. Developmental milestones:- GROSS MOTOR DEVELOPMENT: 2 months: Holds head in plane of rest of the body when held in ventral suspension. In prone position in bed, the chin lifts momentarily. 3 months:lift head above the plane of the body. Head control stas by 3 months and fully developed by 5 months. 4 months:Remain on forearm suppo if put in prone position, lifting the upper pa of the body off the bed. 5 months: Rolls over. 6 months:sit in tripod fashion. 8 months: sits without suppo., crawling 9 months: Takes a few steps with one hand held. Pulls to standing and cruises holding on to furniture by 10 months. 10 months: creeps 12 months:creeps well, walk but falls, stand without suppo. 15 months: walks well, walks backward/ sideways pulling a toy. May crawl upstairs. 18 months: Runs, walks upstair with one hand held. Explores drawers 2 years: walk up and downstairs, jumps. 3 years : rides tricycle, alternate feet going upstairs. 4 years: hops on one foot, alternate feet going downstairs. 5 years:skips FINE MOTOR DEVELOPMENT:- 2 months- eyes follow objects to 180 deg. 3 months-Grasp reflex disappears and hand is open most of the time. 4 months- Bidextrous approach( reaching out for objects with both hands). 6 months- Unidextrous approach( Reach for an object with one hand). 8 months- radial grasp sta to develop. Turns to sound above the level of ear. 9 months- immature pincer grasp, probes with forefinger. 12 months-Unassisted pincer grasp. Releases object on request.Uses objects predominantly for playing, not for mouthing. Holds block on each hand and bang them together. 15 months- imitate scribbling , tower of two blocks 18 months- scribbles, tower of 3 blocks.turn pages of a book, 2-3 at a time. 2 years- tower of 6 blocks, veical and circular stroke. 3 years-Tower of 9 blocks, dressing and undressing with some help, can do buttoning. 4 years- copies cross, bridge with blocks 5 years- copies triangle, gate with blocks. SOCIAL AND ADAPTIVE MILESTONES: 2 months: social smile(smile after being talked to).watches mother when spoken to and may smile. 3 months:Recognizes mother, anticipates feeds. 4 months: Holds rattle when placed in hand and regards it . Laughs aloud. Excited at the sight of food. 6 months:recognizes strangers, stranger anxiety . Enjoy watching own image in mirror, shows displeasure when toy pulled off. 9 months:waves bye bye 12 months:comes when called, plays simple ball game.kisses the parent on request. Makes postural adjustments for dressing. 15 months:jargon, stas imitating mother. 18 months: copies parents in tasking, dry by day, calls mother when he wants potty, points to three pas of body on request. 2 years: ask for food, drink, toilet, pulls people to show toys. 3 years:shares toys, know fullname and gender, dry by night. 4 years:Plays cooperatively in a group, goes to toilet alone, washes face, brushes teeth. Role play . 5 years:helps in household task , dresses and undresses. LANGUAGE MILESTONES: 1 month: Ales to sound. 2 month:respond to sound by stale or quitening to a smooth voice. 3 months: babbles when spoken to. Makes sounds (ahh,coos, ) laughs. 4 months: laughs aloud. 6 months: monosyllables 9 months: understands spoken words, bisyllables. 12 months: 1-2 words with meaning. 18 months: vocabulary of 10 words. Can name one pa of body. 2 years: 3 word simple sentences 3 years:asks questions, knows full name and gender. 4 years: says songs or poem, tells story, knows three colours. 5 years: ask meaning of words. {Reference: GHAI Essential pediatrics, eighth edition}\n\nSo the answer to this question is C"} {"instruction": "At which location along the basilar membrane are the highest frequency sounds detected?\nA. Near oval window\nB. Fahest from the oval window, near the helicotrema\nC. Uniformly along the basilar membrane\nD. At the midpoint of the membrane", "response": "Each wave is relatively weak at the outset but becomes strong when it reaches the poion of the basilar membrane that has a natural resonant frequency equal to the respective sound frequency. At this point, the basilar membrane can vibrate back and foh with such ease that the energy in the wave is dissipated. Consequently, the wave dies at this point and fails to travel the remaining distance along the basilar membrane.Thus, a high-frequency sound wave travels only a sho distance along the basilar membrane before it reaches its resonant point and dies, a medium-frequency sound wave travels about halfway and then dies, and a very low-frequency sound wave travels the entire distance along the membrane.Ref: Guyton; 13th edition; Chapter 53 The Sense of Hearing; Page no: 675\n\nSo the answer to this question is A"} {"instruction": "The most potent stimulator of naive T cells is -\nA. B cell\nB. Mature dendritic cells\nC. Epithelial cells\nD. Macrophages", "response": "Ans. is 'b' i.e., Mature dendritic cells Naive T cellThese are newly produced T cells.This is a T cell arising from immune system production of fresh cells in bone marrow.These cells respond to the newly encountered pathogens containing antigens which the immune system has not processed before.The naive T cell activation and proliferation create an acquired immunity to the newly encountered pathogen.After the disease is eradicated a small portion of T cell population engendered by activated Naive T cell constitute a reservoir of Memory T cell which proliferate and respond very quickly to the recurrence of disease.Proliferation of Naive T cells.Dendritic cells and dendritic cell derived cytokines are the most potent stimulator for proliferation of Naive T cells.\n\nSo the answer to this question is B"} {"instruction": "Confirmation of the diagnosis of vesicular mole is by :\nA. Vaginal examination\nB. X-rays\nC. Abdominal examination\nD. Ultrasonogram", "response": "Ultrasonogram\n\nSo the answer to this question is D"} {"instruction": "Chemotherapeutic drugs can cause:\nA. Only necrosis\nB. Only apoptosis\nC. Both necrosis and apoptosis\nD. Anoikis", "response": "Ans. is 'c' i.e., Both necrosis and apoptosis Chemotherapeutic drugs can cause both necrosis and apoptosis, but it is apoptosis which is the basis of action of chemotherapeutic drugs.Apoptosis is a process by which single cell are removed from the midst of living tissue by fragmentation into membrane bound particles and phagocytosed by other cells without disturbing its architecture or function or eliciting an inflammatory response (therefore known as programmed cell death).Though it is clearly written in Harrison that chemotherapeutic drugs can cause apoptosis and necrosis but its not clear whether necrosis has any role to play in therapeutic action.Also knowNecrosis - refers to cell death induced for example, by physical damage with the hallmark of cell swelling and membrane disruptionAnakusis - refers to death of epithelial cells after removal from the normal milieu of substrate, particularly from cell to cell contact.\n\nSo the answer to this question is C"} {"instruction": "Increased risk of Myocardial infarction is associated with which amino acid?\nA. Valine\nB. Ornithine\nC. Methionine\nD. Homocystine", "response": "Homocysteine is a metabolite of the methionine cycle, is a strong independant risk factor for cardiovascular disease. Homocysteine is said to have a role in both atherogenesis and thrombogenesis. Risk factors for Atheresclerosis: Hypercholesterolemia Low HDL level Hypeension Male gender Diabetes mellitus Family with premature coronary aery disease High lipoprotein level Cigarette smoking Post menopausal state Hyper fibrinogenemia Hyperhomoeysteinemia Physical inactivity Obesity Angiotensin conveing enzyme polymorphism Homocysteine (Hcy) is a sulfydryl aminoacid that lies at an impoant metabolic branch point of methionine metabolism, between remethylation and transulfuration pathways. This lead to the formation of methionine and cystathionine respectively. Several enzymes regulate these pathways under normal condition in the presence of Vit. B12, B6 and Folic acid. Abnormality in any of the enzymes or vitamin deficiency may give rise to hyperhomocysteinemia. Hyperhomocysteinemia has been classified as: Moderate (Hcy >15 to 30 mmol/L), Intermediate (Hcy >30 to 100 .mmol/L) and Severe (Hcy >100 mmol/L) Hyperhomocysteinemia and CVD Hyperhomocysteinemia induce smooth muscle proliferation, accelerate oxidation of LDL cholesterol, impair endothelial derived nitric oxide, decrease synthesis of heparan sulphate proteoglycan and also induce proinflammatory changes in the vessel wall. The exact mechanism of atherothrombosis associated with yperhomocysteinemia is not clear. Several studies have pointed to an association with inhibition of thrombomodulin activity, reduction of protein c activation, increased platelet aggregation, and predisposition to endothelial injury. Ref: Harrison's, Principles of internal medicine,16th Edition, Page 1432\n\nSo the answer to this question is D"} {"instruction": "An 81-year-old female presents to ER. Her son gives a collateral history, as the patient is very difficult to understand. He repos that the patient has had difficulty walking and could not lift her left arm for the past hour. He has also noticed the patient's speech doesn't make sense. O/E-The patient is right-handed. There is reduced power (MRC 2/5) and flaccidity in the left arm and leg. Light touch sensation is also decreased on the left arm and leg. The right arm and leg appear normal. Visual fields are normal, but there is a detion of both eyes to right. According to the Oxford Classification of Stroke, what type of stroke is this ?\nA. Total Anterior Circulation Infarction\nB. Paial Anterior Circulation Infarction\nC. Superior Cerebellar Aery Infarction\nD. Lacunar Infarction", "response": "-Difficulty walking, difficulty in movements- DYSAHRIA (unclear speech). -Visual field are N but optic detion in both eyes i.e optic radiation to the contralateral side at the site of lesion as in coical stroke can be seen. Therefore, here problem in LEFT side, patient's eyes is deted to contra lateral side/towards the side of stroke. Since the question mentions weakness in the arms & legs we can diagnose it as Ant. CIRCULATION. Option C- gait ataxia and cerebellar damage features not mentioned & cannot be the answer. Option D- Causes either pure motor or pure sensory but here there is motor+ sensory involvement affected. Oxford Stroke Classification Type of infarct Criteria and features Total anterior circulation infarct (TACI) Combination of all 3: 1. Unilateral hemiparesis and/or hemisensory loss of face, arm and legs-(motor and sensory coex affected) 2. Homonymous hemianopia (involvement of the optic radiation) 3. Higher cognitive dysfunction: - Expressive or receptive Dysphasia (Dominant hemisphere involved) - Visual and sensory inattention - Neglect(Non dominant hemisphere involved) Paial anterior circulation infarcts (PACI) 2/3 of the criteria for TACI Lacunar Infarction (LACI) Coex is spared(No higher coical function defect) One of the following is needed for diagnosis: - Pure motor hemiparesis - Pure hemi sensory loss - Sensorimotor stroke - Ataxic hemiparesis - Dysahria Posterior Circulation Infarction (POCI) \"Crossed\" syndromes, with I/L cranial nerve palsy C/L motor and/or sensory deficit Features include: - Ataxia - Cerebellar syndrome - Horner's Syndrome - Isolated homonymous hemianopia (occipital lobe supplied by posterior cerebral aery) - Coical blindness (basilar aery occlusion affecting both occipital coices)\n\nSo the answer to this question is B"} {"instruction": "Drug of choice for myoclonic seizures is:\nA. Valproic acid\nB. Phenytoin\nC. Ethosuximide\nD. Carbamazepine", "response": "None\n\nSo the answer to this question is A"} {"instruction": "A Schizophrenic patient is responding well to haloperidol. But, now he has developed symptoms of parkinsonism. What is the drug of choice to treat this condition -\nA. Levodopa\nB. Bromocriptine\nC. Tolcapene\nD. Anticholinergic", "response": "Ans: D AnticholinergicExtrapyramidal side effects of antipsvchotics.Major dose limiting side effects.Maximum with halopridol.Parkinsonism:Appears between 1-4 weeks of therapy.Central anticholinergics like benzhexol are durg of choice for drug induced Parkinsonism.\n\nSo the answer to this question is D"} {"instruction": "Duochrome test is for -\nA. Subjective verification of refraction\nB. Subjective refinement of refraction\nC. Subjective binocular balancing\nD. Subjective monocular balancing", "response": "Duochrome test is based on the principle of chromatic aberrations. It helps in verifying the spherical correction subjectively. In it, the patient is asked to tell the clarity of the letters with red background visa- vis green background. To an emmetropic patient letters of both the colours look equally sharp; while to a slightly myopic patient the red letters appear sharper and to a slightly hypermetropic patient the green letters look sharper. Reference : A K KHURANA OPHTALMOLOGY,Edition 4, Page-563\n\nSo the answer to this question is B"} {"instruction": "Harmonic imaging is used in?\nA. USG\nB. CT\nC. MRI\nD. MRCP", "response": "Harmonic imaging is a technique in ultrasonography that provides images of better quality as compared with conventional ultrasound technique. Advantages over conventional ultrasound Decreased reverberation and side lobe aifacts. Increased axial and lateral resolution. Cyst clearing. Increased signal to noise ratio. Improved resolution in patients with large body habitus.\n\nSo the answer to this question is A"} {"instruction": "Which of the following is polar?\nA. Isoleucine\nB. Methionine\nC. Glutamic acid\nD. Tryptophan", "response": "Classification of aminoacids based on side chain and charges. Acidic amino acids (with negative charge) Basic amino acids (with positive charge) Neutal aminoacids (having non-polar side chains )(hydrophobic) Neutral amino acids (having polar side chains )(hydropilic) Tyrosine Lysine Alanine Aspaic acid Arginine Valine Serine Glutamic acid Histidine Leucine Threonine Isoleucine Cysteine Methionine Glutamine Phenylalanine Asparagine Tryptophan Proline REFERENCE: DM VASUDEVAN TEXTBOOK EIGHTH EDITION ;Page no:27 t\n\nSo the answer to this question is C"} {"instruction": "All of the following statements are true about congenital rubella except\nA. It is diagnosed when the infant has IgM antibodies at bih\nB. It is diagnosed when Ig G antibodies persist for more than 6 months\nC. M.C. congenital defects are deafness, congenital hea disease and cataract\nD. Infection after 16 weeks of gestation result in major congenital defects", "response": "The risk of congenital defects has been estimated at 90% for maternal infection before 11 wks of gestation,33% at 11-12 wks ,11% at 13-14 wks, and 24% at 15-16 wks Defects occuring after 16 wks of gestation are uncommon ,even if fetal infection occurs. The fetus is completely spared if infection occurs beyond 16 weeks. Reference: Nelson textbook of pediatrics 19th edition Page 1075\n\nSo the answer to this question is D"} {"instruction": "Which of the following burs is used for developing\nchamfer margins?