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47a7e08c-e3a3-46bf-8927-d9e194a385c1

Which of the following is freely filtered by kidney across glomerular capillariesa) Albumin (across glomerular capillaries)b) Globulinc) Creatinined) HCO3 e) Glucose

cde

acd

bde

ade

0a

single

Freely filterable substances by glomerulus -        Water -        Na+ -        Cl- -        HCO3- -        Inulin -        Glucose -        Creatinine   -        Free Calcium or phosphate

Physiology

de848149-c145-4341-95fd-5e7fb647e705

Antibodies associated with GTCS in SLE :

Anti neuronal ab

Anti-Ro ab

Anti-Sm ab

None

0a

multi

Ans.A Anti neuronal ab (Ref: Harrison's Internal medicine 18th/Table 319-1; 17th edition, P. 2076). Autoantibodies in Systemic Lupus Erythematosus (SLE) Antibody Prevalence, % Antigen Recognized Clinical Utility Antinuclear antibodies 98 Multiple nuclear Best screening test; repeated negative tests make SLE unlikely Anti-dsDNA 70 DNA (double-stranded) High titers are SLE-specific and in some patients correlate with disease activity, Anti-Sm 25 Protein complexed to 6 species of nuclear U1 RNA Specific for SLE; no definite clinical correlations; most patients also have anti Anti-RNP 40 Protein complexed to U1 RNA Not specific for SLE; high titers associated with syndromes that have overlap blacks than whites Anti-Ro (SS-A) 30 Protein complexed to hY RNA, primarily 60 kDa and 52 kDa Not specific for SLE; associated with sicca syndrome, predisposes to subacute cutaneous with decreased risk for nephritis Anti-La (SS-B) 10 47-kDa protein complexed to hY RNA Usually associated with anti-Ro; associated with decreased risk for nephritis Antihistone 70 Histones associated with DNA (in the nucleosome, chromatin) More frequent in drug-induced lupus than in SLE Antiphospholipid 50 Phospholipids, 2 glycoproteins 1 cofactor, prothrombin Three tests available ELISAs for cardiolipin and 2G1, sensitive prothrombin Antierythrocyte 60 Erythrocyte membrane Measured as direct Coombs' test; a small proportion develops overt hemolysis Antiplatelet 30 Surface and altered cytoplasmic antigens on platelets Associated with thrombocytopenia but sensitivity and specificity are not good; Antineuronal (includes anti-glutamate receptor) 60 Neuronal and lymphocyte surface antigens In some series a positive test in CSF correlates with active CNS lupus. Antiribosomal P 20 Protein in ribosomes In some series a positive test in serum correlates with depression or psychosis Also remember: Antibody Best screening test for Antibody ANA SLE Anti-Histone Drug-induced lupus Antinuclear antibodies SLE, nonspecific Anti-dsDNA; Anti-Sm Specific for SLE Anti-sm (Nelson's Paediatric Textbook) Marker of CNS lupus Anti-DNA Level of which correlates with disease activity Anti-Ro (SS-A) SACL, neonatal lupus Anti-Ro and Anti-La ie risk of nephritis (protective against nephritis) Antiphospholipid Hematological and Fetal Loss Antiribosomal protein Depression and Psychosis Anti-basement membrane Goodpasture syndrome Anticardiolipin, lupus anticoagulant SLE, antiphospholipid syndrome Anticentromere Limited scleroderma (CREST syndrome) Anti--Scl--70 (anti--DNA topoisomerase 1) Scleroderma (diffuse) Anti--SSA, anti--SSB (anti-Ro, anti--La) Sjogren syndrome Anti--Jo--1, anti--SRP, anti--Mi--2 Polymyositis, dermatomyositis Anti--TSH receptor Graves disease Anti--U1RNP (ribonucleoprotein) Mixed connective tissue disease c-ANCA (PR3-ANCA) Granulomatosis with polyangiitis (Wegener) IgA antiendomysial, IgA anti--tissue transglutaminase Celiac disease p-ANCA (MPO--ANCA) Microscopic polyangiitis, Churg--*JStrauss syndrome Anti--ACh receptor Myasthenia gravis Rheumatoid factor (antibody, most commonly IgM, specific to IgG Fc region), anti--CCP Rheumatoid arthritis Anti--glutamate decarboxylase Type 1 diabetes mellitus Anti--desmoglein Pemphigus vulgaris Anti--hemidesmosome Bullous pemphigoid Antimicrosomal, antithyroglobulin Hashimoto thyroiditis Antimitochondria! 1*< biliary cirrhosis Anti--smooth muscle Autoimmune hepatitis ALSO KNOW: LE cells Neutrophils with LE bodies seen in SLE, RA Penicillamine drug induced Hematoxilin bodies SLE endocarditis (Libmann-Sack) 'Wire-loop' lesions SLE type IV nephritis

Unknown

b90b1e07-21e0-4760-a2dc-8edd5fddac7d

Tonsillar fossa is bounded anteriorly by

Pharyngobasilar fascia

Palatopharyngeal fold

Buccopharyngeal fascia

Palatoglossal fold

3d

single

Tonsilar fossa is bounded by Anterior - Palatoglossal fold containing palatoglossal muscle Posterior - Palatopharyngeal fold containing palato pharyngeal muscle Apex - Soft palate, where both arches meet Base - Dorsal surface of posterior one-third of tongue. (Ref: Anatomy of head, neck and brain. Vishram Singh. P 227 )

ENT

Pharynx

8ae09b49-665e-45e3-ac3d-869ff1a96a44

"Castration anxiety" is seen in which phase of Sigmond Freud's psychosexual stages of development

Oral

Anal

Phallic

Genital

2c

multi

Phallic phase (3-5years): Male child develops Oedipus complex (sexual feeling towards mother) and will be afraid that father may castrate him for this termed as "Castration anxiety".

Psychiatry

04c2701f-e97b-451d-a824-49d4c35c4ffb

Shock causes:

Stagnant hypoxia

Anemic hypoxia

Hypoxic hypoxia

Histotoxic hypoxia

0a

single

Ans: A (Stagnant hypoxia)Ref: Pat GK, Hypoxia and Oxygen Therapy, In: Textbook of Medical Physiology, 2nd ed, Abuja Publishing House 2011: 94: 754-55Explanation:Refer the explanation of previous question

Physiology

Circulation: Circulatory Shock and Its Treatment

a8b60e51-39fd-45f3-bc37-6b0ab6126430

Two or more parallel vertical surfaces of abutment teeth shaped to direct the prosthesis during placement and removal, are known as:

Orientation plane

Parallel block out

Survey lines

Guiding planes

3d

multi

Dental

2b84d3c8-a571-4f34-aaea-b58afabb9ee5

Calcium silicate based material is:

MTA

Geristore

Dieket

Retroplast

0a

single

Mineral trioxide aggregate was developed by Dr Torabinejad in 1993.  It contains tricalcium silicate, dicalcium silicate, tricalcium aluminate, bismuth oxide, calcium sulfate and tetracalcium aluminoferrite. pH of MTA is 12.5. Textbook of Endodontics Nisha Garg 3rd Ed

Dental

d364fa9c-b9f9-4328-bf4c-070339d50af1

Which of the following statements about Total Infra–Venous Anaesthesia (TIVA) is true –

Causes More Renal Toxicity

Reduces Cerebral Metabolic Rate

Risk of Malignant Hyperthermia is high

Inhibits Hypoxic Pulmonary Vasconstriction

1b

multi

Total intravenous anaesthesia refers to a technique in general anaesthesia using a compination of agents given solely by IV route and in the absence of all inhalation agents. TIVA (Total intravenous anaesthesia) is produced by IV propoful. Propofol decreases the cerebral metabolic rate. Propofol does not impair renal function, does not trigger malignant hyperthermia and does not inhibit hypoxic pulmonary vasoconstriction.

Anaesthesia

4eafd9d8-b2ea-4f44-ac7f-a12103f61945

In Profound MR, IQ is

50-69

35-49

20-34

< 20

3d

single

IQ range for categoriesICD-10DSM-IVMild50-6950-55 to 70Moderate35-4935-40 to 50-55Severe20-3420-25 to 35-40ProfoundBelow 20Below 20-25Reference: Oxford Textbook of Psychiatry; 3rd edition; Chapter 18; Learning Disability

Psychiatry

Child psychiatry

f0a88604-cf9c-4181-87f8-e3daccd3d389

Which of the following iodinated compound is present in a maximum concentration in the thyroid?

