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Bence jones proteins are associated with
null
2
Hodgkin's lymphoma
Multiple myeloma
Burkitt's Lymphoma
Infectious mononucleosis
Pathology
null
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single
Hyperprolactinoma causes
(Oligomenorhea): (2287-88- H18th edition; 788-Davidson 21st)HYPER PROLACTINEMIA* Hyper prolactinemia is the most common pituitary hormone hyper secretion syndrome in both men and women* PRL- secreting pituitary adenoma (Prolactinomas) are the most common cause of PRL levels > 200 mg/L* Pregnancy and lactation are the important physiologic causes of hyperprolactinemia* Amenorrhea, galactorrhea and infertility are the hall marks of hyperprolactinemia in women* More commonly hyperprolactinemia develops later in life and leads to oligo menorrhea** and ultimately to amenorrhea* Decreased libido, weight gain and mild hirsutism may also complainMen-* Diminished libido , infertility and visual loss, impotence and oligospermia* True galactorrhea is uncommon in men hypogonadism, osteopenia, reduced muscle mass and decreased beard growth
3
Inter menstrual bleeding
Prolonged menstruation
Oligomenorrhea
Polymenorrhea
Medicine
Endocrinology
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single
Which of the following statement about Bradykinin is true:
A i.e. Causes PainBradykinin increases vascular permeability, and causes contraction of smooth muscle (utrine, intestine, bronchoconstriction), dilation of blood vessels and painQ when injected into the skin. These effects are similar to those of histamine.
1
Causes pain
Causes bronchodilation
Causes vasoconstriction
Decreases vascular permeability
Physiology
null
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multi
Suxamethonium is
Depolarizing neuromuscular blockers Succinylcholine (SCh., Suxamethonium), Side effects:- Muscle fasciculations and soreness, changes in BP and HR, arrhythmias, histamine release and K+ efflux from muscles causing hyperkalaemia. Uses:- SCh is the most commonly used muscle relaxant for passing tracheal tube. It induces rapid, complete and predictable paralysis with spontaneous recovery in ~5 min. Excellent intubating condition viz. relaxed jaw, vocal cords apa and immobile with no diaphragmatic movements, is obtained within 1-1.5 min. Avoided/contraindication:- It should be avoided in younger children unless absolutely necessary, because risk of hyperkalaemia and cardiac arrhythmia is higher. Risk of regurgita- tion and aspiration of gastric contents is increased by SCh in GERD patients and in the obese, especially if stomach is full. Ref:- kd tripathi; pg num:-347,353
3
Non depolarizing muscle relaxant
Direct acting muscle relaxant
Depolarising muscle relaxant
All of the above
Pharmacology
Anesthesia
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Movement across socioeconomic levels is termed as –
Social mobility is the degree to which an individual's family or group's social status can change throughout the course of their life through a system of social hierarchy, i.e. Social mobility refers to movement of individuals/ families across different socioeconomic levels. Social Upliftment Social upliftment refers to encouragement and improvement or betterment of previously disadvantaged sections of society. Social equality Social equality is a social state of affairs in which different people have the same status in certain respect such as access to education, health care, social securities etc. Social insurance Social insurance is a government run insurance programme that offers protection against various economic risks and provides economic assistance to unemployed, elderly or the sick and disabled; within a population. Such programs are funded by taxes or premiums paid by the participants (Participation is often compulsory).
3
Social equality
Social upliftment
Social mobility
Social insurance
Social & Preventive Medicine
null
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Ascorbic acid is a potent enhancer of iron absorption because it
Ascorbic acid enhances iron absorption mostly by its reducing capacity, keeping iron in the ferrous state. Ascorbic acid does not enhance heme iron absorption, nor does it affect heme oxygenase activity or the produc on of ferritin or transferrin.
3
Enhances the absorption of heme iron
Enhances the activity of heme oxygenase
Is a reducing agent, thereby helping to keep iron in the ferrous state
Decreases the production of ferritin by enterocytes
Anatomy
All India exam
89f196fa-9d25-48e3-be78-d668f9ab0506
single
Veins communicating the cavernous sinus to pterygoid plexus pass through fossa of :
B i.e. Vesalius; C i.e. OvaleForamen Vesalius is an inconstant foramen that gives passage to an emissary vein that connects pterygoid venous plexus with cavernous sinus (vein of vesalius)Q. It is also k/a sphenoidal emissary foramen as its seen in the great wing of sphenoid, medial to foramen ovale, opposite the root of pterygoid process. When present it opens below near scaphoid fossa (in the pterygoid process of sphenoid & gives origin to tensor vali patatini)Langer's (Axillopectoral) muscle/ Axillary Arch: A muscle originating from coracoid- process of scapula, extending to long head of triceps and adhering to both triceps brachii & tendinous pa of latissimus dorsi muscle.
2
Scapra
Vesalius
Ovale
Langer
Anatomy
null
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Mucosal candidiasis is caused by
(A) Candida albicans # Mucosal Candidiasis> Candidosis describes a group of yeastlike fungal infections involving the skin and mucous membranes.> Infection is caused by Candida species, typically, Candida albicans.> Acute pseudomembranous candidiasis (thrush)> Thrush may be observed in healthy neonates or in persons in whom antibiotics, corticosteroids, or xerostomia disturb the oral microflora.> Oropharyngeal thrush occasionally complicates the use of corticosteroid inhalers.> Immune defects, especially HIV infection, immunosuppressive treatment, leukemias, lymphomas, cancer, and diabetes, may predispose patients to candidal infection.
1
Candida albicans
Candida tropicalis
Candida guilliermondi
Candida krusei
Medicine
Miscellaneous
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Clearance -
Ans. is 'd' i.e., All of the above Clearance of a drug is the theoretical volume of plasma from which the drug is completely removed in unit time.
4
Refers to the efficacy of elimination of a drug by an organ or whole body
Cannot be greater than blood flow to an organ
Determines the steady of the drug concentration
All the above
Pharmacology
null
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multi
An absolute contraindication for extraction of teeth is:
null
4
Hypertension
Myocardial infarction
Thyrotoxicosis
Central hemangioma
Surgery
null
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Who is the chairman of district blindness control society?
Ans. a. District collector (Ref: Park 23/e p439, 22/e p406; www.nrhmtn.gov.in/dbcs.html)District collector is the chairman of district blindness control society.District Blindness Control Society has been established under the chairmanship of District Collector/Deputy Commissioner. Park 23/e p439District Blindness Control SocietyChairmanDistrict CollectorVice-ChairmanDeputy Director of Health ServicesMember SecretaryChief Ophthalmic Surgeon andDistrict Programme ManagerTechnical AdviserDistrict Ophthalmic Surgeon
1
District collector
Programme manager
District health officer
District eye surgeon
Social & Preventive Medicine
Health Programmes in India
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An 18 months baby can do?
a. Hide and seek game(Ref: Nelson's 20/e p 65-77, Ghai 8/e p 52-54)Hide and seek game or peek a boo comes at around 10 months age.
1
Hide and seek game
Write alphabet
Say short sentence
Run
Pediatrics
Growth, Development, and Behavior
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single
A newborn baby presented with profuse bleeding from the umbilical stump after bih. Rest of the examination and PT, APTT are within normal limits. Most of probable diagnosis is:
Ans. a. Factor X deficiency
1
Factor X deficiency
Glanzmann thrombasthenia
von-Willebrand disease
Bernard-Soulier disease
Pathology
null
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A 37-year-old man develops pulmonary hemorrhage and glomerulonephritis. Lung biopsy with immunofluorescence demonstrates IgG deposition along the basement membrane. These antibodies are most likely directed against which of the following types of collagen?
Goodpasture syndrome Autoimmune disease Ceain domains of type IV collagen are intrinsic to the basement membranes of renal glomeruli and pulmonary alveoli. Resulting in necrotizing hemorrhagic interstitial pneumonitis and rapidly progressive glomerulonephritis. The characteristic linear pattern of immunoglobulin deposition (usually IgG) is the hallmark diagnostic
4
Type I
Type II
Type III
Type IV
Pathology
Glomerulonephritis
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Most common cause of Cheyne-Stokes breathing is?
Ans. is'b'i.e., CHF(Ref Clinicalmedicine p. 713)Cause of Cheyne-Stokes respiration,Normally occurs during sleep at high altitudeCongestive cardiac failureDamage to respiratory centers
2
Diabetic ketoacidosis
CHF
Bulbar polio
Pontine hemorrhage
Physiology
null
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single
Most stable in closed reduction is
null
2
Screws
Arch bar
Direct wiring
None of the above
Surgery
null
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The drug of choice for mushroom poisoning is which of the following?
Symptoms of mushroom poisoning are due to excess of muscarine. The polypeptides from these mushrooms are inhibitors of cellular protein synthesis and stimulates post ganglionic cholinergic fibres. Atropine sulphate is the preferred drug of choice to counteract the muscarinic effects. Ref: The Essentials of Forensic Medicine And Toxicology by Dr. K. S. Narayan Reddy 27th edition; Pages 564 - 565; K D Tripathi Texbook of Pharmacology 5th edition; page 100.
1
Atropine
Carbachol
Adrenaline
Physostigmine
Forensic Medicine
null
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Toxins are implicated as the major pathogenic mechanism in all of the following bacterial diarrhoeas except -
null
3
Vibrio cholerae
Shigella sp.
