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Society & Ethics 57

3e8affd9-1f57-4f95-9904-2b453e95abad

After an operation on femur bone, chest x-ray shows widespread mottling throughout the lung field like a snowstorm, the likely cause

Air embolism

Bacterial pneumonitis

Fat embolism

Pulmonary embolism

single

Orthopaedics

7022a295-d3b0-4209-a66e-0a41df750b89

Causes of status epilepticus in a child-

Hypernatremia

Hyponatremia

Hyperkalemia

Hypokalemia

single

Ans. is 'b' i.e., Hyponatremia Causes of status epilepticus in children o Idiopathic o Drug intoxication o Congenital/Developmental neurological abnormalities o Hypoglycemia o Meningitis, Encephalitis o Hyponatremia o Head trauma o Pyridoxin deficiency

Pediatrics

6d8e7874-11ca-4620-8d6a-3f9410c0636b

A female with genital herpes simplex is being treated in the outpatient depament. The doctor teaches her about measures that may prevent herpes recurrences and emphasizes the need for prompt treatment if complications arise. Genital herpes simplex increases the risk of:

Cancer of the ovaries

Cancer of the uterus

Cancer of the cervix

Cancer of the vagina

single

A female with genital herpes simplex is at increased risk for cervical cancer. Genital herpes simplex isn't a risk factor for cancer of the ovaries, uterus, or vagina. HPV is the primary neoplastic-initiating event in the vast majority of women with invasive cervical cancer. HPV- 16 and -18 are the types most frequently associated with high-grade dysplasia.

Dental

Sexually Transmitted Infections

a3e7475c-2f08-402d-a613-fa69aea7ec12

All are chest X-Ray features suggestive of VSD in a child, EXCEPT:

Large aoic knob

Increased splaying of the carina

Cadiomegaly

Pulmonary plethora

multi

Chest X-Ray are typically normal in small VSD. In case of large VSD the findings are: 1. Cardiomegaly 2. Pulmonary plethora 3. Increased splaying of the carina with an anlge more than 90 with left main bronchi. 4. Small aoic knob 5. Increased left atrium Ref: Essentials of Pediatric Radiology, Page - 44

Radiology

dc8ed65e-7931-4687-b942-5b6210c6537b

The drug imatinib acts by inhibtion of:

Tyrosine kinase

Glutathione reductase

Thy midile synthetase

Protein kinase

single

Ans. is 'a' i.e. Tyrosine kinase Chronic myeloid leukemia is characterized by BCR-ABL translocationThe BCR-ABL translocation in chronic myeloid leukemia encodes a tyrosine kinase which is essential for cell proliferation and survivalImatinib (511-571) is a new molecularly targeted drug, which inhibits the tyrosine kinase activity, producing hematological and cytological remission in majority of patients.The treatment of CML has changed with the introduction of imatinib mesylate.The drug is a specifically designed inhibitor of the tyrosine kinase activity of the bcr/abl oncogene.It is well tolerated and results in nearly universal, 98% hematologic control of chronic phase disease.It has now replaced both interferon and hydroxyurea as standard therapy.The addition of either alpha interferon or low dose chemotherapy with cytarabine holds promise for even better results.Adverse effects of imatinibNauseaPeriorbital swellingRashMyalgia

Pharmacology

Anti-Neoplastic Agents

52808b6a-e679-468e-b70f-dcc18a310fd4

Pleomorphic adenoma is usually arise from

Parotid gland

Sub mandibular gland

Minor salivary gland

Superficial lobe

multi

(Parotid gland) (546-HM) (584-Basic pathology 8th)Pleomorphic adenoma (Mixed salivary tumour) is the commonest tumour in the parotid gland and occurs less often in other major and minor salivary gland, common in females.

Pathology

G.I.T.

38f57975-0b1c-4c43-b75a-f1887d517e3e

Drug causing gynecomastia is :

Spironolactone

Rifampicin

Penicillin

Bumetanide

single

Pharmacology

18fecf42-0103-416d-9750-672a5515ba2b

A young female presents with a history of fever and nodular lesion over the shin. Histopathology reveals foamy histiocytes with neutrophilic infiltration. There is no evidence of Vasculitis. Most probable diagnosis is:

Sweet's Syndrome

Erythema nodosum

Erythema nodosum leprosum

Behcet's syndrome

single

Absence of vasculitis, history of fever and nodular lesions with neutrophillic infiltration may be seen in Sweet's syndrome and Erythema Nodosum. However, presence of histiocytic infiltration is rare or uncommon in Sweet's syndrome and more common in Erythema nodosum. Therefore, Erythema nodosum is the right Answer amongst the above options and wins the duel with Sweet's syndrome. Ref: Tarascon pocket rheumatologica, by Andrew E. Thompson, Page 32; Vasculitis in clinical practice, by Richard A.Watts, David G.I. Scott, Page 153.

Skin

a6053c89-bcc7-46b3-8f31-0b1618ef8e17

Chandler’s Index is used for:

Filariasis

Ascariasis

Guinea worm

Ancylostoma

single

Chandler Index It is the average number of hookworm eggs per gram of faeces for the entire community.

Unknown

4ae2e062-b21e-48d0-8bf6-89f40c5c1bf3

Most common site for leiomyoma in GIT ?

Appendix

Jejunum

Ileum

Stomach

single

Stomach is the most common site for leiomyoma in GIT. Most common benign tumor of oesophagus is stomach.

Pathology

672ddcc5-a4e8-42cd-a5b1-853eb680e541

Tachyphylaxis is seen after use of:

Tamoxifen

Ephedrine

Morphine

Chlorpromazine

single

Pharmacology

84f0ed49-9e34-4370-951e-9451f28c65d2

Brunner's glands are present in

Duodenum

Jejunum

Proximal ileum

Distal ileum

single

Ans. a (Duodenum) (Ref. BDC, Vol. II, 3rd ed., 212)THE DUODENAL GLANDS OF BRUNNER (BRUNNER'S GLAND)# These lie in the SUBMUCOSA of the duodenum.# These are small, compound tubuloacinar glands.# They secrete mucus.RegionMajor characteristicsMucosal cell types at surfaceFunction of surface mucosal cellsEsophagus# Nonkeratinized stratified squamous epithelium# Skeletal muscle in muscularia externa (upper 1/3)# Smooth muscle (lower 1/3)--Stomach (body and fundus)Rugae: shallow pits; deep glandsMucous cellsSecrete mucus; form protective layer against acid; tight junctions between these cells probably contribute to the acid barrier of the epithelium Chief cellsSecrete pepsinogen and lipase precursor Parietal cellsEnteroendocrine (EE) cellsSecrete HCI and intrinsic factorSecrete a variety of peptide hormonesPylorusDeep pits; shallow branched glandsMucous cellsParietal cellsEE cellsSame as aboveSame as aboveHigh concentration of gastrinSmall intestineVilli, plicae, and cryptsColumnar absorptive cellsContain numerous microvilli that greatly increase the luminal surface area, facilitating absorptionDuodenumBrunner glands, which discharge alkaline secretionGoblet cellsSecrete acid glycoproteins that protect mucosal liningsPaneth cellsContain granules that contain lysozymeMay play a role in regulating intestinal floraEE cellsHigh concentration of cells that secrete cholecystokinin and secretinJejunumVilli, well developed plica, cryptsSame cell types as found in the duodenal epitheliumSame as aboveIleumAggregations of lymph nodes called Peyer patchesM cells found over lymphatic nodules and Peyer patchesEndocytose and transport antigen from the lumen to lymphoid cellsLarge intestineLacks villi, cryptsMainly mucus-secreting and absorptive cellsTransport Na+ (active) and water (passively) out of lumen

Anatomy

Small Intestine

8fdfdfb1-acdc-40d3-8f70-eafc6f482ed3

Cayenne pepper stippling due to hemosiderin is found in:-

Erythroplasia of Queyrat

Paget's disease

Plasma cell balanitis of zoon

Bowen's disease

single

Cayenne pepper stippling d/t hemosiderin seen in uncircumcised patient in Plasma cell balanitis of zoon/ zoon balanitis C/F - Erythematous, shiny lesions- Over glans penis- Asymptomatic lesion- Mild pruritus- Shows cayenne pepper strippling Cayenne pepper stippling appearance is d/t purpose develops pruritic spot d/t hemosiderin deposition. Erythroplasia of Queyrat- premalignant condition

Dental

JIPMER 2018

6d044ab3-6c3e-42c1-9467-583675478961

Loss of extension of little ring finger, hypothenar atrophy is seen in injury of:

