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A teenager presented with a skin lesion which appeared as thin oval plaque with a fine collarette of scale located inside the periphery of the plaque. Pityriasis rosea is diagnosed. All of the following are characteristic of pityriasis rosea, EXCEPT:
Pityriasis Rosea (PR): Common acute papulosquamous eruption normally lasting 4-10 weeks. Most often begins as a single 2- to 4-cm thin oval plaque with a fine collarette of scale located inside the periphery of the plaque ("herald patch"). Similar-appearing, but smaller, lesions appear several days to weeks later, typically distributed along the lines of cleavage on the trunk ("Christmas tree" pattern). Usually asymptomatic, sometimes pruritic with mild flu-like symptoms. Occurs most commonly in teenagers and young adults. Probably a viral exanthem associated with reactivation of human herpes virus (HHV)-7 and sometimes HHV-6. Treatment is usually suppoive, although midpotency topical coicosteroids can reduce pruritus; high-dose acyclovir for 1 week may hasten recovery. Ref: Blauvelt A. (2012). Chapter 42. Pityriasis Rosea. In L.A. Goldsmith, S.I. Katz, B.A. Gilchrest, A.S. Paller, D.J. Leffell, N.A. Dallas (Eds), Fitzpatrick's Dermatology in General Medicine, 8e.
1
Lower respiratory infection
Herald patch
Moderate itching
Low grade fever
Skin
null
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All of the following features can be observed after the injury to axillary nerve, except -
Muscles responsible for abduction of the shoulder joint -        Supraspinatus- first 15 degrees of abduction -        Deltoid (Acromial fibers) - it is responsible for abduction from 15 to 90 degrees. It does not take part in overhead abduction. -        Trapezius and serratus anterior- They are responsible for upward rotation of the glenoid cavity. And thus helps in abduction over 90 degrees.
3
Loss of rounded contour of shoulder
Loss of sensation along lateral side of upper arm
Loss of overhead abduction
Atrophy of deltoid muscle
Anatomy
null
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multi
A 22 year old woman developed small itchy wheals after physical exertion, walking in the sun, eating hot spicy food and when she was angry. The most likely diagnosis is –
Similar to previous question this women developed urticaria (itchy wheal) after :- Walking in the sun → generalized heating Eating hot spicy food Physical exertion When she was angry → emotional stress Diagnosis is cholinergic urticaria
4
Chronic idiopathic utricaria
Heat urticaria
Solar urticaria
Cholinergic urticaria
Dental
null
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multi
Na+ reabsorption is maximum in ?
Ans. is 'a' i.e., PCT
1
PCT
Loop of Henle
DCT
Collecting duct
Physiology
null
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single
All of the following can be used to predict severe acute pancreatitis, EXCEPT:
On account of difference in the outcome between patients with mild and severe disease, it is impoant to define that group of patients who will develop severe pancreatitis. Criteria used to determine the severity of acute pancreatitis: Criteria used Score at which severity is indicated Apache score 8 Glasgow score 3 Ranson criteria 3 CT severity index 6 C- reactive protein > 150 mg L Ref: Harrison 17/e, Page 2008; Bailey & Love 1140.
4
Glasgow score 3
Apache II score 9
CT severity score 6
C reactive protein < 100
Surgery
null
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multi
"International prognostic index" for lymphoma includes the following prognostic factors, EXCEPT:
Hemoglobin and Albumin are not included as prognostic factors in International prognostic index. International prognostic index of lymphoma can predict the prognosis of lymphoma accurately. It is widely used to categorize patients with intermediate-grade lymphoma into risk group. Prognostic factors includes: Age of 60 or above Stage III or IV disease Performance status High level of lactate dehydrogenase (LDH) Involvement of 2 or more organs outside the lymph nodes Patients with no risk factors or one risk factor have high complete response rates (80%) to standard immunochemotherapy. Patients with two risk factors have a 70% complete response rate. Patients with higher-risk disease have lower response rates and poor survival with standard treatment regimens, and alternative treatments are needed. Ref: Current Medical Diagnosis and Treatment, 2012, Chapter 13; Johns Hopkins Medicine Patients Guide to Lymphoma By Aditya Bardia, Chapter 1
3
LDH
Stage of disease
Hemoglobin and Albumin
Number of extralymphatic sites involved
Medicine
null
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multi
A healthy 30-year-old woman comes to the physician for a routine health maintenance examination. No abnormalities are found on physical examination. A screening Pap smear shows cells consistent with a low-grade squamous intraepithelial lesion (LSIL). Subsequent cervical biopsy specimens confirm the presence of cervical intraepithelial neoplasia (CIN) I. Which of the following risk factors is most likely related to her Pap smear findings?
Cervical intraepithelial neoplasia (CIN) I represent minimal (mild) dysplasia (low-grade squamous intraepithelial lesion, or LSIL) and is a potentially reversible process. Dysplasia is preneoplastic and may progress to carcinomas if not treated. Risk factors for cervical dysplasia and carcinoma include early age at first intercourse, multiple sexual partners, and a male partner with multiple previous sexual partners. These factors all increase the potential for infection with human papillomavirus. Diethylstilbestrol (DES) exposure is a factor in the development of clear cell carcinomas of the vagina and cervix. The use of oral contraceptives, which contain very low amounts of hormonally active compounds, does not cause cervical dysplasia or carcinoma. Treatment of cancers does not typically result in dysplasia, although the atypical changes in epithelial cells from radiation and/or chemotherapy may be challenging to distinguish from cancer. A vitamin B12 deficiency may produce some megaloblastic epithelial changes, but not dysplasia.
2
Diethylstilbestrol (DES) exposure
Multiple sexual partners
Oral contraceptive use
Prior treatment for a malignancy
Pathology
Female Genital Tract
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All are true about Candida except -
Ans. is 'c' i.e., It is a mold [Ref: Harrison 18th/ep. 1651, 1652 &17th/ep. 1254; Candida o Candida is a yeast like a fungus (not mold). o Candida albicans is the most common cause of mucosal candidiasis. o All Candida species pathogenic for humans are also encountered as commensals of humans, particularly in the mouth, stool, and vagina. o Candida albicans is differentiated by other Candida: It forms true hyphae (mycelia) or germ tubes when grown in serum. It forms thick walled large spores called chlamydospores when grown in com meal agar. It is dimorphic. Remember - Candida albicans can produce yeast, true hyphae, and pseudohyphae. o A rapid method of identifying C. albicans is based on its ability to form germ tubes within two hours when incubated in human serum at 37degC - Reynolds - Braude phenomenon (Also known as germ tube test)
3
Pseudohyphae seen
Produce chlamydospore
It is a mould
It is a non-thermally dimorphic fungi
Unknown
null
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multi
Which of the following set is termed as epidemiological triad:
Ans (b) Agent, host and environmentRef : K. Park 23rd ed. / 33-34, Park 19th/ 30A broad concept of disease causation that synthesized the basic factors of agent, host and environment (see adjacent figure)This model--agent, host and environment-- has been in use for many years. It helped epidemiologists to focus on different classes of factors, especially with regards to infectious diseases.
2
Endemic, epidemic and outbreaks
Agent, host and environment
Incidence, prevalence and disease load
Agent, man and disease
Social & Preventive Medicine
Principles of Epidemiology
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All developed up to the adult size at bih except
Tympanic cavity, mastoid (tympanic) antrum, ear ossicles and the Internal ear are of adult size in the foetal skull.
3
Mastoid Antrum
Tympanic cavity
Orbital cavity
Ear ossicle
Anatomy
All India exam
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multi
All the following statements are true about V. cholera 0139, EXCEPT:
Vibrio Cholerae O139 is a derivative of Eltor O1 but it has a distinct lipo polysaccharide and an immunologically related O-antigen polysaccharide capsule. First discovered in chennai, V.cholerae O139 is epidemiologically indistinguishable from O1 Eltor strain. Ref: Textbook of Microbiology, Ananthanarayan and Paniker, 7th Edition, Page 312;Harrisons Principles of Internal Medicine, 16th Edition, Page 909 & 910.
4
Clinical manifestations are similar 01 Eltor strain
First discovered in Chennai
Epidemiologically indistinguishable from 01 Eltor strain
Produces Ol Lipo polysaccharide
Microbiology
null
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multi
The major function of major intrinsic protein-26 (MIP-26) is:
Ans. Transpo of water in lens
2
Glucose transpo in lens
Transpo of water in lens
Diffusion barrier
Capsule of lens
Ophthalmology
null
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single
Lapsed union of skull sutures is commonly noted in:-
In skull, Ectocranial suture closure is very variable. Sometimes, there may not be ectocranial suture closure. This is called lapsed union. This occurs most often in the sagittal suture.
