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08653c14-1263-4d1b-a5a5-e810006007df

In ICDAS — II, score 2 indicates?

First enamel visual change

Distinct enamel change

Microcavitation

Underlying dentin shadow

1b

single

Dental

578a0850-ca30-4678-87f1-2b13166c87a8

What is the pattern of inheritance in the given pedigree chart

Holandric inheritance

Mitochondrial inheritance

X linked dominant inheritance

Autosomal donminant inheritance

1b

single

Mitochondrial DNA is inherited only by Mother. So mother trammits disease related to Mitochondria to all her children.

Pediatrics

c7fac04d-a5e5-4325-84a4-b1b45bb5030b

Pharyngeconjunctival fever is caused by -

Adenovirus 3 and 7

Adenovirus 11, 21

Adenovirus 40, 41

Adenovirus 8, 19

0a

single

Adenovirus causes pharyngitis, pneumonia, ARD, pharyngoconjunctival fever, EKC, acute follicular conjunctivitis, diarrhea, and acute hemorrhagic fever. Pharyngeoconjunctival fever is usually associated with serotypes 3,7 and 14. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:482

Microbiology

Virology

a62c9a9f-9093-4e5c-ad28-c46417808666

IQ = 51 –

Mild MR

Moderate MR

Severe MR

Profound MR

0a

single

IQ between 50-70 is mild mental retardation.

Social & Preventive Medicine

bf40f5cd-c0d9-47d5-9c85-e13642bd77cb

All of the following are example of nominal scale except:

Race

Sex

Body weight

Socio-economic status

2c

multi

Dental

2703c371-ef26-4934-bf3c-f859915fa6f0

All of the following are essential criteria for defining perinatal asphyxia EXCEPT?

Persistence of APGAR score of 5-7 for >5 minutes

Prolonged umbilical aerial blood pH <7.0

Presence of neurological manifestations in the immediate neonatal period

Evidence of multiorgan dysfunction in the immediate neonatal period

0a

multi

Essential criteria for defining perinatal asphyxia include: Persistence of APGAR score of 0-3 for >5 minutes Prolonged acidemia (pH <7.0) on an umbilical aerial blood sample Neurological manifestations, e.g. seizures, coma, hypotonia or hypoxic ischemic encephalopathy (HIE) in the immediate neonatal period Evidence of multiorgan dysfunction in the immediate neonatal period

Pediatrics

Perinatal Asphyxia

f4756f6c-1fe1-455c-a0a6-03aee2af98da

All of the following are drugs for ATT except ?

Kanamycin

Cycloserine

5-flucytosine

Ofloxacin

2c

multi

Ans. is 'c' i.e., 5-flucytosine Antitubercular drugs o First line --> Isoniazid, rifampin, ethambutol, streptomycin, pyrazinamide. o Second line --> Thiacetazone, PAS, ethionamide, cycloserine, kanamycin, amikacin, capreomycin, ciprofloxacin, ofloxacin, clarithromycin, Azithromycin, rifabutin.

Pharmacology

c4a20ef2-c3fb-45b2-931a-41fd199cfea4

Which of the following are acid fast positive with 20% sulphuric acid:

M. avium

M. leprae

M. tuberculosis

Nocardia

2c

single

Ans. (c) M. tuberculosis Features M. tuberculosis M. leprae Acid fastness Resist decolorization by 20% H2SO4 Resist decolorization by 5% H2SO4 Alcohol fastness Present Absent Culture Possible Not possible Niacin Positive (also some strain of M. microti) Negative Generation time 14-15 hours 12-1 3 days Remember:- Nocardia resist 1-4% of sulphuric acid (weakly acid fast).

Microbiology

6062be99-c46d-49cd-b5c9-28cb71fe84e8

True about measles –

Koplik spot appears in prodromal stage

Fever stops after onset of rash

Vaccine given at 9 month

All the above

3d

multi

Measles vaccine is given at the age of 9 months of age.

Pediatrics

91d1ea30-df10-4e1c-b5ff-a00b7ca8439b

In acute knee injuries with swelling and hemahrosis with muscle spasm, which of the following tests in most sensitive to detect anterior cruciate ligament injury?

Lachman's test

Pivot shift test

Apley's grinding test

Anterior drawer test

0a

single

The Lachman test is the most sensitive and specific clinical test for anterior cruciate ligament injury. It is especially useful because it can be performed even in an acutely painful knee when the knee is painful and swollen. Ref: Campbell's Operative Ohopaedics, 11th Edition, Page 2440; Rockwood and Green's Fractures in Adult, 5th Edition, Pages 1902-3; Physical Medicine and Rehabilitation Board Review, Sara J. Cuccurullo, 2nd Edition, Chapter 4, Musculoskeletal Medicine, Page 240

Surgery

bb43aab9-3cec-4d2c-87d0-f5579466ad58

Which of the following antitubercular drugs do not need to be adjusted in presence of renal failure ?

Rifampicin

INH

Ethambutol

Pyrazinamide

0a

single

Ans. is 'a' i.e., Rifampicin o Antitubercular drugs which do not require dose adjustment in renal failure : Rifampicin Rifabutin Rifapentine

Pharmacology

a6fe860e-9613-4ff4-ba48-852bcf6ca3d0

An acutely ill 18-year-old female is brought to the emergency depament. The patient is febrile and markedly hypotensive, and her mental status is obtunded. Numerous petechial and purpuric hemorrhages are scattered over the trunk, and aspiration of a lesion reveals neutrophils engulfing gram-negative diplococci. Serum sodium is markedly decreased, and serum potassium is increased. Coagulation testing reveals increased prothrombin time, activated paial thromboplastin time, and fibrin-fibrinogen split products. Which of the following is most likely?

Conn syndrome

Hyperprolactinoma

Neuroblastoma

Waterhouse-Friderichsen syndrome

3d

single

- Given pt is presenting with signs & symptoms of Waterhouse Friderichsen syndrome, a devastating consequence of disseminated meningococcal infection. - This disease is characterized by hemorrhagic destruction of adrenals complicated by disseminated intravascular coagulation.

Pathology

Adrenal Gland

79da52b8-5aa9-4577-96e7-c9dc32f3d76d

Which of the following is an example of a reverse transcriptase?

Gyrase

Helicase

Telomerase

RNA polymerase

2c

single

Telomerase reverse transcriptase (abbreted to TE, or hTE in humans) is a catalytic subunit of the enzyme telomerase, which, together with the telomerase RNA component (TERC), comprises the most impoant unit of the telomerase complex. Telomerases are pa of a distinct subgroup of RNA-dependent polymerases. Telomerase lengthens telomeres in DNA strands, thereby allowing senescent cells that would otherwise become postmitotic and undergo apoptosis to exceed the Hayflick limit and become potentially immoal, as is often the case with cancerous cells. To be specific, TE is responsible for catalyzing the addition of nucleotides in a TTAGGG sequence to the ends of a chromosome's telomeres. This addition of repetitive DNA sequences prevents degradation of the chromosomal ends following multiple rounds of replication.

Biochemistry

Enzymes

72b85236-72c8-4e5e-a221-3ce1bd7fc1ea

Amino acid used in the synthesis of purines ?

Glycine

Ornithine

Alanine

Threonine

0a

single

Ans. is 'a' i.e.,Glycine Amino acids involved in purine synthesis - Glycine, aspaate, glutamine.Amino acids involved in pyrimidine synthesis - Glutamine, aspaic acid (aspaate).

Biochemistry

4b82d462-ad1b-4c7a-b24d-e2f78e74b418

Which of the following is true about Non-specific interstitial pneumonia?

Early appearance of honey combing on CT

Males are affected more commonly than female

Common in elderly age group

Associated with good prognosis

3d

multi

Ans. d. Associated with good prognosis Non-specific interstitial pneumonia is associated with good prognosis. `Nonspecific interstitial pneumonia (NSIP) patients have diffuse interstitial lung disease of unknown etiology whose lung biopsies fail to show diagnostic features of any of the other well-characterized interstitial diseases. It is impoant to recognize it, since these patients have a much better prognosis than do those with Usual Interstitial Pneumonia Nonspecific Interstitial Pneumonia Nonspecific interstitial pneumonia (NSIP) patients have diffuse interstitial lung disease of unknown etiology whose lung biopsies fail to show diagnostic features of any of the other well-characterized interstitial diseases. It is impoant to recognize it, since these patients have a much better prognosis than do those with Usual Interstitial Pneumonia (UIP) Nonspecific Interstitial Pneumonia Morphology Cellular pattern Fibrosing pattern Consists of mild to moderate chronic interstitial inflammation, containing lymphocytes and a few plasma cells with uniform or patchy distribution Consists of diffuse or patchy, interstitialfibrosis without the temporal heterogeneity that is characteristic of UIP. Clinical Features: Patients present with dyspnea and cough of several months duration. They are typically between 46 and 55 years of age, those having the NSIP cellular pattern being somewhat younger than those with fibrosing pattern or UIP. Patients with cellular pattern have a better outcome than do those with fibrosing pattern and UIP.

