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Which of the following type of face bow is used to locate the exact hinge axis point:
Arbitrary face bows are used to record terminal hinge axis arbitrarily. It is most commonly used in complete denture prosthodontics. It may be of facial type or eyepiece type. Kinematic face bow is used to determine and locate the exact hinge axis point. It is attached to lower jaw. It is not used for complete denture fabrication. It is generally used for the fabrication of FPD and full mouth rehabilitation.
3
Facial type arbitrary.
Eyepiece type arbitrary.
Kinematic face bow.
All of the above.
Dental
null
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multi
0.1 to 0.2 mm nebular corneal opacity is treated by –
Central nebular opacity is treated by phototherapeutic keratectomy with an excimer laser (treatment of choice) or lamellar keratoplasty.
2
Penetrating keratoplasty
Lamellar keratoplasty
Enucleation
Evisceration
Ophthalmology
null
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single
An old man having complaint of anorexia, weakness and paraesthesia. On investigation, his haemoglobin was 5.8g% and peripheral smear showed macrocytes and neutrophils having hypersegmented nuclei. His tendon reflexes were also sluggish. Endoscopy revealed atrophic gastritis. Deficiency of which of the following factor can lead to this situation
Diagnosis of the patient is pernicious anemia. Factors favouring this diagnosis are: Megaloblastic anemia. Demyelination (decreased tendon reflexes) Atrophic gastritis So, he would require B12 supplementation.
3
Folic acid
Riboflavin
VitaminB12
null
Pharmacology
null
1641954f-e6d8-4786-b14c-8204b12e3d90
multi
Which of the following does not develop from the neural ectoderm?
The structures developing from the Neural ectoderm are : Retina with its pigment epithelium Epithelial layers of ciliary body Epithelial layers of iris Sphincter and dilator pupillae muscles Optic nerve(neuroglia and nervous elements only) Melanocytes Secondary vitreous Ciliary zonules (teiary vitreous) Reference: A.K.Khurana; 6th edition; Page no:12
2
Vitreous
Aqueous
Retinal pigment epithelium
Fibres of optic nerve
Ophthalmology
Anatomy, Development and clinical examination
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single
Which of the following condition is diagnosed using a positive urinary anion gap?
Positive urinary anion gap is associated with distal A, as the kidney cannot excrete H+ as NH4Cl. The urinary anion gap (Na+ + K- - Cl-) reflects the ability of the kidney to excrete NH4Cl. It is used to differentiate between gastrointestinal and renal causes of hyperchloremic acidosis. In gastrointestinal cause of hyperchloremic acidosis such as in diarrhea, renal acidification remains normal and NH4Cl excretion increases, and the urinary anion gap is negative. Ref: CURRENT Medical Diagnosis and Treatment, 2012,Chapter 21
4
Acidosis in Diarrhea
Diabetic ketoacidosis
Alcoholic ketoacidosis
Renal tubular Acidosis
Medicine
null
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Multiple drug resistance is transferred through:
Conjugation Sexual contact through the formation of a bridge or sex pilus is common among gram-negative bacilli of the same or another species. This may involve chromosomal or extrachromosomal (plasmid) DNA. The gene carrying the &;resistance&; or &;R&; factor is transferred onlv if another &;resistance transfer factor&; (F) is also present. Conjugation frequently occurs in the colon where large variety of gram-negative bacilli come in close contact. Even nonpathogenic organisms may transfer R factor to pathogenic organisms, which may become widespread by contamination of food or water. Chloramphenicol resistance of typhoid bacilli, streptomycin resistance of E. coli, penicillin resistance of Haemophilus and gonococci and many others have been traced to this mechanism. Concomitant acquisition of multidrug resistance has ocurred by conjugation. Thus, this is a very impoant Mechanism of horizontal transmission of resistance. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:671
3
Transduction
Transformation
Conjugation
Mutation
Pharmacology
Chemotherapy
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Test for ovarian reserve:
Ans. c. FSH /Ref Harrison 19e p2388, 18/e p17/e p2331]Ovarian reserve is the capability of ovary to produce egg. The methods for assessing ovarian reserve are classified into Passive testing and Dynamic testing. FSH level is a method for testing passive ovarian reserve."As woman ages FSH becomes elevated in an attempt to force the aging ovary to respond. Rise in early follicular phase FSH is also accompanied by a decline in oocyte quality. High FSH has been correlated with poor ovarian reserve but it is difficult to establish absolute values that define how high an FSH level can be and still achieve pregnancy."Ovarian reserve* Ovarian reserve is the capability of ovary to produce egg* During the first few days of each monthly cycle, under the influence of FSH and LH there is rapid growth of several follicles in the ovaiy. After a week or more of growth one of the follicles begin to outgrow. AH the others and the remaining follicles involute (a process called atresia), and these follicles are said to become atretic.* The process of atresia is important because it normally allow s only one of the follicles to grow large enough, each month to ovulate. This usually prevents more than one child from developing with each pregnancy.* The single follicle reaches a diameter of l-l .5 centimeters at the time of ovulation and is called the mature follicle.* With advancing age the capability of the ovary to produce eggs declines.Methods of assessing ovarian reserve:* With advancing age the capability of the ovary to produce egg declines i.e. ovarian reserve decrease with age.* Usually age is the best predictor of ovarian reserve but approximately 10% of women have an accelerated loss of ovarian reserve by their mid-30. So age alone does not tell the whole story. Consequently more refined methods for predicting ovrian reserve have been developed.* Goal of methods for assessing ovarian reserve is to provide information regarding oocyte quality and quantity.Methods for Assessing Ovarian ReservePassive testingDynamic testingFSH level:* Early folloicular phase FSH levels play an important role in pregnancy outcomes.* As woman ages FSH becomes elevated in an attempt to force the aging ovary to respond. Rise in early follicular phase FSH is also accompanied by a decline in oocyte quality.* High FSH has been correlated with poor ovarian reserve but it is difficult to establish absolute values that define how high an FSH level can be and still achieve pregnancy.Measurement of Inhibin B:* Inhibin B is an ovarian hormone that inhibits FSH release. Although present in ovulating women it is not normally found in postmenopausal women.* Low inhibin levels suggests poor ovarian reserve.Transvaginal ultrasound:* Diminshed ovarian reserve means that fewer follicles are available for stimulation and recruitment by fertility drugs.* Transvaginal ultrasound allows the observation of ovaries and assess the number of follicles (ovarian volume.)Ciomiphene citrate challenge test:* Clomiphene is an antiestrogen which inhibits the negative feedback of estrogen on hypothalamus i.e. the hypothalamus gets false signals that the patient does not have enough estrogen. In response, the hypothalamus induces the pituitary gland to produce more FSH and LH. This is turn initiates follicular growth to produce estrogen.* Clomiphene is able to exert this effect only when the estrogen level is low or the ovarian reserve is low.* In a normal woman with adequate ovarian reserve there is enough inhibin and estrogen to suppress FSH production through negative feedback and resist the effects clomiphene.* When undergoing clomiphene citrate challenge test. the first step is to measure day 3 FSH and estrogen. Then 100 mg of clomiphere is administered on cycle day 5 through 9 and FSH and estrogen measurement are repeated on cycle day 10.* In general, a high day 10 FSH suggests poor ovarian reserve.
3
LH
LH/FSH ratio
FSH
Estradiol
Gynaecology & Obstetrics
Pathology of Conception
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Gingival clefts may be caused by
null
2
Occlusal disharmonies
Faulty toothbrushing
Normal frenum attachment
Use of dental floss
Dental
null
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single
19 year old boy had a history of fall on out stretched hand while playing. He developed slight radial side pain and tenderness. On examination pressure along the axis of thumb is painful and x rays are normal.
C i.e. Scaphoid fracture
3
Fracture lower end radius
Wrist sprain
Scaphoid fracture
Perilunate dislocation
Surgery
null
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multi
Electronic apex locator is used in Endodontics to determine the
null
2
Root canal morphology
Working length
Pulp stone Location
Pulp vitality
Dental
null
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single
Retinal cells which secrete acetylcholine
The cholinergic amacrine cells of the rabbit retina secrete acetylcholine by two mechanisms. One is activated by stimulation of the retina by light or depolarization of the amacrine cells by K+ ions. It requires the presence of extracellular Ca2+. The second is independent of extracellular Ca2+ and is unaffected by large depolarizations of the cells. It bears some similarity to the acetylcholine &;leakage&; described at the neuromuscular junction. Although the Ca2+-independent mechanism accounts for about two-thirds of the total acetylcholine release in the dark, the amount of acetylcholine released in this way is small compared with the release of acetylcholine triggered by stimulation of the retina with light. Its biological significance is unclear.Ref: Ganong&;s review of medical physiology, 23rd edition, Page no: 182
3
Bipolar cells
Ganglion cells
Amacrine cells
H Cells
Physiology
Nervous system
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Sodium potassium pump is a:
Sodium potassium pump is a heterodimer It has alfa and beta subunits
1
Heterodimer
Homodimer
Polymer
Monomer
Anatomy
General anatomy
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single
Hyperaldosteronism is associated with all except:
Ans. (d) Metabolic acidosis(Ref: Ganong, 25th ed/p.370)Clinical consequences of excess aldosterone are,#Sodium and water retention leading to expansion of ECF volume and hypertension#Excess potassium excretion by kidney (K+ loss)#Excessive urinary excretion of H+ ion leading to metabolic alkalosis
4
Hypernatremia
Hypokalemia
Hypertension
Metabolic acidosis
Physiology
Endocrinology and Reproduction
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Ideal contraceptive for newly married couple is:
Ans b. Combined OCPs Ideal contraceptive for newly married couple is combined oral contraceptive pill"Best contraceptive for newly married couple is combined oral contraceptive pill""Combined oral contraceptive has lesser failure rate than progestins. IUCDs should not be used in newly married couple.""Best contraceptive for parous young women is IUCD (considered the best method for spacing child birth)."
