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Increased LH secretion just before ovulation is due to
Luteinizing hormone (LH) a gonadotropin of the anterior pituitary gland, acting with follicle-stimulating hormone to cause ovulation of mature follicles and secretion of estrogen by thecal and granulosa cells of the ovary; it is also concerned with corpus luteum formation. In the male, it stimulates development of the interstitial cells of the testes and their secretion of testosterone. Called also interstitial cell-stimulating hormone.LH peak is a positive feedback mechanism from estradiol. The levels keep rising through the follicular phase and when they reach an unknown threshold, this results in the peak of the LH. This effect is opposite from the usual negative feedback mechanism presented at lower levels. In other words, the mechanism(s) are not yet clear. The increase in LH production only lasts for 24 to 48 hours. This "LH surge" triggers ovulation, thereby not only releasing the egg from the follicle but also initiating the conversion of the residual follicle into a corpus luteum that, in turn, produces progesterone to prepare the endometrium for a possible implantation. Ref: Ganong&;s review of medical physiology; 24th edition; page no:-407
2
Positive feed-back by progesterone
Positive feed-back by estrogen
Positive feed-back by FSH
Positive feed-bad by relaxin
Physiology
Endocrinology
6c521d0e-36e2-4bca-9ea8-5e6b7c892e89
single
The median of values 2, 5, 7, 10, 10, 13, 25 ?
Ans. is 'a' i.e., 10
1
10
13
25
5
Social & Preventive Medicine
null
5bfdd9aa-6acb-47a1-b4a8-3d2a1e90a88c
single
Salicylate intoxication is characterized by all of the following, EXCEPT:
Salicylate intoxication is associated with hypehermia and not hypothermia, as the drug causes uncoupling of oxidative phosphorylation, resulting in increased metabolism. Mild chronic salicylate intoxication is called salicylism. When fully developed, the syndrome includes headache, dizziness, tinnitus, difficulty hearing, dimness of vision, mental confusion, lassitude, drowsiness, sweating, thirst, hyperventilation, nausea, vomiting, and occasionally diarrhea. Ref: Grosser T., Smyth E. (2011). Chapter 34. Anti-inflammatory, Antipyretic, and Analgesic Agents; Pharmacotherapy of Gout. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.
3
Hyperventilation
Hypoprothrombinemia
Hypothermia
Metabolic acidosis
Pharmacology
null
a128844e-7602-43ee-a403-03f7bb51986b
multi
Which muscle causes opening of the upper end of esophagus?
Ans. is 'd' i.e., Cricopharyngeus of inferior constrictor Upper esophageal sphinctor* The upper esophageal sphincter surrounds the upper part of the esophagus.* It consists of skeletal muscle, but is not under voluntary control.* Opening of the upper esophageal sphincter is triggered by the swallowing reflex.* The primary muscle of the upper esophageal sphincter is the cricopharyngeal part of the inferior pharyngeal constrictor.
4
Epiglottis
Thyropharungeus
Stylopharyngeus
Cricopharyngeus of inferior constrictor
Anatomy
Thorax
91927901-80be-47c6-a626-6b7e467b452d
single
Which of the following is the ego-expansion of JSY?
Janani Suraksha Yojana (JSY) • Launched on 12th April 2005 • It is a ‘modification of National Maternity Benefit Scheme • Objectives of JSY: Reduction of maternal mortality and infant mortality (through institutional deliveries and care especially for poor women.)
4
Janani Sampoorna Yojana
Janani Samridhi Yojana
Janani Swarojgar Yojana
Janani Surakshan Yojana
Social & Preventive Medicine
null
583d4688-0d95-443c-a6c7-316aa33d07a1
single
Drug used in refractory glaucoma ?
Ans. is 'c' i.e., Alpha agonist Drug of choice for initial treatment of open angle glaucoma is either an topical b-blocker or topical PG analogue (latanoprost) It target IOT is not attained either change over to alternative drug or use both concurrently. In refractory cases (who are not responding to (3-blockers and PG analogues), topical a-agonist (Brimozidine) or topical carbonic anhydrase inhibitor (dorazolamide) is added. It target IOT is still not attained, laser trabeculoplasty is considered.
3
Systemic glucocoicoid
ACE inhibitor
Alpha agonist
Beta blocker
Ophthalmology
null
b6ec6bf2-fa70-477e-af00-d6cefeb451d1
single
A 10 year old boy has a fracture of femur. Biochemical evaluation revealed Hb 11.5 gm/dl and ESR 18 mm 1st hr. Serum calcium 12.8 mg/dL, serum phosphorus 2.3 mg/dL, alkaline phosphate 28 KA units and blood urea 32 mg/dL. Which of the following is the most probable diagnosis in his case-
Ans. is 'c' i.e., Hyperparathyroidism o You can solve the question just looking at calcium value. Amongst the given options only hyperparathyroidism causes hypercalcemia. The patient in question has an increased serum Ca', decreased serum phosphorus and increased values of alkaline phosphatase, all of which characterize hyperparathyroidism.
3
Nutritional rickets
Renal rickets
Hyperparathyroidism
Skeletal dysplasia
Pediatrics
null
10572939-fdef-490b-89f1-88597f5c4c2d
single
'Safe zone' of the eye ball is:
Ans. 8-9 mm behind the limbus
3
At the limbus
3-4 mm behind the limbus
8-9 mm behind the limbus
12 mm behind the limbus
Ophthalmology
null
2bba5653-ad8f-4640-86d7-f156e4594685
multi
Peutz Jeghers syndrome-all are true EXCEPT:March 2013
Ans. C i.e. Radiotherapy is the treatment of choict.
3
Pigmentation of lips & oral mucosa
Polyposis of jejunum
Radiotherapy is the treatment of choice
May turn malignant
Pathology
null
119e6b74-a3fc-4b75-aa9f-cbe04608d862
multi
A 45 year old male had multiple hypoaesthetic mildly erythematous large plaques with elevated margins on trunk and extremities. His ulnar and lateral popliteal nerves on both sides were enlarged. The most probable diagnosis is –
This patient has:- Multiple lesions Hypoesthetic Bilateral symmetrical nerve thickening These favour lepromatous end of the spectrum. Now question arises, whether it is BL or LL. Point two (Hypoesthetic) differentiates the two:- Sensations IL : Hypoesthetic or  Normoesthetic TT : Anesthetic BT : Hypoesthetic sometimes anaesthetic BB : Hypoesthetic BL : Hypoesthetic LL : Normoesthetic Late glove & stocking anaesthetic
4
Lepromatous leprosy
Borderline leprosy
Borderline tuberculoid leprosy
Borderline lepromatous leprosy
Dental
null
7cab0044-b837-4414-935e-34daed55b69a
multi
True of poisonous snakes are all, except: Delhi 06
Ans. Belly scales are small
2
Fangs present
Belly scales are small
Small head scales
Grooved teeth
Forensic Medicine
null
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multi
In Abetaltipoproteinemia result in absence of:
A i.e. Chylomicron, B i.e. LDL, C i.e. VLDLAbetalipoproteinemia: is a rare autosomal recessive disease due to defective synthesis or secretion of apo BQ & leads to absent or low level of chylomicrons, VLDL and LDLQ. [Apo protein B is major component of chylomicron (B-48), VLDL & LDL (B- 100)1
4
Chylomicron
LDL
VLDL
All
Biochemistry
null
6e035364-3354-45c1-9e95-0ff57d8590ae
multi
The secondary attack rate of measles is more than mumps. What is the conclusion?
Ans. c (Measles is more infectious than mumps). (Ref: Park PSM 22nd/pg. 58, 96)SECONDARY ATTACK RATE# It is defined as "the number of exposed persons developing the disease within the range of IP, following exposure to primary case"SAR =Number of exposed persons developing the disease within the range of IP------------------------------------------Total number of exposed/wsusceptible" contactsx 100# The primary case is excluded from both the numerator and denominator.# Case fatality rate is a measure of "killing power" of a disease.
3
Measles is more dangerous than mumps.
Mumps is more dangerous than measles.
Measles is more infectious than mumps.
Measles is more common than mumps.
