Medicine in Psychiatry and Behavioral Science By Sandra A. Jacobson page 567.
4
Carotid aery occlusion
MCA occlusion
AC A occlusion
Veebral aery occlusion
Medicine
null
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Preterm baby with PDA, which is the least likely findings?
Ans. is 'a' i.e., CO2 washout PDA in preterm neonate o In previous explanations I have explained that chances of spontaneous closure of PDA are higher in premature infants as there is no structural abnormality. However, you should keep in mind that this fact is true when we are comparing the spontaneous closure of PDA between term and pre-term neonate. Overall, the percentage of spontaneous closure of PDA in preterm neonate is very low. To avoid confusion, I am explaining following facts in brief:? 1) Normal neonate :- Ductus aeriosus closes functionally within about 15 hours of bih. 2) PDA in term (mature) neonate :- The persistence of ductus aeriosus beyond 24 hours after bih is considered as PDA in term neonate. Spontaneous closure of PDA does not usually occur because PDA results from structural abnormality. 3) PDA in pre-term (pre-mature) neonate :- The ductus aeriosus in pre-term neonate is not as responsive to increased oxygen content as it is in term neonate. However, there is no structural abnormality. i) Chances of spontaneous closure are very less (compared to normal term neonate). ii)Chances of spontaneous closure are more than the term-neonate with PDA. However, in premature neonate, where hypoxic pulmonary disease is commonplace, the ductus being sensitive to hypoxia, remains open. o So, it is very unlikely that spontaneous closure of PDA will occur in pre-term neonate. But chances are more when compared to term neonate with PDA (not normal term neonate in which ductus aeriosus closes within 15 hours of bih). Manifestations of PDA in pre-term neonate 1) Apnea for unexplained reasons in an infant recovering from RDS; 2) A hyperdynamic precordium, bounding peripheral pulses, wide pulse pressure, and a continuous or systolic murmur with or without extension into diastole or an apical diastolic murmur, multiple clicks resembling the shaking of dice; 3) Carbon dioxide retention; 4) Increasing oxygen dependence; 5) X-ray evidence of cardiomegaly and increased pulmonary vascular markings; and 6) Hepatomegaly o Increased pulmonary blood flow and compromised ventricular function accompanying dropping pulmonary resistance in the setting of a PDA is a significant risk factor for pulmonary hemorrhage. o The greatest risk factor for NEC is prematurity. Any etiology which leads on to hemodynamic or hypoxic insult predisposes to NEC. PDA is common in preterm infants and it definitely causes hemodynamic stress and is a risk factor for development of NEC.
1
CO2 washout
Bounding pulses
Pulmonary hemorrhage
Necrotising enterocolitis
Pediatrics
null
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Increased acetylcholinesterase in amniotic fluid indicates -
(A) (Open neural tube defects) (1998 - Nelson 19th)* Failure of closure of the neural tube allows excretion of fetal substances (a-fetoprotein , acetylecholinesterase) into the amniotic fluid, serving as biochemical and markers of a neural tube defects (NTD).* Prenatal screening of maternal serum of AFP in the 16th - 18th week gestation is an effective method for identifying pregnancies at risk for features with NTDA in utero.* Risk factor for neural tube defects (william obs)i) Family history of NTD-First degree relative 2 - 3% Autosomal dominant or Autosomal recessive - 20 - 3% times highter.ii) Exposure to certain environmental agents, malnutrition.iii) Diabetes (Hyper glycemia/Matemal obesity).iv) Hyperthermiav) Drugs - valproic acid, carbamazepine, Aminopterin and isotretinoin (Anacephaly or encephalocele)vi) Genetic syndrome with known recurrence risk Meckel - Gruber, Roberts - SC, Phocomelia, Jarco Levin and HARDE syndrome.vii) Trisomy 13 and 18 and Triploidy all have 1% recurrence risk.* Major NTDs include - spina bifida occulta, meningocele, myelomeningocele, encephalocele, anencephaly, caudal regression syndrome, dermal sinus, tethered cord, syringomyelia, diastematomyelia and lipoma involving the conus medullaris and / or filum terminale and the rare condition anencephaly.Prevention - The U.S. Public health service has recommended that all women of child bearing age and who are capable of becoming pregnant take 0.4 mg folic acid daily.* Nuchal translucency is used for screening of Down syndrome in antenatal USG**
1
Open neural tube defects
Oesophageal atresia
Down syndrome
Edwards syndrome
Pediatrics
Miscellaneous
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15/F complains of anterior knee pain, increased on climbing stairs and getting up after prolonged sitting. Diagnosis is:
Given scenario suggests diagnosis of Chondromalacia patellae Plica syndrome- anterior knee pain, clicking, clunking, and a popping sensation on patellofemoral loading activity such as squatting Patellofemoral ahritis will be seen at a later age and will have pain in all movements of knee. Bipaite patella is congenital fragmentation of patella and is usually asymptomatic.