Monoiodotyrosine (MIT)

Diiodotyrosine (DIT)

T3

Reverse T3

1b

single

THYROID HORMONE SYNTHESIS AND SECRETIONThyroid hormones are synthesized in the colloid, near the apical cell membrane of the follicular cells. Catalyzed by the enzyme thyroidal peroxidase, iodide in the thyroid cell is oxidized to iodine.The iodine enters the colloid and is rapidly bound at the 3 position to tyrosine molecules attached to thyroglobulin, forming monoiodotyrosine (MIT).MIT is next iodinated at the 5 position, forming diiodotyrosine (DIT).Two DIT molecules then condense in an oxidative process ("coupling reaction") to form one thyroxine (T4) molecule.Some T3 is probably formed within the thyroid gland by condensation of MIT with DIT. A small amount of reverse T3 (rT3) is also formed.In the normal thyroid, the average distribution of iodinated compounds is 23% MIT, 33% DIT, 35% T4, 7% T3, and 2% reverse T3.

Microbiology

All India exam

7a6581e6-e0e5-4135-a642-cb80351a063c

Silicosis caused by ?

Gold

Coal

CO

Silica

3d

single

Ans. is 'd' i.e., Silica

Social & Preventive Medicine

e3b9ae95-2b0e-42af-a27a-f6c0b51af476

Human development index includes -

Crude death rate

Life expectancy at one year

Life expectancy at bih

All

2c

multi

Ans. is 'c' i.e., Life expectancy at bih According to 22nd/e of Park, options 'd & e' are not the components of HDI. o Expected years of schooling (not adult literacy rate) and GNI per capita (not GDP) are the components of HDI.

Social & Preventive Medicine

4d8ea9c6-e243-4402-8393-ac53373773ce

One of the constituents of the commonly used metered dose inhalers in bronchial asthma which is an air pollutant & dangerous to earth's stratosphere is -

Flurocarbons

Salbutamol

Ozone

Oxygen

0a

single

Medicine

8f5f61e2-a8ea-4d15-ba76-823918e49d3b

H. capsulatum, a dimorphic fungus, is found in soil heavily contaminated with bird droppings. Which of the following statements best describes the presence of the organism in tissue biopsies?

Yeasts with broad-based bud

Single-cell yeasts with pseudohyphae

Arthrospores

Oval budding yeasts inside macrophages

3d

multi

Histoplasma capsulatum is a dimorphic fungus that forms two types of spores: tuberculate macroconidia and microconidia. Inhalation of the microconidia transmits infection. Inhaled spores (microconidia) are engulfed by macrophages and develop into yeast forms. Most infections remain asymptomatic; small granulomatous foci heal by calcification. However, pneumonia can occur. The heterophile antibody test is useful for early diagnosis of infectious mononucleosis. The figure below illustrates the oval budding yeasts.

Microbiology

Mycology

940903a9-03dd-4900-bf86-2a421380958b

Budding reproduction in tissue is seen in

Cryptococcus, candida

Candida, rhizopus

Rhizopus, mucor

Histoplasma, candida

0a

single

Cryptococcus is a yeast, candida is a yeast-like fungus. Both are reproduced by budding Histoplasma is a dimorphic fungus Mucor and Rhizopus are produced by asexual means sporangiospores Reference: Textbook of Microbiology; Baveja; 4th edition

Microbiology

mycology

e6b8da32-0a36-4ef8-8d82-e1eb2a517c9b

True about polio:

Paralytic polio is most common

Spastic paralysis seen

IM injections and increased muscular activity lead to increased paralysis

Polio drops in pulse polio immunisation given only in <3 years old children

2c

multi

False 90-95% of polio infections are asymptomatic False Acute flaccid paralysis is seen in Polio & not spastic paralysis True Risk of paralytic polio is increased by tonsillectomy, strenous physical exercise, tooth extraction,Injection (intramuscular) False OPV drops are given to all children less than 5 yr age in pulse polio immunisation

Pediatrics

Impoant Viral Diseases in Children

c853613f-ef01-4ea6-afc6-2a467d44aecc

The retention of dowel in a pin retained crown is increased by

Increased length, smooth surface and increased taper.

Increased length, serrated surface and increased taper.

Increased length, smooth surface and parallel sides.

Increased length, serrated surface and parallel sides.

3d

multi

Post should be at least 2/3 the root length, parallel sided and serrated for increased retention in the canal

Dental

08531c7b-c9f3-49f2-a8f2-e64ac23974e7

Which of the following drugs can be administered by subcutaneous route?

Albuterol

Metaproterenol

Terbutaline

Pirbuterol

2c

single

terbutaline can be given as s.c (0.25mg) in asthma.

Pharmacology

f00410d1-d829-45fa-8643-4dcc815bb0e6

Mycosis fungoides which is not true:

It is the most common form of cutaneous lymphoma.

Pautriers microabscess.

Indolent course and easily amenable to treatment.

Erythroderma seen and spreads to peripheral.

2c

multi

Mycosis Fungoides: Mycosis fungoides is synonymous with Cutaneous T cell lymphoma.

Medicine

ccb6817f-6a6b-49c6-879b-0bd13daf314d

Bacterial pyogenic parotitis affecting the parotid gland is most common after: March 2008

Uveo-parotid fever

Mumps

Debilitation after major surgery

After administration of iodine

2c

single

Ans. C: Debilitation after major surgery Acute bacterial parotitis is now infrequent, but its historical impoance. Mumps and bacterial parotitis were differentiated by 1800, but neither was effectively treated. The moality rate for bacterial parotitis was 80%. Before antibiotics and intravenous administration of fluids were available, bacterial parotitis occurred in postoperative patients or other severely ill patients who became dehydrated and contributed to their demise as an incurable sepsis.

Surgery

f2bed904-d182-4df2-97d4-3e5d9186bc39

Patient diagnosed as squamous cell intraepithelial lesion which of the following has the highest risk for progression to carcinoma;

Low grade squamous intraepithelial neoplasia

High grade squamous intraepithelial neoplasia

Squamous intraepithelial associated with HPV 16

Squamous intraepithelial neoplasia associated with HIV

1b

single

High grade squamous intraepithelial lesion have a propensity to progress and become invasive, therefore need investigations and treatment Ref: Shaw Gynecology 17 e pg 410.

Gynaecology & Obstetrics

Gynaecological oncology

a2cc3df8-77f3-4290-a580-d66398b9439d

Autosomal recessive polycystic kidney disease features include:

Can be diagnosed intrauterine

Proceeds to renal failure till children reaches school going age

Can be palpated abdominally

Hypertension doesn't develop until late stages of the disease

0a

multi

Ans. A. Can be diagnosed intrauterineExplanationClinical features of ARPKD (Autosomal recessive polycystic kidney disease) are:Classic ARPKD is generally diagnosed in utero or within the neonatal period and characterized by greatly enlarged echogenic kidneys in diseased fetuses. (Option a)Reduced fetal urine production may contribute to oligohydramnios and pulmonary hypoplasia.About 30% of affected neonates die shortly after birth due to respiratory insufficiency. Close to 60% of mortality occurs within the first month of life.In the classic group, most patients are bom with renal insufficiency and ESRD (End stage renal disease). (Option b)However, infants often have a transient improvement in their GFR; death from renal insufficiency at this stage is rare.Some patients are diagnosed after the neonatal stage and form the older group. Morbidity and mortality in this group often involve systemic hypertension, progressive renal insufficiency, and liver manifestations.The hallmarks of ARPKD liver disease are biliary dysgenesis due to a primary ductal plate malformation with associated periportal fibrosis, namely congenital hepatic fibrosis (CHF) and dilatation of intrahepatic bile ducts (Caroli's disease). CHF and Caroli's disease can then lead to portal hypertension exhibiting hepatosplenomegaly, variceal bleeding, and cholangitis.Some patients with the diagnosis of ARPKD at 1 year of age with nephromegaly exhibit slowly declining renal function over 20 years with only minimally enlarged kidneys at ESRD (Option c and e) and markedly atrophic kidneys following renal transplantation.The slow progression of renal disease is likely due to increasing fibrosis rather than the development of cysts.Systemic hypertension is common in all ARPKD patients, even those with normal renal function. (option d)

Pathology

Kidney

78c840a3-5ead-4b96-97b6-6b99a2b98f9b

You are the medical officer in charge of the immunisation programme at a sub-centre and you are informed by the local ASHA worker that one of the children who was immunised has has been dizzy. On fuher investigation it was confirmed that the symptoms were due to anxiety of pain of the injection and not as a result of the vaccine. You would consider the incidence as:

Vaccine reaction

Injection reaction

Programme error

Coincidental

1b

single

The following are the adverse effect following immunisation: Vaccine reaction - Here the event is caused by the inherent propeies of the vaccine when given correctly. Programme error - In this case the event is as a result of error in preparation, handling or administration of the vaccine. Coincidental - The event after immunisation is not caused by the vaccine but by a chance association. Injection reaction - The anxiety of the pain an injection itself may cause hyperventilation, dizziness etc. This is not a result of the vaccine and is called injection reaction. Ref: Park, 21st Edition, Page 103, 107.

