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Society & Ethics 57

67ceb846-ab6f-411b-8c28-d9e47f0fe14d

Most common cause of Papillary necrosis is

Diabetes Mellitus

Sickle cell anaemia

Analgesics

Pyelonephritis

single

Major causes of Papillary Necrosis1. Analgesic nephropathy2. Sickle cell nephropathy3. Diabetes with UTI4. Prolonged NSAID use Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 340; Tubulointerstitial Diseases of the Kidney

Medicine

Kidney

fd8ef88d-5c1d-408a-8821-22c2ad3a590f

Alzheimer's disease is associated with: September 2012

Delerium

Delusion

Dementia

All of the above

multi

Ans. C i.e. Dementia Alzheimer's dementia Coical (NOT subcoical) dementia, Progressive, Associated with Apo E gene, Neurofibrillary tangles are seen and Donepezil is used in management

Psychiatry

ebe354ca-9e17-4c7c-8d77-c2443abc2949

Essential amino acids are all except:

Leucine

Lysine

Methionine

Proline

multi

10 amino acid are essential - T - Threonine V -VALINE P- Phenylalanine A- Arginine T- Tryptophan M- Methionine I -Isoleucine L -Leucine L - Lysine 2 amino acid are semi essential -Arginine and histidine can be synthesized by adults and not by growing children

Biochemistry

DNB 2018

314a1cb9-da06-4362-a1fe-4b5a61a14392

What is tuberculoma?

Granuloma present in the lungs

Tuberculous periapical granuloma

Tuberculous lesion of the lymph nodes

None of the above

multi

Tuberculosis may also involve the bone of the maxilla or mandible. One common mode of entry for the microorganisms is into an area of periapical inflammation by way of the blood stream; an anachoretic effect. It is conceivable also that these microorganisms may enter the periapical tissues by direct immigration through the pulp chamber and root canal of a tooth with an open cavity. The lesion produced is essentially a tuberculous periapical granuloma or tuberculoma. These lesions were usually painful and sometimes involve a considerable amount of bone by relatively rapid extension. Ref: Shafer's textbook of oral pathology 7th edition page 321-322

Pathology

8bcfe52e-721e-419b-b49e-3dc053045196

Clinical features of rheumatic fever are all except-

Cardiomegaly

Joint pains

ST segment elevation

Increased PR interval

multi

Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:146-147 Rheumatic Fever Acute, recurrent, inflammatory disease, mainly of children (aged 5-15 years), typically occurring 1-5 weeks after group A streptococcal infection. Pathophysiology 1. Cross reactivity of host antistreptococcal antibodies to cardiac antigens 2. Microbe initiated autoimmune reactivity. Jones Criteria for Diagnosis of Rheumatic Fever Major Criteria Carditis Pancarditis, seen in 50-60% of patients, develops within the first 2 weeks of rheumatic fever. Pericarditis is evidenced by presence of a pericardial rub, myocarditis by tachycardia, soft S1, presence of S3 and CCF and endocarditis by the presence of Carey-Coombs' murmur (mitral diastolic murmur). Ahritis (60-75%) Flitting and fleeting type of polyahritis involving large joints with no residual deformity is seen in 60-75% of patients and occurs early in rheumatic fever. Jaccod's ahritis: Ulnar detion of 4th and 5th finger with flexion at metacarpophalangeal joints is the only residual deformity seen in rheumatic polyahritis. Subcutaneous Nodules Non-tender nodules are seen over bony prominences like elbows, shin, occiput, spine in 3-5% of patients and occur 3-6 weeks after onset of rheumatic fever. Patients who have subcutaneous nodules almost always have carditis. Erythema Marginatum (< 5% and evanescent) Macular lesions with an erythematous rim and central clearing in a bathing suit distribution are seen in < 5% of patients and occur early in rheumatic fever. Chorea (Sydenham's Chorea) (2-30%) A neurological disorder with rapid, involuntary and purposeless non-repetitive movements with a self limiting course of 2-6 weeks is more common in females and is a late manifestation of rheumatic fever. Minor Criteria Clinical 1. Fever 2. Ahralgia 3. Previous history of rheumatic fever or rheumatic hea disease. Laboratory 1. Acute phase reactants (leucocytosis, raised ESR, C-reactive protein) 2. Prolonged PR interval in ECG (> 0.2 sec). WHO Criteria Jones major and pa of the minor criteria except prior history of rheumatic fever/rheumatic hea disease and C-reactive protein. Essential Criteria Evidence for recent streptococcal infection as evidenced by: 1. Increase in ASO titre a. > 333 Todd units (in children) b. > 250 Todd units (in adults). 2. Positive throat culture for streptococcal infection. 3. Recent history of scarlet fever. Two major (or) one major and two minor criteria, in the presence of essential criteria, is required to diagnose Acute Rheumatic Fever. A Positive Rheumatic Fever history is usually elicited in only 50% of patient with Rheumatic Hea Disease. Valve Involvement in Rheumatic Hea Disease Mitral valve alone 50% Aoic valve alone 15-20% Mitral and Aoic valves together 35-40% Mitral, Aoic and Tricuspid valves 2-3% Pulmonary valve is viually never involved. In RHD, mitral valve is most commonly involved followed by involvement of the aoic valve as the pressure gradient across the mitral valve is the greatest, followed by that across the aoic valve. So, the mitral valve is more susceptible to develop pathological changes than the aoic valve.

Medicine

C.V.S

95443365-5133-4755-885b-b06fbe019af5

A dense persistent nephrogram may be seen in all of the following except:

Acute ureteral obstruction

Systemic hypeension

Severe hydronephrosis

Dehydration

multi

B i.e. Systemic hypeension

Radiology

dd2a0d9a-28f5-4679-9d0b-9d9c8f4d0e29

Most common type of mesentric cyst is

Entergenous cyst

Chelolymphalic cyst

O mental cyst

Urogenital cyst

single

Chelolymphalic cyst : It is commonest type of mesentric cyst. It has congenital misplaced lymphatic tissue.

Surgery

33adc3f0-e555-474f-841d-c61beb8963ed

According to WHO, membranous glomerulonephritis seen in SLE, is -

Class II

Class III

Class IV

Class V

single

Ans. is 'd' i.e., Class V

Pathology

b6154c1e-79ee-461a-8c9e-1f7063c25db5

All the following can be used to grow human viruses except?

Continuous cell lines

Suckling mice

Embryonated egg

Enriched media

multi

The virus needs cellular components for there growth

Microbiology

Virology

3211af99-26bf-4fa3-a702-924410320c6c

When a child is not able to perform the following motor functions such as skipping, walking on heels, hopping in place or going forwards in tandem gati, his motor development is considered to be below ?

3 years

4 years

6 years

8 years

single

Ans. is 'b' i.e., 4 years o A child hops on one foot by 4 years and skips by 5 years. o As this child can not hop, the age of this child is less than 4 years.

Pediatrics

8cb58471-ef9b-485d-89cb-89b15929bab3

The alveoli are filled with exudate. The air is displaced, converting the lung into a solid organ. This description suggests-

Chronic bronchitis

Bronchial asthma

Bronchiectasis

Lobar pneumonia

single

• ‘Bacterial invasion of the lung parenchyma causes the alveoli to be filled with an inflammatory exudate, thus causing consolidation (“solidification”) of the pulmonary tissue’…..Robbins definition of pneumonia

Pathology

8898babd-1c9e-4fbf-8cc6-2ac2d9364eeb

Antoni A & Antoni B Pattern's are seen in

Schwannoma

Neurofibroma

Meningioma

Teratoma

single

Schwannoma *Distinctive histologic patterns seen within the peripheral nerve sheath tumor Schwan noma include the Antoni A and Antoni B regions oThese are the classic microscopic appearances of a schwannoma, which is benign. oNote the more cellular "Antoni A" pattern on the left with palisading nuclei surrounding pink areas (Verocay bodies). On the right is the "Antoni B" pattern with a looser stroma, fewer cells, and myxoid change. oNotice the whirly swirly pattern and how the cell nuclei are closely bunched together ... almost as if they're forming a fence (Verocay bodies). oSchwannomas are benign spindle cell tumors that occur along the edges of peripheral nerves.They can usually be removed without damaging the nerve itself.

Surgery

73a922a7-4e62-497c-8246-1fdb550e29c2

Incised wound which is not a feature ?

Length is the greatest dimention

Width is more than the thickness of the blade

Margins are inveed

Hesitation cuts are seen in suicidal attempt

single

Ans. is 'c' i.e., Margins are inveed Margins are eveed, clear, and clean cut.

