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2 weeks old baby having scrotal pigmentation along with hyponatremia, gypoglycemia and hyperkalemia enzyme deficient?

21 a- hydroxylase

1B

Ans. is 'b' i.e., 21 a- hydroxylase

Pediatrics

None

Management of epidural abscess is:-

Immediate surgical evaluation

0A

BRAIN ABSCESS Etiology location Otitis media, mastoiditis Paranasal sinusitis, dental infections Hematogenous Temporal; lobe > cerebellum Frontal lobes Parietal lobes Management of Brain Abscess Surgical drainage + IV Antibiotics for at least 6 weeks. Multiple small abscesses may be treated medically with antibiotics targeted against organisms. Steroids are reserved for cases with significant edema or mass effect.

Surgery

Cerebrovascular Diseases

1 month old baby has microcephaly, hepatoslenomegaly. His urine stained with Giema shows owl's eye inclusion bodies. What is the diagnosis

CMV

0A

OWL'S eye inclusion bodies are seen in CMV virus.

Microbiology

None

Salt-pepper skull is a feature of ?

Primary hyperparathyroidism

2C

Ans. is 'c' i.e., Primary hyperparathyroidism Radiological features of primary hyperparathyroidism X-ray features of primary hyperparathyroidism are : ? Irregular, diffuse rarefaction of the bones. Salt pepper appearance : The skull bones show a well-marked stippling, but the opaque areas are small pin head size. Loss of lamina dura: A tooth socket is made up of thin coical bone seen as a white line surrounding the teeth. This is called the lamina dura. It gets absorbed in hyperparathyroidism. Sub-periosteal resorption of the phalanges is a diagnostic feature of hyperparathyroidism (generalized variety). Resorption may also occur at lateral end of the clavicle. Spine shows central collapse of the veebral body and biconvex discs. Pelvis and other bones show coarse striations with clear cyst-like spaces. Brown 's tumour is an expansile lytic lesion, which appears like a bone tumour, generally affecting the maxilla/ mandible. Extra-osseous radiological features such as renal calculi etc. may be present.

Surgery

None

RET proto-oncogene is associated with:-

Medullary thyroid cancer

0A

RET proto-oncogene: Associated with development of MEN II syndrome (affects thyroid & adrenal medulla) Therefore, patients have risk of developing medullary thyroid cancer & pheochromocytoma. Thyroid tumors & associated mutations: - Papillary thyroid cancer: RET-PTC gene - Follicular thyroid cancer: RAS gene - Anaplastic thyroid cancer: p53 gene

Pathology

Thyroid Tumor

Glucose is absorbed in intestine by?

Secondary active transpo

0A

In all cells: Glucose enters by (along conc. Gradient) facilitated diffusion GLUT, EXCEPT: GIT & kidney | Glucose has to enter against concentration gradient & cross the apical & basolateral cell surfaces to get absorbed into the bloodstream. The transpoer facilitating glucose absorption into the intestinal cells: SGLT secondary active transpo. Glucose exits from the cell to the bloodstream GLUT -2 (facilitated diffusion) Ans 1>2

Physiology

NEET 2018

An antibiotic not acting on tubulin is ?

Bleomycin

0A

Ans. is 'a' i.e., Bleomycin Bleomycin (an anticancer antibiotic) does not act on tubulin.

Pharmacology

None

Gold standard flap for breast reconstruction -

DIEP flap

2C

Ans. is 'C' i.e., DIEP flap

Unknown

None

A 24 year old male patient complains of yellowish discoloration of the teeth. Intra-oral examination reveals generalized grade 1 tetracycline stains and proximal caries was present with 22. Composite restoration in this patient is delayed for atleast _____ after bleaching.

1 week

1B

With all bleaching techniques, a transitory decrease occurs in the potential bond strength of composite when it is applied to bleached enamel and dentin. This reduction in bond strength results from residual oxygen or peroxide residue in the tooth that inhibits the setting of the bonding resin, precluding adequate resin tag formation in the etched enamel. No loss of bond strength is noted, if the composite restorative treatment is delayed at least 1 week after cessation of any bleaching. Reference-  Sturdevant 6th ed Pg-310

Dental

None

Spontaneous remission is most frequent with

Herpes gestationis

3D

D. i.e. Herpes gestationis

Skin

None

Latanoprost (PGF2 alfa) is used in:

Glaucoma

3D

Glaucoma REF: Goodman and Gillman's 11TH edition page 1103, http://en.wikipedia.org/wiki/Latanoprost "Latanoprost ophthalmic solution is a topical medication used for controlling the progression of glaucoma or ocular hypeension by reducing intraocular pressure. It is a prostaglandin analogue (more specifically an analogue of Prostaglandin F2a)" "The PGF2a analogs consist of Latanoprost, travoprost, bimatoprost, and unoprostone. PGF2a analogs appear to lower IOP by facilitating aqueous outflow through the accessory uveoscleral outflow pathway. The mechanism by which this occurs is unclear"

Pharmacology

None

All are true about Hypertrophic Cardiomyopathy except

Dilated ventricle

0A

(A) Dilated ventricle # Hypertrophic cardiomyopathy (HCM) is characterized by LV hypertrophy, typically of a nondilated chamber, without obvious cause, such as hypertension or aortic stenosis.> It is found in about 1 in 500 of the general population. Two features of HCM have attracted the greatest attention: Asymmetric LV hypertrophy, often with preferential hypertrophy of the interventricular septum; and A dynamic LV outflow tract pressure gradient, related to narrowing of the subaortic area.> About one-third of patients with HCM demonstrate an outflow tract pressure gradient at rest and a similar fraction develop one with provocation.> The ubiquitous pathophysiologic abnormality is diastolic dysfunction, which can be detected by Doppler tissue imaging and results in elevated LV end-diastolic pressures; the latter may be present despite a hyperdynamic, nondilated LV.

Medicine

Miscellaneous

If DNA is damaged in the cell cycle, which gene causes cell cycle arrest?

p53

2C

Ans. (c) p53Ref: Robbins and Cotran Pathologic Basic Disease 9th Ed; Page No-28P53* Gene in chromosome 17p 13.1* It is called as "genome guardian protein".* Encodes a53Ka protein* p53 is universally expressed in all cells.* p53 induces p21, which inhibits CDKs- hypo-phosphorylation (activation) ofRb- inhibition of G1 -S progression.* It regulates cell cycle progressions, DNA repair, cellular senescence and apoptosis.Note* The suppressor gene p53 apoptosis by depositing CD95 on the cell membrane surface.* Mutations in tumor suppressor genes can result in unrestrained cell division (eg, Li-Fraumeni syndrome).Extra Mile* Mutated p53 protein inactivation promotes tumor development.* Its gene product is broken down more slowly than normal protein, leading to intranuclear accumulation of p53 protein.How to rule out other options?* Rb gene:# Tumor suppressive pocket' protein that binds E2F transcription factors in its hyperphosphorylated state.# It prevents G1/S transition.* RAS oncogene# It is a signal transduction protein.# Most common oncogene mutation involved in human cancer (15-20% of human cancer).# Normal RAS proteins alternate between activated GTP- bound signal transmitting and inactive GDP-bound forms.# When the cells are stimulated by growth factors RAS becomes activated by exchanging GDP to GTP# Activated RAS binds to farnesyl transferase to activate MAP kinase for induction of mitogenesis.# The mutant RAS activates the mitogen-activated protein (MAP) kinase pathway leading to cell proliferation.* MYC# It is most common nuclear transcription factor affected in human tumors.# MYC up regulates expression of telomerase.# It reprogram somatic cell into pluripotent stem cells and contribute to cancer cell "sternness".

