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A 5-year-old child refuses to sleep in his bed, claiming there are monsters in his closet and that he has bad dreams. The parents allow him to sleep with them in their bed to avoid the otherwise inevitable screaming fit. The parents note that the child sleeps soundly, waking only at sunrise. Choose the sleep disturbance most consistent with the history

Sleep disturbances are fairly common in childhood. Many children resist going to bed, and parents frequently give in just to get the child to sleep by allowing the child to sleep in the parents' bed or allowing them to stay up late. Unfortunately, children learn remarkably well how to get what they want, and the parents' concessions only make the problem worse. Learned behavior (behavioral insomnia, dyssomnia) is the root of many sleep disturbances in young children.Other types of sleep disturbance in children fall into the category of sleep disruptions, such as nightmares and night terrors.A nightmare is a scary or disturbing dream that usually awakens the child and causes agitation about the content of the dream. Nightmares occur during rapid eye movement (REM) sleep. Many children and adults have an occasional nightmare; recurrent or frequent nightmares, however, may be indicative of an ongoing stress in the child's life. Night terrors (pavor nocturnus) are non-REM phenomena seen less commonly than nightmares, occurring in 1% to 6% of all children. The child will be described as apparently awake but unresponsive; they can have evidence of autonomic arousal such as tachycardia, sweating, and tachypnea, and appear frightened and agitated. Attempts at calming the child are usually not effective, and the child will eventually go back to sleep. Although usually a problem in early childhood, night terrors can sometimes continue through adolescence.Somnambulism, or sleepwalking, occurs in 15% of children and is described as recurrent episodes of rising from bed and walking around. The child is typically hard to arouse and will have amnesia after the event. This usually happens in the first third of the sleep cycle, during stage 4 non- REM sleep. Somniloquy, or sleep talking, can occur at any sleep stage and is seen in all ages.

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Monetary benefit is measured in

ref : park 21st ed

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A 26-year-old woman complains of early fatigue and weakness in doing strenuous activity. Her symptoms are worse near the end of the day. She appears well, muscle bulk, tone, and reflexes are normal. Handgrip strength decreases with repetitive testing.For the above patient with muscle weakness, select the most likely anatomic site for the disorder

Diurnal fluctuations and pathologic fatigue are common in disorders of neuromuscular transmission (e.g., myasthenia gravis). (Ropper, pp. 1250-1251)

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Reichert-Meissl number:

Ans. A. 0.1NKOHReichert-Meissl number is defined as the number of moles of 0.1NKOH required to Completely neutralize the soluble volatile fatty acids distilled from 5g fat.

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This kind of graph can be seen in all of the following condition except

In hyperventilation the EtCO2 value will decrease. Increases ETCO2 is seen in thyrotoxicosis, fever (increased CO2production) and high spinal anesthesia (alveolar hypoventilation). Factors affecting ETCO2 Increased ETCO2 Decreased ETCO2 Metabolism Hypehermia Fever Thyrotoxicosis Pain Shivering Metabolism Hypothermia Metabolic acidosis Respiratory Hypoventilation Respiratory depression COPD Paial airway obstruction Rebreathing Respiratory Hyperventilation Total airway obstruction Extubation Circulatory Increased cardiac output (ROSC after cardiac arrest) Hypeension Circulatory Hypotension Cardiac arrest Pulmonary emboli Apparatus malfunction Exhausted CO2 absorber Inadequate fresh gas flow Ventilatory malfunction Apparatus malfunction Circuit disconnection Leak in sampling Ventilatory malfunction

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A patient was hospitalized after an automobile accident. The wounds became infected and the patient was treated with tobramycin, carbenicillin, and clindamycin. Five days after antibiotic therapy was initiated, the patient developed severe diarrhea and pseudomembranous enterocolitis. Antibioticassociated diarrhea and the more serious pseudomembranous enterocolitis can be caused by

Patients treated with antibiotics develop diarrhea that, in most cases, is self-limiting. However, in some instances, paicularly in those patients treated with ampicillin or clindamycin, a severe, life-threatening pseudomembranous enterocolitis develops. This disease has characteristic histopathology, and membranous plaques can be seen in the colon by endoscopy. Pseudomembranous enterocolitis and antibiotic-associated diarrhea are caused by an anaerobic Gram-positive rod, Clostridium difficile. It has been recently shown that C. difficile produces a protein toxin with a molecular weight of about 250,000. The "toxin" is, in fact, two toxins, toxin A and toxin B. Both toxins are always present in fecal samples, but there is approximately one thousand times more toxin B than toxin A. Toxin A has enterotoxic activity--that is, it elicits a positive fluid response in ligated rabbit ileal loops-- whereas toxin B appears to be primarily a cytotoxin. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition

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Which of the following muscle is derived from 1st pharyngeal arch ? (2019)

.

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Which of the following is an autosomal dominant metabolic disorder -

Mutations involving single genes follow one of three patterns of inheritance: autosomal dominant, autosomal recessive, or X-linked. Autosomal Dominant Inheritance Familial hypercholesterolemia Huntington disease Marfan syndrome Ehlers-Danlos syndrome Hereditary spherocytosis Neurofibromatosis, type 1 Adult polycystic kidney disease Autosomal Recessive Inheritance Cystic fibrosis Phenylketonuria Tay-Sachs disease Severe combined immunodeficiency a- and b-Thalassemias Sickle cell anemia Mucopolysaccharidoses--all types Glycogen storage diseases--all types Galactosemia X-linked Recessive Inheritance Hemophilia A Duchenne/Becker muscular dystrophy Fragile X syndrome (Robbins Basic Pathology,9th edition,pg no. 219)

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Which of the following statements is true about capillaries

Capillaries contain 5% of the blood volume.

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A Patient falls down often with behavioral change and enuresis. What is the condition associated with him?

Ans- B. Normal pressure hydrocephalus Frontotemporal dementia - Associated with poor behavioral control, decision making, and language.Normal-pressure hydrocephalus - Associated with gait disturbance, behavioural change, enuresis, and dementia.Parkinson's disease - Associated with tremor and muscular stiffnessAlzheimer's disease-Associated mainly with memory loss and confusionRef: Normal Pressure Hydrocephalus By Michael J. Fritsch, Uwe Kehler, Ullrich Meier P .16; Oxford textbook of neurological surgery by Adel Helmy P.94

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Life spon of a housefly ?

Ans. is 'd' i.e., 15-20 days Houseflies 'Houseflies should be regarded as a sign of insanitation' and their number as index of that sanitation. Impoant species : Musca domestica, M. vicinia, M. nebula, M. sorbens Life span : 15-25 days Eggs : 8-24 hours Larvae (maggots) : 2-7 days Pupae : 3-6 days Adults : 5-20 days Impoant breeding places (In order of impoance). Fresh horse manure Human excreta Manure of other animals Garbage Decaying fruits and vegetables Rubbish dumps containing organic matter Grounds where liquid wastes are spilled Feeding habits : Housefly does not bite : It cannot eat solid foods; it vomits on ssolid foods to make a solution of it, and sucks in a liquid state. Modus of disease transmission: Mechanical transmission: Houseflies are known as 'Poers of infection' Vomit-drop Defecation Houseflies in disease causation: As vector of diseases : Typhoid and paratyphoid fevers, diarrhoeas and dysenteries, cholera and gastroenteritis, amoebiasis, helminthic manifestations, Poliomyelitis, Yaws, Anthrax, Trachoma, conjunctivitis. As causative agent of disease : Myiasis.

