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Society & Ethics 57

af41e1b3-302d-46d6-8a5a-78daef2cf5c0

Retinoblastoma best evaluated by -

Ultrasonography

CT SCAN

CT SCAN + MRI

MRI

single

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

Radiology

Ultrasonography, CT, and MRI

6fd5a56d-28e1-4720-a5a2-b384c31f0644

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

Disability

Impairment

Handicap

Paralysis

multi

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

Social & Preventive Medicine

Concept of Health and Disease

6e06ea6e-b963-4f73-a1b2-4b1b716f847a

Transcription is inhibited by

Actinomycin D

Amanitin

Chloramphenicol

Streptomycin

single

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

Biochemistry

Metabolism of nucleic acids

a400d365-6ada-45c8-a8cb-695be84522a7

A wave in ERG is due to activity of-

Pigmented epithelium

Rods and cones

Ganglion cell

Bipolar cell

single

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

Ophthalmology

Techniques of Ocular Examination and Diagnostic Tests

e6f2c9b3-955d-485d-9780-ed918cbb4239

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

Non enzymatic glycosylation

Protein Kinase C activation

Disturbance in polyol pathway

Chronic inflammation

single

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

Pathology

Endocrinology

25507155-30c8-4ded-bbcd-301eed6c8789

Hemolysis is seen in all except:

Haemophilia.

Thalassemia.

Sickle cell anemia.

Methotrexate therapy.

multi

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

Physiology

b29a2276-4d5e-4d35-b1de-e9a1cf60736f

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

5

10

15

20

single

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

Social & Preventive Medicine

Communicable diseases

7806b970-b729-45ee-93d2-397d23f410e4

Overgrowth of the bile duct in a localized region is

Hamaoma

Choristoma

Polyp

Malignant tumor

single

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

Pathology

G.I.T

d0fca57d-d316-4112-83db-49962ecccc4b

Which is the most common complication in Monoamniotic twins?

Discordance

Cord entanglement

Conjoined twins

Intertwining

single

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

Gynaecology & Obstetrics

Miscellaneous (Gynae)

a44dd2df-8836-4fb1-9ec2-97e74c8e8f33

All have chances of DVT except -

Hip fracture & resting

Young < 25yrs age

Decreased protein C & S

Factor V defect

multi

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

Unknown

baf85b5b-580b-4b5a-89b7-e6352413dd60

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

Complete resolution is expected

Survival rate is up to 70% depending on risk stratification

Lifelong disease dependent on factor VIII substitution

Lifelong disease dependent on factor IX substitution

multi

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

Pathology

Blood

ff891aa6-bfb4-4831-8311-3c6a6e0cc2d5

Non competitive inhibition is

Reversible

Irreversible

Any of the above

None of the above

multi

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

Biochemistry

c735f345-e8f6-4cfd-9a51-f66c3954a9b2

The earliest manifestations of Chronic lead poisoning include:

Colic and Constipation

Encephalopathy

Punctate basophilia

Lower limb paralysis

single

C i.e. Punctate basophilia

Forensic Medicine

f15d3fea-55ff-4db1-9961-cdd0f476500a

Percentage of sucrose solution used for newborn analgesia is:

5%

10%

24%

50%

single

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

Unknown

a1c23f84-0185-4d56-b16f-05785a4b1215

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

Digoxin

Ramipril

Dobutamine

Spironolactone

single

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

Anatomy

Other topics and Adverse effects

eaa7b4f1-92a3-4441-b24e-ac195daf4185

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

Hyoscine.

Tropicamide.

Homatropine.

All of the above.

multi

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

Pharmacology

d08d3bf0-d69f-4931-ae89-ae21938c5429

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

Vitamin C

Vitamin B 12

Vitamin A

Vitamin D

single

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

Medicine

3b6e62a4-8100-433a-9f62-d95802c0729b

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

Factor VIII concentrate

Fresh frozen plasma

Desmopressin (DDAVP)

Whole blood transfusion

multi

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

Medicine

Oncology

69502b1e-c39c-48db-b564-5dc182d64ffb

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

Deafness

Diarrhea

Dementia

Dermatitis

multi

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

Social & Preventive Medicine

Nutrition and health

3849cc1d-be7b-4b85-870e-cc171bb963e6

Duration of adolescent stage in boys is

3 years

3-5 years

4 years

5 years

single

Dental

63e567b3-f433-4eec-b04f-51a7b5f0cf76

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

Delayed transient increase in permeability

Early transient increase in permeability

Delayed permanent increase in permeability

Early permanent increase in permeability

single

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

Pathology

f51d6bb6-73c6-4d09-84d5-e4c9fef7c0e8

Type I muscle fibers rich in myosin heavy chain are

Fast contracting, susceptible to fatigue

Slow contracting, susceptible to fatigue

Fast contracting, resistant to fatigue

Slow contracting, resistant to fatigue

single

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

Physiology

General

ce8dcd65-5696-4a35-b255-c544b8124285

What is the function of DNA ligase?

Unwinding (denaturation) of dsDNA to provide as ssDNA template

Seals the single strand nick between the nascent chain and Okazaki fragments on lagging strand

Initiation of DNA synthesis and elongation

Initiates synthesis of RNA primers

single

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

Biochemistry

Metabolism of nucleic acids

a38cd2ff-3c8d-4773-a9ab-70fb73ff1fb1

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

Pramipexole

Entacapone

Bromocriptine

Ropinirole

single

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

Pharmacology

33680b52-ee71-42b3-9abd-dd7bcc6e5f43

Which receptors are present in liver for uptake of LDL:

Apo E

Apo A and Apo E

Apo E and Apo B100

Apo B100

single

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

Biochemistry

910b1354-0a99-469f-a654-336d754ed8f9

Pseudo gestational sac is seen in the USG of

Missed aboion

Ectopic gestation

Complete aboion

Hematometra

single

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

Gynaecology & Obstetrics

General obstetrics

3ee7a15a-0141-4ec8-beef-018452278ae3

True about the chronic obstructive pulmonary disease (COPD)

FEVI <30 of predicted value

FEV1/FVC<0.7

total lung capacity increased

All

multi

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

Medicine

18d1fca1-b5af-4450-ad57-b35ec8100bfd

Ectopia lentis in a child is seen in which of the following disease?