1
Chondromalacia patellae
Bipaite patellae
Plica syndrome
Patellofemoral ahritis
Orthopaedics
Neuromuscular disorders
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Which of the following pain is not referred to ear
Reffered pain to ear: Benign ulcers or malignant lesions of the base of tongue tonsil pillars palate Ref: Dhingra 7e pg 435.
4
Pharynx
Teeth
Angle of TM joint
Vestibule of nose
ENT
Ear
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Paget's disease of nipple is stained positive for:
Paget's disease may be confused with superficial spreading melanoma. Differentiation from pagetoid intraepithelial melanoma is based on the presence of S-100 antigen immunostaining in melanoma and carcinoembryonic antigen immunostaining in Paget's disease. Surgical therapy for Paget's disease may involve lumpectomy, mastectomy, or modified radical mastectomy, depending on the extent of involvement and the presence of invasive cancer. Ref: Schwaz's principle of surgery 9th edition, chapter 17.
1
CEA
S 100
Both of the above
None of the above
Surgery
null
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The following is true about term "New Families' -
- all nuclear families of less then 10 years duration is termed as new families. - the concept is impoant in view of studies relating to family planning. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:684 <\p>
2
It is variant of the 3-generation family
It is applied to all nuclear families of less then 10 years duration
It is variant of the joint family
It is applied to all nuclear families of less then 2 years duration
Social & Preventive Medicine
Social science, Mental health & Genetics
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Which of these is not a derivative of 3rd pharyngeal/ branchial arch:
Ans. (a) Lesser cornuRef: Inderbir Singh's Embroyology, 7th ed. /119-120Lesser cornu of hyoid is derived from 2nd branchial arch.1st Branchial arch2nd Branchial arch3rd Branchial arch4th Branchial arch6th Branchial arch* Malleus and Incus* Maxilla* Mandible* Muscle of mastication* Stapes* Upper half of body of hyoid* Lesser cornu of hyoid* Muscle of facial expression* Lower part of body of hyoid* Greater cornu of hyoid* Thymus* Stylopharyngeus* Upper thyroid cartilage* Cricothyroid muscle* Lower half of thyroid cartilage* Arytenoid, Cuneiform, Corniculate cartilage* All intrinsic laryngeal muscle except cricothyroidNerve: Mandibular branch of CN 5thFacial NerveGlossopharyngeal nerveVagus + Superior Laryngeal nerveVagus + Recurrent laryngeal nerve
1
Lesser cornu
Greater cornu
Stylopharyngeus
Lower hyoid
ENT
Larynx
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single
The following drug is effective in treatment of ptyriasis versicolor ?
Ans. is 'a' i.e., Ketoconazole Pityriasis versicolor (Tinea versicolor) Tinea versicolor is a misnomer as it is not caused by dermatophyte; Pityriasis versicolor is more appropriate term. It is caused by a nondermatophyte fungus called Pityrosporum ovale (Malasezia furfur). It usually affects young adults. Clinical features There are multiple small scaly hypopigmented macules (macules may be hyperpigmented also). Scaling is furfuraceous or rice powder like. Macules sta around the hair follicles and then merge with each other to form large areas. Affects trunk and shoulders (mainly chest and back). There may be loosening of scales with finger nails -4 Coupled onle or stroke of nail. Lesions are recurrent in nature (may reappear after treatment). Diagnosis of P.versicolor Examination of scales in 10% KOH shows sho hyphae and round spores (Sphagetti and meat ball appearance). Wood's lamp shows apple green fluorescence (blue-green fluorescence). Skin surface biopsy --) A cyanoacrylate adhesive (crazy glue) is used to remove the layer of stratum corneum on glass slide and then stained with PAS reagent. Treatment of P.versicolor Systemic agents : - Systemic azoles provide a convenient therapeutic option. Drugs used are ketoconazole, Fluconazole or intraconazole. Topical antifungals :- Topical antifungals used are : - i. Azoles --> Clotrimazole, econazole, Miconazole, Ketoconazole. ii. Others --> Selenium Sulfide, Sodium thiosulphate, whield's ointment (3% salicylic acid + 6% Benzoic acid).