Vibrio parahemolyticus
Staphylococcus aureus
Microbiology
null
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Hepatocellular damage of wilson's resembles ?
Ans. is 'a' i.e., Acute hepatitis; 'b' i.e., Chronic hepatitis; 'c' i.e., CholestasisWilson diseaseo This autosomal - recessive disorder is marked by the accumulation of toxic levels of copper in many tissues and organs, principally the liver, brain and eye.Clinical features of Wilson's disease?Organs involved Symptoms producedHepatic o The liver often bears the brunt of injury in wilson disease with hepatic changes ranging from relatively minor to massive damage which are - Fatty change, acute hepatitis, chronic hepatitis, cirrhosis, massive liver necrosis (acute fulminant hepatitis).All forms of hepatitis are seen in wilson disease (chronic active hepatitis also seen)C.N.S. o In brain, the toxic injury primarily affects the basal ganglia paicularly the putamen which demonstrates atrophy and cavitation.The involvement of basal ganglia produces extrapyramidal symptoms which are - Dystonia, incoordination, tremor, dysphagia, dysahria, chorea.Memory loss, migraine headaches and seizures too can occur.Patients can have difficulty in concentrating on tasks but cognition is usually not impaired.Remember that Sensory abnormalities and muscular weakness are not seen in this disease.Psychiatric o H/O of behavioral disturbances within five years of the onset of the disease.Features are diverse and include loss of emotional control (temper tantrums, crying bouts) Depression, hyperactivity, loss of sexual inhibition.Occular o Kayser Flescher ring (green to brown deposits in the descment's membrane in the cornea)Sunflower cataractBlood o Hemolytic anemia (in severe hepatic failure hemolytic anemias may occur because large amounts of copper are released. The association of hemolysis and liver disease makes wilson disease likely diagnosis).Others o Urinary excretion of glucose, phosphates, amino acids, urates
4
Acute hepatitis
Chronic hepatitis
Cholestasis
All
Pathology
null
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28-year old male while playing was hit on the head by a cricket ball . This hit fractures the orbit and damage the optic canal. Which of the following structures are most likely to be damaged during this hit are -
Floor of Anterior Cranial Fossa is formed by :- 1)Cribriform plate of ethmoid bone 2)Frontal bone 3)Lesser wing of sphenoid Frontal bone and lesser wing of sphenoid contribute in forming roof of orbit Lesser wing of sphenoid contains optic canal for passage of ophthalamic aery and optic nerve (2nd CN) Ophthalmic aery is a branch of internal carotid aery (associated with sympathetic fibers) Ant view Post view
1
Optic nerve and ophthalmic aery
Ophthalmic vein and occulomotor aery
Ophthalmic aery and olfactory nerve
Ophthalmic nerve and optic nerve
Ophthalmology
Trauma
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multi
Net weight gain in pregnancy is :
24 lb
2
11 lb
24 lb
36 lb
42 lb
Gynaecology & Obstetrics
null
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Movements of pronation and supination occurs in all the following upper limb joints, EXCEPT?
Supination and pronation movements are not possible in radio-carpal(wrist) joint because the aicular surfaces are ellipsoid shaped. Supination and pronation movements are possible in superior, middle and inferior radio-ulnar joints.
4
Superior radio - ulnar joint
Middle radio - ulnar joint
Inferior radio - ulnar joint
Radio - carpal joint
Anatomy
null
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multi
Oral contraceptive pill containing progesterone which is given in small quantities for 30 days a month is known as :
Micro pill
1
Micro pill
Sequential pill
Combined pill
None of the aboveq
Gynaecology & Obstetrics
null
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A 2 year old boy presented with congested cardiac failure, with right to left shunt. What is the diagnosis?
(B) Vein of Gallen malformation[?]Communicating Hydrocephalus:There is free flow throughout the ventricular system.Impaired CSF resorption by the arachnoid granulation accounts for majority of casesSAHInfectious meningitisMalignant meningitisGranulomatous meningitis: TB, sarcoidosisAltered venous Dynamics: Vein of Galen malformation, venous obstructionVein of Galen Aneurysmal Malformation:Direct AV fistula b/w deep choroidal arteries & persistent embryonic precursor of VOGLarge midline venous pouch behind the 3rd ventricle.Aetiology:Obstructive - Congenital or Acquired:Congenital Causes:-Aqueductal stenosis or forking-Dandy Walker syndrome (Atresia of foramina of Magendie & Luschka)-Arnold Chiari malformation (Type 2-progressive hydrocephalus + myelomeningocele)-Vein of Galen aneurysm Clinical Features:>30% of symptomatic VM in childrenRare in adultsNeonates - high output CCF with cranial bruitOld infants - Macrocrania + hydrocephalus +/-CCFOlder Children - Developmental delay and seizuresYoung adults - HeadacheLarge VGAMS - Cerebral ischemia and dystrophic changes.Left untreated - Die of progressive brain damage and in- tracatable CCF.Dandy-Walker Malformation: Triad of Abnormalities:1. Incomplete development of vermis; Retro-vermian cyst continuous to 4th ventricle; 3. Hydrocephalus Crouzon syndrome:Crouzon syndrome is a genetic disorder characterized by the premature fusion of certain skull bones (craniosynostosis). This early fusion prevents the skull from growing normally and affects the shape of the head and face. Many features of Crouzon syndrome result from the premature fusion of the skull bones.
2
Dandy Walker malformation
Vein of Gallen malformation
Mega cisterna magna
Crouzon syndrome
Pediatrics
C.V.S.
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Which cereal is not to be given in celiac sprue
The precise mechanism of mucosal damage is unclear but immunological responses to gluten play a key role . There is a strong genetic component, with around 10% of first-degree relatives of an index case affected, and there is strong (approximately 75%) concordance in monozygotic twins. There is a strong association with human leukocyte antigen (HLA)-DQ2/DQ8. Dysbiosis of the intestinal microbiota has been identified but it is unclear if this is pathological or a response to the underlying mucosal changes Clinical features Coeliac disease can present at any age. In infancy, it occurs after weaning on to cereals and typically presents with diarrhoea, malabsorption and failure to thrive. In older children, it may present with non-specific features, such as delayed growth. Features of malnutrition are found on examination and mild abdominal distension may be present. Affected children have growth and pubeal delay, leading to sho stature in adulthood. In adults, the disease usually presents during the third or fouh decade and females are affected twice as often as males. The presentation is highly variable, depending on the severity and extent of small bowel involvement. Some have florid malabsorption, while others develop non-specific symptoms, such as tiredness, weight loss, folate deficiency or iron deficiency anaemia. Other presentations include oral ulceration, dyspepsia and bloating. Unrecognised coeliac disease is associated with mild under-nutrition and osteoporosis. Coeliac disease is associated with other HLA-linked autoimmune disorders and with ceain other diseases (Box 21.42). In some centres, people at higher risk of developing coeliac disease, such as those with type 1 diabetes, may undergo periodic antibody screening. Such screening may identify people with asymptomatic or minimally symptomatic disease; there is controversy about the optimum management strategy for such individuals. Ref Davidson edition23rd pg 806
2
Wheat
Maize
Corn
Rice
Medicine
G.I.T
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In staphylococci, plasmids encoding beta lactamase are transmitted by
Ref Goodman Gilman 11/e p 1133 Beta lactamase are encoded by plasmids that can be transferred with the help of bacteriophage in staphylococci and by transformation in pneumococci
2
Conjugation
Transduction
Transposon
Transformation
Pharmacology
Chemotherapy
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Gottron's papules are seen in -
Ans. is 'a' i.e., Dermatomyositis Cutaneous signs of dermatomyosits1. Gottron's papules lilac or violaceous papules on knuckle, dorsa of hands.2. Gottron's sign Violaceous erythema with edema over shoulder, arms, forearms.3. Heliotrope sign Violaceous erythema with edema over eyelids, periorbital region.4. Poikiloderma Atrophy of skin, hypopigmentaion, dilated blood vessels over trunk.5. Mechanic hand Symmetric hyperkeratosis along ulnar aspect of thumb and radial aspect of fingers.6. Shawl Sign Violaceous erythema extending from dorsolateral aspect of hands, forearms, and arms to shoulder & neck.7. Calcinosis cutis Calcium deposits in skin (in Juvenile variant).8. Miscellaneous signs Photosensitivity, vasculitis, panniculitis, Nail-fold telangiectasia.Extracutaneous invplvement1. Proximal myositis2. Cardiomyopathy 3. Raynaud's phenomenon4. Arthralgia
1
Dermatomyositis
Sarcoidosis
Scleroderma
Fungal infection
Skin
Autoimmune Skin Disorders
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The best method of teaching an urban slum about ORS is –
Demonstration A demonstration is a carefully prepared presentation to show how to perform a skill or procedure. Demonstration as a means of communication has been found to have a high educational value in programmes like- Environmental sanitation → installation of a hand pump, construction of a sanitary latrine. Mother and child health → demonstration of oral rehydration technique, Control of disease, e.g. scabies.
3
Lecture
Role play
Demonstration
Flash cards
Social & Preventive Medicine
null
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45-year-old policeman comes from duty with complain of pain in right leg. On examination, pulse in right popliteal fossa was absent and pain in right buttock, where as in left side it was normal. The block is at which level?