Pathology

Neoplasia

The procedure of choice for the evaluation of aoic aneurysm is -

Computed tomography

1B

Ans. is 'b' i.e. Computed tomography "CT is the most precise test for imaging aoic aneurysm" - Sabiston 'As a preoperative scanning tool, CT scan is the gold standard. Angiography has largely been replaced by contrast CT scanning" - Schwaz

Surgery

None

Which of the following is a recently approved drug for post paum depression

Brexanolone

0A

The uses of above drugs are:Brexanolone: Post paum depressionCalpacizumab: Thrombotic thrombocytopenic purpuraSolriamfetol: Excessive sleepiness in narcolepsy or sleep apneaSiponimod: Mutliple sclerosis

Pharmacology

Psychiatric Illness

All are true regarding Lupus anticoagulant,except -

Increased PT

3D

None

Medicine

None

In Ecological studies, the unit of Observation is the

Population

0A

(A) Population[?]ECOLOGICAL STUDIESoCross-sectional, Case-control & Cohort studies and Trials (and not just population case-series) could also be analyzed in relation to such 'ecological' variables and such units of analysis.oMost ecological analyses are based on population case-series.oEcological analyses are subject to the ecological fallacy.oIn an ecological study, the units of analysis are groups of people rather than individuals.oEcological studies can also be done by comparing populations in different places at the same time or in a time series, by comparing the same population in one place at different times.oIn ecological studies the unit of observation is the population or community.oDisease rates and exposures are measured in each of a series of populations and their relation is examined.oOften the information about disease and exposure is abstracted from published statistics and therefore does not require expensive or time.oEcological Concept:-Deficiencies in the biomedical concept gave rise to other concepts.-Ecologists put forward an attractive hypothesis which viewed health as a dynamic equilibrium between man and his environment, and disease a maladjustment of the human organism to environment.-Health implies the relative absence of pain and discomfort and a continuous relative adaptation & adjustment to the environment to ensure optimal function.oHuman ecology is a subset of more general science of ecologyoHuman ecosystem includes in addition to the natural environment, all the dimensions of the man-made environment - physical, chemical, biological.Other Options[?]Patient:-A patient is any recipient of health care services.-Patient is most often ill or injured & in need of treatment by a physician, advanced practice registered nurse, physiotherapist, physician assistant, psychologist, dentist, podiatrist, veterinarian, or other health care provider.[?]Concept of Disease-A condition in which body health is impaired, a departure from a state of health, an alteration of the human body interrupting the performance of vital functions.-Ecological point of view: disease is defined as 'a maladjustment of the human organism to the human organism to the environment-Sociological point of view: disease is considered a social phenomenon, occurring in all societies and defined & fought in terms of the particular cultural forces prevalent in the society.-Simple definition 'disease is just the opposite of health1[?]Case:-A case is defined as 'a person in the population or study group identified as having the particular disease, health disorder or condition under investigation.-A variety of criteria (E.g. clinical, biochemical, laboratory) may be used to identify cases.-Primary case refers to the first case of a communicable disease introduced into the population unit being studied.-Index case refers to the first case to come to the attention of investigator; it is not always the primary case.-Secondary cases are those developing from contact with primary case.-Suspect case is an individual (or group of individuals) who has all of the signs and symptoms of a disease or condition, yet has not been diagnosed as having the disease or had the cause of the symptoms connected tot he suspected pathogen.

Social & Preventive Medicine

Epidemiology

The most common gene associated with renal cell carcinoma is

VHL

2C

Renal cell carcinoma *Renal cancers are mostly sporadic, except for a 4% cases which appear familial *Familial renal cancers are due to mutation of VHL and MET genes*98% of all renal cancers (sporadic and familial) are due to VHL mutation encoded in chr3p*Most common cause of familial papillary renal cell carcinoma (rare disease) is MET protooncogene*Most common risk factor for all renal cancers- Tobacco*Most common type of renal cell carcinoma is clear cell carcinoma , which is followed by papillary carcinoma, chromophobe carcinoma and collecting duct carcinoma*Most common type of renal cancer in patients who develop dialysis associated cystic disease - Papillary carcinoma*VHL is a tumour suppressor gene. Mutation of both the VHL genes causes angiogenesis (by increasing expression of hypoxia inducible factor-1) and cell growth (by increasing expression of insulin like growth factor -1)*Renal cell carcinoma mostly affects the poles Microscopic findings:*Classic clinical features of renal cell carcinoma - Costoveebral pain, palpable mass and hematuria*Clear cell carcinoma -Cells with clear cytoplasm containing glycogen and lipids, delicate capillaries*Papillary carcinoma - Papillary formations, foam cells in interstitium, psammoma bodies*Collecting duct carcinoma - irregular channels lined by atypical cells and show hobnail pattern*Chromophobe cell carcinoma - cells with abundant cytoplasm impaing blue colour in Hale's colloidal iron stain(Ref: Robbins 8/e p964)

Pathology

Urinary tract

Type of movement seen from retruded contact position unto terminal hinge axis:

Only hinge movement

2C

Movement from the retruded contact position unto terminal hinge axis is only hinge movement.

Dental

None

The commonest cyanotic heart disease manifesting as congestive cardiac failure during first week of life is –

Hypoplastic left heart syndorme

3D

Amongst the given options, hypoplastic left heart syndrome causes CHF in First week. Different congenital diseases have different time of onset of CHF : - 1) Left to right shunt At birth, pulmonary vascular resistance is high, i.e., the pressure on rt side of circulation is high -> Pulmonary pressure is almost equal to systemic pressure. So, left to right shunt is small, whether the communication is atrial, ventricular or pulmonary artery level. As the neonate grows, pulmonary vascular resistance falls with maximum fall at the age of six to eight weeks (Note - In normal neonate, maximum fall is between 1 to 3 weeks). This is the time (six to eight weeks) when the size of shunt is maximum as pulmonary vascular resistance is least at this time. So, patients with left to right shunts tend to develop CCF around six to eight weeks of life. 2) Right to left shunt Patients with right to left shunt may have : - a) Shunt at the ventricular or pulmonary artery level. b)Shunt at atrial level Patients with shunt at the ventricular or pulmonary artery level do not develop CCF because the right ventricle is dompressed by the shunt. Patients with shunt at atrial level may have. i) Obstruction at right ventricular outlet (Pulmonary stenosis or atresia)      CCF develops in the first few days of life as rt ventricle does not decompress fully because shunt is at atrial level. Obstruction at right ventricular inlet (Tricuspid atresia) ---> CCF usually does not occur as there is no volume overload to right ventricle. But these patients develop congestive symptoms when the shunt is small. 3)Obstructive lesions If the stenosis is critical (e.g., in aortic or pulmonary atresia), CCF may develop early because of impaired ventricular decompression. Coarctation of aorta may develop CCF with in 1-4 weeks of life. However, if these patients do not manifest CCF in the first year of life, collaterals develop and prevent onset of failure by decompressing the obstruction. 4) Transposition Patients with transposition of great arteries, develop CCF within first week of life, when there is no ventricular communication and the only mixing site is at the atrial level ---> Hypoxemia along with anoxic myocardium results in tachycardia that causes CCF. Patients with transposition of great arteries with an adequate ventricular defect and patients with transposition of pulmonary veins develop CCF somewhat later, usually by the age of six to eight weeks, following the fall in pulmonary vascular resistance as in patient with left to right shunt.