Sarcoidosis

Homocystinuria

Alkaptonuria

Wilson disease

single

Pediatrics

FMGE 2018

8f7c275b-2ba9-4771-ab96-bddcf3e0734d

Alcoholic presents with psychosis and memory loss. Probable diagnosis is:

Wernicke's encephalopathy

Wernicke's Korsakoff psychosis

Acute psychosis

None of the above

multi

Alcoholic patients with chronic thiamine deficiency may also have central nervous system (CNS) manifestations known as Wernicke's encephalopathy, consisting of horizontal nystagmus, ophthalmoplegia (due to weakness of one or more extraocular muscles), cerebellar ataxia, and mental impairment. When there is an additional loss of memory and a confabulatory psychosis, the syndrome is known as Wernicke-Korsakoff syndrome. Ref: Harrison's principle of internal medicine 17th edition, chapter 71.

Medicine

e4b0f449-dbc2-4e5c-a08d-79793ae8763a

The glycolytic enzyme Enolase is inhibited by

Iodoacetate

Fluoride

Arsenate

Arsenic

single

Biochemistry

Metabolism of carbohydrate

bdf0a32e-2bc4-4847-b219-edfe75659a2b

All of the followings are signs of reversible cell injury; except:

Loss of microvilli

Cell Swelling

Bleb formation

Dense Mitochondrial deposit

multi

Ans. (d) Dense Mitochondrial depositRef: Robbins and Cotran Pathologic Basic Disease 9th Ed; Page No-40Cell injuryReversible cell injuryIrreversible cell injury* Cellular swelling* Loss of microvilli* Formation of cytoplasmic blebs* ER swelling* Ribosomal detachment* Myelin figures* Clumping of nuclear chromatin* Flocculent, amorphous mitochondrial densities* Swelling & disruption of lysosomes* Plasma membrane damage* Pyknosis* Karyolysis* Karyorrhexis

Pathology

Cellular Pathology

512c15ea-3b99-4b5c-8dc8-7854a67f3660

Power of reduced eye is ?

55 D

60 D

65 D

70 D

single

Ans. is b' i.e., 60 D Reduced eve (Reduced schematic eye) In schematic model, the optical system of eye behaves like a combination of lenses. The reduced schematic eye treats the eye as if it were a single refracting element consisting of an ideal spherical surface separating two media of refractive indices of 1.00 (air in external environment) and 1.33 (eye as a whole). So, in reduced eye, the entire system (of eye) can be regarded as one lens with one optical centre which lies in the posterior pa of crystalline lens. The diopteric power of reduced eye is + 60D, of which + 44D is contributed by cornea and + 16D by the crystalline lens. Reduced eye concept was introduced by Listing, therefore, it is also referred to as Listing's reduced eye.

Ophthalmology

2acf7e1a-5870-4840-8925-0ae70de2da31

The length of the eye ball is

12 mm

16 mm

20 mm

24 mm

multi

D. i.e. 24 mm Antero posterior diameter of eye is 17.5 mm at bih and reaches 24 mm in adultQ Eye Diameter Power Pressure Refractory index Veical 23 mm Lens +16DQ Goldmann 10.4 - 20. Air 1 Horizontal 23.5 Cornea +44 DQ applantation 4 mmHg Aqueous 1.336 mm Total +60 DQ Schiotz 10.5- 21.7 Humor Anteroposte- 24 New born eye +2.5 Indentation mmHg Vitrous 1.336 nor (adult) mmQ is DQ Humor A-P (bih) 17.5 hypermetropic Cornea 1.376 mm Crystaline 1.386? Circumference 75mm Lens 1.406Q Volume 6.5 ml (coex? core nucleus) Weight 7 gm

Ophthalmology

ba0e5700-7d01-4259-98e8-e1053b1eb8a9

Wilm' s tumor associated with A/E

Hemihypertrophy

Aniridia

Hypertension

Bilateral polycystic kidney disease

single

The genitourinary anomalies most commonly associated with Wilms tumor are hypoplasia, fusion and ectopia of the kidney, duplications of the collecting systems, hypospadias, and cryptorchidism (Bilateral polycystic kidney disease is not associated with the Wilm's tumor) Syndromes Associated with Wilms Tumor Several syndromes and congenital abnormalities commonly are reported in patients with Wilms tumor. WAGR syndrome (contiguous gene deletion of WT1 & PAX6 on 11P13) It consists of Wilms tumor, Aniridia, Genitourinary abnormalities (cryptorchidism, streak ovaries, bicornuate uterus, ambiguous genitalia), and Mental retardation. Patients with this syndrome have a constitutional deletion of chromosome 11p13 where the Wilms tumor gene, WT1, and the aniridia gene, PAX6, are located. Denys- Drash syndrome(missense mutation in WT1 gene)  It is characterized by Male pseudohermaphrodism, Early-onset renal failure characterized by mesangial sclerosis and Increased risk of Wilms tumor. Patients with this syndrome typically carry a missense mutation in the WT1 gene. Beckwith-Wiedemann syndrome (WT2 gene abnormality on chromosome 11P15.5) It is characterized by Hemihypertrophy, Macroglossia, Visceromegaly, Omphalocele Risk of developing Wilms tumor (3-5%) A variety of 11p15.5 abnormalities have been reported in patients with this syndrome, and it is postulated that a second Wilms tumor gene, WT2, is located in this region. Loss of imprinting of the insulin-like growth factor 2 gene, an epigenetic process, also is associated with Wilms tumor. Other syndromes or conditions with an increased risk of Wilms tumor include: Hemihypertrophy, Sporadic aniridia, Genitourinary anomalies, Pearlman syndrome, Sotos syndrome, Neurofibromatosis (von Recklinghausen disease), and Von Willebrand disease. About option 'c' Hypertension. "Hypertension also has been described and probably is due to renal ischemia."- Nelson More about Wilm's tumor (also k/a nephroblastoma): Wilm's tumor is the most common renal neoplasm & 2nd most common malignant abdominal tumor, in children (Most common abdominal malignant tumor is neuroblastoma) Peak incidence is between 2 and 5 yrs of age. 5-10% are bilateral; either both kidneys are involved simultaneously (synchronous) or one after the other (metachronous) Clinical features of W.T. Abdominal lump (most common presenting feature) Abdominal pain Vomiting Hematuria Hypertension Treatment: High cure rates of 80-90% can be achieved with multimodality treatment using surgery, chemotherapy & radiotherapy Surgical resection is done in all stages followed by chemotherapy (stage I&II) or chemotherapy + radiotherapy (stage III, IV, V) Pre op chemotherapy is given in inoperable & bilateral cases Chemotherapeutic agents used are Vincristine, Dactinomycin, Doxorubicin & Cyclophosphamide.

Surgery

dd2165a8-d5fd-4d6e-b84c-9b0580d24065

All are caused by Herpes simplex virus except

CA cervix

Gingivostomatitis

Mollaret meningitis

Herpes labialis

multi

CA cervix is caused by human papilloma virus.