Medicine

b28130ab-1f97-4a49-a0c6-7c39ff59fc6f

Deep branch of ulnar nerve supplies

Adductor pollicis

Flexor digitorum superficialis

1st Lumbrical

2nd Lumbrical

0a

single

Muscles supplied by deep branch of ulnar nerve are - Muscles of hypothenar eminence, medial two lumbricals , 4-1 dorsal interossei muscles and 4-1 palmar interossei and adductor pollicis 1st and 2nd lumbricals are supplied by digital nerves from median nerve. Nerve supplying flexor digitorum superficialis comes from median nerve in the cubital fossa. B D Chaurasia 7th edition Page no: 182

Anatomy

Upper limb

392d96fc-7831-4751-ab5e-3da2d6d2f775

Larvae of Ascaris lumbricoidis most commonly causes?

Cardiac symptoms

Respiratory symptoms

Genitourinary symptoms

Cerebral symptoms

1b

single

Ans. is 'b' i.e., Respiratory symptoms Clinical manifestations of ascariasis can be divided into two groups :- Due to adult worm : Adult worm causes malnutrition, abdominal pain, anorexia, intestinal obstruction, appendicitis, obstructive jaundice, pancreatitis, intestinal perforation and allergic manifestations. in Due to migrating larva : Loeffler's syndrome (eosinophilic pneumonia).

Microbiology

c6de33e2-837e-4fee-bdd0-801a354bb256

Acute adrenal insufficiency can present as

Acute abdomen with abdominal tenderness, nausea, vomiting and fever

Neurologic disease with decreased responsiveness progressing to stupor and coma

Hypovolemic shock

All of the above.

3d

multi

Ans. is 'd' i.e., All of the above Presentation in Acute Adrenal Insufficiency* Acute adrenal insufficiency usually occurs after a prolonged period of nonspecific complaints and is more frequently observed in patients with primary adrenal insufficiency, due to the loss of both glucocorticoid and mineralocorticoid secretion.* Postural hypotension may progress to hypovolemic shock.* Adrenal insufficiency may mimic features of acute abdomen with abdominal tenderness, nausea, vomiting, and fever.* In some cases, the primary presentation may resemble neurologic disease, with decreased responsiveness, progressing to stupor and coma.* An adrenal crisis can be triggered by an intercurrent illness, surgical or other stress, or increased glucocorticoid inactivation (e.g., hyperthyroidism).

Medicine

Endocrinology

5a9d0548-367f-4baa-b501-a55ed3bcd2cd

OATP 1B1/2 gene mutation is seen in

Gilbert syndrome

Rotor syndrome

Crigler Najjar syndrome

Dubin Johnson syndrome

1b

single

OATP 1B1/2 gene mutation - Rotor syndrome ABCCA gene mutation - Dubin johnson syndrome

Pediatrics

0f3631eb-3da3-4e47-a9ba-32743802efbd

Definitive diagnosis of Hirschsprung's disease is done by?

Rectal Manometry

Barium enema

Rectal Biopsy

Enteroclysis

2c

single

Hirschsprung's disease - is characterised by the absence of ganglionic cells in the distal colon and rectum - it occurs due to the failure of migration of neural crest cells to distal bowel segments - affects cells in both - myenteric and submucosal plexuses - functional obstruction developes in the affected pa. It can be anatomically divided into four types according to the length of the aganglionic segment: sho segment disease: ~75% rectal and distal sigmoid colonic involvement only long segment:~15% typically extends to splenic flexure/transverse colon total colonic aganglionosis:~7.5% (range 2-13%) also known as Zuezler-Wilson syndrome occasional extension of aganglionosis into the small bowel ultrasho segment disease 3-4 cm of internal anal spinchter only controversial entity - Definitive diagnosis :- by rectal biopsy Barium enema demonstrates cone shape transition zone and reversal of rectosigmoid ratio. Most impoant sign on barium enema is a sudden change of caliber from the narrow aganglionic segment and dilated proximal bowel

Radiology

Radiology Q Bank

86aa8e3e-1bc5-4702-874b-b957abed3ae9

Periaicular calcification is seen in -

RA

Pseudogout

OA

None of the above

1b

multi

Ans. is 'b' i.e., Pseudogout Periaicular soft tissue calcification Haematoma Crystal ahropathy (Gout, Pseudogout) Dermatomyositis Tumoral calcinosis Myositis ossificans Scleroderma Synol osteochondromatosis Synol sarcoma

Surgery

fbac09be-9d76-4818-b0c8-913f31c63b0c

Kaposi's sarcoma is a tumour of:

Blood vessels

Reticuloendothetial system

Striated muscles

Smooth muscles

0a

single

Pathology

ede9d3e7-b1bf-4f86-a0b8-bf9d4668517f

A patint complains of intermittent claudication,dizziness and headache,likely cardiac lesion is-

TOF

ASD

PDA

Coarctation of aoa

0a

single

Tetralogy of Fallot (TOF) is a cardiac anomaly that refers to a combination of four related hea defects that commonly occur together. The four defects are: Ventricular septal defect (VSD) Tetralogy of Fallot results in low oxygenation of blood. This is due to: Mixing of oxygenated and deoxygenated blood in the left ventricle the ventricular septal defect (VSD) Preferential flow of the mixed blood from both ventricles through the aoa because of the obstruction to flow through the pulmonary valve. This is known as a right-to-left shunt. Infants with TOF -a cyanotic hea disease- have low blood oxygen saturation.Blood oxygenation varies greatly from one patient to another depending on the severity of the anatomic defects.Typical ranges vary from 60% to around 90%.[Depending on the degree of obstruction, symptoms vary from no cyanosis or mild cyanosis to profound cyanosis at bih.If the baby is not cyanotic then it is sometimes referred to as a "pink tet".Other symptoms include a hea murmur which may range from almost imperceptible to very loud, difficulty in feeding, failure to gain weight, retarded growth and physical development, labored breathing (dyspnea) on exeion, clubbing of the fingers and toes, and polycythemiaThe baby may turn blue with breast feeding or crying. Ref Davidson 23rd edition pg 453

Medicine

C.V.S

b3ed22cc-f880-4088-92e3-1428ae0c964c

Which is true about Klebsiella infections?

Most clinical isolates are obtained from the respiratory tract.

Predisposing factors for Klebsiella pneumonia include alcoholism, diabetes mellitus

Klebsiella is closely related to Pseudomonas.

Detecting Klebsiella growth from a sputum culture obtained from an intubated patient mandates treat ment with an aminoglycoside or a third-generation cephalosporin.

1b

multi

Predisposing factors for Klebsiella .............. Klebsiella and the related Serratia and Enterobacter are the most impoant enteric organisms other than E. coli to infect humans. Although respiratory disease is impoant (Klebsiella accounts for 1 % or less of community-acquired pneumonia), most clinical isolates now come from the urinary tract. All three genera are impoant pulmonary nosocomial pathogens. However, merely finding these organisms growing in the sputum of a very ill hospitalized patient does not necessarily implicate the bacteria as pathogenic in that paicular circumstance and may indicate colonization rather than infection. Clinical context and procurement of the sample in a sterile fashion (transtracheal aspiration, bronchoscopy) will aid in the diagnosis Chronic alcoholics, diabetics, and those with chronic lung disease are at increased risk for Klebsiella pneumonia, a difficult disease to treat because of the frequency of suppurative complications (empyema and abscess) with the associated requirement for prolonged (>2 weeks) therapy.