Post interosseous nerve

Radial trunk

Ulnar Nerve

Median nerve

single

Ans. c. Ulnar nerve before division into superficial and deep branches (Ref: BDC 4/vol-I/123) Nerve damaged in case of numbness of little and ring finger, atrophy of hypothenar muscles is ulnar nerve, before division into superficial and deep branches. Supplied muscles Ulnar Nerve (C7C8T1) Musician's NerveQ Median Nerve (C5678T1) Laborer's nerveQ Axilla and Arm No branch No branch Forearm * Flexor carpi ulnarisQ * Flexor digitorum profundus (medial half)Q * Flexor carpi radialis * Flexor digitorum profundus (lateral half) * Flexor digitorum superficialisQ * Flexor pollicis longus * Palmaris longus * Pronator teres and quadratusQ Hand * Last two (3rd and 4th) lumbricalsQ * Palmar and dorsal interosseiQ * Thenar muscles: - Adductor pollicisQ * Hypothenar muscles: - Palmaris brevis - Abductor digiti minimi - Flexor digiti minimi - Opponens digiti minimi * 1st two (1st and 2nd) lumbricalsQ * Thenar muscles: * Abductor pollicis b.revisQ * Flexor pollicis brevisQ * Opponens pollicisQ

Anatomy

Hand

b41d80ab-8e4c-482c-9837-bb9be343594a

Deficinecy of enzyme hexosaminidase, subunit causes -

Tay - Sach's disease

Hurler's syndrome

Fabry disease

Pompe disease

single

Tay-Sachs Disease (GM2 Gangliosidosis: Deficiency in Hexosaminidase b Subunit) Gangliosidoses are characterized by accumulation of gangliosides, principally in the brain, as a result of a deficiency of a catabolic lysosomal enzyme. Depending on the ganglioside involved, these disorders are subclassified into GM1 and GM2 categories. Tay-Sachs disease, by far the most common of all gangliosidoses, is characterized by a mutation in and consequent deficiency of the b subunit of enzyme hexosaminidase A, which is necessary for the degradation of GM2. More than 100 mutations have been described; most affect protein folding or intracellular transpo. Referense:Robbins basic pathology pg no:229,230

Pathology

Pediatrics, environment and nutrition

bd8e2393-f07d-493e-8a47-04a0548ccfe5

A woman has a bilateral headache that worsens with emotional stress; she has two children, both doing badly in school; diagnosis is

Migraine

Cluster headache

Tension headache

Trigeminal neuralgia

multi

A tension-type headache (TTH) is a syndrome characterized by bilateral tight, band-like discomfo, builds slowly, fluctuates in severity, episodic or chronic (present >15 days per month).Usually occurs without accompanying features such as nausea, vomiting, photophobia, phonophobia, osmophobia, throbbing, and aggravation with movement. Ref: Harrison's 18/e p121,122

Medicine

All India exam

e8ddbb46-0383-4152-934d-337873f0390a

Subcapsular orchiectomy is done for cancer of ?

Testes

Prostate

Penis

Urethra

single

Ans. is 'b' i.e., Prostate

Surgery

a85fb7ea-fb52-4871-9dfe-fd088d14f966

All the following are tricyclic antidepressants except

Mianserin

Imipramine

Protriptyline

Maprotiline

multi

there are several types of antidepressants namely tri cyclic antidepressent=== amitriptilline, clomipramine, imipramine, noriptilline SSRI=================fluoxetine, paroxetine, fluvoxamine, seraline, citalopram, escitalopram SNRI=================venlafaxine, desvenlafaxine, duloxetine Mianserin is tetracyclic and atypical antidepressant Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 607

Psychiatry

Mood disorders

fe4d30f3-36ec-4689-b5dc-1e5c49f7c998

FDA indications of inhaled NO is?

Malignant hypeension

Pulmonary hypeension in newborn

Cyanotic CHD

None of the above

multi

Ans. is 'b' i.e., Pulmonary hypeension in newborn According to Goodman Oilman "Inhaled nitric oxide has been approved by FDA for use in newborns with persistent pulmonary hypeension and has become the first line therapy for this disease. In this disease state NO inhalation has been shown to reduce, significantly, the necessity for extracorporeal oxygenation"

Anaesthesia

5d6bfb9f-6b4c-4227-a686-27a6e5f54d90

Epiphyseal enlargement is seen in

Rickets

Scurvy

Spondo-epiphyseal dysgenesis

Juvenile Rheumatoid Ahritis

single

D i.e. Juvenile Rheumatoid

Radiology

800bd0a9-d05f-48af-9c17-ce161396c2e4

The laboratory evidence of flare in SLE is:

Increase in titre of anti-dsDNA

Increase in titre of ANA

Increase in anti-Sm

Elevation of ESR

single

SLE FLARE: LAB RESULTS Increases in quantities of anti-dsDNA herald a flare, paicularly of nephritis or vasculitis It may be associated with declining levels of C3 or C4 complement. Antibodies to Sm is specific for SLE and assist in diagnosis; anti-Sm antibodies do not correlate with disease activity or clinical manifestations. Ref: Harrison, E-18, P-2735

Medicine

e4453f82-0320-4fc3-a8d5-0771184b6f21

Vulvar carcinoma accounts for what percentage of genital tract malignancies?

0.5 - 1%

3 - 5%

7 - 11%

13 - 15%

single

Ans. is 'b' i.e.,3 - 5%Vulval CarcinomaIt occurs in 17/100,000 females.It accounts for 3 - 5% of the genital tract malignanciesIt usually occurs in post menopausal females with median age of 60 years.It has increased association with obesity, hypeension, diabetes and multiparity.

Gynaecology & Obstetrics

761a8cc3-8cf9-4737-a55c-1391f69af678

The most common manifestation of congenital toxoplasmosis -

Hydrocephalus

Chorioretinitis

Hepatospienomegaly

Thrombocytopenia

single

Pediatrics

45757e59-a6c2-4c25-b233-19106a744738

PR interval in ECG denotes

Isovolumetric contraction of ventricle

Insovolumetric relaxation of heart

Atrial contraction

None

multi

Ans. (c) Atrial contractionRef: Ganong, 25th ed/p.525PR interval#From the onset of P wave to the beginning of QRS complex#Duration - 0.12 to 0.20 sec#Denotes atrial contraction and Atrioventricular (AV) conduction time

Physiology

Heart, Circulation, and Blood

4f50da44-cd43-4ea9-8107-c82aff7c1788

A 60-year-old male diabetic and hypeensive patient was found unconscious in the morning. On examination pulse rate is 120/min, BP=160/100 mm Hg. What is the next step to be done for management?

Order CT scan

Check blood glucose

Give intravenous mannitol

Immediately reduce BP with antihypeensives

multi

Choice C is ruled out since no features of raised ICP are given. Choice D is ruled out since BP lowering is done in case of CNS events if the BP> 185/110 mm Hg. Moreover, CT is required for diagnosis of a CNS event. At lower BP values reducing BP would be counterproductive and can lower Brain perfusion. Now we have to choose between the two choices CT scan and blood glucose. As per the algorithm of management of an unconscious patient with DM, blood sugar levels should be checked first.

Medicine

Brain Hemorrhage

34858cbf-f9a2-4930-9af1-89f53157bc8a

A 60 years old male presented to OPD with bleeding PR. On DRE, growth was felt at by the tip of index finger. On sigmoidoscopy, there was an ulcero-proliferative growth located 6 cm from anal verge. On CECT, liver and lungs were not involved. After chemoradiation, what is the next best step?

Observation an follow up

Low anterior resection

Abdominoperineal resection

Haman's procedure

multi

Ca. rectum - Length of surgical anal canal - 3 cm - Growth on DRE - (10 cm) - In rectum - Growth Located >5 cm above anal verge - LAR - Growth located at Anorectal junction or <5 cms from anal verge - APR Stage I - Surgical excision Stage II Stage III Stage IV Neo adjuvant chemoradiation + Surgical excision

Surgery

GIT

c2b593ea-9721-4906-9f81-c2e22a7fcaae

Which of the following bone tumor arise from epiphysis?

Osteoid osteoma

Chondrosarcoma

Ewing's sarcoma

Chondroblastoma

single

Chondroblastoma is an uncommon benign neoplasm consisting of chondroid tissue mixed with more cellular tissue. In 98% cases it arise from the epiphysis. Osteoid osteoma is most commonly located in the proximal medial femoral coex just distal to the lesser trochanter. In long bones it is mostly located in the diaphysis followed by metaphysis. Ewings sarcoma usually arise from the diaphysis of long bones. Chondrosarcoma has a predilection for flat bones especially shoulder and pelvic girdles but can also affect diaphyseal poion of long bones.

