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Earliest method of diagnosing pituitary tumour
Ans. is 'a' i.e., CT Scan
1
CT scan
Visual field chaing
Visual evoked potential
X-ray skull
Surgery
null
d6dc62bb-1a9b-47dc-a657-864be5930829
single
Shortest incubation period in malaria -
null
2
P. vivax
P. falciparum
P. malariae
P. ovale
Microbiology
null
2b086f5a-597e-4ae8-8be5-7b4df1771edd
single
Maintenance of oral health is best achieved by
null
4
hard bristle tooth brush
Mouth wash
A soft bristle brush and tooth paste
A soft bristle brush and dental floss
Dental
null
600661bd-31a5-45c5-ab76-74bc29784fce
single
FAST -
Ans. is 'b' i.e., USG o FAST stands for focused assessment with sonography for trauma,o FAST is the preferred triage method for determining the presence of hemoperitoneum in blunt trauma patients or cardiac tamponade in blunt and penetrating trauma patients,o The four areas scanned in FASTSubxiphoid areaRt. upper quadrantIt upper quadrantPelvis
2
CT
USG
MRI
X-ray
Surgery
Initial Assessment
3cfcc255-6dc0-4392-89ca-cc06ed4872ef
single
In gingival index score 2 means:
null
1
Bleeding on slight provocation
Spontaneous bleeding
Colour change in gingiva
No change in gingiva
Dental
null
8965e8bc-986a-4dad-8af2-0b694be00e98
single
Which of the following vitamins can be used for treatment of hypercholesterolemia?
ANTI-DYSLIPIDEMIC AGENTS Group Mechanism Drugs Special points Statins HMG CoA reductase inhibition Atorvastatin, Rosuvastatin Max LDL lowering capacity Fibrates Stimulation of PPAR-alpha Clofibrate Fenofibrate Gemfibrozil Max TG lowering capacity Bile acid sequestrants Binds bile acids in GIT Cholestyramine, Colestipol, Cholesevalam Safe in pregnancy and children Ezetimibe Inhibit intestinal cholesterol absorption Ezetimibe Given with statins Nicotinic acid Inhibit lipase Niacin Max HDL increasing capacity
4
Thiamine
Biotin
Pyridoxine
Nicotinic acid
Pharmacology
Hematology and CVS
f112a4ea-ae86-4346-a5ad-e70d0b237f63
single
True about EMLA:
B i.e. Mixture of local anesthesia - Procaine, Mepivacaine & BupivacaineQ (Provide me BUM) are never used topically. - EMLA is eutectic mixture of local anesthetics (2.5% lidocaine & 2.5% prilocaine)Q commonly used to make venepuncture painless especially in children.
2
Can be used for intubation
Mixture of local anesthesia
Faster acting
All
Anaesthesia
null
4dfd0a4d-02a5-4939-95d8-dde87e74e0d9
multi
Dose of Carbetocin for post paum hemorrhage
Refer Goodman Gilman 12th/1851 Carbetocin is along acting Oxytocin that us useful to prevent post pay hemorrhage given intramuscularly or intravenously in a dose of 100 microorgam
1
100 microgram intramuscular
50 microorgam Inravenous
150 microgram intravenous
200 microgram intramuscular
Pharmacology
Endocrinology
c39803d4-d603-4cc3-9278-dc84abcc514e
single
Schatzki's ring is present in -
Ans. is 'c' i.e., Squamocolumnar junction in esophagus Schatzki's ringo It occurs at the junction of squamous and columnar epithelium at the lower end of oesophagus and has also been called lower oesophageal ring.o Usually seen in patients above 50 years of age.o Cause is unknown.o Symptomatic patients complain of intermittent dysphagia and some may even present with bolus obstructiono It may be associated with hiatus herniao Treatment is oesophageal dilatation.
3
Upper end of esophagus
Mid-esophagus
Squamocolumnar junction in esophagus
Fundus of stomach
ENT
Oesophagus
fd138f34-a7e3-4ba2-9b5d-c7b705398cb8
single
All are true about ulnar nerve except:
Ans. c. Supply flexor digitorum superficialis Nerve course:Root value of ulnar nerve is C7, C8 6 T1.Ulnar nerve (C8, T1) arises from the medial cord of the brachial plexus & descends in the interval b/w the axillary aery & veinAt elbow, ulnar nerve passes behind the medial epicondyleThe cubital tunnel is a channel which allows the ulnar nerve to travel over the elbowVarious branches of ulnar nerve are :?In arm : No branch.In forearm : There are following branches :?Muscular : In proximal pa of forearm it supplies flexor carpi ulnaris and medial half of flexor digitorumprofundus.Cutaneous : There are two cutaneous branches in forearm:-Superficial terminal branch : It supplies palmaris brevis and skin of palmar surface of medial 11/2 fingers.Palmar cutaneous branch : Supplies skin over the hypothenar eminence.Dorsal (posterior) cutaneous branch : Supplies skin over medial 1/3 of dorsum of hand and dorsal surface of medial 11/2 fingers.In hand : Ulnar nerve enters the palm by passing superficial to flexor retinaculum and divides into two terminal branches :?Deep terminal branch : It supplies adductor pollicis, all interossei, medial two (3rd& 4th)lumbricals and all hypothenar muscles except palmaris brevis (i.e. abductor digitiminimi, flexor digitiminimi, opponensdigitiminimi).
3
Root value C8TI
Pass through cubital tunnel
Supply flexor digitorum superficialis
Supply flexor carpi ulnaris
Anatomy
null
f9675475-3cf1-4701-bbe8-029304841b99
multi
True about the location of parotid gland:
null
2
Between the ramus of the mandible and buccinator.
Between the ramus of the mandible and sternocleidomastoid.
Between the ramus of the mandible and masseter.
Between the ramus of the mandible and medial pterygoid.
Anatomy
null
6e468d73-06d0-49d0-9070-8f93c65443f3
multi
Collagen is found in following, except?
Fibroblasts
3
Ligament
Tendon
Fibroblasts
Aponeurosis
Anatomy
null
a15f2fd1-145c-4c4e-92af-a4a68ab46987
multi
True about blood pressure measurement is all/except
Diastolic blood pressure is indicated by fouh Korotkoff sound According to American Hea Association- onset of phase I Korotkoff s sound corresponds to systolic pressure and the disappearance of sounds (phase V) corresponds to diastolic pressure . More points about measuring blood pressure The standard technique for blood pressure measurement is the auscultatory technique. It was described by Nicolay Korotkoff in 1905 Mercury sphygmomanometers are considered a gold standard for blood pressure measurement, but they are being supplanted by aneroid sphygmomanometers The Korotkoff sound method tends to give values for systolic pressure that are lower than the true intra-aerial pressure, and diastolic values that are higher. Before performing a blood pressure reading, the patient should be comfoably seated with the back and arm suppoed, the legs uncrossed, and the upper arm at the level of the right atrium. The technique used to wrap the cuff is also impoant in assuring accurate readings. Cuffs that are wrapped too loose will result in falsely elevated values. Cuffs should be applied snugly,allowing only enough room for one finger to be slipped between the cuff and the skin surface. Inflation and deflation rate: Inflation and deflation rate of the manometer may affect the blood pressure reading. Inflation rate too slow -- Diastolic pressure is too high Deflation rate too fast -- Systolic pressure too low The sphygmomanometer pressure should then be reduced at 2 to 3 min/second. When measuring blood pressure, the cuff should be inflated to 30 mm Hg above the point at which the radial pulse disappears. The sphygmomanometer pressure should then be reduced at 2 to 3 min/second. Two readings should be performed at least one minute apa. An auscultatory gap is the interval of pressure where Korotkoff sounds indicating true systolic pressure fade away and reappear at a lower pressure point during the manual measurement of blood pressure. The improper interpretation of this gap may lead to errors made in the falsely low recording of systolic blood pressure. This gap usually occurs at a high pressure and can be mistaken for the silence of a pressure greater than the SBP, Except that the pulse can still be palpated. This is why it is greatly recommended to both palpate and auscultate the SBP. Spuriously high blood pressure is noted in: 1.Small cuff 2.0besity 3.Thick calcified aeries eg. Monkenberg's aeriosclerosis, atherosclerosis
2
Cuff width should be 40% of arm circumference
Diastolic blood pressure is indicated by fouh Korotkoff sound
Small cuff measures spuriously elevated Diastolic blood pressure
Monkenberg sclerosis causes pseudohypeension
Physiology
null
82098196-b819-4084-8ed0-c62755ad3c51
multi
In status epilepticus, drug of choice is:
A i.e. IV diazepam Status epilepticus is said to occur when seizures lasts beyond 30 minutes or seizures are repetitive, prolonged & the patient remains unconscious in between the seizures. The drug of choice is /V Lorazepam (Benzodiazipine)Q 0.1 mg/kg at rate of 2 mg/min. Pharmacologic treatment of generalized tonic-clonic status epilepticus in adults. IV, intravenous, PE, phenytoin equivalents. The horizontal bars indicate the approximate duration of drug infusion.