Pediatrics

None

Delusion of persecution occur in :

All

3D

A i.e. Schizophrenia; B i.e. Paranoid psychosis; C i.e. Manic episode Delusion of persecution occurs in schizophrenia, 'paranoid disordersQ, organic mental disorders (eg alcoholic hallucinosis, amphetamine delirium, delusional disorder, other hallucinogenic syndrome, epilepsy & all forms of delirium), and less commonly in melanocholia (severe depression), manic episodeQ and during transitory psychotic breaks in borderline personality disorder. Patients of psychotic mania (mania with psychotic features) often develop mood congruent grandiose delusion (voices suppoing the patients super human power's) & expansive religious delusions (hearing God) and mood incongruent secondary delusion of persecution. It is often misdiagnosed as schizophrenia but the intrusive nature seen in severe mania is of an extremely dominating and manipulative nature, out of context with the setting and the increased social contant of manic patients is clearly different from the emotional bluntness of schizophrenics.

Psychiatry

None

The given site encodes

Complement component C3

0A

MHC class III genes encode*Complement components C2 and C4*Properdin factor B of alternate pathway*TNF - alpha and betaHeat shock proteinsReference: Harrison&;s Principles of Internal Medicine; 19th edition

Pathology

General pathology

Cushing syndrome all are true except -

Hypoglycemia

2C

Ans. is 'c' i.e., Hypoglycemia Cushing syndromeo Chronic exposure of excess glucocorticoid of any etiology,o The 90% of causes - causes by ACTH producing pitutary adenoma.C/F:-o Central obesity, fat pad on back of neck (Buffalo hump),o Diebeteso Diastolic hypertensiono Hirsutismo Depressiono Facial plethorao Purplish skin striae

Pediatrics

Adrenal Gland

Which of the following causes epidemic typhus

R. prowazekii

1B

R prawazekii causes epidemic typhus,distribution is worldwide, in recent times main foci have been eastern Europe,Africa,South America and Asia.in india the endemic spot is kashmir,Humans are the only natural veebrate host,pediculus humanus corporis(human body louse) is the vector,so this disease is also called loseborne typhus Ref:Ananthnarayan and paniker's microbiology 10th edition

Microbiology

Bacteriology

Both lipid and protein contents are equal in membrane of which organelle-

Mitochondria

1B

Ans. is 'b' i.e., Mitochondria o Outer mitochondrial membrane has protein to lipid ratio of 1.1.

Biochemistry

Respiratory Chain

A diabetic person presents with multiple abscess in leg. Microscopic examination of pus shows gram (-)ve bacilli. On staining with methylene blue bacteria shows bipolar staining. The most likely causative agent is:

B. pseudomallei

0A

Ans. is. 'a' i. e., B. pseudomallei

Microbiology

None

A 27-year-old woman is examined by her gynecologist. Upon rectal examination, a firm structure, directly in front of the rectum in the midline, is palpated through the anterior wall of the rectum. Which is this structure?

Cervix of uterus

2C

The cervix of the uterus is anterior to the rectum. Since the cervix is the inferior pa of the uterus that is protruding into the vagina, it should feel like a firm structure upon palpation. The bladder is the most anterior organ in the pelvis. So, the bladder would not be directly in front of the anterior wall of the rectum. The body of the uterus lies upon the bladder, so it is too far in front of the anterior rectal wall to be palpated. The pubic symphysis is the joint connecting the two pubic bones. It forms the anterior boundary of the pelvis, and would be too far forward to palpate through the rectum. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 5. Maternal Physiology. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.

Gynaecology & Obstetrics

None

Radioisotope used for thyroid treatment of metastasis / ablation

1-131

1B

Ans. (b) 1-131Ref: Sutton 7th/1504* Iodine-131 has a radioactive decay half-life of about eight days.* Iodine-131 exhibits a beta mode of decay, and leads to death in cells that it penetrates up to several millimeters and hence is useful for thyroid ablation.* 1-123 has a half-life of 13.22 hours and is a radioactive isotope of iodine used in nuclear medicine imaging, including single photon emission computed tomography.

Radiology

Radiotherapy

Which one of the following condition is true of Barret oesophagus

It is a known precursor of adenocarcinoma of the esophagus

3D

Barrett Esophagus Barrett esophagus is a complication of chronic GERD that is characterized by intestinal metaplasia within the esophageal squamous mucosa. The incidence of Barrett esophagus is rising, and it is estimated to occur in as many as 10% of individuals with symptomatic GERD. Barrett esophagus is most common in white males and typically presents between 40 and 60 years of age. The greatest concern in Barrett esophagus is that it confers an increased risk of esoph- ageal adenocarcinoma. Genomic sequencing of biopsies involved by Barrett esophagus has revealed the presence of mutations that are shared with esophageal adenocarci- noma, in keeping with the idea that Barrett esophagus is a precursor lesion to cancer. Potentially oncogenic mutations are more numerous when biopsies demonstrate dysplasia, which is detected in 0.2% to 2% of persons with Barrett esophagus each year. The presence of dysplasia, a prein- vasive change, is associated with prolonged symptoms, longer segment length, increased patient age, and Caucasian race. Although the vast majority of esophageal adenocar- cinomas are associated with Barrett esophagus, it is impor- tant to remember that most individuals with Barrett esophagus do not develop esophageal tumors.

Anatomy

G.I.T

Which of the following is a characteristic feature of protective epithelium?

Regeneration of membrane

0A

Skin when the epithelium is damaged or removed, it is continuously regenerated. Epithelia possess tight intercellular junctions between cells. These junctions effectively cement cells together into single layered or multilayered sheets of cells. These tissue sheets drape body organs, line cavities, and cover external body surfaces providing protection from microbial invasion or friction. The epithelia of these sheets can also be secretory, producing lubricating, protective, or nutritive fluids of membranes.

