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e9ad821a-c438-4965-9f77-760819dfa155

Chronic urethral obstruction due to benign prismatic hyperplasia can lead to the following change in kidney parenchyma

Hyperplasia

Hyperophy

Atrophy

Dyplasia

single

Chronic urethral obstruction because of urinary calculi, prostatic hyperophy, tumors, normal pregnancy, tumors, uterine prolapse or functional disorders cause hydronephrosis which by definition is used to describe dilatation of renal pelvis and calculus associated with progressive atrophy of the kidney due to obstruction to the outflow of urine Refer Robbins 7yh/9,1012,9/e. P950

Anatomy

Urinary tract

e3d3c4e1-4fb2-45e7-9f88-247cc8f373b3

Which vitamin is supplied from only animal source:

Vitamin C

Vitamin B7

Vitamin B12

Vitamin D

single

Ans. (c) Vitamin B12 Ref: Harrison's 19th ed. P 640* Vitamin B12 (Cobalamin) is synthesized solely by microorganisms.* In humans, the only source for humans is food of animal origin, e.g., meat, fish, and dairy products.* Vegetables, fruits, and other foods of nonanimal origin doesn't contain Vitamin B12 .* Daily requirements of vitamin Bp is about 1-3 pg. Body stores are of the order of 2-3 mg, sufficient for 3-4 years if supplies are completely cut off.

Biochemistry

Vitamins and Minerals

5c38bea6-787a-44a9-b2df-88f4218ab914

All of the following are surgical options for morbid obesity except -

Adjustable gastric banding

Biliopancreatic diversion

Duodenal Switch

Roux en Y Duodenal By pass

multi

Ans. is 'd' i.e., Roux en Y Duodenal Bypass Bariatric surgical procedures include:a. Vertical banded gastroplastyb. Adjustable gastric bandingc. Roux-en Y gastric bypass (Not - Roux-en Y Duodenal Bypass)d. Biliopancreatic diversione. Duodenal switcho The surgical treatment of morbid obesity is known as bariatric surgery.o Morbid obesity is defined as body mass index of 35 kg/m2 or more with obesity related comorbidity, or BMI of 40 kg/m2 or greater without comorbidity.o Bariatric operations produce weight loss as a result of 2 factors. One is restriction of oralintake. The other is malabsorbtion of ingested food.o Gastric restrictive procedures include Vertical banded gastroplasty & Adjustable gastric bandingo Malabsorbtive procedures include Biliopancreatic diversion, and Duodenal switcho Roux-en Y gastric bypass has features of both restriction and malabsorptionBariatric Operations: Mechanism of ActionRestrictiveVertical banded gastroplastyLaparoscopic adjustable gastric bandingLargely Restrictive/Mildly MalabsorptiveRoux-en-Y gastric bypassLargely Malabsorptive/Mildly RestrictiveBiliopancreatic diversionDuodenal switch

Surgery

Surgical Treatment Obesity

cdeedb04-fbe9-432c-937c-d53ac24475de

Following endaerectomy on the right common carotid, a patient is found to be blind in the right eye. It is appears that a small thrombus embolized during surgery and lodged in the aery supplying the optic nerve. Which aery would be blocked?

Central aery of the retina

Infraorbital aery

Lacrimal aery

Nasociliary aretry

multi

The central aery of the retina is a branch of the ophthalmic aery. It is the sole blood supply to the retina; it has no significant collateral circulation and blockage of this vessel leads to blindness. The branches of this aery are what you view during a fundoscopic exam. Note: The infraorbital aery is a branch of the maxillary aery. It comes through the infraorbital foramen, inferior to the eye. It supplies the maxillary sinus, the maxillary incisors, canine and premolar teeth, and the skin of the cheek below the orbit. The supraorbital aery is another branch of the maxillary aery. It comes through the supraorbital foramen and supplies blood to the muscles, skin and fascia of the forehead. The lacrimal aery is a branch of the ophthalmic aery that supplies the lacrimal gland. The nasociliary aery doesn't exist, but there is a nasociliary nerve that travels with the ophthalmic aery. Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 18. Orbit. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy.

Ophthalmology

dc6794a3-b108-47c5-8b1b-3b4931577249

Growth hormone has its effect on growth through?

Directly

IG1-1

Thyroxine

Intranuclear receptors

single

Ans. is 'b' i.e., IGI-1GH has two major functions :-i) Growth of skeletal system :- The growth is mediated by somatomedins (IGF). Increased deposition of cailage (including chondroitin sulfate) and bone with increased proliferation of chondrocytes and osteocytes.ii) Metabolic effects :- Most of the metabolic effects are due to direct action of GH. These include gluconeogenesis, decreased peripheral utilization of glucose (decreased uptake), lipolysis and anabolic effect on proteins.

Physiology

5ab84ea8-12d1-47d4-ab22-668ebf01e64c

Scrub typhus is transmitted by: September 2004

Louse

Tick

Mite

Milk

single

Ans. C i.e. Mite

Social & Preventive Medicine

a83de6e4-9427-4480-b404-d96621ebb640

Abnormal vascular patterns seen with colposcopy in case of cervical intraepithelial neoplasia are all except

Punctation

Mosaicism

Satellite lesions

Atypical vessels

multi

Abnormal vascular pattern include punctation, mosaicism and atypical vessels.

Gynaecology & Obstetrics

f3bf8583-231b-4b7a-828c-179b0f9ccdd9

Per rectum examination is not a useful test for diagnosis of

Anal fissure

Hemorrhoid

Pilonidal sinus

Rectal ulcer

single

PILONIDAL SINUS/DISEASE (Jeep Bottom; Driver's Bottom) Pilus--hair; Nidus--nest It is epithelium lined tract, situated sho distance behind the anus, containing hairs and unhealthy diseased granula- tion tissue. It is due to penetration of hairs through the skin into subcutaneous tissue. It forms granuloma/unhealthy granulation tissue in the deeper plane. It is of infective origin and occurs in sacral region between the buttocks, umbilicus, axilla. Other indications of per rectal examination are:Carcinoma rectum, Stricture rectum, Polyps, BPH and carcinoma prostate, Secondaries in the rectovesical pouch (Blumer shelf), Sphincter tone, Pelvic abscess (is felt as boggy swelling), to feel the internal opening of anal fistulas, in bimanual palpation of the bladder or pelvic tumours, in acute abdominal conditions--it reveals dilated empty rectum with tenderness.Reference : page 967 and 952 SRB's manual of surgery 5th edition

Surgery

Urology

73515f05-e947-4801-8077-3abdeca95c84

Characteristics of Remifentanyl – a) Metabolised by plasma esteraseb) Short half lifec) More potent than Alfentanyld) Dose reduced in hepatic and renal diseasee) Duration of action more than Alfentanyl

ab

bc

abc

bcd

single

Remifentanil is the shortest acting opioid due to its metabolism by plasma esterase → dose adjustment is not needed in liver or kidney disease. It is more potent than alfentanil : Order of potency is Sufentanil > Fentanyl = Remifentanil > Alfentanil.

Anaesthesia

53f79833-21b0-4336-8ef4-404c687ec807

Hypomimia is ?

Decreased ability to copy

Decreased execution

Deficit of expression by gesture

Deficit of fluent speech

single

Ans. C. Deficit of expression by gestureHypomimiaHypomimia or amimia is a deficit or absence of expression by gesture or mimicry.This is usually most obvious as a lack of facial expressive mobility (mask - like facies).This is a feature of frontal subcoical disease.

Psychiatry

b3d1eb6c-3909-4011-ad10-d55538b81456

Naglers reaction is shown by

Clostridium tetani

Clostridium botulinum

Clostridium perfringens

Clostridium septicum

single

Nagler's reaction - when Clostridium perfringens is grown in media containing 6 % agar, 5% Fildes peptic digest of sheep blood and 20% human serum, with antitoxin spread on one half of plate, colonies in the other half without antitoxin will be surrounded by a zone of opacity. No opacity around the colonies on the half of plate with antitoxin, this is due to the specific neutralization of the alpha-toxin. This specific lecithinase effect, known as the Nagler's reaction. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 263

Microbiology

Bacteriology

e529be7c-f360-4dba-b313-7f3fc240697a

Which of the following statements are True/False? 1. Hirsutism, which is defined as androgen-dependent excessive male pattern hair growth, affects approximately 25% of women. 2. Virilization refers to a condition in which androgen levels are sufficiently high to cause additional signs and symptoms. 3. Frequently, patients with growth hormone excess (i.e., acromegaly) present with hirsutism. 4. A simple and commonly used method to grade hair growth is the modified scale of Ferriman and Gallwey. 5. Scores above 8 suggest excess androgen-mediated hair growth.

