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The most important investigation in the given case to diagnose if the condition is a neoplasm?
Ans. (a) JAK-2The figure shows increased platelets in smear and increased megakaryocytes in bone marrow. To diagnose this as essential thrombocythemia (neoplasm); JAK-2 mutation analysis should be done.
1
JAK-2
EPO level
PaO2
Bone marrow aspiration and biopsy
Pathology
Misc. (W.B.C)
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World diabetes day is celebrated on -
Ans. is 'c' i.e., 14th November* 8th may - world red cross day* 8th march - international womens day* 14th november - world diabetes day* 1st december - world AIDS day
3
8th may
8th march
14th November
1st december
Social & Preventive Medicine
Non-Communicable Diseases
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single
An anesthetic agent with boiling temperature more than 75 C is
Refer Anesthesiology by Longnecker 2008/777 Boiling point of methoxyflurane is 104,7 degree Celsius whereas other flurrinated anesthetics have boiling point between 50 C and 60 C
4
Ether
Halothane
Cyclopropane
Methoxyflurane
Pharmacology
Anesthesia
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Takayam test is used for?
Ans. is 'a' i.e. To know the nature of stain o It is a microchemical test to know the nature of stain.Microchemical tests: These tests are based on property of haem part of hemoglobin to form characteristic coloured crystals.1) Teichmann's haemin crystal test2) Takayama hemochromogen crystal test3) Luminal spray test: It is especially useful in old obscure blood stains
1
To know the nature of stain
To know the species
For blood grouping
None of the above
Forensic Medicine
Identification - Medicolegal aspects
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Treatment of choice in desmoid tumours is -
null
2
Irradiation
Wide excision
Local excision
Local excision following radiation
Surgery
null
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A small Ca2+ binding protein that modifies the activity of many enzymes and other proteins m response to changes in Ca2+ concentration, is known as
Calmodulin is a calcium-binding regulatory protein, with a molecular weight of 17,000 daltonsIt can bind with 4 calcium ionsCalcium binding leads to activation of enzymes. It is a pa of various regulatory kinasesRef: DM Vasudevan, 7th edition, page no: 503, 504
2
Cycline
Calmodulin
Collagen
Kinesin
Biochemistry
Endocrinology
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Dead space is reduced in tracheostomy by
Airflow resistance of the normal upper airway is substantial, constituting up to 80% of total airway resistance during nose breathing and 50% during mouth breathing.Theoretically, tracheostomy tubes should decrease airflow resistance, but in fact, this does not occur because of the smaller radius (inner diameter 7-8 mm) of the tubes. Tracheostomy tubes may reduce dead space by up to 100 mL -150 mL, 30-50% when compared to spontaneous breathing. This occurs because the tubes are small and bypass the glottic and supraglottic spaces.
4
5-10%
15-20%
20-30%
30 - 50%
Microbiology
All India exam
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S/E of diethyl stilbesterol when used in pregnant woman-
Ans. is 'c' i.e., Infeility and development vaginal carcinoma in female offspring Stilbestrol given to pregnant women Increased risk of vaginal and cervical carcinoma in the female offspring in childhood or early adulthood.
3
Deep vein thrombosis in pregnant woman
Feminization of external genitalia of male offspring
Infeility and development of vaginal carcinoma in female offspring
Virilization of the external genitalia of female offspring
Pharmacology
null
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ASA -3 is
ASA grade 3 is when comorbidities are present and make patient symptomatic often.
2
Comorbidities with minimal limitation
Comorbidities with moderate limitation
Comorbidities which are constant threat to life
No comorbidities
Anaesthesia
null
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Lesion not seen in Lepromatous leprosy is:-
Lepromatous leprosy The first clinical manifestations are usually dermal (because early nerve involvement is usually asymptomatic) Leonine facies occur due to diffuse involvement of the facial skin Early symptoms Nasal symptoms of stuffiness, discharge and epistaxis, and oedema of legs and ankles due to increased capillary stasis and permeability. Eyebrows and eyelashes become thinned or lost (madarosis) Ear lobes are thickened Nose becomes misshapen, and may collapse due to septal perforation and loss of the anterior nasal spine Dermal signs comprise macules, diffuse papules, infiltration or nodules, Hair growth and sensation are not initially impaired over the lesions.
4
Macule
Papule
Nodule
Vesicle
Dental
Mycobacterial Infections
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The conversion of optically pure isomer (enantiomer) into a mixture of equal amounts of both dextro and levo forms is called as
Depending on the rotation, molecules are called dextrorotatory (+) (d) or levorotatory (-) (l). Thus D-glucose is dextrorotatory but D-fructose is levorotatory. Equimolecular mixture of optical isomers has no net rotation (racemic mixture) or Racemization Ref: Textbook of Biochemistry for Medical Students, 7E (DM Vasudevan)(2013) Pg no.70 & 71.
3
Polymerization
Stereoisomerization
Racemization
Fractionation
Biochemistry
Structure and function of protein
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When a homicide case comes to a doctor, he has to inform police. This comes under which section?
Every person, aware of the Commission of ceain offences shall give information to the nearest Magistrate or police officer.This comes under 39 Crpc section. Examples of such offences are: Offences relating to adulteration of food and drugs, etc Offences affecting life (302, 303, 304 IPC) Offence relating to kidnapping for ransom (364AIPC) Offences of robbery and dacoity
1
39 Crpc
27 Crpc
174 Crpc
176 Crpc
Forensic Medicine
Legal sections
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Post-dural puncture headache is typically ?
Ans is 'c' i.e. Bifrontal or occipital Characteristics of post lumbar puncture Headache Cause - There is loss of C.S.F which decreases the brains suppoive cushion so that when a patient is upright there is dilatation and tension placed on brain's anchoring structures and the pain sensitive dural sinuses, resulting in pain. Nature - Usually a dull ache but may be throbbing Location - Occipito frontal * Accompanying symptoms -Nausea, stiff neck, blurred vision, photophobia, tinnitus and veigo Onset - Pain usually begins within 48hrs., but may be delayed for upto 12 days. Precipitating factors It is dramatically positional, it begins when the patient sits or stands upright Also worsened by head shaking or jugular venous compression Relief is obtained on reclining or with abdominal compression Treatment Post-LP headache usually resolves without specific treatment, and care is largely suppoive with oral analgesics and antiemetics. Patients may obtain relief by lying in a comfoable position. For some patients beverages with caffeine can provide temporary pain relief. For patients with persistent pain, - Treatment with I.V. caffeine may be effective. Epidural blood patch : an epidural blood patch accomplished by injection of 15m1. of autologus whole blood is almost successful in those who do not respond to caffeine.
3
A result of leakage of blood into the epidural space
Worse when lying down than in sitting position
Bifrontal or occipital
Seen within 4 hours of dural puncture
Surgery
null
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The glomus tumor invasion of jugular bulb is diagnosed by
MRI - gives soft tissue extent of tumor; Magnetic Resonance Angiography (MRA) shows compression of the carotid aery whereas magnetic resonance venography shows invasion of jugular bulb by the tumor.
4
Carotid angiography
Veebral venousvenography
X-ray
Jugular venography
ENT
null
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Chemically steroids are derivatives of
Cholesterol is first acted upon by desmolasw and a 6 carbon unit is cleaved off, forming pregnenoloneProgesterone is the first steroid hormone formed from pregnenoloneProgesterone is fuher conveed in to glucocoicoids, mineralocoicoids and sex steroids Ref: DM Vasudevan, 7th edition, page no: 664, 665
1
Cholesterol
Ergosterol
Fatty acids
Perhydrocyclopentanophenantherene
Biochemistry
Endocrinology
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Toxin production by Corynebacterium diphtheria is due to ?