Microbiology

0a261053-64d5-452f-a294-54ae003d94e8

Great auricular nerve originates from?

C2,C3

C3,C4

C4,C5

C5,C6

single

The great auricular nerve is a superficial branch of the cervical plexus composed of branches of spinal C2 and C3. It provides sensory innervation to the skin overlying the parotid gland, angle of mandible, external ear and posterior auricular region. The skin of the face is supplied by three divisions of the trigeminal nerve except for the small area over the angle of mandible and parotid gland which is supplied by greater auricular nerve(C2,C3).

Anatomy

dda9dc5f-93d2-44aa-a958-33f7d46e86cf

Function of CAMP

Ion exchange

Activation of protein kinase

Activation of Ryanodine receptors

Release of acetylcholine

single

CAMP is a secondary messager, used for intracellular signal transduction, such as transferring into cells the effect of hormones like glucagon etc.it is involved in activation of protein kinase Ref:Guyton and Hall textbook of medical physiology 12th edition,page number 540 ,541,542

Physiology

General physiology

a1e42807-b475-4583-bf43-010ba311d45d

Birth trauma is a risk factor for:

Prolapse uterus

Endometriosis

PID

Abortions

single

Birth trauma is an important aetiological factor for prolapse.

Gynaecology & Obstetrics

9a031386-ad7b-4a94-8302-1ade0d9a0c21

During an operation if a pair of scissors is left in abdomen it is known as:(2004)

Petty's method

Res ipsa forcepalis

Res ipsa loquitor

Pharaoh's serpents

single

Ans: cRef: Parikh, 6th ed, p. 1.43

Forensic Medicine

Law & Medicine, Identification, Autopsy & Burn

38fac735-9e58-4d5e-8c6a-5fd9e22550c8

Paranasal sinuses presents at bih are

Frontal and maxillary

Ethmoid and maxillary

Frontal and ethmoid

Sphenoid and ethmoid

single

Paranasal sinuses develop as outpouchings from the mucous membrane of a lateral wall of the nose. The growth of sinuses continues during childhood and into early adult life. Radiologically maxillary sinuses can be identified at 4-5 months, ethmoids at 1 year, sphenoid at 4 years and frontals at 6 years. Reference: Diseases of ear, nose and throat; PL Dhingra; 6th edition; Pg no.189

ENT

Nose and paranasal sinuses

7af9613f-59e3-4ffd-815a-0cdbbf36a008

The incidence of carcinoma cervix in women with multiple sexual paners is 5 times the incidence seen in those with a single paner. Based on this, what is the attributable risk?

20%

40%

50%

80%

single

- If the incidence of carcinoma cervix in those with single paner is 'I' , then the incidence in those with multiple sexual paners will be 5 'I'. - Now attributable risk = (Incidence in exposed-Incidence in non-exposed/Incidence in exposed ) X 100 = (5I-I / 5I) X 100 = (4/5) X 100 = 80%.

Social & Preventive Medicine

Classification, Coho Study

3fce2d1e-23c7-4b14-b957-a75f89a25ce9

Secondary amyloidosis complicates which of the following:

Pneumonia

Chronic glomerulonephritis

Irritable bowel syndrome

Chronic osteomyelitis

single

Chronic osteomyelitis

Pathology

efdf46e2-6ae1-4055-9955-729d4253634a

Thiopentone is used for induction anaesthesia, because it is –

Smooth induction

Rapidly redistributed

Rapid redistribution

easy to monitor

single

All inducing agents have smooth and fast induction. Therefore they are used as inducing agents. Rapid redistribution is responsible for very short duration of action (rapid recovery), not for induction.

Anaesthesia

9ce354ad-9625-4b51-8c82-29678ba78237

If TFR in a population is 4, then GRR would be (approx.)

2

4

8

16

single

- GRR or NRR= 1/2 TFR (approx.) - In given question, TFR is 4; hence GRR is half of 4 = 2

Social & Preventive Medicine

Definition & Concepts

1a763a37-0c5b-4b03-a8a8-4b0add7aa507

Pericardial space is present between ?

Endocardium and pericardium

Epicardium and pericardium

Endocardium and epicardium

Parietal and visceral pericardium

single

Pericardial space (pericardial cavity) lies between parietal serous pericardium and visceral serous pericardium.

Anatomy

cd4677e8-4118-42d4-aa01-aa42d84f341c

Which of the following is primary prevention-

Screening test

Early diagnosis

Use of mosquito net

Restoration of lost function

single

Social & Preventive Medicine

92cc1e0b-f7bf-4dd0-8c44-efd0924c2c0b

Chacroid is caused by?

N. Gonnorrea

H. Ducrei

T. Pallidum

H. Influenza

multi

See APPENDIX-47 for list of “STDs” CHANCROID (SOFT SORE) This venereal infection is caused by the Gram-negative bacillus Haemophilus ducreyi. One to 5 days postinfection, a soft sloughy ulcer appears on the penis or vulva. The treatment of choice is erythromycin (500 mg 6-hourly for 14 days).

Dental

f3e4f6c6-a5bd-4172-8156-913eb996a505

Metrifonate is effective against:

Amoebiasis

Leishmaniosis

Schistosomiasis

Giardiasis

single

Schistosomiasis

Pharmacology

c687fdeb-4569-46ff-9a63-a650ed9b0d37

For which malignancy, intensity Modulated Radiotherapy is the most suitable

Lung

Prostate

Leukemias

Stomach

single

The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. The prostate secretes a fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperm as semen.

Radiology

8d038a47-dfb3-4310-9cfb-ed3ede91fa1f

Eruption of Maxillary 2nd molar occur at

8-9 year

10-11 year

19-20 year

12-13 year

single

Dental

d89cd238-c46d-45ac-800b-7e09897b371d

Most common cause of secondary postpaum hemorrhage:-

Trauma

Atonic uterus

Bleeding disorders

Retained products of conception

single

Most common cause of secondary postpaum hemorrhage is retained tissues Secondary postpaum hemorrhage is bleeding 24 hours to 12 weeks after delivery. Causes of PPH(10 and 20) : Uterine atonicity Injury to any pa of genital tract Coagulopathy (von Willebrand's disease) Retained tissues - MCC of 20PPH

Gynaecology & Obstetrics

Post Paum Haemorrhage (This better stop now !)