1
I/V diazepam
I/M diazepam
Oral clonazepam
I/M phenytoin
Anaesthesia
null
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single
When activated by b-adrenergic receptors, the G protein:
When norepinephrine binds to a beta-adrenergic receptor, it activates a G protein (i.e., a guanosine triphosphate (GTP) binding protein), which, in turn, activates adenylate cyclase. Adenylate cyclase catalyzes the formation of cyclic adenosine 3',5'-monophosphate (cAMP), which activates a variety of kinases. One of these kinases (protein kinase A) phosphorylates phospholamban, which reduces the inhibition of the sarcoplasmic reticular Ca2+ pump, increasing sequestration of Ca2+ from the cytoplasm. Ref: Biaggioni I., Robeson D. (2012). Chapter 9. Adrenoceptor Agonists & Sympathomimetic Drugs. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds),Basic & Clinical Pharmacology, 12e.
2
Activates phospholipase C
Activates adenylate cyclase
Activates protein kinase C
Conves guanosine diphosphate (GDP) to guanosine triphosphate (GTP)
Pharmacology
null
719db82c-ebb3-4933-aa2f-2caf3a7a3546
single
Generator area in a nerve cell is
The first poion of the axon is called the initial segment. The Initial segment in spinal motor neurons, the initial node of Ranvier in cutaneous sensory neurons is a site where propagated action potentials are generated.(Ref: Ganong's Review of Medical Physiology Twenty-Third Edition)
2
Cell body
Initial segment
Axon
Dendrites
Physiology
Nervous system
a4c14d59-53a9-417d-a451-433bf93a0a64
single
Coronary blood flow is maximum during?
ANSWER: (D) I so volumetric relaxationREF: Ganongs 22nd ed page 621CORONARY BLOOD FLOW:Coronary blood flow, like blood flow in other vessels, is dependent on a pressure gradient, principally driven by mean arterial pressure. However, because aortic pressure can vary widely and because the heart beats continuously, the pressure gradient and, hence coronary blood flow fluctuate depending on the state of contraction. During systole, especially on the left side of the heart, the pressure within the coronary artery secondary to extravascular compression from the squeezing effect of the contracting myocardium virtually eliminates antegrade coronary blood flow. The coronary blood flow" goes to zero just prior to ventricular ejection, corresponding to isovolumic contraction and increased extravascular compression. Conversely, coronary blood flow through the left side is maximal during blood flow through the right side, however, is maximal during peak systole, because developed pressure and consequently extravascular compression within the RV are considerably less than in the LV, thus allowing for antegrade flow during both systole and diastole
4
Isovolumetric contraction
Rapid ejection
Slow ejection
Isovolumetric relaxation
Physiology
Circulation: Coronary Circulation and Ischemic Heart Disease
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single
Ideal age for repair of vaginal agenesis is :
Before marriage Repair of vaginal agenesis (seen in testicular feminizaton syndrome and Rokitansky-Kuster Hauser syndrome) is done by vaginoplasty. Vaginoplasty should only be performed when the girl is just married or about to be married. Techniques : 1. Frank dilatation (Non surgical method). 2. Construction of aificial vagina by Mc lndoe operation. 3. Williams vaginoplasty - creates a pouch out of labia majora dissection.
4
6 months
3 years
At pubey
Before marriage
Gynaecology & Obstetrics
null
4d97be90-aaf4-4eec-b626-117d8514e954
single
Which type of articulators permit horizontal as well as vertical motion, but do not orient the motion to the TMJ via facebow transfer?
Class II articulator: Articulator which permit horizontal and vertical motion but they do not orient the movement to TMJ with a facebow. Three types.
2
Class I
Class II
Class III
Class IV
Dental
null
c3234b3f-3633-4778-8acb-798beaf900d8
single
Sensory supply of vocal cord ?
Ans. is 'd' i.e., All of the above Above the vocal cords the sensory innervation of larynx is internal laryngeal nerve (a branch of superior laryngeal nerve). Below vocal cords it is by way of branches of recurrent laryngeal nerve. The vocal cord itself receives dual innervation from both nerves"_en.wikipedia Nerve supply of larynx has been explained in details in previous sessions.
4
Internal laryngeal nerve
Recurrent laryngeal nerve
Superior laryngeal nerve
All of the above
ENT
null
5b6e2440-5f9a-4583-80cc-ff7cd72fdb71
multi
Which is the following is not inherited as X-linked recessive: March 2005, September 2012, March 2013
Ans. C: Cystic fibrosis X-linked diseases usually occur in males. Males have only one X chromosome. A single recessive gene on that X chromosome will cause the disease. The Y chromosome is the other half of the XY gene pair in the male. However, the Y chromosome doesn't contain most of the genes of the X chromosome. It therefore doesn't protect the male. This is seen in diseases such as hemophilia and Duchenne muscular dystrophy. Autosomal dominant: Examples of this type of disorder are Huntington's disease, Neurofibromatosis 1, Marfan Syndrome, Hereditary nonpolyposis colorectal cancer, and Hereditary multiple exostoses, which is a highly penetrant autosomal dominant disorder. Autosomal recessive Examples of this type of disorder are cystic fibrosis, sickle-cell disease, Tay-Sachs disease, Niemann-Pick disease, spinal muscular atrophy etc. 3X-linked dominant X-linked hvpophosphatemic rickets, Rett syndrome, Incontinentia Pigmenti type 2 and Aicardi Syndrome X-linked recessive X-linked recessive conditions include the serious diseases Hemophilia A, Duchenne muscular dystrophy, G-6-PD deficiency and Lesch-Nyhan syndrome as well as common and less serious conditions such as male pattern baldness and red-green color blindness. Y-linked disorders Examples are Male Infeility and hyperichosis pinnae.
3
G-6-PD deficiency
Duchenne muscular dystrophy
Cystic fibrosis
Hemophilia
Pathology
null
6879ce4b-a870-4c52-bdcc-36ca2991b87e
single
The tensile strength of the wound stas and increases after
Wounds do not begin to gain tensile strength from collagen until 5 - 7 days. Wound achieves around 20 % by 3 weeks, and around 60 % by four months. Scar tissue continues to remodel for at least 6 - 12 months after an injury.
2
Immediately after suturing
3-4 days
7-10 days
1 month
Anatomy
G.I.T
44dd5d46-5799-4119-bb66-2179604c29f0
single
Characteristic of obstructive pulmonary disease are all except: March 2007
Ans. C: Reduced residual volume The diagnosis of COPD is confirmed by spirometry. Spirometry measures the forced expiratory volume in one second (FEV1) which is the greatest volume of air that can be breathed out in the first second of a large breath. Spirometry also measures the forced vital capacity (FVC) which is the greatest volume of air that can be breathed out in a whole large breath. Normally at least 70% of the FVC comes out in the first second (i.e. the FEV1/FVC ratio is >70%). In COPD, FEV1 is reduced and hence FEV1/FVC ratio is less than normal, (i.e. FEV/FVC ratio is With worsening disease severity, lung volumes may increase resulting in an increase in total lung capacity, functional residual capacity and residual volume. In emphysema, diffusing capacity may be reduced, reflecting the parenchymal destruction characteristic of the disease. An x-ray of the chest may show an over-expanded lung (hyperinflation). A high-resolution computed tomography scan of the chest may show the distribution of emphysema throughout the lungs. A blood sample taken from an aery can be tested for blood gas levels which may show low oxygen levels (hypoxemia) and/or high carbon dioxide levels (respiratory acidosis). A blood sample taken from a vein may show a high blood count (reactive polythycaemia), a reaction to long-term hypoxemia.
3
Reduced FEV1
Reduced diffusion capacity
Reduced residual volume
Reduced mid expiratory flow rate
Medicine
null
83e24a4f-109a-43f6-9d53-6c3d437d4c58
multi
Which among the following is a true statement about Thymosin?