3
Metopic suture
Coronal suture
Saggital suture
Lambdoid suture
Forensic Medicine
Human identification
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True statement about gallstones are all except:
Ans. (d) More common in males between 30-40 years of ageDiabetes mellitus and Gall stones:* Diabetes though not a direct risk factor for gall stones- the following factors in diabetes may increase the chance of getting Gall stones:# Increased Bile Cholesterol# Poor GB motility# Decreased Bile Acids
4
Lithogenic bile is required for stone formation
May be associated with carcinoma gallbladder
Associated with diabetes mellitus
More common in males between 30-40 years of age
Surgery
Gall Bladder & Bile Ducts
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Which is not used in acne:(2003)
bRef: KDT, 5th ed, p. 800, 801 & 4th ed, p. 858s
2
Erythromycin
Ampicillin
Clindamycin
Doxycycline
Pharmacology
Skin
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single
Mycotic vulvovaginitis is due to :
Candida
1
Candida
Aspergillus
Cryptococcus
Pseudomonas
Gynaecology & Obstetrics
null
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single
Clubbing is the least common in
Skeletal connective tissue syndrome including clubbing is usually not seen in small cell carcinoma. Ref Harrison 19th edition pg 250
2
Squamous cell carcinoma
Small cell carcinoma
Adenocarcinoma
Mesothelioma
Anatomy
Respiratory system
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Greater petrosal nerve is formed from
The greater petrosal nerve arises from the geniculate ganglion. It consists of preganglionic parasympathetic fibres that relay in the pterygopalatine ganglion and supply the secretomotor fibres to the lacrimal gland and the mucous glands of nasal cavity and palate.Reference: Textbook of anatomy, Head neck, and brain, Vishram Singh, 2nd edition, page no342
1
Geniculate ganglion
Plexus around ICA
Plexus around middle meningeal aery
None of the above
Anatomy
Head and neck
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Ossification centre for lunate appears at?
OSSIFICATION: At 2 months to 1-year Ossification of capitate stas, and at 12 years Ossification of Pisiform stas. ossification of lunate occurs at 4 years. REF: BD Chaurasia 7th edition Page no: 27.
3
Bih
2nd Months
4 Year
12 Years
Anatomy
Upper limb
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A 22 year old female Asian immigrant presents with complaints of malaise, fever, arm pain, loss of appetite, and visual problems. Her mother states that she fainted 1 week ago. The physician cannot palpate the patient's lower extremity pulses and notes that the dial pulses are weak. The erythrocyte sedimentation rate (ESR) is elevated. Which of the following is the most likely diagnosis?
Takayasu's aeritis is an uncommon disorder that is most prevalent in young Asian women. In Takayasu's, an inflammatory process produces fibrous thickening of the aoic arch, causing narrowing or near obliteration of the origins of aeries that branch from the arch. Absent or diminished pulses are noted, especially in the upper extremities. Involvement of the carotid circulation can produce ocular disturbances or other neurological dysfunction (syncope or, less commonly, stroke). Buerger's disease (thromboangiitis obliterans is a disease of young-to middle-aged adult (predominantly males) smokers. It is characterized by segmental thrombosis of aeries and veins, often in extremities. Kawasaki's disease is usually seen in children, and is characterized by rash, fever, conjunctivitis, and lymphadenopathy. Coronary vasculitis and aneurysms may occur. Thrombophlebitis usually involves the deep veins of the legs and often occurs in association with predisposing factors such as immobilization, clotting disorders, hea disease, cancer, pregnancy, or tissue injury. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 9. Vascular Pathology. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture.
3
Buerger's disease
Kawasaki's disease
Takayasu's aeritis
Thrombophlebitis
Pathology
null
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All are good prognostic factors for neuroblastoma except
The expression of specific neurotrophin receptors like TrkA are good prognostic factors for Neuroblastoma whereas expression of TrkB like neurotrophin receptors worsens the disease. Refer robbins 9/e 260p
1
Trk-A expression absent
Absence of 1 p loss
Absence of 17 p gain
Absence of 11 q loss
Pathology
Endocrinology
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A 23-year-old man presents with prolonged nose bleeds. He has always noted easy bruising, and ongoing bleeding after minor cuts. There is no prior history of surgery or dental procedures. His hemoglobin is 14.5 g/dL, platelets 200,000/mL, and PT/PPT is normal. Further testing reveals that the bleeding time is elevated; the factor VIII level is reduced, as is the ristocetin cofactor assay.For the above patient with a bleeding disorder, select the most likely diagnosis.
von Willebrand's disease is the most common inherited bleeding disorder. The abnormal plasma glycoprotein, von Willebrand factor (vWF), has two major functions: facilitating platelet adhesion and serving as a carrier for factor VIII. The disease is heterogeneous in its manifestations but can be very severe (type III disease). Evaluation reveals a prolonged bleeding time and decreased factor VIII activity.
1
von Willebrand's disease
hemophilia A
hemophilia B
thrombotic thrombocytopenic purpura (TTP)
Medicine
Blood
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Diabetes control is best monitored by -
Measurement of glycated hemoglobin (HbA1c) is the standard method for assessing long-term glycemic control. When plasma glucose is consistently elevated, there is an increase in nonenzymatic glycation of hemoglobin. This alteration reflects the glycemic history over the previous 2-3 months, because erythrocytes have an average life span of 120 days (glycemic level in the preceding month contributes about 50% to the HbA1c value). Measurement of HbA1c at the "point of care" allows for more rapid feedback and may therefore assist in adjustment of therapy. A rise of 1% in HbA1c corresponds to an approx average increase of 2 mmol/L (36 mg/dL) in blood glucose. Reference : page 2410 Harrison's Principles of Internal Medicine 19th edition
3
Serum glucose
Post prandial blood glucose
HbA1c
HbA2c
Medicine
Endocrinology
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A male patient was undergoing routine health checkup and investigations when a lump was incidentally diagnosed on clinical examination. Clinician advised USG following which USG guided biopsy was done. HPE examination revealed the following diagnosis. Patient was staed on chemotherapy including a drug obtained from the given plant. What is the site of action of the drug mentioned above?
Vinblastine is an alkaloid derived from the periwinkle plant Vinca rosea. It has clinical activity in the treatment of Hodgkin's and non-Hodgkin's lymphomas, breast cancer, and germ cell cancer. It inhibits mitosis that is M phase of cell cycle.
1
B
C
D
A
Unknown
Integrated QBank
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Substrate level phosphorylation in Glycosis is seen in which step?
Conversion of Phosphoenol Pyruvate to Pyruvate Phosphoenolpyruvate is conveed to 'Enol' pyruvate, the reaction is catalyzed by the enzyme Pyruvate kinase. The high energy PO4 of phosphoenolpyruvate is directly transferred to ADP producing ATP (Refer box). Note Reaction is irreversible.ATP is formed at the substrate level without electron transpo chain. This is another example of substrate-level phosphorylation in glycolytic pathway "Enol" pyruvate is conveed to `keto' pyruvate spontaneously. Inhibitors Fluoride inhibits the enzyme enolase. CLINICAL IMPOANCE Sodium fluoride is used along with K-oxalate for collection of blood for glucose estimation. If K-oxalate is used alone, then in vitro glycolysis will reduce the glucose value in the sample. Functions of FluorideInhibits in vitro glycolysis by inhibiting enzyme enolaseAlso acts as anticoagulant,Act. as an antiseptic. Energetics: In this stage, 2 molecules of ATP are produced, per molecule of glucose oxidised. + 2 ATPRef: MN Chatterjea Textbook of Medical Biochemistry, 8th edition, page no: 331
2
Glyceraldehyde-3-phosphate dehydrogenase
Pyruvate kinase
Phosphofructokinase
Enolase
Biochemistry
Respiratory chain
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If blood gas analysis reveal pH = 7.52, pCO = 30 ; pO2 = 105. This will be compensated by ?
First step Determine whether it is acidosis or alkalosis Increase in pH suggests alkalosis Second step Look at CO2 or HCO3- to determine the cause Decreased PCO2 suggests respiratory alkalosis Respiratory alkalosis Respiratory alkalosis occurs because CO2 is blown off in excess equation shifts to left and H+ conc. decrease which leads to alkalosis. Now the kidneys compensate for this alkalosis by excreting more HCOO3-. This shifts the equation to right thus H+ conc. decreases.