Surgery

9978bf8d-9aeb-41e9-82e8-2ed07f541d77

Resting membrane potential of neuron is

+70mv

-70mv

+90mv

-90mv

single

The magnitude of resting membrane potential from tissue to tissue ranges from - 9 to - 100.RMP of nerve Fibre is - 70mV(REF: TEXTBOOK OF MEDICAL PHYSIOLOGY GEETHA N 2 EDITION, PAGE NO 22)

Physiology

General physiology

187e7c8d-4974-4221-9ceb-09a1771acbb1

Which of the following will be the most important adjuvant therapy in a case of fungal corneal ulcer –

Atropine sulphate eye ointment

Dexamethasone eye drops

Pilocarpine eye drops

Lignocaine eye drops

single

Cycloplegics are used in any corneal disease as a symptomatic treatment. Atropine ointment or eye drop is the DOC.

Ophthalmology

049b766c-1986-43e2-9cb6-67dbf36d91d7

Which of the following techniques is the best for differentiating recurrence of brain tumour from radiation therapy induced necrosis?

MRI

Contrast enhanced MR1

PET scan

CT scan

single

Ans. PET scan

Radiology

8fff83bf-e469-4328-8f9d-cea5e72c975c

The most common extracranial solid tumor in pediatric age group is ____:

Juvenile pilocytic astrocytoma

Chloroma

Retinoblastoma

Neuroblastoma

single

Ans. D. Neuroblastoma* Neuroblastoma - is the most common intra-abdominal malignancy and also, the most common extracranial solid tumor in children.* It is an embryonal cancer of the peripheral sympathetic nervous system.* The median age for diagnosis is 22 months and 90% of cases are diagnosed by 5 years of age.* Other options:- Optic nerve glioma, more properly referred to as juvenile pilocytic astrocytoma, is the most frequent tumor of the optic nerve in childhood.- Chloromas, which are collections of myeloid leukemia cells, seen in patients with AML, can occur throughout the neuraxis.- Retinoblastoma is the most common primary malignant intraocular tumor of childhood.

Pediatrics

Childhood Tumors

68591efd-6d00-4693-9656-c00d277125d9

Mechanism of action of donepezil is :

Centrally acting reversible anticholinesterase

Centrally acting irreversible anticholinesterase

Irreversible cholinergic action

Reversible anticholinesterase

multi

Pharmacology

a7434b3f-ee59-4619-a070-c9da63fc2c21

Purpura fulminans is seen in?

Protein C deficiency

Protein S deficiency

AT III deficiency

Factor 5 leiden mutation

single

Purpura fulminans is a severe form of DIC resulting from thrombosis of extensive areas of the skin. It predominantly affects young children following viral or bacterial infection, paicularly those with inherited or acquired hypercoagulability due to deficiencies of the components of the protein C pathway.

Medicine

Platelet & Coagulation disorders

1e860791-b860-4cb7-a19d-90b7b8031150

A 4-month-old infant has undergone surgical treatment for meningo myelo encephalocele. A CT tomogram of head was made immediately after birth (see Figure below). At birth, an operation was carried out in the posterior cranial fossa to partially replace brain cerebellar contents to an intracranial position. In investigations for progressive hydrocephalus, it is noted that there is herniation of the cerebellar tonsils through the foramen magnum, and a diagnosis of Arnold-Chiari syndrome is established. This syndrome may also include which of the following?Tomogram from CT head taken 4 months previously (immediately after birth). Opening in the posterior cranial fossa showing brain and meninges protruding into sac (axial view).

Fusion of the frontal lobes

Fusion of the temporal, parietal, and occipital lobes

Abnormal elongation of the medulla and lower cranial nerves

Partial or complete absence of the pituitary gland

multi

Abnormal elongation of the medulla and lower cranial nerves may be evident in Arnold- Chiari syndrome. Additional features include fusion of the corpora quadrigemina, leading to a "beaked" tectum; partial or complete absence of the corpus callosum; and microgyria. The corpora quadragemina are relay stations for hearing (inferior corpora quadragemina) and the light reflex (superior copora quadragemina), and they form the posterior surface of the midbrain.

Surgery

Nervous System

6f53a7b0-8a07-49bc-9edb-7b3f195f7a81

A man presents with weakness, tachycardia, sweating, palpitations, giddiness on fasting which is prompltly relieved with food intake. What is the most probable diagnosis?

Insulinoma

Pancreatic ca

Carcinoid

Zollinger Ellison syndrome

single

Ref: Robbins Pathologic Basis of Disease, 8'k edition. & Bailey and Love's Short Practice of Surgery 25th EditionExplanation:INSULINOMAfi-cell tumors (insulinomas) are the MC of pancreatic endocrine neoplasms.They may be responsible for the elaboration of sufficient insulin to induce clinically significant hypoglycemia.The characteristic triad of clinical symptomsHypoglycemia (Glucose levels < 50 mg/dL)CNS manifestations such as confusion, stupor, tremor and loss of consciousnessS ymptoms precipitated by fasting or exercise and are promptly relieved by feeding or glucose administrationClinical featuresProfound hypoglycemia during fasting or after exercise.Signs and symptoms of neuroglycopeniaAnxietyTremorConfusionObtundationSympathetic response (Hunger, Sweating, and Tachycardia)Whipple's triad refers to the clinical criteria for the diagnosis of insulinoma:- Hypoglycemic symptoms during monitored fasting.- Blood glucose levels less than 50 mg/dL. and- Relief of symptoms after administration of intravenous glucose.Factitious hypoglycemia (excess exogenous insulin administration) and postprandial reactive hypoglycemia must be excluded. (Estimation of C peptide will differentiate)In insulinoma, C peptide levels are increased but in Factitious hypoglycemia, it is decreasedMorphologyInsulinomas are most often found within the pancreas and are generally benign.Most are solitary, although multiple tumors may be encountered.Bona fide carcinomas, making up only about 10% of cases, are diagnosed on the basis of local invasion and distant metastases.On rare occasions an insulinoma may arise in ectopic pancreatic tissue.In such cases, electron microscopy reveals the distinctive granules of |3.Solitary tumors are usually small (<2 cm in diameter) and are encapsulated, pale to red- brown nodules located anywhere in the pancreas.Histologically, these benign tumors look remarkably like giant islets, with preservation of the regular cords of monotonous celts and their orientation to the vasculature.Deposition of amyloid in the extracellular tissue is a characteristic feature.ImagingDynamic CT scanning at 5-mm intervals with oral and intravenous contrast is the initial localizing test for insulinoma, with success in 35-85% of cases.Endoscopic ultrasound is also effective but is operator dependentIndium-111 (111 In)-octreotide scintigraphy is less effective (approximately 50%) for localization of insulinoma than other islet cell tumors because insulinomas typically have few somatostatin receptors.Selective arteriography with observation of a tumor "blush'- is the single best diagnostic study for the primary tumor and hepatic metastases. If a tumor is still not identified, regional localization to the head. body, or tail of the pancreas can be accomplished by portal venous sampling for insulin or by calcium angiography.Calcium angiography involves injection of calcium into selectively catheterized pancreatic arteries and measurement of plasma insulin through a catheter positioned in a hepatic vein.TreatmentIt is surgical in nearly all cases.Use of intraoperative ultrasonography greatly facilitates identification of small tumors, especially those located in the pancreatic head or uncinate process.Most insulinomas can be enucleated from surrounding pancreas, although those in the body or tail may require resection.In general, blind pancreatectomy should NOT be performed when the tumor cannot be identified. Approximately 5% of insulinomas are malignant, and 10% are multiple (usually in association with MEN type I).Medical treatment for insulinoma with diazoxide. verapamil, or octreotide has limited effectiveness but may be used in preparation for surgery or for patients unfit for surgery.

Surgery

Pathophysiology - Pancreatic Endocrine Tumors

3d9789f0-c494-4130-9f49-e14ba6262939

True about Thrombocytopenic pupura is?