Forensic Medicine

ede0c847-d6e8-47f4-9442-6912bb0e2124

Which among the following NOT a pharmacological action of opioids

Cough suppression

Anti-emesis

Miosis

Truncal rigidity

single

Pharmacology

466854b8-df37-4c54-b353-c104058b0846

Which one of the following is a malignant bone tumour?

Osteoid osteoma

Chondroma

Chondrosarcoma

Osteochondroma

single

(C) Chondrosarcoma # MALIGNANT PRIMARY BONE TUMORS include osteosarcoma, chondrosarcoma, Ewing's sarcoma, malignant fibrous histiocytoma, fibrosarcoma, and other sarcoma types. Multiple myeloma is a hematologic cancer which also frequently presents as one or more bone tumors.# CLASSIFICATION of BONE TUMOURS:> Cartilage tumors Osteochondroma: Chondromas Enchondroma Periosteal chondroma Chondroblastoma Chondromyxoid fibroma Chondrosarcoma Dedifferentiated Mesenchymal Clear cell Periosteal> Osteogenic tumors: Osteoid osteoma (B), Osteoblastoma> Fibrogenic tumors: Desmoplastic fibroma of bone, Fibrosarcoma of bone> Fibrohistiocytic tumors: Histiocytoma of bone> Ewing sarcoma/Primitive neuroectodermal tumor> Giant cell tumors: Giant cell tumor> Notochordal tumors: Chordoma> Vascular tumors: Haemangioma and related lesions, Angiosarcoma> Myogenic, lipogenic, neural and epithelial tumors: Leiomyosarcoma of bone, Lipoma of bone, Adamantinoma and osteofibrous dysplasia> Tumors of undefined neoplastic nature: Aneurysmal bone cyst Simple bone cyst; Fibrous dysplasia (B); Langerhans cell histiocytosis (LCH)

Orthopaedics

Miscellaneous

2a8fd512-a3c3-495d-abb9-414f08273de8

New born term baby born by vaginal delivers' had respiratory' distress, grunt, with scaphoid abdomen -Most probable diagnosis is -

HMD

Diphragmatic hernia

Pneumothorax

Meconium aspiration syndrome

single

Ans. is 'b' i.e., Diaphragmatic hernia o Diaphragmatic Hernia is defined as a communication between abdominal & thoracic cavities with or without abdominalContents in thorax.MC Bochdalek type.More common on left (85%)30% of CDH have associated anomalesCardiac anomalis is MC anomalis.In cardiac (Hypoplastic left heart syndrome most common).o X ray showing multiple gas locales within the lower left chest, the majority of the rest of the left lung opacified. The left hemidiaphragm can not be seen. The mediastinum and the heart are deviated to the contralateral right side.

Pediatrics

Disorders of the Respiratory Tract

06c22c8b-b4d1-47e5-941a-807cdb23bd24

Confirmatory test for syphilis is-rpt qun

FTA-ABS

VDRL

PCR

Culture and sensitivity

single

rpt qun

Microbiology

Bacteriology

4b5598b2-e166-4a6b-bd05-9debb46d2d87

The placenta secretes a hormone that is utilized in the early detection of pregnancy. This hormone is:

Endothelial growth factor (EGF)

Human chorionic gonadotropin (hCG)

Human chorionic somatotropin (HCS)

Relaxin

single

The synthesis and secretion of hCG begins about day 6 of pregnancy, presumably from the trophoblast cells. Pregnancy tests utilize the measurement of hCG for detection of the embryo. Endothelial growth factor (EGF) is synthesized by the cytotrophoblast cells in the early placenta, then is synthesized by the syncytiotrophoblast cells later (6-8 week old placenta). EGF maintains the trophoblast. Relaxin is synthesized by decidual cells at the time of paurition and acts to "soften" the cervix and pelvic ligaments. IGF act similarly to EGF by stimulating differentiation of the cytotrophoblast cells. HCS is synthesized by syncytiotrophoblast cells and will promote general growth. It is essential in the stimulation of mammary duct proliferation in development of the breast during pregnancy. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 22. Reproductive Development & Function of the Female Reproductive System. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.

Physiology

2e50b900-3b19-43e9-bfb9-351ce8907426

Ulceration of the vulva is commonly seen in all except

Bacterial vaginosis

Syphilis

Chancroid

Behcet's disease

multi

Ans. is a, i.e. Bacterial vaginosisRef: Dutta Gynae 6th/ed, p262Vulval ulcersVulval ulcers are predominantly due to sexually transmitted diseases. Rarely, it may be due to non-specific causes.Malignant ulcer is also rare. The various etiological factors related to vulval ulcers are given in the below Table.Ulcers of the VulvaSTD relatedIdiopathicTuberculosisMalignancySystemic disease related or dermatoses* Syphilis* Herpes genitalis* Chancroid* Granuloma inguinale* Lymphogran-uloma venereumBehget's diseaseAphthous ulcersLipschutz ulcersTubercularPrimay* Squamous cell carcinoma* Malignant melanoma* Basal cell carcinomaSecondary* Leukemia* Choriocarcinoma* Lupus erythematosus* Crohn's disease* Lichen planus* Lichen sclerosus* Sjogren's syndromeNote: Lipschutz ulcer: The lesion affects mainly the labia minora and introitus. In acute state, there may be constitutional upset with lymphadenopathy. The causative agent may be Epstein-Barr virus. Treatment is with antiseptic lotions and ointment.

Gynaecology & Obstetrics

Sexually Transmitted Disease in the Female

7d3a48c9-9cfe-4a48-b402-cb45913c8a2d

Thalidomide can be used in all of the followingconditions except?

Behcet syndrome

HIV associated peripheral neuropathy

HIV associated mouth ulcers

Erythema nodosum leprosum

multi

HIV associated peripheral neuropathy

Pharmacology

63f37b72-1533-4ca9-985c-1fc78ad9caaa

In children with classical galactosemia all are true except:

E. coli neonatal sepsis is common

Elimination of galactose in diet will not reverse cataract

Galactose conves to galactitol which is toxic to brain

Children with Duae variant of galactosemia are asymptomatic

multi

E. coli sepsis is common and the onset often precedes the diagnosis of galactosemia Elimination of galactose reverse growth failure, cataract, renal and hepatic dysfunction Galactokinase deficiency -> accumulation of galactose and galactitol Duae variant- a single amino acid substitution, has 50% of normal enzyme activity- asymptomatic

Pediatrics

Disorders of Carbohydrate Metabolism

1871cc41-1e63-4584-a2fe-8b62b4e136b3

When a person changes position from standing to lying down, following change is seen:

Hea rate increases

Venous return to hea increases immediately

Cerebral blood flow increases

Blood flow at apices of lung decreases

single

B i.e. Venous return to hea increases immediately In standing posture, 300- 500m1 of blood pools in venous capacitance vessels of lower extremities, which is immediately returned towards heaQ on assuming lying down posture. Cardiovascular system Onlying On standing - Stroke volume - Cardiac output - Venous return - Central blood pool Increase Decrease - Central venous pressure - Aerial BP - Abdominal & limb flow - Hea rate - Peripheral venous pooling - Total peripheral resistance Decrease Increase - Abdominal & limb resistance - Small vein pressure

Physiology

58cb2f04-f0c1-4ff8-b693-ad8734746d6b

Metrorrhagia is

Heavy menstrual bleeding

Intermenstrual bleeding

Break through bleeding

Post coital bleeding

single

The term intermenstrual bleeding is updated nomenclature for metrorrhagia.