1, 2, 3 True & 4, 5 false

1, 3, 5 True & 2, 4 false

2, 4, 5 True & 1, 3 false

1, 2, 3, 4 True & 5 false

multi

Here statement 1 & 3 are wrong. It is actually a direct pick from harrison, an impoant topic for entrance examinations hirsutism is seen in 10% of woman. Acromegaly rarely causes hirsutism. Ref: Harrisons Principles of Medicine, 18th Edition, Pages 380-382

Medicine

4e6de6fe-8c69-4553-827d-417ce597f3ac

The pharmakokinetic change occurring in geriatric patient is due to

Gastric absorption

Liver metabolism

Renal clearance

Hypersensitivity

single

One of the most impoant pharmacokinetic changes associated with aging is decreased renal elimination of drugs. After age 40, creatinine clearance decreases an average of 8 mL/min/1.73 m2/decade; however, the age-related decrease varies substantially from person to person. Serum creatinine levels often remain within normal limits despite a decrease in GFR because older adults generally have less muscle mass and are generally less physically active than younger adults and thus produce less creatinine. Maintenance of normal serum creatinine levels can mislead clinicians who assume those levels reflect normal kidney function. Decreases in tubular function with age parallel those in glomerular function. Refer katzung 11/e p1039

Anatomy

General anatomy

d64eabcf-da66-438f-a53f-7137d3bba9dd

True regarding lag phase is?

Time taken to adpt in the new environment

Growth occurs exponentially

The plateau in lag phase is due to cell death

It is the 2nd phase in bacterial growth curve

multi

Lag phase: Immediately following the seeding of a culture medium, there is no appreciable number, though there may be an increase in the size of the cells. This initial period is the time required for the adaptation to the new environment, during which the necessary enzymes and metabolic intermediates are built up in adequate quantities for multiplication to proceed. The duration of the lag phase varies with the species, sizes of the inoculation, nature of the culture media and the environmental factors such as temperature REF:Ananthanarayan & Panicker's Textbook of Microbiology 8th edition pg no: 24

Microbiology

general microbiology

35a7eac4-fd96-4184-9a5f-86bba82a5b62

A 60 yr old chronic smoker presents with painless gross hematuria of 1 day duration. Investigation of choice to know the cause of hematuria

USG

X-ray KUB

Urine routine

Urine microscopy for malignant cytology cells

single

Urine microscopy for malignant cytology "Painless haematuria is by far the most common symptom of bladder cancer and should be regarded as indicative of a bladder carcinoma until proven otherwise." Bailey & Love 25/e p1336 (24/e p1363) Cigarette smoking is the main etiological factor and accounts ,for about 50% of bladder cancers Among the given options 'urine microscopy' is the best choice for investigating a pt. with high suspicion for bladder ca. This is not a good screening test but a positive result is highly specific. The best investigation would be cystoscopy & biopsy. Investigations for bladder cancer 1. Urinary cytology - Exfoliated cells from both normal and neoplastic urothelium can be readily identified in voided urine. Examination of cytological specimens can detect the malignant cells either at the time of initial presentation or during follow-up. Cytological examination may be especially useful in screening high-risk population and assessing the response to treatment. 2. Cystourethroscopy and tumor resection - The diagnosis and initial staging of bladder cancer is made by cystoscopy and transurethral resection. 3.Imaging (IVP, CT, MRI) - Although various imaging techniques can detect bladder cancer, its presence is confirmed by cystoscopy & biopsy. - Therefore imaging modalities are used to image the upper urinary tract and, when infiltrating bladder tumors are detected to assess the depth of muscle wall infiltration and the presence of local & distant metastasis. - Intravenous urography remains one of the most common imaging tests for the evaluation of hematuria. However, intravenous pyelography is increasingly being replaced by computed tomography (CT) urography, which is more accurate, for evaluation of the entire abdominal cavity, renal parenchyma, and ureters in patients with hematuria. Bladder tumors may be recognized as pedunculated, radiolucent filling defects projecting into the lumen; nonpapillary, infiltrating tumors may result in fixation or flattening of the bladder wall. 4. Urinary tumor markers - - Several new tests have been developed in order to overcome the shocomings of urinary cytology such as the low sensitivity for low-grade superficial tumors and inter-observer variability. - Commercially available tests include, the BTA test, the BTA stat test, the BTA TRAK assay determination of urinary nuclear matrix protein (NMP22), Immunocyt and UroVysion . - These tests can detect cancer specific proteins in urine (BTA/NMP22) or augment cytology by identifying cell surface or cytogenetic markers in the nucleus. Other tests under investigation include identification of the Lewis X antigen on exfoliated urothelial cells, and the determination of telomerase activity in exfoliated cells. - These tests have been demonstrated to enhance detection of bladder cancer when used either individually or in combination with cytology. They have been used to detect both new index tumors as well as recurrent tumors.

Surgery

fabd82e2-8b86-429a-8adb-ac46dde1aba6

With which of the following receptors theophylline has an antagonistic interaction ?

Histamine receptors

Bradykinin receptors

Adenosine receptors

Imidazoline receptors

single

Pharmacology

f79a972f-3611-4cdc-837e-ce2f9393f592

Hyper viscosity is seen in

Cryoglobulinemia

Multiple myeloma

MGUS

Lymphoma

single

Ref William hematology 6/e p1268 The term cryoglobulinemia refers to the presence in the serum of proteins that precipitate at temperatures below 37 degrees C and redissolve on rewarming. ... The elective treatment for hyperviscosity syndrome, whether associated with monoclonal, mixed, or polyclonalcryoglobulinemia, is plasma exchange.

Anatomy

General anatomy

b1a4e1b8-fb3d-40e4-9da7-ebc8a9c0963b

For a positively skewed curve which measure of central tendency is largest

Mean

Mode

Median

All are equal

multi

A distribution is negatively skewed, or skewed to the left, if the scores fall toward the higher side of the scale and there are very few low scores. In positively skewed distributions, the mean is usually greater than the median, which is always greater than the mode. Ref :

Social & Preventive Medicine

Biostatistics

26ac2e3d-bbd7-44d6-968a-feeb54cf1a92

The process of hardening a cement matrix through hydration with oral fluids to achieve greater mechanical strength is known as:

Maturation

Setting

Hardening

Mineralization

single

Maturation (cement)—The process of hardening a cement matrix through hydration with oral fluids to achieve greater mechanical strength. Ref: Phillip’s Science of Dental Materials ed 12 pg 309

Dental

56b5a2d2-044c-4b80-b778-6fa762206f52

Superior vena cava is derived from:

Aortic arch

Pharyngeal arch

Cardinal vein

Vitelline vein

single

Ans. C Cardinal veinRef; hangman's essesntial medical Embroyology pg. 57# During early embryonic development (through 4th week), paired cardinal veins drain the body. Anterior cardinal veins drain the head and upper limb buds, while posterior cardinal veins drain the body. Both the anterior and posterior veins on each side unite at the common cardinal veins that flow into the sinus venosus and ultimately into the common atrium (Image).# Anterior cardinal veins are retained. An anastomosis between the two forms the left brachiocephalic vein, and anterior segments from both form the jugular system for the head and neck (Image).# Most of the posterior segment on the left disappears except for that forming the left superior intercostal vein, whereas the right posterior segment forms the superior vena cava.Extra mileDefects of SVC Development* Double inferior vena cava occurs when the left supracardinal vein persists, thereby forming an additional inferior vena cava below the level of the kidneys.* Left superior vena cava occurs when the left anterior cardinal vein persists, forming a superior vena cava on the left side. The right anterior cardinal vein abnormally regresses.* Double superior vena cava occurs when the left anterior cardinal vein persists, forming a superior vena cava on the left side. The right anterior cardinal vein also forms a superior vena cava on the right side.

Anatomy

Embryology

9ecbc05b-b255-47b5-b7b1-bf55f0f21abd

Testicular artery usually arises from

Abdominal aorta below renal artery

Renal artery

Internal iliac artery

Ext iliac artery

multi

Ans) a (Abdominal aorta ....) Ref Chaurasia vol 2 pg 186Testicular artery is a branch of abdominal aorta given off at the level of vertebrae L2.Venous drainageVeins emerging from the testis forms pampiniform plexus. Plexus condenses into 4 veins at the superficial inguinal ring & into 2 veins at the deep inguinal ring.Ultimately one vein is formed which drains into IVC (on right side) or left renal vein (on left side).

Surgery

Testis & Scrotum

2583b8c8-aeaa-47c0-86fb-5efc9f386de6

Position of vocal cord in cadaver is:

Median

Paramedian

Intermediate

Full Abduction

single

The vocal fold of the excised larynx is known to be located at an intermediate position(the so-called cadaver position).

