Datasets:

openlifescienceai

/

medmcqa

like 101

af87a839-8794-47b6-bc5c-131da1b3f168

Which of the following clinical laboratory observations is suggestive of Hanup disease?

Burnt sugar smell in urine

High plasma phenylalanine levels

Extremely high levels of citrulline in urine

High fecal levels of tryptophan and indole derivatives

3d

single

High fecal levels of tryptophan and indole derivatives Hanup disease is autosomal recessive metabolic disorder also known as pellagra like dermatosis. This affect the absorption of nonpolar( neutral ) amino acids specially tryptophan. So there is no absorption of tryptophan.

Physiology

All India exam

09e17233-d63c-4399-bf4e-1350747da141

All are true about pathogenesis of Ovarian Hyperstimulation Syndrome, EXCEPT?

Due to ovarian enlargement and fragility

Increase in intravascular volume

Role of VEGF and inflammatory cytokines

Secondary to infeility treatment

1b

multi

Symptoms of OHSS are the result of ovarian enlargement and fragility, extravascular fluid accumulation, and intravascular volume depletion (and not increase as stated in option b). Fluid shifts that accompany OHSS are due to increased protein-rich fluid secretion from the stimulated ovaries, increased renin and prorenin within follicular fluid, increased capillary permeability and VEGF

Gynaecology & Obstetrics

Ovarian Hyperstimulation Syndrome (OHSS)

26a1bbfc-a56e-4059-b43a-768cc11e8b32

Biological value of a protein is related to

Nitrogen content

amino acid content

Sulphur content

Energy content

0a

single

Ans) a (Nitrogen content) Ref paik 20th ed p 549Biological value of a protein is Retained N2 / Absorbed N2 x 100Protein efficiency ratio = Wt gain in gms / Gram of protein consumedNet protein utilization =Digestibility Coefficent x Biological value100 Aminoacid score =No of mg of one AA/gm of proteinNo of mg of same AA/gm of egg proteinx 100Quality of protein is assessed by comparison to the reference protein which is usually egg protein.

Social & Preventive Medicine

Nutrition and Health

595cf09b-34c6-4d89-9033-6ff3ed0b38d5

The study for correlation of genetic disease to consanguinity -

Case Contral Study

Cohort study

Cross-sectional study

Case report

0a

single

Ans. is 'a' i.e., Case Control Study " The association of consanguinity with complex disorders can be studied using different approaches. For example, epidemialogial surveys could compare the frequency of a disorder in the progeny offirst cousin parents with that of unrelated parents, whereas case-control studies could compare the rates of first cousins among affected individuals and controls".

Social & Preventive Medicine

Epidemiological Study

9752d8e3-e260-40dd-97ae-d846f413301e

Von Gierke&;s occurs due to deficiency of

Glucose-6-phosphatase

Liver Phosphorylase

Muscle phosphorylase

Debranching enzyme

0a

single

Glycogen storage disease type I (GSD I) or von Gierke&;s disease, is the most common of the glycogen storage disease. This genetic disease results from deficiency of the enzyme glucose-6-phosphatase and has an incidence in the American population of approximately 1 in 100,000 bihs.Ref: DM Vasudevan, 7th edition, page no: 128

Biochemistry

Metabolism of carbohydrate

805e7f24-2c61-4783-92de-e8757acfc270

A 38 year old male has paroxysmal hypeension. He is subsequently found to have medullary carcinoma of the thyroid, pheochromocytoma, and mucosal neuromas. Parathyroid involvement is not noted. What is the most likely diagnosis?

MEN type I

MEN type II

MEN type III

Sipple's syndrome

2c

single

MEN III, also known as MEN IIb, is characterized by medullary thyroid carcinoma, pheochromocytoma, and mucosal neuromas.Wermer's syndrome is also called MEN type I . It is characterized by pancreatic (insulinoma), pituitary, and parathyroid involvement.Sipple's syndrome, or MEN type II , is similar to MEN III, but it has parathyroid involvement (tumor or adenoma) as opposed to neuromas. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 18. Endocrine Pathology. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture.

Pathology

9a64eaa1-2bac-44e9-9dce-c0d1c64c258a

Mrs Shikha, 50-years-old woman is diagnosed with cervical cancer. Which lymph node group would be the first involved in metastatic spread of this disease beyond the cervix and uterus? NOT RELATED -anatomy

Common iliac nodes

Parametrial nodes

External iliac node

Paracervical or ureteral nodes

3d

single

.

Pharmacology

All India exam

b17a2718-0ecd-4f2a-a95f-782637289638

A viral infection causes damage to both hippocampi in a patient. This damage would cause the patient to exhibit functional deficits in

Recalling an old declarative memory

Recalling an old procedural memory

Forming a new sho-term memory

Forming a new long-term memory

3d

multi

The hippocampus is crucial for the formation of long-term (declarative) memory. Without the hippocampus, sho-term memory is intact but the conversion to long-term does not take place.The retrieval of stored declarative memory does not require the hippocampus. The hippocampus is not needed for the retrieval of procedural memory.Ref: Guyton; 13th edition

Physiology

General physiology

592dd58a-ef4f-4259-b81d-44a5fc989338

Type of collagen maximum in skin:-

Type I

Type II

Type III

Type IV

0a

single

Collagen - the most abundant protein in mammals contains 4-hydroxyproline and 5-hydroxylysine. Vitamin C plays the role of a coenzyme in hydroxylation of proline and lysine while protocollagen is conveed to collagen The hydroxylation reaction is catalysed by lysyl hydroxylase (for lysine) and prolyl hydroxylase (for proline) This reaction is dependent on vitamin C, molecular oxygen and a-ketoglutarate Type Distribution I Noncailaginous connective tissues, including bone, tendon, skin II Cailage, vitreous humor III Extensible connective tissues, including skin, lung, vascular system IV Basement membranes

Biochemistry

NEET 2019

eec09aec-46e6-477d-bed3-4872b61f97fd

Rotameters

Depend on laminar low for their accuracy

Will only function when upright

Are constant pressure drop-constant orifice devices

Are not accurate below 1L/min

1b

single

Rotameters are constant pressure drop-variable orifice devices. They are accurate at values as low as 200mL/min both laminar and turbulent flow determine their accuracy .

Anaesthesia

2f52d409-c4df-4539-8e4b-2eed20e3c99c

Which of the following is true of Wilson's disease all except -

Autosomal recessive

Serum ceruloplasmin level < 20 mg/d1

Urinary coppor excretion < 100 microgram/c11

Zinc acetate is used as maintence therapy

2c

multi

Urinary copper excretion <100 microgram/di Symptomatic pts. of Wilson disease invariably have urine copper levels > 100 pg per day. Wilson disease is an autosomal recessive disorder caused by mutation in the ATP 7B gene (a copper transpoing ATPase) Diagnosis - The gold standard for diagnosis is Liver biopsy with quantitative copper assayQ. Other diagnostic tests used are ? - Serum ceruloplasmin levelQ - KF rings(2 - Urine copper excretiono - DNA Helpful-ye analysisQ Serum copper values have no diagnostic value, since they may be low, normal or elevated depending upon the stage of evolution of disease. Table : Useful Diagnostic Tests for Wilson Disease Test Normal Value Wilson Disease Serum 180-350 mg/L ceruloplasmin (18-35 mg/d1) * Low in 85% * Present in 99% KF rings Absent - If neurologic or psychiatric symptoms present. * Present in 30-50% - in hepatic presentation and presymptomatic state * Urinary copper excretion is increased 24-h urine Cu 0.3-0.8 mmol - >1.6intn ol(>100mg) in symptomatic patients * 0.9 to > mmol (60 to > 100 mg) - in presymptomatic patients Liver Cu 0.3 -- 0.8 mmol/g * Liver copper is increased (20-50 mg) tissue * > 3.1 mmol (200 mg) Haplotype analysis 0 Matches 2 Matches Treatment Zinc is the treatment of choice for Wilson diseaseQ. It produces a negative copper balance - By blocking intestinal absorption of copper - By inducing hepatic metallothionein synthesis which sequesters additional toxic copper. Table : Recommended Anticopper Treatments for Wilson Disease Disease Status First Choice Second Choice Initial hepatic manifestations Zinc Trientine and zinc Trientine and zinc Hepatic transplantation Trientine Penicillainine and zinc Hepatic transplantation Trientine and zinc * Hepatitis or cirrhosis without decompensation * Hepatitis or Cirrhosis with decompensation - Mild - Moderate - Severe Initial neurologic/psychiatric Tetraioinolybdate and zinc Trientine and zinc Maintenance therapy Zinc Trientine Presymptomatic therapy Zinc Trientine Pediatric Zinc Trientine Pregnant Zinc Trientine

Surgery

e41fa443-a31b-4edc-973f-c29a19504a8b

A 25 year male presented with high grade fever, headache, neck stiffness, on examination found to have neck rigidity, kernig's sign positive, csf analysis showed neutrophilic predominance, low glucose and limulus amebocyte lysate assay was positive. Which of the following is the likely pathogen?

Staphylococcus aureus

Streptococcus pneumonia

Neisseria meningitides

Listeria monocytogenes

2c

single

The Limulus amebocyte lysate assay is a rapid diagnostic test for the detection of gram-negative endotoxin in CSF and thus for making a diagnosis of gram-negative bacterial meningitis. The test has a specificity of 85-100% and a sensitivity approaching 100%. Thus, a positive Limulus amebocyte lysate assay occurs in viually all patients with gram-negative bacterial meningitis, but false positives may occur. Ref Harrison 20th edition page 1001

Medicine

C.N.S

039cfb73-ed02-48d5-9402-91cb407a1250

Tuberculin test denotes:

Previous or present sensitivity to tubercle proteins

Patient is resistant to TB

Person is susceptible to TB

Protective immune status of individual against TB

0a

single

Ans. is 'a' i.e., Previous or present sensitivity to tubercle proteins(a) Tuberculin test denotes Type IV (delayed) hypersensitivity to tuberculoprotein 0.1 ml (Purified protein derivative) and used in diagnosis of latent tuberculosis.(b) Positive tuberculin test indicates exposure to Mycobacterium tuberculosis in the form of infection or immunization with or without active disease.