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Threshold radiation dose for hematological syndrome is?

Ans. is'a'i.e., 2 GyBone marrow or hematological syndrome:- Full syndrome occurs with a dose between 0.7 and 3 Gy (70-300 rads).The destruction of bone marrow cells results in pancytopenia.

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Causes of reduced bioavailability of a drug includes

When the metabolism of a drug is high during its passage from the site of absorption into the systemic circulation, the rate, and extent of absorption of that drug decreases. absorption- amount of drug reaching the systemic circulation from the site of administration (Ref.Essentials of medical pharmacology TD Tripathi 7th edition page no.16,27)

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Which strain of streptococci is implicated in neonatal meningitis is:

Group-B

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ASO (Antistreptolysin o) test Is used for the diagnosis of-

Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:146-147 Jones Criteria for Diagnosis of Rheumatic Fever Major Criteria Carditis Pancarditis, seen in 50-60% of patients, develops within the first 2 weeks of rheumatic fever. Pericarditis is evidenced by presence of a pericardial rub, myocarditis by tachycardia, soft S1, presence of S3 and CCF and endocarditis by the presence of Carey-Coombs' murmur (mitral diastolic murmur). Ahritis (60-75%) Flitting and fleeting type of polyahritis involving large joints with no residual deformity is seen in 60-75% of patients and occurs early in rheumatic fever. Jaccod's ahritis: Ulnar detion of 4th and 5th finger with flexion at metacarpophalangeal joints is the only residual deformity seen in rheumatic polyahritis. Subcutaneous Nodules Non-tender nodules are seen over bony prominences like elbows, shin, occiput, spine in 3-5% of patients and occur 3-6 weeks after onset of rheumatic fever. Patients who have subcutaneous nodules almost always have carditis. Erythema Marginatum (< 5% and evanescent) Macular lesions with an erythematous rim and central clearing in a bathing suit distribution are seen in < 5% of patients and occur early in rheumatic fever. Chorea (Sydenham's Chorea) (2-30%) A neurological disorder with rapid, involuntary and purposeless non-repetitive movements with a self limiting course of 2-6 weeks is more common in females and is a late manifestation of rheumatic fever. Minor Criteria Clinical 1. Fever 2. Ahralgia 3. Previous history of rheumatic fever or rheumatic hea disease. Laboratory 1. Acute phase reactants (leucocytosis, raised ESR, C-reactive protein) 2. Prolonged PR interval in ECG (> 0.2 sec). WHO Criteria Jones major and pa of the minor criteria except prior history of rheumatic fever/rheumatic hea disease and C-reactive protein. Essential Criteria Evidence for recent streptococcal infection as evidenced by: 1. Increase in ASO titre a. > 333 Todd units (in children) b. > 250 Todd units (in adults). 2. Positive throat culture for streptococcal infection. 3. Recent history of scarlet fever. Two major (or) one major and two minor criteria, in the presence of essential criteria, is required to diagnose Acute Rheumatic Fever. A Positive Rheumatic Fever history is usually elicited in only 50% of patient with Rheumatic Hea Disease.

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All the following enzymes are involved in the metabolism of xenobiotics except

Oxidation, reduction, and hydroxylation are phase 1 reactionsCyp. 450 is the most common enzyme involved in the metabolism of various drugs in phase 1 and phase 2.Methylase - phase 2 reactionRef: Goodman Gillman 11th ed, pg 71

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Which of the following sites is not involved in a posterior cerebral aery infarct:

Answer is D (Anterior Coex) : Anterior Coex (Frontal lobe) is not involved in posterior cerebral aery infarct Posterior Cerebral Aery infarcts The posterior Cerebral Aery supplies the midbrain, thalamus, lateral geniculate bodies, posterior poion of choroid plexus, occipital lobes, inferior and medial aspect of the temporal lobe and posterior inferior areas of the parietal lobe. Occlusion of the Posterior Cerebral Aery usually results in two common clinical syndromes depending on the areas involved P1 Syndrome Occlusion of the proximal segment of PCA from its origin to its union with the posterior communicating aery P1 syndrome present primarily with the following signs Midbrain signs Thalamic signs Subthalamic signs P2 Syndrome Occlusion of the distal segment of PCA distal to the junction of PCA with the posterior communicating aery P2 syndrome presents primarily with the following signs Temporal lobe signs Occipital lobe signs

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For a weight of 98 kgs and height of 175 cms, BMI is:

32

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Highest fat content is present in:

Fat content of food items: Food item Fat content Jowar 4% Bajra 6.5% - Highest fat content Rice 3% Wheat 3%

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Most accurate treatment of erectile dysfunction:

A i.e. SildenafilSildenafil is only approved & effective oral agent for erectile dysfunctionQ. It is useful in wide range of e.d.including - pyschogenic, diabetogenic, vasculogenic, post radical prostatectomy (nerve sparing procedure) & spinal cord injury.It acts by inhibiting phosphodiesterase - 5 (PDE-5)Q & releasing NOQ from nerve endings & endotheliumOther t/t for Erectile dysfunction are:PIPE therapy (PapaverineQ/ Phentolamine Induced Penile Erection)- AndrogenIntraurethral - alprostodil (PGE1)Penile prosthasis, vaccum constriction deviceMaster Johnson technique is for premature ejaculationQp Blockers can cause erectile dysfunctionQ

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Secondary amyloidosis complicates which of the following

Ref Robbins 9/e p257;8/e p253;7/e p261 TB , bronchiectasis and chronic osteomyelitis were the most impoant underlying conditions but with the advent of effective antimicrobial chemotherapy the connective tissue disorders such as rheumatoid ahritis , ankylosing spondylitis and inflammation bowel disease . paicularly crohn disease and ulcerative colitis

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A patient underwent breast conservation surgery for 3 cm lesion along with sentinel lymph node biopsy., which showed one-third of sentinel lymph nodes are positive for macrometastasis. Next step is

Lymphatic metastasis in Carcinoma Breast: Lymphatic spread in CA breast occurs through subareolar lymphatic plexus of Sappey&;s lymphatic plexus, cutaneous lymphatics & inflammatory lymphatics. Lymphatic metastasis occurs primarily to the axillary (75%) & internal mammary lymph nodes. Tumors in the posterior one-third of breast are more likely to drain to the internal mammary nodes. Involvement of LNs has both biological & chronological significance It represents not only an evolutional event in the spread of the carcinoma but is also a marker for the metastatic potential of that tumor Involvement of supraclavicular nodes and of any contralateral lymph nodes represents advanced disease, LN metastasis is treated by surgical dissection and radiotherapy Axillary Lymph node levels in relation with pectoralis minor Level Relation with pectoralis minor Axillary LNs included I Below or lateral Anterior, Posterior, Lateral II Posterior (behind) Central, Interpectoral (Rotter&;s nodes) III Medial or above Apical Ref: Sabiston 20th edition Pgno: 853

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“Smack” is the “common” name for

Heroin or di-acetyl-morphine is about two times more potent than morphine in injectable form. Apart from the parenteral mode of administration, heroin can also be smoked or ‘chased’ ( chasing the dragon), often in an impure form (called ‘ smack’ or ‘ brown sugar’ in India). Heroin is more addicting than morphine and can cause dependence even after a short period of exposure.