ENT

e9038cb9-56db-473d-9d3f-440f130295ec

Organisms that has not been cultured successfully so far is-

Leptospira

Treponema pallidum

Bordetella

Staphylococcus

multi

Microbiology

b77af8ce-2e9c-4979-a544-a2331f86f6b1

Normal waist hip ratio of a female is below

0.7

0.8

0.9

1

single

WHO CUT-OFF POINTS OF WHR Indicator CUT-OFF points Risk of metabolic complications Waist circumference >94 cm (M) >80 cm (W) Increased Hip cirrcumference >102 cm (M) >88 cm (W) Substantially increased Waist-Hip ratio >= 0.95(M) >= 0.80(W) Substantially increased Ref: Park 23rd edition Pgno : 400 WC & WHR, WHO Consultation 2008

Social & Preventive Medicine

Non communicable diseases

f5df7424-6485-43fa-ba98-6de498561a76

The most common cause of renal scaring in a 3 year old child is -

Trauma

Tuberculosis

Vesicoureteral reflux induced pyelonephritis

Interstitial nephritis

single

Chronic pyelonephritis is characterized by renal inflammation and scarring induced by recurrent or persistent renal infection, vesicoureteral reflux, or other causes of urinary tract obstruction. VUR is a congenital condition that results from incompetence of the ureterovesical valve due to a sho intramural segment Ref Harrison20th edition pg 234

Medicine

Kidney

99ae24e6-10c3-48b5-8c69-a8784ce4a4fc

A 6hours old snake bite patient comes to emergency with mild local edema at the injury site. On examination no abnormalities detected and lab repos are normal. Most appropriate management is

Incision and suction

Wait and watch

Local subcutaneous antisnake venom

Intravenous antisnake venom

single

All patients with a history of snake bite should be observed for 8-12 h after the bite, if the skin is broken and the offending snake cannot be positively identified as non-poisonous. Ref: Krishnan vij ; 5th ed; Page no: 484

Forensic Medicine

Poisoning

a822c6ea-6cfd-44c1-890f-6fac4b97e16d

Which of the following agents is most commonly associated with recurrent meningitis due to CSF leaks?

Meningococci

Pneumococci

Hemophilus Influenza

E. Coli

single

Intracranial CSF leaks cause bacterial meningitis, about 80% are caused by S. Pneumoniae. Other causative organisms are meningococcus, Hemophilus species and S.aurues. Ref: Clinical Pediatric Neurology By Ronald B. David, Page 217

Pediatrics

69e9312c-9be5-4efe-a981-6bd7be0ef65b

Treatment of choice in traumatic facial nerve injury is:

Facial sling

Facial nerve repair

Conservative management

Systemic corticosteroids

single

(b) Facial nerve repair(Ref. Scott Brown, 6th ed., 1404)Since generally following trauma the facial nerve injury occurs as sudden onset. Facial decompression should be the best option.

ENT

Facial Nerve And Its Disorders

108ff605-0712-4a5b-8a74-aa8cbefc3d07

What is the best method of informing the rural population about Oral rehydration technique: March 2013 (d, f)

Chalk and talk/Lecture

Demonstrations

Role play

Flash cards

single

Ans. B i.e. Demonstrations Demonstration involves showing by reason or proof explaining or making clear by use of examples or experiments. Put more simply, demonstration means to clearly show

Social & Preventive Medicine

24b17b1d-0dac-4da1-b215-22451784b9b6

Lymph vessel which drain the posterior 1/3 rd of the tongue:

Basal vessel.

Marginal vessel.

Central vessel.

Lateral vessel.

single

Anatomy

e7f60d58-db4c-4067-981b-2988a9de88ff

Risk factors associated with post-operative nausea and vomiting following strabismus surgery are all except -

Age < 3years

Duration of anesthesia > 30 mins

Personal or family history of post - op nausea and vomiting

Personal or family history of motion sickness

multi

Ans. is 'a' i.e., Age < 3 years Post operative nausea and vomiting (PONY) following strabismus surgery It can cause post - op wound dehiscence, hematoma, orbital hemorrhage and aspiration. 30 % of all procedures are associated with PONV. Major risk factors are: Age > 3years Duration of anesthesia > 30 mins Personal or family history of post - op nausea and vomiting Personal or family history of motion sickness Medical management of PONV includes: dimenhydrinate, metoclopramide, droperidol, dexamethasone, ondansatron

Anaesthesia

7f11c629-b766-486f-a98e-6de0a2be8ae3

All are True about Acute Osteomyelitis except

Common in children

Severe pain

Involves Epiphyseal plate

Treatment involves 6 weeks of Antibiotics

multi

Orthopaedics

7a14deed-5c09-443b-9221-10f3a70fb6a4

Anterolateral ahroscopy of knee is for:

To see patellofemoral aiculation

To see the posterior cruciate ligament

To see the anterior poion of lateral meniscus

To see the periphery of the posterior horn of medial meniscus

single

Standard poals in knee ahroscopy Anterolateral poal Almost all the structures within the knee joint can be seen except- posterior cruciate ligament anterior poion of the lateral meniscus periphery of the posterior horn of the medial meniscus in tight knees. Anteromedial poal Additional viewing of lateral compament Posteromedial poal Used for viewing the posteromedial structures For repair or removal of the displaced posterior horn of meniscal tears Superolateral poal Used for diagnostically viewing the dynamics of patella-femoral joint, excision of medial plica.

Orthopaedics

Spos Injury

05e92aa4-f149-49d2-bfb3-48263f7de421

Regarding vaginal candidiasis which one of the following is false:

Cottage cheese like secretions are seen

Intense pruritus

Most common in non-pregnant women

Buds and hyphae seen in KOH preparation

multi

Ans. C. Most common in non-pregnant womenCandidiasis is caused by Candida albinism which thrives in an acidic medium with an abundant supply of carbohydrates. It is found commonly in pregnancy, and in patients on oral contraceptives, antibiotics and. corticosteroids. It is also seen in patients with diabetes. It causes a profuse discharge and intense pruritus with soreness of vagina and dysuria. Vagina and vulva are edematous and excoriated and the white patches of cheesy material on the vagina and vulva can be easily identified. A 10%KOH smear shows the buds and hyphae of the Candida organism. Nystatin or ketoconazole vaginal tablets used for one week are curative when used along with a cream of the same medication for External use.

Gynaecology & Obstetrics

Miscellaneous (Obs)

d27fbb91-ef90-4092-9175-636be25c357f

25 year old patient Suspected to have a pneumoperitoneum. Patient is unable to stand. Best x-ray view is

Left lateral decubitus view

Right lateral decubitus view

Supine

Prone

single

Left lateral decubitus view demonstrates the air between dense shadow of liver and the abdominal wall.

Radiology

2b42ac45-27a8-4304-b28d-7554722e76ba

What is the most probable poal of entry of Aspergillus?

Puncture wound

Blood

Lungs

Gastrointestinal tract

single

Aspergillus species are widely distributed on decaying plants, producing chains of conidia. Aspergillus species unlike Candida species do not form the pa of normal flora of humans. They are ubiquitous in the environment; hence transmission of infection is mostly exogenous. Aspergillus transmission occurs by inhalation of airborne conidia. Risk Factors for invasive aspergillosis are: Glucocoicoid use (the most impoant risk factor) Profound neutropenia or Neutrophil dysfunction Underlying pneumonia or COPD, tuberculosis or sarcoidosis Antitumor necrosis factor therapy.

Microbiology

Mycology

836756cc-2b92-483b-a8cc-302b578a9eaa

For TOF management in antenatal period includes ?

Balloon valvotomy

Open hea surgery

Karyotyping

Aspirin

multi

Ans. is 'c' i.e., KaryotypingTOF has been associated with untreated maternal diabetes, phenylketonuria, and intake of retinoic acid.Associated chromosomal anomalies occur in 30% cases and include trisomies 21, 18, 13 and 22q11 microdeletion, especially in pulmonary atresia and absent pulmonary valve syndrome (APVS).There is also a high association with extra - cardiac anomalies in paicular, abdominal and thoracic abnormalities.When a TOF is diagnosed during fetal life, karyotyping and targeted morphologic ultrasound examination should be offered.Isolated TOF - Good prognosis in TOF with pulmonary stenosis (>90% survival after surgery).However, other forms of TOF such as pulmonary atresia and absent pulmonary valve syndrome do not have a good prognosis (moderate prognosis for pulmonary atresia and bad prognosis for APVS).