Social & Preventive Medicine
Communicable Diseases
a9050e02-a2e1-4825-8ac0-b364fe620ed4
single
Most common primary leading to secondaries in pancreas:
Ans. (a) LungRef: Blumgart 5/e p 930-933* Secondary deposits in Pancreas is mc from Renal cell cancer (But on Postmortem studies- Lung cancer has been the topmost to produce secondary to pancreas)
1
Lung
Breast
Colon
Stomach
Surgery
Pancreas
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Most common nerve injury associated with thyroid surgery
.The external branch of the superior laryngeal nerve (EBSLN) is at risk of injury during thyroid operations when dissection of the superior pole and ligation of the superior thyroid vessels (STV) are carried out. From that perspective, EBSLN injury poses a threat to handicap all patients undergoing thyroid operations. ref Robbins 9/e pg 345
4
Right recurrent laryngeal
Left recurrent laryngeal
Right internal laryngeal
External branch of superior laryngeal nerve
Pathology
All India exam
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single
Water is used for hardening in -
Water of crystallization is used in Baralime and silica is used in sodalime
2
Sodalime
Baralime
Both
null
Anaesthesia
null
6839518c-62f0-4a05-8763-ce6b43a40580
multi
In tumour lysis syndrome all of the following are seen EXCEPT:
. Hypercalcemia
2
Hypernatremia
Hypercalcemia
Hyperkalemia
Hyperphosphatemia
Pathology
null
dcb1547c-e8f2-47e2-aabe-c1e8ffcf244d
multi
Which of the following most strongly suggests the diagnosis of primary hyperparathyrodism?
Diagnostic criteria for primary hyperparathyroidism and its surgery Ref - semantischolar.org
2
Serum acid phosphatase above 120IU/L
Serum calcium above 11 mg/dL
Urinary calcium below 100 mg/day
Serum alkaline phosphatase abve 120 lU/L
Medicine
Endocrinology
bddaaea4-3663-496f-acbb-ae11f5da01de
multi
Damage to lower pons, leaving upper pons intact, will result in:
Damage to lower pons will damage the apneustic center. This center was causing the breathing to be slow and deep. Upper pons has pneumotaxic center. It causes the breathing to be rapid and shallow. Since this center is intact (and apneustic is damaged), breathing will become shallow and rapid.
2
Apneusis
Rapid, shallow breathing
Irregular gasping type of breathing
No change in pattern of breathing
Physiology
Respiratory System Pa 3
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multi
Pagets disease increases the risk of
Osteosarcoma Osteosarcomas are bulky tumors that are gritty, gray-white, and often contain areas of hemorrhage and cystic degeneration (Fig. 26-24). The tumors frequently destroy the surrounding coices and produce soft tissue masses. They spread exten- sively in the medullary canal, infiltrating and replacing hemato- poietic marrow. Infrequently, they penetrate the epiphyseal plate or enter the joint. When joint invasion occurs, the tumor grows into it along tendoligamentous structures
2
Osteoma
Osteosarcoma
Fivrosarcoma
All
Anatomy
Musculoskeletal system
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multi
Mechanism of action on ondensetron -
Ans. is 'd' i.e., 5HT3 antagonist Ondansetron* It is the prototype of a distinct class of antiemetic drugs developed to control cancer chemotherapy/radiotherapy induced vomiting, and later found to be highly effective in PONV and disease/drug associated vomiting as well.* It blocks the depolarizing action of 5-HT exerted through 5-HT3 receptors on vagal afferents in the g.i.t. as well as in NTS and CTZ.* Cytotoxic drugs/radiation produce nausea and vomiting by causing cellular damage release of mediators including 5-HT from intestinal mucosa activation of vagal afferents in the gut emetogenic impulses to the NTS and CTZ. Ondansetron blocks emetogenic impulses both at their peripheral origin and their central relay.* It does not block dopamine receptors.* Apomorphine or motion sickness induced vomiting is not suppressed.* A weak gastrokinetic action due to 5-HT3 blockade has been detected, but this is clinically insignificant.* A minor 5-HT4 antagonistic action has also been shown, but seems to have no clinical relevance.
4
RANK ligand inhibitor
MMDA antagonist
NK 1 receptor antagonist
5 HT3 antagonist
Pharmacology
G.I.T
43181a37-7d03-4e58-8941-e4458592e6c4
single
DOC for Tenia Ungum
C i.e. Griseofulvin
3
Ampthotericin B
Miconazole
Gresiofulvin
Nystatin
Skin
null
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single
Mechanism of action of statins:
Ref: KDT 6th ed. pg. 614* HMG-CoA Reductase Inhibitors (statins): This class of compound is the most efficacious and best tolerated hypolipidaemic drugs.* MOA: Competitively inhibit conversion of HMG-CoA to mevalonate by the enzyme HMG-CoA reductase.* Drugs (Statins): Lovastatin, Simvastatin, Pravstatin, Atorvastatin, Rosuvastatin* All statins are given at night except: Rosuvastatin, Atorvastain (can be given at anytime)* Major side effects of statins: Myopathy* Most potent statin: Pitavastain
3
Inhibit HMG CoA synthase
Stimulate HMG CoA reductase
Inhibit HMG CoA reductase
Stimulate HMG CoA synthase
Pharmacology
C.V.S
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single
HU units value of bone -
Ans. is 'd' i.e., +1000 SubstanceHU unitsWaterDense cortical boneSoft tissueFatLung tissueAir0+ 1000 (+400 to + 1000)+ 40 to + 80- 60 to -100- 400 to -600- 1000
4
0
40
-100
1000
Radiology
Ultrasonography, CT, and MRI
9584b8ee-ad93-4fca-a417-3e9b64ade107
single
What is histological appearance of vaginal mucosa ?
The vagina is a muscular tube. The lining epithelium is stratified squamous. Underneath the epithelium is a layer of lamina propria, which is rich in elastic fibres, and does not have any glands. Under the lamina propria layer is a layer of smooth muscle, which has an inner circular and outer longitudinal layer. Finally, there is an adventitial layer, which merges with that of the bladder (anteriorly) and rectum (posteriorly). ref - BDC 6e vol2 pg
1
Stratified squamous
Glandular
Simple squamous
Cuboidal
Anatomy
Abdomen and pelvis
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single
The influence of maternal smoking and LBW incidence is studied. Detailed smoking history is taken at first AN visit and smoking history and bih weight were studied later. The type of study is-
prospective coho studies is one which the outcome has not yet occurred at the time the investigation begins.most prospective studies begin in the present and continue into future. ref:park&;s textbook,ed 22,pg no 73
4
Retrospective coho study
Cross sectinal study
Clinical trial
Prospective coho study
Social & Preventive Medicine
Epidemiology
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single
The percentage of glutaraldehyde, as a medicament during primary tooth pulpotomy is
null
4
4.00%
3.00%
1.50%
2.00%
Dental
null
b1d03f24-10e7-4015-9bf4-1366bf666c09
single
Snellen's cha is used to test:
Ans. Vision
1
Vision
Refraction
Presbyopia
Colour blindness
Ophthalmology
null
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single
Site of b-oxidation is ?
Ans. is 'b' i.e., Mitochondria
2
Cytosol
Mitochondria
Lysosome
Golgi apparatus
Biochemistry
null
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single
An enzyme that protects the brain from free radical injury is -
null
3
Myeloperoxidase
MAO
Superoxide dismutase
Hydroxylase
Pathology
null
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About H. Influenza all true except aEUR'
Capsular polypeptide protein is responsible for virulence Hemophilus Infl uenzae Hemophilus influenzae is a grain negative rod. The name hemophilus influenzae shows some of its features. Hemophilus means "blood loving" This organism requires blood containing medium.for growth H. influenzae requires 2 erythrocyte factors for growth. Factor X hemin --> It is required, for synthesis of cytochrome Factor V nicotinanti- --> It is essential for oxidation de adenine dinucleotide reduction In the laboratory it is usually grown on chocolate blood agar which is prepared by adding blood to an agar base at 80degC. The heat releases X and V factors from the RBC and turn the medium a chocolate brown colour. Pathogenesis :? The pathogenesis of H. influenzae infection is not completely understood although the presence of type B polysaccharids capsule is known to be the major factor in virulence. H. influenzae does not secrete any exotoxins, the polysaccharide capsule is considered to be the major factor in virulence. -There are "6" types of capsule designated a, b, c, d, e and f of these type "b" is conunonly associated with invasive Hemophilus influaenzae disease in children. The polysaccharide capsule of type 'b' strain is composed of ribose ribitol and phosphate "(PRP)" capsule and is the proven determinance of virulence. The "PRP capsule" exes its effect in the following way :? It is antiphagocytic It does not induce the alternative complement pathway This allows the bacterium to invade the blood or cerebrospinal .fluid without attracting phagocytes or provoking an inflammatory response and complement mediated bacteriolysis. For this reason anticapsular antibody which promotes both phagocytosis and lysis of bacteria is the main factor in immune defense against H. influenzae infection. Non typable or nonencapsulated strains of bacteria are less virulent. They lack the invasiveness of their capsulated strains and can only cause local reactions. They frequently cause otitis media in children as well as respiratory disease in adults weakned by preexisting lung disease such as chronic bronchitis from smoking or recent viral influenza infection. Hemophilus influenzae is associated with two types of infection -Invasive infections - Non invasive infections Host defenses Host defenses include the :- - Activation of the alternative and classical complement pathways and - Antibodies to the PRP capsule H. influenzae is susceptible to lysis by antibody and complement. Antibodies to the Hib capsule plays the primary role in conferring immunity against H. influenzae. These bactericidal antibody directed against PRP capsule of H. influenzae type h is entirely responsible for host resistance. Newborns have low risk of infection The mother possesses antibodies against the "b" capsule which she has acquired in her life time. She passes these antibodies to the fetus transplacentally and in her breast milk. These passively acquired antibodies last for about 6 months as a result infants are immune to H Influenzae infections. When these transplacental antibodies to the capsule wane infants are at high risk for developing invasive H. influenzae disease. It takes 3-5 years of hemophilus influenzae colonization and infection for children to develop their own antibodies. So there is a "window" during which children are prone to be infected with hemophilus influenzae.