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All of the following are signs of uterine scar dehiscence except: September 2009

Ans. C: Strong Uterine Contractions The signs and symptoms of uterine rupture largely depend on the timing, site, and extent of the uterine defect. Uterine rupture at the site of a previous uterine scar is typically less violent and less dramatic than a spontaneous or traumatic rupture because the scar is relatively avascular. The classic signs and symptoms of uterine rupture are as follows: fetal distress (as evidenced most often by pattern of abnormalities in fetal hea rate), diminished baseline uterine pressure, loss of uterine contractility, abdominal pain, recession of the presenting fetal pa, hemorrhage, and shock.

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Young female with 3 day fever presents with headache, BP 90/60 mmHg, Hea rate of 114/min, and pin point spots developed distal to BP cuff. Most likely organism is:

Ans. (c). i.e. N. meningitidis The patient here is under state of shock (hypotension, tachycardia) in conjunction with meningitis (headache fever)and rash. Meningococcal meningitis is the most common meningitis complicated by shock. CLINICAL MANIFESTATION OF MENINGOCOCCAL DISEASE Rash A nonblanching rash (petechial or purpuric) develops in >80% of cases of meningococcal disease. Rashesare initially blanching in nature but within hours become non-blanching. In severe cases large purpuriclesions (purpura fulminons) develops. Meningitis Commonly present as fever, vomiting, headache, irritability, petechial or purpuric rash occurs in 2/3 of cases. Headache is seen in adults usually. In upto 40% of cases there are some features of septicemia too. Septicemia Can be isolated or as a accomplication of meningitis. The condition may cause death within hours. Purpura fulminans is a specific feature. Chronic meningococcemia Present as repeated episodes of petechial rash associated with fever joint pain, ahritis and splenomegaly. The main differential diagnosis is acute rheumatic fever. This condition has been associated with complement deficiently and with inadequate sulfonamide therapy. If left untreated chances of progression to meningococcal septicemia are high. Postmeningococcal reactive disease In small propoion of patients, an immune complex disease develops 4-10 days after the onset of meningococcal disease with manifestations that include a maculopapular or vasculitic rash, ahritis, pericarditis and/or polyserosites associated with fever.

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The most impoant cells in type I hypersensitivity

Ans. is 'b' i.e., Mast cells Type I hypersensitivity (Immediate hypersensitivity) o It is a rapidly developing immunological reaction occuring within minutes after the combination of an antigen with antibody bound to mast cells in individuals previously sensitized to the antigen. o Immediate hypersensitivity reactions are mediated by Ig E, but T and B cells play impoant role in the development of these antibodies. o Type I reaction requires prior sensitization to a specific antigen (allergen). o Most exposures occur either by inhalation (respiratory route) or ingestion (GIT) of antigen. o Type one hypersensitivity has two phases :- 1.Initial response o After first antigen exposure, this antigen is presented to CD-4 helper T cells (TH2 type) by antigen presenting cells. These primed TH2 cells release IL-4 that acts on B-cells to form Ig E specific for that paicular antigen. The antigen specific lg E antibodies then bind to the surface receptors of mast cells and basophils. The process from first antigen exposure to the coating of mast cells by Ig E acts as sensitization (prior sensitization) and first exposure is also called priming or sensitizing exposure (dose). Subsequent exposure (shocking dose) to same antigen then result in activation of mast cells and basophils with release of mediator from these cells that leads to ? Smooth muscle spasm Increase mucus secretion from the epithelial cells. Vasodilatation Increased vascular permeability Recuritment of inflammatory cells Note - Most of the clinical effects are due to smooth muscle spasm. 2. Late phase response In this phase additional leukocytes are recruited. These cells amplify and sustain the inflammatory response without additional exposure to the triggred antigen. Among the cells that are recruited in the late-phase reaction, eosinophils are paicularly impoant. Eosinophils produce major basic protein and eosinophilic cataionic protein that are toxic to epithelial cells. Platelet activating factor (PAF) recruits and activates inflammatory cells and is most impoant cytokine in the initatiation of late phase response. Type I hypersensitivity occurs in two forms Anaphylaxis --> Acute, potentially fatal, systemic. Atom --> Chronic, Nonfatal, Lacalized. Remember o Mast cells are the most impoant cells in type I hypersensitivity. o Eosinophils are the most impoant cells in the late phase reaction of type I hypersensitivity. o Histamine is the most impoant mediator in type I hypersensitivity. o IL-4 is paicularly impoant, it is essential for turning on IgE secreting B cells. o PAF is the most impoant cytokine in the initiation of late phase reaction. o Most potent eosinophilic activating cytokine is IL-5.

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Atrial fibrillation may occur in all the following conditions, except-

Answer is B (Hypothroidism) Atrial Fibrillation is associated with hypehyroidism and not hypothyroidism Impoant causes of Atrial Fibrillation Cardiovascular causes of Atrial Fibrillation Rheumatic Hea disease (Includes mitral stenosis and mitral regurgitation) Non Rheumatic Mitral valve disease Chronic Hypeension Cardiomyopathy Myocarditis Pericarditis Congenital Hea Disease (eg ASD) Coronary Hea Disease Other Systemic Causes of AF Hypehroidism Pulmonary embolism Hypoxia Excess consumption of alcohol (Also alcohol withdraw) Excess consumption of Caffeine May be seen in normal individuals Paicularly during emotional stress or following surgery, exercise or prominent surge of vagal tone (vasovagal response) AF often develops in patients with hea or lung disease who develop hypoxia, hypercapria or metabolic or hemodynamic derangements Holiday Hea Syndrome: In predisposed individuals, AF may be precipitated by consumption of even small amounts of alcohol. This is called Holiday Syndrome and is usually transient and self limited

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High Glycemic index is defined as value more than?

High Glycemic index foods have values of 70 or greater and include baked potato, white bread and white rice. Low Glycemic index foods have values of 55 or lesser and include multi grain breads, pasta, legumes.

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Threshold of hearing in a young normal adult is ?

Ans. is'a'i.e.,0 dBAudiometric zeroThreshold of hearing, i.e. The faintest intensity which a normal healthy person can hear will vary from person to person.The International Standards Organisation (ISO) adopted a standard for this, which is represented as the zero level on the audiometer (0 dB).According to ISO, audiometric zero is the mean value of minimal audible intensity in a group of normally hearing healthy young adults.

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A 4 years old child suffered from a fall on outstretched hand. X rays revealed a fracture with the fracture line at the physes with a small metaphyseal fragment. There was no epiphyseal fracture. What type of injury by Salter harris Classification is this?

(Refer: Mohindra’s Fundamentals of Orthopedics, 2nd edition, pg no. 510) Type II: the fracture involves the physis and a triangle of metaphyseal bone (Thurston Holland sign).  This is the commonest type of epiphyseal injury accounting for 73 percent of cases over 10 years of age.