2
Barrier method
Combined OCPs
IUCD
Progesterone only pill
Gynaecology & Obstetrics
Methods - Combined Oestrogen-Progestogen Methods
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All are features of hyper-parathyroidism EXCEPT:
Ans. (c) DiarrheaRef.: Harrison 19th ed. / 2342* Hyperparathyroidism leads to increase PTH. PTH increases serum calcium by increasing dietary absorption of vitamin D3. It also ensures that the proximal convoluted tubule start loosing phosphate in urine leading to decreased serum phosphate.* The increase serum calcium leads to deposition in kidney parenchyma forming calcium phosphate stones. The increased level of calcium also leads to constipation. Therefore abdominal pain are a feature of hyperparathyroidism. Renal Colic is due to stones and severe constipation. Diarrhea is not seen with hypercalcemia/ hyperparathyroidism.
3
Increase serum calcium
Decreased serum phosphate
Diarrhea
Nephrocalcinosis
Medicine
Parathyroid
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24 hours after fever, maculopapular rash and erythema appears on the face of infant. This organism can also cause:
The described lesion is slapped cheek rash seen in Erythema infectiosum caused by Parvovirus B19. Parvovirus B19 also causes Pure red cell aplasia. Diseases caused by Parvo virus B19:- Erythema infectiosum (most common) Transient arrest of erythropoiesis (aplastic crisis) Papular purpuric "gloves-and-socks" syndrome (PPGSS)
3
ALL
CML
Pure red cell aplasia
Hairy cell leukemia
Pediatrics
Impoant Viral Diseases in Children
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What is the immediate management of vitreous hemorrhage in eye-
1. Complete absorption may occur without organization and the vitreous becomes clear within 4-8 weeks. 2. Organization of haemorrhage with formation of a yellowish-white debris occurs in persistent or recurrent bleeding. 3. Complications like vitreous liquefaction, degeneration and khaki cell glaucoma (in aphakia) may occur. 4. Retinitis proliferans may occur which may be complicated by tractional retinal detachment. Treatment 1. Conservative treatment consists of bed rest, elevation of patient’s head and bilateral eye patches. This will allow the blood to settle down. 2. Treatment of the cause. Once the blood settles down, indirect ophthalmoscopy should be performed to locate and further manage the causative lesion such as a retinal break, phlebitis, proliferative retinopathy, etc. 3. Vitrectomy by pars plana route should be considered to clear the vitreous, if the haemorrhage is not absorbed after 3 months
2
Steroids
No treatment
Antibiotics
Vitrectomy
Ophthalmology
null
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Cholera toxin irreversibly stimulates the cAMP-dependent pump in intestinal cells resulting in
Cholera toxin irreversibly stimulates the cAMP-dependent Cl- pump in intestinal cells resulting in massive Cl- rich watery diarrhea. Death is caused by extreme dehydration and electrolyte imbalance.
1
Cl- rich watery diarrhea
K+ rich watery diarrhea
Na+ rich watery diarrhea
Ca+ rich watery diarrhea
Microbiology
All India exam
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single
Least chance of cord prolapse is seen in -
Ans. is 'a' i.e., Vertex Factors associated with cord prolapseo Malpresentations - commonest being transverse (5-10%) & breech (3%) especially with flexed legs or footling and compound presentation (10%)o Contracted pelviso Prematurityo Twinso Hydramnioso Placental factors - minor degree of placenta previa with marginal insertion of cord or long cord,o Iatrogenic - low rupture of membranes, manual rotation of head, EC V, IP Vo Stabilising induction
1
Vertex
Breech
Transverse
Compound
Gynaecology & Obstetrics
Classification, Symptoms, and Signs
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Minimum bone width required for a 4 mm diameter implant is about
null
1
5 mm
10 mm
12 mm
14 mm
Dental
null
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single
The organ most vulnerable to ischaemia due to shock-
The susceptibility of a tissue to hypoxia influences the likelihood of infarction. Neurons are most sensitive to hypoxia (irreversible changes develop in 3-4 minutes) followed by myocardial cells (irreversible changes develop in 20-40 minutes). Fibroblasts are amongst the most resistant cells to hypoxia.
4
Lungs
Adrenals
Kidney
Heart
Pathology
null
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18,20,22,24,26,28 and 30, Best Central tendency is determined by:-
The Metric data is evenly dispersed around the mean, and it is not skewed, Hence the best measure of central tendency is MEAN. Median is preferred in case of Ordinal data; outliers. Mode is preferred in Nominal data.
1
Mean
Median
Mode
Range
Social & Preventive Medicine
Central tendency, Dispersion
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Which of the following is true about upper 1/3' of the rectum?
Ans. is'd' i.e., It is covered by peritoneum on the sides and anteriorlylRef: Basic Human Anatomy, O'Rahilly, Muller Chapter 36)Upper 1/3'd of rectum Covered by peritoneum on the front and sidesMiddle 1/3"r of rectum Covered by peritoneum on the sides onlyLower 1/3"r of rectum Devoid of peritoneal aitachmerits
4
It is covered by peritoneum only anteriorly
It is covered by peritoneum on the front, sides and back
It has no peritoneal attachments
It is covered by peritoneum on the sides and anteriorly
Anatomy
null
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STEPS is the WHO recommended tool for -
Park's textbook of preventive and social medicine 23rd edition The STEPS - the non communicable disease risk factors survey to help countries establish CMS surveillance system. It describes 3 steps: questionnaire, physical measurements and biochemical measurements. .
1
Surveillance of non-communicable disease and their risk factors
Surveillance of communicable diseases and their risk factors
Surveillance of socio-economic status of the community
Changes of trends of moality in non-communicable diseases
Social & Preventive Medicine
Non communicable diseases
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Hexokinase is
A hexokinase is an enzyme that phosphorylates hexoses (six-carbon sugars), forming hexose phosphate. In most organisms, glucose is the most impoant substrate of hexokinases, and glucose-6-phosphate is the most impoant product. Hexokinase can transfer an inorganic phosphate group from ATP to a substrate.
2
Ligase
Transferase
Oxidoreductase
Reductase
Biochemistry
Enzymes
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Wallace's rule is better known as?
ANSWER: (C) Rule of 9 in burn assessment REF: Schwartz's 9th ed chapter 8 table 8-2, Bailey & Love 25th ed page 382, Practical plastic surgery by Zol B. Kryger, Mark Sisco page 155
3
Rule of 10% in pheochromocytoma
Rule of 6 in burns assessment
Rule of 9 in burns assessment
null
Surgery
Pathophysiology of Burn and Inhalation Injury
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The water can in the larynx (saccules) are present in:
It is a diveiculum of mucous membrane which stas from the anterior pa of laryngeal ventricle extending between the vestibular folds and lamina of thyroid cailage. The saccule has plenty of mucous glands whose main purpose is to lubricate the vocal cords (vocal cord is devoid of mucous glands) and hence is known as water can of larynx.
4
Paraglottic space
Pyriform fossa
Reinke's space
Laryngeal ventricles
ENT
null
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Which of the following structures give origin to the Primordial Germ cells?
Primordial germ cells normally develop from the wall of the yolk sac close to allantois. After folding of the embryo these cells are present in the wall of hindgut. The primordial germ cells then migrate along the dorsal mesentery of hindgut by active ameboid movement and reach the developing gonad. The primordial germ cells get mixed with the sex cords, which are thus composed of two cell types, the cells of coelomic epithelium and primordial germ cells. Here onwards development of testes and ovaries will follow a different path.
3
Chorion
Amnion
Yolk sac
Cord blood
Anatomy
null
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The maintenance of posture in a normal adult human being depends upon:
A i.e. Integrity of Reflex arc'Postural Reflexes not only maintain the body in an upright balanced position but also provide the constant adjustments necessary to maintain a stable postural background for voluntary activity'- Ganong 22"V207Integrity of the postural reflex arc is therefore the single best answer of choice.
1
Integrity of reflex arc
Muscle power
Type of muscle fibers
Joint movements in physiological range
Physiology
null
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single
A patient arrives at your office with their full gold crown in hand. They explain to you that another dentist delivered it last week. You then examine the crown and the preparation. Which of the following hand instruments is used for creating retentive features in dentin ?