3
Compensatory respiratory acidosis
Compensatory respiratory alkalosis
Compensatory metabolic acidosis
Compensatory metabolic alkalosis
Medicine
null
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single
Which of the following is false about the Valves of Houston
A i.e. Disappear on distensionGastric rugae of stomach, and longitudinal folds in mucosa of upper rectum and colon are temporary mucosal folds and are obliterated by distension. Whereas , plica circularis (valves of kerkring) of small intestine, crescentic mucosal folds of cystic duct ( spiral valve of Heister), transverse (horizontal) rectal folds (Houston's valves or plica transversalis) and permanent longitudinal rectal columns or folds (found in lower rectum & anal canal) are permanent mucosal folds. Mn- "Temporary Ringer Lactate = Temporary Rugae & Longitudinal rectal folds"- Transverse rectal folds (rectal valves of Houston) are most prominent when viscus is distended but are lost after full surgical mobilization of rectum. It consists of mucosa, circular muscle layer with or without longitudinal muscle layer. Longitudinal muscle involvement is marked externally by indentation.
1
Anteriorly correlate with peritoneal reflection
Are placed transversely
Contain all layers of intestine
Disappear on distension
Anatomy
null
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Which of the following local anaesthetic causes least vasodilation:
Prilocaine causes less vasodilation than other local anesthetics and thus used without using epinephrine added to the local anesthetic solution.
2
Bupivacaine
Prilocaine
Ropivacaine
Lignocaine
Anaesthesia
Regional Anesthesia
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Abroviral infection(s) include -a) Chikungunya feverb) West nile feverc) JEd) Sandfly fevere) Malaria
null
1
abcd
acd
bcd
abd
Social & Preventive Medicine
null
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single
A patient underwent thyroidectomy for Hyperthyroidism. Two days later he presented with features of thyroid storm. What is the most likely cause?(AIIMS November 2015. COMED K 2007)
Ans. d. Inadequate preoperative preparation (Ref: Schwartz 9/e p1355: Sabiston 19/e p897; Bailey 26/e p762, 25/e p786- 787; Harrison 18/e p2927)Thyrotoxic crisis (storm) is an acute exacerbation of hyperthyroidism. It occurs if a thyrotoxic patient has been inadequately prepared for thyroidectomy."Thyrotoxic crisis (storm): This is an acute exacerbation of hyperthyroidism. It occurs if a thyrotoxic patient has been inadequately prepared for thyroidectomy and is now extremely rare. Very rarely, a thyrotoxic patient presents in a crisis and this may follow an unrelated operation. Symptomatic and supportive treatment is for dehydration, hyperpyrexia and restlessness. This requires the administration of intravenous fluids, cooling the patient with ice packs, administration of oxygen, diuretics for cardiac failure, digoxin for uncontrolled atrial fibrillation, sedation and intravenous hydrocortisone. Specific treatment is by carbimazole 10-20 mg 6-hourly, LugoVs iodine 10 drops 8-hourly by mouth or sodium iodide Ig i.v. Propranolol intravenously (1--2 mg) or orally (40 mg 6-hourty) will block b-adrenergic effects. " --Bailey 26/e p762Thyroid Storm (Thyrotoxic crisis)It is an emergency due to decompensated hyperthyroidismQ.Treatment of Thyroid Storm (Thyrotoxic crisis)Non-selective beta--blocker (Propranolol):Most valuable measure in thyroid stormQ,In thyroid storm most of the symptoms are because of adrenergic over activity due to increased tissue sensitivity to catecholamines in hyperthyroidism.This increased sensitivity is due to increased number of beta receptorsQ.Quick relief is obtained by blocking beta-receptors.Propylthiouracil:Antithyroid drug of choice for thyroid stormQReduces hormone synthesis as well as peripheral conversion of T4 to T3QCorticosteroids (Hydrocortisone):Inhibits both release of thyroid hormone from the gland and peripheral conversion of T4 to T3QIodides (Potassium iodide or lopanoic acid):Used to inhibit further hormone releaseQ from the gland.Other Measures:Diltiazem, if tachycardia is not controlled by propranolol alone.Rehydration, anxiolytics, external cooling & appropriate antibiotics
4
Poor antibiotic coverage
Rough handling during surgery
Removal of parathyroid
Inadequate preoperative preparation
Surgery
Surgical Approaches to the Thyroid
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Imiquimod used in treatment of anogenital warts acts manly as –
null
3
Antifungal
Antiviral
Immunostimulator
Keratolytic
Dental
null
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Cell wall of bacillus anthracis is composed of -
Ans. is 'a' i.e., Peptidoglycan The layer just outside the bacterial cytoplasmic membrane is the peptidoglycan layer or cell wall.It is present in both gram-positive and gram negative organisms.The peptidoglycan layer of gram positive bacteria is thick and contain teichoic acid, while in gram negative bacteria it is thin and does not contain teichoic acid.In gram negative organisms, there is outer cell membrane just outside the thin peptidoglycan layer (cell wall)Unique feature of gram negative bacteria dissolution of this layer by ethanol is responsible for gram negativityon gram staining.Chemically,cell wall is composed of mucopeptide (peptidoglycan or murein) scaffolding formed by N acetyl glucosamine and N acetyl muramic acid molecules alternating in chains, which are cross linked by peptide chains.
1
Peptidoglycan
Polysaccharide
Lipopolysaccharide
Polypeptide
Microbiology
null
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multi
Best parameter to monitor the response to injection of a bolus dose of fluids in a dehydrated child is
Signs of mild or moderate dehydration include: Thirst ,Dry or sticky mouth. Signs of severe dehydration include: Not peeing or having very dark yellow pee. Very dry skin. Feeling dizzy. Rapid heabeat. Rapid breathing. Sunken eyes. Sleepiness, lack of energy, confusion or irritability. Fainting. Reference: GHAI Essential pediatrics, 8th edition
4
Skin condition
Difference between core and surface temperature
Capillary refilling time
Radial pulse
Pediatrics
Fluid and electrolytes
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Miliary mottling found in – a) Rheumatoid arthritisb) TBc) Pneumocystis carinii pneumoniad) Congestive heart failuree) Pulmonary edema
null
4
abc
bcd
cde
abe
Radiology
null
22f88bc5-b945-4bf9-9263-7dbc3d47102e
single
A decrease in cerebral blood flow to zero causes death of brain tissue within
(A) 4-10 minutes # Decrease in cerebral blood flow to zero causes death of brain tissue within 4-10 minutes;> Values <16-18 mL/100 g tissue per minute cause infarction within an hour; and> Values <20 mL/100 g tissue per minute cause ischemia without infarction unless prolonged for several hours or days.> If blood flow is restored prior to a significant amount of cell death, the patient may experience only transient symptoms, and the clinical syndrome is called a TIA.> Tissue surrounding the core region of infarction is ischemic but reversibly dysfunctional and is referred to as the ischemic penumbra.> The penumbra may be imaged by using perfusion-diffusion imaging with MRI or CT
1
4 -- 10 minutes
20 -- 30 minutes
50 -- 60 minutes
80 -- 90 minutes
Pathology
Misc.
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single
Crohn's disease
null
1
has oral ulcerations similar to major apthous ulcerations
is a self limiting Lesion
is commonly seen among Indian population
is usually treated with Erythromycin
Pathology
null
26a51c71-95d2-4e59-a0ff-3d2935261a2a
multi
What is the recommended lifespan of Cu T 380A is?
The recommended lifespan of various Cu T devices are as follows: Cu T 380A - 10 years Cu T 380Ag - 4 years Cu T 200 - 4 years Nova Cu T 200 - 5 years Cu T 220C - 3 years Multiload Cu T 250 - 3 years Multiload Cu T 375 - 5 years Ref: Comp Textbook of Obstetrics and Gynecology, Sadhana Gupta, 2011, Page 308
4
4 years
5 years
3 Years
10 Years
Gynaecology & Obstetrics
null
01588023-641f-46d3-a9fb-83ce0c09bf7c
single
Which of the drug's main action is increasing uveo-scleral outflow
Ref: HL Sharma 3rd ed pg no:140 DOC for chronic glaucoma is latanoprost- PGF2 alpha analog It acts by increasing uveoscleral outflow of aqueous humor
2
Apraclonidine
Latanoprost
Timolol
Brinzolamide
Pharmacology
Autonomic nervous system
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single
TPN is indicated in all except
Ans. (c) SepsisRef Bailey and Love 27th edition Page 287; Surgery Sixer 3rd Edition Page 5* Indication of parenteral nutrition in 'sepsis' is under intensive study but not proven so far to be effective, however in the above options it is the best Choice.