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Positive hepatojugular reflux is found in all of the following conditions except -

Ans. is 'c' i.e., Associated with decreased afterload [Ref: CMDT 2007p. 318; British Medical Journal May 1999\ Hepatojugular refluxThis is done by applying firm pressure with the palm of the hand to the right upper quadrant of the abdomen for 10- 30 seconds with the patients breathing quietly while the jugular vein is observed.In normal subjects (Negative hepatojugular reflux)Jugular venous pressure rises only transiently with rapid return to the baseline.Positive hepatojugular reflux (Left ventricular failure Q)A positive abdominojugular reflux sign is defined by an increase in the jugular venous pressure of greater than 3 cm, sustained for greater than 15 seconds.ExplanationPushing on the liver (or even midabdomen) for about 15 seconds increases the amount of blood returned to the right atrium and right ventricle (increased preload).Concurrently, there is increase in right ventricle afterload, owing to upward movement of the diaphragm which reduces intrathoracic volumes. (Pulmonary artery pressure is increased due to reduced intrathoracic volumes). (Leading to increased right ventricle afterload)In a normal person the jugular venous pressure would rise temporarily and then normalize quickly as the healthy right ventricle pumps out the additional blood i.e. it handles the increase in preload and afterload quite well.A dysfunctioning right ventricle however fails to accept this increase in preload and afterload and therefore there is persistent elevation of systemic venous pressure.The abdominojugular reflux is not specific to any disorder but rather is a reflection of the inability of the right ventricle to accept or reject the transiently increased venous return."Positive abdominojugular reflux is most commonly associated with left ventricular failure".In the absence of left heart failure a positive abdominal jugular reflex sign should prompt consideration of :-Impaired right ventricular preloadA Decrease in right ventricular compliance.A decrease in right ventricular systolic function orAn elevation in right ventricular afterload.Conditions associated with abdominojugular reflux -Left ventricular failure Q (MC)Right heart failure QConstrictive pericarditis QRight ventricular infarction QRestrictive cardiomyopathy QNote - Both pulmonary stenosis and tricuspid regurgitation cause right heart failure.

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A neurodevelopmental disorder which is characterized by impaired social interaction, impaired verbal and nonverbal communication, and restricted and repetitive behavior is description for:

Autistic disorder (childhood autism) Social deficits. Examples include babies who don't like being held, and also reduced eye contact, unusual facial expressions, lack of gestures, poor understanding of others' feelings, lack of empathy, and few peer relationships. Communication deficits. Speech in autistic children shows wide variety; it may be completely absent (30 per cent), or merely show unusual or asocial qualities. Common abnormalities of speech include echolalia, odd prosody and pronoun reversal. These children have difficulty in two-way conversations, and some ask a string of questions instead. Restricted/repetitive interests and behaviors. Autistic children often show a deep interest in things others regard as very mundane; for example, washing machines or license plates.

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Adrenal aldosteronoma is best diagnosed by -

Ans is option 1 HRCT The usual screening test is to measure the serum potassium level. If it is low, diagnostic tests are done including measuring blood and urinary aldosterone levels and blood renin levels. In Conn's syndrome, the aldosterone is elevated and the renin is suppressed. If these tests are diagnostic then imaging studies are done to see if a tumor can be localized. Since these tumors are small they can be hard to find even with the best CT or CT with contrast or MRI scan. Some patients may have no obvious radiographic tumor but one adrenal is affected (unilateral primary adrenal hyperplasia) and they can benefit from surgical removal. Other patients may have both adrenals affected with no visible tumor (idiopathic hyperaldosteronism) and surgery will not help. In these situations blood has to be drawn from each adrenal vein (so called adrenal venous sampling) in order to measure aldosterone levels to be sure which adrenal has the tumor. The symptoms of hyperaldosteronism may resemble other conditions or medical problems. Always consult your physician for a diagnosis. the diagnostic procedures for aldosteronoma may include: Blood and urine tests to measure potassium and hormone levels Computed tomography (CT or CAT scan) or magnetic resonance imaging (MRI) - are non-invasive procedures that take cross-sectional images of the adrenal or other internal organs; to detect any abnormalities that may not show up on an ordinary x-ray Adrenal venous sampling- an invasive test performed by a radiologist where a catheter is placed in the adrenal veins to measure the hormone level and confirms the tumor location. Ref Harrison 17/e p2260 , Semantischolar.org

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A 70 year old male chronic smoker is diagnosed of having cancer of the urinary bladder. It is confined to the trigone and extention is upto the submucosa. The management would be

Answer- B. Complete transurethral resection with intravesical chemotherapyTreatment-T1Complete TUR followed by intravesical chemo- or immunotherapy or radical cystectomy

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Weakness of extensor Hallucis longus is due to which nerve root mainly?

Ans. is 'a' i.e., L5 Important muscles and their chief myotomesMuscleMyotomeExtensor Hallucis LongusL5Tibialis anteriorL4Flexor Hallucis LongusS1GastrosoleusS1Gluteus Medius and MinimusL5Gluteus MaximusS1Quadriceps FemorisL3

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Which of the following is not branch of the basilar aery ?

Posterior communicating aery is a branch of internal carotid aery. The other branches of basilar aery are: Superior cerebellar aery Posterior cerebral aeries . The branches of cerebral pa of internal carotid aery are: Ophthalmic aery Anterior cerebral aery Middle cerebral aery Posterior communicating aery Anterior choroidal aery . imageref - Vishram singh 2e pg 174

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In ACLS which drug can be given following ventricular fibrillation after cardiac arrest other than epinephrine?

V-Fib or VF is the most common rhythm that occurs immediately after cardiac arrest. In this rhythm, the hea beats with rapid, erratic electrical impulses. Treatment: * Shock / Defibrillation: every 2 minutes in a single one shock, successive, shockable increments * 200 joules - Followed by immediate CPR for 2 minutes / give and circulate a drug(s) * 300 joules - Followed by immediate CPR for 2 minutes / give and circulate a drug(s) * 360 joules - Followed by immediate CPR for 2 minutes / give and circulate a drug(s) * Drugs : * Give Epinephrine 1mg of a 1:10,000 solu,on every 3 to 5 minutes * Give either: * Amiodarone : 300mg first dose / 150mg second dose at 3 to 5 minutes increments. Lidocaine: First dose: 1mg/kg or 1.5 mg/kg. Can repeat it at half the original dose up to a total of 3 mg/kg REF : BAILEY AND LOVE 27TH ED

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Gas gangrene is due to

The alpha-toxin is produced by all types of Clostridium perfringens and most abundantly by type A strains. This is the most impoant toxin biologically and is responsible for the profound toxemia of gas gangrene. It is lethal, dermonecrotic and hemolytic. It is phospholipids which, in the presence of calcium and magnesium ions, splits lecithin into phosphorylcholine and diglyceride. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 259

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Which drug causes osteoporosis on long-term use

Ans. is 'c' i.e., GnRH analogues Drugs causing osteoporosis : o Glucocoicoids o Cytotoxic drugs o Excessive alcohol intake o Excessive thyroxine o Heparin o Cyclosporine o Anticonvulsants o Aluminum o GnRH agonist o Lithium

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Fletcher's medium containing Rabbit serum is used for ?