A special type of excavator is the angle former. It is used primarily for sharpening line angles and creating retentive features in dentin in preparation for gold restorations. It also may be used when placing a bevel on enamel margins. The angle former is mon-angled and has the primary cutting edge at an angle (other than 90 degrees) to the blade.   Ref:   Sturdevant's art and science of operative dentistry page e4
2
Enamel hatchet
Angle former
Straight chisel
GMT
Dental
null
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In strychnine poisoning, convulsions occur because of the antagonist effects at receptors for:
(Ref: KDT 6/e p469) GABA is the principal inhibitory neurotransmitter in the brain and glycine is the inhibitory amino acid in the spinal cord. By antagonizing the glycine receptors, strychnine can result in convulsions and other stimulatory symptoms.
2
Aspaate
Glycine
GABA
Glutamate
Anatomy
Other topics and Adverse effects
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All are true about Huntington's disease except -
null
3
Chorea
Behavioral disturbance
Early onset of memory loss
Cog- wheel rigidity.
Medicine
null
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multi
Investigation of choice for small intestine tumor:
Ans. CT scan with contrast
4
Ba meal follow through
Echo
X-ray abdomen
CT scan with contrast
Radiology
null
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multi
Involvement of pyramidal tract leads to all of the following except
Ans. is 'b' i.e., Fasciculation
2
Spasticity
Fasciculation
Hyper-reflexia
Positive babinski sign
Medicine
null
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Pudendal nerve supplying motor pa to external sphincter is derived from?
S2-S3 roots. There are two sphincters of the urethra a. Internal urethral sphincter (also k/a sphincter vesicae) - it is involuntary in nature - made up of smooth muscle - supplied by sympathetic nerves, from lower thoracic & upper lumbar segments of spinal cord b. External urethral sphincter (also k/a sphincter vesicae) - it is voluntary in nature - made up of striated muscle fibres - supplied by the perineal branch of the pudendal nerve (derived from spinal nerves S2,S3 & S4) - it controls the membranous urethra and is responsible for the voluntary holding of urine.
4
L5-S1 roots
51-S2 roots
L2-L3 roots
S2-S3 roots
Anatomy
null
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Following are principles in the treatment of compound fractures except
B i.e. Immediate wound closure
2
Wound debridement
Immediate wound closure
Tendon repair
Aggressive antibiotic therapy
Surgery
null
18829c65-6ade-4e9f-98af-e3b2f08bad09
multi
All are seen in acute Iridocyclitis except:
C i.e. Mucopurulent discharge Mucopurulent discharge is a feature of acute conjunctivitis not acute iridocyclitisQ.
3
Pain
Ciliary congestion
Mucopurulent discharge
Small pupil
Ophthalmology
null
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One of the following is not included in the major criteria for rheumatic hea disease?
Guidelines of diagnosis used by the American Hea Association include major and minor criteria (ie, modified Jones criteria). In addition to evidence of a previous streptococcal infection, the diagnosis requires 2 major Jones criteria or 1 major plus 2 minor Jones criteria. Major criteria are as follows: Carditis, Migratory polyahritis, Subcutaneous nodules (ie, Aschoff bodies), Erythema marginatum, Chorea (also known as Sydenham chorea and "St Vitus dance"). Minor criteria are as follows: Clinical findings include ahralgia, fever, and previous history of ARF. Laboratory findings include elevated acute-phase reactants (eg, erythrocyte sedimentation rate, C reactive protein), a prolonged PR interval, and suppoing evidence of antecedent group A streptococcal infections (ie, positive throat culture or rapid streptococcal screen and an elevated or rising streptococcal antibody titer).
4
Ahritis
Carditis
Erythema marginatum
Raised ASLO titer
Pediatrics
null
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single
Which statement is false regarding familial adenomatous polyposis :
Ans. is 'a' i.e. males are usually carriers Familiar polyposis coli is an autosomal dominant* condition affecting males and females equally.It is characterized by presence of thousands of adenomatous polyps throughout the large bowel.Carcinomatous change* supervenes in these polyps in 100% of cases by the age of 30-35yrs.Therefore prophylactic colectomy is done. *
1
Males are usually carriers
Autosomal dominant inheritance
If not treated progress to malignancy in 100% of cases
Males and females are affected equally.
Pathology
Small and Large Intestines
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III nerve palsy causes all of the following except -
Features of 3rd(occulomotor) nerve palsy Paralysis of superior rectus, inferior rectus, medial rectus and inferior oblique. Eye is down and out due to unopposed action of superior oblique and lateral rectus. Medial & upward gaze is not possible. Paralysis of sphinctor pupillae → Loss of ipsilateral direct and consensual pupillary light reflex and there is mydriasis. Paralysis of ciliary muscle → Paralysis of accommodation. Two extraocular muscles are spared :- Superior oblique: - Intorsion, abduction and depression remain active. Lateral rectus: - Abduction remains active. So eye is deviated lateraly. Paralysis of levator palpabrae superioris → Ptosis
3
Ptosis
Mydriasis
Medial deviation of eyeball
Pupillary reflex lost
Ophthalmology
null
3a3c1227-5800-4eb1-b90f-e6517c50ff5c
multi
Which neck swelling moves on swallowing
Ans. is 'b' i.e., Thyroid gland
2
Submandibular salivary gland
Thyroid gland
Supraclavicular lymph gland
Sternomastoid tumour
Surgery
null
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multi
"Stary sky" appearance is seen in -
The tumor consists of sheets of a monotonous (i.e. similar in size and morphology) population of medium-sized lymphoid cells with high proliferative activity and apoptotic activity. The "starry sky" appearance seen under low power is due to scattered tingible body-laden macrophages (macrophages containing dead apoptotic tumor cells). The old descriptive term of "small non-cleaved cell" is misleading. The tumor cells are mostly medium in size (i.e. tumor nuclei size similar to that of histiocytes or endothelial cells). "Small non-cleaved cells" are compared to "large non-cleaved cells" of normal germinal center lymphocytes. Tumor cells possess small amount of basophilic cytoplasm with three to four small nucleoli. The cellular outline usually appears squared off.
1
Burkitt's lymphoma
Mantle cell lymphoma
Extra nodal marginal Zone B-cell lymphoma of MALT type
Chronic myeloid leukemia
Pathology
Haematology
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Cardiomyopathy is caused by
Ref: Katzung 14th ed. pg. 964-65; KDTy 6th ed. pg. 826-27* Doxorubicin and daunorubicin are anti-tumor antibiotics. Activity of Daunorubicin is limited to acute leukemia while doxorubicin is effective in several solid tumors.# MOA: Cause breaks in DNA strands by activating topoisomerse II and generating quinolone type free radicals.# Doxrorubicin and daunorubicin both these antibiotics produce cardiotoxicity as a unique adverse effect.* Actinomycin D (Dactinomycin) It is a very potent antineoplastic drug, highly efficacious in Wilms' tumour and rhabdomyosarcoma# Prominent adverse effects are vomiting, stomatitis, diarrhoea, erythema and desquamation of skin, alopecia and bone marrow depression* Mitoxantrone: Recently introduced analogue of doxorubicin with lower cardiotoxicity, probably because it does not produce quinine type free radicals. Though cardiomyopathy can occur, major toxicity is marrow depression and mucosal inflammation.* Mitomycin C: This highly toxic drug is used only in resistant cancers of stomach, cervix, colon, rectum, bladder, etc# Bone marrow and GIT are the primary targets of toxicity.
2
Actinomycin D
Doxorubicin
Mitomycin C
Mitoxantrone
Pharmacology
Anti-Cancer
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single
Restrictive and constrictive cardiomyopathy occurs together in
The etiologies of RCM may be grouped into broad categories as follows: Primary/idiopathic: Endomyocardial fibrosis (EMF), loeffler eosinophilic endomyocardial disease Secondary: Infiltrative, amyloidosis (the most common cause of RCM in the United States), sarcoidosis , progressive systemic sclerosis (scleroderma) , hemochromatosis, , carcinoid hea disease, glycogen storage disease of the hea, radiation/treatment induced, metastatic malignancy, anthracycline toxicity Ref Davidson 23rd edition pg 467
4
Radiation
Adriamycin
Post cardiotomy
Amyloidosis
Medicine
C.V.S
7b5c8f3a-9423-4a3c-9bcd-41bdf784ab8b
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Centromere is almost at the tip of the chromosome in:
Types Of CHROMOSOMES:
3
Metacentric
Submetacentric
Acrocentric
Telocentric
Pathology
null
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Action of topoisomerase III -
Ans. is 4d' i.e., Single strand breako Topoisomerase I - Removes negative supercoiling.o Topoisomerase II - Relaxes positive supercoils and forms negative supercoiling by condensation, of chromosome,o Topoisomerase III - Can introduce single strand breaks during recombination that are required for DNA to be exchanged by adjacent chromosome.o Topoisomerase IV- Acts to disentangle the replicated intertwined DNA strands by making double-strand breaks that allow one duplex to pass through the other.