Gynaecology & Obstetrics

4600d02f-5965-4b62-8549-0626a3952919

Effective red cell diameter

Different in males and females

Diameter of 500 microns

Thalassemia minor anemia may present with normal RBC diameter

Mixed iron and folic deficiency anemia produce microcytic

single

Answer: (C) Thalassemia minor anemia may present with normal RBC diameter (265-68-Hrshmohon 7th) (630= Rabbins- basis disease)Red blood cell distribution width (RDW or RCDW) is a measure of the variation of red blood cell (RBC) volume that is reported as part of a standard complete blood count. Usually red blood cells are a standard size of about 6-8 pm in diameter. Certain disorders, however, cause a significant variation in cell size. Higher RDW values indicate greater variation in size. Normal reference range in human red blood cells is 11.5-14.5%. If anemia is observed, RDW test results are often used together with mean corpuscular volume (MCV) results to determine the possible causes of the anemia. It is mainly used to differentiate an anemia of mixed causes from an anemia of a single cause. Deficiencies of Vitamin Bl2 orfolate produce a macrocytic anemia (large cell anemia) in which the RDW is elevated in roughly two- thirds of all cases; however, a varied size distribution of red blood cells is a hallmark of iron deficiency anemia, and as such shows an increased RDW in virtually all cases. In the case of a mixed iron and B!2 deficiency, there will normally be a mix of both large cells and small cells, causing the RDW to be elevated. An elevated RDW (red blood cells of unequal sizes) is known as anisocytosis. An elevation in the RDW is not characteristic of all anemias; anemia of chronic disease,hereditary spherocytosis, acute blood loss, aplastic anemia (anemia resulting from an inability of the bone marrow to produce red blood cells), and certain hereditary hemoglobinopathies (including some cases of thalassemia minor) all may present with a normal RDW* The human erythrocyte is a biconcave disc, 7-2 pm in diameter, and has a thickness of 2-4 pm at the periphery and 1 mm in the centre* More than 90% of the weight of erythrocytes consists of haemoglobin. The life span of red cell is 120 +- 30 day.* Range of normal red cell count in health in 5.5 +- 1.0 x1012/L in men and 4.8 +- l.0x 1012/l in women* Packed cell volume (PCV) or haematocrit- 0.47 + 0.07L/L (40-54%) in men- 0.42 +- 0.05 L/L (37-47%) in women* Reticulocyte count (%)0.5-l .5* Red cell distribution width-11.5-14.51. Mean corpuscular volume (MCV) =PCV in L/LRBC Count/L Normal value is 85 +- 8fl (77-93 fl)2. Mean corpuscular haemoglobin (MCH) =Hb/LRBC Count/L Normal range is 29.5 +2.5pg (27-32 Pg)3. Mean corpuscular haemoglobin concentration (MCHC) =Hb /dlPCV in L/LNormal value is 32.5 +2.5 g/dl (30-35 g/dl)* The size of the RBC is measured by MCV. MCHC is independent of red cell count and size *** Monocyte is the largest mature leucocyte in peripheral blood* Flow cytometry is done on - Lymphocytes* The anticoagulant used in Wintrobe ESR- Double oxalate1. Alkaline phosphatase is specific to Neutrophils cells2. Acid phasphatase is found in all hematopoitic cells but the highest levels are found in macrophages and osteoclasts (Monocytes)* Anticoagalant of choice for coagulation test is 3.2% sodium citrate *** Potassium oxalate + sodium fluoride is anticoagulant used in collection of blood sugar.Increases Leucocyte Alkaline phosphateDecreased Leucocyte Alkaline phosphate* Infections* Leukamoid reactions* Polycythemia- vera* Paroxysmal nocturnal hemoglobinuria (PNH)* CMLBlood group A is associated with1. Carcinoma stomach, cervix salivary gland pancreas2. Pernicious anemia3. Thrombosis in OCP users

Pathology

Blood

0373c995-1375-4b64-b4fc-757f2ee9055c

The most impoant indication for surgical repair of a Bicornuate Uterus is -

Infeility

Dysmenorrhoea

Menorrhagia

Recurrent aboions

single

The most impoant indication for surgical repair of a Bicornuate Uterus is Recurrent aboions Recurrent aboions occur due to - Decreased space for embryo to grow and Relatively less blood supply

Gynaecology & Obstetrics

Aboions, Spontaneous & Induced Emergency Contraception (Hey,whats the hurry !)

e8a22fc1-13a5-4097-a643-4c67ec2b090b

Uses of α2 agonists are all EXCEPT:

To produce sedation

Glaucoma

Benign hyperplasia of prostate

Hypertension

multi

Pharmacology

f52691c3-72ef-4683-808b-fb8ce8418f83

Treatment of solitary rectal ulcer are A/E:a) Laxativesb) Rectopexyc) Bandingd) Sclerosant injectione) Enema

cd

bc

bd

ac

single

Surgery

4a2d3570-642b-4afb-812a-761a67380ef9

Craniotabes is seen in following except –

Rickets

Syphilis

Osteogenesis imperfecta

Thalassemia

multi

Pediatrics

686cd2ab-481a-4ae2-9939-5de79056ae75

Maternal moality rate is -

Maternal deaths / 100000 live bihs

Maternal death /100 live bihs

Maternal death /1000 bihs

Maternal death /1000 live bihs

single

Park&;s textbook of preventive and social medicine 23rd edition. * Maternal moality rate is the no of maternal deaths in a given period per 100,000 women of reproductive age during the same time period.

Social & Preventive Medicine

obstetrics,pediatrics and geriatrics

7010f58c-0284-4199-bf04-72b8821ca5a2

Colour of crystals in positive Florence test is -

Yellow

White

Purple

Dark Brown

single

Ref:The essential of forensic medicine and toxicology Dr.K.S NARAYAN REDDY 32nd edition pg no 415 the stain is estracted by 10% HCL and a drop is placed on a glass slide and allow to dry a cover slip is place dover this , and a drop of florence solution(KI,iodide and water) this allowed to run under the cover slip .if the semen is present, dark brown crystals of choline iodide appeared immediately , they are rhombic or needle shaped crystals resembling haemin but are larger, arranged in clusters,rossettes, crosses etc... Choline orginate from the seminal vessicles,the test is not a proof of seminal fluid but only of presence of some vegetables or animal substances . a negative reaction is proof that the stain is not seminal

Forensic Medicine

Special topics

039f5c62-0aad-41af-af51-6f98b51cd97e

Factor Xa is necessary for conversion of prothrombin to thrombin

Only in the extrinsic pathway

Only in the intrinsic pathway

As part of both extrinsic and intrinsic pathways

Only if the normal blood clotting cascade is inhibited

multi

Ans. (c) As part of both extrinsic and intrinsic pathways(Ref: Robbins 9th/pg 118-119; 8th/pg 119)Activated factor IX along with factor VIIIa (Intrinsic pathway) & factor VIIa (extrinsic pathway), converge to activate Factor X to Xa is necessary for conversion of prothrombin to thrombin (common pathway)

Pathology

Bleeding Disorders

abec181b-7779-41cf-87de-124ae93f5e69

True about Rotameter –

Rotameter reading may not get affected by dirt inside the tube

Rotameter reading may not get affected by static electricity

The height to which bobbin rises indicates the flow rate

A rotameter is a variable pressure flowmeter

multi

As the gas flows through the rotameter, bobbin rises and the upper end of bobbin determines the flow rate. Rotameter works on variable area (variable orifice) and constant pressure principle (not variable pressure). Causes of inaccurate reading in rotameter are :- Static electricity, Dirt inside the tube, Non-vertical tube, back pressure by ventilator, Defect in top sealing washer.

Anaesthesia

7c5f7238-1b8d-4c64-a1cc-1ed6965d42f0

Neurocysticercosis is treated by all the following drugs, EXCEPT -

Albendazole

Niclosamide

Flubendazole

Praziquantel

multi

Medicine

78647e01-58cb-4288-98b9-1044314042fb

What is an ideal method to prevent aspiration pneumonia?

Cuffed endotracheal tube

Inhalational anaesthesia

Increased intra abdominal pressure

Full stomach

single

Ans: A (Cuffed endotracheal tube) Ref: Bailey, 24th ed, p. 46; Ajay Yadav, p. 101A cuffed endotracheal tube is used to:1. Facilitate artificial airway ventilation or surgery around face or airway.2. Protection of lung if there is a risk of pulmonary aspiration.Predisposing factors for aspiration:1. Full stomach-- single, most important factor.2. | Level of consciousness.3. Conditions which reduce the tone of LES:Pregnancy (acid aspiration in late pregnancy- Mendelson syndrome)Abdominal tumorsObesity, hiatus herniaPresence of nasogastric tubeDrugs-Atropine, glycopyrrolate, opioids, thiopentone.4. Conditions delaying gastric emptyingDiabetes, hypothyroidism, pain, anxiety, anticholinergics, opium.Management:Prevention:Management - full stomach patients:1. Empty stomach2. H2blockers- to reduce acid production.3. Metoclopramide4. Neutralisation of gastric contents by antacids1. Regional anesthesia is preferred2. Awake intubation3. Rapid sequence intubation- Sellick maneuver

Unknown

9d401433-8335-487e-8723-fcfc3b43c520

A mutation that results in a value replacement for glutamic acid at position 6 of the B chain of hemoglobin 5 hinders normal hemoglobin function and results in sickle-cell anemia when the patient is homozygous for this mutation. This is an example of which of the following types of mutation?