Ans. is 'c' i.e., Lysogenic conversion o The toxigenicity of the diphtheria bacilli depends on the presence in it of corynephages (tox +). Nontoxigenic strains may be rendered toxigenic by infecting them with beta phage or some other larger phage. This is known as lysogenic conversion or phage conversion.
3
Chromosomal mutation
Presence of plasmid
Lysogenic conversion
Transformation
Microbiology
Corynebacterium
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Azoospermia is seen in which syndrome -
Young's syndrome, also known as azoospermia sinopulmonary infections, sinusitis-infertility syndrome and Barry-Perkins-Young syndrome, is a rare condition that encompasses a combination of syndromes such as bronchiectasis, rhinosinusitis and reduced fertility. In individuals with this syndrome, the functioning of the lungs is usually normal but the mucus is abnormally viscous. The reduced fertility (azoospermia) is due to functional obstruction of sperm transport down the genital tract at the epididymis where the sperms are found in viscous, lipid-rich fluid.
2
Kartagener syndrome
Young syndrome
Both
None
Pathology
null
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Which is the rarest type of von Willebrand disease?
Type III vWD is the rarest type of von Willebrand disease. It result from the inheritance of a mutant vWF gene from both parents. TYPES OF vBD: Condition Defect vWD type 1 Mild to moderate quantitative deficiency of vWF (i.e., about 20-50% of normal levels). vWD type 2A The most common qualitative abnormality of vWF selective loss of large and medium-sized multimers vWD type 2B Loss of only large multimers vWD type 2N Characterized by a defect residing within the patient's plasma vWF that interferes with its ability to bind F VIII. vWD type 2M Involves qualitative variants with decreased platelet-dependent function vWD type 3 A severe, quantitative deficiency associated with very little or no detectable plasma or platelet vWF, have a profound bleeding disorder
4
vWD type 1
vWD type 2A
vWD type 2N
vWD type 3
Medicine
Platelet & Coagulation disorders
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chelioscopy is the study of -
Lip prints
4
Foot prints
Palatal prints
Finger prints
Lip prints
Unknown
null
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Anatomical closure of ductus arteriosus occurs at –
Circulatory adjustments at birth These are brought about because of a shift from placental dependance for gas exchange in the fetus to pulmonary gas exchange in the neonate. 1) Pulmonary circulation Immediately after birth lungs expand due to the first few breaths of the neonate. This causes a fall in pulmonary vascular resistance (O2 causes pulmonary vasodilatation). This results in increased flow into pulmonary trunk and arteries. The pulmonary artery pressure falls due to lowering of pulmonary vascular resistance. The pressure relations between the aorta and pulmonary trunk are reversed so that the blood flow through the ductus arteriosus is reversed → Instead of blood flowing from the pulmonary artery to aorta, the direction of flow through ductus, is from the aorta to pulmonary trunk. Increasing oxygen saturation causes the muscle of ductus to constrict → In full term neonates, the ductus  arteriosus closes within 10 to 25 days. 2) System circulation and circulation through the heart Loss of placental circulation and clamping of the cord after birth results in an increase in systemic vascular resistance. This tends to increase the aortic blood pressure and the left ventricular systolic pressure. The loss of placental circulation results in a sudden reduction of flow through ductus venosus which closes off  → Flow through ductus venosus disappears by the 7th day of postnatal life. The loss of placental flow results in a decrease in the volume of blood returning to right atrium → Right atrial pressure decreases. The left atrial pressure becomes higher than right atrial pressure and the septum primum which ats as a valve of fossa ovalis, approximates with the septum secundum to close off formen ovale. Functional closure of foramen ovale occurs very quickly. Over a period of months, the septum primtun and septum secundum become firmly adherent resulting in anatomical closure of the foramen ovale. After closure of ductus arteriosus, there is establishment of postnatal circulation : - The blood reaching the right atrium through IVC and SVC is emptied into the right ventricle from where it is pumped into pulmonary trunk. After coursing through lungs for gas exchange, it reaches the left atrium and ventricle. The left ventricle pumps it out for distribution in the body for oxygenation of the tissues. The venous return again comes back to right atrium through IVC and SVC. All of the blood leaving the right ventricle, after coursing through lungs, reaches the left ventricle → The two ventricles are connected in series and therefore, the output of right and left ventricles are same (in contrast to fetal circulation, where right ventricular output is more).
3
Birth
3–4 day
10th day
30th day
Pediatrics
null
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Rheumatoid factor is directed against-
harshmohan textbook of pathology *detection of circulating autoantibody called rheumatoid factor against Fc poion of autologous IgG in about 80% of cases
1
IgG
IgD
IgM
IgA
Pathology
General pathology
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Most sensitive investigation for air embolism is
C i.e. Doppler Ultrasound
3
Decreased tidal volume of CO2
Decreased tidal volume of NO2
Doppler ultrasound
Central Venous Presure
Radiology
null
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Under the National Programme for Control of Blindness, the goal is to reduce the prevalence of blindness to a level of -
To reduce prevalence of blindness in population from 1.38% to 0.31% by 2000. Ref- Park&;s textbook of Preventive and social medicine 24th edition. .
2
0.10%
0.31%
0.50%
1%
Social & Preventive Medicine
Non communicable diseases
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Conjugate vaccine are available for the prevention of invasive disease caused by all of the following bacteria except:
Ans. (d) Neisseria meningitidis (Group B) Note: Conjugate vaccines are available for: a. Hemophilus influenza B. b. Menigococcal serotypes A, C, Y and W-135. c. Streptococcalpneumoniae(pneumococcus).
4
H. influenzae
Strep pneumoniae
Neisseria meningitidis (Group-C)
Neisseria meningitidis (Group-B)
Microbiology
null
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Which of the following is not required for conversion of acetyl CoA to palmitate?
The pathway conves acetyl-CoA to palmitate and requires NADPH, ATP, Mn2+, biotin, pantothenic acid, and as cofactors. Ref: Harper 28th edition, chapter 23.
2
ATP
Niacin
NADPH
Biotin
Biochemistry
null
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Nutrient artery to Femur is a branch of
Femur gets its nutrient artery from 2nd perforating Branch arising from profunda femoris artery.
3
Inferior gluteal Artery
1st perforating Branch of profunda femoris artery
2nd perforating Branch of profunda femoris artery
Lateral circumflex femoral artery
Anatomy
null
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All are stages of anaesthesia except-
Ans. is 'b' i.e., Allodynia o Stages of anaesthesia are Stage of analgesia ( stage 1), stage of delirium or excitment (stage 2), stage of surgical anesthesia (stage 3) and stage of medullary'- paralysis (stage 4).o Guedel described four stages of ether anesthesia known as Guedel stages.Stages of anaesthesiao GAs cause an irregular descending depression of the CNS, i.e., higher functions are lost first and pregressively lower area of brain are involved. In spinal cord lower segments are affected earlier than upper segments. The vital centers located in the medulla are paralyzed the last as the depth of anaesthesia increases,o Guedel discribed four stages of ether anaesthesia dividing the Illrd stage into 4 planes. With faster acting GAs these clear cut stages are not seen nowr days as induction with these agents is too fast. Stage 1 (Stage of analgesia): - It extends from beginning of anaesthetic inhalation to the loss of conciousness. Stage 2 (Stage of delirium or excitment): - From the loss of conciousness to beginning of regular respiration. There is roving eye ball (maximum movement of eye). Pupil is partially dilated. Eye lashr eflex is lost - First reflex to be lost However eyelid reflex remains present.C) Stage 3 ( stage of surgical anaesthesia): - From beginning of regular respiration to cessation of spontaneous breathing. Most surgeries are done in this stage. It is divided into 4 planes : -Plane 1 : - From beginning of regular respiration to cessation of eye movement. There is roving eye ball. Eye lid reflex is lost. This plane ends when eye ball become fixed. Pupil size is normal.Plane 2 : - From cessation of eye movement to respiratory Paresis. Eye ball is fixed. There is loss of corneal reflex.Pupil starts dilating ( 1/2 dilated).Plane 3 : - From respiratory paresis to respiratoy' paralysis. Pupil 3/4 dilated. Swallowing reflex and laryngeal reflexes are tost.Plane 4 : - Intercostal paralysis, there is only abdominal respiration. Pupil is fully dilated. Carinal reflex (Cough reflex) is lost - Last reflex to be lostLacrimation is present in plane II & III and absent in Plane III, IV.D) Stage 4 (stage of medullary paralysis): - There is respiratory arrest and apnea. Pupil is fully dilated & fixed.
