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Efficiency of pasteurization can be best assessed by?
Phosphatase test is widely used yo check the efficiency of pasteurizationREF.PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE.Editon-21.Page no.-606.
2
Oxidase test
Phosphatase test
Catalase test
Indole test
Social & Preventive Medicine
Nutrition and health
39b2a812-cfbc-41b4-ade6-5434966f206e
single
Most common cause of hypothyroidism in pregnancy is ?
Ans. is 'd' i.e., Anti TPO antibodyHypothyroidism in pregnancyThe clinical association of hypothyroidism in pregnancy may be due to :First time diagnosis in pregnancyHypothyroid women who either discontinue thyroid therapy or who need larger doses in pregnancyHypehyroid women on excessive amounts of antithyroid drugsWomen with lithium or amiodarone therapyPrimary hypothyroidism met in pregnancy is mostly related to thyroid autoimmunity (Hashimoto thyroiditis).Serum thyroid peroxidase antibodies (TPO-Ab) or antimicrosomal antibodies are elevated in autoimmune thyroiditis.
4
Nutritional
Irradiation
Anti thyroid drugs ie iatrogenic
Anti TPO antibody
Gynaecology & Obstetrics
null
6c423d0c-71eb-41b2-8e9f-5c47fde3408f
single
Which of the following is true regarding competitive inhibition?
Competitive inhibition leads to increase in Km, and Vmax remains constant.
3
Vmax increases
Vmax decreases
Km increases
Km decreases
Biochemistry
null
7a843e6e-51d0-456a-950f-7f0626c43778
multi
A patient was brought to the hospital with a history of A eight hours back. A few drops of blood is noted at the external urethral meatus. He has not passed urine and his bladder is palpable per abdomen. The probable diagnosis is :
Ans. is 'a' i.e. Urethral injury Blood at urethral meatus and urine retention are suggestive of urethral injury.
1
Urethral injury
Rupture bladder
Urethral injury with extravasation of urine in the retroperitoneum
Anuria due to hypovolemia
Surgery
null
dc531381-d572-4dc8-b7f7-c035ca54115c
single
Strong correlation is signified by a correlation coefficient of:
CORRELATION COEFFICIENT (R): Measures the degree or strength of relationship in a correlation (relationship between 2 quantitative or continuous variables). Correlation coefficient (r) lies between: –1 to +1 (–1 < r < +1) Strength of correlation: Weak positive correlation: 0 < r < 0.3 Moderate positive correlation: 0.4 < r < 0.6 Strong positive correlation: r > 0.7
2
Zero
1
Less than 1
More than 1
Dental
null
2750f818-1a35-4a9b-8873-f056186bc226
single
Drug of choice for treating anaphylaxis is:
null
1
Adrenaline
Corticosteroid
Antihistaminics
Sodium chromoglycate
Pharmacology
null
e87a8e59-da04-43d5-8a08-65916510b7ab
single
The gold standard for the diagnosis of osteoporosis is –
Dual Energy X-ray absorptiometry (DEXA) is the gold standard and investigation of choice for diagnosis of osteoporosis.
1
Dual energy X-ray absorptiometry
Single energy X-ray absorptiometry
Ultrasound
Quantitative computed tomography
Radiology
null
2f0647c1-7f24-4fad-af78-925c5d0f0e4d
single
According to ADA Specification No. 28, what is the rate of increase in file diameter per running millimeter of length for a K-type file from point D0 to point D16?
Each number should represent diameter of instrument in 100th of millimeter at the tip.  For example, a No. 25 K file shall have 0.25 mm at D1 and 0.57 mm (0.25 + 0.32) at D2.  These sizes ensure a constant increase in taper, i.e. 0.02 mm/mm of the instrument regardless of the size.
1
0.02 mm per running millimeter of length
0.04 mm per running millimeter of length
0.06 mm per running millimeter of length
Parallel sided, so no increase in diameter
Dental
null
9aea8dc3-8f5b-44fa-85fd-414d0f5adae2
multi
Auditory pathway passes through
null
1
Medial geniculate body
Lateral geniculate body
Reciculate formation
Cerebellar fornix
Anatomy
null
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single
All statement is true about modified rapid sequence induction- except-
Any changes from classical RSI steps is called modified RSI. Today we practice lot of modifications. Instead of thiopentone we can use some other intravenous anesthetic depending upon requirement. We can use instead of succinylcholine rocuronium . Positive pressure ventilation with Bag + Mask is not done Preoxygenation is mandatory even in modified RSI.
4
Rocuronium is used as neuromuscular blocker
Any IV induction agent can be used
Positive pressure ventilation with Bag + Mask is not done
Preoxygenation is not mandatory
Anaesthesia
Neuromuscular Blocker
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Goose skin or cutis anserina seen in -
Cutis anserina (goose skin) is seen in drowning, especially on exposure to cold water. It is not a diagnostic sign of drowning and this sign is rarely seen in India, water being usually warm.
1
Drowning
Lightening
Strangulation
Fire arm injury
Forensic Medicine
null
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single
Useful screening test for lead is measurement of
Diagnosis of lead poisoning:
2
Amino-laevulinic acid in urine
Coproprophyrin in urine
Lead in blood
Lead in urine
Social & Preventive Medicine
null
677a68ac-940c-439d-bf13-5f1bda4d24c6
single
An IV drug abuser develops an aggressive form of nephrotic syndrome that does not respond to steroids. A renal biopsy is performed. Which of the following histological diagnoses will most likely be made from the biopsy tissue?
Focal segmental glomerulosclerosis Associated with IV drug abuse and HIV nephropathy. Aggressive form of nephrotic syndrome Poor prognosis Non responsive to steroid therapy (called as 'collapsing variant').
1
Focal segmental glomerulosclerosis
IgA nephropathy
Membranous glomerulonephritis
Membranoproliferative glomerulonephritis
Pathology
Nephrotic Syndrome
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The current drug of choice in paroxysmal Sypraventricular Tachycardia (PAVT ) is
adenosine is the drug of choice for PSVT. Immediate electrical cardioversion is indicated if the arrhythmia is associated with hemodynamic collapse. Adenosine is the preferred drug in those patients in whom verapamil has failed or may cause adverse effects, such as those with hea failure or wide-complex tachycardia In most patients, the drug of choice for acute therapy is either adenosine or verapamil. The use of intravenous adenosine or the calcium channel blocker verapamil are considered safe and effective therapies for controlling SVTs Ref Harrison 20th edition pg 1465
4
Digoxin
Dilantoin
Propranolol
Adenosine
Medicine
C.V.S
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single
Anti progesterone drug is :
Mifepristone
2
Cyproterone
Mifepristone
Spironolactone
Tamoxifen
Gynaecology & Obstetrics
null
afe18535-2b94-42d4-a20f-41146b79fb29
single
Multiple lytic lesions of skull with beveled edges are seen in –
Punched out lesions of skull are seen both in Eosinophilic granuloma and multiple myeloma. However, beveled edges (double contour) is characteristic of eosinophilic granuloma due to uneven destruction of the inner and outer table of the skull.            Punched out lesions of skull                    →  Multiple myeloma            Punched out lesions with beveled edges   →  Eosinophilic granuloma
1
Eosinophilic granuloma
Metastases
Multiple myeloma
Neuroblastoma
Radiology
null
c6a9a7d9-627b-4b59-99e8-98fab12e9f38
single
Which of the following is a zoonotic disease ?
Ans. is 'a' i.e., Hydatid cyst Impoant zoonoses I. Bacterial -4 Anthrax, Brucellosis, Ornithoses, Q-fever, Leptospirosis, TB, Plague, Tularemia, Salmonellosis. 2. Viral --> Cowpox, Monkeypox, Easternequine, encephalitis, Ross river fever, Yellow fever, Japanese encephalitis, Lassa fever, Rabies. 3. Protozoal ---> Leishmaniasis, Toxoplasmosis, Trypanosomiasis, Babesiosis. 4. Helminthic ----> Clonorchiasis, Fasciolopsis, Schistosomiasis, Echinococus (hydatid disease), Taeniasis, Trichinellosis.
1
Hydatid cyst
Malaria
Filariasis
dengue fever
Social & Preventive Medicine
null
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single
Which of the following is not a benign tumor?
Ans. c (Hepatoma). (Ref. Robbin, Pathology, 7th ed., 273)BENIGN TUMORS# Fibroma,Lipoma,Chondroma# Osteoma,HemangiomaMeningioma# Leiomyoma,Rhabdomyoma,Squamous cell papilloma# Liver cell adenoma,AdenomaPapilloma# CystadenomaBronchial adenomaRenal tubular adenomaEducational Points:# An ectopic rest of normal tissue--choristoma.Q# Aberrant differentiation may produce mass of disorganized but mature specialized cells or tissue indigenous to particular site--Hamartoma.# Hepatoma is malignant tumor (A misnomer).