7247b17d-945d-433a-acf2-03a6a7d6bcc0

A 53 year old male presents with an enlarged supraclavicular lymph node, and examination reveals enlargement of the Waldeyer ring of oropharyngeal lymphoid tissue. There is no hepatosplenornegaly. Lymph node biopsy reveals replacements by a monomorphous population of large lymphoid cells with enlarged nuclei and prominent nucleoli. The CBC is normal except for finding of mild anemia. Immunohistochemical staining and flow cytometry of the node reveals that most lymphoid cells are CDl9 CD10=,CD3-, CD15-, and negative (TdT). These findings are most consistent with a diagnosis of

Chronic lymphadenitis

Diffuse large B-cell lymphoma

Hodgkin disease

Lymphoblastic lymphoma

multi

Diffuse large B-cell lymphoma occurs in older individuals and frequently presents as localized disease with extranodal involvement, paicularly of the Waldeyer ring. The staining pattern indicates a B-cell proliferation (CD19, CD1O). T-cell (CD3) and monocytic (CD15) markers are absent, TdT can be expressed in B- lineage cells at an earlier stage of maturation. Small lymphocytic lymphoma is also a B-cell neoplasm, but it manifests with widespread lymphadenopathy, liver and spleen enlargement, and lymphocytosis, Lymphoblastic lymphoma is a T-cell neoplasm that occurs typically in the mediastinum of children. Reed-Stem berg cells characterize Hodgkin disease. In chronic lymphaderiitis, the lymph node has many cell types-macrophages, lymphocytes, and plasma cells. A monomorphous infiltrate is typical of non-Hodgkin lymphomas.

Medicine

9ecf8d5a-c156-4631-9983-520753508ca9

Clonorches sinenensis is-

Tapeworm

Roundworm

Threadworm

Fluke

single

Ans. is 'd' i.e., FlukeTrematodes (fluke)o These are flat, leaf like helminths.o They can be classified depending on their site of localization in human tissues.Blood flukesVesical venous plexus: Schistosoma hematobium.Rectal venous plexus & portal venous system : S mansoni (inferior mesentric vein), S japonicum (superior mesenteric vein).Intestinal flukesSmall intestine : Fasciola buski, Heterophyes heterophes, Metagonimus vokogawi, Watsonius watsoni.Large intestine : Gastrodiscoides hominis.Tissue flukesLiver flukes : Fasciola hepatica, Clonorchis sinensis, Opisthorchis felineus, O viverrini.Lung fluke : Paragonimus westermani.o Trematodes are monoecious (hermaphrodite), i.e. sexes are not separate. One exception being Schistosomes, which are diecious with separate sexes.o Trematodes complete their life cycle in three hosts: One definitive (man) and two intermediate hosts (Freshwater snail or mollusc as first intermediate host and fish or crab as second intermediate host),o Trematodes are Oviparous and lay operculated eggs, except for schistosomes which lay non-operculated eggs.Metazoa (Helminths)NemathelminthesPlatyhelminthes ||||Class : Nemafoda(Roundworms)Class : Cestoda(Tapeworms)Class: Trematoda(Flukes)||||||||Intestinal speciesIntestinal-tissue speciesBlood-tissue speciesIntestinal speceisIntestinal-tissue speciesIntestinal speciesBlood speciesTissue species1. Enterobius vermicularisl. Triehinella spiralis1. Wuchereria bancrofti1. Taenia sagnata1. Echinococcus granulosus1. Fasciolo- psis buski1. Schis- tosoma species1. Fasciola hapatic (liver fluke)2. Trichura trichisis2. Dracunculus medinensis2. Brutgia malayi2. Taenia solium 3. Ascaris lumbricoides 3. Loa toa4. Onchocerca3. Hvmenolepsis nana 2. Parago- nimus wester-mni (lung fluke)4. Necator americanus volvulus4. Diphyllobothrium latum 5. Ancylotoma duodenalc 6. Strongyloide stercoraliss

Microbiology

Parasitology

69937838-45c4-4df6-a9b4-8cccba64d352

Use of FAST?

To detect fluid in pericardial and peritoneal sacs

Pyoperitoneum

Intestinal obstruction

Pancreatitis

single

Ans. is 'a' i.e., To detect fluid in pericardial and peritoneal sacs o FASTFocused Assessment of Sonographic examination of Trauma patient is a rapid diagnostic examination to assess patients with potential thoraco abdominal injuries.It sequentially survavs for pressence of blood in pericardial sac and dependent abdominal regions.It is exquistely sensitive for detecting fluid of > 250 ml. After application of vs transmission gel, a 3.5 MHZ convex transducer is used to assess, in sequence-pericardial area, RUQ, LUQ and Pelvis.It is very accurate in assessing Hypotensive patients with blunt trauma abdomen; if FAST positive, immediate surgery is justified.

Surgery

Initial Assessment

2b7fd17a-a23b-4f44-8fff-6c5592612246

The 'Japanese Detergent Suicide Technique' involves mixing of common household chemical to produce:

H2S and other poisonous gases

Deadly foam

Deadly Acidic Compond

Deadly fluid cyanide compound

single

A ie. H2S - Japanese Detergent Suicide technique involves mixing of house hold chemicals like bath sulfur with toilet bowl cleaner to produce a deadly poisonous hydrogen sulfide gas cloudQ. It is used in enclosed spaces like car or closets to achieve near instant death. American version substitutes a common insecticide for bath sulfur as bath sulfur is not available in US.

Forensic Medicine

428fe8cb-334f-49bb-8324-7e7f8e5a358b

Substance with same atomic number but different mass number –

Isotope

Isobar

Atom

Mineral

single

Isotopes → Atoms of the same elements with same atomic number but different atomic mass (mass number).

Radiology

0e1e1452-e560-4bb0-95a1-6bf50c806d91

NSAIDs are used in all except -

As analgesic

In peptic ulcer

R.A.

O.A.

multi

Ans. is 'b' i.e., Peptic ulcer o Peptic ulcer is a contraindication.

Pharmacology

dcf71d51-f812-4c7f-b037-8ebeb710b70d

On USG finding of cystic hygroma in fetus is suggestive of

Down's syndrome

Marphan's syndrome

Turner's syndrome

Klinfelter's syndrome

single

C i.e. Turner's Syndrome

Radiology

df40b8bf-a3c0-4cbe-9ac4-28de844f579c

A 22-year-old man has a sudden loss of vision in the right eye. On physical examination, there is a subluxation of the right crystalline lens. On auscultation of the chest, a midsystolic click is audible. An echocardiogram shows a floppy mitral valve and dilated aortic arch. The patient's brother and his cousin are similarly affected. He is prescribed a beta-blocker. A genetic defect involving which of the following substances is most likely to be present in this patient?