Microbiology

Bacteria

eca9d17a-d5bd-4f49-a5e2-09f054da5e57

Tumor suppressor gene p53 prevents carcinoma by?

DNA repair

Cell cycle arrest

Apoptosis induction

All of the above

3d

multi

Ans. is 'd' i.e., All of the above * p53 gene is located on chromosome 17 & acts as molecular policeman that prevents the propagation of genetically damage cell. p53 gene product, i.e. p53 protein is a DNA binding protein in the nucleus, when called into action, it controls the transcription of several other genes.* When there is DNA damage due to irradiation, UV light or mutagenic chemicals, there is rapid increase in p53 levels.* p53 causes :-a) Cell cycle arrest: p-53 induces transcription of p21, a CDK inhibitor. p21 inhibit cyclin DCDK- 4 complex and there is arrest of cell cycle late in G1 phase. This allow time for DNA repair.b) DNA repair: p-53 also helps in DNA repair directly by inducing transcription of GADD 45 (growth arrest and DNA damage). GADD 45 encodes a protein that is involved in DNA repair.* If DNA damage is repaired successfully, p53 activate MDM-3 and this MDM-3 induce degradation of p-53 - Relieve in cell cycle block. If DNA damage cannot be successfully repaired, p53 induces apoptosis by inducing the activation of apoptosis inducing gene BAX. So p-53 prevents replication of cell with defective DNA - p53 functions as a critical gatekeeper against formation of cancer. Mutation in p53 leads to carcinogenesis because of loss of above protective mechanism.

Pathology

Neoplasia

6ad43210-4f47-46e0-9336-3f713731bab5

Most specific enzyme for mi is:

Cpk-MM

Cpk-MB

Cpk-BB

LDH

1b

single

Ans: bRef: Harrison, 16thed, p. 1450

Medicine

C.V.S.

71c50ecc-ce9f-452b-9637-20990cc519da

Which of the following is not a part of fatty acid synthase Complex?

Ketoacyl reductase

Enoyl reductase

Acetyl-CoA carboxylase

Ketoacyl synthase

2c

single

Ans. C. Acetyl-CoA carboxylase(Ref: Harper 31/e page 217)Fatty Acid Synthase (FAS) Multienzyme ComplexThe complex is a homodimer of two identical polypeptide monomers in which six enzyme activities and the acyl carrier protein (ACP)ACP contains the vitamin pantothenic acid in the form of 4'-phosphopantetheineX-ray crystallography of the three-dimensional structure, shown that the complex is arranged in an X shapeAcetyl-CoA carboxylase is not a part FAS ComplexQ.

Biochemistry

Lipids

058349ad-8cad-49e2-bd7d-1adefceb3093

All of the followings are responsible for Right shifting of O2 saturation curve; except:

Hypoxia

Hypocapnia

Increase temp

Increased 2,3 DPG

1b

multi

Ans. b. HypocapniaThe factors shift the curve to the right:Increased CO2 (Bohr effect)Increased hydrogen ion (decrease pH)Increased temperatureIncreased 2,3-bisphosphoglycerate (2,3-BPG)Shifts in Hb-O2 dissociation curveStored blood loses 2, 3-bisphosphoglycerate, causing a left shift in the curve, while hypoxia stimulates the production of 2,3-bisphosphoglycerate, thereby causing a right shift.Extra MileRight shiftAcidCO2 Exercise2, 3-BPGAltitudeTemperatureMnemonics: ACE BATs right handed

Physiology

Respiratory System

de4708cf-da2a-43fb-9096-ea14fe9532c4

A nineteen year old female with short stature, wide spread nipples and primary amenorrhoea most likely has karyotype of –

47, XX + 18

46XXXY

47, XXY

45 XO

3d

single

Pediatrics

08c323e3-034d-4a3c-8c75-7eae5ba43778

True about rash of chickenpox

Centripetal

Deep Seated

Affectspalm

Slow to evolute

0a

multi

Rash of chicken pox : Superficial, unilocular, centripetal, pleomorphic, symmetrical, affects flexor surfaces and axilla, spares palms and sales, has inflammation around, rapid evolution and dew-drop on rose petal appeamace.

Social & Preventive Medicine

52ba5acd-dd2c-49ce-89d1-9a848b0f775f

All are true about Klumpke's paralysis except

Claw hand is never seen

Intrincsic muscles of hand are paralysed

Horner's syndrome can be associated

Involves lower trunk of brachial plexus

0a

multi

Klumpke's paralysis C8 and T1 roots involved. Intrinsic muscles of hand paralysed. Wrist and finger flexous are weak. Unilateral Horner's syndrome. Claw hand is seen.

Orthopaedics

5e1e3fb1-06ae-47f7-afb4-6daa01fe92c4

Hyperglycemia is seen in all except?

Cirrhosis

Myotonic dystrophy

Lipodystrophy

Sarcoma

3d

multi

In cirrhosis, blood sugar is elevated, due to reduced uptake of sugar by liver. In myotonic dystrophy and lipodystrophy, there is tissue insensitivity to insulin leading to hyperglycemia. Sarcoma especially large retroperitoneal sarcomas secrete IGF-2 and lead to hypoglycaemia.

Medicine

Diabetes Mellitus

10f7eb85-ebda-4224-bb87-18914bc64576

LSD was introducd by

albe hoffman

delay and deniker

John F Cade

Egaz Moniz

0a

single

Hallucinogens * ALSO CALLED AS Psychotomimetic/ Psychedelic * FIRST Man made HALLICINOGEN ==================== Albe Hoffman * MECHANISM OF ACTION Lysergic acid diethylamide=======serotonin * Introduced by Albe Hoffmann and he himself experienced its effects * Phencyclidine =======NMDA antagonist * Also known as angel dust * Related to ketamine=== dissociative anesthetic * Has anti-suicidal propey Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no.649

Psychiatry

Substance abuse

4a5a1278-2ae8-4808-8548-29acfb03ef49

Decreased basal metabolic rate is seen in

Obesity

Hypehyroidism

Feeding

Exercise

0a

single

The remaining options utilise energy. Basal metabolic rate and obesity The basal metabolic rate accounts for about 60 to 75% of the daily calorie expenditure by individuals. It is influenced by several factors. BMR typically declines by 1-2% per decade after age 20, mostly due to loss of fat-free mass, although the variability between individuals is high. Ref guyton and hall textbook of medical physiology 12/e pg843

Physiology

General physiology

1044a6a2-d3bc-430c-8d3b-972ba533c2a8

A 70 kg athlete is taken for surgery, due to unavailability of vecuronium, succinylcholine is given repeatedly (>640mg). He now is unable to take breath and his lower limbs are paralyzed. What will be cause?

Phase II block

Succinylcholine causes muscle paralysis due to fasciculation

Hidden muscle dystrophy

Pseudo cholinesterase deficiency

0a

single

Prolonged apnea due to repeated dosing with succinylcholine is due to it entering phase 2 block. Phase I depolarizing block is preceded by muscle fasciculation. During paial neuromuscular block, phase I depolarizing block is characterised by: No fade during repetitive stimulation (tetanic or TOF) No post tetanic facilitation (potentiation) Rapid hydrolysis by butyrylcholinesterase (plasma cholinesterase) terminates phase I depolarizing blockade of succinylcholine. Phase II block resembles non depolarizing block, is characterised by: Fade during repetitive stimulation (tetanic or TOF) Post tetanic facilitation (potentiation) Phase II block can be antagonized by administering a cholinesterase inhibitor like neostigmine.

Anaesthesia

Neuromuscular Blocker

a6ae10e2-80ca-44a2-bfca-5442cdf0d3fd

Inheritance of ABO blood group is:

X-linked inheritance

Recessive inheritance

Mitochondria] inheritance

Codominance

3d

single

Ans. d. Codominance (Ref Robbins 9/e p140; Ganong 23/e p527)Inheritance of ABO blood group is Codominance."Although Mendelian traits are usually described as dominant or recessive, in some cases both of the alleles of a gene pair contribute to the phenotype--a condition called codominance. Histocompatibility and blood group antigens are good examples of codominant inheritance. "--Robbins 9/e p140Codominance is a relationship between two versions of a gene, individuals receive one version of a gene, called an allele, from each parent. If the alleles are different, the dominant allele usually will be expressed, while the effect of the other allele, called recessive, is masked. In Codominance, however, neither allele is recessive nor are the phenotypes of both alleles are expressed, e.g., ABO blood group, where in AB blood group both A and B are dominant."Codominance: When both alleles of a gene pair contribute to the phenotype. E.g., Blood group AB.ABO Blood Group SystemA and B antigens of the ABO blood group system are glycoproteins present on the RBC membrane.H substance is the immediate precursor on which A and B antigens are added.H substance is formed by the addition of fucose to the glycolipid or glycoprotein backbone.The subsequent N-acetyl glucosamine creates the A antigen, while the addition of galactose produces the B antigen.Bombay phenotypeIndividuals with the rare Bombay phenotype (hh) do not express the H antigen (also called the H substance), the antigen, which is present in blood group OQ.As a result of the absence of the H antigen they cannot make either the A antigen or the B antigenQ.These individuals have antibodies not only against A and B antigens but also against the H antigenQ.