Social & Preventive Medicine

dc05e667-659f-4f8f-a534-b329a1b356cc

Bicipital aponeurosis lies over which structure in cubital fossa:-

Median cubital vein

Radial nerve

Brachial aery

Anterior interosseous aery

2c

single

Bicipital aponeurosis lies superficial to the brachial aery and median nerve. -lies deep to superficial veins. -provides protection for the deeper structures during venepuncture at cubital fossa. -routinely released to decompress the median nerve

Anatomy

Muscles of arm and forearm region & Cubital fossa

77e67056-21d4-4dad-ba62-f785e6ce4e38

Postponing paying attention of conscious impulse or conflict is a mature defence mechanism known as -

Sublimation

Suppression

Humor

Anticipation

1b

single

Suppression is pushing of unwanted feelings into unconscious which has reached conscious awareness.

Psychiatry

3779c7ae-2be8-498b-adc9-45465595bf19

The commonest site of perforation during colonoscopy is -

Caecum

Hepatic flexure

Splenic flexure

Sigmoid colon

3d

single

• Risks of colonoscopy: Perforation and hemorrhage • MC site of bleeding after colonoscopy: Stalk after polypectomy. • MC site of perforation during colonoscopy: Sigmoid colon • Perforation can be caused by excessive air pressure, tearing of the antimesenteric border of the colon from excessive pressure on colonic loops, and at the sites of electrosurgical applications

Surgery

cbd91783-e901-4672-9ec1-7f58bce041da

A 74-year-old woman develops occipital headache, vomiting, and dizziness. She looks unwell, her blood pressure is 180/100 mm Hg, pulse is 70/min, and respirations are 30/min. She is unable to sit or walk because of unsteadiness. Over the next few hours, she develops a decline in her level of consciousness.For the above patient with altered level of consciousness, select the most likely diagnosis.

basal ganglia hemorrhage

cerebellar hemorrhage

pontine hemorrhage

lobar intracerebral hemorrhage

1b

multi

Cerebellar hemorrhage, when mild, may present with only headache, vomiting, and ataxia of gait. Patients may complain of dizziness or vertigo. The eyes may be deviated to the side opposite the hemorrhage. Nystagmus is not common, but an ipsilateral sixth nerve palsy can occur. This is the only type of intracerebral hemorrhage that commonly benefits from surgical intervention.

Medicine

C.N.S.

6c5c0933-9307-485a-a14b-305f77c287ef

Which is an uricosuric drug-

Allopurinol

Probenecid

Indomethacin

Aspirin

1b

multi

Ans. is 'b' i.e., Probenecid Uricosuric drugs are probenacid, sulfinpyrazone and benzbromarone.

Pharmacology

8556ec34-5fc9-46de-8be9-bce2fbd3ea06

After an incised wound ,new collagen fibrils are seen along with a thick layer of growing epithelium.The approximate age of the wound is

4-5days

About 1week

12-24hrs

24-48 hrs

0a

single

Ref Robbins 9/e p106 Incised wound for the formation of collagen and new tissue, thick layer of epithelial ,and granulation tissue formation along with new blood vessels requires atleast 4_5 days

Anatomy

General anatomy

7a277163-0216-4d34-838f-3f4ca53d763c

After delivery, a 28 year old pre ecclamptic primigra has a soft uterus with moderate-to-heavy bleeding. There is no laceration and there is PPH diagnosed due to uterine atony. Which of the following is the best management option?

0.2-mg intramuscular (IM) ergonovine (Methergine)

20 units of IV oxytocin

10 units of oral oxytocin

250 mg prostaglandin F2-alpha orally

1b

multi

Ergot derivatives should not be given in patients with hypeension since this is classically known to increase blood pressure. A high BP may provoke a post paum ecclampsia Oxytocin is not orally effective . Prostaglandin F2-alpha is given IM.

Gynaecology & Obstetrics

Pregnancy induced Hypeension

784827e3-b944-4c14-98d5-ed648eb38bc8

Trendlenburg's test done for varicose veins is for detection of:

Perforator in competency

Deep veins patency

Saphenofemoral incompetency

Site of perforators

2c

single

Ans: C (Saphenofemoral incompetency) Ref : 74 A Manual on Clinical Surgery S. DasExplanation:Clinical Examination of Varicose VeinsBrodie-Trendelenherg TestDone to determine the incompetency of Saphenofemoral valve.Patient is placed in recumbent position.Limbs are raised to empty the veins. Veins are milked proximally for further emptying.Saphenofemoral junction is compressed either with the thumb of the examiner/toumiquet and the patient is asked to stand up quickly.There are two variants of this test.The first method is to assess saphenofemoral incompetency. The pressure is released and if the column of blood fills up quickly from above downwards it indicates saphenofemoral incompetency.The second method is to assess the perforators. Here, the pressure is maintained for one minute. Gradual filling of the veins during this period indicates incompetent perforators allowing reflux of blood from deep veins to superficial veins.Positive Brodie--Trendelenberg test i~ an indication for surgery.Tests to Assess Saphenofemoral IncompetencyBrodie -Trendelenberg testMorrisey's cough impulse testTests to Assess Deep VeinsPerthe's testModified Perthe's testTests to Assess PerforatorsMultiple tourniquet testPratt's testFegan's testBrodie-Trendelenberg testTest to Assess V alves in Superficial VeinSchwartz testNote:Even though Brodie-Trendelenberg test is used to assess both saphenofemoral incompetency and incompetent perforators its primary purpose is to assess saphenofemoral incompetency.

Surgery

Varicose Veins

1a161e71-2d41-43e3-a3ed-4317413c6d86

Arrange the following 4 enzymes of gluconeogenesis in sequence: A. Pyruvate carboxylase B. Glucose - 6 - phosphatase C. Phosphoenol pyruvate carboxy kinase D. Fructose 1,6 Bisphosphatase

D-C-A-B

A-C-D-B

B-A-D-C

C-D-B-A

1b

single

Biochemistry

Gluconeogenesis

463091e2-e514-46e3-aedb-931a3af6545e

Specific poison for succinate dehydrogenase is ?

Cyanide

Malonate

Arsenite

Fluoride

1b

single

B i.e. Malonate

Biochemistry

3a63a6c3-1c1d-4578-a6b2-08e42456d546

Most common widespread zoonotic disease in the world is -

Rabies

Leptospirosis

Brucella

Anthrax

1b

single

<p> Leptospirosis is the most wide zoonotic disease in the world. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:291. <\p>

Social & Preventive Medicine

Communicable diseases

e68f5568-fcaa-4ff5-b664-5065ebba2d96

Post operative muscle ache is caused by

d-TC

Suxamethonium

Gallamine

Pancuronium

1b

multi

Anaesthesia

Muscle relaxants

aa9ef9b2-7854-491c-baf4-6df499428906

Blood stained sputum may be the only symptom in?

Bronchiectasis

Carcinoma bronchus

Adenoma bronchus

Pulmonary T.B.

2c

single

Ans. is 'c' i.e., Adenoma bronchus

Surgery

1e61071d-fa24-4df4-b39d-ad51308c63e2

Inherited hyperammonemia is a result of deficiency of which enzyme of Krebs-Henseleit urea cycle?

Malate dehydrogenase

Isocitrate dehydrogenase

N-acetyl glutamate synthetase

Succinate dehydrogenase

2c

single

Inherited hyperammonemias are a group of six diseases caused by inborn deficiencies of the enzymes of the Krebs-Henseleit urea cycle. The enzymes involved are: 1. N-acetyl glutamate synthetase 2. Arbamyl phosphate synthetase (CPS) 3. Ornithine transcarbamylase (OTC) 4. Argininosuccinic acid synthetase (citrullinemia) 5. Argininosuccinase deficiency 6. Arginase deficiency Most Severe Cases: In the most severe forms of the hyperammonemic disorders, the infants are asymptomatic at bih and during the first day or two of life, after which they refuse their feedings, vomit, and rapidly become inactive and lethargic, soon lapsing into an irreversible coma. Profuse sweating, focal or generalized seizures, rigidity with opisthotonos, hypothermia, and hyperventilation have been observed in the course of the illness. These symptoms constitute a medical emergency, but even with measures to reduce serum ammonia, the disease is usually fatal. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 37. Inherited Metabolic Diseases of the Nervous System. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.

Biochemistry

598d5484-6c3d-4983-aa72-cafaf6a4719a

Punishment for infanticide comes under -

IPC102

IPC324

IPC302

IPC300

2c

single

Ref:Textbook of forensic medicine and toxicology (V.V.Pillay) 17th edition, page no.377 Infanticide refers to the deliberate killings of chlid below the age of one year.In England, Germany, UK, there is a clear-cut distinction between homicide and infanticides. In India, no such distinction exists, and accuse is punished under sec.302IPC,the same manner as in murder.