Collagen

Dystrophin

Fibrillin-1

NF1 protein

multi

Marfan syndrome is an autosomal dominant condition that is most often caused by qualitative defects in fibrillin from missense mutations in the fibrillin (FBN1) gene. An abnormal collagen gene can cause osteogenesis imperfecta and Ehlers-Danlos syndrome. Genetic mutations in the dystrophin gene are involved in Duchenne and Becker muscular dystrophies. The NF1 protein is abnormal in neurofibromatosis type 1. Disordered spectrin causes hereditary spherocytosis.

Pathology

Genetics

3fec6dd9-5e3c-4109-8c09-27d915aaf98f

Hypokalemia is seen with -

Frusemide

Coisol

Metabolic acidosis

Amiloride

single

Furosemide also can lead to gout caused by hyperuricemia. Hyperglycemia is also a common side effect. The tendency, as for all loop diuretics, to cause low serum potassium concentration (hypokalemia) has given rise to combination products, either with potassium or with the potassium-sparing diuretic amiloride (Co-amilofruse). Other electrolyte abnormalities that can result from furosemide use include hyponatremia, hypochloremia, hypomagnesemia, and hypocalcemia. In the treatment of hea failure, many studies have shown that the long-term use of furosemide can cause varying degrees of thiamine deficiency, so thiamine supplementation is also suggested. Although disputed, it is considered ototoxic: "usually with large intravenous doses and rapid administration and in renal impairment". Other precautions include: nephrotoxicity, sulfonamide (sulfa) allergy, and increases free thyroid hormone effects with large doses Ref Davidson 23rd edition pg 365

Medicine

Fluid and electrolytes

ae354388-0f82-416f-8db2-764ed2181010

An 19-year-old man is admitted to the emergency room following a motorcycle accident. He is ale and fully oriented, but witnesses to the accident repo an interval of unresponsiveness following the injury. Skull films show a fracture of the left temporal bone. Following x-ray, the patient suddenly loses consciousness and dilation of the left pupil is noted. This patient should be considered to have?

Ruptured berry aneurysm

Epidural hematoma

Acute subdural hematoma

Intra Abdominal hemorrhage

single

Epidural hematomas are typically caused by a tear of the middle meningeal aery or vein or a dural venous sinus. Ninety percent of epidural hematomas are associated with linear skull fractures, usually in the temporal region. The lesion appears as a hyperdense biconvex mass between the skull and brain on CT scan. The typical history is one of head trauma followed by a momentary alteration in consciousness and then a lucid interval lasting for up to a few hours. This is followed by a loss of consciousness, dilation of the pupil on the side of the epidural hematoma, and then compromise of the brainstem and death.

Surgery

8ff4a9ef-abc7-4c30-8812-6d051af146c8

All these structures are found in the lateral nasal wall except:

Superior turbinate

Vomer

Agger nasi

Hasner's valve

multi

(b) Vomer(Ref. Cummings, 6th ed., 659)Vomer is an independent separate bone which forms the postero-inferior part of the septum proper, i.e. the medial wall of nose.Rest all are found on the lateral wall

ENT

Congenital Lesions and Stridor

df32abb3-a09e-46a5-acad-1135d15e1985

If thiopentone is injected accidently into an artery the first symptom is –

Analgesia

Paralysis

Skin ulceration

Pain

single

First symptom of inadverent intra-arterial injection is pain and first sign is blanching.

Anaesthesia

3172055b-d115-4db9-a0ac-a3d7a99c55d2

True about pugilistic attitude?

Indicate only antimoem burn

Indicate only postmoem burn

Cannot differentiate between antemoem & postmoem burn

Indicate defense by victim during antemoem death

multi

Puglistic attitude : It is due to coagulation of the proteins of the muscles and dehydration which cause contraction. The flexor muscles being bulkier than extensor, contracts more due to which joints of all limbs are flexed. It occurs whether the person was alive or dead at the time of burning. So it is non specific ,hence Cannot differentiate between antemoem & postmoem burn

Forensic Medicine

Thermal injuries

5d69e905-80fe-4c62-be1f-73f23c84639b

Which of the following drug when taken in excess can be removed by dialysis?

Digoxin

Salicylates

Benzodiazepines

Organophosphates

single

Forced alkaline diuresis or hemodialysis is indicated in severe salicylate poisoning to remove unabsorbed drug. Other treatment modalities in salicylate poisoning are external cooling and intravenous fluids with sodium, potassium, bicarbonate and glucose. Gastric lavage is done to remove the unabsorbed drug. Blood transfusion and vitamin K is given if bleeding occurs. Fatal dose in salicylate poisoning is 15-30gm. Serious toxicity occur at serum salicylate levels >50mg/dl. Manifestations include vomiting, dehydration, acidotic breathing, hypoglycemia, delirium, hallucinations, convulsion, coma and death due to respiratory failure and cardiovascular collapse. Ref: Essentials of Medical Pharmacology, 5th Edition, Pages 172-3; Irwin and Rippe's Intensive Care Medicine By Richard S. Irwin, Page 1553; Pediatric Critical Care Medicine: Basic Science and Clinical Evidence By Derek S. Wheele, Page 1633.

Pharmacology

299b8c5b-46aa-48dd-bd70-81db6ec700b5

All of the following are true about cluster sampling except-

Samples are similar to those in simple Random sampling

Is a Rapid and simple method

The sample size may very according to study design

It is a type of probability sample

multi

.

Social & Preventive Medicine

Biostatistics

ca38421f-18eb-4d4b-ab5b-cf7f8e41db46

Dofetilide is which class of anti arrhythmia drug

Class 1

Class 11

Class 111

Class 1V

single

Refer kDT 7/e 529 Dofetilide is a class III antiarrhythmic agent Dofetilide is used for the maintenance of sinus rhythm in individuals prone to the occurrence of atrial fibrillation and flutterarrhythmias, and for chemical cardioversionto sinus rhythm from atrial fibrillation and flutter

Pharmacology

Cardiovascular system

b6643772-f438-480a-a68e-881bcb05598a

Bone pearl's or wax drippings is pathogonomic of:

Burns

Scalds

Lightening

Electrocution

single

Ans. (D). Electrocution(Ref: Review of Forensic Medicine & toxicology; Gautum Biswas; 2nd edition; Pg - 275)

Forensic Medicine

Death and Investigations

23ee69f9-a9ea-47f8-a697-7984fd9f0ec0

Metal fume fever can be seen in poisoning by all EXCEPT: March 2003

Lead

Arsenic

Iron

Zinc

multi

Ans. B i.e. Arsenic

Forensic Medicine

02cc032f-e632-4e71-aa24-614419c508b4

Fructose is transpoed by:

GLUT 1

GLUT 2

GLUT 5

GLUT 4

single

GLUT 5is membrane channel for the facilitated diffusion of glucose It is seen in testis,gastrointestinal tract