Thymosin is a thymic hormone that regulates pre-T cell development. It is not released from the pituitary. Antithymocyte antibodies are not thymosin but are useful in transplantation rejection therapy. Lymphokines are released from T cells, but thymosin is a thymic hormone, not a lymphokine. Ref: Kipps T.J. (2010). Chapter 5. The Organization and Structure of Lymphoid Tissues. In J.T. Prchal, K. Kaushansky, M.A. Lichtman, T.J. Kipps, U. Seligsohn (Eds), Williams Hematology, 8e.
4
A Pituitary hormone that regulates thymic development
A Glycoprotein that confers passive immunity to non sensitized hosts
An antiserum against thymocytes
A thymic hormone that induces maturation of pre-T cells
Physiology
null
ca1850b8-32b5-4ee3-a803-a4f826a4d926
multi
Which of the following malignant disease of children has the best prognosis?
Ans. is 'a' i.e. Wilms' tumour Ref: C.P.D.T 16th/e page 807-809, 811 Schwartz Surgery page 1748, 1749, 1747Prognosis depends most importantly upon staging but there are multiple factors affecting the prognosisAfter going through the survival rates of these tumours and confirming our answer with a paediatric oncologist we found the Wilms' tumor to have the best prognosis among the given options.If you have time go through the below given tables for your own satisfaction and conclusions.Wilms' tumour: CSDT 11th/e p 1345Stage4 year Survival % Favorable histologyUnfavorable histologyLimited to kidney9789Extends beyond kidney9468Residual tumor confined to abdomen8868Distant metastasis8255Bilateral renal involvement8416* Prognosis of Rhabdomyosarcoma: CPDT 15th/e p 812Site3 year disease free survivalPredominant Pathologic subtypeHead & Neck EmbryonalOrbit93% Parameningeal71% Other69% Genitourinary Embryonal (botryoid variant in bladder and vagina)Bladder and prostate64-80% Vagina and uterus60-80% Paratesticular60-80% Extremities56%Alveolar (50%) undifferentiatedTrunk57%Alveolar undifferentiated* Neuroblastoma: CSDT 11th/e p 1343Staging and survival of NeuroblastomaSurvivalI. Tumor confined to site of origin100%Ila. Unilateral tumour completely excised. Nodes Negative80%lIb. Unilateral tumour; complete or incomplete excision nodes positive70%.III. Tumor infiltrating across the midline, or a unilateral tumor with contralateral40%nodes positive IV. Remote disease in bone, soft tissue, distant nodes15%V. Infants with stage I or stage II primary and spread to Liver skin or bone marrow.85%Primitive neuroectodermal tumours -PETs includeMedulloepitheliomaMedulloblastoma (known as PET-MB)Primary cerebral neuroblastomaPineoblastomaEpendymoblastomaPrognosis: 5 year survival rate is near about 75% after total tumor removal.
1
Wilm's tumor
Neuroblastoma
Rhabdomyosarcoma
Primitive neuroectodermal tumor
Surgery
Renal Tumors
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single
Which of the following is true about fouh hea sound 'S4'
4th hea sound cannot be heard even by a stethoscope since its frequency is below the audible limit (20 Hz). It is produced during last rapid filling of ventricles, which occurs due to atrial systole. Hence, it is also called "atrial sound". S1: Closure of A.V. valves (25-45 Hz) and S2: closure of semilunar valves (50 Hz). They can be heard by stethoscope.
3
Can be heard by the unaided ear
Frequency is greater than 20 Hz
Heard during ventricular filling phase
Heard during ventricular ejection phase
Physiology
Cardiac Cycle
252ebf68-20e2-463d-9970-32106af5969a
multi
All are included in Amsler's criteria, EXCEPT:
Amsler's criteria used for the diagnosis of bacterial vaginosis is based on clinical & lab indicators: Vaginal pH >4.5, alkaline Positive amine test Clue cells> 20% of total vaginal epithelial cells Homogenous thin discharge Scanty / absent lactobacilli 3 out of 5 criteria suggests this diagnosis Ref: Sexually transmitted infections, Bhushan Kumar, 2nd edition pg 673.
1
Vaginal pH <4.5
Positive amine test
Clue cells> 20% of total vaginal epithelial cells
Homogenous thin discharge
Skin
null
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multi
A 60 year old man presents with chest pain which last 6 hours and is diagnosed as acute myocardial infarction. Angiography showed involvement of anterior descending branch of left coronary artery The most probable site of infarct is-
null
1
Anterolateral wall
Posterior wall
Inferior wall
Septal
Medicine
null
bee794e9-b504-4d94-b565-20e45d8b2d4b
multi
Patients with porphyria are highly sensitive to which wavelength :
Porphyrin are excited by visible light with a wavelength between 400 and 410 nm and emit an intense red fluorescence. The released energy reacts with oxygen to produce free radicals and singlet oxygen that damages tissues Mc porphyria - porphyria cutaneatarda (if- Red urine - D/D - myoglobinuria )
2
290-320 nm
400-420 nm
320-400 nm
250-290 nm
Dental
JIPMER 2018
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Killian's dehisence is seen in:
Ans. C Cricopharynx Ref. Scott Brown's lth/ed Vol 2 Chapter 155 p 2045; Dhingra 5th/ed p 253, 6th/ed p 238 Killian's Dehiscence (Fig. 8.6) it is an area of weakness between the two pas of inferior constrictor muscle-sub thyropharyngeus and cricopha-ryngeus A pulsion diveiculum of pharyngeal mucosa can emerge posteriorly through the Killian's dehiscence called as Zenker's diveiculum or pharyngeal pouch. Since it is an area of weakness it is one of the sites of esophageal perforation during instrumentation and scopy-hence also called 'Gateway of Tears
3
Oropharynx
Nasophrynx
Cricopharynx
Vocal cords
ENT
null
869a79f4-a9b6-4f4c-9ea6-4b9789db8ac3
single
Chromosome-associated with bipolar disease -
Chromosomes involved in bipolar disorder are chromosome 18, 21, and 22.
3
Chromosome 16
Chromosome 13
Chromosome 18
Chromosome 11
Psychiatry
null
48f8b172-a374-4d0d-ab0c-f902e7d33e8d
single
Feature that differentiates true from aificial bruise
contusion: not well defined, diffuse, and irregular margins Aificial bruise: well defined with regular margins. Ref: FORENSIC MEDICINE AND TOXICOLOGY DR PC IGNATIUS THIRD EDITION PAGE 120
2
Round shape, irregular margins
Irregular shape with regular margins
Swelling of surrounding area
Erythema of surrounding areas
Forensic Medicine
Mechanical injuries
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multi
Which one of the following elements is NOT added in small amount to be used as grain refiners?
null
4
Iridium
Ruthinium
Indium
Platinum
Dental
null
9ffd6fd9-dcdb-4e1a-9968-53e84b62f3b5
multi
The prototype of type-H hypersensitivity reaction is?
Ans. is 'c' i.e., Autoimmune hemolytic anemia
3
Ahus reaction
SLE
Autoimmune hemolytic anemia
Contact dermatitis
Microbiology
null
1c23e1f1-760e-48cc-93f7-1f717f894a0c
single
True statement about ductus Arteriosus is –
This question deals with the changes in blood circulation that occur at birth : Closure of Ductus arteriosus The closure occurs almost immediately after birth by contraction of its muscular wall, mediated by bradykinin. i.e. Physiological closure. Anatomic closure occurs by proliferation of intima, and may take from 10-21 days (& not in 24 hrs. as given in choice 'A'). After obliteration, it forms ligamentum arteriosum. (& not the ligamentum venosum as given in choice 'ID') Ligamentum venosum, on the other hand, is formed by closure of the ductus venosus. "In neonates with congenital heart defects, till surgery is undertaken, PGE1 (Alprostadil) is used to maintain patency of ductus arteriosus". Therefore prostaglandins maintain patency of ductus arteriosus, and not induce it to close (as given in choice 'C'). Prostaglandins maintain patency of ductus arteriosus NSAIDs - help in early closure of ductus arteriosus "Shunt murmur is a continuous machinery murmur". The murmur is best heard at the 2nd left intercostal space and is also well heard below the left clavicle, where it maintains its continuous machinery character.
