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HRCT is investigation of choice for diagnosing all of the following conditions, EXCEPT:
|
CT/MRI aeriography is used for investigation of pulmonary aery aneurysms. HRCT findings in Sarcoidosis: Common findings are: Small nodules in a perilymphatic distribution (i.e. along subpleural surface and fissures, along interlobular septa and the peribronchovascular bundle). Upper and middle zone predominance. Lymphadenopathy in left hilus, right hilus and paratracheal (1-2-3 sign). Often with calcifications. HRCT findings in Miliary TB: It is characterized by uniform small nodules (2-3 mm) with a random distribution. Characteristic high-resolution CT (HRCT) findings of idiopathic pulmonary fibrosis (IPF) includes reticulation, architectural distoion, and honeycombing involving mainly the lung periphery and the lower lobes.
| 4
|
Sarcoidosis
|
Miliary tuberculosis
|
Interstitial fibrosis
|
Pulmonary aery aneurysm
|
Radiology
| null |
7f643195-1177-4be6-9c66-32c608b28660
|
multi
|
Most important quality that a partial denture should possess:
|
The most important quality that a partial denture should possess is stability.
| 1
|
Stability
|
Support
|
Retention
|
All of the above
|
Dental
| null |
b08c6de5-8f8c-4854-aa20-9726f48495b8
|
multi
|
SARS causative agent
|
Ans. a. Corona-virus SARS-associated coronavirus (SARS-CoV) caused epidemics of pneumonia from November 2002 to July 2003. Corona Virus SARS virus is corona virus. Corona virus infections in human beings usually remain limited to upper respiratory tract. In contrast, the outbreak of SARS in 2003 was characterized by serious respiratory illness, including pneumonia and progressive respiratory failure. In all likelihood, the SARS virus originated in a non-human host and acquired the ability to infect humans. Chinese horse-shoe bats are natural reservoirs of SARS-like Coronavirus. Incubation period of SARS Coronavirus: 6 days Death from progressive respiratory failure occurs in almost 10% of cases, with highest death rates among elderly.
| 1
|
Corona-virus
|
Picorna-virus
|
Myxovirus
|
Retrovirus
|
Medicine
| null |
20fc8d82-b9ab-47c2-bc1c-e636008f3666
|
single
|
The most likely diagnosis is a case of the intractable convulsions mental defect and facial nevus is-
|
Sturge Weber syndrome and Von-Reckling-Hausen disease (NF-1) have been explained earlier about other options.
Tuberous sclerosis ( Bourneville's disease)
Tuberous sclerosis is characterized by : -
Cutaneous lesions → Adenoma sebaceum, ash-leaf shaped hypopigmented macules, shagreen patches, depigmented nevi.
Seizures
Mental retardation
Other features → Calcified subependymal nodules, Subependymal giant cell astrocytoma, ependymoma,
Rhabdomyomas of the heart, and angiomyomas of the kidney, liver, adrenals and pancreas.
Von Hippel - Lindau syndrome
This syndrome consists of Retinal, cerebellar and spinal hemangioblastoma.
Renal cell carcinoma, Pheochromocytoma, benign cyst of the kidney, liver, pancreas and epididymis may also occur.
Polycythemia may occur due to secretion of erythropoietin from hemangioblastoma.
| 1
|
Sturge Weber syndrome
|
Tuberous sclerosis
|
Von-Hippen -Lindau disease
|
Von- Reckling-Hausens disease
|
Pathology
| null |
61e00303-9d23-4267-a808-e28c7333b0ba
|
single
|
All are features of Pompe's disease except
|
Type II(Pompe) disease results from lysosomal storage of glycogen in skeletal muscles,cardiac muscles, and central nervous system.
There is progressive cardiomyopathy.ECG shows left axis deviation,short PR interval & large QRS.Heart failure with dyspnoea and cyanosis may occur.Skeletal muscles show hypotonia and marked weakness.The tongue is large & protruding.It is also characterised by hepatomegaly and hypoglycemia.
| 1
|
Hyperglycemia
|
Cardiomyopathy
|
Skeletal myopathy
|
Hepatomegaly
|
Pediatrics
| null |
e5a518c0-8249-4e5c-a11d-4651fce482b7
|
multi
|
Which of the following would most likely be observed in the lung during an autopsy of 2week old infant who died of neonatal respiratory distress syndrome
|
Neonatal respiratory distress syndrome is a disease of immaturity. The immature lung is not able to produce sufficient surfactant to prevent collapse of many alveloku. Severe diffuse damage to alveoli causes precipitation of protein adjacent to many alveolar walls Abundant neutrophils are seen in pneumonia. Fibrosis is a late not early feature of respiratory distress syndrome whereas the airspaces are not collapsed not enlarged in option C condition
| 4
|
Alveolar filledwith neutrophils
|
Dense fibrosis of the alveolar walls
|
Enlarged air space
|
Hyaline membrane and collapsed alveoli
|
Anatomy
|
Respiratory system
|
15669ff1-c3b9-4746-bc80-9f68ef3d8ab5
|
multi
|
A patient of 18 years of age presents with sudden agonising pain in the groin and the lower abdomen. The patient feels nausea
and gives a history of vomiting. On physical examination, the testis seems high. The cremasteric reflex is lost. What is the most
possible cause?
|
Testicular torsion is most common between 10 and 25 years of age, although a few cases occur in infancy.
Typically, there is sudden agonising pain in the groin and the lower abdomen. The patient feels nauseated and may vomit.
Torsion of a fully descended testis is usually easily recognized. The testis seems high and the tender twisted cord can be palpated above it.
The cremasteric reflex is lost
| 4
|
Epididymo-orchitis
|
Mumps orchitis
|
Idiopathic scrotal edema
|
Testicular torsion
|
Surgery
| null |
3c3386eb-b6e7-48e1-8dbf-47a56602bb7c
|
single
|
A 52 years male present with pain in the lower limbs, on performing Doppler it shows sapheno femoral junction incompetence and dilatation of great saphenous vein, deep veins appear normal, which of the following statement regarding the management of this patient is false?
|
Ans. (b) Sclerotherapy.Image indicates varicose veins which is further confirmed by doppler. Sclerotherapy is used for telangiectatic vessel and varicose veins less than 3 mm in diameter, involvement of great saphenous vein along with saphenofemoral junction indicates varicosity over 3 mm where sclerotherapy has no role.Image Source- style="font-family: Times New Roman, Times, serif">
| 2
|
Stab avulsion
|
Sclerotherapy
|
Endovascular stripping
|
Saphenofemoral flush ligation with stripping
|
Surgery
|
Varicose Veins
|
b2743457-5e9c-40d2-9954-026be53c1cab
|
multi
|
Rosen's incision is used for
|
Rosen's incision is the most commonly used for stapedectomy. It requires the meatus and canal to be wide enough to work. It consists of two pas: A small veical incision at 12 o'clock position near the annulus and A curvilinear incision staing at 6 o'clock position to meet the first incision in the posterosuperior region of the canals, 5-7 mm away from the annulus. Tympanomeatal flap is raised to expose the middle ear in endomeatal approach. Rosen's incision is used in the endomeatal approach for stapedectomy. It is also used for exploratory tympanotomy Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition
| 3
|
Septoplasty
|
SMR
|
Stapedectomy
|
Tonsillectomy
|
ENT
|
Diagnostic and operative ENT
|
61839004-a26e-40dd-b12b-5569822e2781
|
single
|
Blood agar is
|
Ans. (b) Enriched media
| 2
|
Enrichment media
|
Enriched media
|
Selective media
|
Transport media
|
Microbiology
|
General
|
bf7e41c2-399c-4ea6-b598-0cb0b8fc1594
|
single
|
Ram has a 4 ml lignocaine vial of 2% solution. How much lignocaine is present in 1 ml ?
| null | 3
|
2 mg
|
8 mg
|
20 mg
|
200 mg
|
Pharmacology
| null |
2ce932b2-287b-40c8-89d6-6bcd25d26fcb
|
single
|
Which of the following occur as a result of persistant vomiting?
|
Hypochloremia usually manifests when its levels are If the urinary Cl- levels are higher (>40 mEq/L), then hypochloremia may be secondary to volume overload or dilution. Increased urinary Cl- can also result from increased mineralocoicoid activity, which leads to the retention of HCO3- and Na+ at the expense of H+, K+, and Cl-. The treatment of chloride-responsive metabolic alkalosis (urinary Cl- = 10 mEq/L) is IV NS administration. Ref: Tintinalli's Emergency Medicine : A Comprehensive Study Guide, 7 Edition, Chapter 21 ; Harrisons Principles of Internal Medicine, 18th Edition, Chapter 45.