Anatomy

General anatomy

45d47097-ba83-4b1e-89ef-584737a309b5

A child with alopecia, hyperpigmentation, hypogonadism and rash of genital area and mouth is likely to suffer from:

Iron deficiency

Zinc deficiency

Calcium deficiency

Copper deficiency

single

Ans. (b) Zinc deficiencyRef. Harrison's 19th ed. / 96e-9* Zinc is an essential trace nutrient required for the proper function of more than 100 enzymes and plays a crucial role in nucleic acid metabolism.* Acrodermatitis enteropathica is an autosomal recessive disorder postulated to occur as a result of mutations in the SLC39A4 gene located on band 8q24.3.* This protein is highly expressed in the enterocytes in the duodenum and jejunum. Therefore, affected individuals have a decreased ability to absorb zinc from dietary sources. Absence of a binding ligand needed to transport zinc may further contribute to zinc malabsorption.* Clinical manifestations include diarrhea, alopecia, muscle wasting, depression, irritability, and a rash involving the extremities, face, and perineum. The rash is characterized by vesicular and pustular crusting with scaling and erythema.* Features of acrodermatitis enteropathica start appearing in the first few months of life, if mother discontinues breast milk.Deficiency and toxicity of several metalsPhosphorus ElementDeficiencyToxicityTolerable Upper (Dietary) Intake LevelBoronNo biologic function determinedDevelopmental defects, male sterility, testicular atrophy20mg/d (extrapolated from animal data)CalciumReduced bone mass, osteoporosisRenal insufficiency (milk-alkali syndrome) nephrolithiasis, impaired iron absorption, thiazide diuretics.2500 mg/d (milk alkali)CopperAnemia, growth retardation, defective keratinization and pigmentation of hair, hypothermia, degenerative changes in aortic elastin, osteopenia, mental deterioration.Nausea, vomiting, diarrhea, hepatic failure, tremor, mental deterioration, hemolytc anemia, renal dysfunction10 mg/d (liver toxicity)ChromiumImpaired glucose toleranceOccupational',Renal failure, dermatitis, pulmonary cancerNot determinedFluoride|Dental cariesDental and skeletal flurosis, osteosclerosis10 mg/d (Blurosis)IodineThyroid enlargement, |T4 cretinismThyroid dysfunction, acne-like eruptions.1100 mg/d (thyroid dysfunction)IronMuscle abnormalities, koilonychia, pica anemia, |work performance, impaired cognitive development, premature labor, |perinatal maternal deathGastrointestinal effects, (nausea, vomiting, diarrhea, constipation), iron overload with organ damage, acute and chronic systemic toxicity, increased susceptibility to malaria, increased risk association with certain chronic diseases (e.g. diabetes)45 mg/d of elemental Iron (gastrointestinal side effects)ManganeseImpaired growth and skeletal development reproduction, lipid and carbohydrate metabolism, upper body rashGeneral: Neurotoxicity, Parkinson-like symptoms Occupational: Encephalitis like syndrome, Parkinson like syndrome, psychosis, pneumoconiosis.11 mg/d (neurotoxicity)MolybdenumSevere neurologic abnormalitiesReproductive and fetal abnormalities2mg/d (extrapolated from animal data)SeleniumCardiomyopathy, heart failure, striated muscle degenerationGeneral: Alopecia , nausea, vomiting, abnormal nails, emotional400 pg/d (hair, nail changes)PhosphorusRickets (osteomalacia) proximal muscle weakness, rhabdomyolysis, paresthesia, ataxia, seizure confusion, heart failure, hemolysis acidosis.Hyperphosphatemia4000 mg/dZincGrowth retardation, |taste and smell alopecia, dermatitis, diarrhea, immune dysfunction, failure to thrive, gonasal atrophy, congenital malfomations.General: Reduced copper, absorption, gastritis, sweating fever,nausea, vomitingOccupational; Respiratory distress, pulmonary fibrosis40 mg/d (impaired copper metabolism)

Biochemistry

Micronutrient Metabolism

4f6d36b2-db6f-4f40-8a15-baef636099b2

True about carcinoma esophagus is-

Most common site is lower end

Both adeno and suqamous cell carcinoma occur

Commonest histology is adenocarcinoma

More common in females

multi

Surgery

c1ab2b07-4411-422d-95ad-839d5a17eb72

Use of tamoxifen in carcinoma of breast patients does not lead to the following side effects :

Thromboembolic events

Endometrial carcinoma

Cataract

Cancer in opposite breast

single

Pharmacology

e72bd6ed-4a3b-4efc-9723-249191d75a80

Sternal edema is seen in -

Measles

Mumps

Diphtheria

Varicella

single

Medicine

5e3358a6-bb92-44a6-9f3a-f5a824e64e00

Which of the following nerve fibers are first to get blocked by local anaesthetic

A alpha

A beta

A delta

A gamma

single

Sequence of block is Beta > A delta = C > A gamma > A beta >A alpha

Anaesthesia

0f87aded-05af-4728-acc4-707018dabee3

Ketamine belongs to which of the following group of drugs ?

Phencyclidine

Phenols

Barbiturate

Benzodiazepine

single

Ketamine is a phencyclidine derivative presented as a racemic mixture of R-and S-ketamine.

Anaesthesia

20bcb0e4-8217-4ec0-aaaa-4ccd27aca529

Anti-D Rh is given for: September 2005

Rh positive father,Rh positive mother

Rh negative father,Rh positive mother

Rh negative father,Rh negative mother

Rh positive father,Rh negative mother

single

Ans. D: Rh positive father,Rh negative mother Rho(D) Immune Globulin is given by intramuscular injection that is used to prevent the immunological condition known as Rhesus disease (or hemolytic disease of newborn) paicularly when father is Rh positive and mother is Rh negative. It is a solution of IgG anti-D (anti-RhD) antibodies that bind to, and lead to the destruction of, fetal Rh D positive red blood cells that have passed from the fetal circulation to the maternal circulation. Therefore, in a Rhesus negative mother it can prevent sensitization of the maternal immune system to Rh D antigens, which can cause rhesus disease in the current or in subsequent pregnancies

Gynaecology & Obstetrics

bd44a852-56fb-4a20-b5f8-3ef956d6dc14

About Ectopia vesicae, following is true except ?

CA bladder may occur

Ventral curvature of penis

Incontinence of urine

Visible uretero - vesical efflux

multi

Answer is 'b' i.e. Ventral curvature of penis Ectopia vesicae is associated with epispadias in which dorsal or upwards curvatuve of penis is noted. Ventral curvature is noted in hypospadias.