3
Lipoma
Leiomyoma
Hepatoma
Chondroma
Pathology
Neoplasia
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single
Rokitansky Kuster Hauser syndrome ta associated with :
Vaginal atresia Friends MRKH syndrome is associated with vaginal atresia - as is suggested by "A more common form of vaginal atresia is congenital absence of both uterus and vagina which is also referred to as mullerian aplasia. mullarian agensis or Mayer Rokinstansky - Kuster Hauser Syndrome." ... Williams Gyane. 1/e, p 416 I know some of you might be thinking option 'b' i.e. absent fallopian tubes is also correct. Now to understand why this option is not absolutely correct lets go back to the development of mullarian ducts -Mullerian ducts grow downward therefore there will be cases where there will be well formed abdominal ostia associated with hypoplasia or absence of the remainder of the tubes, uterus and vagina or the tubes and uteras_ Tay be present and the vagina absent The converse is not true as the ducts grow downwards so vaginal atresia has to be present always in MRKH syndrome therefore option 'c' seems more correct.deg
3
Ovarian agenesis
Absent fallopian tube
Vaginal atresia
Bicornuate uterus
Gynaecology & Obstetrics
null
e0ed73bc-5f9e-43c2-999a-87216cedbe1d
multi
The most common cause of TMJ ankylosis is:
null
1
Trauma
Osteoarthritis
Childhood illness
Rheumatoid arthritis
Pathology
null
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single
Which of the following drugs required a dose adjustment in patient during radiotherapy in order to present radiation toxicity ?
Ans. is 'b' i.e., Dactinomycin o Like anthracyclines (doxo and daunorubicin), dactinomycin can also cause radiation recall syndrome and the dose should be adjusted with radiotherapy.
2
Vincristine
Dactinomycin
Cyclophosphamide
6-Mercaptopurine
Pharmacology
null
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single
Proteins are linear polymers of amino acids. They fold into compact structures. Sometimes, these folded structures associate to form homo or hetero-dimers. Which of the following refers to this associated form?
Quaternary structure defines the polypeptide composition of a protein and, for an oligomeric protein, the spatial relationships between its protomers or subunits. Monomeric proteins consist of a single polypeptide chain. Dimeric proteins contain two polypeptide chains. Homodimers contain two copies of the same polypeptide chain, while in a heterodimer the polypeptides differ. Ref: Harper 28th Ed. Page-35, Harper 27th Ed. Page: 34
4
Denatured state
Molecular aggregation
Precipitation
Quaternary structure
Biochemistry
Structure and function of protein
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True about dementia is: Karnataka 07
Ans. Dementia is the loss of distant memory
2
Alzheimer's disease is due to multiple small strokes in the cerebral coex
Dementia is the loss of distant memory
Dementia due to atherosclerosis does not progress like Alzheimer's
Alzheimer's disease is associated with an increase in ACh release in the cerebral coex
Forensic Medicine
null
429c34fe-b313-46eb-a0c3-25dfb8c6178e
multi
Deep injury of neck always involves
Investing layer lies deep to the platysma and surrounds the neck like a collar. The surgeon has to stitch platysma muscle separately so that skin does not adhere to deeper neck muscles otherwise the skin will get an ugly scar. Ref BDC volume 3;sixth edition pg 81
1
Platysma
Trapezius
Sternocleidomastoid
Longus colli
Anatomy
Head and neck
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single
A female patient after injury comes to casualty. Her ABG shows low pH, pCO2 high, bicarbonate normal. The diagnosis is:
Answer is B (Respiratory acidosis) The acid base disorder is respiratory acidosis. There is acidosis (pH : low) Raised pCO2 (acidosis) indicates that the change in CO2 is therefore primary Normal bicarbonate indicates that there is no alteration in the metabolic component The acid base disorder therefore is Respiratory acidosis.
2
Respiratory alkalosis
Respiratory acidosis
Metabolic acidosis
Metabolic alkalosis
Medicine
null
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single
Drug of choice for central diabetes insipidus
Ans. is'b'i.e., DesmopressinDesmopressin (intranasal) is the DbC for central DI.
2
Vasopressin
Desmopressin
Lypressin
Presselin
Pharmacology
null
51caac51-a6aa-4398-93e1-7945d3f4082c
single
Most common cause of End stage renal disease is:
Ref: Harrison's Principles of Internal Medicine. 18ed.Explanation:The dispiriting term end-stage renal disease' should not be used and is replaced by the term stage 5 CKD"The most frequent cause of CKD is diabetic nephropathy. most often secondary to type 2 diabetes melli- tus Ref: HarrisonLeading Categories of Etiologies of CKDDiabetic glomerular disease (MC Cause)GlomerulonephritisHypertensive nephropathyPrimary glomerulopathy with hypertensionVascular and ischemic renal diseaseAutosomal dominant polycystic kidney diseaseOther cystic and tubulointerstitial nephropathy
1
Diabetes
Hypertension
Chronic GN
Polycystic Kidney disease
Medicine
Chronic Kidney Disease and Uremia
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single
Presumptive treatment of malaria in a chloroquine resistant area:
Ans. is 'b' ie sulph lene + pyrimethamine Presumptive treatment in Chloroquine resistant areaSingle dose of 25 mg/kg body wt. sulfalene/sulfadoxine and 1.25 mg/kg body wt. Pyrimethamine combination and thereafter tab. Primaquine 0.75 mg/kg body wt.
2
Chloroquine + pyrimethamine
Sulphalene + pyrimethamine
Chloroquine + primaquine
Sulphalene 1000 mg
Social & Preventive Medicine
Communicable Diseases
8227baea-4cf2-4ec6-8c40-9d83a74fe4bb
single
In a fetus highest oxygen concentration is found in?
Among the following options, highest oxygen conc is found in IVC Saturation of Oxygen in fetal structures - Umbilical vein - 80% (PO2 of 30-35 mm Hg ) ( Max. in entire body of fetus ) Inferior vena cava - 70% (PO2 of 26-28 mm Hg) Left ventricle - 65% Right Ventricle - 55-60% Umbilical aery - very low SVC - (PO2 of 12-14 mm Hg)
1
Inferior vena cava
Superior vena cava
Left ventricle
Ascending aoa
Pediatrics
NEET Jan 2020
f2d6a184-7d89-4e77-9997-48fce5ad56c0
single
Which is the best initial fluid for resuscitation during the shock state:
Crystalloids predominantly expand the interstitial and then the intracellular compartment not the intravascular compartment (expansion of intravascular compartment is only transient). This is necessary to replenish the intracellular and interstitial compartment as in a hypovolemic patient, the shock induced homeostasis has already shifted the intracellular and interstitial fluid into the vascular compartment. Colloids on the other hand cause expansion of the vascular compartment; colloids imbibe fluid from the interstitial and intracellular compartment thus further compromising the already depleted intracellular compartment. Hence crystalloids are the initial fluid of choice. Examples of Crystalloids: Ringer lactate (most commonly used crystalloid), Normal saline, 5 % Dextrose, Isolyte Examples of Colloids: Albumins, Dextrans, Hydroxyethyl starches(HES), Gelatins
1
Crystalloids
Colloids
Blood
Plasma substitutes
Surgery
null
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multi
IL-1 is secreted from which cells
Tumor necrosis factor (TNF)Interleukin-1 (IL-1)Granulocyte-monocyte colony-stimulating factor (GM-CSF)Granulocyte colony-stimulating factor (G-CSF)Monocyte colony-stimulating factor (M-CSF)These factors are formed by activated macrophage cells in the inflamed tissues and in smaller quantities by other inflamed tissue cells.Ref: Guyton and Hall textbook of medical physiology 13th edition. Page:462
3
Mast cells
Eosinophils
Macrophages
Neutrophils
Physiology
Cardiovascular system
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All are in cystinuria except
Cystinuria is one of the inborn errors of metabolism. It is autosomal recessive disorder. The disorder is attributed to the deficiency in transpo of amino acids. Abnormal excretion of cysteine and to a lesser extent lysine, ornithine and arginine. Hence the condition is also known as Cysteine-lysinuriaRef: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 219
3
Cystine
Ornithine
Alanine
Arginine
Biochemistry
Metabolism of protein and amino acid
0019cdcf-45ed-4c92-af66-1b0bbf5f47bc
multi
Implantation occurs at the stage of -
null
3
Zygote
Morula
Blastocyst
Primary villi
Anatomy
null
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single
Streptococcal Toxic shock syndrome is due to the following virulence factor -
Option 1 M protein: Mediates adherence to epithelial cells, inhibits phagocytosis Option 2 Streptococcal toxic shock syndrome By S. pyogenes (M serotypes 1 or 3)with hyaluronic acid capsule. Caused by SPE (Streptococcal pyrogenic exotoxin) or Erythrogenic toxin. 3 Types : Type A and C - Superantigens. Type A and C bacteriophage coded, B toxin chromosomal mediated. Associated with- Scarlet fever, Necrotizing fasciitis, Streptococcal toxic shock syndrome. Option 3 Streptolysin-O (SL-O):- 1. Oxygen labile ( streptolysin-O ), Heat labile 2. Antistreptolysin-O antibodies (ASO) are raised in most of the streptococcal infections and are used as a standard marker for retrospective diagnosis of streptococcal infections (except in glomerulonephritis and pyoderma; where ASO titer is low). Option 4 Lancefield's grouping (for b haemolytic streptococci):- Based on carbohydrate antigen in cell wall, b haemolytic streptococci are fuher divided into 20 serogroups: Group A to V except I and J.