4
It undergoes anatomic closure within 24 hours of birth
Forms the ligamentum venosum in later life
It is induced to close by high levels ofprostaglandins
May cause a machinary murmur by its patency.
Pediatrics
null
8b7d9930-955e-4bd8-baf4-c7cf266cb8c0
multi
A five year old child presents with ballooning of prepuce after micturation. Examination of penis reveals prepucial adhesions which the following the best treatment
The child is having congenital phimosis(inability to retract the prepuce over the glans) in which case the child has pinhole meatus and ballooning of prepuce on voiding. The best treatment is circumcision. Patients with phimosis are more prone for recurrent infection, smegma collection and carcinoma penis. Reference : page 1061-62 SRB's manual of surgery 5th edition.
2
Adhesiolysis & dilatation
Circumcision
Dorsal slit
Conservative management
Surgery
Urology
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multi
Torus aorticus involves:
Ans. d (Right atrium). (Ref. Grey, Anatomy, 36th ed., 644)Torus aorticusAnterosuperior part of septal wall of right atrium bulges to some degree into the atrial cavity as torus aorticus. It is caused by proximity of right posterior aortic sinus and cusp.Torus auditoryThe postero-inferior wall of external meatus occasionally presents a smooth to roughened longitudinal elevation, known as auditory torus.Torus mandibularisAbove myelohyoid line, the bone medial to roots of molar teeth is sometimes developed into a rounded ridge called torus mandibularis.Torus palatineIntermaxillary sutures are sometimes raised forming a longitudinal midline ridge.Torus maxillarisIt is occasionally present on the alveolar process spanning the palatal aspect of subcervical roots of upper molar teeth.
4
Left atrium
Arch of aorta
Ascending aorta
Right atrium
Anatomy
Thorax
526dc19c-99d2-4acc-994c-c1ae24eaf947
single
Cavett test is used for detection of
Test for alcohol : Cavett test Kozelka and thine test Alcohol dehydrogenase test Gas chromatography (Most specific)
2
Opiates
Alcohol
Barbiturates
Cocaine
Forensic Medicine
null
258609c2-6dfd-45f0-852f-d25665a6c0ec
single
All are features of Meniere's disease except:
Giddiness occurring in certain head positions such as bending forward to pick up an article or reaching for an article in the overhead shelf or turning one's position in the bed is a feature of benign paroxysmal positional vertigo (BPPV). The condition is due to free-floating particles (otoconia) in the endolymph of vestibular labyrinth. Due to change in head position, they settle on the cupula of posterior semicircular canal causing its deflection and giddiness.Meniere's disease is characterised by episodic vertigo, sense of fullness in the ear, fluctuating hearing loss and low-pitched roaring tinnitus.
2
Hearing loss that fluctuates
Giddiness is provoked in certain head positions
Sense of pressure or fullness in the ear
Roaring tinnitus
ENT
Ear
118da4b4-d2c1-4452-a6bd-cd749faacf0a
multi
The most common complication of immunosuppression is:
Ans. (c) InfectionRef: Bailey 26th edition, Page 1416* Bacterial infection is most common in 1st month and is most common in those who are critically ill before and after transplant.* Viral infection is most common in 6 months--Most common is CMV > HSV* BK virus is universal in childhood causes urinary infection* Pneumocystis Jiroveci (Previously known as Pneumocystis carnii) is one important fungal infection.
3
Malignancy
Graft rejection
Infection
Thrombocytopenia
Surgery
Transplantation
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'Time out' is useful in the treatment of:
Time-out- behavioral modification that involves temporarily separating child from an environment where an unacceptable behavior has occurred. The goal is to remove that child from an enriched, enjoyable environment- lead to extinction of the offending behavior. Distraction and 'time-out' strategies are useful in treatment of Temper Tantrums.
1
Temper Tantrums
Pica
Anorexia nervosa
Nocturnal enuresis
Pediatrics
Behavioral Disorders in Children
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single
The extended sickness benefit is given for:
309 days
1
309 days
409 days
365 days
490 days
Social & Preventive Medicine
null
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single
Which among the following is a killed vaccine
Japanese encephalitis vaccine is a killed vaccine Killed vaccines are produced by growing virus or bacteria in a culture media and then inactivating them with heat or chemicals They are usually safe but less efficacious than live attenuated vaccines. Measles, yellow fever and influenza vaccines are live attenuated vaccines Ref : Park&;s Textbook of Preventive and Social Medicine; 23rd edition
1
Japanese encephalitis
Measles
Influenza vaccine
Yellow fever
Social & Preventive Medicine
Communicable diseases
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single
Undiagnosed or undetected ectopic pregnancy is a common cause of maternal death during the first trimester. Most valuable diagnostic test in a case of suspected ectopic pregnancy is:
Transvaginal ultrasonography (TVUS) has the advantage of earlier and better localization of the pregnancy, with less pelvic discomfo because the bladder is not painfully distended. The double-ring sign and the yolk sac must be identified to ensure that the pregnancy is intrauterine. When an intrauterine pregnancy is not visualized on TVUS and the hCG level exceeds 1000-2000 mIU/mL, suspicion for an ectopic pregnancy should be high. Ref: Hill M.J., DeCherney A.H. (2013). Chapter 36. Imaging in Gynecology. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.
2
Serial (3-hCG levels)
Transvaginal USG
Progesterone measurement
Culdocentesis
Gynaecology & Obstetrics
null
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A 6 - year - old boy with lymphoreticular malignancy has come for a cycle of chemotherapy. Which of the following investigatins need to be done for next 4 hours to diagnose tumour lysis syndrome?
Tumour lysis syndrome (TLS) - -Uric acid, phosphate and potassium are released in large quantities from death of tumour cells. -Hyperuricemia can lead to impairment of renal function, which fuher exacerbates the metabolic abnormalities. -Hypocalcaemia is a consequence of acute hyperphosphatemia with subsequent precipitation of calcium phosphate in soft tissues. 'TLS can occur before therapy in patients with a large tumour burden (e.g., Burkitt lymphoma, Hyperleukocytosis) It is usually seen within 12-48 hr of initiating chemotherapy.
2
Urea, creatinine, chloride, Ca2+ and K+
Urea, creatinine, phosphate, Ca2+ and K+
Urea, creatinine, magnesium, Ca2+ and K+
Urea, creatinine, sodium and phosphate
Pediatrics
JIPMER 2017
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All true about CisATRACURIUM except-
Cisatracurium is pure sis isomer of atracurium. It is more potent and has longer onset time than atracurium. Metabolism is similar to atracurium. It releases less histamine than atracurium. Cisatracurium does not cause histamine release unlike atracurium. Cisatracurium produces laudanosine but is about five times lesser than that of atracurium. Cisatracurium is a stereoisomer of atracurium that is four times more potent. Cisatracurium undergoes Hofmann Elimination which is a spontaneous non-enzymatic organ-independent degradation. So its clearance is independent of renal function. Hence it is the agent of choice in renal failure patients.
3
It is pure Cis isomer of atracurium
It is more potent than atracurium
It is also causes histamine release like atracurium
Metabolism similar to atracurium
Anaesthesia
Neuromuscular Blocker
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Pre-renal azotemia is associated with one of the following characteristic feature -
null
1
Urinary Na+ < 10 mmol/L
Renal failure index > 1
Osmolality < 500
Urinary creatinine/P. creatinine ratio < 20
Medicine
null
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single
Ejection fraction is about
The ejection fraction, the percent of the end-diastolic ventricular volume that is ejected with each stroke, is about 65%. The ejection fraction is a valuable index of ventricular function.
4
25%
45%
55%
65%
Physiology
null
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Opaque white areas covering more than 25% but less than 50% of the tooth surface is given the Dean's score of:
null
2
1
2
3
4
Dental
null
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In a man lifting up a suitcase, posterior dislocation of glenohumeral joint is prevented by:
Ans. (c) CoracobrachialisRef : Gray's 41st ed./819-821* The coracobrachialis is an elongated muscle in the superomedial part of the arm. The coracobrachialis helps flex and adduct the arm and stabilize the glenohumeral joint.* With the deltoid and long head of the triceps, it serves as a shunt muscle, resisting downward dislocation of the head of the humerus, as when carrying a heavy suitcase.* The median nerve and/or the brachial artery may run deep to the coracobrachialis and be compressed by it.* Nerve supply - Musculo-cutaneous nerve.
