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Larvae of Ascaris lumbricoidis most commonly causes?

Ans. is 'b' i.e., Respiratory symptoms Clinical manifestations of ascariasis can be divided into two groups :- Due to adult worm : Adult worm causes malnutrition, abdominal pain, anorexia, intestinal obstruction, appendicitis, obstructive jaundice, pancreatitis, intestinal perforation and allergic manifestations. in Due to migrating larva : Loeffler's syndrome (eosinophilic pneumonia).

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Acute adrenal insufficiency can present as

Ans. is 'd' i.e., All of the above Presentation in Acute Adrenal Insufficiency* Acute adrenal insufficiency usually occurs after a prolonged period of nonspecific complaints and is more frequently observed in patients with primary adrenal insufficiency, due to the loss of both glucocorticoid and mineralocorticoid secretion.* Postural hypotension may progress to hypovolemic shock.* Adrenal insufficiency may mimic features of acute abdomen with abdominal tenderness, nausea, vomiting, and fever.* In some cases, the primary presentation may resemble neurologic disease, with decreased responsiveness, progressing to stupor and coma.* An adrenal crisis can be triggered by an intercurrent illness, surgical or other stress, or increased glucocorticoid inactivation (e.g., hyperthyroidism).

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OATP 1B1/2 gene mutation is seen in

OATP 1B1/2 gene mutation - Rotor syndrome ABCCA gene mutation - Dubin johnson syndrome

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Definitive diagnosis of Hirschsprung's disease is done by?

Hirschsprung's disease - is characterised by the absence of ganglionic cells in the distal colon and rectum - it occurs due to the failure of migration of neural crest cells to distal bowel segments - affects cells in both - myenteric and submucosal plexuses - functional obstruction developes in the affected pa. It can be anatomically divided into four types according to the length of the aganglionic segment: sho segment disease: ~75% rectal and distal sigmoid colonic involvement only long segment:~15% typically extends to splenic flexure/transverse colon total colonic aganglionosis:~7.5% (range 2-13%) also known as Zuezler-Wilson syndrome occasional extension of aganglionosis into the small bowel ultrasho segment disease 3-4 cm of internal anal spinchter only controversial entity - Definitive diagnosis :- by rectal biopsy Barium enema demonstrates cone shape transition zone and reversal of rectosigmoid ratio. Most impoant sign on barium enema is a sudden change of caliber from the narrow aganglionic segment and dilated proximal bowel

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Periaicular calcification is seen in -

Ans. is 'b' i.e., Pseudogout Periaicular soft tissue calcification Haematoma Crystal ahropathy (Gout, Pseudogout) Dermatomyositis Tumoral calcinosis Myositis ossificans Scleroderma Synol osteochondromatosis Synol sarcoma

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A patint complains of intermittent claudication,dizziness and headache,likely cardiac lesion is-

Tetralogy of Fallot (TOF) is a cardiac anomaly that refers to a combination of four related hea defects that commonly occur together. The four defects are: Ventricular septal defect (VSD) Tetralogy of Fallot results in low oxygenation of blood. This is due to: Mixing of oxygenated and deoxygenated blood in the left ventricle the ventricular septal defect (VSD) Preferential flow of the mixed blood from both ventricles through the aoa because of the obstruction to flow through the pulmonary valve. This is known as a right-to-left shunt. Infants with TOF -a cyanotic hea disease- have low blood oxygen saturation.Blood oxygenation varies greatly from one patient to another depending on the severity of the anatomic defects.Typical ranges vary from 60% to around 90%.[Depending on the degree of obstruction, symptoms vary from no cyanosis or mild cyanosis to profound cyanosis at bih.If the baby is not cyanotic then it is sometimes referred to as a "pink tet".Other symptoms include a hea murmur which may range from almost imperceptible to very loud, difficulty in feeding, failure to gain weight, retarded growth and physical development, labored breathing (dyspnea) on exeion, clubbing of the fingers and toes, and polycythemiaThe baby may turn blue with breast feeding or crying. Ref Davidson 23rd edition pg 453

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Which is true about Klebsiella infections?

Predisposing factors for Klebsiella .............. Klebsiella and the related Serratia and Enterobacter are the most impoant enteric organisms other than E. coli to infect humans. Although respiratory disease is impoant (Klebsiella accounts for 1 % or less of community-acquired pneumonia), most clinical isolates now come from the urinary tract. All three genera are impoant pulmonary nosocomial pathogens. However, merely finding these organisms growing in the sputum of a very ill hospitalized patient does not necessarily implicate the bacteria as pathogenic in that paicular circumstance and may indicate colonization rather than infection. Clinical context and procurement of the sample in a sterile fashion (transtracheal aspiration, bronchoscopy) will aid in the diagnosis Chronic alcoholics, diabetics, and those with chronic lung disease are at increased risk for Klebsiella pneumonia, a difficult disease to treat because of the frequency of suppurative complications (empyema and abscess) with the associated requirement for prolonged (>2 weeks) therapy.

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Chronic Burrowing ulcer is caused by:

Microaerophilic streptococci ''This type of ulcer is due to symbiotic action of tnicroaerophilic non-haemolytic streptococci and haemolytic staphylococcus aureus" - S. Das Chronic burrowing ulcers or Meleney's ulcers are seen in the post-operative wounds either after the operation for perforated viscus or for drainage of empyema thoracis. Clinicaly it is an undermined ulcer with lot of granulation tissue in the floor. This condition is painful, toxaemic, and the general condition deteriorates without treatment. Textbook of Surgery by ljazAhsan writes -"The microaerophilic streptococcus causes infections that develop slowly. Chronic burrowing ulcer and chronic cutaneous gangrene are good examples. Radical drainage is necessary .for cure, antibiotics alone being useless."

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Drug of choice for neurocysticercosis is:

Out of the two anthelmintics effective in killing cysticerci, albendazole is now preferred over praziquantel for the following reasons: * The course of treatment is shoer (8-15 day) compared to praziquantel (15-30 days). * Cure rates in terms of resolution of symptoms and disappearance of cysts are higher (75-85% with albendazole) than praziquantel (50-60%). * Coicosteroids (which have to be given concurrently) enhance the absorption of albendazole, but lower the blood levels of praziquantel. * Albendazole is cheaper. ESSENTIALS OF PHARMACOLOGY page no. 856

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Which of the following about severe combined immunodeficiency is not true -

Ans. is 'a' i.e., Due to deficiency of adenylate kinase

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The following radiograph shows:

Gemination Geminated teeth are anomalies which arise from an attempt at the division of a single tooth germ by an invagination, with resultant incomplete formation of two teeth. The structure is usually one with two completely or incompletely separated crowns that have a single root and root canal. It is seen in deciduous as well as permanent dentition, and in some reported cases, appears to exhibit a hereditary tendency. It is not always possible to differentiate between gemination and a case in which there has been a fusion between a normal tooth and a supernumerary tooth. Radiological signs The tooth has a notched incisal margin with a confluent or partially joined pulp canal system.

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In Ulnar nerve injury in arm, all of the following are seen except?