2
M protein
Pyrogenic exotoxin
Streptolysin O
Carbohydrate cell wall
Microbiology
Systemic Bacteriology Pa 1 (Gram Positive Cocci, Gram Negative Cocci)
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multi
Which one is not poor prognostic factor for acute pancreatitis:
Answer is D (Hyperamylasemia) Serum amylase levels do not form any criteria for prognosis in acute pancreatitis. Hyperglycemia, Hypocalcemia and raised LDH levels are poor prognostic factors according to Ranson's criteria.
4
Hyperglycemia
Hypocalcemia
Raised LDH level in blood
Hyperamylasemia
Medicine
null
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single
Concomitant administration of this drug with organic nitrates is contraindicated due to marked potentiation of vasodilatory action leading to profound hypotension. This drug is:
null
4
Propranolol
Fluoxetine
Hydrochlorothiazide
Sildenafil
Pharmacology
null
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single
Fungus not isolated in culture ?
Ans. is 'd' i.e., P. jiroveci Culture of fungi Culture media used in mycology are : Sabouraud's glucose agar (most common) Czapek - Dox medium Corn meal agar Culture media are supplemented with chloramphenicol to minimize bacterial contamination and cycloheximide to reduce contamination with saprophitic fungi. Cultures are incubated at 22 - 30degC and 37degC. Rhinosporidium seebri and Pneumocystis jiroveci (formerly P. carinii) can not be cultivated in media. Malassezia furfur does not grow on regular sabouraud's medium. It requires complex media to grow. Malassezia furfur does not grow on regular sabouraud's medium. It requires complex media to grow M. furfur is a lipid dependent fungus and 1% emulsified olive oil is added to sabouraud medium for its cultivation Two media are now widely employed for all malassezia species. Dixon medium Modified dixon medium
4
Cryptococcus
Dermatophyte
Candida
P. jiroveci
Microbiology
null
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The stability of the ankle joint is maintained by the following, except
A. i.e. Planter calcaneonavicular ligament Calcaneonavicular/ Spring ligament is most impoant ligament for maintaining the median longitudinal arch of foot but has nothing to do with stability of ankle joint because it is not around ankle joint
1
Plantar calcaneonavicular (spring) ligament
Deltoid ligament
Lateral ligament
Shape of the superior talar aicular surface
Anatomy
null
ea81837e-b331-402e-8fe3-a36927d0e93f
multi
Osmoreceptor is located at which site
null
1
Anterior hypothalamus
Renal medulla
Carotid body
Atrial chamber
Physiology
null
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single
45 year old alcoholic male came for deaddiction treatment. He has alcohol induced hepatitis with other blood parameters within normal limits. The drug that should not be chosen for relapse prevention is
NALTREXONE is an OPIOID ANTAGONIST given at a dosage of 50-150mg, should not be used in LIVER DYSFUNCTION ACAMPROSATE is an GABA AGONIST given at a dosage of 666MG TDS, should not be used in KIDNEY DYSFUNCTION Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no.626
3
Disulfiram
chlordiazepoxide
Naltrexone
Acamprosate
Anatomy
Substance abuse
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single
Which of the following prevent lens opacity by free radical scavenging?
Rediced glutathione is the most impoant anti-oxidant mechanism in lens. Ref: Yanoff ch.501; Biochemistry of Lens p.330; Parson 22nd/e p.261&20th/e p.248; Alder's Physiology 10th/e p.130.
1
Glutathione
Catalase
Vitamin A
Vitamin E
Ophthalmology
Lens
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single
Brick incinerator is used for ?
Ans. is 'c' i.e., Infectious waste Drum (or field) incinerator and brick incinerator should be used only as a last reso, as it is difficult to burn the waste completely without generating potentially harmful smoke.The option is appropriate only in emergency situations during acute outbreaks of communicable diseases and should be used only for infectious waste.
3
Waste sharp
Discarded medicine
Infectious waste
Disposable items
Social & Preventive Medicine
null
50c7d69d-65db-4432-8369-a4a456f5980d
single
Pseudomyxoma peritonii is seen in which ovarian cancer?
Ans. is 'b' i.e., Mucinous cystadenocarcinoma o Mucinous tumors are multiloculated cysts lined by epithelium resembling the endocervix.o The cut section reveals loculi filled with mucinous contents.o If the tumor ruptures, it may lead to formation of pseudomyxoma peritonei and the viscera showing extensive adhesions.o Bilateral tumors are often metastatic from the gastrointestinal tract, mainly mucocele of appendix or primary adenocarcinoma of appendix.o Appendicectomy at the time of primary surgery prevents pseudomyxoma peritonei, as often mucocele of the appendix is known to cause this complication.
2
Serous cystadenocarcinoma
Mucinous cystadenocarcinoma
Brenner Tumor
Fibroma
Gynaecology & Obstetrics
Presentation (Carcinoma Ovary)
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single
The following substance acts as a 'satiety signal' for lipids
Enterostatin, a peptide that selectively reduces fat intake. It is formed in the intestine by the cleavage of secreted pancreatic procolipase, the remaining colipase serving as an obligatory cofactor for pancreatic lipase during fat digestion. After feeding, enterostatin appears in the lymph and circulation. Enterostatin will selectively inhibit fat intake during normal feeding and in experimental paradigms that involve dietary choice. Both peripheral and central sites of action have been proposed. The peripheral mechanism involves an afferent vagal signaling pathway to hypothalamic centers. The central responses are mediated through a pathway that includes both serotonergic and opioidergic components. Chronically, enterostatin reduces fat intake, body weight, and body fat. This response may involve multiple metabolic effects of enterostatin, which include a reduction of insulin secretion, an increase in sympathetic drive to brown adipose tissue, and the stimulation of adrenal coicosteroid secretionReference: Enterostatin-a peptide regulating fat intake; Erlanson-Albesson C, York D; Obes Res.1997 Jul;5(4):360-72
4
Apo-A
HCL
Fastrine
Enterostatin
Biochemistry
Metabolism of lipid
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single
All of the following act as cell adhesion molecules, EXCEPT:
Most adhesion proteins, also called CAMs (cell adhesion molecules), can be classified into four main families: immunoglobulin family CAMs, cadherins, integrins, and selectins. Ref: Robbins 8th edition, Chapter 3.
4
Integrin
Selectin
Cadherin
Lecithin
Pathology
null
9a84f938-456c-4356-a3ca-87061d2cc246
multi
Bacitracin acts on -
Ans. is 'a' i.e., Cell wall Bacitracin acts by inhibiting cell wall synthesis. o Bacitracin is a polypeptide antibiotic. o Other polypeptide antibiotics (Polymyxin B, colistin and tyrothricin) act on cell membrane.
1
Cell Wall
Cell Membrane
Nucleic Acid
Ribosome
Pharmacology
null
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multi
A 55-year-old man presented to his general physician with pain and swelling of his right great toe. He repoed he has had this pain for approximately 2 days and it is getting worse. He also stated that he had a similar episode of this 4 years ago, but in the interim, he has been symptom free. He was given something for the prior episode, but does not recall the name. He denied trauma, fever, chills or sweats, and has been afebrile. On physical examination, he was afebrile and his right great toe is swollen at the metatarsophalangeal joint. There was decreased range of motion. X-ray films are unrevealing. He had no other joint involvement. A joint aspiration is performed. Which of the following types of crystals in the joint aspirate would confirm the likely diagnosis?