Ans. is 'c' i.e., Leptospira Media for the culture of leptospirae usually contain either rabbit serum (Flatcher medium, stua broth) or bovine serum albumin (EMJH medium plus long - chain fatty acids and vitamins (B1 & B12).

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A blood stained discharge from the nipple indicates -

"Bloody discharge is more suggestive of cancer but is usually caused by a benign papilloma in the duct." - CSDT "Intraductal papilloma is the most common cause of bloody nipple discharge." — Schwartz 7/e p 553 Also, remember Nipple discharge is suggestive of cancer if it is spontaneous, unilateral, localized to a single duct, occurs in women age 40 years or more, is bloody, or is associated with a mass. Nipple discharge is suggestive of a benign condition if it is bilateral or multiductal in origin, occurs in women age 39 years or less, or is milky or blue-green in colour.

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The following separation technique depends on the molecular size of the protein

Answer is C Size-exclusion--or gel filtration--chromatography separates proteins based on their Stokes radius, the radius of the sphere they occupy as they tumble in a solution. The stokes radius is a function of molecular mass and shape. When rapidly tumbling, an elongated protein occupies a larger effective volume than a spherical protein of the same mass. Size-exclusion chromatography employs porous beads. Ref: Harper's Illustrated Biochemistry, 30E (2015) Pg No 27. in Ion Exchanege chromatography ,Cation-exchange solid phases contain covalently bound, negatively charged functional groups. Examples include strongly acidic groups, such as sulfonate ions, or weakly acidic groups, such as carboxyl or carboxymethyl . Immobilized enzymes have been chemically bonded to adsorbents, such as (1) microcrystalline cellulose,(2) diethylaminoethyl (DEAE) cellulose, (3) carboxymethyl cellulose, and (4) agarose. Ref: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, 5E Pg no 308 and 375 Iso Electric focussing is based on electric field and pH. Ionic buffers called ampholytes and an applied electric field are used to generate a pH gradient within a polyacrylamide matrix. Applied proteins migrate until they reach the region of the matrix where the pH matches their isoelectric point (pI). Ref: Harper's Illustrated Biochemistry, 30E (2015) Pg No 29.

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Stimulation of which of the following nerves cause improvement in mood?

2 Advanced treatment options for depression: Vagus Nerve Stimulation: A number of clinical studies have shown that vagus nerve stimulation (VNS) has antidepressant effects in patients with depression resistant to four or more treatments. Improvement with VNS result in enhanced neurocognitive function in many patients. VNS appears to be most effective in patients with low to moderate antidepressant resistance. Response rates usually range from 30-40%, and long-term VNS treatment appears to be associated with sustained symptomatic improvement. VNS is also known to improve mood in depressed patients with epilepsy. Transcranial Magnetic Stimulation: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive and easily tolerated method of altering coical physiology. Clinical studies suppo an antidepressant effect of high-frequency rTMS administered to the left PFC; however, antidepressive efficacy is not consistent, and where efficacy is demonstrated, degree of clinical improvement appears to be small. The absence of psychosis, and younger age may be predictors of treatment success. Low frequency TMS to the right PFC also has shown promise. Repetitive TMS may be useful in augmenting or hastening the response of antidepressant drugs in patients with major depressive disorder. Ref: Loosen P.T., Shelton R.C. (2008). Chapter 18. Mood Disorders. In M.H. Ebe, P.T. Loosen, B. Nurcombe, J.F. Leckman (Eds), CURRENT Diagnosis & Treatment: Psychiatry, 2e.

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Not true about experimental study

Experimental epidemiology meant the study of epidemics among colonies of experimental animals such as rats and mice ( refer pg: 80, park 23 rd edition)

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All of the following are used to assess the nutritional status of an individual, except -

Serum immunoglobulin is not a measure to assess the nutritional status. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 586

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Transesophageal echocardiogram (TEE) is preferred to Trans-thoracic echocardiogram (TTE) in:

Answer is D (Evaluation of Left Atrial Appendage Thrombi) Trans-esophageal echocardiogram (TEE) is preferred to Trans-thoracic echocardiogram (TTE) for smaller, atrial and posterior masses such as the Left Atrial Appendage Thrombi. TTE is the standard test for the noninvasive evaluation of pericardial disease. Identification of vegetations on tricuspid valves is no better overall by TEE than by TEE (as the tricuspid valve is equidistant from the chest wall and the esophagus). Very anterior masses, Such as left ventricular apical thrombi, are equally well and, far more easily imaged by TTE. Trans-esophageal echocardiogram (TEE) vs. Trans-thoracic echocardiogram (TTE) Trans-esophageal Echocardiography (TEE) is generally more sensitive than Trans-thoracic Echocardiography (TTE) and provides a unique window for high resolution imaging of posterior structures of the hea paicularly the left atrium, mitral valve and aoa. TEE is however an invasive and more expensive procedure and hence its indications must be weighed against these factors and TTE remains the initial investigation of choice for most situations. However if a high clinical index of suspicion remains after a negative or non-diagnostic transthoracic study, Trans-esophageal echocardiography should be considered. Situations in which Trans-esophageal echocardiography should be performed as the initial test of choice include Those patients in whom image quality on chest wall imaging is unacceptable. Those with prosthetic valves, and Those in whom complications such as abscess formation are suspected on clinical rounds.

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Child with h/o hypopigmented macule on back, infantile spasm and delayed milestone has

C i.e. Tuberous sclerosis

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Diuretic causing impaired glucose tolerance is ?

Ans. is'd'i.e., ThiazideRef KDT &/e p. 567; Katung If le p. 261Diuretics causing hyperglycemia are loop diuretics (furosemide) and thiazide diuretics.

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Causes of community-acquired native valve endocarditis are

Streptococcus viridans is a group which normally resides in the mouth and upper respiratory tract and is alpha hemolytic. In persons with pre-existing cardiac lesions, they may cause bacterial endocarditis, Streptococcus sanguis being most often responsible. Following tooth extraction or dental procedures, they cause transient bacteremia and get implanted on damaged or prosthetic valves or in congenitally diseased hea and grow to form vegetation. Streptococcus mutans is also a member of viridans group which causes endocarditis in individuals with risk factors ( dental extraction in people with damaged valves). Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 220

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Which of the following is the mechanism of action of methyl dopa?

So, both the Methyl dopa & clonidine are used as Anti- hypeensive drugs. KEY POINTS ABOUT METHYL DOPA It's a prodrug DOC in pregnancy induced hypeension (but if both Labetalol and Methyl dopa are given in option mark Labetalol as the drug of choice S/E of Methyl Dopa - Hemolytic Anemia

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Rickettsial pox is caused by ?

Rickettsial pox caused by R.akari Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 316

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Elements of primary health care include all except:

Elements of Primary Health Care:  E - Health Education (health problem & control).  L - Locally Endemic disease (prevention & control).  E - Essential drugs.  M - MCH (Maternal & Child Health) including FP.  E - EPI (Immunization against 6 Vaccine Preventable Diseases).  N - Nutrition/ food supply.  T - Treatment of common illness & injury.  S - Safe water supply & Sanitation.

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A newborn presenting with intestinal obstruction showed on abdominal X-ray, multiple air fluid levels. The diagnosis is not likely to be -

Ans- A Question ask -The diagnosis is not likely to be

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Both hepatic and renal failures can be

D i.e. All Both hepatic and renal failure can be caused by Paracetamol, Carbon tetrachloride, Arsenic, CuSO4, & Mushroom poisoningQ

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In which type of poisonings is gastric lavage contraindicated?