Adduction of thumb. Injury to the Ulnar nerve Ulnar nerve is most commonly injured at the elbow, where it lies behind the medial epicondyle and at the wrist where it lies in front of flexor retinaculum. In high ulnar nerve injury at or proximal to elbow, all the muscles supplied by the ulnar nerve in the forearm and hand are paralyzed whereas in low ulnar nerve palsy, there is sparing of the forearm muscles (in flexor carpi ulnaris and flexor digitorum profundus). Sensory deficit are same in both high & low ulnar nerve injury.

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True about sickle anemia is?

Ans. is 'b' i.e., Decreased ESR Investigation1) Peripheral smear shows sickle cells, target cells and Howell - Jolly bodies.2) ESR is decreased (only important anemia in which ESR is decreased, in most of other anemias ESR is increased).3) There is positive sickling test with a reducing substance like sodium metabisulfite.4) Hb electrophoresis shows two bands in heterozygous state/sickle cell trait (40% HbS & 60% HbA) and one bands in homozygous state (only HbS). HbS is slower moving than HbA towards positive electrode.5) Bone changes on X-ray showA. Fish mouth vertebraeB. Crew hair cut (hair on end) appearance of skull.(Hair on end appearance' is also seen in thalassemia, hereditary spherocytosis and G6PD deficiency.)6)There may be cardiomegaly and leukocytosis.7) Gamma Gandy bodies (nodules of hemosiderine and calcium deposition in spleen) are found.

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Drug of choice for acute severe asthma is:-

Sho acting beta 2 agonists like salbutamol are drug of choice for acute severe asthma Condition Drug of choice Bronchial Asthma Acute attack Salbutamol Acute attack in pregnancy Salbutamol Acute attack during labour Ipratropium Acute attack in patients on beta blocker therapy Ipratropium Prophylaxis Coicosteroids Exercise-induced asthma Acute attack Salbutamol Prophylaxis Coicosteroids Aspirin-induced asthma Acute attack Salbutamol Prophylaxis Coicosteroids Brittle asthma Type 1 S.C. Terbutaline infusion Type 2 S.C. Adrenaline

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A factor that is likely to increase the duration of action of a drug D that is partially metabolized by CYP3A4 in the liver is:

- Microsomal enzyme inducers- Rifampicin, Phenobarbital- will increase the activity of enzymes, leading to decreased duration of action of a drug. - Microsomal enzyme inhibitor- Cimetidine- will decrease the activity of enzyme resulting in increased duration of action of the drug. - A drug displaced from the binding site gets easily metabolized.

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The number of muscle fibers innervated by a motor axon is smallest in

The extraocular and hand muscles have an innervations ratio of 3 to 6 whereas gastrocnemius and back muscle has a ratio of 2000.(Refer Medical Physiology by Guyton & Hall, 12th edition, page no: 96)

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This arrangement of myofibrils are found in

Refer robbins 9/e 569 Hyperophic cardiomyopathy (HCM) is a disease in which the hea muscle (myocardium) becomes abnormally thick (hyperophied). The thickened hea muscle can make it harder for the hea to pump blood. Hyperophic cardiomyopathy often goes undiagnosed because many people with the disease have few, if any, symptoms and can lead normal lives with no significant problems. However, in a small number of people with HCM, the thickened hea muscle can cause shoness of breath, chest pain or problems in the hea's electrical system, resulting in life-threatening abnormal hea rhythms (arrhythmias).

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Which of the following may cause biliary obstruction -

In most cases the disease tends to remain low grade and chronic producing only minor symptoms of abdominal distress,intermittent diarrhea and liver pain or tenderness.C.sinensis has been linked to bile duct carcinoma.It is mostly observed in areas where clonorchiasis is endemic (refer pgno:126 baveja 3 rd edition)

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False regarding Parasuicide?

Also known as attempted suicide/ pseudocide. Mostly seen in psychological disturbances. Conscious, impulse, manipulative act to get rid of an intolerable situation. POISONING ( drug ingestion )is the most common form.

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Intra-tumoral calcification in the brain is seen in all except?

Intratumoral calcification develops in the slow-growing tumors like Craniopharyngioma Meningioma Oligodendroglioma -Hemangioblastoma is a highly vascular tumor.

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Most common type of supracondylar fracture in children

One of the most serious fractures in childhood. Caused by fall on an out stretched hand. Fracture line extends transversely through the distal metaphysis of humerus just above the condyles. The distal fragment may be displaced in the following directions: Posterior or backward shift Posterior tilt Proximal shift Medial or lateral shift Medial tilt Internal rotation Ref: Maheshwari and Mhaskar 6e pg 97

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Soap bubble appearance at lower end of radius, the treatment of choice is:

Treatment for GCT at commoner sites is as given in Table Site Treatment of choice Lower end of femur Excision with Turn-o-Plasty Upper end of tibia Excision with Turn-o-Plasty Lower end of radius Excision with fibular grafting Lower end of ulna Excision Upper end of fibula Excision

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Oncocytes are found in all of the following, except:

Pineal body

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True statement about esophageal varices is:

Epidemiology of esophageal varices and correlation with liver disease At the time of diagnosis, 30% of cirrhotic patients have esophageal varices, and 90% after approximately 10 years. Bleeding from esophageal varices is associated with a moality rate of 20% at 6 weeks, Variceal bleeding is the most common fatal complication of cirrhosis. Some patients develop varices and hemorrhage early in the course of the disease, even in the absence of cirrhosis. Ref: WGO Practice Guidelines Esophageal varices

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Which of the following drug is NOT effective against chemotherapy induced vomiting?

Ans. (b) HyoscineRef: KDT 6th ed. / 646-47

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A patient presents with acute renal failure with normal ultrasound abdomen repo Next most useful investigation is-

DTPA A renal scan involves the use of radioactive material to examine your kidneys and assess their function. A renal scan is also known as a renal scintigraphy, renal imaging, or a renogram. During this procedure, a technician injects a radioactive material called a radioisotope into your vein. The radioisotope releases gamma rays. A gamma camera or scanner can detect gamma rays from outside your body. The gamma camera scans the kidney area. It tracks the radioisotope and measures how the kidneys process it. The camera also works with a computer to create images. These images detail the structure and functioning of the kidneys based on how they interact with the radioisotope. Images from a renal scan can show both structural and functional abnormalities. This helps doctors diagnose a kidney problem in its earlier stages without invasive techniques or surgery Ref Harrison20th edition pg 223

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A Patient presented with Hypokalemia, Severe Hypertension, and Metabolic Alkalosis. The diagnosis is