2
Analgesia
Allodynia
Delirium
Surgical anesthesia
Anaesthesia
Miscellaneous General Anesthesia
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Kuppuswamy socioeconomic status scale comprises of -
Kuppuswamy &;s socio-economic status scale education occupation family income per month (refer pgno:690 park 23 rd edition)
4
Education, family size and housing
Education, occupation and housing
Income, family size and land holding
Education, occupation and income
Social & Preventive Medicine
Health education & planning
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Early strict toilet training can result in
A condition in which a child resists having bowel movements, causing impacted stool to collect in the colon and rectum and lead to leakage. Common causes of this symptom Encopresis can have causes that aren&;t due to underlying disease. Examples include sneezing, constipation, incontinence due to lack of potty training or incontinence due to misinterpretation of body signals. Reference: GHAI Essential pediatrics, 8th edition
2
Nocturnal enuresis
Encopresis
Night terror
Temper tantrauma
Pediatrics
Growth and development
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A 60 year female present with tender irreducible mass immediately bellow and lateral to the pubic tubercle. plain abdominal x- ray shows intestinal obstruction
null
4
Small bowel carcinoma
Adhesions
Strangulated inguinal hernia
Strangulated femoral hernia
Surgery
null
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Xray showing air column between soft tissue mass and posterior wall of nasopharynx is suggestive of -
Ans. is 'b' i.e., Antrochoanal polyp o On xray.antrochoanal polyp appears as a soft tissue density and shows a column of air between the soft tissue mass and posterior wall of nasopharynx.
2
Ethmoidal polyp
Antrochoanal polyp
Nasalmyiasis
None of the above
ENT
Pharynx
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Salk vaccine is a
null
4
Live vaccine
Live attenuated vaccine
Toxoid
Killed vaccine
Social & Preventive Medicine
null
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The daily requirement of Vitamin C is –
null
1
40 mg
100 mg
200 mg
500 mg
Social & Preventive Medicine
null
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single
To which of the following family of chemical mediator of inflammation,the lipoxins belong
ref Robbins 7/e p69 lipoxins are a recent addition to the family of bioactive products generated from arachidonic acid.they have anti inflammatory activity
4
Kinin system
Cytokines
Chemokines
Arachidonic acid metabolites
Anatomy
General anatomy
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Not present in Sideroblastic anaemia is ?
Ans. is 'b' i.e., Decreased transferrin saturation Sideroblastic anemia Sideroblastic anemia is a type of anemia in which the body has adequate amount of iron but is unable to corporate it into hemoglobin. Pathogensis o The basis defect is a failure to completely form heme molecules, whose biosynthesis takes place paly in the mitochondria. o The iron enters into the mitochondria, but cannot be utilized to synthesize heme. So iron, accumulates in mitochrondria giving a ringed appearance --> Ringed sideroblast. o Because these ringed sideroblastis can develop poorly or not at all into mature RBCs, anemia is a consequence.
2
Microcytic anaemia
Decreased transferrin saturation
Sideroblast cells in blood smear film
Ineffective erythropoesis
Pathology
null
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Which of the following tests can differentiate MRKH from testicular feminizing syndrome
Karyotyping is best to differentiate between MRKH and testicular feminization syndrome.
3
3D USG
MRI
Karyotyping
Serum testosterone levels.
Gynaecology & Obstetrics
null
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The posterior urethra is best visualized by ?
Voiding cystourethrography is the best method to visualize posterior urethra. Remember, Urethra can be imaged radiographically in two ways. Anterograde techniques --> Best for visualization of posterior urethra. (This is done along with voiding cystourethrography or with voiding following excretory urography) Retrograde technique --> Best for examining the anterior (penile) urethra (Contrast is injected through tip of urethra). Ref: Sabiston 20th Ed. ; Schwaz 11th Ed.
3
Static cystogram
Retrograde urethrogram
Voiding cystogram
CT cystogram
Surgery
All India exam
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Total body iodine is about –
null
4
20 mg
30 mg
40 mg
50 mg
Social & Preventive Medicine
null
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Which nerve is damaged in fracture surgical neck humerus -
Ans. is 'a' i.e., Axillary Complications of fracture surgical neck humeruso Shoulder stiffness.o Axillary nerve is particularly vulnerable, both from the injury and from surgeryo Axillary artery injury o Malunion o Nonunion o Myositis ossificans
1
Axillary
Radial
Ulnar
Median
Orthopaedics
Fracture of the Humerus
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A herd immunity of over - % is considered necessary to prevent epidemic spread of diphtheria-
Ans. is 'd' i.e., 70% o A herd immunity of over 70% is considered necessary to prevent epidemic spread, but some believe that the critical level may be as high as 90%.Diphtheriao Diphtheria is an acute infectious disease caused by toxigenic strains of corynebacterium diphtheriae.o Source of infection - cases or carriers; carriers are common sources of infection, their ratio is estimated to be 95 carriers for 5 clinical cases.o Infective period-14-28 days from the onset of disease,o Age group-1 to 5 yearso Sex-Both sexeso Incubation period-2-6 dayso The period of infectivity may vary from 14 to 28 days from the onset of the disease, but carriers may remain infective for much longer period.o A case or carrier may be considered non-communicable when at least 2 cultures properly obtained from nose and throat, 24 hours apart, are negative for diphtheria bacilli.Control of diphtheriao Control diphtheria requiresControl in cases and carrierControl for contacts (prophylaxis for contact)Prophylaxis for community ->> by vaccinationControl in cases and carrier1) Early diagnosis-By nose & throat examination and culture.2) Isolation-For at least 14 days or until proved free of infection, i.e. at least 2 consecutive nose and throat swabs, taken 24 hours apart, should be negative before terminating isolation.Treatmenti) Cases-Diphtheria antitoxin plus penicillin or erythromycin.ii) Carrier-Erythromycin
4
50%
55%
60%
70%
Social & Preventive Medicine
Communicable Diseases
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Drug of choice for schizophrenic patient with poor oral absorption is?
Clozapine REF: Kaplan and sadock's synopsis in psychiatry 10th ed p. 489-490 Antipsychotics can be categorized into two main groups: the older conventional antipsychotics, which have also been called first-generation antipsychotics or dopamine receptor antagonists (DRA), and the newer drugs, which have been called second-generation antipsychotics or serotonin dopamine antagonists (SDAs) Strategies for Poor Responders of Antipsychotic: It may suggest that the patient is a rapid metabolizer of the antipsychotic or that the drug is not being adequately absorbed. Changing to another drug is preferable to changing to a high dose. If a patient has responded poorly to a conventional DRA, it is unlikely that this individual will do well on another DRA. Changing to an SDA is more likely to be helpful. Clozapine is effective for patients who respond poorly to DRAs. Double-blind studies comparing clozapine to other antipsychotics indicated that clozapine had the clearest advantage over conventional drugs in patients with the most severe psychotic symptoms, as well as in those who had previously responded poorly to other antipsychotics.
