Datasets:

society-ethics

/

medmcqa_age_gender_custom

like 0

1a609bd8-639f-4895-a5f5-80bbb896e2f6

Magistrate inquest not needed in: JIPMER 14

Homicide

Exhumation

Police custody death

Dowry death

0a

single

Ans. Homicide

Forensic Medicine

2d3da5b6-6af9-49c5-9439-17fbc983657d

Which of the following disease with bird, ahropod and human chain

Malaria

Japanese encephalitis

Paragonimus

Plague

1b

single

Agent factors :- * Caused by group B arbovirus (flavivirus) * The main reservoirs are Ardeid birds and pigs * Pigs are amplifiers of the virus and they do not manifest ove symptoms but circulates the virus Host factors :- * Most common in the age group of <15 years of age * Man - incidental dead end host * Affects other animals also and horse is the only animal which does not shows symptoms of encephalitis Vector:- * Transmitted by culex tritaeniorrhynchus - most impoant vector, others are C.Vishnuii and c. Gelidus * Incubation period is 5-15 days * Case fatality rate - 20-40% Ref:- K Park, 24th ed; pg num:- 302-303

Social & Preventive Medicine

Communicable diseases

91cfdd64-e451-462f-b6a2-c5b338415892

Potter syndrome is not assoiated with

Bilateral renal agenesis

Bilateral multicystic kidney disease

oligohydromnios

Polyhydromnios

0a

single

Since there is b/l kidney agenesis or cystic disease there is no urine production leading to oligohydromnios

Surgery

f1f94f1c-3d9d-4b68-9c3d-b6757a8a4fcd

Increase in pauwel's angle indicate

Good prognosis

Impaction

More chances of displacement

Trabecular alignment displacement

2c

single

Pauwel's classification - depending on angle (Pauwel's angle) formed by the line with the horizontal. More the Pauwell's angle, more unstable is the fracture with poorer prognosis Type I : <30deg Type II : 30-50deg Type III: >50deg(worst prognosis)

Orthopaedics

Lower Limb Traumatology

e08402ae-00b1-4649-872f-dfa4df0f6eb2

A 28 year old female teacher is found to have a prolonged bleeding time and normal platelet count. She had a bleeding of "easy bleeding" with frequent bleeding of the gums, epistaxis, cutaneous bleeding and menorrhagia, further testing revealed a deficiency of Von willebrand factor. Which of the following thrombogenic processes involving platelets is most directly impaired?

Adhesion

Aggregation

Formation of fibrinogen bridges

Conformational change with activation of phospholipid surface

0a

single

Disruption of the endothelium exposes subendothelial Von willebrand factor (VWF) and collagen, which promotes platelet adherence and activation. Deficiency of Von willebrand factor (VWF) causes ↓ Platelet adhesion (↑ BT) ↓ Intrinsic pathway activity (↑ aPTT)

Pathology

0d4f79ee-cc91-4c9a-902d-020973012371

Ifa Panchayat is dissolved, elections are to be held within?

1 month

3 months

6 months

1 year

2c

single

Ans. is 'c' i.e., 6 months

Social & Preventive Medicine

7a9a95de-c499-4203-bee7-fc1f9bf3abd1

Stomach is derived from ?

Foregut

Midgut

Hindgut

Allantois

0a

multi

Foregut

Anatomy

053c4aff-1541-4fbd-8f3c-32fa0921e82a

Which of the following is the main enzyme responsible for activation of xenobiotics?

Cytochrome P-450

Glucuronyl transferase

Glutathione S-transferase

NADPH cytochrome P-450-reductase

0a

single

Xenobiotics are compounds which may be accidently ingested or taken as drugs or compounds produced in the body by bacterial metabolism. The cytochrome P-450 enzyme family is involved in the biotransformation reaction of xenobiotics. They are heme containing membrane proteins localized in the smooth endoplasmic reticulum of liver. They are so named because they absorb light at wavelength of 450nm, when exposed to carbon monoxide. Ref: Vasudevan Biochemistry, 3rd Edition, Pages 310-2

Biochemistry

fabc62e9-fb0e-472f-b241-0c4bcf67fb58

In Familial hypercholesterolemia there is deficiency of

LDL receptor

Apoprotein A

Apo protein C

Lipoprotein lipase

0a

single

LDL receptors  Familial hypercholesterolemia (type IIa) is due to deficiency of functional LDL receptors as a result of different types of mutations.

Biochemistry

9e679825-10cc-4de3-8119-2c4bf95f52f0

Botulinum affects all of the following, EXCEPT:

Neuromuscular junction

Preganglionic junction

Post ganglionic nerves

CNS

3d

multi

Diplopia, dysphagia, dysahria, dry mouth, vomiting, thirst, constipation are the clinical features associated with botulinum toxin. Patients experience minimal or no CNS effects and usually there's no significant alteration in their mental status. Ingested, inhaled or formed botulinum toxin travels through the vascular system and affects neuromuscular junction, pre ganglionic junction and post ganglionic nerves. Ref: Textbook of Microbiology, Ananthanarayan and Paniker, 7th Edition, Chapter 28, Page 263 & 264 ; Harrisons Principles of Internal Medicine, 16th Edition, Page 843.

Microbiology

0ba825fe-e43e-4ae9-80a9-9072015050a5

Which of the following is a poor prognostic factor for childhood ALL.

Total Leukocyte count 4000-100,000

Age < 2 years

Testicular involvement

Blasts in peripheral smear

2c

multi

Answer is C (Testicular involvement) Testicular involvement / enlargement is a typical poor prognostic factor for childhood ALL Age < 2 years versus Testicular Involvement Typically Age < 1 year is considered a poor prognostic factor Although Age < 2 year has been mentioned as a poor prognostic factor in ceain textbooks including Hoffman's Hematology (4th/1158) most textbooks use the criteria of Age < 1 year to define a poor prognostic factor Since testicular involvement provided amongst the option is an established poor prognostic factor, this is selected as the single best answer of choice.

Medicine

1fb6c54f-550d-4cbc-8589-2d74176aa032

Relining of complete denture is not indicated when

Denture contains broken teeth

There is excessive resorption of the ridge

Vertical dimension is excessively reduced and has to be changed

Centric relation does not coincide with centric occlusion

2c

single

Dental

eeb3a5e2-a7c2-47da-9432-d862656581e7

Which of the following condition is necessary prerequisite for this change?

Rupture of membranes

Scanty liquor amnii

Adequate liquor amnii

Air inside the uterine cavity

2c

single

Ans. (C). Adequate liquor amniiThe photograph shows maceration, a sign of intrauterine death.Conditions favoring maceration: Intact membranes; adequate liquor amnii & NO air.

Forensic Medicine

Sexual Offenses

db812c4b-e8f1-46dc-9427-762cf351a82e

Savita is 32 weeks pregnant presents in causality and diagnosed as a case of APH. Vitals are unstable with BP 80/60 which of the following is next step in M/n

Careful observation

Blood transfusion

Medical induction of labour

Immediate cesarean section

1b

multi

Ans. is b i.e. Blood transfusion

Gynaecology & Obstetrics

02822b49-7e2e-4242-be13-00ea86d52dac

All are true about Cancer breast, except:

Affected sibling is a risk factor

Paget's disease of nipple is intraductal type of CA

Common in aged nulliparous

Increased incidence with prolonged breast feeding

3d

multi

Ans. (d) Increased incidence with prolonged breast feeding* Paget's Disease is a superficial manifest of an underlying Intra ductal carcinoma breast

Surgery

Breast

d1fd564a-489c-4075-9f2d-fe1fcf5a93b3

Which of the following vitamin reduces the risk of insulin resistance, obesity, and the metabolic syndrome?

Vitamin A

Vitamin C

Vitamin D

Vitamin B12

2c

single

Higher Intakes of Vitamin D May Be Beneficial There is evidence that Vitamin D intake considerably higher than that required to maintain calcium homeostasis reduce the risk of insulin resistance, obesity, and the metabolic syndrome, as well as various cancers. There is growing evidence that higher vitamin D status is protective against various cancers, including prostate and colorectal cancer, and also against prediabetes and the metabolic syndrome. Desirable levels of intake may be considerably higher than current reference intakes, and ceainly could not be met from unfoified foods. While increased sunlight exposure would meet the need, it carries the risk of developing skin cancer. Reference: Harper; 30th edition; Page no: 552, 553

Biochemistry

vitamins

0e24270a-7b1e-4f2c-b71c-0de8a0f931c8

The following drugs have significant drug interactions with digoxin except:

Cholestyramine

Thiazide diuretics

Quinidine

Amlodipine

3d

multi

Ref:KDT 6/e p499 Cholestyramine inhibits itestinal absorption of digoxin. Thiazides result in hypokalemia and thus make precipitate digitalis toxicity by pharmacodynamic interaction. Quinidine and verampil reduces the exceion of digoxin and does make precipitate toxicity (pharmacokinetic interaction)

Pharmacology

Cardiovascular system

e718f928-325c-4060-9148-a827bc5e985b

Antiboiotic Prophylaxis for infective endocarditis is indicated in:

Isolated secundum ASD

Mitral valve prolapse without regurgitation

Prior coronary aery bypass graft

Coarctation of aoa

3d

single

Answer is D (Coarctation of Aoa) Coarctation of Aoa is a high risk cardiac lesion fior the development of infective endocarditis and an indication fir antibiotic prophyloxis.