Surgery

8feaad18-b321-4c37-a53a-28dd67b11e76

In which leukemia, autoimmune hemolytic anemia is most common

ALL

AML

CMIL

CLL

3d

multi

Medicine

b03ab06b-89ce-4b0c-8fd6-75d28ed9d1d8

Chronic Burrowing ulcer is caused by:

Microaerophilic streptococci

Peptostreptococcus

Streptococcus viridans

Streptococcus pyogenes

0a

single

Microaerophilic streptococci ''This type of ulcer is due to symbiotic action of tnicroaerophilic non-haemolytic streptococci and haemolytic staphylococcus aureus" - S. Das Chronic burrowing ulcers or Meleney's ulcers are seen in the post-operative wounds either after the operation for perforated viscus or for drainage of empyema thoracis. Clinicaly it is an undermined ulcer with lot of granulation tissue in the floor. This condition is painful, toxaemic, and the general condition deteriorates without treatment. Textbook of Surgery by ljazAhsan writes -"The microaerophilic streptococcus causes infections that develop slowly. Chronic burrowing ulcer and chronic cutaneous gangrene are good examples. Radical drainage is necessary .for cure, antibiotics alone being useless."

Surgery

dcec3266-75a5-4703-8bc8-95f9e263f079

Drug of choice for neurocysticercosis is:

Praziquantel

Albendazole

Levamisole

Piperazine

1b

single

Out of the two anthelmintics effective in killing cysticerci, albendazole is now preferred over praziquantel for the following reasons: * The course of treatment is shoer (8-15 day) compared to praziquantel (15-30 days). * Cure rates in terms of resolution of symptoms and disappearance of cysts are higher (75-85% with albendazole) than praziquantel (50-60%). * Coicosteroids (which have to be given concurrently) enhance the absorption of albendazole, but lower the blood levels of praziquantel. * Albendazole is cheaper. ESSENTIALS OF PHARMACOLOGY page no. 856

Pharmacology

Chemotherapy

8238a9e0-8857-484e-8c53-99b992a581d6

Which of the following about severe combined immunodeficiency is not true -

Due to deficiency of adenylate kinase

Toxicity to leucocytes due to accumulation of dAMP

Both cellular and humoral immunity affected

Bone marrow transplantation is the treatment

0a

multi

Ans. is 'a' i.e., Due to deficiency of adenylate kinase

Microbiology

6c50a254-76a3-4a75-87b1-04dd2907eb91

Strain of V. cholerae in Bengal -

0:37

0.096527778

0:17

0:40

1b

single

Microbiology

92b4442d-bfba-411d-a2d4-391795cec1af

The following radiograph shows:

Fusion in 22

Gemination in 22

Concrescence in 22

Dilaceration in 21

1b

single

Gemination Geminated teeth are anomalies which arise from an attempt at the division of a single tooth germ by an invagination, with resultant incomplete formation of two teeth. The structure is usually one with two completely or incompletely separated crowns that have a single root and root canal. It is seen in deciduous as well as permanent dentition, and in some reported cases, appears to exhibit a hereditary tendency. It is not always possible to differentiate between gemination and a case in which there has been a fusion between a normal tooth and a supernumerary tooth. Radiological signs The tooth has a notched incisal margin with a confluent or partially joined pulp canal system.

Radiology

4e6d187c-6bf9-4871-91b5-942bc2c77697

Pancreatitis is a common complication of which one of the following :

Zidovudine

Didanosine

Zalcitabine

Stavudine

1b

single

Pharmacology

4346f1f5-7d9d-4eeb-b7e3-8d0ca8cc030e

In Ulnar nerve injury in arm, all of the following are seen except?

Hypothenar atrophy

Adduction of thumb

Loss of sensation of medial 1/3 of the hand

Claw hand

1b

multi

Adduction of thumb. Injury to the Ulnar nerve Ulnar nerve is most commonly injured at the elbow, where it lies behind the medial epicondyle and at the wrist where it lies in front of flexor retinaculum. In high ulnar nerve injury at or proximal to elbow, all the muscles supplied by the ulnar nerve in the forearm and hand are paralyzed whereas in low ulnar nerve palsy, there is sparing of the forearm muscles (in flexor carpi ulnaris and flexor digitorum profundus). Sensory deficit are same in both high & low ulnar nerve injury.

Anatomy

46b3af93-b838-4696-b024-98cf1999793a

True about sickle anemia is?

Leucopenia

Decreased ESR

Microcardia

Ringedsideroblast

1b

multi

Ans. is 'b' i.e., Decreased ESR Investigation1) Peripheral smear shows sickle cells, target cells and Howell - Jolly bodies.2) ESR is decreased (only important anemia in which ESR is decreased, in most of other anemias ESR is increased).3) There is positive sickling test with a reducing substance like sodium metabisulfite.4) Hb electrophoresis shows two bands in heterozygous state/sickle cell trait (40% HbS & 60% HbA) and one bands in homozygous state (only HbS). HbS is slower moving than HbA towards positive electrode.5) Bone changes on X-ray showA. Fish mouth vertebraeB. Crew hair cut (hair on end) appearance of skull.(Hair on end appearance' is also seen in thalassemia, hereditary spherocytosis and G6PD deficiency.)6)There may be cardiomegaly and leukocytosis.7) Gamma Gandy bodies (nodules of hemosiderine and calcium deposition in spleen) are found.

Pathology

Hemolytic anemia

5b479f21-f41e-4335-93a1-f2950332776d

Drug of choice for acute severe asthma is:-

Sho acting beta 2 agonists

Long acting beta 2 agonist

Oral theophylline

Inhaled ipratropium bromide

0a

single

Sho acting beta 2 agonists like salbutamol are drug of choice for acute severe asthma Condition Drug of choice Bronchial Asthma Acute attack Salbutamol Acute attack in pregnancy Salbutamol Acute attack during labour Ipratropium Acute attack in patients on beta blocker therapy Ipratropium Prophylaxis Coicosteroids Exercise-induced asthma Acute attack Salbutamol Prophylaxis Coicosteroids Aspirin-induced asthma Acute attack Salbutamol Prophylaxis Coicosteroids Brittle asthma Type 1 S.C. Terbutaline infusion Type 2 S.C. Adrenaline

Pharmacology

Respiratory System

f320f7fc-7a5b-4808-b4a1-350fe4e6505f

A factor that is likely to increase the duration of action of a drug D that is partially metabolized by CYP3A4 in the liver is:

Chronic administration of phenobarbital with the drug

Chronic administration of cimetidine with the drug

Displacement from tissues binding sites by another drug

Chronic administration of rifampicin

1b

multi

- Microsomal enzyme inducers- Rifampicin, Phenobarbital- will increase the activity of enzymes, leading to decreased duration of action of a drug. - Microsomal enzyme inhibitor- Cimetidine- will decrease the activity of enzyme resulting in increased duration of action of the drug. - A drug displaced from the binding site gets easily metabolized.

Pharmacology

e049bbe8-c45b-4e17-b661-51d664fc1377

The number of muscle fibers innervated by a motor axon is smallest in

Gastrocnemius

Orbicularis oculi

Single unit smooth muscle

Soleus

1b

multi

The extraocular and hand muscles have an innervations ratio of 3 to 6 whereas gastrocnemius and back muscle has a ratio of 2000.(Refer Medical Physiology by Guyton & Hall, 12th edition, page no: 96)

Physiology

General physiology

6fd68fbf-c7c2-45b0-8eea-fab91229c93c

This arrangement of myofibrils are found in

Dilated cardiomyopathy

Constrictive cardiomyopathy

Fibroelastic cardiomyopathy

Hyperophic cardiomyopathy

3d

single

Refer robbins 9/e 569 Hyperophic cardiomyopathy (HCM) is a disease in which the hea muscle (myocardium) becomes abnormally thick (hyperophied). The thickened hea muscle can make it harder for the hea to pump blood. Hyperophic cardiomyopathy often goes undiagnosed because many people with the disease have few, if any, symptoms and can lead normal lives with no significant problems. However, in a small number of people with HCM, the thickened hea muscle can cause shoness of breath, chest pain or problems in the hea's electrical system, resulting in life-threatening abnormal hea rhythms (arrhythmias).

Anatomy

Cardiovascular system

d2b0c512-eccb-4915-99c1-3477d9f71074

Which of the following may cause biliary obstruction -

Ancylostoma

Entrobius

Strongyloides

Clonorchis

3d

single

In most cases the disease tends to remain low grade and chronic producing only minor symptoms of abdominal distress,intermittent diarrhea and liver pain or tenderness.C.sinensis has been linked to bile duct carcinoma.It is mostly observed in areas where clonorchiasis is endemic (refer pgno:126 baveja 3 rd edition)

Microbiology

parasitology

350e4125-a353-4a15-a87f-d12676990c3b

False regarding Parasuicide?

