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49acf5af-293e-4976-9663-22970825fe09

Cavernous sinus communicates with

Superior petrosal sinus

Inferior petrosal sinus

Superior ophthalmic vein

Middle meningeal vein

0a

single

Draining channels or communications the cavernous sinus drains: 1.into the transverse sinus through the superior petrosal sinus. 2.into the internal jugular vein through the inferior petrosal sinus and through a plexus around the internal carotid aery. 3. into the pterygoid plexus of veins through the emissary veins passing through the foramen ovals, the foramen lacerum, and the emissary sphenoidal foramen 4. In to the facial vein through the superior ophthalmic vein. 5.the right and left cavernous sinuses communicate with each other through the anterior and posterior intercavernous sinuses and through the basilar plexus of veins. Notes: all these communications are valveless and blood can flow through them in either direction Ref: BDC volume3;Sixth edition pg 195

Anatomy

Head and neck

31c088ca-004c-42f1-8c02-3fa438c18f03

In civil negligence, onus of proof lies on:

Judicial first degree magistrate

Police not below the level of sub inspector

Doctor

Patient

3d

single

D i.e. Patient In case of malpractice, punishment is given by civil or criminal couQ (depending on type of negligence). Generally, the innocence of doctor is assumed and in cases where negligence is alleged, the plantiff (complainant, patient) has to establish the guilt. The patient is expected to prove that the defendant (doctor) was negligent; there fore the onus (responsibility) of proof lies on patient. But when the doctrine of res ipsa loquitor (ie thing speaks for itself) is applied such as in case of surgery on wrong patient / side / organ etc, the doctor will have to prove that what has happened is not due to his negligenceQ. This means onus of proof lies on patient in negligence (all civil & most criminal case) except in cases where doctrine of res ipsa loquitor appliesQ. Therapeutic misadventure (mischance / disaster / accident) is death or injury of a patient due to some unintentional act by doctor /nurse /hospitalQ during treatment (therapeutic), diagnosis (diagnostic) or experimental study. It provides defence against neglince because a doctor can't be held responsible for injuries resulting from adverse reaction of drug. However, the doctor must warn patient about possible side effects (eg death during surgery or transfusion). And ignorance of the possibility of reaction to drug prescribed to patient amounts to negligence (ie it is not 100% = absolute defence). At times it is not possible to explain every thing to the patient (who may be scared of procedure). Under such circumstances doctor can reveal the details to any one of close relatives of patient. This is called doctrine of therapeutic privilege. Doctrine of emergency says that doctor can provide the treatment without taking prior consent from a patient who is gravely sick, (critically ill), unconscious, or not able to understand the suggestion, or when mentally ill (IPC section 92). In emergency situation involving children, when their parents are not available, a/t doctrine of locoparentis, consent can be obtained from accompanying person (eg teacher or relative). On ceain occasions, despite all proper care given by doctor during treatment, the patient might suffer severe injuries or permanent deformity. This is k/a medical maloccurance, inevitable act or Act of God. If doctor proves this before cou, it will be an absolute defence against malpractice. Free (charity) treatment of patient does not give doctor immunity (defence) against negligenceQ. Whereas judgemental (diagnostic) error, therapeutic misadventure, medical maloccurance, calculated risk doctrine, contributory negligence (on pa of patient), product liability, and res judicata (complain already tried once in cou) provide defenses to a doctor against charges of negligence. Law does not consider doctrine of contributory negligence & consent in charges of criminal negligence; whereas these provide defence in civil negligence.