Forensic Medicine

Sexual offences and infanticide

ed76ceeb-7206-424c-b2b0-222a1d226703

Carotid artery stenosis screening invivo choice is -

USG

CT

MRI

Doppler

3d

single

Ans. is 'd' i.e., Doppler o Color doppler ultrasonography is the screening method of choice (not simple USG : option a is incorrect),o Carotid angiography is the investigation of choice for diagnosis,o MRI is the investigation of choice for demyelinating disorder, e.g. multiple sclerosis.Investigations in nervous systemo Investigation of choice for white matter disease - MRI (CT is second choice),o Investigation of choice of acoustic neuroma - GD enhanced MRIo Best investigation for all brain tumors - Contrast enhanced MRIo Investigation of choice for meningeal carcinomatosis - Contrast (gadolinium) enhanced MRI.o Investigation of choice for posterior fossa tumor - MRIo Investigation of choice for para meningeal rhabdomyosarcoma - MRIo Investigation of choice for nasopharyngeal angiofibroma - Contrast enhanced CT.o Investigation of choice for hydrocephalus in older patients and for low pressure hydrocephalus - MRI.o Investigation of choice for acute (<48hrs) subarachnoid hemorrhage (SAH) - Non-Contrast CT scan,o Investivation of choice to know the etiology of SAH - Four vessels digital substruction angiography.o Hallmark of SAH - Blood in CSF on lumbar puncture,o Investigation of choice for chronic SAH - MRI.o Primary procedure of choice for evaluating intracranial complications of acute head injury - CT scan,o Best modality for assessing fractures of the skull base, calvarium and facial bone - CT scan,o Investigation of choice for demyelinating disorders MRI.o Investigation of choice for AV malformation and aneurysm - Angiography (MRI angiography or CT angiography),o Investigation of choice for Craniospinal infection - MRIo Investigation of choice for all intrinsic spinal cord lesions; all causes of cord compression - MRI.o Procedure of choice for emergent evaluation of acute intracerebral hemorrhage - CT scan,o Investigation of choice for myelopathy - MRI.o Shape of epidural hematomas on imaging - Biconvex, hyperdense or mixed density.o Shape of acute subdural hematoma on imaging - Crescent-shaped, hyperdense or mixed density ,o Chronic subdural hematoma on imaging - Hypodense.o Most sensitive test for ischaemic stroke - Diffusion weighted (DW) MRI.

Radiology

Head and Neck Imaging

9696296f-f81e-42b8-90e5-398da9c83945

Proposed guideline value for Radioactivity in drinking water is:

Gross a activity 0.1 Bq/L and Gross b activity 1.0 Bq/L

Gross a activity 1.0 Bq/L adn Gross b activity 0.1 Bq/L

Gross a activity 1.0 Bq/L and Gross b activity 10.0 Bq/L

Gross a activity 10 Bq/L and Gross b activity 1.0 Bq/L

0a

single

Key guidelines aspects of WHO recommended drinking water quality: Colour <15 true colour units (TCU) Turbidity <1 nephlometric turbidity units (NTU) pH: 6.5-8.5 Total dissolved solids (TDS) <500 mg/Litre Zero pathogenic microorganisms Zero infectious viruses Absence of pathogenic protozoa and infective stages of helminthes Fluoride <1.0 ppm (0.5-0.8 ppm: Optimum level) Nitrates <45 mg/Litre Nitrites <3 mg/Litre Gross alpha radiological activity <0.5 Bq/Litre (new guidelines -WHO) Gross Beta radiological activity <1.0 Bq/Litre (new guidelines-WHO) Ref: Park 25th edition Pgno: 762

Social & Preventive Medicine

Environment and health

ec9dbeb5-1b72-43fd-869c-896778e840e3

Lens develops from?

Endoderm

Mesoderm

Surface ectoderm

Neuroectoderm

2c

single

Ans. c (Surface ectoderm). (Ref. Human Embryology by IB Singh, 6th/352)LENS# LENS develops from surface ectoderm.# Compared to the cornea, it has a much lower converging power of 17 diopters because of the relatively similar refractive indices of aqueous humor, lens, and vitreous body (cornea 42 D).# However, the lens is the only part of the refractive apparatus that is adjustable.# Adjustment to near vision (accommodation) therefore involves only the lens.# In addition, the lens functions as a UV filter for wavelengths between 300 and 400 nm and thus has a protective function for the macula.# Notching of the lens = "pseudocoloboma".# Wilson's disease can induce a yellow-green lens discoloration (chalcosis/ sunflower cataract).# Granular gold deposits located under the lens (chrysiasis lends) can occasionally occur after prolonged treatment with gold preparations (e. g. in primary chronic polyarthritis ).# Other medications, e.g., amiodarone or chlorpromazine, are sometimes deposited in the lens.# In patients with cataract, glittering cholesterol crystals are not infrequently found in the lens (so-called Christmas tree/ decoration cataract).

Ophthalmology

Lens

36d1d9e0-62d6-4065-832c-1fedd97d046c

Features of neurogenic shock are

↑Peripheral resistance ↓ cardiac output

↑ Venous return ↑ cardiac output

↓Peripheral resistence↓cardiac output

Venoconstriction ↓cardiac output

2c

single

Medicine

eee99c0a-bd81-4fc8-9fa2-3e168d8be995

Palm of one hand is placed horizontally across the mouth and nostrils in

Manual strangulation

Palmar strangulation

Garrotting

Mugging

1b

multi

palmar strangulation Here the palm of one hand is placed horizontally across the mouth and nostrils, it's pressure being reinforced by placing the other palm on the top of it at right angles, the heel of the palm above pressing upon the front of the neck. Ref: TEXTBOOK OF FORENSIC MEDICINE AND TOXICOLOGY KRISHNAN VIJ FIFTH EDITION PAGE 134

Forensic Medicine

Asphyxia

90172650-01d2-4312-8c6d-5f71bbe8695c

In RDS all of the following statements are true except

Usually occurs in infants born before 34 weeks of gestation

Is more common in babies born to diabetic mothers

Leads to cyanosis

Is treated by administering 100% oxygen

3d

multi

Administration of 100% oxygen may increase the O2 load on fetal lung tissue. Hence, it is not given . Reference: GHAI Essential pediatrics, 8th edition

Pediatrics

New born infants

b9799e1c-a706-43df-8a51-7f1fa165d79c

National program for prevention and control of Cancer, Diabetes, Cardiovascular disease and stroke (NPCDCS), true is -

Separate centre for stroke, DM, cancer

Implementation in some 5 states over 10 districts

District hospital has specialised facilities

Subcentre has facility for diagnosis and treatment

2c

multi

Ans. is 'c' i.e., District hospital has specialised facilities Sational program for prevention and control of cancer, diabetes, cardiovascular diseases and stroke (NPCDCS1 Introduction Single centre fi- cancer, diabetes, cardiovascular disease, stroke. 100 districts in 21 states being covered in 1 1 th live year plan. 20,000 subcentres and 700 community health centres (CHCs) covered. o Activities as sub-centres Health promotion for behaviour and lifestyle change. Oppounistic screening of BP. blood glucose (strip method) in age > 30 years. Referral to CHC of cases of DM, HT. o Activities at CHCs : Diagnosis and management at NCD clinic. Home visits by nurse for bedridden cases. Referral to district hospital for complicated cases. o Activities as District hospital : Health promotion Screening of population > 30 years. Diagnosis and management of cardiovascular disease. Home-based palliative care for chronic, debilitating progressive patients. Specialized facilities. Urban health check-up shceme JOr diabetes and high BP : Screen urban slum population. Screen population > 30 years and pregnant females. Cancer control in NPCDCS : Regional cancer control scheme : Regional cancer centres to act as referral centres for complicated cases. Oncology wing development scheme. Decentralized NGO scheme : IEC activities and early cancer detection. lEC at central level. Research and mining.

Social & Preventive Medicine

5a242165-f06e-49de-9b9c-0cc4e1303f75

All of the following are ACTH independent Cushing syndrome except :

Pituitary adenoma

Adrenal hyperplasia

Adrenocoical carcinoma

McCune Albright Syndrome

0a

multi

ACTH dependent Cushing syndrome is caused by : ACTH producing pituitary adenoma Ectopic ACTH Bronchial or pancreatic carcinoid Small cell cancer of lung Medullary carcinoma of thyroids Pheochromocytoma ACTH Independent Cushing syndrome is caused by : Adrenocoical adenoma/ carcinoma Primary pigmented nodular adrenal disease Adrenal hyperplasia McCune Albright Syndrome Petrosal/Peripheral ACTH ratio > 2 indicates the presence of a pituitary adenoma-secreting ACTH. NOTE: Overall the most common cause of Cushing's syndrome is Iatrogenic steroids but if asked regarding ACTH dependent cause then answer should be given as Pituitary adenoma.

