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37fd8c47-1e6f-4928-9fec-9654385c0f57
Allen's test is used to diagnose:
Thoracic outlet syndrome
Palmar arch insufficiency
Superior vena cava syndrome
Coarctation of aorta
1b
multi
Ref: Bailey and One's Short Practice of Surgery 25th EditionExplanation:Allen's testIt is a test for the patency of the radial artery after insertion of an indwelling monitoring catheter. The patient's hand is formed into a fist *nd the ulnar artery is compressedcompression continues while the fist is opened.If blood perfusion through the radial artery is adequate, the hand should Hush and resume its normal pinkish coloration.Adsonks testIt is the loss of the radial pulse in the arm by- rotating head to the ipsi lateral side with extended neck following deep inspiration.It is seen in thoracic outlet syndrome (TOS)
Surgery
Orthopedics
5a3d546b-b468-49f2-b715-c418b7b78938
Which is denatured collagen in humans?
Gelatin
Homocollagen
Tropocollagen
None
0a
multi
heat denatured collagen is gelatin . REFERENCE; DM VASUDEVAN TEXTBOOK SEVENTH EDITION ; Page no;39
Biochemistry
Structure and function of protein
46506475-1e8b-44b8-ad8e-07921a210434
Isoform of LDH in skeletal muscles ?
LDH-1
LDH-2
LDH-3
LDH-4
3d
single
Ans. is 'd' i.e., LDH-4
Biochemistry
null
88619abc-fa4a-4713-b9ac-aaab17fb29fe
False statement about lateral medullary syndrome?
5,7,nerve lesions
I/L pain ,temperature loss of body
I/L pain temperature loss of face
10 nerve palsy
1b
multi
Lateral medullary syndrome also known as Wallenberg syndrome. Lateral medullary ischemia d/o ipsilateral veebral aery (in most cases) or PICA(in few cases) I/L Horner's + I/L sensory alternation of pain and temp on face (V nerve nucleus involvement) I/L Cerebellar ataxia (involvement of inferior cerebellar peduncle) C/L Alternation of pain and temp on body (Spinothalamic tract involvement) I/L Loss of taste (involvement of Nucleus tractus solitarious) Difficulty in speech and swallowing (involvement of Nucleus ambiguus)
Anatomy
Brainstem lesions and blood supply of CNS
85173cd6-0839-427a-954c-00d3a84e57f5
Rate limiting step in cholesterol synthesis is:
HMG CoA synthetase
HMG CoA reductase
Thiokinase
Mevalonate kinase
1b
multi
HMG CoA reductase
Biochemistry
null
af750bd3-a41a-4a04-a9f2-d2d3af291207
Reinke's crystals are seen in?
Leydig cells
Sertoli cells
Curschmann spirals
Creola bodies
0a
single
Ans. (a) Leydig cellsRef: Bailey & Love 26th ed. /1341Rectangular, crystal-like inclusions, composed of protein, with pointed or rounded ends in the interstitial cells of the testis (Leydig cells) and hilus cells in the ovary. Inside the Leydig cells of human males can be found Reinkes crystals. The purpose of these crystals is uncertain, some believe that they are a by-product of a degenerative process related to aging. They appear to have no contribution to androgen or testosterone production, and they can be used to identify Leydig cells easily when viewing testicular tissue under a microscope
Surgery
Anatomy & Physiology (Testis & Scrotum)
65165057-c63c-4cae-a044-f91618bb41cc
Dystrophic calcification is seen in ?
Milk alkali syndrome
Atheromatous plaque
Hyperparathyroidism
Vitamin A intoxication
1b
single
Ans. is 'b' i.e., Atheromatous plaqueDystrophic calcification o When pathological calcification takes place in dead, dying or degenerated tissue, it is called dystrophic calcification. o Calcium metabolism is not altered and serum calcium level is normal.Dystrophic calcification in dead tissues1.In caseous necrosis of tuberculosis(most common which may be in lymph nodes)2.Chronic abscess in liquifactive necrosis3.Fungal granuloma4.Infarct5.Thrombi6.Haematomas7.Dead parasites-Cystecercosis/Toxoplasma Hydatid/Schistosoma8.In fat necrosis of breast & other tissuesDystrophic calcification in degenerated tissuesAtheromatous plagueMonkeberg's sclerosisPsommama bodiesDens old scarsSenile degenrated changes such as in costal cailage, tracheal, bronchial rings, Pineal gland in brain.Hea valves damaged by rheumatic fever.How does calcification occurs in these site with normal serum calcium ?o Calcification of dead and dying cells and tissues is a common finding in human pathologic conditions. o Denatured proteins in dead or irreversible damaged tissues preferentially bind phosphate ions. o Phosphate ions react with calcium ions to form a precipitate or calcium phosphate.o Thus, necrotic tissue serves as a calcium sink.
Pathology
null
689b829a-e507-45fe-8784-db90ba50a3ae
A 55-year-old woman present due to recent onset of chest pain and dyspnea. Six weeks prior, patient suffered MI. On physical examination, friction rub over 5th intercostal space in midclavicular line along with elevated JVP. What is the most likely cause of this presentation?
Cardiac rupture syndrome
Thromboembolism
Dressler syndrome
Ventricular aneurysm
2c
single
Dressler syndrome is an autoimmune phenomenon that result in fibrinous pericarditis. Fibrinous pericarditis is both an early and late complication of MI. The delayed pericarditis typically develops 2-10 weeks post MI and present clinically as chest pain and pericardial friction rub. It is generally treated with aspirin or coicosteroid. Cardiac arrythmia is a common cause of post MI death, typically occurring the first few days following the event. It is not associated with friction rub. Ventricular rupture is a serious cause of post MI death typically occurs 3-7 days after initial event. It can present with persistent chest pain, syncope and distended jugular veins.
Pathology
Myocardial Infarction
0fb6fa10-5407-4363-9888-d317425e9da8
What is the pressure at which oxygen is stored ?
75 psi
1600 psi
760 psi
2200 psi
3d
single
Oxygen is stored at a pressure of 1900psi
Anaesthesia
Anaesthetic equipments
25e3f0f1-cfb6-40be-bc4b-b80174a33f81
Which of the following is false about varicocele
Most common in left testis
Causes infertility
Treated by palomo procedure
Present in old age patients
3d
multi
It is common in young males. Bag of worms consistency e is present on examination It has high recurrence rate.
Surgery
null
fa772049-7274-4a11-a27a-4c1d3bb864c7
Testicular Feminization syndrome is characterised by all except
Absent uterus
Primary amenorrhea
Normal breast
Barr body present
3d
multi
Karyotype in testicular feminization syndrome is 46 XY. Barr body is therfore absent.
Gynaecology & Obstetrics
null
f09a05ea-fa08-41a4-a7c8-a243ce4f17b9
The Periapical lesion that would most likely contain bacteria within the lesion is
Periapical abscess
Periapical cyst
Periapical granuloma
Condensing osteitis
0a
single
null
Dental
null
1f45779a-010a-4ecb-a284-532a3aab3ae9
Facial nerve exits the skull through
Stylomastoid foramen
Internal acoustic meatus
Foramen Lacerum
Foramen Rotundum
0a
single
Facial nerve enters the temporal bone through - Internal acoustic meatus Facial nerve exits the skull through - Stylomastoid foramen. Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 99
ENT
Oral cavity & Oesophagus
58049b95-9b55-437d-b0d7-6a0c39eca507
A child presenting with clinical features of an endocrine abnormality showed epiphyseal dysgenesis in imaging studies. Epiphyseal dysgenesis is a pathognomonic feature of:
Hypoparathyroidism
Hyperparathyroidism
Hypothyroidism
Hypehyroidism
2c
single
Epiphyseal dysgenesis is radiological finding of hypothyroidism which is characterized by centers of ossification, especially of the hip, may show multiple small centers or a single stippled, porous, or fragmented center. Other radiological findings of hypothyroidism: Delayed bone age Cardiomegaly Thyrotrophic hyperplasia characterized by an enlarged sella or pituitary gland Ref: Zeitler P.S., Travers S.H., Nadeau K., Barker J.M., Kelsey M.M., Kappy M.S. (2012). Chapter 34. Endocrine Disorders. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
Pediatrics
null
59af5c63-ffd8-426a-915c-53806a071d91
All of the following statement regarding stones in the submandibular gland are true except: March 2008
80% of stones occur in the submandibular gland
Majority of submandibular stones are radio-lucent
Stones are the most common cause of obstruction within the submandibular gland
Patient presents with acute swelling in the region of the submandibular gland
1b
multi
Ans. B: Majority of submandibular stones are radio-lucent
Surgery
null
d1e3de35-3e36-4bc5-b0a5-8f750dacadf6
A 90-year-old woman with mild diabetes and Alzheimer's disease die in her sleep. At autopsy, hepatocytes are noted to contain golden cytoplasmic granules that do not stain with Prussian blue. Which of the following best accounts for pigment accumulation in the liver of this patient?