\nA. Flat ended, tapered diamond cylinder\nB. Round ended, tapered diamond cylinder\nC. Twelve fluted carbide burs\nD. End cutting burs", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Social Mobility is -\nA. From rural to urban areas for work\nB. Industrialization\nC. Interaction between cultures\nD. Movement in socio-economic stratas", "response": "Ans. is 'd' i.e., Movement in socio-economic status Social mobilityo Social mobility is the degree to which an individual's is family or group's social status can change throughout the course of their life through a system of social hierarchy or stratification.o The individual or family can move up or down the social classes based on achievements or factors beyond their control.o If such mobility involves a change in position, especially in occupation, but no change in social class, it is called \"horizontal mobility \". Example - a person who moves from a managerial position in one company to a similar position in another.o If the move involves a change in social class it is called \"vertical mobilityExample - An industrial worker who becomes a wealthy businessman moves upward in the class system.\n\nSo the answer to this question is D"} {"instruction": "The mechanism of action of topically applied sodium fluoride includes all of the following EXCEPT-\nA. When sodium fluoride solution is applied on the tooth surface as a topical agent, it reacts with the hydroxy apatite crystals in enamel to form calcium fluoride which is the main end product of the reaction.\nB. As a thick layer of calcium fluoride gets formed, it interferes with the further diffusion of fluoride from the topical fluoride solution to react with hydroxyapatite and blocks further entry of fluoride ions.\nC. Calcium fluoride acts as a reservoir for fluoride release\nD. The stoppage of release of fluoride is termed as chocking off effect.", "response": "Mechanism of action of sodium fluoride –\nWhen sodium fluoride solution is applied on the tooth surface as a topical agent, it reacts with the hydroxy apatite crystals in enamel to form calcium fluoride which is the main end product of the reaction. As a thick layer of calcium fluoride gets formed, it interferes with the further diffusion of fluoride from the topical fluoride solution to react with hydroxyapatite and blocks further entry of fluoride ions. This sudden stop of the entry of fluoride is termed as \"Choking off effect\". Fluoride then slowly leaches from the calcium fluoride. Thus calcium fluoride acts as a reservoir for fluoride release (It is for this reason that after each application of sodium fluoride on to the tooth surface, it is left to dry for 4 minutes). The calcium fluoride formed reacts with the hydroxyapatite crystals to form fluoridated hydroxyapatite. The hydroxyapatite thus formed increases the concentration of fluoride on enamel surface, which in turn makes the tooth surface resistant against caries attack through the action of fluoride.\n\nSo the answer to this question is D"} {"instruction": "Fox Fordyce's disease is a disease of -\nA. Eccrine sweat glands\nB. Apocrine sweat glands\nC. Sebaceous glands\nD. Pilosebaceous glands", "response": "Ans. is 'b' i.e., Apocrine sweat glands Diseases of Sweat glands 1) Eccrine glands - Hyperhydrosis, Anhydrosis, 2) Apocrine glands - Chromhidrosis (colored sweet), Osmidrosis (offensive sweat odor), Bromhidrosis (hyperhidrosis + offensive odor), Fox - Fordyce's disease (apocrine miliaria), hidradenitis suppurativa. Diseases of sebaceous glands 1) Pilosebaceous glands - Acne vulgaris. Epidermoid (sebaceous) cyst. 2) Ectopic sebaceous glands - Fordyce's spot, Montgomery's tubercle Note: Fordyce's spot represents ectopic sebaceous glands on lips (most common site) and oral mucosa. They may also appear on vulva and penis, where they are called Tyson's gland, i.e., an ectopic sebaceous gland at penis (prepuce) and vulva is called Tyson's gland. o Thus Fox Fordyces spots: the disease of apocrine sweat glands wile fordyces spots: ectopic sebaceous glands.\n\nSo the answer to this question is B"} {"instruction": "Anaesthetic agent(s) safe to use in↑ICP –\nA. Halothane\nB. Thiopentone\nC. Ketamine\nD. Ether", "response": "All IV inducing agents (including thiopentone) except for ketamine decrease ICT.\nKetamine increases ICT.\nInhalational agents (Ether, Halothane) increase ICT.\n\nSo the answer to this question is B"} {"instruction": "A 15-year-old female presents with primary amen-orrhea. Her breasts are Tanner 4 but she has no ax-illary or pubic hair. The most likely diagnosis is:\nA. Turner's syndrome\nB. Mullerian agenesis\nC. Testicular feminization syndrome\nD. Premature ovarian failure", "response": "None\n\nSo the answer to this question is C"} {"instruction": "This patient was a former smoker and was being treated for essential hypertension, hypercholesterolemia, and hyperuricemia. Oral examination during the three follow up visits are being shown What is the most likely diagnosis of the tongue involvement?\nA. Geographic tongue\nB. Oral candidiasis\nC. Lichen planus\nD. Oral hairy leukoplakia", "response": "Ans. A. Geographic tongue* Geographic tongue, also known as benign migratory glossitis and migratory stomatitis, is the correct answer.* The changing lesions are suggestive of a geographic map (hence geographic tongue) with pink continents surrounded by whiter oceans.* It is a recurrent, benign, usually asymptomatic, inflammatory condition, of unknown etiology, of the tongue, affecting nearly 2% of the general population.* Geographic tongue typically presents with migratory red lingual patches, which are irregularly shaped erythematous patches bordered by a white keratotic band. Tongue lesions exhibit central erythema because of atrophy of the filiform papillae of tongue epithelium.* Lesions may last days, months, or years. THE LESIONS DO NOT SCAR.* It being a benign asymptomatic condition, therefore requires no treatment.\n\nSo the answer to this question is A"} {"instruction": "A 75-year-old woman lives alone and eats sparingly because of her low fixed retirement income. For the past 2 weeks, she has noticed pain in her right leg. On physical examination, there is marked tenderness to palpation over the lateral aspect of the right shin, a poorly healed cut on the right hand, and a diffuse hyperkeratotic skin rash. A radiograph shows a right tibial diaphyseal subperiosteal hematoma. Laboratory studies show a hemoglobin level of 11.3 g/dL. A deficiency of which of the following nutrients is most likely to explain these findings?\nA. Ascorbic acid\nB. Folate\nC. Niacin\nD. Riboflavin", "response": "Signs and symptoms of scurvy can be subtle. The diet must contain a constant supply of vitamin C (ascorbic acid) because none is produced endogenously. Older individuals with an inadequate diet are as much at risk as younger individuals. Folate deficiency can lead to anemia, but it does not cause capillary fragility with hematoma formation or skin rash. Niacin deficiency can lead to an erythematous skin rash in sun-exposed areas, but not to anemia. Riboflavin deficiency can lead to findings such as glossitis, cheilosis, and neuropathy. Vitamin A deficiency can produce a skin rash, but it does not cause anemia. Vitamin K is important in maintaining proper coagulation, but a deficiency state is not associated with anemia or skin rash.\n\nSo the answer to this question is A"} {"instruction": "Legacy effect is related to which of the diabetes complication ?\nA. Renal\nB. Neuropathy\nC. Retinopathy\nD. Cardiovascular", "response": ".\n\nSo the answer to this question is D"} {"instruction": "In secondary syphilis, which one of the following features is not found -\nA. Maculopapular rashes\nB. Generalised non tender lymphadenopathy\nC. Aoitis\nD. Follicular syphilides", "response": "Ans. is 'c' i.e., Aoitis Aoitis is seen in teiary syphilis.\n\nSo the answer to this question is C"} {"instruction": "Commonest cause of Nephritic syndrome in children is\nA. Minimal change disease\nB. Membranous GN\nC. IgA nephropathy\nD. Mesangioproliferative GN", "response": "There are many conditions that may cause nephritic syndrome, and it can occur in people of all ages. Common causes are infections, immune system disorders and inflammation of the blood vessels. The main symptoms are passing less urine than normal, leading to a fluid buildup in the body, and having blood in the urine. Reference: GHAI Essential pediatrics, 8th edition\n\nSo the answer to this question is A"} {"instruction": "The number of openings per square inch of a standard mosquito net should be:\nA. 100\nB. 150\nC. 250\nD. 175", "response": "The material of the mosquito net should be white for easy detection of mosquitoes. The best pattern is the rectangular net. The size of the opening of mosquito net is of utmost impoance, the size should not exceed 0.0475 inch in any diameter. The number of holes in one square inch is usually 150.\n\nSo the answer to this question is B"} {"instruction": "The symptoms of Hyperparathyroidism include ?\nA. Constipation & muscle weakness\nB. Anorexia & weight loss\nC. Polydipsia & polyuria\nD. All of the above", "response": "Ans. is 'd' i.e., All of the above\n\nSo the answer to this question is D"} {"instruction": "The normal biting force in natural dentition and complete denture is\nA. 200 N and 600 N\nB. 9000 N and 7000 N\nC. 100 N and 30 N\nD. 600 N and 110 N", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Which of the following statements about prostaglandins is true?\nA. They are precursors to arachidonic acid\nB. They release arachidonic acid from membranes through the action of phospholipase A\nC. They were first observed to cause uterine contraction and lowering of blood pressure\nD. Although found in many organs, they are synthesized only in the prostate and seminal vesicles", "response": "Although prostaglandins were originally isolated from prostate glands, seminal vesicles, and semen, their synthesis in other organs has been amply documented; indeed, few organs have failed to demonstrate prostaglandin release. Prostaglandins cause platelet aggregation, smooth-muscle contraction, vasodilation, and uterine contraction. Prostaglandins are synthesized from arachidonic acid, a 20-carbon fatty acid with interspersed carbon double bonds. Signals such as angiotensin II, bradykinin, epinephrine, and thrombin can activate phospholipase A2 and release arachidonic acid from membrane lipids. The arachidonic acid is cyclized by cyclooxygenase to form prostaglandins. Arachidonic acid can also be oxidized to leukotrienes by the action of lipoxygenases.\n\nSo the answer to this question is C"} {"instruction": "Adenovirus 40/41\nA. Cervical tissue\nB. Synovial fluid\nC. Blood\nD. Stool", "response": "The diagnosis of a viral infection is made easier by the creation of a greater number of diagnostic virology laboratories during the past few decades. In order for viral diagnosis to be successful, the most appropriate specimen must be collected for the disease in question.Many viruses can be isolated from feces. Of the viral groups in these questions, adenovirus 40/41 is the most common stool isolate. Norwalk agent and other caliciviruses may also be isolated or detected from stools, but usually only in specialized laboratories.\n\nSo the answer to this question is D"} {"instruction": "The fascia seperating rectum from coccyx is called\nA. Scarpa's fascia\nB. Waldeyer's fascia\nC. Denonvillier's fascia\nD. Colle's fascia", "response": "The lower third of the rectum is separated by a fascial condensation - Denonvilliers' fascia - from the prostate/vagina in front, and behind by another fascial layer - Waldeyer's fascia - from the coccyx and lower two sacral veebrae (Table 68.1). These fascial layers are surgically impoant as they are a barrier to malignant invasion . Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1219\n\nSo the answer to this question is B"} {"instruction": "Treatment for pertussis contacts children for\nA. Prophylactic antibiotic for 11 days\nB. Prophylactic antibiotic for 14 days\nC. Prophylactic antibiotic for 12 days\nD. Prophylactic antibiotic for 10 days", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Main transpoer of cholesterol to peripheral tissue is:\nA. HDL\nB. LDL\nC. IDL\nD. VLDL", "response": "B i.e. LDL- Maximum content of triglycerides (& exogenous TG) is present in chylomicrons which carries exogenous dietary TG's to peripheral tissuesQ.Highest amount of cholesterol is present in LDL which is the most impoant carrier of cholesterol and provides (transpos) choelestrol to extrahepatic peripheral tissueQ.\n\nSo the answer to this question is B"} {"instruction": "Rain, a 10 yr old boy is having difficulty in learning at school. He has sho lapses of awareness with eyelid fluttering that occur every 5-10 minutes. EEG studies reveal brief 3 Hz spike and wave discharges appearing synchronously in all the leads. Which of the following drugs would be effective but has the disadvantage that it causes sedation and tolerance?\nA. Diazepam\nB. Ethosuximide\nC. Clonazepam\nD. Valproic acid", "response": "(Ref: KDT 6/e p411, 412) Diagnosis of the patient is petit mal epilepsy (absence seizures). Drugs effective against absence seizures are: - Ethosuximide - Valproate - Clonazepam - Lamotrigine Clonazepam is a benzodiazepine that can cause sedation and tolerance.\n\nSo the answer to this question is C"} {"instruction": "Shovel shaped pulp chamber is found in:\nA. Maxillary central incisor\nB. Maxillary lateral incisor\nC. Mandibular central incisor\nD. Mandibular lateral incisor", "response": "Maxillary central incisor → pulp is shovel shaped + has pulp horn.\n\nSo the answer to this question is A"} {"instruction": "Alcholholic Hyaline Seen in alcoholic liver disease is composed of\nA. Lipofuscin\nB. Eosinophilic intracytoplasmic inclusions\nC. Basophilic intracytoplasmic inclusions\nD. Hemazoin", "response": "Refer Robbins page no 843\n\nSo the answer to this question is B"} {"instruction": "Which of the following is the MOST impoant factor in the prevention of the endophthalmitis due to cataract surgery?