Pediatrics

08255d75-8015-4389-b7ce-7621634c98d2

What change will be seen in vertebral column in ochronosis-

Calcification of disc

Bamboo spine

Increased disc space

multi

Ans. is 'a' i.e., Calcification of discAlkaptonuria# It is due to deficiency of homogentisate oxidase. As a result homogentisic acid (homogentisate) is excreted execessively in urine, There are three important characteristic features in alkaptonuria-Urine becomes dark after being exposed to air. It is due spontaneous oxidation of homogentisate into benzoquinone acetate, which polvmerse to form black-brown pigment alkapton which imparts a characteristic black-brown colour to urine.Alkapton deposition occurs in sclera, ear, nose, cheeks and intervertebral disc space. A condition called ochronosis. There may be calcification of intervertebral discs.Onchronosis arthritis affecting shoulder, hips, knee.# Benedict's test is strongly positive in urine and so is the ferric chloride (FeClyl test. Benedict's reagent gives a greenish brown precipitate with brownish black supematent. Feh ling's reagent (FeClj gives blue green colour.

Orthopaedics

Anatomy of Bone & Fracture Healing

55b3bce3-3a08-4770-a6c6-c416160de22e

If solid line represent the rigid height, then the following diagram with excessive inter arch space is classified in?

Class - 1

Class - 2

Class - 3

Class - 4

single

Dental

476a3ecd-7c42-4c85-9982-1ce80c95ab82

Pearsonian measure of skewness -

Mode - Mean/ SD

Mean - Mode/ SD

SD/Mode - mean

Mean - Mode/ SD

single

Ans. is b' i.e., Mean-Mode Measures of Skewness o There are following measures of skewness 1. Karl pearson's measure The formula for measuring skewness is divided into a) absolute measure Skewness = Mean - Mode b) relative measure The relative measure is known as the Coefficient of Skewness and is more frequently used than the absolute measure of skewness. Fuher, when a comparison between two or more distributions is involved, it is the relative measure of Skewness which is used.

Social & Preventive Medicine

509f300d-f354-48fb-a2c9-fb1a55cb8e00

Following are the causes of sudden loss of vision except ?

Angle closure glaucoma

Endophthalmitis

Central serous retinopathy

Corneal ulceration

multi

Ans. is 'd' i.e., Corneal ulceration

Ophthalmology

cb8dbb33-9f74-4e01-8ac3-fe295178d2a1

All of the following are features of Lymph node histology except

Subcapsular sinus present

Both Efferent and Afferent are present

Coex and Medulla are present

Red pulp and White pulp are present

multi

Red pulp and White pulp are present in spleenHistologically, a lymph node is subdivided into three regions: coex, paracoex, and medulla. All three regions have a rich supply of sinusoids, enlarged endothelially lined spaces through which lymph percolates.The afferent lymph vessels pierce the capsule on the convex surface of the node and empty their lymph into the subcapsular sinus. This sinus is continuous with the coical sinuses and delivers the lymph into the medullary sinuses, eventually to enter the efferent lymphatic vessels.Reference: Krishna Garg Histology; 5th edition; Page no: 92

Anatomy

General anatomy

21ab1846-bbea-4bca-bd03-8933fa61ea5d

During Sx for meningioma, the left paracentral lobule was injured. It would lead to paresis of

Rt. Leg and perineus

Left face

Right face

Right shoulder & trunk

single

Ans. is 'a' i.e Rt. Leg and perineum Paracentral lobule:On the medial surface of cerebral hemisphere, the U shaped gyrus around the end of the central sulcus is the paracentral lobule.Motor cortex is located in the precentral gyrus on the superolateral surface of the hemisphere and in the anterior part of the paracentral lobule.Stimulation in this area results in movements in the opposite half of the body.The body is represented upside down in this area.A look at the motor homunculus in Ganong will show that the leg and perineum are represented in the paracentral lobule.

Anatomy

Cerebrum

af3f9375-99f2-4495-8e66-c875d70c9612

Which of the following bacterial meningitis is associated with sudural effusion?

H. influenza

Neisseria meningitits

Streptococcus pneumonia

Enterococcus

single

Chronic Subdural Empyema It may be primary infection of subdural space from sinusitis focus causing suppuration and pus formation. It can be complication of the chronic subdural haematoma. It is due to secondary bacterial infection of collected clot/fluid. Infection is from sinusitis scalp (common)/through earlier trauma wound/haematogenous. Commonly Gram positive organisms cause empyema like streptococci (viridans/milleri) but other virulent organisms like Gram negative bacteria (H.influenzae) occasionally can cause. There is coical venous thrombophlebitis and coical infarction. Headache, fever, meningism and convulsions are the features. MRI is ideal than CT to diagnose. Treatment: Antibiotics, craniotomy and drainage; anticonvulsants, ICU care, proper monitoring, regular follow up. Condition has got 10% moality. Ref: SRB's Manual of Surgery 5th edition Pgno : 1097

Surgery

Trauma

af913acc-4ca3-4266-a199-86b667524325

All of the following statements are true regarding hyperophy, except:

Occurs due to synthesis and assembly of additional intracellular components.

There is an increase in the size of the cells.

Cells capable of division respond to stress by hyperophy and hyperplasia.

There is an increase in the number of cells.

multi

The increased size of the cells is due to the synthesis and assembly of additional intracellular structural components. Hyperophy refers to an increase in the size of cells, which results in an increase in the size of the affected organ. Cells capable of division may respond to stress by undergoing both hyperplasia and hyperophy. The hyperophied organ has no new cells, just larger cells.

Pathology

Reversible Cell Injury

90c75fdd-c6c6-4320-8411-9a5a750b5c5d

Glucose sympo occurs with:

Na+

Ca++

K+

Cl-

single

A i.e. Na+

Physiology

4fb5da8e-6fa9-4308-829d-bef54d70af7c

All are true about temporal arteritis except -

Can leads to sudden bilateral blindness

More corrunon in females

Worsen on exposure to heat

Mostly affects elderly

multi

Medicine

9595ba1f-bc34-42ab-8603-45961b925ad0

Of the various modalities used in the treatment of re-threatening effects of hyperkalemia which one of the following as the most rapid onset of action ?

Hemodialysis

Sodium bicarbonate infusion

Insulin and glucose infusion

Intravenous calcium gluconate

single

Medicine

b801715b-75b9-41bd-8f3c-828469d01266

In chronic alcoholism the rate limiting component for alcohol metabolism excluding enzymes is/are : (PGI Dec 2008)

NADP

NAD+

NADPH

FADH

single

Ans : B (NAD+) & C (NADPH) In chronic alcoholism rate limiting component for alcohol metabolism is NAD* & NADPHOxidation of ethanol by alcohol dehydrogenaseQ & NADQ leads to excess production of NADHSome metabolism of ethanol takes place via a cytochrome P450 dependent microsomal ethanol oxidising systme (MEOS) Q involving NADPH & O2:, This system increase in activity in chronic alcoholism & may account for the increased metabolic clearnce in this condition.Ethanol + NADPH + H+ O2 MEOS Acetaldehyde

Biochemistry

Biosynthesis of Fatty Acids and Eicosanoids

12b668e8-af03-47d7-bc80-41dec978da4d

Minimum level of iodine iodized salt reaching the consumer level according to iodine programme should be:-

5 ppm

30 ppm

15 ppm

20 ppm

single

National Iodine deficiency disorder programme , 1992: - National goitre control programme, 1962 is conveed to NIDDCP, 1992 - Impact indicators: Major indicator - Urinary iodine excretion levels ( generally measured in pregnant women over 24hrs) Others - Neonatal hypothyroidism , Goitre - Level of salt iodinisation: 30 ppm at production level 15 ppm at consumer level - Two-in-one salt: 40mcg iodine + 1mg iron/gm of salt MBI kits- Field Test Kits that allow Iodised salt manufacturers, quality controllers, health inspectors, social workers, NGO activists and even school children to assess the amount of iodine in iodised salt.

Social & Preventive Medicine

Other NHPs

8a72ed74-b546-481b-bf0c-0c812ce2f3df

True statement regarding specific death rates

Specific for age and sex

Identify particular group or groups "at risk" for preventive action

Find out cause or disease specific

All of the above

multi

(A1I of the above) (54- Park 20th)Specific death rates - may be (a) cause or disease specific e.g. TB, cancer, accidents (b) Related to specific groups e.g. age specific, sex specific, age and sex specific etc.* Rates can also be made specific for many others variables such as income, religion, race, housing etc.* Specific death rates can help us to identify particular groups or groups "at risk" for preventive action. They permit comparisons between different causes within the same populations* Specific death rates are obtained mainly in countries in which a satisfactory civil registration system operates and in which a high proportion of death is certified medically.