Advanced age
Alzheimer disease
Congestive hea failure
Diabetic ketoacidosis
0a
single
The answer is A: Advanced age. Substances that cannot be metabolized accumulate in cells. Examples include:- (1) endogenous substrates that are not processed because a key enzyme is missing (lysosomal storage diseases) (2) insoluble endogenous pigments (lipofuscin and melanin) (3) exogenous paiculates (silica and carbon) Lipofuscin is a "wear and tear" pigment of aging that accumulates in organs such as the brain, hea, and liver. None of the other choices are associated with lipofuscin accumulation.Diagnosis: Aging, lipofuscin
Pathology
Pigmentation
a1f9efa9-99e6-46ff-ad88-35ea7697cc17
Iliac crest graft should ideally be taken from
Lateral aspect
Medial aspect
Posterosuperior aspect
Antero inferior aspect
1b
multi
null
Dental
null
9d0863a9-3345-43fc-836f-c014dd9d096a
The lymphatic drainage from the tip of tongue first passes to:
Submental nodes
Supra clavicular nodes
Sub mandibular nodes
Superior deep cervical nodes
0a
single
null
Anatomy
null
0f3deb65-cc6b-44cd-bc83-d00d4905ab22
The following statements are related to clear cell carcinoma of the vagina except :
Common to those whose mothers were given diethylstilbestrol during early pregnancy
Vaginal adenosis may progress to this conditions
The middle one-third is the commonest site
May be multicentric and may involve even the cervix as well
2c
multi
clear cell adenocarcinoma of vagina: Found in adolescent girls who have a history of intrauterine exposure to diethylstilbestrol Incidence following DES exposure is 1:1000 may develop vaginal adenosis lesion usually involves upper third of anterior vaginal wall and cervix may be involved Treatment: radical hysterectomy,vaginectomy with pelvic lymphadenectomy. D.C.DUTTA'S TEXTBOOKOF GYNECOLOGY,Pg no:339,6th edition
Gynaecology & Obstetrics
Gynaecological oncology
f0013e89-e17a-4684-a19b-c6fab23d5b3d
A 55 years old smoking presents with history of five episodes of macroscopic hematuria each lasting for about 4-5 days in the past five years. Which of the following investigations should be performed to evaluate the suspected diagnosis?
Urine microscopy and cytology
X-ray KUB
Ultrasound KUB
DTPA scan
0a
single
Ans. (a) Urine microscopy and cytologyRef: Smith 17th Edition, Pages 308-315Diagnosis of Urinary bladder carcinoma:* Cystoscopy and transurethral resection is the IOC for obvious lesions.* Urinary cytology is the IOC for carcinoma in situ.* Cytological examination of exfoliated cells from tumor is useful in detecting cancer in symptomatic patients and assessing the response to treatment.* Cytological examination is also most useful to detect early recurrence* CT and MRI are used in stagingExfoliative markers:* NMP22 (Nuclear matrix protein 22)* Hyaluronidase* Lewis X ag* Telomerase activity
Surgery
Urethra & Penis
cfb12c2d-c5d8-49d5-a2a5-42afdebbcbbf
Right shift of oxygen dissociation curve is caused by?
Hypothermia
Hypoxia
Alkalosis
HbF
1b
single
Ans. is `b' i.e., Hypoxia
Physiology
null
75f686b2-0de1-4692-b43e-e4369a67efec
The most common manifestation of congenital toxoplasmosis
Deafness
Chorioretinitis
Hepatosplenomegaly
Thrombocytopenia
1b
single
*Congenital toxoplasmosis is caused by toxoplasma gondi .The transmissibility increases but the risk of feral disease decreases with advancing pregnancy * The classical triad of toxoplasmosis includes intracranial calcification, hydrocephalus and chorioretinitis. Diagnosis is confirmed by demonstrating IgM in serum of the baby Image : Severe, active retinochoroiditis. Reference : Ghai essential pediatrics, 9 th edition, pgno :264
Pediatrics
Infectious disease
f1b5bbf5-1072-421e-87da-846c05e52a85
The diagnostic procedure not done in case of ph eochromoc ytoma.
CT scan
MRI
FNAC
MIBG scan
2c
single
FNAC "Percutaneous fine-needle aspiration of chromallin tumors is contraindicated; indeed, pheochronwcytoma should be considered before adrenal lesions are aspirated." -Harrison "Catastrophic hypeensive crisis and fatal cardiac arrhythmias can occur spontaneously or may be triggered by intravenous contrast dye or glucagon injection, needle biopsy of the mass, anesthesia, and surgical procedures." -
Pathology
null
c5dda503-75dc-43b5-bc1e-d9e3e5e5661d
Which of the following necrosis occurs characteristically in brain infarcts?
Caseous necrosis
Fibrinoid necrosis
Coagulative necrosis
Liquefactive necrosis
3d
multi
CNS parenchymal infarcts organize an influx of macrophages into the area of necrosis. The macrophages ingest the lipid-rich, necrotic parenchyma, ultimately conveing the area to a fluid-filled cavity (liquefactive necrosis). This process is usually complete by about 6 months after the development of the infarct.
Pathology
All India exam
c5a99dbe-1d66-4920-8789-b59b488a70ca
In deltoid paralysis, which nerve is involved :
Circumflex N
Musculocutaneous N
Axillary N
Radial N
2c
single
C. i.e. Axillary nerve
Anatomy
null
3733b529-ec93-41c9-8863-2d47450783b2
A 41 year old woman presented with a history of aches and pains all over the body and generalized weakness for four years. She cannot sleep because of the illness and has lost her appetite as well. She has a lack of interest in work and doesn't like to meet friends and relatives. She denies feelings of sadness. Her most likely diagnosis is -
Somatoform pain disorder
Major depression
Somatization disorder
Dissociative
1b
multi
This is a case of somatized (masked) depression which is a form of major depression in which the depressed patients may present their distress as somatic symptoms, e.g. chronic pain, anorexia (loss of appetite), insomnia (cannot sleep), paresthesia, atypical facial pain, and generalized weakness. Depressive mood is not easily apparent as it is usually hidden behind the somatic symptoms, (e.g. in this question she denies the feeling of sadness).
Psychiatry
null
5ff554e7-d44b-4733-a082-a11222f0b3c8
'Tentative cuts' are seen with
Homicide
Suicide
Culpicide
Fabricated wounds
1b
single
Ans. b (Suicide) (Ref. FMT by N. Reddy 5th/pg.93)TENTATIVE (preliminary cuts) CUTS# Hesitation cuts derive their name from the hesitation with which these incisions are made by a person intending to commit suicide by a cutting instrument.# He or she usually makes preliminary cuts before gathering sufficient courage to make final deep incision.# These are generally small, multiple, superficial, and usually skin deep.# They are seen with commencement of the incised wound and merge with the main incision.
Forensic Medicine
Injuries by Sharp Force
45815be4-f1cc-47e7-beee-c8d7b38af30a
Which of the following is FALSE about SOMATIZATION Syndrome -
Involves 2 sexual disturbance Symptoms
Two GI symptoms
Four pain symptoms
Multiple recurrent symptoms
0a
multi
Ans. is 'a' i.e., Involves 2 sexual disturbance Symptomso For diagnostic criteria at least 1 sexual symptom should be there (not two),o All other diagnostic criteria (other three options) are true.Somatization disordero The essential features of somatization disorder are multiple recurrent somatic symptoms of long duration (chronic) that are caused by psychological basis and no physical illness can be found,o The disorder begins before the age of 30 years and then has a chronic course (over a period of several years).Diagnostic criteria for somatization disordero Each of the following should be present: -Four pain symptoms: - Pain, at least at four different sites or functions - Head (headache), abdomen, back, joint, extremites, chest, rectum, during mensturation or sexual intercourse or urination.Two gastrointestinal symptoms : - Nausea, bloating, vomiting, diarrhea.One sexual symptom : - Erectile dysfunction ( Impotence), ejaculatory dysfunction, irregular menses, excessive menstural bleeding.One pseudoneurological symptom : - Conversion symptoms (impaired coordination or balance, paralysis, weakness, blindness, deafness, glove & stocking anesthesia. Paresthesia, seizure, aphonia); Dissociative symptoms (amnesia); loss of consciousness.