As the pulse is absent in right popliteal fossa and also there is impaired blood supply in right buttock and left side is normal, the block lies in the right sided iliac vessel. Image showing blood supply of pelvis and lower limb. If block is in femoral or popliteal vessels, there will be no pain in buttocks. If aooiliac vessels are blocked, both limbs will be affected
2
Femoral
Iliac
Aooiliac
Popliteal
Anatomy
FMGE 2019
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A first-grade teacher is concerned about a 6- year old girl in her class who has not spoken a single word since school staed. The little girl paicipate appropriately in the class activities and uses gestures and drawings and nods and shakes her head to communicate. The parents repo that the little girl talks only in the home and only in the presence of her closest relatives. Which of the following is the most appropriate diagnosis?
In selective mutism, a child voluntarily abstains from talking in paicular situations (usually at school) while remaining appropriately verbal at home. Some children only speak with their parents and siblings and are mute with relatives and friends. Children with selective mutism do not have a language impediment, nor do they display the lack of social interactions, lack of imagination, and g behavior characteristic of autism. On the contrary, they can be quite interactive and communicative in a nonverbal way, using drawing, writing, and pantomime. Children with school phobia refuse to go to school but do not have problems communicating through language. Oppositional defiant disorder is characterized by persistent refusal to follow rules and defiance toward authorities, not by failure to speak.
4
Autism
Expressive language disorder
School phobia
Selective mutism
Surgery
null
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The major contribution of amniotic fluid after 20 weeks of gestation :
Origin of amniotic fluid : Early week -Maternal plasma 2 nd trimester - Fetal skin Beyond 20 weeks -Fetal urine Ref: Datta Obs 9e pg 34.
2
Ultrafiltrate and maternal plasma
Fetal urine
Fetal lung fluid
Fetal skin
Anatomy
General obstetrics
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Complication of massive blood transfusion?
Ans is 'c' i.e. Hyperkalemia * The potassium concentration of blood increases during storage & massive transfusion of units containing increased potassium may lead to hyperkalemia - adding to elevated potassium levels caused by severe shock, renal dysfunction and muscle necrosis.Massive blood transfusion* A massive blood transfusion is defined as the replacement of a patient's total blood volume in <24 h which is generally described as transfusion of >10 units of blood products (specifically Packed red blood cells within a 24-hour period)* Hemorrhagic shock is the only indication for a massive transfusion* The greatest concern during MTP is the lethal triad:i) Hypothermiaii) Coagulopathy (dilutional)iii) Acidosis (Lactic acidosis from inability to breakdown citrate secondary to hepatic dysfunction)Other complication include1) Hypocalcemia and hypomagnesemia from high citrate concentration2) Hyperkalemia3) Air embolism4) Metabolic alkalosis from breakdown of citrate5) Paradoxical hypokalaemia6) Metabolic alkalosis7) Transfusion-associated acute lung injury8) Transfusion reactions such as ABO incompatibility, anaphylaxis, febrile non-haemolytic reactions9) Infectionsa) HIV / AIDS, hepatitis, vCJD, HTLV, malaria, CMVb) sepsis / septicaemia10) Fluid overload and acute pulmonary oedema (APO)11) Transfusion-associated graft vs host disease12) DIC
3
Hypercalcemia
Hypermagnesemia
Hyperkalemia
Hyperthermia
Anaesthesia
Complications Of Anaesthesia
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Uterus and cervix develop from
Two embryonic structures that play an impoant role in the development of the urogenital system are the intermediate mesoderm and the cloaca. Intermediate Mesoderm is subdivided into three pas: 1. Paraxial mesoderm which becomes segmented to form the somites. 2. Lateral plate mesoderm in which the intraembryonic coelom appears. 3. Intermediate mesoderm lying between the two. Paramesonephric ducts are present in the intermediate mesoderm. They are formed by invagination of coelomic epithelium In the female, the paramesonephric ducts( give origin to the uterine tubes, the uterus, and pa of the vagina. Ref: Inderbir Singh's Human Embryology, Eleventh edition, pg.no., 265, 273. table Ref: Inderbir Singh's Human Embryology, Eleventh edition, pg.no., 286(Table 16.1).
1
Mullerian duct
Wolffian duct
Mesonephirc duct
None
Anatomy
General anatomy
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Red cell Protoporphyrin levels more than 100 microgram/ dL is suggestive of which of the following?
Ans. a (Iron deficiency anemia) (Ref. Harrison 18th/ ch. 103)RED CELL PROTOPORPHYRIN LEVELS# Protoporphyrin is an intermediate in the pathway to heme synthesis.# Under conditions in which heme synthesis is impaired, protoporphyrin accumulates within the red cell.# This can reflect an inadequate iron supply to erythroid precursors to support hemoglobin synthesis.# Normal values are less than 30 microg/dL of red cells.# In iron deficiency, values in excess of 100 microg/dL are seen.# The most common causes of increased red cell protoporphyrin levels are absolute or relative iron deficiency and lead poisoning.
1
Iron deficiency anemia
Lead poisoning
Myelodysplasia
All
Pediatrics
Blood
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All of them are true about retinoblastoma except
Retinoblastoma (RB) gene has been identified as 14 band on the long-arm of chromosome 13 (13q 14) and is a 'cancer suppressor' or 'antioncogenic' gene. Deletion or inactivation of this protective gene by two mutations (Knudson's two hit hypothesis) results in occurrence of retinoblastoma. Retinoblastoma is commonest tumor of eye in children while in adults it is malignant melanoma of choroid.
1
Rb1 gene is located on 11q14
The commonest cause of intraocular calcification
Trilateral retinoblastoma is a combination of bilateral retinoblastoma with pinealoblastoma
The commonest tumour of the eye in children
Ophthalmology
Retina
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Which nerve is involved in this presentation?
Ans. A long thoracic nerveNerve involvedMuscleLong thoracic NerveSerratus anteriorMusculocutaneous NerveCoracobrachialis muscleLateral anterior thoracic NervePectoralis major muscleThoracodorsal NerveLatissimus Dorsi
1
Long thoracic Nerve
Musculocutaneous nerve
Lateral anterior thoracic nerve
Thoracodorsal nerve
Anatomy
Upper Extremity
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Shoest incubation perion in malaria -
Duration of erythrocytic schizogony 48 hrs- vivax Less than or equal to 48 hrs-falciparum 72 hrs -malariae 48 hrs -ovale (refer pgno:58 baveja 3 rd edition)
2
P. vivax
P. falciparum
P. malariae
P. ovale
Microbiology
parasitology
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other name of othello syndrome is called as
othello syndrome is called as delusion of marital infedility othello syndrome is common in alcoholic males this is is the most repeatedly asked question in entrance examinations the possible mechanism that is told for othello syndrome is that alcohol causes sexual dysfunction in males and thus inturn results in doubting the fidelity of the paner Ref.Kaplon and Sadock, synopsis of psychiatry,11th edition, pg.No.333
1
delusion of infedility
delusion of love
delusion of doubles
delusion of persecution
Psychiatry
Schizophrenia and other psychotic disorders
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Clasp arms serves the function of
Function and Position of Clasp Assembly Parts
4
Stabilization
Reciprocation
Retention
Both 2 and 3
Dental
null
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All of the following drugs are documented to be porphyrinogenic EXCEPT:
Aspirin is not a porphyrinogenic drug. There is a very exhaustive list of drugs given in the table from Harrison; I am giving some impoant drugs! Carbamezapine , chloramphenicol, clindamycin Dihydroergotamine , droperidol Hydralazine Fosphenytoin Indinavir Ketamine, ketoconazole Lidocaine Medroxyprogesterone , mifepristone , Nitrofurantoin, norethistronate Phenobarbitone, phenytoin Rifampicin Spirinolactone Taxmoxifem, testosterone Valproate
4
Estrogen therapy
Carbamezapine
Phenytoin
Aspirin
Medicine
null
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multi
A patient of Varicose veins came to hospital; intern was on duty. Which test he shall perform to rule out the DVT?
Pehes test is used to differentiate between Varicose veins and Deep vein thrombosis. The limb is elevated and an elastic bandage is applied firmly from the toes to the upper 1/3 of the thigh to obliterate the superficial veins only. With the bandage applied the patient is asked to walk for 5 minutes. If deep system is competent, the blood will go through and back to the hea. If the deep system is incompetent, the patient will feel pain in the leg.
2
Brodie Trendelenburg test
Pehes test
Thomas test
Ober test
Surgery
FMGE 2019
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All of the following glands are supplied by the facial nerve, EXCEPT?
Parotid glandreceives parasympathetic innervations from glossopharyngeal nerve and not facial nerve.
3
Nasal glands
Lacrimal gland
Parotid gland
Submandibular gland
Anatomy
null
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multi
A female neonate is noted at birth to have a gross deformity of her lower back. Examination of the subcutaneous lesion reveals disorganized neural tissue with entrapment of nerve roots. What is the appropriate diagnosis?