Anatomy

None

The kidney normally does NOT allow transglomerular passage of

B-2 microglobulin

0A

The kidney normally does NOT allow transglomerular passage of B-2 microglobulin Beta-2 microglobulin or b2 microglobulin also known as B2M is a component of MHC class I molecules, which are present on all nucleated cells(excludes red blood cells).Ref: Ganong&;s review of medical physiology; 24th edition; Page no: 678

Physiology

Renal physiology

Insulin secretion is/are increased by all except:

VIP

1B

B i.e. VIP

Physiology

None

Micturating cystourethrogram shows filling defect in the urinary bladder. Likely diagnosis is________

Ureterocele

3D

A ureterocele is a bih defect that affects the kidney, ureters (the tubes that carry urine from the kidneys to the bladder), andbladder. A ureterocele blocks the flow of urine resulting in swelling at the bottom of one of the ureters. Blockage that cannot be resolved and possible infection can damage the kidneys. Reference: GHAI Essential pediatrics, 8th edition

Pediatrics

Urinary tract

nutmeg liver is seen in

Right sided hea failure

0A

Nutmeg liver refers to the mottled appearance of the liver as a result of hepatic venous congestion. Radiologically, it is most appreciable on poovenous phase imaging on cross-sectional imaging. It is named after the cut appearance of thenutmeg seed. Refer robbins 9/e

Pathology

G.I.T

Psoriatic arthritis classically involves:

DIP joint

1B

Ans: b (DIPjoint) Ref: Maheswari, 3rd ed, p. 251Psoriatic arthropathy is polyarthritis & distal IP joints are typically involved.(Unlike rheumatoid arthritis, where these are spared)Psoriatic arthritis can present with a wide spectrum of clinical features namely1) Asymmetrical inflammatory oligoarthritis - 40%2) Symmetrical polyarthritis - 25%3) Predominant distal interphalangeal joint arthritis -15%4) Psoriatic spondy 1 itis -15%5) Arthritis mutilans - 5%. It is the most serious condition and the skin of fingers appears telescoped.NoteOsteoarthritis - involves PIP, DIP and 1st carpometacarpal joint (base of thumb). Spares MCP and wrist.Rheumatoid arthritis-involves any small joint of hand e.g., PIP. MCP, wrist. Sparing of DIP.Psoriatic arthritis - involvement of PIP. DIP, MCP and wrist. Sparing of any joint may or may not be present.If DIP is involved rheumatoid arthritis can be ruled out.Similarly if MCP joint is involved osteoarthritis can be ruled out.

Orthopaedics

Arthritis

With which of the following types of viral hepatitis infection in pregnancy, the maternal moality is the highest?

Hepatitis-E

3D

Viral hepatitis is the most common cause of jaundice in pregnancy Viral hepatitis in pregnancy by Hep E is associated with the most fulminant course Pregnant women with hepatitis E infection exhibit markedly increased fatality rates: 10-20 %.

Gynaecology & Obstetrics

Medical Illness Complicating Pregnancy

All occurs in botulism except :

Diarrhoea

1B

“Botulism toxin act as parasympatholytic so it cause severe constipation not diarrhoea.” Also produce vomiting, thirst, ocular paresis, difficulty in swallowing/ speaking/ breathing.

Microbiology

None

All of the following can be done in a case of pelvic fracture with pelvic hematoma and had not passed urine since trauma EXCEPT -

Pass indwelling urethral catheter

0A

None

Surgery

None

Submandibular gland is supplied by:

Facial artery

1B

None

Anatomy

None

Auto haemolysis test is positive in -

Hereditary spherocytosis

1B

None

Medicine

None

Neutropenia is associated with:

Nafcillin

0A

NAFCILLIN:It is a narrow spectrum beta lactam antibiotic. Pharmacology Mechanism of Action Inhibit synthesis of bacterial cell wall synthesis, which results in bactericidal activity Pharmacokinetics Half-Life: 0.5-1.5 hr (adults); 0.75-1.9 hr (children) Peak Plasma Time: 0.5-1 hr Protein binding: 90% Absorption: Poorly absorbed orally Distribution: In fluid, bone, bile, crosses placenta. Adverse Effects 1-10%: Hypersensitivity Neutropenia Interstitial nephritis Possible hypokalemia <1%: Neurotoxicity (high doses) Pseudomembranous colitis Phlebitis (oxacillin preferred in peds) REFERANCE:reference.medscape.com

Pharmacology

Chemotherapy

A 55 year-old man with unstable angina is treated with an intravenously administered glycoprotein IIb - IIIa inhibitor. The mechanism of action of this agent is the ability to.

Inhibit platelet aggregation

1B

Solution: Glycoprotein IIb - IIIa Prevent the action of the platelet surface receptor glycoprotein complex, which is mrequired for formation of fibrinogen bridges between adjacent platelets. Thus inhibiting platelet aggregation.

Pathology

None

A 56-year-old male patient develops an accentric hard breast lump over the past few months and a biopsy proves this to be breast carcinoma. Of all breast cancers, the rate of occurrence in males is which of the following?

<1%

0A

Cancer of the breast in males constitutes <1% of total cases. It tends to present at a more advanced stage in men than in women, because it is often overlooked. It may easily be confused with the more commonly occurring condition of gynecomastia. Careful clinical radiological follow-up studies are indicated.

Surgery

Breast

Which of the following type of fissure is not self cleansable?

All of the above

3D

MORPHOLOGY OF PIT & FISSURES Nagano (1961) described following principal types of fissures, based on the alphabetical description of shape: V – Type (34%) U – Type (14%) I – Type (19%) IK – Type (26%) Inverted Y – Type (7%)

Dental

None

Which of the following antimicrobials should not be given to a chronic asthmatic patient managed on theophylline therapy?

Erythromycin

0A

Drugs which inhibit theophylline metabolism and increase its plasma level are -erythromycin, ciprofloxacin, cimetidine, oral contraceptives, allopurinol etc. Enzyme Inducers G - Griseofulvin P - Phenytoin R - Rifampicin S - Smoking Cell - Carbamazepine Phone - Phenobarbitone Enzyme Inhibitors Vit -Valproate K - Ketoconazole Can't -Cimetidine Cause - Ciprofloxacin Enzyme -Erythromycin Inhibition - Isoniazid

Pharmacology

NEET Jan 2020

Sullivan index is an index for

Life free of disability

0A

Sullivan's index also known as Disability Free Life Expectancy (DFLE) is a method to compute life expectancy free of disability. It is calculated by formula:Life expectancy minus duration of disability Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 26

Social & Preventive Medicine

Concept of health and disease

A patient presents with a penetrating chest wound associated with intrathoracic haemorrhage. A thoracotomy is done by taking an incision in the 41h/51h intercostals space staing 1 cm away from the lateral margin of the sternum.This is done to avoid injury to the

Internal thoracic aery

2C

C i.e. Internal thoracic aeryIntercostal (external, internal & innermost) muscles (not transverses thoracic) are pierced in pleural taping in mild axillary line.Latissimus dorsi, serratus anterior, rhomboidus major & intercostal muscles are cut in posterolateral thoracotomy whereas pectoralis is cut in anterior & anterolateral approach.Thoracotomy in upper 6 intercostal spaces is done by taking an incision 1 cm lateral to sternum to avoid injury to internal thoracic (mammary) aeryQ.

Anatomy

None

Diffusion hypoxia is seen during -

Recovering anaesthesia

1B

DIFFUSION HYPOXIA also known as FINK EFFECT OR THIRD GAS EFFECT At the end of general anesthesia, N2O is switched off so that inspired gas changes from N2O+O2 - N2+O2. As a result, N2O stas diffusing out of the blood into alveoli while N2 diffuses into blood. Due to the difference in solubilities of the two gases, N2O diffuses out more rapidly as it has high solubility. This diluted other gases present in alveoli and relative concentration of O2 falls. It is termed as diffusion hypoxia. Clinical Significance : 100% oxygen should be given for at least 5-10minutes after switching off N2O in order to overcome the relative fall of O2 concentration in the alveoli during Recovery from general anesthesia.