Psychiatry
Somatic Symptom Disorder
e82ac2dc-bfb4-413f-94c4-9e3f193d73c0
Coagulation defect associated with increased coagulation are seen in
Increased protein C
Increased protein S
Increased anti thrombin 3
Protein C resistance
3d
single
Ref Harrison 16/e p1491 ,9/e p123 Protein C and protein S are two vitamin K-dependent proteins that act in a complex to proteolytically inacti- vate cofactors Va and VIIIa. Protein C activation by thrombomodulin was described earlier; protein S is a cofactor for protein C activity Resistance to activated protein C due to the factor V R506Q (Leiden) mutation is the most common clotting abnormality in patients with venous thromboembolism
Anatomy
General anatomy
e0227b97-3cbd-4d9e-98ea-f8bd7ad5a958
Patient with leprosy, smear sample taken show 10 - 100 bacilli in one field. Bacterial index is ?
1+
2+
3+
4+
3d
single
Ans. is 'd' i.e., 4+ Bacteriological Index For Leprosy It is a rough index expressing probable number of acid fast bacilli for standardized microscopic field in skin smear. It is indicative of the load of bacteria at the site from which smear is taken. It does not differentiate between live and dead bacilli. It is not an indication of total bacillary load in the body. Ridleys scale is followed to calculate the bacterial index. = no bacilli in 100 fields 1+ = 1 - 10 bacilli in 100 fields 2+ = 1 - 10 bacilli in 10 fields 3+ = 1 - 10 bacilli in 1 fields 4+ = 10 - 100 bacilli in 1 field 5+ = 100 - 1000 bacilli in 1 field 6+ = >1000 bacilli in 1 field. Our patient has 10 - 100 bacilli in 1 field thus the bacteriological index is - 4+
Skin
null
3cddd21f-6b6b-4b9a-935b-7dc0e19b0cdb
Enteroviruses are associated with all of the following, EXCEPT:
Aseptic Meningitis
Pleurodynia
Herpangina
Hemorrhagic fever
3d
multi
Acute hemorrhagic fever is not caused by the enteroviruses. It usually causes non specific febrile illness, hand foot mouth disease, Herpangina, coryza, conjunctivitis, pericarditis, myocarditis, gastrointestinal symptoms and neurological symptoms. Ref: Kliegman, Behrman, Jenson, Stanton (2008), "Nelson Textbook of Pediatrics", Chapter 247, "Nonpolio Enteroviruses", Volume 1, Page 1350; Medical Microbiology By Jawetz , 24th Edition, Page 494; Harrison's Principle of Internal Medicine, 17th Edition, Page 1208
Microbiology
null
10dbd538-989e-48e8-973a-6e5793123479
The commonest type of Pemphigus is
Pemphigus vulgaris
Pemphigus foliaceous
Pemphigus erythematous
Pemphigus vegetans
0a
single
Pemphigus vulgaris is the most common form of pemphigus and occurs when antibodies attack Desmoglein 3. Usually begins with painful blisters in your mouth and then on the skin or genital mucous membranes. Ref Harrison20th edition pg 1334
Dental
Vestibulobullous disorders
9c350cb2-2a64-48a1-830c-e0109493d9f3
Under-running may involve:
Crush injury abdomen
Run over injury
Decapitation
Chest injury
2c
single
Under-running/ tail gating Tail-gating occasionally occurs with cars driving into the back of large trucks. In such case, the windscreen and front of the passenger compament are smashed with severe injuries to the head and in some cases decapitation of the occupants of the front seat. Also seen where the motorcyclist drives under the rear of the truck, causing head injuries and even decapitation.
Forensic Medicine
Regional injuries
2e676945-99ef-4ae1-866c-6416e4d826e4
The following branches originate directly from the subclavian artery, except
Vertebral
Thyro-cervical trunk
Internal Thoracic
Supra scapular
3d
multi
null
Anatomy
null
35daf664-ac5d-43c9-a209-1220364ea9c5
The highest quantity of lipid and lowest concentration of protein are found in
Chylomicrons
Very low density lipoproteins
Low density lipoproteins
High density lipoproteins
0a
single
null
Biochemistry
null
096ce485-a8f2-4357-9244-4f5a8d41797f
A young tourist presents with a skin lesion after being to Rajastan. He presents with an erythematous lesion on the cheek with central crusting. What is the likely dermatological condition?
Cutaneous Leishmaniasis
Systemic Lupus Erythematosis
Lupus vulgaris
Chilblains
0a
single
A typical lesion of Acute Cutaneous Leishmaniasis is papule at the site of the sand fly bite which enlarges and breaks down in the centre. The ulcer usually has a rolled border. When the lesion heals in a year's time it leaves a distinctive depressed hyper pigmented scar. The typical sites are cheeks and arms (exposed areas). Localised Cutaneous Leishmaniasis (LCL) is seen in India in the forests of Rajastan, caused mostly by Leishmania tropica. Himachal Pradesh is repoed as a recent focus. Ref: Thieme Clinical Companions Dermatology By Wolfram Sterry, Ralf Paus, Walter H. C. Burgdo; Leishmania: After the Genome By Peter J. Myler, Nicolas Fasel, Pages 2-3.
Skin
null
7b922ffe-7372-43b3-bd2d-2923c09944c0
Which of the following association is true regarding facial nerve palsy in temporal bone fractures?
Common with Longitudinal fractures
Common with Transverse Fracture
Always associated with CSF Otorrhea
Facial nerve injury is always complete
1b
multi
Longitudinal fractures of Temporal bone are more common than transverse fracture but, facial nerve injury is most commonly associated with Transverse fracture of the temporal bone.
ENT
null
4dcabed9-630e-40ca-8b8e-309f2ac4bd4b
A 1-year-old female infant has failure to thrive, poor neurologic development, and poor motor function. Physical examination shows a "cherry red" spot on the macula of the retina. The infant's muscle tone is poor. Both parents and a brother and sister are healthy, with no apparent abnormalities. One brother with a similar condition died at the age of 18 months. This genetic disorder most likely resulted from a mutation involving a gene encoding for which of the following?
Mitochondrial enzyme
Lysosomal enzyme
Cell surface receptor protein
Structural protein
1b
multi
The findings listed suggest a severe inherited neurologic disease, and the pattern of inheritance (e.g., normal parents, an affected sibling) is consistent with an autosomal recessive disorder. This inheritance pattern and the cherry red spot in the retina are characteristic of Tay-Sachs disease, caused by mutations in the gene that encodes a lysosomal enzyme hexosaminidase A. Mitochondrial genes have a maternal pattern of transmission. Mutations in genes affecting receptor proteins and structural proteins typically give rise to an autosomal dominant pattern of inheritance.
Pathology
Genetics
e72c5519-e944-45ce-8787-08de7bd530af
In prolactinoma most common symptom other than galactorrea is?
Bitemporal hemianopia
Amennorhea
Thyroid dysfuntion
Headache
1b
single
Pituitary tumors 1.Eosinophil (Acidophil) adenomas: Tumour is usually small. Rarely it causes compressive features. It secretes excess growth hormone causing acromegaly in adults and gigantism in children. 2. Chromophobe adenomas are common in females and in the age group--20-50 years. Initially, it is intrasellar and after sometime becomes suprasellar. Later, it extends intracranially often massively, causing features of intracranial space occupying lesion. It presents with myxoedema, amenorrhoea, infeility, headache, visual disturbances, bitemporal hemianopia, blindness, intracranial hypeension, epilepsy. Differential diagnosis: Meningiomas, aneurysms. CT scan, angiogram, X-ray skull are diagnostic. Treatment is surgical decompression by craniotomy through subfrontal approach or trans-sphenoidal approach. Deep external radiotherapy and steroids are also used. 3. Basophil adenomas are usually small. They secrete ACTH and presents as Cushing's disease with all its features. 4. Prolactin-secreting adenomas causes infeility, amenorrhoea and galactorrhoea. Ref: SRB's Manual of Surgery 5th Pgno : 1105
Surgery
Trauma
9e55d3c7-3554-4e70-9601-f53aee558d22
Lens develops from.