Also known as attempted suicide

Mostly seen in psychological disturbances

Conscious, impulse, manipulative act to get rid of an intolerable situation

Hanging is the most common form

3d

multi

Also known as attempted suicide/ pseudocide. Mostly seen in psychological disturbances. Conscious, impulse, manipulative act to get rid of an intolerable situation. POISONING ( drug ingestion )is the most common form.

Forensic Medicine

Toxicology - 1

1a4f8ece-02f0-47b9-8a7b-3e9c13763061

Intra-tumoral calcification in the brain is seen in all except?

Craniopharyngioma

Meningioma

Oligodendroglioma

Hemangioblastoma

3d

multi

Intratumoral calcification develops in the slow-growing tumors like Craniopharyngioma Meningioma Oligodendroglioma -Hemangioblastoma is a highly vascular tumor.

Medicine

Intracranial Space Occupying Lesion

32e97b5f-3ca2-4e78-9996-c28f54292cb9

Most common type of supracondylar fracture in children

Posteromedial extension

Posterolateral extension

Anteromedial flexion

Anterolateral flexion

0a

single

One of the most serious fractures in childhood. Caused by fall on an out stretched hand. Fracture line extends transversely through the distal metaphysis of humerus just above the condyles. The distal fragment may be displaced in the following directions: Posterior or backward shift Posterior tilt Proximal shift Medial or lateral shift Medial tilt Internal rotation Ref: Maheshwari and Mhaskar 6e pg 97

Orthopaedics

Elbow injuries

f295cb33-ca3c-4b1d-9118-97a4ccc3686d

Soap bubble appearance at lower end of radius, the treatment of choice is:

Local excision

Excision and bone grafting

Amputation

Radiotherapy

1b

single

Treatment for GCT at commoner sites is as given in Table Site Treatment of choice Lower end of femur Excision with Turn-o-Plasty Upper end of tibia Excision with Turn-o-Plasty Lower end of radius Excision with fibular grafting Lower end of ulna Excision Upper end of fibula Excision

Surgery

3960176e-dfc6-4edb-87dd-24470703261f

Oncocytes are found in all of the following, except:

Thyroid

Kidneys

Pituitary

Pineal body

3d

multi

Pineal body

Pathology

46ccf360-09b3-4f2b-b29b-b8f7c355df5e

If a Mandibular canine has bifurcated roots, they are most commonly placed:

Mesial and distal

Facial and lingual

Mesiobuccal and distobuccal

Mesiolingual and distolingual

1b

single

Dental

e741b3dd-83be-43c7-88b5-63c94b150d7a

True statement about esophageal varices is:

90 % of cirrhotic patients have varices at the time of diagnosis

Bleeding cirrhotic varices moality is 90%

Variceal hemorrhage is the most common fatal complication of cirrhosis

Varices is not possible in the absence of cirrhosis

2c

multi

Epidemiology of esophageal varices and correlation with liver disease At the time of diagnosis, 30% of cirrhotic patients have esophageal varices, and 90% after approximately 10 years. Bleeding from esophageal varices is associated with a moality rate of 20% at 6 weeks, Variceal bleeding is the most common fatal complication of cirrhosis. Some patients develop varices and hemorrhage early in the course of the disease, even in the absence of cirrhosis. Ref: WGO Practice Guidelines Esophageal varices

Medicine

dae90013-4f75-4411-916a-c58d017c38e0

Which of the following drug is NOT effective against chemotherapy induced vomiting?

Aprepitant

Hyoscine

Metoclopramide

Ondansetron

1b

single

Ans. (b) HyoscineRef: KDT 6th ed. / 646-47

Pharmacology

Anti-Neoplastic Agents

2cc2667e-1a5b-4070-b0a5-1e0414cc1016

A patient presents with acute renal failure with normal ultrasound abdomen repo Next most useful investigation is-

Intravenous pyelography

DTPA scan

Retrograde pyelography

X-ray abdomen and CT scan.

1b

single

DTPA A renal scan involves the use of radioactive material to examine your kidneys and assess their function. A renal scan is also known as a renal scintigraphy, renal imaging, or a renogram. During this procedure, a technician injects a radioactive material called a radioisotope into your vein. The radioisotope releases gamma rays. A gamma camera or scanner can detect gamma rays from outside your body. The gamma camera scans the kidney area. It tracks the radioisotope and measures how the kidneys process it. The camera also works with a computer to create images. These images detail the structure and functioning of the kidneys based on how they interact with the radioisotope. Images from a renal scan can show both structural and functional abnormalities. This helps doctors diagnose a kidney problem in its earlier stages without invasive techniques or surgery Ref Harrison20th edition pg 223

Medicine

Kidney

6738d961-f289-432a-942e-2c4f832a2348

A Patient presented with Hypokalemia, Severe Hypertension, and Metabolic Alkalosis. The diagnosis is

Liddle syndrome

Bartter syndrome

Gitelman syndrome

Renal tubular acidosis

0a

single

(A) Liddle syndrome[?]Liddle's Syndrome: Autosomal dominant & is characterized by activating mutation of collecting duct Na+ channel with enhanced sodium reabsorption.oLow renin, low aldosterone levels.oClinical picture mimics Primary Hyperaldosteronism: Hypertension, Hypokalemia & Alkalosis.oIncreased activity of the Epithelial Sodium Channel (E-Na Ch):-Activating kidneys to excrete potassium retaining excessive sodium & water, leading to hypertension.-Classically manifest severe hypertension with hypokalemia, unresponsive to spironolactone yet sensitive to amiloride.oHypertension & hypokalemia are, however, variable aspects of the Liddle's phenotype; more consistent features include a blunted aldosteirone response to ACTH & reduced urinary aldosterone excretion.oIt is a 'gain of function' mutation in the gene encoding ENaC of the collecting tubule resulting in autonomous function of these channel without the influence of aldosterone.oCan be differentiated from Primary Hyperaldosteronism by normal Na+ level and low aldosterone and reninOther OptionsCONGENITAL HYPOKALEMIA ASSOCIATED SYNDROMES[?]Bartter's Syndrome (BS):-Loss of the transport functions of the TALH nephron segments causes hereditary hypokalemic alkalosis.-Typically suffer from polyuria & polydipsia, due to the reduction in renal concentrating ability. May have an increase in urinary calcium excretion & 20% are hypomagnesemia-Marked activation of the renin-angiotensin-aldosterone axis.-Antenatal patients suffer from marked electrolyte wasting, polyhydramnios, and hypercalciuria with nephrocalcinosis; renal prostaglandin synthesis and excretion are significantly increased, accounting for much of the systemic symptoms.-Presence of five disease genes for BS, all of them functioning in some aspect of regulated Na+,K+ & Cl- transport by the TALH.[?]Gitelman's Syndrome (GS):-Loss of the transport functions of the DCT nephron segments causes hereditary hypokalemic alkalosis.-Genetically homogeneous, caused almost exclusively by loss-of-function mutations in thiazide-sensitive Na+-Cl- co transporter of DCT.-Uniformly hypomagnesemic & exhibit marked hypocalciuria, rather than the hypercalciuria typically seen in BS; urinary calcium excretion is thus a critical diagnostic test in GS.-May suffer from chondrocalcinosis, an abnormal deposition of Calcium Pyrophosphate Dihydrate (CPPD) in joint cartilage.[?]Distal Renal Tubular Acidosis:-Defects in multiple renal tubular transport pathways are associated with hypokalemia.-Loss-of-function mutations in subunits of the acidifying-H+-ATPase in alpha-intercalated cells cause hypokalemic distal renal tubular acidosis, as do many acquired disorders of the distal nephron.[?]Cushing's Syndrome:-Hypokalemia may also occur with systemic increasing in glucocorticoids.-Increase in pituitary ACTH incidence of hypokalemia is only 10%, whereas, 60-100% in patients with ectopic secretion of ACTH.

Medicine

Fluid & Electrolyte

e2e81f58-1d3f-4e1a-b0a9-db16a38482fa

Scabies is caused by a small mite that burrows into the skin. The disease is best described by which one of the following statements?

It is caused by a species of Sarcoptes

Secondary bacterial infection is rare

It is synonymous with Kawasaki's syndrome

It is best diagnosed by biopsy of the inflammatory region around the mite bite

0a

multi

Sarcoptes scabiei is a small mite that burrows into human skin. Itching is significant, and a vesicular eruption, which often becomes secondarily infected with bacteria, develops. Diagnosis is made by microscopic detection of the mites. Gamma benzene hexachloride (Kwell), a topical insecticide, is an effective treatment for scabies. A number of etiologic agents have been proposed for Kawasaki's disease (KD), among them mites, but there is no evidence that mites either cause or are vectors of KD.