Deletion

Frameshift

Inseion

Missense

single

Missense mutations are those in which a single base change (point mutation) results in a codon that encodes for a different amino acid residue. The effects of these types of mutations can range from very minor or even undetectable to major, depending on the impoance of the altered residue to protein folding and function. Nonsense mutations are also point mutations in which the affected codon is altered to a stop (nonsense) codon, resulting hi a truncated protein. Frame shift mutations are due to one or two base "pair inseions or deletions such that the reading frame is altered. These mutations generally lead to truncated proteins as well, since in most protein coding regions the unused reading frames contain numerous stop codons.

Biochemistry

1c6b51f6-061b-4337-be54-7a3afdb0121a

Which of the following vessel does not cross the midline of the body:

Left gonadal vein

Left renal vein

Left brachiocephalic vein

Hemiazygous vein

single

The left gonadal vein drains into the left renal vein which crosses the midline to join inferior vena cava. All the other options (Left renal vein, left brachiocephalic vein and hemiazygous vein) cross the midline.Ref: Human Anatomy, B D Chaurasia, 4th Edition, Volume 2, Chapter 24, Page 297, 307, 316; Clinical Anatomy by Systems, Richard S. Snell, 2007 Edition, Page 166, 167, 840.

Anatomy

88f65fcf-7f12-4cd9-a59d-7e1933832055

Daily maintenance fluid for a child weighing 24 kg is:

1000 mL/day

800 mL/day

1540 mL/day

1580 mL/day

single

Fluid requirement in a child in this child weighing 24 kg is:1540 mL. For first 10 kg: 100ml/kg For next 10 kg : 50ml/kg For each kg. above 20 : 20 ml/kg (1-10 kg) 100 x 10 = 1000 mL (11-20 kg) 50 x 10 = 500 mL; For next 4 kg (21-24 kg) 20 x 4= 80 mL

Pediatrics

Fluid, Electrolyte

21ccfd25-2de4-4c76-a545-4e8e20990135

OCP protects against all EXCEPT: September2012

Hepatic adenoma

Fibroadenoma breast

Carcinoma ovary

Uterine malignancy

multi

Ans. A i.e. Hepatic adenoma OCP's administration may result in hepatic adenoma. Oral contraceptive pills Protects against: - Uterine Ca, - Ovarian Ca, - RA, - Endometriosis etc.

Gynaecology & Obstetrics

9d9ab080-4904-4d16-8c55-91d9f246d59e

In a chronic alcoholic, all the following may be seen in the liver except -

Fatty degeneration

Chronic hepatitis

Granuloma formation

Cholestatic hepatitis

multi

Alcoholic liver disease There are three distinct forms of liver disease - 1. Hepatic steatosis (fatty liver) 2. Alcoholic hepatitis (a) Acute alcoholic hepatitis      Focal necrosis      Cholestasis      Mallory hyaline bodies (b) Chronic hepatitis 3. Alcoholic cirrhosis

Pathology

d72f1d0f-b091-48f0-8986-c1920d587db4

Ring sideroblasts, with iron laden occurs in

Endoplasmic reticulum

Nucleus

Mitochondria

Nuclear membrane

single

i.e. (Mitochondria) : (301-Harsh Mohan 6th ) (625-Robbins & Cotran-Pathologic basis of disease 8th)Ringed sideroblasts is characteristic of sideroblastic anemia /Myelodysplastic SyndromeRinged sideroblast in which haem synthesis is disturbed as occurs in sideroblastic anaemiasRinged sideroblasts containing numerous large granules, often forming a complete or partial ring around the nucleus. These ringed arrangement of these granules is due to presence of iron laden mitochondria around the nucleus

Pathology

Blood

20bea810-4e48-472f-9763-77c1bc4abfc6

Signal from Baroreceptors goes to -

Caudal ventrolateral medulla

Rostral dorsolateral medulla

Nucleus of tractus solitarius

None of the above

multi

Ans. is C Nucleus of tractus solitarius o Baroreceptors are mechanoreceptors that are located in the adventia of carotid artery and aorta, at specialized locations called sinuses. Carotid sinus is a little bulge at the root of internal carotid artery, located just above the bifurcation of the common carotid artery. It is innerv ated by the sinus nerve, a branch of glossopharyngeal (IX cranial) nerve. Aortic arch (aortic sinus) also contains mechenoreceptors (stretch receptors) which are similar to carotid sinus receptors. However, their afferent nerve fibers travel in the aortic nerve, a branch of Vagus (X cranial) nerve. o The sinus nerve (from carotid sinus) and aortic nerve/vagal fibers (from aortic sinus) are together called 'Sino- aortic nerves'. They, together, are also refered to as 'Buffer nerves' because they are the afferents of cardiovascular reflexes that buffer abrupt changes in blood pressure. o Baroreceptors are highly sensitive to any change in mean blood pressure. Sinoaortic nerves (buffer nerves) normally discharge rhythmically, synchronous with the pressure fluctuation during systole and diastole. They respond to BP changes between 70 mm Hg and 150 mm Hg. When BP rises, baroreceptors are stimulated and their afferents (through sinoaortic nerves) stimulate nucleus of tractus solitarus (NTS) which inturn inhibits the pressor area of VMC, i.e., Rostral ventrolateral medula (RVLM). This results in decreased sympathetic outflow and therefore decreases in vasomotor tone and vasodilation. Vasodilation brings down the BP. Thereby helping hemostasis. Activated NTS also stimulates nucleus ambiguous (cardioinhibitory center) of medulla, which increases parasympathetic (vagal) output, through vagus, that decreases heart rate. Reduction in heart rate reduces the cardiac output, which also reduces BP. Baroreceptor stimulation also weekly inhibits respiration, o When BP falls, for instance while changing the posture from lying down to standing, reverse change takes place. When a person stands up, his blood is pooled in the veins of lowrer limbs by the effect of gravity. Central venous pressure and venous return decrease, which causes a fall in stroke volume. Hence the systolic BP falls. As a result, the discharge rate of baroreceptors decreases leading to a decrease in the inhibitory' influence on the pressor area of VMC. Hence vasomotor tone increases, leading to vasoconstriction, and consequently an increase in BP. Simultaneously, the nucleus ambiguous of the vagus is also inhibited, increasing the heart rate and consequently stroke volume and eventually BP. Thus fall in BP due to change of posture is very brief (Transient).

Unknown

6a25c0d5-4d53-429a-ac5c-0bf0145cba6d

Intrinsic factor of castle is secreted by which of the following cells in gastric glands

Chief cells

Parietal cells

Enterochromaffin cells

B cells

single

The stomach also adds a significant volume of digestive juices to the meal. Like salivary secretion, the stomach actually readies itself to receive the meal before it is actually taken in, during the so-called cephalic phase that can be influenced by food preferences. The gastric secretions arise from glands in the wall of the stomach that drain into its lumen, and also from the surface cells that secrete primarily mucus and bicarbonate to protect the stomach from digesting itself, as well as substances known as trefoil peptides that stabilize the mucus-bicarbonate layer. The glandular secretions of the stomach differ in different regions of the organ. The most characteristic secretions derive from the glands in the fundus or body of the stomach. These contain two distinctive cell types from which the gastric secretions arise: the parietal cells, which secrete hydrochloric acid and intrinsic factor; and the chief cells, which produce pepsinogens and gastric lipase. The acid secreted by parietal cells serves to sterilize the meal and also to begin the hydrolysis of dietary macromolecules. Intrinsic factor is impoant for the later absorption ofvitamin B12 or cobalamin. Pepsinogen is the precursor of pepsin, which initiates protein digestion. Lipase similarly begins the digestion of dietary fats.REF: GANONG&;S REVIEW OF MEDICAL PHYSIOLOGY, KIM BARRETT, HEDDWEN BROOKS, SCOTT BOITANO, SUSAN BARMANTWENTY THIRD EDITIONPAGE NO:432

Physiology

G.I.T

424f3042-0451-4000-b7b0-98263483b83b

Which is not echogenic while doing ultrasonography-

Bile

Gas

Bone

Gall stones

multi

Bile and urine are least echogenic. Bone, gas, and organ boundaries are most echogenic.

Radiology

90c70586-ea3f-41f4-8ac1-708dc4adf6a8

Features of mycotic aneurysm are all except

Bacterial endocarditis is common etiology

Commonly it is fusiform aneurysm

Aorta and visceral vessels affected commonly

Multilobed aneurysm with narrow neck

multi

Mycotic aneursm is commonly saccular.