\nA. Preoperative preparation with povidone iodine\nB. One week antibiotic therapy prior to surgery\nC. Trimming of eyelashes\nD. Use of intravitreal antibiotics", "response": "Clinical studies have proven that use of 5% povidone iodine cream to clean conjunctiva and eyelids before cataract surgery has significant benefits in reducing the rate of endophthalmitis. Therefore it should be applied to eyes before surgery to reduce the incidence of endophthalmitis. Studies have shown some efficacy of intracameral antibiotics in prevention of postoperative endophthalmitis. The addition of gentamicin and vancomycin to the irrigating fluid during phacoemulsification may result in significant reduction in the microbial contamination of anterior chamber aspirates. Ref: Modern Ophthalmology: The Highlights By Benjamin F. Boyd, page 273-4.\n\nSo the answer to this question is A"} {"instruction": "Angular vein infection causes thrombosis in?\nA. Cavernous sinus\nB. Suprasaggital sinus\nC. Inferior saggital sinus\nD. Straight sinus", "response": "ANSWER: (A) Cavernous sinusREF: Gray's anatomy 40th ed ch: 29Angular vein is related to the danger area of the face. It is formed by junction of supra orbital and supra trochlear vein. It can be seen 8mm medial to medial canthus. it pierces orbucalis oculi. It drains into anterior facial vein. Angular vein communicates with the cavernous sinus through a communicating vein and it gives a tributary to formation of superiorophthalmic vein. Deep facial vein from the pterygoid plexus joins the anterior facial vein. The pterygoid plexus is connected to cavernous sinus through communicating veins which pass through foramen of vesalvius.\n\nSo the answer to this question is A"} {"instruction": "A patient of acute myocardial infarction being treated in intensive care unit developed left ventricular failure with raised central venous pressure. It was decided to use nitroglycerine. Which route of administration would be most suitable?\nA. Sublingual\nB. Oral\nC. Intravenous bolus injection\nD. Slow intravenous infusion", "response": "(Ref: KDT 6/e p527) Nitrates can be used in acute LVF by slow i.v. infusion.\n\nSo the answer to this question is D"} {"instruction": "The following structures may be injured during surgery to repair an inguinal hernia:\nA. The ilioinguinal, genitofemoral, Iliohypogastric, and lateral femoral cutaneous nerves\nB. The femoral nerve\nC. The popliteal nerve\nD. The nerve to the psoas major muscle", "response": "Any of these nerves may be divided, crushed, or entrapped by suture or mesh during repair of a groin hernia. The lateral femoral cutaneous nerve is vulnerable especially during laparoscopic hernia repair.\n\nSo the answer to this question is A"} {"instruction": "Occlusal view of upper canine is\nA. Diamond as angles are accentuated\nB. Diamond as angles are decreased\nC. Ovoid as angles are rounded\nD. Rhomboid as angles are accentuated", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Electron microscopy findings of renal biopsy shows permeation of the lamina densa of the glomerular basement membrane (GBM) by a ribbon-like, homogeneous, extremely electron-dense material of unknown composition. Which of the following is the likely diagnosis?\nA. Dense-deposit disease (DDD)\nB. Collapsing glomerulopathy\nC. Minimal change disease\nD. Focal segmental glomerulosclerosis (FSGS)", "response": "Dense-deposit disease (formerly called Type II MPGN) Excessive activation of the alternative complement pathway. Electron M/E - Permeation of the lamina densa of the GBM by a ribbon-like, homogeneous, extremely electron-dense material of unknown composition. By immunofluorescence, C3 is present in irregular granular or linear foci in the basement membranes on either side but not within the dense deposits. C3 is also present in the mesangium in characteristic circular aggregates (mesangial rings). IgG is usually absent, as are components of the classical pathway of complement activation (such as C1q and C4).\n\nSo the answer to this question is A"} {"instruction": "Pink teeth is seen in\nA. Asphyxial deaths\nB. Carbon monoxide poisoning\nC. Putrefaction\nD. Cyanide poisoning", "response": "Pink teeth: In putrefied bodies, the teeth are sometimes seen to be pink in color, especially near the gum line as a result of hemolysis of extravasated blood in the dentinal tubules.\n\nSo the answer to this question is C"} {"instruction": "Best prognosis in reversibility occurs in :\nA. lsthmo - Isthmic type\nB. lsthmo - ampullary type\nC. Ampullary - foreacial type\nD. Ampullary fimbrial type", "response": "lsthmo - Isthmic type\n\nSo the answer to this question is A"} {"instruction": "Pulled Elbow is:\nA. Disaiculation of elbow\nB. Disaiculation of elbow\nC. Subluxation of proximal radio ulnar joint\nD. None of the above", "response": "C i.e. subluxation of proximal radio ulnar joint\n\nSo the answer to this question is C"} {"instruction": "In normal NST, the time period for two or three accelerations that peak at 15 bpm or more above baseline is:\nA. 3\nB. 15\nC. 20\nD. 60", "response": "Definition of nonstress test (NST) currently recommended by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics: Two or more accelerations that peak at 15 bpm or more above baseline, each lasting 15 seconds or more, and all occurring within 20 minutes of beginning the test. Accelerations with or without fetal movements be accepted, and that a 40-minute or longer tracing--to account for fetal sleep cycles--should be performed before concluding that there was insufficient fetal reactivity. Although a normal number and amplitude of accelerations seems to reflect fetal well-being, \"insufficient acceleration\" does not invariably predict fetal compromise. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 15. Antepaum Assessment. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.\n\nSo the answer to this question is C"} {"instruction": "Amyloidosis of kidney may be seen in the following except -\nA. Enteric fever\nB. Ulcerative colitis\nC. Suppurative lung disease\nD. Hansen's disease", "response": "TEXT BOOK OF PATHOLOGY HARSH MOHAN 6THEDITION PG NO 86 Secondary/Reactive (AA) Systemic Amyloidosis The second form of systemic or generalised amyloidosis is reactive or inflammatory or secondary in which the fibril proteins contain AA amyloid. Secondary or reactive amyloidosis occurs typically as a complication of chronic infectious (e.g. tuberculosis, bronchiectasis, chronic osteomyelitis, chronic pyelonephritis, leprosy, chronic skin infections), non-infectious chronic inflammatory conditions associated with tissue destruction (e.g. autoimmune disorders such as rheumatoid ahritis, inflammatory bowel disease), some tumours (e.g. renal cell carcinoma, Hodgkin's disease) and in familial Mediterranean fever, an inherited disorder (discussed below). Secondary amyloidosis is typically distributed in solid abdominal viscera like the kidney, liver, spleen and adrenals. Secondary reactive amyloidosis is seen less frequently in developed countries due to containment of infections before they become chronic but this is the more common type of amyloidosis in underdeveloped and developing countries of the world. Secondary systemic amyloidosis can occur at any age including children. AA amyloid occurs spontaneously in some birds and animals; it can also be experimentally induced in animals. <\\p>\n\nSo the answer to this question is A"} {"instruction": "Investigation of choice for Posterior urethral valves:\nA. Micturating Cystourethrography (MCU)\nB. Ultrasound\nC. Intravenous Pyelography\nD. Retrograde urethrography", "response": "Ans. a (MCU). (Ref. Sutton Radiology 7th ed. 1017, 1061)- MCU is IOC for PU valve and VUR.Posterior urethral valves (PUV)# Varying degree of chronic urethral obstruction due to fusion and prominence of plicae colliculi, normal concentric folds of urethra.# Usually located in posterior urethra just distal to the level verumontanum.c;# It is the most common cause of severe obstructive uropathy in infants and children.# MCU is 'gold standard' in diagnosis of PUV.# Rx: Cystoscopic fulguration of the valves.Three types of PUV are described :\n\nSo the answer to this question is A"} {"instruction": "Minimum time duration for the diagnosis for mania is?\nA. 1 week\nB. 2 week\nC. 3 week\nD. 4 week", "response": "ANSWER: (A) 1 weekREF: Kaplan 8f Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition, American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders. 4th editionRepeat from June 2010Time frame of mood disorders:ConditionMinimum timeMajor depressive episode2 weeksMajor depressWe disorder, Recurrent2 episodes separated by 2 monthsDysthymic disorder2 yearsCyclothymic disorder2 yearsManic episode1 weekMixed episode1 weekHypomanic episode4 daysRapid cycling bipolar IAt least 4 episodes/yearSlow cyclers bipolar I1-3 episodes/yearPostpartum mood disturbanceOnset within 4 weeks postpartumDSM-IV-TR Criteria for Manic EpisodeA distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:Inflated self-esteem or grandiosityDecreased need for sleep (e.g., feels rested after only 3 hours of sleep)More talkative than usual or pressure to keep talkingFlight of ideas or subjective experience that thoughts are racingDistractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitationExcessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)The symptoms do not meet criteria for a mixed episode.The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism). Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, and light therapy) should not count toward a diagnosis of bipolar I disorder.\n\nSo the answer to this question is A"} {"instruction": "For the prevention of parent to child transmission of HIV, the NACO's recommendation is to give –\nA. Niverapine 200 mg in active labour to mother\nB. Niverapine 200 mg, four hours after rupture to membranes, to mother\nC. Niverapine 200 mg in active about to mother and syrup niverapine 2 mg/kg body weight to newborn with 72 hours of delivery\nD. Syrup niverapine 2 mg/kg body weight to newborn within 72 hours of birth", "response": "None\n\nSo the answer to this question is C"} {"instruction": "A 12-year-child, who has intellectual disability, is having large face, large jaw, large ear and macroorchidism. Diagnosis?\nA. Mc Cune Albright syndrome\nB. Down's syndrome\nC. Cri-du chat syndrome\nD. Fragile X syndrome", "response": "Fragile X syndrome- CGG trinucleotide repeats. Intellectual disability, large face, large jaw, large ear and macro-orchidism. Cri-du chat syndrome- high pitched cry, microcephaly, intellectual disability, hypotonia Mc Cune Albright syndrome- cafe au lait pigmentation, fibrous dysplasia, endocrine dysfunction Down's syndrome- mongloid slant, epicanthal folds, depressed nasal bridge\n\nSo the answer to this question is D"} {"instruction": "High risk HPV types are:\nA. 16 and 18\nB. 6 and 11\nC. 42 and 44\nD. 70 and 72", "response": "Risk Classification HPV Types Lesions Low risk 6, 11, 42, 43, 44, 54, 61, 70, 72, 81 Condyloma, LSIL High risk 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 61, 66, 68, 73, 82 LSIL, HSIL, carcinoma Abbretions: HSIL - high grade intraepithelial lesion LSIL-low grade squamous intraepithelial lesion\n\nSo the answer to this question is A"} {"instruction": "Which of the following is the BEST way to treat medullary carcinoma of thyroid?\nA. Near total thyroidectomy + Radioiodine\nB. Subtotal thyroidectomy + Radiotherapy\nC. Total thyroidectomy + Radioiodine\nD. Total thyroidectomy + Radiotherapy", "response": "Treatment of choice for the medullary carcinoma of thyroid is the Total thyroidectomy + modified radical neck dissection. But the option is not provided among options. As total thyroidectomy is provide in option 3 and 4 so answer should be either 3 or 4 Now as far as radioiodine is concerned, it is clearly mentioned in the schwaz that radioiodine is ineffective and about radiotherapy, it has been mentioned that \"External beam radiotherapy is controversial, but is recommended for patient with unresectable residual or recurrent tumor\" So option 4 i.e. Total thyroidectomy + radiotherapy is the answer here. Ref: Schwaz Surgery 9/e, Page 1368.\n\nSo the answer to this question is D"} {"instruction": "Opsoclonus as a paraneoplastic manifestation is most commonly seen in\nA. Renal cell carcinoma\nB. Colon cancer\nC. Hepatocellular cancer\nD. Neuroblastoma", "response": "Opsoclonus affects children more frequently than adults. Screening for occult neuroblastoma is necessary in all patients with opsoclonus.\n\nSo the answer to this question is D"} {"instruction": "Neurological symptoms and premature graying of hair is\nassociated with:\nA. Folic acid deficiency\nB. Pernicious anaemia\nC. Plummer-Vinson syndrome\nD. Paterson-Kelly syndrome", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Aspirin-sensitive asthma is associated with\nA. Obesity\nB. Uicaria\nC. Nasal polyp\nD. Extrinsic asthma", "response": "`Aspirin associated Asthma usually begins with perennial vasomotor rhinitis that is followed by hyperplastic rhinosinusitis with nasal polyps&; -- Harrisons Aspirin associated Asthma: Primarily affects adults, although the condition may occur in childhood. Usually begins with perennial vasomotor rhinitis that is followed by hyperplastic rhinosinusitis with nasal polyps. Progressive asthma then appears. On exposure to even very small quantities of aspirin, affected individuals typically develop ocular and nasal congestion and acute, often severe episodes of airways obstruction. Death may follow ingestion of aspirin. REF: Harrison book of internal medicine 21ST EDITION\n\nSo the answer to this question is C"} {"instruction": "Which Immunoglobulin is involved in anaphylaxis: March 2007 & September 2011 March 2013\nA. IgA\nB. IgE\nC. IgG\nD. IgM", "response": "Ans. B: IgE\n\nSo the answer to this question is B"} {"instruction": "All are true about spontaneous bacterial peritonitis except\nA. High ascitic fluid protein increases the risk\nB. E coli is the commonest organism\nC. Due to bacterial translocation from normal gut flora\nD. Neutrophil count >250/mL in ascitic sample is diagnostic", "response": "SBP is a common and severe complication of ascites characterized by spontaneous infection of the ascitic fluid without an intraabdominal source. When levels of ascitic fluid proteins are very low, patients are at increased risk for developing SBP.Bacterial translocation is the presumed mechanism for development of SBPThe most common organisms are Escherichia coli and other gut bacteria; however, gram-positive bacteria, including Streptococcus viridans, Staphylococcus aureus, and Enterococcus sp., can also be foundThe diagnosis of SBP is made when the fluid sample has an absolute neutrophil count >250/mL.Ref: Harrison 19e pg: 2066\n\nSo the answer to this question is A"} {"instruction": "Which of the following represent frequency of continuous variables?