1
Ketoconazole
Metronidazole
Griseofulvin
Chloroquine
Skin
null
69cda036-fe20-4d53-be80-5e563c9122f2
single
Hypoxia due to the slowing of circulation is seen in which of the following?
Hypoxia is O2 deficiency at the tissue level. Traditionally, hypoxia has been divided into four types.Type of hypoxiaSignificanceHypoxic hypoxia The PO2 of the aerial blood is reduced.Anemic hypoxia The aerial PO2 is normal but the amount of hemoglobin available to carry O2 is reducedStagnant hypoxia The blood flow to a tissue is so low that adequate O2 is not delivered to it despite a normal PO2 and hemoglobin concentrationHistotoxic hypoxia The amount of O, delivered to a tissue is adequate. But, because of the action of a toxic agent, the tissue cells cannot make use of the O2 supplied to them.Effects of hypoxia on cellsHypoxia causes the production of transcription factors (hypoxia-inducible factors; HIFs). In hypoxic cells, the subunits dimerize with subunits, and the dimers activate genes that produce angiogenic factors and erythropoietin.(Refer: Ganong&;s Review of Medical physiology 24th edition,pg no: 649,653)
4
Anemic hypoxia
Histotoxic hypoxia
Hypoxic hypoxia
Stagnant hypoxia
Anatomy
All India exam
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single
A male was brought unconscious with external injuries. CT brain showed no midline shift, but basal cistern were compressed with multiple small hemorrhages. Diagnosis is: AIIMS 06
Ans. Diffuse axonal injuries
4
Cerebral contusion
Cerebral laceration
Multiple infarcts
Diffuse axonal injuries
Forensic Medicine
null
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Infectivity of HBsAg is best/commonly diagnosed by-
null
1
HBeAg
HbsAg
HBV DNA
Anti HBs Ag
Microbiology
null
11480ad5-d375-4976-80a6-81641180058a
single
Accuracy refers to:
null
3
Sensitivity
Specificity.
Both
Any of the above.
Dental
null
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multi
A patient has Hb 6 gm% folic acid 82g/ml, vitamin B12 60 pg/ml, serum iron 180g/dl, and MCV-104.The diagnosis is -
null
2
Iron deficiency anaemia
Vitamin B12 deficiency
Folic acid deficiency
Pyridoxine deficiency
Medicine
null
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single
Predisposing factors for coronary aery disease include, all Except:
Predisposing factors for coronary aery disease include an increased lipoprotein &;a&; and not lipoprotein &;6&;. REF: Harrison book of internal medicine 21ST EDITION
2
Homocysteinemia
| Lipoprotein B
| Fibrinogen
| plasminogen activator inhibitors 1
Medicine
All India exam
760f2023-6644-4361-8a2f-92b7ba531f54
multi
Cell swelling is seen in all except?
Ans. (c) CalcificationRef: Robbiris pathology 9th ed. 140-41, 65* Cellular swelling may occur due to cellular hypoxia, which damages the sodium-potassium membrane pump; it is reversible when the cause is eliminated.* Cellular swelling is the first manifestation of almost all forms of injury to cells.* On microscopic examination, small clear vacuoles may be seen within the cytoplasm; these represent distended and pinched-off segments of the endoplasmic reticulum.* This pattern of non-lethal injury is sometimes called hydropic change or vacuolar degeneration.* The ultrastructural changes of reversible cell injury include: Blebbing blunting, distortion of microvilli, loosening of intercellular attachments, mitochondrial changes, dilation of the endoplasmic reticulum.
3
Infection
Malignancy
Calcification
Hypoxia
Pathology
Cellular Pathology
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If during blood transfusion reaction develops in the form of incompatibility, the first thing to be done is
null
1
Stop the transfusion
Inj Hydrocortisone to be given
Inj Chlorpheneramine maleate to be given
Inj Frusemide to be given
Surgery
null
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(HIT)Head impulse test is used to diagnose?