Forensic Medicine

0b745a57-5e16-4736-bdb4-b145164e33c8

Chemical plaque control

is an effective replacement for mechanical plaque control

is especially recommended after periodontal surgery

is best achieved using cetylpyridium chloride mouth washes

is of no use

1b

multi

Dental

5263d080-8409-4b50-a18c-03f0294db021

Which aery Supplies the deep cerebellar nuclei

Anterior inferior cerebellar aery

Anterior spinal aery

Posterior cerebral aery

Superior cerebellar aery

3d

single

The superior cerebellar aery supplies the superior surface of the cerebellum and the cerebellar nuclei (dentate nucleus)

Anatomy

Brainstem lesions and blood supply of CNS

54afcd86-126c-4a0d-8f2d-9a362ab535e1

True about blood supply of scaphoid-

Mainly through ulnar artery

Major supply from ventral surface

Major supply from dorsal surface

Proximal supply in antegrade fashion

2c

multi

Ans. is 'c' i.e., Major supply from dorsal surfaceo Major blood supply (70-80%) of scaphoid comes through dorsal surface via dorsal branches of radial artery,o These dorsal vessels enter the scaphoid at or just distal to waist area and supply the proximal pole in retrograde fashion.o Proximal 2/3 rd to 3/4 scaphoid is supplied by these dorsal vesselso 20-30% of blood supply comes through palmar and superficial palmar branches of radial artery,o Distal 1/3 rd or 1/4 th and distal tubercle are supplied by these palmar vessels.

Anatomy

Blood Vessels of Thorax

0c41e116-c0c7-4a02-b9d0-c1440eb70589

Straining and dribbling of urine in a male infant with recurrent urinary infection should lead to the suspicion of :

Vesico – ureteric reflux

Posterior urethral valve

Pelvic ureteric junction obstruction

Phimosis

1b

single

The informations provided in this question are : Straining —> Sign of obstruction Driblling  —>  Sign of obstruction and incomplete bladder emptying. UTI May be due to urinary obstruction. All these suggest the diagnosis of obstructive uropathy, and posterior urethral valve is most common cause of obstructive uropathy.

Pediatrics

b767b144-d466-48cb-ba56-756a371c4044

Which protein is abundant in our body:

Collagen

Albumin

Myoglobin

Hemoglobin

0a

single

Ans. (a) CollagenRef: Harrisons, 19th ed. pg. 2504* Collagen is the most abundant protein in the body.* Harrisons states: "The first genes cloned for connective tissues were the two genes coding for type I collagen, the most abundant protein in bones, skin, tendons, and several other tissues.

Biochemistry

Proteins and Amino Acids

abef4c0a-cbee-4563-8f3a-78262ebb5505

Myoglobinuria is seen in which type of burns:

Contact burn

Electric burn

Scald

Flame burn

1b

single

Electrical burns may cause extensive muscle necrosis and consequent myoglobinuria and hemoglobinuria, both of which may lead to renal insufficiency.

Surgery

5bb2ad99-6145-425f-8600-597f08d6d8e5

Sign of the groove is seen in:

Lymphogranuloma venereum

Granuloma inguinale

Syphilis

Chancroid

0a

single

LGV is caused by Chlamydia trachomatis serovars L1, L2 and L3 and occurs in three stages. In the secondary stage or inguinal stage, enlargement of the femoral and inguinal lymph nodes separated by the inguinal ligament produces the 'sign of the groove'/sign of Greenblatt. NOTE: Ramrod /saxophone penis in males and Esthiomene in females occurs in the third stage of LGV. Ref: Sexually Transmitted infections, Bhushan Kumar, 2nd edition, pg 510-511.

Skin

865375da-5bbd-43a3-b921-7959f2c6c5c7

A patient with psoriasis was staed on systemic steroids. After stopping the treatment, the patient developed generalized pustules all over the body.The cause is most likely to be -

Bacterial infection

Erythrodermic Psoriasis

Drug induced reaction

Pustular psoriasis

3d

multi

Patient of psoriasis on withdrawal of systemic steroids leads to: 1)Pustular Psoriasis: - Multiple sterile pustules develop on whole body(including palms & soles) k/a sterile as there is no infection, only infiltration present. -If generalised k/a Von Zumbusch disease. - Other provocating factors include Infection, Pregnancy and Hypocalcaemia associated with hypoparathyroidism. 2) Erythrodermic psoriasis >90% body surface area shows redness/inflamed or/- scaling Systemic steroids are contraindicated in psoriasis as, on withdrawal it causes pustular psoriasis except inpregnancy where they are drug of choice

Dental

Psoriasis

934a6ba8-1573-4605-8a5e-fce2721155ca

Cholesteatoma is seen in:

ASOM

CSOM

Secretory Otitis media

Otosclerosis

1b

single

(b) CSOM(Ref. Cummings, 6th ed., 2141)Cholesteatoma formation is characteristic of unsafe CSOM.The other mentioned options are not associated with cholesteatoma.