Anaesthesia

General anaesthesia

Gottron's papules are seen in:

Dermatomyositis

0A

Ans: A (Dermatomyositis) Ref: Connective Tissue Disorders. In: Thappa DM, editor. Essentials in Dermatology, 2nd edn. New Del hi: Jay pee; 134-47Explanation:DERMATOMYOSITISConnective tissue disorder characterized by inflammatory myositis presenting with proximal muscle weakness and cutaneous manifestations in the form of:Pathognomonic features:Gottron's papules - violaceous flat topped papules on IP joints and knuckles; also knee, elbow, medial malleoliGottron's sign- violaceous erythematous macules with or without edema at the above mentioned sitesCharacteristic features:Heliotrope rash- periorbital violaceous erythema with edemaShawl sign- erythema and scaling with or without poikiloderma over shoulder regionPeriungual telangiectasia and dystrophic cuticlesMechanic's hands- hyperkeratosis, scaling, Assuring and hyperpigmentation over fing-ertips, sides of thumbs and fingersCompatible features:Calcinosis cutisPoikilodermaa trophicans vasculare

Skin

Autoimmune Skin Disorders

The antibiotic of choice in patients sensitive to penicillin is

Erythromycin

0A

None

Pharmacology

None

False about brown pigmented stones:

More common in Caucasians

1B

Ans. (b) More common in Caucasians* Brown stones may happen in disorders of motility + Bacterial infection* MC in ASIANS* Soft and earthy stone.* Content: Ca.Bilirubinate +Ca. Palmitate +Ca Stearate + Cholesterol(Black stone- Insoluble Bilirubin Polymer +Ca. PO4 + Ca. bicarbonate)

Surgery

Gall Bladder & Bile Ducts

Tissue thromboplastin activates

Factor 7

0A

Ref Robbins 9/e, p 118 Coagulation Cascade The coagulation cascade constitutes the third arm of the hemostatic system. The pathways are schematically pre- sented in Figure 3-8; only general principles are discussed here. The coagulation cascade is a successive series of ampli- fying enzymatic reactions. At each step in the process, a proenzyme is proteolyzed to become an active enzyme, which in turn proteolyzes the next proenzyme in the series, eventually leading to the activation of thrombin and the formation of fibrin. Thrombin has a key role, as it acts at numerous points in the cascade (highlighted in Fig. 3-8). Thrombin proteolyzes fibrinogen into fibrin monomers that polymerize into an insoluble gel; this gel encases platelets and other circulating cells in the definitive secondary hemostatic plug. Fibrin polymers are stabilized by the cross-linking activity of factor XIIIa, which also is activated by thrombin. Each reaction in the pathway depends on the assembly of a complex composed of an enzyme (an activated coagula- tion factor), a substrate (a proenzyme form of the next coag- ulation factor in the series), and a cofactor (a reaction accelerator). These components typically are assembled on a phospholipid surface (provided by endothelial cells or platelets) and are held together by interactions that depend on calcium ions (explaining why blood clotting is preventedby calcium chelators). Figure 3-8 The coagulation cascade. Factor IX can be activated by either factor XIa or factor VIIa: In laboratory tests, activation is predominantly dependent on factor XIa, whereas in vivo, factor VIIa appears to be the predominant activator of factor IX. Factors in red boxes represent inactive molecules; activated factors, indicated with a lowercase a, are in green boxes. Note that thrombin (factor IIa) (in light blue boxes) contributes to coagula- tion through multiple positive feedback loops. The red X's denote points at which tissue factor pathway inhibitor (TFPI) inhibits activation of factor X and factor IX by factor VIIa. HMWK, high-molecular-weight kininogen; PL, phospholipid.

Anatomy

General anatomy

Toxicity of Amphotericin B can be reduced by using?

Liposomal preparation

2C

Ans. is 'c' i.e., Liposomal preparation o Liposomal amphotericin has some advantages in terms of reduced toxicity (especially nephrotoxicity) compared with conventional preparation. o However, it is very expensive and prescription requires careful individual patient assessment.

Pharmacology

None

Liver synthesizes

All of the above

3D

(D) All of the above # Proteins produced and secreted by the liver> A large part of amino acid synthesis occurs in liver> Liver performs several roles in carbohydrate metabolism: Gluconeogenesis (the synthesis of glucose from certain amino acids, lactate or glycerol) Glycogenolysis (the breakdown of glycogen into glucose) Glycogenesis (the formation of glycogen from glucose) (muscle tissues can also do this)> The liver is responsible for the mainstay of protein metabolism, synthesis as well as degradation> The liver also performs several roles in lipid metabolism: Cholesterol synthesis Lipogenesis, the production of triglycerides (fats).> The liver produces coagulation factors I (fibrinogen), II (prothrombin), V, VII, IX, X and XI, as well as protein C, protein S and anti-thrombin.> In the first trimester fetus, the liver is the main site of red blood cell production.> The liver produces and excretes bile> The liver also produces insulin-like growth factor 1 (IGF-1), a polypeptide protein hormone that plays an important role in childhood growth and continues to have anabolic effects in adults.> The liver is a major site of thrombopoietin production. Thrombopoietin is a glycoprotein hormone that regulates the productior of platelets by the bone marrow.> Breakdown The breakdown of insulin and other hormones The liver breaks down hemoglobin, creating metabolites that are added to bile as pigment (bilirubin and biliverdin). The liver breaks down or modifies toxic substances (E.g.. Methylation) and most medicinal products in a process called drug metabolism. This sometimes results in toxication, when the metabolite is more toxic than its precursor. Preferably, the toxins are conjugated to avail excretion in bile or urine.> The liver converts ammonia to urea.# Other functions> The liver stores a multitude of substances, including glucose (in the form of glycogen), vitamin A (1-2 years' supply), vitamin D (1--4 months' supply), vitamin B12, iron, and copper.> The liver is responsible for immunological effects- the reticuloendothelial system of the liver contains many immunologically active cells, acting as a 'sieve' for antigens carried to it via the portal system.> The liver produces albumin, the major osmolar component of blood serum.> The liver synthesizes angiotensinogen, a hormone that is responsible for raising the blood pressure when activated by renin, a kidney enzyme that is released when the juxtaglomerular apparatus senses low blood pressure.

Physiology

Misc.

A patient with distal gastric carcinoma, following procedure, is done. Name the procedure

Roux-en-Y gastrectomy

3D

In the above image, after distal gastrectomy Roux-en-Y reconstruction is done.In this anastomosis, the Roux limb is the efferent or antegrade limb that serves as the primary recipient of food after the surgery (Gastro-jejunostomy), while the hepatobiliary or afferent limb that anastomoses with the biliary system serves as the recipient for biliary secretions, which then travel through the excluded small bowel to the distal anastomosis at the mid-jejunum (Jejuno-jejunostomy)In Billroth I technique gastroduodenal anastomosis after distal gastrectomyIn Billroth II technique gastrojejunal anastomosis is donebailey and love 27e pg: 1136

Surgery

G.I.T

Necrotizing granulomatous lymphadenopathy is caused by -

Syphilis

0A

Ans. is 'a' i.e., Syphilis . Impoant disease causing necrotizing granulomatous lymphadenopathy --> Syphilis, TB, Histoplasmosis, Coccidiomycosis.