Option A & C ruled out as SAH presents with Nuchal rigidity. Option B- Sudden neck flexion causes shooting pain in the back which is feature of TABES DORSALIS. HIT test is a bedside technique used to diagnose reduction in vestibular function in one ear vs. the other. HINTS exam (Head Impulse, Nystagmus and Test for Skew Detion) can be used to differentiate acute continuous veigo. The 3 components of the HINTS exam include: HINTS Test Reassuring Finding Head Impulse Test Abnormal (corrective saccade) Nystagmus Unidirectional, horizontal Test of Skew No skew detion
4
Subarachnoid haemorrhage
Lhermite sign
Nuchal rigidity
Vestibular disease
Medicine
Headache And Migraine
fbafe949-e281-4310-bfab-53fe65e85921
single
Epiphora & lagopthalmous following VII nerve injury is due to-
Ans. is 'a' i.e., Failure of lacrimal pump o Symptomatic epiphora following facial paralysis is most often associated with one or more of the following -i) Impairment of eyelid closure.ii) A compromised lacrimal pump.iii) Lower lid laxity
1
Failure of lacrimal pump
Increased lacrimal secretion
Nasolacrimal duct obstruction
None of the above
Ophthalmology
Intra Ocular Tumour
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multi
Poor prognostic indicator of Pott's paraplegia
Ans. is 'c' i.e., Healed disease Prognosis of Pott's paraplegia Good Poor Degree Paial (only sensory or motor) Complete paraplegia (grade IV) Duration Shoer Longer (> 12 months) Type Early (acute) onset Late (chronic) onset Speed of onset Slow (insidious) Rapid (sudden) Age Younger Old General condition Good Poor Veebral disease Active Healed Kyphotic deformity < 600 > 60deg Cord on MRI Normal Myelomalacia or syringomyelia Preoperative Wet lesion Dry lesion
3
Early onset
Active disease
Healed disease
Wet lesion
Surgery
null
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single
A 21 year old student is found to have hyperthyroidism. She is counselled on treatment options including radioactive iodine and antithyroid medications. Carbimazole acts on which part of the thyroid hormone synthesis pathway?
Iodide is actively transported into follicular cells by a sodium/iodide transporter (Fig. 18.6). Pendrin is found at the apical membrane, where it transports iodide into colloid. A defect in this transporter underlies Pend red's syndrome (congenital hypothyroidism and deafness). Thyroid peroxidase catalyses the conversion of iodide ions into organic iodine and couples it with tyrosine to form MIT and DIT. This later step is inhibited by thionamides such as carbimazole. DIT and MIT combine forming T4 and T3. The organification of iodide and coupling of iodinated tyrosine molecules occurs on the surface of thyroglobulin. This is subsequently cleaved, releasing thyroid hormone. Uncoupled iodinated tyrosine can be dehalogenated, allowing recycling of the iodine. The majority of T4 circulates bound to thyroxine-binding globulin (TBG).
4
Cleavage of thyroglobulin by proteolysis
Coupling of monoiodotyrosine (MIT) and diiodotyrosine (DIT) forming triiodothyronine CTsl and thyroxine (T4)
Dehalogenation of iodinated tyrosine to recycle iodide
Organification of iodide by thyroid peroxidase incorporating tyrosine forming MIT and DIT
Medicine
null
18221aab-d0e9-4194-98aa-3aad32aef0a0
multi
Sickle cell anemia is the clinical manifestation of homozygous genes for an abnormal haemoglobin molecule. The event responsible for the mutation in the B chain is -
D i.e. point mutation
4
Inseion
Deletion
Non disj unction
Point mutation
Biochemistry
null
9d839c27-fff0-49c5-8c46-f245d208d6bb
single
As compared to morphine, methadone is -
Ans. is 'a' i.e., Superior analgesic and inferior hypnotic I mg of methadone can be substituted for 4 mg of morphine. Methadone is less hypnotic than morphine (sedative action is less intense).