4
Remove positive supercoil
Remove negative supercoil
Form negative supercoid
Single strand break
Biochemistry
DNA Replication
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Fracture scaphoid is usually seen in
Scaphoid fracture is more common in young adults. Its rare in children and in elderly people. Fracture occurs through the waist of scaphoid. Rarely, occurs through tuberosity. It may be either a crack or a displaced fracture. On examination tenderness on scaphoid fossa or anatomical snuff box. Complications: avascular necrosis, delayed and non-union, wrist osteoahritis. Ref: Essential Ohopaedics, Maheswari & Mhaskar, 9th ed Page no: 115
3
Elderly male
Elderly postmenopausal female
Young active adult
Children
Orthopaedics
Forearm wrist and hand injuries
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True about apoptosis is all, except -
Ans. is 'c' i.e., Apoptosis of cells induce Inflammatory reaction oThe two most striking features of apoptosis are: 1. In contrast to necrosis it does not elicit inflammation 2. Considerable apoptosis may occur in tissues before it becomes apparent in histological section (because it occurs very rapidly). Morphological changes in apoptosis Cell shrinkage o This is the earliest change. o It is due to damage of cytoskeletal proteins that provide structural suppo to the cell. Chromatic Condensation (Pyknosis) o This is due to breakdown and clumping of chromatin. o This is most characteristic feature of apoptosis Formation of cytoplasimic blebs and apoptotic bodies -4 End stage is characterised by bleb formation. Chromosomal DNA fragmentation o It is due to activity of endoneuclease and caspases. Phagocytosis of apoptotic cells and bodies by adjacent macrophages or healthy parenchymal cells. In histological sections apoptotic cell appears as round or oval mass of intensely eosinophilic cytoplasm with dens nucleus chromatin fragments. Note : o Cell shrinkage and fragmentation allow the cells to be efficienccy phagocytosed without release of proinflammatory cellular component.
3
Considerable apoptosis may occur in tissues before it becomes apparent in histology
Apoptotic cells appear round mass of the intensely eosinophillic cytoplasm with dense nuclear chromatin fragments
Apoptosis of cells induce inflammatory reaction
Macrophages phagocytose the apoptotic cells and degrade them.
Pathology
null
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Classical triad of Budd-Chiari syndrome:
BUDD-CHIARI SYNDROME TRIAD- Ascites + Hepatomegaly + Abdominal pain . Treatment Side to Side Poo-caval Shunt is the most effective therapy.
3
Fever, jaundice, abdominal pain
Fever, ascites, jaundice
Hepatomegaly, abdominal pain, ascites
Abdominal pain, jaundice, Hepatomegaly
Surgery
Liver
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Most common disease of human body is:
Dental caries, the most common disease in the mouth, is also the most common disease of the entire body. The first step in treating this disease is to identify it, and radiology is one of the best tools available to do so.
4
Gingivitis
Hypertension
Diabetes
Dental caries
Radiology
null
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Volcano ulcers in esophagus are seen in:
Volcano ulcers - Herpetic esophagitis - odynophagia Candida esophagitis Whitish plague adheres to wall of esophagus
1
Herpetic esophagitis
Candida esophagitis
Apthous ulcer in Crohn
HIV esophagitis
Medicine
viral infection
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Mesangial cells are contracted by
Contraction Relaxation Endothelins ANP AngiotensinII Dopamine Vasopressin PGE2 Norepinephrine cAMP Platelet-activating factor Platelet-derived growth factor Thromboxane A2 PGF2 Leukotrienes C4 and D4 Histamine Ref: Ganong's Review of medical physiology 25th edition. Page: 678 Table 37-3
1
Histamine
Nitric oxide
Bradykinin
Dopamine
Physiology
Cardiovascular system
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A 40-year-old non-alcoholic male patient presented to the OPD with jaundice, lethargy, ahralgia, skin pigmentation, loss of libido, polyuria, polydipsia and exeional dyspnea. O/E, Hepatosplenomegaly Increased pigmentation and spider angiomas Ahropathy Ascites Loss of body hair and testicular atrophy Iron studies were done. LFTs were deranged and insulin levels were raised. Liver biopsy was also performed. Patient had no history of intake of any long-term medication. Iron studies are: - Plasma iron - 200 microgm/dL TIBC- 300 microgm/dL Transferrin saturation -90% Serum ferritin -5000 microgm/L Liver iron -10000 microgm/ gm of dry weight Hepatic iron index - 3 Which is the most common mutation seen in the above condition: -
This is a case of haemochromatosis with C282Y mutation. HPE image shows Prussian blue-stained section, hepatocellular iron appears blue. The most common HFE mutation is a cysteine-to-tyrosine substitution at amino acid 282 (called C282Y). The other common mutation is H63D (histidine at position 63 to aspaate). DETERMINATION NORMAL SYMPTOMATIC HAEMOCHROMATOSIS PLASMA IRON (microgm/dL) 9-27 180-300 TIBC (microgm/dL) 45-66 200-300 TRANSFERRIN SATURATION % 22-45 50-100 SERUM FERRITIN (microgm/L) 20-150 1000-6000 LIVER IRON (microgm/ gm dry wt.) 300-1400 6000-18000 HEPATIC IRON INDEX <1 >2
1
C282Y
H63D
H62D
C283Y
Unknown
Integrated QBank
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A preterm neonate with hyaline membrane disease needs to be treated with:
d. Surfactant(Ref: Nelson's 20/e p 854)Systemic or inhaled corticosteroids have been used, mainly in those infants with RDS, who continue to require respiratory support & in whom bronchopulmonary dysplasia (BPD) develops.Routine use of corticosteroids for the prevention or treatment of BPD is not recommended by the American Academy of Pediatrics.
4
Dexamethasone
Betamethasone
Hydrocortisone
Surfactant
Pediatrics
New Born Infants
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In normal diurnal variation, intraocular pressure is:
Ans. Highest on awakening and lowest during evening
1
Highest on awakening and lowest during evening
Lowest during morning and highest during evening
Highest in the morning and evening
Lowest in the morning and evening
Ophthalmology
null
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Example of syndesmosis joint is: September 2007
Ans. B: Tibiofibular Joint I. Six types of synol joints are: Hinge Ball-and-socket Pivot Condyloid (angular or ellipsoidal) Plane (gliding) Saddle. - The elbow is an example of a hinge joint. Here, the convex and concave aiculating bones allow movement along one plane, similar to a door. -The shoulder and hip are the only ball-and-socket joints in the body. In this type of joint, one bone has a spherical head that aiculates with a corresponding concavity. This joint frees the joint to move in many directions. - In a pivot joint, one round-shaped aiculating bone fits within a corresponding depression on another bone. This joint allows one bone to rotate against the other. An example is the radioulnar joint (joint of the radius and ulna) in the forearm. - In a condyloid (angular) joint, one bone has an oval aiculating head that rests within an oval concavity. This joint permits angular movement of the bones. The metacarpophalangeal joint (junction between the metacarpals and phalanges) of the hand are examples of condyloid joints - Plane joints have two flat bones joined. The sole movement of the bones is sho gliding motions. An example of this joint is the intearsal joint (junction between the tarsal bones) of the feet. Saddle joint bones have convex and concave surfaces similar to a saddle. This joint allows the joint to move in many directions. The carpometacarpal joint of the thumb is an example saddle joint. II. As their name implies, amphiahrosis joints (slightly movable joints) have limited movement. The two types of amphiahrosis joints are: Syndesmosis (fibrous) Symphysis (cailaginous). - A Syndesmosis joint occurs when two bones join by a section of cailage. The junction between the tibia and fibula is an example. A symphysis joint forms when two bones fuse by a fibrocailage pad. Typical symphysis joints are between the pubic symphysis (pubic bones in the pelvis), and in the veebral column between individual veebrae. Interveebral discs act as weight-bearing shock absorbers for walking, jumping, and lifting. III. An immovable joint is called a synahrosis. The two types of this joint are: Sutures Gomphoses. - Sutures are joined by sho fibers of dense fibrous connective tissue and are in the skull. - The single example of a gomphosis joint is the teeth sitting within their sockets. IV. An example of a bony fusion joint is the fusion of the three bones forming a coxa (hip bone): the ilium, ischium, and pubis.
2
Tibiotalar joint
Tibiofibular joint
Elbow joint
Carpometacarpal joint
Surgery
null
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Epidemic dropsy results from -
Sanguarine,a toxic alkalpid from argemone oil interfers with the oxidation of pyruvic acid which accumulates in the blood causing epidemic dropsy.seeds of argemone mexicana closely resembles mustard seeds.(Ref.PARK'S textbook of social and preventive medicine 21st edition page no.608)
2
Dhatura poisoning
Argemone poisoning
Aluminum phosphide poisoning
Organophosphorus poisoning
Social & Preventive Medicine
Nutrition and health
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Sullivan's Index is
Sullivan's Index : Life expectancy - Duration of disability.