Medicine

Cushing Syndrome

396db5cd-55ab-434e-b14e-5c2742dd08d9

Hereditary spherocytosis is characterized by: March 2004

Anemia

Splenomegaly

Jaundice

All of the above

3d

multi

Ans. D i.e. All of the above

Pathology

653fbea7-3a1f-41e2-87fc-e541eb92292b

Ketamine can be given by all of following routes except-

IV

IM

SC

Nasally

2c

multi

Ketamine has been administered intravenously, orally , rectally, intramuscularly and epidural route and very rare intranasal but not subcutaneous

Anaesthesia

Intravenous Anesthetic Agents

f8d93899-b196-427e-9c0e-0f2a4e909a21

All of the following are features of Devic's syndrome (neuromyelitis optica), except?

Separate attacks of acute optic neuritis and myelitis

Optic neuritis is either unilateral or bilateral

Brain MRI is typically normal

It has a fulminant demyelinating process and progress to death in 1-2 year

3d

multi

Devic's disease is a variant of multiple sclerosis. Fulminant demyelinating process is seen with another variant called Marburg's variant.

Medicine

23a3d4a0-103f-4d6c-bcb9-dc8bab68b013

Which of the following is true about calcification of teeth?

Calcification of primary teeth is almost complete at time of birth

Calcification of all primary teeth and few permanent teeth complete at birth

Calcification of all permanent teeth complete at birt

Calcification of primary teeth starts around birth

0a

multi

Dental

2cb2be45-b5db-4716-b3a6-84875ab3ee77

A 7 years old boy presented with painful boggy swelling of scalp, multiple sinuses with purulent discharge, easily pluckable hairs and lymph nodes enlarged in occipital region. Which one of the following would be most helpful for diagnostic evaluation?

Bacterial culture

Biopsy

KOH mount

Patch test

2c

single

Ans. c. KOH mount

Skin

2bd24bb6-bc8e-44cd-b4da-e5b6808aaa6d

All the following are seen in Hyperparathyroidism except

Subperiosteal erosion of bone

Loss of lamina dura

Calvarial thickening

Pepper - pot skull

2c

multi

Calvarial thickening is a feature of Hypoparathyroidism.

Radiology

edf16f12-4d4c-48c3-bb35-478666e34498

Spore forming anaerobic gram positive bacilli ?

Bacillus Anthracis

Clostridia

Corynebacterium

Peptostreptococcus

1b

single

Ans. is 'b' i.e., Clostridia There are two medically impoant spore forming bacteria. Both of them are 'gram positive' `bacilli' :-Aerobic : BacillusAnaerobic (obligate anaerobes) : Clostridia.

Microbiology

daf88486-94e5-4799-960e-a3fc5137e1ab

Drug of choice for Falciparum Malaria is:-

Chloroquine

Mefloquine

ACT

Proguanil

2c

single

DOC for Falciparum Malaria - ACT.( Aemisinin based Combination therapy ) In Noh Eastern states:- ACT-AL co-formulated tablet of Aemether-20 mg / Lumefantrine - 120 mg. Primaquine 0.75 mg/ kg Body weight on day 2. 2. In Other States:- ACT-SP -Aesunate 50 mg tablet for 3 days and Sulphadoxine (500mg) - Pyremethamine (25mg) tablets for 1 Day. Primaquine tablets should be given on Day 2.

Social & Preventive Medicine

VBDs, Arboviral & Viral Infections, Surface Infections

b44f4bc6-30c3-4cd1-81b2-f172a886dea9

All are causes of white-dot syndrome except:

Fuch's heterochromic uveitis

VKH syndrome

HIV retinopathy

Sympathetic ophthalmitis

3d

multi

Ans. Sympathetic ophthalmitis

Ophthalmology

12af2d6a-1cf7-4dda-ab1d-0044c5ad8243

Maximum flow of Type1 inlay wax at 45degree

2%

3%

10%

70%

3d

single

Dental

a7bcda01-d462-4e60-bd9c-394439c1f79f

Platypnea is seen with?

Hepato-pulmonary syndrome

Hepato-renal syndrome

Renal aery stenosis

Kyphoscoliosis

0a

single

Platypnea: Increase dyspnea on sitting position Seen in 1. Atrial myxoma 2. Hepatopulmonary syndrome

Medicine

Acute Kidney Injury

013a96ca-7ed9-437b-bdf4-e7482a816fa3

Neuro lathyrism results due to

Aflatoxin

Pyruvic acid

BOAA

Sanguinarine

2c

single

Social & Preventive Medicine

9dda09e1-8bdc-4fae-be9e-ef95d04e3f71

Factor V Leiden is caused due to a mutation that results in a substitution at position 506 glutamine to which of the following:

Alanine

Arginine

Glycine

Glutamine

1b

single

Mutation in factor V (called the Leiden mutation, after the city in the Netherlands where it was discovered) causes recurrent DVTs. The mutation results in a glutamine to arginine substitution at position 506 that renders factor V resistant to cleavage by protein C. As a result, an impoant antithrombotic counter-regulatory pathway is lost Ref: Robbins 8th edition Chapter 4.

Pathology

0729894e-e71d-4e69-8f53-5ae6a8ee75c2

Kunkel's test is done to demonstrate presence of ................. in blood.

Lead

CuSO4

CO

Dhatura

2c

single

Carbon monoxide (CO)

Forensic Medicine

7af5d515-19b4-4b9c-b795-224e68a0176b

In which case cystometric study is indicated -

Neurogenic bladder

Stress incontinence

Fistula

Urge incontinence

0a

single

Cystometric studies are urodynamic studies in which the pressure changes in the bladder is simultaneously measured with bladder filling and during micturition. It helps in accurate assessment of detrusor and sphincter activity especially if a neurogenic abnormality is suspected. Though it is also used in stress incontinence but the aim here is to rule out any neurogenic cause.

Surgery

a18b8864-370a-4ef2-a61f-1265eba77975

Fish tank granuloma is seen in -

Mfortuitum

Mkansasi

Mmarinum

M leprosy

2c

single

Ans. is 'c' i.e., M. Marinum o Fish tank granulomaalso called ' swimming pool granuiomaf is caused by M. marinum.Principal types of opportunist mycobacterial disease in man and the usual causative agents.DiseasesUsual causative agentLymphadenopathyM. avium complexM. scrofulaceumSkin lesionPost-trauma abscessSwimming pool granulomaBuruli ulcerM. chelonaeM.fortuitumM. terraeM.marinumM. ulceransPulmonary' diseaseM. avium complexM. kansasiiM.xenopiM.malmoenseDisseminated diseaseAIDS-relatedM, avium complexM.genevenseM.avium complexM. chelonae

Microbiology

Bacteria

f30e750a-793d-4431-9be7-df8681f20a4f

TYNDALLISATION is a type of

intermittent sterilization

pasteurisation

boiling

autoclaving

0a

multi

Microbiology

6928a986-b002-4115-9c81-631f67d6c07a

A 49-year-old female taking ibuprofen for increasing joint pain in her hands presents with increasing pain in her midsternal area. Gastroscopy reveals multiple, scattered, punctate hemorrhagic areas in her gastric mucosa. Biopsies from one of these hemorrhagic lesions reveal mucosal erosions with edema and hemorrhage. No mucosal ulceration is seen.

Active chronic gastritis

Acute gastritis

Autoimmune gastritis

Chronic gastritis

1b

single

Gastritis is a nonspecific term that describes any inflammation of the gastric mucosa. Acute gastritis refers to the clinical situation of gastric mucosal erosions (not mucosal ulcers). Acute gastritis is also known as hemorrhagic gastritis or acute erosive gastritis. Acute gastritis is associated with the use of nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and coicosteroids, and also with alcohol, chemotherapy, ischemia, shock, and even severe stress. Two types of stress ulcers are Curling's ulcers, seen in patients with severe burns, and Cushing's ulcers, seen in patients with intracranial lesions. Grossly acute gastritis appears as multiple, scattered, punctate (less than 1 cm) hemorrhagic areas in the gastric mucosa. This is helpful in differentiating acute gastritis from peptic ulcers, which tend to be solitary and larger. Microscopically the gastric mucosa from a patient with acute gastritis is likely to reveal mucosal erosions, scattered neutrophils, edema, and possibly hemorrhage. Acute gastritis. Erosion and complete effacement of the epithelium is observed. The residual glands, on the left, display regenerative changes with basophilic epithelium. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition

Pathology

miscellaneous

3ce61463-a3ad-4e05-8e97-b404f9f04e0e

Sedimentation coefficient of Ig E is:

7S

8S

11S

20 S

1b

single

Ans : b 8S Ref: Ananthanarayanan 8th editionSvedberg unit - a sedimentation constant of 1 x 1013sec. Sedimentation unit is studied by ultracentrifugation - for diversity of antibody moleculeIgG -7IgA -7IgM -19Ig D -7IgE -8

Microbiology

Immunology

5f8a32c1-31db-477e-99cd-467e1f443720

DNA dependent RNA synthesis is inhibited by:

Rifampicin

Ethambutol

Colchicine

Chloromycetin

0a

single

Rifampicin

Pharmacology

9e9842eb-7ec0-4d06-9a22-bbcb97151aec

Iliac crest involvement is common in which condition: March 2007

Ankylosing spondylitis

Rheumatoid ahritis

Reiter's syndrome

Osteoahritis

0a

single

Ans. A: Ankylosing Spondylitis The basic pathologic lesion of ankylosing spondylitis occurs at the entheses, which are sites of attachment to bone of ligaments, tendons, and joint capsules. Enthesopathy results from inflammation, with subsequent calcification and ossification at and around the entheses. Inflammation with cellular infiltration by lymphocytes, plasma cells, and polymorphonuclear leukocytes is associated with erosion and eburnation of the subligamentous bone. The process usually stas at the sacroiliac joints. Other enthesopathic sites include the iliac crest, ischial tuberosity, greater trochanter, patella, and calcaneum. Ankylosing spondylitis/ AS/ Bechterew's disease/ Bechterew syndrome/ Marie Strumpell disease/Spondyloahritis is a chronic, painful, degenerative inflammatory ahritis primarily affecting spine and sacroiliac joints, causing eventual fusion of the spine. AS is a systemic rheumatic disease and one of the seronegative spondyloahropathies. About 90% of the patients express the HLA-B27 genotype. Men are affected more than women by a ratio in excess of 10:1. Typical signs of progressed AS are the visible formation of syndesmophytes on X-rays and abnormal bone outgrowths similar to osteophytes affecting the spine. Complete fusion results in a complete rigidity of the spine, a condition known as bamboo spine. In 40% of cases, ankylosing spondylitis is associated with iridocyclitis causing eye pain and photophobia. 4.1 AS is also associated with ulcerative colitis, Crohn's disease, psoriasis, and Reiter's disease Other complications are aoic regurgitation, Achilles tendinitis, AV node block and amyloidosis & restrictive lung disease. A clinical examination and X-ray studies of the spine, which show characteristic spinal changes and sacroiliitis, are the major diagnostic tools. The Schober's test is a useful clinical measure of flexion of the lumbar spine performed during examination.

Surgery

17a37bf5-e78b-48f2-be15-16c1049d1427

A 40-year-old man presents with a 2-week history of recur- rent oral ulcers, genital ulcers, intermittent arthritic pain of the knees, and abdominal pain. Physical examination reveals shallow ulcerations of the mucosa of the glans penis, as well as oral aphthous ulcers and conjunctivitis. Which of the following is the most likely diagnosis?

Behyet disease

Genital herpes

Gonorrhea

Polyarteritis nodosa

0a

multi

Behget disease is a systemic vasculitis characterized by oral aphthous ulcers, genital ulceration, and ocular inflammation, with occasional involvement of the nervous, gastrointestinal, and cardiovascular systems. The mucocutaneous lesions show a non-specific vasculitis of arterioles, capillaries, and venules. The cause of the necrotizing inflammation of small blood vessels is not known, but an association with specific HLA subtypes suggests an immune basis. Herpes (choice B) does not present with arthritis.Diagnosis: Behqet disease

Pathology

Blood Vessels

c6e0048e-68f8-493d-8bdf-bcd1afea8f1e

About biotransformation not true ?

Active metabolite generation

Polar to less polar

Less polar to more polar

Generate active drug from prodrug

1b

multi

Ans. is 'b' i.e., Polar to less polar

Pharmacology

be876641-0cee-4b0d-973f-af68790776da

In which phase of cell cycle, proof reading occurs?

G1

S

G2

M

1b

single

EVENTS PHASE of cell cycle Proofreading S phase Most repairs G1 phase Mismatch repair G2 phase

Biochemistry

Molecular Biology

2435c2fd-0ab9-4097-9969-6ce371e46532

The number of ATPs generated in krebs cycleare ?

12

24

15

30

1b

single

Ans. is 'b' > b' i.e., 24 One turn of the TCA cycle, staing with acetyl CoA produces 10 ATPs. When the staing molecule is pyruvate, the oxidative decarboxylation of pyruvate, the oxidative decarboxylation of pyruvate yields 2.5 ATPs and therefore, 12.5 ATPs are produced when staing compound is pyruvate. Since, two molecules of pyruvate enter the TCA cycle when glucose is metabolized (glycolysis produces 2 molecules of pyruvate), the number of ATPs is doubled. Therefore, 25 ATP molecules, per glucose molecule, are produced when pyruvate enters the TCA cycle.Note : Previously calculations were made assuming that NADH produces 3 ATPs and FADH generates 2 ATPs. This will amount a net generation of 30 ATP molecules in TCA per molecule glucose and total 38 molecules from staing. Recent experiments show that these values are overestimates and NADH produces 2.5 ATPs and FADH produces 1.5 ATPs. Therefore, net generation during TCA is 25 ATPs and complete oxidation of glucose through glycolysis plus citric acid cycle yield a net 32 ATPs.Energy yield (number of ATP generated) per molecule of glucose when it is completely oxidized through glycolysis plus citric acid cycle, under aerobic conditions, is as follows :- Method ofNo of ATPsNo of ATPsPathwayStepEnzymeSource ATP formationgained perglucose(new calculation)As per oldcalculationGlycolysis1Hexokinase MinusMinus 1Do3Phosphofructokinase MinusMinus 1Do5Glyceraldehyde-3-p DHNADH Respiratory chain2.5 x 2 = 53 x 2 = 6Do61,3-BPGkinase ATPSubstrate level1 x 2 -- 21 x 2 = 2Do9Pyruvate kinaseATP Substrate level1 x 2 = 21 x 2 = 2Pyruvate to?PyruvateNADH Respiratory chain2.5x2= 53x2= 6Acetyl CoA Dehydrogenase TCA cycle3Isocitrate DHNADH Respiratory chain2.5x2= 53 x 2= 6Do4Alpha keto glutarate DHNADH Respiratory chain2.5x2= 53x2= 6Do5Succinate thiokinaseGTP Substrate level1 x 2 = 21 x 2 = 2Do6Succicinate DHFADH2Respiratory chain1.5x2= 32 x 2= 4Do8Malate DHNADH Respiratory chain2.5x2= 53 x 2= 6Net generation in glycolytic pathway 9 minus 2= 7 10 minus 2= 8Generation in pyruvate dehydrogenase reaction 5 * 6Generation in citric acid cycle 20 * 24Net generation of ATP from one glucose mole 32 * 38

Biochemistry

10fa25e5-2afd-4660-bd47-8759e3004d33

Child with mild squint. Intrauterine, bih history, developmental history till date all normal. Corneal reflex normal. All other eye parameters normal except exaggerated epicanthal fold. Diagnosis ?

Pseudostrabismus

Accomodative squint

Exophoria

Esophoria

0a

multi

Ans. is 'a' i.e., Pseudostrabismus Epicantnic fold causes Pseudoesotropia (Pseudostrabismus).

Ophthalmology

9c66c905-3a4a-440e-973f-270b04fe9a86

Pain-sensitive intracranial structure is:

Piamater

Pial vassels

Duramater

Brain matter

2c

single

C i.e.Duramater

Physiology

afa909b3-f7e2-4c1c-9747-9638994735ce

Not used for iron poison in: FMGE 09; NEET 13

Magnesium hydroxide

Desferrioxamine

Gastric lavage

Penicillamine

3d

single

Ans. Penicillamine

Forensic Medicine

23294025-db77-485a-a342-16e13930f3b2

Posterior relations of the head of the pancreas include all of the following, except:

First pa of the duodenum

Common bile duct

Inferior vena cava

Aoa

0a

multi

The posterior relations of the head of the pancreas include the common bile duct, inferior vena cava and the right and left renal veins terminating into it. The first pa of the duodenum is an anterior relation of the head of the pancreas.Ref: Clinical Anatomy, By Richard S. Snell, 6th edition, Page 230; Clinical Anatomy (A Problem Solving Approach), By Neeta V Kulkarni, 2nd edition, Page 689.

Anatomy

daea259a-2232-46db-8d5a-e04d5a1d4c5c

Which of the following events is involved in cleavage of the zygote during week 1 of development?

A series of meiotic divisions forming blastomeres

Production of highly differentiated blastomeres

An increased cytoplasmic content of blastomeres

A decrease in size of blastomeres

3d

single

Cleavage is a series of mitotic divisions by which the large amount of zygote cytoplasm is successively paitioned among the newly formed blastomeres. Although the number of blastomeres increases during cleavage, the size of individual blastomeres decreases until they resemble adult cells in size.