Pathology

Mendelian Disorders: Single-Gene Defects

a9ca8f83-da91-4a09-8b5d-0ecb5748a6ae

Which is not ketogenic

Leucine

Lysine

Methionine

Tryptophan

2c

single

Ans. is 'c >d' i.e., Methionine > TryptophanLeucine and lysine are purely ketogenic.Trypotophan is not purely ketogenic, but it is ketogenic along with glucogenic. Methionine is purely glucogenic.

Biochemistry

fdd78ece-f205-448d-90cd-4c70fc33aab7

Glossodynia is

Pain in the tongue

Burning of the tongue

Swelling of the tongue

White patch on tongue

0a

single

Pathology

9e813b84-1465-47c4-bce4-d4b9d21aae66

All are the branches of internal iliac artery except:

Obturator artery

Middle rectal artery

Femoral artery

Internal pudendal artery

2c

multi

Ans. C. Femoral arteryThe internal iliac artery supplies the walls and viscera of the pelvis, the buttock, the reproductive organs, and the medial compartment of the thigh.It arises at the bifurcation of the common iliac artery, opposite the lumbosacral articulation, and, passing downward to the upper margin of the greater sciatic foramen, divides into two large trunks, an anterior and a posterior.The anterior division gives rise to these arteries:a. Umbilical artery (in fetus),b. Obturator artery,c. Vaginal artery,d. Superior &inferior vesical artery,e. Uterine artery,f. Middle rectal artery,g. Internal pudendal artery,h. Inferior gluteal artery.The posterior division gives rise to the superior gluteal, iliolumbar, and lateral sacral arteries.

Anatomy

Abdomen & Pelvis

e7a593de-77a8-46f8-b876-3a8186b36abc

SACD (Subacute combined degeneration of cord) is feature of which vitamin deficiency?

Vitamin A

Vitamin B6

Vitamin B9

Vitamin B12

3d

single

Ans. d (Vitamin B12) (Ref. H - 17th/pg. Table 71-1).Vitamins: Major FunctionsVITAMINFUNCTIONVitamin AA component of visual pigment; Maintenance of specialized epithelia; Maintenance of resistance to infectionVitamin DFacilitates intestinal absorption of calcium and phosphorus and mineralization of boneVitamin EMajor antioxidant; scavenges free radicalsVitamin KCofactor in hepatic carboxylation of procoagulants--factors II (prothrombin), VII, IX, and X; and protein C and protein S.Vitamin B1 (thiamine)As pyrophosphate, is coenzyme in decarboxylation reactions. Converted to coenzymes flavin mononucleotide and flavin adenine dinucleotide, cofactors for many enzymes in intermediary metabolismNiacinIncorporated into nicotinamide adenine dinucleotide (NAD) and NAD phosphate, involved in a variety of redox reactionsVitamin B6 (pyridoxine)Derivatives serve as coenzymes in many intermediary reactionsVitamin B12Required for normal folate metabolism and DNA synthesis; Maintenance of myelinization of spinal cord tractsVitamin CServes in many oxidation-reduction (redox) reactions and hydroxylation of collagenFolateEssential for transfer and use of 1-carbon units in DNA synthesisPantothenic acidIncorporated in coenzyme ABiotinCofactor in carboxylation reactionsVitamin B12.introductionStored primarily in the liver. Very large reserve pool (several years). Synthesized only by microorganisms. Found only in animal products.FunctionCofactor for homocysteine methyltransferase (transfers CH3 groups as methylcobalamin) and methyimalonyl-CoA mutase. Abnormal myelin is seen in B12 deficiency, possibly due to | methionine or | methylmalonic acid (from metabolism of accumulated methylmalonyl-CoA).Causes of deficiencyVitamin B12 deficiency is usually caused by malabsorption (sprue, enteritis, Diphyllobothrium latum), lack of intrinsic factor (pernicious anemia, gastric bypass surgery), or absence of terminal ileum (Crohn's disease). Use Schilling test to detect the etiology of the deficiency.Deficiency featuresMacrocytic, megaloblastic anemia; neurologic symptoms (optic neuropathy, subacute combined degeneration, paresthesia); glossitis.PRINCIPAL CLINICAL FINDINGS OF VITAMIN MALNUTRITIONNutrientClinical findingDietary level per day associated with overt deficiency in adultsContributing factors to deficiencyThiamineBeriberi:Neuropathy,Muscle weakness and wasting, Cardiomegaly,Edema,Ophthalmoplegia,Confabulation<0.3 mg/1000 kcalAlcoholism, chronic diuretic use, hyperemesisRiboflavinMagenta tongue,Angular stomatitis,Seborrhea,Cheilosis<0.6 mg-NiacinPellagra:Dermatitis: Pigmented rash with silvery/ varnish-like scales of sun-exposed areas.Bright red beefy tongue.DiarrheaDementiaApathyDisorientationDeath (if untreated)<9.0 niacin equivalentsAlcoholism, vitamin B6 deficiency, riboflavin deficiency, tryptophan deficiencyVitamin B6SeborrheaGlossitisConvulsions (especially in neonates),Neuropathy,Depression,Confusion,Microcytic anemia<0.2 mgAlcoholism, isoniazid (most common cause)FolateMegaloblastic anemia,Atrophic glossitis,Depression, -Homocysteine<100 mg/dAlcoholism, sulfasalazine, pyrimethamine, triamtereneVitamin B12Megaloblastic anemia,SACD:Loss of vibratory and position sense, Abnormal gait,Dementia, impotence,Loss of bladder and bowel control, -homocysteine, -methylmalonic acid.<1.0 mg/dGastric atrophy (pernicious anemia), terminal ileal disease, strict vegetarianism, acid reducing drugs (e.g., H2 blockers)Vitamin CScurvy:petechiae, ecchymosis, coiled hairs, inflamed and bleeding gums, joint effusion, poor wound healing, fatigue, perifollicular hemorrhages, subperiosteal hematoma (Woody leg).<10 mg/dSmoking, alcoholismVitamin AXerophthalmia, night blindness, Bitot's spots,Follicular hyperkeratosis,Impaired embryonic development, Immune dysfunction<300 mg/dFat malabsorption, infection, measles, alcoholism, protein-energy malnutritionVitamin DRickets: skeletal deformation, rachitic rosary, bowed legs; osteomalacia<2.0 mg/dAging, lack of sunlight exposure, fat malabsorption, deeply pigmented skinVitamin EPeripheral neuropathy,Spinocerebellar ataxia,Skeletal muscle atrophy, retinopathyNot described unless underlying contributing factor is presentOccurs only with fat malabsorption, or genetic abnormalities of vitamin E metabolism/transportVitamin KElevated prothrombin time, bleeding<10 mg/dFat malabsorption, liver disease, antibiotic use

Biochemistry

Vitamins and Minerals

dfa84cb3-c018-4049-92c0-9facb1fedf72

Main aim for treatment of TB ?

Prevention of complication

Prevention of disease transmission

Complete clinical cure

Complete bacteriological cure

3d

single

Ans. is 'd' i.e., Complete bacteriological cure Chemotherapy is indicated in every case of active tuberculosis. The objective of treatment is cure-that is, the elimination of both the fast and slowly multiplying bacilli from the patient's body. The effects of chemotherapy are judged not by the anatomic healing of lesions, but maily by the elimination of bacilli from the patient's sputum.

Social & Preventive Medicine

d6cbcff3-4fd8-472d-8749-874eb7e6676f

All of the following are functions of CD 4 helper cells, except-

Immunogenic memory

Produce immnoglobulins

Activate macrophages

Activate cytotoxic cells

1b

multi

CD4 T cells are helper T cells. They stimulate B cells to produce antibodies, release of cytokines and are responsible for memory. They do not directly produce any antibody by their own. Basic Pathology, Robbins. Page no.:101

Pathology

General pathology

cd1c6dc6-e13e-46e4-a1bf-0e58f335fcab

A 35-year-old man with duodenal stump leak after partial gastrectomy is receiving central parenteral nutrition containing the standard D25W, 4.25% amino acid solution. Which is TRUE of essential fatty acid deficiency seen after hyperalimentation?

It occurs if soybean oil is given only once weekly.

It is usually noted at the end of the first week.

It causes dry scaly skin with loss of hair.

It is accompanied by hypercholesterolemia.

2c

multi

Essential fatty acid deficiency usually occurs if hyperalimentation is extended for more than 1 month and when soybean oil is not administered at least twice a week. There is a decrease in linolenic, linoleic, and arachidonic acids and an increase in oleic and palmitoleic acid. In addition to the skin changes, there may be poor wound healing, increased susceptibility to infection, lethargy, and thrombocytopenia. It is characterized by a triene-to-tetraene ratio >0.4.

Surgery

Wounds, Tissue Repair & Scars

6bdc5753-1ecc-4c7f-9b13-c12a98cc27b6

Sacrum becomes a single bone at ___ years of age.:-

15

25

30

40

1b

single

Sacrum The five sacral veebrae are separated by cailage until pubey. Later, fusion of epiphyses takes place and ossification of interveebral discs extend from below upwards. Sacrum becomes single bone at 21-25 years of age. Sometimes, it leaves a gap between S1 and S2, until 32 years called as 'lapsed union'.

Forensic Medicine

Human identification

e2fd6f27-7d7f-4716-aa70-ecba8b9eabad

Which is True about dobutamine?