| 2
|
Hyperkalemia
|
Hypochloraemia
|
Hyperventilation
|
Acidic urine excretion
|
Medicine
| null |
4754e7cd-3d88-4239-aa99-a9fe0f73e2ea
|
single
|
Sexual gratification obtained by wearing dresses of opposite sides in
|
TRANSVESTISM In this type of sexual perversion, sexual satisfaction is obtained by wearing clothes of the opposite sex. His whole personality is dominated to be identified as a member of the opposite sex. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 312
| 4
|
Necrophilia
|
Fetichism
|
Frotteurism
|
Transvestism
|
Forensic Medicine
|
Sexual offences and infanticide
|
34eda887-9724-4d47-a182-3efb695a6533
|
single
|
Marjolin's ulcer (after burn) predisposes to:
|
Ans: B i.e. Squamous cell carcinoma Skin malignancy The strongest predisposing factor for basal cell carcinoma is ultraviolet radiation When a squamous cell carcinoma appears in a scar, it is known as Marjolin's ulcer
| 2
|
Basal cell carcinoma
|
Squamous cell carcinoma
|
Adenocarcinoma
|
Round cell carcinoma
|
Surgery
| null |
4c5a86d0-2671-41f3-8c21-22e6c1c12102
|
single
|
What is true about ischiorectal fossa:
|
D. i.e. Communicates with other side posteriorly
| 4
|
Apex is formed by obturater internus
|
Levater ani forms the roof
|
Lateral wall is formed by inferior pubic ramus
|
Communicates with the other side Posteriorly
|
Anatomy
| null |
29d75a05-0ebf-4508-913f-1a625f7ec98e
|
multi
|
A man had Egg omelet 1-4 hours back and developed diarrhea, vomiting and abdominal cramps. Most likely cause of poisoning is
|
Bacterium Typical food Disease Staphylococcus Custard-filled pastries; Potato, egg, tuna or fish salads Food poisoning especially vomiting Bacillus cereus Reheated rice Diarrhea Clostridium perfringens Cooked meat, stew and gravy Diarrhea E.coli Various food and water Diarrhea E.coli Undercooked meat Hemorrhagic colitis Salmonella enteritidis Poultry, meats, and eggs Diarrhea Shigella species Various foods and water Diarrhea Vibrio cholera Seafood and water Diarrhea Vibrio parahemolyticus Seafood Diarrhea Campylobacter jejuni Various foods Diarrhea Yersinia enterocolitica Various foods Diarrhea Ref : Ananthanarayana textbook of Microbiology 9th edition Pgno : 201
| 1
|
Staphylocoocus
|
Salmonella
|
Bacillus cereus
|
Clostridium
|
Microbiology
|
All India exam
|
d9a49048-7357-4f4d-b698-c8b29479a40b
|
single
|
Treatment of lymphoma of appendix?
|
Ans. (a) Right hemicolectomyRef Internet SourcesAppendix lymphoma:* Most common presentation is like acute appendicitis* Most common in men >55 years age* CT scan will show aneurysmal dilatation of lumen* Most are NHL type lymphomas* Treatment involves right hemicolectomy including nodes followed by CHOP therapy
| 1
|
Right hemicolectomy
|
Extended right hemicolectomy
|
Left hemicolectomy
|
Extended left hemicolectomy
|
Surgery
|
Small & Large Intestine
|
fdf712bb-fde2-4e36-b9ef-0e6544d2443c
|
single
|
Patient pays a stipulated amount of money towards the treatment is termed
| null | 1
|
Deductible
|
Coinsurance
|
Fee for service
|
Third party payment
|
Dental
| null |
2573f490-618d-45ea-ac16-aa2c4f217b07
|
single
|
All of the following are features of juvenile myoclonic epilepsy, except:
|
Juvenile myoclonic epilepsy is a generalized seizure disorder of unknown cause.Occurs in early adolescence & characterized by bilateral myoclonic jerks that may be single or repetitive, more common after awakening and can be provoked by sleep deprivation.Also experience generalized tonic-clonic seizures, and up to one-third have absence seizures.Complete remission is uncommon but well respond to anticonvulsant medication.Mesial temporal lobe epilepsy (MTLE) is the most common syndrome associated with focal seizures with dyscognitive features shows automatisms.Harrison 19e pg: 2544
| 3
|
Myoclonus on awakening
|
Generalized tonic-clonic seizures
|
Automatism
|
Absence seizures
|
Medicine
|
C.N.S
|
19a283a7-7302-4d20-aee7-ea35a23ee184
|
multi
|
Which of the following types of viral hepatitis infection in pregnancy, the maternal mortality is the highest?
|
Ans. is d, i.e. Hepatitis ERef. Dutta Obs. 7/e, p 292; Robbin's 6/e, p 862Maximum risk of maternal mortality is with hepatitis E.Maximum risk of hepatic encephalopathy is with hepatitis E.Maximum risk of perinatal transmission is with hepatitis B.All pregnant females should be screened for HBV infection in their first antenatal visit and repeated in the last trimester.Screening of HBV is done by determination of HBsAg.Maximum transmission of HBB infection occurs at the time of delivery Q. Hence MTP is not recommended in case of first trimester. There is no evidence that cesarean section lowers the risk of vertical transmission.Breastfeeding is not contraindicated in case of hepatitis.
| 4
|
Hepatitis A
|
Hepatitis B
|
Hepatitis C
|
Hepatitis E
|
Gynaecology & Obstetrics
|
Hepatic, Biliary, and Pancreatic Disorders
|
3bc32d89-2ff2-4093-a890-7a45a9a740a6
|
single
|
The inferior border of the rectus sheath posteriorly is called the:
|
The rectus sheath is a tough, tendinous sheath over the rectus abdominis muscle. It covers the entire anterior surface of the rectus abdominis. However, on the posterior side of the muscle, the sheath is incomplete. It ends inferiorly at the arcuate line. Below the arcuate line, the rectus abdominis is covered by transversalis fascia, not the rectus sheath! The linea alba is also related to the rectus abdominis. It is a ligament that runs down the middle of the abdomen, bisecting the rectus abdominis. It is made by the intermingling of the aponeuroses of the external oblique, internal oblique, and transversus abdominis. All of the other answer choices are related to the inguinal canal. The falx inguinalis (sometimes called the inguinal falx or conjoint tendon), is the inferomedial attachment of transversus abdominis with some fibers of internal abdominal oblique. It contributes to the posterior wall of the inguinal canal. The inguinal ligament is the ligament that connects the anterior superior iliac spine with the pubic tubercle. It makes the floor of the inguinal canal. The internal (deep) inguinal ring is the entrance to the inguinal canal, where the transversalis fascia pouches out and creates an opening through which structures can leave the abdominal cavity. Ref: Seymour N.E., Bell R.L. (2010). Chapter 35. Abdominal Wall, Omentum, Mesentery, and Retroperitoneum. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.
| 4
|
Falx inguinalis
|
Inguinal ligament
|
Internal inguinal ring
|
Arcuate line
|
Anatomy
| null |
697e6047-6e1c-4be2-ade2-2b55e5d9ebdd
|
multi
|
Procedure to be performed in case of arrest of after coming head due to contracted pelvis in breech:
|
Entrapment of aftercoming head This complication is usually seen with preterm delivery as the incompletely dilated cervix constricts aruond the neck .Duhurssen&;s incisions can be placed over the cervix avoiding the 3 and 9 o&;clock positions .other alternatives are intravenous nitroglycerin for cervical dilatation.General an anaesthesia followed by breech extraction is another option.As a last reso replacement of fetus high into the vagina and uterus followed by Caesarean section can be attended (Zavanelli manoeuvre).Another option with those who have experience of the same is symphysiotomy to widen the anterior pelvis (refer sheila textbook of obstetrics pgno:381 2 nd edition)
| 3
|
Craniotomy
|
Decapitation
|
Zavanelli maneuver
|
Cleidotomy
|
Gynaecology & Obstetrics
|
Abnormal labor
|
9382b75b-cc3f-478e-aedd-00f2d18a9a4e
|
single
|
Centchroman is :
|
Centchroman/ Ormeloxifene Nonsteroidal estrogen antagonist : SERM (Selective estrogen receptor modulator) Developed at CDRI, Lucknow. Tablets of 30 mg to be taken twice a week for 3 months and then once a week for contraception . Has a weak Estrogenic and potent antiestrogenic effect--acting mostly on the endometrial target organs to suppress proliferation of the endometrium, thereby interfering with nidation of the embryo; Causes asynchrony between the Ovulation and the endometrial development Other uses: Breast cancer, benign breast diseases, abnormal uterine bleeding
| 4
|
New drug for fibroids
|
New drug for endometriosis
|
Injectable contraception
|
Nonsteroidal oral contraception
|
Gynaecology & Obstetrics
|
Contraceptives
|
b7c9f3b1-6c35-4c37-9622-9e845ad1d4ee
|
single
|
Chyme is -
|
Ans. is 'a' i.e., Food in stomach o After food in the stomach has become throughly mixed with stomach secretions, the resulting mixture that passes down the gut is called chyme.o Chyme is usually semifluid mass. However, degree of fluidity of chyme depends on the relative amounts of food, water and stomach secretions and on the degree of digestion that has occurred.
| 1
|
Food in stomach
|
Biliary secretion
|
Pancreatic secretion
|
None of the above
|
Physiology
|
Digestion and Absorption
|
2c5816e2-d544-4b7d-b293-7a71eae0ea7a
|
multi
|
The gold alloys used for casting contain at
least ________ percent of precious metal according
to ADA specification number 5:
| null | 3
|
55
|
65
|
75
|
85
|
Dental
| null |
7402c699-c005-442b-8496-4dcca07fa1f0
|
multi
|
The most effective treatment of pruritus in uremia is :
|
A. i.e. Ultraviolet light
| 1
|
Ultraviolet light
|
Cholestyramine
|
Eskazine
|
Topical benzocaine
|
Skin
| null |
ea2aa9a2-9781-4fcf-86f3-4e65ece44a9e
|
single
|
Large vessel vasculitis is/are:a) Takayasu diseaseb) Temporal arteritisc) PANd) Giant cell arteritise) Wegner granulomatosis
|
Large vessel vasculitis are Giant cell arteritis, Takayasu arteritis and Cogan syndrome.