Surgery

c2f0d312-7bfb-4ff6-bb64-fe4ff7dba0fa

On USG finding of cystic hygroma in fetus is suggestive of :

Down's syndrome

Marfan's syndrome

Turner's syndrome

Klinfelter's syndrome

single

Turner's syndrome (XO) may have - Cystic hygroma, Widely spaced nipples, Webbed neck, Infertility, Normal I.Q.

Radiology

157316a2-cd60-4eb0-94bc-c62da236f92f

Oesophageal atresia may occur as a pa of VACTERAL group of anomalies. What does `TE' stand for?

Tetralogy of Fallot

Thoracic empyema

Tracheo-oesophageal fistula

Talipes equinovarus

multi

Ans. is 'c' i.e., Tracheo-oesophageal fistulaVACTERL association is a disorder that affects many body systems. VACTERL stands for :V:Veebral defectsA:Anal atresiaC:Cardiac defectsTE:Tracheo-Esophageal fistulaR:Renal anomalies,L:Limb abnormalities.People diagnosed withVACTERL association typically have at least three of these characteristic features.

Pediatrics

bd99710c-5f78-4222-a191-45872a9cbcf3

The time between primary and secondary case is called:

A period of communicability

Serial interval

Incubation period

Generation time

multi

Serial interval - gap in time between onset of the primary case and the secondary case. A period of communicability - time during which an infectious agent may be transferred directly or indirectly from an infected person to another person, from an infected animal to man or from an infected person to an animal including ahropods. Incubation period - time interval between invasion by an infectious agent and appearance of the first sign or symptoms of the disease Generation time - interval of time between reciept of infection by a host and maximal infectivity of the host Ref: Park 21st edition, page 95.

Social & Preventive Medicine

a14b3941-8e39-4751-a11d-bd6902347986

Best treatment of old fracture is

Manipulation and POP cast application.

Open reduction and internal fixation and bone grafting.

K Wire fixation

External fixation

single

Nonunion fracture shaft femur requires open reduction and rigid internal fixation with either intramedullary nail or DC plating and bone grafting.

Unknown

8c4b0e05-a555-43c8-ac31-89b4af725a46

Duodenal adenocarcinoma -a) Most common small bowel carcinomab) Periampullary carcinomac) Jaundice & anemia - most common symptomd) Local resection - curative

ac

bc

ad

b

multi

• Duodenum is MC site of small intestinal adenocarcinoma • 15% in the proximal; 40% in the middle and 45% in the distal duodenum (MC) • Resectability and prognosis are better than other upper GI cancers. Clinical Features • Most often presents as obstruction, with nausea, vomiting, and abdominal pain as the most frequent symptoms. • Anemia from bleeding and biliary or pancreatic obstructive symptoms can also be seen on initial presentation if the tumor is located within the periampullary region. Diagnosis • Endoscopy is the diagnostic test of choice for duodenal tumors, which allows for direct visualization and biopsy as needed. Treatment • For 1st or 2nd portion: Whipple procedure • For 3rd or 4th portion: Segmental duodenal resection

Surgery

6b7fa008-79f3-42e2-b2aa-299f527fbef4

Which is a noveneral form of trephonemal infection – a) Yawsb) Pintac) Syphillisd) GV

ab

a

ad

bc

single

Dental

cee3c1f1-c97b-4f39-a23d-da191d9923d3

A 10-year old boy presents to the pediatric emergency unit with seizures. Blood pressure in the upper extremity measured as 200/140 mm Hg. Femoral pulses were not palpable. The most likely diagnosis amongst the following is:

Takayasu's aooaeritis

Renal parenchymal disease

Grand mal seizures

Coarctation of aoa

single

Isolated upper extremity hypeension (200/140 mm Hg), with absent/diminished femoral pulses, is characteristic of coarctation of the aoaSeizures may be due to severe hypeension or due to intracranial haemorrhage(from berry aneurysms which are more common in patients with coarctation)The classic sign of coarctation of the aoa is a disparity in pulsations and blood pressures in arms and legsThe femoral, popliteal, posterior tibial and dorsalis pedis pulses are weak (or absent in about 40% of patients) in contrast to bounding pulses in the arms and carotid vesselsBP in the legs is lower than in the arms and 90% of patients have hypeension in upper extremity greater than the 95th percentile for ageAge (yrs)95th percentile (mm Hg)>1 110/601-5115/756-10125/8511-18140/90Takayasu aooaeritis may also present with severe hypeension and absent femoral pulses due to acquired mid-aoic coarctation (but this is an uncommon presentation)Most commonly affects subclan aery and more commonly presents with claudicationCoarctation TakayasuMore commonMore common in boysUpper extremity hypeensionBounding pulses in arms and diminished or absent pulses in lower limbsHypeension is frequentLess commonMore common in girls (8:1 = f:m)Absent or decreased upper limb pulses and blood pressure difference between left and right arms are characteristicHypeension is frequentSystemic symptoms are more common(ref: Harrison's 18/e p1925)

Medicine

All India exam

84d0a511-645e-4220-9a42-43924cfe504b

Over closure of jaws is accentuated muscle activity:

Buccinator

Lateral pterygoid

Temporalis

medial pterygoid

single

Hyperactive mentalis activity and abnormal buccinator activity is seen in class-II division-1 cases. Over closure of jaws is associated with accentuated temporatis muscle activity.

Dental

3c63dae1-94ee-43ba-a69c-8eadf2d7b7f9

Artifical radioisotopsa) Radiumb) Uraniumc) Plutoniumd) Iridiume) Cobalt

ab

bc

de

bd

single

Important artificial radionuclides :- Tritium - 1, Carbon - 14, Cobalt - 60, Strontium 89, Strontium - 90, Iodine 131, Cesium 134, Cesium 137, Plutonium - 239, Iridium, Tc - 99.

Radiology

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According to Poiseuille's law, reducing the radius of an airway to one-third will increase its resistance how many fold?

3-Jan

3

9

81

single

Poiseuille's law states that during laminar flow, airway resistance is inversely propoional to the 4th power of the radius, other things being equal. Therefore, a reduction in the radius by a factor of 3 increases the resistance by 34, that is, 81.