3
Haloperidol
Fluphenazine
Clozapine
Olanzapine
Psychiatry
null
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Most common infections after splenectomy are
Oppounist post-splenectomy infection is caused by capsulated bacteria.Post-splenectomy septicaemia may result from Streptococcus pneumoniae, Neisseria meningitides, Haemophilus influenzae and Escherichia coli.Bailey and love 26th edition pg: 1096
1
Capsulated bacteria
Uncapsulated bacteria
Gram positive sepsis
Gram negative bacteria
Surgery
G.I.T
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Type of inheritance in MELAS -
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes - abbreted to MELAS - is one of the family of mitochondrial cytopathies, which also include MERRF, and Leber's hereditary optic neuropathy. It was first characterized under this name in 1984. A feature of these diseases is that they are caused by defects in the mitochondrial genome which is inherited purely from the female parent. However, it is impoant to know that some of the proteins essential to normal mitochondrial function are produced by the nuclear genome, and are subsequently transpoed to the mitochondria for use. As such, mutations in these proteins can result in mitochondrial disorders, but can be inherited from both male and female parent in the typical fashion. The disease can manifest in both sexes.This condition is inherited in a mitochondrial pattern, which is also known as maternal inheritance and heteroplasmy. This pattern of inheritance applies to genes contained in mitochondrial DNA. Because egg cells, but not sperm cells, contribute mitochondria to the developing embryo, only females pass mitochondrial conditions to their children. Mitochondrial disorders can appear in every generation of a family and can affect both males and females, but fathers do not pass mitochondrial traits to their children. In most cases, people with MELAS inherit an altered mitochondrial gene from their mother. Less commonly, the disorder results from a new mutation in a mitochondrial gene and occurs in people with no family history of MELAS.
3
AD
AR
Mitochondrial
X-linked
Pathology
General pathology
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single
During bilateral adrenalectomy, intra-operative dose of hydrocoisone should be given after:
Patients undergoing surgical treatment of endogenous hypercoisolism require glucocoicoid replacement. Steroids are not given pre-operatively because these patients are already hypercoisolemic. Instead hydrocoisone 100 mg IV is given after the removal of second hyperplastic adrenal gland.
4
Opening the abdomen
Ligation of left adrenal vein
Ligation of right adrenal vein
Excision of both adrenal glands
Surgery
Parathyroid and adrenal glands
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multi
Which of the following tumors is characterized histologically by pseudopalisading, necrosis, endoneural proliferation, hypercellularity, and atypical nuclei?
The features listed in the question are characteristic of a glioblastoma multiforme. Astrocytomas, the most common primary brain tumors in adults, range from low-grade to very high-grade (glioblastoma multiforme). These grades of astrocytomas include grade I (the least aggressive and histologically difficult to differentiate from reactive astrocytosis), grade II (some pleomorphism microscopically), grade III (anaplastic astrocytoma, characterized histologically by increased pleomorphism and prominent mitoses), and grade IV (glioblastoma multiforme). Glioblastoma multiforme is a highly malignant tumor characterized histologically by endothelial proliferation and serpentine areas of necrosis surrounded by peripheral palisading of tumor cells. It frequently crosses the midline ("butterfly tumor"). In contrast, schwannomas generally appear as extremely cellular spindle cell neoplasms, sometimes with metaplastic elements of bone, cailage, and skeletal muscle. Medulloblastomas occur exclusively in the cerebellum and microscopically are highly cellular with uniform nuclei, scant cytoplasm, and, in about one-third of cases, rosette formation centered by neurofibrillary material. Oligodendrogliomas, which are marked by foci of calcification in 70% of cases, commonly show a pattern of uniform cellularity and are composed of round cells with small dark nuclei, clear cytoplasm, and a clearly defined cell membrane. Ependymomas are distinguished by ependymal rosettes, which are ductlike structures with a central lumen around which columnar tumor cells are arranged in a concentric fashion. Glioblastoma Multiforme Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition
4
Schwannoma
Medulloblastoma
Oligodendroglioma
Glioblastoma multiforme
Pathology
Nervous system
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multi
Spiral ganglion innervates which cells in the following diagram
Ans. (a) A(Ref: Ganong, 25th ed/p.202)Spiral ganglionContains cell bodies of the auditory nerve whose peripheral axons innervate hair cells on the organ of Corti90% to 95% of these sensory neurons innervate the inner hair cells (point A)Only 5-10% innervate the more numerous outer hair cells
1
A
B
C
D
Physiology
Nervous System
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single
A 30 year old male presented with pain in lower extremities, aggravated by walking. He gives the history of cigarette smoking. In this patient prevalence of which histocompatibility antigen is increased?
The history suggests that the patient is suffering from Buerger disease. There is increased prevalence of HLA-A9 and HLA-B5 in these patients. HLA DISEASE HLA-B8 Myasthenia gravis, Graves Disease HLA-DR2 Narcolepsy HLA-DR3 Myasthenia gravis, Celiac sprue HLA-DR4/DW4 Rheumatoid ahritis
1
HLA-B5
HLA-B8
HLA-DR2
HLA-DR3
Surgery
null
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Marker of glomus tumor -
Additional studies using immunohistochemical techniques revealed that malignant glomus tumors are characterized by the presence of MIB-1, p53, Bcl-2, and CD34. Up to 4% of the tumors are functional and produce clinically significant levels of catecholamines, norepinephrine, or dopamine with symptoms mimicking a pheochromocytoma. Pheochromocytoma, parathyroid adenoma, and thyroid carcinoma have been repoed in association with glomus jugulare tumors. Ref: Medscape
4
CD-57
Cytokeratin
S-100
CD-34
Pathology
miscellaneous
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A patient has small, oval multiple ulcers in oral cavity with red erythematous margins. The diagnosis is:
Aphthous ulcer Small and oval multiple ulcers in oral cavity Has red erythematous margins Syphilitic ulcer Firm, painless, non-itchy skin ulceration Tubercular ulcer Firm, nontender erythematous nodules that soften, ulcerate, and form sinuses.
3
Carcinoma
Tubercular ulcer
Aphthous ulcer
Syphilitic ulcer
Surgery
Oral cavity
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multi
Absolute contraindication for IUCD are all except
Absolute contraindications Suspected pregnancy Undiagnosed vaginal bleeding Cancer cervix Previous ectopic pregnancy Relative contraindications Distoions of the uterine cavity due to Congenital malformations Fibroids Anaemia Menorrhagia Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 497
4
Pregnancy
Undiagnosed vaginal bleeding
Pelvic inflammatory disease
Uterine malformation
Social & Preventive Medicine
Demography and family planning
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Rape is defined under: September 2010
Ans. A: IPC-375 IPC-375 defines rape. A man is said to commit "rape" who, except in the case hereinafter excepted, has sexual intercourse with a woman under circumstances falling under any of the six following descriptions: ? First: - Against her will. Secondly: - Without her consent. Thirdly: - With her consent, when her consent has been obtained by putting her or any person in whom she is interested in fear of death or of hu. Fouhly: - With her consent, when the man knows that he is not her husband, and that her consent is given because she believes that he is another man to whom she is or believes herself to be lawfully married. Fifthly: - With her consent, when at the time of giving such consent, by reason of unsoundness of mind or intoxication or the administration by him personally or through another of any stupefying or unwholesome substance, she is unable to understand the nature and consequences of that to which she gives consent. Sixthly: - With or without her consent, when she is under sixteen years of age. Explanation: - Penetration is sufficient to constitute the sexual intercourse necessary to the offence of rape. Exception: - Sexual intercourse by a man with his wife, the wife not being under fifteen years of age, is not rape.