| 2
|
acd
|
abd
|
abc
|
ab
|
Pathology
| null |
f6b15b82-01ad-4f35-a9fa-276b2d1af41a
|
single
|
Insulin increases the activities of all of the following enzymes, EXCEPT
|
Insulin suppresses gluconeogenesis by suppressing the enzymes glucose 6 phosphatase, PEP, carboxykinase and pyruvate carboxylase. Biological effects of insulin: Metabolism Key enzyme Action of insulin on the enzyme Carbohydrate Translocase Glucokinase PFK Pyruvate kinase Pyruvate carboxylase PEPCK Fructose 1,6 bisphosphatase Glucose-6-phosphatase Glycogen synthase Glycogen phosphorylase Stimulation Stimulation Stimulation Stimulation Inhibition Inhibition Inhibition Inhibition Activation Inactivation Lipid Acetyl CoA Carboxylase Glycerol kinase Hormone sensitive lipase HMG CoA reductase Stimulation Stimulation Inhibition Stimulation Protein Transaminases Ornithine transcarbamoylase RNA polymerase and ribosome assembly Inhibition Inhibition Favoured Ref: Textbook of Biochemistry for Medical Students By D. M. Vasudevan, page 321.Principles of Biochemistry and Biophysics By Dr. B.S. Chauhan page 341.
| 2
|
Glucokinase
|
Pyruvate carboxylase
|
Glycogen synthase
|
Acetyl-CoA carboxylase
|
Biochemistry
| null |
6383ff4e-d705-402d-9b57-9901d868dab8
|
multi
|
Infantile myocarditis and pericarditis is due to
|
Ans. is 'b' i.e., Coxsackie B o The commonest cause of myocarditis is coxsackie B infection, which occurs any where from the age of a few hours to 7 weeks, with a peak around two weeks.
| 2
|
Coxsackie A
|
Coxsackie B
|
Mumps
|
Pox virus
|
Pediatrics
| null |
a78ee142-0316-4956-b077-3306e8d0e9ca
|
single
|
Acute poststreptococcal glomerulonephritis is characterised by which of the following hypersensitivity reactions?
|
Acute poststreptococcal glomerulonephritis is a well-known immune complex disease. Its onset occurs several weeks after a group A alpha hemolytic streptococcal infection, paicularly of the skin, and often occurs with infection due to nephritogenic types of streptococci. The complement level is typically low, suggesting an antigen-antibody reaction with consumption of complement. Lumpy deposits of immunoglobulin and complement component C3 are seen along glomerular basement membranes stained by immunofluorescence, suggesting antigen-antibody complexes. It is likely that streptococcal antigen-antibody complexes are filtered out by glomeruli, fix complement, and attract neutrophils. This series of events results in an inflammatory process that damages the kidney. Ref: Brooks G.F. (2013). Chapter 8. Immunology. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.
| 4
|
Type II: Hypersensitivity
|
Type IV: Cell-Mediated Hypersensitivity
|
Tuberculin-Type Hypersensitivity
|
Type III: Immune Complex Hypersensitivity
|
Microbiology
| null |
a4e9c4ae-0736-473b-8a88-ee57fcd0e435
|
single
|
A female in the emergency depament is found to have CSF rhinorrhea following a motor vehicle accident. What is the first line of treatment for CSF rhinorrhoea in this patient?
|
Early cases of post-traumatic CSF rhinorrhea are managed conservatively by placing the patient in semi-sitting position, avoiding blowing of nose, sneezing and straining. Prophylactic antibiotics are also administered to prevent meningitis. Persistent cases of CSF rhinorrhoea are treated surgically through nasal endoscopic or intracranial approach. Nasal endoscopic approach is useful for leaks from the frontal sinus, cribriform plate, ethmoid or sphenoid sinuses.
| 4
|
Immediate plugging of nose with petroleum gauze
|
Forceful blowing of nose
|
Craniotomy
|
Observation for 7 - 10 days with antibiotic therapy
|
ENT
| null |
7271c15a-4fb2-4c60-826b-55f3de32bf4b
|
single
|
Postnatally when is the growth velocity maximum?
|
Postnatally there are 2 periods of accelerated growth: first year of life and growth spu during pubey.
| 1
|
In the first year of life
|
In the second year of life
|
In the seventh year of life
|
In adolescence
|
Pediatrics
|
Growth
|
97ae6006-6ae2-4e50-8c75-77c206498104
|
multi
|
Which ion channel is affected in hypokalemic periodic paralysis?
|
Ans. (d) Ca2+Ref : Harrison's Internal medicine 18/e, chapter 387, table 387-10
| 4
|
K+
|
Na+
|
Cl-
|
Ca2+
|
Medicine
|
Fluid & Electrolyte
|
1364dced-6487-45bb-b444-05852ae7e12b
|
single
|
At the end of C6 which is not true:
|
Ans. A Trachea bifurcatesRef: BDC, 6ted. Vol II pg. 280-81* Trachea begins at lower border of cricoid cartilage opposite to the lower border of C6 vertebra.* Trachea extends up to upper border of T5* Tracheal bifurcation (carina) is at T4-T5 level.* Length of trachea is 10-12 cm* Thyroid cartilage is over 3, 4 & 5 tracheal ringsAt C6 vertebral level: Landmark is Cricoid cartilage* Larynx ends; Trachea begins* Pharynx ends; Esophagus begins* Inferior thyroid artery crosses posterior to carotid sheath.* Middle cervical sympathetic ganglion behind inferior thyroid artery* Inferior laryngeal nerve enters the larynx.* Vertebral artery enters the transverse foramen of C6.
| 1
|
Trachea bifurcates
|
Pharynx ends
|
Esophagus begins
|
Larynx ends
|
Anatomy
|
Neuroanatomy
|
ddec217e-c383-4905-943f-1bc13be31808
|
multi
|
Most vascular structure of eyeball is
| null | 3
|
Iris
|
Ciliary body
|
Choroid
|
Sclera
|
Ophthalmology
| null |
4755533d-c8b5-4839-a546-f93f2713fcc5
|
multi
|
Which insulin is never mixed with other insulins?
|
Ans. is 'd' i.e., Glargine o All insulin preparations are supplied at neutral pH (7.2-7.4) except glargine (supplied at pH 4.0); therefore, glargine cannot be mixed with any insulin.
| 4
|
Utile
|
Aspa
|
Lispro
|
Glargine
|
Pharmacology
| null |
c4e8104d-3705-4545-9d99-950aa83e8f60
|
single
|
Which is a not an essential criteria according to WHO for normal semen analysis :
|
Volume > 1 ml
| 2
|
Sperm count > 20 million / ml
|
Volume > 1 ml
|
Sperm with normal morphology (strict criteria) > 15%
|
Motility > 25% with rapidly progressive motilityTubal pathology
|
Gynaecology & Obstetrics
| null |
14a8af1b-5fc6-4182-ba0d-929e31039ba3
|
single
|
Which of the following would be the best morphological feature to distinguish ulcerative colitis from Crohn's disease -
|
Pseudopolyps (inflammatory polyps) can be seen in both Crohn's disease and ulcerative colitis
In ulcerative colitis, the distribution of these pseudopolyps can be diffuse but in Crohn's disease, the distribution cannot be diffuse because a classic feature of crohn's disease is the sharp demarcation of diseased bowel segments from the adjacent uninvolved bowel. When multiple bowel segments are involved the intervening bowel is essentially normal (skip lesions).
Mucosal edema
- The hallmark of both ulcerative colitis and crohn's disease is mucosal inflammation and chronic mucosal damage. So mucosal edema is a feature of both of these diseases.
- The important point is that while in Ulcerative colitis these processes are limited to mucosa or submucosal, in crohn's disease these processes extend beyond the mucosa and submucosa and involves the entire wall.
Crypt abscesses -
- Crypt abscesses are produced due to infiltration of the neutrophil into crypt lumen.
- These crypt abscesses are not specific for ulcerative colitis and may be observed in crohn's disease or any active inflammatory colitis.