Haemolysis is extravasular

Normal renal function test

Thrombosis in cerebral blood vessels

Immediate cure following plasmapheresis

multi

Ans. is 'c' i.e., Thrombosis in cerebral vessels Thrombotic thromhocytopenic purpura (TTP) o TTP is included among group of diseases called thrombotic microangiopathic which are characterised by widespread thrombosis in microcirculation. o The other disorder which is included in this group include hemolytic uremic syndrome (HUS). o Small vessels like terminal aerioles and capillaries are involved. Pathogenesis of TTP o Patients with TTP are deficient in an enzyme called ADAMTSB.13 also known as vWF metalloprotease that degrades very high molecular weight multitimers of vWF. o In the absence of this enzyme, these multimers of vWF accumulate in plasma and promote platelet macroaggregate formation throughout the microcirculation leading to symptoms of TTP. Clinical features o TTP is characterized by a pentad of : ? 1.Microangiopathic hemolytic anemia --> Because red cells are forced to squeeze through abnormally narrowed small vessels because of thrombi. 2. Thrombocytopenia Due to consuption of platelets in formation of platelet thrombi. 3. Neurological symptoms Due to presence of thrombi in CNS microcirculation. 4. Renal dysfunction --> Due to presence of thrombi in renal microcirculation. 5. Fever

Pathology

bccc793d-a17d-4cab-a32a-3291bd629a7b

Which of the following is a superantigen

Cholera toxin

Diphtheria toxin

TSST

Vero-cytoxin

single

Superantigens  Certain species of infectious microorganisms produce powerful, immunostimulatory and disease-causing toxins called superantigen, so called because of their ability' to a polyclonally active large fraction ( up to 20% ) of T cell population.  Superangens are potent acvators of T-lymphocytes.  Superangens smulate very large numbers of T cells, without relaon to their epitope specificity'. This leads to an excessive and dysregulated immune response with release of cytokines IL - 1, IL - 2, TNF - α and IF - γ. Conventional antigens bind to MHC class I or II molecules in the groove of the β dimer (T cell receptor). In contrast, superantigen bind directly to the lateral portion of TCR β chain and MHC class II β chain, and stimulate T cells solely on γ β gene segment utilized independent of the D, J and γ aα - sequences present → γ β restricted T cell mitogens. Superantigens are capable of giving up to 20% of the peripheral T-cell pool, whereas conventional antigens activate < 1 in 10, 000.  Examples of superantigen Staphylococcal toxic shock syndrome toxin □ Certain nonhuman retroviral proteins, Staphylococcal enterotoxins □ Yersinia pseudotuberculosis Staphylococcal exfoliative (erythrogenic) toxin □ Mycoplasma arthritis. Streptococcal toxic shock syndrome toxin □ Mouse mammary tumor virus.

Microbiology

8b447b4f-7d8f-46b6-a269-a818aab18b86

Infection become localized in the form of abscess, bacteria responsible for this is:

Streptococci

Staphylococci

Actinomyces

All of the above

multi

Pyogenic organisms, predominantly Staphylococcus aureus, cause tissue necrosis and suppuration. Pus is composed of dead and dying white blood cells, predominantly neutrophils, that have succumbed to bacterial toxins. An abscess is surrounded by an acute inflammatory response composed of a fibrinous exudate, oedema and the cells of acute inflammation. Granulation tissue (macrophages, fibroblasts and new blood vessel proliferation) forms later around the suppurative process and leads to collagen deposition. If it is not drained or resorbed completely, a chronic abscess may result. If it is partly sterilised with antibiotics, an antibioma may form. Ref: Bailey and love's short practise of surgery 27th edition page 48

Pathology

2f0a6154-7376-459f-bb93-9ee6eb9d39c8

All are the feature (s) of chancorid except:

Ulcer bleed easily

Painful

Bubo formation

Typically indurated

multi

Ans: d. Typically indurated, Chancroid or soft sore is characterized by tender non-indurated irregular ulcers on the genitaliaThe infection remains localized, spreading only to the regional lymph nodes which are enlarged & painful"Haemophilus ducreyi: After an incubation period of 4-7 days, the initial lesion--a papule with surrounding erythema--appears.In 2 or 3 days, the papule evolves into a pustule, which spontaneously ruptures and forms a sharply circumscribed ulcer that is generally not indurated. The ulcers are painful and bleed easily; little or no inflammation of the surrounding skin is evident.Approximately half of patients develop enlarged, tender become fluctuant and spontaneously rupture" (Harrison 18th)

Microbiology

90c2d77b-3178-480f-882c-8df67e0e3c61

Lateral boundary of cubital fossa is formed by -

Biceps

Pronater teres

Brachialis

Brachioradialis

single

Ans. is 'd' i.e., Brachioradialis o Lateral boundary of cubital fossa is formed by brachioradialis and medial boundary is formed by pronater teres. Cubital FossaLateral boundryBrachioradialisMedial boundryPronater teresBaseLine joining the two epicondyles of humerusApexPoint joining lateral and medial boundriesFloorBrachialis, supinatorRoofSkin, superficial fascia (containing medial cubital vein, lateral and medial cutaneous nerve of forearm), deep facia, bicipital aponeourosis Contents of cubital fossa (medial to lateral)o Median nerveo Brachial artery termination and begining of radial and ulnar arteries.o Biceps tendono Radial nerve and Radial collateral artery

Anatomy

Arm and Cubital Fossa

27a754c6-eb0a-4ddc-8474-de5212dbe3d9

BCG should be given: September 2005

Immediately after bih

At the age of 1 month

At the age of 6 months

At the age of 1 year

single

Ans. A: Immediately after bih Bacillus Calmette-Guerin/BCG is a vaccine against tuberculosis that is prepared from a strain of the attenuated (weakened) live bovine tuberculosis bacillus, Mycobacterium bovis, that has lost its virulence in humans by being specially cultured in an aificial medium for years. The bacilli have retained enough strong antigenicity to become a somewhat effective vaccine for the prevention of human tuberculosis. It should be given at bih. If missed at bih, it should be given at 6 weeks as per Indian National Immunization Schedule.

Social & Preventive Medicine

79b09401-9cad-4af3-a88b-4a2a9ba6229e

Not associated with malignancy: JIPMER 13

Down's syndrome

Turner syndrome

Noonan syndrome

Klinefelter syndrome

single

Ans. Turner syndrome

Forensic Medicine

7959efa7-3c97-4d5c-8b09-46348111c406

N K cells activity is enahnced by -

IL-1

TNF

IL-2

TGP-b

single

IL-2 promote growth and differentiation of T & B cells , cytotoxicity of T & NK cells Reff: Ananthanarayan & Panikers textbook of microbiology 9th edition pg: 154 table 15.3

Microbiology

Immunology

d4cb51de-7d4b-4edc-9c78-6ab615b2967a

Shenton's Line is present in-

knee

Shoulder

Elow

Hip

single

*Shenton's line is an imaginary line drawn along the inferior border of the superior pubic ramus and along the infero- medial border of the neck of femur. REF:Ref: Maheshwari J.Essential Ohopaedics 6th/e p.222

Anatomy

a3cbf092-5849-4e46-98e4-4c7aa5714d4f

Chance of subsequent baby having NTD when first baby was born with NTD -

2%

4%

10%

20%

single

Ans. is 'b' i.e., 4%The recurrence risk of neural tube defect is :3 - 5 % if a couple has previously had a child with either anencephaly or spina bifida.5% if either parent was born with a NTD.10% if a couple has two affected children

Gynaecology & Obstetrics

1a45798e-b827-45af-86b8-58fdc8d22700

Most common histological variety of Uterine carcinoma is?

Squmous cell carcinoma

Columnar cell carcinoma

Adeno carcinoma

Mixed carcinoma

single

ANSWER: (C) AdenocarcinomaREF: Novaks gynaecology 14th ed.pg no 1350Uterine sarcomas are, in general, the most malignant group of uterine tumorsAbout 90% of women with endometrial carcinoma have vaginal bleeding or discharge as their only presenting symptom.The risk for endometrial cancer is 4 to 8 times greater in postmenopausal women receiving unopposed estrogen therapy, and the risk increases with time and higher estrogen doses.The endometrioid type of adenocarcinoma accounts for about 80% of endometrial carcinomas.

Gynaecology & Obstetrics

Carcinoma Endometrium

0746a7bc-ded7-4861-a9a0-8a54282ca85b

In restraining of child everything involved except

Avoidance

Discrimination

Pedi wrap and papoose board

Aversive conditioning

multi

Dental

3acff2e2-e05c-42e2-b0d3-59c49b6bf74d

Action of intramedullary 'K' nail is

Two-point fixation

Three-point fixation

Compression

Weight concentration

single

B i.e. Three - point fixation

Surgery

8c22bc36-1a71-4fda-a3cf-347e85c752f5

Hyperacute rejection is due to

Preformed antibodies

Cytotoxic T lymphocyte mediated injury

Endothelitis caused by donor antibodies

Circulating macrophage mediated injury

single

Hyperacute rejection occurs when preformed anti-donor antibodies are present in the circulation of the recipient. Such antibodies may be present in a recipient who has previously rejected kidney transplant, Multiparous women, Prior blood transfusionsHyperacute Rejection occurs within minutes or hours after transplantation.Robbins pathology 9e Pg: 233

Surgery

General surgery

78671892-8186-4a19-9e29-0ee349dc34e4

Site of bleeding in Gastro-esophageal varices:

Sho Gastric veins

Right Gastric veins

Left Gastric veins

All

multi

Ans is A (Sho Gastric veins), B (Right Gastric veins), & C (Left Gastric veins) "Varices in the distal esophagus and proximal stomach are a component of the collateral network that dives high-pressure poal venous flow through the left and right gastric veins and the sho gastric veins to the azygous system."- Sabiston 18/e p1529

Surgery

5323df28-e1f1-449c-af03-95c860de8e98

Which of the following is NOT an important/ frequent/well-known manifestation of an adverse drug reaction?