Neuroectoderm
Surface ectoderm
Mesoderm
Neural crest
1b
single
Ans. (b) Surface ectodermSurface EctodermNeural EctodermMesodermNeural Crest* Conjunctival Epithelium* Corneal Epithelium* Lacrimal gland* Tarsal gland* Lens* Smooth muscle of Iris* Iris Epithelium* Ciliary Epithelium* Retina & its pigment epithelium* Optic nerve fibre* Part of vitrous* EOM* Sclera* Iris* Vascular endothelium* Choroid* Part of vitrous* Corneal stroma* Ciliary ganglion* Schwann cell* Uveal and conj melanocytes* Meningeal sheath of ON* Part of vitrous
Ophthalmology
Miscellaneous (Lens)
3203ecaa-a38e-4ea6-a2f8-9bdc8fdbb1b5
The lower lip gets its sensory supply through the:
Buccal branch of the facial nerve
Buccal branch of the mandibular nerve
Mandibular branch of the facial nerve
Mental nerve
3d
single
null
Anatomy
null
aa333fc7-f40d-4b10-ad73-83ec9bf1f4ed
Rough, poorly polished areas of pontics may cause
Halitosis
Discomfort
Chronic inflammation of the ridge tissue
All of the above
3d
multi
null
Dental
null
9275fad7-2ffd-4508-b94f-c25531ffffb6
Manoeuvre carried out for diagnosing medial meniscus injury is: March 2010, March 2013 (c, d)
McMurray's test
Lachmann's test
Valgus stress test
Varus stress test
0a
single
Ans. A: McMurray's Test McMurray's test is performed for meniscus injury For medial meniscus: Patient lying flat (non-weight bearing), the knee is completely flexed. The foot is rotated externally and the leg abducted. The joint is now slowly extended keeping the leg externally rotated and abducted. As the torn cailage gets caught during this manoeuvre, the patient will experience pain or a click may be heard and felt.
Surgery
null
e347704c-605b-4aa7-a308-9251d308d188
A young boy came with dyspnea and was found to have a mediastinal mass. Which of the following is known to produce mediastinal lymphadenopathy?
Diffuse large B cell Lymphoma
B cell rich T cell lymphoma
Mediastinal rich B cell lymphoma
T cell Lymphoblastic ALL
3d
multi
mediastinal lymphadenopathy ,sternal tenderness and mediastinal mass are seen with ALL.
Pathology
Acute Lymphoblastic Leukemia
3cdcb8a3-7240-430c-96f7-3838086bcb59
Only male are affected in
Scheie's syndrome
Hunter's syndrome
Hurler's syndrome
Gaucher's disease
1b
single
Hunter's syndrome belongs to Type II mucopolysaccharidoses in which mucopolysaccharides accumulate in the lysosomes causing disorganization of the cell structure & function.This syndrome is characterised by mild mental retardation;marked skeletal changes like thickening of the skull,marked deformity of sella tursica,broad spatula like ribs,beak shaped veebrae(around L1 veebra) and proximal tapering of metacarpals-these abnormalities are referred to as dysostosis multiplex;coarse facies & hepatosplenomegaly. Reference:Essential pediatrics-Ghai,8th edition,page no: 660,661.
Pediatrics
Metabolic disorders
7e7393c1-0e7f-4473-916b-800944abe7ad
Adoptive immunity is by?
Infection
Injection of antibodies
Injection of lymphocytes
Immunization
2c
single
Aadoptive immunity: a special type of immunisation is the injection of immunologically competent lymphocytes. - instead of whole lymphocytes, an extract of immunologically competent lymphocytes, known as the transfer factor can be used. Reference: Anathanarayan & paniker's 9th edition, pg no:84 <\p>
Microbiology
Immunology
f6b8f3c0-c8da-4a7c-a43c-8d6d5624892c
A 41 y/o male presents with complaints of inability to achieve proper erections during sexual intercourse. He repos that there were no abnormalities till last month, when on one occasion he tried having sex with wife while he was drunk. He was not able to achieve a proper erection at that time and since than, on four other occasions , he was not able to have an erection during attempted sex. He repos that his morning erections are fine and erection during masturbation was also normal. He is a diabetic, and the blood repos show, FBS-103 mg/dl, HbA1C- 6.6. His BP was 138/88 mm Hg What is the likely cause of erection disturbances?
Anxiety
Diabetes
Alcohol
Hypeension
0a
single
History of sudden onset, normal morning erections and normal erection during masturbation is suggestive of Psychogenic Erectile dysfunction. The cause is usually performance anxiety. To differentiate between psychogenic and organic erectile dysfunction best test is ask for nocturnal / early morning erections as patient is relaxed in these conditions. So in the above case it rules out all organic causes.
Psychiatry
Sexual Disorders
feb7f7b3-2c62-43ec-b544-d585f93d48d9
All of the following can cause hypersecretion of prolactin, except?
Prolactinoma
Haloperidol
Hypothyroidism
Cabergoline
3d
multi
The function of dopamine is to supress the prolactin secretion. Prolactin agonists reduce secretion of prolactin and antagonists increase the secretion of prolactin. Cabergoline is a long acting dopamine agonist. The drug suppresses prolactin secretion. Used to treat prolactinoma. All others can cause increased secretion. High prolactin levels are also associated with Hypothyroidism.
Medicine
null
a0a269b2-39d3-4952-ac4a-b94612a51731
A 10 years boy presented with sensory neural deafness not benefited with hearing aid, Next treatment is
Cochlear implant
Fenestromy
Stapedectomy
Stapes fixation
0a
single
A. i.e. (Cochlear implant) (125- Maqbool 11th) (121- Dhingra 4th)COCHLEAR IMPLANT - is indicated in patients with bilateral severe sensorineural deafness who do not respond to amplified sound stimuli* Cochlear implants are more useful in post lingually deaf patients i.e. who lost their hearing after acquisition of language* Stapedectomy with prosthesis replacement is the treatment of choice for otosclerosis*** Pathway for extension of the infection from meninges to labyrinth - Cochlear aqueduct*** **Cochlear implants electrodes are most commonly placed at cochlea to directly stimulate the fibre of VIII. nerve
ENT
Ear
84c6ab92-006a-40fd-8ec5-cef733fb56f0
A 15-year-old boy complains of right-sided weakness and gait impairment. A CT scan shows a large, non-enhancing cyst in the posterior cranial fossa, with an enhancing tumor nodule in the left cerebellum. What is the most likely diagnosis?
An arachnoid cyst
A cystic astrocytoma
Rathke's cleft cyst
Glioblastoma multiforme
1b
single
Cystic astrocytoma's are neoplasms of the CNS. They usually consist of a large, non-enhancing cyst on the wall of which is an enhancing tumor nodule. They are most commonly found within the substance of the cerebellar hemispheres of children and young adults. A Rathke's cleft cyst is a remnant of the embryologic Rathke's pouch. These are found within the sella turcica.
Surgery
Nervous System
0fd7b0d0-2ea2-4af1-932a-d36901f0c2cc
Ketamine produces ?
Emergence delirium
Pain on injection
Bronchoconstriction
Depression of cardiovascular system
0a
single
Ans. is 'a' i.e., Emergence delirium Ketamine The primary site of action is in the coex and subcoical areas; not in the reticular activating system (site of action of barbiturates). It acts on NMDA receptors. Sho duration of action (10-15 minutes) is due to redistribution from brain and blood to other tissues of the body. Ketamine is different from most other anaesthetic induction agents in that it has significant analgesic action. Ketamine increases IOT and cerebral metabolism --> contraindicated in head injury. It causes sympathetic stimulation with elevation of HR, CO & BP --) contraindicated in hypeension and ischemic hea disease. It also raises IOT --> contraindicated in glaucoma. It relieves bronchospasm --> intravenous anaesthetic of choice in asthmatics (inhalation anaesthetic of choice in asthmatic is halothane). Injection is not painful (All other inducing agents cause pain on injection). It is i.v. anaesthetic of choice in children (Sevoflurane is inhalation agent of choice). Because it causes sympathetic stimulation it is intravenous anaesthetic of choice in patients with shock and hypovolumia. It has no muscle relaxant propey rather muscle tone is increased. Airway reflexes (pharyngeal and laryngeal) are not depressed --> intravenous anaesthetic of choice for emergency anaesthesia (no starvation is required). Ketamine produces emergence reaction during awakening from anaesthesia --> vivid dreaming, illusions, extracorporeal experiences, excitment, confusion, fear and euphoria --> contraindicated in psychiatric illness like schizophrenia.
Anaesthesia
null
f9272077-b4e0-4691-ade0-a5fa3bfccb06
Splenectomy is done to tide over the acute crises of uncontrollable:
ITP
TTP
HUS
All of the above
0a
multi
Indications of splenectomy in ITP: Failure of medical therapy Prolonged use of steroids with undesirable effects Most cases of first relapse Splenectomy provides a permanent response without subsequent need for steroids in 75-85% of patients. Laparoscopic splenectomy has become the gold standard for ITP patients. Responses usually occur within the first postoperative week.
Surgery
Spleen
90b3f354-77a5-487c-ad11-1698f2a7bbee
Osteoahritis not seen in ?