Anatomy

Development period- week 1,2,3,4

2490c0e2-5e57-46de-a276-0163f4b35337

A female child with virilization, hypertension with low plasma renin diagnosis is :

21α hydroxylase deficiency

11 β hydroxylase deficiency

3β hydroxylase deficiency

Conn’s syndrome

1b

single

9] Congenital adrenal hyperplasia represents a group of autosomal recessive inherited, metabolic errors, each characterized by decency or total lack of a particular enzyme involved in the biosynthesis of cortical steroids, Steroidogenesis is then channelled into other pathways leading to increased production of androgens, which accounts for virilization. Simultaneously, the decency of cortisol results in increased secretion of ACTH resulting in adrenal hyperplasia. Following enzymes are implicated in the congenital adrenal hyperplasia 21 α hydroxylase decency (partial or complete) 17 α hydroxylase deficiency 11β hydroxylase deficiency 21 α hydroxylase deficiency • Two forms of this deficiency include - A. Salt-wasting adrenogenital ism B. Simple Virilizing adrenogenital ism A) Salt-wasting syndrome (complete lack) The salt wasting syndrome results from complete lack of 21 hydroxylases. There is no synthesis of mineralocorticoids and glucocorticoids in the adrenal cortex. Decreased mineralocorticoids causes marked sodium loss in the urine, resulting in hyponatremia, hyperkalemia, acidosis and hypotension. Because of the enzyme block, there is increased formation of 17 - hydroxyprogesterone, which is then shunted into the production of testosterone. This may cause virilism (pseudo-hermaphroditism) in female infants. That is (XX) Female with 21 hydroxylase deficiency develops ovaries, female ductal structures and external male genitalia. But in the male child, the effect of increased testosterone will not be manifested at the time of birth. The complete21 hydroxylase deficiency or salt wasting syndrome usually comes to light only after the birth because in utero the electrolytes and uids can be maintained by maternal kidneys. Males with this disorder comes to clinical attention 5 to 15 days later because of salt losing crisis while females come to attention soon after the birth because of the virilization. B) Simple Virilizing adrenogenital syndrome (Partial deficiency) Occurs in individuals with partial deficiency of 21 hydroxylases Less severe deficiency of mineralocorticoid, is sufficient for salt reabsorption, but the lowered glucocorticoid fails to cause feedback inhibition of ACTH secretion. Thus level of aldosterone is mildly reduced, testosterone is increased and ACTH elevated with resultant adrenal hyperplasia. 11B hydroxylase deficiency-. Rare Leads to decreased cortisol and increased ACTH. This, in turn, leads to the accumulation of DOC (deoxycorticosterone) and 11 deoxycortisol both of which are strong mineralocorticoids. This results in increased sodium retention by the kidneys and hypertension, hypokalemia. Patients also develop virilization due to androgen excess. 17 α hydroxylase deficiency - Patients with deficiency of 17 hydroxylases also have impaired cortisol production, increased ACTH and secondary increased DOC. These patients, however, cannot synthesize normal amount of androgens and estrogens. This is because the gene that codes for 17 α hydroxylase is the same for the enzyme in the adrenal cortex and the gonads and the decency is same in both organs. Because of decreased sex hormones, genotypic females develop primary amenorrhoea and fail to develop secondary sex characteristics while genotypic males will present as pseudohermaphrodite. 3 β hydroxylase deficiency 3-β hydroxylase deficiency is a rare genetic disorder of steroid biosynthesis that results in decreased production of all three groups of adrenal steroids which include mineralocorticoid, glucocorticoid and sex steroids. Decreased mineralocorticoid secretion results in varying degrees of salt wasting in both males and females. Decent androgen production results in ambiguous genitalia in males The usual presentation is a male child with ambiguous genitalia and severe salt wasting. Sometimes it may also occur in females

Medicine

0b9a50a8-7210-4ff5-81f6-b49dee01c09b

'Patterned' abrasion is variety of:

Linear abrasion

Pressure abrasion

Sliding abrasion

Superficial bruise

1b

single

Ans. is 'b' ie pressure abrasion (Ref: Parikh; 6/e, p4.3).An abrasion is a superficial injury involving only the superficial layers of the skin (epidermis only), caused by friction and / or pressure between the skin and some rough object or surface. It bleeds very slightly, heals rapidly in a few days and leaves no scar.They can be classified into 3 types, depending on the manner they are created.ScratchIs a linear injury produced by a sharp object, such as pin, thorn or finger nail.Graze (Sliding, scraping or grinding abrasion).Is produced when a broad surface of skin slides against a rough surface.It is also known as brush or friction burn because it is caused by the frictional force and resembles a burn after dryingIt is commonly found in road traffic accidents.Imprint, Pressure or contact abrasion.Is produced as a result of direct impact or pressure of or contact with some object at right angles to the skin surface.The cuticle is crushed, and the object marks a reproduction of its shape and pattern on the to the skin, therefore it is known as patterned abrasion.Example are ligature marks in hanging and strangulation, nail and thumbs marks in throttling, teeth marks in biting, radiator, grill or tyre mask in vehicular accidents.

Forensic Medicine

Sexual Offenses

1d267206-3dd2-462b-9b44-8a3a48c31c12

Pimozide belongs to class of:

Thiothixanthene

Phenothiazine

Butyrophenone

Diphenyl butyl piperidine

3d

multi

Thioxanthenes are flupenthioxol. Butyrophenones are haloperidol, trifluperidol , penfluridol. Phenothiazines are Chlorpromazine, triflupromazine , thioridazine, flufenazine. Promazine belongs to the group of other of other hetero cyclics that is diphenyl butyl piperidine. Ref: KD Tripathi 8th ed.

Pharmacology

Central Nervous system

7b33754c-beaa-43e5-81f5-f4c3f8bf2245

Which of the following drugs is antipseudomonal penicillin?

Cephalexin

Dicloxacillin

Piperacillin

Cloxacillin

2c

single

Pharmacology

b3dcc864-5d6f-4d14-b6bf-143f4d777784

Following poisoning retards putrefaction: NEET 13

Aluminium phosphide

Lead

Arsenic

Copper

2c

single

Ans. Arsenic

Forensic Medicine

3bad3d0c-b14c-4ec4-a203-a124976139a0

True statements about parotid gland

Duct opens oppsite to upper 2nd molar tooth

Duct pierces Masseter

Develops from ectoderm

Secretomotor fibres come from facial nerve

0a

multi

The duct runs forwards for a sho distance between the buccinator and the oral mucosa. Finally, the duct turns medically and opens into the vestibule of the mouth(gingivobuccal vestibule)opposite the crown of the upper second molar tooth. Notes: Parotid abscess may be caused by spread of infection from the opening of parotid duct in the mouth cavity. <img src=" /> REF.BDC VOL.3,Sixth edition pg 110

Anatomy

Head and neck

17b8471f-d82c-4236-a843-66e19ce561b0

Which of the following statement is false about hydrocele?

Arises due to patent processus vaginalis

Wait for 5 years for spontaneous closure of congenital hydrocele

Lord's plication of sac for small hydrocele

Jaboulay's eversion of sac for medium hydrocele

1b

multi

Treatment of Hydrocele Congenital Hydrocele: Usually spontaneous obliteration by 2 years age. If persists then Herniotomy. Treatment of Vaginal Hydrocele 1. Small hydrocele: Lord's procedure (Plication of sac)Q 2. Medium hydrocele: Jaboulay's procedure (Eversion of sac)Q 3. Large hydrocele: Excision of sacQ

Surgery

Testis and scrotum

0efb3876-ad2b-44d1-99c9-73c50708d75b

The main difference between dental stone and dental plaster is:

Chemical composition

Self life

Shape and size of particles

Solubility in water

2c

single

Dental

fa6f9581-fb3b-49be-b366-c97793f765ff

A normally developing 10 months old child should be able to do all of the following except –

Stand alone

Play peak to boo

Pick up a pellet with thumb and index finger

Build a tower of 3–4 cubes

3d

multi

A child starts trying to build a tower of cubes (2 cubes) by the age of 1 year. About other options Child can stand with support by 9 months. Child can play peak-a-boo game by 10 months. Child can pick up a pellet with thumb and index finger (pincer grasp) by 9 months.

Pediatrics

2d7752b3-6526-4bba-90a1-b7862767573b

Lines of Blaschko&;s are along

Lymphatics

Nervs

Developmental

Blood vessels

2c

single

Blaschko&;s lines, are lines of normal cell development in the skin. These lines are invisible under normal conditions.