Microbiology

Parasitology

00d998a8-acd5-4f4b-9d0b-af02dea93eef

Where is bruit heard in thyroid gland

Upper pole

Lower pole

Middle pole

Lateral side

0a

single

Thrill is felt in the upper pole of the thyroid and also bruit on auscultation. It is because in the upper pole, superior thyroid aery enters the gland superficially and so thrill and bruit can easily be felt. In the lower pole inferior thyroid aery enters the gland from deeper plane and so thrill cannot be felt. Reference: SRB's Manual of Surgery, 6th Edition, page no = 463.

Surgery

Endocrinology and breast

f8072d53-9043-4e99-bc97-b4eb577b3a5a

Which of the following enzyme is constituent of HMP shunt

Glucose 6 Phosphatase

Hexokinase

G6P dehydrogenase

Phosphorylase

2c

single

Biochemistry

29ab53ac-5e21-47fd-802d-254913e484b6

A 45 year old man presents to a physician with back pain and facial pain. Physical examination demonstrates coarse facial features and kyphosis. Laboratory examination is remarkable for elevated alkaline phosphatase. .X-ray studies demonstrate skull thickening with narrowing of foramina, and bowing of the femur and tibia. Bone biopsy reveals a mosaic pattern of bone spicules with prominent osteoid seams. Which of the following neoplasms occurs at an increased frequency in patients with this disorder?

Astrocytoma

Hodgkin's lymphoma

Meningioma

Osteosarcoma

3d

single

The phrase "mosaic pattern" of newly formed woven bone is a specific tip-off for Paget's disease of bone, and is not seen in other bone conditions. The clinical and radiologic presentation are typical; an increased hat size may also be a clue. In its early stages, Paget's disease is characterised by osteolysis, producing patchwork areas of bone resorption with bizarre, large osteoclasts. In the middle stage of the disease, secondary osteoblastic activity compensates with new bone formation, producing the mosaic pattern. In late Paget's, the bones are dense and osteosclerotic. Paget's disease is suspected to be related to prior viral infection, but the cause remains mysterious. Complications include myelophthisic anemia, high output cardiac failure, pain secondary to nerve compression, deformities secondary to skeletal changes, and in about 1% of patients, osteosarcoma or other sarcoma, typically involving the jaw, pelvis, or femur. An increased incidence of astrocytomas is associated with tuberous sclerosis.Hodgkin's lymphoma is usually a disease of young adults, although older patients may have the lymphocyte-depleted form.Meningiomas are mostly benign tumors that affect adults, especially females. There may be an association with breast cancer, possibly related to high estrogen states. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 19. Pathology of the Bones and Joints. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture.

Pathology

65dad4a4-4248-40d7-9f9d-15e31b760bdd

Pubic symphysis is which type of joint

Synol

Fibrous

Cailaginous

Syndesmoses

2c

single

Primary cailaginous joints Known as "synchondroses". These bones are connected by hyaline cailage and sometimes occur between ossification centers.This cailage may ossify with age.Examples in humans are the "growth plates" between ossification centers in long bones. These joints here allow for only a little movement, such as in the spine or ribs.Secondary cailaginous joints Known as "symphysis". Fibrocailaginous and hyaline joints, usually occurring in the midlineExamples in human anatomy would be the manubriosternal joint (between the manubrium and the sternum), interveebral discs, and the pubic symphysis.

Anatomy

General anatomy

e0934d5e-6c6c-4240-b038-0700beab46e9

Most common cause of urinary tract infection in children is -

EColi

Klebsiella sp.

Psedomonas Aerognosa

Candida

0a

single

Ans. is 'a' i.e., E Coli o Bacterial infections are the most common cause of UTI, with E coli being the most frequent pathogen, causing 75- 90% of UTIs. Other bacterial sources of UTI include the following:# Klebsiella species# Proteus species# Enterococcus species# Staphylococcus saprophyticus, especially among female adolescents and sexually active females# Streptococcus group B, especially among neonates# Pseudomonas aeruginosao Fungi (Candida species) may also cause UTIs, especially after instrumentation of the urinary tract. Adenovirus is a rare cause of UTI and may cause hemorrhagic cystitis.

Pediatrics

Urinary Tract Infections

35c25ee1-d16c-4862-a482-1098c14c1494

Deep perineal pouch in males does not include:

Pudendal nerve

Sphincter urethrae

Long perineal nerve

Dorsal nerve of penis

2c

single

Coronal section of pelvis. Deep perineal pouch is located between the superior and inferior layers of the urogenital diaphragm. Long perineal nerve is located in the superficial perineal pouch. Contents of deep perineal pouch in males:Muscles - Sphincter urethrae, Deep transversus perineiNerves - Dorsal nerve of penis, muscular branch from perineal nerveVessels - Deep and dorsal aeries of penis, stem of origin of aery to the bulb of penis, urethral aery

Anatomy

Abdomen, Pelvis and Perineum

b0d9aab1-ba98-43a7-be87-742c4e6e8826

A multipara developed postpaum haemorrhage (PPH) during her 3rd child bih. The most probable cause for her PPH is:

Fibroid

Retained placenta

Uterine atony

Uterine perforation

2c

single

Causes of postpaum hemorrhage include uterine atony, obstetric lacerations, retained placental tissue, and coagulation defects. Atony is the most common cause of postpaum hemorrhage (50% of cases). Predisposing causes include, Excessive manipulation of the uterus General anesthesia (paicularly with halogenated compounds) Uterine overdistension (twins or polyhydramnios) Prolonged labor Grand multiparity Uterine leiomyomas Operative delivery and intrauterine manipulation Oxytocin induction or augmentation of labor Previous hemorrhage in the third stage Uterine infection Extravasation of blood into the myometrium (Couvelaire uterus) Intrinsic myometrial dysfunction Ref: Poggi S.B. (2013). Chapter 21. Postpaum Hemorrhage & the Abnormal Puerperium. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

Gynaecology & Obstetrics

d98db46f-ff41-4765-a2e5-1bbf1a0d51ce

A child with hypopigmented hair and mentally retarded with mousy odour urine. Enzyme deficient is?

Cystathione synthase

Tyrosine hydroxylase

Phenylalanine hydroxylase

Tyrosine transaminase

2c

multi

(C) Phenyalanine hydroxylase # PHENYLKETONURIA: phenylalanine hydroxylase deficiency.> Disease presents clinically with seizures, hypo pigmentation, musty odour to baby sweat and urine(due to phenylacetate, a carboxylic acid produced by oxidation of phenylketone).> Phenylalanine is first converted to tyrosine.> Hyper phenylalaninemias arise from defects in phenylalanine hydroxylase,(type I, classic phenylketonuria (PKU), frequency 1 in 10,000 births), in dihydrobiopterin reductase (types II and III), or in dihydrobiopterin biosynthesis (types IV and V).> Alternative catabolites are excreted.> Diet low in phenylalanine can prevent the mental retardation of PKU.> DNA probes facilitate prenatal diagnosis of defects in phenylalanine hydroxylase or dihydrobiopterin reductase.> Elevated blood phenylalanine may not be detectable until 3 to 4 days postpartum.> False-positives in premature infants may reflect delayed maturation of enzymes of phenylalanine catabolism.> An older and less reliable screening test employs FeCI3 to detect urinary phenylpyruvate.> FeCI3 screening for PKU of the urine of newborn infants is compulsory in many countries, but in the United States has been largely supplanted by tandem mass spectrometry.

Biochemistry

Miscellaneous (Bio-Chemistry)

7fe22ca2-5ae5-4342-82f4-15f35ec7c1ad

Transcription is the synthesis of

Single stranded complimentary copy of DNA

Double stranded complimentary copy of DNA

Complimentary copy of RNA

Complimentary copy of rRNA

0a

single

Biochemistry

39d81a9f-686c-4b84-a2d8-26f64887f446

Surgery used to treat posterior capsular Opacification is

Laser Posterior Capsulotomy

Extracapsular cataract Extraction

Phacoemulsification

Lensectomy

0a

single

Posterior Capsular opacification is a complication of Cataract surgery. Treatment is Nd : YAG laser posterior capsulotomy.