\nA. Line diagram\nB. Histogram\nC. Simple bar chart\nD. Component bar chart", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Drugs which produce gynecomastia are all EXCEPT:\nA. Cimetidine\nB. Digoxin\nC. Coisol\nD. Spironolactone", "response": "Drugs causing gynecomastia anti-androgens used to treat prostate enlargement, prostate cancer-flutamide, nilutamide finasteride, dutasteride Anabolic steroids like stanozolol Anti-anxiety medications, such as diazepam (Valium). Tricyclic antidepressants. cimetidine spironolactone digoxin metochlopromide ESSENTIAL of MEDICAL PHARMACOLOGY SIXTH EDITION -KD TRIPATHI Page:298d\n\nSo the answer to this question is C"} {"instruction": "A hypertensive patient with BP 160/90 mm of Hg presents with increased level of Lipoprotein a. Which Hypolipidemic drug will you prescribe?\nA. Fenofibrate\nB. Pitavastatin\nC. Niacin\nD. Ezetimibe", "response": "Ans: (c) NiacinRef: SN Narasingan, Newer Lipid Guidelines: Interpretation and Applications for Indians. ttp://www.apiindia.org/pdf/medicine_update_2017/mu_155.pdfNiacin is the only drug that lowers lipoprotein (a).So, niacin may be preferable for individuals with lipoprotein (a) elevations.It causes maximum HDL increase among drugs used in dyslipidemia treatment.Other options:FenofibrateIt is a fibric acid derivative, acting through PPAR alpha receptor and activates lipoprotein lipase.It reduces triglycerides.PitavastatinHMG CoA Reductase inhibitor.Causes maximum reduction of LDL.EzetimibeIt is a cholesterol ester transport inhibitor, inhibiting transport of cholesterol from intestine to circulation.It is used along with statins.\n\nSo the answer to this question is C"} {"instruction": "Growth factor needed for salmonella -\nA. Tryptophan\nB. Niacin\nC. B-12\nD. Citrate", "response": "Ans. is 'a' i.e., Tryptophan\n\nSo the answer to this question is A"} {"instruction": "Which one of the following local anaesthetics belongs to the ester group?\nA. Procaine\nB. Buovacaine\nC. Lignocaine\nD. Mepivacaine", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Slowest acting buffer system in the body ?\nA. PCO, buffer\nB. Respiratory buffer\nC. Chemical buffer\nD. Renal buffer", "response": "Ans. is 'd' i.e., Renal buffer(Re/ Principles of medical physiology p. 712)Not all buffer systems begin work at the same time.Chemical buffers respond first, followed by the respiratory system and finally, the renal system.\n\nSo the answer to this question is D"} {"instruction": "Repeated transcranial magnetic stimulation (rTMS) of brain is used in the treatment of which of the following conditions?\nA. Depression\nB. Resistant schizophrenia\nC. Resistant OCD\nD. Acute psychosis", "response": "Repeated transcranial magnetic stimulation (rTMS) is a non-invasive method that has been introduced as a treatment alternative for depression. Ref: Depression And Dementia: Progress In Brain Research, Clinical Applications ... By S. N. Sarbadhikari, 2006, Page 198; Kaplan and Sadock's Concise Textbook of Clinical Psychiatry By Benjamin J. Sadock, Virginia A. Sadock, 2008, Page 566\n\nSo the answer to this question is A"} {"instruction": "A boy presents with an injury to the medial epicondyle of the humerus. Which of the following would not be seen -\nA. Weakness of the ulnar deviation and flexion\nB. Complete paralysis of the IIIrd and IV th digits\nC. Atrophy of the hypothenar eminence.\nD. Decreased sensation of the hypothenar eminence", "response": "Medial epicondyle fracture causes injury to the ulnar nerve.\nIn ulnar nerve palsy only following muscles of 3rd & 4th fingers are paralysed:-\n\ni) Palmar & Dorsal interossei\nii) 3rd & 4th lumbricals\niii) Hypothenar muscles\n\nHowever, extensors of these two fingers are not paralysed which are supplied by the radial nerve.\n\nAbout other options\n\nThe weakness of ulnar deviation & flexion is due to paralysis of FCU and medial half of FDP.\nThere atrophy of hypothenar eminence and sensory loss over the hypothenar area.\n\nSo the answer to this question is B"} {"instruction": "All are true about rabolazine except\nA. It causes hypotension\nB. It is recommended as first-line treatment for angina\nC. It improve glycemic control\nD. It is not indicated for acute attack of angina", "response": "Refer CMDT 2014/347 Ranolazine is the first new anti anginal drug to be approved by the FDA in many years and is approved as treatment for first line chronic angina Ranolazine has no effect on hea rate and blood pressure It is safe to use in erectile dysfunction drug It also decreases the occurrence of atrial fibrillation and results in small decrease in haemoglobin It can cause QT prolongation\n\nSo the answer to this question is A"} {"instruction": "Polychromatic lusture is seen in\nA. Zonular cataract\nB. Posterior subscapular cataract\nC. Nuclear cataract\nD. Anterior subscapular cataract", "response": "Polychromatic luster is a pathognomic feature of complicated cataract which is most commonly posterior subcapsular Refer: Khurana 6th edition page number 187\n\nSo the answer to this question is B"} {"instruction": "who gave the concept of saftey needs in the heirachy of motivation\nA. lorenz\nB. seligman\nC. freud\nD. maslow", "response": "ABRAHAM MASLOW Gave the hierarchy of needs It is also called as hierarchy of motivation According to Maslow the basic needs should be met to move on to the next stage Once the basic step is attained, we work on to the higher stage The final stage is self-actualization, that is acceptance of your positives, negatives, sho comings, doing things that you are good at and working with satisfaction. Ref, kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 485\n\nSo the answer to this question is D"} {"instruction": "A patient developed paraplegia. On routine examination and X-ray it was found that there are osteoblastic lesion in his spine. Most probable diagnosis is\nA. Carcinoma thyroid\nB. Ca. Prostate\nC. Renal cell Ca\nD. Pancreatic Ca.", "response": "Ans. is 'b' i.e Ca prostate Metastasis in bone may produce osteolytic lesion or osteoblastic (osteogenesis) lesion. Most metastatic lesions produce both types of lesions and may go through stages where one or other predominate, Although some tumors mainly produce osteolytic lesion---- Renal cell Ca*. And some mainly osteoblastic ----Prostate Ca*. Also know Bone metastasis is most common from-----Ca Breast* Ca prostrate* Bone metastasis is most common in -----vertebrae*, Pelvis, Rib, Proximal femur.\n\nSo the answer to this question is B"} {"instruction": "A severely injured patient with multiple injuries is brought to casualty. Primary survey done and patient is stabilized. What is the preferred investigation?\nA. Whole body CT with IV contrast\nB. CT head, abdomen and Xray of suspected limb fractures\nC. CT head, FAST scan with Xray C-spine and Pelvis\nD. CT head and neck, FAST scan chest and pelvis Xray", "response": "Computed tomography(CT) from the head to pelvis with IV contrast, the so called 'whole body CT' (WBCT) is the gold standard investigation in patients with signs or symptoms of multiple injury or deranged physiology.There is no role for scanning selective bodysystems in the severely injured trauma patient. Wherever possible,WBCT should be performed as soon as possible during the patient's resuscitation. A provisional 'hot repo' can be issued within minutes to identify immediate life-threatening pathology to the trauma team. A more detailed definitive repo should be available within 30-60 minutes.Bailey and love 27e 324\n\nSo the answer to this question is A"} {"instruction": "For Arsenic poisoning Antidote is\nA. Penicillamine\nB. E.D.T.A\nC. Desferrixamine\nD. B.A.L", "response": "None\n\nSo the answer to this question is D"} {"instruction": "One month old baby is referred for failure to thrive. On examination there are features of congestive cardiac failure. Femoral pulses are feeble compared to brachial pulses. The likely diagnosis is\nA. Coarctation of aoa\nB. Patent ductus aeriosus\nC. Congenital aoic stenosis\nD. Congenital aoa-iliac disease", "response": "In coarctation of aoa there will be radiofemoral delay. Ghai essential of pediatrics, eighth edition, p.no:432\n\nSo the answer to this question is A"} {"instruction": "Cryptomenorrhoea is most commonly seen with:\nA. Imperforate hymen\nB. Asherman syndrome\nC. PCOD\nD. Vaginal agenesis", "response": "Ans: a (Imperforate hymen) Ref: Shaw, 13th ed,p.280In women with cryptomenorrhoea presenting as primary amenorrhoea the commonest cause is a intact hymen.Imperforate hymenClinical features1deg amenorrhoeaUrinary retentionPeriodic lower abdominal painSign: Visualization of tense bluish bulging membrane on separation of labia.Newborn - Mucocolpos (with in one week of birth)Diagnosis: USG pelvisTreatment of imperforate hymen: Cruciate incision on hymen(Commonest site at which hymen ruptures during intercourse - postero lateral area)\n\nSo the answer to this question is A"} {"instruction": "All of the following are contraindications for root\nplanning EXCEPT\nA. deficient or overhanging margins of amalgam restorations\nB. erosion and /or abrasion\nC. recession\nD. root caries", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Acute lung injury in caused by all of the following except\nA. Aspiration\nB. Toxic gas inhalation\nC. Cardiopulmonary bypass with hea lung machine\nD. Lung contusion", "response": "ARDS, most cases (>80%) are caused by a relatively small number of clinical disorders: severe sepsis syndrome and/or bacterial pneumonia (~40-50%), trauma, multiple transfusions, aspiration of gastric contents, and drug overdose. Among patients with trauma, the most frequently repoed surgical conditions in ARDS are pulmonary contusion, multiple bone fractures, and chest wall trauma/flail chest, whereas head trauma, near-drowning, toxic inhalation, and burns are rare causes. Ref Davidson edition23rd pg 606,199,170\n\nSo the answer to this question is C"} {"instruction": "Ash leaf maculae is found in :\nA. Tuberous sclerosis\nB. Neurofibromatosis\nC. Lymphangioma\nD. None", "response": "A i.e. Tuberous sclerosis\n\nSo the answer to this question is A"} {"instruction": "Causes of a transudate ascites include all the following except:\nA. Tuberculosis\nB. Nephrotic syndrome\nC. Hypoproteinemia\nD. Congestive cardiac failure", "response": "None\n\nSo the answer to this question is A"} {"instruction": "All of the following statements are TRUE about second generation antihistaminic agents EXCEPT :\nA. These do not impair psychomotor performance\nB. These possess high anti–motion sickness activity\nC. These lack anticholinergic actions\nD. These may possess additional antiallergic mechanisms", "response": "Anti-motion sickness activity is related to the anticholinergic property. This property is exhibited by first-generation compounds whereas second-generation antihistaminics lack this potential.\n\nSo the answer to this question is B"} {"instruction": "Which of the following blood gas results is most likely in a patient with hyperventilation caused by anxiety?\nA. increased PCO2\nB. decreased PO2\nC. decreased pH\nD. decreased PCO2", "response": "The behavioral respiratory control system of the brain drives the hyperventilation, which leads to decreased PCO2 and increased pH. If alkalemia is present with the hypocarbia, symptoms can be quite significant. They include dizziness, visual impairment, syncope, and seizures secondary to cerebral vasoconstriction; paresthesia's, carpopedal spasm, and tetany (secondary to decreased free serum calcium); muscle weakness (secondary to hypophosphatemia); and cardiac arrhythmias (secondary to alkalemia).\n\nSo the answer to this question is D"} {"instruction": "Hard Tick causes a/e –\nA. Relapsing fever\nB. KFD\nC. Indian tick typhus\nD. Tularemia", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Which of the following is not a cardioselective beta blocker?\nA. Esmolol\nB. Nebivolol\nC. Acebutolol\nD. Oxprenolol", "response": "Ans. is 'd' i.e., Oxprenoiol Selective b1 blockers are (cardioselective):1. Atenolol3. Bisoprolol5.Celiprolo!7. Metoprolol2. Acebutalol4. Betoxolol6. Esmolol8. Nebivolol\n\nSo the answer to this question is D"} {"instruction": "DOC for acute attack of asthma in patients on Beta blockers\nA. Salbutamol\nB. Theophylline\nC. Ipratropium bomide\nD. Chlorpheniramine", "response": "Respiratory airway has beta adrenergic receptors(beta 2 receptors). Beta 2 agonists cause bronchodilatation, and beta 2 blockers cause bronchoconstriction. ipratropium bromide:- Atropine like drugs cause bronchodilatation by blocking M3 receptor mediated cholinergic constrictor tone; act primarily in the larger airways which receive vagal innervation. Ipratropium bromideis a sho acting (duration 4-6 hours) inhaled anticholinergic bronchodilator, while tiotropium bromide is long acting (duration 24 hours). They are the bronchodilators of choice in COPD. Ref:- kd tripathi;pg num:- 227,228\n\nSo the answer to this question is C"} {"instruction": "What is not associated with DIC -\nA. Thrombocytopenia\nB. Increased PT\nC. Hyperfibrinogenemia\nD. Increased FDP", "response": "Plasma fibrinogen levels are reduced due to consumption in microvascular coagulation by which intravascular clotting occurs. Reference to earlier comments on normal blood coagulation (Chapter 3) may be helpful at this point. It suffices here to recall that clotting can be initiated by either the extrinsic pathway, which is triggered by the release of tissue factor (tissue thromboplastin); or the intrinsic pathway, which involves the activation of factor XII by surface contact, collagen, or other negatively charged substances. Both pathways lead to the generation of throm- bin. Clotting normally is limited by the rapid clearance of activated clotting factors by the macrophages and the liver, endogenous anticoagulants (e.g., protein C), and the con- comitant activation of fibrinolysis. DIC usually is triggered by either (1) the release of tissue factor or thromboplastic substances into the circulation or (2) widespread endothelial cell damage (Fig. 11-28). Throm- boplastic