Negatively-birefringent needle-shaped crystals are classically found in the diagnosis of gout. Positively-birefringent rhomboidal crystals are diagnostic for pseudogout, or calcium pyrophosphate crystal deposition. The other choices are not diagnostic or commonly occurring combinations.
1
Negatively-birefringent needle-shaped crystals.
Negatively-birefringent oval crystals.
Negatively-birefringent rhomboidal shaped crystals.
Positively-birefringent needle-shaped crystals.
Surgery
null
3969b60c-4c8b-40ee-9347-e3905c9b0199
multi
What is the microscopic finding of cervical mucus during post-ovulatory period?
Dried cervical mucus examined microscopically has characteristic patterns dependent on the stage of the ovarian cycle. Mucus crystallization necessary for the production of the fern pattern is dependent on an increased sodium chloride concentration. Cervical mucus is relatively rich in sodium chloride when estrogen, but not progesterone, is being produced. Thus, during post-ovulatory cycle from approximately the 7th to the 18th day of the cycle, a fernlike pattern is seen. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 8. Prenatal Care. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
1
Shows pattern on drying
Is thick
Is thin and cellular
Is thin and alkaline
Gynaecology & Obstetrics
null
32c49e69-4af0-493c-a585-481f2c777373
single
Which one of the following is characteristic of microfilaria of W. bancrofti?
The features of microfilaria of W. bancrofti are: General appearance: Graceful, sweeping curves. Free cephalic space: As long as broad.   Excretory pore: Not prominent:   Caudal end: Uniformly tapering to a delicate point and no terminal nuclei present.   5. Nuclear column: Nuclei discrete; Important points   Microfilaria of W. bancrofti and B. malayi in India display a nocturnal periodicity. Maximum density of Mf in blood is reported between 10 pm and 2 am.   Man is the definitive host and mosquito the intermediate host of Bancroftian and Brugian filariasis.   Third stage larva in mosquito is infective form.   Adult worm may survive for 15 years or more.   Duration of mosquito cycle (extrinsic incubation period) is between 10 and 14 days.   Main vectors in India are: C. quinquefasciatus (C. fatigans) for Bancroftian filariasis and Mansonia mosquitoes for Brugian filariasis.   Prepatent period: It is the time interval between inoculation of infective larvae and the first appearance of detectable Mf.   Clinical incubation period: Time interval from invasion of infective larvae to the development of clinical manifestations.
4
Cephalic space twice as long as broad
Excretory pore prominent
Nuclear column smudged
Caudal end uniformly tapering to a delicate point, and no terminal nuclei present
Unknown
null
1a44268a-14f5-4c1a-9e2a-dfec9fc4216a
single
Diameter of head mirror
null
2
3 inches
3.5 inches
2.5 inches
9 mm
ENT
null
15ec2b3d-9257-446f-8ac9-87493c6eecac
single
Most suitable radioisotope of Iodine for treating hypehyroidism is:
I131
3
V"
1125
I131
1132
Radiology
null
5e8c8201-ae4f-43b0-8e5a-ff79e533ded1
single
All of the following statements about carbohydrate antigen are true, EXCEPT:
Carbohydrate C -Ag is found in the cell wall of streptococcus pneumoniae. It is independent of T cell response, so memory response is present in the carbohydrate C - Ag. Polysaccharides (carbohydrates) are less immunogenic than protein antigens, but are more antigenic than lipids & nucleic acids. Carbohydrate (Polysaccharide) antigens are T- cell independent. Their immune response does not require activation of T-cells. These antigens directly stimulate B-cells without processing by antigen presenting cells. There is no memory response. Ref: Ananthanarayanan & Paniker's textbook of microbiology 7th ed pg 81.
2
It has lower immunogenicity
Memory response is seen
Cause polyclonal B cell stimulation
Does not require stimulation by T cells
Microbiology
null
612751ea-8c2e-4dda-affd-459eb90d739a
multi
All are true about Neisseria gonorrhea EXCEPT
null
1
Gram positive cocci
Causes stricture urethra
Involves seminal vesicals and spreads to epididymis
Drug of choice is Ceftriaxone
Medicine
null
07edb824-c0fa-4c45-b58d-c001b291e563
multi
A 50-year-old man with aortic stenosis is doing exercise for 11 minutes according to Bruce protocol. Exercise had to be stopped due to fatigue. He had a peak sytolic gradient of 60 mmHg across the aortic valve at rest. What is the best management for this patient?
Ans. b > a (Aortic valve replacement > Medical Management) (Ref: ACC/AHA guidelines; European Cardiology Society Guidelines: http:// circ. ahajountals.org/ content/ 122/17/ 1734.full.pdf+html; Braunwald's Heart Disease: 9/e p1474)The patient in question has asymptomatic aortic stenosis but develops symptoms on exercise (abnormal/positive exercise test). Also the presence of mean pressure gradient of 60mm Hg put this patient into the category of 'Very Severe Aortic Stenosis' or 'Critical Aortic Stenosis'.Optimal management of asymptomatic severe Aortic Stenosis continues to be a source of ongoing clinical controversy. Surgical Aortic Valve Replacement and Watchful waiting with frequent reassessments (observation), both continue to be legitimate though debatable treatment options. Since the patient in question has 'Very Severe AS' and 'Abnormal Stress Testing' he should be considered for surgical intervention in the form of Aortic Valve Replacement (AVR).50-year-old patient with Asymptomatic Severe Aortic StenosisPositive Exercise Stress TestMean Pressure Gradient > 60 mm HgSymptoms during exercise such as dyspnea, angina, and syncope or near syncope constitute positive criteria indicating an abnormal stress test in patients with asymptomatic aortic stenosis.Mean pressure gradient >60 mm Hg and or aortic valve area < 0.6 cm2 and /or aortic jet velocity >5.0 m per second is classified as 'Extremely Severe Aortic Stenosis' (Critical Aortic Stenosis)Severe aortic stenosis with an abnormal response to exercise is considered a Class lIb indication for aortic valve replacement according to the ACC/AHA Guidelines.' Severe aortic stenosis with an abnormal response to exercise is considered a Class IC indication for aortic valve replacement according to European Cardiology Society Guidelines (ECS Guidelines)''Extremely severe aortic stenosis (mean gradient > 60 mm Hg) is considered a class lIb indication for aortic valve replacement according to the ACC/AHA Guidelines.' Indications of AVR in Asymptomatic Severe Aortic StenosisClass IClass lIb* Patients undergoing cardiac surgery for other indications (Coronary artery bypass graft surgery or aortic surgery)* Left ventricular ejection fraction <_50 %* Abnormal hemodynamic response to exercise (Symptoms or asymptomatic hypotension)* High probability of rapid progression (Age, Calcification, Concomitant CAD)* Asymptomatic 'very severe AS'
2
Medical management
Aortic valve replacement
Aortic valve balloon dilatation to prevent further worsening
Coronary angiography
Medicine
C.V.S.
04f74156-6101-4d44-86c0-13cf854378b0
multi
False about disaster management
null
1
Response in pre-disaster phase
Mitigation in pre-disaster phase
Gastroenteritis is commonest infection after disaster
Yellow color is for medium priority
Social & Preventive Medicine
null
979b13c1-124d-416e-980c-c6752b576694
multi
Following are causes of unconjugated hyperbilirubinemia except
Rotors is conjugated hyperbilirubinemia. Others are unconjugated hyperbilirubinemia. Reference: davidson, 23rd edition, page 860
3
Hemolytic anemia
Large hematoma
Rotor syndrome
Megaloblastic anemia
Medicine
G.I.T
28d6ee2a-c727-4944-81ed-3f38ccbc8167
multi
Which of the following is a non-Iodine containing contrast?