Dobutamine decreases peripheral resistance

Acts on D1 and D2 receptors

Decrease kidney circulation

Has no effect on coronary circulation

0a

multi

Ref: HL Sharma 3rd ed pg no: 177 Dobutamine is a derivative of dopamine and is a selective beta1 agonist. It causes an increase in the force of contraction without a significant increase in hea rate. It also produces some vasodilatation by stimulating the beta 2 receptors. It doesn't decrease kidney circulation.

Pharmacology

Autonomic nervous system

530064a0-72a7-4912-a2f0-3d7c504b57a5

Which of the following statements about cutaneous shunt~vessels is true?

Perform nutritive function

Have role in thermoregulation

Not under the control of autonomic nervous system

These vessels are evenly distributed throughout the skin

1b

multi

These are low resistance connection between the aerioles and veins bypassing the capillariesAbundantly innervated by sympathetic nerve fibresEspecially found in skin of fingers, toes and earlobes where they are involved in the thermoregulationRef: Medical Physiology Indu Khurana 2015 edition page No: 237

Physiology

Cardiovascular system

69f3e303-e24a-46df-81de-e7caa5bf29db

Volume of infarcted area in acute myocardial infarction (AMI) can be detected by -a) ECHOb) ECGc) Levels of CPKMBd) Thallium scan

b

c

ac

ad

3d

multi

Medicine

5d7fcdca-98b9-43e6-bfed-edf8891c9ac9

Blow out fracture of orbit commonly produces

Deviation of septum

Retinal haemorrhage

Fracture of nasal bones

Fracture of floor of orbit

3d

single

(D) Fracture of floor of orbit # Blow out fracture of orbit; Intraorbital haemorrhages, proptosis, paralysis of extrinsic muscles and fracture of the floor of the orbit are not infrequent following a blunt injury to the orbital region> Proptosis develops due to reactive oedema and intra-orbital haemorrhage.> Partial or complete ophthalmoplegia occurs as a result of injury to the muscles or due to profuse orbital oedema.> In the fracture of the floor of orbit, the eyeball is depressed into the maxillary antrum & the inferior rectus and inferior oblique muscles are entrapped causing diplopia.> There occurs limitation of upward gaze, and downward gaze may also be reduced because of the pinched inferior rectus muscle in between the chips of the broken bone> A positive forced duction test, downwards and inwards displacement of the globe and radiological evidence virtually confirm the diagnosis of blowout fracture with incarcerated orbital tissue.> The fracture of the base of skull implicates optic foramen and may cause optic atrophy or pulsating exophthalmos.> The fracture of the optic canal is characterised by a wound at the lateral part of the eyebrow, loss of direct homolateral pupillary reaction and hemianopic field defects.> The patient may suffer from epistaxis and varying periods of unconsciousness.> The pallor of the optic disc may be noticed 2-3 weeks after the injury. Serial radiological tomograms taken at one minute intervals may confirm the diagnosis.

Ophthalmology

Miscellaneous

57b5b287-ca45-4e1b-be8f-a09a847fb97f

Drug used in cancer chemotherapy induced vomiting is?

Aprepitant

Dexamethasone

Ondansetrin

All of the above

3d

multi

Ondansetron is drug of choice for chemotherapy induced vomiting Dexamethasone,lorazepam and aprepitant are also used for chemotharapy induced vomiting.( ref KDT 7/e p876)

Pharmacology

Gastrointestinal tract

0ff5d474-8b83-4e08-a720-1546fc5dee6f

NOT a cause of granular contracted kidney ?

Diabetes mellitus

Chronic pyelonephritis

Benign nephrosclerosis

Chronic glomerulonephritis

0a

single

Ans. is 'a' i.e., Diabetes mellitusCauses of Granular contracted kidney ?Chronic glomerulonephritis (symmetric)Chronic pyelonephritis (asymmetric) o Benign Nephrosclerosis (Symmetric) Sometimes, Diabetes too can cause granular contracted kidney

Pathology

9a3e2aa9-a4b3-4745-850f-b113a6ec519f

Anticoagulant of choice for prophylaxis of venous thromboembolism in patient with cancer surgery is:-

Heparin sulfate

Protamine sulfate

Low molecular weight heparin

Warfarin

2c

single

Venous Thromboembolism- precipitating factor -estrogen in females PREVENTION OF Venous Thromboembolism AMONG HOSPITALIZED PATIENTS Condition Prophylaxis High risk non - ohopedic surgery Unfractionated heparin Low molecular weight heparin (LMWH) Cancer surgery(associated thromboembolism ) LMWH Major ohopedic surgery Warfarin LMWH Aspirin Factor Xa inhibitors (Apixaban) Dabigatran Medically ill patients during hospitalization Unfractionated heparin LMWH Medically ill patients after hospitalization Betrixaban

Pharmacology

Hematology

8141bbae-712a-4c78-b66f-c742fe4eea44

Which of the following does not belong to dystrophin-glycoprotein complex

Perlecan

Dystrophin

Dystroglycan

Sarcoglycan

0a

single

Perlecan is a large extracellular matrix proteoglycan that plays a crucial role in tissue development and organogenesis. Dystrophin-glycoprotein complex The dystrophin-glycoprotein complex provides a structural link between the cytoskeleton of the muscle cell and the extracellular matrix, which appears to stabilize the sarcolemma, adds strength to the muscle by providing a scaffolding for the fibrils and prevents contraction-induced injury(rupture). Organisation of DG complex Dystrophin connects F-actin to the transmembrane protein b-dystroglycan smaller proteins called syntrophins. This b-dystroglycan, in turn connects to the merosin subunit of laminin 211 in the extracellular matrix a-dystroglycan The dytroglycans are also associated with a complex of four transmembrane glycoproteins, a-,b-,g- and d- sarcoglycan and sarcospan. Ref: Ganong's Review of Medical physiology 25th edition Pgno: 103

Physiology

General physiology

0872023a-b442-4c33-8fb4-e916e3cbc681

Patient came to the OPD with recent onset photphobia within 24 hours and sloughing corneal ulcer. There is greenish ulcer base. Which of the following can be the causative organism:

Acanthamoeba

Nocardia

Pseudomonas

Herpes

2c

single

Pseudomonas Ulcer Rapid onset & Greenish ulcer base Produce biofilm that cause resistance MC cause of infection in contact lens users Nocardia ulcer resembles fungal ulcer in its characteristics.

Ophthalmology

Diseases of Cornea

b369df7e-9844-445d-911d-e14306aaf867

Culture media used for leptospira

MYPA agar

BYCE agar

EMJH Medium

Skirrow's medium

2c

single

Culture media for leptospira is EMJH media, Korthof's, Stuart's and fletcher's media.

Microbiology

dd9154c8-18f3-40ee-9309-5be6f26e6818

The advantage of using a tooth positioner as a retainer is :

Final setting of occlusion

Used in uncooperative patients

Esthetics

Gingival margin inflamed during orthodontic treatment

3d

single

The use of a tooth positioner rather than final settling archwires has two advantages:  It allows the fixed appliance to be removed somewhat more quickly than otherwise would have been the case (i.e., some finishing that could have been done with the final archwires can be left to the positioner) It serves not only to reposition the teeth but also to massage the gingiva, which is almost always at least slightly inflamed and swollen after comprehensive orthodontic treatment. The gingival stimulation provided by a positioner is an excellent way to promote a rapid return to normal gingival contours. As a general rule, a tooth positioner in a cooperative patient will produce any changes it is capable of within 2-3 weeks. Final (post-treatment) records and retainer impressions can be taken 2 or 3 weeks after the positioner is placed. Beyond that time, if the positioner is continued, it is serving as a retainer rather than a finishing device-and positioners, as a rule, are not good retainers. Contemporary orthodontics- proffit 4th edition page 614

Dental

0c1fe138-cff1-4040-a4cc-b16466e99a3e

Cryosurgery is used in treatment of cervical intraepithelial neoplasia. It is appropriate in all except

Transformation zone lying entirely on ectocervix.

Smooth cervical surface without deep crevices.

Cervical intraepithelial neoplasia -3.

CIN limited to two quadrants of the cervix.

2c

multi

Cryosurgery is generally not favoured for treatment of CIN-3 due to higher rates of disease persistence following treatment, and lack of histologic specimen to exclude occult invasive cancer.

Gynaecology & Obstetrics

a67701a3-f954-488a-875d-12f4fd7ef127

In respiratory and GIT infections, which is the most affected immunoglobulin -

IgA

IgG

IgM

IgD

0a

single

IgA Antibody:- IgA is the second most abundant antibody (2nd highest for DHS). It is of two types: Serum IgA: Predominantly in monomeric form. Secretory IgA (SIgA): It is dimeric (valency four); Secretory IgA is responsible for Mucosal /local immunity. IgA also exist in two subclasses/isotypes: IgA1 is mainly found in serum. IgA2 predominates in secretions. IgA (Secretory IgA) is selectively concentrated in secretions and on mucous surfaces forming an antibody paste and is believed to play, an impoant role in local immunity against respiratory and intestinal pathogens. It protects the mucous membranes against microbial pathogens. It serves an impoant effector function at mucous membrane surfaces, which are the main entry sites for most pathogenic organisms.