substances can be released into the circulation from a variety of sources--for example, the placenta in obstetric complications or ceain types of cancer cells, paicularly those of acute promyelocytic leukemia and adenocarcino- mas. Cancer cells can also provoke coagulation in other ways, such as by releasing proteolytic enzymes and by expressing tissue factor. In gram-negative and gram-positive sepsis (impoant causes of DIC), endotoxins or exotoxins stimu- late the release of tissue factor from monocytes. Activated monocytes also release IL-1 and tumor necrosis factor, both of which stimulate the expression of tissue factor on endo- thelial cells and simultaneously decrease the expression of thrombomodulin. The latter, you may recall, activates protein C, an anticoagulant (Chapter 3). The net result of these alterations is the enhanced generation of thrombin and the blunting of inhibitory pathways that limit coagulation. Severe endothelial cell injury can initiate DIC by causing the release of tissue factor and by exposing subendothelial col- lagen and von Willebrand factor (vWF). However, even subtle forms of endothelial damage can unleash procoagulant activity by stimulating the increased expression of tissue factor on endothelial cell surfaces. Widespread endothelial injury can be produced by the deposition of antigen-antibody complexes (e.g., in systemic lupus erythematosus), by tem- perature extremes (e.g., after heat stroke or burn injury), or by infections (e.g., due to meningococci or rickettsiae). As discussed in Chapter 3, endothelial injury is an impoant consequence of endotoxemia, and, not surprisingly, DIC is a frequent complication of gram-negative sepsis. Disorders associated with DIC are listed in Table 11-12. Of these, DIC is most often associated with sepsis, obstetric complications, malignancy, and major trauma (especially trauma to the brain). The initiating events in these conditions are multiple and often interrelated. For example, in obstetric conditions, tissue factor derived from the placenta, retained dead fetus, or amniotic fluid enters the circulation; however, shock, hypoxia, and acidosis often coexist and can lead to widespread endothelial injury. Trauma to the brain releases fat and phospholipids, which act as contact factors and thereby activate the intrinsic arm of the coagulation cascade. Whatever the pathogenetic mechanism, DIC has two con- sequences. First, there is widespread fibrin deposition within the microcirculation. The associated obstruction leads to ischemia in the more severely affected or vulnerable organs and hemolysis as red cells are traumatized while passing through vessels narrowed by fibrin thrombi (micro- angiopathic hemolytic anemia). Second, a bleeding diathesis results from the depletion of platelets and clotting factors and the secondary release of plasminogen activators. Plasmin cleaves not only fibrin (fibrinolysis) but also factors V and VIII, thereby reducing their concentration fuher. In addition, fibrinolysis creates fibrin degradation products. These inhibit platelet aggregation, have antithrombin activity, and impair fibrin polymerization, all of which contribute to the hemostatic failure (Fig. 11-28). Reference: textbook of Pathology, 7th edition, Author :Harsha Mohan, page number 317 Ref Robbins 9/e pg 450\n\nSo the answer to this question is C"} {"instruction": "Inferior rib notching is seen in\nA. Coarctation of aoa\nB. Rickets\nC. ASD\nD. Multiple myeloma", "response": "A i.e. Coarctation of aoa Inferior rib notching in coarctation of aoa is d/t pressure erosion of intercostal aeriesQ It usually takes several years to develop, so is unusual before 10 years of age.\n\nSo the answer to this question is A"} {"instruction": "Which state has the lowest IMR\nA. Uttar Pradesh\nB. Kerala\nC. Tamil Nadu\nD. Maharashtra", "response": "Ref:Park's Textbook of Preventive and Social Medicine 25th Ed\n\nSo the answer to this question is B"} {"instruction": "Absolute contraindication to ECT is:\nA. Glaucoma\nB. Brain tumor\nC. Aoic aneurism\nD. MI", "response": "There are no absolute contraindications for ECT. Earlier, raised intracranial tension and space occupying lesions were considered as absolute contraindications, hence the best answer here is brain tumor.\n\nSo the answer to this question is B"} {"instruction": "True about diabetic nephropathy -\nA. Microalbuminiuria is not an indicator of long term cardiovascular morbidity.\nB. Strict glycemic control cannot prevent microalbuminuria\nC. b-islet cell\\/pancreatic transplantation can improve the proteinuria in early stage.\nD. Angiotensin receptor blockers have no additive advantage over other drugs except B.P. control.", "response": "Beta islet cell/ pancreatic transplantation can improve proteinuria in early stages.. Strict control of blood glucose retards the progression of any diabetes related complication Early pathological change and albumin excretion abnormalities is reversible with normalization of plasma glucose Administration of ACE inhibitors or ARB&;s, is also effective in slowing progression from Microalbuminuria to ove nephropathy Ref Harrison 17/e p 2287-88\n\nSo the answer to this question is C"} {"instruction": "SRK formula is used to calculate\nA. Power of intraocular lens\nB. Corneal curvature\nC. Corneal endothelial cell count\nD. Extent of retinal detachment", "response": "Answer- A. Power of intraocular lensIntraocular lens power calculation :- Which requires Keratometry (K), Axial length of eyeball or Biometry (L) and aconstant (A). It is calculated by SRK formula:Power of IOL= A- 2.5L -0.9K\n\nSo the answer to this question is A"} {"instruction": "Cells of parafollicular cells are derived from?\nA. 1st branchial pouch\nB. 2nd hrahchial pouch\nC. 5th brachial pouch\nD. 4th brachial pouch", "response": "C i.e. 5th brachial pouch\n\nSo the answer to this question is C"} {"instruction": "Anesthetic agent known to cause pain on intravenous injection:\nA. Ketamine\nB. Etomidate\nC. Thiopentone\nD. Propofol", "response": "Ans: (d) PropofolRef: Stoelting's Pharmacology and Physiology in Anesthetic Practice, 4th editionPropofol: Causes pain on intravenous injection due to presence of egg lecithin in its commercial preparation.Etomidate - Pain and venous irritation has been virtually eliminated with the use of lipid emulsion vehicle and avoid in propylene glycol.Ketamine and Thipenthol Na are not emulsion preparations and do not cause pain on IV injection.Composition of 1% Propofol Emulsion:1% propofol o 10% soyabean oil2.25% Glycerol o 1.2% egg lecithin0.005% di sodium edetate (to prevent bacterial growth)Prevention of pain duration IV injection of Propofol:Should be given in large bore cannula and in running fluidAdd 1% lidocaine with 10 ml of propofol before injectionGive fentanyl before propofol injectionUse lipid based formulation of propofolFospropofol (Aquavan): Is a phosphorylated prodrug of propofolNo pain on IV injectionLonger shelf half lifeSlight longer peak effect and more prolong duration of action1 mg Fospropofol=0.54mg propofol\n\nSo the answer to this question is D"} {"instruction": "Exclamation mark hairs are seen in:\nA. Syphilis\nB. Alopecia areata\nC. Psoriasis\nD. Dermatophytosis", "response": "Ans is 'b' i.e, Alopecia areata\n\nSo the answer to this question is B"} {"instruction": "Lady with recent delivery engorged shiny mass on breast under nipple fever -\nA. Breast abscess\nB. Fibroadenosis\nC. Sebaceous cyst\nD. Fibroadenoma", "response": "Ans. is 'a' i.e., Breast abscess * Features favouring breast abscess:# Lactating woman# Tender swelling# Pyreia# Tense shiny overlying skin* Diagnosis- Ultrasound would be the most useful investigation to diagnose the condition and in delineating the required extent of the drainage procedure.\n\nSo the answer to this question is A"} {"instruction": "Digoxin is useful in -\nA. Atrial fibrillation in thyrotoxicosis\nB. Complete hea-block with CHF\nC. Ventricular tachycardia\nD. Myocarditis", "response": "Ans. is 'b' i.e., Complete hea-block with CHF Digitalis has depressant action on AV node -4 it delayes the conduction through AV node by increased ERP. If paial block is present, digitals may conve it into complete block. But, if complete block is already present, digitalis cannot worsen the condition (as conduction is blocked to maximum block, i.e., complete hea block). So, in this condition digitalis can be used for hea failure. About other options In thyrotoxicosis and myocarditis there is reduced responsiveness and patient becomes more prone for digitalis induced arrhythmias. Digitalis is contraindicated in ventricular tachycardia as ventricular fibrillation may be precipitated.\n\nSo the answer to this question is B"} {"instruction": "Occupational hazards to the dentists result from\nA. Posture\nB. Accidental infection\nC. Dermatitis\nD. All of the above", "response": "None\n\nSo the answer to this question is D"} {"instruction": "In ETC, oxidative phosphylartion (ATP formation) is regulated by\nA. NADH Co-Q reductase\nB. Cytochrome C oxidase\nC. Co-Q cytochrome C reductase\nD. All of these", "response": "NADH Co-Q reductase; 'b' i.e., Cytochrome C oxidase & `e' i.e., Co-Q cytochrome C reductase\n\nSo the answer to this question is D"} {"instruction": "Which of the following is content of Littre's hernia?\nA. Urinary bladder\nB. Meckel's diverticulum\nC. Circumference of intestinal wall\nD. Appendix", "response": "Ans. b (Meckel's diverticulum). (Ref. Bailey & Love, Surgery, 25lh/pg. 969, Ritcher Hernia (MH'2000)A Meckel's diverticulum = a Littre's hernia;An aphorism attributed to Dr. Charles Mayo: 'a Meckel's diverticulum is frequently suspected, often sought for and seldom found'.HerniasLittre's herniaMeckel's diverticulum is found in an inguinal or a femoral hernia sacRichter's herniaSac contains only a portion of the circumference of the intestine (usually small intestine). It usually complicates femoral and, rarely, obturator hernias.Dual(saddie bag; pantaloon)herniaConsists of two sacs which straddle the inferior epigastric artery, one sac being medial and the other lateral to this vessel.MAYDL'S hernia (SYN. HERNIA-IN-W).Strangulated loop of the \"W\" lies within the abdomen, thus local tenderness over hernia is not marked.Spigelian herniaA variety of interparietal hernia occurring at the level of the arcuate line, it is very rare with only 1000 cases reported in the literature.The fundus of the sac, clothed by extraperitoneal fat, may lie beneath the internal oblique muscle where it is virtually impalpable. More often it advances through that muscle and spreads out like a mushroom between the internal and external oblique muscles, and gives rise to a more evident swelling. The patient is often corpulent and usually over 50 years of age, men and women being equally affected. Typically, a soft, reducible mass will be encountered lateral to the rectus muscle and below the umbilicus.Diagnosis is confirmed by computerised tomography (CT) or ultrasound scanning, the latter having the advantage of being able to stand the patient upright if no defect is visible in the reclining position. Owing to the rigid fascia surrounding the neck, strangulation may occur.Lumbar herniaMost primary lumbar hernias occur through the inferior lumbar triangle of Petit, bounded below by the crest of the ilium, laterally by the external oblique and medially by the latissimus dorsi.Less commonly, the sac comes through the superior lumbar triangle which is bounded by the twelfth rib above, medially by the sacrospinalis and laterally by the posterior border of the internal oblique.More commonly lumbar hernias are secondary to renal operations, when extensive incisional sacs may be present.Educational Points:The rule that constipation is present in intestinal obstruction does not apply in:# Richter's hernia;# Gallstone obturation;# Mesenteric vascular occlusion;# Obstruction associated with a pelvic abscess;# Partial obstruction (faecal impaction/colonic neoplasm) where diarrhoea may often occur.\n\nSo the answer to this question is B"} {"instruction": "Testicular lymphatics drain into -\nA. Deep inguinal lymphnodes\nB. Internal iliac lymph nodes\nC. Para aortic lymph nods\nD. Superficial inguinal lymphnodes", "response": "Ans. is 'c' i.e., Para aortic lymph nods o Testicular lymphatics drain into paraaortic and prearotic group of lymph nodes at level of L2.o The lymphatics from the cervix drain into the external iliac, internal iliac and sacral nodes,o Lymphatic Drainage of uterus:Fundus and upper body - aortic nodes and superficial inguinal nodesLower body - external iliac nodesCervix - external iliac, internal iliac and sacral nodes,o Lymphatic drainage of Vagina:Upper 1/3 - external iliac nodesMiddle 1/3 - internal iliac nodesLower 1/3- superficial inguinal nodesOrganDraining Lymph nodeGians Penis & ClitorisRest of PenisDeep inguinal nodes of cloquefQSuperficial inguinal nodesTestis and ovaryPre & Para aortic lymph nodesParotid & ThyroidDeep cervical lymph nodesPharynxDeep cervical & Retropharyngeal lymph n.Palatine tonsilJugulo-diagastric lymph nodesTongue TipAnt 2/3Post 1/3rdSubmental lymph nodesSubmandibular lymph nodesJugulo-omohyoid lymph nodesAll finally reach deep cervical lymph nodesUterus & Cervix* Fundus & upper part of body o Mainly to aortic lymh nodeso Partly to superficial inguinal lymph nodes along round ligamento External iliac lymph nodeso External iliac lymph nodeso Internal iliac lymph nodeso Sacral lymph nodes* Lower part of body* CervixSuprerenal glando Lateral Aortic lymph nodesRectum & Anal Canal above pectinate line Anal canal below pectinate lineo Internal iliac lymph nodeso Superficial inguinal lymph nodes\n\nSo the answer to this question is C"} {"instruction": "Laryngeal mask Airway (LMA) is used for;\nA. Maintenance of the airway\nB. Facilitating laryngeal surgery\nC. Prevention of aspiration\nD. Removing oral secretions", "response": "A i.e. Maintenance of airway\n\nSo the answer to this question is A"} {"instruction": "True about parosteal osteosarcoma -\nA. Same prognosis as medullary type\nB. Never go to medulla\nC. May involve medulla\nD. All of the above", "response": "This question is quite different from previous one.\nThough medullary cavity is not involved in parosteal osteosarcoma, some dedifferentiated type (grao sarcoma may involve medullary cavity. -- DD of bone tumor.