Lymphoid aggregates in mucosa
The characteristic mucosal feature of idiopathic inflammatory bowel disease on histology includes —
i. Distortion of crypt architecture
ii.Destruction and loss of crypt
iii.A marked increase in lymphocytes and plasma cells in lamina propria.
iv. These features are specific to inflammatory bowel disease and help to differentiate idiopathic inflammatory bowel disease from acute infectious colitis and other chronic colitis.
| 1
|
Diffuse distributions of pseudopolyps
|
Mucosal edema
|
Crypt abscesses
|
Lymphoid aggregates in the mucosa
|
Pathology
| null |
b84c3e66-52e7-4e18-a1b7-e7576d9f528d
|
single
|
Y-chromosome is:
|
Y chromosome is Acrocentric. X chromosome is Submetacentric. IMG showing METACENTRIC CHROMOSOME. IMG showing SUBMETACENTRIC chromosome. IMG showing ACROCENTRIC chromosome. IMG showing TELOCENTRIC chromosome. Sub-Metacentric chromosome - example - 'X' chromosome Acrocentric chromosome - example - 'Y' chromosome, 13,14,15,21,22 chromosome. Telocentric chromosome - are not seen in humans.
| 4
|
Telocentric
|
Metacentric
|
Submetacentric
|
Acrocentric
|
Pathology
|
Introduction
|
fe9ff7b5-27de-40d1-8508-63415026438d
|
single
|
Mirena is:
| null | 3
|
Used in abortions
|
Antiprogesterone
|
Progesterone IUCD
|
Hormonal implant
|
Gynaecology & Obstetrics
| null |
30eee6d0-cc51-452d-aaf9-7b1db4884aeb
|
single
|
Which organ that is commonly involved in a stab injury to the abdomen is which of the following?
|
The organs most commonly injured with anterior abdominal stab wounds are the small bowel, the liver, and the colon. Abdominal stab wound exploration is indicated in a patient who presents with a stab wound to the anterior abdomen, normal vital signs, no signs of peritonitis, and no evidence of evisceration. Abdominal stab wound exploration is contraindicated if immediate laparotomy is indicated. The situations in which immediate laparotomy is indicated include, unstable patient, peritonitis, evisceration, blood on rectal examination or blood in nasogastric tube aspirate suggests intra-abdominal injury.
| 1
|
Small intestine
|
Spleen
|
Kidney
|
Bladder
|
Surgery
| null |
8be635e4-4760-4f07-a21d-f6ca9db57605
|
multi
|
Investing layer of deep cervical fascia encloses all except
|
Axillary vessels are enclosed by prevertebral fascia.
| 3
|
Sternocleidomastoid and trapezius
|
Two salivary glands
|
Axillary vessels
|
Two spaces
|
Anatomy
| null |
7d0c78ca-d0fd-4a12-9cff-6e4b001523de
|
multi
|
Which zone is the hottest and efficient burning zone of the flame used for casting?
| null | 2
|
Oxidizing zone
|
Reducing zone
|
Combustion zone
|
None of the above
|
Dental
| null |
cc4a277b-59c8-4c08-8945-2b30c9946623
|
multi
|
All of the following are branches of splenic aery, except?
|
Right Gastroepiploic aery is a branch of superior mesentric aery, a branch of hepatic aery. The left Gastroepiploic aery is a branch of splenic aery which anastomoses with the right Gastroepiploic aery. Ref: Gray&;s anatomy text book of anatomy BD chaurasia 21st Ed.
| 4
|
Hilar branches Sho Gastric Aery
|
Sho Gastric Aery
|
Aeria Pancreatica Magna
|
Right Gastroepiploic Aery
|
Anatomy
|
All India exam
|
912069cd-ea58-407b-8222-529885ecb82d
|
multi
|
Which of the following is used in the treatment of thyroid malignancy.
|
131I is used in treatment of thyroid cancer.
| 1
|
131
I
|
125
I
|
99
Tc
|
32
p
|
Surgery
| null |
4b2aa1fb-f777-43a1-ab44-a13adc54e370
|
single
|
Post moem lividity persists till :
|
D i.e. Merges with putrefactive changes - Postmoem lividity also k/a suggilation, vabices, hypostasis, staining, darkening of death is an early sign of death & commences within an hour of death.Q - Fixed in about 4 - 6 hoursQ; reaches maximum between 6-12 hoursQ and persists until putrefaction sets in.Q Lividity does not develop in drowning in running water & areas of contact flattening.Q When lividity first develops (i.e. before fixing), on applying firm pressure it disappears & releasing pressure it reappears (Difference from bruise).
| 4
|
24 hours
|
18 hours
|
2-3 days
|
Merges with putrefactive changes
|
Forensic Medicine
| null |
2a153c6c-4133-42aa-89ca-b7dffd7651e8
|
single
|
All of the following antibacterial agents act by inhibiting cell wall synthesis EXCEPT :
| null | 4
|
Carbapenems
|
Monobactams
|
Cephalosporins
|
Nitrofurantoin
|
Pharmacology
| null |
6e9b5a8d-9bf7-4a29-a18c-ace59061bd65
|
multi
|
The treatment of choice in fistula in ano
|
Ans. is 'd' i.e., Fistulotomy
| 4
|
Anal dilatation
|
Fissurotomy
|
Fistulectomy
|
Fistulotomy
|
Surgery
| null |
6732c75c-1838-4f99-8590-a2385f0f6f6a
|
single
|
Which of the following finding is suggestive of Bicornuate uterus
|
All other options are suggestive of septate uterus.
| 2
|
Intercornual angle < 75°
|
Diverging horns
|
Intrafundal downward cleft < 1 cm
|
Hysteroscopic resection is treatment
|
Gynaecology & Obstetrics
| null |
2dc6456f-71d6-4718-a6a6-2d7637a80a95
|
single
|
Which is not the indication of CT in head trauma
|
GCS < 13 is an indication for CT
| 3
|
Seizures
|
Loss of consciousness
|
GCS < 14
|
ENT bleed
|
Surgery
| null |
dcbec553-b357-4029-bd4e-fadec858f5bf
|
single
|
In left sided massive pneumothorax, ECG shows all, except-
|
Abnormal left axis detion in left-sided pneumothorax. Relevant QRS abnormalities (incomplete RBBB and T-wave inversion) in(10%). QRS amplitude in V2-V6 leads was significantly decreased in left-sided pneumothorax. Ref Harrison 20th edition pg 1546
| 1
|
Left axis detion
|
Absent R wave
|
Peaked P wave
|
Precordial T wave inversion
|
Medicine
|
C.V.S
|
24852754-77dd-457b-8904-70f1be3324d6
|
multi
|
You are shown the screening mammogram right CC and MLO of a 55-year-old woman. Which one of the following is the MOST likely diagnosis?
|
Fibroadenomas are typicially homogeneous well defined masses and do not contain internal lucency. Hamaomas are typically well defined mass with interspersed internal lucency, as seen in this patient. Hematomas do not contain central lucency. Acutely, these appear as ill-defined masses at the site of trauma and decrease in size and visibility as they resolve. While galactocele, may contain fat density, this will only occur in a lactating female. A history of lactation (which is unlikely in a 55 year old patient) or fat/fluid level on straight lateral view would be necessary to suggest this diagnosis.
| 2
|
Fibroadenoma
|
Hamaoma
|
Hematoma
|
Galactocele
|
Radiology
|
Fundamentals in Radiology
|
04e1e6fb-8ef0-4825-bb92-97fb949b41a0
|
single
|
True about deep palmar arch ?
|
Deep palmar archIt lies across the base of metacarpal bones. It is formed mainly by radial aery and completed by deep branch of ulnar aery. Its branches are :-Three palmar metacarpal aeries on the II, III and IV palmar interossei muscles to join the digital branches of superficial palmar arch.Three perforating aeries :- Anastomose with dorsal metacarpal aeries.Recurrent branches :- Supply carpal bones and join palmar carpal arch.The deep palmar arch lies deep to the oblique head of adductor pollicis, long flexor tendon and lumbrical muscles and passes across the base of metacarpal and interossei.
| 3
|
Main contribution is by ulnar aery
|
Lie superficial to lumbricals
|
Gives three perforating branches
|
Gives four palmar metacarpal aeries
|
Anatomy
| null |
7f3afee3-097a-4ff9-ad70-45a257522550
|
multi
|
Palatine tonsil develops from
| null | 2
|
Dorsal part of II pharyngeal pouches
|
Ventral part of II pharyngeal pouches
|
Dorsal part of III pharyngeal pouches
|
Ventral part of I pharyngeal pouches
|
Anatomy
| null |
ca5cf9de-1c1d-4520-afec-0ec291c29156
|
single
|
In klumpke's paralysis nerve roots involved are
|
In klumpke's paralysis lower trunk of brachial plexus is involved that is mainly T1 and paly C8. C6 is mainly involved in Erb's paralysis along with C5. B D Chaurasia 7th edition Page no: 59
| 3
|
C6 -C7
|
C7- C8
|
C8-T1
|
T1-T2
|
Anatomy
|
Upper limb
|
a4e9845e-cb27-47c7-b616-6ddc1eb1fc8d
|
single
|
Coprolalia is seen in
|
coprolalia-involuntary use of vulgar or obscene language. Observed in some cases of schizophrenia and in Tourette's syndrome. coprophagia- Eating of filth or feces. The echolalia-psychopathological repeating of words or phrases of one person by another; tends to be repetitive and persistent. Seen in catatonic schizophrenia. Reference: Page No 922 signs and symptoms in psychiatry(Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th Edition)
| 4
|
Delirium
|
Alcoholic intoxication
|
Mania
|
Tourette syndrome
|
Psychiatry
|
All India exam
|
5becf6ff-8b2c-4319-be38-ed95dd037a67
|
single
|
Injectable tetanus toxoid (TT ) is an example of:
|
The toxins produced by organisms such as Diptheria & Tetanus are detoxicated and used in preparation of Vaccines (Toxoids). This detoxified toxins when administered in the body can elicit immune response resulting in antibody production & memory. The Antibodies produced neutralize the toxic moeity produced during infection by these organisms thus providing active immunization to the body. Active Immunity Passive Immunity Definition Include humoral and cellular responses of host Results in Ab production in the body. Formed by transfer of ready made antibodies Host body does not produce its own Ab. Modes of acquiring Following clinical infection, subclinical/ inapparent infection or immunization with an Ag. Administering Ig / antiserum or transplacental transfer of Ab/ Transfer of lymphocytes.