Physiology

Respiratory System Pa 1

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Which is used for sterilization of cystoscope

Glutaraldehyde

Formaldehyde

Isopropyl alcohol

Ethylene oxide

single

Ans. (a) Glutaraldehyde

Microbiology

General

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A neonate is said be low birth weight (LBW) if his weight is less than ----- gms:

2000

2200

2500

2800

single

Ans. C. 2500 gramsA neonate weighing < 2500 grams at birth irrespective of gestational age is classified as low birth weight (LBW). A neonate weighing less than 1500 grams is classified as very low birth weight (VLBW). A neonate weighing less than 1000 grams at birth irrespective of the gestational age is classified as extremely low birth weight (ELBW)

Pediatrics

New Born Infants

5e547bdd-fc62-4c53-be6d-ed3c66691bbd

Which is most lipogenic carbohydrate:

Glucose

Galactose

Fructose

Starch

single

All carbohydrates (if in excess), gets conveed to fat in body (endogenous fat). Sucrose is made up of glucose and fructose. So, when sucrose is taken instead of glucose, it increases lipogenesis because: Fructose is most rapidly metabolised sugar It bypasses PFK-1 step (Rate Limiting Enzyme of glycolysis). So fructose forms acetyl CoA and thus fats. So fructose is regarded as most lipogenic sugar. Fructose | Uses the enzymes of Glycolysis | Finally forms Pyruvate | Acetyl CoA | Fats (TG, Fatty Acids, Cholesterol) Fructose is present in fruits, honey, table sugar.

Biochemistry

Fat and Carbohydrate interconversion

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The nucleotide triplet CTC in the sixth position of the l3-chain in DNA forms the complementary nucleotide on (mRNA) that codes for glutamic acid. A point mutation on the l3-chain resulting in the nucleotide triplet CAC forms a com¬plementary nucleotide on mRNA that codes for valine. In sickle cell anemia, you would expect the comple¬mentary nucleotide triplet on mRNA from 5' to 3' to read

GAG

CTC

GTG

GUG

single

Note that by changing the CTC triplet to a CAC, the messenger RNA (mRNA) changes from GAG, which normally codes for glutamic acid in the sixth position of the -chain of hemoglobin, to GUG, which now codes for valine. This point mutation of a single base pair is responsible for sickle cell anemia.

Unknown

935d46c0-448d-4005-8891-f953a4b43af0

Which of the following condition masks low serum haptoglobin in hemolysis?

Bile duct obstruction

Liver disease

Malnutrition

Pregnancy

single

Haptoglobin is a glycoprotein synthesized in the liver that binds free hemoglobin. Its scavenging function counteracts the potentially harmful oxidative and nitric oxide-scavenging effects associated with "free" hemoglobin. Low haptoglobin is considered an indicator of hemolysis. But it is increased in biliary obstruction, hence it will mask the effect of hemolysis on haptoglobin. Increased in: Acute and chronic infection (acute-phase reactant) Malignancy Biliary obstruction Ulcerative colitis Myocardial infarction Diabetes mellitus Decreased in: Newborns and children Pregnancy Malnutrition Posttransfusion Intravascular hemolysis Autoimmune hemolytic anemia Liver disease Ref: Nicoll D., Lu C.M., Pignone M., McPhee S.J. (2012). Chapter 3. Common Laboratory Tests: Selection and Interpretation. In D. Nicoll, C.M. Lu, M. Pignone, S.J. McPhee (Eds), Pocket Guide to Diagnostic Tests, 6e.

Pathology

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EBV causes: March 2013

Infectious mononucleosis

Nasopharyngeal carcinoma

Glandular fever

All of the above

multi

Ans. D i.e. All of the above Epstein-Barr virus (EBV)/ Human herpesvirus 4 (HHV-4) It is a virus of the herpes family, and is one of the most common viruses in humans. It is best known as the cause of infectious mononucleosis (glandular fever). It is also associated with paicular forms of cancer, such as Hodgkin's lymphoma, Burkitt's lymphoma, nasopharyngeal carcinoma, and conditions associated with human immunodeficiency virus (HIV) such as hairy leukoplakia and central nervous system lymphomas. There is evidence that infection with the virus is associated with a higher risk of ceain autoimmune diseases, especially dermatomyositis, systemic lupus erythematosus, rheumatoid ahritis, Sjogren's syndrome, and multiple sclerosis. Infection with EBV occurs by the oral transfer of saliva and genital secretions.

Microbiology

1c782070-7770-4f92-bd24-c75648a6648f

Which of the following snake produces paralysis with convulsions -

Vipers

Sea Snakes

Cobra

Krait

single

Types of venom -- may be * Neurotoxic -- cobra, krait * Hemotoxic -- vipers * Myotoxic -- sea snake NEUROTOXIC in krait,eventhough it is neurotoxic,there is no swelling or burning pain at the site of bite and convulsions are milder REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION

Forensic Medicine

Poisoning

faadc75e-08fe-4018-92aa-46db40c79f9c

Dehiscence in the external auditory canal cause infection in the parotid gland via:

Fissure of Santorini

Notch of Rivinus

Petro-tympanic fissure

Retro pharyngeal fissure

single

(a) Fissure of Santorini(Ref. Cummings, 6th ed., 1981)The notch of Rivinus is the upper attachment of pars flaccida.Petro-tympanic fissure is present on the anterior wall of middle ear, on which attaches the anterior malleolar ligament.Retropharyngeal fissure does not exist.

ENT

Ear

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Amino acids not coded by triplet codon:

Lysine

Hydroxyproline

Selenocysteine

Pyrrolysine

single

B i.e. Hydroxyproline

Biochemistry

584f3c02-7f5d-41a8-bd10-32ba7ef5214b

Which index of obesity does not include height?

BMI

Ponderal's index

Broca's index

Corpulence index

single

Ref: Park 25th edition Pgno : 418

Social & Preventive Medicine

Non communicable diseases

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Lalita, a female patient presents with pigmentation of the lips and oral mucosa and intestinal polyps. Her sister also gives the same history. Most probable diagnosis is:

Carcinoid tumor

Melanoma

Villous adenoma

Peutz-Jegher's syndrome

single

The polyps of Peutz-Jeghers syndrome are generally considered to be hamaomas Hamaomatous polyps (usually <100) throughout the GIT, most common in jejunum Associated with Hypermelanotic macule in the perioral region, buccal mucosa. Mucocutaneous pigmentation usually occurs during infancy and most commonly noted in perioral and buccal region. Pigment spots usually appear in first few years of life, reach a maximum level in early adolescence and can fade in adulthood. However, pigmentation on the buccal mucosa remains throughout the life. The pigmented macules of PJS have no malignant potential. Screening consists of a baseline colonoscopy and upper endoscopy at age 20 years, followed by annual flexible sigmoidoscopy thereafter.

Surgery

Large intestine

5958b43e-8cff-40ea-a3ea-7236e3d60fcf

Not true about virulence of endodontic microflora is

Endotoxin

Exotoxin

Bacterial enzymes

Microbial interferences

multi

Dental