(A) Liddle syndrome[?]Liddle's Syndrome: Autosomal dominant & is characterized by activating mutation of collecting duct Na+ channel with enhanced sodium reabsorption.oLow renin, low aldosterone levels.oClinical picture mimics Primary Hyperaldosteronism: Hypertension, Hypokalemia & Alkalosis.oIncreased activity of the Epithelial Sodium Channel (E-Na Ch):-Activating kidneys to excrete potassium retaining excessive sodium & water, leading to hypertension.-Classically manifest severe hypertension with hypokalemia, unresponsive to spironolactone yet sensitive to amiloride.oHypertension & hypokalemia are, however, variable aspects of the Liddle's phenotype; more consistent features include a blunted aldosteirone response to ACTH & reduced urinary aldosterone excretion.oIt is a 'gain of function' mutation in the gene encoding ENaC of the collecting tubule resulting in autonomous function of these channel without the influence of aldosterone.oCan be differentiated from Primary Hyperaldosteronism by normal Na+ level and low aldosterone and reninOther OptionsCONGENITAL HYPOKALEMIA ASSOCIATED SYNDROMES[?]Bartter's Syndrome (BS):-Loss of the transport functions of the TALH nephron segments causes hereditary hypokalemic alkalosis.-Typically suffer from polyuria & polydipsia, due to the reduction in renal concentrating ability. May have an increase in urinary calcium excretion & 20% are hypomagnesemia-Marked activation of the renin-angiotensin-aldosterone axis.-Antenatal patients suffer from marked electrolyte wasting, polyhydramnios, and hypercalciuria with nephrocalcinosis; renal prostaglandin synthesis and excretion are significantly increased, accounting for much of the systemic symptoms.-Presence of five disease genes for BS, all of them functioning in some aspect of regulated Na+,K+ & Cl- transport by the TALH.[?]Gitelman's Syndrome (GS):-Loss of the transport functions of the DCT nephron segments causes hereditary hypokalemic alkalosis.-Genetically homogeneous, caused almost exclusively by loss-of-function mutations in thiazide-sensitive Na+-Cl- co transporter of DCT.-Uniformly hypomagnesemic & exhibit marked hypocalciuria, rather than the hypercalciuria typically seen in BS; urinary calcium excretion is thus a critical diagnostic test in GS.-May suffer from chondrocalcinosis, an abnormal deposition of Calcium Pyrophosphate Dihydrate (CPPD) in joint cartilage.[?]Distal Renal Tubular Acidosis:-Defects in multiple renal tubular transport pathways are associated with hypokalemia.-Loss-of-function mutations in subunits of the acidifying-H+-ATPase in alpha-intercalated cells cause hypokalemic distal renal tubular acidosis, as do many acquired disorders of the distal nephron.[?]Cushing's Syndrome:-Hypokalemia may also occur with systemic increasing in glucocorticoids.-Increase in pituitary ACTH incidence of hypokalemia is only 10%, whereas, 60-100% in patients with ectopic secretion of ACTH.

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Scabies is caused by a small mite that burrows into the skin. The disease is best described by which one of the following statements?

Sarcoptes scabiei is a small mite that burrows into human skin. Itching is significant, and a vesicular eruption, which often becomes secondarily infected with bacteria, develops. Diagnosis is made by microscopic detection of the mites. Gamma benzene hexachloride (Kwell), a topical insecticide, is an effective treatment for scabies. A number of etiologic agents have been proposed for Kawasaki's disease (KD), among them mites, but there is no evidence that mites either cause or are vectors of KD.

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Where is bruit heard in thyroid gland

Thrill is felt in the upper pole of the thyroid and also bruit on auscultation. It is because in the upper pole, superior thyroid aery enters the gland superficially and so thrill and bruit can easily be felt. In the lower pole inferior thyroid aery enters the gland from deeper plane and so thrill cannot be felt. Reference: SRB's Manual of Surgery, 6th Edition, page no = 463.

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A 45 year old man presents to a physician with back pain and facial pain. Physical examination demonstrates coarse facial features and kyphosis. Laboratory examination is remarkable for elevated alkaline phosphatase. .X-ray studies demonstrate skull thickening with narrowing of foramina, and bowing of the femur and tibia. Bone biopsy reveals a mosaic pattern of bone spicules with prominent osteoid seams. Which of the following neoplasms occurs at an increased frequency in patients with this disorder?

The phrase "mosaic pattern" of newly formed woven bone is a specific tip-off for Paget's disease of bone, and is not seen in other bone conditions. The clinical and radiologic presentation are typical; an increased hat size may also be a clue. In its early stages, Paget's disease is characterised by osteolysis, producing patchwork areas of bone resorption with bizarre, large osteoclasts. In the middle stage of the disease, secondary osteoblastic activity compensates with new bone formation, producing the mosaic pattern. In late Paget's, the bones are dense and osteosclerotic. Paget's disease is suspected to be related to prior viral infection, but the cause remains mysterious. Complications include myelophthisic anemia, high output cardiac failure, pain secondary to nerve compression, deformities secondary to skeletal changes, and in about 1% of patients, osteosarcoma or other sarcoma, typically involving the jaw, pelvis, or femur. An increased incidence of astrocytomas is associated with tuberous sclerosis.Hodgkin's lymphoma is usually a disease of young adults, although older patients may have the lymphocyte-depleted form.Meningiomas are mostly benign tumors that affect adults, especially females. There may be an association with breast cancer, possibly related to high estrogen states. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 19. Pathology of the Bones and Joints. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture.

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Pubic symphysis is which type of joint

Primary cailaginous joints Known as "synchondroses". These bones are connected by hyaline cailage and sometimes occur between ossification centers.This cailage may ossify with age.Examples in humans are the "growth plates" between ossification centers in long bones. These joints here allow for only a little movement, such as in the spine or ribs.Secondary cailaginous joints Known as "symphysis". Fibrocailaginous and hyaline joints, usually occurring in the midlineExamples in human anatomy would be the manubriosternal joint (between the manubrium and the sternum), interveebral discs, and the pubic symphysis.

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Most common cause of urinary tract infection in children is -

Ans. is 'a' i.e., E Coli o Bacterial infections are the most common cause of UTI, with E coli being the most frequent pathogen, causing 75- 90% of UTIs. Other bacterial sources of UTI include the following:# Klebsiella species# Proteus species# Enterococcus species# Staphylococcus saprophyticus, especially among female adolescents and sexually active females# Streptococcus group B, especially among neonates# Pseudomonas aeruginosao Fungi (Candida species) may also cause UTIs, especially after instrumentation of the urinary tract. Adenovirus is a rare cause of UTI and may cause hemorrhagic cystitis.

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Deep perineal pouch in males does not include:

Coronal section of pelvis. Deep perineal pouch is located between the superior and inferior layers of the urogenital diaphragm. Long perineal nerve is located in the superficial perineal pouch. Contents of deep perineal pouch in males:Muscles - Sphincter urethrae, Deep transversus perineiNerves - Dorsal nerve of penis, muscular branch from perineal nerveVessels - Deep and dorsal aeries of penis, stem of origin of aery to the bulb of penis, urethral aery

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A multipara developed postpaum haemorrhage (PPH) during her 3rd child bih. The most probable cause for her PPH is:

Causes of postpaum hemorrhage include uterine atony, obstetric lacerations, retained placental tissue, and coagulation defects. Atony is the most common cause of postpaum hemorrhage (50% of cases). Predisposing causes include, Excessive manipulation of the uterus General anesthesia (paicularly with halogenated compounds) Uterine overdistension (twins or polyhydramnios) Prolonged labor Grand multiparity Uterine leiomyomas Operative delivery and intrauterine manipulation Oxytocin induction or augmentation of labor Previous hemorrhage in the third stage Uterine infection Extravasation of blood into the myometrium (Couvelaire uterus) Intrinsic myometrial dysfunction Ref: Poggi S.B. (2013). Chapter 21. Postpaum Hemorrhage & the Abnormal Puerperium. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

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A child with hypopigmented hair and mentally retarded with mousy odour urine. Enzyme deficient is?