Neural tube defects (dysraphic anomalies) reflect impaired closure of the dorsal aspect of the vertebral column. These abnormalities are classified according the extent of the defect, ranging in severity from spina bifida occulta to meningocele, meningomyelocele, and rachischisis. Spina bifida (choice D) is restricted to the vertebral arches and is usually asymptomatic. Meningocele (choice A) permits protrusion of the meninges as a fluid-filled sac. Meningomyelocele (choice B) exposes the spinal canal and causes the nerve roots to be entrapped. Rachischisis (choice C) is an extreme defect, often without a recognizable spinal cord. Syringomyelia (choice E) is a congenital malformation, in which a tubular cavitation (syrinx) extends for variable distances along the entire length of the spinal cord.Diagnosis: Neural tube defect, meningomyelocele
2
Meningocele
Meningomyelocele
Rachischisis
Spina bifida occulta
Pathology
Central Nervous System
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Best time for surgery in case of combined unilateral cleft lip and hard palate is
If cleft is in hard palate surgery is done between 15-18 months.
1
15-18 months
3 - 6 months
6 - 9 months
9- 15 months
Surgery
null
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Keratin of skin and nail differ because
Keratins - Keratins are proteins present in hair, skin and nails, horn, hoof, etc. The fibers present are called alpha keratins and matrix as keratohyalin. They mainly have the alpha helical structure. Each fibril has 3 polypeptide chains and each bundle has about 10-12 fibrils. The keratohyalin matrix has cysteinerich polypeptide chains which are held together by disulfide bonds. The more the number of disulfide bonds, the harder the keratin is. REF: DM VASUDEVAN TEXTBOOK OF BIOCHEMISTRY,EIGHTH EDITION,PG.NO.,674.
3
Vander waal bond
Lipolysis
Disulphide bond
Covalent bond
Biochemistry
Metabolism of carbohydrate
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single
Conventional contraception is: September 2006
Ans. C: Condoms Barrier methods of contraception involve the use of device that prevents the passage of sperm through canal. Due to many reasons, use of condom is the most popular conventional contraceptive device worldwide. These are cheaper and relatively simple to use, but when used alone, the pregnancy rate is relatively high.
3
OCP
Surgical sterilization
Condoms
IUCD
Gynaecology & Obstetrics
null
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Following are true with respect to genus Neisseria Except
Neisseria genus is gram-negative cocci, It is oxidase positive, non-sporulating, aerobic and non-motile cocci typically arranged in pairs. Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 230
2
Gram negative
Anaerobic
Non-sporulating
Oxidase positive cocci
Microbiology
Bacteriology
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The impression for a diagnostic cast of a partial edentulous mouth should be taken in:
null
3
Impression wax
Modelling compound
Hydro-colloid
Hydro cal
Dental
null
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The nerve roots blocked in pudendal nerve block is :
Pudendal nerve arises from S2,3,4 roots Pudendal block will block all the roots. Ref: Datta Obs 9e pg 480.
3
L1,2,3
L2,3
S2,3,4
S4
Anatomy
General obstetrics
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Senile ptosis is:
Ans/. Aponeurotic
3
Neurogenic
Myogenic
Aponeurotic
Mechanical
Ophthalmology
null
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single
Anterior maxillary occlusal projection shows all of the following except:
In anterior maxillary occlusal projection, the central ray is oriented through the tip of nose toward the middle of film with approximately +45 degrees vertical angulation and 0 degrees horizontal angulation. The primary field of this projection includes the anterior maxilla and its dentition, as well as the anterior floor of the nasal fossa and teeth from canine to canine.
2
Anterior maxilla
Teeth from 1st premolar to 1st premolar
Teeth from canine to canine
Anterior floor of the nasal fossa
Radiology
null
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A 38-year-old male presented with a suspected diagnosis of suppurate labyrinthitis. A positive Rinne's test and positive fistula test was recorded on initial examination. The patient refused treatment, and returned to the emergency depament after 2 weeks complaining of deafness in the affected ear. On examination, fistula test was observed to be negative. What is the likely expected finding on repeating the Rinne test?
In severe SNHL: Rinne's test is false negative and because labyrinth is dead. Fistula test is negative.False negative Rinne test occurs in case of severe SNHL because patient does not perceive any sound of tuning fork by air conduction but responds to bone conduction due to intracranial transmission of sound from opposite healthy ear.Fistula TestThe basis of this test is to induce nystagmus by producing pressure changes in the external canal which are then transmitted to the labyrinth. Stimulation of the labyrinth results in nystagmus and veigo. Normally the test is negative because the pressure changes in the EAC cannot be transmitted to the labyrinth.Positive Fistula Test is seen in:Erosion of horizontal semicircular canal (Cholesteatoma or fenestration operation)Abnormal opening in oval window (post stapedectomy fistula) or round window (rupture of round window).A positive fistula test also implies that the labyrinth is still functioning.False-negative fistula test: Dead labyrinth, cholesteatoma covering site of fistula.False-positive fistula test (Positive fistula test without Fistula): Congenital syphilis, 25% cases of Meniere's disease (Hennebe's sign.)OAE is considered as best screening test as it is less time consuming, easy to perform, child does not need to be sedated and results are available immediatelyAbsent OAE indicates cochlear lesion.If OAE are absent child is taken up for BERA which is confirmatory.
4
True positive Rinne's test
False positive Rinne's test
True negative Rinne's test
False negative Rinne's test
ENT
null
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Which of the following is an increased risk of breast cancer?
Ans is b i.e. Atypical hyperplasia A history of breast biopsy for benign breast disease have an increased risk of breast cancer. The degree of increase in risk depends on the specific epithelial abnormality. The table below shows the relative associated risks for patients with benign histologic findings. American Board of Pathology Histologic Classiflairli of Benign Disease Histopathology Approximate Relative Risk No added risk Nonproliferative Cysts Duct ectasia Calcification Fibroadenoma Milk ductal epithelial hyperplasia Sclerosing adenosis No added risk Papillomatosis Slight added risk Radial scars Complex sclerosing lesions ? Moderate or florid hyperplasia 1.5:1 to 2:1 Atypical hyperplasia (ductal and lobular) 4:1 Extensive ductal involvement of atypical hyperplasia 7:1 Lobular carcinoma in situ 10:1 Ductal carcinoma in situ 10:1
2
Sclerosing adenosis
Atypical hyperplasia
Fibroadenoma
Florid hyperplasia
Surgery
null
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Most specific antiemetic for chemotherapy induced vomiting is:
Ans. (A) Granisetron(Ref: Harrison 20th/e p501)Drugs for chemotherapy induced vomiting5 HT3 blockers like ondansetron, granisetron, dolasetron, palonosetron and ramosetron are DOC for this condition.Palonosetron is most potent 5 HT3 blocker. Dolasetron may prolong QT interval.Palonosetron has longest t1/2 whereas ondansetron has shortest t1/2.Efficacy of these drugs increases if used along with antihistaminics, D2 blockers or dexamethasone.
1
Granisetron
Tegaserod
Domperidone
Doxylamine
Pharmacology
G.I.T
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Maple syrup urine disease is characterised by all except -
Ans. is 'd' i.e., Hypopigmentation* Maple syrup urine disease is caused by a defect of branched chain keto acid dehydrogenase (BCKADH), the enzyme which is involved in the catabolism of branched chain amino acids - valine, leucine and isoleucine* The disorder is so called because of the classic sweet odour observed in urine. This classic odour is found to be because of the presence of sotolone (a metabolite of branched chain keto acids) in urine* The enzyme BCKADH has three subunits - Branched chain keto acid dehydrogenase, Dihydrolipoyl transacetylase, Dihydrolipoyl dehydrogenase. It uses 5 coenzymes - thiamine pyrophosphate,, lipoamide, CoA, FAD and NAD* Mutation of any of the genes of any of the subunits involved in the complex can result in maple syrup urine disease.* It presents as either an early onset acute illness or as late onset chronic disorder.* Early onset acute illness# The infant is normal at birth but slowly neurodegenerative features are observed and it progresses rapidly and the infant dies close to 6 months* Late onset chronic illness# In late onset type, the person is normal and features appear during metabolic crisis states like during starvation or catabolic states. As during starvation or during catabolic states, the person presents with# Weight loss# Hypoglycemia# Ketoacidosis# Diorrhea, vomiting, dehydration# Neurological manifestations like alternating hypotonia and hypertonia, ataxia, seizures, coma# Pancreatitis* Diagnosis can be done using dried blood spot analysed using HPLC and Tandem mass spectrometry* Screening tests includes DNPH test (Dinitrophenylhydrazine test). DNPH reacts with the carbonyl groups of aldehydes and ketone to give a red or yellow complex.* Treatment involves diet (restriction of valine, leucine and isoleucine with formula foods) and supplementation of vitamins, minerals and omega 3 fatty acid)* To avoid RBCs of the sample utilising glucose of the plasma, fluride is added in the tube (Grey topped tube). Fluride inhibits glycolysis in RBCs. Hence it avoids false low values of glucose.* Pyruvate dehydrogenase is an enzyme complex made up of three subunits - pyruvate dehydrogenase, dihydrolipoyl transacetylase. Dihydrolipoyl dehydrogenase. Lipoamide is one of the coenzymes required for this enzyme complex. During the process of conversion of pyruvate to acetyl CoA, lipoamide gets reduced to form dihydrolipoamide. Regeneration of lipoamide is not possible in the presence of arsenite
4
Hypotonia
Hypertonia
Pancreatitis
Hypopigmentation
Biochemistry
Proteins and Amino Acids
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The typical appearance of 'Granulation tissue' is due to
The term granulation tissue derives from its pink, so, granular appearance on the surface of wounds, and the characteristic histological features include the formation of the new vessels (angiogenesis) with budding ends of capillaries and proliferation of fibroblast.