1
Superior analgesic and inferior hypnotic
Superior hypnotic and inferior analgesic
Superior analgesic and superior hypnotic
Inferior analgenic and inferior hypnotic
Pharmacology
null
82e657d9-2911-4d2e-a004-b0a4c480a741
single
Drug of choice for primary syphilis is :
null
2
Ampicillin
Benzathine penicillin
Erythromycin
Tetracycline
Pharmacology
null
5616e3ae-1210-4582-bfe8-e538300e2559
single
Antiparkinson's drug known to cause cardiac valvular fibrosis is
Pergolide, ergot derivative, directly stimulates both D1 and D2 receptors. It has been widely used for parkinsonism but is no longer available because its use has been associated with the development of valvular hea disease.Reference: Katzung Pharmacology; 13th edition; Chapter 28; Pharmacologic Management of Parkinsonism & Other Movement Disorders
4
Levodopa
Ropinirole
Pramipexole
Pergolide
Pharmacology
Central Nervous system
aafd05ba-1121-4f53-b1cf-44ec4c586daa
single
Which of the following is a Rho kinase inhibitor? (AIIMS November.2013. May 2013. November 2012)
Ans. a. Fasudil (Ref: Katzung 11/e p203; Harrison 19/e p1590, 18/e p2011)Fasudil is a Rho kinase inhibitor leading to vasodilatation.FasudilRho kinase (protein kinase)-Vasocontrictor signalFasudil is a Rho kinase inhibitorQ leading to vasodilatation.New Anti-Anginal DrugsFasudilRho kinase inhibitorQTrimeiazidine* Metabolic modulatorsIvabardine* Direct bradycardic agentDedanonoate* Protein kinase G facilitatorGlybenclamide* Sulphonyl ureasOther New Anti-Anginaf DrugsThiazolidinedionesVasopeptidase inhibitorsNitric oxide donors (L-arginine)CapsaicinAmilorideRanolazine (Harrison 19/e p1590, 18/e p2011)MOA: Reduced contractility , due to blockade of late Na+ current that facilitates Ca2+ entry via Na+-Ca2+ exchanger, thus prevents CaJ- overloadQNicorandil (Harrison 19/e p1590, 18/e p2011)K' channel opener - reduction of free intracellular Ca2
1
Fasudil
Ranolazine
Amiloride
Nicorandil
Pharmacology
Anti-Anginal
368161c1-15ef-4d0b-986c-ff62ca444eb4
single
Efficacy of new drug A is compared with an existing drug B in:
Phase Unit of study Purpose PRECLINICAL PHASE Lab experiments Animals Pretesting CLINICAL PHASE Typical No. of patients Phase 0 Healthy human volunteers Micro - dosing Phase I Healthy human volunteers Safety and non - toxicity profile 10 to 30 usually healthy volunteers Phase II Patients Effectiveness Fewer than 100 Phase III Patients Comparison with existing drugs Hundreds or thousands Phase IV Patients Long term side effects Many thousands
3
Clinical trial phase I
Clinical trial phase II
Clinical trial phase III
Clinical trial phase IV
Social & Preventive Medicine
RCT, Trials
9d4a8b6b-e3fc-4eac-92bb-08cc589c7b54
single
Which is not true about Cryptococcus neoformans
It hydrolyses urea which differentiates Cryptococcus neoformans from non-pathogenic cryptococcus. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition
4
Grows at 37 o C
Grows on sabouraud's agar
Polysaccharide capsule
Urease negative
Microbiology
mycology
84379f6e-080b-4991-8a2d-0b7e54c4ffb6
multi
Most common site involved in Otosclerosis is
(A) Foot plate stapes # Stapedial Otosclerosis:> Stapedial otosclerosis causing stapes fixation and conductive deafness is the most common variety.> Here lesion starts just in front of the oval window in an area call 'fissula ante fenestram'.> This is the site predilection (anterior focus).> Lesion may be behind the oval window (posterior focus), around the margin of the stapes foot plate (circumferential), in the foot plate but annular ligament being free (biscuit type).> Sometimes, may completely obliterate the oval window niche (obliterative type).
1
Foot plate stapes
Malleus head
Incus
Ear drum
ENT
Miscellaneous (E.N.T.)