ENT

Disorders of Middle Ear (Otitis Media)

c4587b26-9ba2-44e0-9095-655ac8e9e1b6

Which of the following indicates anticipated difficult bag mask ventilation

Age >30 yrs

BMI >20

Beard

None of the above

2c

multi

Predicting difficulty in mask ventilation Mask ventilation is the most basic, and arguably most impoant, skill in airway management. Patients who have been identified as having DMV, or who are predicted to be difficult, are, or potentially are, at the highest risk in airway management. It is this facet of management that should influence our decision-making the most, potentially with consideration given to awake techniques. DMV can also be suggestive of difficulty in subsequent laryngoscopy. DMV occurs in up to 5% of patients, and there are several factors that are known to be predictive of this. An early study highlighted five independent factors Mnemonic OBESE to be used. Fuher study of DMV added modified Mallampati class of 3 or 4, limited jaw protrusion, and the male sex. Neck irradiation is the most significant predictor of impossible mask ventilation, defined as an inability to achieve gas exchange despite the use of adjuncts, multiple providers, and neuromuscular block, as it causes development of fibrotic non-compliant tissue affecting the airway. BMI itself is not a very useful predictor, although it can be a marker for potential oxygenation issues (due to reduced FRC) and increased aspiration risk. In predicting DA, the actual distribution of body fat should be considered, with fat deposition in the parapharyngeal tissues increasing airway collapsibility, predisposing to OSA. This is seen more in android pattern obesity with distribution of adipose tissue around the trunk, upper body, and neck. The increased fat deposits in neck tissue can fuher narrow the airway. OSA, snoring without apnoea, and increasing neck circumference, above 40 cm, are associated with DMV. The probability of DMV increases with increasing neck circumference. Age >55 BMI > 26 (obesity) Beard Lack of teeth(edentulous) History of snoring (OSA) Neck circumference (>17 inches in men and > 16cm in women) Thyromental distance Large tongue facial and neck deformity Cervical spine disease or previous cervical spine surgery

Anaesthesia

Anaesthesia Q Bank

aa5e36af-04ae-464b-9734-f0464875e97a

Which of the following is a nonculturalable fungus-

Rhinosporidium

Candida

Sporothrix

Penicillium

0a

single

Microbiology

5d4f09e3-65b1-4e92-84ad-b06ad40cd7cc

Enzyme replacement therapy is used for-

Gaucher's disease

Krabbe's disease

Metachromatic leukodystrophy

Tay Sach's disease

0a

single

Ans. is 'a' i.e., Gaucher's disease * Alglucerase (ceredase) is used in the treatment of Gaucher's disease.* Enzyme replacement therapy (ERT) is also available for Fabry's disease, Type I, Type II and Type VI Mucoploysaccharidosis, Pompe's disease and ADA deficiency

Biochemistry

Enzymes

b5d353fe-4bb4-4a71-9da2-4f654cde7f8d

Pseudopolyposis is seen in -

Crohn's disease

Ulcerative colitis

Juvenile polyposis

Enteric fever

1b

single

Pathology

ca769633-3650-4209-8d22-b81a2e171d25

Organism that causes emphysematous cholecystitis is:

Salmonella typhi

Cytomegalovirus

Clostridium perfringens

Bacteroides

2c

single

Ref: Harrison's 18th editionExplanation:Emphysematous CholecystitisIt is thought to begin with acute cholecystitis (calculous or acalculous) followed by ischemia or gangrene of the gallbladder wall and infection by gas-producing organisms.Bacteria most frequently cultured in this setting includeAnaerobes, such as C. welchii or C. perfringensAerobes, such as E. coli.This condition occurs most frequently in elderly men and in patients with diabetes mellitus.The clinical manifestations are essentially indistinguishable from those of nongaseous cholecystitis.The diagnosis is usually made on plain abdominal film by finding gas within the gallbladder lumen, dissecting within the gallbladder w all to form a gaseous ring, or in the pericholecvstic tissues.The morbidity and mortality rates with emphysematous cholecystitis are considerable.Prompt surgical intervention coupled with appropriate antibiotics is mandatory.