1
IPC 375
IPC 376
IPC 377
IPC 378
Forensic Medicine
null
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single
Which of the following is the most common presenting symptom of non-cirrhotic portal hypertension ?
null
3
Chronic liver failure
Ascites
Upper gastrointestinal bleeding
Encephalopathy
Medicine
null
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single
Least common cause of ambiguous genitalia in female genotype:
Ans. C. Fetal steroid sulphatase deficiencyRef: Sperojf, 9th/ed, pll9ExplanationPlacental sulfatase deficiency# There is an X-linked metabolic disease characterized by a placental sulfatase deficiency in the syncytiotrophoblast, and postnatally, ichthyosis, occurring in about 1 in 2000-3000 newborn males.# Patients with the placental sulphatase disorder are unable to hydrolyze DHAS or 16a-hydroxy- DHAS, and, therefore, the placenta cannot form normal amounts of estrogen.# A deficiency in placental sulphatase is usually discovered when patients go beyond term and are found to have extremely low estriol levels and no evidence of fetal distress.# All newborn children, with a few exceptions, have been male.# The steroid sulfatase X-linked recessive ichthyosis locus (the steroid sulphatase gene) has been mapped to the distal short arm portion of the X chromosome.# Family history of scaling in males (as well as repeated postdate pregnancies) should prompt a consideration for prenatal diagnosis.WT1 gene# The VVT2 gene is named after the Wilms' tumor nephroblastoma because it is one of the genes on chromosome 11 deleted in patients with this tumor. Mutant mice lacking WT2 fail to develop kidneys and gonads.# WT1 mutations, however, could not be detected in 25 patients with a congenital absence of the uterus and vagina, indicating that WT1 may be necessary for normal renal and gonadal development, but not for early Mullerian duct development.
3
21 hydroxylase deficiency
11 hydroxylase deficiency
Fetal steroid sulphatase deficiency
WT1 gene
Gynaecology & Obstetrics
Sex Intersexuality
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single
Most common malignancy found in Marjolins ulcer is -
Ans. is 'b' i.e., SCC o Malignancy arising in burn scar is k-'a Marjolin s ulcer. It is most commonly squamous cell ca, although basal cell carcinoma may also be seen.
2
BCC
SCC
Malignant fibrous histiocytoma
Malignant melanoma
Surgery
Miscellaneous (Neoplasia)
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single
Babloo a 10-year-old boy presents with # of the humerus. X-ray reveals a lytic lesion at the upper end. Likely condition is
Here, two options are there which are included in the differential diagnosis of the lytic lesion in the proximal humerus, i.e., unicameral bone cyst and aneurysmal bone cyst. We cannot differentiate between two on the basis of information provided in the question. However, the best option here is a unicameral bone cyst because : - A pathological fracture is more common in the unicameral bone cyst. In unicameral bone, cyst patient is asymptomatic and presents only after the occurrence of pathological fracture. Most common site of unicameral bone cyst is proximal humerus. A unicameral bone cyst is more common in a male child. So in this question, the best answer is a unicameral bone cyst. However, the exactly similar presentation may occur in aneurysmal bone cyst also.
1
Unicameral bone cyst
Osteosarcoma
Osteoclastoma
Aneurysmal bone cyst
Orthopaedics
null
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single
Most common type cancer gallbladder in a patient with gallstones
The most common cancer in a patient with gallstones is adenocarcinoma(90%).Occasionally squamous cell carcinoma,adenosquamous or carcinoid tumour can occur. Reference: SRB&;s manual of surgery,5th edition, page no.659
1
Adenocarcinoma
squamous carcinoma
Adenosquamous carcinoma
Liposarcoma
Surgery
G.I.T
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multi
All are tocolytics except
Misoprostol is indicated in cervical ripening prior to Labour whereas tocolytics inhibit uterine contractions and keep the uterus quiescent. Reference: Textbook of Obstetrics : Sheila Balakrishnan pg. 573,196
4
Ritodrine
Salbutamol
Isoxsuprine
Misoprostol
Gynaecology & Obstetrics
Abnormal labor
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multi
In body pethysmography, a person is asked to expire against a closed glottis. What will be the change in the pressure in the lung and the box
null
3
Increase in both
Decrease n both
Increase in lung decrease in box
Decrease in lung increase in box
Physiology
null
478f8784-73dd-4f46-9337-f0f35cde5ef6
multi
Frey's Syndrome is due to injury of which of the following nerve branch
* Auriculo temporal nerve is the Post ganglionic parasympathetic nerve which on injury during parotidectomy, results in Gustatory sweating syndrome known as Frey's syndrome after 2-3 months. * Auriculotemporal nerve is the branch of Mandibular division of Trigeminal Nerve( 5th Cranial Nerve) Ref:- Surgery Sixer 3rd Edition; Pg num:- 191
2
Facial Nerve
Trigeminal nerve
Glossopharyngeal nerve
Vagus nerve
Surgery
Head and neck
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single
Treatment of choice for carcinoma of lip of lessthan 1 cm is -
null
3
Radiation
Chemotherapy
Excision
Radiation and Chemotherapy
Surgery
null
54fec56d-c7a7-44a1-babe-2da9f8cd84fd
single
Which of the following is not a teiary amine
Refer kDT 7/e p 108,113 The structure of teiary and quaternary amine is depicted in the picture As seen in the diagram, quaternary amine are ionized and thus water soluble. These drugs are not able to cross the blood brain barrier Atropine hyoscine and physostigmine are teiary amines (and thus lipid soluble) and can cross blood brain barrier whereas glycopyrrolate is quaternary amine and cannot cross the blood brain barrier
3
Atropine
Hyoscine
Glycopyrolate
Physostigmine
Pharmacology
Autonomic nervous system
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single
Onset of LH surge precedes ovulation by:
LH surge 36 hrs (24- 36 hrs) before ovulation. LH peak 12 hrs before ovulation.
3
12 hours
24 hours
36 hours
48 hours
Gynaecology & Obstetrics
Normal Menstruation, Abnormal Menstruation, Menopausal Physiology and forsight of conception
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single
Rave drug is ?
Rave drugs are ectasy (MDMA), gamma-hydroxybutyrate and rohypnol.
4
Cannabis
Cocaine
Heroin
Ecstasy
Forensic Medicine
null
54bdae92-1c11-40a3-a4d0-b8881d3ad372
single
Which of the following is present in Paneth cells?
Paneth cells, located in the basal poion of the intestinal crypts below the stem cells, are exocrine cells with large, eosinophilic secretory granules in their apical cytoplasm. The granules contain the bactericidal enzyme lysozyme, an arginine-rich protein, and zinc. Paneth cell granules undergo exocytosis to release lysozyme, phospholipase A2, and hydrophobic peptides called defensins, all of which bind and breakdown membranes of microorganisms and bacterial walls. Paneth cells have an impoant role in innate immunity and in regulating the microenvironment of the intestinal crypts. Ref: Mescher A.L. (2010). Chapter 15. Digestive Tract. In A.L. Mescher (Ed), Junqueira's Basic Histology: Text & Atlas, 12e.
1
Zinc
Copper
Molybdenum
Selenium
Pathology
null
67f82c76-9223-4a75-b1ea-7daccca87f5c
single
The following features are hallmarks of postprimary pulmonary tuberculosis except-
Tuberculosis is classified as one of the granulomatous inflammatory diseases. Macrophages, T lymphocytes, B lymphocytes, and fibroblasts aggregate to form granulomas, with lymphocytes surrounding the infected macrophages. When other macrophages attack the infected macrophage, they fuse together to form a giant multinucleated cell in the alveolar lumen. The granuloma may prevent dissemination of the mycobacteria and provide a local environment for interaction of cells of the immune system.However, more recent evidence suggests that the bacteria use the granulomas to avoid destruction by the host's immune system. Macrophages and dendritic cells in the granulomas are unable to present antigen to lymphocytes; thus the immune response is suppressed. Bacteria inside the granuloma can become dormant, resulting in latent infection. Another feature of the granulomas is the development of abnormal cell death (necrosis) in the center of tubercles. To the naked eye, this has the texture of soft, white cheese and is termed caseous necrosis. TB bacteria gain entry to the blood stream from an area of damaged tissue, they can spread throughout the body and set up many foci of infection, all appearing as tiny, white tubercles in the tissuesThis severe form of TB disease, most common in young children and those with HIV, is called miliary tuberculosis.People with this disseminated TB have a high fatality rate even with treatment (about 30%). In many people, the infection waxes and wanes. Tissue destruction and necrosis are often balanced by healing and fibrosis.Affected tissue is replaced by scarring and cavities filled with caseous necrotic material. During active disease, some of these cavities are joined to the air passages (bronchi) and this material can be coughed up. It contains living bacteria, and thus can spread the infection. Treatment with appropriate antibiotics kills bacteria and allows healing to take place. Upon cure, affected areas are eventually replaced by scar tissue Ref Harrison20th edition pg 1079
2
It results from endogenous reactivation of latent infection
The disease is usually localized to the anterior segment of the upper lobe
If cavity formation occurs, satellite lesions result from the discharge of liquefied contents into the airways
Up to one-third of untreated patients die due to severe pulmonary TB within a few weeks or months after onset
Medicine
Infection
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multi
Greatest portion of teeth is formed by:
null
2
Enamel
Dentin
Pulp
Cementum
Dental
null
194db215-38f0-4aa7-8759-e3fcd51be4df
single
The virus causing which of the following disease produces both intranuclear and intracytoplasmic inclusion bodies ?