Social & Preventive Medicine

Concept of Health and Disease

6d21ae16-b1b7-42d3-ba62-7e310d8b0198

Pre-exposure prophylaxis for rabies is given on days

0, 3, 7, 14, 28, 90

0, 3, 7, 28, 90

0, 3

0, 7, 28

single

New recommended regimen/Schedule (New guidelines( Type of prophylaxis Regimen Post exposure Intramuscular Essen Regimen (1-1-1-1-1) Day 0,3,7,14,28 Post exposure intradermal Updated Thai Red Cross Regimen (2-2-2-0-2) Day 0,3,7,28 Post exposure in vaccinated individuals Day 0,3 Pre-exposure prophylaxis Day 0,7,21/28 Minimum potency: 2.5 IU per IM dose Zagreb regimen of rabies Vaccine (Intramuscular Post-exposure) : 1. 4-dose abbreted multisite regimen 2-0-1-0-1 (2 doses on Day 0,1 dose on Day 7, 1 dose on day 21 Ref: Park 25th edition Pgno : 297-298

Social & Preventive Medicine

Communicable diseases

bf09d252-e987-480b-9a17-fe566ad398b9

Regarding Sjogren's syndrome, all are true except: September 2010

Keratoconjuctivitis sicca

Rheumatoid ahritis

Epiphora

Autoimmune in nature

multi

Ans. C: Epiphora SjOgren's syndrome (also known as "Mikulicz disease" and "Sicca syndrome", is a systemic autoimmune disease in which immune cells attack and destroy the exocrine glands that produce tears and saliva SjOgren's syndrome can exist as a disorder in its own right (Primary Sjogren's syndrome) or it may develop years after the onset of an associated rheumatic disorder such as rheumatoid ahritis, systemic lupus erythematosus, scleroderma, primary biliary cirrhosis etc. (Secondary SjOgren's syndrome)

Ophthalmology

a79732e1-a0c9-4e81-bce6-fbcacaaab4e7

Best indicator of antemoum drowning is :

Froth in mouth and nostrils

Cutis anserina

Washerman's hand

Water in nose

single

A i.e. Fine froth in mouth & nostril

Forensic Medicine

432ce240-2b6c-47aa-afd7-18bd49806239

Splenomegaly may be a feature of: March 2013

Megaloblastic anemia

Sickle cell anemia

Thalassemia

G6PD deficiency

single

Ans. B i.e. Sickle cell anemia Splenomegaly Splenomegaly refers strictly to spleen enlargement, and is distinct from hyperspineism , which connotes overactive function by a spleen of any size. Splenomegaly and hypersplenism should not be confused. Each may be found separately, or they may coexist. Clinically if a spleen is palpable, it means it is enlarged as it has to undergo enlargement by at least two folds to become palpable. However, the tip of the spleen may be palpable in a newborn baby up to 3 months of age Early sickle cell anemia may present with splenomegaly

Pathology

e6c29c8b-af47-4dd6-8154-663358bed3b8

Gp2b3A inhibitors are all except -

Abciximab

Eptifibatide

Tirofiban

Prasugrel

multi

Ans. is 'd' i.e., Prasugrel Glycoproteins lIb / IIIa inhibitorso The platelet glycoprotein mediates platelet aggregation via binding of adhesive proteins such as fibrinogen and Von Willebrand factor.o GP lib / Ilia inhibitors, inhibit platelet aggregation by blocking GPIIb / IlIa.o They are more complete inhibitors than either aspirin or clopidogrel / ticlopidinejj because they inhibit final pathway in platelet aggregation (whether it is mediated by ADP or TXA2), while aspirin blocks only TXA2 pathway and clopidogrel blocks only ADP pathway,o Drugs are -o In addition to inhibiting Gp lib / Ilia receptor, abciximab also inhibits ay(33 receptor (which binds vitronectin) and amb2 (a leukocyte integerin). This action is responsible for anti-inflammatory and antiproliferative properties of abciximab.

Pharmacology

Antiplatelets and Fibrinolytics

81b24099-1d53-4130-ac61-72364a99d53f

True of case control studies -

It proceeds from cause to effect

Odds ratio can be calculated

Incidence can be calculated

Needs many patients

multi

Social & Preventive Medicine

c08137c8-34c0-4f03-9b07-227dfeb8ec8e

All of the following could include the mechanism or function of oxigenases, EXCEPT:

Incorporate 2 atoms of oxygen

Incorporate 1 atom of oxygen

Required for hydroxylation of steroids

Required for carboxylation of drugs

multi

Carboxylation is a function of carboxylase enzymes which belong to the class of 'Ligases'. It is not a function of oxygenase enzymes. Monoxygenases incorporate one atom of oxygen and play an impoant role in hydroxylation of steroids. Dioxygenases incorporate 2 atoms of oxygen into the substrate. Ref: Harper's Illustrated Biochemistry 27th Edition, Page 96, 97; Enzyme Assays: High-Throughput Screening, Genetic Selection and Fingerprinting edited by Jean-Louis Reymond, 2006, Page 85.

Biochemistry

95a23ec3-c2d6-40f4-890f-bece76c568cd

According to recent SC judgment, doctor can be charged for medical negligence under 304-A, only if: AIIMS 12

He is from corporate hospital

Negligence is from inadveent error

Simple negligence

Gross negligence

single

Ans. Gross negligence

Forensic Medicine

3c3ba303-b196-45de-8ced-6c888c9e0d4e

Which of the following is very difficult to induce antibody -

Polysaccharide

Protein

Antigen

Effector

single

An antigen is any substance that causes an immune system to produce antibodies against it. Antigens are usually peptides, polysaccharides or lipids. In general, molecules other than peptides (saccharides and lipids) qualify as antigens but not as immunogens since they cannot elicit an immune response on their own. Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:88

Microbiology

Immunology

452b1926-6027-40a1-a934-6d58f2a8caed

Prevalence is a:

Rate

Ratio

Propoion

None of the above

multi

Tools of measurement in epidemics: - Rate = x 1000/ 10000/ 100000 ; a is pa of b - Ratio = a/b ; a is not a pa of b - Propoion = x 100 = % ; a is pa of b Prevalence = No. of all current cases of a disease at a time /Estimated total population at that time X 100 Hence, Prevalence is a propoion (Prevalence is NOT a Ratio): Numerator is a pa of denominator & is always expressed in percentage. Incidence is rate.

Social & Preventive Medicine

Epidemiology

9531838e-9009-47d8-8d6e-3880fab47804

S2 is best appreciated in -

3rd left intercostal space

2nd right intercostal space

4th left intercostal space

5th left intercostal space

single

Ans. is 'a' i.e., 3rd left intercostal space o Best areas to auscultate for both components of the second heart sound (A2 and P2) are either the left sternal border at the level of second intercostal space (Pulmonic area) or the left sternal border at the level of third intercostal space (Erb s point).

Medicine

General

764ad788-556b-49cd-b976-c93086492894

Position of limb in posterior dislocation of hip -

Flexion, abduction & external rotation

Flexion, adduction & internal rotation

Flexion, adduction & external rotation

Flexion, abduction & internal rotation

single

Ans. is 'b' i.e., Flexion, adduction & internal rotation Hip conditionDeformitySynovitisArthritisPosterior dislocationAnterior dislocationFemoral neck fractureIntertrochantric fractureFlexion, abduction, external rotation, apparent lengtheningFlexion, adduction, internal rotation, true shorteningFlexion, adduction, internal rotation, apparent & true shorteningFlexion, abduction, external rotation, true lengtheningExternal rotation, later adduction & flexionMarked external rotation, later adduction & flexion

Orthopaedics

Congenital Dislocation of Hip (C.D.H.)