Microbiology

None

Predisposing factors for esophagal cancer is all except

Mediastinal fibrosis

0A

Refer Robbins page no 758-759 External beam irradiation but not mediastainal fibrosis is a risk factor for esophagal cancer *HPV DNA is found frequently in esophagal squamous cell carcinoma in high incidence

Anatomy

G.I.T

Drug of choice in lignocaine toxicity -

Diazepan

3D

Ans. is `d' i.e., Diazepan o If lignocaine toxicity is suspected, stop the injection immediately. o Ensure adequate oxygenation, whether by face mask or by intubation. o Anticonvulsants such as benzodiazepines and barbiturates are the drug of choice for seizure control. o Succinylcholine is sometimes also used to terminate the neuromuscular effects of seizures. o If CVS symptoms occur (cardiac depression and hypotension), IV fluid and vasopressor agents may be required. o If metabolic acidosis develops, use of sodium bicarbonate can be considered, although, as in other instances of acute metabolic acidosis, this is controversial.

Pharmacology

None

Sustained neutropenia is seen with ?

Carmustine

2C

Carmustine Myelosuppression leading to neutropenia, thrombocytopenia and anemia is seen with most of the anticancer drugs. The characteristic feature of myclosuppression produced by carmustine is that it causes delayed myelosuppression that is prolonged too According to Goodman Gilman "It causes profound and delayed myelosuppression with recovery 4-6 weeks after a single dose. The myelosuppression leads to leukopenia and thrombocytopenia (may be prolonged)" More on Carmustine: Carmustine belongs to nitrosoureas class of anticancer drugs They have an impoant role in the treatment of brain tumours. It is highly lipophilic and thus it readily crosses the blood brain barrier. Other adverse effects of carmustine Delayed renal damage Reversible liver damage Leukemia Myocardial ischemia

Pharmacology

None

True about benzodiazepines -

Lorazepam is shoer acting than temazepam

2C

Ans. is 'c' i.e., Lorazepam is shoer acting than temazepam o Lorazepam has t1/2 10-20 hours, while Temazepam has t1/2 10-40 hours. About other options o BZDs do not increase or decrease the release of GABA, they bind on GABAA receptors and increase Cl- conductance --> GABA facilitatory action. o Flumazenil (not atropine) is the antagonist of BZDs.

Pharmacology

None

5 yr old child going to sitting craniotomy while positioning in O.T. developed End Tidal CO2 0mm Hg P02 80 mm Hg implies

Venous air Embolism

2C

C i.e. Venous Air embolism A patient undergoing lapro/thoraco-scopyQ or procedure (eg craniotomy) in sitting, head upQ, park-bench, knee-chest positions that place the operative site above the right atrium carry an increased risk of VAE. Sudden decrease in end-tidal CO2 concentration (ETCO?), sudden hypotension/circulatory arrest and Mill wheel murmur indicate the diagnosisQ.

Anaesthesia

None

Pharmacovigilance is to monitor:

Drug safety

2C

National pharmacovigilance programme was launched in in India in 2005. It is sponsored by the WHO and funded by the World bank. It monitors the adverse drug reactions, institute periodic safety update recording, exchange pharmacovigilance information with other international regulatory bodies, recommend label amendments, product withdrawals or suspension, and inform end users. Pharmaceutical companies are required to submit periodic safety update repos of all new drugs, every six months for the first two years following market launch in India, and then annually for the next two years. Ref: Global Clinical Trials: Effective Implementation and Management edited by Richard Chin page 150

Pharmacology

None

Minimum protrusion required for condylar guidance programming on an articulator is:

6 mm

2C

The sensitivity of semi-adjustable articulator is minimum of 6 mm to program using a protrusive record.

Dental

None

Parkinosn's disease results from a lesion in the

Striatum

0A

(A) Striatum Chorea is characterized by rapid, involuntary dancing movements.> Athetosis: Continuous, slow, writhing movements is due to globus pallidus lesion> Hemiballismus: A lesion in subthalamus often leads to sudden flailing movements of an entire limb, a condition called hemiballismus.> Parkinson's disease: Lesions of the substantia nigra leads to the Parkinsonism.

Physiology

Nervous System

Which of the following is best type of inquest at the international level ?

Medical examiner's inquest

2C

Medical examiner's system type of inquest is the best type of inquest. In this system, the medical expert carries out the inquiry into the death. He visits the scene of the crime and examines the dead body. He then conducts a postmortem examination on the dead body. Thus, he is in a better situation to correlate the findings of postmortem examination with the scene of the crime and thus give a better opinion into the cause of death. This system is not practised in India and is held in the United States, Japan, and some other European countries.

Forensic Medicine

None

Juxtamedullary nephrons constitute what percentage of nephrons

30

2C

Juxtamedullary nephrons constitute only 30 percent of total nephrons .....remaining being coical nephrons. Ref: guyton and hall textbook of medical physiology 12 edition page number:460,461,462

Physiology

Renal physiology

Which of the following drug should not be given along with levodopa :

Vitamin B complex

2C

None

Pharmacology

None

Infectivity of HBV is indicated by ?

HBeAg

0A

Ans. is 'a' i.e., H BeAg

Microbiology

None

Spot map is used for-

Local distribution of disease

0A

Ans. is 'a' i.e., Local distribution of disease o Inner and outer city variations in disease frequency are well known. o These variations are best studied with the aid of "spot maps" or "shaded maps". o These maps show at a glance areas of high and low frequency, the boundaries and distribution. o For example, if the map shows "clustering" of cases, it may suggest a common source of infection or a common risk factor shared by all the cases. o The classical example of use of spot maps was by John snow for cholera epidemic in 1854.

Social & Preventive Medicine

None

Consanguinous marriages increase the risk of which of the following diseases?

Autosomal recessive diseases

1B

Consanguinity Increases risk of autosomal recessive diseasesNo change in risk of autosomal dominant, X - linked recessive (if neither parent affected)Not Proven in complex late-onset diseases like diabetes, schizophrenia, cardiovascular diseases(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 595-598)

Pediatrics

All India exam

Bisphosphonates are prescribed to a patient with the following advice

Take empty stomach with plenty of water

0A

Ans. (A) Take empty stomach with plenty of water(Ref: KDT 8th/370)Bisphosphonates are to be taken empty stomach in the morning with full glass of water and patient is instructed not to lie down or take food for at least 30 min. These measures are required to prevent contact of the drug with esophageal mucosa which result in esophagitis.

Pharmacology

Endocrinology

Which disease is transmitted by all the components of blood-

Malaria

0A

Ans. is 'a' i.e., Malaria o All components, including RBCs, WBCs, platelet concentrates, granulocyte concentrates, fresh plasma and cryoprecipitate can transmit malaria.