3
Requires factor X and V for growth
Rarely presents as meningitis in children less than 2 months of age
Capsular polypeptide protein is responsible for virulence
M.0 invasive disease of H influenza is meningitis
Microbiology
null
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multi
In a case of chest pain with pericarditis and pericardial effussion, pain is referred by?
Phrenic nerveThe pericardium is composed of two layers.The tough external layer, the fibrous pericardium. The parietal layer of serous pericardium is attached to its internal surface. The visceral layer of serous pericardium is fused to the hea.The fibrous and parietal pericardia are supplied by the phrenic nerve (C3-05). They are sensitive to pain.The visceral pericardium or epicardium is supplied by autonomic nerves, not sensitive to pain.
1
Phrenic nerve
Superficial cardiac plexus
Deep cardiac plexus
Vagus nerve
Anatomy
null
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single
The root canal instrument most likely to break during use is a
null
2
File
Broach
Reamers
Spreaders
Dental
null
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single
A 60 yrs old male comes to casualty with acute retention of urine since 12 hrs. On examination there was distended bladder. His wife gives a history of taking some drug by the patient since 2 days as he is suffering from depression. The most likely drug is:
Anticholinergic effects of tricyclic antidepressants (TCAs) are most common. These effects result in dry mouth, constipation, urinary retention, blurred vision, and confusion. They are more common with teiary amine TCAs such as amitriptyline and imipramine than with the secondary amine TCAs desipramine and noriptyline. The potent alpha blocking propey of TCAs often results in ohostatic hypotension. H1 antagonism by the TCAs is associated with weight gain and sedation. The TCAs are class 1A antiarrhythmic agents and are arrhythmogenic at higher doses. Sexual effects are common, paicularly with highly serotonergic TCAs such as clomipramine. The TCAs have a prominent discontinuation syndrome characterized by cholinergic rebound and flulike symptoms. Ref: DeBattista C. (2012). Chapter 30. Antidepressant Agents. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical Pharmacology, 12e.
2
CPZ
Amitriptyline
Haloperidol
Pimozide
Psychiatry
null
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Root value of intercostobrachial nerve is
The intercostobrachial nerve is a lateral cutaneous branch of the second intercostal nerve that supplies sensation to the skin of the Axilla . It leaves the second intercostal space at the midaxillary line and subsequently pierces the serratus anterior muscle to enter the subcutaneous tissues of the axilla. The nerve may be injured during axillary surgery such as nodal clearance for breast cancer The anterior divisions of the second, third, fouh, fifth, and sixth thoracic nerves, and the small branch from the first thoracic, are confined to the walls of the thorax, and are named thoracic intercostal nerves respectively . They pass forward in the intercostal spaces below the intercostal vessels. At the back of the chest they lie between the pleura and the posterior intercostal membranes, but soon they run between the internal intercostals and the innermost intercostals then anteriorly they lie between the pleura and the internal intercostals . Ref - radiology assistant.com
2
T1
T2
T3
T4
Anatomy
Thorax
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single
What is the most probable diagnosis in this neonate shown below?
a. Infant of diabetic mother(Ref: Nelson's 20/e p 898-899)Large for date baby with hairy pinna suggests a diagnosis of Infant of diabetic mother.
1
Infant of diabetic mother
Beckwith Wiedemann syndrome
Congenital hypothyroidism
IUCR baby
Pediatrics
New Born Infants
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single
True about boundaries of inguinal canal are all, EXCEPT:
Conjoint tendon is formed by the condensation of fibers of internal oblique and transverse abdominis. It forms the posterior wall of inguinal canal.Boundaries of inguinal canal:Anterior wall of inguinal canalis made up of external oblique aponeurosis with some fibers of internal oblique which attach to lateral pa of inguinal ligament.Posterior wall is formed from transversalis facia, except medially where the conjoint tendon from transversus abdominis intervenes.Inferior wall (floor) is formed from the inguinal ligament as it turns inward, and it is composed medially of lacunar ligament.Roof consist of lowermost fibers of internal oblique and transversus abdominis as they arch over the canal to join together as conjoined tendon.
1
Conjoint tendon is seen anteriorly
Fascia transversalis forms posterior boundary
Inguinal ligament forms the base
Internal oblique forms the roof
Anatomy
null
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multi
Which of the following is the investigation of choice for assessment of depth of penetration and perirectal node involvement in rectal cancer?
Investigations for rectal carcinoma: For Diagnosis: Best diagnosed by sigmoidoscopy (rigid not flexible) and biopsy of tumour Barium enema For Staging: TRUS (transrectal ultrasonography) CT MRI TRUS (Transrectal Ultrasonography) The depth of the tumour invasion can be accurately determined by TRUS, but it cannot detect cancer metastasis in lymph nodes (though it can detect enlarged lymph nodes, but it cannot predict if- cancer infiltration is present or not). CT Scan CT scan is also helpful for cancer extension, but again CT scan also cannot tell clearly about node invasion by cancer cell. MRI Scan It has become the most useful investigation tool (specially with the use of transrectal coils) for rectal carcinoma. It can very well predict the invasion of tumour in rectum as well as lymph node invasion with high accuracy. Ref: Maingot's 11/e, Page 701.
1
MRI scan
CT scan pelvis
Double contrast barium enema
Transrectal ultrasound
Surgery
null
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single
"White plague" is
In 1700s,TB was called "White Plague" due to the Paleness of Patients. Ref: Pg No: 317, IAPSM Textbook of Community Medicine
3
Pneumonic Plague
Bubonic Plague
Tuberculosis
leprosy
Social & Preventive Medicine
Communicable diseases
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single
Upon contact between the sperm head and the zona pellucida, penetration of the sperm into the egg is allowed because of:
Ans. A. The acrosome reactionThe acrosome reaction causes a fusion of the plasma membrane and the acrosomal membrane of the sperm, with subsequent release of proteolytic enzymes that help the sperm enter the ovum. The zona reaction and Pro nuclei formation occur after the sperm has entered the ovum. Sperm enter the perivitelline space after penetration; there is no evidence that this space has any role in penetration. Cumulus expansion assists in movement of the sperm through the mass of granulosa cells for the sperm to get to the surface of the zona pellucida. However, the cumulus cells do not assist in actual penetration of the zona.