52e6dc81-fb25-495d-b941-543e03158f7c

Drug causing malignant hyperthermia:(Asked twice in the exam)

Cisatracurium

Suxamethonium

Propofol

Thiopentone

single

Ans. b. SuxamethoniumSuxamethonium is the drug most commonly responsible for causing malignant hyperthermia.'Drugs causing malignant hyperthermia are- succinylcholine (most common cause), halothane (MC inhalational agent), iso/des/sevo/methoxy- fluranes, lignocaine, TCA, MAO inhibitors and phenothiazines.''Thiopentone and pancuronium are protective drugs for malignant hyperthermia, as these raise the triggering threshold.''In malignant hyperthermia susceptible patients, safe anesthetics are N2O, Non-depolarizing muscle relaxants (atracurium), opiates, tranquilizers, etomidate, barbiturates (thiopentone) and propofol.'Malignant Hyperthermia* Autosomal dominant genetic disorder of skeletal muscle* Occurs in susceptible individuals due to exposure to some triggering agents, typically Suxamethonium or volatile agents, which cause an abnormal increase in intracellular calcium.* It is caused by dysregulation of excitation-contraction coupling in skeletal muscle.Triggering Agents:* Succinylcholine (most common cause)* Halothane (MC inhalational agent)* Halogenated Anesthesia:- Fluranes: Isoflurane, desflurane, sevoflurane. methoxy-flurane- Ether- Cyclopropane* Lignocaine* TCA* MAO inhibitors* PhenothiazinesClinical Features:* Rise in end tidal CO2 (1st sign)* Masseter muscle rigidity (MMR) and tachycardia are earliest sign* Hypermetabolic features, metabolic acidosis, fever, hyperthermia* Sympathetic over activity: Tachycardia, arrhythmia, unstable BP. initial hypertension* Muscle damage: Masseter muscle spasm, generalized rigidity, hyperkalemiaTretment:* Triggering agent must be stopped and hyperventilate with 100% oxygen* The mainstay of therapy is immediate administration of IV dantrolene.* Dantrolene is the only drug effective in reversing the symptoms and preventing the episode.

Anaesthesia

Complications Of Anaesthesia

91d73a6d-7f5b-44bb-b0ac-477ea9338efb

Household insectiside used for malaria-

Malathion

Pyrethrum

Paris green

Permethrin

single

Ans. is 'a' i.e., Malathion* Insectisides used for control of malaria are-i) Residual sprapy-# In residual spray, spraying of houses with residual insectisides is done. Residual insectisides remains active over extended periods i.e., they have residual action even after the time of spray.# Commonly used residual insectisides are - Malathion, DDT, Lindane, propoxure (OMS-33).ToxicantDosage in g/m2Average duration of effectiveness (months)DDT1 to 26 to 12Lindane0-53Malathion23OMS-3323ii) Space spray# Space sprays are those where the insecticidal formation is sprayed into the atmosphere in the form of a mist or fog to kill insect. Action is short lived and temporary since there is no residual action.# The most commonly used space spray insecticide is Pyrethrum.# New equipment has been developed to use residual insectiside as space spray by ultra low volume (ULV) technique. Malathions and fenthion are most commonly used.

Social & Preventive Medicine

Environment and Health

d9f648af-a752-4368-999d-05e13c345ce0

False about obstructive jaundice

Unconjugated bilirubin

Pruritus

Pale stools

Icterus

multi

Obstructive jaundice Most common surgical cause of obstructive jaundice is CBD stones Characterized by dark urine, pale coloured stools, icterus and Pruritus Presence of urobilinogen in urine rules out obstructive jaundice USG is the best test to differentiate medical from surgical jaundice Unconjugated bilirubin is normal Ref: Harrison's 19th edition Pg no : 1998

Anatomy

G.I.T

0e3852f0-45a6-493c-96d5-aefe1e0fa769

All of the following structure lies outside the cavernous sinus except

Sphenoidal air sinus

Internal carotid aery

Foramen lacerum

Maxillary nerve

multi

structures outside the sinus: 1. Superiorly: optic tract, optic chiasma, olfactory tract, internal carotid aery and anterior perforated substance. 2.inferiorly: foramen lacerum and the junction of the body and greater wing of the sphenoid bone 3.medically: hypophysis cerebri and sphenoidal air sinus 4.laterally: temporal lobe with uncus 5.below laterally: mandibular nerve 6.anteriorly: superior orbital fissure and apex of the orbit 7.posteriorly: apex of the petrous temporal and the crus cerebri of the midbrain Ref BDC volume 3:sixth edition pg 193

Anatomy

Head and neck

1d4ccb9d-1924-4aa6-b07c-0ed46fe31c20

Which of the following is the best procedure done for intrapaum fetal monitoring:

Fetal echocardiography

Fetal scalp pH

Continuous electrical fetal hea monitoring

Physical examination

single

Electrical Fetal hea monitoring is useful as: (1) Provides accurate information, (2) Helpful in diagnosing fetal distress, (3) Directs about intervention to prevent fetal death or morbidity, (4) It is superior to intermittent monitoring methods.

Gynaecology & Obstetrics

Intra Uterine Growth Restriction, Intrapaum and Antepaum Fetal Surviellance

236d1eb1-f2e1-43b0-90f3-f88deff358cb

Which of the following is measured by the device, Bellow's spirometer?

TLC

RV

Closing volume

ERV

single

The spirometer is a simple device for measuring gas volumes. The frequently used water spirometer, rolling seal spirometer and bellows spirometer. The last two are not water-filled and are more poable. The VT, IRV, ERV, IC, and VC can all be measured with a spirometer (as can the forced expiratory volume in 1 second , forced vital capacity , and forced expiratory flow ). The RV, the FRC, and the TLC, however, cannot be determined with a spirometer because the subject cannot exhale all the gas in the lungs. The lung volumes not measurable with spirometry can be determined by the nitrogen-washout technique, by the helium-dilution technique, and by body plethysmography. The FRC is usually determined, and RV (which is equal to FRC minus ERV) and the TLC (which is equal to VC plus RV) are then calculated from volumes obtained by spirometry. Ref: Levitzky M.G. (2007). Chapter 3. Alveolar Ventilation. In M.G. Levitzky (Ed), Pulmonary Physiology, 7e.

Physiology

a2630da3-17a1-4149-b424-4b04b2c42f1c

Which of the following is a newly emerging food poisoning organism

Salmonella typhimurium

Enterococcus

Diphtheria

Pseudomonas

single

Ans: a (Salmonella typhimurium) Ref: Ananathanarayan,7th ed, p. 303Of the above given, S. typhimurium causes food poisoningSalmonella gastroenteritisS. typhimurium is the most common cause of food poisoning due to salmonella species.Incubation period--6-24 hrsFood poisoning is never caused by S. typhi. Source of transmission: poultry, meat, milk and milk products.C/F-nausea, vomiting, diarrhoea, abdominal cramps, fever.Blood culture is usually negativeNoteS. aureus is the most common cause of food poisoning in the westIP and clinical features of various bacteria causing food poisoiningIncubation period Organism responsible 1- hrs S. aureus-nausea, vomiting, diarrheaB. cereus-nausea, vomiting 8-16 hrs C. perfringes-abdominal cramps, diarrhoea (vomiting rare)B. cereus-abdominal cramps, diarrhoea, vomiting > 16 hrs Vibrio cholera-watery diarrhoeaETEC-watery diarrhoeaEHEC-bloody diarrhoeaSalmonella species-inflammatory diarrhoeaCamphylobacter jej uni-inflammatory diarrhoeaShigella species- dysentryV. parahaemolyticus-dysentry

Microbiology

Enterobecteriaceae

f94f9f8f-fb28-44f0-9381-3dca473e305d

Atherosclerosis initiation by fibroblast plaque is mediated by injury to ?

Smooth muscle

Media

Adventitia

Endothelium

single

Ans. is 'd' i.e., Endothelium The most acceptable hypothesis for the pathogenesis of atherosclerosis is "the response to injury hypothesis". According to this hypothesis, atherosclerosis is a chronic inflammatory response of the aerial wall initiated by injury to endothelium. Pathogenesis of atherosclerosis Following stages occurs in the pathogenesis of Atherosclerosis: Endothelial injury Earliest stages of the development of atherosclerosis are mediated by the inflammatory cascade. Inflammation mediated injury to endothelium is the cornestone in the development of atherosclerosis. After injury, endothelium is activated and there is increased expression of adhesion molecule-VCAM-1 and there is increased permeability to endothelium. TNF is the major cytokine to induce this expression. Migration of leukocytes When VCAM-1 is expressed on endothelium, leukocytes adhere to the endothelium. Leukocytes than cross the endothelial barrier and begin to accumulate in subendothelial intimal space. Macrophages engulf LDL cholesterol and form foam cells - formation of earliest lesion, i.e. fatty streak. Macrophages also form oxygen free radicals that cause oxidation of LDL to yield oxidized LDL (modified LDL). Smooth muscle cell migration and proliferation Inflammatory cells in subendothelial intimal space secrete cytokines, mainly PDGF, TGF-ct and FGF which cause migration of smooth muscle cells from media to subendothelial intimal space as well as their proliferation. Maturation of plaque Smooth muscle cells synthesize extracellular matrix (especially collegen) and conve a fatty streak into a mature fibrofatty atheroma, and contribute to the progressive growth of atherosclerotic lesions.