Agranulocytosis

Aplastic anaemia

Haemolysis

Leukaemia

single

Pharmacology

70123f24-ea9f-45bb-b261-d79b38d46597

Painless burn in hand is a characteristic feature of?

Thalamic syndrome

Syringomyelia

Cord compression

SLE

single

Ans is 'b' i.e. Syringomyelia * In Syringomyelia, there sensory deficit in upper extrimities in the form of loss of pain and temperature sensations with touch and vibration being intact.

Pathology

Central Nervous System

f293bf95-1a65-4606-b2cd-56cbc31b2e3b

Insulin is secreted along with the following molecule in a 1:1 ratio

Pancreatic polypeptide

Glucagon

GLP- 1

Somatostatin

single

Glucagon-like peptide 1 (GLP-1) is an appetite suppressing substance found in the brain and intestine. In the brain, GLP-1 acts as a satiety signal. In the intestine, it slows emptying of the stomach and stimulates the release of insulin from the pancreas.Pancreatic polypeptide is a 36-amino acid peptide secreted by islet cells of the pancreas in response to a meal and of unceain physiologic function;glucagon a polypeptide hormone secreted by the alpha cells of the islets of Langerhans in response to hypoglycemia or to stimulation by growth hormone. It increases blood glucose concentration by stimulating glycogenolysis in the liver and can be administered parenterally to relieve severe hypoglycemia from any cause, especially hyperinsulinism.Somatostatin is a cyclic tetradecapeptide hormone and neurotransmitter that inhibits the release of peptide hormones in many tissues. It is released by the hypothalamus to inhibit the release of growth hormone (GH, somatotropin) and thyroid stimulating hormone (TSH) from the anterior pituitary; it is also released by the delta cells of the islets of Langerhans in the pancreas to inhibit the release of glucagon and insulin and by the similar D cells in the gastrointestinal tract.Ref: Ganong&;s review of medical physiology;24th edition; page no-433

Physiology

Endocrinology

1dec6929-4aca-4d43-8ea8-9050b3226867

Blood loss during major surgery is best estimated by:

Visual assessment

Suction bottles

Transesophageal USG Doppler

Cardiac output by thermodilution

single

Measurement of blood loss during surgery (Gravimetric Method) Blood loss during operation is measured by: Weighing the swabs after use and subtracting the dry weight and fluid used + volume of blood collected in suction bottles (after subtracting irrigating fluid)

Surgery

33a13c98-b450-4bd7-8b74-6fde20ad4c46

Which drug can cause psychosis: September 2004

Ofloxacin

Amfetamine

Capreomycin

Rifampicin

single

Ans. B i.e. Amfetamine

Psychiatry

1fbfc98a-f744-4f57-8a6e-45cb51c84e27

Fast muscle fibers are?

Red

Oxidative

Tonic

Glycolytic

single

Ans. is'd'i.e., Glycolytic(Ref: Principles of medicalphysiolog p. 512)TYPES OF MUSCLE FIBERS:Two fibers types:Type I/red fibersType II/white fibers.Motor unit contains only one muscle fibers type:I.e., All motor unit fibers are either type-I or type II.Hence, named accordingly.CHARACTERISTICS OF MUSCLE FIBER TYPES:Parameters/CharacteristicsType I muscle fiberType II muscle fiberDifference according to fiber typeRed -Due to |ed myoglobin & mitochondrial content.White -Lack myoglobin & have few mitochondria.Subtypes- Nil -Type IIA & Type IIBIIA - Oxidative & glycolytic.IIB - Glycolytic.Usually type IIB fibers refer type II fibers.Other names1. "Slow-twitch" fibers:Due to small fiber length & diameter.Maintain relatively sustained contraction.2. "Slow motor units"Have early recruitment.1. "Fast-twitch" fibers -Sho duration of twitch.Due to bigger diameter & |ed myosin & actin filaments.Generate greater tension comparatively.2. Type IIa/"Fast Fatigue Resistant" (FR) units:Intermediate fatigability.3. Type IIb/"Fast fatigable units":Late recruitment thresholdMetabolismAerobic.Slow oxidative.Anaerobic.Fast glycolytic.Glycolytic capacity &glycogen contentLowHighSarcoplasmic reticulumNormalExtensiveBlood supplyHighNormalMyosin ATPase activityLowHighConduction velocitySlowFastContractile propeiesSlow time to peak tensionType IIa - Fast time to peak tension.Type IIb - Fastest time to peak tension.Type of muscleRed muscles -In muscles required for prolonged contraction.Also with muscles maintaining posture.Back muscles (At back of hip)Gluteus muscles .Calf muscles.White/Pale muscles -Muscles helpful in rapid contractions & finer movements.Hand & extraocular muscles.

Physiology

e85df0e9-7a64-4e94-8866-bd991d1c037f

Which is the first line of treatment for overactive bladder?

Antimuscarinic drug

Behavioural therapy

Cholinergic drug

Botulinum toxin type A

single

Behavioural therapy includes bladder training, pelvic floor exercise, fluid management.

Pharmacology

44b196a5-e155-4fd9-ad33-bc7bb3b38a41

Within practical limits, using less water in mixing plaster will result in a set product that

Contracts

Is stronger

Is more porous

Is less brittle

single

Dental

ae3e0956-2070-4273-aebd-175b679406e2

Drug for prophylaxis of malaria in chloroquine resistant P.falciparum ?

Mefloquine

Quinine

Halofantrine

Aesunate

single

Ans. is 'a' i.e., Mefloquine Chemoprophylaxis of malaria Chemoprophylaxis is recommended for travellers from non-endemic areas, and as a sho term measure for soldiers, police and labour forces serving in highly endemic areas. Chemoprophylaxis should begin a week before arrival in malarious area and continued for at least 4 weeks or preferably 6 weeks after leaving malarious area. Drugs used are : ? Chloroquine - DOC for chemoprophylaxis in chloroquine sensitive P. falciparum areas. Atovaquone/Proguanil - Used in areas with chloroquine or mefloquine resistant P. falciparum. Doxycycline - Used in areas with chloroquine or mefloquine resistant P. falciarum. Mefloquine - Used in areas with chloroquine resistant P. falciparum Hydroxychloroquine - Alternative to chloroquine in areas with chloroquine sensitive P. falciparum

Social & Preventive Medicine

aa2018bc-4a47-4b17-82be-063f77abddb1

Mala-N contains

Ethinyl estradiol 30 mcg

Norgesterol 50 mcg

Ethinyl estradiol 50 mcg

Progesterone 10 mg

single

MALA-N contains levonorgestrel 0.15 mg and ethinyl estradiol 0.03mg MALA-N is supplied free of cost through all PHC&;s, Urban family welfare centres etc. Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 500

Social & Preventive Medicine

Demography and family planning

95f19616-1ba6-474a-9ac1-9fa96ccad686

Retinoblastoma is bilateral in

100 % of cases

1 % of cases

50 % of cases

30 % of cases

single

Retinoblastoma: It is a malignant glioma of the retina, usually unilateral, that occurs in young children and usually is hereditary. In about 30 % of patients retinoblastoma is bilateral. The initial diagnostic finding is usually a yellow or white light reflex seen at the pupil (cat's eye reflex).

Ophthalmology

All India exam

a9f916d7-6a0e-42b2-9167-f74b1f2d365c

Which of the following is most common fingerprint pattern

Loops

Whorl

Composite

Arches

single

The patterns of fingerprints : Loops-these reconstitute 60-70 percent patients encountered Whorl-represent 25-30 percent patients encountered Arch -represent about 5 percent of patients encountered Least commonly encountered is composite Refernce:Essentials of Forensic Medicine and toxicology PG no 2,vol 3

Forensic Medicine

Identification

a710ef33-0ac7-4ac7-9e24-f5a271145fad

Outer blood retinal barrier is formed by

Internal limiting mebrane

Endothelium

Retinal pigment epithelium

Ganglion cells

single

Outer blood retinal barrier is formed by retinal pigment epithelium Blood Retinal Barrier * Outer BRB: Formed by RPE * Inner BRB: Formed by endothelium of microvasculature

Ophthalmology

Retina

a5724364-a404-4a60-9ce4-8a1dc8e5b405

Which of the following radiographic presentation cannot be seen in a patient with intussusception?

Target sign

Corkscrew sign

Crescent sign

Normal radiograph

single

Radiographic signs of Intussusception: 1. Target sign 2. Crescent sign 3. Absent liver edge sign (also called the absence of the subhepatic angle) 4. Bowel obstruction 5. May have a normal x-ray The corkscrew sign describes the spiral appearance of the distal duodenum and proximal jejunum seen in midgut volvulus. It has been identified as a diagnostic indicator of midgut volvulus. Ref: Oiz-neira CL. The corkscrew sign: midgut volvulus. Radiology. 2007;242 (1): 315-6.