| 1
|
Active immunity
|
Passive Immunity
|
Native Immunity
|
Reaction Immunity
|
Social & Preventive Medicine
|
Concepts of Immunity, Classification of Vaccines
|
bc4eede8-b281-4802-8f1c-4e913be70251
|
single
|
Cystic fibrosis is inherited as an autosomal recessive condition. A normal couple has one daughter affected with the disease. They are now planning to have another child. What is the chance of her sibling being affected by the disease -
|
Ans. is. 'c' i.e., 1/4 o The fact that one child of a normal couple is affected by an autosomal recessive condition (cystic fibrosis) indicates that both parents are carriers of this condition. o The recurrence risk of autosomal recessive disorders in siblings is 25% (') for each bih. Both the parents are carrier --> 25% children will be affected, 50% will be carrier and 25% will be normal. o From above flow cha it is clear that with each bih :? (i) One chance in four been affected (25%), i.e. the risk of recurrence is 25% for each bih. (ii) Two in four chance to being normal but a carrier (50%) (iii) One in four chance of being normal and unaffected (25%) (iv) Three in four chances of being phenotypically normal (75%), i.e. not manifesting disease
| 3
|
0
|
2-Jan
|
4-Jan
|
4-Mar
|
Pathology
| null |
47f9e1f2-5cf5-4b21-b2fb-de91d48252d8
|
single
|
The regional anaesthesia technique that would not be expected to provide appropriate analgesic benefit during the first stage of labor is
|
Pudendal nerve block during delivery mitigates somatic pain during second stage of labor.
| 2
|
Lumbar epidural
|
Pudendal nerve block
|
Lumbar sympathetic block
|
Paracervical block
|
Anaesthesia
| null |
d43682d6-da0b-4579-a51b-0fb3cee61dc7
|
single
|
Recommendation for exclusive feeding is up to:
|
Ans. (d) 6 monthsRef : OP Ghai 8th ed./150* Exclusive breast feeding is up to 6 months and should be continued uptil 2 years.* Prelacteal feeds like water, honey, and so called health tonics are contraindicated in children less than 6 months of age.
| 4
|
3 months
|
4 months
|
5 months
|
6 months
|
Pediatrics
|
Newborn Infant - Parent-Infant Bonding
|
628efaba-b94e-45b2-802a-fc78a1a8b5a8
|
single
|
Half-life of digoxin is?
|
Digoxin half-life is long -40 hrs It gets trapped in muscles and vd -volume of distribution is more elimination is difficult in cases of poisoning Ref: KD Tripathi 8th ed.
| 2
|
24 hours
|
40 hours
|
48 hours
|
60 hours
|
Pharmacology
|
Cardiovascular system
|
f38737e4-491f-4272-8b6e-1f2e34f0ebfc
|
single
|
Spouse jealousy is a feature of -
|
Ans. is 'a' i.e., Othello syndrome o Othello Syndrome :- When the content of delusions is predominantly jealousy (infedility) involving the spouse, person feels an unreasonable fear that a partner has been unfaithful, is presently unfaithful, or plans to be unfaithful, it is called as Othello Symdrome or conjugal paranoia. Elaborate steps are taken to prevent the spouse to go outside (Locks the spouse, not allowing her to go outside).o Clerambaultfs syndrome :- When the content of delusions is erotic (erotomanic), the condition is knowm as Clerambaulfs syndrome or erotomania. It occurs most often in women, there is an erotic conviction that a person with (usually a) higher status is in love with the patient.o Stockholm syndrome, or capture-bonding: is a psychological phenomenon in which hostages express empathy and sympathy and have positive feelings towrard their captors, sometimes to the point of defending and identifying with the captors.
| 1
|
Othello syndrome
|
Chronic alcoholism
|
Stockholm syndrome
|
Clerambault's syndrome
|
Psychiatry
|
Disorders of Adult Personality
|
c91195bc-a2e8-4a39-9dd8-016b14b66626
|
single
|
Niemann-Pick disease is due to deficiency of
|
It is a lipid storage disease, due to deficiency of sphingomyelinase. Leads to the accumulation of sphingomyelin.Ref: DM Vasudevan, 7th edition, page no: 193
| 2
|
Hexosaminidase
|
Sphingomyelinase
|
Galactokinase
|
Glucosidase
|
Biochemistry
|
Metabolism of carbohydrate
|
fa8e485d-4f2b-400e-b334-fe0b43b11b4c
|
single
|
A 40yrs old man has chronic cough with fever for several months . The radiography reveals a diffuse reticulonodular Patten's.microscopically on transbronchial biopsy there are focal areas of inflammation conraining epithioid cell granuloma , Langerhans cells, lymphocytes, these findings are typically for which of the following type of hypersensitivity immunological response
|
Ref Robbins 9/e p 210 T Cell-Mediated (Type IV) Hypersensitivity Several autoimmune disorders, as well as pathologic reactions to environmental chemicals and persistent microbes, are now known to be caused by T cells (Table 4-5). The occurrence and significance of T lymphocyte-mediated tissue injury have been increasingly appreciated as the methods for detecting and purifying T cells from patients' circulation and lesions have improved. This group of diseases is of great clinical interest because many of the new, rationally designed biologic therapies for immune-mediated inflam- matory diseases have been developed to target abnormal T cell reactions. Two types of T cell reactions are capable of causing tissue injury and disease: (1) cytokine-mediated inflammation, in which the cytokines are produced mainly by CD4+ T cells, and (2) direct cell cytotoxicity, mediated by CD8+ T cells (Fig. 4-12). In inflammation, exemplified by the delayed-type hypersensitivity (DTH) reaction, CD4+ T cells of the TH1 and TH17 subsets secrete cytokines, which recruit and activate other cells, especially macrophages, and these are the major effector cells of injury. In cell-mediated cytotoxicity, cytotoxic CD8+ T cells are responsible for tissue damage. Inflammatory Reactions Elicited by CD4+ T Cells The sequence of events in T cell-mediated inflammatory reactions begins with the first exposure to antigen and is essentially the same as the reactions of cell-mediated immunity (Fig. 4-4). Naive CD4+ T lymphocytes recognize peptide antigens of self or microbial proteins in association with class II MHC molecules on the surface of DCs (or macrophages) that have processed the antigens. If the DCs produce IL-12, the naive T cells differentiate into effector cells of the TH1 type. The cytokine IFN-g, made by NK cells and by the TH1 cells themselves, fuher promotes TH1 dif- ferentiation, providing a powerful positive feedback loop. If the APCs produce IL-1, IL-6, or IL-23 instead of IL-12, the CD4+ cells develop into TH17 effectors. On subsequent exposure to the antigen, the previously generated effector cells are recruited to the site of antigen exposure and are activated by the antigen presented by local APCs. The TH1 cells secrete IFN-g, which is the most potent macrophage- activating cytokine known. Activated macrophages have increased phagocytic and microbicidal activity. Activated macrophages also express more class II MHC molecules and costimulators, leading to augmented antigen presenta- tion capacity, and the cells secrete more IL-12, thus stimu- lating more TH1 responses. Upon activation by antigen, TH17 effector cells secrete IL-17 and several other cytokines, which promote the recruitment of neutrophils (and mono- cytes) and thus induce inflammation. Because the cyto- kines produced by the T cells enhance leukocyte recruitment and activation, these inflammatory reactions become chronic unless the offending agent is eliminated or the cycle is interrupted therapeutically. In fact, inflammation occurs as an early response to microbes and dead cells (Chapter 2), but it is greatly increased and prolonged when T cells are involved. Delayed-type hypersensitivity (DTH), described next, is an illustrative model of T cell-mediated inflammation and tissue injury. The same reactions are the underlying basis for several diseases. Contact dermatitis is an example of tissue injury resulting from T cell-mediated inflammation. It is evoked by contact with pentadecylcatechol (also known as urushiol, the active component of poison ivy and poison oak, which probably becomes antigenic by binding to a host protein). On reexposure of a previously exposed person to the plants, sensitized TH1 CD4+ cells accumulate in the dermis and migrate toward the antigen within the epidermis. Here they release cytokines that damage kera- tinocytes, causing separation of these cells and formation of an intraepidermal vesicle, and inflammation manifested as a vesicular dermatitis. It has long been thought that several systemic diseases, such as type 1 diabetes and mul- tiple sclerosis, are caused by TH1 and TH17 reactions against self antigens, and Crohn disease may be caused by uncon- trolled reactions involving the same T cells but directed against intestinal bacteria. T cell-mediated inflammation also plays a role in the rejection of transplants, described later in the chapter. Figure 4-12 Mechanisms of T cell-mediated (type IV) hypersensitivity reactions. A, In cytokine-mediated inflammatory reactions, CD4+ T cells respond to tissue antigens by secreting cytokines that stimulate inflammation and activate phagocytes, leading to tissue injury. B, In some diseases, CD8+ CTLs directly kill tissue cells. APC, antigen-presenting cell; CTLs, cytotoxic T lymphocytes. Cytokine-mediated inflammation Inflammation Tissue injury APC presenting tissue antigen Normal tissue CD4+ T cell Cell killing and tissue injury CD8+ CTLs Cytokines T cell-mediated cytolysis A B Delayed-Type Hypersensitivity DTH is a T cell-mediated reaction that develops in response to antigen challenge in a previously sensitized individual. In contrast with immediate hypersensitivity, the DTH reac- tion is delayed for 12 to 48 hours, which is the time