Medicine

baae18da-a29b-47f6-b733-828463dcb084

Adder Head" appearance is found in:

X-ray

USG

IVP

CT

2c

single

VP

Radiology

0745edd3-4f4f-4971-97c5-89e0880be160

Ortolani's test is done for

Congenial dislocation of the knee joints

Congenital dislocation of the hip joints

Congenital dislocation of the shoulder joints

Congenital dislocation of the elbow joints

1b

single

B. i.e. (Congenital dislocation of hip joints) (410 - Apley 8th)Important Tests**Ortolani's and Barlow's test Galeazzi test (604 CDT 4th)Congenital dislocation of hip joints** Apprehension testRecurrent dislocation of shoulder joints* Bryant's Call ways Hamilton ruler testHamilton ruler testAnterior dislocation of shoulder joints* **Pivot-shift testAnterior cruciate ligament* Lachman testAnterior cruciate ligament* Drawer testCruciate ligament (Ant & Post)* **Mc-Murray's testMeniscus injury* Appley's grinding testMeniscus injury* **Thomas testHip flexion deformity* ** Ankle joint has LEAST chances for recurrent dislocations

Orthopaedics

Congenital Dislocation of Hip (C.D.H.)

6e0a9179-1648-4b92-ae0a-fd8970b75146

A 50 year old female patient complains of difficulty in swallowing. Patient gives h/o multiple diagnostic CT-scans of the head and neck region. This patient may be predominantly susceptible to which of the following?

Medullary thyroid carcinoma

Follicular thyroid carcinoma

Anaplastic thyroid carcinoma

Papillary thyroid carcinoma

3d

multi

The incidence of thyroid carcinomas, predominantly papillary thyroid carcinomas, increases in humans after radiation exposure. There is strong dependence on age at exposure—susceptibility to radiation-induced thyroid cancer is higher in children than adults. There is little evidence for a dose response for individuals exposed during adulthood. Females are 2 to 3 times more susceptible than males to radiogenic and spontaneous thyroid cancers. Reference: White and Pharoah, Oral radiology, ed 8th, pg-92

Radiology

b72ab647-ae5f-45cf-99fa-a2cf138ae036

Secondary retention for a removable partial denture is provided by

The indirect retainer

The direct retainer

Intimate contact between the denture bases and the underlying tissues

Direct and indirect retainers

2c

single

Dental

3dcd635a-5f00-4e07-962c-4feafc753682

Which of the following may be seen in second degree Hea block (select three options):

Change in QRS complex morphology

Atrial rate more than ventricular rate

Prolonged conduction time

All of the above

3d

multi

Answer is A, B, and C Second degree AV block (Type I and /or Type II) may be associated with prolonged conduction time (prolonged PR interval), Atrial rate more than ventricular rate and change in QRS complex morphology (Tipe II). Name Rhythm Rate (beats/minute) P waves (lead II) PR Interval QRS complex First-degree atrio- ventricular (AV) block Regular That of underlying sinus rhythm; both atrial and ventricular rates will be the same Sinus origin: one P wave to each QRS complex Prolonged (more than 0.20 second); remains constant Normal (0.10 second or less) Second-degree AV Atrial: regular Atrial: that of Sinus origin Varies; progressively Normal (0.10 block, Mobitz I Ventricular: irregular underlying sinus rhythm lengthens until a P wave isn't conducted second or less) Ventricular: depends on number of impulses conducted through AV node: will he less than atrial rate (P wave occurs without the QRS cmplex); a pause follows the dropped QRS complex Second-degree AV Atrial: regular Atrial: that of Sinus origin: two or Normal or Normal if block at block, Mobitz II ventricular: usually underlying sinus three P waves prolonged; remains level of bundle of regular, but may be rhythm (sometimes more) constant His; irregular if Ventricular: depends before each QRS conductions ratios vary on number of Impulses conducted through AV node; will be less than atrial rate complex bundle branches Third-degree AV block Atrial: regular Atrial: that of Sinus P waves with Varies greatly Normal if block at Ventricular: regular underlying sinus rhythm Ventricular:40 to 60 if paced by AV junction; 30 to 40 (sometimes less) if paced by ventricles; will be less than atrial rate no constant relationship to the QRS complex; P waves found hidden in QRS complexes and T waves level of AV node or bundle of His; wide if block in bundle branches No constant Relationship between P wave and QRS complex is a feature of Third degree or complete hea block. One P wave to each QRS complex is a feature of First degree block

Medicine

31868f6c-233a-40ee-880e-9c668509a8b1

An ill 16 days old baby girl is brought to the emergency. On examination pallor and dyspnoea present with a respiratory rate of 85 per minute. Her HR is 200 bpm, hea sounds are distant and a gallop is heard. X-ray showed cardiomegaly. An echocardiogram shows dilated ventricles and dilation of the left atrium. An ECG shows ventricular depolarization complexes that have low voltage. Which of the following is the most likely diagnosis?

CHF

Glycogen storage disease

Pericarditis

Aberrant left coronary aery arising from pulmonary aery

0a

multi

In CHF pallor, dyspnoea, tachypnoea, tachycardia and cardiomegaly are common regardless of the cause.The most common causes of CHF in children include myocarditis caused by adenovirus and coxsackievirus B.The echocardiogram shows ventricular and left atrial dilatation as well as poor ventricular function. With glycogen storage disease of the hea muscle thickening would be expected. With pericarditis- pericardial effusion is seen. On ECG, the voltages of the ventricular complexes seen with aberrant origin of the left coronary aery are not diminished, and a pattern of myocardial infarction can be seen. *

Pediatrics

Impoant Viral Diseases in Children

8265f7d0-1476-40a3-bdf9-b42bc2f25dc2

Egg shell calcification is seen in all except –

Sarcoidosis

Silicosis

Post irradiation lymphoma

Bronchogenic CA

3d

multi

Radiology

4e296c2e-150a-4123-bc01-b56e4e0d89af

In inversion of the foot, the sole will face:

Upwards

Downwards

Laterally

Medially

3d

multi

Ans: d (Medially) Ref: BDC, Vol. II, 4th ed, p. 155; Kieth L. Moore, 4th ed, p. 638Inversion is the movement in which the medial border of the foot is elevated, so that the sole faces medially.Eversion is the movement in which the lateral border of the foot is elevated. So that the sole faces laterally.Joints of the foot and the Movements taking place there:JOINTTYPE OF JOINTMOVEMENTSAnkle jointHinge jointPlantar flexion, dorsiflexionSubtalar joint (talocalcaneal)Plane synovialInversion, eversionT alocalcaneonavicularBall and socketGliding and rotator movementsCalcaneocuboidPlane synovialInversion, EversionTarsometatarsalPlane synovialGliding or slidingIntermetatarsalPlane synovialLittle movement possibleMetatarsophalangealCondylarFlexion, extension, adduction, abduction and circumductionInterphalangealHinge varietyFlexion, Extension

Anatomy

Foot

7b859b05-5bd6-4dc0-828f-d5ff4da65f24

Where does the "knot" is put in the neck during judicial hanging?

The back of the neck

Under angle of jaw

Below the chin

Choice of hangman

1b

single

In judicial hanging, a rope to allow a drop of five to seven metres according to the weight, build and age of the person, is looped round the neck, with the knot under the angle of the jaw. This causes fracture-dislocation usually at the level of the second and third, or third and fouh cervical veebrae. Ref: The essentials of forensic medicine and toxicology by Dr K S Narayan Reddy, 27th edition, Page 306.

Forensic Medicine

7025db05-412a-4479-89f3-fecc9ec7b174

Seal finger and whale finger are associated with -

Listeria

Erysipelothrix

Corynebacterium

Treponema

1b

single

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

Microbiology

22e6e599-7193-4569-be03-a7a0a006faec

Which of the following muscle acts as unlocker of knee?

Gracilis

Popliteus

Saorius

Biceps femoris

1b

single

Popliteus rotates the tibia medially on the femur or, when the tibia is fixed, rotates the femur laterally on the tibia. At the beginning of flexion of the fully extended knee, lateral femoral rotation by popliteus muscle unlocks the joint.Must know:Locking of knee joint is due to the the action of quadriceps femoris, that brings about medial rotation of femur on tibia in later stages of extension. Ref: Snells, Clinical anatomy, 7th Edition, Page 650.

Anatomy

7a9e4db6-6173-4fc2-8d5f-daf8061734a3

A 60 yr old chronic smoker presents with painless gross hematuria of 1 day duration. Which is the investigation of choice to know the cause of hematuria?

USG

X-ray KUB

Urine routine

Urine microscopy for malignant cytology cells

3d

single

A chronic smoker with painless gross hematuria should be suspected as having bladder cancer. The most common form of bladder cancer is transitional cell carcinoma (TCC). Tobacco use, followed by occupational exposure to various carcinogenic materials such as automobile exhaust or industrial solvents are the most frequent risk factors. Hematuria is the presenting symptom in 85-90% of patients with bladder cancer. It may be gross or microscopic, intermittent rather than constant. Exfoliated cells from both normal and neoplastic urothelium can be readily identified in voided urine. Ref: Scher H.I., Motzer R.J. (2012). Chapter 94. Bladder and Renal Cell Carcinomas. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.