2
Thrombosed capillaries
Budding ends of capillaries
Densely packed collagen
Chronic inflammatory cells
Pathology
All India exam
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single
Which of the following drugs should be sold only on prescription of a registered medical practitioner?
(a) Schedule H drugsRef: Sharma & Sharma's Principles of Pharmacology, 3rd edpg. 6 and style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif">.in/newsite/PrintRelease.aspx?re/id=101251* According to the drugs and cosmetic act, 1940 (rules 1945), schedule H deals with the drugs which must be sold by retail only when a prescription by registered medical practitioner is produced. Most of the drugs fall under this schedule.* Schedule X gives the names of psychotropic drugs requiring speciallicenses for manufacturing and sale.* Schedule J deals with list of ailments for which no drug claims prevention or cure.* Schedule Y specifies requirements and guidelines on clinical trials, import and manufacture of new drugs.Other important drug schedules* Schedule G: Deals with medicines which must be labeled with the words "caution"- it is dangerous to take this preparation except under medical supervision.* Recently, a new Schedule HI has been introduced through Gazette notification GSR 588 (E) dated 30-08-2013, which contain certain 3rd and 4th generation antibiotics, certain habit-forming drugs and anti-TB drugs. These drugs are required to be sold in the country with the following conditions:0 The supply of a drug specified in Schedule HI shall be recorded in a separate register at the time of the supply giving the name and address of the prescriber, the name of the patient, the name of the drug and the quantity supplied, and such records shall be maintained for three years and be open for inspection.0 The drug specified in Schedule HI shall be labeled with the symbol Rx which shall be in red and conspicuously displayed on the left top corner of the label, and shall also be labeled with the following words in a box with a red border "Schedule HI Drug-Warning:# It is dangerous to take this preparation except in accordance with themedical advice.# Not to be sold by retail without the prescription of a Registered Medical Practitioner."
1
Schedule H drugs
Schedule X drugs
Schedule J drugs
Schedule Y drugs
Pharmacology
General Pharmacology
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Blau syndrome is associated with mutation of:
Ans: (a) NOD2/CARD 15 geneRef: Harrison, 19th edition, Page 2215 and Genetic Home ReferenceBlau's syndromeCaused by mutations in CARD15 (also known as NOD2), which regulates nuclear factor-xB activation.The protein produced from this gene helps defend the body from foreign invaders, such as viruses and bacteria, by playing several essential roles in the immune response, including inflammatory reactions.Inheritance - Autosomal dominant.Blau's syndrome is characterized by granulomatous dermatitis, uveitis and arthritis; distinct CARD15 variants predispose to Crohn's disease.Recessive mutations in one or more components of the proteasome lead to excessive interferon signaling and the syndrome of chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE), a severe form of generalized panniculitis.
1
NOD2/CARD 15 gene
NOD 1/CARD 1 gene
NOD2/CARD 10 gene
NOD3/CARD 12 gene
Pathology
Genetics
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Which cooking oil bast most PUFA?
Ans. is 'a' i.e., Safflower oil
1
Safflower oil
Coconut oil
Butter
Vanaspati
Social & Preventive Medicine
null
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single
Supranuclear lesion of facial nerve affects
It is caused by cerebrovascular accidents (haemorrhage, thrombosis or embolism), tumour or an abscess. It causes paralysis of only the lower half of face on the contralateral side. Forehead movements are retained due to bilateral innervation of frontalis muscle. Involuntary emotional movements and the tone of facial muscles are also retained. Ref: Dhingra 7e pg 107.
1
Lower pa of face
Upper pa of face
Face
Spares Face
ENT
Ear
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A young patients presented with loss of sensation in sole of foot with paralysis of medial side of plantar muscles of the foot, Most likely nerve involvement is
TIBIAL NERVE:- Root value:ventral division of ventral rami of L4,L5,S1,S2,S3 segments of spinal cord.Beginning: largest subdivision of sciatic nerve.Course: descends veically in popliteal fossa. It continues in back of leg as the neurovascular bundle with posterior tibial vessels. Lastly passes deep to flexor retinaculum of ankle joint.Branches:Muscular branches to gastrocnemius,soleus, popliteus, plantaris, FHL, FDL and Tibialis posterior.Aicular branches to superior,middle and inferior genicular .Cutaneous and vascular branch: sural nerve ,medial calcaneal branch and branch to posterior tibial aery.Terminates by dividing into medial and lateral plantar nerves.MEDIAL PLANTAR NERVE:-Muscular branches: Abductor hallucis, flexor digitorum brevis, flexor hallucis brevis and first lumbrical.Cutaneous branch: skin of medial pa of sole and medial three and a half toes.LATERAL PLANTAR NERVE:-Main trunk: flexor digitorum accessorius and abductor digiti minimi and skin of sole. Ends by dividing into superficial and deep branches.Superficial branch: lateral and medial branch Lateral branch:flexor digiti minimi brevis ,3rd plantar, 4th interossei and skin on lateral side of little toe.Medial branch: 4th interdigital cleft. Deep branch:2nd,3rd,4th lumbricals1st,2nd,3rd dorsal interossei 1st,2nd plantar interossei andAdductor hallucis. COMMON PERONEAL:-Branch of sciatic nerve Root value:L4,L5,S1,S2 Branches:Muscular branch: sho head of biceps Cutaneous:lateral cutaneous nerve of calf.Aicular: superior lateral,inferior lateral and recurrent genicular .Terminal branches: superficial and deep peroneal. SUPERFICIAL PERONEAL:-Muscular branches: peroneus longus and brevis Cutaneous branches:Digital branches to medial side of big toe,adjacent sides of 2nd and 3rd, 3rd and 4th ,and 4th and 5th toes. DEEP PERONEAL:-Muscular branches to muscles of anterior compament of leg:Tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus teius.Extensor digitorum brevis Cutaneous: dorsal digital nerves for adjacent sides of big toe and second toe.Aicular branches:Ankle joint, tarsal joints, tarsometatarsal joints and metatarsophalangeal joint of big toe. {Reference:BDC 6E vol2 pg 79}
4
Common peroneal nerve
Deep peroneal nerve
Superficial peroneal nerve
Tibial nerve
Anatomy
Lower limb
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34-year-old patient has moderately severe new onset asthma, and physician gave him a selective b2 agonist inhaler. All of the following signs can be seen in this patient after taking the drug EXCEPT?
Tremor is a common b2 action, Beta 2 agonists increase the movement of K inside the cells, so these can result in hypokalemia. This action is the basis of use of salbutamol in treatment of hyperkalemia At high doses, selectivity is lost and therefore overdose of beta 2 agonists can result in tachycardia. Beta2 agonist leads to hyperglycemia due to action on the liver.
3
Tachycardia
Skeletal muscle tremor
Hypoglycemia
Hypokalemia
Pharmacology
Sympathetic System
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multi
Features of vernal conjunctivitis are –a) Shield ulcerb) Horner–Trantas spotsc) Papillary hypertrophy d) Herbert pitse) Pannus
Conjunctival signs of spring catarrh .Palpebral form: Papillary hypertrophy, cobblestone appearance (Pavement stone appearance). Bulbar form: Dusky triangular congestion, gelatinous thickening around limbus, Horner - Tranta's spot. Corneal signs (vernal keratopathy) Punctate epithelial keratitis Ulcerative vernal keratitis: shallow transverse ulcer (Shield ulcer) Vernal corneal plaques Subepithelial scarring Pseudogerontoxon: characterized by a classical "cupid's bow" outline.
3
ab
bc
abc
bcd
Ophthalmology
null
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single
Total fluid secreted by salivary gland, stomach, pancrease and itestine in a day -
Ans. is 'c' i.e., 6500 ml Daily water turnover (mL) in the gastrointestinal tractIngested 2000Endogenous secretions 7000Salivary glands1500 Stomach2500 Bile500 Pancreas1500 Intestine+ 1000 7000 Total input 9000Reabsorbed 8800Jejunum5500 Ileum2000 Colon+ 1300 8800 Balance in stool 200
3
2000ml
4000ml
6500 ml
10000 ml
Physiology
Secretory Functions of the Alimentary Tract
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single
Most common radiosensitive ovarian tumour ?
Ans. is 'a' i.e., Dysgerminomao Dysgerminomas are extremely radiosensitive, and even those that have extended beyond the ovary can generally be controlled by radiotherapy.