Ans. a. Gadolinium (Ref: Grainger 5/e p32-51, 1249-1253; Sutton 7/e p419-421; Wolfgang 7/e p1147)Gadolinium is a non-iodine containing contrast."Gadolinium is a lanthanide. Gd-DTPA is classified as an acyclic, ionic gadolinium contrast medium Its paramagnetic property reduces the T1 relaxation time. Gadolinium based agents may cause a toxic reaction known as nephrogenic systemic fibrosis (NSF) in patients with severe kidney problems."Contrast used inCT scanMRIlodinatedQParamagnetic (non-iodinated): GadoliniumQ Contrast AgentsIonic Contrast AgentsNonionic Contrast Agents* Ionic contrast agents ionize in water in 2 ions per molecule* All monomers contain 1 benzene ring with 3 iodine atoms and dimers contain 2 benzene rings with 6 iodine atoms per molecule.* Therefore ionic monomers have 3 iodine atoms per 2 ionic/ osmotic particles in solutionQ and a contrast agent ratio of 3:2 (i.e. 1.5).* And ionic dimers have 6 iodine atoms per 2 ionic /osmotic particles in solution with a contrast agent ratio of 6:2 or 3:1.* Nonionic agents do not ionize so they have only 1 osmotic particle per molecule.* And similarly monomers contain 3 iodine atom and dimers contain 6 iodine atoms per molecule of contrast agent* Therefore contrast agent ratio of non ionic monomers is 3:1 and nonionic dimers are 6:1. High Osmolar Contrast Agents (HOCM)Low Osmolar Contrast Agents (LOCM)* HOCM are all ionic monomersQ* HOCM have osmolality in range of 1500 mosmols/kg water at concentrations of 300 mg lodine/ml.* Osmolality is proportional to the ratio of iodine atoms to the number of particles in solution.* The contrast agents with lower ratio (3:2) are HOCM and they have more particles in solution per iodine atom.* LOCM may be ionic dimers, and nonionic monomers or dimers (i.e. both ionic and nonionic)Q.* LOCM osmolality is less than half of the osmolality of HOCM.* As compared to physiological osmolality of 300 mosmols/kg water, non-ionic dimers are physiologically isotonic in solution at 300 mg lodine/ml.* Lowest osmolality/osmolarity is seen in non-ionic dimer agents, which becomes almost physiologically isotonic or iso-osmolarQ (visipaque 320 is 290 mosmol/kg and isovist 300 is 320 mosmol/kg H2O: 320 and 300 are iodine concentrations).* Agents with higher ratio (3:1 or 6:2 and 6:1) are LOCM.* lohexol (omnipaque) is a nonionic monomer (LOCM with 3:1 ratio)Qlodinated contrast agentslodinated contrast agents have low lipid solubility, low toxicity, low binding affinities for protein, receptor or membranes, low molecular weight and are very hydrophilic.On IV injection due to high capillary permeability they all are distributed rapidly into extravascular, extracellular interstitial space (except in CNS)Q but do not enter blood or tissue cells.Pharmacokinetics of all extracellular MRI contrast agents (all gadolinium except Gd-BOPTA) are similar to iodinated water soluble contrast media. They do not cross the blood brain barrier unless the barrier is disruptedQ. These agents accumulate in tissues with abnormal vascularity (inflammation and malignancy) and in regions where BBB is disrupted.Contrast enhanced CT scans use intravenous injection of iodinated contrast mediumQ contrast enhanced MRI use non iodinated contrast medium containing paramagnetic metal ions gadolinium (Gd3+), Copper (Cu2+) or manganese (Mn2+)Q.Gd is the most powerful (with 7 unpaired electrons) but unfortunately most toxic of these ions and therefore it is necessary to encapsulate it by a chelate such as DTPA (diethylene triamine pentaacetic acid salt) forming Gd-DTPA.Paramagnetic agents are mainly positive enhancers that reduce the T1 and T2 relaxation times, increase tissue signal intensity on T1 weighted images and almost have no effect on T2 weighted MR images.
1
Gadolinium
Visipaque
lopamidol
Diatrozoate
Radiology
Contrast agents
2d2b4ff8-7f6c-4eed-86ff-cdc42586d0c2
single
Incubation period of chancroid is
null
1
Less than 7 days
10-15 days
2-3 weeks
3-4 weeks
Social & Preventive Medicine
null
ad730709-0b5b-4bcd-87d7-94843340172d
single
Volume of distribution is NOT affected by all EXCEPT
(Binding to plasma protein) (31-33-KDT 6th)* The extent of distribution of drug depends on* Lipid solubility* Ionization at physiological pH (dependent on pKa)* The extent of binding to plasma and tissue proteins* Differences in regional bloodflow
1
Binding to plasma protein
Drug clearance
Lipid insolubility
Absence of blood brain barrier
Unknown
null
090008b6-1306-4e7b-967f-0683dac64ce1
multi
Cough is an adverse reaction with intake of ?
Ans. is 'a' i.e., Enalapril Bradykinin and substance P are also substrate (in addition to angiotensin - I) for ACE. By inhibiting ACE, enalapril inhibits degradation of Bradykinin and substance Pin the lung, which are responsible for cough and angioedema.
1
Enalapril
Prazocin
Nifedipine
Thiazide
Pharmacology
null
dfb4598a-14da-4e1f-97f8-2abd89ff22f0
single
Drug acting on V2 receptors and used in DI (REPEAT)
Desmopressin is USED IN central DIREF:KDT7/e p597
3
Telypressin
Vasopressin
Desmopressin
Pralispressin
Pharmacology
All India exam
5d111830-d9d5-4e2c-86a4-f6eb3579ddc8
single
Function of Topoisomerases
Classes of Proteins Involved in ReplicationProteinFunctionDNA polymerasesDeoxynucleotide polymerizationHelicasesATP -driven processive unwinding of DNATopoisomerasesRelieve torsional strain that results fromhelicase-induced unwindingDNA primaseInitiates synthesis of RNA primersSingle-strand bindingproteins (SSBs)Prevent premature reannealing of dsDNADNA ligaseSeals the single strand nick between thenascent chain and Okazaki fragments on the lagging strandRef: Harper&;s Biochemistry; 30th edition; Chapter 35; DNA Organization, Replication, & Repair
2
Deoxynucleotide polymerization
Relieve torsional strain
Initiates synthesis of RNA primers
Prevent premature reannealing of dsDNA
Biochemistry
Structure and function of protein
a0a9c464-b050-43b1-bdaa-cb2555be090a
single
Anemic hypoxia is seen CMC (Vellore) 14
Ans. CO poisoning
1
CO poisoning
CO2 poisoning
HCN poisoning
Nerve gas
Forensic Medicine
null
60085cb5-ea46-4d89-8da2-16f45ed36667
single
A child presents with failure to thrive to pediatrics OPD. The doctor counseled the parents about improving nutrition of child , to which mother strongly asseed that they have ensured everything is perfect from their side especially nutrition, but to no avail. Then doctor requested for few investigations. What is the diagnosis?
Echocardiographic findings in secundum atrial septal defect. Two-dimensional echocardiogram (apical 4-chamber view) shows a moderate-sized secundum ASD. A child with an ostium secundum ASD is most often asymptomatic; the lesion is often discovered inadveently during physical examination as conveyed in the above question's clinical history. The physical findings of an ASD are subtle and require careful examination of the hea, especially the hea sounds. Characteristic finding: 2nd hea sound is widely split and fixed in its splitting during all phases of respiration.
2
Ebstein anomaly
Ostium secundum, type of ASD
Ostium primum, type of ASD
sinus venosus, type of ASD
Unknown
Integrated QBank
e87284bc-9f63-42f5-9cc4-a88bf766a563
multi
Genital was are caused by which virus?
Genital was are soft growths that appear on the genitals. Genital was are a sexually transmitted infection (STI) caused by ceain strains of the human papillomavirus (HPV). These skin growths can cause pain, discomfo, and itching REF : THOMAS HABIF 6TH ED
2
Herpes simplex
Human papilloma
Cytomegalovirus
Varicella zoster
Dental
All India exam
663d5c31-da1d-49cc-afe2-5b2cf07ffbd1
single
Clinical manifestations of Lesch-Nyhan syndrome is due to the defective recycling of the following:
Lesch-Nyhan syndrome is a genetic disease, affecting almost solely males, of excessive synthesis of purines because of defective recycling and, therefore, uric acid production from their breakdown. Lesch-Nyhan syndrome is characterized by gouty ahritis but, in addition, affects the brain, resulting in mental retardation, loss of control of arm/leg/face movements, aggressive behavior, and self-mutilation by biting and scratching. Ref: Janson L.W., Tischler M.E. (2012). Chapter 4. Nucleosides, Nucleotides, DNA, and RNA. In L.W. Janson, M.E. Tischler (Eds), The Big Picture: Medical Biochemistry.