Ophthalmology

0e09f58f-adb1-4f41-8878-a095b3c01511

A patient develops acute respiratory distress, stridor, hyperinflation on one side of chest with decreased breath sound on that side. Most likely cause is :

Asthma

Aspiration pneumonia

Foreign body aspiration

Pleural effusion

2c

single

Ans. is 'c' i.e Foreign Body Aspiration Foreign Body Aspiration :It is an important cause of stridor in children.If obstruction occurs it leads to hyperinflation.The overlying chest wall shows hyperresonance.There will be decreased breath sounds.All the other choices mentioned in the question do not cause stridor.Asthma - It is bilateral, There is no stridor (wheezing is present)Aspiration Pneumonia - In Pneumonia there is consolidation of the lung, instead of hyperinflation there is dullness present.Pleural effusion - Dullness is present instead of Hyperinflation. PercussionBreath soundVoice transmissionAdventitious soundForeign body aspirationHyperresonantDecreased Aspiration pneumoniaDullDecreasedDecreasedAbsentAsthmaHyperresonantVesicularNormalWheezingPleural effusionDullDecreasedDecreasedAbsent or pleural friction rubPneumothoraxDullDecreasedDecreasedAbsent or pleural friction rubEmphysemaHyperresonantDecreasedDecreasedAbsent or wheezing

Medicine

C.N.S.

f16a84c1-d8b9-4e11-b8ae-f1bebcc67e0f

Local vasoconstriction is seen with:

Cocaine

Lignocaine

Bupivacaine

Mepivacaine

0a

single

Cocaine is sympathomimetic and thus causes vasoconstriction. Cocaine is a local anesthetic with potential for abuse. It produces euphoria by inhibiting the uptake of catecholamines in the CNS, especially dopamine. Because of its abuse potential, cocaine is listed as a schedule II controlled substance by the U.S. Drug Enforcement Agency. Because of its abuse liability and high toxicity, cocaine use is limited to topical anesthesia of the upper respiratory tract. It is available as 1%, 4% and 10% solutions for topical use. It has intrinsic vasoconstrictor propeies along with local anesthetic propeies.

Anaesthesia

Regional Anesthesia

fa55715d-8586-4e07-bc16-f897d66d44e8

Which of the following drugs combination shows antimicrobial synergism?

Penicillin + Streptomycin in SABE

Ampicillin + Tetracycline in endocarditis

Sulfamethoxazole + Trimethoprim in UTI

Amphotericin B + Flucytosine in cryptococcal meningitis

0a

single

Every AMA has a specific effect on selected microorganisms. Depending on the drug pair as well as the organism involved, either synergism (supra-additive effect), additive action, indifference or antagonism may be observed when two AMAs belonging to different classes are used together Every combination is unique; the same drugs may be synergistic for one organism but antagonistic for another. However, general guidelines are: (a) Two bacteriostatic agents are often additive, rarely synergistic,i.e. combination of tetracyclines, chloramphenicol, erythromycin, etc. (b) Two bactericidal drugs are frequently additive and sometime synergistic if the organism is sensitive to both, e.g.: * Penicillin/ ampicillin + streptomycin/ gentamicin or vancomycin + gentamicin for enterococcal SABE. Penicillins by acting on the cell wall may enhance the penetration of the aminoglycoside into the bacterium (c) Combination of a bactericidal with a bacteriostatic drug may be synergistic or antagonistic depending on the organism ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:677

Pharmacology

Chemotherapy

e3bedef4-47de-45df-9bf2-58e005643a3d

Penal code for death sentence is ?

300

302

304

306

0a

single

Ans. is 'a' i.e., 300

Forensic Medicine

4b755cb5-e40d-4582-9a38-34528975f5e5

Sentinel lymph node is defined as

Primary LN draining tumor

LN which is first excised during MRM

LN nearest to tumor

None

0a

multi

The first axillary lymphnode draining the breast (by direct drainage) is designated as sentinel lymph node. SLN is first node involved by tumour cells and presence or absence of its histological involvement when assesed will give a predictive idea about fuher spread of tunour to other nodes. SRB's Manual of Surgery.Edition -5. Pg no:543

Surgery

Endocrinology and breast

69d0d0a7-e932-4212-a54c-fc0ee2bd9aa9

Ramesh singh, a 40 yrs old man, was admitted with fracture shaft femur following a road traffic accident. Three days after tauma he was tachypnoeic, and had conjunctival petechiae. Most likely diagnosis is ?

Pulomary embolism

Sepsis syndrome

Fat embolism

Hemothorax

2c

single

Ans. is 'c' i.e., Fat embolism This patient in question has femur fracture has developed classical triad of fat embolism :- Respiratory symptom :- Tachypnea Neurological symptom :- Disorientation Petechial rash :- Conjunctivalpetechiae So, the most probable diagnosis is fat embolism syndrome.

Surgery

8b8d4057-66f6-4938-8a36-0e0e3dcb9cd7

False about Angurugu syndrome is

Associated with manganese toxicity

Characterised by UMN lesions, cerebellar signs, oculomotor symptoms

Seen in western Australia

None of the above

3d

multi

ANGURUGU SYNDROME: Associated with manganese toxicity Characterised by UMN lesions, cerebellar signs, oculomotor symptoms Seen in western Australia

Forensic Medicine

Toxicology - 1

5d7f390a-709a-461a-8719-67cfabbeb195

Basanti, 27 year female thinks that her nose is ugly. Her idea is fixed and is not shared by anyone else. Whenever she goes out of the home, She hides her face? She visits a surgeon for plastic surgery. The appropriate next step would be:-

Investigate and then operate

Reassure the patient

Immediate operation

Refer to psychiatrist

3d

multi

This appears to be a case of delusional disorder, somatic type. Its impoant to differentiate it from body dysmorphic disorder. here, the question says that idea is fixed and is not shared by anyone else and patient is fuher hiding her face when visiting outside. In body dysmorphic disorder, the belief is not fixed and may be at least temporarily changed by reassurances of others.

Psychiatry

Schizophrenia Spectrum and Other Psychotic Disorders

0723a62a-db4a-46a0-a667-84d368a1ecb0

Which of the following is responsible for green color on antibiotic disk sensitivity testing?

Pyoverdin and pyocyanin

Pneumolysin

Optochin

Alpha hemolysin

0a

single

Ans. (a) Pyoverdin and pyocyanin.* Pseudomonas produce pigments by the name of pyoverdin and pyocyanin leading to greenish pigmentation in culture plate.* Pneumococci produce pneumolysin that break downs hemoglobin into a green pigment. This causes pneumococcal colonies to be surrounded by green zone during growth on blood agar plates. The plate in question is not blood agar.Image source- style="font-family: Times New Roman, Times, serif">

Microbiology

Pseudomonas

7439aa66-9d98-4868-a9b6-2ed6f9b68505

Which of the following is not a neuroparasite?

Acantamoeba

Naegleria fowleri

Taenia solium

Trichinella spiralis

3d

single

Trichinella spiralis is not a neuro parasite, it is seen in striated muscles. It causes trichinosis. Pigs are the most impoant reservoirs of human disease. Humans are infected by eating raw or undercooked meat containing larvae encysted in the muscle. The larvae excyst and mature into adults within the mucosa of the small intestine. Eggs hatch within the adult females, and larvae are released and distributed the bloodstream to many organs; however, they develop only in striated muscle cells. Within the muscle cells they can remain ble for several years but eventually calcify. Ref: Review of Medical Microbiology and Immunology By Warren Levinson, 11th Edition, Chapter 56; Self Assessment and Review Microbiology Immunology Revision at a Glance By Chaurasia, 4th Edition, 2009, Page 407

Microbiology

16af5f0c-910f-49ac-ab59-4a81c6486349

How much ethinyl estriol does the new low dose oral contraceptive pill contain (in micrograms)

20

25

30

35

0a

single

Composition of 'New low dose OCP' : (Brand name : Femilon/Elogen) Ethinyl estradiol: 0.02mg (20 mcg) Desogestrel: 0.15mg(150 mcg) Composition of Combined OCP: MALA-N Ethinyl estradiol: 0.03mg (30mcg) Norgestrel : 0.15mg (150mcg) Ref: Internet, Organon-India website

Social & Preventive Medicine

Demography and family planning

e3a75277-2eae-4104-9dd8-e1424a8df6e4

False about the precipitate formed as a result of reaction of chlorhexidine and NaOCl

Interferes with seal of obturation

Causes cyanosis

To prevent rinse canal with absolute alchohol

NaOCl is always used as final rinse

3d

multi

Dental

a1e4fef1-0b5d-4985-9a05-e8943c17c4f4

How is cooling curve of the body postmoem?