1
Disability Free Life expectancy(DFLE)
Disability Adjusted Life expectancy(DALE)
Quality Adjusted Life Expectancy(QALE)
Health Adjusted Life Expectancy(HALE)
Social & Preventive Medicine
null
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single
Which structure prevents spread of infection from middle ear to brain
Tegmen tympani forms the roof of the middle ear and it also extends posteriorly to form a roof of aditus and antrum. Reference: Dhingra 6th edition
1
Tegmen tympani
Cribriform plate
Fundus tympani
Petrous apex
ENT
Ear
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Systolic murmur in TOF is due to ?
Ejection systolic murmur in TOF is due to pulmonary stenosis. Ref : Ghai essential of pediatrics, eighth edition, p.no:420
2
VSD
Pulmonary stenosis
ASD
null
Pediatrics
C.V.S
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Longest cranial nerve is
The word "vagus" means wandering in Latin. This is a very appropriate name, as the vagus nerve is the longest cranial nerve. It runs all the way from the brain stem to pa of the colon. Ref - medscape.com
1
Vagus
Trigeminal
Trochlear
Olfactory
Anatomy
Head and neck
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A patient with sputum positive pulmonary tuberculosis is on ATT for the last 5 months but the patient is still positive fo AFB in the sputum. This case refers to -
- any patient treated with category I of DOTS who has a positive s near at 5 months of the treatment should be considered as failure case. - the patient should be staed with Category II treatment afresh. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:188 <\p>
2
New case
Failure case
Relapse case
Drug defaulter
Social & Preventive Medicine
Communicable diseases
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Hypercarbia is characterized by:
Excess CO2 in aerial blood (hypercarbia/hypercapnia) has a direct peripheral effect; it causes cutaneous vasodilation. However, it acts on the VMC, resulting in increased sympathetic vasoconstrictor discharge. This will result in vasoconstriction in other vascular beds. These effects tend to cancel out, yet there is increased blood pressure. The overwhelming effect of CO2 on the VMC would cause hypeension. Hence, option D is correct. The increased sympathetic discharge would also cause tachycardia, mydriasis. There is cerebral and cutaneous vasodilation. Cutaneous vasodilation leads to flushed skin and warm extremities. There is increased sweating.
4
Miosis
Cool extremities
Bradycardia
Hypeension
Physiology
Respiratory System Pa 3
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Which of the following drug have high volume of distribution of drug?
Ans. A. Lipophilic. (Ref KDT 6th/pg. 19; Harrison's 17th edition, page 29)APPARENT VOLUME OF DISTRIBUTION (Theoretical volume occupied by the total absorbed drug amount at the plasma concentration.)# Vd = amount of drug in the body / plasma drug concentrationFactors governing the volume of drug distribution:# Lipid: Water partition Co-efficient of the drug: Lipid insoluble drugs do not enter cells - V approximates extracellular fluid volume, e.g. streptomycin, gentamicin 0.25L/kg.# pKa value of the drug.# Degree of plasma protein binding: The volume of distribution of drugs extensively bound to plasma proteins but not to tissue components approaches plasma volume (are largely restricted to the vascular compartment) and hence have low V values e.g. diclofenac and warfarin (99% bound) V = 0.15L/kg.# Affinity for different tissues: By contrast, for drugs highly bound to tissues, the volume of distribution can be far greater than any physiologic space. Thus, drugs sequestrated in tissues may have, V much more than total body water or even body mass, e.g. digoxin 6 L/kg, propranolol 4L/kg, morphine 3.5 L/kg, because most of the drug is present in other tissues and plasma concentration is low. Thus, in case of poisoning, drugs with large volume of distribution are not easily removed by hemodialysis.# Fat: lean body mass ratio, which can very with age, sex, obesity, etc.# Diseases like CHF, uremia, cirrhosisVd COMPARTMENT DRUG TYPESLowBlood (4-8 L)Large/charged molecules; plasma protein boundMediumECFSmall hydrophilic moleculesHighAll tissues including fatSmall lipophilic molecules, especially if bound to tissue proteinHarrison's 17th edition, page 29.............DRUG DISTRIBUTIONIn a typical 70-kg human, plasma volume is ~3 L, blood volume is ~5.5 L, and extracellular water outside the vasculature is ~42 L. The volume of distribution of drugs extensively bound to plasma proteins but not to tissue components approaches plasma volume; warfarin is an example. By contrast, for drugs highly bound to tissues, the volume of distribution can be far greater than any physiologic space. For example, the volume of distribution of digoxin and tricyclic antidepressants is hundreds of liters, obviously exceeding total-body volume. Such drugs are not readily removed by dialysis, an important consideration in overdose.Only when distribution is near-complete does the concentration of digoxin in plasma reflect pharmacologic effect. For this reason, there should be a 6-8 h wait after administration before plasma levels of digoxin are measured as a guide to therapy.Educational pointsClinical Implications of Altered Protein BindingThe acute-phase reactant ?l-acid glycoprotein binds to basic drugs, such as lidocaine or quinidine, and is increased in a range of common conditions, including myocardial infarction, surgery, neoplastic disease, rheumatoid arthritis, and burns. This increased binding can lead to reduced pharmacologic effects at therapeutic concentrations of total drug. Conversely, conditions such as hypoalbuminemia, liver disease, and renal disease can decrease the extent of drug binding, particularly of acidic and neutral drugs, such as phenytoin. Here, plasma concentration of free drug is increased, so drug efficacy and toxicity are enhanced if total (free + bound) drug concentration is used to monitor therapy.
1
Lipophilic
Hydrophilic
Highly protein bound
Drug with low therapeutic index
Pharmacology
General Pharmacology
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Most common cardiac involvement in Rheumatoid arthritis is
(B) Pericarditis # CARDIAC COMPLICATIONS OF RHEUMATOID ARTHRITIS> Pericarditis: Asymptomatic. One-third of patients with seropositive RA.> Myocarditis.> Endocarditis.> Conduction defects.> Coronary vasculitis.> Granulomatous aortitis.
2
Conduction defects
Pericarditis
Myocarditis
Infective Endocarditis
Medicine
Miscellaneous
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Young Helmholtz theory is associated with which of the following?
The Young-Helmholtz theory of color vision in humans postulates the existence of three kinds of cones, each containing a different photopigment and that are maximally sensitive to one of the three primary colors, with the sensation of any given color being determined by the relative frequency of the impulses from each of these cone systems. Ref: Ganong's Review of Medical Physiology 23rd edition, Chapter 12.
1
Colour vision
Nerve conduction
Nerve conduction
None of the above
Ophthalmology
null
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Regarding congenital hypertrophic pyloric stenosis true statement is:
Ans. (b) On non feeding a mass is palpated in right upper quadrantRef: Bailey and Love 27th Edition, Page 128Congenital Hypertrophic Pyloric Stenosis* Diagnosed by clinical finding* During a test feed a visible gastric peristalsis is seen passing from left to right across upper abdomen.* In a relaxed baby (nonfeeding): Pyloric tumor is palpated as an Olive-shaped mass in right upper quadrant (Author's Note: As I Have already told a direct line from Bailey by NBE examiners)* Diagnosis is confirmed by USG.
2
On feeding an olive mass palpated in epigastric region
On nonfeeding a mass is palpated in right upper quadrant
Mass is felt in umbilical region
A palpable mass is seen in right iliac fossa
Surgery
Stomach & Duodenum
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Which congenital heart disease is associated with pre excitation ?
null
3
Atrial Septal Defect
Bicuspid Aortic Valve
Ebstein's Anomaly
Patent Ductus Arteriosus
Medicine
null
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single
The MOST commonly used chemotherapeutic agent in trans aerial chemoembolisaion for hepatocellular carcinoma is:
Doxorubicin, Cisplatin and Mitomycin all are used in TACE. However the most commonly used agent is Doxorubicin. Ref: Quality-Improvement Guidelines for Hepatic Transaerial Chemoembolization: Cardiovasc Intervent Radiol
1
Doxorubicin
Cisplatin
Mitomycin C
5 FU
Medicine
null
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single
Which of the following muscle act as tensor of vocal cord?
Cricothyroid Vocalis which is the internal pa of thyroarytenoid act as tensor of vocal cord. Muscles acting as abductors of vocal cords: posterior cricoarytenoid Adductors of vocal cords: lateral cricoarytenoid, interarytenoid and thyroarytenoid (external pa). Muscles which acts as openers of laryngeal inlet: Thyroepiglottic (pa of thyroarytenoid) Muscles which close laryngeal inlet: Interarytenoid (oblique pa), aryepiglottic (posterior oblique pa of interarytenoids).
2
Vocalis
Cricothyroid
Cricoarytenoid
Thyroarytenoid
ENT
null
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single
Doc for Cryptosporidium parvum is
Nitazoxanide is Doc for Cryptosporidium. Cotrimoxazole is Doc for Cyclospora and isospora.