it takes for effector T cells to be recruited to the site of antigen chal- lenge and to be activated to secrete cytokines. The classic example of DTH is the tuberculin reaction, elicited by chal- lenge with a protein extract of M. tuberculosis (tuberculin) in a person who has previously been exposed to the tuber- cle bacillus. Between 8 and 12 hours after intracutaneous injection of tuberculin, a local area of erythema and indura- tion appears, reaching a peak (typically 1 to 2 cm in diam- eter) in 24 to 72 hours and thereafter slowly subsiding. On histologic examination, the DTH reaction is characterized by perivascular accumulation ("cuffing") of CD4+ helper T cells and macrophages (Fig. 4-13). Local secretion of cyto- kines by these cells leads to increased microvascular per- meability, giving rise to dermal edema and fibrin deposition; the latter is the main cause of the tissue induration in these responses. DTH reactions are mediated primarily by TH1 cells; the contribution of TH17 cells is unclear. The tubercu- lin response is used to screen populations for people who have had previous exposure to tuberculosis and therefore have circulating memory T cells specific for mycobacterial proteins. Notably, immunosuppression or loss of CD4+ T cells (e.g., resulting from HIV infection) may lead to a nega- tive tuberculin response even in the presence of a severe infection. Prolonged DTH reactions against persistent microbes or other stimuli may result in a special morphologic pattern of reaction called granulomatous inflammation. The initial perivascular CD4+ T cell infiltrate is progressively replaced by macrophages over a period of 2 to 3 weeks. These accumulated macrophages typically exhibit morphologic evidence of activation; that is, they become large, flat, and eosinophilic, and are called epithelioid cells. The epitheli- oid cells occasionally fuse under the influence of cytokines (e.g., IFN-g) to form multinucleate giant cells. A micro- scopic aggregate of epithelioid cells, typically surrounded by a collar of lymphocytes, is called a granuloma (Fig. 4-14, A). The process is essentially a chronic form of TH1-mediated inflammation and macrophage activation (Fig. 4-14, B). Older granulomas develop an enclosing rim of fibroblasts and connective tissue. Recognition of a granuloma is of diagnostic impoance because of the limited number of conditions that can cause it (Chapter 2). T Cell-Mediated Cytotoxicity In this form of T cell-mediated tissue injury, CD8+ CTLs kill antigen-bearing target cells. As discussed earlier, class I MHC molecules bind to intracellular peptide antigens and present the peptides to CD8+ T lymphocytes, stimulat- ing the differentiation of these T cells into effector cells called CTLs. CTLs play a critical role in resistance to virus infections and some tumors. The principal mechanism of killing by CTLs is dependent on the perforin-granzyme system. Perforin and granzymes are stored in the granules of CTLs and are rapidly released when CTLs engage their targets (cells bearing the appropriate class I MHC-bound peptides). Perforin binds to the plasma membrane of th target cells and promotes the entry of granzymes, which are proteases that specifically cleave and thereby activate cellular caspases. These enzymes induce apoptotic death of the target cells (Chapter 1). CTLs play an impoant role in the rejection of solid-organ transplants and may contribute to many immunologic diseases, such as type 1 diabetes (in which insulin-producing b cells in pancreatic islets are destroyed by an autoimmune T cell reaction). CD8+ T cells may also secrete IFN-g and contribute to cytokine-mediated inflammation, but less so than CD4+ cells. Figure 4-14 Granulomatous inflammation. A, A section of a lymph node shows several granulomas, each made up of an aggregate of epi- thelioid cells and surrounded by lymphocytes. The granuloma in the center shows several multinucleate giant cells. B, The events that give rise to the formation of granulomas in type IV hypersensitivity reactions. Note the role played by T cell-derived cytokines. (A, Couesy of Dr. Trace Worrell, Depament of Pathology, University of Texas Southwestern Medical School, Dallas, Texas.) A Antigen-presenting cell CD4+ TH1 cell IL-12 TNF Monocytes Fibroblast IFN-g Giant cell Epithelioid cell B Lymphocyte Macrophage Antigen SUMMARY Mechanisms of T Cell-Mediated Hypersensitivity Reactions * Cytokine-mediated inflammation: CD4+ T cells are acti- vated by exposure to a protein antigen and differentiate into TH1 and TH17 effector cells. Subsequent exposure to the antigen results in the secretion of cytokines. IFN-g activates macrophages to produce substances that cause tissue damage and promote fibrosis, and IL-17 and other cytokines recruit leukocytes, thus promoting inflammation. * T cell-mediated cytotoxicity: CD8+ CTLs specific for an antigen recognize cells expressing the target antigen and kill these cells. CD8+ T cells also secrete IFN-g. With the basic mechanisms of pathologic immune reac- tions as background, we now proceed to a consideration of two categories of reactions that are of great clinical impor- tance: autoimmunity and transplant rejection. Figure 4-13 Delayed-type hypersensitivity reaction in the skin. A, Peri- vascular accumulation ("cuffing") of mononuclear inflammatory cells (lymphocytes and macrophages), with associated dermal edema and fibrin deposition. B, Immunoperoxidase staining reveals a predomiA nantly perivascular cellular infiltrate that marks positively with anti-CD4 antibodies. (B, Couesy of Dr. Louis Picker, Depament of Pathology, Oregon Health & Science University, Poland, Oregon.)
| 4
|
Type1
|
Type2
|
Type3
|
Type4
|
Anatomy
|
General anatomy
|
7c60a6a1-5abe-40f6-958e-5cc2332a949f
|
multi
|
Retina is pa of ?
|
Retina is a pa of CNS and develops from Neuroectoderm.
| 1
|
CNS
|
PNA
|
ANS
| null |
Anatomy
| null |
46721381-8d08-470b-8777-48a6ab4dae4b
|
multi
|
Sign suggestive of malignant change in parotid gland tumor-
|
Ans. is 'd' i.e., All of the above'Red flag' features suggesting the possibility of malignancy include:o Facial nerve weaknesso Rapid increase in the size of the lump.o Ulceration or induration (or both) of the mucosa or skin overlying fixed skino Paraesthesia or anaesthesia of neighbouring sensory nerveso Intermittent pain, increasing relentlessly.o History of previous skin cancer, Sjogren's syndrome or previous radiation to the head and neck.
| 4
|
Skin ulceration
|
Increasing pain
|
Facial palsy
|
All of the above
|
ENT
|
Tumors
|
89d69c0a-3044-4aa6-91cd-718ceae6007b
|
multi
|
Ewings sarcoma clinically mimics ?
|
Ans. is 'a' i.e., Osteomyelitis Ewing sarcoma is one of the differential diagnosis for subacute osteomyelitis. (see following table)
| 1
|
Osteomyelitis
|
Osteochondroses
|
Osteosclerosis
|
Heterotopic ossification
|
Surgery
| null |
860e94ad-4c82-4af6-9dbf-d2e53dd0f797
|
multi
|
Which of the following is a non-essentialmetal/mineral?
|
Lead Lead is not at all an essential mineral; rather it is toxic to the body. (Harrison I7/e Chapter e34. Heavy Metal Poisoning ) Harper gives a list of essential minerals along with their functions in the body. Essential minerals and their function Function Mineral Structural function Calcium, magnesium, phosphate Involved in membrane function Sodium, potassium Function as prosthetic groups in enzymes Cobalt, copper, iron, molybdenum, selenium, zinc Regulatory role or role in hormone action Calcium, chromium, iodine, magnesium, manganese, sodium, potassium Known to be essential, but function unknown Silicon, vanadium, nickel, tin Have effects in the body, but essentiality is not establislifd Fluoride, lithium May occur in foods and known to be toxic in excess Aluminum, arsenic, antimony, boron, bromine, cadmium, cesium, germanium, lead, mercury, silver, strontium
| 4
|
Sodium
|
Manganese
|
Iron
|
Lead
|
Biochemistry
| null |
f8f7a0ca-cfaf-41a2-b3df-f631c85e06a2
|
single
|
Feature of slow filter (w.r.t. fast filter) is/are : a) Occupies less spaceb) Highly skilled operationc) Poor bacterial qualityd) Takes more time for purificatione) Size of sand is smaller
|
Slow sand filter occupies large area (more space).
Slow and filter requires less skilled operation.
Slow sand filter removes more bacteria and has better bacterial control (99.9-99.99%)
Slow sand filter requires longer duration for purification.
Size of sand is smaller (0.2-0.3 mm).
| 1
|
de
|
bc
|
cd
|
bd
|
Social & Preventive Medicine
| null |
176cc460-e991-41b4-a636-3cc6b2236e84
|
multi
|
Rampal 45 yr old man present with history of recurrent haemoptysis and purulent sputum.his chest X-RAY is normal, which of the following will be the next best investigation for him.?
|
Presence of purulent sputum with recurrent haemoptysis suggests a diagnosis of bronchiectasis. HRCT .is now the diagnostic procedure of choice having repalced bronchiography Ref Harrison 19th edition pg 1710
| 1
|
HRCT
|
CT guided angiography
|
Angiography
|
Spiral CT
|
Anatomy
|
Respiratory system
|
2466fa61-249b-4556-9926-5a5cc765d248
|
single
|
Anti androgen used in hea failure ?
|
Ans. is 'c' i.e., Spironolactone o Spironolactone and eplerenone are the aldosterone antagonists. They are used as potassium sparing diuretics. Their diurectic effect is quite feeble, but in CHF these drugs reduce the moality (at doses lower than diuretic doses) by antagonizing the effect of aldosterone (reversal of remodelling). Spironolactone also possesses anti- androgenic effects.
| 3
|
Carvedilol
|
Sampatrilat
|
Spironolactone
|
Abiraterone
|
Pharmacology
| null |
6ac9f389-419b-4d9c-ad12-48f924323859
|
single
|
Who is ASHA?