Pathology

bdf94942-49c0-4d9a-b990-a7bfb7099857

The WBC that is considered “second line of defence” is:

Neutrophil

Eosinophil

Basophil

Monocyte

single

Monocyte is considered as the second line of defence.   Phagocytosis by Macrophages. Macrophages are the end-stage product of monocytes that enter the tissues from the blood. When activated by the immune system, they are much more powerful phagocytes than neutrophils, often capable of phagocytizing as many as 100 bacteria. They also have the ability to engulf much larger particles, even whole RBCs or, occasionally, malarial parasites, whereas neutrophils are not capable of phagocytizing particles much larger than bacteria. Also, after digesting particles, macrophages can extrude the residual products and often survive and function for many more months. Reference: GUYTON AND HALL TEXTBOOK OF MEDICAL PHYSIOLOGY, THIRTEENTH EDITION(INTERNATIONAL EDITION ) page no 458

Physiology

cbc8a1b1-532c-490e-a17d-9168083fabae

Mark the true statement regarding use of Lithium in maniac-depressive psychosis?

Monotherapy for acute episodes

Monitoring of serum concentration is not useful for guiding dose adjustment

Can result in leucocytosis

Can result in hypehyroidism on long term use

multi

Lithium Use : Prophylaxis of mania alone, with sedatives in acute mania. Monitoring of S. concentration is significant to know the toxicity of drug S/E of Lithium Lithium use for a long time causes benign and reversible T-wave flattening Seizures Polyuria and compensatory polydipsia Dermatitis, folliculitis, vasculitis Weight gain

Pharmacology

Psychiatric Illness

2b7ff41e-66e4-467a-97ec-9ea4e5e98cbc

Determination of Pulp vitality by pulse oximeter based on:

Beer's law.

Pascal's law.

Doppler law.

Poisslues law.

single

Pulse oxymetry- Based on Beer Lambert law Utilization of a probe that transmits red (640 mm) and infrared light Photo detector as a receptor site Different absorption ability of light by oxygenated and deoxygenated haemoglobin leads to changes in the amount of light differently absorbed by the vascular bed before reaching the photo detector.

Dental

c5165fb3-3a59-49ed-9de0-4dbbced2cf08

An Isograft indicates transfer of tissues between -

Unrelated donors

Related donors

Monozygotic twins

From the same individual

single

Surgery

e197f947-1bdd-4efd-887a-b72faa9441c5

All of the following are causes of congenital blindness Except

Toxoplasmosis

Congenital rubella

Vitamin A deficiency

Cataract

multi

Causes of congenital blindness:ToxoplasmosisCongenital cataractsGenetic diseaseCongenital rubellaCongenital glaucomaUsher syndrome(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 318 - 319)

Pediatrics

All India exam

b15c5039-0f3c-4195-8331-35b9632899c7

Hypersecretory glaucoma is seen in –

Epidemic dropsy

Marfan's syndrome

Hypertension

Diabetes

single

"In epidemic dropsy, glaucoma is wide angle glaucoma, with normal chamber and angle. Outflow is within normal limits. The queous shows raised level of histamin, prostaglandin and protein suggesting that glaucoma is hypersecretory". _ Mukherjee

Ophthalmology

01b9f068-4db2-45e5-94b8-19d4f7d290f7

A 14-year-old girl presents with quadriparesis, facial palsy, winging of scapula and ptosis. There is h/o similar illness in father and brother but less severe. Her CPK level is also raised (500IU/L). She is probably suffering from?

Emery-Dreifuss muscular dystrophy

Becker muscular dystrophy

Limb-girdle dystrophy

Scapulofaciohumeral dystrophy

single

Facial muscle involvement is not seen with Becker and Limb-girdle muscular dystrophy Emery Dreifuss and Becker are XLR disease so can't be present in a girl child. Hence by exclusion the diagnosis is Dx: Scapulo-Faciohumeraldystrophy. Facio-Scapulo-humeral dystrophy Autosomal dominant inheritance and has an onset in childhood or young adulthood. Facial weakness is the initial manifestation-->inability to smile, whistle or fully close the eyes. Weakness of the shoulder girdles-->makes arm elevation difficult. Scapular winging becomes apparent with attempts at abduction and forward movement of the arms. The serum CK level may be normal or mildly elevated. No specific treatment is available, ankle-foot ohoses are helpful for foot-drop.

Medicine

Myasthenia Gravis and Muscular dystrophy

44e3f7ec-ad90-49bc-9f91-54f959bae81b

Which of the following is true statement regarding human eye

Cornea cut off wavelength upto 400 nm

Normal eye medium will permit wavelength of 400- 700 nm

Even after cataract surgery UV rays are not penetrated

Lens will not reflect light

multi

Ans. b (normal rye medium will permit wavelength of 400- 700 ntn) Ref: yanoff 3rd ed p 383, internet sitesCornea and lens act as special filters absorbing the more energetic wavelength of the electromagnetic spectrum that can damage the retina. Cornea absorbs wavelength below 295nm where as lens absorbs strongly in the long U V B (300 - 315) and most of the UV A (315 - 400) wave-lengths. Eye light transmittance is relatively high in the 400nm-700nm range.

Ophthalmology

Anatomy

6a19df3c-6af0-4673-8e2b-02d86ddc7523

Which of the following muscle is not a hybrid muscle

Pectoralis major

Extensor digitorum

Flexor digitorum profundus

Brachialis

single

Extensor digitorum Hybrid muscles are the muscles having more than one nerve supply Pctoralis major: lateral & medial pectoral nerves Brachialis: additional proprioceptive fibres from radial nerve, in addition to its muscular nerve, musculocutaneous nerve. Extensor digitorum is supplied by the posterior interosseous nerve only.

Surgery

161fc4a5-e9fb-44c6-9a4b-2d734cf01ebc

Delayed union of fracture of a bone follo-wing a surgical treatment may be due to

Infection

Inadequate circulation

Inadequate mobilization

All of the above

multi

D i.e. All

Surgery

f18b19db-efc0-40d3-accd-5d2dcb3b1879

What is the pressure of inspiration?

Intrapleuarl

Transpulmonary

Trans chest wall

Alveolar pressure

multi

Ans: a (Intrapleural) Ref: Ganong,22nd ed,p. 6651The main pressure in lung related to inspiration is intrapleural pressure.Intrapleural pressure.The pressure in the intrapleural space between the lungs and chest wall is intrapleural pressure.Intrapleural pressure changes from -2.5 to -6 mmHg during inspiration. During strong inspiratory effort it may reach up to -30 mmHg.Transpulmonary pressureIt is the difference between alveolar pressure and intrapleural pressure. It is the measure of elastic forces in the lungs.Alveolar pressure or intrapulmonary pressureIt is the pressure inside the lung alveoli. When no air flows the alveolar pressure is considered to be equal to the atmospheric pressure, i.e., 0 cm of water.During inspiration it decreases to -1 cm of water.During expiration it increases to+1 cm of water.

Physiology

Respiratory System

cdfbd205-6f98-4cdc-9d76-29c0e9887cef

One standard detion in normal standard curev includes value-

50%

68%

95%

100%

single

Ref:Parks 23rd edition pg 849. 1SD : confidence limit = 68% 2SD : confidence limit = 95% 3SD : confidence limit = 99.7%

Social & Preventive Medicine

Biostatistics

d000623f-eba6-4e64-8cc0-3ed932403fce

Foam cells are seen in infection with which virus ?

Measles

EBV

Molluscum contagiosum

RSV

single

Ans. is 'b' i.e., EBV EBV encephalomyelitis shows :Abnormal white matter with perivascular infiltrates of inflammatory cells and foam cells.Some myelin is replaced by lipid-filled macrophages and hyperplastic astrocytes.

Microbiology

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During extraction of the upper first molar, the mesio buccal root is missing and is suspected to have been pushed into the maxillary sinus. The best position for the patient immediately after the incident is

To position the patient upright

To position the patients in a semi inclined posture to visualize the perforation

Trendelenberg position

Reverse trendelenberg position

single

Surgery

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Rescue P.C.I is done for which of the following?

Persistent chest pain with ST elevation > 60 min after thrombolysis

Persistent chest pain with ST elevation > 30 min after thrombolysis

Persistent Chest pain with ST elevation >90 min after thrombolysis

Pain with ST elevation for >120minutes after thrombolysis

single

Option C = Rescue P.C.I. After thrombolysis ST Elevation begin to reduce If ST Elevation persisting in spite of thrombolysis. So it's failure of thrombolysis | within 90 minutes Rescue PCI Types of PCI Primary PCI done for STEMI (Door to device time < 90 minutes). Delayed PCI done for Unstable Angina NSTEMI Rescue PCI Failure of thrombolysis (within 90 minutes).