3
Short bowel syndrome
Burns
Sepsis
Enterocutaneous Fistula
Surgery
Small & Large Intestine
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multi
Vertebra plana seen in -a) Eosinophilia granulomab) Traumac) Paget's diseased) Malignancye) Ewing's sarcoma
Vertebra plana This term is used to describe uniform collapse of a vertebral body into a thin, flat disc. The most common cause is eosinophilic granuloma, with the thoracic vertebrae most frequently affected. Causes are :- Histocytosis - X (Eosinophilic granuloma) Leukemia TB Metastasis, Multiple myeloma, Ewing's sarcoma, lymphoma Osteochondritis of vertebral body (Calve's disease) Hemangioma Trauma Steroids
3
abcd
bcde
abde
ade
Orthopaedics
null
bb8e117f-2c6f-4d64-9f6a-62e4567222d2
single
Which is the most common site for berry aneurysm in circle of willis is seen at bifurcation between
Ans. is 'a' i.e., Anterior communicating artery and anterior cerebral artery AZX
1
Anterior communicating artery and anterior cerebral artery
Basilar artery and posterior cerebral artery
Internal carotid artery and posterior communicating artery
Anterior cerebral and middle cerebral artery
Surgery
Nervous System
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single
BCG is
Ans. a (Live attenuated vaccine). (Ref. Park, PSM, 17th ed., 148)VACCINESLive attenuated vaccinesInactivated or killed vaccines1.BCG1.Typhoid2.Typhoid oral2.Cholera3.Plague3.Pertussis4.Mumps4.C.S. Meningitis5.Measles5.Plague6.Rubella6.Rabies7.Yellow fever7.Influenza8.OPV8.KFD vaccine9.Influenza9.Salk (Polio)10.Epi. typhus10.Hepatitis B 11.Japanese Encephalitis
1
Live attenuated vaccine
Killed vaccine
Toxoid
Immunosuppressant agent
Social & Preventive Medicine
Communicable Diseases
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A 50-year-old construction worker continues to have elevated BP of 160/100 mmHg after a third agent (thiazide) is added to his anti-hypeensive regimen. Physical examination is normal, electrolytes are normal and he is not taking any over the counter medications. Which is the next helpful step in the diagnosis of this patient?
The patient is suffering from resistant hypeension and the leading cause of resistant hypeension is non- compliance on the pa of patient. Resistant hypeension is defined as blood pressure that remains above goal in spite of the concurrent use of 3 antihypeensive agents of different classes. Ideally, one of the 3 agents should be a diuretic and all agents should be prescribed at optimal dose amounts.
1
Check pill count
Perform renal Doppler
MRI aoa
Adrenal CT scan
Medicine
Acute coronary syndrome
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multi
A 50-year-old know asthmatic develops sudden onset right-sided chest pain with dyspnea. Chest X-ray reveals hyperlucency on right side with shift of trachea to left side. The best option of treatment for immediate relief of symptoms is
Patient might have developed pneumothorax , Pathophysiology Airway hyper-reactivity (AHR) - the tendency for airways to narrow excessively in response to triggers that have little or no effect in normal individuals - is integral to the diagnosis of asthma and appears to be related, although not exclusively, to airway inflammation . Other factors likely to be impoant in the behaviour of airway smooth muscle include the degree of airway narrowing and neurogenic mechanisms. The relationship between atopy (the propensity to produce IgE) and asthma is well established and in many individuals there is a clear relationship between sensitisation and allergen exposure, as demonstrated by skin-prick reactivity or elevated serum-specific IgE. Common examples of allergens include house dust mites, pets such as cats and dogs, pests such as cockroaches, and fungi. Inhalation of an allergen into the airway is followed by an early and late-phase bronchoconstrictor response . Allergic mechanisms are also implicated in some cases of occupational asthma . In cases of aspirin-sensitive asthma, the ingestion of salicylates results in inhibition of the cyclo-oxygenase enzymes, preferentially shunting the metabolism of arachidonic acid through the lipoxygenase pathway with resultant production of the asthmogenic cysteinyl leukotrienes. In exercise-induced asthma, hyperventilation results in water loss from the pericellular lining fluid of the respiratory mucosa, which, in turn, triggers mediator release. Heat loss from the respiratory mucosa may also be impoant. In persistent asthma, a chronic and complex inflammatory response ensues, characterised by an influx of numerous inflammatory cells, the transformation and paicipation of airway structural cells, and the secretion of an array of cytokines, chemokines and growth factors. Examination of the inflammatory cell profile in induced sputum samples demonstrates that, although asthma is predominantly characterised by airway eosinophilia, neutrophilic inflammation predominates in some patients while in others scant inflammation is observed: so-called 'pauci- granulocytic' With increasing severity and chronicity of the disease, remodelling of the airway may occur, leading to fibrosis of the airway wall, fixed narrowing of the airway and a reduced response to bronchodilator medication. Chest drains also known as under water sealed drains (UWSD) are inseed to allow draining of the pleural spaces of air, blood or fluid, allowing expansion of the lungs and restoration of negative pressure in the thoracic cavity. The underwater seal also prevents backflow of air or fluid into the pleural cavity Ref Davidson edition23rd pg 568
4
Intravenous morphine
Nebulization of beta 2 agonist, Ex salbutamol
Intravenous aminophylline
Water seal intercostal drainage on right side of chest
Medicine
Respiratory system
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NOT a content of middle mediastinum:
The esophagus is considered to be located in the superior and posterior mediastinum.
2
Ascending aoa
Oesophagus
Pulmonary trunk
Phrenic nerve
Anatomy
null
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Leucine zipper complex is
Proteins that bind to DNA contain a limited number of motifs.The helix-loop-helix motif is an example found in a number of proteins that function in a number of proteins that function as transcription factors Example: zinc fingers, and leucine zippers . REF :LIPPINCOTT'S TEXTBOOK OF BICHEMISTRY ;8th EDITION ;Page no :18 AND 422.
3
B cell epitomes
Receptor ligand protein
DNA binding protein
Membrane attack complex
Biochemistry
Metabolism of nucleic acids
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A 6 yr. old boy presents with small hypopigmented scaly macules on cheek. Some of his friends also have similar lesions. Most probable diagnosis is?
Ans. D. Pityriasis alba* Occurs predominantly in children between the ages of 3 and 16 years, the sexes are equally susceptible.* The individual lesion is a rounded, oval or irregular plaque, which is red, pink or skin-colored and has fine lamellar or branny scaling. Initially, the erythema may be conspicuous and there may even be minimal serous crusting. Later, the erythema subsides completely, and at the stage at which the lesions are commonly seen by a physician they show only persistent fine scaling and hypopigmentation.* There are usually several patches ranging from 0.5to2cm in diameter, but they may be larger, especially on the trunk. In children, the lesions are often confined to the face, and are most common around the mouth, chin and cheeks. In 20% of affected children the neck, arms and there are scattered lesions on the trunk and limbs.* The course is extremely variable. The average duration of the common facial form in childhood is a year or more.P. Versicolor.* Scaly macule.* Perifollicular* Seen on upper trunk and shoulders commonly* Rare in children and common in young adultIndeterminated leprosy:* Non scaly* Epidermal atrophy* AnesthesiaP. Rosea.* Herald patch* Collarette scaling* Firtree appearance* Common in females
4
Pityriasis rosea
Pityriasis versicolor
Indeterminate leprosy
Pityriasis Alba
Skin
Skin Lesions And Disorders Of Pigmentation
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multi
Hypotony maculopathy, which of the following is not a cause?