Surgery

69eaa494-e859-4153-8835-b552dddc2d21

Microvesicular fatty liver is caused by -

DM

Valproate

Starvation

IBD

single

Ans. is 'b' i.e., Valproate Steatosiso Accumulation of triglyceride fat droplets within the heaptocytes is known as steatosis or fatty liver. It may be of two types -1. Microvesicular steatosis - Multiple tiny droplets accumulate that do not displace the nucleus.2. Macrovasicular steatosis - A single large droplet accumulates that displaces the nucleus.Causes of steatosisMicrovesicularMacrovesicularo Reye's syndromeo Acute fatty liver of pregnancyo Jamaican vomiting sicknesso Drugs - valproic acid, tetracycline, nucleoside analogueo Wolman's diseaseo Lysosomal acid lipase deficiencyo Congenital defects of urea cycle enzymeso Early stage of alcoholic cirrhosiso Chronic viral hepatitiso Alcoholic liver diseaseo DM - insulin resistanceo Lipodystrophyo PEM, starvationo Dysbetalipoproteinemiao TPN, Jejunoileal bypasso Inflammatory bowel diseaseo Syndrome x (obesity, DM, hypertriglyceridemia)o Drugs - CCBs, synthetic estrogens, nucleoside analogues

Pathology

Liver

4319f41c-953a-4903-82a9-96c4b32c6849

Child protection scheme is under which ministry -

Ministry of health and family welfare

Ministry' of Social welfare

Ministry' of women and child development

Ministry of education

single

Ans. is 'c' i.e., Ministry of women and child developmento In 2006 the Ministry' of Women and Child Development (MWCD) proposed adoption of Integrated Child Protection Scheme (ICPS).o In 2009 the central government take the scheme its approval and has begun the extensive task of providing children with a protective and safe environment to develop and florish.o The purpose of the scheme is to provide for children in difficult circumstances, as well as to reduce the risks and vulnerabilities children have in various situations and actions that lead to abuse, neglect, exploitation, abandonment and separation of children.

Social & Preventive Medicine

Health Programmes in India

7084cbc3-05da-4499-bfb4-df024e39ebe5

Indication for surgery in a case of adrenal incidentaloma

Size>5 cm

Bilateral adrenal metastasis

Functional tumor

All of the above

multi

Ref: Bailey&;s 26thE pg: 780. Treatment of Incidentaloma: Any non-functioning adrenal tumour greater than 4 cm in diameter and smaller tumours that increase in size over time should undergo surgical resection. Non-functioning tumours smaller than 4 cm should be followed-up after 6, 12 and 24 months by MRI and hormonal evaluation.

Surgery

Endocrinology and breast

06d06437-d265-4554-ab42-19b43d7aa768

In case control study of buccal carcinoma-

CA is commoner in zarda pan users than non users

Zarda pan is a cause of buccal CA

Zarda pan is associated with buccal CA

If use of zarda pan is stopped, number of cases will reduce

single

Case control studies often retrospective studies are a common first approach to test causal hypothesis. In recent years case control study has emerged as a permanent method of epidemiological investigation. Both exposure and outcome has occurred before the study. Study proceeds backwards from effect to cause. It uses a control or comparison group to suppo or refute an inference (refer pgno:71 park 23 rd edition)

Social & Preventive Medicine

Epidemiology

55ba5eb4-7157-40c5-988f-26f06ff082f9

Nephrotic syndrome is characterised by

Proteinuria

Hyperlipidemia

Oedema

All

multi

Ans. is 'a' i.e., Proteinuria; 'b' i.e., Hyperlpidemia; 'c' i.e., Oedema Pathophvsiologv of nephrotic syndrome Proteinuria o The most impoant feature of nephrotic syndrome is massive proteinuria (>3.5 gm/day) o Proteinuria results from altered permeability of glomerular filtration barrier for protein. o The largest propoion of protein lost in the urine is albumin but globulins are also excreted in some diseases. The ratio of low to high molecular weight proteins in urine in various cases of syndrome is a manifestation of the selectivity of proteinuria. A highly selective proteinuria consists mostly of low molecular weight proteins, i.e. albumin & transferrin, where as apoorly selective proteinuria consists of higher molecular weight globulin in addition to albumin. Edema o Proteinuria leads to hypoalbuminemia that results in decreased colloid osmotic pressure edema. Hyperlipidemia o Increased synthesis of lipoproteins by liver. o Decreased catabolism of lipids. o There is increased cholesterol, triglycerides VLDL, and LDL. Lipiduria o Hyperlipidemia results in lipiduria due to excessive leakiness of glomerular filtration barrier.

Pathology

821f6586-f2f3-4fee-9c2f-eb7e53aa5a03

All the following are the risk factors for cervical cancer except

Young age at first intercourse

Multiple sexual paners

Low parity

Low socioeconomic status

multi

There are numerous risk factors for cervical cancer: Young age at first intercourse (younger than 16 years), Multiple sexual paners, Cigarette smoking, race, High parity, Low socioeconomic status, and Chronic immune suppression. Reference: Novak's gynaecology; 14th edition; Chapter 35; Uterine cancer

Gynaecology & Obstetrics

Gynaecological oncology

addd9f5a-ff2d-4161-a9f7-8409749ff195

Characteristic feature of korsakoff psychosis is

Disorientation

Delirium

Coarse tremor

Amnesia

single

Medicine

e64863b6-ded9-4aa5-b987-b06de7b394d3

Person preoccupied by worries about ill health is :

Hypochondriac

Maniac

Depressed

Delirium

single

A i.e. Hypochondriasis

Psychiatry

07e8f3a1-63b5-4eae-a132-0286b9ef48d3

Terminal branches of facial nerve are all, EXCEPT:

Mandibular nerve

Marginal branch

Temporal

Cervical

multi

The facial nerve crosses lateral to the styloid process and penetrates the parotid gland. In the parotid gland, the nerve divides at the pes anserinus into 2 major divisions; ie, the superiorly directed temporal-facial and the inferiorly directed cervicofacial branches. After the main point of division, 5 major branches of the facial nerve exist, as follows:Temporal (ie, frontal)ZygomaticBuccalMarginalCervical

Anatomy

d53153f0-8be3-4794-9307-aafc24da8c85

Which of the following is orexigenic?

Serotonin

Ghrelin

OCX

GA

single

Ghrelin: Anorexigenic and somatotrophic signal from the stomach Akio Inui1 About the author top of page Abstract Ghrelin, an endogenous ligand for the growth hormone secretagogue receptor, is synthesized principally in the stomach and is released in response to fasting. Ghrelin is structurally related to motilin and, together, they represent a novel family of gut-brain regulatory peptides. In addition to having a powerful effect on the secretion of growth hormone, ghrelin stimulates energy production and signals directly to the hypothalamic regulatory nuclei that control energy homeostasis. The study of ghrelin has extended our understanding of how growth is controlled and has shown that the stomach is an impoant component of this system.

Physiology

General physiology

455bf6be-62c3-4ec0-ba1e-eafa0b49459b

Metformin is NOT effective in lowering of blood sugar level in which of the following patients?

Non diabetics

Obese diabetics

Type 2 diabetics

Diabetics not responding to sulfonylureas

single

(Ref:KDT 6/e p269) Metformin is the drug of choice for the treatment of obese diabetic patients, as it causes weight loss. It does not cause release of insulin, therefore less chances of hypoglycemia.