1
Dysgerminoma
Granulosa cell tumour
Teratoma
Theca cell tumour
Pathology
null
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single
"Herald patch" is characteristic feature of -
Ans. is 'd' i.e., Pityriasis rosea o Herald patch or mother patch is a characteristic feature of P. rosea.o P. rosea is a common scaly disorder, occuring usually in children and young adults (10-35 years). Characterized by round/oval pink brown patches with a superficial, centrifugal scale, distributed over trunk in a Christmas tree pattern. The disease is thought to be viral disease, is self limiting, and subsides in 6-12 weeks. The exact etiology is not known, but it is considered to be a viral disease; Human Herpes virus 6 (HHV 6) and Human Herpes virus 7 (HHV 7) may play a role.Clinical manifestations of P. roseao The disease starts with an upper respiratory prodrome or a mild flu. After 1-2 weeks, Annular erythmatous plaque appears on trunk that is referred to as mother patch or herald patch. Over the next 1 -2 weeks, fresh patch appear all over the trunk, in a Christmas tree configuration or Fir tree Configration. The lesions are pinkish in white skin, hence the name rosea. However, on the dark Indian skin the lesions are skin coloured or brown. The most characteristic clue for the diagnosis is the presence of a fine scale at the edge of the lesion referrred to as centrifugal scale or collarette scales or cigarette paper scales. Lesions subside with hyperpigmentation. Trunk is involved predominantly, Sometimes (in 20% of patients) lesions occur predominantly on extremities and neck (inverse pattern).o Hanging curtain sign is seen in patients with pityriasis rosea. When the skin is stretched across long axis of herald patch, the scale is noted to be finer, lighter, and attached to one end, which tends to fold across the line of scratch.Drug induced pityriasis roseao Some drugs may cause pityriasis rosea like skin lesions. Drugs causing pityriasis rosea like drug eruptions are : -# ACE inhibitors# Gold# Methotrexate# Metronidazole# Isotretinoin# b-blockers# Bismuth# Barbiturates# D- Penicillamine
4
Pityriasis rubra pilaris
Psoriasis
Lichen planus
Pityriasis rosea
Skin
Erythmato-Squamous and Lichenoid Eruption
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single
Shock lung is characterized by
ref Robbins 7/r p715,9/e p134 Harrison 17/e p1680_1681 The cellular and tissue effects of shock are essentially those of hypoxic injury (Chapter 1) and are caused by a combina- tion of hypoperfusion and microvascular thrombosis. Although any organ can be affected, brain, hea, kidneys, adrenals, and gastrointestinal tract are most commonly involved. Fibrin thrombi can form in any tissue but typically are most readily visualized in kidney glomeruli. Adrenal cor- tical cell lipid depletion is akin to that seen in all forms of stress and reflects increased utilization of stored lipids for steroid synthesis. While the lungs are resistant to hypoxic injury in hypovolemic shock occurring after hemorrhage, sepsis or trauma can precipitate diffuse alveolar damage (Chapter 12), leading to so-called shock lung.
4
Alveolar proteinosis
Bronchiolitis obliterans
Diffuse pulmonary haemorrhage
Diffuse alveolar damage
Anatomy
General anatomy
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single
Most common muscle involved in Tropical pyomyositis
Tropical pyomyositis is caused by S.Aureus which mainly involves Quadriceps > Gluteus.
3
Biceps
Triceps
Quadriceps
Gluteus
Microbiology
null
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single
Visual analog scale is a -
Ans. is 'a' i.e., Pain scale Visual analog Scaleo The visual analogue scale or visual analog scale (VAS) is a psychometric response scale which can be used in questionnaires.o It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured,o When responding to a VAS item, respondents specify their level of agreement to a statement by indicating a position along a continuous line between two end-points,o VAS is the most common pain scale for quantification of severity of pain.
1
Pain scale
Pressure scale
Vision scale
Auditory scale
Psychiatry
Symptoms & Signs
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single
Type of pneumonia in P. jiroveci:
Ans. b. Interstitial pneumonia
2
Lobar pneumonia
Interstitial pneumonia
Bronchopneumonia
Any of the above
Microbiology
null
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multi
Which of the following neurotransmitter has an inhibitory control over the GnRH neurons before the onset of pubey?
Before the onset of pubey, the GnRH neurons are under the inhibitory control of GABA. Gamma amino butyric acid is a dominant inhibitory neurotransmitter in the hypothalamus. Inhibition of GnRH neurons by GABA is mediated Glutamergic neurons. A reciprocal innervations between GABAergic and Glutamergic neurons are found. During development GABA concentration and the number of GABAergic neurons increase from 13th day to second postnatal week, which is then followed by a decline in 3rd postnatal week. GABA release in the median eminence decrease concomitantly with the pubeal increase of GnRH secretion. Ref: Male Hypogonadism: Basic, Clinical, and Therapeutic Principles By Stephen J. Winters, Page 69 ; Goldfrank's Toxicologic Emergencies By Lewis R, Page 232 - 238.
3
Glycine
Glutamate
Gamma amino butyric acid (GABA)
Beta-endorphin
Physiology
null
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single
A middle aged female presents with chronic pain in right side of abdomen with intermittent fever. Clinical examination revealed mild hepatomegaly and hence a contrast enhanced CT abdomen was performed. Based on the imaging characteristics of this focal lesion the most likely diagnosis is?
Ans. B. Hydatid cystThe Portal phase CT demonstrates a large cystic structure with a discrete wall, separated internal membranes and several 'daughter cysts'This is an infection of the liver with Echinococcus granulosus, a parasitic tapeworm presents worldwide and transmitted from sheep, foxes and other wild animals to humans as part of its lifecycle. Larvae migrate from the gut and embed in the liver, where they encyst and develop, slowly provoking a surrounding inflammatory reaction. The disease may remain occult for several years. On imaging there is a wide range of appearances, from a simple cyst indistinguishable from a true hepatic cyst to a complicated cyst with any or all of the following features: debris (hydatid 'sand" made up of dead scolices, which may calcify), daughter cysts, membrane separation, and wall calcification. The lesions may be multiple and vary widely in size. Serological testing can be employed to confirm the presence of infection prior to any therapy or intervention. Although the risk of anaphylaxis following aspiration or surgery of these lesions is well recognized, it is less than previously thought, and uncomplicated aspiration following medical treatment has been described.US demonstrates clearly not only the simple cyst form but also the more complex cyst features, such as the dependent debris, daughter cysts (cyst within a cyst appearance), membrane separation and wall calcification. CT defines all these features as well and is helpful where wall calcification obscures the view on US. MRI will define the cystic structure and internal anatomy but is insensitive to the calcification.
2
Liver abscess
Hydatid cyst
HCC
Hepatic adenoma
Radiology
G.I.T.
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single
Millard Gubler syndrome includes the following except
Millard-Gubler syndrome (MGS) is one of the classical brainstem-crossed syndromes caused due to a unilateral lesion in ventral pons, manifesting as ipsilateral palsy of CN VI and VII with contralateral hemiplegia Ref Harrison20th edition pg 2234
1
5th nerve palsy
6th nerve palsy
7th nerve palsy
Contralateral hemiparesis
Medicine
C.N.S
fb865f28-72e2-4d53-ab73-361d218151af
multi
C. trachomatis is a well-known cause of venereal disease. This organism is also implicated in which of the following?
Trachoma has been the greatest single cause of blindness in the world. Chlamydia trachomatis is the most common cause of sexually transmitted disease in the United States and is also responsible for the majority of cases of infant conjunctivitis and infant pneumonia.
1
Classic trachoma infection
Sexually transmitted cardiac disease in adults
Perinatal retinitis
Middle-ear infection in young children
Microbiology
Bacteria
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multi
Prostaglandins are produced by ?
Ans. is 'd' i.e., All of the above
4
Neutrophils
Endothelium
Macrophages
All of the above
Pathology
null
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multi
All of the following statements about Parvovirus B -19 are TRUE, EXCEPT:
Parvovirus B-19 causes a infection called Erythema infectiosum or Fifth disease. Around 50-70% cases are around 5-15 years of age. Transmission from mother to fetus is around 15-30%. It causes, anemia, aplastic crisis, rashes, ahralgia, rarely hydrops fetalis. Ref: Kliegman, Behrman, Jenson, Stanton (2008), "Nelson textbook of Pediatrics", Chapter 248, "Parvovirus B19", Volume 1, Page 1357; Medical Microbiology By Jawetz , 24th Edition, Pages 414, 417
2
DNA virus
Crosses placenta in only < 10% of cases
Can cause severe anemia
Can cause Aplastic crisis
Microbiology
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multi
'Pie in the sky' visual field defect seen in lesions of:
A. Left Hemianopia Left optic nerve lesion B. Bitemporal Hemianopia Optic chiasm lesion C. Right Nasal Hemianopia Outer optic tract lesion Internal carotid aery thrombus D. Right Homonymous Hemianopia Optic tract lesion E. Right Superior Quadrantanopia Meyer's Loop lesion Left temporal lesion F. Right Inferior Quadrantanopia Dorsal optic radiation lesion Left parietal lesion G. Right Hemianopia with Macular Sparing PCA infarct Superior/ Inferior quadrantanopia Lesion of optic radiation. Lesion of the meyer's loop (temporal pathway)-Superior quadrantanopia (pie in the sky) Lesions of the parietal pathway- inferior quadrantanopia (pie on the floor) causes- neoplasm, inflammatory process, ischemia, infection (eg: encephalitis)
2
Optic tract
Temporal coex
Optic chiasma
Occipital coex
Medicine
JIPMER 2017
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What is true regarding Barret's esophagus:
Answer is B (Premalignant condition) Barret's oesophagus is a premalignant condition with increased risk of adenocarcinoma. Barret's esophagus is more common in males More common in males (Males > Females)0 More common in White (Whites > Blacks)e More common with increasing ageU Barret's metaplasia once established does not respond to conservative management `Established Metaplasia does not regress with antisecretory treatment' - Harrison Although medical treatment does not regress the metaplastic changes, it is still advocated to prevent continued insult. Barret's esophagus is associated with columnar metaplasia and not squamous metaplasia.