(C) Phenyalanine hydroxylase # PHENYLKETONURIA: phenylalanine hydroxylase deficiency.> Disease presents clinically with seizures, hypo pigmentation, musty odour to baby sweat and urine(due to phenylacetate, a carboxylic acid produced by oxidation of phenylketone).> Phenylalanine is first converted to tyrosine.> Hyper phenylalaninemias arise from defects in phenylalanine hydroxylase,(type I, classic phenylketonuria (PKU), frequency 1 in 10,000 births), in dihydrobiopterin reductase (types II and III), or in dihydrobiopterin biosynthesis (types IV and V).> Alternative catabolites are excreted.> Diet low in phenylalanine can prevent the mental retardation of PKU.> DNA probes facilitate prenatal diagnosis of defects in phenylalanine hydroxylase or dihydrobiopterin reductase.> Elevated blood phenylalanine may not be detectable until 3 to 4 days postpartum.> False-positives in premature infants may reflect delayed maturation of enzymes of phenylalanine catabolism.> An older and less reliable screening test employs FeCI3 to detect urinary phenylpyruvate.> FeCI3 screening for PKU of the urine of newborn infants is compulsory in many countries, but in the United States has been largely supplanted by tandem mass spectrometry.

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Surgery used to treat posterior capsular Opacification is

Posterior Capsular opacification is a complication of Cataract surgery. Treatment is Nd : YAG laser posterior capsulotomy.

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A patient develops acute respiratory distress, stridor, hyperinflation on one side of chest with decreased breath sound on that side. Most likely cause is :

Ans. is 'c' i.e Foreign Body Aspiration Foreign Body Aspiration :It is an important cause of stridor in children.If obstruction occurs it leads to hyperinflation.The overlying chest wall shows hyperresonance.There will be decreased breath sounds.All the other choices mentioned in the question do not cause stridor.Asthma - It is bilateral, There is no stridor (wheezing is present)Aspiration Pneumonia - In Pneumonia there is consolidation of the lung, instead of hyperinflation there is dullness present.Pleural effusion - Dullness is present instead of Hyperinflation. PercussionBreath soundVoice transmissionAdventitious soundForeign body aspirationHyperresonantDecreased Aspiration pneumoniaDullDecreasedDecreasedAbsentAsthmaHyperresonantVesicularNormalWheezingPleural effusionDullDecreasedDecreasedAbsent or pleural friction rubPneumothoraxDullDecreasedDecreasedAbsent or pleural friction rubEmphysemaHyperresonantDecreasedDecreasedAbsent or wheezing

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Local vasoconstriction is seen with:

Cocaine is sympathomimetic and thus causes vasoconstriction. Cocaine is a local anesthetic with potential for abuse. It produces euphoria by inhibiting the uptake of catecholamines in the CNS, especially dopamine. Because of its abuse potential, cocaine is listed as a schedule II controlled substance by the U.S. Drug Enforcement Agency. Because of its abuse liability and high toxicity, cocaine use is limited to topical anesthesia of the upper respiratory tract. It is available as 1%, 4% and 10% solutions for topical use. It has intrinsic vasoconstrictor propeies along with local anesthetic propeies.

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Which of the following drugs combination shows antimicrobial synergism?

Every AMA has a specific effect on selected microorganisms. Depending on the drug pair as well as the organism involved, either synergism (supra-additive effect), additive action, indifference or antagonism may be observed when two AMAs belonging to different classes are used together Every combination is unique; the same drugs may be synergistic for one organism but antagonistic for another. However, general guidelines are: (a) Two bacteriostatic agents are often additive, rarely synergistic,i.e. combination of tetracyclines, chloramphenicol, erythromycin, etc. (b) Two bactericidal drugs are frequently additive and sometime synergistic if the organism is sensitive to both, e.g.: * Penicillin/ ampicillin + streptomycin/ gentamicin or vancomycin + gentamicin for enterococcal SABE. Penicillins by acting on the cell wall may enhance the penetration of the aminoglycoside into the bacterium (c) Combination of a bactericidal with a bacteriostatic drug may be synergistic or antagonistic depending on the organism ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:677

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Penal code for death sentence is ?

Ans. is 'a' i.e., 300

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Sentinel lymph node is defined as

The first axillary lymphnode draining the breast (by direct drainage) is designated as sentinel lymph node. SLN is first node involved by tumour cells and presence or absence of its histological involvement when assesed will give a predictive idea about fuher spread of tunour to other nodes. SRB's Manual of Surgery.Edition -5. Pg no:543

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Ramesh singh, a 40 yrs old man, was admitted with fracture shaft femur following a road traffic accident. Three days after tauma he was tachypnoeic, and had conjunctival petechiae. Most likely diagnosis is ?

Ans. is 'c' i.e., Fat embolism This patient in question has femur fracture has developed classical triad of fat embolism :- Respiratory symptom :- Tachypnea Neurological symptom :- Disorientation Petechial rash :- Conjunctivalpetechiae So, the most probable diagnosis is fat embolism syndrome.

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False about Angurugu syndrome is

ANGURUGU SYNDROME: Associated with manganese toxicity Characterised by UMN lesions, cerebellar signs, oculomotor symptoms Seen in western Australia

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Basanti, 27 year female thinks that her nose is ugly. Her idea is fixed and is not shared by anyone else. Whenever she goes out of the home, She hides her face? She visits a surgeon for plastic surgery. The appropriate next step would be:-

This appears to be a case of delusional disorder, somatic type. Its impoant to differentiate it from body dysmorphic disorder. here, the question says that idea is fixed and is not shared by anyone else and patient is fuher hiding her face when visiting outside. In body dysmorphic disorder, the belief is not fixed and may be at least temporarily changed by reassurances of others.

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Which of the following is responsible for green color on antibiotic disk sensitivity testing?

Ans. (a) Pyoverdin and pyocyanin.* Pseudomonas produce pigments by the name of pyoverdin and pyocyanin leading to greenish pigmentation in culture plate.* Pneumococci produce pneumolysin that break downs hemoglobin into a green pigment. This causes pneumococcal colonies to be surrounded by green zone during growth on blood agar plates. The plate in question is not blood agar.Image source- style="font-family: Times New Roman, Times, serif">

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Which of the following is not a neuroparasite?