Microbiology

Immunology Pa 1 (Immune Response, Antigen-Antibody Reactions, Hypersensitivity, Structure of Immune System, Immunodeficiency Disorders)

745dd5aa-461f-4928-9b6a-6bcd597d685e

All are risk factors of squamous cell carcinoma except

Ultraviolet radiation

Tar

Tobacco

HPV 18

3d

multi

Ultraviolet radiation, chronic inflammation, and chemical carcinogens (arsenicals, tar) and infection with HPV 5 and 16.There is also evidence that current and previous tobacco use doubles the relative risk of SCC.Ref: Bailey and Love, 27e, page: 606

Surgery

General surgery

dc30cf9f-3905-4ae1-ac1a-97312f1567a8

Judge can ask questions: Punjab 07

During cross-examination

Examination-in-Chief

Any time during trial

Re-examination

2c

single

Ans. Any time during trial

Forensic Medicine

96952c56-c9f6-43f2-a638-122711492aa0

Which is not an aryl phosphate -

Parathion

TIK-20

Malathion

Paraoxon

2c

single

Organophosphate poisoning is the most common poisoning in India followed by aluminium phosphide. Organophosphorus compounds are classified as 1. Alkyl compounds -- such as tetraethyl pyrophosphate (TEPP), hexa ethyl tetraphosphate (HETP), octa methyl pyrophosphate (OMPA), malathion etc. 2. Aryl compounds -- such as parathion, chlorothion, diazinon (Tik-20), paraoxon etc. REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO 291

Forensic Medicine

Poisoning

59165dbb-66fe-4ccd-bd9f-26c60ca3c161

A female, Lalita, aged 26 yrs accidentally takes 100 tablets of paracetamol. What is the treatment of choice -

Lavage with charcoal

Dialysis

Alkaline diuresis

Acetylcysteine

3d

multi

Ans. is 'd' i.e Acetylcysteine "In cases of moderate to severe poisoning N acetylcysteine (Mucomyst) should be given orally. It is most effective when given within 16-24 hours of overdosage. It prevents hepatic damage". - Parikh

Unknown

8f26f931-d9ad-4446-8735-8a2a0891cd89

True for Bochdalek hernia:

Commonly occurs on the right side

Congenital disorder

Anterior position

Breathing difficulty in newborns from day 2-3

1b

multi

Ans. B. Congenital disorderBochdalek hernia is the other name for congenital diaphragmatic hernia. It is a posterior (and not anterior) congenital defect of the diaphragm and is primarily due to lack of closure of the pleuroperitoneal cavity between the eighth and tenth week of embryonic life. Majority of cases occur on the left side. Affected newborns frequently present with breathing difficulty, particularly within the first few hours of life.

Pediatrics

New Born Infants

7fc5f783-e5de-47e8-be02-0b2e2d2cf123

Hypercalcemia is most commonly associated in which of the following cancers?

Renal cell cancer

Carcinoma stomach

Squamous cell carcinoma of lung

Hepatocellular carcinoma

2c

single

The most common neoplasm associated with hypercalcemia is squamous cell carcinoma. Other tumors often associated with paraneoplastic hypercalcemia are carcinomas of the lung, kidney, breast and ovary. Paraneoplastic hypercalcemia is caused by parathyroid hormone-related protein (PTHRP) secreted by these tumours. PTHRP increases bone resorp-tion and renal calcium uptake, while inhibiting renal phosphate transpo, effects that raise serum calcium levels.

Pathology

General Concepts

6cbef59c-cfd7-44a3-be03-2dcde2226526

Ethanol is given in methyl alcohol poisoning because:

It inhibit alcohol dehydrogenase

It inhibit aldehyde synthetase

It binds 100 times stronger than methanol

None

0a

multi

Ethanol is preferentially metabolised by alcohol dehydrogenase over methanol.At a concenteration 100mg/DL in blood it saturates alcohol dehydrogenase over methanol &retads methanol metabolism. This reduces formation of formaldehyde & formic acid. Ref KD Tripathi 8th ed.

Pharmacology

Central Nervous system

a37fa7cc-898e-46b1-8909-8ea8c34e5761

A term born 6-month-old, lethargic blonde infant, presented with multiple episodes of vomiting, poor feeding, convulsions and severe psychomotor retardation. O/E: - Microcephaly with prominent maxillae and widely spaced teeth Blue iris Seborrheic or eczematoid rash Spasticity, hyperreflexia, and tremor Musty odour of urine MRI brain All of the following statements are true about the disease except: -

May be caused due to the deficiency of cofactor tetrahydrobiopterin BH4

Tandem mass spectrometry is useful in the diagnosis.

The complications can't be prevented by restricting the use of the involved amino acid in diet.

Pegvaliase can be given in adults suffering from this.

2c

multi

This is a case of Phenylketonuria. Autosomal recessive Deficiency of Phenylalanine hydroxylase May also be due to deficiency of cofactor tetrahydrobiopterin BH4 Leads to hyperphenylalaninemia - Impairs brain development Normal at bih Becomes symptomatic later on in life Present with seizures, hypopigmentation of skin and hair, mental retardation. Complications can be avoided by restricting phenylalanine intake in diet. Diagnosed by: - Guthrie test Tandem mass spectrometry- measure amino acid Immunoassays MRI image shows affected periventricular/ parieto-occipital white matter (due to hypomyelination). Pegvaliase can be given in adults.

Unknown

Integrated QBank

7d0da418-4874-4cf7-b692-7ac48dae2708

PK reactio detects -

IgG

IgA

IgE

IgM

2c

single

The Prausnitz-Kustner test (PK test, Prausnitz-Kustner reaction) is an immunologic test formerly used by physicians to determine if a patient has an allergic reaction to a specific antigen i.e, IgE Ref: Ananthanarayan & Parkers textbook of microbiology 9th edition pg:98

Microbiology

Immunology

9fd65ddc-1d99-4f2a-9cde-eb506e3f3aef

Most common cause of facial nerve palsy:

Idiopathic Bell's palsy

Herpes zoster oticus

Mastoid surgery

Chronic suppurative Otitis media

0a

single

Facial Nerve - Course Intracranial pa 15-17mm Intra temporal pa Meatal segment 8-10mm Labyrinthine segment 4.0mm Tympanic / horizontal segment 11.0mm Mastoid / veical segment 13.0mm Extracranial pa Branches Greater superficial petrosal nerve 1st branch Nerve to stapedius Chorda tympani Communicating branch Posterior auricular nerve Muscular branches, peripheral branches Causes of facial nerve palsy Most common cause is idiopathic bell's palsy paralysis acute onset Bell's palsy idiopathic, Ipsilateral lower motor neuron palsy Loss of forehead and brow movements Inability to close eyes drooping of eyelids Loss of nasolabial folds, drooping of lower lip herpes zoster oticus/Ramsay hunt syndrome herpes zoster oticus/Ramsay hunt syndrome Mastoid surgery is the most common iatrogenic cause of facial nerve palsy.

ENT

FMGE 2018

58414fd5-9a46-4f3e-9877-99124ced85fd

Sinus of Morgagni is between:

Middle constrictor and inferior constrictor

Middle constrictor and superior constrictor

Superior constrictor and skull

None of the above

2c

multi

Sinus of Morgagni is a gap between the base of skull and the upper concave border of superior constrictor muscle. Structures passing through that are: Auditory tube, levator palati muscle, ascending palatine artery and palatine branch of the ascending pharyngeal artery.

Anatomy

cf27425c-59c2-4d8c-90c9-8fe4c02249df

The typical bone marrow finding in ITP is:March 2004

Absent megakaryocytes

Foam cells

Increased megakaryocytes

Fragmented megakaryocytes

2c

single

Ans. C i.e. Increased megakaryocytesDiagnosis of ITPDespite the destruction of platelets by splenic macrophages, the spleen is normally not enlarged.In fact, an enlarged spleen should lead to a search for other possible causes for the thrombocytopenia.Bleeding time is usually prolonged in ITP patients.Normal bleeding time does not exclude a platelet disorder.Bone marrow examination may be performed on patients over the age of 60 and those who do not respond to treatment, or when the diagnosis is in doubt.On examination of the marrow, an increase in the production of megakaryocytes may be observed and may help in establishing a diagnosis of ITP.An analysis for anti-platelet antibodies is a matter of clinician's preference

Pathology

eaae9ff2-57e0-4987-91b7-aa9ee8d1d304

The final sugars in intestinal chyme are

Glucose and fructose

Ribose and mannose

Ribose and xylulose

Xylulose and fructose

0a

single

Physiology

b89a8870-4b04-40a5-b61c-08b2f20f955a

Abdominal ultra-sonography in a 3 year old boy show a solid circumscribed hypoechnoic renal mass. Most likely diagnosis is -

Wilm's tumor

Renal cell carcinoma

Mesoblastic nephroma

Oncocytoma

0a

single

Amongst the given options only Wilms tumor is common at 3 years of age :-  Wilm's tumor                  → young children (mean 3 years) Mesoblastic nephroma     → < 1 year Renal cell carcinoma        → > 40 years Oncocytoma                    → 25-95 years (mean 65)

Radiology

602e8406-1778-4b75-9fd9-9fd67000b90e

The term that best describes the nuclear dissolution is

Pyknosis

Karyorrhexis

Karyolysis

None of the above

2c

multi

Pyknosis is condensation of nucleus. Karyorrhexis is fragmentation of nucleus. Karyolysis is dissolution of nucleus.

Pathology

38548ecb-a51d-4c93-bb67-bd82e9d4af79

Which of the following test is used to estimate the amount of fetal maternal hemorrhage:

Coomb's test

Apt test

Liley's spectrophotometer

Kleihauer betke test

3d

single

KLEIHAUER BETKE TEST or ACID ELUTION TEST done to measure the amount of feto maternal hemorrhage usually in an Rh negative mother to calculate the dose of anti D required This method is based on the fact that an acid solution (citric acid phosphate buffer, pH 3.5) elutes the adult but not the fetal hemoglobin from the red cells; can detect as little as 0.2 ml of fetal blood diluted in 5 L of maternal blood. More accurate tests are immunofluorescence and flow cytometry. Schiller test:- Schiller's iodine solution is applied to the uterine cervix under direct vision. Normal mucosa contains glycogen and stains brown, whereas abnormal areas, such as early CIN, do not take up the stain and appear white/yellow. Liley's spectrophotometer: Spectrophotometric analysis of amniotic fluid at optical density difference at 450 nm wavelength to see detion bulge in Rh hemolytic disease.