Ankle joints
Knee joints
Hip joints
I stmetacarpophalangeal joint
0a
single
Ans. is 'a' i.e., Ankle joints OA affects ceain joints, yet spares others. Commonly affected joints include the cervical and lumbosacral spine, hip, knee, and first metatarsal phalangeal joint (MTP). In the hands, the distal and proximal interphalangeal joints and the base of the thumb are often affected. Usually spared are the wrist, elbow, and ankle. Our joints were designed, in an evolutionary sense, for brachiating apes, animals that still walked on four limbs. We thus develop OA in joints that were ill designed for human tasks such as pincer grip (OA in the thumb base) and walking upright (OA in knees and hips). Some joints, like the ankles, may be spared because their aicular cailage may be uniquely resistant to loading stresses.
Surgery
null
6ec7e218-c7ca-4232-836e-b7b0feddaefc
Compared with cow's milk, mother's milk has more-
Lactose
Vitamin D
Proteins
Fat
0a
single
Ans. is 'a' i.e., Lactose Lactose (g) Cow's milk 4.4 Human milk 7.4 Proteins (g) 3.2 1.1 Fat (g) 4.1 3.4 Calcium (mg) 120 28 Iron (mg) 0.2 1.0 Water (g) 87 Energy (Kcal) 67 65
Social & Preventive Medicine
null
0946bf0a-8374-4bfc-a0d4-af39a888a610
Characteric finding in restrictive lung disease is:
Decreased FEV1
Increased TLC
Normal FEV1/VC
All
2c
multi
Ans. c (Normal FEV, /Vc). (Ref. Harrison, Principles of Medicine, 18th/1448)OBSTRUCTIVE PATTERNRESTRICTIVE PATTERN (Al 2005)EXTRAPARENCHYMAL PATTERN (INSPIRATORY DYSFUNCTION)Decreased expiratory flow rates (hallmark)Normal forced expiratory flow ratesExpiratory flow rates not affectedDecreased FEV1/VC (in fully established disease)-FEVl/FVC variableTLC normal or increased (Minor change)Decreased lung violume (TLC and VC)TLC not predictableIncreased residual volume (striking)Decreased residual volumeIncreased RVIncresed ratio of RV/TLC--Decreased VC-Decreased MIP
Medicine
Respiratory
0aa64051-b76f-448a-aa96-ca40a043c2c6
Down beat nystagmus is seen in?
Arnold chiari malformation
Brain stem damage
Pontine hemorrhage
Labyrinthine damage
0a
single
Ans. is 'a' i.e., Arnold chiari malformation Down-beat nystagmus are seen in cerebellar lesion and Arnold-chiary malformation
Ophthalmology
null
24b818e3-feae-4620-b7f0-a2c2123770c0
Which of the following is not true for ZollingerEllison syndrome: September 2008
Recurrence after operation
Reduced BAO : MAO ratio
Gastrin producing tumour
Diarrhoea may be a presenting feature
1b
multi
Ans. B: Reduced BAO : MAO ratio Zollinger-Ellison syndrome (ZES) is a rare condition characterized by peptic ulcers that are refractory to conventional medical therapy. Gastrin-producing tumors or gastrinomas cause excessive gastric acid secretion, leading to ulcers of the upper GI tract, as well as diarrhea and severe abdominal pain. Laboratory studies to confirm the diagnosis of ZES include the following: Measurements of fasting serum gastrin levels - Gastrin levels higher than 100 pg,/mL are highly suggestive of ZES. If the gastric pH level is less than 2.5, a gastrin level of higher than 1000 pg/mL is diagnostic of ZES. If the patient is not receiving acid-suppressing medication and the gastric pH levels are higher than 2, ZES can be ruled out. Secretin stimulation test After blood to measure the basal gastrin level is obtained, 2 IU/kg of secretin is intravenously administered. Blood is obtained at 2.5 minutes, 5 minutes, 10 minutes, 15 minutes, and 30 minutes. An increase of serum gastrin levels to higher than 200 pg/mL is diagnostic of ZES. - It is the most impoant diagnostic test to exclude other conditions with increased acid secretion, hypergastrinemia, or both. - Clinical conditions in which patients present with hypergastrinemia, such as gastric outlet obstruction, pernicious anemia, renal failure, and achlorhydria due to atrophic gastritis, must be excluded with secretin provocative testing. Measurement of basal acid output - Before measurement of the basal acid output (BAO), acid-inhibitory agents must be discontinued: 24 hours for H2 receptor antagonists and 7 days for proton pump inhibitors (PPIs). - In the 24 hours prior to the test, the patient receives antacids. - In an unoperated stomach, a BAO of more than 15 mEq/h is diagnostic of Zollinger-Ellison syndrome. If the patient underwent gastric resection for acid reduction, a BAO of more than 10 mEq/h is diagnostic for Zollinger-Ellison syndrome. If the patient has multiple endocrine neoplasia type 1 (MEN-1), other laboratory abnormalities may be suggestive of Zollinger-Ellison syndrome. - High plasma calcium levels High parathyroid hormone (PTH) levels - High prolactin levels
Surgery
null
83ad06ae-c3bc-4774-bd5b-c6b037c9a88a
All are seen in Malignant hyperthermia except :
Bradycardia
Hyperkalemia
Metabolic acidosis
Hypertension
0a
multi
null
Unknown
null
806ab85f-ad81-4119-80d5-d1914fee41ae
Edman's reagent is -
2-4 dinitrophenol
1 -fluoro-2, 4-dinitrobenzene
Phenyl-isocyanate
Cynogen bromide
2c
single
Ans. is 6c' i.e., Phenyl-isocyanateo Determination of amino acid sequence (sequence analysis) is performed by Edman degradation method on automatic mechines, called cyclic sequentors. Edman's reagent is phenyl-isothiocyanate, and forms a covalent bond to N- terminal of amino-acid. This can be identified.o Sanger's reagent (l-fluoro-2,4-dinitrobenzene) can be used in place of Edman's reagent.
Biochemistry
Proteins and Amino Acids
094776a9-8ba4-4f25-b216-64304d58165b
Farmer presents with the features of high fever, painful inguinal lymphadenopathy, vomiting and diarrhea and 'Ivpotension. Which stain will help in the diagnosis
Neisser stain
Wayson's stain
Albe's stain
McFadyean's stain
1b
single
Ans. b. Wayson's stain Farmer presents with the features of high fever, painful inguinal lymphadenopathy, vomiting and diarrhea and hypotension. This clinical picture is suggestive of Bubonic plague. Bubonic plague Bubonic plague symptoms can occur within two to six days of being infected by the bacteria Yersinia pestisdeg. If left untreated, symptoms, such as vomiting, abdominal pain, and diarrhea, can progress rapidly to septicemic plaguedeg. Approximately 10 to 20 percent of people with bubonic plague symptoms will also develop symptoms in the lungs. This is called pneumonic plague, and is often fataldeg. Plague Caused by bacteria Yersinia pestisdeg. Animal reservoir for Yersinia pestis: Rodentsdeg Vector: Rat flea (Xenopsylla cheopsisdeg) carries infection from rat to rat and rat to humans Characterized by rapid onset of fever and other systemic manifestations of Gram (-)ve bacterial infections. It is of Bubonic Plague Incubation period 2-7 daysdeg MC type of plague and almost always caused by bite of infected fleadeg. MC site of bubo- femoral, inguinal regiondeg >axillary, cervical. Distinguished from lymphadenitis by its rapid onset, its extreme tenderness, accompanying signs of toxemia and absence of cellulites or obvious ascending lymphadenitis DIC is common and may lead to gangrenedeg. Y. pestis can also be cultured from blood of most bubonic plague patientdeg. Septicemic Plague: Often present with GI symptoms, DIC, multiorgan failuredeg Incubation period 2-7 days Pneumonic Plague Most infectious, most fatal type of plague with incubation period of 1-3 daysdeg Primary pneumonia: Cyanosis is very prominent, with bloody mucoid sputumdeg Secondary pneumonia: Diffuse interstitial pneumonia, less infectious. Diagnosis Yersinia pestis is best demonstrated by polychromatic stains (Wayson, Wright-Giemsadeg). These polychromatic stains accurately highlight bipolar stainingdeg characteristics of these gram negative bacilli
Microbiology
null
38360e1d-5d6a-4427-945a-25daacdbc13e
Area of Cornea indented in Goldman Applanation tonometer for measuring IOP
3.66mm
3.6mm
3.0mm
3.06mm
3d
single
Area of Cornea indented in Goldman Applanation  tonometer  for measuring IOP is 3.06mm.