1
The acrosome reaction
The zona reaction
The perivitelline space
Pro nuclei formation
Physiology
Sex Hormones
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QRS complex is due to -
Ans. is "d" i.e., Ventricular depolarization Event of ECGCauseP-waveAtrial depolarizationQRS complexVentricular depolarizationTwaveVentricular repolarizationPR intervalRepresents time taken by impulse to travel from SA node to ventricle (Atrial depolarization and AV conduction)QT intervalDuration of full ventricular contraction (Ventricular depolarization + Repolarization)
4
Ventricular repolarization
Atrial depolarization
Conduction through AV node
Ventricular depolarization
Physiology
Heart: Normal Electrocardiogram
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The symptoms of hyperparathyroidism include:
Ans. (d) All of the aboveClinical features of Hypoparathyroidism:* Weakness* Fatigue* Polydipsia, Polyuria, Nocturia,* Bone and Joint Pain* Constipation, Decreased appetite, heart burn* Pruritus* Depression* Memory loss* CapO4 and Ca. Oxalate Renal calculi
4
Constipation and muscle weakness
Anorexia and weight loss
Polydipsia and polyuria
All of the above
Surgery
Pancreas
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multi
Anorectal anomalies are commonly associated with:
Ref: Robbins Pathologic Basis of Disease, 8th editionExplanation:Anorectal malformations (ARMs)or Imperforate anusThese are birth defects in which the rectum is malformed.The cause of ARMs is unknownThe genetic basis of these anomalies is very complexAnorectal Malformation in Currarino Syndrome represent the only association for which the homeobox gene HLXB9 has been identified.The new classification is in relation of the type of associated fistula.The classical classification was in low and high anomalies:A low lesionThe colon remains close to the skin, stenosis (narrowing) of the anus, or the anus may be missing altogether, with the rectum ending in a blind pouch.A high lesionThe colon is higher up in the pelvisThere is a fistula connecting the rectum and the bladder, urethra or the vagina.A persistent cloaca in which the rectum, vagina and urinary tract are joined into a single channel.Imperforate anus is associated with an increased incidence of some other specific anomalies (VACTERL association)V - Vertebral anomaliesA - Anal atresiaC - Cardiovascular anomaliesT - Tracheoesophageal fistulaE - Esophageal atresiaR - Renal (Kidney) and/or radial anomaliesL - Limb defectsCurrarino syndrome (Currarino triad)The sacrum dysgenesisPresacra I massAnorectal MalformationsIt can also cause an anterior meningocele or a presacral teratoma.
1
Cardiac anomalies
Duodenal atresia
CMS abnormalities
Abdominal wall defects
Surgery
Rectum
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A transection made at the lower end of medulla through the pyramids would cause all/except:
B. i.e. Involuantry movements LMN involves anterior horn cells, anterior spinal nerve root and peripheral nerve.- Involuantry movements & tremors are characteristic features of extrapyramidal disorder- Inocordination (ataxia) is mostly seen in cerebellar lesions but UMN lesions may also present with incordination due to spasticity & weakness.
2
In coordination
Involuntary movements
Spasticity
Increased tendon reflexes
Anatomy
null
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A 48-year-old woman presents with complaints of moderate weight loss over the past 6 months, heat intolerance, palpitations, and fine tremors in the hands. Physical examination reveals the presence of a diffuse goiter and exophthalmos. Which of the following laboratory findings would be expected in this individual?
The description given above is of an individual with Graves' disease. Hypersecretion of thyroid hormone because of stimulation of the TSH receptor by thyroid-stimulating immunoglobulins results in excessive movement of thyroglobulin from the colloid to the plasma. The presence of exophthalmos is thought to be pa of the autoimmune disorder in Graves' disease. It is postulated that the thyroid and orbital muscles may share a common antigen. Lymphocytic infiltration and inflammation of orbital muscle then produces the ophthalmopathy. Serum T4 is increased in Graves' disease. Because of excessive stimulation of the thyroid by the thyroid stimulating immunoglobulins, radioactive iodine uptake, which assesses iodine trapping, is increased. The increase in free T4 due to hypersecretion by the thyroid shifts the equilibrium between free and bound T4 toward an increase in thyroxine binding globulin (TBG)-bound hormone. Concomitantly, the concentration of unbound TBG falls. Hence, the radioactive T3 in the resin T3 uptake test would preferentially bind to the resin and resin uptake would be increased. Ref: Jaume J.C. (2011). Chapter 2. Endocrine Autoimmunity. In D.G. Gardner, D. Shoback (Eds), Greenspan's Basic & Clinical Endocrinology, 9e.
4
Decreased serum T4
Decreased radioactive iodine uptake
Decreased resin T3 uptake
Increased plasma concentration of thyroglobulin
Medicine
null
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Causative agent of malaria -
Malarial parasite infecting human belongs to genus plasmodium. P.vivax, P.falciparum,P.malariae,p.ovale.They are protozoa causing malaria in man.In India P.vivax and P. Falciparum are very common.(refer pgno:54 baveja 3 rd edition)
1
Protozoa
Mosquito
Bacteria
Virus
Microbiology
parasitology
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Morbid jealousy is diagnostic of-
Morbid (pathological) jealousy is seen in alcoholism.
3
Cocaine
Cannabis
Alcoholism
Tabacco Intoxication
Forensic Medicine
null
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All of the following have a causative association with primary epistaxis in an elderly patient except:
Factors associated with Primary adult Epistaxis: 1. CHRONOBIOLOGY The frequency of admission is greatest in the autumn and winter months.This seasonal variation correlates with fluctuations in environmental temperature and humidity. A chronobiological rhythm is also observed at the circadian level where onset of bleeding and hospital admission show a biphasic pattern with peaks in the morning and late evening. 2. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAID): The action of non-steroidal anti-inflammatory drugs is mediated an anti-platelet aggregation effect due to altered platelet membrane physiology. 3. ALCOHOL Epistaxis patients are more likely to have consumed alcohol within 24 hours. The use of alcohol by epistaxis patients is associated with a prolongation of the bleeding time despite normal platelet counts and coagulation factor activity. HYPEENSION (NOT A Causative Factor) This has long been considered a cause of epistaxis. However,a number of large studies have failed to show a causal relationship between hypeension and epistaxis. The apparent hypeension in acute admissions of epistaxis may be a result of anxiety associated with hospital admission and the invasive techniques used to control the bleeding.
4
Winter season
NSAIDs
Alcohol Consumption
Hypeension
ENT
Epistaxis
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Calabar swelling is produced by-
Calabar Swelling: Localized angioedema and erythema usually on the extremities, characterized by fugitive, swollen lumps of subcutaneous tissue caused by a parasitic filarial worm (Loa loa) endemic to Central and West Africa. The swollen areas migrate with the worm through the body at a speed of about 1 cm per minute and may become as large as a small egg.
2
Onchocerca volvulus
Loa loa
Brugia malayi
Wuchereria bancrofti
Microbiology
null
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Following several days of 12-hour daily rehearsals of the symphony orchestra for a performance of a Wagnerian opera, the 52-year-old male conductor experienced such excruciating pain in the posterior aspect of his right forearm that he could no longer direct the musicians. When the maestro's forearm was palpated 2 cm distal to, and posteromedial to, the lateral epicondyle, the resulting excruciating pain caused the conductor to weep. Injections of steroids and rest were recommended to ease the pain. Which of the following injuries is most likely?
The Deep radial nerve courses between the two heads of the supinator and is located just medial and distal to the lateral epicondyle. It can be compressed by hyperophy of the supinator causing pain and weakness. The Median nerve passes into the forearm flexor compament. Superficial radial nerve courses down the lateral aspect of the posterior forearm and would not cause pain due to pressure applied to the posterior forearm.
4
Compression of the median nerve by the pronator teres
Compression of the median nerve by the flexor digitorum superficialis
Compression of the superficial radial nerve by the brachioradialis
Compression of the deep radial nerve by the supinator
Anatomy
Nerve Lesions
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single
Which of the following will occur in an exclusively breast fed baby -
Ans. is 'a' i.e., Jaundice o "13% of breast fed infants develop unconjugated hyperlbilirubinemia in the 1st week of life. The breast fed infants have higher, bilirubin levels than formula fed infants." o It is due to inhibitory substances (Pregananediol and free fatty acids) in breast milk that interfere with bilirubin conjugation.
1
Jaundice
Scurvy
Tetany
Eczema
Pediatrics
null
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In school water fluoridation, amount of F used is:
null
3
0.7-1.2 ppm
1.6-3 ppm
3-4 ppm
12 ppm
Dental
null
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The chemotherapy drug fluorouracil undergoes a series of chemical changes in vivo that result in a covalent complex such that it is bound to both thymidylate synthase and methylene-tetrahydrofolate. The inhibition of deoxythymidilate formation and subsequent blockage of cell division is due to
Since rapidly multiplying cancer cells are dependent upon the synthesis of deoxythymidilate (dTMP) from deoxyuridylate (dUMP), a prime target in cancer therapy has been inhibition of dTMP synthesis. The anticancer drug fluorouracil is conveed in vivo to fluorodeoxyuridylate (FdUMP), which is an analogue of dUMP. FdUMP irreversibly forms a covalent complex with the enzyme thymidylate synthase and its substrate N5,N10-methylene- tetrahydrofolate. This is a case of suicide inhibition, where an enzyme actually paicipates in the change of a substrate into a covalently linked inhibitor that irreversibly inhibits its catalytic activity.