Surgery

a3e2c40f-e525-4ee7-9740-5198788b345f

The most sensitive method for detecting cervical Chlamydia trachomatis infection is:

Direct fluorescent antibody test

Enzyme immunoassay

Polymerase chain reaction

Culture on irradiated McConkey cells

2c

single

Ans. is 'c' i.e., Polymerase chain reactionRef: Harrison, 17th/e, p. 1074,19th/e, p. 1165 and Ananthanarayan, 9th/e, p. 415Amplification assays such as ligase chain reaction and polymerase chain reaction are the most sensitive chlamydial diagnostic method.Other methods are:(a) Cell culture: Sensitivity (60-80%).(b) Direct immunofluorescent antibody test: Sensitivity 70-80% and quite specific.(c) ELISA: 60-80%.

Microbiology

Bacteria

5256f96e-c7f4-4440-a781-fc2bd24471cd

A labourer involved with repair-work of sewers was admitted with fever, jaundice and renal failure. The most appropriate test to diagnose the infection in this patient is -

Weil Felix test

Paul Bunnell test

Microscopic agglutination test

Microimmunofluorescence test

2c

single

Microbiology

6e42770a-97fb-4a08-8c0d-1dd4126cfb63

Congestive hea failure in an infant is characterized by all except

Pedal edema

Tachypnea

Sweating

Poor weight gain

0a

multi

Congestive Cardiac Failure in InfantsSymptomsSignsuFeeding difficultyuTakes less volume per feeduDiaphoretic while suckinguForehead sweating.uSuck-rest-suck cycle.uPoor weight gainuPeriorbital edema uClothes no longer fituIncreasing cloth sizeuRapid breathing/nasal flaring/cyanosis/chest retractions.uTachycardia.uHepatomegaly.uOccasionally Splenomegaly.uPeriorbital edemauEdema in flanks. uDependent edema (Refer: Nelson's Textbook of Paediatrics, 19thedition, pg no:1530)

Anatomy

All India exam

fa2a40f5-7d07-473b-9175-f891e8923e19

Congenital hydrocele is best treated by

Eversion of sac

Excision of sac

Lord's procedure

Herniotomy

3d

single

Congenital hydrocele is best treated with herniotomy if they do not resolve spontaneously. Established acquired hydrocele often have thick walls. They are treated by subtotal excision of the sac. If the sac is small, thin walled and contains clear fluid, Lord's operation is done. Jaboulay's operation where the sac is eveed with placement of testis in a pouch created by dissection in the fascial planes of the scrotum, is an alternative. Reference : page 1328 Bailey and Love's sho practice of surgery 25th edition and page 1072 SRB's manual of surgery 5th edition

Surgery

Urology

90d792a9-7a4b-460c-b069-b9aa6a2d7823

Rate limiting step in cholesterol synthesis is catalysed by which of the following enzyme?

HMG CoA synthetase

HMG CoA reductase

Thiokinase

Mevalonate kinase

1b

multi

Conversion of HMG CoA to mevalonate by HMG CoA reductase is the rate limiting step in the synthesis of cholesterol. Cholesterol is an allosteric inhibitor of HMG CoA reductase Statin drugs acts as competitive inhibitors with mevalonate for binding to HMG CoA reductase. Insulin ors the active form of HMG CoA reductase and increases cholesterol synthesis. Glucagon ours the inactive form and decreases cholesterol synthesis. Ref: Biochemistry By John W. Pelley, page 89.

Biochemistry

63de4ee4-9b7b-4312-aad2-45f5aa3cac7b

Vaccine administered by following route is

Typhoral live

H1n1 killed

H1n1 live

Yellow fever live

2c

single

Hlnl live (Intranasal route)

Social & Preventive Medicine

Influenza

1ce23a0f-15cf-429f-a350-a4050d1d43f6

A 40-year old diabetic patient presents with proptosis of one eye and black eschar over palate. The likely organism is :

Pseudomonas

Candida

E. coli

Mucor

3d

single

Medicine

53ae491c-15c1-4c77-8dcb-fba7d3f5dd29

Coloured urine is not seen in :

Quinine

Rifampcin

Nitrofurantoin

Pyridium

0a

single

Answer is A (Quinine) Quinine is not associated with discoloured urine.

Medicine

eccfcb56-f984-4dc4-bcd2-db1dfa7a96cc

Investigations in a clinically suspected case of tuberculosis -

Mantoux (in children)

Sputum AFB

Bactec

All of the above

3d

multi

Medicine

fec423fb-be98-40a8-a9f3-477f6e7555f4

Schizophrenia is treated by

Anti depressants

Anti psychotics

Anti epileptics

Mood stabilizers

1b

single

Ans. is 'b' i.e., Anti psychotics

Pharmacology

bdf6c4e6-9034-4e26-9b63-674a147b16c3

Fries test is used in the diagnosis of:

Gonorrhoea

Herpes

Chanchroid

Granuloma venereum

3d

single

Granuloma venereum

Microbiology

e151e45d-2260-4b55-a9b1-564232e2982e

A 45-year-old woman complains of severe headaches and difficulty in swallowing. Over the past 6 months, she has noticed small, red lesions around her mouth as well as thickening of her skin. The patient has "stone facies" on physical examination. Which of the following antigens is the most common and most specific target of autoantibody in patients with this disease?

C-ANCA (anti-proteinase-3)

Double-stranded DNA

P-ANCA (anti-myeloperoxidase)

Scl-70 (anti-topoisomerase I)

3d

multi

Scleroderma (refer to the image below) Autoimmune disease of connective tissue. Antinuclear antibodies are common but are usually present in a lower titer than in patients with SLE. Antibodies viually specific for scleroderma include:- Nucleolar autoantibodies (primarily against RNA polymerase) Antibodies to Scl-70, a non-histone nuclear protein topoisomerase; Anticentromere antibodies (associated with the "CREST" variant of the disease). The Scl-70 autoantibody is most common and specific for the diffuse form of scleroderma and is seen in 70% of patients. -Autoantibodies to double-stranded DNA (choice B) are seen in patients with SLE. -Autoantibodies to SS-A/SS-B are seen in patients with Sjogren syndrome. (Fig: A fibroblastic focus is present at the arrows.) Diagnosis: Scleroderma

Pathology

Immunity disorders

23b2d44a-f5e5-47b8-9004-ddd6e0c183d8

Grave's ophthalmopathy mostly presents as September 2010

Proptosis

Ptosis

Reduced intraocular tension

Increased power of convergence

0a

single

Ans. A: Proptosis Graves' ophthalmopathy (also known as thyroid eye disease (TED), dysthyroid/thyroid-associated orbitopathy (TAO), Graves' orbitopathy) is an autoimmune inflammatory disorder affecting the orbit around the eye, characterized by upper eyelid retraction, swelling (edema), redness (erythema), conjunctivitis, reduce dpower convergence and bulging eyes (proptosis).

Ophthalmology

6a48770d-2b73-46ee-a45f-151619ca08ad

Earliest lesion seen in atherosclerosis is:

Fatty streaks

Intimal thickening

Fibrinoid necrosis

Plaque

0a

single

Ans: A (Fatty streaks) Ref: Robbins Pathologic Basis of Disease, 8th edition.Explanation:Fatty streaks are the earliest lesions in atherosclerosis " Ref: RobbinsMorphology of AtherosclerosisFatty StreaksThese are the earliest lesions in atherosclerosis.They are composed of lipid-filled foamy macrophages.Beginning as multiple minute flat yellow spots, they eventually coalesce into elongated streaks 1 cm or more in length.These lesions are not significantly raised and do not cause any flow disturbanceAortas of infants less than 1 year old can exhibit fatty streaks, and such lesions are seen in virtually all children older than 10 years, regardless of geography, race, sex, or environment.The relationship of fatty streaks to atherosclerotic plaques is uncertainThey may evolve into precursors of plaques, not all fatty streaks are destined to become advanced lesions.Atherosclerotic PlaqueThe key processes in atherosclerosis are intimal thickening and lipid accumulationAtheromatous plaques impinge on the lumen of the artery and grossly appear white to yellow: superimposed thrombus over ulcerated plaques is red-brown.Plaques vary from 0.3 to 1.5 cm in diameter but can coalesce to form larger massesAtherosclerotic lesions are patchy, on cross- section, the lesions appear "eccentric"Local flow disturbances (e.g., turbulence at branch points) leads to increased susceptibility to plaque formation.In descending order, the most extensively involved vessels are theLower abdominal aorta (MC)The coronary arteries (Second MC)The popliteal arteriesThe internal carotid arteriesVessels of the circle of WillisVessels of the upper extremities are usually spared, as are the mesenteric and renal arteries, except at their ostia.Atherosclerotic plaques have three principal components:Cells, including smooth muscle cells, macrophages, and T cellsECM, including collagen, elastic fibers, and proteoglycansIntracellular and extracellular lipidSuperficial fibrous cap composed of smooth muscle cells and dense collagen.Beneath and to the side of the cap (the "shoulder") is a more cellular area containing macrophages, T cells, and smooth muscle cells.Deep to the fibrous cap is a necrotic core, containing lipid (primarily cholesterol and cholesterol esters), debris from dead cells, foam cells (lipid-laden macrophages and smooth muscle cells), fibrin, variably organized thrombus, and other plasma proteins and cholesterolThe periphery of the lesions show neovascularization (proliferating small blood vessels;Plaques generally continue to change and progressively enlarge due to cell death and degeneration, synthesis and degradation (remodeling) of ECM, and organization of thrombus.Atheromas often undergo calcificationAtherosclerotic plaques are susceptible to the following clinically important changes* Rupture, ulceration, or erosion of the intimal surface of atheromatous plaques exposes the blood to highly thrombogenic substances and induces thrombosis.* Such thrombosis can partially or completely occlude the lumen and lead to downstream ischemia.* If the patient survives the initial thrombotic occlusion, the clot may become organized and incorporated into the growing plaque.* Hemorrhage into a plaque. Rupture of the overlying fibrous cap, or of the thin-walled vessels in the areas of neovascularization, can cause intra-plaque hemorrhage; a contained hematoma may expand the plaque or induce plaque rupture.* Atheroembolism. Plaque rupture can discharge atherosclerotic debris into the bloodstream, producing microemboli* Alienism formation. Atherosclerosis-induced pressure or ischemic atrophy of the underlying media, with loss of elastic tissue, causes weakness resulting in aneurysmal dilation and potential rupture.