Anatomy

General anatomy

864d863c-3c3f-4f72-b1dc-bf0ec9e8d0c3

All the teeth in patient’s mouth are similarly affected as shown in the radiograph. What is the most likely anomaly?

Type 1 dentinal dysplasia

Type 2 dentinal dysplasia

Taurodontism

Amelogenesis imperfecta

1b

multi

Dentinal dysplasia Dentinal dysplasia is an inherited condition affecting both dentitions. It is divided into two types: Type I (radicular dentinal dysplasia) and Type II (coronal dentinal dysplasia). It occurs less frequently than dentinogenesis imperfecta. Clinical features Type I is the more frequent type. Teeth erupt normally with no obvious abnormality but rapidly develop mobility resulting from limited root support. In type II, the deciduous teeth are similar to those in dentinogenesis imperfecta, whereas the permanent teeth appear normal. Radiological signs In Type I, all the teeth, except the canines, have extremely short roots. The roots are conical or blunted. There is pulpal obliteration and the inferior aspects of the crown exhibit linear crescent-shaped radiolucent lines. Periapical radiolucencies are commonly seen associated with non-carious teeth in Type I dentinal dysplasia. In Type II dentinal dysplasia, obliteration of the pulp occurs post eruption in the deciduous dentition. In the permanent dentition, there is alteration in the configuration of the pulp resulting in enlarged pulp chambers extending well down into the root. The pulp contains multiple calcifications. Ref: Interpreting Dental Radiographs by Keith Horner, Jon Rout and Vivian E Rushton

Radiology

4ad3b836-706a-47a9-9ccc-68d9feb2f5e7

Middle aged female with mass in sella turcica hormone increased is -

Prolactin

Thyroxine

Extrogen

ADH

0a

single

The sella turcica is a saddle shaped depression of the sphenoid bone. It forms the caudal border of the pituitary gland. Sella turcica is an anatomically complex area with a number of different potential pathologies especially neoplastic process. Pathologies of sella turcica can lead to important clinical presentations such as hormonal imbalances from pathologies affecting the pituitary gland and neurological symptoms from the mass effect. Sella turcica is critically located as several structures pass close to it due to compression of the adjacent structures. Important anatomical structures related to sella Optic chiasm Pituiatry gland Internal carotids​ Gavernous sinus and cranial nerves Sphenoid sinuses

Medicine

3d26c59a-23b7-4f94-bd3a-46c52e94717f

Hyoid bone fracture most common occurs in ?

Manual strangulation

Hanging

Smothering

Traumatic asphyxia

0a

single

Ans. is 'a' i.e., Manual strangulation As manual strangulation (throttling) is among the most violent form of asphyxia, hyoid fracture and other injury to neck structures is more common.

Forensic Medicine

e8e89c2e-3ded-4f79-8b72-c4c15b0e0022

"Acute Meningoencephalitis" is caused by:

E. histolytica

Nageleria

Giardia

E.coli

1b

single

Nageleria

Microbiology

d700bd56-0b0c-44cc-9099-5986224e73ba

The process of destroying all microbes including spores is called :

Disinfection

Antisepsis

Asepsis

Sterilization

3d

multi

Microbiology

6ff91b9c-ef2d-4e23-8bbe-91abe79cf929

All are major symptoms of sinusitis except

Nasal blockage

Facial congestion

Nasal congestion

Halitosis

3d

multi

According to Rhinosinusitis task force definition of sinusitis,Major criteria-Facial pain, pressure, congestion, nasal obstruction, nasal/postnasal discharge, hyposmia and feverMinor criteria- Headache, halitosis, and dental painRef: Hazarika; 3rd ed; Pg 328

ENT

Nose and paranasal sinuses

fd69db25-3857-40ab-acb4-d7aedc45b959

Most sensitive nerve fiber to hypoxia

A

B

C

All are equally sensitive

1b

multi

Question repeated

Physiology

Nervous system

344ff8fd-3b80-4311-9f67-a5f54e3e0fff

Nasal septum is formed except by

Perpendicular plate of ethmoid

Vomer

Nasal bone

Lateral cailage

3d

multi

The bony pa is formed by: 1.Vomer 2.Perpendicular plate of ethmoid 3.Nasal spine of frontal bone 4.Rostrum of sphenoid 5.Nasal crest of nasal, palatine and maxillary bones. NOTES: The cailaginous pa is formed by; 1.Septal cailage 2.Septal process of inferior nasal cailages The cuticular pa is formed by; 1.Fibrofatty tissue Ref.BDC volume3,Sixth edition pg 240

Anatomy

Head and neck

041f5188-7539-4b9a-8784-b7ebf0f10021

Metoprolol is preferred over Propranolol as it: September 2010

Is more potent in blocking beta-1 receptors

Is more potent in blocking beta-2 receptors

Is more effective in suppressing essential tremors

Impairs exercise capacity

0a

single

Ans. A: Is more potent in blocking beta-1 receptors Metoprolol is cardioselective beta blocker, more potent in blocking beta-1 than beta-2 adrenergic receptors.

Pharmacology

6acbf6b1-7c5c-42a8-a0f9-cae7485b9eb3

All will predispose to atherosclerosis, except

Homocystinemia

Fibrinogen

Calcium

Lipoprotein A

2c

multi

Elevated plasma levels of  homocysteine are associated with increased risk of atherosclerosis, thrombosis and hypertension. Lipoprotein A inhibits fibrinolysis, therefore predisposes to atherosclerosis. Atherosclerosis (Greek  athere-mush)  is a complex disease characterized by thickening or hardening of arteries due to the accumulation of lipids (particularly cholesterol, free, and esterified), collagen, fibrous tissue, proteoglycans, calcium deposits, etc. in the inner arterial wall.  Satyanarayana, Ed 3, Pg No 152

Biochemistry

c4dbe11c-2ef0-4043-adcb-5a068e9afe0e

Most serious complication seen in other eye after traumatic injury to one eye: March 2005, September 2008

Subconjunctival hemorrhage

Corneal edema

Sympathetic ophthalmia

Sudden loss of vision

2c

single

Ans. C: Sympathetic ophthalmia Sympathetic ophthalmia (SO) is a condition in which serious inflammation attacks the sound eye after injury (including intraocular surgeries) to the other. It is the most dreaded complication of unilateral severe eye injury, as it can leave the patient completely blind. Symptoms may develop from days to several years after a penetrating eye injury. Sympathetic ophthalmia is thought to be an autoimmune inflammatory response toward ocular antigens, specifically a delayed hypersensitivity to melanin-containing structures from the outer segments of the photoreceptor layer of the retina. It is thought that Louis Braille, who injured his left eye as a child, lost vision in his right eye due to SO Floating spots and loss of accommodation are among the earliest symptoms. The disease may progress to severe iridocyclitis with pain and photophobia. Commonly the eye remains relatively painless while the inflammatory disease spreads through the uvea. The retina, however, usually remains uninvolved. Papilledema, secondary glaucoma, vitiligo and poliosis of the eyelashes may accompany SO. Diagnosis is clinical, seeking a history of eye injury. An impoant differential diagnosis is Vogt-Koyanagi-Harada syndrome (VKH), which is thought to have the same pathogenesis, without a history of surgery or penetrating eye injury. Definitive prevention of SO requires prompt (within the first 7 to 10 days following injury) enucleation of the injured eye. Evisceration--the removal of the contents of the globe while leaving the sclera and extraocular muscles intact--is easier to perform, offers long-term orbital stability, and is more aesthetically pleasing. But evisceration may lead to a higher incidence of SO compared to enucleation. Immunosuppressive therapy is the mainstay of treatment for SO. When initiated promptly following injury, it is effective in controlling the inflammation and improving the prognosis.

Ophthalmology

efdbc8fc-57c6-4154-b35f-0907d23ad414

Least commonly seen in conduct disorder seen in girls:-

Run away from home

High risk sexual behavior

Physical aggression

Emotional bullying

2c

single

Conduct disorder - Persistent pattern of antisocial behavior in which the individual repeatedly breaks social rules and carries out aggressive acts.in conduct disorder they do it deliberately usually characterized by aggression and violation of the rights of others boys with conduct disorder show physical & relationship aggression but In girls relationship aggression is more predominant than physical aggression children with conduct disorder usually have behaviors characterized by aggression to persons or animals, destruction of propey, deceitfulness or theft, and multiple violations of rules, such as truancy from school.

Psychiatry

JIPMER 2018

4a4c2a4f-37d5-469b-a65e-107ee1b863da

Which of the following aminoglycosides has the highest nephrotoxicity?

Paromomycin

Streptomycin

Amikacin

Neomycin

3d

single

Pharmacology

3d486b16-b896-442c-8c67-2e9530e89fce

Least conduction velocity is seen in:

AV node

Purkinje fibers

Bundle of His

Ventricular myocardial fibres

0a

single

Physiology