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True about NPCDCS is all except
Ans. c. CHC has facilities for diagnosis and treatment of CVD, Diabetes The NPCDCS program has two components viz. (i) Cancer and (ii) Diabetes, CVDs and Stroke. These two components have been integrated at different levels as far as possible for optimal utilization of the resources. The activities at State, Districts, CHC and Sub Centre level have been planned under the programme and will be closely monitored through NCD cell at different levels. The strategies proposed will be implemented in 20,000 Sub Centres and 700 Community Health Centre in 100 Districts across 21 States during 2010-12. O " height="592" align="left" width="63">Early diagnosis of diabetes, CVDs, Stroke and Cancer is done at District Hospital, not at CHC. Packages of services to be made available at different levels under NPCDCS Health Facility Packages of services Sub centre Health promotion for behavior change 'Oppounistic' Screening using B.P. measurement and blood glucose by strip method Referral of suspected cases to CHC CHC Prevention and health promotion including counselingdeg Early diagnosisdeg through clinical and laboratory investigations Common lab investigations: Blood Sugar, lipid profile, ECG, Ultrasound, X- ray etc.) Management of common CVD, diabetes and stroke cases (outpatient and in patients.)deg Home based care for bed ridden chronic cases Referral of difficult cases to District Hospital/higher health care facility District Hospital Early diagnosis of diabetes, CVDs, Stroke and CancerdegInvestigations: Blood Sugar, lipid profile, Kidney Function Test (KFT), Liver Function Test (LFT), ECG, Ultrasound, X-ray, colposcopy , mammography etc. (if not available, will be outsourced) Medical management of cases (Outpatient, inpatient and intensive Care )4. Follow up and care of bed ridden cases 5. Day care facility6. Referral of difficult cases to higher health care facility7. Health promotion for behavior change Teiary CancerCentre Comprehensive cancer care including prevention, early detection, diagnosis, treatment, minimalaccess surgery after care, palliative care and rehabilitation
3
Separate centre for stroke, DM
Implementation in some 5 states over 10 district
CHC has facilities for diagnosis and treatment of CVD, Diabetes
Day care facilities are available at subcentre
Social & Preventive Medicine
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The court which can sentence imprisonment for a maximum of 10 years
Answer: c) Assistant Sessions court (KS NARAYAN REDDY 33rd ED P-7)COURTS OF LAWCourtImprisonmentFineSupreme courtAny sentenceAny amount of fineHigh courtAny sentence authorized by lawAny amount of fineSessions courtAny sentence authorized by law (but death sentence must be confirmed by High court)Any amount of fineAssistant sessions court10 years imprisonmentAny amount of fineChief Judicial magistrateChief Metropolitan Magistrate7 years imprisonmentAny amount of fineFirst class Judicial magistrateMetropolitan Magistrate3 years imprisonment10000 rupeesSecond class judicial magistrate1 year imprisonment5000 rupees
3
Chief Judicial Magistrate
First class Judicial Magistrate
Assistant Sessions court
Additional Sessions court
Forensic Medicine
Law & Medicine, Identification, Autopsy & Burn
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Where are the dentists feet during any procedure when four handed dentistry is practiced
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2
On the stool support rim
On the floor
On the dental chair base
Where ever is convenient
Dental
null
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Which of the following is the most significant risk factor for postoperative nausea and vomiting
Postoperative nausea and vomiting is most common in women, young people, and patients who have received opioids during surgery. Surprisingly, perhaps the one advantage of smoking is that smokers tend to have less postoperative nausea and vomiting than nonsmokers. Similarly, the incidence of postoperative nausea and vomiting is lower in the geriatric population.
1
Female gender
Smoking
Age over 60 years
Surgery on the breast
Anaesthesia
Preoperative assessment and monitoring in anaesthesia
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All are symptoms of molar pregnancy except:
Ans: B (Symptoms of Hypothyroidism) Ref: Shaw's textbook, of gynaecology 15th ed. Pg 253Explanation: (See the following tabletCLASSIC CLINICAL FEATURES OF COMPLETE MOLEAmenorrhoea of 8- 12 weeksAbnormal vaginal bleedingLower abdominal painHyperemesis gravidarumFeatures of early onset preeclampsia (< 20 weeks)Uterine Ht > POGAbsence of fetal parts and fhrExpulsion of grape like vesiclesTheca lutein cyst of ovariesSymptoms of Hyperthyroidism (High HCG can mimic TSH)Serum HCG > 100000 miu/mlUSG : Snow storm appearance
2
Amenorrhea
Symptoms of Hypothyroidism
Abnormal vaginal bleeding
Expulsion of grape like vesicles
Gynaecology & Obstetrics
Miscellaneous (Gynae)
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Which of the following passes through the foramen magnum EXCEPT
A i.e Veebral Aery
1
Veebral Aery
Sympathetic chain
Xlth cranial nerve
Internal carotid Aery
Anatomy
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multi
Subaortic stenosis is not associated with?
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2
Ventricular septal defect
Aortic regargitation
Patent ductus arteriosus
Coarctation of aorta
Medicine
null
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A 85 year old female developed multiple blisters on trunk and thighs. Nikolsky's sign negative. The lesions came on and off. The most probable diagnosis is NOT RELATED-DERMATOLOGY
.