Pathology

Atherosclerosis and Arteriosclerosis

fce5a305-66f4-4bcf-9ef7-30f40f13724d

Flipped LDH indicating Myocardial Infarction is represented by:

LDH-1> LDH-2

LDH-2 > LDH-1

LDH-4 > LDH-5

LDH-5 > LDH-4

0a

single

When LDH-1 is greater than LDH-2, it is referred to as flipped LDH and is indicative of MI. LDH-1 isoenzyme is found primarily in hea muscle and is lesser in concentration than the LDH-2 Isoenzyme which is primarily found in RBC. When the concentration of LDH-1 is observed to be greater than LDH2. It is referred to as flipped LDH and is indicative of Myocardial infarction. LDH has five isoenzymes: LDH-1 LDH-1 is found primarily in hea muscle 17% to 27% LDH-2 LDH-2 is primarily found in Red blood cells 27% to 37% LDH-3 LDH-3 is highest in the lung 18% to 25% LDH-4 LDH-4 is highest in the kidney, placenta, and pancreas 3% to 8% LDH-5 LDH-5 is highest in the liver and skeletal muscle 0% to 5% The LDH test helps determine the location of tissue damage. Thus in Normal ratios LDH-1 is less than LDH-2 and LDH-5 is less than LDH-4. When LDH-1 is greater than LDH-2: It is referred to as flipped LDH. It is indicative of MI. When your LDH-5 is greater than your LDH-4: It could mean damage to the liver or liver disease. This includes cirrhosis and hepatitis. Ref: Harrisons 19th edition

Medicine

C.V.S

97ae6d3d-e7f8-4c18-9093-50932f99240b

Dimension stability of hydrocollids may be achieved by

optimizing w:p

using cold water

prolonged manipulation

using humidor

3d

single

Dental

ffc37c4f-6c0f-4cb2-8cf2-abd2349316d0

Blood supply of stomach is/are:

Left gastric aery

Sho gastric aery

Lt gastroepiploic aery

All

3d

multi

A. i.e. Left gastric aery; B. i.e. Sho gastric aery; C. i.e. Left gastroepiploic aery

Anatomy

39115fee-b58b-4020-ae8f-9a2653811340

Which of the following ultrasound finding has the highest association with aneuploidy?

Choroid plexus cyst

Nuchal translucency

Cystic hygroma

Single umbilical aery

2c

single

All the above mentioned are ultrasound findings associated with increased risk of aneuploidy although the highest association is seen with cystic hygroma Nuchal translucency and cystic hygroma are both measured in the first trimesterTrisomy 21 is the most common aneuploidy associated with increased NT and cystic hygroma While monosomy X presents as second-trimester hygroma.

Microbiology

All India exam

a90571f1-9a01-4477-ab8a-5613d6dd48f9

Which of the following is not a component of transpo system?

Receptor activation

Selective gate

Non-selective channel

Energy coupling system

0a

single

Functions: Transpo Systems An essential role of biomembranes is to allow movement of all compounds necessary for the normal function of a cell across the membrane barrier. These compounds include a vast array of substances like sugars, amino acids, fatty acids, steroids, cations and anions to mention a few. These compounds must enter or leave the cells in an orderly manner for normal functioning of the cell. A. 1. Ion Channels Ion channels are transmembrane channels, pore-like structures composed of proteins. Specific channels for Na+, K+, Ca++, and Cl- have been identified. Cation conductive channels are negatively charged within the channel and have an average diameter of about 5 to 8 nm. All ion channels are basically made up of transmembrane subunits that come together to form a central pore through which ions pass selectively. All channels have gates and are controlled by opening and closing. Types of Gates Two types of gated channels. They are a. Ligand-gated channels: In this, a specific molecule binds to a receptor and opens the channel. Example: Acetylcholine receptor is present in the postsynaptic membrane. It is a complex of five subunits, having a binding site for acetylcholine. Acetylcholine released from the presynaptic region binds with the binding site of the postsynaptic region, which triggers the opening of the channel and influx of Na+. b. Voltage-gated channels: These channels open or close in response to changes in membrane potential. Some propeies of ion channels * Composed of transmembrane protein subunits. * Highly selective. * Well regulated by the presence of "gates". * Two main types of gates: Ligand-gated and voltage-gated. * Activities are affected by ceain drugs. * Mutations of genes encoding transmembrane proteins can cause specific diseases. 2. Ionophores Ceain microorganisms can synthesize small organic molecules, called ionophores, which function as shuttles for the movement of ions across the membrane. Structure: These ionophores contain hydrophilic centres that bind specific ions and are surrounded by peripheral hydrophobic regions. Types: Two types: (a) Mobile ion carriers: Like valinomycin (Refer uncouplers of oxidative phosphorylation). (b) Channel formers: Like gramicidin. 3. Water Channels (Aquaporins) In ceain cells, e.g. in red blood cells, and cells of the collecting ductules of the kidney, the movement of water by simple diffusion is enhanced by movements of water through water channels, composed of tetrameric transmembrane proteins called aquaporins. About five distinct types of aquaporins have been recognised. CLINICAL ASPECT Recently mutations in the gene encoding AP-2 (Aquaporin 2) protein, have been shown to be the cause of one type of nephrogenic diabetes insipidus. 4. Gap Junction Ceain cells develop specialized regions on their membranes for intercellular communications which are in close proximity. Function: They mediate and regulate the passage of ions and small molecules upto 1000 to 2000 mol wt, through a narrow hydrophilic core connecting the cytosol of adjacent cells. Structure: They are primarily composed of protein, called connexon which contains four membrane-spanning a-helices. the mitochondrial membrane also has paicularly energy coupling mechanism.Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition

Biochemistry

Respiratory chain

963aee66-8c6e-46da-ae29-8b9d67cdad80

Burst supression pattern on EEG is typically seen in:

Anoxic encephalopathy

Absence seizures

SSPE

Herpes simplex encephalitis

0a

multi

Ref: Ref: Harrisons 18/e p e-45 chapter  As the depth of coma increases, the EEG becomes nonreactive and may show a burst-suppression pattern, with bursts of mixed-frequency activity separated by intervals of relative cerebral inactivity. In other instances there is a reduction in amplitude of the EEG until eventually activity cannot be detected. Such electrocerebral silence does not necessarily reflect irreversible brain damage, because it may occur in hypothermic patients or with drug overdose. The prognosis of electrocerebral silence, when recorded using an adequate technique, depends upon the clinical context in which it is found. In patients with severe cerebral anoxia, for example, electrocerebral silence in a technically satisfactory record implies that useful cognitive recovery will not occur.