3
Allosteric inhibition
Competitive inhibition
Irreversible inhibition
Noncovalent inhibition
Surgery
null
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In the evaluation of a 26-year-old patient with 4 months of secondary amenorrhea, you order serum prolactin and b-hCG assays. The pregnancy test is positive, and the prolactin comes back at 100 ng/mL (normal <25 ng/mL in this assay). This patient requires
There is a marked increase in levels of serum prolactin during gestation to over 10 times those values found in nonpregnant women. If this woman were not pregnant, the prolactin value could easily explain the amenorrhea and further evaluation of hyperprolactinemia would be necessary. The physiologic significance of increasing prolactin in pregnancy appears to involve preparation of the breasts for lactation.
1
Routine obstetric care
Computed tomography (CT) scan of her sella turcica to rule out pituitary adenoma
Repeat measurements of serum prolactin to ensure that values do not increase over 300 ng/mL
Bromocriptine to suppress prolactin
Gynaecology & Obstetrics
Physiology & Histology
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Knee with leg x- ray of an adolescent boy is shown. Probable diagnosis:
Chondromyxoid Fibroma Disease of adolescent Knee X-ray Sclerotic lesion around the coex in the tibia. . Small eccentric lytic lesion which lie parallel to the long axis of the bone. * Bone cyst with fracture will show a larger lesion and is mostly unilateral. * Osteitis Fibrosis cystica will present with multiple lesions and also has a history of abdominal groans, psychic moans and renal stones. * Osteosarcoma is a malignant lesion usually occurs above the joint.
1
Chondromyxoid fibroma
Osteosarcoma
Bone cyst with fracture
Osteitis Fibrosis cystica
Orthopaedics
Ohopedics Oncology
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Centrilobular necrosis of liver may be seen with -
Ans. is 'c' i.e., CC14 Hepatocellular necrosis: - o Liver necrosis is a common manifestation of many liver diseases and it can present in various ways, o If severe it can cause liver failure. o In some cases however the necrosis is subclinical, revealed only by elevations of liver enzymes in serum, o Various diseases can cause different patterns of necrosis. These are -] Focal Necrosis - Randomly occurring necrosis of single cells or small clusters of cells. It can involve any area of the lobule All lobules are not involved. Characteristic features on biopsy are - Councilman bodies Areas of lysed liver cells surrounded by collection of kupffer cells and inflammatory cells. Causes of Focal necrosis - Viral hepatitis, Bacterial infections, Toxic damage Zonal necrosis - The characteristic of zonal necrosis is that identical regions of liver lobules are involved. All liver lobules are involved. The necrosis is divided according to the zone involved (Note: In focal necrosis any area of lobule and some lobules are involved.) Types of zonal necrosis Centrizonal necrosis (centrilobular) ->> Necrosis in the cells surrounding central hepatic vein, seen in - i) Cardiac failure or shock iii) Chloroform toxicity ii) Carbon tetrachloride toxicity (CC14) iv) Viral hepatitis Peripheral zonal necrosis (periportal) - Necrosis is seen in areas around the portal tracts, Seen in i) Eclampsia ii) Phosphorus poisoning Midzonal necrosis - Rare, seen in yellow fever Also know - o Submassive necrosis - Occurrence of liver cell necrosis that is not limited by lobular boundaries i.e., the necrosis extends beyond lobular boundaries. o Massive liver necrosis - In this large areas of liver cell undergo necrosis. Only small areas are left intact, o Massive and submassive fiver necrosis are clinically manifested as. # Acute fiver failure of variable severity # Serum enzyme levels are very high
3
Phosphorus
Arsenic
CCI4
Ethanol
Pathology
Liver
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Most diffusable ion in excitable tissue is -
Points to note Concentration of ions Na+ concentration higher in ECF K+ concentration higher in ICF Cl- concentration higher in ECF K+ leak channels allow K+ to move from ICF to ECF Na+ is prevented from entering the cell. Thus diffusion is highest for K+, then Cl- and least for Na+, when the cell is at rest.
2
Na+
K+
PO4-
Cl-
Physiology
null
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which of the following tricyclic antidepressent used for peripheral neuropathy
TCA * MECHANISM This is an antidepressant with three rings. It acts by blocking the transpoers of neurotransmitters resulting in increased neurotransmitters in synapse DRUGS AMITRYPTILLINE IMIPRAMINE CLOMIPRAMINE DESIPRAMINE NORIPTILLINE DOXEPINE * USE AMITRYPTILLINE========PAIN WITH DEPRESSION IMIPRAMINE==========CHILDHOOD ENEURESIS CLOMIPRAMINE========OCD * SIDE EFFECTS ANTI HISTAMINERGIC==== sedation, weight gain ANTI MUSCURANIC=======dryness of mouth ANTI ADRENERGIC========hypotension, giddiness SWITCH TO MANIA when used in BIPOLAR DEPRESSION REf. kaplon and Sadock,synopsis of psychiatry, 11 th edition,pg no. 955
1
amitriptilline
clomipramine
fluoxetine
imipramine
Anatomy
General anatomy
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Which aery does not contribute to Little's area
LITTLE'S AREA (Anterior inferior pa of nasal septum) - Usual site for epistaxis in children. Four Aeries anastomose here and form Kiesselbach's Plexus. Anterior ethmoidal aery(Ophthalmic aery) Sphenopalatine(Maxillary aery) Septal branch of superior labial(Facial aery) Greater palatine aery(Maxillary aery) Ref: Dhingra 7e pg 197.
4
Septal branch of facial aery
Anterior ethmoidal aery
Sphenopalantine aery
Posterior ethmoidal aery
ENT
Nose and paranasal sinuses
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Erythrophagia and Mononuclear cell infiltration ulcers are seen in -
Erythrophagocytosis (erythrophagia) is characteristic of typhoid ulcer.
4
Necrotising colitis
Ulcerative colitis
Crohn's disease
Typhoid ulcers
Pathology
null
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Velvety appearance of stomach is seen in poisoning with:(1995)
Ans: cRef: Parikh, 6th ed, p. 9.10 and 5th ed, p. 748
3
Abrus precatorius
Barbiturates
Arsenic
lead
Forensic Medicine
Toxicology
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single
All are used for the treatment of Pulmonary hypeension except
Refer kDT 6/e p 297 Vasodilators are used for the treatment of Pulmonary hypeension. Treatments include: endothelin receptor antagonists - such as bosentan, ambrisentan and macitentan phosphodiesterase 5 inhibitors - sildenafil and tadalafil prostaglandins - epoprostenol, iloprost and treprostinil soluble guanylate cyclase stimulators - such as riociguat calcium channel blockers - nifedipine, diltiazem, nicardipine and amlodipine
4
Endothelin receptor antagonist
Phosphodiesterase inhibitors
Calcium channel blockers
Beta blockers
Pharmacology
Cardiovascular system
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Which of the following is the national level system that provides annual national as well as state level reliable estimation of feility and moality -
.