Parabola

Hyperbola

Sigmoid

Linear

2c

single

Ans. is 'c' i.e., Sigmoid Body cooling postmoem follows the Newton's law of cooling.The rates of cooling at the ends of the curve are slower than the rates in the mid poion - resulting in Sigmoidal shape of the cooling curve

Forensic Medicine

b5ae0188-af16-4d4d-bcf7-33e9f7a6d8d4

Most common cause of splenic rupture is -

Malaria

ITP

Thalassemia

Cirrhosis

0a

single

Most common cause of splenic rupture is Trauma. In the absence of trauma Spontaneous rupture of spleen occurs due to some minor physical insult to a spleen that has been rendered fragile by an underlying condition. The most common predisposing conditions are IMN, malaria, typhoid fever and lymphoid neoplasms.

Pathology

11af4a5d-3fbf-4e83-ae51-3f86905cce22

All of the following are contraindications for root planning EXCEPT

deficient or overhanging margins of amalgam restorations

erosion and /or abrasion

recession

root caries

2c

multi

Dental

a70c5d01-099a-4a24-8b7d-719d62ced1c2

Which of the following statements is true regarding hemangioma of the bone -a) Occurs common in skull bonesb) Requires observation as it is premalignantc) Hamartomous in origind) Forms 10-12% of the bone tumorse) Local gigantism occurs when it occurs in an extremity

acd

bde

ace

ade

2c

multi

Orthopaedics

80a5a35c-e901-41ff-b86f-d4da86151649

Increased serum calcium is seen in all except:

Myxedema

Multiple myeloma

Sarcoidosis

Primary hyperparathyroidism

0a

multi

Answer is A (Myxoedema): Hypercakemia is a feature of Hypehyroidism and not hypothyroidism (Myxoedema)

Medicine

e14e9810-befc-45ae-aca7-2f06c15aa23f

In a patient with AIDS, chorioretinitis is typically caused by

Cytomegalovirus

Toxoplasma gondii

Cryptococcus neoformans

Histoplasma capsulatum

0a

multi

Commonest ocular infection in HIV patient - CMV retinitis Bush- Fire appeareance Pizza- Pie Appearance Sauce & Cheese Appearance OCULAR HIV : - M/C ocular manifestation - Cotton wool spot or soft exudate or HIV retinopathy - M/C occular infection - CMV retinitis - M/C occular tumor - kaposi sarcoma > Lymphoma

Ophthalmology

Uveitis

d4621abe-85e5-4666-bfa4-4dcf89e99f11

All are abductors of thigh, except:

Gluteus medius

Gluteus minimus

Saorius

Piriformis

3d

multi

Piriformis

Anatomy

0165bb7b-e869-48e8-8ba6-c62a17df5a37

Corneal vascularisation is/are caused by:

Graft rejection

Chemical burn

Contact lens use

All

3d

multi

Ans. A, B and C

Ophthalmology

e2082560-1d4c-4b18-b4a9-bd32b981f862

Antibody coated bacteria (A.C.B.) is characteristic of which one of the following conditions?

Glomerulonephritis

Pyelonephritis

Hypeension

Perinephric abscess

0a

single

.

Pathology

All India exam

c44e6189-0dbd-4763-b2c9-5a83674762f3

True about Latissimus dorsi

Nerve supply from long thoracic nerve

Inseed into bicipital groove of humerus

Use to fill up back defects

Blood supply from lateral thoracic aery

1b

multi

The tendon is twisted upside down and is inseed into floor of the inteubercular sulcus Latissimus dorsi is supplied by the thoracodorsal (long scapular) nerve. The latissimus dorsi is a potential source of muscle for breast reconstruction surgery after mastectomy The dominant blood supply arises from the thoracodorsal aery, which is the terminal branch of the subscapular aery. It also has a secondary blood supply, which arises from segmental perforating branches off of the intercostal and lumbar aeries . Ref - BDC 6th edition Vol 1 ; pg 62,64

Anatomy

Thorax

19add4df-9a45-401f-8e7f-faed447a0f4d

Fallot physiology includes all except

TA

Eisenmenger complex

TGA

Tricuspid atresia

1b

multi

Eisenmenger syndrome include reversal of shunt. FALLOT PHYSIOLOGY SYNDROMES # Tetralogy of Fallot # Tricuspid. atresia - PS # Single ventricle - PS # TGA with VSD -- PS # DORV -- VSD -- PS Ghai essential of pediatrics, eighth edition, p.no:428

Pediatrics

C.V.S

ab172f73-30d1-4996-a212-d16694612a76

Abduction of Hand is caused by

FCR

FCU

FDP

FDS

0a

single

The flexor carpi radialis muscle originates from the medial epicondlyle of humerus and inses into the bases of 2nd and 3rd metacarpal bones. Its action is abduction of hand at the wrist joint. BD CHAURASIA 7th edition ,page 108 table 9.2

Anatomy

Upper limb

197a44c7-831a-40a4-9a0f-cc99b8717af6

Which of the following is true regarding lattice formation

Associated with precipitation and not agglutination

Associated with agglutination and not precipitation

Associated with both precipitation and agglutination

Associated with neither precipitation and nor agglutination

2c

multi

Lattice formation is possible only in the zone of equivalence.in the zones of antibody or antigen excess lattice doesn't enlarge as their respective valencies are stisfied,this lattice hypothesis holds good for agglutination also. Ref: anantnarayan and panikers 10 th edition.

Microbiology

Immunology

c59b8339-81b6-4df2-8c34-694aa5884567

First change to occur in the distal segment of cut nerve:

Myelin degeneration

Axonal degeneration

Mitosis of Schwann cell

Sprouting

1b

single

After axotomy, the nerve terminals of the injured neuron begin to degenerate (first).

Physiology

a4a2e59d-3a02-4cf4-bfd6-9aa0fa74d6b9

Most common causative organism of acute pyelonephritis in pregnancy is?

E.coli

Klebsiella pneumonia

Enterobacter

Staphylococcus group

0a

single

ANSWER: (A) E.coliREF: Dutta's textbook of obstetrics 6th ed page 296Incidence of pyelonephritis in pregnancy 1-3%Previous history of urinary tract infection increases chance by 50%Organisms associated are: E:coli (70%), Klebsiella (10%), Enterobacter, Proteus pseudomonas, Staphylococcus aureus

Gynaecology & Obstetrics

Renal and Urinary Tract Disorders

f01a39d8-6e55-404e-a5b1-acc7fd8e4aa1

A patient undergoes a total gastrectomy because of a proximally located gastric cancer. After the surgery, which of the following digestive enzymes will be produced in inadequate amounts?

Amylase

Chymotrypsin

Lipase

Pepsin

3d

multi

Pepsin is secreted (in an inactive or zymogen form as pepsinogen) by the chief cells of the stomach. Pepsinogen is activated by contact with stomach acid. Although protein digestion usually begins with the actions of hydrochloric acid and pepsin, pancreatic enzymes complete the job as the food passes into the small intestine. Amylases hydrolyze 1->4 glycosidic linkages of starches to produce oligosaccharides, maltose, maltotriose, and limit dextrins. These enzymes are produced by the pancreas and salivary glands. Chymotrypsin is a proteolytic enzyme released by the pancreas as the inactive proenzyme, chymotrypsinogen. Lipases are mostly released by the pancreas, and serve to digest various lipids, including triacylglycerols. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 25. Overview of Gastrointestinal Function & Regulation. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.

Physiology

a48df783-463d-4687-8476-9b9e4e1b97c5

The type of study that determines the norms and limits of the distribution of variables, including the characteristics of the events and population under study, is reffered to as-

Explanatory

Cross-sectional

Descriptive

Analytical

2c

single

Descriptive studies are the first phase of an epidemiological investigation. Procedures in descriptive studies include: 1)defining the population to be studied 2)defining the disease under study 3)describing the study by time , place, person 4)measurement of disease 5)comparing with known indices 6)formulation of an aetiological hypothesis (refer pgno:63 park 23 rd Edition)

Social & Preventive Medicine

Epidemiology

89b7691a-f779-4519-a15a-29657cec59e5

HRT therapy can increase the risk of -

Osteoporosis

Breast carcinoma

Alzeihmer's disease

Colorectal cancer

1b

single

Ans. is 'b' i.e., Breast carcinoma o HRT increases the risk of the following:# Endometrial cancer# Breast carcinomao Reduced risk of the following with HRT:# Alzeihmer's disease# Colorectal cancer# Osteoporosis# Age related hearing loss# HRT prevents lens opacities

Gynaecology & Obstetrics

Radiotherapy & Chemotherapy

046e5dff-f326-4cea-992c-333307271621

Reverse cholesterol transpo is mediated by ?