Surgery

G.I.T

e242aeb4-47c8-4331-ae6f-19b02a530994

Cervix contains

Mainly muscle fibres

Mainly collagen

Both muscle and collagen are in equal proportion

None of the above

multi

Cervix contains mainly collagen and only 10 % of muscle fibres.

Gynaecology & Obstetrics

2a3148e2-464e-491d-98ab-8ca190e4e970

Calcification around the joint is seen in:

Pseudogout

Hyperparathyroidism

Rh. ahritis

Gout

single

A i.e. Pseudogout In pseudogout (CPPD), there is intra & peri-aicular calcificationQ due to radio dense deposits are deposited in menisci & aicular hyaline cailage.

Radiology

94f802f9-ef67-47e1-a750-869eafc8790b

A child develop skin tumor with blisters on exposure to sunlight. Irregular dark spots on the skin were also found. He is very likely has defect in which of the following mechanism?

Thymidine dimmers repair

Base excision repair

Mismatch repair

Double strand break repair

single

Ans. a. Thymidine dimmers repair (Ref: Harper 27/e p345-346; Lehning 5/e p1003)This patient is most likely have xeroderma pigmentosa, in which damage produced by UV-rays is caused due to formation of pyrimidine (mainly thymidine) dimmers.The damage produced by UV rays is caused due to formation of pyrimidine (mainly thymine) dimmersQ. The thymine dimmer prevent DNA polymerase from replicatingQ the DNA strand beyond the dimmer, thus inhibiting the repair of defective DNA.In Xeroderma Pigmentosa mechanism for repair (nucleotide excision repair)Q of damaged DNA is defective due to formation of Thymidine dimmersQ.Xeroderma Pigmentosa (AR)An autosomal recessive condition in which cells cannot repair the damaged DNA.The clinical syndrome include marked sensitivity to sun lightQ resulting inSkin cancersQPremature deathQArises because of defect in 'nucleotide excision' pathway of repair due to defect in either of three:UV specific endonuclease (MC defect)Q DNA polymerase 1QDNA IigaseQ Mechanism of DNA RepairMechanismProblemSolutionMismatch RepairCopying errorsQMethyl directed strand cutting, exonudease digestion and replacementBase Excision RepairSpontaneous or chemical, or radiation damage to a single baseQBase removal by N-glycosylase, a basic sugar removal, replacementNucleotide Excision RepairSpontaneous or chemical, or radiation damage to a single segmentQRemoval of approximately 30 nucleotide oligomer and replacementDouble Strand Break repairIonizing radiation, chemotherapy,oxidative free radicalsQSynapsis, unwinding, alignment, ligationAtaxia telangiectasia, Bloom's syndrome, Fanconi's anemia, Xeroderma pigmentosa, HNPCC and few breast cancers are due to DNA repair defectsQ.

Biochemistry

Molecular Genetics

34768824-b627-4e02-a12a-3069c7e9c617

The clinical use of leuprolide include all the following except

Endometriosis

Osteoporosis

Prostate cancer

Precocious pubey

multi

Refer KDT 6/e p 239 GnRH agonists as well as antagonists can cause hit flushes, loss of libido and osteoporosis as adverse effects

Pharmacology

Endocrinology

45c68e1a-39bd-4f44-b7fd-301f60386209

Dumping syndrome is due to:

Diarrhoea

Presence of hypeonic content in small intestine

Vagotomy

Reduced gastric capacity

multi

Answer is B (Presence of Hypeonic Contents in small intestine) DUMPING SYNDROME refers to a syndrome of abdominal and vasomator symptoms which results from dumping of food stuffs with a high osmotic load, front the stomach, into the small bowel. Loss of storage capacity of stomach and ablation, by pass or destruction of pylorus, results in rapid emptying of hyperostnolar chyme into duodenummm and small intestine. Extracellular fluid then shifts into the intestinal lumen to restore isotonicity resulting in decreased intravascular volume, which gives rise to the vasomotor symptoms. Note that while reduced gastric capacity contributes, option (b) is a more accurate answer. Dumping Syndrome is actually of two types: Early dumping syndrome (as described above) Late dumping syndrome: This is Reactive hypoglvcemiae. The carbohydrate load in thesmall intestine later causes a rise in plasma glucose, which in turn causes insulin levels to rise causing a secondary hypoglycemia.

Medicine

42713bab-2119-47f1-9298-b11923598ac7

Meniere's disease is:

Perilymphatic hydrops

Endolymphatic hydrops

Otospongiosis

Coalescent mastoiditis

single

(b) Endolymphatic hydrops(Ref. Cummings, 6th ed., 2331)Meniere's is also known as endolymphatic hydrops.There is no condition called Perilymphatic hydrops.Otospongiosis also known as otosclerosis is fixation of foot plate of stapes.Coalescent mastoiditis is infection of the mastoid air cells and is a complication following ASOM/ unsafe CSOM.

ENT

Otosclerosis

98626654-2e98-438a-8a62-6a8c78867cb2

Bictegravir was approved by FDA recently for

Cystic fibrosis

TB

Hypeension

HIV

single

Bictegravir (an Integrase Inhibitor) is a component of the fixed-dose combination product bictegravir/emtricitabine/tenofovir alafenamide (brand name: Biktarvy), which received marketing approval for the treatment of HIV infection by U.S. Food and Drug Administration in February 2018.

Pharmacology

All India exam

f7982d79-b9e1-41ac-a378-c69f1afe897e

Sinus arrhythmia is due to-

Sinus node disease

Exaggerated response to sympathetic system

Fluctuating parasympathetic response during respiration

Decreased hea rate in inspiration

single

Answer-C. Fluctuating parasympathetic response during respirationSinus rhythm with a beat-to-beat variation in the P-P interval (the time between successive P waves), producing an irregular ventricular rate.Sinus arrhythmia is a normal physiological phenomenon, most commnonly seen in young, healthy people.The hea rate varies due to reflex changes in vagal ( parasyntpathetic ) tone during the different stages of the respiratory cycle,Inspiration increases the hea rate by decreasing vagal tone.With the onset of expiration, vagal tone is restored, leading to a subsequent decrease in hea rate.

Medicine

989ea808-e1cf-4ec8-bd78-dba14489ea2e

Lovibond profile sign is seen in ?

Koilonychia

Platynochia

Clubbing

Onycholysis

single

Ans. is 'c' i.e., Clubbing Clinical indicators of clubbing are Lovibond profile sign and cuh's modified profile sign". Lovibond angle is the angle located at the junction between the nail plate and proximal nail fold. It is normally less than 160deg. In clubbing, the angle exceeds 180deg (Lovibond profile sign).

Skin

ef614fae-b369-466f-bf78-15e084318f6c

All are true regarding Rabies virus, except?

Single Stranded RNA virus

Linear

Negative sense

Space vehicle shaped

multi

It is a bullet shaped virus with a single serotype. It is detected by immunofluoresence. The rabies virus is a neurotropic virus. These viruses areenveloped and have a single stranded RNA genome with negative-sense. All transcription and replication events take place in the cytoplasm inside a specialized "virus factory", the Negri body.

Microbiology

b17bd4ab-a488-47e7-a654-383ef09bef3d

OsteoscLerosis of bone occurs due to

Decreased host resistance

Increase in the virulence of organisms causes infection

Increased host response

Occurs in immunocompromised patients

single

Pathology

9f41822d-ab3b-453b-b052-17af221535dc

Not true about retinoblastoma -

Bilateral in 20-30%

Affects age group 1-5 years

More common in males

Leukocoria is earliest symptom

multi

Ans. is 'c' More common in males o Retinoblastoma is the most common intraocular tumor in children. The tumor is confined to infancy and very young children (1-2 years). There is no sex predisposition. Retinoblastoma is unilateral in 70-75% of cases and bilateral in 25-30% of cases.o Gaze Fixation starts developing in the first month and is completed in 6 months,o Macula is fully developed by 4 - 6 months.o Fusional reflexes, stereopsis and accommodation is well developed by 4 - 6 months,o Cornea attains normal adult diameter by 2 years of age.o Lens grows throughout life.

Ophthalmology

Intra Ocular Tumour

3e03b82c-ad2f-40b7-8089-28030721c153

Which of the following artery passes between the roots of the auriculotemporal nerve?

Maxillary artery

Middle meningeal artery

Superficial temporal artery

Accessory meningeal artery

single

Middle meningeal artery passes between roots of auriculotemporal nerve.

Anatomy

4ed6e899-6187-4086-b16e-87e30e01a2b2

Ethambutol is safer in patient of:

Liver disease

Kidney disease

Gout

Both 1 and 2

multi

All first line drugs used against M.Tuberculosis are hepatotoxic except Ethambutol. But it requires dose adjustment in renal failure.