Cytopathic effect consist of multinucleate syncytium formation with numerous acidophilic nuclear and cytoplasmic inclusions REF:ANANTHANARYANAN TEXTBOOK OF MICROBIOLOGY 9EDITION PGNO.512
4
Chickenpox
Rabies
Small pox
Measles
Microbiology
Virology
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multi
Nucleotides serve all of the following roles, EXCEPT:
Nucleotide Nucleic acids are polynucleotides CAMP and cGMP are cyclic nucleotides involved in signaling pathways. ATP is the cellular currency of energy Membrane is made up of phospholipids and cholesterol and not nucleotides.
4
Monomeric units of nucleic acids
Mediators in cellular signalling
Source of energy
Structural component of membrane
Biochemistry
Nucleotides
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multi
Which is not a branch of cavernous pa of internal carotid aery?
Internal carotid aery is a terminal branch of common carotid aery. It first runs through the neck (cervical pa), then passes through the petrous bone(petrous pa), then courses through the sinuses(cavernous sinuses)and lastly lies in relation to the brain(cerebral pa). AREA OF DISTRIBUTION Cervical pa of the aery does not give any branch. Petrous pa gives branches for the middle ear. Cavernous pa supplies hypophysis cerebrospinal.The cerebral pa gives ophthalmic aery for orbit,anterior cerebral,middle cerebral,anterior choroidal and posterior communicating for the brain. Ref BDC volume 3,Sixth edition pg 312
4
Cavernous branch
Inferior hypophyseal
Meningeal aery
Ophthalmic aery
Anatomy
Head and neck
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single
Stain for fat, all except:
Ans. is 'd' i.e., Congo redo Congo red is not used in lipid staining. It is used in the staining of amyloid protein.Staining for lipidsExamplesStain usedNon nolar linidsUnconjugatedlipidsFatty acidsOil red O, Sudanblack, Sudan III & IVFilipinSchultzCalcium lipaseCholesterolCholesteryl estersMono, di and Tri-glyceridesEstersPolar lipidsPhospholipids Glycerol basesPhosphatidylcholinePhosphatidvlserinePhosphatidylethanol amineSphingomyelinsCerebrosidesSulfatidesGangliosidesNile blue sulfateNile blue sulfatePlasmal reactionFerric hematoxylinPASAcetone/Toluidine buePASSphingosine-baseGlycolipids
4
Oil red O
Sudan black
Sudan III
Congo red
Pathology
Histo Pathology
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multi
MC site of injury to the ureter during a hysterectomy is: March 2004
Ans. C i.e. Site of crossing by the uterine aery
3
At the pelvic brim
In the ovarian fossa
Site of crossing by the uterine aery
As it enters the bladder
Gynaecology & Obstetrics
null
afee4256-35a4-4ca1-97a1-328095e8fafd
single
Keratomalacia is associated with:
A i.e. Measles Measles and diarrhoea can cause vit A deficiency and thus lead to keratomalacia Q
1
Measles
Mumps
Rubella
All
Ophthalmology
null
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multi
Butterfly rash is associated with: September 2006, September 2012
Ans. B: SLE Cutaneous LE may be pa of an uncommon disease called systemic lupus erythematosus (SLE). Only a few people with cutaneous LE also have SLE. The most common presentation is with a malar eruption or 'butterfly rash' (red patches across the cheeks). Other skin changes in SLE are photosensitivity (a rash on all sun exposed skin), mouth ulcers, uicaria (hives) and diffuse hair thinning. Rarely, it may cause blisters (bullous LE). SLE may also affect joints, kidneys, lungs, hea, liver, brain, blood vessels (vasculitis) and blood cells. It may be accompanied by antiphospholipid syndrome.
2
DLE
SLE
Rheumatoid ahritis
Reiter's syndrome
Skin
null
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single
A 14 year old girl on exposure to cold has pallor of extremities followed by pain and cyanosis. In later stages of life she is most prone to develop:
Answer is B i.e. (Scleroderma): Pallor of extremities, followed by pain and cyanosis suggests a diagnosis of Reynaud's Phenomenon. Reynaud's phenomenon as the presenting manifestation is most strongly associated with scleroderma or systemic sclerosis. Reynaud's Phenomenon and Scleroderma Reynaud's phenomenon (RP) is the clinical syndrome of episodic color change of the digits in response to cold and in some patients, emotional stress. The typical sequence is pallor (aerial constriction) followed by cyanosis (vasospasm and desaturation) of hemoglobin. Reynaud's Phenomenon is may be associated with a variety of connective tissue disorders including SLE, Rheumatoid ahritis, scleroderma and dermatomyositis (all options provided in question), however its association with scleroderma is exceptionally strong. Secondary causes of Raynaud Phenomenon: Rheumatologic Hematologic disorders Systemic sclerosis (scleroderma) Cryoglobulinemia Systemic lupus erythematosus Paraproteinemia Rheumatoid ahritis Polycythemia Sjogren syndrome Cold agglutinins Dermatomyositis Polymyositis Vasculitis Mechanical Endocrine disorders Vibration injury Hypothyroidism Frostbite Carcinoid syndrome Thoracic outlet syndrome Pheochromocytoma Vascular embolus or occlusion Vasospasm Drugs Migraine headaches Sympathomimetics drugs (decongestants, diet pills) Serotonin agonists (sumatriptan) Chemotherapeutic agents (bleomycin, cisplatin, carboplatin, vinvlastine) Ergotamine tarate Caffeine Nicotine
2
SLE
Scleroderma
Rheumatoid Ahritis
Dermatomyositis
Medicine
null
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multi
Infected gangrene of skin and subcutaneous tissues is ?
Answer- B. Wet gangreneWet gangene When overlying skin of dry gangrenous tissue is devitalized, bacterial infection is superimposed.More commonly due to venous occlusion then aerial occlusion.
2
Dry gangrene
Wet gangrene
Erysipelas
None of the above
Pathology
null
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multi
A 6-year-old girl complains of otalgia, fever, and irritability. Physical examination reveals a stiff, bulging, red tympanic membrane. Previous history of ear infections is denied. Clinical response to amoxicillin is maximized on which of the following durations?
Prospective nonrandomized evaluations of treatment duration of acute otitis media reveal no difference in outcome if given over 5-day, 7-day, or 10-day duration. However, 10-day treatment is indicated for children with history of acute otitis media within the preceding month.
2
1 day
5 days
7 days
10 days
Surgery
Miscellaneous
6c2bcf77-b767-488a-b3ba-5489cd889915
single
Which of the following fluoroquinolone has broadest spectrum activity against bacteria ?