3
Deltoid
Latissimus dorsi
Coracobrachialis
Supra spinatous
Anatomy
Back, Deltoid, and Scapular Region
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Xerosis is seen in: September 2006
Ans. A: Vitamin A deficiency
1
Vitamin A deficiency
Vitamin B deficiency
Vitamin C deficiency
Vitamin D deficiency
Ophthalmology
null
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single
What is the treatment of choice in duodenal ulcer without any complication of hemorrhage?
Proton pump inhibitors like Omeprazole can produce relief in patients with duodenal ulcer. Perforation complicates duodenal ulcer about half as often as bleeding and most perforated ulcers are on the anterior surface of the duodenum. The patient population tends to be elderly (mean age 60-70), chronically, ill patients often (40-50%) taking ulcerogenic medication. Helicobacter pylori is implicated in 70-92% of all perforated duodenal ulcers even if those secondary to Non-Steroidal Antiinflammatory Drugs are included. The second most common cause of perforated duodenal ulcer is the ingestion of Non-Steroidal Antiinflammatory drugs. The traditional management of a perforated duodenal ulcer has been a Graham Omental Patch and a thorough abdominal lavage.
3
Highly selective vagotomy
Trunkal vagotomy
Proton pump inhibitors
null
Surgery
null
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The maintenance dose of digoxin
Slow digitalization: Here maintenance dose of Digoxin (average 0.25 mg/day) is given from the beginning. Full response takes 5-7 days to develop, but the procedure is much safer. In case an adequate response is not seen after I week, increase the dose to 0.375 and then to 0.5 mg after another week.Rapid oral digitalization: Here Digoxin 0.5 - 1.0 mg stat dose given followed by 0.25 mg every 6 hours with careful monitoring and watch for toxicity till response occurs - generally takes 6-24 hours (total dose 0.75 - 1.5 mg). This is seldom practised now.Emergency digitalization: It is practised rarely now, only as a desperate measure in CHF or in atrial fibrillation. Digoxin 0.25 mg followed 0.1 mg hourly is given by slow IV. Injection with close ECG, BP and CVP monitoring till response occurs (2-6 hours, total dose 0.5 - 1.0 mg)
1
0.25 mg/day
2.5 mg/day
25 mg/day
250 mg/day
Microbiology
All India exam
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single
Pentosuria is due to defect in which pathway?
Essential Pentosuria i. It is one of the members of the Garrod&;s tetrad. The incidence is 1 in 2,500 bihs. ii.It is an inborn error of metabolism, due to defect in glucuronic acid pathway of glucose. In the pathway, L-xylulose is conveed to D-xylulose by two enzymes, xylitol dehydrogenase and xylulose reductase absence of any of this enzyme lead to pentosuria.Ref: DM Vasudevan, 7th edition, page no: 134
3
Glycolysis
Polyol pathway
Uronic acid pathway
Kreb's cycel
Biochemistry
Metabolism of carbohydrate
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Which of the following milestone is achieved at 36 months -
Ans. is 'c' i.e., Riding a tricycle Milestones seen at 36 monthso Rides tricycleo Stands momentarily on one footo Draws a circle.o Can dress or undress himself completely and succesfully buckles his shoeso Builds tower of 10 cubeso Knows his gender and ageo Repeats a sentence of 6 syllableso Has a vocabulary of 250 wordso Counts 3 objects correctlyo Can withhold and postpone bowel movemento Handedness is established
3
Drawing a rectangle
Building a tower of 20 cubes
Riding a tricycle
Skipping
Pediatrics
Developmental-Behavioral Screening and Surveillance
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single
Which of the following ovarian tumor is most prone to undergo torsion during pregnancy?
Ans. is c, i.e. Dermoid cystRef. Novak 14/e, p 510; Dutta Obs. 6/e, p 310"Incidence of dermoid cyst increases two times in pregnancy and it becomes the most commonly diagnosed ovarian tumour during pregnancy." --Dutta Obs. 7/e, p 310"A benign cystic teratoma is the most common neoplasm to undergo torsion." --Novak 14/e, p 510Note: Benign cystic teratoma is another name for dermoid cyst.From the above two lines it is clear that dermoid cyst is the most common ovarian tumour to undergo torsion during pregnancy.For more details on dermoid cyst and other ovarian tumours kindly see "Self Assessment and Review Gynaecology" by the same author.
3
Serous cystadenoma
Mucinous cystadenoma
Dermoid cyst
Theca lutein cyst
Gynaecology & Obstetrics
Gynaecological Disorders in Obs.
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Thermo-stability in DNA is contributed mostly by:
B i.e. G CThermostability in DNA is constributed mostly by C GQ because there are 3 Hydrogen bonds between C & GQ. G C bonds are much more resistant to denaturation or melting than A= T rich region (2 Hydrogen bonds)
2
A=T
GEC
Molecular base
Parallel arrangement
Biochemistry
null
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Direct action of radiation is the dominant process for
Ionizing radiation acts by two methods: Direct and IndirectDirect action is radiation directly causing DNA damage; example: neutrons and alpha paiclesIndirect action is radiation causing free radical production which acts on DNA; example: photons and gamma raysReference: Khan Physics of Radiation therapy; 5th edition
2
X-rays
Neutrons and alpha paicles
Electrons
Gamma rays
Radiology
Radiotherapy
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single
Chesser Moir technique is used in :
VVF Chassar Moir technique is used for repair of vesico vaginal fistula. Few named surgical procedures In Few named surgical procedures In Procedure Indication Marshall -- Marchetti Krant surgery Marshall and Bonneys test Boari operation Manchester operation Fothergill operation Strassmam Metroplasty Jones Metroplasty Thompkins Metroplasty Mc Indoe technique Stress incontinence Stress incontinence Uretric transition, Bladder flap procedure Prolapse uterus Prolapse uterus Bicornuate uterus Septate uterus Septate uterus
1
VVF
Stress incontinence
Urethrocoete
Enterocoele
Gynaecology & Obstetrics
null
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single
The storage triacylglycerol are hydrolysed by:
Ans. D. Hormone sensitive lipase(Ref: Harper 31/e page 244)Pancreatic lipase to hydrolyse dietary TGsLipoprotein lipase to hydrolyse TGs in lipoprotein in the bloodLysosomal hydrolase to act on TGs in lysosomes
4
Pancreatic lipase
Lipoprotein lipase
Lysosomal lipase
Hormone sensitive lipase
Biochemistry
Lipids
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single
Shelf life of platelets in blood bank is?
Platelets are stored in plasma or in additive solution up to 5-7 days at 20-24degC and under permanent motion.
1
5 days
8 days
10 days
21 days
Medicine
Platelet & Coagulation disorders
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single
All the following pathogenic bacteria fulfill Koch's postulates, except -
Ans. is 'a' i.e., Treponema pallidum
1
Treponema pallidum
Yersinia pestis
Bacillus anthracis
Helicobacter pylori
Microbiology
null
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multi
Which is the most common location of carcinoid tumor ?
Location of carcinoid tumors: Bronchus 27.9% , Ileum 14.9%, Rectum 13.6 %, colon 8.6 %. So Ileum comes next to bronchus and first in GI tract. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 3058, Table 350-3
1
Bronchus
Ileum
Rectum
Colon
Medicine
null
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Limits of confidence of a hypothesis determined by?