Trichinella spiralis is not a neuro parasite, it is seen in striated muscles. It causes trichinosis. Pigs are the most impoant reservoirs of human disease. Humans are infected by eating raw or undercooked meat containing larvae encysted in the muscle. The larvae excyst and mature into adults within the mucosa of the small intestine. Eggs hatch within the adult females, and larvae are released and distributed the bloodstream to many organs; however, they develop only in striated muscle cells. Within the muscle cells they can remain ble for several years but eventually calcify. Ref: Review of Medical Microbiology and Immunology By Warren Levinson, 11th Edition, Chapter 56; Self Assessment and Review Microbiology Immunology Revision at a Glance By Chaurasia, 4th Edition, 2009, Page 407

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How much ethinyl estriol does the new low dose oral contraceptive pill contain (in micrograms)

Composition of 'New low dose OCP' : (Brand name : Femilon/Elogen) Ethinyl estradiol: 0.02mg (20 mcg) Desogestrel: 0.15mg(150 mcg) Composition of Combined OCP: MALA-N Ethinyl estradiol: 0.03mg (30mcg) Norgestrel : 0.15mg (150mcg) Ref: Internet, Organon-India website

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How is cooling curve of the body postmoem?

Ans. is 'c' i.e., Sigmoid Body cooling postmoem follows the Newton's law of cooling.The rates of cooling at the ends of the curve are slower than the rates in the mid poion - resulting in Sigmoidal shape of the cooling curve

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Most common cause of splenic rupture is -

Most common cause of splenic rupture is Trauma. In the absence of trauma Spontaneous rupture of spleen occurs due to some minor physical insult to a spleen that has been rendered fragile by an underlying condition. The most common predisposing conditions are IMN, malaria, typhoid fever and lymphoid neoplasms.

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Increased serum calcium is seen in all except:

Answer is A (Myxoedema): Hypercakemia is a feature of Hypehyroidism and not hypothyroidism (Myxoedema)

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In a patient with AIDS, chorioretinitis is typically caused by

Commonest ocular infection in HIV patient - CMV retinitis Bush- Fire appeareance Pizza- Pie Appearance Sauce & Cheese Appearance OCULAR HIV : - M/C ocular manifestation - Cotton wool spot or soft exudate or HIV retinopathy - M/C occular infection - CMV retinitis - M/C occular tumor - kaposi sarcoma > Lymphoma

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All are abductors of thigh, except:

Piriformis

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Corneal vascularisation is/are caused by:

Ans. A, B and C

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Antibody coated bacteria (A.C.B.) is characteristic of which one of the following conditions?

.

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True about Latissimus dorsi

The tendon is twisted upside down and is inseed into floor of the inteubercular sulcus Latissimus dorsi is supplied by the thoracodorsal (long scapular) nerve. The latissimus dorsi is a potential source of muscle for breast reconstruction surgery after mastectomy The dominant blood supply arises from the thoracodorsal aery, which is the terminal branch of the subscapular aery. It also has a secondary blood supply, which arises from segmental perforating branches off of the intercostal and lumbar aeries . Ref - BDC 6th edition Vol 1 ; pg 62,64

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Fallot physiology includes all except

Eisenmenger syndrome include reversal of shunt. FALLOT PHYSIOLOGY SYNDROMES # Tetralogy of Fallot # Tricuspid. atresia - PS # Single ventricle - PS # TGA with VSD -- PS # DORV -- VSD -- PS Ghai essential of pediatrics, eighth edition, p.no:428

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Abduction of Hand is caused by

The flexor carpi radialis muscle originates from the medial epicondlyle of humerus and inses into the bases of 2nd and 3rd metacarpal bones. Its action is abduction of hand at the wrist joint. BD CHAURASIA 7th edition ,page 108 table 9.2

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Which of the following is true regarding lattice formation

Lattice formation is possible only in the zone of equivalence.in the zones of antibody or antigen excess lattice doesn't enlarge as their respective valencies are stisfied,this lattice hypothesis holds good for agglutination also. Ref: anantnarayan and panikers 10 th edition.

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First change to occur in the distal segment of cut nerve:

After axotomy, the nerve terminals of the injured neuron begin to degenerate (first).

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Most common causative organism of acute pyelonephritis in pregnancy is?

ANSWER: (A) E.coliREF: Dutta's textbook of obstetrics 6th ed page 296Incidence of pyelonephritis in pregnancy 1-3%Previous history of urinary tract infection increases chance by 50%Organisms associated are: E:coli (70%), Klebsiella (10%), Enterobacter, Proteus pseudomonas, Staphylococcus aureus

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A patient undergoes a total gastrectomy because of a proximally located gastric cancer. After the surgery, which of the following digestive enzymes will be produced in inadequate amounts?

Pepsin is secreted (in an inactive or zymogen form as pepsinogen) by the chief cells of the stomach. Pepsinogen is activated by contact with stomach acid. Although protein digestion usually begins with the actions of hydrochloric acid and pepsin, pancreatic enzymes complete the job as the food passes into the small intestine. Amylases hydrolyze 1->4 glycosidic linkages of starches to produce oligosaccharides, maltose, maltotriose, and limit dextrins. These enzymes are produced by the pancreas and salivary glands. Chymotrypsin is a proteolytic enzyme released by the pancreas as the inactive proenzyme, chymotrypsinogen. Lipases are mostly released by the pancreas, and serve to digest various lipids, including triacylglycerols. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 25. Overview of Gastrointestinal Function & Regulation. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.

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The type of study that determines the norms and limits of the distribution of variables, including the characteristics of the events and population under study, is reffered to as-

Descriptive studies are the first phase of an epidemiological investigation. Procedures in descriptive studies include: 1)defining the population to be studied 2)defining the disease under study 3)describing the study by time , place, person 4)measurement of disease 5)comparing with known indices 6)formulation of an aetiological hypothesis (refer pgno:63 park 23 rd Edition)

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HRT therapy can increase the risk of -

Ans. is 'b' i.e., Breast carcinoma o HRT increases the risk of the following:# Endometrial cancer# Breast carcinomao Reduced risk of the following with HRT:# Alzeihmer's disease# Colorectal cancer# Osteoporosis# Age related hearing loss# HRT prevents lens opacities

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Reverse cholesterol transpo is mediated by ?

Ans. is 'a' i.e., HDLReverse cholesterol transpoAll nucleated cells in different tissues synthesize cholesterol, but the excretion of cholesterol is mainly by liver in the bile or by enterocytes in gut lumen.So, cholesterol must be transpoed from peripheral tissue to liver for excretion.o This is facilitated by HDL and is called reverse cholesterol transpo because it transpos the cholesterol in reverse direction to that is transpoed from liver to peripheral tissues through VLDL LDL cycle. Processo HDL is synthesized in liver and small intestine.o Nascent HDL contain phospholipids and unesterified cholesterol and Apo-A, C, E.This nascent HDL is secreted into circulation where it acquires additional unesterified cholesterol from peripheral tissues.o Within the HDL paicle, the cholesterol is esterified by lecithin - cholesterol acetyltransferase (LCAT) to form cholesteryl ester and additional lipid are transpoed to HDL from VLDL and chylomicrons.o There are two pathway by which this cholesterol is transpoed to liver.

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Most common chromosomal syndrome in children is?

**Down syndrome (Trisomy 21) is the most common of the chromosomal disorder. **Trisomy 16 is the most common trisomy overall, however most do not survive and die in utero Hence, among the live bihs, or among children, most common chromosomal abnormality is Trisomy 21

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A child can make a tower of 6 cubes at the age of?