1
Nitazoxanide
Cotrimoxazole
Ivermectin
DEC
Microbiology
null
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single
All of the following are features of cochlear hearing loss except-
Ans. is 'b' i.e., Speech discrimination is highly impaired Cochlear SNHLRetrocochlear SNHLDamage to hair cellsDamage to VIII nerve and its connectionsRecruitment presentRecruitment AbsentNo significant tone decaySignificant tone decaySISI PositiveSISI NegativeSpeech discrimination not highly impairedSpeech discrimination highly impairedSubjective diplacusis, hyperacusis, ear fullnessNo such feelingBekesy shows no gap between I and C tracing (Type II)Bekesy shows wide gap between I and C tracings (type III)
2
SISI test is positive
Speech discrimination is highly impaired
No tone decay
Damage to hair cells
ENT
Hearing Loss
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Testing of Hypothesis is
null
2
Descriptive epidemiology
Analytical
Experimental
None of the above
Social & Preventive Medicine
null
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multi
Which is the best investigation to detect Pneumoperitoneum?
The term pneumoperitoneum refers to the presence of air within the peritoneal cavity. The most common cause is a perforation of the abdominal viscus--most commonly, a perforated ulcer. At least 2 radiographs should be obtained, including a supine abdominal radiograph and either an erect chest image or a left lateral decubitus image. The patient should remain in position for 5-10 minutes before a horizontal-beam radiograph is acquired. A lateral chest x-ray has been found to be even more sensitive for the diagnosis of pneumoperitoneum than an erect chest x-ray. Signs of a large pneumoperitoneum include the following: The football sign, which usually represents a large collection of air within the greater sac. The gas-relief sign, the Rigler sign, and the double-wall sign are all terms applied to the visualization of the outer wall of bowel loops caused by gas outside the bowel loop and normal intraluminal gas. The lateral umbilical ligaments, which contain the inferior epigastric vessels, may become visible as an inveed V sign in the pelvis as a result of a large pneumoperitoneum. A telltale triangle sign represents a triangular pocket of air between 2 loops of bowel and the abdominal wall. Free air under the diaphragm may depict the diaphragmatic muscle slips as arcuate soft tissue bands, arching parallel to the diaphragmatic dome. Air may be present around the spleen.
3
Plain X ray abdomen, erect
Left lateral decubitus
Plain X ray chest, erect
CT Scan
Radiology
null
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Index of duration of malnutrition is -
<p> Malnutrition: Defined as a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients. It comprises: Undernutrition, Overnitrition, Imbalance and Specific deficiency. Main victims are children under 15 years. Children under 5 years are hit the hardest. Malnutrition in India is mainly attributed to kwashiorkar, marasmus, xerophthalmia, nutritional anemia and endemic goitre. Iron deficiency anemia is the most widespread micronutrient deficiency affecting all age groups in India. The effects are direct and indirect. Direct effects are occurence of frank and subclinical nutrition deficiency diseases such as kwashiorkar, marasmus, vitamin and mineral deficiency. Indirect effects are a high morbidity and moality among young children retarded physical and mental growth. Malnutrition predisposes to infection and infection to malnutrition. Waterlow&;s classification of PEM: It defines two groups- 1. Malnutrition with a retarded growth, in which a drop in height/age ratio points to a chronic condition - shoness/stunting. It is an index of duration of malnutrition 2. Malnutrition with a low weight fir a normal height, in ehich the weight for height ratio is indicative of acute condition of rapid weight loss/ wasting . It is an index of severity of malnutrition. Classification of grades of PEM is given by ICMR. IAP Classification of malnutrition: Based on % of ideal weight expected for the age. 1. Normal : >80% 2. Grade 1 PEM: 71-80% 3. Grade 2 PEM:61-70% 4. Grade 3 PEM:51-60% 5. Grade 4 PEM:<50% {Reference: Park&;s textbook of community medicine 23 rd edition, pg no. 640}
2
Weight for height
Height for age
Weight for age
null
Social & Preventive Medicine
Nutrition and health
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multi
All are components of Meig's syndrome. Except -
Ans. is 'd' ' Pericardial effusion (Ref : Shaws, 13/e, p 365 (12/e, p 322))."Meigs syndrome is combination of ovarian fibroma* with ascites* and hydrothorax* usually right sided" - Shaws, 12/e.Other than fibroma, other ovarian tumours associated with this syndrome are -Granulosa tumours*Brenner tumour*
4
Pleural effusion
Ovarian tumour
Ascitis
Pericardial effusion
Gynaecology & Obstetrics
Presentation (Carcinoma Ovary)
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With which heart diseases in Pregnancy is prognosis worst:
Ans. a (Eisenmenger's syndrome). (Ref. Textbook of obstetrics D C Dutta 6th ed. 296)HEART DISEASE IN PREGNANCY# The risk of fetal congenital malformations is increased by 3-10% if either parents have congenital lesions. In mother with AV septal defect, risk of having concordant abnormality in baby is very much high.# Most common heart disease in pregnancy is mitral stenosis.# Most common congenital heart disease during pregnancy is ASD.# Absolute indications for termination of pregnancy are = primary pulmonary hypertension, and Eisenmenger's syndrome as maternal mortality is otherwise found to be highest in them.
1
Eisenmenger's syndrome
Aortic Stenosis
Mitral Stenosis
MVP
Gynaecology & Obstetrics
Miscellaneous (Gynae)
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single
All of the following are seen in Coarctation of Aorta, except-
Ans. is 'd' i.e., Boot Shaped Heart Coarctation of Aorta -o Symptoms of coarctation of Aorta occurs due to decrease in blood supply distal to Aortic obstruction.o Narrowing or constriction of lumen in coarctation of Aorta may occur anywhere along its length but is most common distal to the origin of the left subclavian artery but sometimes it occurs above the origin of the left subclavian artery.o In these cases the blood supply to left arm (supplied by left subclavian) is interrupted whereas blood supply to the right arm is normal. This results in pressure difference between two arms.o The main reason for symptoms in coarctation of Aorta is interruption of blood supply to the organs located distally to obstructiono Very little of the left ventricle output reaches the descending Aorta.o The symptoms are weak pulses and lower blood pressure in the lower extremities associated with manifestations of arterial insufficiency (i.e., claudication and coldness).o Physical examination shows delayed or weak impalpable femorals compared to strong brachial arteries.o Collateral circulation develops between the precoarctation arterial branches and the postcoarctation arteries through enlarged intercostal and internal mammary arteries.o This produces the radiologically visible erosions (notching) of the undersurface of ribs.o Initially when the narrowing is not very severe the blood flowing through the obstruction produces mid systolic murmur passing through the anterior part of chest, back and spinous process, But when the lumen is sufficiently narrowed, the blood flowing across it results in, high velocity jet across the lesion throughout the cardiac cycle resulting in continuous murmur.o Although coarctation of Aorta may occur as solitary defect, it is accompanied by Biscuspid aortic valve in 50% cases. The Biscuspid valve produces Aortic regurgitation and this results in diastolic murmur seen in coarctation of Aorta.o In coarctation of Aorta unless the hypertension is very severe or left ventricular failure has ensued, cardiac output responds normally to exercise.o Coarctation of Aorta is characterized by Hypertension.Pathophysiology of Hypertension in Coarctation of Aorta.o In coarctation of Aorta the narrowing is typically found just after the vessels are given off to the left arm.o This leads to diminished blood supply in organs distal to the narrowing.o There is diminished blood supply to the kidney. So the kidney releases renin to compensate for the diminished blood supply. But the renin release leads to hypertension in organs which originally had normal B.P.o In this way heart and brain are subjected to very high pressures caused due low blood supply to kidney. The hypertension produces headache and dizziness.Treatment of coarctation of Aorta:o Coarctations generally require repair. Dilating the segment with balloons is a possibility, particularly in the young.o Surgical removal of the narrowed segment needs to be accomplished. If allowed to persist, the high blood pressure which is induced may become "permanent" even after removal of the narrowed segment, due to changes in some organs which are irreversible.o In coarctation of Aorta constriction of the Aorta occurs distal to the origin of the left subclavian artery.o So the blood supply of the organs supplied by Aortic segment before the constriction is normal where as the blood supply of the organs supplied by portion of Aorta distal to the constriction is reduced.o This causes marked difference in blood supply between the upper and lower parts of the body.o The pulses and the pressure is greater in upper extremities compared to the pressure and pulses in lower extremities.o On physical examination there is delay in the femoral pulse.o The reduced blood supply in lower extremities produces manifestations of arterial insufficiency i.e., claudication and coldness.Murmur in Coarctation of Aortao The blood passing through the narrowed Aorta produces midsystolic murmur which can be heard over the anterior part of the chest back and spinous process.o When the lumen becomes severely narrowed the blood flow through it, turns in to a high velocity jet which produces continuous systolic murmur.The chest radiographNotching of undersurface of ribso Compensatory collaterals develop between the precoarctation arterial branches and postcoarctation arteries through the enlarged intercostal and internal mammary arteries.o These produces the radiologically visible erosions ("notching") of the undersurface of ribs."3" Signo The characteristic "3" sign of the coarctation of Aorta is produced due to indentation or constriction of Aorta at the site of coarctation and pre and post stenotic dilatation of Aorta.