Pharmacology

b1bd64eb-8730-4c67-b90e-22e177ab50e0

The age changes in dentin include:

Sclerotic dentin

Dead tracts

Both

None

multi

The age changes in dentin include the formation of sclerotic dentin and dead tracts. Hydroxyapatite crystals are laid down in the intertubular dentin and within dentinal tubules to block the tubules, against the entry of bacteria, etc. The dentin then becomes transparent in transmitted light, hence often called transparent dentin. Permeability of dentin becomes reduced ,while hardness increases in these regions. Breakage of apical thirds of roots during extraction of teeth of elderly is due to the brittle nature of sclerotic dentin. Dead tracts are areas containing degenerated dentinal tubules, which appear dark in transmitted light. These are often seen in attrited or abraded teeth or below the carious lesions.

Dental

438f68a9-6e98-4d3e-b706-97146f74c8ac

Oil drop cataract is characteristic of ?

Diabetes

Chalcosis

Galactosemia

Wilson's disease

single

Ans. C) Galactosemia Oil drop cataract Commonly seen in patients with galactosemia (a recessively inherited inborn error of carbohydrate metabolism). Accumulation of dulcitol (galactose reduction product) within the lens cells leads to increased intracellular osmotic pressure and fluid influx into the lens.

Ophthalmology

8350f6f8-cdb3-45ff-8468-ed8e6c5a1bdd

D–tubocurarine acts by –

Inhibiting nicotinic receptors at myoneural junction

Inhibiting nicotinic receptors at autonomic ganglion

Producing depolarizing block

By inhibiting reuptake of acetylcholine

single

All non-depolarizing blockers (D-tubocurarine) act as competitive antagonist of acetylcholine on nicotinic (Nm) receptors at myoneural junction.

Anaesthesia

8e138438-da17-490e-9eaf-d46862303f7d

Hyperkalemia without ECG changes may be treated with all except :

Calcium gluconate

Salbutamol

Na bicarbonate

Insulin with dextrose

multi

Calcium antagonizes the cardiac conduction abnormalities induced by potassium. In the given question, the patient has no ECG changes; therefore calcium gluconate will not be useful. Use of calcium gluconate should be restricted to life-threatening hyperkalemia.

Pharmacology

7cc28cb2-7b58-4770-b077-691b44c8492b

Growth hormone secretion is decrease by all except

Glucose

Stressful stimuli

Sleep

Somatostatin

multi

(C) Sleep > Stressful stimuli also increases GH levels.> Whereas REM sleep decreases GH secretion, but going to sleep increases it.# Stimulators of growth hormone (GH) secretion include: peptide hormones; GHRH (somatocrinin) through binding to the growth hormone-releasing hormone receptor (GHRHR) Ghrelin through binding to growth hormone secretagogue receptors (GHSR) Sex hormones; increased androgen secretion during puberty (in males from testis and in females from adrenal cortex); estrogen> Inhibitors of GH secretion include: GHIH (somatostatin) from the periventricular nucleus circulating concentrations of GH and IGF-1 (negative feedback on the pituitary and hypothalamus) hyperglycemia; glucocorticoids; dihydrotestosterone> in addition to control by endogenous and stimulus processes, a number of foreign compounds (xenobiotics such as drugs and endocrine disruptors) are known to influence GH secretion and function.

Physiology

Misc.

dcb4e06e-4461-4dc4-846d-cc2f2eb86f85

Nitrates are contraindicated with

Sulphonylureas

Immunomodulators

SSRI's

PDE-5 inhibitors

single

Sildenafil & Tadalafil are the PDE-5 inhibitors which are contrainidicated with Nitrates to prevent severe hypotension.

Pharmacology

c25aa1bc-32fd-4bf7-93fa-c3fe65034669

In low ovarian reserve,anti mullerian hormone level will be:

<1

4-Jan

>7

>10

single

Ans. A. <1AMH and ovarian reserveAMH of 1.0 has very poor ovarian reserveThe central concept for the measurement of blood levels of AMH to determine ovarian reserve is this: women with lower AMH levels have a lower ovarian reserve than women with high AMH levels. AMH is currently being used by feility specialists to help predict women who may respond poorly to feility medications and in general, couples who are less likely to be successful with feility treatment.

Gynaecology & Obstetrics

694aecb0-4eb3-4026-aff1-322c0dec77d5

Which are segments of upper lobe of right lung ?

Anterior, posterior, medial

lateral,medial,superior

Apical, anterior, posterior

Basal, medial, lateral

single

Right upper lobe segments-apical,posterior,anterior B D CHAURASIA'S HUMAN ANATOMY UPPER LIMB THORAX-VOLUME1 SIXTH EDITION,Page no-241

Anatomy

Thorax

294792e4-d7d2-4a8b-919b-95346c69d425

Most common among the Non-Hodgkin s Lymphoma (NHL) is

Diffuse large B-cell lymphoma (DLBCL or DLBL)

Haiiy cell Leukemia

Burkitt's lymphoma

Mantle Cell lymphoma

single

(A) Diffuse large B-cell lymphoma (DLBCL or DLBL)[?]Diffuse Large B-Cell LymphomaoDiffuse large B-cell lymphoma (DLBCL) is the most common form of NHL.oEach year in the United States there are about 25,000 new cases.oThere is a slight male predominance. The median patient age is about 60 years, but DLBCL also occurs in young adults and children. Germinal centre or post germinal center B celloDiverse chromosomal re-arrangements, most often BC26 (30%), BCL2 (10%), or C-MYC (5%).oAll ages, most common in Adults, 30% extranodal, aggressiveoTHC positive for CD10, CD20, CD10 & BCL6oPathogenesis:-Genetic, gene expression profiling, and immunohistochemical studies indicate that DLBCL is molecularly heterogeneous.-One frequent pathogenic event is dysregulation of BCL6, a DNA-binding zinc-finger transcriptional repressor that is required for the formation of normal germinal centers.-About 30% of DLBCLs contain various translocations that have in common a breakpoint in BCL6 at chromosome 3q27.-Acquired mutations in BCL6 promoter sequences that abrogate BCL6 autoregulation (an important negative-regulatory mechanism) are seen even more frequently.oImmunophenotype:-These mature B-cell tumors express CD19 and CD20 and show variable expression of germinal center B-cell markers such as CD10 and BCL6. Most have surface Ig.oSpecial Subtypes: Immunodeficiency-associated large B-cell lymphoma, Primary effusion lymphomaoClinical Features:-DLBCL typically presents as a rapidly enlarging mass at a nodal or extranodal site.-It can arise virtually anywhere in the body.-Waldeyer ring, the oropharyngeal lymphoid tissue that includes the tonsils and adenoids, is involved commonly.-Primary or secondary involvement of the liver and spleen may take the form of large destructive masses.-Extranodal sites include the gastrointestinal tract, skin, bone, brain, and other tissues.-Bone marrow involvement is relatively uncommon and usually occurs late in the course.-Rarely, a leukemic picture emerges.Other Options[?]Hairy cell Leukemia:-This rare but distinctive B-cell neoplasm constitutes about 2% of all leukemias.-Hairy cell leukemias are associated in more than 90% of cases with activating point mutations in the serine/threonine kinase BRAF, which is positioned immediately downstream of RAS in the MAPK signaling cdscade[?]Burkitt's lymphoma:-Within the category of Burkitt Lymphoma fall (1) African (endemic) Burkitt lymphoma, (2) sporadic (non-endemic) Burkitt lymphoma, and (3) a subset of aggressive lymphomas occurring in individuals infected with HIV.-Burkitt lymphomas occurring in each of these settings are histologically identical but differ in some clinical, genotypic, and virologic characteristics.-All forms of Burkitt lymphoma are highly associated with translocations of the MYC gene on chromosome 8 that lead to increased MYC protein levels.-Essentially all endemic Burkitt lymphomas are latently infected with EBV, which is also present in about 25% of HIV-associated tumors and 15% to 20% of sporadic cases.-Characteristic "starry sky" pattern.-When the bone marrow is involved, aspirates reveal tumor cells with slightly clumped nuclear chromatin, two to five distinct nucleoli, and royal blue cytoplasm containing clear cytoplasmic vacuoles.[?]Mantle Cell lymphoma:-Mantle cell lymphoma is an uncommon lymphoid neoplasm that makes up about 2.5% of NHL in the United States and 7% to 9% of NHL in Europe.-It usually presents in the fifth to sixth decades of life and shows a male predominance.-As the name implies, the tumor cells closely resemble the normal mantle zone B cells that surround germinal centers.-Virtually all mantle cell lymphomas have an (11;14) translocation involving the IgH locus on chromosome 14 and the cyclin D1 locus on chromosome 11 that leads to over expression of cyclin D1.-Most common presentation is painless lymphadenopathy.-Symptoms related to involvement of the spleen (present in -50% of cases) and gut are also common.