Ophthalmology
null
74f810fb-59d2-417d-87d0-3590eba9c585
Not used in the treatment of Juvenile Larynegeal papillomatosis
INF α
INF β
Bevacizumab
Cedofovir
1b
single
null
ENT
null
f79c7007-034c-4da7-9940-b5ed6385083f
The commonest extradural spinal tumour is ?
Neurofibroma
Glioma
Meningioma
Metastasis
3d
single
Ans. is 'd' i.e., Metastasis
Surgery
null
18e37ea6-e4b5-479c-966b-2a92cab18158
Causes of acute flaccid paralysis -
Poliomyelitis
Tick paralysis
ADEM
All of the above
3d
multi
null
Medicine
null
37f710ed-5b93-4a98-8232-6eed3b95a8e8
A 45 year old woman presents with a hard and mobile lump in the breast. Next investigation is -
FNAC
USG
Mammography
Excision biopsy
0a
single
Ans. is 'a' i.e., FNAC In any patient with a breast lump or other symptoms suggestive of carcinoma, diagnosis should be made by a combination of : 'Triple Assessment' : a. Clinical assessment b. Radiological imaging c. Tissue sampling for either cytological or histological examination. FNAC is more than often the first investigation for a tissue assessment. Bailey writes ? "FNAC is the least invasive technique for obtaining a cell diagnosis and is very accurate if both operator and cytologists are experienced. However false negatives do occur, mainly through sampling error, and invasive cancer cannot be distinguished from 'in situ' disease. A histological specimen taken by core biopsy allows a definitive preoperative diagnosis, differentiates between duct carcinoma in situ (DCIS) and invasive disease and also allows the tumor to be stained for receptor status. This is impoant before commencing neoadjuvant therapy."
Surgery
null
e00fddd9-6e29-4595-b6d6-50621e789563
Primary Regulator for central chemoreceptor -
PaCO2
PCO2
H+
O2
2c
single
Ans. is 'c' i.e., H+ Central chemoreceptors o These receptors are located in a chemosensitive area on the ventral surface of the medulla near the exit of the ninth and tenth cranial nerves. The primary stimulus for the central chemoreceptors is an increase in the hydrogen ion concentration. Stimulation of central chemoreceptors by increased hydrogen ion concentration leads to excitation of the respiratory neurons, thereby producing an increase in the rate and depth of respiration o Although the primary stimulus for central chemoreceptors is an increase in hydrogen ion concentration, in actual practice the physiological stimulus is an increase in PCO2. The reason is that hydrogen ions cannot cross the blood-brain barrier. Therefore, a change in the blood hydrogen ion concentration does not change the hydrogen ion concentration in the immediate vicinity of the chemosensitive neurons (i.e., in CSF and brain interstitial fluid). On the other hand, CO2 being lipid soluble can easily cross the blood-brain barrier. It enters the brain, where it is hydrated to give rise to H+ and HCO2 ions. Now these H+ directly stimulate the central chemoreceptors. o Thus, central chemoreceptors are directly stimulated by an increase in H+ concentration in CSF and brain interstitial tissue, which is brought about by the change in arterial PCO2 (PaCO2). o Change in CSF & Brain interstitial tissue - | H+ concentration (Primary direct stimulus) o Change in Blood - | PCO2 (Actual physiological stimulus). o Central chemoreceptors are not stimulated by hypoxia; rather like any other cells, they are depressed by hypoxia.
Physiology
Regulation of Respiration
6a835aa8-6ce4-4237-b3b7-90c901697777
The commonest cause of primary Amenorrhoea is:
Genital tuberculosis
Ovarian dysgenesis
Mullerian duct anomalies
Hypothyroidism
1b
single
Most common cause of Primary Amenorrhea = Gonadal dysgenesis/ovarian dysgenesis 2nd most common cause of Primary Amenorrhea = Mullerian agenesis (Mayer Rokitansky Kuster Hauser Syndrome)  “Mullerian agenesis is a relatively common cause of primary amenorrhea, more frequent than congenital androgen insensitivity and second only to gonadal dysgenesis”  3rd most common cause is testicular feminizing syndrome.
Gynaecology & Obstetrics
null
300a84bb-a38f-48f8-9351-fe4702ed5551
All the following types of hypersensitivity reactions can be demonstrated by skin test except ?
Type I
Type II
Type III
Type IV
1b
multi
Ans. is 'b' i.e., Type II Has been explained
Microbiology
null
d31d7a90-ab98-44ce-a50f-5e9188e5ca85
All of these hormones use cAMP as second messenger except:
Corticotropin
Dopamine
Glucagon
Vasopressin
3d
multi
Ans. (D) Vasopressin(Ref: Katzung 11/e p301, Gationg 22/e p41-43)Vasopressin acts via V1 and V2 receptors. V1 receptors use IP3 -DAG-Ca2+ pathway whereas V2 use cAMP as second messenger. All other drugs mentioned in the question act by cAMP pathway only. Thus, all of these use cAMP as second messenger, but if we need to choose one option we can answer vasopressin as it is acting through IP3 -DAG-Ca2+ pathway also.
Pharmacology
Endocrinology
efd7312d-6635-4163-9508-fc2785ac421f
An elderly multigravida female presents in labor. She has multiple fibroids in lower uterine segment. Management is:
Vaginal delivery
Trial of labor
LSCS
Classical cesarean followed by hysterectomy
3d
single
Ans. is d, i.e. Classical cesarean section followed by hysterectomySince this female is multigravida with multiple fibroids in lower uterine segments - vaginal delivery is not possible as multiple fibroids are present in lower uterine segment. We will have to do cesarean - but LSCS is also not feasible due to fibroids in lower segment (a lot of bleeding will occur if we cut through fibroid). Hence classical cesarean section should be done. The treatment of multiple fibroids in a multipara is hysterectomy, so classical cesarean section should be followed by hysterectomy).
Gynaecology & Obstetrics
Operative Obs
e9e36fed-87e2-455b-9a0b-a62f3bf54a27
All post-operative patients must be supplemented with oxygen concentration of at least :
50-60%
40-45%
30-35%
20-25%
2c
multi
null
Surgery
null
a0ac5899-caa4-479f-904c-70282a6f1255
Microfalaria in Culex depicts what kind of Biological transmission?
Cyclo-developmental
Cyclo-propagative
Developmental
Propagative
0a
single
Microfalaria in culex is an example of cyclo-developmental transmission. In Culex mosquito, it undergoes only development. stages will change There is no multiplication taking place in it. TYPES OF BIOLOGICAL TRANSMISSION- Propogative transmission Cyclo-developmental Cyclo-propogative
Social & Preventive Medicine
Other Key Definitions & Concepts
025acc86-47be-449f-8d13-acd582532027
All extra-ocular muscles are supplied by the oculomotor nerve except
Superior rectus
Inferior oblique
Lateral rectus
Medial rectus
2c
multi
The superior oblique is supplied by the trochlear nerve The lateral rectus is supplied by abducent nerve The superior rectus, inferior rectus, medial rectus and inferior oblique are supplied by occulomotor nerve Ref BDC volume 3,sixth edition pg 208
Anatomy
Head and neck
ea5e485a-1529-49c8-9d6e-331ab509dbb8
Which of the following chemical mediator of inflammation is an example of a C-X-C or alpha chemokine
Lipoxin LXA4
Interleukin IL8
Interleukin IL 6
Monocyte chemo attractant protein MPC1
1b
single
Ref Robbins 9/e p87 IL-8, also known as neutrophil chemotactic factor, has two primary functions. It induces chemotaxis in target cells, primarily neutrophils but also other granulocytes, causing them to migrate toward the site of infection. IL-8 also stimulates phagocytosis once they have arrived. IL-8 is also known to be a potent promoter of angiogenesis. In target cells, IL-8 induces a series of physiological responses required for migration and phagocytosis, such as increases in intracellular Ca2+, exocytosis (e.g. histamine release), and the respiratory burst. IL-8 can be secreted by any cells with toll-like receptors that are involved in the innate immune response. Usually, it is the macrophages that see an antigen first, and thus are the first cells to release IL-8 to recruit other cells. Both monomer and homodimerforms of IL-8 have been repoed to be potent inducers of the chemokine receptors CXCR1 and CXCR2. The homodimer is more potent, but methylation of Leu25 can block the activity of homodimers.