\n\nSo the answer to this question is C"} {"instruction": "Nuclear family consist of -\nA. Husband, wife and son\nB. Husband, wife and dependent children\nC. Husband and wife only\nD. Fathermother husband and wife", "response": "- nuclear or elementary family consist of married couples and their children while they are still regarded as dependents. - husband plays the dominant role in nuclear family. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:683,684 <\\p>\n\nSo the answer to this question is B"} {"instruction": "True regarding PKU is all except:-\nA. Due to deficiency of phenyl alanine hydroxylase\nB. Neurological symptoms are due to excess phenyl alanine\nC. Blood phenyl alanine level >20 mg/dl causes severe disease\nD. Method of choice for screening is urinary phenyl alanine by Guthrie;s test", "response": "Diagnosis of PKU was detected by screening the new-born babies for the increased plasma levels of phenylalanine (PKU, 20-65 mg/dl; normal 1-2mg/dl). This was carried out by Guthrie test, which is a bacterial (Bacillus subtilis) bioassay for phenylalanine. Phenylpyruvate in urine can be detected by ferric chloride test (a green colour is obtained). Method of Choice is Tandem Mass Spectrometry, also for all the Inborn metabolic Error disease\n\nSo the answer to this question is D"} {"instruction": "The \"Ugly duckling\" stage of the transitional dentition\nis characterized by all of the following except\nA. Deep overbite\nB. Distoangular axial inclination of the maxillary incisors\nC. Mandibular lateral incisors erupting lingual to the mandibular central incisors\nD. Possible overjet", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Which of the following drugs is best for reducing proteinuria in a diabetic patient ?\nA. Metoprolol\nB. Perindopril\nC. Chlorothiazide\nD. Clonidine", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Delusion is a disorder of:\nA. Thinking\nB. Memory\nC. Perception\nD. Intellect", "response": "Ans. is 'a' Thinking Cognition (Thought) Disorders are -Schizophrenia*Obsessive compulsive neurosis*Delusions* & phobias*Also rememberHallucinations are disorder of - perception*\n\nSo the answer to this question is A"} {"instruction": "Characteristic feature of still's disease:\nA. Prominent kidney involvement\nB. Rashes\nC. Positive Rheumatoid factor\nD. Neutropenia", "response": "Ans. is 'b' Rashes Stills disease is a variant of rheumatoid commonly occurring in adults in 20's and 30's patients characteristics clinical features are:High spiking fever often upto 40deg C.Sore throatEvanescent salmon coloured non pruritic rash, seen on chest & abdomenLymphadenopathyPericardial effusionWrist joint involvementChances are that you might confuse it with Felty's syndrome so I am giving the important features of both these conditions togetherStills ds Feltv's syndromeRheumatoid arthritis * Rheumatoid arthritisSplenomegaly * SplenomegalyLeucocytosis * NeutropeniaRash * High titres of rheumatoid factorRheumatoid factor is usually not present\n\nSo the answer to this question is B"} {"instruction": "Organism most likely to cause \"fever of unknown origin\" in a farmer who raises goats\nA. Brucella melitensis\nB. Clostridium novyi\nC. Histoplasma capsulatum\nD. Mycobacterium tuberculosis", "response": "Human brucellosis is acquired from animals, directly or indirectly. Goats, sheep, cattle, buffalos, and swine are common sources. Most human infections in various pas of India are due to B.melitensis acquired from goats and sheep. Ref: Textbook of microbiology; Ananthanarayana and paniker's; 10th edition; Pg: 348\n\nSo the answer to this question is A"} {"instruction": "\"Active management of third stage of labour\" includes all of the following steps, except ?\nA. Controlled cord traction\nB. Uterine massage\nC. Oxytocin\nD. Methergine", "response": "WHO definition of PPH - Blood loss of 500 ml or more following vaginal delivery or blood loss 1000 ml or more following a caesarean section. Third stage of labor includes the period from delivery of the baby to delivery of placenta and membranes. Active management of third stage of labor for prevention of postpaum hemorrhage (PPH) includes: Intramuscular oxytocin 10 U given at the delivery of anterior shoulder. Controlled cord traction to deliver the placenta. Uterine massage holding the fundus of uterus after delivery of placenta. Recently, delayed cord clamping has be advocated for all deliveries to make sure the fetus gets maximum blood from the placenta (except cases like R. isoimmunisation and fetal distress, see table below). The American College of Obstetricians and Gynecologists' Committee on Obstetric Practice, 2017 January repo, makes the following recommendations regarding the timing of umbilical cord clamping after bih: In term infants, delayed umbilical cord clamping increases hemoglobin levels at bih and improves iron stores in the first several months of life, which may have a orable effect on developmental outcomes. Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage. Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after bih. There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician-gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice. Delayed umbilical cord clamping does not increase the risk of postpaum hemorrhage. (Students to Please note the last point: This is the reason why 'early cord clamping' is not a pa of AMTSL)\n\nSo the answer to this question is D"} {"instruction": "A chronic alcoholic is presenting with clinical features of meningitis. Most likely organism which will grow on CSF culture:\nA. Streptococcus pneumoniae\nB. N. meningitidis\nC. Listeria monocytogenes\nD. E coli", "response": "Streptococcus pneumoniae REF : ananthanarayana 10th ed\n\nSo the answer to this question is A"} {"instruction": "Third coronary aery is -\nA. Right coronary aery\nB. Left coronary aery\nC. Conus aery\nD. Anterior interventricular aery", "response": "Ans. is 'c' i.e.,Conus aeryThird coronary aery is seen only in 50% of human heas. It is also called conus aery.The conus aery is a small early branch off the right coronary aery (RCA) circulation.\n\nSo the answer to this question is C"} {"instruction": "Waste types not to be incinerated are\nA. Pressurized gas containers\nB. Reactive chemical waste\nC. Radiographic waste\nD. All of the above", "response": "Categories of bio-medical waste in IndiaCategory NoWaste category1Human anatomical waste2Animal waste3Microbiology and biotechnology waste4Sharps5Discarded medicines and cytotoxic drugs6Solid waste 7Solid waste 8Liquid waste9Incineration ash10Chemicals used in the production of biologicalsColor codingType of containerWaste categoryTreatment optionsYellowPlastic bagCat 1, 2, 3 & 6Incineration/deep burialRedDisinfected container/plastic bagCat 3, 6 & 7Autoclaving/Microwaving/Chemical treatmentBlue/White translucentPlastic bag/Puncture proof containerCat 4 & 7Autoclaving/Microwaving/Chemical treatment and Destruction/ShreddingBlackPlastic bagCat 5, 9 & 10 Disposal in secured landfillRef: Park; 23rd ed; Pg 793, 794\n\nSo the answer to this question is D"} {"instruction": "Clara cells are seen in:\nA. Bronchoalveolar cell Ca\nB. Small cell Ca\nC. Squamous cell Ca\nD. Non small cell Ca", "response": "Ans: a (Bronchoalveolar cell Ca) Ref: Robbins, 7th ed, p. 761Clara cells are seen in bronchoalveolar carcinomaBronchoalveolar cell Ca1 -9% of lung tumoursAffect terminal bronchoalveolar regionsGrowth pattern is referred to as \"Lepdic\"Types:Non mucinous - Columnar, peg shaped or cuboidal cellsMucinous - Distinct columnar with cytoplasmic & intra-alveolar mucinAerogenous spread presentG/A: Single or multiple nodules coalescing to form pneumonia like consolidationM/E: Mucin secreting bronchoalveolar cellsClara cellsType II pneumocytes.\n\nSo the answer to this question is A"} {"instruction": "A female patient presented with left iliac fossa pain for the past 6 months. On investigation, a 3 cm left renal pelvic stone was found with no hydroureteronephrosis, normal functioning kidneys on both sides and no distal obstruction. The ideal management would be\nA. Percutaneous nephrolithotomy (PCNL)\nB. Extra-corporeal shock wave lithotripsy (ESWL)\nC. Laparoscopic nephrolithotomy\nD. Medical dissolution therapy with oral potassium citrate", "response": "Ans. a. Percutaneous nephrolithotomy\n\nSo the answer to this question is A"} {"instruction": "The thickness of the spacer used in special tray is\nA. 2.5 mm\nB. 2.0 mm\nC. 1.5 mm\nD. 1.0 mm", "response": "None\n\nSo the answer to this question is B"} {"instruction": "The most common cardiovascular lesion in Down&;s syndrome is:\nA. VSD\nB. Endocardial cushion defect\nC. TOF\nD. COA", "response": "The most common cardiovascular lesion in Down&;s syndrome is endocardial cushion defect. Other associated defects are atrial septum defects(ASD), ventricular septum defect(VSD), and patent ductus aeriosus(PDA), aberrant subclan aery, and pulmonary hypeension. Clinical Features: Intellectual disability/Incurved or sho fifth finger with clinodactyly Congenital hea disease Acute megakaryoblastic leukemia/Alzheimer&;s disease/Atlantoaxial instability/Atresia of the duodenum Protruding tongue Round face Occiput flat/Open wide fontanelle/Open mouth Brachycephalic/Brushfiel&;s spots Low (depressed) nasal bridge Epicanthal fold/Ears low set and dysplastic Mongoloid slant (Oblique palpebral fissure) Simian palmar crease and wider gap between first and second toes. Ref: Nelson textbook of pediatrics 21st edition Pgno: 660\n\nSo the answer to this question is B"} {"instruction": "Which of the following drug can be used topically in eye: September 2007\nA. Erythromycin\nB. Ganciclovir\nC. Clindamycin\nD. Tetracyclines", "response": "Ans. D: Tetracyclines Tetracyclines are broad spectrum antibiotics with considerable bacteriostatic action against both gram-positive and gram-negative organisms as well as some fungi, rickettsiae and the chlamydiae. They are essentially used in the form of drops or ointment for superficial ocular infections such as trachoma. They get deposited in bones and teeth and hence not to be used in children and pregnant/lactating women.\n\nSo the answer to this question is D"} {"instruction": "Regarding the use of halothane in obsteric surgery,which is true –\nA. There is increased risk of PPH\nB. It has no effect on uterine musculature\nC. Best used in caesarean section\nD. None is true", "response": "As halothane causes uterine relaxation, post-partum hemorrhage can occur.\n\nSo the answer to this question is A"} {"instruction": "Study time, place, and person of a disease is ________________ study-\nA. Descriptive\nB. Analytic\nC. Association\nD. Comparison", "response": ".DESCRIPTIVE STUDIES are usually the first phase of epidemiological investigation.these studies are concerned with observing the distribution of disease or healthrelated charecteristics in human populations.procedures in descriptive epidsemiology mainly includes,defining the population to be studied,defining the disease under study,describing the disease by time,place,person and measurement of disease. etc. ref:park&;s textbook of preventive and social medicine,22nd edition,pg no 60\n\nSo the answer to this question is A"} {"instruction": "Dicrotic notch is due to ?\nA. AV valve closure\nB. Mitral valve closure\nC. Pulmonary valve closure\nD. Tricuspid valve closure", "response": "dicrotic notch. : a secondary upstroke in the descending pa of a pulse tracing corresponding to the transient increase in aoic pressure upon closure of the aoic valve. -- called also dicrotic wave Ref Davidson 23rd edition pg 430\n\nSo the answer to this question is A"} {"instruction": "The number of girls a woman would bear if she passes through her reproductive age with the same feility rate gives: March 2009\nA. Total feility rate\nB. Feility rate\nC. Gross reproductive rate\nD. Net reproductive rate", "response": "Ans. C: Gross reproductive rate The net reproduction rate (NRR) measures the effective feility in a population, taking account not only of bihs but also of the fact that not all women born will survive to their own reproductive years. The NRR is the average number of daughters of reproductive age that a woman would have if she experienced over her lifetime the prevailing age-specific rates of feility and if her daughters experienced the prevailing rates of moality. The gross reproduction rate (GRR) for a paicular year is the average number of daughters that a woman would have if she experienced over her lifetime the age-specific feility rates of that year. In that it refers only to the number of daughters born to women, not the total number of children, it is a special case of the (period) total feility rate; in most circumstances (unless the sex ratio at bih is highly unequal) the GRR equals roughly half the TFR. The general feility rate is similar to the crude bih rate except that it uses a more restricted denominator, the female population of childbearing age, ages 15 to 49. Age-specific feility rates (also called age-specific bih rates) are similar to the crude bih rate but are calculated for specific age groups of women of childbearing age. The range of childbearing ages is conventionally considered to be ages 15 to 49 (sometimes 15 to 44 is used), and a full set of age-specific feility rates would span this interval-usually either in single-year age groups or, more commonly, in five-year groups: 15 to 19, 20 to 24, ..., 45 to 49. Marital feility rates can be calculated either for the full range of reproductive ages (15 to 49 or 15 to 44) or as age-specific rates. The numerator is usually taken as the total number of live-bihs to women in the specified age range, regardless of the marital status of the mother; the denominator is the number of currently married women in the specified age range The total feility rate (TFR) at a given time (technically referred to as the period total feility rate) is the average number of children a woman would bear in her life if she experienced the age-specific feility rates prevailing at that time.\n\nSo the answer to this question is C"} {"instruction": "Which is not seen in polycythemia vera -\nA. Increased vitamin B12 binding capacity\nB. Increase erythropoietin level\nC. Increase RBC count\nD. Ocular congestion", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Conclusive test for semen: Jharkhand 11\nA. Acid phosphatase test\nB. Barberio test\nC. Florence test\nD. Phenolphthalein test", "response": "Ans. Acid phosphatase test\n\nSo the answer to this question is A"} {"instruction": "Which of the following is not a surgical method for tubal ligation ?