Ans. C. Corrosive acid poisoningGastric Lavage is contraindicated when patients havea. Corrosive substance poisoningb. Convulsion (strychnine, tetanus)c. Comad. Volatile poisons (kerosene)e. Hypothermiaf. patients at risk of gastrointestinal hemorrhage or perforation.g. aluminum phosphide poisoning

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True about atopic dermatitis are all except -

Mica like scales are characteristic of pityriasis lichenoidis chronica(PLC) Pruritus,scratching and Xe rosins are the features of atopic dermatitis. Ref Harrison20th edition pg 2341

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A disease that produces decreased inhibitory input to the internal segment of the globus pallidus should have what effect on the motor area of the cerebral coex

The decrease in inhibition of globus pallidus internus will make its signals more strong.Globus pallidus internus inhibits thalamus. so inhibition of thalamus increases.Thalamus have an excitatory effect on motor coex, this signal is decreased as thalamus is inhibited.

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Kernicterus is invariably associated with

Inherited Unconjugated HyperbilirubinemiaCrigler Najjar Type - 1 Crigler Najjar Type - 2Persistence of unconjugated bilirubin > 20mg/dl after 1st week in the absence of hemolysis suggests CN-1.KERNICTERUS -usual UDPGT activity reduced.Autosomal recessive.Rx - Phototherapy.Heme oxygenase inhibition by metalloporphyrin therapy.Cure - ohotropic liver transplantation.Can be differentiated from CN1 by marked decrease in serum bilirubin with phenobarbitone.KERNICTERUS -unusual.Inducible phenobarbitone response on UGTA1 promoter.Orlistat intestinal lipase inhibitor reduces bilirubin in both CN-1 & CN -2Inherited Conjugated HyperbilirubinemiaDubin Johnson syndrome Rotor syndrome Absent MRP2 protein - multiple drug resistant protein is responsible defectCholangiography fails to visualize gall bladderTotal urinary coproporphyrin is normal||| coproporphyrin 1 excretion||| coproporphyrin 3 excretionX ray -Gall bladder abnormalLiver histology-Black pigment.Additional deficiency of organic anion uptakeTotal urinary coproporphyrin is increasedX ray gall bladder - normalNo black pigment(Refer: Nelson's Textbook of Paediatrics, 19thedition, pg no:604)

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The most appropriate technique for mammography is:

Ans. (b) Medio lateral oblique viewRef: Harrison 19th ed. / 525There are numerous mammography views that can broadly be split into two groups* Standard views- Medio-Lateral, Medio-lateral oblique, Craniocaudal* Supplementary views - Additional information or problem solving# The mediolateral oblique (MLO) view is one of standard mammographic views. It is the most important projection as it allows to depict most breast tissue.# The Mediolateral view loses significant tissue volume in the upper outer quadrant of the breast where statistically the most breast cancers are found. By doing an MLO view you get extra tissue without extra exposure.

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In microcornea, diameter of cornea is less than:

Ans. 10 mm

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A 3-week-female infant is brought for ambiguous genitalia and hyperpigmentation of skin. She has hyponatremia and hyperkalemia. Which one of the following is the most likely diagnosis?

a. 21 hydroxylase deficiency(Ref: Nelson's 20/e p 2227-2729, Ghai 8/e p 525)The given clinical scenario of ambiguous genitalia, hyperpigmentation and electrolyte disturbances suggest a diagnosis of CAH due to 21 hydroxylase deficiency.Features Seen in Adrenal Enzyme Deficiency17-a-hydroxylase11-b hydroxylase21 hydroxylase and 3b-HSDSalt retention and hypertensionFeminization of maleSalt retention and hypertensionVirilization of femalePrecocious puberty in maleSalt losingVirilization of femalePrecocious puberty in male

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Death of a person due to compressing of neck by another person is:

Ans. b (Throttling). (Ref. Textbook of FMT by Parikh 6th ed. 3.53)Throttlingis defined as a form of strangulation effected by hand, and is therefore often called manual strangulation.Mugging (choke-hold)When strangulation is effected by compressing the victim's neck against forearm.GarrotingVictim is attacked from back without warning and strangulated by throwing ligature over the neck and tightening it quickly. It was the mode of execution in Spain, Portugal and Turkey.BansdolaNeck is compressed between two sticks or hard objects, usually bamboo, one being placed across the throat in front and another behind. It is practiced in north India.

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Infection with herpes simplex virus, a common human pathogen, is best described by which of the following statements?

The initial infection by herpes simplex virus is often inapparent and occurs through a break in the skin or mucous membranes, such as in the eye, throat, or genitals. Latent infection often persists at the initial site despite high antibody titers. Recurrent disease can be triggered by temperature change, emotional distress, and hormonal factors. Type 1 herpes simplex virus is usually, but not exclusively, associated with ocular and oral lesions; type 2 is usually, but not exclusively, associated with genital and anal lesions. Type 2 infection is more common. In addition to mucocutaneous infections, the CNS and occasionally visceral organs can be involved.

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Increase is Pauwel's angle indicate -

*The more the angle, the more unstable is the fracture, and worse the prognosis. Ref: Maheshwari 9th/e p.132,133& 4th/e p.129

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Investigation of choice of diphtheria carrier is -

Ans. is 'a' i.e., Throat Swab Culture Carriers can be detected only by cultural methods --> Swabs are taken from nose and throat and it is examined by cultural methods for Diphtheria bacilli

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Ergot alkaloid commonly used to prevent postpartum hemorrhage is :

Methylergometrine (methergine) is administered during delivery of anterior shoulder to prevent postpartum hemorrhage.

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True about hyperkalemia -

Classically, the electrocardiographic manifestations in hyperkalemia progress from tall peaked T waves (5.5-6.5 mM), to a loss of P waves (6.5-7.5 mM) to a widened QRS complex (7.0-8.0 mM), and, ultimately, a to a sine wave pattern (>8.0 mM). However, these changes are notoriously insensitive, paicularly in patients with chronic kidney disease or end-stage renal disease. ( ref: harrisons principles of internal medicine, 19E page 310)

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With couinaud's segment nomenclature, which one the following segments of liver has an independent vascularization

Segment I is the caudate lobe and is situated posterior l and it may receive its supply from both the right and the left branches of poal vein. It contains one or more hepatic veins which drain directly into the IVC Ref: Sabiston 20th edition Pgno : 1422

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The mechanism of action of surfactant is

Ans. is 'd' i.e. Breaks the structure of water in the alveoli The water molecules on the surface of water (at air-water interphase) have an especially strong attraction for one another. This results in the water surface to contract producing surface tension.Thus the water molecules lining the alveoli produce an elastic contractile force due to surface tension which causes the alveoli to collapse.This surface tension force of water molecules is broken by surfactant (a mixture of phospholipids, proteins and ions, most important phospholipid of which is dipalmitoylphosphatidyl-choline-DPCC). It is secreted by type II alveolar epithelial cells and lines the alveoli.The phospholipid molecules have a hydrophilic head and two parallel hydrophobic 'tails'. Thus only head part of the molecule dissolves in the fluid lining the alveolar surface and the hydrophobic tails face the alveolar lumen. This new surface thus formed of the surfactant has a significantly reduced surface tension than the water molecules.By reducing the surface tension, surfactant serves two purposes:Prevents the alveoli from collapsingPrevents pulmonary edema.