Ans. is 'd' i.e., 1-Level of significance First read about these different terms : ? Confidence interval It is the interval within which a parameter value is expected to lie with ceain confidence levels, as could be revealed by repeated samples. o It is the interval (range) around the mean of population in which the means of multiple samples of same population are dispersed. o If independent samples are taken repeatedly from the same population, and a confidence interval is calculated, then a ceain percentage (confidence level) of the intervals will include the unknown population parameter. o For example 95% of sample means will be covered by 2SD from population mean here. Confidence level --> 95%. 95% confidence interval for population mean --> Mean +- 2SD. o A narrow confidence interval is always preferable as it tells more precisely about the population mean:-- i) Large the sample size, narrower the confidence interval. ii) Smaller the Standard detion, narrower the confidence interval. Confidence limits o Are the upper and lower boundries of confidence interval, i.e., the values which define the range of confidence interval. Confidence limits is calculated by mean and standard detion. I am giving a very simple example : ? o If mean weight of a sample of children in a school is 30 Kg and SD is 1. Then. i) Confidence interval = Mean +- 2SD = 30 +- 2 = 28 to 32 kg. ii) Confidence level = 95% (that means 95% of values will be covered under the range 38 to 32). iii) Confidence limit = 28 (lower limit) and 32 (upper limit) Level of significance Level of significance is the criterian used to rejecting null hypothesis, i.e., to find out significant difference between two variable. o In simple words, it is defined as the probability of making a decision to reject the null hypothesis. o The decision is often made by using p value, i.e., p value denotes significance level. P vlalue 0.01 means that there is 99% of probability of rejecting null hypothesis when it is false, that is there is significant difference between two variable. o The significance level is usually set at 0.05 (p=0.05). The smaller the p-value (significance level), the more significant the result said to be. Now explanation for this question is : ? Confidence intervals are closely related to statistical significance testing. In many situations, if the point estimate of parameter is 'X', with confidence interval `a-b' at confidence level P, then any value outside this interval (a-b) will be significantly different from X at significance level a =1 - P under the same distributional assumption that were made to generate the confidence interval. o That means, if in an estimtion of second parameter we obsrved a value less than 'a' or greater than 'b' we would reject null hypothesis that the true value of this parameter equaled 'X' at the level of significance. o Conversely, if the estimate of second parameter lay within the interval `a-b', we would be unable to reject the null hypothesis that the parameter equaled 'X'. In consequence, if the estimates of two parameters have a confidence interval at a given P value that do not overlap, it is very likely that the two values are significantly different at the corresponding value of a.
4
Power factor
Level of significance
1-power factor
1 -lev el of significance
Social & Preventive Medicine
null
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single
A patient suffering from Zollinger- Ellison syndrome would be expected to have:
Ans. C. A gastrin-secreting tumor of the pancreas, causing excessive stomach acid secretion and peptic ulcersExcessive production of gastrin results in acid hypersecretion and peptic ulcer disease. Patients with Zollinger-Ellison syndrome do not suffer from excessive acid reflux, excessive secretion of CCK, failure of the liver to secrete VLDLs, or failure to secrete a bicarbonate-rich pancreatic juice
3
Excessive acid reflux into the esophagus, resulting in esophagitis
Excessive secretion of CCK, causing continuous contraction of the gallbladder
A gastrin-secreting tumor of the pancreas, causing excessive stomach acid secretion and peptic ulcers
Low plasma lipid levels, due to failure of the liver to secrete VLDLs
Physiology
G.I.T.
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multi
Most common ALL subtype:
Ans. (a) Pre B cellRef: Robbin's pathology 9th ed. /590-93* Most common subtype of ALL is LI according to older classification and Pre B cell variety by the latest WHO classification.* The recent WHO International panel on ALL recommends that the FAB classification be abandoned, since the morphological classification has no clinical or prognostic relevance. It instead advocates the use of the immunophenotypic classification mentioned below:* Acute lymphoblastic leukemia/lymphoma.# Synonyms: Former Fab L1/L2Precursor B Acute Lymphoblastic Leukemia/Lymphoma.Cytogenetic Subtypes1. t(12;21) (pl2,q22)2. t(l;19) (q23;pl3)3. t(9;22) (q34;ql 1)4. t(V,l l) (V;q23)Precursor T Acute Lymphoblastic leukemia/lymphoma* Burkitts leukemia/lymphoma. Synonyms: Former FAB L3* Biphenotypic acute leukemia
1
Pre B cell
Pre T cell
T cell
B cell
Pathology
Lukemia
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Crude birth rate – Not true is
Crude birth rate (CBR) : is the natality or childbirths per 1,000 people per year. CBR (World) : 19.9 per 1000 population (Max 15 Niger ; Min 7 Monaco) . CBR (india) : 21.8 per 1000 population . Is a measure of fertility. CRUDE means it includes all causes and all ages - It is independent of age of population.
1
It is actually a ratio not a rate
It is a measure of fertility
It is independent of age of population
Numerator does not include still births
Social & Preventive Medicine
null
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multi
A 28-year-old previously healthy woman arrives in the emergency room complaining of 24 h of anorexia and nausea and lower abdominal pain that is more intense in the right lower quadrant than elsewhere. On examination she has peritoneal signs of the right lower quadrant and a rectal temperature of 38.38degC (101.8degF). At exploration through incision of the right lower quadrant, she is found to have a small, contained perforation of a cecal diverticulum. Which of the following statements regarding this situation is true?
Cecal diverticula must be differentiated from the more common variety of diverticula that are usually found in the left colon. Cecal diverticula are thought to be a congenital entity. The cecal diverticulum is often solitary and involves all layers of the bowel wall; therefore, cecal diverticula are true diverticula. Diverticula elsewhere in the colon are almost always multiple and are thought to be an acquired disorder. These acquired diverticula are really herniations of mucosa through weakened areas of the muscularis propria of the colon wall. The preoperative diagnosis in the case of cecal diverticulitis is "acute appendicitis" about 80% of the time. If there is extensive inflammation involving much of the cecum, an ileocolectomy is indicated. If the inflammation is well localized to the area of the diverticulum, a simple diverticulectomy with closure of the defect is the procedure of choice. To avoid diagnostic confusion in the future, the appendix should be removed whenever an incision is made in the right lower quadrant, unless operatively contraindicated.
4
Cecal diverticula are acquired disorders
Cecal diverticula are usually multiple
Cecal diverticula are mucosal herniations through the muscularis propria
Diverticulectomy, closure of the cecal defect, and appendectomy may be indicated
Surgery
Liver
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multi
A 30 years old male presented with silvery scales on elbow and knee, that bleed on removal. The probable diagnosis is –
Morphology of papules/plaques in various papulosquamotas disorders Psoriasis - Erythematous papules and plaques on extensors (elbow & knee Lichen planus - Violaceous papules with Wickham's striae an flexural surface Pityriasis rosea - Annular plaques on Trunk Seborrheic dermatitis - Yellowish, follicular papules on scalp and face  Pityriasis rubra pilaris - Erythematous follicular papules on Trunk & dorsum of hand Secondary syphilis - Dusky erythematous papules Pityriasis lichenoides et varioliformis acuta - Erythematous edematous papules surmounted by vesicles/crust Coming to question Clues in this question are :- Characterstic scales → silver scale Involvement of elbow & knee Bleeding on scale removal → Auspitz sign
3
Pityriasis
Seborrhoeic dermatitis
Psoriasis
Secondary syphilis
Dental
null
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single
Fluroide ions act by inhibiting -
A i.e. Enolase
1
Enolase
Hexokinase
Cytochrome oxidase
Carbonic anydrase
Biochemistry
null
8bb8e5d7-9594-41bc-8854-5e4e37ef38a8
single
Following trauma, which hormone is not released-
null
1
Thyroxine
Glucagon
ADH
GH
Surgery
null
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single
Not an experimental study
null
2
RCT
Ecological study
Pre - post clinical study
Meta - Analysis
Social & Preventive Medicine
null
24983e8c-2deb-4313-a12b-3607043ef1df
single
Which of the following agents is useful for the oral treatment ofboth pituitary as well as renal diabetes insipidus?
(Ref: KDT 6/e p577, 578) Thiazides are useful in the treatment of central as well as nephrogenic DI. Vasopressin, chlorpropamide and carbamazepine are useful only in central DI.
2
Vasopressin
Hydrochlohiazide
Chlorpropamide
Carbamazepine
Anatomy
Other topics and Adverse effects
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multi
Which of the following protein binds to free heme?
Ans: c) Hemopexin Option analysis: Binding protein Ceruloplasmin is a copper containing protein Haptoglobin Free Haemoglobin Hemosiderin Denatured ferritin Hemopexin is a b1-globulin that binds free heme
3
Ceruloplasmin
Haptoglobin
Hemopexin
Hemosiderin
Biochemistry
Vitamins and Minerals
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single
Pregnant patient comes at 34 weeks gestation with leaking. which investigation can be done for diagnosing the leak?