A child can make a tower of 6 cubes at 2 years. -tower of 2 cubes at 15 months, 3 cube tower at the age of 18 months

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All of the following are features of Goodpasture syndrome, except:

Goodpasture syndrome Uncommon autoimmune disease in which kidney and lung injury are caused by circulating autoantibodies. Most common in 2nd & 3rd decades of life. Anti-GBM antibody-mediated disease Goodpasture syndrome applies to the 40% to 60% of patients with these autoantibodies who develop pulmonary hemorrhage in addition to renal disease. Characterized by linear deposits of IgG and, in many cases, C3 in the GBM. The antigen common to the alveoli and GBM is a peptide within the noncollagenous poion of the a3 chain of collagen type IV (COL4A3).

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systematic sensitization is used in

SYSTEMATIC DESENSITIZATION JOSEPH WOLPE Joseph Wolpe gave the concept of systematic desensitization This is a treatment used in phobia In phobia there is a conditioned fear response to aversive neutral stimulus and avoidance of that response leads to phobia Whenever there is a fear response there is stimulation of sympathetic system In that case stimulation of parasympathetic system by relaxation there is reduction in anxiety First step is to make a step ladder which are arranged based on the severity Then is go step by step and along with doing applied relaxation Slowly the the sympathetic system is reduced The patient will be able to approach stimulus without anxiety Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 845

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Epiphyseal dysgenesis is a pathognomonic feature of:

Hypothyroidism

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True about specificity-

Ans. is 'c' Le., True negative o When a screening test is used to diagnose a disease, the test oucome can be positive (diseased) or negative (healthy), while the actual health status of the person may be different,o In that settingi) True positive-Diseased people correctly diagnosed as diseased.ii) False positive-Healthy people wrongly identified as diseased.iii) Tme negative-Healthy people correctly identified as healthy.iv) False negative-Diseased people wrongly identified as healthy.o There are two major statistical measures for the validity of a screening test: -i) Sensitivityii) SpecificitySensitivityo It is the ability of a test to identify correctly all those who have the disease, i.e., true positive.o In other words sensitivity measures the precentage of sick people who are identified as having disease,o For example if a test is 90% sensitive, that means out of 100 diseased people, it will diagnose 90 (90% of diseased people will be diagnosed). Remaining 10% will be wrongly indentified as not having the disease, i.e., false negative.Specificityo It is the ability of a test to identify correctly those who do not have the disease i.e., true negativeo In other words specificity measures the percentage of well people who are identified as not having the disease,o For example, a 90 percent specificity' means that 90% of nondiseased people will be identified as not having the disease. The remaining 10% will be wrongly classified as diseased, i.e., false positive.

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A 75 year old patient presents with deterioration of vision. On examination the pupillary reflex is observed to be sluggish and the intraocular pressure is normal. Optic disc evaluation shows a large and deep cup and paracentral scotomas. The most likely diagnosis is:

Ans. (b) Normal Tension GlaucomaRef: Kanski 7/e, p. 346; Yanoff 3/e, p. 1159Glaucomatous cupping (large and deep cup) along with glaucomatous visual field defects (paracentral scotomas are the most frequent) in patients with normal intraocular pressure suggests a diagnosis of Normal Tension Glaucoma (NTG).

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Lungs do not collapse during expiration because of the presence of?

b. Dipalmitoyl phosphatidyl choline(Ref: Ghai 8/e p 169-170)Dipalmitoyl phosphatidyl choline is an important constituent of Surfactant, which prevent alveolar collapse during expiration.

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Artery usually torn in temporal bone fracture is:

Ans. (A). Middle meningeal arteryType of haemorrhageCommonest sourceExtradural haemorrhageMiddle meningeal arterySub dural haemorrhageBridging veinsSub arachnoid haemorrhageAneurysm - Circle of willisIntracerebral haemorrhageLenticulo-striate artery

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Saroj, a 32 year old female, from rural background presented with a h/o chronic tobacco chewing since 14 year of age. Now she has difficulty in opening her mouth. On oral examination, no ulcers are seen - Most probable diagnosis is -

Ans. is 'a' ie. Submucous oral fibrosis " Submucous oral fibrosis is a progressive ds. in which fibrous bands form beneath the oral mucosa. These bands progressively contract so that ultimately mouth opening is severly limited. Tongue movements may also be limited. This conditon is almost entirely confined to Asians. Histologically it is characterized by juxtaepithelial fibrosis with atrophy or hyperplasia of the overlying epithelium which also shows areas of epithelial dysplasias. The etiology is abscure. Hypersensitivity to chilli ; betel nut, tobacco and vitamin deficiencies have been implicated. The scar bands of submucous fibrosis, which result in difficulty in opening can be treated either by intralesional injection of steroids or by surgical excision and grafting, but this has little effect in preventing the onset of squamous cell Ca in the generally atrophic oral mucosa (Submucous oral fibrosis is a precancerous conditon for squamons cell Ca)."- Bailey & Love

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Retinoblastoma best evaluated by -

Ans. is 'c' i.e., CT SCAN + MRI Imaging in Retinoblastomao MRI - best for challenging retinoblastoma patient evaluation; also used to rule out optic nerve and intracranial invovlemento CT SCAN - detects calcification, can also be used for initial evaluation.o MRI + CT SCAN - best for trilateral, tetralateral, recurrent retinoblastoma, metastases from retinoblastoma

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Loss of an anatomical structure or a physiological function is called:

Ans: b (Impairment) Ref: Park, 19th ed, p. 39,40Impairment- is defined as any loss or abnormality of psychological, physiological, or anatomical structure or function.e.g., loss of foot, defective vision, or mental retardation.Disability- is defined as any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being.Handicap- is defined as a disadvantage for a given individual, resulting from an impairment or disability, which limits or prevents the fulfillment of a role, that is normal (depending on the age, sex, and social and cultural factors) for that individual.Taking accidents as an example the above terms can be explained as:AccidentDisease (disorder)Loss of footImpairment (extrinsic or intrinsic)Cannot walkDisability (objectified)unemployedHandicap (socialized)Disease --- impairment --- disability --- handicap

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Transcription is inhibited by

Clindamycin -D antibiotics from StreptomycesMode of action is by inseion of phenoxa-zone ring between two G-C bp of DNA USed as anti-cancer drugRef: DM Vasudevan, 7th edition, page no: 593 table 45.2

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A wave in ERG is due to activity of-

Ans. is 'b' i.e.. Rods and cones Electroretinogramo The changes induced by the stimulation of light in the resting potential of the eye are measured by electroretinography. It is extinguished or absent in complete failure of function of rods and cones, e.g. pigmentary retinal dystrophy, complete occlution of retinal artery, complete retinal detachment, advanced siderosis etc.Negative 'a1 wave represent the activity in rods and cones.Positive 'b' wave arises in inner retinal layers.Positive 'c' wave is associated with the pigmentary epithelium.Uses1) Diagnosis and prognosis of retinal disorders such as retinitis pigmentosa, Leber's congenital amaurosis, retinal ischaemia and other chorioretinal degenerations.2) To assess retinal function when fundus examination is not possible, e.g. in the presence of dense cataract and corneal opacity.3) To assess the retinal function of the babies where possibilities of impaired vision is considered.