Unknown

9f2fbb1d-f367-43da-9dd8-8571d1fafb84

To feel comfoable and cool in a factory the conrrected effective temperature ( in degree Farenheit) should be -

Less tha 69

Between 69 and 76

Between 77 and 80

Between 81 and 82

1b

single

Comfo zones: In deg C of corrected effective temperature Pleasant and cool 20 Comfoable and cool 20-25 (69-76F) Comfoable 25- 27 (77-80F) Hot and uncomfoable 27-28 Extremely hot 28+ Intolerably hot 30+. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 792

Social & Preventive Medicine

Environment and health

fb2e4621-c209-4746-9c52-e8679882f93b

Test used for factor VIII deficiency identification is-

PT

APTT

D dimer

FDP

1b

single

Ans. is 'b' i.e., APTT o Factor VIII is a part of the intrinsic pathway of coagulation. The test used to identity1 the defects in the intrinsic and common pathways of coagulation is PTT. Thus prolonged PTT is a feature of patient with factor VIII deficiency.o Patients with hemophilia have deficiency of factor VIII that results in prolonged PTT.o Tests used to evaluate different aspects of hemostasis.Bleeding timeo It is not a test for coagulation rathers it tests the ability of the vessels to vasoconstrict and the platelets to form a hemostatic plug.o It is the time taken for a standardized skin puncture to stop bleeding,o Normal reference value is between 2-9 minutes.o Prolongation generally indicates the defect in platelet number or function.Prothrombin time (PT)o This assay tests the extrinsic and common coagulation pathway.o So, a Prolonged PT can result from deficiency of factor V, VII. X, prothrombin or fibrinogen.Partial thromboplastin time (PTT)o This assay tests the intrinsic and common coagulation pathways.o So, a prolonged PTT. can results from the deficiency of factor V, VHI, IX, X, XI, XII, prothrombin or fibrinogen.Thrombin timeo It is the time taken for clotting to occur when thrombin is added to the plasma,o It tests the conversion of fibrinogen to fibrin and depends on adequate fibrinogen level,o Prolonged thrombin time results from decreased level of fibrinogen.Defective coagulation pathwayPTAPTTExtrinsicIntrinsicCommonIncreasedNormalIncreasedNormalIncreasedIncreased

Pathology

Bleeding Disorders

090f4f67-eab2-4ffc-a9d0-d03da739bf9f

A 19 year old female presents with pain in the neck for 5 days. She is not able to wear tie for her job because of neck pain. H/O fatigue and lethargy for 10 days. She had flu like symptoms 20 days ago which resolved spontaneously. BP 110/80 mmHg, Pulse 48/min. Extremities are cold and dry. Neck is very tender. ECG normal. TSH is elevated. ESR 30 mm/hr. Next appropriate step

Atropine injection

Levothyroxine administration

Aspirin

Increase iodine intake in food

2c

multi

Answer: c) Aspirin (SCHWARTZ 19TH ED, P-1525; SABISTON 19TH ED, P-895)Granulomatous or Subacute or De Quervain's thyroiditisMost commonly occurs in 30- 40 year-old womenStrong association with the HLA-B35Fever with Sudden or gradual onset of neck painH/o preceding URI; Viral etiologyGland - enlarged, tender, firmClassically progresses through four stages: Hyperthyroid-Euthyroid-Hypothyroid-EuthyroidA few patients develop recurrent diseaseEarly stages: | ESR, Tg, T4, and T3 levels are elevated, TSH decreasedDuring Hypothyroid stage: elevated TSHLow radio-iodine uptakeFNAC - multinucleated giant cells of an epithelioid foreign body type and aggregates of lymphocytes activated macrophages, and plasma cellsSelf-limiting diseaseAspirin and NSAIDs are used for pain reliefPrednisolone for severe casesShort-term thyroid replacement may be needed and may shorten the duration of symptoms

Surgery

Thyroid Gland

b37eb019-4f8c-4131-8ff9-c2413a5b227e

Headache, apathy and deteriorating level of consciousness occurring weeks after head injury suggests;

Chronic subdral haematoma.

Pontine hemorrhage

Continuing cerebral.

Depressed skull fracture.

0a

single

Chronic subdral haematoma

Surgery

ee83bd7f-cd04-446e-b0a5-da98e920bc7c

A 27-year female wearing high heels stumbled and sustained inversion injury at ankle. Which ligament is most likely to be injured in the given case?

A

B

C

D

0a

single

Ans. A. (A)A. Anterior Talofibular ligamentAnkle sprains: Usually caused by the falls from height or twists of ankle. When the plantar-flexed foot is excessively inverted, the anterior and posterior talofibular and calcaneofibular ligaments are stretched and torn. The anterior talofibular ligament is most commonly torn.

Anatomy

Lower Extremity

be77f10a-1e08-4ccb-9d32-23f49a68712d

Asymmetric tonic neck reflex (ATNR) disappears at ______

6 months

5 months

9 months

8 months

0a

single

Asymmetric tonic reflex (ATNR) diappears by 6-7 months postnatally The tonic neck reflex is produced by manually rotating the infant&;s head to 1 side and observing for the characteristic fencing posture (extension of the arm on the side to which the face is rotated and flexion of the conralateral arm) An obligatory tonic neck response, in which the infant becomes "stuck" in the fencing posture, is always abnormal and implies a CNS disorder Ref: Nelson 21st edition pgno: 3059

Pediatrics

New born infants

b1bc5067-e456-4968-b690-6d49ec25e155

Ligament teres is a remnant of ?

Ductus aeriosus

Umbilical aery

Umbilical vein

Ductus venosus

2c

single

Umbilical vein

Anatomy

0f810d3c-d7f0-4783-b806-e554b894b843

Sho structured primi gravida has height less then

140 cm

145 cm

150 cm

135 cm

0a

single

140 cm

Gynaecology & Obstetrics

1081d0b1-9e05-4d2a-8c52-1668deea11ac

Which of the following is the most specific and sensitive screening test for renovascular hypeension?

HRCT

CT Angiography

Captopril enhanced radionucleotide scan

Doppler ultrasound of renal aeries

1b

single

Hypeension due to an occlusive lesion of a renal aery is renovascular hypeensionIn the initial stages, the mechanism of hypeension generally is related to activation of the renin-angiotensin system. Obstruction of the renal aery leads to decreased renal perfusion pressure, thereby stimulating renin secretion. Over time, possibly as a consequence of secondary renal damage, this form of hypeension may become less renin-dependent.As a screening test, renal blood flow may be evaluated with a radionuclide -ohoiodohippurate (OIH) scan, or glomerular filtration rate may be evaluated with a - diethylenetriamine pentaacetic acid (DTPA) scan before and after a single dose of captopril (or another ACE inhibitor).Contrast aeriography remains the "gold standard" for evaluation and identification of renal aery lesions.Harrison 19e pg: 1618

Medicine

All India exam

00ff4465-6c03-4e07-8986-8f169563b6fc

Role of egg lecithin in propofol formulation is?

Acts as emulsifying agent

Acts as preservative

Acts as carrier vehicle

Acts as antibacterial

0a

single

Propofol is an insoluble drug that requires a lipid vehicle for emulsification. Current formulations of propofol use a soybean oil as the oil phase and egg lecithin as the emulsifying agent.

Anaesthesia

Intravenous Anesthetic Agents

97680640-ea40-4384-bdfb-b6ae47417707

A 63 year old man presents with a triad of angina, syncope and congestive hea failure. Which of the following valvular hea lesion can be suspected-

antral stenosis

Tricuspid regurgitation

Aoic stenosis

Aoic regurgitation

2c

single

Even severe AS may exist for many years without producing any symptoms because of the ability of the hyperophied LV to generate the elevated intraventricular pressures required to maintain a normal stroke volume. Most patients with pure or predominant AS have gradually increasing obstruction over years, but do not become symptomatic until the sixth to eighth decades. Exeional dyspnea, angina pectoris, and syncope are the three cardinal symptoms. Dyspnea results primarily from elevation of the pulmonary capillary pressure caused by elevations of LV diastolic pressures secondary to reduced left ventricular compliance and impaired relaxation. Angina pectoris usually develops somewhat later and reflects an imbalance between the augmented myocardial oxygen requirements and reduced oxygen availability. Exeional syncope may result from a decline in aerial pressure caused by vasodilation in the exercising muscles and inadequate vasoconstriction in nonexercising muscles in the face of a fixed CO, or from a sudden fall in CO produced by an arrhythmia. ( Harrison&;s principle of internal medicine,18th edition,pg no.1939 )

Medicine

C.V.S

0ba7be74-d02c-464a-beab-eb016eab8ec3

Generalised thickening of cortical and cancellous bones is seen in

Osteopetrosis

Pagets disease

Osteogenesis imperfecta

Infantile hyperostosis

3d

single

Pathology

e4d314d7-fe07-4bd3-ab11-21901e00f699

An athelete presented with red coloured urine after 2 days of history of severe exeion. The most probable cause is?

Hemoglobinuria

Hemosiderinuria

Hematuria

Myoglobinuria

3d

single

Myoglobinuria REF: Harrison's Internal Medicine 17th edition chapter 382, Physiology and pathology of the urine by john dixon p. 49 Red color urine may be due to hemoglobin or myoglobin. In the question clue is given that patient is an athlete who competed in an event which lead to sternous exercise and hence increased myoglobin in the urine. "The states of energy deficiency cause activity-related muscle breakdown accompanied by myoglobinuria, appearing as light-brown- to dark-brown-colored urine"

Surgery

b358361d-b258-43e3-8919-436d1a86eefc

High false positive cases in a community signify that disease has -

High prevalence & Low incidence

High incidence & Low prevalence

Low prevalence & Low incidence

High incidence & High prevalence

1b

multi

Social & Preventive Medicine

a0f71cba-c03d-4edd-859b-c5c33ada55af

Which of the following is released from hypothalamus?

Orexin

Cortisol releasing hormone

Neuropeptide

Ghrelin

1b

single

There are 6 established hypothalamic releasing and inhibiting hormones : Corticotropin-releasing hormone (CRH), Thyrotropin releasing hormone (TRH), Growth hormone releasing hormone (GRH), Growth  hormone inhibiting hormone (GIH), Luteinizing hormone releasing hormone (LHRH) and Prolactin inhibiting hormone(PIH).