2
Pemphigus vulgaris
Bullous pemphigoid
Lichen planus
Lepra reaction
Pharmacology
All India exam
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single
Amyl nitrite is used as antidote in which poisoning?
Ans. is 'a' i.e., Cyanide
1
Cyanide
Cholinesterase
Benzodiazepine
Barbiturate
Forensic Medicine
null
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single
Hypoglycemia is an impoant feature of which of the following condition?
.
2
Hypoparathyroid
Addison disease
Pheochromocytoma
All of the above
Medicine
All India exam
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multi
There is no cyanosis in severe anemia because -
Ans is 'a' i.e. Certain min. amount of reduced Hb should be present o Cyanosis is a blue coloration of the skin and mucous membranes due to the presence of >5g/dl reduced hemoglobin in blood vessels near the skin surface. Now since in anemia the total amount of hemoglobin is decreased, the amount of reduced Hb to produce Cyanosis is not sufficient.
1
Certain min. amount of reduced Hb should be present
In anemia, O2 saturation increases
Hypoxia stimulates erythropoietin production
O2 hemoglobin curve shifts to right
Pathology
Misc. (R.B.C)
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A 65 year old lady underwent mastectomy for Carcinoma breast. Later she developed frontal headache, pain in temple region and around eye. Her ESR is 55 mm/hour. What is the most probable diagnosis?
GIANT CELL AERITIS Headache, scalp tenderness, visual symptoms, jaw claudication, or throat pain The temporal aery is usually normal on physical examination but may be nodular, enlarged, tender, or pulseless Blindness Results from occlusive aeritis of the posterior ciliary branch of the ophthalmic aery Ischemic optic neuropathy may produce no funduscopic findings for the first 24-48 hours after the onset of blindness Asymmetry of pulses in the arms, a murmur of aoic regurgitation, or bruits heard near the clavicle resulting from subclan aery stenoses identify an affected aoa or its major branches Foy percent of patients with giant cell aeritis have nonclassic symptoms at presentation, primarily respiratory tract problems (most frequently dry cough), mononeuritis multiplex (most frequently with painful paralysis of a shoulder), or fever of unknown origin The fever can be as high as 40degC and is frequently associated with rigors and sweats Unexplained head or neck pain in an older patient may signal the presence of giant cell aeritis Diagnosis An elevated ESR, with a median result of about 65 mm/h, occurs in more than 90% of patients with polymyalgia rheumatica or giant cell aeritis Magnetic resonance angiography or CT angiography establishes the diagnosis by demonstrating long stretches of narrowing of the subclan and axillary aeries Imaging of the temporal aery with ultrasound, MRI, or CT angiography can sometimes obte the need for biopsy Temporal aery biopsy -Diagnostic findings of giant cell aeritis may still be present 2 weeks (or even considerably longer) after staing coicosteroids . TREATMENT The urgency of early diagnosis and treatment in giant cell aeritis relates to the prevention of blindness When a patient has symptoms and findings suggestive of temporal aeritis, therapy with prednisone, 60 mg daily orally, is initiated immediately Prednisone should be continued in a dosage of 60 mg/day for 1-2 months before tapering Intravenous pulse methylprednisolone (eg, 1 g/day for 3 days) may help patients with visual loss and may increase chance of remission; however, data suppoing this recommendation are preliminary Low-dose aspirin (~81 mg/day orally) may reduce the risk of visual loss or stroke and should be added to prednisone Tocilizumab, an anti-interleukin-6 receptor monoclonal antibody Phase 2 clinical trials have shown that patients initially treated withtocilizumaband prednisone were able to be tapered off prednisone faster than those who were treated with prednisone alone After 1 year of treatment,tocilizumabachieves coicosteroid-free remission in approximately 50% of patients
4
Cavernous sinus thrombosis
Meningeal metastasis
Frontal sinusitis
Giant cell aeritis
Medicine
JIPMER 2019
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The most effective means of Limiting applied loads to abutment teeth in a distal extension partial denture is by
null
4
Using a stress breaker
Using acrylic replacement teeth
Splinting abutments to adjacent teeth
Maintaining a stable base tissue relationship
Dental
null
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single
Continuous murmur is present in
A continuous murmur is predicated on a pressure gradient that persists between two cardiac chambers or blood vessels across systole and diastole.The murmurs typically begin in systole, envelop the second heart sound (S 2 ), and continue through some portion of diastole. They can often be difficult to distinguish from individual systolic and diastolic murmurs in patients with mixed valvular heart disease.  The classic example of a continuous murmur is that associated with a patent ductus arteriosus, which usually is heard in the second or third interspace at a slight distance from the sternal border. Other causes of a continuous murmur include a ruptured sinus of Valsalva aneurysm with creation of an aortic–right atrial or right ventricular fistula, a coronary or great vessel arteriovenous fistula, and an arteriovenous fistula constructed to provide dialysis access.