Speculum Examination- Done taking aseptic precautions to inspect the liquor escaping out through the cervix. During sterile speculum examination,ruptured membranes are diagnosed if Amniotic fluid pools in the posterior fornix or clear fluid flows from cervical canal
1
Speculum examination
USG
Non stress test
3 swab test
Gynaecology & Obstetrics
JIPMER 2017
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single
mood stabilizer used in the tretament of rapid cycling
Lamotrigine is a mood stabilizer which works best in BIPOLAR DEPRESSION Lithium is a mood stabilizer which works best in BIPOLAR MANIA valproate is a mood stabilizer which works best in RAPID CYCLING ref. kaplon and sadock, synopsis of psychiatry, 11 thedition, pg no.935
1
vaproate
lithium
carbamezepine
lamotrigine
Anatomy
Pharmacotherapy in psychiatry
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single
The protective value of vaccine is 95%. It means
Vaccine is an immuno-biological substance designed to produce specific protection against a given disease It stimulates the production of protective antibody and other immune mechanisms Vaccines can be prepared from live modified organisms, inactivated or killed organisms, extracted cellular fractions, toxoids or combination of these Vaccine efficacy is the percentage reduction of disease in a vaccinated group of people compared to an unvaccinated group, using the most favorable conditions Vaccine efficacy was designed and calculated by Greenwood and Yule in 1915 for cholera and typhoid vaccines It is best measured using double-blind, randomized, clinical controlled trials, such that it is studied under “best case scenarios
2
All those vaccinated are protected
5 among 100 have the probability of getting infected after vaccination
Among those vaccinated, 95% persons are not susceptible to the injections
95% of persons do not get the disease, where as 5% get the disease
Social & Preventive Medicine
null
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multi
Commonest complication following haemorrhoidectomy is -
null
4
Hemorrhage
Infection
Facal impaction
Urinary Retention
Surgery
null
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single
Quellung's reaction is seen in all except:
Ans. D. Neisseria meningitidesQuellung reaction is capsular swelling seen in capsulated bacteria. N. gonorrhoeae is not capsulated.
4
Strep pneumoniae
Neisseria gonorrhoeae
Hemophilus influenza
Neisseria meningitides
Microbiology
Bacteria
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multi
False statement about TX A2 is
TX A2 is produced inside the platelets with the help of TX A2 synthetase It is formed from cyclic Endo peroxidase(PGG2/H2) with the help of an enzyme, cyclooxygenase Aspirin inhibit its production by reversible inhibition of cyclooxygenase enzyme TX A2 causes aggregation of platelets, therefore is prothrombotic Refer kDT 6/e p174
3
It is formed in platelets
It is formed from PGG2/h2
It is having platelet anti aggregatory reactivity
Asprin can inhibit its production
Pharmacology
Autacoids
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multi
Drug of choice for strongyloides stercoralis?
Ans. C. IvermectinRef: K.D,T, Thle p, 850i Katzung 13th/e p. 909; Satoskar Pharma 24'e p. 816; Rang and Dale |th/e p. 573Strongyloid - IvermectinAnaerobes - MetronidazoleAtypical Pneumonia (mycoplasma) - ErythromycinCholera - DoxycyclineStaphylococci - PenicillinVRSA - LinezolidP. Carinii (jiroveci) - CotrimoxazolePseudomonas -Antipseudomonal beta-lactam + aminoglycosideStreptococcus - PenicillinToxoplasma - CotrimoxazoleToxoplasma in pregnancy Spiramycin.Rheumatic fever - Benzathine penicillinTB - INH with or without rifamPicinRickettsia - TetracYclinesInfluenza A and B - OsetamivirDiphtheria - Penicillin / ErythromycinAnthraxCiprofloxacin / Doxycycline + Peussis - ErYthromYcinHSV - AcYclovirLePtosPirosisMilder - Oral amoxicillinSevere - Iv Penicillin GLyme's disease - DoxycYclineSyphilis - Penicillin GPeussis - ErYthromYcinActinomycosis - Penicillin GLymphogranuloma venereum - Azithromycin or DoxycyclineLegionella - Azithromycin or levofloxacinPlague - StrePtomYcinListeria - Ampicillin + GentamicinMAC - Azithromycin / clarithromycinGroup B - streptococcus - AmpicillinUTI - CotrimoxazoleEndocarditis - Amoxicillin / ClindamycinBabesiosis - Quinine + ClindamycinP vivax - ChloroquineChloroquine resistant P vivax - Aemisinin combination therapy (ACT)
3
Mebendazole
Albendazole
Ivermectin
Levamisole
Pharmacology
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PHYSICAL QUALITY OF LIFE INDEX (PQLI) includes:
Ans. a (Infant mortality, Life expectancy and Literacy). (Ref Park PSM 22nd/ pg. 16)INDEXPHYSICAL QUALITY OF LIFE INDEX (PQLI)Consist of# Infant mortality,# Life expectancy at age one, and# Literacy.National and international comparison can be done.Kerala has highest PQLI.KUPUSWAMY INDEXKupuswamy index of social classification include:# Education# Occupation# IncomeSULLIVAN'S INDEX (MH'01)This index (expectation of life free of disability) is computed by subtracting from life expectancy the probable duration of bed disability and inability to perform major activities.It is considered one of the most advanced indicator/measure of disability rate, currently available.HUMAN DEVELOPMENT INDEXConsist of three dimensions:# Longevity (life expectancy at birth);# Knowledge (Adult literacy rate and mean years of schooling); and# Income (real GDP per capita in purchasing power).The HDI ranges between 0 to 1.In India HDI is 0.545DALY (DISABILITY ADJUSTED LIFE YEARS)Measure of burden of disease in defined population and effectiveness of intervention.1DALY = 1 lost year of healthy life.HALE (HEALTH ADJUSTED LIFE YEARS)It consists of life expectancy at birth and adjustment of time spent in poor healthICIDH 2 (International Classification of Impairments, Activities, and Participation)Concept:# sequences of illness related phenomenon;# Diseases--impairment--disability--handicapSections (coding for each section)# impairment# disability# handicapWHODASDeveloped for assessment of social functioning in psychiatric patients on 1CIDHmodelITEMS# Pts overall behavior# Social role performance# Social functioning in ward and occupational setting# Functioning in home and environmentWorld Health Organization'Disability Assessment Scale II (WHO-DAS II)A generic health-status instrument that provides six domain scores and a total, aggregate score.IDEAS# Brief scale for Indian setting# Developed to identify and quantify disability produced by mental disorders# Purpose: determining eligibility for welfare programmes.# Items: 4-self care, interpersonal activities, communication and understanding, and work.
1
Infant mortality, Life expectancy and Literacy
Maternal mortality, Life expectancy and Literacy.
Disability rate, Pregnancy rate and GNP
Longevity, Knowledge and Income
Social & Preventive Medicine
Concept of Health and Disease
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A 26 years old primigravida at 30 weeks of gestation on clinical examination, has blood pressure values of 142/100 mm Hg. 150/94 mmHg and 150/100 at 6 hours intervals. The next line of management is:
Ans. is c, i.e. Add methyldopaIn this case although patient has mild elevated BP but her BP is continuously increasing which means she needs antihypertensive. The antihypertensive which can be used in pregnancy is Methyldopa.
3
Add captopril
Add atenolol
Add methyldopa
No medical management is necessary at present
Gynaecology & Obstetrics
Miscellaneous (Obs)
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Which of the following can be used as tumor marker in pancreatic carcinoma?
CA 19-9 is a tumor marker for pancreatic as well as colon cancers.
3
CA-125
CA 27-29
CA 19-9
CA 15-3
Pathology
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Incubation period for diptheria and salmonella is
Diphtheria Causative agent : Corynebacterium diphtheriae, a gran positive non-motile organism Diphtheria is an endemic disease in India Source of Infection Carriers are more impoant as source of infection: 95% of total disease transmission Nasal carriers are more dangerous than throat carriers Incidence of carriers in a community : 0.5-1% Immunization does not prevent carrier state Incubation period : 2-6 days Mode of transmission Droplet infection (main mode), directly from cutaneous lesions anf fomites. Ref : Park 25th edition Pgno : 235 Typhoid Causative agent : Salmonella typhi Reservoir of infection : Man (cases and carriers) Source of infection : Faeces, urine of cases/carriers (primary source) and water, food fingers, flies (secondary sources) Incubation period: 10-14 days Mode of transmission : Faeco-oral route, urine-oral route Ref: Park 25th edition Pgno : 174,258
3
1-2 days and 20-40 days
2-6 days and 7-21 days
2-6 days and 10-14 days
1-2 days and 10-14 days
Social & Preventive Medicine
Communicable diseases
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What would you advise a mother who has an allergy to protein but still wants to breastfeed?
A: Breast milk does not contain protein unlike cow’s milk, so it is safe to let the mother breastfeed the infant. B: The nurse should inform the mother of the benefits of breastfeeding and should not simply hand over the responsibility to the physician. C: Formula milk contains cow’s milk protein which could trigger an allergy. D: The mother is still using formula milk which could trigger the allergy because of the protein in cow’s milk.