4
Diminution of femoral pulsations
High incidence of associated Bicuspid aortic valve
Left ventricular Hypertrophy
Boot Shaped Heart
Medicine
Diseases of the Aorta
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Hernia into pouch of Douglas is ..... hernia -
Ans. is 'd' i.e., Berger's Beclard's hernia ---> is the femoral hernia through the opening of the saphenous vein (named after Pierre Augustin Beclard) [Ref: www.whonamedit.comj
4
Beclard's
Bochdaleks
Blandin's
Berger's
Surgery
null
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Most common cerebellar tumor in children
Refer Robbins page no 8/e
3
Medullobalstoma
Epdendymoma
Astrocytoma
PNET
Anatomy
General anatomy
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"Blow-out" fracture of orbit involves:
Ans. All of the above
3
Floor
Medial wall
All of the above
None of the above
Ophthalmology
null
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According to Herrington classification, the decerebrate rigidity is characterized by all except
In decerebrate rigidity, there is rigidity in extensor muscles of all the four extremities (not all muscles of the body). Decerebration Complete transection of the brain stem between the superior and inferior colliculi permits the brain stem pathways to function independently of their input from higher brain structures. This is called a mid-collilcular decerebration. This lesion interrupts all input from the coex (coicospinal and coicobulbar tracts) and red nucleus (rubbrospinal tract), primarily to distal muscles of the extremities. The excitatory and inhibitory reticulospinal pathways (primarily to postural extensor muscles) remain intact. The dominance of drive from ascending sensory pathways to the excitatory reticulospinal pathway leads to hyperactivity in extensor muscles in all four extremities which are called decerebrate rigidity . The excitatory input from the reticulospinal pathway activates Y-motor neurons which indirectly activate alpha-motor neurons ( la spindle afferent activity ). This is called the gamma loop. REf: Ganong&;s review of Medical Physiology 25th edition Pgno: 241, 242
1
Rigidity occurs in all the muscles of the body
Increase in the rate of discharge of the Y efferent neuron
Increased excitability of the motor neuron pool
Decerebration produces no phenomenon akin to spinal shock
Physiology
All India exam
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The type of chisel with the shank and blade slightly curved is:
null
2
Straight chisel
Wedelsaedt chisel
Enamel hatchet
GMT
Dental
null
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Platlets can be stored at
Ans. is (a) i.e. 20-24degC for 5 days
1
20-24degC for 5 days
20-24degC for 8 days
4-8degC for 5 days
4-8degC for 8 days
Surgery
null
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Enlarged liver with Hepatocellular dysfunction seen In-
Pathophysiology Normally, dietary copper is absorbed from the stomach and proximal small intestine and is rapidly taken into the liver, where it is stored and incorporated into caeruloplasmin, which is secreted into the blood. The accumulation of excessive copper in the body is ultimately prevented by its excretion, the most impoant route being bile. In Wilson's disease, there is almost always a failure of synthesis of caeruloplasmin; however, some 5% of patients have a normal circulating caeruloplasmin concentration and this is not the primary pathogenic defect. The amount of copper in the body at bih is normal but thereafter it increases steadily; the organs most affected are the liver, basal ganglia of the brain, eyes, kidneys and skeleton. The ATP7B gene encodes a member of the copper-transpoing P-type adenosine triphosphatase family, which functions to expo copper from various cell types. At least 200 different mutations have been described. Most cases are compound heterozygotes with two different mutations in ATP7B. Attempts to correlate the genotype with the mode of presentation and clinical course have not shown any consistent patterns. The large number of culprit mutations means that, in contrast to haemochromatosis, genetic diagnosis is not routine in Wilson's disease, although it may have a role in screening families following identification of the genotype in an index patient. Clinical features Symptoms usually arise between the ages of 5 and 45 years. Hepatic disease occurs predominantly in childhood and early adolescence, although it can present in adults in their fifties. Neurological damage causes basal ganglion syndromes and dementia, which tends to present in later adolescence. These features can occur alone or simultaneously. Other manifestations include renal tubular damage and osteoporosis, but these are rarely presenting features. Liver disease Episodes of acute hepatitis, sometimes recurrent, can occur, especially in children, and may progress to fulminant liver failure. The latter is characterised by the liberation of free copper into the blood stream, causing massive haemolysis and renal tubulopathy. Chronic hepatitis can also develop insidiously and eventually present with established cirrhosis; liver failure and poal hypeension may supervene. The possibility of Wilson's disease should be considered in any patient under the age of 40 presenting with recurrent acute hepatitis or chronic liver disease of unknown cause, especially when this is accompanied by haemolysis. Neurological disease Clinical features include a variety of extrapyramidal features, paicularly tremor, choreoathetosis, dystonia, parkinsonism and dementia . Unusual clumsiness for age may be an early symptom. Neurological disease typically develops after the onset of liver disease and can be prevented by effective treatment staed following diagnosis in the liver disease phase. This increases the impoance of diagnosis in the liver phase beyond just allowing effective management of liver disease. Ref Davidson edition23rd pg896
1
Wilson's disease
Budd. Chiari syndrome
Alcoholic hepatitis
NASH
Medicine
G.I.T
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The major cause of us is
Favus is a chronic infection caused most commonly by T schoenleinii and usually affecting the scalp. Most common organism associated with us is Trichophyton schoenlenii. E. floccosum- cause Tinea unguium (nail beds) M. canis- cause ECTOTHRIX(infection of hair) T. rubrum- cause Tinea cruris (groin area)
4
M. canis
E. floccosum
T. rubrum
T. schoenlenii
Microbiology
Mycology
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Time difference between screening test and standard test is known as-
<p>Screening is the search for unrecognised disease or defect by means of rapidly applied tests ,examinations or other procedures in apparently healthy individuals. Lead time is the advantage gained by screening.it is the time period between diagonosis by early detection and diagonosis by other means.That is lead time is the time difference between diagonosis by screening tests and standard test. Parks textbook of preventive and social medicine.K Park. Edition 23.Pg no: 136</p>
1
Lead time
Generation time
CIP
Lag time
Social & Preventive Medicine
Screening
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Uncommon complication of meckels diveiculum is: September 2005
Ans. C: Malignancy Epidemiology - More common in males by ratio of 3:2 Lifetime complication rate: 4% - More than 50% of complications occur before age 10 History-Initial repo by Hildanus in 1598, Detailed description by Johann Meckel in 1809 Pathophysiology: Meckel's Diveiculum - Incomplete vitelline duct (omphalomesenteric) closure - Location . Proximal to ileocecal valve by 100 cm Usually within 45 to 60 cm of ileocecal valve Differential Diagnosis of Meckel's Diveiculitis-Appendicitis Complications of Meckel's Diveiculum - GI Bleeding (25-50% of complications) Often associated with ectopic gastric mucosa Hemorrhage is most common presentation under age 2 - Meckel's Diveiculitis (10-20% of complications)-Similar in presentation to Appendicitis - Bowel Obstruction Volvulus at fibrotic band attached to abdominal wall Intussusception Incarcerated Inguinal Hernia (Littre's hernia) - Other complications-Carcinoid Tumor Radiology - Radionuclide Scintigraphy (Sodium Tc-peechnetate) Preferential uptake by gastric tissue Most accurate test in Meckel's Diveiculum-Test Sensitivity is 85% in children and Test Specificity is 95% in children Less accurate in adults -Cimetidine increases accuracy in adults - Small bowel enema-Indicated for negative scintigraphy in adults - Aeriography (indicated for acute hemorrhage)
3
Intussusception
Diveiculitis
Malignancy
Increased bleeding
Surgery
null
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A 50-year-old male patient presented to the OPD with the complaint of progressive dysphagia for 4 months both to solids and liquids but more to the solids. There was history of significant weight loss, loss of appetite, pain while swallowing, a hoarse voice and cervical lymphadenopathy. Upper GI endoscopy and barium studies were conducted. During endoscopy a sample of the lesion was also taken and sent for HPE examination: - ] All of the following are risk factors for the above disease except: -
This is a case of carcinoma esophagus (squamous cell carcinoma) 1ST image shows a mass in the lumen of the esophagus. 2nd image shows the rat tailing seen on Barium swallow in carcinoma esophagus. 3rd image shows the classical keratin pearl seen in squamous cell carcinoma. Barret's esophagus is a risk factor adenocarcinoma of the esophagus.
4
Smoking
Plummer Vinson syndrome
Achalasia cardia
Barrett's esophagus
Unknown
Integrated QBank
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Tumorgenesis in Aging is due to:
Telomerase reactivation
1
Telomerase reactivation
Telomerase inactivation
Increased apoptosis
Suppression of proto-oncogenes
Pathology
null
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Patient came with H/O prolonged labour (15 hrs) in emergency. On examination there were signs of obstructed labour. Ideal position for the patient to undergo the cesarean section?