4
Civil registration system
Census
Adhoc survey
Sample registration system
Social & Preventive Medicine
Biostatistics
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The classification proposed by the International Lymphoma Study Group for non-Hodgkin's lymphoma is known as:
Answer is B (REAL Classification) In 1994, a group of hematopathologists, oncologists and molecular biologists came together (International Lymphoma Study Group) and introduced a new classification, called the 'Revised European-American Classification of Lymphoid Neoplasms (REAL). WHO has now reviewed and updated the real classification resulting in inclusion of additional rare entities. WHO Classification / Modified 'REAL' Classification I. Precursor B-cell Neoplasm Precursor-B lymphoblastic leukemia/lymphoma II. Peripheral B-Cell Neoplasms Chronic lymphocytic leukemia/small lymphocytic lymphoma B-cell prolymphocytic leukemia Lymphoplasmacytic lymphoma Splenic and nodal marginal zone lymphomas Extranodal marginal zone lymphomas Mantle cell lymphoma Follicular lymphoma Marginal zone lymphoma Hairy cell leukemia Plasmacytoma/plasma cell myeloma Diffuse large B-cell lymphoma Burkitt lymphoma III. Precursor T-Cell Neoplasms Precursor-T lymphoblastic leukemia/lymphoma iv Peripheral T-Cell and NK-Cell Neoplasms T-cell prolymphocytic leukemia Large granular lymphocytic leukemia Mycosis fungoides/Sezary syndrome Peripheral large cell lymphoma, unspecified Anaplastic large cell lymphoma Enteropathy-associated T-cell lymphoma Hepatosplenic y8 T-cell lymphoma Adult T-cell leukemia/lymphoma NK/T-cell lymphoma, nasal type NK cell leukemia V. Hodgkins LF mphoma - Classical subtypes - Nodular sclerosis - Mixed cellularity - Lymphocyte-rich - Lymphocyte depletion Lymphocyte predominance
2
Kiel classification
REAL classification
WHO classification
Rappapo classification
Medicine
null
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single
Normal intracranial pressure in a child is:
Normal intracranial pressures : - Newborns : < 5mm of Hg - Infants : 6-15 mm of Hg - Children : 10-15mm of Hg ICP is considered severely elevated, if raised above 40mm of Hg
3
< 5mm of Hg
50-80 mm of Hg
10-15 mm of Hg
20-30 mm of Hg
Pediatrics
Raised intracranial tension
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MIC-2 is a marker of? -
Harshmohan textbook of pathology 7th edition In Ewings sarcoma - the cell surface marker by the tumor cells of ES / PNET group is CD99 which is a product of MIC2 gene located on X and Y chromosome. .
1
Ewing sarcoma
Chronic lymphocytic leukemia
Mantle cell lymphoma
All of these
Pathology
General pathology
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Cause of hairy leukoplakia which is characterised by severe discomfort on lateral part of the tongue
(B) EBV # Hairy leukoplakia is a distinctive oral lesion that is seen in immunocompromised patients.> Approximately 80% of patients with hairy leukoplakia have been infected with the human immunodeficiency virus (HIV); the presence of this lesion sometimes calls attention to the existence of the infection.> Hairy leukoplakia takes the form of white, confluent patches of fluffy ("hairy") hyperkeratotic thickenings, almost always situated on the lateral border of the tongue.> The distinctive microscopic appearance consists of hyperparakeratosis and acanthosis with "balloon cells" in the upper spinous layer.
2
HIV
EBV
Herpes virus
HPV
Medicine
Miscellaneous
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single
Which of the following is an impoant disinfectant on account of effectively destroying gram positive and gram negative bacteria, viruses and even spores at low pH levels -
Ans. is 'c' i.e., Chlorine
3
Phenol
Alcohol
Chlorine
Hexachlorophene
Microbiology
null
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Which of the following infection, if occurs in the first trimester, leads to maximum incidence of congenital malformations: March 2010
Ans. A: Rubella T = toxoplasmosis: Caused by protozoan - Toxoplasma gondii - Domestic cat is the definitive host with infections : Ingestion of cysts (meats, garden products), Contact with oocysts in feces - Much higher prevalence of infection in European countries - Acute infection usually asymptomatic 1/3 risk of fetal infection with primary maternal infection in pregnancy - Infection rate higher with infection in 3rd trimester - Fetal death higher with infection in 1st trimester - Mostly (70-90%) asymptomatic at bih Classic triad of symptoms: Chorioretinitis Hydrocephalus Intracranial calcifications 0=other (syphilis) - Early congenital (typically 1st 5 weeks): Cutaneous lesions (palms/soles) Jaundice Anemia Snuffles Periostitis and metaphysial dystrophy Funisitis (umbilical cord vasculitis) - Late congenital: Frontal bossing Sho maxilla High palatal arch Hutchinson teeth 8th nerve deafness Saddle nose Perioral fissures R = rubella Sensorineural hearing loss (50-75%) Cataracts and glaucoma (20-50%) malformations (20-50%) Neurologic (10-20%) Others to include growth retardation, bone disease, thrombocytopenia, "blueberry muffin" lesions C = cytomegalovirus (CMV) 90% are asymptomatic at bih Up to 15% develop symptoms later, notably sensorineural hearing loss Symptomatic infection Petechiae, jaundice, chorioretinitis, periventricular calcifications, neurological deficits >80% develop long term complications Hearing loss, vision impairment, developmental delay H=herpes simplex (HSV) Most are asymptomatic at bih - 3 patterns of equal frequency with symptoms between bih and 4 weeks: Skin, eyes, mouth (SEM) CNS disease Disseminated disease (present earliest) Initial manifestations very nonspecific with skin lesions NOT necessarily present
1
Rubella
Toxoplasmosis
CMV
All of the above
Microbiology
null
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All are antioxidant except -
Ans. is 'd' i.e., Glutamineo There are two types of antioxidant systems :-Enzymatic antioxidant systemThis includeCatalaseSuperoxide dismutase (SOD)Glutathione peroxidaseNon-enzymatic antioxidant systemThis is further subdivided intoVitamins : Vitamin E, Vitamin A & beta carotene. Vitamin C.Minerals : Selenium, Copper, Zinc, ManganeseTissue proteins : Transferrin, ferritin, lactoferrin, ceruloplasminAmino acids : Glutathione, Cysteine
4
Vitamin A
Catalase
Cystein
Glutamine
Biochemistry
Vitamins
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Patient because of positive biopsy findings and negative workup undergoes a radical prostatectomy. The pathology repo reveals Gleason score 9/10 and involvement of several pelvic lymph nodes. Which is the most likely site for prostatic cancer metastasis?
Bone metastasis is a characteristic feature of prostatic cancer. The lesions are typically osteoblastic on x-ray, and the serum acid phosphatase level becomes elevated
4
Liver
Kidney
Lung
Bone
Surgery
Prostate and seminal vesicles
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Ahus reaction is what type of hypersensitivity reaction
Ahus reaction Localized area of tissue necrosis resulting from acute immune complex vasculitis, usually elicited in the skin. "SHARP" S- Serum sickness, Schick test, SLE H- HS pneumonitis (Farmers lung), HSP A- Ahus reaction R- Reactive ahritis, RA, Raji assay P - PAN, PSGN
1
Localized immune complex
Ag- Ab reaction
Complement mediated
Ab mediated
Pathology
General pathology
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single
Investigation of choice for dysphagia for solids:
Answer is D (Manometry) Esophageal manometry is the gold standard test for esophageal motility disorders. Esophageal Motility Disorders : Manometry is the test of choice Achalasia Cardia Diffuse Oesophageal Spasm (Discoordinated motility) Nutcracker Oesophagus (Hypercontractile motility) Hypeensive LES (Hypercontractile motility) Hypotensive LES(Hypocontractile motility) Ineffective Oesophageal motility (Hypocontractile motility)
4
Barium swallow
Endoscopy
X-ray chest
C.T. scan
Medicine
null
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The following anticancer drug has high emetogenic potential
PLATINUM COORDINATION COMPLEXES Cisplatin Mech of action:- It is hydrolysed intracellularly to produce a highly reactive moiety which causes cross linking of DNA. The oured site is N7 of guanine residue. Adverse effects:- It is a highly emetic drug. Antiemetics are routinely administered before infusing it. The most impoant toxicity is renal impairment which is dependent on total dose administered. Renal toxicity can be reduced by maintaining good hydration. Tinnitus,deafness, sensory neuropathy and hyperuricaemia are other problems. Ref:- kd tripathi; pg num:-861
4
Chlorambucil
Vincristine
6-Mercaptopurine
Cisplatin
Pharmacology
Chemotherapy
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Spironolactone should not be given with
Sprinolanctone is a potassium sparing diurectic It doesn't excrete potassium - increasing potassium levels in the blood ACE IN. also increases potassium levels in the blood Hence the combination is contraindicated Ref: KD Tripathi 8th ed
3
Chlohiazide
Beta blockers
ACE inhibitors
Amlodipine
Pharmacology
Cardiovascular system
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A total of 5000 patients of glaucoma are identified and surveyed by patient interviews regarding family history of glaucoma. Such a study design is called-
Case series repo: A case series repo is a descriptive study where in more than one patients having a paicular disease are studied. No cause related analysis or hypothesis testing is involved. Case control study: Backward looking/ retrospective study in which multiple risk factors are studied together. Odd's ratio can be calculated. Coho study: Forward / prospective study in which multiple outcomes can be studied together. Incidence & relative risk can be calculated.