1
Purines
Methylcobalamin
Pyrimidines
Thiamine
Biochemistry
null
ff7cfc4e-d381-4c04-98c7-64e251f80af5
single
Web constriction is seen in which pa of esophagus, in Plummer-Vinson syndrome
Predominantly, it affects females past 40 years. Barium swallow shows a web in the postcricoid region and the same can be seen on oesophagoscopy. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 388)
3
Thoracic
Abdominal
Cervical
Any of the above
ENT
Oral cavity & Oesophagus
8bdcb749-c1ed-4d25-b996-20c70919c5c9
multi
Warfarin anticoagulants inhibits following coagulation factors :
null
2
II, V, VII, IX
II, VII, IX, X
II, V, IX, X
II, IX, X, XIII
Pharmacology
null
761fd36f-8a50-47d5-8f0e-f5b50ea909df
single
Which terminal plane is favorable for E/E to have class I molar relationship?
null
2
Flush terminal plane
Mesial step
Distal step
None of the above
Dental
null
1bfc8e1e-136f-4e58-b622-c12ee7487abd
multi
Granulomatous uveitis is seen in:
A i.e. Vogt-Koyanagi-Harada disease - Granulomatous uveitis is seen in chronic tuberculosis, leprosy, brucellosis, syphilis, leptospirosis, as well as most viral (esp herpes simplex, herpes zoster & varicella), fungal, protozoal and helminthic infectionsQ. It is also seen in sarcoidosis, sympathetic ophthalmitis, Vogt-Koyanagi-Harada's disease and phacoanaphylactic (lens induced) uveitis. Chronic granulomatous uveitis is caused by tuberculosis, syphilis, leprosy, brucellosis, herpes simplex, herpes zoster, varicella, sarcoidosis and phacoanaphylactic uveitis. Chronic nongranulomatous uveitis is associated with juvenile chronic ahritis, chronic iridocyclitis of children and Fuchs hetrochromic iridocyclitis.
1
Vogt-Koyanagi-Harada disease
Fuch's disease
Bechet's syndrome
All
Ophthalmology
null
28d85333-b1a0-4a33-a437-9871e72ac68c
multi
Type of fibroadenosis most likely to undergo malignant change is -
null
2
Adenosis
Epitheliosis
Sclerosing adenosis
Cystic
Surgery
null
2c5a843e-0926-4e79-98fd-69e4a616e1e8
single
A 36 years old factory worker developed itchy annular scaly plaques in both groins. Application of a caicosteroid ointment led to temporarY relief but the plaques continued to extend at the periphery. The most likely diagnosis is -
Itchy annular lesion in groins with scaling and peripheral spreading and central clearing indicates tinea cruris initially tinea responds to coicosteroids due to masking of infection by steroid effect. iadvl textbook of dermatology, page page 253
4
Erythema annulare centrifugam
Granuloma annulare
Annular lichen planus
Tinea cruris
Dental
Bacterial infections
b7819b96-5708-4994-b4c8-1827e9f29baf
multi
A 45 yr old woman has increasing abdominal girth for the past 2 years. On physical examination, She has abdominal distension. CT scan shows multiple nodules on peritoneal surfaces along with low attenuation mucinous ascites. Cytological examination was done after doing paracentesis. It showed well differentiated columnar cells with minimal nuclear atypia. From which sit did this pathology start?
Pseudomyxoma pertonei is being described. It may arise from low grade mucinous adenocarcinoma of the appendix. Mucinous tumors may also arise in pancreas, but are less likely to disseminate through peritoneal cavity. These tumors are very rare in small intestine. Mucin producing malignancies of the stomach are most likely to have signet ring pattern and diffusely infillrate gastric wall.
4
Pancreas
Ileum
Jejunum
Appendix
Pathology
null
7d9740d8-0f45-436c-aa99-ba5d6cd27432
single
USG done at 18-20 weeks mainly to:
A i.e. Detect fetal abnormality
1
Detect fetal abnormality
Determine sex
Estimate liquor
Determine maturity
Radiology
null
314baaf6-0aea-4ae6-a54c-b357b8852b1b
single
All of the following are features of acromegaly,except -
null
4
Glucose intolerance
Nonsuppressibility of growth hormone by glucose ingestion
Raised levels of plasma somatomedin D
Low serum phophate
Medicine
null
db531341-7006-40fd-88bc-a26f247f2a2c
multi
Mental retardation is defined when I.Q. is below :
C i.e. 70
3
90
80
70
65
Forensic Medicine
null
6ebb3b99-136f-40e0-bf52-dfa7b4f90854
single
In which of the following, interpretation of benefits is done in terms of results achieved: September 2010
Ans. D: Cost effective analysis Cost-effectiveness analysis (CEA) is a form of economic analysis that compares the relative costs and outcomes (effects) of two or more courses of action. Cost-effectiveness analysis is distinct from cost-benefit analysis, which assigns a monetary value to the measure of effect. Cost-effectiveness analysis is often used in the field of health services, where it may be inappropriate to monetize health effect. Typically the CEA is expressed in terms of a ratio where the denominator is a gain in health from a measure (years of life, premature bihs aveed, sight-years gained) and the numerator is the cost associated with the health gain. The most commonly used outcome measure is quality-adjusted life years (QALY). Cost-utility analysis is similar to cost-effectiveness analysis.
4
System analysis
Cost accounting
Cost benefit analysis
Cost effective analysis
Social & Preventive Medicine
null
008ebe70-eb23-4733-81af-1759261566ad
single
Skin test are used for which hypersensitivity reactions?
Type I hypersensitivity reaction is IgE dependent. When a small shocking dose of an antigen is administered intradermally to a sensitised host, there will be a local wheal and flare response. This is cutaneous anaphylaxis. Cutaneous anaphylaxis ( skin test for typ I hypersensitivity ), is useful in testing for hypersensitivity and in identifying the allergen responsible in atopic diseases. Reference : Anathanarayan & paniker's 9th edition, pg no: 163,164 <\p>
1
I
II
III
IV
Microbiology
Immunology
7baba0dd-c85a-44bc-b38f-76ceaf3f2065
single
A Bone marrow transplant recipient patientdeveloped chest infection. On HRCT 'Tree in bud appearance' is seen. Most likely causative agent is:
Pneumocystis [Ref: Harrison I7/e p843; Aicle 'Tree in bud sign' in Journal 'Radiology' and 'Radiographics7 Tree-in-bud is a sign seen in HRCT, most commonly seen with endobronchial spread of Tuberculosis, but can be seen with a wide variety of conditions, most commonly infections. (Described ahead in detail). Theoretically all the options can cause 'Tree-in-bud' sign (although Klebsiella has not been mentioned in the list). So the next clue is Bone marrow transplant. Bone marrow transplant causes a transient state of immunological deficiency leading to a wide variety of oppounistic infections. Among the given options, according to the table and text of Harrison (17/e chapter 'Infections in Transplant Recipients') Pneumocystis and RSV can cause pneumonia after transplant: butPneumocystis is a much more common than RSV. Common Sources of Infections after Hematopoietic Stein Cell Transplantation Period after Transplantation Infection Site Early (<1 Month) Middle (1-4 months) Late (>6 Months) Disseminated Aerobic gram-negative, grain-positive bacteria Nocardia Candida, Aspergillus Encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis) Skin and mucous membranes HSV- HHV-6 VZV Lungs Candida, Aspergillus HSV CMV, seasonal respiratory viruses Pneumocystis Toxoplasma Pneumocystis Gastrointestinal tract CMV Kidney BK virus, adenovirus BK virus Brain HHV-6 Toxoplasma Toxoplasma JC virus Bone marrow HHV-6 Tree-in-bud sign The tree-in-bud sign is a finding seen on thin-section computed tomographic images of the lung (HRCT). (Not seen on X-rays) Peripheral, small, centrilobular nodules are connected to linear, branching opacities that have more than one contiguous branching site, thus resembling a budding or, fruiting tree: this is known as tree-in-bud-pattern. It represents dilated and impacted (mucus or pus-filled) centrilobular bronchioles. The presence of tree-in-bud is indicative of small airway disease. It is most commonly associated with endobronchial spread of Mycobacterium tuberculosis. But it can also be seen in a large number of conditions. Pulmonary infectious disorders involving the small airways are the most common causes of the tree-in-bud sign. Any infectious organism, including bacterial, mycobacterial, viral, parasitic, and fungal agents, can involve the small airways and cause a tree-in-bud pattern. Causes of Tree-in-bud appearance Peripheral airway disease Infection Bacterial Mycobacterium tuberculosis M avium-intracellulare complex Staphylococcus aureus Haemophilus influenzae Fungal Aspergillus Pneumocystis carinii, (renamed Pneumocystis jiroveci) Viral Cytomegalovirus Respiratory syncytial virus Congenital disorders Cystic fibrosis Kaagener syndrome Idiopathic disorders Obliterative bronchiolitis Diffuse panbronchiolitis A spiration Inhalation Toxic fumes and gases Immunologic disorders Allergic bronchopulmonary aspergillosis Connective tissue disorders Rheumatoid ahritis Sjo-gren syndrome Peripheral pulmonary vascular disease Neoplasms Primary pulmonary lymphoma Neoplastic pulmonary emboli Gastric cancer Breast cancer Ewing sarcoma Renal cancer
2
Klebsiella
Pneumocystis
TB
RSV
Surgery
null
68cfbcb3-2bca-4353-bcf4-59bbdaebd411
single
Secondary (AA) amyloid is seen in all except ?