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Which of the following mechanisms is not responsible for complications in DM

The things responsible for chronic complications of DM are 1)Formation of Advanced glucation end products 2) Activation of Protein Kinase C 3)Oxidative stress and disturbance in Polyol pathways . Possible complications include: Cardiovascular disease. ... Nerve damage (neuropathy). ... Kidney damage (nephropathy). ... Eye damage (retinopathy). ... Foot damage. ... Skin conditions. ... Hearing impairment. ... Alzheimer's disease Ref: Robbins and cotrans 9e Pg 1116

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Hemolysis is seen in all except:

Other than these, hemolysis is also seen in hemolytic jaundice.

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A full course of immunization against, Tetanus with 3 doses of Tetanus toxoid, confers immunity for how many years -

<p> 5 years TT given as a primary course of immunisation of two doses at interval of 1-2 month.then a booster after 1 year. The opinion was expressed that no more than one additional. Booster dose given 5 year after the third dose is required in adult in developing countries. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:312. <\p>

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Overgrowth of the bile duct in a localized region is

The term hamaoma refers to an excessive, focal overgrowth of cells and tissues native to the organ in which it occurs. Although the cellular elements are mature and identical to those found in the remainder of the organ, they do not reproduce the normal architecture of the surrounding tissue. Von Meyenburg complexes are small bile duct hamaomas. Occasional von Meyenburg complexes are common in otherwise normal individuals. When they are diffuse they signal the underlying, more clinically impoant fibropolycystic disease. Reference: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 18; Liver and Gallbladder

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Which is the most common complication in Monoamniotic twins?

Ans. D. Intertwining. (Ref. Williams Obstetrics 22nd ed. ch. 39. Multifetal Gestation; Fig. 39-16).TypeUNIQUE COMPLICATIONSMONOAMNIONIC TWINSApproximately 1 percent of monozygotic twins are monoamnionic.A high fetal death rate is associated with this rare variety of monozygotic twinning.Intertwining of their umbilical cords, a common cause of death, is estimated to complicate at least half of cases.DISCORDANT TWINSThe cause of birthweight inequality in twin fetuses is often unclear, but evidence indicates that etiology in monochorionic twins differs from that in dichorionic twins.ACARDIAC TWINTwin reversed-arterial-perfusion (TRAP) sequence is a rare (1 in 35,000 births) but serious complication of monochorionic, monozygotic multiple gestation.CONJOINED TWINSThe majority are of the thoracopagus.Twin-to-Twin Transfusion SyndromeIn this syndrome, blood is transfused from a donor twin to its recipient sibling such that the donor becomes anemic and its growth may be restricted, whereas the recipient becomes polycythemic and may develop circulatory overload manifest as hydrops. The donor twin is pale, and its recipient sibling is plethoric. Seen in Monochorionic twin. Overview of the incidence of twin pregnancy Zygosity & corresponding twin-specific complicationsTwin-Specific Complication (percent)Type of TwinningTwinsFetal Growth RestrictionPreterm DeliveryPlacental Vascular AnastomosisPerinatal MortalityDizygotic802540010-12Monozygotic204050 15-18Diamnionic/dichorionic6-73040018-20Diamnionic/monochorionic13-14506010030-40Monoamnionic/monochorionic< 14060-7080-9058-60Conjoined0.002- 0.008--70-8010070-90Extra Educational points:In women with a uterus that appears large for gestational age, the following possibilities are considered:# Multiple fetuses# Elevation of the uterus by a distended bladder# Inaccurate menstrual history# Hydramnios# Hydatidiform mole# Uterine myomas# A closely attached adnexal mass# Fetal macrosomia (late in pregnancy)

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All have chances of DVT except -

Ans. is 'b' i.e., Young <25 yrs. Risk factors for DVT -o Advanced Age# Major abdominal.''orthopedic surgery/major trauma# Prolonged immobilisation (>3 days)# HRT and OCP use# Pregnancy and puerperium# Malignancy# Obesity/Diabetes/CHF/Shock# Nephrotic syndrome# Varicose veins# Antiphospholipid antibody syndrome# Myeloproliferative disease# Tobacco Smoking

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A 5-year-old boy is brought in by his mother because of petechial bleeding and bruises on his torso and limbs. The child doesn't have any other signs or symptoms and doesn't appear to be ill. Mother reports gastrointestinal infection several weeks prior to petechiae and bruising. CBC shows thrombocytopenia (<20xl09/L). Other parameters of CBC are within expected range for age. Also, PT, PTT and metabolic panels are all within referent range. What is the expected outcome of this blood disorder?

Answer: a) Complete resolution is expectedDiagnosis appears to be UP. It usually follows viral infections in children aged 2 to 5 years and is of autoimmune origin. It is self-limiting in most cases and resolves completely in 6 weeks to 6 months in 80% of children.IMMUNE THROMBOCYTOPENIC PURPURA (ITP)CHRONIC ITP* More common form* Most common in adult women < 40 yrs (female-to-male ratio -3:1)* Can be associated with connective tissue diseases, lymphoproliferative disease, medications and infections (hepatitis C virus and HIV)* Auto-antibodies (mostly IgG) against platelet membrane glycoproteins (llb-llla or Ib-IX)* Spleen is the major site of destruction of platelets* Petechiae, ecchymosis, easy bruising, bleeding from nose and gums, menorrhagia* Splenomegaly & lymphadenopathy - rare* Subarachnoid and intracerebral hemorrhage are rare but fatal complications* Wet purpura (blood blisters in the mouth)* Peripheral smear shows abnormally large platelets (megathrombocytes) & low platelet count* Bone marrow - hypercellular & increased megakaryocytes* Bleeding time prolonged* PT and PTT are normalTreatment* Initial treatment for patients without significant bleeding: Glucocorticoids (Prednisone or Dexa) +- IV immunoglobulin or anti-D or anti-CD20 antibody (rituximab)* Two-thirds of patients respond to initial treatment, but most people relapse following reduction of the corticosteroid dose* Patients with severe ITP and/or symptoms of bleeding: hospital admission and combined therapy (high-dose glucocorticoids + IVIgG or anti-RhO (D) therapy)* Relapse: Splenectomy* Refractory cases: Thrombopoietin receptor agonists (Romiplostim and eltrombopag) or splenectomyACUTE ITP* Disease of childhood* Affects both sexes equally* Onset is abrupt* Many cases are preceded by viral illness* The usual interval between the infection and onset of purpura is 2 weeks* Self-limited, spontaneous resolution in 6 months* 20% children (those without viral prodrome) have persistent low platelet counts after 6 months

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Non competitive inhibition is

Features of noncompetitive inhibition Inhibitor have no structural resemblance to substrate. Mostly Irreversible (Except a few reversible non-competitive inhibition). Excess substrate do not abolish the inhibition. Km remains the same. Vmax remains the same. Features of competitive inhibition Inhibitor will be structural analogue of substrate. Reversible. Excess substrate abolishes inhibition. Vmax remains the same. Km increases.