Anatomy
General anatomy
0e8fa3cf-c409-4f0a-8623-32daa1aeca56
Epidural anaesthesia is preferred over spinal anaesthesia because: September 2006
Prolonged duration of effect
Cheaper
Less incidence of intravascular injection
Less incidence of epidural hematoma
0a
single
Ans. A: Prolonged duration of effect Epidural anaesthesia, a form of regional anaesthesia involving injection of drugs through a catheter placed into the epidural space. The injection can cause both a loss of sensation (anaesthesia) and a loss of pain (analgesia), by blocking the transmission of signals through nerves in or near the spinal cord The anaesthetist may use epidural analgesia in addition to general anaesthesia. This may reduce the patient's requirement for opioid analgesics. This is suitable for a wide variety of surgery, for example gynaecological surgery (e.g. hysterectomy), ohopaedic surgery (e.g. hip replacement), general surgery (e.g. laparotomy) and vascular surgery (e.g. open aoic aneurysm repair) which are longer duration surgeries. Other features of epidural anaesthesia: Expensive compared to spinal anaesthesia More incidence of intravascular injection (epidural space has venous plexus of Batson) More incidence of epidural hematoma Level of block can be changed by increasing the dose through the catheter
Anaesthesia
null
e8e6d29f-7524-49ca-9d4f-4460cd353462
Which of the following drugs cause relaxation of LES? 1. Nitrates 2. Histamine blockers 3. Morphine 4. Atropine 5. Calcium channel blockers
1,2 & 3
1,4 & 5
1,2 & 5
All
1b
multi
Factor causing relaxation of LES Factor increasing LES pressure Pharmacological agents:nitrates, anticholinergics, barbiturates, calcium channel blockers, caffeine, theophylline, diazepam, dopamine, prostaglandin E1 and E2 and meperidine Pepperdine Chocolate Coffee Alcohol Smoking Fat Antacids Cholinergics Domperidone Metoclopramide Prostaglandin F2 Also know: LES pressure is higher in the supine position than in the upright position. Ref: Schwarz 9/e, Page 812; Harrison 17/e, Page 1741.
Surgery
null
83b3d1eb-c31c-4045-9d0f-85378a4ba217
Plasma membrane is freely permeable to -
Glucose
Urea
Glycerol
Alcohol
3d
single
Ans. is 'd' i.e., Alcoholo As the major middle portion of membrane (core of the membrane) is formed by hydrophobic region of phospholipids, this portion is impermeable to the usual water-soluble substances, such as ions, glucose and urea.o Conversely, fat-soluble substances, such as oxygen, carbon dioxide, and alcohol, can penetrate this portion of the membrane with ease.o Permeability coefficient and permeability of some important molecules in increasing order of frequency are Na+ < K+ < Cl- < Glucose < Tryptophan < Urea = Glycerol< Indole < H2O.
Physiology
Nervous System
a847d0a6-6a8b-4829-82f0-456ac21691bf
Which of the following drugs is not useful in the management of Postpaum Hemorrhage(PPH)?
Mifepristone
Misoprostol
Oxytocin
Ergotamine
0a
single
Mifepristone is a progestin analogue and it blocks the effects of progesterone. It is used as a medical termination of pregnancy in the first trimester and as a post-coital contraceptive. While misoprostol, oxytocin and ergotamine are oxytocics and as uterine stimulants are used in the management of postpaum hemorrhage. Ref: Dutta textbook of Obstetrics 6th edition, Pages 175, 550, 411-22
Gynaecology & Obstetrics
null
1d2bdc84-54fe-4039-b3e2-a9e1f89db629
Which is not a alkylating agent?
Cyclophosphamide
Chlorambucil
5-FU
Melphalan
2c
single
5-FU is an metabolite
Pharmacology
All India exam
d0e3a4ce-3d2f-44cc-b425-ad3a7e55b7c5
100% Oxygen is not effective in: March 2005
Pulmonary edema
MI
Tetralogy of fallot
COPD
2c
multi
Ans. C: Tetralogy of fallot
Medicine
null
9789dcf5-540d-4cd0-8e7a-d13b9dfd31b4
The lymph nodes first involved in cancer of the skin of the scrotum are -
Superfical inguinal
External iliac
Para aortic
Gland of Cloquet
0a
single
• Squamous cell carcinoma of scrotumQ, most commonly resulted from exposure to environmental carcinogens including chimney soot, tars, paraffin and petroleum products. • Superficial inguinal lymph nodes are the first lymph nodes involved.  Risk Factors • Most cases results from poor hygiene and chronic inflammation. Diagnosis • Diagnosis is established by biopsy of scrotal skin. Treatment • Wide excision with 2 cm margins should be performed for malignant tumors. • Prognosis correlates with presence or absence of nodal involvement.
Surgery
null
7e6261a2-7fc3-4c85-ab54-63c5dab33faf
The primary therapy to prevent oesophageal varices is :
Surgical approaches
Sclerotherapy
TIPPS
Shunt operation
1b
single
The treatment of patients with varices that have never bled is usually referred to as prophylactic therapy (eg, prophylactic sclerotherapy or prophylactic propranolol). By convention, procedures performed on patients who have bled previously are referred to as therapeutic (eg, therapeutic shunts). Prophylactic therapy is of value, since the moality rate of variceal bleeding is high (25%), the risk of bleeding in patients with varices is relatively high (30%), and varices can often be diagnosed before the initial episode of bleeding. Ref :Jarnagin W.R. (2010). Chapter 24. Liver & Poal Venous System. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
Surgery
null
16826f89-a0cc-41a1-bac5-5664c2d97345
The followng does not occur with asbestosis -
Methaemoglobinemia
Pneumoconiosis
Pleural mesothelioma
Pleural calcification
0a
single
Ref:Textbook of pathology (Harsh mohan) 6th edition,page no.492 Overexposure to asbestos is associated with 3 types of lesions: asbestosis, pleural disease and ceain tumours. A. ASBESTOSIS. The gross pulmonary fibrosis caused by asbestos exposure and histologic demonstration of asbestos bodies on asbestos fibres is termed asbestosis. Grossly, the affected lungs are small and firm with cailage-like thickening of the pleura. The sectioned surface shows variable degree of pulmonary fibrosis, especially in the subpleural areas and in the bases of lungs . The advanced cases may show cystic changes. Histologically, the following changes are observed: 1. There is non-specific interstitial fibrosis. 2. There is presence of characteristic asbestos bodies in the involved areas . These are asbestos fibres coated with glycoprotein and haemosiderin and appear beaded or dumbbell-shaped. The coating stains positively for Prussian blue reaction. 3. There may be changes of emphysema in the pulmonary parenchyma between the areas of interstitial fibrosis. 4. The involvement of hilar lymph nodes in asbestosis is not as significant as in silicosis. B. PLEURAL DISEASE. Pleural disease in asbestos exposure may produce one of the following 3 types of lesions: 1. Pleural effusion. It develops in about 5% of asbestos workers and is usually serious type. Pleural effusion is generally accompanied by subpleural asbestosis. 2. Visceral pleural fibrosis. Quite often, asbestosis is associated with dense fibrous thickening of the visceral pleura encasing the lung. 3. Pleural plaques. Fibrocalcific pleural plaques are the most common lesions associated with asbestos exposure. Grossly, the lesions appear as circumscribed, flat, small (upto 1 cm in diameter), firm or hard, bilateral nodules. They are seen more often on the posterolateral pa of parietal pleura and on the pleural surface of the diaphragm. Microscopically, they consist of hyalinised collagenous tissue which may be calcified so that they are visible on chest X-ray. Asbestos bodies are generally not found within the plaques. C. TUMOURS. Asbestos exposure predisposes to a number of cancers, most impoantly bronchogenic carcinoma and malignant mesothelioma . A few others are: carcinomas of oesophagus, stomach, colon, kidneys and larynx and various lymphoid malignancies. 1. Bronchogenic carcinoma is the most common malignancy in asbestos workers. Its incidence is 5 times higher in non-smoker asbestos workers than the nonsmoker general population and 10 times higher in smoker asbestos workers than the other smokers. 2. Malignant mesothelioma is an uncommon tumour but association with asbestos exposure is present in 30 to 80% of cases with mesothelioma. The exposure need not be heavy because mesothelioma is known to develop in people living near asbestos plants or in wives of asbestos workers.
Pathology
Respiratory system
8ab48902-c522-444c-9539-1f3f016e9726
True about phobia are all, except: NIMHANS 08; NEET 13
Generalized anxiety
Avoiding paicular situation
Fear and anxiety of specific thing
Insight is present
0a
multi
Ans. Generalized anxiety
Forensic Medicine
null
6683f089-c480-4c20-a8be-cc5bb8105d32
An adolescent is brought to the emergency depament following an episode of myoclonic jerks at morning after waking up. His consciousness was not impaired. His EEG shows generalized 3-4 Hz spike and slow wave complexes. Most probable diagnosis is?