Gynaecology & Obstetrics

Obstetrics

c8b518b5-9d0e-4188-a73e-4ddcb59365e0

Failure to initiate and maintain spontaneous respiration following birth is clinically k/a –

Birth asphyxia

RDS–Respiratory distress syndrome

Respiratory failure

Pulmonary oedema

1b

multi

Pediatrics

12e7ce79-1a49-41e2-b806-16ac4daee47d

In volume cycled ventilation the inspiratory' flow rate is set at:

140-160 L/min

110-130L/min

60-100 L/min

30-50L/mm

2c

single

In volume cycled ventilation the inspiratory flow rate is usually set at 60-100 U/min to allow greater expiration time for each breath. Use of high inspiratory flow rate can minimize end inspiratory lung volume and intrinsic PEEP, but it can cause higher peak airway pressures. Volume cycled assist control mode of ventilation is the most commonly used mode of ventilation. Volume targeted modes deliver a preset volume unless a specified circuit pressure limit is exceeded. Its major advantages are capacity to deliver unvarying tidal volumes, flexibility of flow and volume adjustments, and power to ventilate difficult patients. Disadvantages of this type of ventilation are: Unless the airway is well sealed volume cycled modes cannot ventilate effectively and consistently. After the flow rate and profile are set the inflation time of machine is set and remains unresponsive to patients native cycling rythm and flow demands. Ref: Respiratory Emergencies By Stephan Kamholtz, page 413. Critical Care Medicine: The Essentials By John J. Marini, page 134.

Anaesthesia

19950a16-a96f-42d6-baef-f52950186f2b

Which of the following statement is/are true about Obstructive lung disease ?

mMRC dyspnea scale ,grade 2 includes shoness of breath when hurrying up inclines

Decreased FEV1/FVC ,TLC is increased

Normal PEFR and decreased in Lung volume

Roflumilast is introduced in management of COPD in Group C

1b

multi

Acute asthma and Emphysema- TLC | due to air trapping Myasthenia gravis- TLC | RV| Obstructive Restrictive | in airflow | Lung volume - Expiratory -Inspiratory COPD Asthma Bronchiectasis ILD Scoliosis NM causes FEV1-| FVC- Normal or | TLC - Normal or | | PEFR Normal | | |PEFR Management of COPD Group A Low Risk, low symptom Bronchodilator Group B Low Risk, High symptom LABA/LAMA, if failed- LAMA+LABA Group C High Risk, Low symptom LAMA+LABA or LABA+ICS Group D High Risk, High symptom LAMA+LABA+ICS | symptoms persists Phosphodiesterase inhibitor (Roflumilast) or Macrolides mMRC DYSPNOEA SCALE (for COPD patients) Grade Impact 1 Incline (Breathlessness on going upstairs) 2 Slow walk than peers (Breathlessness on walking in straight surface) 3 Stops (Keeps on stops walking in between) 4 Too breathless to go out of his house GOLD (Global Initiative for Obstructive Lung Disease) classification

Medicine

COPD and Asthma

6d0376b2-01a1-4bb7-a704-26adee194bf5

Diplopia is not a presenting feature in:

Manifest squint

Paralytic squint

Latent squint

Anisometropia

2c

single

C i.e. Latent squint Hetrophoria or latent strabismus is a condition in which there is a tendency to misalignment of the visual axis, which is corrected by the fusional capacity. Often latent squints give no trouble until the demand of near vision increase the strain. No symptoms arise, perhaps, until after reading or writing for an hour or two when the letter seems to run together'. There diplopia, which is often not appreciated as actual double vision, causes blurring of the print. With effo, blurring is overcome, but eventually this becomes impossible, headache supervenes & the work has to be abandoned. Anisometropia presents with - imperfect binocular vision, amblyopia, squint & diplopia (Basak p-68).

Ophthalmology

d67a810d-ee8d-4738-8547-b7f42558fe6d

Not a branch of external carotid aery:-

Superior thyroid

Ophthalmic

Lingual

Ascending pharyngeal

1b

single

Branch of ECA: - Superior thyroid aery Lingual aery Facial aery Anteriorly Ascending pharyngeal aery medially Occipital aery Posteriorly Posterior auricular aery Superficial temporal aery Maxillary aery Terminal aery Branches of ICA Ophthalmic aery Anterior choroidal aery Anterior cerebral Middle cerebral Posterior communication aery.

Anatomy

JIPMER 2018

9c40aa07-0f46-43b6-b8c0-82de8d34dc21

Not a marker for hyperparathyroidism is :

Increase in serum calcium

Increase in 24 hour urinary calcium excretion

Decrease in serum calcitonin

Subperiosteal resorption of phalanges

2c

single

Answer is C (Decrease in serum calcitonin) : Serum calcitonin is no marker fir hyperparathyroidism. It antagonizes the actions of parathyroid hormone and may be used as a modality of treatment of hypercalcemia secondary to hyperparathyroidism. Markers of hyperparathyroidism (|ed PTH): 1. Increased serum calcium: Stimulates Vit D which causes increased absorption of Ca-H- from gut Increased calcium reabsorption from tubules Increases osteoblastic activity in bones and mobilizes calcium from bone into serum. 2. Decreased serum phosphorus: - PTH acts on tubules to increase excretion of phosphorus. 3. Increased 24 hr urine calcium: - Despite increased reabsorption of Ca++ in renal tubules urinary calcium is increased owing to increased filtration of calcium in glomerular filtrate. 4. Increased Alkaline phosphatase: -Increased resorption of bone leads to compensatory elevation of osteoblastic activity 5. Radiological changes: Subperiosteal resorption of phalanges is characteristic (hand X Rays are always advised) Bone resorption i.e. osteitis fibrosa et cystica (brown tumours) `Salt pepper' or 'pepper pot skull' appearance - Loss of lamina dura

Medicine

a4be5e8f-df2e-47c3-bd52-8a502b42c096

Which of the following is TRUE about branchial cyst?

Usually seen along the posterior border of the sternocleidomastoid muscle

Mostly arises from 2nd branchial system

Always present in preschool children

Conservatory treatment is indicated

1b

multi

Branchial cleft cysts usually present as a soft cystic mass along the anterior border of the sternocleidomastoid muscle. These lesions are usually recognized in the second or third decades of life. To prevent recurrent infection and possible carcinoma, they should be completely excised, along with their fistulous tracts. First branchial cleft cysts present high in the neck, sometimes just below the ear. A fistulous connection with the floor of the external auditory canal may be present. Second branchial cleft cysts, which are far more common, may communicate with the tonsillar fossa. Third branchial cleft cysts, which may communicate with the piriform sinus, are rare and present low in the neck. Ref: Lustig L.R., Schindler J.S. (2013). Chapter 8. Ear, Nose, & Throat Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow, T.G. Berger (Eds), CURRENT Medical Diagnosis & Treatment 2014.

Surgery

d7c32d13-4b43-4d79-90aa-6a059cca55e0

In a UK study, it was found that there were more deaths from asthma than the sale of anti-asthma drugs. This is an example of:

Cohort study.

Case reference study.

Ecological study.

Experimental study.

2c

single

Dental

1dec7811-ae14-4d26-9470-0c73a4f8d0aa

Pawaer burr, appearance on laparoscopy is characteristic of :

Endometriosis

Endometroid tumour

Epithelial ovarian tumour

Endometrial cancer

0a

single

Endometriosis

Gynaecology & Obstetrics

f10db7ed-acb5-46dd-9714-e1079a390de9

An adult female patient presents with asthma symptoms for at least 4 days a week and wakes up at night due to breathlessness approximately 2 -3 days in a month. she is classified to be having.

Severe persistent Asthma

Mild persistent Asthma

Intermittent Asthma

Moderate persistent Asthma

1b

single

Medicine

eef73746-8a75-4d05-befb-67d65f405a3f

Which structure(s) passes behind the inguinal ligament -a) Femoral branch of genitofemoral nerveb) Superficial epigastric arteryc) Psoas majord) Femoral veine) Saphenous vein

abc

ad

bc

acd

3d

single

Structures passing deep to inguinal ligament. -        Psoas major, Iliacus, pectineus -        Femoral nerve and vessels -        Lateral cutaneous nerve of thigh -        Femoral branch of genitofemoral nerve -        Lymphatics

Anatomy

33d9bc14-330b-42c8-b597-0a4388ba22df

I/V contrast is not used in –

HRCT

MRI

IVP

Myelography

3d

single

IV contrast agent is given in :- X-ray based investigation (Radiocontrast agent) :- Radiography (simple x-ray), CT-Scan. MRI (MR contrast agents). Ultrasound (USG contrast agents). IVP (intravenous pyelography) as the name suggests, the contrast agent is given intravenously. In myelography, the contrast agent is injected into subarachnoid space.