Anatomy

Other topics and Adverse effects

9f553c15-928f-41f8-8e94-021521702b9b

You are conducting a survey in your village and the person you are interviewing is a 32 year old post graduate working as a clerk. His total family income is 20,000 Rs per month. According to Kuppuswamy's socio economic status scale, he belongs to:

Upper socioeconomic class

Upper socioeconomic class

Lower middle socioeconomic class

Upper lower socioeconomic class

single

Kuppuswamy's socio economic status scale takes into account education, occupation and monthly family income. Since he is a post graduate he gets 6 points for education. His job as a clerk gives him 5 points and a monthly family income of 20000 Rs gives him 12 points which gives him a total of 23 points and so he belongs to upper middle socioeconomic class. Socio economic status Total score Upper socio economic status 26 - 29 Upper middle socioeconomic status 16 - 25 Lower middle socioeconomic status 11 - 15 Upper lower socioeconomic status 5 - 10 Lower socioeconomic status <5 Ref: Park, Edition 21, Page 639

Social & Preventive Medicine

3bad04f5-219b-4bb5-ae68-388ffbc6415f

True regarding the development of ear:

Eustachian tube opens at the level of interior turbinate

Pinna develops from the cleft of Ist arch

Growth of the inner- ear completed by 4th month

All

multi

A i.e. Eustachian tube opens at the level of inferior turbinate; B i.e. Pinna develops from the cleft of arch; C i.e. Growth of inner ear completed by 4th monthEustachian tube connects tympanic cavity with nasopharynx. It is about 36cm long in adults and runs downwards, forwards & medially at an angle of 45deg with horizontal from bony tympanic end to slit like pharyngeal end. Tympanic end is in the anterior wall of middle ear, just above the level of floor. While nasopharyngeal end is situated in the lateral wall about 1 -1.25 cm behind the posterior end of inferiro turbinateQ

Anatomy

6c222a4a-e7b4-49f9-a9ee-e09f8545f7df

Gastric irritation is least with following NSA1D: (PGI June 2008)

Diclofenac

Acetaminophen

Ibuprofen

Naproxen

single

Ans. B (Acetaminophen) "Gastric mucosal damageQ: Gastric pain, mucosal erosion/ ulceration and blood loss are produced by all MSAIDs to varying extents: relative gastric toxicity is a major consideration in the choice of MSAIDs. Paracetamol", a very weak inhibitor of COX is practically free of gastric toxicity and selective (misoprosto) administered concurrently with NSAIDsanatgonise their gastric toxicity"- KDT 6th/186Aspirin is acetylsalicylic acid KDT 6th/187

Pharmacology

Prostaglandins

bbfbb8af-7798-4233-8908-54a4b8611430

The concetration of potassium in microgram in ORS is-

30 meq

20 meq

90 meq

60 meq

single

Ans. is 'b' i.e., 20 meq

Pediatrics

64f80edc-9494-4b09-b361-0d50d21ff9cb

Abnormal mousy/mushy odour of urine is associated with

Phenylketonuria

Tyrosinemia

Maple syrup urine disease

Hawkinsuria

single

Ans. a (Phenylketonuria) (Ref. Harrison's Internal Medicine 17th/Ch. 358)Inborn errors of amino acid metabolism associated with abnormal odourInborn error of metabolismUrine odorGlutaric acidemia (type II)Sweaty feet, acridHawkinsinuriaSwimming poolIsovaleric acidemiaSweaty feet, acridMaple syrup urine diseaseMaple syrup/Burnt sugarHypermethioninemiaBoiled cabbageMultiple carboxylase deficiencyTomcat urineOasthouse urine diseaseHops-likePhenylketonuriaMousy or mustyTrimethylaminuriaRotting fishTyrosinemiaBoiled cabbage, rancid butterTHE HYPERPHENYLALANINEMIAS# result from impaired conversion of phenylalanine to tyrosine.# The most common and clinically important is phenylketonuria (frequency 1:10,000), which is an autosomal recessive disorder characterized by an | concentration of phenylalanine and its by-products in body fluids and by severe mental retardation if untreated in infancy.# It results from | activity of phenylalanine hydroxylase (phenylketonuria type I).# The accumulation of phenylalanine inhibits the transport of other amino acids required for protein or neurotransmitter synthesis, reduces synthesis and increases degradation of myelin, and leads to inadequate formation of norepinephrine and serotonin.# Phenylalanine is a competitive inhibitor of tyrosinase, a key enzyme in the pathway of melanin synthesis, and ac- counts for the hypopigmentation of hair and skin.# Untreated children with classic phenylketonuria are normal at birth but fail to attain early developmental milestones, develop microcephaly, and demonstrate progressive impairment of cerebral function.# Hyperactivity, seizures, and severe mental retardation are major clinical problems later in life.# EEG abnormalities; "mousy" odor of skin, hair, and urine (due to phenylacetate accumulation); and a tendency to hypopigmentation and eczema are devastating clinical picture.# In contrast, affected children who are detected and treated at birth show none of these abnormalities.Treatment# To prevent mental retardation, diagnosis and initiation of dietary treatment of classic phenylketonuria must occur before the child is 3 weeks of age.# Dietary phenylalanine restriction is usually instituted if blood phenylalanine levels are >250 pmol/L (4 mg/dL).# Treatment consists of a special diet low in phenylalanine and supplemented with tyrosine, since tyrosine becomes an essential amino acid in phenylalanine hydroxylase deficiency.# With therapy, plasma phenylalanine cone should be maintained between 120 and 360 pmol/L (2 and 6 mg/dL).# Dietary restriction should be continued and monitored indefinitely..# Pregnancy risks can be minimized by continuing lifelong phenylalanine-restricted diets and assuring strict phenylalanine restriction 2 months prior to conception and throughout gestation.ConditionEnzyme DefectClinical FindingsInheritance1. Phenylketonuria type IPhenylalanine hydroxylaseMental retardation, microcephaly, hypopig- mented skin and hairs, eczema, "mousy" odorAR2. Phenylketonuria type IIDihydropteridine reductaseMental retardation, hypotonia, spasticity, myoclonusAR3. Phenylketonuria type III6-Pyruvoyl- tetrahydropterin synthaseDystonia, neurologic deterioration, seizures, mental retardationAR4. GTP cyclohydrolase I deficiencyGTP cyclohydrolase IMental retardation, seizures, dystonia, temperature instabilityAR5. Carbinolamine dehydratase deficiencyPterin-4-carbinolamine dehydrataseTransient hyperphenylalaninemia (benign)AR

Pediatrics

Inborn Errors of Metabolism

38ccb378-9091-4565-a595-bfd77b13ea9a

Clinical features of infectious mononucleosis

Glandular involvement

Febrile

Palatine petechiae

All of the above

multi

Pathology

cae8e457-d314-4013-b5a3-15fc16015f33

Small cuff size will lead to?

Falsely increased BP

Falsely low BP

No effect on BP

Fluctuating BP

multi

a. Falsely increased BP(Ref: Nelson's 20/e p 2164)In older children, a mercury sphygmomanometer with a cuff that covers approximately two-thirds of the upper part of the arm or leg may be used for blood pressure measurement. A cuff that is too small results in falsely high readings, whereas a cuff that is too large records slightly decreased pressure.

Pediatrics

Miscellaneous

8ea4240e-bfb6-448a-9a91-288b8198fd93

Ulcer with undermined edges is seen in

Malignant ulcer

Tubercular ulcer

Venous ulcer

Diabetic ulcer

single

Tubercular ulcers typically have undermined edges. Reference: Bailey & Love&;s Sho Practices of Surgery 27th Edition, Page no. 78

Surgery

General surgery

f52cfc68-7b88-4f84-9a79-117dbce9da60

Which of the following is NOT associated with elevation of prostatic specific antigen?

Acute prostatitis

BPH

Prostatic intraepithelial neoplasm

Prostatic needle biopsy

single

Prostatic Intraepithelial Neoplasia ( PIN) is a precancerous condition; not detected by rectal examination, TRUS , or MRI; does not cause rise in PSA level . It is usually identified after TURP for BPH with final histology or by prostatic biopsy.Reference: page1048 SRB&;s manual of surgery 5th edition

Surgery

Urology

fa1276ec-3538-4c56-a23c-85732a5eb5b1

Muscle relaxant used in renal failure :

Ketamine

Atracurium

Pancuronium

Fentanyl

single

B i.e. Atracurium

Anaesthesia

17073b03-4f15-462e-86f2-79428819b591

Redistribution phenomenon is seen in:

Halothane

Ether

Thiopentone

All

multi

Pharmacology

b634a7e2-4f0b-4d25-ba86-3da9ccf4726a

A 20 years female has hepatosplenomegaly, fever, pallor and generalized lymphadenopathy. Lab test useful for diagnosis is/are -a) ESRb) Electrophoresisc) Parasite detection in aspirated) ELISAe) Routine haemogram

acd

ace

cde

ade

multi

Microbiology

3a963c53-2aa9-4e2c-96e4-4570516f18fb

Gastrinoma a/w

Diarrhoea

Constipation

Achlorhydria

Multiple superficial gastric ulcers

single

Diarrhoea is due to hypergastrinaemia.It is associated with severe ulcers,not superficial SRB's manual of surgery,5th edition,710.

Surgery

G.I.T

d9fd0e3c-af5e-4108-abd5-6e5c40f71bab

CAGE questionnaire is used in:AP 07; MP 09; NEET 13

Alcohol dependence

Opiate poisoning

Dhatura poisoning

Barbiturate poisoning

single

Ans. Alcohol dependence

Forensic Medicine

966accb6-3050-4ff9-9e8f-9b9d46f44bea

Which of the following is used in exocytosis?