Ans. is 'c' i.e., Multiple myelomao In Multiple myeloma the amyloidosis is AL type (primary amyloidosis).
3
RA
TB
Multiple myeloma
RCC
Pathology
null
e9c60d9f-aecb-4626-a6e5-f8364cd354ce
multi
Large bowel Colonic Diarrhoea is associated with all of the following, except:
Answer is A (Large Stool Volume): Large Bowel Colonic Diarrhoea is typically associated with frequent small volume stools since reservoir capacity of the bowel is reduced. Right-sided (Small Bowel) diarrhea is characterized by large-volume stools. The increase in the number of stools is modest and symptoms attributed to inflammation of the recto-sigmoid are absent. Left-sided (Colonic) diarrhea is characterized by frequent, small-volume stools with obvious evidence of. inflammation Right-Sided and Left-Sided Diarrhea: Contrasts in Clinical Presentation: Feature Small-bowel Diarrhea (Right-sided) Intact Large Bowel Colonic diarrhea (Leftt-sided) Decreased Reservoir capacity Stool volume Large Small Increase in number of stools Modest Large Urgency Absent Present Tenesmus Absent Absent Mucus Absent Absent Blood Absent Present Proctosigmoidoscopy Usually Normal Usually Confirms Inflammation Mechanism Non-Specific Usually Exudative
1
Large Volume Stool
Urgency
Tenesmus
Mucus
Medicine
null
88a8dc07-3999-4d22-9b83-54b0f3bedfc4
multi
A 20 year old girl, presents with 9 month history of neck swelling with thyrotoxic symptoms. On investigation, increased T4 and decreased TSH with palpable 2 cm nodule was found. Next investigation will be:
null
2
USG
Thyroid scan
Radioactive iodine uptake
CT scan
Surgery
null
2ab97b92-9c5a-4d0f-bdd1-30f87070aa80
single
Polycarboxylate cement is used for:
ZINC POLYCARBOXYLATE CEMENT APPLICATIONS: Primarily for luting permanent restorations. As bases and liners. Used in orthodontics for cementation of bands. Also used as root canal fillings in endodontics. Ref: Manappalil P: 95
2
Temporary restoration
Luting
Permanent restoration
Die material
Dental
null
e5cd0f45-a845-4747-8852-47f4455c1d82
single
'Stomach bowel test' is also known as
Live-born infant swallows air into the stomach during respiration, and if present in small intestine it fuher confirms live bih. But air may be present in the stomach after decomposition, or in the stillborn attempting to free the air passages of fluid obstruction. Demonstration: The stomach and intestines are removed after tying double ligatures at each end. They are kept under water and incision is given between the ligatures. Air bubbles will come out if respiration has taken place--Breslau's second life test or stomach bowel test. If milk is present in the stomach, it is a positive evidence of live bih. Ref - Krishan Vij textbook of forensic medicine and toxicology 5e pg - 148,150
3
Hydrostatic test
Breslau's first life test
Breslau's second lfe test
Raygat's test
Forensic Medicine
Sexual offences and infanticide
63bf4a9d-8f28-4ae8-a3b3-d5bee8e18175
single
Maintenance of the corpus luteum during the first trimester of pregnancy is accomplished principally by the secretion of ?
The corpus luteum secretes estrogens, progesterone, and relaxin. hCG, secreted by the syncytiotrophoblast lining the placental villi, maintains the corpus luteum during the first trimester of pregnancy. Antidiuretic hormone (vasopressin does not play a significant role during pregnancy. FSH acts on granulosa cells to promote the conversion of androstenedione to estradiol. LH acts on theca cells to promote androstenedione secretion. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 22. Reproductive Development & Function of the Female Reproductive System. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.
3
Antidiuretic hormone (ADH)
Follicle stimulating hormone (FSH)
Human chorionic gonadotropin (hCG)
Luteinizing hormone (LH)
Physiology
null
e0e53de8-6c92-419f-9ee7-1c7f93fe48b8
multi
The tube as shown in PLATE X-11 is in which space?
ANSWER: (B) Pleural spaceREF: Sabiston 18th ed chapter 57See PLATE X-11 Key PLATE X-11 KeyINTERCOSTAL CHEST TUBE DRAIN (TUBE THORACOSTOMY)A chest tube can be a diagnostic procedure as well as a therapeutic oneINDICATIONS FOR CHEST TUBE DRAIN INSERTION1. Pneumothorax2. In any ventilated patient3. Tension pneumothorax after initial needle relief4. Persistent or recurrent pneumothorax after simple aspiration5. Large secondary spontaneous pneumothorax in patients over 50 years6. Malignant pleural effusion7. Empyema and complicated parapneumonic pleural effusion8. Traumatic haemopneumothorax9. Postoperative--for example, thoracotomy, oesophagectomy. cardiac surgery10 To deliver intrapleural local analgesia in Flail chest CONTRAINDICATIONS OF TUBE THORACOSTOMYThe need for emergent thoracotomy is an absolute contraindication to tube thoracostomy. Relative contraindications include the following:1. Coagulopathy2. Pulmonary bullae3. Diaphragmatic hernia4. Pulmonary, pleural, or thoracic adhesions5. Loculated pleural effusion or empyema6. Skin infection over the chest tube insertion sitePatient position:The preferred position for drain insertion is on the bed, slightly rotated, with the arm on the side of the lesion behind the patient s head to expose the axillary area. An alternative is for the patient to sit upright leaning over an adjacent table with a pillow or in the lateral decubitus position.Drain insertion site: The most common position for chest tube insertion is in the fifth intercostal space in the mid axillary line, through the "safe triangle". This is the triangle bordered by the anterior border of the latissimus dorsi, the lateral border of the pectoralis major muscle, a line superior to the horizontal level of the nipple, and an apex below the axilla. This position minimises risk to underlying structures such as the internal mammary artery and avoids damage to muscle and breast tissue resulting in unsightly scarring.In Open pneumothorax {'sucking chest wound')f A chest tube is inserted as soon as possible in a site remote from the injury site.In Tension pneumothorax a chest tube is inserted through the fifth intercostal space in the anterior axillarylineDrain size: Small bore drains are recommended as they are more comfortable than larger bore tubes but there is no e%ddence that either is therapeutically superior. A large-bore (32-36 French) chest tube should be used in adolescents and adult patientsProcedure:Local anaesthetic should be infiltrated prior to insertion of the drain.Skin incision is made in between the midaxillary and anterior axillary lines over a rib that is below the intercostal level selected for chest tube insertion. The incision for insertion of the chest drain should be similar to the diameter of the tube being inserted. The incision should be made just above and parallel to a rib.Blunt dissection of the subcutaneous tissue and muscle into the pleural cavity. A closed and locked Kelly clamp is used to enter the chest wall into the pleural cavity to develop the tract and then with finger. The index finger should be inserted into the pleural space before tube placement to ensure that the pleural cavity has been entered and is free of adhesions and that any intra-abdominal organs have not herniated through the diaphragm.The tube should be advanced (with or without trochar) posteriorly and superiorly in the pleural cavity. The position of the tip of the chest tube should ideally be aimed apically for a pneumothorax or basally for fluid. However, any tube position can be effective at draining air or fluid and an effectively functioning drain should not be repositioned solely because of its radiographic position.After insertion, the tube should be secured in the skin of the chest wall and connected to a collection system under suction. A chest radiograph is usually obtained after insertion of the chest tube to confirm adequate placement and positioning.All chest tubes should be connected to a single flow drainage system e.g. under water seal bottle or flutter valve. When chest drain suction is required, a high volume/lowr pressure system should be used.Avoid damping the ICD, as it may leads to tension pneumothorax, if forget to remove the clamp.Removal of the chest tube: Genera! criteria for chest tube removal include absence of air leak and less than 100 mL of fluid drainage over a 24-hour period. The chest tube should be removed either while the patient performs Valsalva's manoeuvre or during expiration with a brisk firm movement while an assistant ties the previously placed closure suture. In cases of pneumothorax, the chest tube should not be clamped at the time of its removal.