Physiology

b9596ff7-85da-4b76-992a-3d853eb04bfd

Vestibulo-Ocular Reflex Mediated by:

Flocculonodular Lobe

Vermal portion of Spinocerebel 1 um

Neocerebellum

Paravermal region of Spinocerebellum

0a

single

Ans:A (Flocculonodular Lobe) Ref: Pal GK. Cerbellurn. In: Textbook of Medical Physiology. Ahuja Publishing House. 2007: 116: 871.Explanation:Functional Division of CerebellumVestibulo cerebellum/Arch-cerebellum (Flocculonodular lobe)Connections with vestibular apparatusConcerned with equilibrium and learning induced changes in vesiihulo-occular reflexSpino cerebellumVermis - controls muscle movements of axial bodyIntermediate zone - controls muscle movements of limbsCerbrocerbellum (Ponto cerebellum/Neo cerbellurn) Overall planning programming of motor activities

Physiology

Cerebellum and Brainstem

c05388eb-3222-4392-9709-dbb418dd27f8

Which statement best describes the cranial fossa?

The middle cranial fossa contains the cribriform plate.

The anterior cranial fossa contains the pituitary gland.

The middle cranial fossa is floored by the sphenoid and temporal bones.

The internal acoustic meatus lies in the middle cranial fossa.

2c

multi

The floor of the middle cranial fossa is made up of the body and greater wing of the sphenoid as well as the squamous temporal bone. The cribriform plate forms pa of the floor of the anterior cranial fossa The middle cranial fossa contains the pituitary gland. The internal acoustic meatus lies in the posterior cranial fossa.

Anatomy

Cranial cavity

5709cea6-ffc2-4d49-b423-28d815cec8da

Which of the following vitamin enhances intestinal absorption of calcium?

Vitamin D

Vitamin K

Vitamin B1

Vitamin B2

0a

single

Vitamin Functions Deficiency Disease D Maintenance of calcium balance Enhances intestinal absorption of Ca2+ and mobilizes bone mineral Regulation of gene expression and cell differentiation Rickets = poor mineralization of bone Osteomalacia = bone demineralization Reference: Harper; 30th edition; Page no: 550

Biochemistry

vitamins

168e4c3a-95f4-42fe-9a7b-6e3bff6fd7b2

Which of these is the most impoant indication for Strassmans Metroplasty done for a bicornuate uterus?

Infeility

Menorrhagia

Repeated early pregnancy losses

Associated vaginal atresia

2c

single

Habitual aboion is the most impoant indication for surgical treatment of women who have a double uterus. The aboion rate in women who have a double uterus is to three times greater than that of the general population. Best diagnosis of the condition is made by laparohysteroscopy. Strassmans Metroplasty

Gynaecology & Obstetrics

Mullerian Abnormalities

ad1aeb26-1595-4830-b4bf-1253674644df

A 2-year-old child had burns on buttocks, both legs, face, neck and singeing of hair. Total surface area burnt: JIPMER 14

27%

37%

45%

55%

1b

multi

Ans. 37%

Forensic Medicine

81d4b17e-e48f-43dc-82ee-034548e32fd2

Which test helps to differentiate between concomitant squint and paralytic squint

Cover - uncover test

Alternate covertest

Direct cover test

None of the above

1b

multi

This procedure causes breakdown of binocular fusion mechanism thus helpful to differentiate.

Ophthalmology

bf4e6c71-9fa8-4d6b-b5ed-20bb873383f1

Best disinfectant of cholera stool is-

Bleaching powder

Cresol

Phenol

Lime

1b

single

Cresol is an excellent coal-tar disinfectant. It is 3 to 10 times as powerful as phenol, yet no more toxic. Cresol is best used in 5 to 20 percent strength for disinfection of farces and urine. Cresol is an all-purpose general disinfectant. (refer pgno :128 park 23 rd edition)

Social & Preventive Medicine

Epidemiology

fee1883d-f49b-43d6-99bc-07aabf7f2f9b

Black eye is a type of -

Patterend abrasion

Ectopic abrasion

Ectopic bruise

Friction abrasion

2c

single

The synopsis of forensic medicine & toxicology ; Dr k.s.narayan reddy ; 28th edition ; Pg .no . 107 Black eye is the most common example for ectopic bruising or percolated contusion .

Forensic Medicine

Mechanical injuries

edf8a6fd-63af-4c0e-8013-e3ba366dcec7

In a patient with a type of familial dyslipidemias he presented with palmar Xanthomas and he ias at increased risk of atherosclerosis and CAD.In Lipid profile there was elevation of triacylglycerols and cholesterol.And the IDL and chylomicrons were elevated.What is the pathophysiology of the condition?

LDL deficiency

VLDL overproduction

Apo C-2 deficiency

Apo E deficiency

3d

single

Reference: Harpers illustrated biochemistry 30th edition page 275

Biochemistry

Metabolism of lipid

1ab02ba4-f579-4542-b16f-a0df6a4f05c9

Endolymphatic duct drains into :

Subdural space

External space

Subarachnoid space

Succulus

0a

single

Ans:A.)Subdural Perilymph drains into subarachnoid space through the aqueduct of cochlea... Endolymph is absorbed in subdural space.

Anatomy

ecbe331f-316c-4739-b032-121e412c8e02

Usually associated with parvovirus B19 infection in those with hereditary spherocytosis-

Mild to moderate splenomegaly

Aplastic crisis

Gallstones

Hemolytic crisis

1b

multi

Ans. is 'b' i.e., Aplastic crisis o Parvovirus B19 selectively infects erythroidprecursors and is the most common aetiological agent that induces aplastic crisis in patients with hereditary spherocytosis (and other Hemolytic disorders).Transient aplastic crisiso Persons with decreased erythrocytes caused by conditions such as iron deficiency anemia, human immunodeficiency virus sickle cell disease, spherocytosis or thalassemia are at risk of transient aplastic crisis if infected with parvovirus B19.o The virus causes a cessation of erythrocyte production,o Parvovirus infection may be the first manifestation in HS.o It begins with reticulocytosis and thrombocytosis.

Medicine

Immunology and Rheumatology

eb7ac4a5-646e-48cd-ab30-430f8643bb30

Carcinoma of the prostate arise from -

Central zone

Peripheral zone

Transitional zone

Periurethral zone

1b

single

Surgery

62f6d5bb-6085-4328-97a0-3e3776f9ae78

A patient with cushinoid features presents with hemoptysis; he shows no response to dexamethasone suppression test; most likely diagnosis here is:

Adrenal hyperplasia

Adrenal adenoma

Ca lung with ectopic ACTH production

Pituitary microadenoma

2c

single

Answer is C (Ca lung with ectopic ACTH production); Lack of suppression to dexamethasone challenge (ACTH producing tumor) and presence of hemoptysis (Carcinoma lung) in a patient with Cushinoid features suggests a diagnosis of Carcinoma lung with ectopic ACTH secretion. As a method of diagnostic workup of any patient with suspected Cushings we screen the patient with plasma coisol levels at 8:00 a.m. in the morning. Those with increased coisol levels are subjected to a dexamethasone supression test. In the given question there is lack of suppression to dexamethasone challenge so option (d) is out. Out of the choices remaining the presence of hemoptysis points towards the diagnosis of carcinoma lung with ectopic ACTH.

Medicine

b72c9d20-5b2a-4353-ab60-fa1a899fde6b

Symptomatic treatment is not required in withdrawal of:

Cannabis

Morphine

Alcohol

Cocaine

0a

single

Since cannabis causes very mild withdrawal symptoms hence, no symptomatic treatment is required. LSD and other hallucinations also do not cause any withdrawal symptoms .

Psychiatry

Substance Related and Addictive Disorders

e7127a67-7144-4e6f-9cdc-28dd805000dd

Following death of a person, what happens to potassium level in the vitreous.

Potassium level falls

Potassium level increases

Remains unchanged

It depends on cause of death

1b

multi

Potassium concentration raises at the rate of 0.17-0.25 mmol per hour following death. It helps in determination of time since death.

Forensic Medicine

3ec267ef-dc91-4a47-81de-070ce0bf7213

Under transplantation of humans organs act, the punishment for the doctor involved is

< 1 year

< 2 years

2-5 years

> 5 years

2c

single

The Transplantation of Human Organs Act 1994, amended in 2011, and 2012 Chapter VI and VII deals with the trial and punishment of offences under this act. Under this act, doctors involved will be punished for a period of 2-5yrs. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr. PC IGNATIUS PAGE NO: 389

Forensic Medicine

Medical Jurisprudence

37de6d96-2eee-4132-8db9-89e72edab01b

Staphylococcus aureus does not cause which of the following skin infection:

Ecthyma gangrenosum

Bullous impetigo

Botryomycosis

Cellulitis

0a

single

Ans. is. a. Ecthyma gangrenosum

Microbiology

2aa8f835-c0c4-4f2e-895f-4630adf47221

A young lady with symptoms of hypehyroidism with elevated T4 and TSH levels. On examination, patient was not experiencing Tachycardia or excessive sweating.Fuher examination reveals bitemporal hemianopia. Next step of management

Sta beta blockers immediately

Conservative management sufficient

Sta antithyroid drugs and wait for symptoms to resolve.