1
Case series repo
Case control study
Clinical trial
Coho study
Social & Preventive Medicine
Other Analytical Studies
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multi
Based upon this PA ulnar detion view of the wrist, what is the MOST likely diagnosis?
There is focal periostitis at the radial styloid. The radial styloid itself is normal. This is secondary to adjacent inflammation at the extensor pollicis brevis and abductor pollicis longus tendons (De Quervains tenosynovitis). The periosteal reaction of osteomyelitis is usually associated with abnormal underlying bone. The periosteal reaction of hyperophic osteoahropathy is more diffuse involving both the radius and ulna. New bone formation is not a feature of rheumatoid ahritis.
2
Osteomyelitis
De Quervain tenosynovitis
Hyperophic osteoahropathy
Rheumatoid ahritis
Radiology
Skeletal system
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single
Turbinate that aiculates with ethmoid is:
Middle turbinate and superior turbinate are a pa of the ethmoidal bone where as inferior turbinate is an independant bone which aiculates with the ethmoid bone,completing the medial wall of Nasolacrimal duct. Ref. Scotts Brown 7/e,Vol 2 p 1329.
3
superior
Middle
Inferior
All the above
ENT
Nose and paranasal sinuses
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multi
An enzyme that recognizes a specific (palindromic) sequence and cuts within a DNA molecule is?
ANSWER: (D) Restriction endonucleaseREF: Basic Genetics: Textbook and Activities by Ahmed Abouelmagd, Hussein M. Ageely page 117A palindromic sequence is a nucleic acid sequence {DNA or RNA) that is the same whether read 5' (five-prime) to 3' (three prime) on one strand or 5' to 3' on the complementary strand with which it forms a double helix.A restriction enzyme (or restriction endonuclease) is an enzyme that cuts DNA at specific recognition nucleotide sequences (with Type II restriction enzymes cutting double-stranded DNA) known as restriction sites. Such enzymes, found in bacteria and archaea, are thought to have evolved to provide a defense mechanism against invading viruses. Inside a bacterial host, the restriction enzymes selectively cut up foreign DNA in a process called restriction; host DNA is methylated by a modification enzyme (a methylase) to protect it from the restriction enzyme's activity. Collectively, these two processes form the restriction modification systemRestriction enzymes recognize a specific sequence of nucleotides and produce a double-stranded cut in the DNA. While recognition sequences vary betwreen 4 and 8 nucleotides, many of them are palindromic, wrhich correspond to nitrogenous base sequences that read the same backwards and forwards. In theory, there are two types of palindromic sequences that can be possible in DNA.The mirror-like palindrome is similar to those found in ordinary text, in which a sequence reads the same forward and backwards on a single strand of DNA strand, as in GTAATG.The inverted repeat palindrome is also a sequence that reads the same forward and backwards, but the forward and backward sequences are found in complementary DNA strands (i.e., of double-stranded DNA), as in GTATAC (GTATAC being complementary to CATATG). Inverted repeat palindromes are more common and have greater biological importance than mirror-like palindromes.Naturally occurring restriction endonucleases are categorized into four groups (Types I, II III, and IV) based on their composition and enzyme cofactor requirements, the nature of their target sequence, and the position of their DNA cleavage site relative to the target sequenceCategoryFunctionCofactors requiredCleavageType IMultifunctional protein with both restriction and DNA modify-cation (methylase) activityMg2+, ATP SAM (S- adenosylmethionine)Cleave DNA at non specific sites usually remote from recognition siteType IISingle function (restriction) en-zymes independent of methylaseOnly Mg2+Site specific 8t cleave writhin or at short specific distances from recognition siteType IIICombine restriction and DNA modification (methylase) activity in a single enzyme complex with different subunitsMg2+, SAM stimulates reaction but is not requiredCleave at sites a short distance from recognition siteHere are some restriction enzymes and the palindromic sequences which they recognizeEnzymeSourceRecognition SequenceCutEcoRlEscherichia coli5'GAATTC3'CTTAAG5---G AATTC---3'3---CTTAAG---5'BamH1Bacillus amylobquefaciens5'GGATCC3'CCTAGG5'---G GATCC---3'3'---CCTAG G---5'Taq1Thermus aquaticus5'TCGA3'AGCT5'---T CGA--3'3'---AGC T---5'Alul*Arthrobacter luteus5'AGCT3'TCGA5'---AG CT---3'3'---TC GA---5'* = blunt ends
4
Exonuclease
Methylase
Modification enzyme
Restriction endonuclease
Pathology
Genetics
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In pontaic fever, which antigen is seen in urine-
Ans. is 'a' i.e., Group specific antigen of Legionella serogroup-1 (LP1) o The examination of urine for legionella antigen by ELISA is a rapid and specific method for identifying L pneumophila,o However, disadvantage of urine antigen test is that it only detects Legionella pneumophila serogroup 1 (LP-1) and negative urinary antigen test does not exclude infection with Iegionellae other than L pneumophila serogroup-1.o Only culture can detect non-LPl strains (strains other than serogroup-1).
1
Group specific antigen of Legionella serogroup- 1 (LP 1)
Group specific antigen of L egionella serogroup- 1. (LP 2)
Group specific antigen of Legionella serogroup- 4 (LP 4)
Group specific antigen of Legionella serogroup- 6 (LP 6)
Microbiology
Bacteria
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A patient with Hypeension presents with Hypokalemia. Aldosterone levels and Renin levels are both elevated. The most likely diagnosis is
Answer- A. Renal Aery stenosisThe association of High aldosterone and High Renin levels in a hypeensive patient with hypokalemia suggests a diagnosis ofSecondary Hyperaldosteronism of from Renal Aery Stenosis.
1
Renal Aery stenosis
Primary Hyperaldosteronism {Conn's syndrome}
Addison's disease
Cushing's syndrome
Medicine
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Mycosis fungoides: March 2013
Ans. A i.e. Cutaneous T cell lymphoma Mycosis fungoides Mycosis fungoides is also known as: Cutaneous T cell lymphoma, Special features: - MC skin lymphoma, - Pautrier's microabscesses - Presents with diffuse erythroderma
1
Cutaneous T cell lymphoma
Fungal infection
Bacterial infection
Cutaneous B cell lymphoma
Skin
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Me Callum patch is seen in the:(1988)
Ans: b
2
Right atrium
Left atrium
Left ventricle
Right ventricle
Pathology
C.V.S
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The main catabolic product/products of purine nuleotides in humans is which one of the following:
Ans. (c) Uric AcidRef: Harper's Biochemistry, 30th edn. pg. 347-357Purines are metabolized by several enzymes:GUANINE* A nuclease frees the nucleotide* A nucleotidase creates guanosine* Purine nucleoside phosphorylase converts guanosine to guanine* Guanase converts guanine to xanthine* Xanthine oxidase (a form of xanthine oxidoreductase) catalyzes the oxidation of xanthine to uric acidADENINE* A nuclease frees the nucleotide# A nucleotidase creates adenosine, then adenosine deaminase creates inosine# Alternatively, AMP deaminase creates inosinic acid, then a nucleotidase creates inosine* Purine nucleoside phosphorylase acts upon inosine to create hypoxanthine* Xanthine oxidoreductase catalyzes the biotransformation of hypoxanthine to xanthine* Xanthine oxido-reductase acts upon xanthine to create uric acid
3
Ammonia + CO2
Ammonia
Uric Acid
CO2 and Water
Biochemistry
Proteins and Amino Acids
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Intraoperative Radiotherapy for treating pancreatic carcinoma mainly uses
Electron Beam is preferred for intraoperative Radiotherapy. The Intraoperative radiotherapy (IO) appears to be an ideal therapeutic strategy for pancreatic cancer, Having the advantage of enabling the delivery of high doses of radiation to areas that are at risk for microscopic disease, saving critical organs and reducing the possibility of inducing radiotoxicity.