3
cardiomyopathy
MS
PDA
cardiac tamponade
Medicine
null
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single
Function of endonucleases:-
Endonuclease Exonuclease Cut in between the DNA sequence Cut from the sides either from 5' or from 3' side Cut ds DNA Cut ss & ds DNA
1
Cut DNA at specific DNA sequences
Enhancers
To find out antibiotic resistances
To point out the coding regions
Biochemistry
Basics of DNA
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single
Which is a clean surgery
.In adults surgical management includes * It includes herniotomy, i.e. excision of hernial sac and herniorrhaphy (strengthening of the posterior wall of inguinal canal either by repair or mesh). Precipitating causes should be treated first, like TURP for BPH, dilatation of stricture urethra, treatment of chronic bronchitis. Patient is advised to avoid smoking. * Hernioplasty is the present choice (ideal) for all inguinal and groin hernias. Mesh is placed either onlay (over conjoint tendon to inguinal ligament) or inlay (in preperitoneal space). Polypropylene mesh is used. Herniotomy is done prior to mesh placement. TEP (Totally extraperitoneal laparoscopic preperitoneal mesh repair) is preferred method. ref:SRB&;s manual of surgery,ed 3,pg no 686
1
Hernia surgery
Gastric surgery
Cholecystectomy
Rectal surgery
Surgery
Urology
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single
Which of the following drugs is supposed to prevent congenital neural tube defects -
Folic acid plays a role in synthesis of nucleic acids. It is needed for normal development of blood cells in the marrow. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 620
3
Thiamine
Riboflavin
Folic acid
Pyridoxine
Social & Preventive Medicine
Nutrition and health
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single
Pressure of normal uterine contractions is between 190-300 units. Which unit is being referred to here?
Ans. is a, i.e. Montevideo unitsRef Williams Obs, 23/e, p 4371 montevideo unit = Intensity of constraction x number of contractions in 10 mins.Montevideo unit is to define uterine activity.As per this:Clinical labour usually commences when uterine activity reaches values between 80-120 Montevideo units (This translates into approximate 3 contractions of 40 mm of Hg every 10 minutes).During labour--Normal uterine contractions are between 190-300 Montevideo units (At the time of delivery it is 300 Montevideo units)
1
Montevideo units
mm of Hg
cm of water
Joules/kg
Gynaecology & Obstetrics
Normal Labour
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single
LES pressure is decreased by all except:
Lower Esophageal Sphincter (LES) Pressure Decreased by Increased by Prostaglandin E1 and E2, Progesterone Theophylline Barbiturates, Diazepam, Dopamine CCB, Atropine, Nitrates Chocolate, Coffee Alcohol, Pippermint Smoking, Fat Bombesin, Angiotensin II PP, Substance P, Motilin Gastrin Antacids Cholinergics Domeperidone Metoclopramide PMT BD CAN decrease LES pressure; Prostaglandin E1 and E2, Progesterone, Morphine and Meperidine, Theophylline, Barbiturates, Diazepam, Dopamine, CCB, Atropine Nitrates CAPS Fat decrease LES pressure: Chocolate, Coffee, Alcohol, Pippermint, Smoking, Fat. PSM BAG increase LES pressure: PP, Substance P, Motilin, Bombesin, Angiotensin II, Gastrin
2
Alcohol
Gastrin
Fat
Peppermint
Surgery
Esophagus
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multi
Treatment of choice for aplastic anaemia is
The prognosis of severe aplastic anemia managed with suppoive therapy is only poor and more than 50% of people die, usually in the first year. The curative treatment for patients under 35 years of age is allogenic hematopoietic stem cell transplantation if there is an available sibling donor. Older patients and those with suitable donors should proced to bone marrow transplantion as soon as possible. Reference : Davidson, 23rd Edition, page no : 969.
3
Blood transfusion
Oxymethalone
Bone marrow transplantation
Azathioprine
Medicine
Haematology
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