Sta antithyroid drugs and do urgent MRI

3d

multi

Hypehyroidism with elevated levels of T4 and TSH levels and bitemporal hemianopia is highly suggestive of TSH secreting adenoma. Urgent MRI should be done to confirm the diagnosis of TSH secreting pituitary adenoma along with antithyroid drugs. Thyrotropin-secreting pituitary tumors (TSH-omas) are a rare cause of hypehyroidism and account for less than 1% of all pituitary adenomas. - Origin - anterior pituitary- MC cause of hyper pituitarism - Pituitary adenoma C/F Functional (Secreting) Non-Functional (Non-Secreting)Early Presentation due to physiologic Delayed presentation (Big enough toeffect cause neurological deficit) | Bitemporal Hemianopia Seen on 3rd / 4th Decade- M = F- MC type of pituitary adenoma is Prolactinoma IOC for diagnosis - MRIOther work-up done Full Endocrinologic ProfileFormal visual field testing TreatmentBromocriptine (Dopamine agonist) -Prolactinoma- Shrink prolactinoma in 6 to 8 weeks- Growth hormone security tumors - shrinkage occur < 20% Pts | Agent Octreotide | GH level in 70% Pts , | Tumor volume in 30% Indications of Sx in pituitary adenoma- GH Secreting tumors- Primarily Cushing Disease- Adenoma causing acute visual deterioration- Non-Prolactin secreting macroadenoma causing symptoms by mass effect Surgical ApproachIntranasal Trans-Sphenoidal , Sub labial Indications of Radiosurgery in pituitary adenoma- Used as primary therapy- Adjuvant therapy after subtotal resection- Recurrent disease

Surgery

Thyroid

688c3768-9fb8-4541-b844-f89b7c2c6af5

Statuary rape is -

Less than 15 years

Less than 16 years

Less than 18 years

Less than 20 years

2c

single

Ref:Textbook of Forensic medicine and toxicology (V.V.Pillay) 17th edition, page no.388 Minimum age at which female can give consent for sex by what age is 18 years. As per Sec.375IPC unlawful sexual intercourse by man with a woman with or without her consent when she is under 18 years of age. The criminal law (Amendment) Act,2013 has increased the previous recomended age of consent from 16 to 18 years, which means any sexual activity irespective of presence of consent with a woman below the age of 18 will constitute statutory rape.

Forensic Medicine

Sexual offences and infanticide

2a1c313d-df98-47f8-9d5c-bf439f33f228

A patient on amiodarone is diagnosed to have cornea verticillata. What should be management –

Stop the drug

Penetrating keratoplasty

Lamellar keratoplasty

Observation

0a

single

Cornea Verticillata This is a whorl-like opacity in the corneal epithelium seen in patients on long-term treatment with medication such as amiodarone, chloroquine, phenothiazines and indomethacin. It is also seen in patients with Fabry disease and its carrier state. The condition is generally asymptomatic, harmless and reversible on stopping the drug. The whorl-like pattern shows the direction of migration of corneal epithelial cells. Occasionally the condition had been known to cause glare and surface discomfort which response to topical lubricants.

Ophthalmology

a46b9738-93ca-472e-bea5-de525420db24

Most aggressive lung CA:

Squamous cell CA

Adenocarcinoma

Small cell lung CA

Large cell CA

2c

multi

Ans. (c) Small cell lung CARef: Robbings 9th ed./ 717* Small cell carcinoma is a highly malignant tumor with a strong relationship to cigarette smoking.* Around 1% occurs in nonsmokers.* They are the most aggressive of lung tumors, metastasizing widely and are always fatal.

Pathology

Characteristics and Epidemiology of Neoplasia

356ed30d-cba2-4520-97e7-23c04c4067e4

Chemoprophylaxis is indicated for all except-

Typhoid

Meningococcal meningitis

Cholera

Plague

0a

multi

Chemoprophylaxis There is no role of Chemoprophylaxis in Typhoid. For chemoprophylaxis in meningococcal meningitis, Rifampicin, Ciprofloxacin & Ceftriaxone is used. Tetracycline is used in Cholera and Plague.

Social & Preventive Medicine

Intestinal Infections, Worm Infestations

becc6670-95ca-4530-a5ee-afcd3b4ca1b6

In pontaic fever, which antigen is seen in urine?

Lipopolysaccharide-1

Lipopolysaccharide-2

Lipopolysaccharide-4

Lipopolysaccharide-6

0a

single

Ans. is 'a' i.e., Lipopolysaccharide-1 Legionella are classified into serogroup on the basis ofgroup specific lipopolysaccharide (somatic antigen or 'O' antigen). Legionella pneumophila sero-group-1 (LP-1) is the most common infecting organism. Urine test detect LP-1.

Microbiology

7903a702-b0c9-42b8-aca5-1642a098ff81

Mediastinal lymph node calcification is seen in which one of the following-

Metastatic neoplasm

Lymphoma

Sarcoidosis

Bronchiectasis

2c

single

Ref:Robbins Basic Pathology (9th Edition),page no.478,479 Sarcoidosis Although sarcoidosis is considered here as an example of a restrictive lung disease, it is impoant to note that sarcoidosis is a multisystem disease of unknown etiology characterized by noncaseating granulomas in many tissues and organs. MORPHOLOGY The diagnostic histopathologic feature of sarcoidosis is the noncaseating epithelioid granuloma, irrespective of the organ involved. This is a discrete, compact collection of epithelioid cells rimmed by an outer zone of largely CD4+ T cells. The epithelioid cells are derived from macrophages and are characterized by abundant eosinophilic cytoplasm and vesicular nuclei. It is not uncommon to see intermixed multinucleate giant cells formed by fusion of macrophages. A thin layer of laminated fibroblasts is present peripheral to the granuloma; over time, these proliferate and lay down collagen that replaces the entire granuloma with a hyalinized scar. Two other microscopic features are sometimes seen in the granulomas: (1) Schaumann bodies, laminated concretions composed of calcium and proteins; and (2) asteroid bodies, stellate inclusions enclosed within giant cells. Their presence is not required for diagnosis of sarcoidosis--they also may occur in granulomas of other origins. Rarely, foci of central necrosis may be present in sarcoid granulomas, suggesting an infectious process. Caseation necrosis typical of tuberculosis is absent The lungs are involved at some stage of the disease in 90% of patients. The granulomas predominantly involve the interstitium rather than air spaces, with some tendency to localize in the connective tissue around bronchioles and pulmonary venules and in the pleura ("lymphangitic" distribution). The bronchoalveolar lavage fluid contains abundant CD4+ T cells. In 5% to 15% of patients, the granulomas eventually are replaced by diffuse interstitial fibrosis, resulting in a so-called honeycomb lung. Intrathoracic hilar and paratracheal lymph nodes are enlarged and calcification in 75% to 90% of patients, while a third present with peripheral lymphadenopathy. The nodes are characteristically painless and have a firm, rubbery texture. Unlike in tuberculosis, lymph nodes in sarcoidosis are "nonmatted" (nonadherent) and do not ulcerate.

Pathology

Respiratory system

44634f4a-e203-402e-9a56-aec9702a1423

"Candle-wax spots" in the retina are present in

Sarcoidosis

Toxoplasmosis

Syphilis

Tuberculosis

0a

single

(A) Sarcoidosis # OCULAR MANIFESTATIONS OF SARCOIDOSIS:> Anterior segment: Conjunctival involvement has been reported in patients with ocular sarcoidosis.> Sarcoidosis granulomas are solitary, yellow "millet-seed" nodules.> Anterior uveitis occurs in 22%- 70% of patients with ocular sarcoidosis, and is usually granulomatous & chronic.> Iris nodules have been reported in up to 12.5% of patients with sarcoidosis associated uveitis.> Exacerbations of granulomatous uveitis are often associated with an appearance of fresh iris or fundus nodules.> Posterior synechiae, cataract and glaucoma are common complications.> Corneal band keratopathy develops in a few patients and is usually associated with hypercalcemia.> Posterior segment: The most common manifestations at the posterior segment are vitritis, intermediate uveitis, panuveitis, posterior uveitis, retinal vasculitis & optic nerve involvement. Other manifestations include choroidal nodules & exudative retinal detachment.> Overall, patients with chronic posterior uveitis and panuveitis have significantly more complications than do patients with anterior uveitis.> "Candle wax drippings" and "punched-out" lesions can be seen in patients with uveitis secondary to sarcoidosis.

Ophthalmology

Miscellaneous

2fa36968-f396-4677-a256-c353757b82b8

The number of doses recommended for oral Ty21a typhoid vaccine is:

14

5

3

1

2c

single

The Ty21a vaccine is licensed for use in individuals > 5 years. A three dose regimen is recommended. Vaccine is administered on alternate days: 0n days 1, 3 and 5. Ref: Park 21st edition, page 215.

Social & Preventive Medicine

9587b40f-5950-423e-aaa2-7a05f813f832

The drug used in petit mal seizures and has a narrow spectrum of antiepileptic activity is

Lamotrigine

Ethosuximide

Phenytoin

Primidone

1b

single

Ethosuximide and valproate are the drugs of choice for absence seizures and are more effective than lamotrigineReference: Katzung Pharmacology; 12th edition; Page no: 418

Pharmacology

Central Nervous system

037720db-3d5f-4488-be9b-b12a0cc81c2d

Which test is not useful in a patient with history of Syncopal attack?