3
Alpha Rays
Gamma Rays
Electron Beam
Proton beam
Radiology
Radiotherapy Pa 1
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Distally, Gubernaculum attaches to all except:-
Gubernaculum is the fibro muscular band which helps in descent of testes. Proximally, it is attached to:- Lower pole of testis. Peritoneum of saccus vaginalis in front of testis. Mesonephric duct. Distally, it is attached to:- Bottom of scrotum. Superficial perineal pouch. Pubic symphysis above penis. Saphenous opening of thigh. Anterior superior iliac spine
4
Pubic symphysis
Superficial perineal pouch
Anterior superior iliac spine
Inguinal ligament
Anatomy
Pelvis and Perineum 2
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MMR (Measles, mumps, rubella) vaccine is an example of:
Ans: a. Live attenuated.. LIVE ATTENUATEDKILLED WHOLE ORGANISMTOXOID PROTEINSPOLYSACCHARIDEGLYCOCONJUGATERCOMBINANTBCG, Yellow fever, OPV, Measles, Mumps, Rubella,Typhoid, Varicella,Rotavirus, Cholera,Cold-adapted influenza,Rotavirus reassoants.ZostTyphoid, Cholera, Plague,Peussis, Influenza,Typhus, lPV, Rabies, JE,Tickborne encephalitis, HAVDiphtheria, Tetanus,Acellular peussis,Anthrax, InfluenzasubunitPneumococcus,Meningococcus,Hib, Typhoid(Vi)Hib, Pneumococ-cus,MenACWY(Meningococcus)HBV Lymedisease, CholeraToxin B, HPV
1
Live attenuated vaccine
Conjugated vaccine
Polysaccharide vaccine
Killed vaccine
Social & Preventive Medicine
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Which is the most common aerobic bacteria found in vagina?
Normal vaginal flora is mostly aerobic with an average of six different species of bacteria, most common of which is hydrogen peroxide producing lactobacilli. Other commonly found aerobic bacteria found in the vagina are Diphtheroids, Streptococci, Staphylococcus epidermidis and Gardenella vaginalis. Most prevalent anaerobic bacteria which are detected are Peptococcus, Peptostreptococcus and Bacteroids.
1
Lactobacilli
Gardnerella
Mobilincus
Clostridium
Gynaecology & Obstetrics
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A 30 year old male presents with severe pain chest, breathlessness, hypotension and ECG shows ST elevation in V3, V4 V5 and V6 leads. He will be best treated with:
Percutaneous transluminal coronary angioplasty (PCTA or angioplasty) is a procedure that is commonly performed on people with hea disease. This procedure is done to open up the blood vessel to allow the blood to pass through more easily PTCA is a minimally invasive procedure to open up blocked coronary aeries, allowing blood to circulate unobstructed to the hea muscle. The indications for PTCA are: Persistent chest pain (angina) Blockage of only one or two coronary aeries Ref Davidson edition23rd pg 460
4
Streptokinase
t-PA
Heparin
PTCA
Medicine
C.V.S
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Figure B shows:
null
2
Spinal tap needle
Shortened Spinal tap needle assembled with H file
Side vent needle for irrigation
Needle with file for simultaneous filing and irrigation
Dental
null
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Which of the following-is the first sign of sexual maturity in boys?
Ans. (d) Increase in testicular sizePlease refer explanation of question 40
4
Increase in height
Appearance of facial hair
Change in voice
Increase in testicular size
Pediatrics
Assessment of Growth
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Thomsen friedensreich phenomenon is -
Ans. is 'b' i.e., Red cell agglutination by all blood group sera Thomsen-Freidenreich Phenomenono Red cell suspensions contaminated with certain bacteria, e.g. pseudomonas aeruginosa, become aggluiinable by alt blood group sera and even by normal human sera,o This is known as Thomsen Friedenreich phenomenon and is due to unmasking of a hidden antigen normally present on all human erythryocytes, i.e. T-antigen.o Anti-T agglutinins are normally present in human sera.o Such panagglutinability of red cells has occasionally been observed in persons suffering from systemic bacterial infections.
2
Red cells infection by CMV
Red cell agglutination by all blood group sera
Hemolysis of transfused blood
Due to B antigen
Microbiology
Antigen-antibody reaction
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In mood disorder, rapid cyclers are defined as
(A) 4 or more episodes per year# Rapid cycling:> Most people who meet criteria for bipolar disorder experience a number of episodes, on average 0.4 to 0.7 per year, lasting three to six months.> Rapid cycling, however, is a course specifier that may be applied to any of the above subtypes. It is defined as having four or more episodes per year and is found in a significant fraction of individuals with bipolar disorder. The definition of rapid cycling most frequently cited in the literature (including the DSM) is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes are required to have occurred during a 12-month period.There are references that describe very rapid (ultra-rapid) or extremely rapid (ultra-ultra or ultradian) cycling. One definition of ultra-ultra rapid cycling is defining distinct shifts in mood within a 24-48-hour period.
1
4 or more episodes per year
Mania occuring during summer
Mania consistent during lunar year
Depressive episodes during winter
Psychiatry
Miscellaneous
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Best marker of SLE?
Ans. (b) Anti-ds DNA antibodies(Ref: Harrison 18th/chapter 319)Anti dsDNA is specific for SLE, only in high titers;But still, anti ds DNA is the best marker for SLE because its prevalence in SLE is 70%;Whereas, Anti Sm antibody, which is specific for SLE, but is seen in only 25% patients with SLE
2
Anti Sm antibodies
Anti-ds DNA antibodies
Anti-Histone antibodies
Anti Ro (SS-A) antibodies
Pathology
Immunity
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Enzyme deficiency in Hurler syndrome?
Disease name Abbretion Enzyme Defective GaG(s) affected Symptoms Hurler syndrome MPS I a-l-Iduronidase Dermatan sulfate, Heparan sulfate Mental retardation, coarse facial features, hepatosplenomegaly, cloudy cornea Reference: Harper; 30th edition; Page no:639; Table: 50-8
2
Iduronate sulfatase
a-l-Iduronidase
b-Galactosidase
Galactosamine 6-sulfatase
Biochemistry
Metabolism of carbohydrate
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Which of the following is a prodrug ?
All ACE inhibitors are prodrugs except captopril and lisinopril.
2
Lisinopril
Enalapril
Chlorpromazine
Dopamine
Pharmacology
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When the sympathetic nervous system is activated:
Ans. C. Norepinephrine is released from axons onto the arteriolar wallNerve fibers, not vascular smooth muscle, release norepinephrine. The norepinephrine from the sympathetic nerves simply diffuses from the axons and binds to specific receptors on smooth muscle cells.
3
Norepinephrine is released by the vascular smooth muscle cells
Acetylcholine is released onto vascular smooth muscle cells
Norepinephrine is released from axons onto the arteriolar wall
The arterioles constrict because nitric oxide production is suppressed
Physiology
Nervous System
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Histological finding in Reye&;s syndrome is
Reyes syndrome characterised by mitochondrial injury and decreased synthesis of mitochondrial enzymes in liver. Which leads to rise in blood ammonia and accumulation of triglycerides within hepatocytes. TEXTBOOK OF PATHOLOGY HARSH MOHAN 6TH EDITION PAGE 602
4
Budding and branching of mitochondria
Swelling of endoplasmic reticulum
Para nuclear micro dense deposits
Glycogen depletion
Pathology
G.I.T
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All of the following play a significant role in bone resorption except:
Pro-resorptive factors are hormones and cytokines are:- PTH (Parathyroid hormone) 1,25dihydroxyvitamin D3, IL-1 IL-6 TNF (Tumour necrosis factor) LIF (Leukaemia inhibitory factor) Corticosteroids, which activate osteoblasts and stroma cells to produce RANKL and depress OPG.
4
Parathyroid hormone.
Interleukin1.
Interleukin6.
Interferon-gamma.
Dental
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Surgical treatment for asymptomatic uterine myoma is indicated if
Management of myomas: Asymptomatic : observation with regular follow up Size < 12 weeks Uncomplicated pregnancy with fibroid Surgery: Size > 12weeks Cornual fibroid causing infeility Pedunculated cornual fibroid Pregnancy with torsion of pedunculated fibroid Symptomatic myoma: Medical: Hormones to shrink the fibroid _ surgery unterine aery embolization Myomectomy Lap myomectomy Lap myolysis MRI guided ablation Total / sub total abdominal hysterectomy Vaginal hysterectomy Total laproscopic hysterectomy Lap hysterectomy Lap assisted vaginal hysterectomy Cervical (1%): Vaginal polypectomy Myomectomy Lap myomectomy MRI guided myolysis Vaginal hysterectomy Total abdominal hysterectomy Ref Shaw 16th edition pg 409
4
If myoma is pedunculated
Tumour is larger than size of 3months pregnancy
Diagnosis is unceain
All the above
Gynaecology & Obstetrics
PCOD, hirsutism and galactorrhea
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