2
Pericardial cavity
Pleural space
Mediastinum
Lung parenchyma
Surgery
Miscellaneous (Lung)
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single
Nerve supply of tympanic membrane-a) Auriculotemporalb) Auricular branch of vagusc) Occipital nerved) Great auricular nervee) Glossopharyngeal nerve
null
1
abe
bcd
cde
acd
ENT
null
e05ae094-512d-4ed1-9387-6342fc2b1a6e
single
Telmisartan lowers blood pressure by:
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3
Inhibiting formation of angiotensin I to angiotensin II
Inhibiting conversion of renin to angiotensin I
Blocking AT1 receptors
Interfering with degradation of bradykinin
Pharmacology
null
e5893734-1fe0-4c8b-aecb-16bd4cafc29f
single
Best treatment of tension pneumothorax is -
Ans. is 'a' i.e., Immediate letting out of air Tension pneumothorax must be treated as a medical emergency. If the tension in the pleural space is not relieved, the patient is likely to die from inadequate cardiac output or marked hypoxemia. A large-bore needle should be inseed into the pleural space through the second anterior intercostal space. If large amounts of gas escape from the needle after inseion, the diagnosis is confirmed. The needle should be left in place until a thoracostomy tube can be inseed.
1
Immediate letting out of air
Wait and watch
Rib resection
Underwater drainage
Surgery
null
5087acbf-cf2f-4e1a-a0a8-156b6401f239
single
Viper bite resembles poisoning by -
Ans. is 'b' i.e., Abrus precatorius * Abrus precatorius seed is odourless, tasteless, oval (egg shaped), bright scarlet coloured with a black spot at one pole and contain abrin, a toxalbumin as its active principle, which is similar to viper snake venom.* Raw or cooked seeds, when swallowed are non-poisonous. But if extract is injected into wound or under skin, poisonous symptoms occur which resemble viper bite. This method is used to poison cattels by means of needle, known as sin needle.
2
Semicarpus anacardium
Abrus precatorius
Ricinus communis
Capsicum annum
Forensic Medicine
Toxicology
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single
Two weeks after birth, a baby has persistent tachypnea, tachycardia, diaphoresis, and cyanosis. Workup reveals a patent ductus arteriosus. This can be closed with the use of:
The nonsteroidal anti-inflammatory drug, indomethacin, is the drug of choice for closure of a patient ductus arteriosus in a premature infant with an isolated patient ductus arteriosus. For complex cardiac anomalies, which require a patient ductus arteriosus to sustain life until corrective surgery can be done, prostaglandin E1 can be administered to keep the ductus arteriosus open. The other choices are not indicated in patient ductus arteriosus.
1
Indomethacin
Acetaminophen
Aspirin
Cyclosporine
Surgery
Miscellaneous
6cd9c2b5-aadf-4225-b30f-db07bd43276a
single
Dead Layer of epidermis-
Stratum corneum the outermost layer of the epidermis made up of terminally differentiated, dead keratinocytes known as corneocytes. Corneocytes are devoid of cytoplasm and organelles, but loaded with keratin filaments in an amorphous protein matrix, which is held together by the cornified envelope. Ref Harrison20th edition pg 1233
3
Stratum basale
Stratum spinosum
Stratum corneum
Stratum granulosum
Dental
Anatomy of skin
bf8a5b8f-6e74-4632-a4b5-c92bef5bc4fc
single
The chloride shift occurs rapidly and is essentially completes in
Chloride ShiftSince the rise in the HCO3- content of red cells is much greater than that in plasma as the blood passes through the capillaries, about 70% of the HCO3- formed in the red cells enters the plasma.The excess HCO3- leaves the red cells in exchange for Cl-, a process mediated by Band 3, a major membrane protein. This exchange is called the chloride shift. Because of it, the Cl- content of the red cells in venous blood is therefore significantly greater than in aerial blood. The chloride shift occurs rapidly and is essentially completes in 1 second.
1
1 second
2 seconds
5 seconds
60 seconds
Microbiology
All India exam
50b4aecb-4b2e-4f7d-aedb-af9013113ed4
multi
Which one of the following is a tyrosine tRNA analogue that causes premature chain termination?
Puromycin Structural analogue of tyrosinyl tRNA. Incorporated into nascent protein chains by a nonhydrolyzable peptide bond. Growing of the peptide bond is inhibited. Inhibits protein synthesis in both prokaryotes and eukaryotes Causes premature chain termination
2
Cycloheximide
Puromycin
Paromomycin
Erythromycin
Biochemistry
Translation
9403525e-b315-4b13-bf78-c69c9be1460e
single
Macrocytic anaemia occurs in all,except -
null
4
Thiamine deficiency
Liver disease
Orotic aciduria
Copper deficiency
Medicine
null
7c75d933-4869-4cb5-8b9a-2d38feb83af3
multi
Which of the sulfonylureas is best choice in chronic kidney disease patients
Glipizide is the sulphoylurea which is the best and safest among the group for use in ckd patients Ref: Harrison page no 2265,
3
Glimipride
Glibenclanide
Glipizide
Glyburide
Medicine
Endocrinology
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single
Florence test is used for
Ans. (b) SemenRef,: The Essentials of FSM by K.S. Narayan Reddy 31st ed. / 405Tests for Detection ofSeminal Stain (Mnemonic- "Creat Acid Fast Bacilli')* Acid phosphatase test: to detect Aspermia cases* BarberioS test: to detect Spermine (yellow needle shaped spermine picrate)* Creatine phosphokinase test: for old seminal stain* Florence test: choline crystals of semen shows fluoroscence when examined (Rhombotic crystals of choline iodide)* Most specific test for seminal stain: Isoenzyme LDH assay* For dry seminal stain: UV rays used Blood Benzidine test* Best preliminary test as it detects blood present in dilution of 1 in 3 lakhs.* Color produced: Deep Blue* Not used because it is a potential carcinogen.Kastle-Mayer/Phenolpthalein test- color produced is Pink Purple.Microchemical test: based on RBC content of blood.1. Takayama's test: Hb converted to Haemochromogen crystal.# Salmon pink feathery haemochromogen crystals are obtained.2. Teichmann's Haemin crystal test: Hb converted into Hemin/Hematin crystals.# Brown rhombic haemic crystal are seen3. Spectroscopic test: Most specific/confirmatory method for blood stain test4. Thin layer chromatography (TLC)5. ElectrophoresisNOTE: Test to distinguish human vs. animal blood- Precipitin Test,
2
Blood
Semen
Urine
Albumin
Forensic Medicine
Biological Materials & Stains
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single
All are seen in cystitis EXCEPT:
ANSWER: (A) FeverREF: Smith urology 17th ed page 206Acute cystitis refers to urinary infection of the lower urinary tract, principally the bladder.Acute cystitis more commonly affects women than men.Patients with acute cystitis present with irritative voiding symptoms such as dysuria, frequency, Nocturia and urgency,Low back and suprapubic pain, hematuria, and doudy/foul smelling urine are also common symptoms.Fever and systemic symptoms are rare.Urinalysis demonstrates WBCs in the urine, and hematuria may be present.Urine culture is required to confirm the diagnosis and identify the causative organism. However, when the clinical picture and urinalysis are highly suggestive of the diagnosis of acute cystitis, urine culture may not be needed.E. coli causes most of the acute cystitis. Other gram-negative (Klebsiella and Proteus spp.) and gram-positive (S. saprophyticus and enterococci) bacteria are uncommon pathogens.Diabetes and lifetime history of UTI are risk factors for acute cystitis.In general, those in whom acute cystitis developed do not usually require any extensive radiologic investigation (such as a voiding cystourethrogram), but those in whom pyelonephritis developed do.Choice of Antibiotics: 1st: TMP-SMX, 2nd: Fluoroquinolone, 1-3 days
1
Fever
Hematuria
Dysuria
Nocturia
Surgery
Miscellaneous (Bladder)
4452d3fb-b9fd-438d-b2d6-b70cb4fd4eb3
multi
Population covered by anganwadi in tribal area is?
Ans. is 'd' i.e., 700 "According to the existing norms of the government there should be one unganwadi per 1000 population in rural and urban areas, and one anganwadi per 700 population in tribal areas"
4
1000
300
400
700
Social & Preventive Medicine
null
c33c2992-ae9e-41c7-8f34-fef69e35bb67
single
Bisected pearls appearance on culture medium is seen in ?
Ans. is 'b' i.e., Bordetella Bordetella are gram-negative, capsulated, fimbriated, nonmotile coccobacillus.They show bipolar metachromatic granules on staining with toluidine blue.
2
Brucella
Bordetella
Haemophilus ducreyi
Pseudomonas
Microbiology
null
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single