Suprachoroidal Hemorrhage is not a cause of hypotony maculopathy. Hypotony maculopathy is low IOP associated with chorioretinal folds near macula, optic nerve head edema and vessel touosity. Causes Postoperative Hypotony Mitomycin C (MMC) toxicity of the ciliary body Overfiltering Bleb Wound Leak Traumatic Hypotony Scleral perforation Retinal Detachment Cyclodialysis Bilateral Hypotony Osmotic Dehydration Diabetic coma Uremia
4
Perforating Corneal ulcer
Overfiltering bleb
Cyclodialysis
Suprachoroidal hemorrhage
Ophthalmology
Glaucoma
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Stage of falciparum not seen in PBS is -
P.falciparum Forms in peripheral blood-ring forms and gametocytes (crescent shaped) A) Most pathogenic B). No relapses in P.falciparum-exo-erythrocytic schizogony is absent C). Complications-pernicious malaria,black water fever D)pernicious malaria-1). Cerebral malaria-hyperpyrexia, coma,paralysis.Brain is congested.Capillaries of the brain are plugged with parasitised erythrocytes 2). Algid malaria-cold clammy skin leading to circulatory failure 3). Septicaemic malaria- high continuous fever with involvement of various organs Black water fever * Previously infected * Intravascular haemolysis fever and haemoglobinuria * Autoimmune mechanism * Bilious vomiting+prostration+black urine(refer pgno:60 baveja 3 rd edition)
1
Schizont
Gametocyte
Ring form
Double ring
Microbiology
parasitology
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Austenite is an alloy of iron and carbon with the iron in:
At room temperature, pure iron has a body-centered-cubic (bcc) structure. This phase is stable up to 912 °C, where it transforms to a face-centered-cubic (fcc) structure. The solubility of carbon in bcc is very low and reaches a maximum of  0.02% at 723°C. This material is known as ferrite.   Above 723 °C, a solid solution of carbon in an fcc iron matrix called austenite is formed. The maximal solubility of carbon in fcc matrix is 2.1%. When plain carbon steel containing 0.8% carbon is cooled slowly in the austenitic phase to 723 °C, it undergoes a solid-state eutectoid transformation to yield a microstructural constituent called pearlite, which consists of alternating fine-scale lamellae of ferrite and iron carbide (Fe3C), referred to as cementite, or simply, carbide.  The Fe3C phase is much harder and more rigid than austenite or ferrite. Key Concept It is an interstitial solid of a small of a carbon dissolved in γ iron. The maximum solubility is 2.1%C at 1147o C. The crystal structure of Austenite (γ) is F.C.C. Hardness – 40 HRC and toughness is high. Ref:Phillips Ed-12th P: 406
3
Alpha form
Beta form
Gamma form
None of the above
Dental
null
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Antihypertensive of choice in pregnancy is:
Ref: Dana Textbook of Obstetrics, 5th ed pg 506 Explanation: See the following table Antihypertensives Used in Pregnancy MOA Side effects Remarks Methyl dopa Centrally acting anti-adrenergic * Drowsiness * Headache * Postnatal depression * Postural hypotension * Liver dysfunction * Leukopenia * Hemolytic anemia Contraindicated in patients taking * MAO inhibitors * Lithium * Liver failure * Positive Coombs test Clonidine Centrally acting sympathetic inhibitor * Drowsiness * Dry mouth * Dry eyes * Nausea * Reduced fetal heart rate Sudden stoppage should be avoided due to pressor effect Oxprenolot Beta blocker * Nightmares Labetalol Alpha and beta blocker * Worsening asthma * Cough * Nightmares * Bradycardia Contraindicated in asthmatics Avoided in * Pbemochoromocytoma * Heart failure, bradycardia * Peripheral vascular disease * Raynaud's phenomenon Nifedipine Calcium channel blocker * Headache * Edema * Palpitations * Nausea * Dizziness Metabolised through CYT P450-3A4 - Possible interaction with phenytoin and cisapride Hydralazine Peripheral vasodilator * Flushing * Palpitations * Headache * Nausea 2nd or 3rd line agent. Can cause autoimmune lupus
4
Hydralazine
Propranolol
Alpha methyl dopa
Labetalol
Gynaecology & Obstetrics
Management and Long-Term Consequences
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True about formalin
Formalin is not used as preservative for chemical analysis because extraction of poison becomes difficult. PRESERVATIVES : 1. Saturated solution of NaCl - commonly used 2. Rectified spirit (95% alcohol )- Best preservative 3. 10% Formalin - for histopathological examination 4. 50% Glycerol - for virology 5. NaF - For Co, Cyanide, Alcohol poisoning. Avoid salts in Avoid Rectified Spirit in 1. Corrosive except phenol 2. Aconite 1. Alcohol 2. Formalin 3. Phenol
2
Used as preservative in alcohol poisoning
Never used as preservative for chemical analysis
Used as preservative only in digitalis poisoning
Used as preservative for any plant poisoning
Forensic Medicine
Toxicology - 2
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A newborn child is noted to have a bulky abdominal tumor. CT scans reveal that the mass involves the right abdomen and retroperitoneum. The tumor is resected, revealing ganglion cells and primitive, small, round cells occasionally organized in rosettes, embedded in a fibrillary pink matrix. Special studies confirm the likely diagnosis. Which of the following features of this tumor is associated with a poorer prognosis?
Neuroblastoma is a childhood tumor of the sympathetic nerves, which most commonly arises along the paraveebral chain or within the adrenal medulla. Neuroblastoma has two characteristic genetic markers: a 1p deletion and an N-myc translocation. N-myc is an oncogene that resides on chromosome 2p, and is amplified up to 300 times in neuroblastoma. Amplification of this gene is associated with a poorer prognosis. Cellular aneuploidy and hyperdiploidy reflect a better prognosis for neuroblastoma, whereas diploid and tetraploid tumors have an intermediate or poor prognosis. Tumor presentation at a younger age predicts a better outcome for neuroblastoma.Children under one year of age have an excellent prognosis, regardless of tumor stage. Ganglion cells within the tumor are a reflection of focal differentiation of the neuroblastoma into ganglioneuroma. Better differentiated tumors have a more orable outcome. Ref: Graham D.K., Quinones R.R., Keating A.K., Maloney K., Foreman N.K., Giller R.H., Greffe B.S. (2012). Chapter 31. Neoplastic Disease. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
1
Amplification of N-myc gene
Cellular aneuploidy
Diagnosis at bih
Numerous ganglion cells
Pediatrics
null
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A 50-year-old drug abuser presents with fever and weight loss. Exam shows hypeension, nodular skin rash, and peripheral neuropathy. ESR is 100 mm/L, and RBC casts are seen on urinalysis. (SELECT 1 DIAGNOSIS)
Behcet syndrome is a multisystem disorder that usually presents with recurrent oral and genital ulcers. Onefouh of patients develop superficial or deep vein thrombophlebitis. Iritis, uveitis, and nondeforming ahritis may also occur. The 50-year-old drug abuser also has a multisystem disease, including systemic complaints, hypeension, skin lesions, neuropathy, and an abnormal urine sediment. This complex suggests a vasculitis, paicularly polyaeritis nodosa. The disease is a necrotizing vasculitis of small and medium muscular aeries. The pathology of the kidney includes an aeritis and, in some cases, a glomerulitis. Nodular skin lesions show vasculitis on biopsy. The 19-year-old with low back pain, morning stiffness, and eye pain has complaints that suggest ankylosing spondylitis. This is an inflammatory disorder that affects the axial skeleton. It is an autoimmune disorder that has a close association with HLA-B27 histocompatibility antigen. Anterior uveitis is the most common extraaicular complaint. Aoic regurgitation occurs in a few percent of patients. The elderly male presents with nonspecific joint complaints typical of polymyalgia rheumatica. The high erythrocyte sedimentation rate is characteristic. The transient loss of vision suggests concomitant temporal aeritis, an impoant association seen paicularly.
4
Behcet syndrome
Ankylosing spondylitis
Polymyalgia rheumatic
Polyaeritis nodosa
Surgery
null
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Which of the following is not a complication of surgery for thoracic outlet syndrome.