2
Seen in females
Premalignant
Responds to conservative management
Squamous metaplasia is seen
Medicine
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91ced434-5bf5-4549-be6c-0a89f3709f4f
multi
Combined oral pill reduces the risk of:
null
2
Breast cancer
Ovarian cancer
Cervical cancer
Vaginal cancer
Pharmacology
null
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Gas shadow in hea and vessels are seen in
Robe sign - the presence of a gas shadow within the hea or the greater vessels, seen in cases of fetal death in utero.It is a rare sign caused by postmoem blood degeneration, usually seen 1-2 days after death; and may be seen as early as 12 hours(Ref: Diagnostic Ultrasound by Carol M. Rumack, Stephanie R. Wilson, J. William Charboneau, and Deborah Levine,4thed, page 1090)
1
IUD
Still bih
Aboion
Live IUGR
Radiology
All India exam
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single
Structures passing through the centre of the cavernous sinus
null
4
Occulomotor nerve
Trochlear nerve
Maxillary nerve
Abducent nerve
Anatomy
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Latte's crust of blood stain is used to detect: NEET 14
Ans. Blood group
3
Nature of stain
Detection species
Blood group
Secretor status
Forensic Medicine
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The cause of fetal death in ectopic pregnancy is postulated as:
Ans. is a, i.e. Vascular accidentRef Williams Gynae 1/e, p 158Ectopic pregnancy is the leading cause of early pregnancy related deaths.Most common cause of death in ectopic pregnancy is tubal rupture - severe hemorrhage - death.Ectopic pregnancy can have 2 outcomes:1. Tubal abortion - M/C outcome. It is most common outcome of ectopic pregnancy in ampulla2. Tubal rupture-ectopic pregnancy of isthmus are the ones which usually rupture.
1
Vascular accident
Nutritional adequacy
Endocrine insufficiency
Immune response to mother
Gynaecology & Obstetrics
Ecotopic Pregnancy
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When a stretch reflex occurs the muscles that antagonize the action of the muscle involved relaxes. This phenomenon is known as:
Reciprocal innervation is a phenomenon in which, when a stretch reflex occurs the muscles that anotogonize the action of the muscle involved relaxes. The pathway mediating this effect is bisynaptic. Golgi bottle neurons (inhibitory interneurons) are involved in this phenomenon. Ref:Ganong's Review of Medical Physiology, 21st Edition, Page 133
2
Inverse stretch reflex
Reciprocal innervation
Autogenic inhibition
Lenthening reaction
Physiology
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single
Jaw tightness is typically seen in:
Answer is C (Giant Cell Aeritis): Jaw Claudication (law Tightness) is a typical manifestation of Temporal aeritis or Giant cell aeritis.
3
PAN
Coarctation of aoa
Giant cell aeritis
Wegner's Granulomatosis
Medicine
null
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multi
Salpingitis/Endosalpingitis is best confirmed by:
Ans. is a, i.e. Hysteroscopy and laparoscopyRef: Shaw 15th/ed, p451; William's Gynae 1st/ed, p74; Gynecology by Ostrzenski (Lippincott Williams 2(X)l/282); Dutta Gynae 6th/ed, p130Laparoscopy is considered the "gold standard". While it is the most reliable aid to support the clinical diagnosis but it may not be feasible to do in all cases. It is reserved only in those cases in which differential diagnosis includes salpingitis, appendicitis or ectopic pregnancy. Nonresponding pelvic mass needs laparoscopic clarification.Hysterscopy may also provide confirmatory evidence for salpingitis."Fallopian tube culture can be obtained laparoscopically and recently the hysteroscopic approach has been introduced. The specimen is obtained during hysteroscopy with a cytobrush." - Ref: Gynecology by Ostrzenski (Lippincott Williams) (200l)/282Also KnowSince laparoscopy is an invasive procedure for diagnosis of salpingitis/PID, diagnosis should first be made clinically.
1
Hysteroscopy and laparoscopy
X-ray
Hysterosalpingography
Sonosalpingography
Gynaecology & Obstetrics
Sexually Transmitted Disease in the Female
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Lymes disease all are true except
Polymorphonuclear leucocytosis in C.S.F. suggests meningeal involvement Spread of infection and immune response in Lyme disease Lyme disease is caused by Borrelia Burgdorferi. Borrelia burgdorferi is transmitted to humans the bite of ixodes tick vector. Borrelia burgdorferi is inoculated in the skin, where local replication takes place locally and outward migration in the dermis occurs. Days to week after the tick bite, hematogenous dissemination to secondary sites (like joints, hea eye, nervous system) takes place. If untreated, the bacteria may persist in the body for months or even years, despite the production of anti-Borrelia burgodorferi antibodies by the immune system. The following mechanisms have been described - i) Tick saliva, which accompanies the spirochete into the skin during the feeding process, contains substances that disrupt the immune response at the site of the bite. - This provides a protective environment where the spirochete can establish the infect on. ii) Once inside the body, Borrelia burgdorferi becomes a "stealth invader" i.e., it changes shape. In the tick and mice which host the bacterium through most of its life cycle, the bacterium has a thick cell wall and spiral shape. If it maintains its thick cell wall and its spiral shape, immune system can control infection. However, in the human body, it can shed its cell wall and can take a different shape. When under attack from immune system, it simply changes shape so it is not recognized. iii) Borrelia burgdorferi produces antigenic variation in a "cell surface lipoprotein VIsE", during the course of infection The VIsE system presents a challenge to immune system because after an immune response is generated to one version of VIsE protein, a different version is quickly produced. By using this type of antigenic variation, B. burgdorferi can escape the adaptive immune system. Lyme meningitis Meningitis (meningeal involvement) is the most common neurological event that occurs in the setting of early lyme dissemination. - In this clinical setting CSF is always abnormal and shows: I) Pleocytosis with predominantly lymphocytosise (not polymorphonuclear leukocytosis). 2) Increased protein 3) Glucose content is usually normal, but it falls below the serum concentration in 20% of patients. Immunoglobulin abnormalities are common in the CSF of patients with lyme meningitis. - Specific IgM, IgG or IgA antibody against B. burgdorferi appears in CSF and indicates intrathecal antibody synthesis.
3
Borellia bourgdroferi replicates locally and invades locally
Infection progresses inspite of good humoral jmmunity
Polymorphonuclear lymphocytosis in CSF suggest meningial involvement
IgA intrathecally confirms meningitis
Microbiology
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Approximate time, at the end of which the quantity of ATP within ischemic cardiac myocytes is reduced to 10% of the original is
Metabolic changes slow as the duration of ischemia increases. Irreversibly injured myocytes exhibit (a) very low levels of ATP (less than 10% of control); (b) cessation of anaerobic glycolysis; (c) high levels of H+, AMP, INO, lactate, and alpha GP; (d) a greatly increased osmolar load; (e) mitochondrial swelling and formation of amorphous matrix densities; and (f) disruption of the sarcolemma. Approximately 40 minutes of time may there as the metabolic changes slow down with the decrease in ATP levels Ref internet and Robbins 9/e p,27;28
4
<2 minutes
10 minutes
20 minutes
40 minutes
Pathology
General pathology
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single
Aluminium phosphide poisoning - all true except
inhibits cytochrome a oxidase Aluminium phosphide produces phosphine gas on coming in contact with moisture which inhibits cytochrome c oxidase (and not cytochrome a oxidase). Sub-endocardial infarction and esophageal strictures both have been described with ALP poisoning (Ref: various journals on web) Aluminium phosphide poisoning It is one of the most common causes of acute poisoning in India. Acute aluminium phosphide (Celphos) poisoning is an extremely lethal poisoning. The absence of a specific antidote results in very high moality and the key to treatment lies in rapid decontamination and institution of resuscitative measures. Aluminium phosphide (A1P) is one of the most commonly used grain fumigants because of its propeies which are considered to be near ideal; it is toxic to all stages of insects, highly potent, does not affect seed bility, is free from toxic residues. After ingestion of aluminium phosphide, phosphine gas is released in the stomach which after absorption into the circulation results in early signs and symptoms. AlP causes widespread organ damage due to cellular hypoxia as a consequence of non-competitive inhibition of the enzyme cytochrome oxidase of the mitochondria. Organs with the greatest oxygen requirements appear to be especially sensitive to phosphine, including the brain, kidneys, hea, and liver. The initial symptoms after ingestion are retrosternal burning, epigastric pain and vomiting which are soon followed by development of hypotension which is the cardinal feature. Other common features are restlessness, tachypnoea, oliguria or anuria, jaundice, impaired sensorium and cardiac arrhythmias. Several EKG abnormalities have been described. These have been attributed to focal myocardial necrosis and changes in action membrane potential as result of alteration in permeability of Na+, Mg++ and Ca+ ions Diagnosis A positive history of ingestion is the basis of diagnosis in most cases. The presence of typical clinical features, garlicky (or decaying fish) odour from the mouth and highly variable arrhythmias in a young patient with shock and no previous history of cardiac disease points towards aluminium phosphide poisoning. Confirmation can be done by the Silver Nitrate Test. In this test, 5 ml of gastric aspirate and 15 ml of water are put in a flask and the mouth of the flask is covered by filter paper impregnated with 0.1N silver nitrate. The flask is heated at 50 o C for 15 to 20 min. If phosphine is present the filter paper turns black. However the most specific and sensitive method for detecting the presence of P1-13 in blood/air is gas chromatography. (Vies Jansen A, Thrane KE. Gas chromatographic determination of PH3 in ambient air. Analysis 1978;103:1195-8.) Management The management continues to be unsatisfactory as there is no specific antidote and remains suppoive only. The most impoant factor for success is resuscitation of shock and institution of suppoive measures as soon as possible. To reduce the absorption of phosphine, gastric lavage with potassium permanganate (1:10,000) is done. Permanganate is used as it oxidizes PH3 to form non-toxic phosphate. This is followed by a slurry of activated charcoal (approximately 100 gin) given through a nasogastric tube. A cathaic (liquid paraffin) is given to accelerate the excretion of aluminium phosphide and phosphine. Antacids and proton pump blockers are added for symptomatic relief.