Electrophysiological testing

Tilt Table testing

PET Scan

Holter monitoring

2c

single

Answer is C (PET Scan) : PET scan has- not been mentioned as a test to investigate syncope in Harrisons text. It is the single best answer of exclusion. Electrophysiological tests and 24 hour ECG Holter monitoring are indicated in patients where history suggests a cardiac disease. Upright tilt table testing is indicated for suspected neurogenic / vasodepressor syncope in patients with normal history / examination. Invasive Cardiac Electrophysiologic testing : provides diagnostic and prognostic information regarding Sinus Node function, AV conduction and Supraventricular and Ventricular arrhythmia. Holter monitor : provides 24 - 48 hours monitoring of ECG rhythm on an outpatient basis and is indicated for detection of conduction abnormalities. Upright tilt table testing : Is a test for vasodepressor / neurogenic syncope in patients with normal history / examination. In susceptible patients upright tilt at an angle between 60deg to 80deg for 30 to 60 minutes induces a vasovagal episode. Indications for Table Tilt test include : Recurrent syncope - Single syncope episode that caused injury - Single syncope event in high risk setting (pilot, commercial vehicle driver) Syncope The choice of diagnostic test should be guided by the history and physical examination For All patients Serum electrolytes Glucose Haematocrit

Medicine

897b2724-c93d-4e41-965a-d58fbd6c8cde

Magic syndrome is seen in:

Behcet disease

Aphthous major

Herpetiform

Bloom syndrome

0a

single

“MAGIC syndrome” (Mouth and Genital ulcers with Inflamed Cartilage) has been proposed to describe patients with clinical features of both relapsing polychondritis and Behcet disease.

Pathology

3eb8e753-2c11-4d5a-aee4-da83f114752e

Acute hemorrhagic conjunctivitis is caused by ?

Enterovirus 70

Adenovirus

Poliovirus

Hepadnavirus

0a

single

Ans. is 'a' i.e., Enterovirus 70 Acute hemorrhagic conjunctivitis (AHC) may be caused by adenoviruses, but two enteroviruses, enterovirus 70 and coxsackie A24 variant, are the major causes.

Microbiology

f5168131-b12b-4477-8c70-9199583db3ae

In a 24 year old man weight of the upper limb is transmitted to the axial skeleton by:

Coracoacromial ligament

Coracoclavicular ligament

Costoclavicular ligament

Coracohumeral ligament

1b

single

The axial skeleton shapes the longitudinal axis of the human body. Coracoclavicular ligament suspends the scapula from the lower one third of the clavicle and forms a strong bond between them. The weight of the upper limb is transmitted to the axial skeleton through this ligament. A fracture of the clavicle, medial to the attachment of this ligament leads to drooping of upper limb. Ref: TB of Anatomy and Physiology PR Ashalatha, 1st Ed, Page 110

Anatomy

edcaea9c-f584-43db-a696-4422c66034d4

Primary health care was proposed in 1978 at:

Alma ata

New York

Geneva

Delhi

0a

single

Answer: A. Alma ata. (Ref Park's Textbook of PSM 22nd/Pg.832)The new approach to health care came into existence in 1978 following an international conference at Alma Ata (USSR).The Alma-Ata conference defines the primary health care as follows: Primary health care is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community and the country can afford.Millennium Development Summit was held in New York in 2000 where MDG are formulated.World Health Assembly is held in Geneva, which is a head quarter of WHO.Note: The term "comprehensive health care" (womb to tomb) was first used by Bhore committee in 1946.

Social & Preventive Medicine

Healthcare of the Community & International Health

f5469d2e-345d-44db-89b9-e3f00f74341d

Schizophrenia is treated by:

Anti depressants

Anti psychotics

Anti epileptics

Mood stabilizers

1b

single

Pharmacology

c55a313a-5fd4-479d-9513-944926fede44

Gene involved in Cowden syndrome is

P53

PTEN

RB

Ras

1b

single

(B) PTENo"Phosphatase and Tensin'' homolog (PTEN) - protein in humans encoded by the PTEN gene. Gene mutations promotes development of cancers.[?]Cowden's disease/Multiple Hamartoma Syndrome:-Part of PTEN hamartoma tumor syndrome-An autosomal dominant syndrome-Trichilemmomas - Numerous tumors of hair follicles in face-Multiple hamartomatous polyps in GI tract, Lipomas, Granulomas-Very high risk of breast, Follicular endometrail carcinoma & thyroid carcinomaoTreatment: Bilateral mastectomies recommended-Contraindicated are mammography & other radiation exposure of breast tissue.-Mean age at presentation <10 years-Very high risk of breast, follicular carcinoma of thyroid & Endometrial carcinomaoPTEN (phosphatase and tensin homologue) is a membrane-associated phosphatase encoded by a gene on chromosome 10q23 that is mutated in Cowden syndrome, an autosomal dominant disorder marked by frequent benign growths, such as skin appendage tumors, and an increased incidence of epithelial cancers, particularly of the breast, endometrium, and thyroid.oPTEN acts as a tumor suppressor by serving as a brake on the PI3K/AKT arm of the receptor tyrosine kinase pathway.oPTEN gene function is lost in many cancers through deletion, deleterious point mutations, or epigenetic silencing.SELECTED TUMOR SUPPRESSOR GENES & ASSOCIATED FAMILIAL SYNDROMES & CANCERS, SORTED BY CANCER HALLMARKS*Gene (Protein)Familial SyndromesAssociated CancersInhibitors of Mitogenic Signaling PathwaysAPC (Adenomatous polyposis coli protein)Familial colonic polyps and carcinomasCarcinomas of stomach, colon, pancreas; melanoma*. NF1 (Neurofibromin-1)Neurofibromatosis type 1 (neurofibromas and malignant peripheral nerve sheath tumors)Neuroblastoma, juvenile myeloid leukemia*. NF2 (Merlin)Neurofibromatosis type 2 (acoustic schwannoma and meningioma)Schwannoma, meningioma*. PTCH (Patched)Gorlin syndrome (basal cell carcinoma, medulloblastoma, several benign tumors)Basal cell carcinoma, medulloblastoma*. PTEN (Phosphatase and tension homologue)Cowden syndrome (variety of benign skin, GI, and CNS growths; breast, endometrial, and thyroid carcinoma)Diverse cancers, particularly carcinomas and lymphoid tumors*. SMAD2, SMAD4 (SMAD2, SMAD4)Juvenile polyposisFrequently mutated (along with other components of TGFb signaling pathway) in colonic & pancreatic CaInhibitors of Ceil Cycle Progression*. RB Retinoblastoma (RB) proteinFamilial retinoblastoma syndrome (retinoblastoma, osteosarcoma, other sarcomas)Retinoblastoma; osteosarcoma carcinomas of breast, colon, lung*. CDKN2A p16/INK4a & pU/ARFFamilial melanomaPancreatic, breast, and esophageal carcinoma, melanoma, certain leukemiasInhibitors of "Pro-growth" Programs of Metabolism and Angiogenesis*. VHL (Von Hippel Lindau (VHL) protein)Von Hippel Lindau syndrome (cerebellar hemangioblastoma, retinal angioma, renal cell carcinoma)Renal cell carcinoma*. STK11 (Liver kinase B1 (LKB1) or STK11)Peutz-Jeghers syndrome (GI polyps, GI cancers, pancreatic carcinoma and other carcinomas)Diverse carcinomas (5%-20% of cases, depending on type)*. SDHB, SDHD (Succinate dehydrogenase complex subunits B & D)Familial paraganglioma, familial pheochromocytomaParaganglioma

Pathology

Neoplasia

78353090-0d67-40f9-9067-b6ddcfa932cc

Supraventricular crest lies between-

Pulmonary orifice and atrioventricular orifice

Atrioventricular orifice and fossa ovalis

SVC and right atrium

Right an dleft coronary artery

0a

single

Ans. is 'a' i.e., Pulmonary orifice and atrioventricular orifice Interior of right ventricle* It is anteroinferior chamber and projects to the left of right atrium. It is in contact with the sternum.* It is divided into -i) Rough inflowing part (ventricle proper)# It is developed from right half of primitive ventricle.# Its interior is rough due to the presence of muscular ridges known as trabeculae carneae, which are more prominent in apical region.# Trabeculae carneae are of 3 types: -1. Ridges - Linear elevations.Supraventricular crest - a ridge present between the pulmonary and atrioventricular orifices, extends downwards in the posterior wall of the infundibulum.2. Bridges -'Muscular elevations with fixed ends on ventricular walls, the center being free.Septomarginal trabecula: It is a specialized bridge which extends from the right of ventricularseptum to the base of anterior papillary muscle. It contains the right branch of atrioventricular bundle.3. Papillary muscles are conical projections of muscle fiber bundles. Their base is attached to the ventricular wall and the apex is attached to the chordae tendinae, which are further attached to the cusps of atrioventricular (AV) valves. There are three papillary muscles in the right and two in the left ventricle. They regulate closure of atrioventricular valves.ii) Smooth outflowing part (infundibulum or conus arteriosus)# Smooth outflowing part develops from mid portion of bulbus cordis and surrounds pulmonary valveSupraventricular crest (crista supraventriculars) or infundibuloventricular crest separates tricuspid (AV) orifice and pulmonary orifice, i.e. inlet and outlet parts.

Anatomy

Thorax