Radiology

241f1ab2-55fa-4a54-8351-6db48a5bcf4a

Patient with persistent diarrhea & hypotension. Diagnosis -

VIPoma

ACTHoma

GRFoma

Glucagnoma

0a

single

Ans. is 'a' i.e., VIPoma Pancreatic Neuroendocrine TumorsTumourBiologicaly active peptide secretedTumour locationMalignant percentageMain symptoms and signsGastrinoma (non b cell tumour)GastrinDuodenum (70%) Pancreas (25%) other sites (5%)60-90o Pain (79-J 00%)o Diarrhoea (30-73%)o GERD (30-35%)o Peptic ulcerInsulinoma (b cell tumour)InsulinPancreas > 99% (Insulinomas are distributed equally on head body and tail of pancrease)< 10o Symptoms of hypoglycemiao Symptoms releive on administration of glucoseVIPOMA (Verner-Morrison syndrome, pancreatic cholera (WDHA)Vasoactive intestinal peptidePancreas 90%40-70o Watery diarrhoea (90-100%)o Hypokalemia (80-100%)o Hypochlorhydriao Dehydration (83%)GlucagonomaGlucagonPancreas 100% (usually occurs singly in pancreatic tail)50-80%o Dermatitis (migratory necrolytic erythema) 67-90%o Glucose intolerance (40-90%)o Weight loss (66 to 96%)o .Anemia(33-85%)o Diarrhoea (15-29%)o Thromboembolism

Medicine

G.I.T.

ba5b5d9c-6e4d-4073-a17a-2cf5247d2c1e

Lamina densa of the basal lamina beneath the epithelium is composed of

Type I Collagen

Type II Collagen

Type III Collagen

Type IV Collagen

3d

single

Dental

05987701-c793-4312-9f50-17a2420f70e6

Haascheiben cells in epidermis are responsible for?

Touch

Temperature

Pressure

Proprioception

0a

single

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

Skin

28e5fc62-670b-4c5a-90fe-531e5638943d

Pancytopenia with cellular marrow is seen in all Except:

Megaloblastic anemia

Myelodysplasia

Paroxysmal nocturnal hemoglobinuria

G6 PD deficiency

3d

multi

Answer is D (G-6PD Deficiency) Glucose - 6 - PD Deficiency is not associated with Pancytopenia and a cellular marrow Myelodysplasias, PNH and Megaloblastic anemia (Vit B12,Folate deficiency) may present with Pancytopenia and a cellular marrow.

Medicine

9e4156f1-ffbe-462c-ab24-8c77494d025c

The following are adverse effects of SSRIs except

Weight changes

Diarrhoea

Delayed ejaculation

Galactorrhea

3d

multi

Galactorrhea is a side effect of hyperprolactinemia is not usually seen with SSRIs Side effects of SSRIs include weight changes, delayed ejaculation,diarrhoea,bleeding , discontinuation syndrome,insomnia. Ref: KD Tripathi 8th ed.

Pharmacology

Central Nervous system

4fce6607-dcce-4b01-bb64-40c4d8cc968a

The germinal cell layer surrounding the oocyte before ovulation is known as :

Zona pellucida

Zona reticularis

Cumulous oophorus

Zona glomerulosa

2c

single

In one area , the granulosa cells are collected together to form a projection into the cavity of graffian follicle. This projection is referred to as the discus proligerus or cumulus oophorus. The ovum itself lies within it.With the exception of area around the discus, the peripheral granulosa cells form a layer only a few cells in thickness.,whereas at the discus the cells are between 12 and 20 layers thick. Reference: Shaw's Textbook of Obstetrics 15th edition page 28

Gynaecology & Obstetrics

General obstetrics

1f10b85e-0f5b-4265-97c2-c4c1b8b13252

Folie a deux is

OCD

Shared delusion disorder

Hysteria

Neurasthenia

1b

single

Shared psychotic disorder or folie a deux, the characteristic feature is the transmission of delusions from "inducer" (primary patient), who is the "originally" ill patient and suffers from a psychotic disorder to another person who may share the inducer's delusions in entirety or in pa. the person who receives the delusion is usually financially dependent on the inducer person the person who receives the delusion is intellectually less normal and tend to beleive everything that the inducer person tells. both the person who induces and receives the delusion live in close proximity they live in social isolation with less contact with the outside world as they remain together delusion system perpetutes. treament of choice for such patients is seperation of the receiver of delusion from the inducer and the symptom of delusion reduces. Depending on whether the delusions are shared among two, three, four, five and even twelve people, it is called as folie a deux, folie a trios, folie a quatre, folie a cinq and folie a douze. Shared psychotic disorder is mostly observed among people who live in close proximity and in close relationships. Reference: Kaplon and sadock, 11 th edition, synopsis of psychiatry, 11 th edition, pg no. 390

Psychiatry

Personality disorders

df6cb8f2-27d5-41be-a8b1-32cdda520ca6

After the death of the 78 years old male patient in a hospital , who was suffering from COPD. His relatives entered the hospital with heavy sharp weapons and damaged the hospital propey and stared abusing and beating the doctor as well as his staff, Violence against a medical practitioner is considered as:

Non-cognizable and non-bailable offense

Non-cognizable and bailable offense

Cognizable and bailable offense

Cognizable and non-bailable offense

3d

single

Medical protection act: The Act, covering doctors affiliated to institutions as well as independent practitioners, outlaws attacks against physicians and damage to their propey. Offenders can get a jail term of up to 3 years and a fine of Rs 50,000. As per the medicare service persons and damage to propey in medicare service institutions (Prevention of violence and damage or loss to propey) Act , Violence against a registered medical practitioner is considered as a cognizable and non-bialable offence.

Forensic Medicine

Medical Jurisprudence

c132f6f0-3e32-4a1a-9f86-4f2410c31ab4

Which soft tissue sarcoma commonly gives to bone secondaries: (PGI June 2008)

Fibrosarcoma

Liposarcoma

Osteosarcoma

Neurofibroma

2c

single

Ans. C (Osteosarcoma) "Any cancer can spread to bone ,but in adults more than 75% of skeletal metastases originate from cancers of the prostate,breast,kidney & lung. In children, metastases to bone originate from Neuroblastoma, Wilm's tumor, Osteosarcoma, Ewing sarcoma & Rhabdomyosarcoma"- Robbins7th/1303Sarcoma Metastasizing through lymhatics (causing L.N involvement) LymhosarcomaQ RhabdomyosarcomaQ AngiosarcomaQ Clear cell sarcomaQ Epithelial sarcoma M aligna nt fibrous histiocytomaQ Synovial cell sarcomaQ

Orthopaedics

Osteogenic Sarcoma

6d71ffb5-12aa-46f1-84a3-1849029c6f93

The intermediate host for T. Saginata is:

Man

Cow

Dog

Pig

1b

single

Cow

Microbiology

98dce37e-30db-461f-81bd-8fc6e3c21dca

Which of the following is associated with cough?

Lisinopril

Propranolol

Verapamil

Sodium nitroprusside

0a

single

Ans: a (Lisinopril) Ref: KDT, 6th ed, p. 484* Cough is a side effect of ACE-1.* Bradykinin and substance P seem to be responsible for the cough. Thromboxane antagonism, aspirin, and iron supplementation reduce cough induced by ACE inhibitors. Once ACE inhibitors are stopped, the cough disappears, usually within 4 days.Important points on ACE inhibitorsEnalapril, fosinopril, perindopril, and ramipril are prodrags.Captopril & lisinopril does not require hydrolysis to become active ACE inhibitorEnalapril is converted in the body into enalaprilat. Enalaprilat differs from captopril in that it is an analog of a tripeptide rather than a dipeptide.Adverse effects of ACE inhibitors are cough; hypotension; hyperkalaemia; acute renal failure in patients with bilateral renal artery stenosis, stenosis of the artery to a single remaining kidney, heart failure, or volume depletion owing to diarrhea or diuretics; teratogenicity; skin rash; proteinuria, angioedema and dysguesia.

Pharmacology

ACE Inhibitors

8821ae63-6fe0-4ddd-912e-de5be35752f4

Lowest most level of integration of stretch reflex is at

Cerebral cortex

Lower Medulla

Spinal cord

All of the above

2c

multi

Physiology

b74d5aca-2c9f-42ed-8184-98c465b7ac61

Wernicke&;s encephalopathy involves

Mammillary body

Thalamus

Frontal lobe

Arcuate fasciculus

0a

single

Wernicke's encephalopathy : The neuropathological lesions are symmetrical and paraventricular, involving the mammillary bodies, the thalamus, the hypothalamus, the midbrain, the pons, the medulla, the fornix, and the cerebellum. Ref: Synopsis of Psychiatry, 11th edition, page 632.

Psychiatry

Substance abuse

824706cb-9571-4bcd-ae12-d893256f0c35

When VA/Q is infinity, it means

Dead space

The PO2 of alveolar air is 159 mmHg and PCO2 is 40 mmHg

Paial pressure of O2 and CO are equal

Atelectasis

0a

single

-Ventilation / perfusion ratio - normal = 4l/min/5l/min=0.8 - AV/Q= INFINITY - Means Perfusion (Q) to lungs is zero that is blood supply to that area is hindered making it awasted ventilationin those alveoli. - This may be due to pulmonary embolism causing |ed Physiological DEAD space . DEAD SPACE- Some of the air a person breathes never reaches the gas exchange areas but simply fills respiratory passages where gas exchange does not occur, - called so as its not useful for gas exchange. Physiologial / total dead space = anatomical dead space +alveolar dead space (non perfused/ non functioning Alveoli) In Atelectasisventilation: perfusion ratio (VA/Q) iszero. it is is the most common cause of a physiologic shunt.

Physiology

NEET Jan 2020

95fbb4f0-8b34-4251-b067-03673cedc609

Which is true regarding Savage syndrome?