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The earliest manifestations of Chronic lead poisoning include:

C i.e. Punctate basophilia

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Percentage of sucrose solution used for newborn analgesia is:

Analgesia in newborn A. Analgesia for minimally-invasive Sucrose analgesia is drug of choice

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Which of the following drugs are useful for long term treatment of congestive hea failure

Dobutamine (Ref: KDT 6/e p507) Dobutamine is indicated only for the acute treatment of decompensated CHF. Cardiac glycosides (digoxin) can be used for acute treatment as well as maintenance therapy of CHF. ACE inhibitors and spironolactone are indicated only for chronic CHF.

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Which of the following drug possess similar cycloplegic action and is more potent mydriatic than atropine is:

It's  duration of action is also long but less than the atropine.

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Which of the following vitamin deficiency is found in patients with gastric cancer ?

Gastric cancers can grow to an extent to cause damage to cells producing intrinsic factors and hence vitamin B12 deficiency. Vitamin B12 deficiency may also occur in post gastrectomy patients of gastric carcinoma, autoimmune pernicious anemia predisposing to gastric cancer and atrophic gastritis.

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A 25-year-old woman complains of persistent bleeding for 5 days after a dental extraction. She has noticed easy bruisability since childhood and was given a blood transfusion at age 17 because of prolonged bleeding after an apparently minor cut. She denies ecchymoses or bleeding into joints. Her father has noticed similar symptoms but has not sought medical care. Physical examination is normal except for mild oozing from the dental site. She does not have splenomegaly or enlarged lymph nodes. Her CBC is normal, with a platelet count of 230,000. Her prothrombin time is normal, but the partial thromboplastin time is mildly prolonged. The bleeding time is 12 minutes (normal 3-9 minutes). What is most appropriate way to control her bleeding?

This woman's lifelong history of excessive bleeding suggests an inherited bleeding problem, as does the positive family history. The prolonged PTT indicates a deficiency of factors VIII, IX, XI, or XII, but the commonest of these deficiencies (classic hemophilia A and Christmas disease, or hemophilia B) are vanishingly rare in women. Furthermore, the continued oozing from dental sites and the absence of ecchymoses or hemarthroses suggest a platelet function disorder, as does the prolonged bleeding time. Von Willebrand disease is an autosomal dominant condition that leads to both platelet and factor VIII dysfunction and is the likeliest diagnosis in this patient. Although factor VIII concentrates can be used for life-threatening bleeding, most will respond to desmopressin, which raises the von Willebrand factor level in the most common form (the so- called type 1 form) of this disease. Mild von Willebrand disease is fairly common (1 in 250 individuals). Fresh frozen plasma and whole blood are much less effective ways to deliver factor YIII. Platelet transfusion would not be as effective as correction of the von Willebrand factor level.

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In Niacin deficiency, all of the following are seen except -

- niacin is essential for the metabolism of carbohydrate, fat and protein. It is also essential for the normal functioning of skin , intestinal and nervous system. - niacin deficiency results in pellagra. The disease is characterized by diarrhea, dermatitis and dementia. Reference: Park's textbook of preventive and social medicine, 23rd edition, pg no:619 <\p>

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In acute inflammation, contraction of endothelial cells results in the following:

Endothelial cell contraction leading to intercellular gaps in postcapillary venules is the most common cause of increased vascular permeability. Endothelial cell contraction occurs rapidly after binding of histamine, bradykinin, leukotrienes, and many other mediators to specific receptors, and is usually sho lived (15-30 min). Ref: Robbins Basic Pathology edited by Vinay Kumar, Abul K. Abbas, Jon C. Aster, 2012, Page 34.

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Type I muscle fibers rich in myosin heavy chain are

Ans. d (Slow contracting, resistant to fatigue)Two Major Fiber Types: type I and type II fibers Type IType II Slow TwitchFast TwitchMyosin ATPaseLowHighEnergy utilizationLowHighMitochondriaManyFewColorRedWhiteMyoglobinYesNoContraction rateSlowFastDurationProlongedShortResistance to fatigueincreased /morelessEducational points:ProteinLocationComment orjunctionTitinReaches from the Z line to the M lineLargest protein in body. Role in relaxation of muscle.NebulinFrom Z line along length of actin filamentsMay regulate assembly and length of actin filaments.ctr Act in inAnchors actin to Z linesStabilizes actin filaments.DesminLies alongside actin filamentsAttaches to plasma membrane (plasmalemma).DystrophinAttached to plasmalemmaDeficient in Duchenne muscular dystrophy.Mutations of its gene can also cause dilated cardiomyopathy.CalcineurinCytosolA calmodulin-regulated protein phosphatase.May play important roles in cardiac hypertrophy and in regulating amounts of slow and fast twitch muscles.Myosin-binding protein CArranged transversely in sarcomere A-bandsBinds myosin and titin. Plays a role in maintaining the structural integrity of the sarcomere.

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What is the function of DNA ligase?

DNA ligase Seals the single strand nick between the nascent chain and Okazaki fragments on lagging strandRef: Harpers Illustrated Biochemistry, 30th edition, page no: 382

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Which of the following anti-Parkinson drugs has the potential to cause retroperitoneal fibrosis ?

Ans. is 'c' i.e., Bromocriptine Retroperitoneal fibrosis can be caused by ergot antiparkinsonism drugs (bromocriptine and pergolide).

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Which receptors are present in liver for uptake of LDL:

Apo E and Apo B100 "Apolipoproteins carry out several roles: (1) they can form pa of the structure of the lipoprotein, eg, apo B; (2) they are enzyme cofactors, eg, C-II for lipoprotein lipase, A-I for lecithin:cholesterol acyltransferase, or enzyme inhibitors, eg, apo A-II and apo C-III for lipoprotein lipase, apo C-I for cholesteryl ester transfer protein; and (3) they act as ligands for interaction with lipoprotein receptors in tissues, eg, apo B-100 and apo E for the LDL receptor, apo E for the LDL receptor-related protein (LRP), which has been identified as the remnant receptor, and apo A-I for the HDL receptor. The functions of apo A-IV and apo D, however, are not yet clearly defined."-Harper 26/ p206 "The liver and many extrahepatic tissues express the LDL (B-100, E) receptor. It is so designated because it is specific for apo B-I00 but not B-48..." - Harper 26/e p209

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Pseudo gestational sac is seen in the USG of

Pseudo gestational sac : Irregular in outline Usually, uterus is centrally located No double decidual sign Sac remains empty Seen in ectopic pregnancy Ref: Dutta Obs 9e pg 601.

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True about the chronic obstructive pulmonary disease (COPD)

In COPD, airflow obstruction is demonstrated by spirometry in which the post-bronchodilator FEV1/FVC is less than 70%. The severity of COPD may be defined in relation to the post-bronchodilator FEV1 which is <30% predicted in very severe type. Measurement of lung volumes provides an assessment of hyperinflation.COPD is characterised by an increase in residual volume, residual volume/total lung capacity ratio, and progressive hyperinflation(increased total lung capacity) late in the disease.

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