In this condition, position should be supine with wedge under right hip so the position will be a bit tilted towards the left to prevent compression of vena cava and the hea will get sufficient various return, giving good output to fetus.
3
Prone position with legs in stirrup
Trendelenberg with legs in stirrup
Supine with wedge under right hip.
Semi fowler position
Gynaecology & Obstetrics
Labour - III
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Resting membrane potential is maximally affected by which ion-
Ans. is 'b' i.e., K+ "RMP is mainly due to difference of concentrations ofK+ ions in ECF and ICF". -- Chaudhari* The cell membrane is selectively permeable. Due to presence of potassium leak channels K+ ions are freely permeable but permeability of Na+ is much less. In the generation of RMP, following sequence of events occur: -i) K+ diffuses out of cell along its concentration gradient (K+ concentration is very high inside the cells and very low in ECF).ii) The diffusion of K+ produces an intracellular negativity (due to non-diffusibleprotein anion in the cells) which is not nullified by the diffusion of Na+ in the opposite direction (membrane is impermeable to Na+) or diffusion of Cl- in same direction (Cl- concentration is already very high in ECF in comparison to ICF).iii) So, intracellular negativity is produced which opposes outward diffusion of K+ and when the equilibrium is reached, the inward force on K+ due to electrical gradient balances outward force on K+ due to concentation gradient.iv) Finally, at equilibrium inner side of cell is negatively charged with respect to outer side, and resting membrane potential is produced.* So, the RMP is principally due to concentration difference (chemical difference) of K+ in ECF and ICF. In neurons, the resting membrane potential is usually about -70 mV, which is close to the equilibrium potential for K+. Here, it is worth noting that RMP is close to the equilibrium potential of K+ but the value of RMP is exactly same as equilibrium potential of Cl~. It is because other ions also diffuse through membrane, though their effect is very little.
2
Na+
K+
Ca2+
Cl-
Physiology
General
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All of the following are true about Ebola virus except?
Ebola virus belongs to Filoviridae.
2
Incubation period is 2-21 days
Belongs to flaviviridae
Bowl of spaghetti appearance seen
Investigation of choice is RT - PCR
Microbiology
null
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multi
Which one of the following is NOT an Endocrine Myopathy?
(C) Myasthenia gravis # ENDOCRINE MYOPATHY:> Major categories of endocrine myopathy include those associated with Adrenal dysfunction (as in Gushing disease or steroid myopathy); Thyroid dysfunction (as in myxedema coma or thyrotoxic myopathy); Parathyroid dysfunction (as in multiple endocrine neoplasia); Pituitary dysfunction; and Islands of Langerhans dysfunction (as in diabetic myopathy from ischemic infarction of the femoral muscles).> Adrenal dysfunction: Aetiology of Hypoadrenalism: includes infection, inflammatory disease, and tumor. Adrenal failure may follow pituitary failure. In hypoadrenalism, neurological manifestations such as disturbances of behavior and mentation are prominent; myopathy is not likely to be a presenting finding. Factors contributing to muscle weakness in adrenal insufficiency include circulatory insufficiency, fluid and electrolyte imbalance, impaired carbohydrate metabolism, and starvation. The etiologies of hyperadrenalism include pituitary or ectopic overproduction of adrenocorticotropic hormone (ACTH), adrenal tumors, or exogenous corticosteroid administration. Pituitary ACTH hypersecretion (i.e., Cushing's disease) is caused by a corticotroph macroadenomas in 90% of patients and by a macroadenoma in most of the rest.> Hypoparathyroidism causes tetany, with or without carpopedal spasm.> Pathophysiology of Hypoparathyroidism may involve either deficiency of parathyroid hormone or inability of the hormone to have an effect at end-receptors because of dysfunction of the hormone receptors.> Hyperparathyroidism does not cause tetany but results in muscle wasting and myopathy (i.e., proximal muscle weakness). The pathophysiology is over secretion of hormone, frequently from a parathyroid adenoma.> Myasthenia gravis: Fluctuating weakness of commonly used voluntary muscles, producing, symptoms such as diplopia ptosis and difficulty in swallowing. Weakness of affected muscle increased by activity. Associated with thymic tumor or thyrotoxicosis and rheumatoid arthritis and lupus erythematosus. Other options are clearly endocrine related myopathies.
3
Addison's disease
Cushing's disease
Myasthenia gravis
Primary Hypoparathyroidism
Medicine
Miscellaneous
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single
Which of the following is true regarding anthracoid bacilli?
Anthracoid bacilli usually grow in penicillin agar. Their growth is not inhibited by chloral hydrate. They usually grow at 45 degree celsius. They are not susceptible to gamma phage. They are motile, non capsulated bacilli which grow in sho chains.
3
No growth in penicillin agar
Growth inhibited by chloral hydrate
Not susceptible to gamma phage
No growth at 45 degree celsius
Microbiology
Systemic Bacteriology (Gram Positive Bacilli, Gram Negative Bacilli)
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multi
Magistrate inquest can be done by all except
Magistrate inquest This is conducted by Executive Magistrates They are Collector Deputy collector Revenue Divisional Officer Tahsildar Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 7
4
Collector
Deputy collector
Tahsildar
Village officer
Anatomy
General anatomy
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multi
Pasteur developed the vaccine for
Pasteur introduced an attenuated vaccine for chicken pox, cholera, anthrax and rabies. Development of vaccine for hydrophobic marked a milestone in the development of immunisation in medicine.
4
Anthrax
Rabies
Chicken cholera
All of the above
Microbiology
general microbiology
969a4476-2375-4998-aa47-1808325145e7
multi
All of the following statements regarding total anomalous pulmonary connection are true except –
Hemodynamics of TAPVC TAPVC results in the pulmonary venous blood reaching the right atrium which also receives the systemic venous blood. This results in volume overload to right atrium -p Right atrial enlargement. Larger volume of blood reaches the right ventricle --> Right ventricle enlargement. The blood flow to the left atrium is through patent foramen ovale or ASD. Because there is mixing of unoxygenated blood from systemic circulation and oxygenated blood from pulmonary circulation in the right atrium —> The oxygen saturation of blood in pulmonary artery is higher or identical to that in Aorta. TAPVC can be divided into : - i) TAPVC with pulmonary venous obstruction Pulmonary venous obstruction results in pulmonary arterial hypertension. Pulmonary obstruction —> T back pressure —> 1' Pulmonary capillary pressure T Pulmonary artery pressure u Because of pulmonary venous obstruction oxygenated blood cannot reach heart —> Cyanosis and CHF during first week of life. ii) TAPVC without obstruction (more common) In TAPVC without obstruction, pulmonary blood flow is high. Patients develops CHF at around 6-8 weeks when the fetal pulmonary resistance falls maximally and pulmonary circulation reaches the maximum. Infracardiac type of TAPVC is always obstructive whereas cardiac and supracardiac type may be obstructive or nonobstructive.
2
The total pulmonary venous blood reaches the right atrium
Always associated with a VSD
The oxygen saturation of the blood in the pulmonary artery is higher than that in the aorta
Infracardiac type is always obstructive
Pediatrics
null
25b37aef-8126-47cb-83fe-241675f21322
multi
Which of the following drugs should not be used in a setting of severe hypeension in elderly on empirical basis
Postsynaptic, selective a-adrenoreceptor antagonists lower blood pressure by decreasing peripheral vascular resistance. They are effective antihypeensive agents used either as monotherapy or in combination with other agents. However, in clinical trials of hypeensive patients, alpha blockade has not been shown to reduce cardiovascular morbidity and moality or to provide as much protection against CHF as other classes of antihypeensive agents. These agents are also effectivein treating lower urinary tract symptoms in men with prostatic hyperophy. Nonselective a-adrenoreceptor antagonists bind to postsynaptic and presynaptic receptors and are used primarily for the management of patients with pheochromocytoma. ref:harrison&;s principles of internal medicine,ed 18,pg no 4279
4
Enalapril
Amlodipine
Chlohiazide
Prazosin
Medicine
C.V.S
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single
A 30 year old male patient complains of food lodgment and pain in lower right back teeth region. RCT was done with 46 and 45 was missing. Cast metal restoration was planned. The distortion during the fabrication of this prosthesis is because of all of the following except-
DISTORTION Any marked distortion of the casting is probably related to a distortion of the wax pattern. This type of distortion can be minimized or prevented by proper manipulation of the wax and handling of the pattern. Unquestionably some distortion of the wax pattern occurs as the investment hardens around it. The setting and hygroscopic expansions of the investment may produce a non-uniform expansion of the walls of the pattern. This type of distortion occurs in part from the nonuniform outward movement of the proximal walls. The gingival margins are forced apart by the mold expansion, whereas the solid occlusal bar of wax resists expansion during the early stages of setting. The configuration of the pattern, the type of wax, and the thickness influence the distortion that occurs. For example, distortion increases as the thickness of the pattern decreases. As would be expected, the lower is the setting expansion of the investment, the less lower is distortion.  Philips’ Dental Material, pg- 223
4
Configuration of the pattern
Type of wax used
Thickness of the pattern
null
Dental
null
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