Ans. is'c'i.e., TrovafloxacinFouh generation quinolones/fluoroquinolones have broadest spectrum.These are trovafloxacin, fleroxacin, gemifloxacin, prulifloxacin, sitafloxacin and clinafloxacin.
3
Ciprofloxacin
Norfloxacin
Trovafloxacin
Nalidixic acid
Pharmacology
null
16e3368e-eed2-4b5e-9340-19c1f918c73c
single
A 28 years old female at term presents with gush of fluid and regular contractions. Prenatal investigations reveals Rh negative, antibody negative, husband- Rh positive homozygous. After 10 hours her labor progresses and delivered 3600g baby via normal vaginal delivery. Placenta did not separate spontaneously and manual removal was done. The next step of investigation is
Answer: c) Direct Coomb's testRh NEGATIVE PREGNANCYINVESTIGATION OF Rh NEGATIVE MOTHERSI-Husband's blood grouping & Rh typing.II-Obstetric History: If the woman is primi, it is unlikely for the baby to be affectedIII-Antibody detection: In all cases of Rh negativity, albumin antibody is detected by indirect Coomb's test at 12th week to detect unbound antibodies in maternal serum.If the test is found negative, it is to be repeated at 28th and 36th week in primi & at monthly intervals from 24th week onwards in multi.If the test is found positive:Genotype of the husband should be determined If he is found to be homozygous, the fetus is likely to be affected & in heterozygous, the fetus may be affected in 50% cases.Quantitative estimation of the albumin antibody at weekly intervals. A titre of 1:16 or antibody level >10 lU/ml is critical.Fetal Rh status & blood grouping is done by amniocentesis.Amniocentesis is done & bilirubin in the amniotic fluid is estimated by spectrophotometer at 250-700nm wave length.In presence of bilirubin, there is a "deviation bulge" at 450nm wave length.This deviation is plotted in a Liley's chart.ANTI-D ADMINISTRATIONCalculation of the dose: Approximate volume of fetal blood entering into the maternal circulation is estimated by Kleihauer-Betke test/ rosette. (Calculating the RBC's under 50 low power fields).80 fetal RBCs correspond to 4 ml of fetal bloodDosage: 10mg for every 1 ml of fetal whole bloodTime of administration & Dosage:It should be given when the baby born is Rh positive and the direct Coombs test is negative.Should be given preferably within 72 hours or earlier following delivery or abortion.First trimester- abortion, ectopic pregnancy, chorion villous biopsy: 50 mg l.m.Beyond twelve weeks & Following delivery: 300mg l.m.In case of Rh iso immunization:Cord should be kept long (2-4cms) to enable exchange transfusion if requiredCord blood sample should be taken from the placental end for:ABO and Rh groupingDirect Coomb's testMeasurement of serum bilirubinHemoglobin estimationBlood smear for presence of immature RBC's.
3
RhoGAM
Indirect Coomb's test
Direct Coomb's test
Detection of fetal cells in maternal circulation
Gynaecology & Obstetrics
Miscellaneous (Gynae)
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multi
RPGN(rapidly progressive glomerulonephritis) caused by-
Granulomatosis With Polyangiitis Previously called Wegener granulomatosis, granulomatosis with polyangiitis (GPA) is a necrotizing vasculitis characterized by a triad of the following: * Necrotizing granulomas of the upper-respiratory tract (ear, nose, sinuses, throat) or the lower-respiratory-tract (lung) or both * Necrotizing or granulomatous vasculitis affecting small- to medium-sized vessels (e.g., capillaries, venules, aerioles, and aeries), most prominently the lungs and upper airways but other sites as well * Focal necrotizing, often crescentic, glomerulonephritis Ref: ROBBINS BASIC PATHOLOGY 10th ed Pg no: 388
2
FSGS
Wegener's granulomatosis
Good pasteur's syndrome
PAN
Pathology
Urinary tract
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single
True about nutritional rickets -a) Craniotabesb) Multiple #c) Widening of wristd) ↓ Phosphate in serume) Growth retardation
Craniotabes, widening of wrist and growth retardation occur in rickets. Serum phosphate is low.
1
acde
bde
abcd
abde
Orthopaedics
null
5c89a7cb-941c-49a8-83c4-869d439990b9
multi
Vitamin K dependent clotting factors include all EXCEPT
VITAMIN K DEPENDENT CLOTTING FACTORS ARE: Factor II (Prothrombin) Factor VII (Proconvertin/Stable factor) Factor IX (Christmas factor/ Antihemophilic Factor B) Factor X (Stuart Prower factor) Protein C Protein S NOTE' Clotting factors inhibited by Antithrombin III are: Factor IX, X, XI & XII
2
Factor VII
Factor VIII
Prothrombin
Facor IX
Physiology
null
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multi
All are true about nitrous oxide except ?
Ans. is 'd' i.e., Good muscle relaxant Nitrous oxide N,O It is also called laughing gas. It has good analgesic but poor muscle relaxant activity. Second gas effect and diffusion hypoxia occur with N20 only. N20 is the only anaesthetic repoed to produce hematologic toxicity and neurotoxicity with long term administration. Both toxicities are the result of the interaction of N20 with vit B12.
4
Laughing gas
Causes megaloblastic anemia
Causes diffusion hypoxia
Good muscle relaxant
Pharmacology
null
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multi
A young adult shows non-fluctuant, tender and red swellingin the marginal gingival lesion. This is most likely:
null
3
Periodontal abscess
Periapical abscess
Gingival abscess
Periapical sinus
Dental
null
eedbe06d-a860-4076-9c48-784698083220
single
Right eye superotemporal quadrantopia, left eye centrocaecal scotoma with headache. Site of lesion is:
Ans. (a) Left optic nerve + chiasmaRef: Kanski 7/e, p. 826-827This type of field defect is seen in meningiomas where the lesion is at the junction of optic nerve and the chiasma. This is called "junctional scotoma of Traquair". (VFD No. 3-Text)
1
Left optic nerve + chiasma
Left optic tract + chiasma
Right optic nerve + chiasma
Right optic tract + chiasma
Ophthalmology
Neuro-Ophthalmology
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Viroids are ?
Genome much smaller than those of known virus. Agent is a protien free low molecular wt RNA REF:ANANTHANARYANAN TEXT BOOK OF MICROBIOLOGY 9EDITION PDNO.442
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ssRNA
DNA from matric proteins
Naked pathogenic human viruses
Fragments of viruses
Microbiology
Virology
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Treatment for fibrous dysplasia in a young 25 yrs old patient involving maxilla is best treated by
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Enbloc resection
Cosmetic contouring
Maxillary resection
Radiation therapy
Surgery
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Anticholinesterases are effective against all, except :
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Cobra bite.
Postoperative ileus.
Carbamate poisoning.
Belladona poisoning.
Pharmacology
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A 25 years female was found in the room with 100% burns on her body. The tongue was protruding out; the body was in pugilistic attitude with heat ruptures, peeling of skin, and heat haematoma and heat fractures of the skull. Carboxyhemoglobin was 25% and soot particles were present in the trachea. Which of the combinations of two findings will establish that the burns were antemortem in nature-
Presence of carbon particles (soot) in respiratory passages and elevated level of carboxy-hemoglobin confirms that victim was alive when the burn occurred. i.e. Ante-mortem burn.