Ca

Mg

Na

K

single

Ans. (a) CaExocytosis is a calcium dependent process where in the cellular contents are moved out of the cell in the form of vesicles (Cell Vomiting)

Physiology

General

4d208459-fcab-41dc-a5b7-d984359ac2b9

Therapeutic blood range of theophylline in microgram per L is:

0-5

10-May

15-May

20-May

single

Theophylline is having a narrow margin of safety so therapeutic drug monitoring is essential If levels increase more than 20mg/L- side effects occurs ESSENTIAL OF MEDICAL PHARMACOLOGY SEVENTH EDITION KD TRIPATHI PGNO.226

Pharmacology

Respiratory system

00f2c259-7b5b-407e-81f1-172da8846455

Lift off test is used for which of the following muscles?

Supraspinatus

Subscapularis

Infraspinatus

Biceps Breachii

single

Ans. is 'b' i.e., Subscapularis TestMuscle TestedLift off testSubscapularisJobe testSupraspinatusSpeed testBicepsYergason testBicepsBelly press testSubscapularis

Orthopaedics

Injuries Around Shoulder

26b146ff-0f13-4e9d-b4fe-d3aac7fd1f7d

Which of the following is not a structural element of TMJ?

Sigmoid notch

Articular disc

Capsular ligament

Joint cavities

single

Sigmoid notch (or) mandibular notch forms the sharp upper border of the ramus the condyle and coronoid process.

Dental

10ff3d1e-3020-4a37-956e-a1bc43b06fc8

Prognostic stage groups in carcinoma breast include all except

Tumour size

Grade

HER-2 status

Age

multi

Prognostic stage groups include TNM plus grading, and status of biomarkers HER-2, ER, and PR Ref: AJCC 8th edition

Surgery

Endocrinology and breast

e11268cf-9f08-491b-8937-3875cbd26f46

Arrange the following subtypes of schizophrenia, in order of prognosis, with the best prognosis first and the worst prognosis last, 1. Paranoid schizophrenia2. Catatonic schizophrenia3. Simple schizophrenia4. Disorganised schizophrenia

4-2-1-3

2-1-3-4

2-1-4-3

1-2-4-3

single

The correct sequence is Catatonic schizophrenia followed by Paranoid schizophrenia followed by Disorganised schizophrenia followed by Simple Schizophrenia Please remember in both DSM-5 and ICD-11, these subtypes have been removed

Psychiatry

Schizophrenia Spectrum and Other Psychotic Disorders

92659a1c-5537-4957-ba76-a9c6551a8730

Mammalian Mitochondria are involved in all of the following Except

Fatty acid synthesis

DNA synthesis

Fatty acid oxidation (b-oxidation)

Protein synthesis

multi

Protein synthesis is a cytoplasmic process.Fatty acid synthesis stas with the production of Acetyl Co-A within the mitochondria. b-oxidation of fatty acid oxidation also occurs in mitochondria. Mitochondrial DNA synthesis occurs within the mitochondria.

Microbiology

All India exam

46385fe7-8048-4d88-86e2-fea7ab1cef01

Cross examination of the prosecution witness is done by-

Public prosecutor

Defence counsel

Judge

None

multi

In government prosecutions, cross examination is done by defense lawyer.

Forensic Medicine

802fc468-07e6-4fe2-af8b-5843c890a6b2

Pseudo pocket is seen in the

Base of the pocket lies on cementum

Gingivitis

Periodontitis

Base of the pocket and lies on alveolar bone

single

Dental

da060f81-4590-4c94-a8e7-76d29351bb61

Thickness of oxygen inhibition layer in composite curing is:

1-50 micrometer

15-150 micrometer

50-500 micrometer

1000-2000 micrometer

single

When composite is light cured, oxygen in the air causes an interference in the polymerization resulting in the formation of an oxygen inhibition layer on the surface of the composite.The oxygen-inhibited layer is the sticky, resin-rich uncured layer that is left on the surface.Thickness is about 50-500 micrometer. Reference- Sturdevant 6th ed P:237

Dental

61b825a9-0c74-4550-925c-ccd161969c2a

Hassall&;s corpuscles are present in

Thymus

Lymphnode

Spleen

Liver

multi

Inderbir Singh's Human Histology Sixth edition Pg 140 The medulla of thymus contains pink staining rounded masses called the corpuscles of Hassal

Anatomy

General anatomy

84911b71-e906-4984-8346-6418c0aed663

Triamterene causes

Better glucose tolerance

Muscle cramps

Decrease in urea level

Hypokalemia

single

Inhibitors of renal epithelial Na+ channel Include Triamterene and amiloride. Triamterene:- It is incompletely absorbed orally, paly bound to plasma proteins, largely metabolized in liver to an active metabolite and excreted in urine. Plasma t 1/2 is 4 hours, effect of a single dose lasts 6-8 hours. Side effects:- consist of nausea, dizziness, muscle cramps and rise in blood urea. Impaired glucose tolerance and photosensitivity are repoed, but urate level is not increased. Ref:- kd tripathi; pg num:-590

Pharmacology

Kidney

f885e11a-4a80-464f-aa2a-9bdaa6baff55

Persistent vomiting in G.O.O. causes -a) Hyponatremic hyperchloremia occurb) Hypernatremia without ↓ed Cl- alkalosisc) Hypokalemic metabolic alkalosisd) Paradoxical aciduria

cd

bc

bd

ac

single

Repetitive vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria) Cause of paradoxical aciduria Initially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney starts retaining these ions in exchange of hydrogen ions, thus the urine becomes acidic and metabolic alkaline state is further aggravated.

Surgery

cdf04af4-0d45-4d27-8595-36b6c320df52

All are immediate causes of death in burns except

Injury

Suffocation

Toxemia

Shock

multi

Immediate causes of death in burns Shock Suffocation Injury Delayed causes of death Toxemia Inflammatory complications Ref: TEXTBOOK OF FORENSIC MEDICINE AND TOXICOLOGY KRISHNAN VIJ FIFTH EDITION PAGE 163

Forensic Medicine

Thermal injury

b2f91d4c-fb35-4117-a5a0-673197e79b72

Mucositis is caused by:

5-Fluorouracil

Methotrexate

Paclitaxel

Cisplatin

single

Flurouracil is used mainly for solid malignancies,i.e colon, rectum, pancreas, liver, urinary bladder, head, and neck. Genetic deficiency of dihydropyridine dehydrogenase(DPD) leads to Fluorouracil toxicity. Major toxicity is myelosuppression, mucositis, diarrhea, nausea, vomiting, peripheral neuropathy (hand-foot syndrome)also occurs. Other given drugs are anti-cancerous drugs without mucositis. ESSENTIALS OF MEDICAL PHARMACOLOGY-SEVENTH EDITION-K.D TRIPATHI Page; 864

Pharmacology

Other topics and Adverse effects

b39016d6-d5f1-4498-bef3-37d4eec914d7

Complications of therapy with radioactive iodine includes -

Thyroid malignancy

Hypothyroidism

Leukemia

All

multi

Ans. is 'b' i.e. Hypothyroidism

Surgery

f8bbd265-100a-4cda-9ec7-c1e9f4dafc0a

Uterine souffle :

Is a soft blowing murmur synchronous with foetal hea sounds

Is due to increase in blood flow through the dilated uterine vessels

Is due to the active foetal movements

Indicates the underlying foetal distress

single

Ans. is b i.e. Is due to increase in blood flow through the dilated uterine vessels Uterine souffle is a soft blowing systolic murmur The sound is synchronous with maternal pulse It is due to increase in blood flow through the dilated uterine vessels Heard low down at the sides of the uterus, best on the left side It can also be heard in big uterine fibroid. Note Soft blowing murmur synchronous with the fetal hea sound is called Fetal / Funic souffle.

Gynaecology & Obstetrics

d84bbbff-2835-4d0a-bd1f-2b8ee74e126c

Investigation of choice in bronchiectasis is

Bronchoscopy

MRI thorax

HRCT lung

Chest X-ray

single

HRCT chest is more specific for bronchiectasis and is the imaging modality of choice for confirming the diagnosis.CT findings include airway dilation(detected as parallel "tram tracks" or as the "signet-ring sign"-a cross sectional area of the airway with a diameter at least 1.5 times that of the adjacent vessel),lack of bronchial tapering(including the presence of tubular structures within 1 cm from the pleural surface.),bronchial wall thickening in dilated airways,inspissated secretions (eg.,the " tree-in-bud" pattern ),or cysts emanating from the bronchial wall(especially pronounced in cystic bronchiectasis.) Reference:Harrison's medicine-18th edition,page no:2143.