4
subendocardial infarction
produces phosphine gas
oesophageal stricture
inhibits cytochrome a oxidase
Forensic Medicine
null
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multi
The small intestine secretes various triglyceride-rich lipoproteins, but the liver secretes only
Although both chylomicrons and VLDLs are triglyceride-rich lipoproteins, the liver, unlike the small intestine, produces only VLDLs. LDLs and HDLs are not triglyceride-rich lipoproteins. Chylomicron remnants are generated in the circulation by the metabolism of chylomicrons.
2
Chylomicrons
VLDLs
LDLs
HDLs
Pathology
All India exam
14879dd5-20b7-461e-ad63-febe0162ea20
multi
Snyder's test measures
null
1
Amount of acid produced
Number of new caries lesion
Buffering action of saliva
Antibiotic activity of saliva
Dental
null
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single
Features not seen in Cushing's Syndrome is :
Answer is A (Hypoglycemia): Cushing's syndrome is characterised by Hy perglycemia. Increased hepatic gluconeogenesis and insulin resistance causes increase in blood glucose. Hypeension is common, & emotional changes may be profound, ranging from irritability & emotional liability to severe depressions, confusion or even frank psychosis. Hvpokalemia. hypochloremia and metabolic alkalosis may be seen
1
Hypoglycemia
Hypeension
Frank psychosis
Hypokalemia
Medicine
null
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single
Fulminant hepatitis is most commonly associated with which type of hepatitis -
Ans. is 'b' i.e., Hepatitis B Fulminant hepatits* The most feared complication of viral hepatitis is fulminant hepatitis (massive hepatic necrosis); fortunately, this is a rare event.* Fulminant hepatitis is primarily seen in hepatitis B and D, as well as hepatitis E, but rare fulminant cases of hepatitis A occur primarily in older adults and in persons with underlying chronic liver disease, including, according to some reports, chronic hepatitis B and C.* Hepatitis B accounts for > 50% of fulminant cases of viral hepatitis, a sizable proportion of which are associated with HDV infection and another proportion with underlying chronic hepatitis C.* Fulminant hepatitis is hardly ever seen in hepatitis C, but hepatitis E, as noted above, can be complicated by fatal fulminant hepatitis in 1-2% of all cases and in up to 20% of cases in pregnant women.* Patients usually present with signs and symptoms of encephalopathy that may evolve to deep coma.* The liver is usually small and the PT excessively prolonged.* The combination of rapidly shrinking liver size, rapidly rising bilirubin level, and marked prolongation of the PT, even as aminotransferase levels fall, together with clinical signs of confusion, disorientation, somnolence, ascites, and edema, indicates that the patient has hepatic failure with encephalopathy.* Cerebral edema is common; brainstem compression, gastrointestinal bleeding, sepsis, respiratory failure, cardiovascular collapse, and renal failure are terminal events.* The mortality rate is exceedingly high (> 80% in patients with deep coma), but patients who survive may have a complete biochemical and histologic recovery.* If a donor liver can be located in time, liver transplantation may be life- saving in patients with fulminant hepatitis.
2
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Medicine
Infection
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single
Blood samples for glucose estimation are collected in fluoride bulbs/tubes as fluride prevents glycolysis byinhibition of
Ans. a (Enolase) (Ref. Harper's Illustrated 26th ed., 137; 27th/Ch. 18)ENOLASE# The step of glycolysis catalyzed by enolase involves dehydration, forming phosphoenolpyruvate.# Enolase is inhibited by fluoride.- To prevent glycolysis in the estimation of glucose, blood is collected in tubes containing fluoride.# The enzyme is also dependent on the presence of either Mg2+ or Mn2+.# The phosphate of phosphoenolpyruvate is transferred to ADP by pyruvate kinase to generate, at this stage, two molecules of ATP per molecule of glucose oxidized.# The product of the enzyme-catalyzed reaction, enolpyruvate, undergoes spontaneous (nonenzymic) isomerization to pyruvate and so is not available to undergo the reverse reaction.# The pyruvate kinase reaction is thus also irreversible under physiologic conditions. EnzymeInhibitorPathway1.AconitaseFluoroacetateKrebs cycle2.L-KG dehydrogenaseArseniteKrebs cycle3.EnolaseFluorideGlycolysis4.Succinate dehydrogenaseMalonate oxaloacetateKrebs cycle5.Glyceradehyde-3 phosphateLactoacetate dehydrogenaseGlycolysis6.MOAIproniazid 7.Pyruvate dehydrogenaseArsenite 8.Carbonic anhydraseSulfanilamide
1
Enolase
Aldolase
Glucokinase
Phosphofructokinase
Biochemistry
Carbohydrates
019d5e6b-3ee0-4586-b24b-6e8b6bd4d3fe
single
Which is a communicating hydrocele?
Funicular hydrocele Communicating hydrocele: (a) Funicular hydrocele, and (b) Congenital hydrocele. a. Funicular Hydrocele: Processus vaginalis remains patent up to the top where it is shut off from the tunica vaginalis. Diagnostic features: (i) The swelling is inguinal rather than scrotal. (ii) The test is it can be felt separate! (iii) Other features are similar to those of congenital hydrocele. b. Congenital Hydrocele: In this condition the processus vaginalis remains patent so there is direct communication of the tunica vaginalis with the peritoneal cavity. The communicating orifice at the deep inguinal ring is too small for the development of a hernia.
4
Vaginal hydrocele
Hydrocele of the cord
Infantile hydrocele
Funicular hydrocele
Surgery
null
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single
Compound odontoma shows on a radiograph as
null
4
Supernumerary teeth
Radiolucent and radiopaque areas
Masses of calcified areas
Distinguishable tooth -Like structures
Pathology
null
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single
1st evidence of calcification of Maxillary deciduous Lateral incisor occurs
null
2
14 wk IU
16 wk IU
17 wk IU
15 wk IU
Dental
null
ac019b99-9105-4cf9-8542-46e8229e88de
single
Which of the following structures is most significant in resisting hyperextension of the hip joint?,
The Iliofemoral Ligament resist both hyperextension and lateral rotation at the hip joint. The Pubofemoral ligament reinforces the joint inferiorly and limits extension and abduction. The Ischiofemoral ligament reinforces the joint posteriorly and limits extension and medial rotation. The Gluteus Maximus muscle extends and laterally rotates the thigh and does not paicularly resist hyperextension
3
Pubofemoral ligament
Ischiofemoral ligament
Iliofemoral ligament
Gluteus maximus muscle
Anatomy
Bones Joints and Ligaments
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single
Rhinophyma occurs as complication of
Rosacea:-Chronic skin infection characterised by symptoms of facial flushing and a spectrum of signs including erythema, telangiectasia,coarseness of skin and inflammatory papulopustular lesion.Features:-1. Red papules and pustules on nose ,forehead,cheeks and chin.2. Frequent flushing 3. Aggravated by sun exposure,foods , alcolhol, spicy foods, hot tea or coffeeextreme temperatures,vasodilator drugs,, h.pylori infection There are 4 subtypes of rosacea erythematotelengieatatic rosacea- flushing,central facial erythema, telengiectasia papulopustular rosacea- persistent central facial erythema with transient papules , pustules, in central facial distribution phymatous rosacea: thick skin with modularity most common over nose-rhinophyma ocular rosacea watery eyes, foreign body sensation, burning/stinging, dryness, itching blepharitis. iadvltextbook of dermatology, page page 856
2
Acne vulgais
Acne rosacea
Psoriasis
Plicinphigus
Dental
Photosensitive disorders
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single
In CuT 200, the number stands for:
Ans: A (Surface...) "The number included in the names of the devices refer to the surface area (in sq, mm) of the copper on the device. Park 21st/459 IUDs: Review of Facts# CuT-200 B being used in India , under the national family welfare programme,Later CuT 380A is introduced in the programme.# Studies have shown that the effectiveness of copper device is directly related to the amountofcopper surface area (usually this is 200 or 220 mm2')- Park 19th/395# IUD is not a method of first choice for nulliparous women. They have more problems such as expulsion, low abdominal pain Si pelvic infection.intra-Uterine Devices; Classification 1st Generation IUDs (inert or non medicated devices) 2nd Generation IUDsEarlier devices* Copper 7* Copper T - 200Newer devices* Variants of the T device(i) T Cu - 220 C(jj) T Cu - 380 A or Ag* Nova T*Multi load devices(i)-Cu-250(ii)-Cu-375 3rd Generation IUDs (Hormonal deinces)* Progestasert* LNG-20 (Mirena)13
1
SurfaceAreaofCopper
Weight of Cu in microgram
Weight of Cu in milligram
Effective half life in weeks
Social & Preventive Medicine
Family Planning
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