Pathology

Blood

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Placental enlargement is seen in which of the following infections except?

Toxoplasma

CMV

Parvovirus

Plasmodium

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Ans. D.PlasmodiumMaternalMaternal diabetesRh incompatibilityAnemiaChronic intrauterine infection: TORCH (Toxoplasmosis, rubella, CMV, herpes), syphilis, VZV, Parvovirus B-19.Alpha - thalassemiaFetalHigh output hea failureUmbilical vein obstructionHydrops fetalis (all causes)Sacrococcygeal teratomaBeckwith - Wiedemann syndromePlacental :Choriocarcinoma, Hemorrhage, hydatidiform moleFinnish type nephrotic syndrome

Gynaecology & Obstetrics

2e878337-829f-4a66-8144-5fea39438d02

Apoptosis is characterized by all of the following EXCEPT

DNA fragmentation

Chromatin condensation

Cell shrinkage

Inflammation

multi

(D) Inflammation # Cell undergoing apoptosis shows a characteristic morphology:> Cell shrinkage and rounding are shown because of the breakdown of the proteinaceous cytoskeleton by caspases.> Cytoplasm appears dense, and the organelles appear tightly packed.> Chromatin undergoes condensation into compact patches against the nuclear envelope (also known as the perinuclear envelope) in a process known as pyknosis, a hallmark of apoptosis,> Nuclear envelope becomes discontinuous and the DNA inside it is fragmented in a process referred to as karyorrhexis.> Nucleus breaks into several discrete chromatin bodies or nucleosomal units due to the degradation of DNA.> Cell membrane shows irregular buds known as blebs.> Cell breaks apart into several vesicles called apoptotic bodies, which are then phagocytosed.

Pathology

Misc.

76294a31-d4e8-4b3b-8aa8-16a1168f0aeb

Internal pudendal aery is a branch of ?

Anterior division of internal iliac

Posterior division of internal iliac

Anterior division of external iliac

Posterior division of external iliac

single

Ans. is `a' i.e., Anterior division of internal iliacBranches of anterior division of internal iliac aery are : (i) Superior vesical, (ii) Middle rectal, (iii) Inferior vesical (in males), (iv) Internal pudendal, (v) Vaginal (in females), (vi) Uterine (in females), (vii) Obturator, and (viii) Inferior gluteal.Branches of posterior division are : (i) Iliolumbar, (ii) Lateral sacral, and (iii) Superior gluteal.

Anatomy

3a253388-26c0-4857-9858-264916653c04

In amyloidosis, the following appearance will be seen in

X-ray crystallography

Electron microscope

Spiral electron microscope

Congo red stain

multi

X-ray crystallography and infrared spectroscopy demonstrate a characteristic cross-b-pleated sheet conformation.This confirmation is seen regardless of the clinical setting or chemical composition and is responsible for the distinctive Congo red staining and birefringence of amyloid.By electron microscopy, all types of amyloid consist of continuous, nonbranching fibrils with a diameter of approximately 7.5 to 10 nm.Ref: Robbins Pathology; 9th edition; Page no: 257

Pathology

General pathology

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Daisy head colonies are seen with -

Staph. Aureus

Corynebacterium diphtheriae

Staph. Pyogenes

Anthrax

single

Ans. is 'b' i.e., Corynebacterium Diphtheriae

Microbiology

645ee434-e40f-4962-afa8-045865c623de

True about pectoralis major muscle

Abductor & Internal rotator of shoulder

Blood supply by perforating branch of internal thoracic aery

Blood supply by thoraco acromial aery

Nerve supply by intercostal aery

multi

PECTORALIS MAJOR:-Origin: Small clavicular head- medial half of anterior aspect of clavicle.Sternocostal head- lateral half of sternum upto 6th cailage., and medial pas of 2nd to 6th costal cailages.Inseion:-U shaped inseion into lateral lip of bicipital groove.Nerve supply:-Lateral pectoral( C5-C7)Medial pectoral (C6-C8, T1)Action:-Clavicular head- flexes arm Sternocostal head-adducts and medially rotates armOnly muscle of upper limb which is supplied by all 5 spinal segments that form brachial plexus.Blood supply:- pectoral branch of thoracoacromial aery{Reference: Vishram Singh, pg no.40}

Anatomy

Upper limb

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Characteristic feature of Systemic Juvenile Idiopathic Arthritis is

Uveitis is a feature

It occurs after 16 years of age

NSAIDs are contraindicated

RA factor is negative

single

Systemic Juvenile Idiopathic Arthritis It begins at below 16 years of age NSAIDs are given  Ra factor is negative Uveitus is seen in oligoarticular JIA

Pediatrics

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Which of the following is not a cause of acute pancreatitis ?

Hypercalcemia

Thrombotic thrombocytopenic purpura

Cystic fibrosis

Magnetic resonance cholangiopancreatography (MRCP)

single

Ans. is 'd' i.e., Magnetic resonance cholangiopancreatography (MRCP) Causes of Acute Pancreatitis Common causes Gallstones (including microlithiasis) - most common Hyperiglyceridemia Endoscopic retrograde cholangiopancreatography (ERCP), especially after biliary manometry. Trauma (especially blunt abdominal trauma) Postooperative (abdominal and nonabdominal operation) Drugs (L-asparginase, thiazide diuretics, frusomide, estrogens, azathioprime, 6-mercaptopurine, methyldopa, sulfonamide, tetracyclin, valproic acid, anti-HIV medicacations) Sphincter of Oddi dysfunction Uncommon causes Vascular causes and vasculitis (ischemic-hypoperfusion states after cardiac surgery) Connective tissue disorders and thrombotic thrombocytopenic purpura (TTP) Cancer of the pancreas Hypercalcemia Periampullary diveiculum Pancreas divisum Hereditary pancreatitis Cystic fibrosis Renal failure

Pathology

854a5440-6eff-4f6e-a900-a22be4196eba

For an arterial blood content of 20 mL oxygen per 100 mL blood and venous blood content of 15 mL oxygen per 100 mL of blood, how much oxygen is transferred from blood to tissue if the blood flow is 200 mL/min?

5 mL/min

10 mL/min

15 mL/min

20 mL/min

single

Ans. B. 10 mL/minThe amount of oxygen exchanged is equal to the product of the blood flow and the arterial venous oxygen content difference: 200mL/minx(20mL/100mL-15mL/100mL)=10mL/min.

Physiology

Heart, Circulation, and Blood

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Which of the following infection affects fetal growth?

CMV

Rubella

Herpes simplex

All

multi

Ans: d (All) Ref: Dutta, 6th ed, p. 296All the above infections cause IUGR.Causes oflUGR:3. Placental* Placenta previa* Abruptio placenta* Circumvallate placenta* Infarction4. Idiopathic - 40%1. Maternal* Constitutional* Maternal nutrition* Maternal diseases - anaemia, HTN, heart disease etc.* Toxins - alcohol, drugs, smoking2. Fetal* Chromosomal abnormalities - Trisomies 13,18,21 and Turner syndrome.* Structural abnormalities - C VS, renal etc* Infections - Toxoplasma, rubella, CMV, HSV, malaria.* Multiple pregnancy

Gynaecology & Obstetrics

Miscellaneous (Gynae)

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What is true about chorda tympani?

Postganglionic sympathetic

Postganglionic parasympathetic

Preganglionic parasympathetic

Postganglionic parasympathetic

multi

Chorda tympani from facial nerve provides preganglionic secretomotor fibres ( parasympathetic fibres ) to the glands. Ref : B D Chaurasia's Human Anatomy, seventh edition , volume 3 , pg. no., 136.

Anatomy

Head and neck

8540be06-254f-4daa-9214-ce0d1b2911cf

Whiff test is positive in:

Candidians

Chlamydial infection

Trichomonas vaginitis

HSV infection

single

Ans. is c, i.e. Trichomonas infectionRef: Williams Gynae 3rd/ed, p52* Whiff Test:Vaginal discharge +10% KOH gives a Fishy odour.This test is characteristic of BV with vaginal pH >4.5 and this stems from diminished acid production by bacteria.Similarly Trichomonas vaginals infection is also associated with anaerobic overgrowth & resultant elaborated lamines.Thus women diagnosed with bacterial vaginosis should have no microscopic evidence of trichomoniasis

Gynaecology & Obstetrics

Sexually Transmitted Disease in the Female

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A drug that binds to and inhibits Gp IIb/IIIa glycoprotein and is responsible for platelet antiaggregatory effects is:

Clopidogrel

Enoxaparin

Fondaparinux

Tirofiban

single

Aspirin Clopidogrel Ticlopidine 3 Act on TXA2 2 Act on ADP Abciximab Tirofiban Eptifibatide Act on GpIIb/IIIa

Pharmacology

Hematology