Pathology

None

The culture medium used for corynebacterium diphtheriae

Loeffler's serum slope

0A

• The usual media employed for cultivation of diphtheria bacillus are 1) Loeffler’s serum slope ■ It is used for rapid diagnosis as growth is shown within 4-8 hours. 2) Tellurite blood agar (Tinsdale medium) ■ It acts as selective media, as tellurite inhibits the growth of most other bacteria. ■ Growth may take two days to appear.

Microbiology

None

Triple therapy in Rheumatoid Ahritis involves all except

Steroids

2C

Methotrexate is the DMARD of the first choice for initial treatment of moderate to severe RA. Failure to achieve adequate improvement with methotrexate therapy calls for a change in DMARD therapy, usually transition to an effective combination regimen. Effective combinations include methotrexate, sulfasalazine, and hydroxychloroquine (oral triple therapy); methotrexate and leflunomide; and methotrexate plus a biological.Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 380; Rheumatoid ahritis

Medicine

C.V.S

Resistance to acyclovir is most commonly due to mutation in the viral gene that encodes a protein that

Phosphorylates acyclovir

1B

Ref-KDT 6/e p768 Nucleoside/tide analogues act by conveing to NTPs. First phosphorylation step occurs inside the virus and resistance occurs if there is mutation in this gene

Anatomy

Other topics and Adverse effects

'Nothing is an offence which is done by a child under seven years of age' is included under which of the following section:

Section 82 IPC

0A

Age Medicolegal IPC Explanation <7 year 7-12 years <12 years Criminal Responsibility Criminal Responsibility Consent Sec. 82 IPC Sec. 83 IPC Sec. 89 IPC No criminal intent guilty of offence parents give consent for noninvasive procedure

Surgery

None

Young child weighing 20 kg was given a drug in the dose 100mg/kg body weight. The plasma concentration of the drug is 2mg/ dl and the clearance is 200 ml/hr. What is the time required to reach steady state plasma concentration -

20hrs

1B

Ans. is 'b' i.e., 20 hours Volume of distribution = total dose/plasma concentration Total dose= dose/ kg x body weight = 100 x 20 = 2000 mg Volume of distribution = 2000/2 = 1000 Half life = 0.693 x Volume of distribution/ clearance = 0.693 x 1000/200 = 3.5 hours Time required to reach steady state plasma concentration is 5.5 half lives = 5.5 x 3.5 = 19.25 hours Therefore the most appropriate answer is 20 hours.

Pharmacology

None

In the following food items, which one has the highest 'Glycemic Index'?

Corn-flakes

0A

Ans. is 'a' i.e. Corn-flakesRef. Sunday edition of Hindustan Times, 16th November; 2003, various internet sites.Glycemic index is a measure of a food's ability to elevate blood sugar level.The indexing is done by comparing a foodstuffs digestion rate to that of glucose, with a glycemic index of 100.The higher the glycemic index, the faster will it enter the blood and increase the blood sugar level.Glycemic index is used to label the food as good and evil. Foods with a high glycemic index of 60 and above are considered unhealthy as they break down quickly and spike blood sugar level. Low glycemic foods enter the blood stream slowly and provide sustained long term energy (maintain stable blood sugar levels)High glycemic food Glucose100Baked potato85Corn flakes84Honey73Watermelon72White bread70-72Table sugar65Ice Cream61Moderately Glycemic food Orange Papaya58White rice58Brown rice55Popcorn55Sweet potato54Mango55Banana50Carrots49Orange44Low Glycemic food Apple37Yoghurt33Skimmed milk32Kidney beans27Peanuts14

Biochemistry

Endocrinology

A patient of bronchial asthma is on theophylline. Which of the following drugs should not be indicated to treat the upper respiratory tract infection in the same patient?

Ciprofloxacin

0A

Drugs like ciprofloxacin, erythromycin and cimetidine are powerful microsomal enzyme inhibitors, predisposing to toxicity of theophylline.

Pharmacology

None

All of the following conditions may predispose to pulmonary embolism except -

Progesterone therapy

3D

"Oesterogen predisposes to thrombosis and not progesterone" -

Surgery

None

Herpes gestatioinalis is

Autoimmune reaction to collagen XVII in basement membrane of skin

1B

Herpes gestationalis (pemphigoid gestationis ) is characterized by eosinophilic degranulation at dermal-epidermal junction. Becomes severe with subsequent pregnancies.

Gynaecology & Obstetrics

None

Drug of choice for Late East African Trypanosomiasis

Melarsoprol

2C

Early east African trypanosomiasis : Suramine Late east African trypanosomiasis : Melarsoprol American trypanosomiasis : Benznidazole

Pharmacology

None

Which is not a high energy molecule?

Glucose-6-phosphate

2C

HIGH ENERGY COMPOUNDS ARE 1. Nucleotides: (ATP, GTP, UTP, UDP-glucose) ATP to AMP + PPi ATP to ADP + Pi 2. Creatine phosphate 3. Arginine phosphate 4. 1,3-bisphosphoglycerate 5. Phosphoenolpyruvate 6. Inorganic pyrophosphate 7. Carbamoyl phosphate 8. Aminoacyl adenylate (aminoacyl AMP) Sulfur Compounds 9. CoA derivatives: Acetyl CoA- 45.6 kj- 30.5- 43.1- 49.4- 61.9- 7.3- 51.4 Succinyl CoA Fatty acyl CoA HMG CoA 10.S-adenosylmethionine (SAM) 11.Adenosine phosphosulfate (active sulfate). HIGH ENERGY COMPOUNDS These compounds, when hydrolyzed, will release a large quantity of energy, that is, they have a large DG0&;'. The high energy bond in compounds is usually indicated by a squiggle bond (~). The free energy of hydrolysis DG0' of an ordinary bond varies from -1 to -6 kcal/mol. For example, glucose-6-phosphate has a free energy of only 13.8 kJ/mol (-3.3 kcal/mol). On the other hand, the free energy of high energy bonds varies from >25 kJ/mol (-7 to -15 kcal/ mol).Ref: DM Vasudevan Textbook of Medical Biochemistry, 6th edition, page no: 226

Biochemistry

Respiratory chain

Congenital mega colon is confirmed by:

Rectal biopsy

0A

a. Rectal biopsy(Ref: Nelson's 20/e p 1894-1897Ghai 8/e p 285-286)Congenital Aganglionic Megacolon is the other name for Hirschsprung diseaseDiagnosis of Hirschsprung disease is confirmed by rectal biopsy.

Pediatrics

Gastro Intestinal System

Which of the following is not true about cataract surgery rate?