Medicine

Respiratory system

cdc0bbbc-6b84-4ff4-927d-4641d2b07d58

Nyctalopia is due to deficiency of

Vitamin A

Vitamin B

Vitamin C

Vitamin E

single

Biochemistry

5287cf4d-ca07-40e0-b32a-81ebe7c460b8

False about hepatic adenoma-

Benign lesion

OCP use

Older females

Cold on isotopescan

multi

Ans. is 'c' i.e., Older females o Hepatic adenomas are benign solid neoplasms of liver.MC seen in younger females (20-40 years of age)Usually solitaryRisk factor - Prior/current use of estrogens (OCP)o Clinical FeaturesPatients usually present with upper abdominal pain.Physical examinated is usually unrevealing,o Microscopic FeaturesCords of congested or Fat laden hepatocvtes-absent biliary ductules or normal liver architecture,o DiagnosisCT Scan - Well circumscribed heterogenous mass showing early enhancement during arterial phase.MRI Scan - Hyperintense on T, weighted image and enhance early after gadolinium injection,o Isotope Scan - Hepatoma appears cold.o ComplicationsRupture with intraperitoneal bleeding.Malignant transformation (rare) - to HCCo TreatmentHepatic artery embolisation.Resection.

Surgery

Hepatic Tumors, Cysts, and Abscesses

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Renal threshold for serum glucose level-

100 mg/dl

200 mg/dl

300 mg/dl

400 mg/dl

single

Ans. is 'b' i.e., 200 mg/dl * The transport maximum for glucose is 375 mg/min whereas the filtered load of glucose is only 125 mg/min.* Therefore, in normal conditions 100% of glucose is reabsorbed in proximal tubules.* When plasma glucose concentration is 100 mg/dl the filtered load is at its normal level, 125 mg/min, there is no loss of glucose in the urine.* However, when the plasma concentration of glucose rises above about 200 mg/dl, increasing the filtered load about 250 mg/min, a small amount of glucose begins to appear in the urine.* This point is termed as threshold for glucose.* Note that this appearance of glucose in the urine occurs before the transport maximum is reached.* The reason for the difference between threshold and transport maximum is that not all nephron have same transport maimum for glucose, and some of the nephron therefore begin to excrete glucose before others have reached their transport maximum.* The overall transport maximum for the kidneys, which is normally about 375 mg/min, is reached when all nephrons have reached their maximal capacity to reabsorb glucose.* That means, above filtered load of 250 mg/min of glucose, some glucose will appear in the urine (threshold level), whereas above filtered load of 375 mg/min, all the glucose will be excreted because all the nephrons have reached to their transport maximum.* Thus, Renal threshold for glucosei) At plasma levels - 200 mg/dlii) At filtered load - 250 mg/min

Physiology

Kidneys and Body Fluids

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A 9-year-old boy diagnosed as uncomplicated pulmonary tuberculosis. He is put on isoniazid, rifampin, and ethambutol at home after initial treatment given at hospital. Which is accurate statement for this scenario?

His 3-year-old sibling should receive INH prophylaxis

A baseline test of auditory function test is essential before drug treatment is initiated

Polyahralgia is a potential adverse effect of the drugs the boy is taking

His mother, who takes care of him, does not need INH prophylaxis

multi

Prophylaxis with INH is always advisable for family members and close contacts in active cases. None of the drugs prescribed is associated with nephrotoxicity. Polyahralgia is a side effect of pyrazinamide that's not given in this case. Routine LFTs should be done in younger patients if INH plus rifampin given in higher doses. Ocular Function test should be done before staing ethambutol.

Pharmacology

Mycobacterial Diseases (TB, Leprosy and MAC)

47d1dbea-e18b-4ece-8462-61a575298168

How much luting agent is required for cementation of crown?

3/4th filled slightly upto the margin

1/4th filled

1/2 filled

Full to prevent bubble

single

Dental

7e4ff08e-29c7-47d1-9239-f79e6e0595d0

Functional unit of muscle:

Sarcomere

Actin

Myosin

Troponin

single

Functional unit of muscle is : sarcomere It is the pa of myofibril present between two succsive z lines. Ref: Guyton and Hall textbook of medical physiology 12th edition, page number:86,87

Physiology

Cardiovascular system

86281c8e-6384-4402-aa3a-80420e029ef0

Cause of exudative retinal detachment are:

Scleritis

Toxaemia of pregnancy

Central serous retinopathy

All

multi

Ans. All

Ophthalmology

4d147d09-ab73-40ed-814e-379b8d4df231

A 47-year-old man suddenly develops high fever and hypotension. He has a generalized erythematous macular rash, and over the next day, develops gangrene of his left leg. Which of the following is the most likely organism?

Corynebacterium diphtheriae

Streptococcus group C

Neisseria gonorrhoeae

Streptococcus group A

single

Streptococcus group A can cause a toxic shock-like syndrome, and has been increasing in frequency in North America. Streptococcal toxic shock-like syndrome was so named because of its similarity to staphylococcal toxic shock syndrome. The illness includes fever, hypotension, renal impairment, and the respiratory distress syndrome. It is usually caused by strains that produce exotoxin. It may be associated with localized infection as well; the most common associated infection is a soft tissue infection such as necrotizing fasciitis. The mortality is high (up to 30%), usually secondary to shock and respiratory failure. The rapid progression of the disease and its high mortality demand early recognition and aggressive treatment. Management includes fluid resuscitation, pressor agents, mechanical ventilation, antibodies, and, if necrotizing fasciitis is present, surgical debridement.

Medicine

Infection

197f4476-5229-44a6-b9fb-813967c23cfc

In amyloidosis of the tongue, the amyloid is deposited primarily in the:

Stromal connective tissue

Cells of the surface epithelium

Nuclei of the striated muscle cells

Cytoplasm of the striated muscle cells

single

Pathology

37585fbd-5eda-48c4-8b39-761335c90b6e

Which of the following is the most common cause of emergency depament visit related to LSD and its related substances?

Bad trip

Flashbacks

Synaesthesia

Papillary dilatation

single

The most frequent acute medical emergency associated with LSD use is a panic episode (the "bad trip"), which may persist up to 24 h.A trip is a period of intoxication from a hallucinogenic drug, such as lysergic acid (LSD) or magic mushrooms (psilocybin). It is called a trip because perceptions of the world change so dramatically, it can feel as if a trip to a strange, new land is taken. Unpleasant experience of hallucinogen intoxication is known as a bad trip.Harrison 19e pg: Cocaine and Other Commonly Abused Drugs

Microbiology

All India exam

9f5413a7-dacf-4629-94f5-0e1ecc12dfbf

Bilateral destruction of auditory cortex in man causes

Almost total deafness

Hearing defect for higher frequency sounds

Deficiency in interpretation of sounds

Inability for the orientation of sounds

single

(C) Deficiency in interpretation of sounds # Lesion of auditory cortex leads to loss of recognition of total patterns with loss of analysis of properties of sound and sound localisation.> Thus lesion of auditory cortex leads to defect in interpretation of sounds.

Physiology

Special Senses: Hearing and Equilibrium

db51ede8-e2b6-4637-9ff2-bc6efb98d662

The following infection resembles malignancy -

Echinococcus granulosus

E. multilocularis

E.vogeli

E. oligarthus

single

Ans. is 4b' i.e., E. multilocularis o The chief character of E. multilocularis cyst is its tendency to proliferate, thereby resembling a neoplasm.Hydatid disease of liver is caused byo Echinococcus granulosuso Echinococcus multiloculariso Echinococcus vogeli- Unilocular cystic lesions- Multi locular alveolar hydatid cyst- Polycystic hydatid disease.

Microbiology

Parasitology

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A 1 year old child is brought to you with delayed milestones. On examination you note that the child is very fair with hypopigmented hair and blue eye. He has also got eczemas. The child was also very irritable. What is your diagnosis?

Albinism

Phenylketonuria

Alkaptonuria

Cystinosis

single

This child is suffering from Phenylketonuria. Here there is inability to conve phenylalanine to tyrosine due to phenylalanine hydroxylase deficiency. The decreased pigmentation in this condition is due to reduced melanin formation. The treatment is a diet low in phenylalanine with tyrosine supplementation. Delay in initiation of treatment will lead to mental retardation. Ref: Essential revision notes for MRCP by Philip A Kalra, Edition 3, Page - 322 ; Harrison, Edition 17, Page - 2470

Pediatrics