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Cell lining of common bile duct is :

Ans. 4. Simple columnar > 3. Simple cuboidal Cell lining of common bile duct is simple columnar epithelium, it may be cuboidal at the proximal region. The Intrahepatic ducts, cystic duct, and the common bile duct are lined by tall columnar epithelium. Ducts are usually lined by simple cuboidal epithelium, which differentiates to form the secretory and duct poions of glands. Stratified cuboidal epithelium protects areas such as the ducts of sweat glands, mammary glands, and salivary glands. At locations like common bile duct, the ducts may be lined by columnar epithelium.

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In tetany the increased membrane excitability is caused by:

Membrane excitability is related to the ease with which depolarization opens Na+ channels. The opening of the Na+ channel in response to depolarization is, in pa, related to the extracellular Ca2+ concentration; the lower the extracellular Ca2+ concentration, the easier it is for Na + channels to open when the membrane depolarizes. Hyperventilation (lowering aerial CO2 tension) decreases extracellular Ca+ concentration by increasing aerial pH. When pH rises, H+ is released from plasma proteins in exchange for Ca and ionized Ca+ concentration decreases.

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Which of the following is true regarding cardiac MRI

Ans. is 'b' i.e., Viable myocardium can be differentiated from infarcted myocardium.Infarcted myocardium appears hypointense on T1-MRI and hyperintense on T2-MRIViable myocardium can be easily differentiated from infarcted tissue.Prosthetic hea valves are a relative contraindications for MRI.Multislice CT is a better modality than cardiac MRI for the non invasive assessment of coronary aeries.

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Day light factor in living room should he?

Ans. is 'a' i.e., 8%

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Cathelicidins are rich in which of the following amino acid?

Microbial killing can also occur through the action of other substances in leukocyte granules. Cationic arginine-rich granule peptides that are toxic to microbes; cathelicidins is present in leukocyte granules. Ref: Robbins 8th edition, Chapter 2.

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Neonate triangular cord sign on USG is seen in –

Triangular cord sign is seen in biliary ateria due to fibrosis.

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Peyronie's disease affects the -

Ans. is 'd' i.e., Penis

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A 67-year-old man with an 18-year history of type 2 diabetes mellitus presents for a routine physical examination. His temperature is 36.9 C (98.5 F), his blood pressure is 158/98 mm Hg and his pulse is 82/minute and regular. On examination, the physician notes a non tender, pulsatile, mass in the mid-abdomen. A plain abdominal x-ray film with the patient in the lateral position reveals spotty calcification of a markedly dilated abdominal aoic walI. Which of the following physiologic observations helps to account for the fact that 75% of the aneurysms of this patient's type are found in the abdomen and only 25% principally involve the thorax?

Increased blood pressure is a strong risk factor for atherosclerosis, and humans pay a price for their erect sitting and standing postures. In these postures, the abdominal aoa experiences the weight of a column of blood added to the pressure produced by the hea. In the supine posture, the pressures in the thoracic and abdominal aoa are similar. So, if an average daily pressure is taken, the abdominal aoa tends to have a significantly higher pressure than does the thoracic aoa. Diastolic pressure is actually greater in the thoracic aoa compared to the abdominal aoa in the supine position. However, the systolic blood pressure is greater in the abdominal aoa. A negative intrathoracic pressure would tend to increase transmural pressure across the wall of the thoracic aoa, and thereby increase wall tension and promote the development of aneurysms. Blood flow in the abdominal aoa is less than that in the thoracic aoa, because some blood leaves the aoa through its thoracic branches. Ref: Creager M.A., Loscalzo J. (2012). Chapter 248. Diseases of the Aoa. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds),Harrison's Principles of Internal Medicine, 18e.

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Most important from of carbon-dioxide transport in the blood

The route by which most of the carbon dioxide is carried in the bloodstream. Once dissolved in the blood plasma, carbon dioxide combines with water to form carbonic acid, which immediately ionizes into hydrogen and bicarbonate ions. The bicarbonate ions serve as part of the alkaline reserve.

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A 45 year old comes with symptoms of septic ahritis. What will be the most common cause in this patient?

Staphylococcus aureus is the most common (about 90%) organism isolated in septic ahritis in adults. In neonates joint sepsis is caused by S. aureus with group B streptococci being the next most common. In young children aged 2 months to 2 years, S. aureus, Streptococcus and Haemophilus influenza in an decreasing order. In young adults, S. aureus and N. gonorrhoeae are the most common organisms causing joint sepsis. In elderly people, S.aureus causes infection. Gram negative septic ahritis may occur in patients with sickle cell anemia.

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Which of the following therapeutic index (T.I.) values represent the greatest safety profile for a drug?

Although factors such as idiosyncratic reactions or allergic reactions can contribute to the overall safety profile of a drug, the therapeutic index gives a reliable indication of the drugs safety margin if other considerations are assumed to be equal. The therapeutic index represents the ratio between the median lethal dose (LD50) and the median effective dose ( ED50) of a drug. This calculation of LD50/ DD50 generates an index that is the therapeutic window between the dose that produces the desired effect and the dose that results in toxic effects. Like all indices, the T.I. is dimensionless since the dose units, usually express in "mg-kg ", cancel each other. The therapeutic index conveniently represents the safety merger of a drug. The greater the therapeutic ratio, or spread, between the ED50 and LD50, the greater the drug safety. Therefore a T.I. of one thousand represents a drug with a far greater safety profile than a drug with a T.I. of two. Ref: Von Zastrow M. (2012). Chapter 2. Drug Receptors & Pharmacodynamics. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical Pharmacology, 12e.

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Mechanism of analgesia is by

The degree to which a person reacts to pain varies tremendously. This variation results paly from a capability of the brain itself to suppress input of pain signals to thenervous system by activating a pain control system called an analgesia system. The analgesia system consists of three major components: (1) The periaqueductal gray and periventricular areas of the mesencephalon and upper pons surround the aqueduct of Sylvius and poions of the third and fouh ventricles. Neurons from these areas send signals to (2) the raphe magnus nucleus, a thin midline nucleus located in the lower pons and upper medulla, and the nucleus reticularis paragigantocellularis, located laterally in the medulla. From these nuclei, second-order signals are transmitted down the dorsolateral columns in the spinal cord to (3) a pain inhibitory complex located in the dorsal horns of the spinal cord. At this point, the analgesia signals can block the pain before it is relayed to the brain. Ref: guyton and hall textbook of medical physiology 12 edition page number:698,699,700

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Investigation of choice in a pregnant lady at 16 weeks of pregnancy with past H/0 delivering a baby with Downs syndrome:

Dual marker and Triple marker tests are screening tests and since the patient here already has a past history of Downs syndrome fetus, she is at an increased risk of having an aneuploid fetus again, so it is advisable to undergo a diagnostic procedure rather than a screening test. Fetal chromosomes can be assessed only on amniocentesis and chorionic villous sampling But CVS is best done between 10 to 13 weeks of gestation and amniocentesis is best done between 16 to 18 weeks of pregnancy

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Collection duct has which cells

Ans. (a) Principal and intercalated(Ref: Ganong, 25th ed/p.672)Colleting duct is made up of two types of cell: principal cells (P cells) and intercalated cells (I cells)

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In a population of 200 people with normal distribution. How many people would be included in 1 SD

Ans. a. 136

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If the prevalence of a disease in a population increases, the predictive value of a positive test ?