|
Ans: B (Community level voluntary worker for heath) Ref: Park 22nd editionExplanation: ASHA (Accredited social health activist) are involved in health care of community under the National Rural Health Mission. Accredited social health activists (ASHAs) are community health workers instituted by the Government of India's Ministry of Health and Family Welfare (MoHFW) as part of the National Rural Health Mission (NRMM The mission began in 2005; full implementation was targeted for 2012. Once fully implemented, there is to be "an ASHA in every village" in India, a target that translates into 250.000 ASHAs in 10 states.Roles and ResponsibilitiesASHAs are local women trained to act as health educators and promoters in their communities. Their tasks include;Motivating women to give birth in hospitals.Bringing children to immunization clinics.Encouraging family planning (e.g., surgical sterilization).Treating basic illness.Injury with first aid.Keeping demographic records.Improving village sanitation.ASHAs are also meant to serve as a key communication mechanism between the healthcare system and rural populations.SelectionASHAs must primarily be female residents of the village that they have been selected to serve, who are likely to remain in that village for the foreseeable future.Married, widowed or divorced women are preferred over women who have yet to marry since Indian cultural norms dictate that upon marriage a woman leaves her village and migrates to that of her husband.ASHAs must have class eight education or higher, preferably be between the ages of 25 and 45, and are selected by and accountable to the gram panchayat (local government).If there is no suitable literate candidate, a semiliterate woman with a formal education lower than eighth standard, may be selected.RemunerationAlthough ASHAs are considered volunteers, they receive outcome-based remuneration and financial compensation for training days.For example, if an ASHA facilitates an institutional delivery she receives Rs. 600 and the mother receives Rs. 1400.ASHAs also receive Rs. 150 for each child completing an immunization session and Rs. 150 for each individual who undergoes family planning.
| 2
|
Worker of a Non-Governmental Organization
|
Community level voluntary worker for health
|
Government health worker
|
Helper of anganwadi
|
Social & Preventive Medicine
|
Health Planning and Management
|
04a6feaa-fa55-4630-af72-624630e770ed
|
single
|
The absolute contraindication for Electro-Convulsive Therapy (ECT) is -
|
The only absolute contraindication for ECT is raised ICT.
| 1
|
Raised Intra-Cranial Tension
|
Vascular Dementia
|
Diabetic Retinopathy
|
Peripheral Neuropathy
|
Psychiatry
| null |
cf61c601-6f3f-42c0-b986-ed5d4d0bf839
|
single
|
In acute congestive glaucoma, pupil is –
|
In acute congestive glaucoma, pupil is semidilated (mild dilated), vertically oval and fixed.
| 2
|
Oval and horizontal
|
Oval and vertical
|
Circular
|
Slit like
|
Ophthalmology
| null |
9d439b63-7572-4e1f-87f3-a28775ad0fc5
|
single
|
Abnormalities of copper metabolism are implicated in the pathogenesis of all the following except –
|
Keshan disease is a disorder of selenium metabolism.
Following diseases are related to copper metabolism :-
Wilson's disease
Menkes kinky hair syndrome
Indian childhood cirrhosis (increased hepatic, urinary and serum copper concentration are characteristic of ICC).
| 4
|
Wilson's disease
|
Monke's Kinky–hair syndrome
|
Indian childhood cirrhosis
|
Keshan disease
|
Pediatrics
| null |
70ba5367-f256-42f4-9ffa-149a9d276cd2
|
multi
|
Ammonia is detoxified in brain by formation of
|
The transpo form of Ammonia in blood and from Brain is Glutamine. From muscles, it is Alanine. The answer is not glutamate because free ammonia is trapped by glutamine Glutamate is formed transamination of amino acids, not from free ammonia.
| 3
|
Glutamate
|
Uric acid
|
Glutamine
|
Urea
|
Biochemistry
|
Urea cycle
|
c47357ef-9bb6-4ba7-8d54-5d5f552ea814
|
single
|
Hand cutting instruments are composed of
| null | 2
|
Handle and blade
|
Handle, shank and blade
|
Shank and blade
|
Handle, shank and head
|
Dental
| null |
50d40d73-59a3-4ff4-ae86-d2c9bfa526bc
|
single
|
The following diagram depicts blood smear of which species?
|
Ans. (b) P. falciparum This is a thin smear representing ring forms of P. falciparum. For details of blood picture see image platelets.
| 2
|
P. vivax
|
P. falciparum
|
P. ovale
|
P. malariae
|
Microbiology
| null |
694ca767-9cec-4d35-8018-d38e5e5db351
|
single
|
HBV is associated with all of the following except -
| null | 3
|
Hepatic cancer
|
Chronic hepatitis
|
Hepatic adenoma
|
Cirrhosis
|
Microbiology
| null |
8e4dd8b5-73c7-477e-bc5e-a70af328fd73
|
multi
|
Cruelty of Mrs. X for dowry by her husband Mr. Y and in Laws is Punishable under
|
Sec 498 A IPC- Subjecting a married woman to cruelty by husband or in laws. Sec 320 IPC- Grievous Hu - Definition Sec 304 A IPC- Death caused by rash and negligent act - 2 yrs. Sec 304 B IPC- Dowry death: death of a female within 7 yrs of marriage.
| 3
|
304 A IPC
|
304 B IPC
|
498 A IPC
|
320 IPC
|
Forensic Medicine
|
Legal sections
|
088d3ec9-54ea-45dc-a88a-08da73e715c8
|
single
|
The most radiosensitive tissue is -
|
Radiosensitivity of important organs in decreasing order.
Bone marrow > Testes > Ovary > Kidney > Liver > Lung > Heart > GIT (Stomach > Intestine) > Thyroid > Brain & spinal cord (CNS) > Skin + Cartilage > Adult bone > Vagina > Uterus.
| 2
|
Brain
|
Bone marrow
|
Thyroid
|
Liver
|
Pathology
| null |
cb1a4a54-4efa-4b98-95af-4e5f085abfb4
|
single
|
Persons with mild cognitive impairments who smoke may experience a worsening of symptoms if they stop smoking. This worsening of symptoms is because nicotine acts as an agonist for receptors of a paicular neurotransmitter. That neurotransmitter is
|
.
| 1
|
Acetylcholine
|
Dopamine
|
Neuropeptide Y
|
Nitric oxide
|
Pathology
|
All India exam
|
d6503a17-e27c-4e6d-9048-9ac75d92c05b
|
single
|
While discharging a patient of meningitis due to H. influenzae the essential step you will do:
|
H. influenzae is one of the three M/C/C of childhood otitis media (the other two being Streptococcus pneumoniae and Moraxella catarrhalis). A diagnosis of otitis media is based on the detection by pneumatic otoscopy of fluid in the middle ear and bilateral evoked auditory response.
| 3
|
EEG
|
Assess developmental milestones
|
Bilateral evoked auditory response
|
Refer for physiotherapy
|
Medicine
|
Bacterial infection
|
ca0f48ec-9b5d-47d9-9a8f-2115c1cf59bf
|
multi
|
Antithyroid drug of choice in pregnancy is :
|
Ans. is a i.e. Propylthiouracil Management of Hypehyroidism during Pregnancy : Medical management is the management of choice.deg Antithyroid drug of choice is propylthiouracildeg because it : -- Inhibits conversion of T, to -13deg -- Crosses placenta less rapidly than rnethimazoledeg -- It is not associated with aplasia cutis seen with methimazole deg Both propylthiouracil and methimazole / carbimazole are however effective and safedeg Side effect of propyithiouracil : Transient leukopenia, Agranulocytosis and Fetal hypothyroidism Side effect of methimazole/carbimazole : -- Aplasia cutis -- Esophageal atresia -- Choanal atresia Radio active iodine is an absolute contraindication in the treatment of thyrotoxicosis in pregnancy. Infect it should not be given to patients even wanting pregnancy within 1 year. Surgical Management : Thyroidectomy may be carried out after thyrotoxicosis has been brought under medical control.deg Because of increased vascularity of thyroid gland during pregnancy, such surgery is more complicated than in non preg? nant state. It is indicated in women who cannot adhere to medical treatment or in whom drug therapy proves toxic.
| 1
|
Propyithiouracil
|
Carbimazole
|
Propranolol
|
Lugol's iodine
|
Gynaecology & Obstetrics
| null |
d43e6ec4-bd5a-4eff-818e-790a93a7d459
|
single
|
Following condition is most likely seen in which of the following condition:
|
Ans. A. HypothyroidThe image showing loss of lateral l/3rd eyebrows or lateral madarosis. This is seen in many conditions:a. Leprosyb. Syphilisc. Hypothyroidismd. Blepharitise. Dermatitisf. Fungal Infectionsg. Drug Therapiesh. Autoimmune diseases
| 1
|
Hypothyroid
|
Acromegaly
|
Cushing syndrome
|
Grave Disease
|
Medicine
|
Endocrinology
|
a3323d52-99fe-4e2e-82ed-4ed86c8baeb5
|
single
|
Painless loss of vision is seen in following except:
|
Ans. d Acute Angle closure glaucoma. (Ref Basak, Ophthalmology, 2nd ed., 215)# Vitreous hemorrhage is associated with sudden painless loss of vision & on attempted ophthalmoscopy the fundamental glow is characteristically absent as the fundus is hidden by a dark red haze of blood. It can occur due to retinal & vitreous detachment, in diabetes, sickle cell disease, hypertension & other ischemic diseases.# Common causes of sudden, painless vision loss include retinal detachment, retinal artery or vein occlusion, and ischemic optic neuritis. Cataracts and open angle glaucoma would be among the most common causes of painless vision loss that is gradual over the course of months or years.# Acute angle closure glaucoma is a cause of acute, painful vision loss.