HDL

VLDL

LDL

IDL

0a

single

Ans. is 'a' i.e., HDLReverse cholesterol transpoAll nucleated cells in different tissues synthesize cholesterol, but the excretion of cholesterol is mainly by liver in the bile or by enterocytes in gut lumen.So, cholesterol must be transpoed from peripheral tissue to liver for excretion.o This is facilitated by HDL and is called reverse cholesterol transpo because it transpos the cholesterol in reverse direction to that is transpoed from liver to peripheral tissues through VLDL LDL cycle. Processo HDL is synthesized in liver and small intestine.o Nascent HDL contain phospholipids and unesterified cholesterol and Apo-A, C, E.This nascent HDL is secreted into circulation where it acquires additional unesterified cholesterol from peripheral tissues.o Within the HDL paicle, the cholesterol is esterified by lecithin - cholesterol acetyltransferase (LCAT) to form cholesteryl ester and additional lipid are transpoed to HDL from VLDL and chylomicrons.o There are two pathway by which this cholesterol is transpoed to liver.

Pathology

2e42b446-76dd-4b84-997f-8579950b15a4

Most common chromosomal syndrome in children is?

Fragile X-syndrome

Trisomy 17

Trisomy 21

Trisomy 13

2c

single

**Down syndrome (Trisomy 21) is the most common of the chromosomal disorder. **Trisomy 16 is the most common trisomy overall, however most do not survive and die in utero Hence, among the live bihs, or among children, most common chromosomal abnormality is Trisomy 21

Pediatrics

Impoant Genetic Syndromes

b772a042-90cd-41d9-8232-015cc31b1272

A child can make a tower of 6 cubes at the age of?

36 months

18 months

12 months

24 months

3d

single

A child can make a tower of 6 cubes at 2 years. -tower of 2 cubes at 15 months, 3 cube tower at the age of 18 months

Pediatrics

Impoant Motor Milestones

73f7d429-5401-4ee3-84c0-8048e0f115d9

All of the following are features of Goodpasture syndrome, except:

Antibody to alpha-3 chain of type IV collagen (COL4A3)

Glomerular basement membrane is involved

Pulmonary haemorrhage

Subendothelial IgG deposits in renal biopsy

3d

multi

Goodpasture syndrome Uncommon autoimmune disease in which kidney and lung injury are caused by circulating autoantibodies. Most common in 2nd & 3rd decades of life. Anti-GBM antibody-mediated disease Goodpasture syndrome applies to the 40% to 60% of patients with these autoantibodies who develop pulmonary hemorrhage in addition to renal disease. Characterized by linear deposits of IgG and, in many cases, C3 in the GBM. The antigen common to the alveoli and GBM is a peptide within the noncollagenous poion of the a3 chain of collagen type IV (COL4A3).

Pathology

Nephritic Syndrome

5b11c7e8-7b55-45e2-89e8-0b11352de959

systematic sensitization is used in

dissosiation

phobia

schioid personality

psychosis

1b

single

SYSTEMATIC DESENSITIZATION JOSEPH WOLPE Joseph Wolpe gave the concept of systematic desensitization This is a treatment used in phobia In phobia there is a conditioned fear response to aversive neutral stimulus and avoidance of that response leads to phobia Whenever there is a fear response there is stimulation of sympathetic system In that case stimulation of parasympathetic system by relaxation there is reduction in anxiety First step is to make a step ladder which are arranged based on the severity Then is go step by step and along with doing applied relaxation Slowly the the sympathetic system is reduced The patient will be able to approach stimulus without anxiety Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 845

Anatomy

Treatment in psychiatry

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Epiphyseal dysgenesis is a pathognomonic feature of:

Hypoparathyroidism

Hyperparathyroidism

Hypothyroidism

Hypehyroidism

2c

single

Hypothyroidism

Radiology

31d066ce-f6a2-4ee1-8c5a-126da773038d

True about specificity-

True positive

False positive

True negative

False negative

2c

multi

Ans. is 'c' Le., True negative o When a screening test is used to diagnose a disease, the test oucome can be positive (diseased) or negative (healthy), while the actual health status of the person may be different,o In that settingi) True positive-Diseased people correctly diagnosed as diseased.ii) False positive-Healthy people wrongly identified as diseased.iii) Tme negative-Healthy people correctly identified as healthy.iv) False negative-Diseased people wrongly identified as healthy.o There are two major statistical measures for the validity of a screening test: -i) Sensitivityii) SpecificitySensitivityo It is the ability of a test to identify correctly all those who have the disease, i.e., true positive.o In other words sensitivity measures the precentage of sick people who are identified as having disease,o For example if a test is 90% sensitive, that means out of 100 diseased people, it will diagnose 90 (90% of diseased people will be diagnosed). Remaining 10% will be wrongly indentified as not having the disease, i.e., false negative.Specificityo It is the ability of a test to identify correctly those who do not have the disease i.e., true negativeo In other words specificity measures the percentage of well people who are identified as not having the disease,o For example, a 90 percent specificity' means that 90% of nondiseased people will be identified as not having the disease. The remaining 10% will be wrongly classified as diseased, i.e., false positive.

Social & Preventive Medicine

Screening for Disease

93b473bb-b949-4892-b3f7-ba52b1416bc6

A 75 year old patient presents with deterioration of vision. On examination the pupillary reflex is observed to be sluggish and the intraocular pressure is normal. Optic disc evaluation shows a large and deep cup and paracentral scotomas. The most likely diagnosis is:

Primary Narrow angle glaucoma

Normal Tension Glaucoma

Neovascular Glaucoma

Absolute Glaucoma

1b

single

Ans. (b) Normal Tension GlaucomaRef: Kanski 7/e, p. 346; Yanoff 3/e, p. 1159Glaucomatous cupping (large and deep cup) along with glaucomatous visual field defects (paracentral scotomas are the most frequent) in patients with normal intraocular pressure suggests a diagnosis of Normal Tension Glaucoma (NTG).

Ophthalmology

Glaucoma

f78a32fa-4ec9-4d74-a363-9be7595f20e7

Lungs do not collapse during expiration because of the presence of?

Hyaline membrane

Dipalmitoyl phosphatidyl choline

Macrophages

Interstitial fluid

1b

single

b. Dipalmitoyl phosphatidyl choline(Ref: Ghai 8/e p 169-170)Dipalmitoyl phosphatidyl choline is an important constituent of Surfactant, which prevent alveolar collapse during expiration.

Pediatrics

New Born Infants

cf868d16-f8ec-4052-a0cf-6c404ffe4cae

Artery usually torn in temporal bone fracture is:

Middle meningeal artery

Posterior auricular artery

Transverse facial artery

Deep temporal artery

0a

multi

Ans. (A). Middle meningeal arteryType of haemorrhageCommonest sourceExtradural haemorrhageMiddle meningeal arterySub dural haemorrhageBridging veinsSub arachnoid haemorrhageAneurysm - Circle of willisIntracerebral haemorrhageLenticulo-striate artery

Forensic Medicine

Sexual Offenses

a74a1c05-57a4-4c1e-b0f4-a9b5baaca5db

Saroj, a 32 year old female, from rural background presented with a h/o chronic tobacco chewing since 14 year of age. Now she has difficulty in opening her mouth. On oral examination, no ulcers are seen - Most probable diagnosis is -

Submucous oral fibrosis

Carcinoma of buccal mucosa

TM joint ahritis

Trigeminal nerve paralysis

0a

single

Ans. is 'a' ie. Submucous oral fibrosis " Submucous oral fibrosis is a progressive ds. in which fibrous bands form beneath the oral mucosa. These bands progressively contract so that ultimately mouth opening is severly limited. Tongue movements may also be limited. This conditon is almost entirely confined to Asians. Histologically it is characterized by juxtaepithelial fibrosis with atrophy or hyperplasia of the overlying epithelium which also shows areas of epithelial dysplasias. The etiology is abscure. Hypersensitivity to chilli ; betel nut, tobacco and vitamin deficiencies have been implicated. The scar bands of submucous fibrosis, which result in difficulty in opening can be treated either by intralesional injection of steroids or by surgical excision and grafting, but this has little effect in preventing the onset of squamous cell Ca in the generally atrophic oral mucosa (Submucous oral fibrosis is a precancerous conditon for squamons cell Ca)."- Bailey & Love

Surgery