\nA. Pomeroy\nB. Parkland\nC. Essure\nD. Irving", "response": "Various methods are Pomeroy method, Parkland procedure, madlener procedure, Irwing, Uchida, Aldridge, Shirodkar etc. THE TEXTBOOK OF GYNAECOLOGY SHEILA BALAKRISHNAN SECOND EDITION PAGE NO 388\n\nSo the answer to this question is C"} {"instruction": "Intravenous Mannitol is indicated in\nA. Normal tension glaucoma\nB. Acute angle closure glaucoma\nC. Sympathetic ophthalmitis\nD. Primary Open angle glaucoma", "response": "* Iv mannitol is an hyperosmotic agents which acts by increasing the osmotic pressure in the plasma thereby imbibing water from the vitreous . Indications:- * Acute rise in IOP --> Primary angle closure glaucoma, Secondary angle closure glaucoma , Posner Schlossman syndrome * In the pre-operative period to reduce IOP in case of lens induced glaucomas, trabeculectomy, etc. Dosage:- * 1-2 mg /kg body weight ; 20% solution Adverse Effects:- * Volume overload in cardiac patients * Increase in BP Other Hyperosmotic Agents: - * Glycerol - increases blood glucose, Contraindicated in Diabetics. * Urea - not routinely used * Isosorbide Ref:- Parson's Diseases of the eye 22nd edition; pg num:- 53,76\n\nSo the answer to this question is B"} {"instruction": "Candidiasis is a complication of all of the following except\nA. Prolonged antibiotic therapy\nB. Corticosteroid therapy\nC. Immuno compromised disease\nD. Aspiration pneumonia", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Serum enzyme used for MI -\nA. CPK\nB. Alkaline phosphatase\nC. Acid phosphatase\nD. Lipase", "response": "Ans. is 'a' i.e., CPK Organ/dtseaseSerum Enzymes used for assayHeart (Myocardial infarction)o Commonly used: - Creatine phosphokinae (CK or CPK Q), Aspartate transaminase (AST or SCOT Q), LDH Qo Not commonly used : - g-glutamyl transpeptidase, Histaminase. Pseudocho 1 inesteraseMusclesSGOT (AST) Q, SGPT (AJLT) Q, aldolase, CPK QBoneAlkaline phosphatasePancreatitisAmylase, lipaseLiverSGOT (AST), SGPT (ALT), Alkaline phosphatase, g-glutamyl transferase, LDH (isozyme-5).\n\nSo the answer to this question is A"} {"instruction": "Medical treatment of unruptured ectopic pregnancy is contraindicated in :\nA. Sac size 3 cm\nB. HCG level 3000 IU\nC. Foetal hea activity present\nD. 70 ml blood collection in pelvis", "response": "Foetal hea activity present\n\nSo the answer to this question is C"} {"instruction": "False about Tinea versicolor\nA. It is superficial fungal infection caused by Malassezia\nB. Scratch sign is positive\nC. Lesions can be both hypo & hyperpigmented\nD. Wood's lamp examination gives Apple green Fluorescence", "response": "The lesions show \"Pale yellow\" Flourescene on Wood's lamp examination.\n\nSo the answer to this question is D"} {"instruction": "Which is most common side effect of inhaled beclometh- asone dipropionate:\nA. Pneumonia\nB. Oropharyngeal candidiasis\nC. Atrophic rhinitis\nD. Pituitary adrenal suppression", "response": "Ans. (b) Oropharyngeal candidiasis* Most of the side effects of steroids are mainly hoarseness, orophyrangeal candidiasis, decreased growth in children with adrenal suppression.* The plausible explanation is that since these drugs are inhaled, they avoid the first pass metabolism that orally administered steroids undergo and hence have preponderance to cause the usual manifestations of steroid toxicity.\n\nSo the answer to this question is B"} {"instruction": "All of the following drugs act on ionic channels except:\nA. Nicotine\nB. Insulin\nC. Glibenclamide\nD. Diazepam", "response": "Ans. B. Insulina. insulin acts on enzymatic (tyrosine kinase) receptorsb. Nicotine acts on NM and NN receptors which are ion channel receptorsc. Diazepam acts on GABA-BZD-Cl channel complex that mediates entry of chlorided. Glibenclamide is a sulfonylurea that acts on ACh sensitive K+ channels.\n\nSo the answer to this question is B"} {"instruction": "Sialyl-Lewis X is linked to __________.\nA. Selectin\nB. ICAM\nC. CD31\nD. VCAM", "response": "The two major families of molecules involved in leukocyte adhesion and migration are the selectins and integrins \nThese molecules are expressed on leukocytes and endothelial cells.\nSelectins mediate the initial weak interactions between leukocytes and endothelium.\n\nSo the answer to this question is A"} {"instruction": "Meissner's corpuscle is for-\nA. Touch\nB. Temperature\nC. Pressure\nD. Proprioception", "response": "Ans. A. TouchCUTANEOUS MECHANORECEPTORS: -Sensory receptors can be specialized dendritic endings of afferent nerve fibers, and they are often associated with non- neural cells that surround them forming a sense organ. Touch and pressure are sensed by four types of mechanoreceptors.a. Meissner corpuscles are dendrites encapsulated in connective tissue and respond to changes in texture and slow vibrations.b. Merkel cells are expanded dendritic endings, and they respond to sustained pressure and touch.c. Ruffini corpuscles are enlarged dendritic endings with elongated capsules, and they respond to sustained pressure.d. Pacinian corpuscles consist of unmyelinated dendritic endings of a sensory nerve fiber, 2 um in diameter, encapsulated by concentric lamellae of connective tissue that give the organ the appearance of a cocktail onion. These receptors respond to deep pressure and fast vibration.e. The sensory nerves from these mechanoreceptors are large myelinated Aa and Ab fibers whose conduction velocities range from ~ 70-120 to ~ 40-75 m/s, respectively.a. Sensory systems encode four elementary attributes of stimuli: modality, location (receptive field), intensity, and duration (timing).b. The human hand has four types of mechanoreceptors; their combined activation produces the sensation of contact with an object. Selective activation of Merkel cells and Ruffini endings causes sensation of steady pressure; selective activation of Meissner and Pacinian corpuscles causes tingling and vibratory sensation.c. Location of a stimulus is encoded by spatial distribution of the population of receptors activated. A receptor fires only when the skin close to its sensory terminals is touched. These receptive fields of mechanoreceptors (shown as red areas on fingertips) differ in size and response to touch. Merkel cells and Meissner corpuscles provide the most precise localization as they have the smallest receptive fields and are most sensitive to pressure applied by a small probe.d. Stimulus intensity is signaled by firing rates of individual receptors; duration of stimulus is signaled by time course of firing. The spike trains indicate action potentials elicited by pressure from a small probe at the center of each receptive field. Meissner and Pacinian corpuscles adapt rapidly; the others adapt slowly.\n\nSo the answer to this question is A"} {"instruction": "Modafinil is approved by FDA for treatment of all, except:\nA. Narcolepsy\nB. Shift work syndrome (SWS)\nC. Obstructive sleep apnea syndrome (OSAS)\nD. Lethargy in depression", "response": "Modafinil is an FDA approved drug in the treatment of obstructive sleep apnea, shift work disorder and narcolepsy. It is not FDA approved in the treatment of lethargy in major depression. Ref: Sleepiness: Causes, Consequences and Treatment By Michael J. Thorpy, Pages 415-6\n\nSo the answer to this question is D"} {"instruction": "Which of the following is true regarding thyrotoxicosis?\nA. In Grave’s disease, antibodies are formed to TSH receptors, which result in excessive thyroxine secretion\nB. Hashimoto's thyroiditis occur in young males\nC. In primary hypothyroidism, decreased TSH levels are seen\nD. All of the above", "response": "Pathophysiology of Graves’ thyrotoxicosis\nThe thyrotoxicosis results from the production of immunoglobulin G (IgG) antibodies directed against the TSH receptor on the thyroid follicular cell, which stimulate thyroid hormone production and proliferation of follicular cells, leading to goitre in the majority of patients. These antibodies are termed thyroid-stimulating immunoglobulins or TSH receptor antibodies (TRAb) and can be detected in the serum of 80–95% of patients with Graves’ disease. \nThe concentration of TRAb in the serum is presumed to fluctuate to account for the natural history of Graves’ thyrotoxicosis. Thyroid failure seen in some patients may result from the presence of blocking antibodies against the TSH receptor, and from tissue destruction by cytotoxic antibodies and cell-mediated immunity.\nHashimoto’s thyroiditis is characterised by destructive lymphoid infiltration of the thyroid, ultimately leading to a varying degree of fibrosis and thyroid enlargement. Hashimoto’s thyroiditis increases in incidence with age and affects approximately 3.5 per 1000 women and 0.8 per 1000 men each year.\nIn the vast majority of cases, hypothyroidism results from an intrinsic disorder of the thyroid gland (primary hypothyroidism). In this situation, serum T 4 is low and TSH is elevated, usually in excess of 20 mIU/L. Measurements of serum T 3 are unhelpful since they do not discriminate reliably between euthyroidism and hypothyroidism.\nReference: : Davidson P R I N C I P L E S and Practice O F M E D I C I N E 23rd edition page no 643,646, 640\n\nSo the answer to this question is A"} {"instruction": "Somatomedin mediates which of the following process?\nA. Deposition of chondroitin sulfate\nB. Lipolysis\nC. Gluconeogenesis\nD. Decreased rate of glucose uptake by cells", "response": "Somatomedins are polypeptide growth factors secreted by the liver and other tissues. The first of these factors isolated was called sulfation factor because it stimulated the incorporation of sulfate into cailage. However, it also stimulated collagen formation, and its name was changed to somatomedin. It then became clear that there are a variety of different somatomedins and that they are members of an increasingly large family of growth factors that affect many different tissues and organs. The principal (and in humans probably the only) circulating somatomedins are insulin-like growth factor I (IGF-I, somatomedin C) and IGF-II. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 18. The Pituitary Gland. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds),Ganong's Review of Medical Physiology, 24e.\n\nSo the answer to this question is A"} {"instruction": "Which one of the following statements regarding collagen is true?\nA. It is composed of Tropocollagen.\nB. Reticular Fibers are composed of type II collagen.\nC. It is synthesized mostly by Mast cells.\nD. Elastic Fibers are composed of type IV collagen.", "response": "Collagen is composed of closely packed Tropocollagen Molecules. Reticular Fibers are composed of type III collagen, Elastic Fibers are composed of Elastin microfibrils rather than collagen. Collagen is synthesized by Fibroblasts not mast cells.\n\nSo the answer to this question is A"} {"instruction": "Characteristic Direct immunofluorescence findings in Herpes gestationis is\nA. Epidermal cell-surface deposits of IgG and C3\nB. Linear, homogeneous deposits of IgGand C3 at the dermal-epidermal junction\nC. Linear homogeneous deposits of C3 at the dermal-epidermal junction\nD. Focal granular deposits of IgA at the papillary tips", "response": "DIRECT IMMUNOFLUORESCENCE FINDINGS IN AUTOIMMUNE BLISTERING DISEASE. Disease Pattern and nature of immunoreactants Pemphigus Epidermal cell-surface deposits of IgG and C3 giving fishnet appearance Bullous pemphigoid Linear, homogeneous deposits of IgG (epidermal side on salt-split skin) and C3 at the dermal-epidermal junction. Linear IgA dermatosis Linear homogeneous deposits of IgA at the dermal-epidermal junction Herpes gestationis Linear homogeneous deposits of C3 at the dermal-epidermal junction Epidermolysis bullosa acquisita Linear homogeneous deposits of IgG (dermal side on the salt-split skin) and C3 at the dermal-epidermal junction. Cicatricial pemphigoid Linear homogeneous deposits of IgG and C3 at the dermal-epidermal junction Dermatitis herpetiformis Focal granular deposits of IgA at the papillary tips The bullous eruption of lupus erythematosus Linear homogeneous, or non-homogeneous, deposits of multiple immunoglobulins, C3 and fibrin at the dermal-epidermal junction. (Ref. Harrison's Table 7.9) Ref Harrison 20th edition pg 1256\n\nSo the answer to this question is C"} {"instruction": "In extra amniotic 2nd trimester medicolegal termination of pregnancy, which of the following is used?\nA. Ethacrydine lactate\nB. Prostaglandin\nC. Hypertonic saline\nD. Glucose", "response": "Ans. is a, i.e. Ethacrydine lactateRef. Dutta Obs. 7/e, p 173Ethacridine lactate is drug of choice for extra-amniotic instillationAvailable as injection Emcredil (0.1%)Foleys catheter is introduced into extra-amniotic or extraovular space and bulb is inflated by 10-20 ml of Ethacridine solution.Dose is calculated as 10 ml/week of gestation upto maximum of 150 mlCatheter is left for 6 hours.Uterine action begins in 16-18 hours.In 30% cases abortion is incomplete and requires oxytocin drip or supplementation with prostaglandin.\n\nSo the answer to this question is A"} {"instruction": "Corpus striatum includes all except\nA. Caudate nucleus\nB. Putamen\nC. Globus pallidus\nD. Amygdala", "response": "The corpus striatum, which is paially divided by the internal capsule into two nuclei: (a) The caudate nucleus; and (b) the lentiform nucleus. These two nuclei are interconnected by a few bands of grey matter below the anterior limb of the internal capsule. The bands give it a striped appearance, hence the name.The lentiform nucleus is divided into a lateral pa, the putamen, and a medial pa, the globus pallidus. The caudate nucleus and putamen (neostriatum) are often grouped as the striatum, whereas the globus pallidus (paleostriatum) is the pallidum.The amygdaloid body forms a pa of the limbic system.Ref: BD Chaurasia; Volume 3; 6th edition; Brain; Page no: 358\n\nSo the answer to this question is D"} {"instruction": "The characteristic of the pulmonary circulation:\nA. High resistance, high compliance\nB. Low resistance, low compliance\nC. High resistance, low compliance\nD. Low resistance, high compliance", "response": "Pulmonary aery pressures are reflective of RV pressures .Pulmonary circulation is low pressure, low resistance circulation as compared to systemic circulation. Pulmonary vessels are about 24 times more compliant compared to their systemic counterpas. Pulmonary circulation, in a sho route, has to accommodate large quantities of blood. Due to their high compliance and large amounts of blood accommodated within them, lungs are called 'reservoir of blood'. At any given time, lungs accommodate about 15% of the total blood volume.