Cataract surgery- rate is a true rate

2C

Ans. c. Cataract surgery rate is a true rate (Ref: www.ncbI.nlm.nih.gov/pmc/articles/PMC2612994/'Current status of cataract blindness and Vision 2020: The right to sight initiative in India ' Murthy. Sanjeev K Gupta et al)'CSR is defined as (Total number of cataract surgeries performed/Total population) x 1,000,000''Conventionally, a rate as defined in epidemiology has a numerator which is related to and derived from the denominator and has a specific time dimension (such as one year). As against 'rates', CSR is a proportion, where the numerator may not be derived from the denominator.''Cataract surgical rate is a quantifiable measure of the delivery of cataract services in a country. It is thus a good indicator of how well a country is organizing its efforts in tackling cataract-related blindness,'A CSR of 3000 was targeted under Vision 2020: the right to sight, for India, by the year 2000. Current trends show that this target has been achieved, but still there are regional disparities across the country.Cataract Surgical Rate (CSR)CSR is defined as '(Total number of cataract surgeries performed / Total population) x 1,000,000'Conventionally, a rate as defined in epidemiology has a numerator which is related to and derived from the denominator and has a specific time dimensionQ (such as one year).As against 'rates'. CSR is a proportion, where the numerator may not be derived from the denominatorQ.Cataract surgical rate is a quantifiable measure of the delivery of cataract services in a country. It is thus a good indicator of how well a country is organizing its efforts in tackling cataract-related blindnessQ.There has been a substantial increase in CSR in India especially after the inception of the World Bank-supported Cataract Blindness Control Project.A CSR of 3000 was targeted under Vision 2020Q: the right to sight, for India, by the year 2000. Current trends show that this target has been achieved, but still there are regional disparities across the country.

Social & Preventive Medicine

Health Programmes in India

Which of the following is the first electron donor among the component of developer?

Phenidone

0A

None

Radiology

None

In an epidemic, the 1st step is

Verification of diagnosis

0A

The steps in an epidemic investigation are :Verification of diagnosisConfirmation of the existence of the epidemicDefining the population at riskObtaining a map of the areaCounting the populationRapid search for all cases & their characteristicsMedical surveyEpidemiological case sheetSearching for more casesData analysisFormulation of hypothesisEvaluation of ecological factorsFuher investigation of the population at riskWriting the repo

Microbiology

All India exam

Beta alanine is formed by

Pantothenic acid

2C

Reference: Harpers illustrated biochemistry 30th edition

Biochemistry

vitamins

The thinnest part of the lens capsule is?

Posterior pole

1B

ANSWER: B

Unknown

None

Attico antral disease is treated by ?

Modified radical mastoidectomy

0A

Ans. is 'a' i.e., Modified radical mastoidectomy Treatment of atticoantral disease Since cholesteatoma is going to expand and destroy bone and mucous membrane, it has to be removed. Therefore, surgery is the mainstay of treatment. Primary aim is removal of disease by mastoidectomy to make ear safe followed by reconstruction of hearing at a later stage. Modified radical mastoidectomy is the surgery of choice. Two types of surgical procedures (mastoidectomy) are done to deal with cholesteatoma. 1) Canal wall down procedures These leave the mastoid cavity open into the external auditory canal so that the diseased area is fully exteriorized. The commonly used procedures for atticoantral disease are atticotomy, modified radical mastoidectomy and rarely radical mastoidectomy. Modified radical mastoidectomy is the procedure of choice. 2) Canal wall up procedures (coical mastoidectomy) Here disease is removed by combined approach through the meatus and mastoid but retaining the posterior bony meatus wall, thereby avoiding an open mastoid cavity. For reconstruction of hearing mechanism myringoplasty or tympanoplasty can be done at the time of primary surgery or as a second stage procedure.

ENT

None

Most common occular foreign body is :

Chiesel and hammer

0A

A i.e. Chisel and hammer

Ophthalmology

None

A 68-year-old woman presents to the clinic for evaluation of new symptoms of burning when when voiding. She has no fever, chills, or back discomfort. Her urinalysis reveals numerous white cells and bacteria. Which of the following medical comorbidities is most likely to coexist in this patient?

diabetes mellitus

2C

Urinary tract infections (UTIs) are increased in diabetes mellitus as well as in pregnancy, sickle cell disease, polycystic disease, and structural abnormalities of the urinary tract.

Medicine

Oncology

Pain at left shoulder tip in a patient with splenic trauma is known as -

Kehr's sign

1B

Ans. is 'b' i.e., Kehr's signo In splenic rupture the pain may be referred to the tip of the left shoulder.This is known as Kehr's signo It occurs due to irritation of the undersurface of the diaphragm with blood and the pain is referred to the shoulder through the affected fibres of phrenic nerve (C4 and C5).o Kehr's sign can be elicited by bimaual compression of the left upper quadrant after the patient has been in Trendelenburg's position for about 10 minutes prior to the manoeuvre.

Surgery

Stomach & Duodenum

The heart of randomized control trial (RCT)

Randomization

3D

None

Dental

None

Maternal mortality rate the denominator is:

1000 live births '

0A

Explanation: The denominator 1000 live births is the best choice. Strictly speaking Maternal mortality ratio: Number of maternal deaths during a given time period per 100,000 live births during same time period. In many countries reporting and recording of live birth is more complete than that of total births. Hence live birth is taken as the denominator in most indicators. The denominator of 100.000 is taken so as to avoid decimals when in the maternal mortality decreases to a great extent. Maternal mortality rate: Number of maternal deaths in a given period per 100.000 women of reproductive age during the same time period.

Social & Preventive Medicine

None

Which differentiating prerenal azotemia with ATN features oring pre-renal azotemia -

Urine osmolality > 500 mosmol/kg

0A

The normal kidney can elaborate urine with a maximum concentration greater than 1,200 mOsm/kg in states of dehydration. A urinary osmolality (Uosm) greater than 500 mOsm/kg,, is highly suggestive of prerenal azotemia Ref Harrison20th edition pg ,299

Medicine

Kidney

A woman presents with chest pain and shoulder pain. On examination, she is found to have pericarditis with pericardial effusion. This shoulder pain is mediated by

Phrenic nerve

2C

The pain of pericarditis is mediated by the phrenic nerve. The somatic sensation from the pericardium is carried by the somatic afferent fibers of the phrenic nerve. The pericardial pain may be referred to the supraclavicular region of the shoulder or lateral neck area (dermatomes C3, C4 and C5. Ref: Gray&;s Anatomy for students 3rd edition Pgno: 183

Anatomy

Thorax

A poison which is illuminous, translucent and waxy?

Yellow phosphorus

3D

D i.e. Yellow phosphorus - Yellow (or white) phosphorus exists in translucent, waxy, luminous cylinders of garlicky smell & tasteQ. - Iodine occurs as brown (bluish-black), soft and scaly crystals with a metallic lusture and unpleasant taste. It gives off violet coloured vapour having a characteristic odour at all temperatures. - Caustic alkalis occurs as white powders. Whereas venom (salive) of cobra is faint transparent yellow and slightly viscous which becomes slightly turbid when exposed to sun.

Forensic Medicine

None

Which of the following is not a protein misfolding disorder?

Tuberculosis

0A

Ans. A. TuberculosisTuberculosis is not a disorder of protein misfoldingProtein Misfolding Disordersa. Protein misfolding disorders, also known as proteopathies are conditions in which some proteins become structurally abnormal and impair the function of cells and tissues.b. Protein folding is abnormal and they fail to perform normally and may even gain toxic effects.c. e.g. Alzheimer's disease (beta amyloid peptide), Creutzfeldt Jakob disease (prion disease), Cystic fibrosis (CFTR).

Biochemistry

Proteins and Amino Acids

In the treatment of variocele, testicular vein ligation is done at the level of :

Above inguinal ligament

0A

"The simplest surgical procedure is ligation of the testicular vein above the inguinal ligament where the pampiniform plexus has coalesced into one or two vessels". - Bailey & Love

Surgery

None