| 4
|
Vitreous hemorrhage
|
Optic atrophy
|
Developmental cataract
|
Acute Angle closure glaucoma.
|
Ophthalmology
|
Glaucoma
|
8319177a-4f1b-4fa7-bd35-2a278fa0c974
|
multi
|
Cyclophosphamide is used in all except -
|
Ans. is 'c' i.e., Choriocarcinoma Cyclophosphamide is used in o Acute leukemias o Wilm's tumour o CLL & CML o Prostate carcinoma o Multiple myeloma o Breast carcinoma o Ewing's sarcoma o Ovarian carcinoma o Small cell lung cancer o Carcinoma cervix o Hodgkin's disease
| 3
|
Burkitt's lymphoma
|
Hodgkin's
|
Choriocarcinoma
|
Ovarian Ca
|
Pharmacology
| null |
9fd1d057-08a0-49c1-9bb9-07b7feadd79a
|
multi
|
Wax pattern for casting is made up of
| null | 1
|
Inlay wax
|
Sticky wax
|
Modelling wax
|
Carnuba wax.
|
Dental
| null |
9d70bf85-8310-43c2-9e7a-ba3aeccc9cb8
|
single
|
An antipsychotic drug with prolonged action -
|
Long acting antipsychotics are Fluphenazine (2 - 4 weeks) and Penfluridol (1 week).
| 4
|
Trifluperazine
|
Thioridazine
|
Penfluridol
|
Fluphenazine
|
Psychiatry
| null |
38b5ced9-1875-4725-8ebb-882bdb107a5d
|
single
|
Non - sampling errors may occur due to all the following except-
|
Errors may occur not only due to error in sample survey but also due to inadequately calibrated instruments, observer variation, incomplete coverage, and conceptual errors. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 913
| 2
|
Inadequately calibrated instruments
|
Repeated sampling
|
Observer variation
|
Conceptual errors
|
Social & Preventive Medicine
|
Epidemiology
|
52632461-9ff2-4e95-abdc-382b6fe065e2
|
multi
|
True about tuberculin test are all except -
| null | 3
|
Recent conversion in adult is an indication for ATT
|
INH prophylaxis is started if the test is positive
|
No risk in negative
|
May be false negative in immunocompromised patients
|
Microbiology
| null |
44cff2b4-b4b6-4b90-b6bd-ab8dea7f0f4f
|
multi
|
Fomepizole is a selective antidote for poisoning with:
| null | 3
|
MAO inhibitors
|
Ethyl alcohol
|
Methyl alcohol
|
Tricyclic antidepressants
|
Pharmacology
| null |
d4a19530-ae25-4ab7-b34e-cbe2266d5d21
|
single
|
True about Rocuronium bromide is all except
|
It is metabolized by liver and kidney so to be avoided in preexisting hepatic and renal disorder. Hepatic and Renal failure , the neuromuscular blocker of choice is Atracurium and Cisatracurium Cis-atracurium undergoes Hofmann elimination - which is spontaneous non-enzymatic degradation. So renal failure doesn't affect the clearance of cis atracurium. Hence it is the agent of choice in renal failure patients. Atracurium also undergo Hofmann elimination and so is an alternative to cis atracurium in renal failure. Steroidal muscle relaxants are predominantly eliminated by ultrafiltration by the glomeruli before urinary excretion. Doxacurium, pancuronium, and pipecuronium are paially excreted by the kidneys, and so the neuromuscular block is prolonged in patients with renal failure.
| 4
|
One of the most commonly used non depolarizing agent
|
Non depolarizing agent of choice for RSI
|
Sugammadex is the specific reversal agent
|
Most preferred in hepatic and renal failure
|
Anaesthesia
|
Neuromuscular Blocker
|
46aad5d9-c3c8-42b8-9732-fe9545b0a170
|
multi
|
Which of the following is not a diahrosis ?
|
Ans. is 'c' i.e., Skull sutures Functional classification of joints (movement) Joints can also be classified functionally according to the type and degree of movement they allow: Synahrosis - Permits little or no mobility. Most synahrosis joints are fibrous joints (e.g., skull sutures). Amphiahrosis - Permits slight mobility. Most amphiahrosis joints are cailaginous joints (e.g., interveebral discs). Diahrosis - Freely movable. All diahrosis joints are synol joints (e.g., shoulder, hip, elbow, knee, etc.), and the terms "diahrosis" and "synol joint" are considered equivalent by Terminologia Anatomica
| 3
|
Elbow joint
|
Interphalangeal joint
|
Skull sutures
|
Hip joint
|
Surgery
| null |
5384ed88-5f83-46df-a13a-10853669f1a3
|
single
|
True about obsessive compulsive disorder is/are :
|
A i.e. Irresistible desire to do a thing repeatedly; C i.e. Denial is the defence mechanism against OCP; B i.e. Patient is conscious about the disorder An idea intrudes into Conscious awareness repeatedly. 4' - Recognized as one's own idea but is Ego-alien (Foreign to one's personality) Q. - Recognized as irrational & absurd (insight is present)Q. - Patient tries to resist against but unable to do soQ. Failure to resist leads to marked distress.
| 4
|
Irresistible desire to do a thing repeatedly
|
Patient is conscious about the disorder
|
Denial is the defense mechanism against O.C.D
|
All
|
Psychiatry
| null |
7b98e446-8bed-4520-9c03-746fc1b267e9
|
multi
|
Steeple sign is seen in -
|
Ans. is 'b' i.e., Laryngotracheobronchitis (croup) Croupo Me cause of acute upper airway obstruction,o Mild upper RTI for 1-3 days followed by upper airway obstruction,o Barking cough, hoarsness, Inspiratory stridor,o X-ray shows subglottic narrowing or steeple sign.Acute epiglottitiso Acute potential fatal condition,o Redpiratry progressine respiratory obstruction,o Cherry red swollen epiglottis,o X-ray show's thumb sign.The steeple sign as seen on an anteroposterior neck X-ray of a child with croupNeck X-ray showing thumb sign.
| 2
|
Acute epiglottis
|
Laryngotracheobronchitis (croup)
|
In both cases
|
None of above
|
Pediatrics
|
Disorders of the Respiratory Tract
|
c31d1771-06f7-405a-8dae-2585e3c3ef08
|
multi
|
Right coronary artery arises from which sinus:
|
Right coronary artery
origin: Left posterior aortic sinus of aorta
Supplies :
a) Right atrium
b) right ventricle except area adjoining anterior inter ventricular groove.
c) small part of left atrium
Left Coronary Artery
Origin: left posterior aortic sinus of ascending aorta.
Supplies:
a) Left atrium
b) left ventricle except area adjoining posterior inter ventricular groove
c) small part of right ventricle.
| 4
|
Right aortic
|
Left aortic
|
Coronary sinus
|
Anterior aortic sinus
|
Anatomy
| null |
edce30f6-1702-4b67-b830-52e9c57bcbb0
|
single
|
Aaron's sign is seen in:
|
Abdominal Examination Signs Sign Description Diagnosis Aaron Sign Pain or pressure in epigastrium or anterior chest with persistent firm pressure applied to McBurney's point. Acute appendicitis Bassler Sign Sharp pain created by compressing appendix between abdominal wall and iliacus Chronic appendicitis Blumberg's Sign Transient abdominal wall rebound tenderness Peritoneal inflammation Carnett's Sign Loss of abdominal tenderness when abdominal wall muscles are contracted Intra-abdominal source of abdominal pain Claybrook Sign Accentuation of breath and cardiac sounds through abdominal wall Ruptured abdominal viscus Mannkopf's Sign Increased pulse when painful abdomen palpated Absent if malingering Ten Horn Sign Pain caused by gentle traction of right testicle Acute appendicitis
| 4
|
Chronic appendicitis
|
Hiatus hernia
|
Mediastinum emphysema
|
Acute appendicitis
|
Surgery
|
Vermiform Appendix
|
4ca328e3-bce0-4218-b6e3-4bb06e364a97
|
single
|
After application of one stimulus, the time period in which the second stronger stimuli can from an impulse is called
|
Ans. (b) Relative refraction period(Ref: Ganong, 25th ed/p.90)Absolute refractory period - No stimulus, no matter how strong, will not excite the nerve during absolute refractory periodRelative refractory period - Stronger than normal stimulus (suprathreshold stimulus) produces action potential in relative refractory period
| 2
|
Absolute refractory period
|
Relative refraction period
|
Latent refractory period
|
Local response
|
Physiology
|
Nervous System
|
f4091af1-ed63-4276-a495-3624b8a74981
|
multi
|
Under which level of prevention should sentinel surveillance be categorised
|
Sentinel surveillance is a method for identifying the missing cases and thereby supplementing the notified cases. it estimates disease prevalence in the total population. Repoing biases are minimised. It detects missing cases; so it comes under secondary prevention. Ref : Park&;s Textbook of Preventive and Social Medicine; 23rd edition - Pgno 40
| 3
|
Primordial prevention
|
Primary prevention
|
Secondary prevention
|
Teiary prevention
|
Social & Preventive Medicine
|
Concept of health and disease
|
dc14a2c0-88ad-4eaa-9c5c-cc20c80ca4f9
|
single
|
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