Surgical treatment in thoracic outlet syndrome has been known to have devastating complications, especially brachial plexopathy (eg, injury to the long thoracic nerve with scapular winging). Conservative treatment appears to be the most universally accepted approach, with even surgeons recommending a prolonged trial before any operative procedure Complications of surgical tit of thoracic outlet syndrome Brachial plexus injury Injury to long thoracic nerve leading to winging of the scapula Homer's syndrome Vascular injuries — subclavian artery , subclavian vein Air embolus as a result of subclavian vein injury Pneumothorax Thoracic Outlet Syndrome Thoracic outlet syndrome ( TOS ) refers to compression of the subclavian vessels and nerves of the brachial plexus in the region of the thoracic inlet. ( note that even though the actual site of pathology is the thoracic inlet the condition is called thoracic outlet syndrome ) These neurovascular structures of the upper extremity may be compressed by a variety of structures, such as Bone- cervical rib, abnormal first rib, long transverse process of C7, osteoarthritis Muscles- scalenus Trauma- neck hematoma, bone dislocation, clavicular fracture Fibrous bands- congenital or acquired Neoplasms- Pancoast's tumor emedicine.com writes The primary cause is believed to be mechanical or postural. Stress, depression, overuse, and habit all can lead to the forward head, droopy shoulder, and collapsed chest posture that allows the thoracic outlet to narrow and compress the neurovascular structures. Accessory ribs or fibrous bands when present, predispose the site to narrow and compression. Management Initial method of management is nonsurgical. Physical and occupational therapy: improvements in a postural sitting, standing, and sleeping positions are recommended, along with behavior modification at work. muscle strengthening and stretching exercises superficial or deep heat therapy 50 to 90% of patients can be treated with these nonsurgical measures. Surgery resection of the first rib, accessory rib or fibrous band, scalenectomy
3
Pneumothorax
Brachial plexus injury
Lymphocutaneous fistula
Long thoracic nerve injury
Surgery
null
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Following are true about HCO3-except:
C i.e. 7.5% solution gives 2n molsConcentration of bicarbonate- Intracellular : 10 mmoVLQ- Extracellular : 27 mmol/LQIn kidney bicarbonate is produced by carbonic anhydraseQ.
3
Extracellular concentration 25 m mol
Intracellular concentration 10 m mol
7.5% solution gives 2 nmols
In kidney, HCO3- is produced by carbonic anhydrase
Physiology
null
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Which is TRUE regarding nerve conduction:
A i.e. All or none phenomenon All or none law: Action potential will not develop unless the stimulus searches a threshold intensity. Once a threshold in tensity is reached, a full fledged action potential is produced. Fuher increase in the intensity of stimulus produce no increment or other change in action potential as long as other experimental condition remain constant and is said to obey "all or none law". Action Potential - develops in the initial segment of axonQ and the impulse is transmitted along the axon to its termination. - follow 'all or none' phenomenon - conduction of nerve is an active self propagating process and impulse moves at a constant amplitude & velocity.Q - conduction is faster in myelinated axonsQ.
1
All or none phenomenon
Conduction independent of amplitude
Propagated action potential is generated in dendrites
Faster in unmyelinated fibres
Physiology
null
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Which of the following statements about Rhythm method is false?
Anencephaly is not a repoed complication of calender method. The calender method or rhythm method: By this method, couple is advised avoidance of sexual intercourse around ovulation. In a 28-day cycle, ovulation normally occurs on the 14th day of the cycle, but may occur anytime between the 12th and 16th day. Spermatozoa deposited in the female genital tract may survive for 24 hrs. The ovum itself may live for 12-24 hrs. Hence intercourse between the 11th and 17th day may result in a pregnancy. The safe period is, therefore calculated from the first day of the menstrual period untill the 10th day of cycle and from the 18th and 28th day. An alternative method is to calculate the risk period, which is from 3 days before ovulation to 3 days after ovulation. In a 35-day menstrual cycle, therefore, ovulation will occur on the 21st day (that is 14 days before the nexe period) so that the risk period is from day 18 to day 24 Ref: Shaw&;s Textbook of Gynaecology 17th edition Pgno: 253
1
Anencephaly is a repoed complication of calender method
It is associated with no costs
Safe period can also be observed using temperature rhythm or mucous method
Abstinence is needed for about 7-10 days
Gynaecology & Obstetrics
Contraception
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Yoke muscle pair -
Ans. is 'c' i.e., Rt LR + Lt MRo Yoke muscle refers to the pair of muscles (one from each eye) which contract simultaneously during various movements.o For example, right lateral rectus and left medial rectus act as yoke muscles for Dextroversion movement.MovementYoke MusclesDextroelevationRight superior rectusLeft inferior obliqueLevoelevationLeft superior rectusRight inferior obliqueDextrodepressionRight inferior rectusLeft superior obliqueLevodepressionLeft inferior rectusRight superior obliqueDextroversionRight lateral rectusleft medial rectusLevoversionLeft lateral rectusRight medial rectus
3
Rt IR + Rt SR
Rt LR + Rt MR
Rt LR + Lt MR
Lt LR + Lt MR
Ophthalmology
Ocular Motility
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Retinitis pigmentosa is a feature of all except -
Retinitis pigmentosa has features of : 1.Refsum's syndrome. It is characterised by retinitis pigmentosa, peripheral neuropathy and cerebellar ataxia. 2.Usher's syndrome. It includes retinitis pigmentosa and labyrinthine deafness. 3.Hallgren's syndrome. It comprises retinitis pigmentosa, vestibulocerebellar ataxia, congenital deafness and mental deficiency. 4. Other associated syndromes include Bussen- Koranzweig syndrome (Abetalipoproteinaemia), Kearns-Sayer syndrome, Friedreich's ataxia, Bardet-Biedle syndrome, NARP (neuropathy, ataxia, and retinitis pigmentosa), neuronal ceroid lipofuscinosis, olivopontocerebellar degeneration. Ref AK khurana 6/e p 289
2
Refsum's disease
Hallervorden-Spatz disease
NARP
Abetalipoproteinemia
Ophthalmology
Vitreous and retina
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multi
Employee's contribution to Employee State Insurance
According to ESI Act amendment 2019
4
3.75
3.5
2.75
0.75
Social & Preventive Medicine
Hospital waste and disaster management, Occupational health
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Bohler's angle is decreased in fracture of-
*Bohler's Tuber angle and crucial angle of Gissane are measured for Intra Aicular Fractures of Calcaneum. Ref: Apley's 9th/e p.926
1
Calcaneum
Talus
Navicular
Cuboid
Orthopaedics
Thigh, Knee,Leg,Foot & Ankle injuries
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The common cause of subarachnoid hemorrhage is-
null
3
Arterio-venous malformation
Cavernous angioma
Aneurysm
Hypertension
Medicine
null
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single
Iminoquimod is used in the treatment of -
Ans. is 'a' i.e., Anogenital wart Treatment options in wartsType of wartsTreatment optionsVarruca vulgarisCryotherapyElectric cautery, RFAWart paint (non on face, anogenital region)Mechanical removalPalmoplantar wartsWart paintCryotherapyFormain soaksFiliform wartsElectric cautery, RFAPlane wartsTrichloracetic acid touchRetionoic acidEpidermodyplasia verruciformisAcitretinAnoenital wartsPodophyllin/podophyllotoxinlmiquimodCryotherapy
1
Anogenital warts
Tenia versicolor
Melanoma
Sezary syndrome
Pharmacology
Skin
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single
Which of the following produces irreversible cell injury faster?
Ans: c (Ischaemia) Ref: Robbins, 7th ed,p. 12Both hypoxia and ischaemia produces irreversible cell injury by reducing aerobic oxidative respiration, but ischaemia not only compromises the supply of oxygen but also compromises metabolic substrates including glucose (which is normally provided by the blood). Therefore ischaemic injuries are more rapid and severe than hypoxic injuries.Depletion of ATP: ATP depletion and decreased ATP synthesis are frequently associated with both hypoxic and toxic (chemical) injuries. They are slower than ischaemic injury.Increased cytosolic Ca2+: Increase in cytosolic Ca2+ can occur in cell injury due to ischaemia as well as toxins. But it is not specific for irreversible cell injury. It can be found in reversible cell injury also.Also, loss of Ca2+ homeostasis is not always a proximal event in irreversible cell injury.
3
Increased cytosolic Ca2+
Decreased ATP
Ischaemia
Hypoxia
Pathology
Cellular Pathology
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The most reliable method of identification of an individual is: NEET 14
Ans. Galton system
2
Gustafson's method
Galton system
Beillion system
Scars
Forensic Medicine
null
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single
Richest source of vitamin C -
Ans. is 'a' i.e., Guava o The richest source of vitamin C is Indian goosebery (Amla),o Important sources of vitamin C in decreasing order : -Amla > Guava > Cabbage > Amaranath > Lime > Cauliflower > Orange > Spinach > Tomato > Potato
1
Guava
Lime
Orange
Tomato
Social & Preventive Medicine
Vitamins
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single
An -HIV drug known to cause myopathy resembling Mitochondrial myopathy with ragged red Fibers?
.