Medicine

Gall Bladder

92eb4da6-b9b9-4dfe-8533-366f1aed4c5c

Which of the following conditions may necessitate emergency tracheostomy to prevent suffocation

Cellulitis

Ludwig's angina

Cavernous sinus thrombosis

Maxillary sinusitis

1b

single

Surgery

04519631-61e3-4ef4-b2d6-c352cf349ded

Most common site for extra mammary Paget&;s disease is

Vulva

Vagina

Penis

Anus

0a

single

.It is superficial manifestation of an intraductal carcinoma. The malignancy spreads within the duct up to the skin of the nipple and down into the substance of the breast. It mimics eczema of nipple and areola.most commonly extra mammary manifestations of paget&;s disease is seen in the vulva. * Paget's disease of penis (Erythroplasia of Querat is persistent rawness of glans penis). ref:SRB&;s manual of surgery,ed 3,pg no 1009,473

Surgery

Urology

fa6b40a1-459a-401c-96e7-fac5608e7744

Inferior Rib notching is seen in all except?

Coarctation of aoa

Classical blalock tausing operation

SVC obstruction

Neurofibromatosis

3d

multi

Answer is D (Neurofibromatosis) Neurofibromatosis is associated with superior rib notching Inferior rib notching is characteristically seen in coarctation of Aoa and may also be seen in Superior vena cava obstruction and a Blalock-Taussig shunt operation Rib-Signs in Coarctation of aoa: Inferior rib notching is characteristic, and is believed to be due to pressure erosion by intercostal aeries. Inferior rib notching takes several years to develop and is rarely seen before the age of 8 years.e '3' signemay be seen due to enlargement of left subclan aery above the coarctation Usually spares fist two ribse where intercostal aeries arise from costocervical trunk which is proximal to the usual site of CA. Mostly commonly affected ribs are the 4th to 8th ribs. Usually bilateral but asymmetrical.

Medicine

4ecebffe-72f6-4988-8d64-738e43ad6086

Which is false regarding cryptococcus neoformans?

Grows at 5degC and 37degC

It has 4 serotypes

Urease negative

Causes superficial skin infection

2c

multi

Ans. is 'c' i e., Urease negative Cryptococcus neoformans is distinguished from other non-pathogenic crvptococci by ? - Ability to grow at 37degC Lack of fermentative ability - Ability to hydrolyze urease (urease positive) - Formation of brown pigment on niger seed agar - Ability to assimilate inositol Ability to produce phenole oxidase.

Microbiology

7cf99676-f2b5-4f6d-9cf5-03ff7651afb3

Histopathological finding of gluten hypersensitivity is?

Crypt hyperplasia

Increase in thickness of the mucosa

Distal intestine involvement

Villous hypertrophy

0a

single

Ans. is 'a' i.e., Crypt hyperplasia Histopathological findings of gluten sensitivity enteropathy* Villous atrophy and Crypt hyperplasia with decrease in villus: crypt ratio.* Loss of microvilli brush border.* Inflammatory cells are present in lamina propria : plasma cells, macrophages, lymphocytes, eosinophils and mast cells.* One of the characteristic feature is that overall mucosal thickness remains same (as villous atrophy is compensated by crypt hyperplasia).* Mainly proximal intestine is involved.

Pathology

G.I.T.

b6130415-f3ab-464a-8854-9a1811d8f8f9

All except one are centrally acting muscle blockers:

Meprobamate

Baclofen

Diazepam

Dantrolene sodium

3d

multi

Pharmacology