Receptor defect to gonadotrophic hormones

Sho stature

Ovaries do not contain follicles

FSH is normal

0a

multi

In Savage syndrome, there is receptor defect to gonadotrophic hormones. The clinical features resemble autoimmune disease. Height is normal. The ovaries contain follicles. FSH is raised. Ref: Shaw's Textbook of Gynaecology, 18th edition, p286

Gynaecology & Obstetrics

All India exam

0c4db971-ade8-4aeb-8c6f-0bbcd0212c39

What is the dosage of retinol palmitate for early stages of xerophthalmia: September 2011

90 mg orally on two successive days

100 mg orally on two successive days

110 mg orally on two successive days

120 mg orally on two successive days

2c

multi

Ans. C: 110 mg orally on two successive days Nearly all of the early stages of xerophthalmia can be reversed by administration of a massive dose (2,00,000 IU or 110 mg of retinol palmitate) orally on 2 successive days Xerophthalmia/ Dry eyes Condition in which the eye fails to produce tears. Xerophthalmia caused by a severe vitamin A deficiency is described by pathologic dryness of the conjunctiva and * cornea. The conjunctiva becomes dry, thick and wrinkled. If untreated, it can lead to corneal ulceration and ultimately to blindness as a result of corneal damage. Xerophthalmia is a term that usually implies a destructive dryness of the conjunctival epithelium due to dietary vitamin A deficiency -- a rare condition in developed countries, but still causing much damage in developing countries. Other forms of dry eye are associated with aging, poor lid closure, scarring from previous injury, or autoimmune diseases such as rheumatoid ahritis and SjOgren's syndrome, and these can all cause chronic conjunctivitis. Radioiodine therapy can also induce xerophthalmia, often transiently Xerophthalmia from hypovitaminosis A is specifically due to lack of the hormone-like vitamin A metabolite retinoic acid Treatment can occur in two ways: treating symptoms and treating the deficiency. Treatment of symptoms usually includes use of aificial tears in the form of eye drops, increasing the humidity of the environment with humidifiers, and wearing wrap around glasses when outdoors. Treatment of the deficiency can be accomplished with a Vitamin A or multivitamin supplement or by eating foods rich in Vitamin A. Treatment with supplements and/or diet can be successful until the disease progresses as far as corneal ulceration, at which point only an extreme surgery can offer a chance of returning sight.

Social & Preventive Medicine

3812332f-67f7-4c05-860e-c6c0e51325bc

Which among the following organisms causes Buruli ulcer?

M. Marinum

M. Ulcerans

M. kansasii

M. Smegmatis

1b

single

Ans. B. M. UlceransM. Ulcerans causes Buruli ulcer.* It starts as a nodule or papule which progresses further to form a shallow necrotic ulcer.* Children (5-15 years old) have the highest incidence of Buruli ulcers, with most lesions on the lower extremities.Image: Extensive Buruli ulcer

Skin

Bacterial Infection of Skin

8b679fd4-ddf7-4292-8db8-815e18215fdd

A 41 year old patient presented with chronic diarrhoea for 3 months. A d-xylose absorption test was ordered to look for:

Carbohydrate malabsorption due to mucosa] disease

Carbohydrate malabsorption due to chronic pancreatitis

Fat malabsorption due to mucosal disease

Fat malabsorption due to chronic pancreatitis

0a

single

Ans is A (Carbohydrate malabsorption due to mucosal disease) `The urinary D-xylose test for carbohydrate absorption provides an assessment of proximal small intestine mucosal function.' Urinary D-xylose test: Principle D-xylose is a `pentose. that is completely absorbed almost exclusively in the proximal small intestine and excreted subsequently in the urine. The level of excreted D-xylose in urine is estimated. Any decrease in its level in urine means abnormality in carbohydrate absorption in proximal intestine. Procedure & interpretation 25g D-xylose is given and urine is collected for 5 hrs. An excretion of < 4.5e primarily reflects the presence of duodenal /jejuna) mucosal disease.

Medicine

937dc386-a681-40b5-891f-3e2a125907cf

Which of the following extraocular muscles does not arise from annulus:

Inferior rectus

Medial rectus

Lateral rectus

Superior oblique

3d

single

The annulus of Zinn, also known as the annular tendon or common tendinous ring, is a ring of fibrous tissue surrounding the optic nerve at its entrance at the apex of the orbit.It can be used to divide the regions of the superior orbital fissure.The aeries surrounding the optic nerve are sometimes called the "circle of Zinn-Haller" (CZH).Some sources distinguish between these terms more precisely, with the annulus tendineus communis being the parent structure, divided into two pas:A lower, the ligament or tendon of Zinn, which gives origin to the Rectus inferior, pa of the Rectus internus, and the lower head of origin of the Rectus lateralis.An upper, which gives origin to the Rectus superior, the rest of the Rectus medialis, and the upper head of the Rectus lateralis. This upper band is sometimes termed the superior tendon of Lockwood.The site of origin of the superior oblique muscle is from the lesser wing of sphenoid above the optic canal.

Anatomy

7e09fed0-c064-482b-802c-77f23bd4a1c2

Compared to follicular Ca, papillary Ca of thyroid have :a) More male preponderanceb) Bilateralityc) Local recurrence commond) Increased mortalitye) Increased lymph node metastasis.

ab

bce

acd

ace

1b

single

Surgery

9c65da0f-5b74-4a30-9da0-fbe0a9dee64a

Ptosis is due to:

3rd CN palsy

4th CN palsy

5th CN palsy

6th CN palsy

0a

single

Ans. (a) 3rd CN palsy (oculomotor)Ref.:BDC 6th ed. Vol-III/361-62* Ptosis is drooping of eyelid.* Eyelid is comprised of 4 muscles:Muscles, their innervation and functionMuscleCN innervationFunction* LPSIIIOpens the eyelid* Muller's muscleT1 (NOT a CN; sympathetic nerve)Opens eyelid when LPS tired* FrontalisVIICloses the eyelid* Orbicularis oculiVIICloses the eyelid* CN III palsy leads to drooping of eyelid (Ptosis).* CN VII palsy may also cause ptosis.Also Know*All the extraocular muscles are supplied by CN III except lateral rectus and superior oblique.* Lateral rectus supplied by- CN VI* Superior oblique supplied by- CN IVRemember- LR6; So4

Anatomy

Orbit

07d8e80e-51bc-4550-b39e-aeede6810447

True about isoenzymes is/are

Different km value

Consist of multimeric complex

Have different physical properties

All of these

3d

multi

Consist of multimeric complex & `e' i.e., Have different physical properties isozymes are the physically distinct forms of the same enzymes that catalyze the same reaction, and differ from each other structurally, electrophoretically and immunologically. They differ in their physical properties because of genetically determined difference in amino acid sequence. They are separated by electrophoresis as they have different electrophoretic mobility. They have different Kin value. Isoenzyme of an oligomeric enzyme process differ in combination of its peptide protomer.

Biochemistry

6dc3ca7d-e70e-4a71-9d19-d8ca18fe74cc

Which of the following is not an action of epinephrine when administered intravenously in a high dose?

Increases liver glycogenolysis

Causes broachiolar constriction

Evokes extrasystoles in the heart

Produces restlessness and anxiety

1b

single

Pharmacology

5e5a624d-7d19-459a-8462-97deb1ede7d5

Osteoclast has specific receptor for:

Parathyroid hormone

Calcitonin

Thyroxin

Vit D3

1b

single

Calcitonin receptor is expressed in osteoclasts. Calcitonin inhibits bone resorption by inhibiting osteoclasts; and promotes Ca2+ from blood to be deposited on the bone. This decreases blood Ca2+. PTH is a primary endocrine regulator of bone remodeling in adults. The PTH/PTHrP receptor is expressed on osteoblasts, but not on osteoclasts.

Physiology

Endocrine System

968f0797-5a02-45e6-8ddc-2174b37144ee

All are true about precocious puberty except -

Secondary sexual characters before the age of 8 years

Secondary sexual characters before the age of 6 years

Menstruation before the age of 10 years

Most common cause is constitutional

1b

multi

Ans. is 'b' i.e., Secondary sexual characters before the age of 6 years o Precocious puberty is the appearance of appropriate secondary sexual characters before the age of 8 years and occurrence of menstruation before 10 years of chronological age.o It is divided into the following types:A) Gonadotropin dependent precocious puberty/ Central precocious puberty / True precocious puberty:# Most common cause is constitutional, due to early maturation and activation of the hypothalamic - pituitary - gonadal axis.# Both breast and pubic hair development in girls# Pubic hair development and testicular enlargement in boys# Early developing sexual characteristics are "isosexual", meaning they are consistent with the child's gender.# Initial spurt in the height followed by premature closure of epiphysis with the result the ultimate height remains stunted.B) Gonadotropin - independent precocious puberty/ Peripheral precocious puberty/Pseudo - precocious puberty:# Exposure to sex steroid hormones that derive from the gonads, the adrenals or the environment.# Further subclassified as isosexual when sexual characters are consistent with gender, and as contrasexual when inconsistent with gender (virilization in girls, or feminization in boys).# Autonomous functional ovarian follicular cysts are the most common cause of gonadotropin - independent precocious puberty in girls.C) Incomplete precocious puberty':# Children with isolated premature thelarche or premature adrenarche. Both usually represent variants of normal pubertal development, but some will progress to complete precocious puberty that may be gonadotropin - dependent or independent.

Gynaecology & Obstetrics

Disorders in Menstruation

57fa1424-b761-4bfd-b26a-5d69ec3c3752

Initiation of nerve impulse occurs at the axon hillock because :

It has a lower threshold than the rest of axon

It is unmyelinated

Neurotransmitter release occurs here

None of the above

0a

multi

A i.e. It has lower threshold than rest of axonAxon hillock is the initial segment of neuron, nerve impulses begin in this initial segment of axon because it has lowest threshold potential.QAxon hillock:- This is a thickened area of cell body from which originates the long fibrous axon.AP is generated in this segment because the membrane at the axon hillock has grater concentration of voltage gated Na+ channels and therefore the threshold for excitation is lower than the rest of neuronsQ

Physiology