1
Zidovudine
Enfuviide
Nevirapine
Tenofovir
Pharmacology
All India exam
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The following is true about scalenus anterior muscle -
Scalenus anterior origins from anterior tubercles of the transverse process of four typical cervical vertebrae (i.e. C3-C6) and insert on scalene tubercle and adjoining ridge on inner border and upper surface of first (1st) rib between subclavian artery and subclavian vein. Thus it separates subclavian vein from subclavian artery and divides the subclavian artery (which lies posterior to it) in three (3) parts – 1st medial, 2nd posterior and 3rd part lateral to it. Phrenic nerve covered with a prevertebral layer of deep cervical fascia run vertically down on the anterior surface of scalenus anterior muscle (but do not pierce it). Ascending cervical artery (a branch of inferior thyroid artery or thyrocervical trunk) runs along with phrenic nerve but medial to it. Whereas transverse cervical and suprascapular arteries lie anterior to scalenus anterior and posterior to the lateral part of the carotid sheath (containing internal jugular vein), run transversely and bind phrenic nerve to muscle.
4
It is attached to the tubercle of second rib
It is anterior to the transverse cervical artery
It is pierced by the phrenic nerve
It separates the subclavian vein from the subclavian artery
Anatomy
null
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Commonest site of extramedullary relapse of ALL
Despite success of modern treatment,20-30% of children with ALL relapse.The main cause of treatment failure in leukemia is relapse of the disease.Common sites of relapse are the bone marrow(20%),central nervous system(5%),and testis(3%).Relapse in extramedullary sites,paicularly testes,is more ourable in terms of survival. Reference:Essential pediatrics-Ghai,8th edition,page no:604
1
CNS
Lung
Liver
Testis
Pediatrics
Childhood tumors
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Coronary aery disease is associated with all except?
Alcohol in mild amounts has been shown to have a beneficial effect on thehea. Studies have shown chlamydia and poor dental hygiene as incriminating factors for atherosclerosis. Red wine contains siuin that increases levels of H.D.L and increases longevity.
4
Chlamydia
Poor dental hygiene
Smoking
Alcohol
Medicine
Acute coronary syndrome
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multi
Most common psychiatric illness -
Ans. is 'a' i.e., Depressiono Depresson is the most common psychiatric disorder that affect 15% of the population at some time in their lives (Mates - 8-12%; Females -20-25%). Middle aged (25-45 years) females are most commonly affected.o Note : Among the given options, depression is most common. Overall, anxiety disorder is the most common psychiatric illness.
1
Depression
Bipolar
Mania
Cyclothymia
Psychiatry
Substance Abuse
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single
Dopamine agonist used in diabetes
Bromocriptine and cabergoline are dopamine agonists but bromocriptine usage in type 2 diabetes is approved.It has an interesting mechanism of action by inhibiting the dopamine dip that causes in early morning leading to hyperglycemia. Ref: Goodman and Gillman 13th ed
2
Metformin
Bromocriptine
Cabergoline
Vanadium salts
Pharmacology
Endocrinology
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single
True about pheochromocytoma is
10% are bilateral 10% are malignant 10% occur in pediatric patients 10% are extra-adrenal 10% are familial
1
Arises from chromaffin cells of adrenal medulla
Bilateral in 20% of all cases
Hypotension rules out pheochromocytoma
Almost always a malignant tumor
Physiology
All India exam
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multi
Raised MCV in pregnancy can be due to all except
MCV > 100fl is macrocytic First sign of megaloblastic anemia in pregnancy is usually an elevated red cell MCV Causes Megaloblastic: Folate deficiency, Vitamin B 12 deficiency and Orotic aciduria Non-Megaloblastic: Liver disease, Alcoholism, Reticulocytosis, Hypothyroidism Drugs: Azathioprine, 5-Flourouracil, Zidovudine, Hydroxyurea Reference: High risk pregnancy; Fernando Arias; 4th edition; Page no: 236, 237
4
Megaloblastic Anaemia
Alcohol use
Hypothyroidism
Iron Deficiency
Gynaecology & Obstetrics
Medical, surgical and gynaecological illness complicating pregnancy
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About hemothorax -a) Seen in choriocarcinomab) Supine posture is better than erect posturec) Needle aspiration may be needed for diagnosisd) Thoracotomy is always done
Hemothorax: Causes trauma (most common) tumor tuberculosis Diagnosis is made by needle aspiration of pleural fluid. Harrison writes that for making a diagnosis of hemothorax, the pleural fluid hematocrit should be > 50% of the peripheral blood. Chest X rays are taken to assess the presence and extent of pleural cavity collection (blood or simple plural fluid) a supine position with horizontal x-ray beam (k/a decubitus position) is better than an erect film, as about 400-500 ml of blood may be hidden by diaphragm on upright chest x-ray. Management of hemothorax Most of the hemothorax can be t/t effectively with a large bore chest tube drainage and in most of the cases the bleeding stops as the lungs re-expands. A small number of cases will require thoracotomy continued bleeding a significant blood clot has formed. Currently, most hemothoraces requiring more than simple tube drainage can be managed with Videothoracoscopy. Thoracotomy may be needed only if more extensive exposure is needed to manage an active source of bleeding or if extensive decortication of the lung is necessary.
4
ab
bc
acd
abc
Surgery
null
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All of the following occur in mitochondria except:
Ans. B. GlycogenolysisGlycogenolysis occurs in the cytoplasm.Other metabolic reactions in the cytosol - glycolysis, glycogenesis, cholesterol synthesis, HMP shunt, bile acid synthesis
2
Citric acid cycle (Krebs's cycle)
Glycogenolysis
Fatty acid oxidation
Electron transport chain
Biochemistry
Respiratory Chain
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multi
Which of the following is absent in normal pulp
null
1
Mast cells
Antigen presenting cells
T lymphocytes
Macrophages
Dental
null
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single
In brachial plexus nerve arising from root is
Nerve to serratus anterior or long thoracic nerve arises from the nerve root of C5-C7. Injury to this nerve causes the condition called winging of scapula due to paralysis of serratus anterior muscle. B D Chaurasia 7th edition Page no: 45
1
Nerve to serratus anterior
Axillary nerve
Ulnar nerve
Suprascapular nerve
Anatomy
Upper limb
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Range of OHI is:
The Oral Hygiene Index (OHI) was developed in 1960 by John C. Greene and Jack R. Vermillion to classify and assess oral hygiene status. To calculate the OHI, the DI and CI are summed: OHI = DI + CI  The DI and CI values range from 0 to 6. OHI value ranges from 0 to 12. Essentials of preventive and community dentistry Soben Peter 5th edition page no. 318
4
0-4
3-Jan
0-6
0-12
Dental
null
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A child come with fever, cold, cough, membrane over tonsils; nasal swab is taken, culture should be done on which medium for earliest diagnosis ?
Ans. is 'a' i.e., Loffelers serum slop Diphtheria bacilli grow on Loeffler's serum slope very rapidly and colonies can be seen in 6-8 hours, long before other bacteria grow.
1
Loffelers serum slop
L. J. media
MC Conkey's Agar
Citrate media
Microbiology
null
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Class I MHC molecules are expressed on all Except
Class I MHC molecules are expressed on all nucleated cells and plateletsReference: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Volume I; Page no: 195
4
Dendritic cells
Epithelial cells
Platelets
Red Blood Cells
Pathology
General pathology
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The following statements are true about Peyronie's disease except -
Peyronie's disease is usually seen over 40 years of age Impoant points about Pevronie's disease It is also k/a penile fibromatosis It is due to fibrous plaques in one or both corpus cavernosum.They may later calcify or ossify. Fibrous plaques lead to pain and curvature of the penis on erection Palpable induration or mass appears usually on the dorsolateral aspect of the penis. Palmar fibromatosis (Dupuytren's contracture), plantar fibromatosis and penile fibromatosis (Peyronie's ds.) are components of the same pathological process called superficial fibromatosis. The aetilogy is unceain, but it may be a result of past trauma. Treatment is difficult but some cases may show spontaneous regression. Medical treatments are often ineffective. If the penile deformity is distressing, Nesbitt's operation can be performed to straighten the penis Ref : Bailey and Love 25/e p1373
2
Spontaneous regression occurs in 50% of the cases.
Condition affects adolescent males.
The condition can be associated with Dupuytren's contracture of the tendon of the hand.
Pt. presents with complaints of painful erection.