Ans. is 'a' i.e., Increases

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Which of the following is TRUE differential cause of referred otalgia?

Otalgia can occur as a symptom of carcinoma on the base of tongue, pharynx or larynx. Ear receives nerve supply from 4 cranial nerves such as trigeminal, facial, glossopharyngeal and vagus; and from two branches of cervical plexus called C2 (lesser occipital) and C2 and C3 (greater auricular), pain maybe referred from these remote areas. Facial nerve refers pain to the external ear canal and post auricular region. Second and third cervical nerves refer pain to the postauricular and mastoid regions. Trigeminal referred otalgia arise from lesions involving the oral cavity and floor of mouth, teeth, mandible, temporomandibular joint, palate and pre auricular skin. Glossopharyngeal referred otalgia arise from the tonsil, base of the tongue, soft palate, nasopharynx, Eustachian tube and pharynx. Vagal referred otalgia arise from the hypopharynx, larynx and trachea. Differential causes of referred otalgia includes migraine, TMJ syndrome, cervical myalgia, fibromyalgia, dental abscess, head and neck malignancy (neoplasm of nasopharynx, sinus, tonsil, base of tongue, hypopharynx), temporal aeritis, inflammatory sinusitis, carotidynia, trigeminal neuralgia, glossopharyngeal neuralgia and GERD.

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Child with generalized petechiae. CSF shows gram negative diplococci. Treatment

Most patients (70-80%) presenting with fever and petechiae have defined or presumed viral infections, which are often caused by enteroviruses or adenovirus. Parvovirus B19 may also be responsible for many cases of fever and generalized petechiae inchildren. Reference: GHAI Essential pediatrics, 8th edition

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An elderly couple living in a very cold apament turned on the oven, opened the oven door, and went to sleep. The next morning, the neighbors found the couple dead. The direct mechanism by which death was caused most likely involves which of the following?

The scenario described in the question stem is unfounately not at all uncommon. The open oven door is a tip-off that carbon monoxide was involved. Carbon monoxide has a very high affinity for hemoglobin, and binds, nearly irreversibly, to it in such a manner that oxygen cannot bind, drastically decreasing the oxygen-carrying capacity of the blood. Carbon monoxide also causes the oxygen-hemoglobin dissociation curve to shift to the left, making oxygen more difficult to unload. Traditionally, patients with carbon monoxide poisoning have been described as having "cherry red" blood and, consequently, skin, but this change is somewhat unreliable in real life. The 1st and 3rd Choices list secondary changes that are commonly observed in injured cells, no matter what the cause of the injury. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 32. Cardiovascular Regulatory Mechanisms. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.

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Cholinesterase is seen in venom of: DNB 08

Ans. Elapids

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The following are the components of apgar score except

*Apgar score is an objective method of evaluating the newborn&;s condition. It includes Hea rate, Respiratory effo, Muscle tone, Reflex irritability and Color. *It is generally performed at 1min and again at 5 min after bih. Reference : page 127 Ghai Essential Pediatrics 9 th edition

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Anaesthetic agent causing hallucination is

Ans. is 'a' i.e. Ketamine Ketamine is an analogue of phencyclidine and therefore it causes hallucinations.Facts you must always remember about Ketamine.It causes Dissociative Anaesthesia *It causes sympathetic stimulation which leads to* Cardiac stimulation-increase O2 demand** Bronchodilation-it is anaesthetic of choice for Bronchial Asthma* Increase all pressure*-B.P. I.C.T. I.O.P.* It causes muscular rigidity* It increases salivation so Atropine is always given with it*

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When is surgery not done in cases of Ulcerative Colitis?

Surgical indications for ulcerative colitis: Urgent Non-urgent: Fulminant colitis Toxic megacolon Perforation Massive hemorrhage Acute colonic obstruction Colon cancer Medically refractory disease Unacceptable medication related toxicity Dysplasia Suspected ca Ulcerative colitis Crohn's disease MC pa involved is Rectum(colon) MC is terminal ileum (mouth to anus) Hallmark is pseudo polyp Fistula More prone for malignancy Less prone that ulcerative colitis Mucosa and submucosa involved Transmural involvement Complications: Hemorrhage Toxic megacolon Fistula Abscess Obstruction Perforation Lead pipe colon String of Kantor Surgery can be done DOC is sulphasalazine Surgery is of no use DOC is sulphasalazine

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In contrast to heparin, enoxaparin:

Enoxaprin is a LMW heparin. It does not require monitoring. Both heparin as well as enoxaprin do not cross placenta and are not teratogenic.

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Cigar body is seen in -

Cigar shaped yeast cells are seen in sporothrix schenkii which is a dimorphic fungus. at 37 degree C - it is yeast at 25 degree C - it is mold Flower like sporulation appearance is seen in mould form of the sporothrix Sporotrichosis ( Rose gardener's disease)

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Ultrasound frequency used for diagnostic purposes in obstetrics :

A i.e. 1-20 MHz

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Disseminated intravascular coagulation is present in all except -

Ans: A

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What is ligament of lockwood related to

Ans. (c) OrbitRef: Khurana Anatomy 2/e, p. 493It is a fascial expansion of the extraocular muscles formed by fusion of sheaths of MR, IR, LR, IO extending from the posterior lacrimal crest to the lateral orbital margin.

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Why is a child abler to breathe and suckle at the same time

High placed larynx A baby can suck milk into mouth and because of its palate its mouth is separated from its nasal cavity so white it is sucking in milk it can also breathe through its nose. When the infant has to swallow the soft palate rapidly moves upward to close off the hack of the nasal air tube. At the same time, the epiglottis closes off the larynx and guides the milk into the esophagus (food tube). Because of these factors infants can breath and swallow in quick succession. - Its lumen is sho and. funnel shaped and dispropoionately narrower than that of adult. - It lies higher in the neck than the adult larynx. -It rest the upper border of the infant epiglottis is at the level of the second or third cervical veebrae. - When larynx is elevated it reaches the level of first cervical veebrae. - This high position enables an infant to use its nasal airway to breathe while sucking.

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Fatty liver with hepatomegaly is seen in:

OPTION B: Metabolic syndrome - Obesity - Fatty liver Option A: Marasmus do not have hepatomegaly rather kwashiorkor will have hepatomegaly Option C: Wilson disease leads to Cirrhosis Option D: Nutmeg liver leads to Cirrhosis Best test for fatty liver = Gamma GGT Alcoholic liver disease + fatty liver - Best Test - SGOT / SGPT Ratio more than 2

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Prognosis for carcinoma rectum is best assessed by -

No effect on Prognosis: Tumor size and duration of symptoms. Tumor size and configuration (endophytic, exophytic, annular) do not carry any prognostic significance in colorectal carcinoma.

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