1
Assure her that breastfeeding would not pass on the allergy to the infant
Advise her to consult her primary health care provider regarding this issue
Advise her to use formula milk instead to avoid allergies.
Let her alternate between breast milk and formula milk to reduce chances of acquiring the allergen.
Surgery
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Fluoroacetate blocks the Krebs cycle by inhibiting the following enzyme
The poison fluoroacetate is found in some of the plants, and their consumption can be fatal to grazing animals. Some fluorinated compounds used as anticancer agents and industrial chemicals (including pesticides) are metabolized to fluoroacetate. It is toxic because fluoroacetyl-CoA condenses with oxaloacetate to form fluorocitrate, which inhibits aconitase, causing citrate to accumulate.Reference: Harper&;s Biochemistry; 30th edition; Chapter 16; The Citric Acid Cycle: The Central Pathway of Carbohydrate, Lipid & Amino Acid Metabolism
2
Citrate synthase
Aconitase
a-KG dehydrogenase
Succinate dehydrogenase
Biochemistry
Metabolism of carbohydrate
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single
An organism not invading intact cornea-
Following three pathogens can invade the intact corneal epithelium and produce ulceration: Neisseria gonorrhoea, corynebacterium diphtheriae and Neisseria meningitidis.
4
Gonococci
C. diphtheriae
Meningococci
Pseudomonas
Ophthalmology
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True of case control studies
<p>case control studies usually known as retrospective studies.are those which proceeds from efect to cause .it mainly involves two study populations cases and controls.they are basically comparison studies from which the"odds ratio" can be calculated.focus is on a health problem that has already occurred.not much patients are required for the study.ODDS RATIO is a measure of the strength of association between risk factor and outcome.it is closely related to relative risk.</p><p>ref:park&;s textbook of preventive and social medicine,22 nd edition ,pg no 68</p>
2
It proceeds from cause to effect
Odds ratio can be calculated
Incidence can be calculated
Needs many patients
Social & Preventive Medicine
Epidemiology
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multi
Which of the following adaptations will be apt to increase the work capacity at high altitude?
Exercise increases oxygen requirements, which must now be met in the face of this decreased oxygen. Increase workload, will increase sever O2 demand, which cannot be met at high altitude due to low paial pressure of oxygen, fuhermore it can precipitate pulmonary edema. But decrease workload and increase duration, will produce a low-grade hypoxic drive. This hypoxia produces hypoxia-inducible factor-1a, which stimulate vascular endothelial growth factor (VEGF) production. This promotes angiogenesis, augmenting blood flow and supplying more oxygen to the tissues. All these changes are helpful for acclimatization
3
Increasing workload, decreasing duration of exercise
Increasing workload, increasing duration of exercise
Decreasing workload, increasing duration of exercise
Decreasing workload, decreasing duration of exercise
Physiology
Respiratory System Pa 1
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All of the following are true about Helicobacter pylori except:
Ans. is 'c' i.e., All children in developing countries have immunity by five years of age(Ref: Harrison, 16th/e, p. 886,19th/e, p. 1038; Ananthanarayan, 9th/e, p. 400)* Duodenal ulcer (80%) and Gastric ulcer (60%) are associated with H. pylori.* Gastric adenocarcinoma, gastric MALT lymphoma, Autoimmune gastritis, Hyperacidity.* Chronic gastritis in adults due to the reinfection and Treatment prevents the gastric lymphoma.* Approximately 50% of world population and 85% of developing countries are affected by H. pylori.
3
About 50% of world population affected
85% of population is affected, in some developing countries
All children in developing countries have immunity by five years of age
Infection is common in low socio-economic status
Microbiology
Bacteria
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Laryngeal prominence is formed by-
The lower part of anterior borders of right and left laminae of thyroid fuse and form a median projection called laryngeal prominence.
4
Cricoid cartilage
Hyoid bone
Anterior margin of thyroid
Angle of the thyroid cartilage
Anatomy
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single
A 35 year old man who recently traveled to a third world country develops chronic, severe dysentery. Colonoscopy demonstrates ulceration of the cecum, and a cecal biopsy reveals 15-to-40 micron amoebae with ingested erythrocytes and small nuclei with distinctive tiny central karyosomes. Which of the following organisms is the most likely culprit?
Entamoeba histolytica is the usual cause of intestinal amebiasis, and has the microscopic features described in the question stem. A paicularly helpful (but not always present) feature of this organism is the presence of ingested red blood cells within the amoebae. These amoebae cause flask-shaped ulceration of the intestinal mucosa and submucosa, with a paicular propensity for involving the cecum and ascending colon. The disease manifestations range from none (asymptomatic carriers) to mild chronic diarrhea, to severe, purging dysentery. In symptomatic cases, the liver may develop destructive amoebic liver abscesses that tend to become secondarily (and potentially life-threateningly) infected by bacteria. Acanthamoeba is a free-living amoebae that can cause amoebic meningocephalitis. Balantidium coli is a large ciliated intestinal parasite that can occasionally cause colonic disease resembling that caused by Entamoeba histolytica. Giardia lamblia is a small intestinal protozoa with a distinctive pear-shaped morphology that appears to have a "face." Ref: Ray C.G., Ryan K.J. (2010). Chapter 51. Rhizopods. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.
3
Acanthamoeba sp
Balantidium coli
Entamoeba histolytica
Giardia lamblia
Microbiology
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multi
Strongest oxygen radical amongst the following is
Reactive Oxygen Species (ROS) radicals like the hydroxyl radical . It is the most reactive of them all; note how it differs from the hydroxyl ion . the superoxide anion which is both ion and radical
2
O2-
OH-
H2O2
HCIO
Biochemistry
Respiratory chain
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single
Which of the following causes minimal Poo hepatic compromise
Sclerotherapy is used in esophageal varices Endoscopic sclerotherapy controls active hemorrhage in 80% to 90% of patients. The combination of sclerotherapy with somatostatin, octreotide, and vapreotide has been repoed to be superior to sclerotherapy alone in terms of control of bleeding and reduction of treatment failures within 5 days.
4
Non selective shunts
TIPSS
Distal splenorenal shunt
Sclerotherapy
Anatomy
G.I.T
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single
Eye of tiger sign on MRI is seen in
The eye of tiger sign refers to abnormal low T2 signal on MRI in the globus pallidus with a logitudinal stripe of high signal (due to gliosis and spongiosis).
4
Hallervorden spatz syndrome
Progressive supra nuclear palsy
Early onset levodopa - responsive Parkinsonism
All of the above
Radiology
null
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multi
Minimal Ascites can be best detected by:
A i.e. USG Earliest detection Investigation Ascites USGQ Pericardial effusion EchocardiographyQ Bronchiectasis CT-ScanQ Fetal life DopplerQ Pleural effusion IA lateral decubitus viewQ Pneumoperitonum Erect chest X-ray or left lateral decubitus abdominal X-rayQ
1
USG
Plain X-ray abdomen
MRI
CT scan
Radiology
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single
Benzodiazepine without anticonvulsant propey is?
Ans. is 'd' i.e., Temazepam BZDs with significant anticonvulsant propey are diazepam, clonazepam, nitrazepam, lorazepam and flurazepam.
4
Nitrazepam
Diazepam
Clonazepam
Temazepam
Pharmacology
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single
A tumor has the following characteristics. Retrobulbar location within the muscle cone, well defined capsule, presents with slowly progressive proptosis, easily resectable, occurs most commonly in the 2nd to 4th decade. Most likely diagnosis is -
Cavernous hemangioma is the most common benign, intraconal tumor in adults. Hemangiopericytoma is also retrobulbar intraconal lesion found in adults but is a rare tumor Moreover owing to its tendency to invade the adjacent tissues, its margins are less distinct than cavernous hemangioma. Rest 2 options i.e. Dermoid and Capillary hemangiomas are primarily extraconal lesions.
2
Capillary hemangioma
Cavernous hemangioma
Lymhangioma
Hemangiopericytoma
Ophthalmology
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single
MgCl2 is added to polio vaccine because of the following -
molar MgCl2 is used to dtabilise the vaccine against heat inactivation REF:ANATHANARAYANAN MICROBIOLOGY NINTH EDITION PAGE.488
2
Potentiates the vaccine
Vaccine can be kept at higher temperatures
Preservative
None of the above
Microbiology
Virology
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