Generalized tonic clonic seizure
Absent seizure
Temporal lobe epilepsy
Juvenile myoclonic epilepsy
3d
single
Juvenile myoclonic epilepsy is a subtype of idiopathic generalized epilepsy with onset usually between 8 and 20 years of age. Myoclonic jerks, especially in the morning, are of variable intensity ranging from simple twitching ("flying saucer syndrome") to falls; consciousness is not impaired in it. It is precipitated by alcohol and sleep deprivation. Patients will have normal intelligence. The typical interictal EEG abnormality consists of a generalized 4- to 6-Hz spike or polyspike and slow-wave discharges lasting 1-20 seconds. Usually, 1-3 spikes precede each slow wave. Also know: In Generalized tonic clonic seizure EEG shows a normal background with generalized epileptiform discharges such as spike or polyspike wave complexes at 2.5 to 4 Hz. During absence seizures there is an abrupt onset of bilaterally synchronous and symmetrical 3 Hz spike-wave discharge, irrespective of whether typical absences are simple or complex. Ictal recordings from patients with typical temporal lobe epilepsy usually exhibit 5-7 Hz, rhythmic, sharp theta activity, maximal in the sphenoidal and the basal temporal electrodes on the side of seizure origin. Ref: A-Z of Neurological Practice: A Guide to Clinical Neurology By Andrew J. Larner, Alasdair J Coles, Neil J. Scolding, Roger A Barker, 2011, Page 368 ; Clinical Electroencephalography by Misra,2005, Page 188
Pediatrics
null
f9e30cbe-04b7-496d-a3fb-17843c17df59
Thiopentone is not used in?
Induction of anesthesia
Medically induced coma
As truth serum
As antidepressant
3d
multi
Ans. is 'd' i.e., As antidepressant
Anaesthesia
null
b04c0b13-32db-4f4b-a75a-fb7e643bcc85
True about tracheal bifurcation -
At lower border of T4
At lower border of T4 Tracheal ring has hoop-shaped process
Called Carina
All of the above
3d
multi
Trachea The trachea is 10-15 cm long tube formed by C-Shaped hyaline cartilaginous rings and fibromuscular membrane. It extends from the lower border of cricoid cartilage (at C6 level) to lower border of T4 or upper border of T5 vertebra (T4-T5 disc space) where it bifurcates. Its external diameter is about 2 cm in males and about 1.5 cm in females. It has 16-20 cartilaginous rings. The first tracheal ring is the broadest. The last ring at tracheal bifurcation shows carina, a triangular hoop-shaped process separating the bronchi, i.e. Carina is a bifurcation of the trachea. The trachea is lined by ciliated columnar epithelium.  It is supplied by the inferior thyroid artery and is drained by left brachiocephalic vein.  Sensory and motor supply to the trachea is provided by the parasympathetic system through vagi and recurrent laryngeal nerve. Vasomotor supply is by sympathetic fibres through middle cervical ganglion along inferior thyroid arteries.
Anatomy
null
9fc4737e-dcf3-494f-ab2f-7656da2f5a0f
Autopsy of lung of an old man shows that the bronchi are lined by stratified squamous epithelium. What is this change
Metaplasia
Dysplasia
Hyperplasia
Hypertrophy
0a
single
null
Medicine
null
3607051a-f54b-4f28-b274-657ac23afdc4
How does hyperammonemia inhibit TCA cycle?
By depleting alpha ketoglutarate
By depleting oxaloacetate
By increasing concentration of alpha ketoglutarate
By increasing concentration of oxaloacetate.
0a
single
Build up of cummonemia which occurs in urea cycle disorder or advanced liver disease, inhibits TCA cycle by depleting alpha ketoglutarate.
Biochemistry
null
f9db1cc5-7776-474c-a460-7fe530c244ef
True regarding neoplasms of the ovary are:a) Stromal invasion is commonly present in ovarian tumours of borderline malignancyb) Lymphocytic infiltration is characteristic to dysgerminomac) Presence of ascites and pleural effusion in Brenner tumour indicates poor prognosisd) Endometrioid carcinoma of the ovary may coexist with endometrial adenocarcinoma
c
d
bd
ac
2c
multi
null
Gynaecology & Obstetrics
null
6811467f-02fe-4237-b138-812a49c8544e
Genital ulcer is/are caused by – a) HPVb) HSVc) HIVd) Treponema pallidum
c
d
ab
bd
3d
multi
null
Dental
null
fd7fd408-f792-4af9-b1dc-d47cbd60bf77
The most common cause of painful pericarditis is
Viral
Tuberculous
Uraemic
All of these
0a
multi
The cause of pericarditis is believed to be most often due to a viral infection. Other causes include bacterial infections such as tuberculosis, uremic pericarditis, following a hea attack, cancer, autoimmune disorders, and chest trauma Ref: guyton and hall textbook of medical physiology 12 edition
Physiology
G.I.T
6977c03b-e61d-4987-b682-05272eadd984
Most common site of ectopic salivary gland is?
Cheek
Palate
Angle of mandible
Tongue
2c
single
Ans is 'c' i.e. Angle of mandible * An accessory salivary gland is ectopic salivary gland tissue with a salivary gland duct system. The most common location of accessory salivary gland tissue is an extra major salivary gland in front of the parotid gland.* Salivary gland heterotopia is where salivary gland acini cells are present in an abnormal location without any duct system. The most common location is the cervical lymph nodes.* Most common ectopic salivary gland tissue is Stafne bone cyst.* It presents as asymptomatic, clearly demarcated radiolucency of the angle of mouth, characteristically, below inferior dental neurovascular bundle.
Pathology
Head & Neck
4733182d-6f89-4adb-9b69-fd444a865865
All of the following are reducing sugars except
Glucose
Lactose
Maltose
Sucrose
3d
multi
null
Biochemistry
null
011cb59e-80e7-48fe-aeba-65cc0fef4c7b
An eight-year-old boy had abdominal pain, fever with bloody diarrhea for 18 months. His height is 100 cm and weight is 14.5 kg. Stool culture was negative for known entero-pathogens. The sigmoidoscopy was normal. During the same period child had an episode of renal colic and passed urinary gravel. The Mantoux test was 5 x 5 mm. The most probable diagnosis is:
Ulcerative colitis
Crohn's disease
Intestinal tuberculosis
Strongyloidiasis
1b
single
The boy in question is obviously malnourished (Expected weight is 20-25 kg and expected height is 125-130 cm) A normal sigmoidoscopy rules out ulcerative colitis as it extends in a continuous fashion proximally from the rectum. A negative Mantoux test goes against active tuberculosis and a negative stool culture also rules out strongyloidiasis. Interpretation of Mantoux test: If the width of the induration is: >= 10 mm: Positive (tuberculin reactors) 6-9 mm: Equivocal/doubtful reaction <=5 mm: Negative reaction Hence, the obvious choice left is option '2', i.e. Crohn's disease.
Pediatrics
Disorders of Gastrointestinal System Including Diarrhea
50a57ec8-b2c2-4b56-a95c-e46e81b7754e
All are autosomal recessive EXCEPT: September 2004
Sickle cell anemia
Phenylketonuria
Marfan's syndrome
Wilson's disease
2c
multi
Ans. C i.e. Marfan's syndrome Marfan syndrome is a disorder of connective tissue, manifested principally by changes in the skeleton, eyes, and cardiovascular system. It is transmitted by autosomal dominant inheritance.
Pathology
null
b68402ae-7fa5-4906-8fb4-b29892aedac0
All the following drugs are used for Absence seizures except –
Clonazepam
Phenytoin
Valproate
Ethosuximide
1b
multi
null
Pediatrics
null
289f747d-3981-4aa2-baa2-07b6acabd6ef
Minimum thickness of calcium hydroxide required to protect near or actual pulp exposure is?
2-3 mm
0.5-1mm
3-4mm
5mm
1b
single
null
Dental
null
fb4f5360-e332-4c05-8032-0131e2a53d1d
A 17-year-old girl with amenorrhea, atrophied breast, hypoplastic uterus :
Turner's syndrome
Gonadal dysgenesis
Androgen insensitivity syndrome
Klinefelter's syndrome
0a
single
Turner's syndrome Phenotype is female Karyotype is 45,XO Sho stature,webbed neck underdeveloped uterus and vagina ovaries lack graffian follicles breasts are not developed,axillary and pubic hair is scanty or absent SHAW'S TEXTBOOK OF GYNAECOLOGY,pg no:111,115th edition
Gynaecology & Obstetrics
Sexuality and intersexuality
e4f1328b-a894-4abd-ab8a-c902d5eac926
All are fibrinolytic, except -
Streptokinase
Urokinase
Alteplase
Epsilon amino caproic acid
3d
multi
Ans. is 'd' i.e., Epsilon amino caproic acid
Pharmacology
null