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Heat haematoma & heat ruptures
Heat fracture of skull and peeling of skin
Heat haematoma and pugilistic attitude
Carboxy hemoglobin (25%) and soot particles in trachea
Forensic Medicine
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Altered perception of real objects is
Illusion: A misinterpretation of stimuli arising from an external object(s). Hallucination: A perception that occurs in the absence of a stimulus. Delusion: A false, unshakable belief which is not amenable to reasoning, and is not in keeping with the patient's socio-cultural and educational background. Delirium: it is the commonest organic mental disorder seen in clinical practice. Delirium is characterised by the following features: 1. A relatively acute onset, 2. Clouding of consciousness, characterised by a decreased awareness of surroundings and a decreased ability to respond to environmental stimuli, and 3. Disorientation (most commonly in time, then in place and usually later in person), associated with a decreased attention span and distractibility. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 247, 246, 19
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Illusion
Delusion
Hallucination
Delirium
Psychiatry
Symptoms and signs in psychiatry and classification
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Q. Initial Antihypeensive agent of choice in a patient with stable ischemic hea disease is
Answer is A (Beta-Blockers) Beta Blockers are recommended as First Line Agents of choice for treatment of hypeension in hypeensive patients with Stable Ischemic Hea Disease.
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Beta-Blockers
Alpha-Blockers
Calcium Channel Blockers
Ace Inhibitors
Medicine
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A 20-year-old man fell from the parallel bar during the Olympic trial. A neurologic examination reveals that he has a lesion of the lateral cord of the brachial plexus. Which of the following muscles is most likely weakened by this injury?,
The pectoralis major is innervated by the lateral and medial pectoral nerves originating from the lateral and medial cords of the brachial plexus, respectively. The subscapularis, teres major, latissimus dorsi, and teres minor muscles are innervated by nerves originating from the posterior cord of the brachial plexus.
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Subscapularis
Teres major
Latissimus dorsi
Pectoralis major
Anatomy
Nerve supply, Nerve Lesions
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False about ropivacaine
Ropivacaine contains only S enantiomer so cardiotoxicity is less than bupivacaine (but still higher than lignocaine). Anaesthetic propeies (onset, intensity; duration of I action) of ropivacaine are almost similar to bupivacaine.
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Less cardiotoxic than bupivacaine
More cardiotoxic than lignocaine
Contains only R enantiomer
Onset of action is faster than bupivacaine
Anaesthesia
All India exam
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After which of the following gestational age is a dead baby said to be a still born ?
The term stillborn refers to the death of a fetus after 28 weeks of gestation or death of a fetus weighing 1000gms.
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20 days
28 days
20 weeks
28 weeks
Gynaecology & Obstetrics
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Normal daily faecal fat excretion:
Fats excretion less than 7 gm per day in feces is considered normal. More than this amount in feces indicates malabsorption; more than 8 gm/day in feces is called steatorrhea
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0-5 gm
5-10 gm
10-15gm
15-20gm
Physiology
Gastrointestinal System
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Forceps are preferred over vacuum for the delivery because of the following, reasons except?
Ans. a. Vacuum requires more clinical skills than forceps (Ref: Dutta 7/e p579, 581)Forceps requires more clinical skills than forceps vacuum.Advantages of Ventouse:It is comfortable and has lower rates of maternal trauma and genital tract lacerationsReduced maternal pelvic floor injuries and is advocated as the instrument of the first choicePerineal injuries (3rd and 4th degree tears) are lessDue to above mentioned reasons, Vacuum is preferred more than forceps in HIV patient to decrease the transmission. Comparison of Forceps Vs VentouseAdvantages of VentouseAdvantages of Forceps* It can be used in the unrotated or malrotated head (OP, OT position), it helps in auto rotation* It is not a space-occupying device* Traction force is less (10 kg)Q* It is comfortable and has lower rates of maternal trauma and genital tract lacerations* Analgesia need is less* Reduced maternal pelvic floor injuries and is advocated as the instrument of the first choice* Perineal injuries (3rd and 4th degree tears) are less* Post-partum maternal discomfort (pain) is less* Easier to learn* The simplicity of use in delivery makes it convenient to the operator (suitable for trained midwives)* In case, where moderate traction is required, forceps will be more effective* Forceps operation can quickly expedite the delivery in case of fetal distress* Safer in premature babies* Can be employed in the anterior face or after coming head of the breech presentation* Lesser neonatal scalp trauma, retinal hemorrhage, jaundice or cephalhematoma* The higher rate of successful vaginal delivery* Cup detachment (pop-off) occurs when the vacuum is not maintained in ventouse* No. of types of forceps are available for an outlet, mid-cavity or rotational delivery Complications of Forceps OperationMaternal-Fetal* Injury: vaginal laceration, sulcus tear, cervical tear, complete perineal tear* Nerve injury: Femoral (L2, 3, 4), lumbosacral trunk with mid-forceps delivery* Post-partum hemorrhage* Anesthetic complications* Puerperal sepsis and maternal morbidity* Remote:* Painful perineal scars, dyspareunia, low back ache, genital prolapse, stress urinary incontinence, and anal sphincter dysfunctionImmediate:* Asphyxia, facial bruising, intracranial hemorrhage, facial palsy, skull fractures, cervical spine injury (rotational forceps)Remote:* Cerebral or spastic palsy Complications of Ventouse OperationMaternalFetal* Injuries are uncommon* Soft tissue such as cervix or vaginal wall may be injured* Superficial scalp abrasion* Sloughing of the scalp* CephalhematomaQ* Subgaleal hemorrhage* Intracranial hemorrhage (rare)* Retinal hemorrhage* Jaundice
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Vacuum requires more clinical skills than forceps
Vacuum is preferred more than forceps in HIV patient
Forceps are more commonly associated with fetal facial injury
Vacuum has more chance of formation of cephalhematoma
Unknown
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Normal pressure in superficial venous system of leg while walking is
Pressure in superficial venous system decreases to 30 mmHg while walking as blood flows from superficial to deep veins.
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80 mmHg
60 mmHg
50 mmHg
30 mmHg
Surgery
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Warfarin therapy is prolonged by all except:
Barbiturates (but not benzodiazepines), carbamazepine, rifampicin and griseofulvin induce the metabolism of warfarin.The dose of anticoagulant determined during therapy with these drugs would be higher: if the same is continued after withdrawing the inducer- marked hypoprothrombinemia can occur causing fatal bleeding. Reference: Essentials of Medical Pharmacology Eighth Edition KD TRIPATHI page no 670
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Rifampicin
Amoxicillin
Erythromycin
Tetracycline
Pharmacology
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Commando operation describes
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Maxillectomy, Neck Dissection, Omohyoid muscle removal
Mandibulectomy, Neck Dissection, Omohyoid muscle removal
Mandibulectomy, Neck dissection, Oropharyngeal resection
Ombined maxillectomy and mandibulectomy
ENT
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Gamma efferent system is involved in
(D) All of the above # Motor neurons of y efferent system are regulated to a large degree by descending tracts from a number of areas in the brain.> Golgi tendon organs, are stimulated by both passive stretch and active contraction of the muscle.> The muscles are generally hypotonic when the rate of y efferent discharge is low and hypertonic when it is high.> Increased y efferent discharge is present is inclonus> Ankle clonus is atypical example.
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Tendon reflex
Clonus
Muscle tone
All of the above
Physiology
Nervous System
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In takayasu aeritis there is
Takayasu aeritis affects the aoa, its major branches and occasionally the pulmonary aeries. The typical age at onset is 25-30 years, with an 8 : 1 female-to-male ratio. It has a worldwide distribution but is most common in Asia. Takayasu aeritis is characterised by granulomatous inflammation of the vessel wall, leading to occlusion or weakening of the vessel wall. It presents with claudication, fever, ahralgia and weight loss. Clinical examination may reveal loss of pulses, bruits, hypeension and aoic incompetence. Investigation will identify an acute phase response and normocytic, normochromic anaemia but the diagnosis is based on angiography, which reveals coarctation, occlusion and aneurysmal dilatation. Treatment is with high-dose glucocoicoids and immunosuppressants, as described for ANCA-associated vasculitis. With successful treatment, the 5-year survival is 83%. Ref - Davidsons 23e p 1041
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Loss of pulses
Renal hypeension
Coronary aneurysm or its dilation
All of the above
Medicine
Immune system
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