Medicine

Acute coronary syndrome

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Fever associated with infection

Accelerates bacterial and viral replication

Left shifts the oxygen dissociation curve

Is due to interleukin-1 released from CD4 T-helper cells

Increase oxygen release to tissue

single

Fever right shifts the oxygen dissociation curve, which allows for a greater release of oxygen to the tissue, making oxygen easily available to neutrophils and monocytes for use in the oxygen-dependent myeloperoxidase system of bactericidal killing. Having more oxygen available to tissue also enhances wound healing. In addition, fever interferes with bacterial and viral replication by providing a hostile environment for incubation. Fever is produced by the release of interleukin-I from macrophages. Interleukin-I, in turn, stimulates the hypothalamus to synthesize prostaglandins, which interact with the thermoregulatory center to produce fever.

Physiology

General physiology

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Last organ to putrefy in females is?

Liver

Uterus

Brain

Breast

single

Ans. is 'b' i.e., Uterus Order of putrefactiono Order of appearance of putrefaction from earliest to last is : larynx, trachea > stomach, intestine > spleen, liver > brain, lungs > heart > kidney, bladder > uterus/prostate > bone.o Amongst the soft tissues uterus in female and prostate in malesm are last to undergo putrefaction, as uterus and prostate resist putrefaction. Otherwise bones are last to undergo putrefaction, overall.

Forensic Medicine

Injuries

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Hamartomatous lung tissue is?

Hypoplasia of lung

Congenital cyst

Lobar sequestration

Congenital cystic adenomatoid malformation

single

Ans. (d) Congenital cystic adenomatoid malformation(Ref: Robbins 9th/pg 670; 8th/pg 679)Congenital cystic adenomatoid malformation (CCAM): Hamartomatous Q or dysplastic lung tissue, usually confined to one lobe.

Pathology

Respiration

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Test for diagnosis of pyogenic meningitis is?

Widal

CSF PCR

CSF examination

PET scan

single

ANSWER: (C) CSF examinationREF: Harrison 17th ed chapter 376The diagnosis of bacterial meningitis is made by examination of the CSF. The need to obtain neuroimaging studies (CT or MRI) prior to LP requires clinical judgment.A broad-range PCR can detect small numbers of viable and nonviable organisms in CSF and is expected to be useful for making a diagnosis of bacterial meningitis in patients who have been pretreated with oral or parenteral antibiotics and in whom Gram's stain and CSF culture are negative

Microbiology

Bacteria

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Causes of thickened gallbladder wall on ultrasound examination are all except:

Postprandial state

Cholecystitis

Congestive cardiac failure

Kawasaki disease

multi

Ans: D (Kawasaki disease) Ref: Manual of Emergency Critical Care Ultrasound Vicke E Noble. 2nd ed. Pg 156Explanation:Kawasaki disease is associated with hydrops of gallbladder.Gallbladder Wall Thickening A gallbladder wall that is thickened is a sign of inflammation. This is a non-specific finding, and many other pathologic processes, as well as a postprandial gallbladder, can give you falsely elevated measurements.It is important to measure the wall of the anterior gallbladder surface because of the acoustic enhancement artifact mentioned.Because sound waves travel through a fluid-filled structure, no attenuation occurs. Thus, when those sound weaves hit the back of the gallbladder, they will be so strong that they will obscure an accurate picture of the wall thickness.For gallbladder wall thickness, greater than 3 mm is abnormal.Differential for Thickened Gallbladder WallPostprandialRenal failureAscitesHepatitisHypoalbuminemiaHIV/AIDSAdenomyomatosisMultiple myelomaCholecystitisCongestive heart failure

Radiology

Abdominal Radiography

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In caloric test, cold water stimulation causes movement of eye -

Some side

Opposite side

Up

Do\vn

single

Ans. is 'b' i.e., Opposite side [Ref: Dhingra 5th/e p. 48}o Each ear is irrigated twice : once with cold water (70C below the body temperature, i. e. 300C) and then with warm water (70C above the body temperature, i.e. 440C).o Cold water provokes nystagmus towards the opposite ear, while warm water provokes nystagmus towardssame ear (COWS Cold - oppsite, Warm - same).

ENT

Assessment of Vestibular Function

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Which of the following is not false about annual risk of TB

ARI of 1% = 75 new cases

Current ARI in India is 1.7%

It is represents new cases of TB

It is assessed by tuberculin conversion in previously non-vaccinated children

multi

Incidence of TB infection (Annual infection rate, Annual risk of Infection ARI) : Percentage of population under study who will be newly infected (not diseased or cases) with TB among Non-infected in 1 year. Expresses attacking force of TB in community In developing countries 1% ARI corresponds to: 50 SS +ve cases per 100,000 general population Tuberculin conversion index is the "best indicator for evaluation of TB problem and its trend" in the community. Current ARI in India : 1.5% Ref: Park 25th edition Pgno : 190-191

Social & Preventive Medicine

Communicable diseases

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A 12-year-old girl presents to the casualty with symptoms of fever, shoness of breath, and cough. A chest X-ray reveals complete consolidation of the lower lobe of the left lung. Cultures of the lower lobe of the left lung would most likely reveal which organism?

Streptococcus pneumoniae

Staphylococcus aureus

Klebsiella pneumoniae

Pseudomonas aeruginosa

single

The history and findings are consistent with a lobar pneumonia. The most common etiologic agent of lobar pneumonia is Streptococcus pneumoniae. ESSENTIALS OF DIAGNOSIS Productive cough, fever, rigors, dyspnea, early pleuritic chest pain Consolidating lobar pneumonia on chest radiograph Lancet-shaped gram-positive diplococci on Gram stain of sputum Ref: Papadakis MA, McPhee SJ, "Pneumonia, Pneumococcal." Quick Medical Diagnosis & Treatment

Microbiology

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IgA deposits on skin biopsy

Henoch Schouleiln puspura

Giant cell aeritis

Microscopic polyangitis

Wegener's granulomatosis

single

A.i.e. Henosch Schonlein purpura

Skin

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A Dentin 'Primer'?

Etches the dentin

It increases the surface energy & wets the dentin surface

Removes the smear layer

Conditions the dentin

single

Dental

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Which of the following hormonal activity is expected immediately prior to Ovulation?

LH surge

FSH surge

Progestrone surge

Estrogen surge

single

Ovulation occurs due to the effect of increased concentration of LH. In the pre-ovulatory phase of the menstrual cycle, the ovarian follicle will undergo a series of transformations called cumulus expansion, which is stimulated by FSH. This is followed by LH surge.

Physiology

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Following are fibrous joints :

Pubic symphysis

Fronto parietal suture

Manubrio sternal joint

Inf. radio ulnar joint

single

B. i.e. Frontoparietal sutureSkull sutures (except sphen-occipital), vomer- sphenoid rostrum schindylesisQ, inferior tibiofibular syndesmosis and dentoalveolar gomphosis (tooth socket) joints are fibrous joints. A Schindylesis is a specialized suture where a rigid bone fits into a groove on a neighbouring element eg a cleft between the alae of vomer, which receives the rostrum of the sphenoid. (i.e. vomer - sphenoidal rostrum junction)Q- Epiphyseo-diaphyseal growth plateQ, costochondral, 1st chondrosternal and sphenoocipital joints are synchondrosis/ syncendrosis or primary cailaginous joints; whereas, symphysis pubis, symphysis menti, sacrococcygeal, interveebral and manubriosternal jointsQ are symphyses or secondary cailaginous joints.Aicular cailage of most (not all) synol joints are lined by hyaline cailage Q. In some synol joints the cavity is paially or completely subdivided into two by an aicular disc, made up of fibrocailage eg. Temporomadibular jt, sternoclavicular jt, menisci of knee joint. More mobile the joint the more commonly it discloates eg shoulder jtQ. MCP Jt. is a condylar - synol joint

Anatomy

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For exhumation the order should be passed by -

Chief judicial magistrate

Executive magistrate

Police officer

Session judge

single

The body is exhumed only when, there is written order from the executive magistrate.

Forensic Medicine

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The radiograph of a 32 year old patient is shown below. The patient is asymptomatic and the lesion revealed in the radiograph is an accidental finding. The most likely diagnosis is:

Stafne’s bone cavity

Radicular Cyst

Dentigerous cyst

Lateral periodontal cyst

single

Radiological signs: The lesion presents as a chance radiographic finding. It is a round or an ovoid (<3 cm) uniform radiolucency with a well-defined, usually corticated, margin. Stafne’s bone cavity is non-expansile and is found below the mandibular canal just anterior to the angle of the mandible. The location of Stafne’s bone cavity distinguishes it from odontogenic lesions, whose origin is within the alveolar bone.

Radiology