Anatomy
Urology
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multi
Semi-Smoke less black powder is a mixture of
Semi-smokeless powder: It consists of a mixture of 80% black and 20% smokeless type Gunpowders: Black powder: It produces flame, smoke, and heat, and consists of granular ingredients, like sulfur, charcoal, and saltpeter (potassium nitrate) Smokeless powder: It is more effective than black powder as it burns more efficiently and produces much less smoke, resulting in less blackening and tattooing around the entry wound. Ref - Krishnan Vij 5th edition pg 238-240
4
50% black powder + 50% smokeless powder
60% black powder + 40% smokeless powder
70% black powder + 30% smokeless powder
80% black powder + 20% smokeless powder
Forensic Medicine
Special topics
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The method of prepayment wherein the patient pays a percent of total cost:
null
2
Loan
Co-insurance
Reasonable fee
Fee for service
Dental
null
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single
Leptospira icterohemorrhagica infection is transmitted by -
Ans. is 'b' i.e., Rats
2
Bats
Rats
Birds
Dogs
Microbiology
null
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single
Positive Kehrs sign is -
Ans. is 'a' i.e., Haemoperitoneum
1
Haemopeionium
Acute cholecystitis
Acute pancreatitis
Amoebic abscess
Surgery
null
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single
Best test for diagnosis of Carcinoid tumor:
Ans. (a) 24 hour urinary 5H.I.A.ARef: Harrison 19th ed. 1564-65* 5-HLAA is the major urinary metabolite of serotonin, a ubiquitous bioactive amine. Serotonin, and consequently 5-HLAA, are produced in excess by most carcinoid tumors, especially those producing the carcinoid syndrome of flushing, hepatomegaly, diarrhea, bronchospasm, and heart disease.
1
24 hour urinary 5H.I.A.A
24 hour catecholamines
24 hour vaniylmandelic acid levels
24 hour metanephrine levels
Medicine
Miscellaneous (Endocrinology)
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single
Name the procedure shown here in ureter:
Ans. (b) Dormia BasketThe use of wire baskets under image intensifier control has been replaced by ureteroscopic techniques but they may be useful when the instruments and expertise are not available
2
Stenting
Dormia Basket
Dilatation
Cannulation
Surgery
Kidney & Ureturs
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single
Case of 30 year chronic smoker male, visited your clinic with this condition. Diagnosis:
Ans. (b) Buerger's disease.Buerger's disease is also known as thromboangiitis obliterans. An inflammatory and obliterative disease of blood vessels of the extremities, mainly lower extremities. Occurring chiefly in smoker young men and leading to ischemia of the tissues and gangrene. Involvement of artery vein and nerve, most commonly involved is tibial artery. Intermittent claudication, pain at rest relieved by dangling legs. Dry gangrene in toes shows shriveled woody induration.IOC: Duplex USG (ankle brachial index: 0.5 to 0.9)Treatment: For Claudication pain, reducing the viscosity of blood pentoxifylline is used. For resting pain, lumbar sympathectomy. If gangrene, amputation done.Image source- style="font-family: Times New Roman, Times, serif">
2
Diabetic gangrene
Buerger's disease
Atherosclerotic plaque
Clostridium welchii infection
Surgery
Peripheral Arterial Occlusive Disease
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single
A second choice of tooth isolation is by:
Partial  isolation  with  cotton  rolls,  absorbent  wafers  and saliva  ejector  provides  rapid  and  effective  control  of  the operative field for some limited procedures in  which absolute dryness  is not required.
4
Cotton rolls
Cotton roll holders
Absorbent wafers
All of the above
Dental
null
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multi
Age independent anthropometric measure of malnutrition is ?
null
2
Weight/Height
Mid arm circumference
Head circumference
Mid arm circumference/height
Social & Preventive Medicine
null
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single
Which of the following local anaesthetic has the potential to cause methamoglobinemia ?
Prilocaine is a local anaesthetic similar to lignocaine. A metabolite of prilocaine has the potential to cause methaemoglobinemia. Prilocaine is used mainly for infiltration, nerve block and for providing intravenous regional anaesthesia.
2
Procaine
Prilocaine
Tetracaine
Bupivacaine
Anaesthesia
null
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single
HIV C subtype is seen in -
<p> HIV-C is most common in India. Reference:HIV/AIDS care and counselling by ACV Dyk,4th edition,page no.21.
1
India
Europe
America
Thailand
Social & Preventive Medicine
Communicable diseases
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single
A 27-year-old woman occasionally uses calcium carbonate (Turns) for "heartburn" symptoms after a large meal.For the above patient with an acid-peptic disorder, select the mechanism of action of the prescribed medication.
Although doctors seldom prescribe antacids because of the availability of superior medications, patients still use them extensively. As well as neutralizing acid, calcium carbonate enhances secretion in the stomach. The release of CO2 from bicarbonate can result in belching, nausea, and abdominal distension. Belching can exacerbate gastroesophageal reflex.
1
neutralizes gastric acid
works by binding to cysteine
inhibits gastrin release
irreversible H1-receptor blockade
Medicine
Miscellaneous
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multi
Granulomatous inflammatory reaction is caused by all, except-
It is a distinctive pattern of chronic inflammation characterised by aggregates of Macrophages with scattered lymphocytes. Seen in all of above except mycoplasma infection. Mycoplasma species have been isolated from women with bacterial vaginosis. M. genitalium is found in women with pelvic inflammatory disease. In addition, infection is associated with increased risk of cervicitis, preterm bih and spontaneous aboion, and infeility. Mycoplasma genitalium has developed resistance to some antibiotics.Mycoplasmae are associated with fetal respiratory distress syndrome, bronchopulmonary dysplasia, and intraventricular hemorrhage in preterm infants. Basic Pathology, Robbins. Page no.:56
4
M. Tuberculosis
M. Leprae
Yersinia pestis
Mycoplasma
Pathology
General pathology
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Antimicrobial resistance in frequent lens user is due to-
(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 50) The contaminated contact lens provides Psuedomonas aeruginosa an idea site for attachment and biofilm production Continuous contact of the eye to the biofilm-infested lens can lead to serious ocular diseases, such as keratitis (corneal ulcers) The biofilm also prevent effective penetration of the antibiotics, which increase the chances of antibiotic resistance
1
Biofilm formation
Improper handling
Unhygienic formation
Low potency of antibiotics
Unknown
null
477a50e7-ec53-47c6-bd22-9a8c5ce8c5b1
single
What is your diagnosis:
Ans. D. CranioschisisCranioschisis (Greek: "kranion - kranion" skull, and "schisis -skhi/sis;" - split), or dysraphism, is a developmental birth defect involving the skull. In this disease, the cranium fails to close completely (especially at the occipital region). Thus, the brain is exposed to the amnios, and eventually degenerates, causing anencephaly.Craniorachischisis is on the extreme end of the dysraphism spectrum, wherein the entire length of the neural tube fails to close
4
Anencephaly
Iniencephaly
Myelomeningocele
Craniorachischisis
Pediatrics
Genetics And Genetic Disorders
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single
Subconjunctival hemorrhages are evident in the following cases except ?
Ans. is 'd' i.e., Pellagra Subconjunctival haemorrhage Occurs due to the rupture of small vessels. The condition, though unsightly, is tril. This can occur spontaneously in elderly people with fragile vessels or those with systolic hypeension or after local ocular trauma or eye surgery. Very minute ecchymoses, or possibly thromboses, are seen in severe conjunctivitis; large extravasations accompany severe straining, especially in old people, as on lifting heavy weights or vomiting. They are not infrequently seen in children with whooping cough and may occur in scurvy, blood diseases such as purpura, or in malaria. Recurrent subconjunctival haemorrhages warrant investigations for a bleeding diatheses or leukaemia. The differential diagnosis includes Kaposi sarcoma. More serious are the large sub-conjunctival ecchymoses which seep forwards from the fonix following head injuries. They are due to an extravasation of blood along the floor of the orbit, secondary to a fracture of the base of the skull. In fractures of the sphenoid the blood appears later on the temporal side than elsewhere. Haemorrhages also result from severe or prolonged pressure on the thorax and abdomen, as in persons squeezed in a crowd or by machinery. The blood gradually changes colour and gets absorbed in 1 to 3 weeks without treatment. The use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided and if mild ocular irritation is present, aificial tears can be prescribed four to six times a day.
4
Whooping cough
Scurvy
Purpura
Pellagra
Ophthalmology
null
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multi
Flushing is common in patient taking which of the follwing oral hypoglycemic drug with alcohol:
Chlorpropamide is a first generation sulphonylurea. It causes cholestatic jaundice, intolerance to alcohol in predisposed subjects(flushing and a disulfiram like reaction). Disulfiram like reaction seen with: chlorpropomide, tolbutamide, metronidazole, gresiofulvin, cefoperazone, cefomandole etc (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 267)
1
Chlorprompamide
Phenformin
Glibenclamide
Tolazamide
Pharmacology
Endocrinology
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