\n\nSo the answer to this question is D"} {"instruction": "Causes of localized hypopigmented macule or patch are all except\nA. Vitiligo\nB. Piebaldism\nC. Pityr i as is alba\nD. Freckle", "response": "Freckles - multiple, ill-defined brown macules, which darken on sun exposure. Individual macules may show variation in skin color. All the other three condition produces localized hypopigmented macules or patch.\n\nSo the answer to this question is D"} {"instruction": "The earliest muscle to be involved in dermatomyositis is\nA. Deltoid\nB. Gluteal\nC. Lumbricals\nD. Quadriceps", "response": "Dermatomyositis (DM) is a long-term inflammatory disorder which affects muscles. Its symptoms are generally a skin rash and worsening muscle weakness over time.These may occur suddenly or develop over months.Other symptoms may include weight loss, fever, lung inflammation, or light sensitivity.Complications may include calcium deposits in muscles or skin. People with DM experience progressively worsening muscle weakness in the proximal muscles (for example, the shoulders and thighs).Tasks that use these muscles: standing from sitting, lifting, and climbing stairs, can become increasingly difficult for people with dermatomyositis .(quadriceps are first effected) Ref Robbins 9/e pg 172\n\nSo the answer to this question is D"} {"instruction": "Which of the following is most specific and sensitive screening test in a case of renovascular hypeension\nA. HRCT\nB. CT guided angiography\nC. Captopril induced radionuclide scan\nD. MRl", "response": "A number of investigations may be abnormal in patients with renovascular disease. Renal function may be impaired and plasma renin activity may be elevated, sometimes with hypokalaemia due to hyperaldosteronism. Ultrasound may reveal a discrepancy in size between the two kidneys. Unfounately, these simple non-invasive tests are insufficiently sensitive for screening in hypeensive patients and vascular imaging is required to diagnose renovascular disease. Such imaging is usually undeaken only in patients in whom intervention to improve renal perfusion would be contemplated; this is usually limited to young patients and those in whom blood pressure cannot be controlled with antihypeensive agents ('resistant hypeension'), those who have a history of 'flash' pulmonary oedema or accelerated phase ('malignant') hypeension, or those in whom renal function is deteriorating. CT and MRI angiographic techniques have largely replaced Doppler ultrasound or renal isotope scanning (including 'captopril renography') in diagnosing renal aery stenosis. Conventional renal aery cannulation and aeriography is now usually undeaken for therapeutic rather than diagnostic purposes. CT angiography entails large intravenously administered doses of contrast medium which may be nephrotoxic. ref:Harrison&;s principles of internal medicine,ed 18,pg no 3045\n\nSo the answer to this question is D"} {"instruction": "Organic content of Dentin is\nA. 15%\nB. 35%\nC. 65%\nD. 5%", "response": "Dentin forms bulk of the tooth tissues and occupies both the crown and the root. It is surrounded by the enamel in the crown and cementum in the root. Physically and chemically it resembles bone. Dentin consists of 65% inorganic and 35% organic material. The organic substance consists mainly of type I collagen fibers embedded in ground substance of mucopolysaccharides. The inorganic component consists of plate shaped hydroxyapatite crystals.\n\nSo the answer to this question is B"} {"instruction": "True about MHC\nA. Transplantation reaction\nB. Autoimmune disease\nC. Immunosuppression\nD. Involved in T cell function", "response": "Ref Harrison 16/e p1930; Robbins 7/e p204_ 205 Also involved in autoimmune disease, involved T cell function MHC class II molecules are a class of major histocompatibility complex (MHC) molecules normally found only on professional antigen-presenting cells such as dendritic cells, mononuclear phagocytes, some endothelial cells, thymic epithelial cells, and B cells. Thesecells are impoant in initiating immune responses.\n\nSo the answer to this question is A"} {"instruction": "Neurological complications of meningitis include all of the following, except:\nA. Seizures.\nB. Increased intra-cranial pressure.\nC. Cerebral hamartoma.\nD. Subdural effusions.", "response": "Ans. is 'c' i.e. Cerebral hamartoma Cerebral hamartoma is a benign, neoplastic condition and is not associated with meningitis.Complications of MeningitisHydrocephalusCranial nerve involvementSeizuresSubdural effusionsSubdural empyemaCerebral herniation d/t increased ICT.\n\nSo the answer to this question is C"} {"instruction": "The following statements are true of patent ductus arteriosus(PDA) except – a) Spontaneous closure occurs in some term infantsb) Pulmonary hypertension developsc) Bacterial endocarditis is more frequent with small PDAd) Recurrent chest infection and congestive failure may develope) Anatomic existence of PDA is an indication for surgery\nA. a\nB. b\nC. ae\nD. ad", "response": "Spontaneous closure of PDA\n1) In premature infants\n\nIn premature infants, spontaneous closure of PDA may occur because in these infants PDA is due to unresponsiveness to oxygen and there is no structural abnormality.\n\n2) In Full-term infants\n\nUnlike that in premature infants, spontaneous closure of a PDA does not usually occur in full-term infants.\nThis is because the PDA in term infants results from a structural abnormality of the ductal smooth muscle.\n\nClinical manifestations of PIA\n\nPatient may be asymptomatic\nSymptoms develop early and CHF may develop at 6 to 8th weeks of age.\nCommon symptoms → Dysnea on exertion, palpitation and frequent chest infections.\n\nSigns\n\nTachypnea & Tachycardia\nBounding pulse with wide pulse pressure (with elevated systolic and lower diastolic pressure).\nHyperkinetic cardiac impulse\nSystolic or continuous thrill.\nAccentuated S1\nThe narrow or paradoxical split of S2 (But it may be masked by continuous murmur since the maximum intensity of continuous murmur occurs at S2).\nContinuous (machinery) murmur → Murmur starts after S and reaches the peak at S2. It then diminishes and is audible only during a part of the diastole. Murmur is best heard at second left intercostal space and is also heard below left clavicle.\nS3 may occur at apex followed by a delayed diastolic murmur.\n\nSo the answer to this question is C"} {"instruction": "A 52-year-old female, Rukmini presents at the outpatient clinic with pain in the groin. Physical examination reveals a bulge in the groin area immediately inferior to the inguinal canal. The physician suspects that the patient has a femoral hernia containing a loop of small intestine. Which of the following structures is located immediately medial to the hernia sac?\nA. Femoral aery\nB. Femoral nerve\nC. Femoral vein\nD. Lacunar ligament", "response": "A femoral hernia exits the abdominal cavity through the femoral ring to enter the femoral canal. The femoral ring is bounded medially by the lacunar ligament. Compression of the herniated intestine against the sharp edge of the lacunar ligament may cause strangulation of the intestine. The other borders of the femoral ring are the inguinal ligament anteriorly, the pubis posteriorly, and the femoral vein laterally. The femoral aery is within the femoral sheath along with the femoral hernia, but is lateral to the femoral vein, which separates the aery from the hernia. The femoral nerve is not inside of the femoral sheath, but is lateral to the sheath. The femoral vein is lateral to the femoral canal within the femoral sheath.\n\nSo the answer to this question is D"} {"instruction": "All are true regarding DDT, Except\nA. It acts as neurotoxin\nB. It is primarily a contact poison\nC. It does not cause immediate death, but it takes several hours to kill\nD. It has repellent action on insects", "response": "DDT (Dichloro diphenyl trichloroethane)It was first synthesized by a German chemist, Ziedler.Its insecticidal action was described by Paul Muller.It is primarily a contact poison.It acts on the nervous system of insects.It takes several hours to kill the insect.The residual action of DDT may last as long as 18 months.It has no repellent action on insects.As a residual spray, DDT is applied at a dosage of 100-200 mg/ sq. foot area.The formulation of choice is a 5 % suspension, 5-10 % strength for the control of lice, fleas, ticks, and bugs.\n\nSo the answer to this question is D"} {"instruction": "Replacement of columnar epithelium in respiratory tract to squamous epithelium is -\nA. Hyperplasia\nB. Hypoplasia\nC. None of the above\nD. Metaplasia", "response": "Metaplasia\no Metaplasia is a reversible change in which one differenated cell type is replaced by another differenated cell type.\no Metaplasia represents an adapve substuon of cells that are sensive to stress by cell types beer able to withstand the adverse environment,\no Metaplasia may be of two types\n\nSo the answer to this question is D"} {"instruction": "A 45 - year old cirrhotic patient presented with severe haematemesis. The management of choice is :\nA. Whole blood transfusion is the best\nB. Colloids are preferred over crystalloids\nC. Normal saline infusion\nD. IV fluid with diuretics", "response": "Ans. is 'a' Whole Blood transfusion \"Patients with significant hemorrhage, Anaemia or Intravascular volume depletion require Blood transfusion or colloid containing solutions (albumin, Dextran) but whole blood transfusion is the t/t of choice because colloidal solutions are expensive and they have some adverse effect\"T/T of hypovolemia :The therapeutic goals are to restore normovolemia with fluid similar in composition to that lost and to replace ongoing losses.Mild volume contraction can usually be corrected via oral route. More severe hypovolemia requires intravenous therapy. Normonatremic or Mildly - Isotonic or normal saline (0.9% NaCl) and should be hyponatremic individuals administered initially in pts with hypotension or shock.Severe Hyponatremia - Hypertonic Saline (3.0% NaCl)Hypernatremia - Half Normal Saline(0.5% NaCl)If Hypokalemia also occurs - Add appropriate amount of KC1 to replacement solution.Significant haemorrhage, - Whole blood transfusion.Anaemia or IntravascularVolume depletion\n\nSo the answer to this question is A"} {"instruction": "Which of the following is a feature of temporal aeries\nA. Giant cells aeries\nB. Granulomatous vasculitis\nC. Necrotizing vasculitis\nD. Leukocytoclastic vasculitis", "response": "Refer robbins 9/e p506 Temporal aeritis is a condition in which the temporal aeries, which supply blood to the head and brain, become inflamed or damaged. It is also known as cranial aeritis or giant cell aeritis. Although this condition usually occurs in the temporal aeries, it can occur in almost any medium to large aery in the body\n\nSo the answer to this question is A"} {"instruction": "What psychopathology does the term 'perseveration' describe?\nA. Patient feeling very distressed\nB. Characteristic feature of schizophrenia\nC. Characteristic of obsessive compulsive disorder (OCD)\nD. Persistent and inappropriate repetition of the same thoughts", "response": "Perseveration refers to inappropriate recurrence or continuance of a paicular behavior (in sucession). E.g. talk the same sentence many times and not able to move away from it. It is unintentional and the patient may or may not be aware of this disorder. Perseveration usually indicates an organic pathology like a brain injury, stroke etc. Ref: Linguistic Disorders and Pathologies: An International Handbook By Gerhard Blanken, page 230.; Medical-Legal and Forensic Aspects of Communication Disorders, By Dennis C. Tanner page 80.\n\nSo the answer to this question is D"} {"instruction": "All of the following are true about bacillus anthracis except -\nA. Plasmid is responsible for toxin production\nB. Cutaneous anthrax generally resolve spontaneously\nC. Capsular polypeptide aids virulence by inhibiting phagocytosis\nD. Toxin is a complex of two fractions", "response": "None\n\nSo the answer to this question is D"} {"instruction": "This is known as ?\nA. Falanga\nB. Bansdola\nC. Telefono\nD. Jack knife Toure", "response": "FALANGA/ BASTINADO It is a type of toure method in which the soles of the feet of the victim are beaten by stick or blunt object Findings : Hematoma on the sole of the feet TELEFONO :Repeated slapping on the ears DRY SUBMARINE :Plastic bag asphyxiation WET SUBMARINE : Forced immersion of head under water. PICANA :Electric shock toure. PLANTON :Prolonged standing\n\nSo the answer to this question is A"} {"instruction": "A 60 year old male suffering from auditory hallucination says that people staying upwards are talking about him and conspiring against him. He dropped police complaint against them but the allegations were proved to be wrong. The diagnosis is -\nA. Depression\nB. Dementia\nC. Delusional disorder\nD. Schizophrenia", "response": "This patient has third person hallucination (voices are talking about the patient) which is characteristic of schizophrenia, and only one characteristic symptom is required for diagnosis if third person hallucination is present.\n\nSo the answer to this question is D"} {"instruction": "True about polio vaccination is all EXCEPT -\nA. Follow up of AFP for 30 dyas\nB. Salk contains three types of polio virus\nC. Pulse polio doses are extra and supplemental\nD. Oral polio vaccine provides intestinal immunity also", "response": "
Follow up in 60 days. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:203. <\\p>\n\nSo the answer to this question is A"} {"instruction": "All the following are features of Guillain-Barre syndrome except:\nA. Predominant motor involvement\nB. Facial nerve involvement\nC. Absence of pleocytosis in CSF\nD. Bladder bowel involvement", "response": "Answer is D (Bladder bowel involvement): Bladder bowel involvement is rare in G. B. syndrome. Bladder dysfunction may occur in severe cases but is usually transient. 'If bladder dysfunction is prominent and comes early possibilities other than GBS should be considered'.- Harrison Guillain Barre syndrome (GBS) is an autoimmune disease characterized by acute demyelinating polyneuropathy. It has several distinctive features, which are so often asked. These include : Aetiology Preceding evidence of a viral infection such as that with - Herpes group : CMV / EBV Campylobacter jejuni gastroenteritis Lymphoma / Lupus Erythematosus Clinical manifestation Predominant motor involvement Sensory disturbance Autonomic * Paraplegia / Quadriplegia * Sensory disturbance may or may not be * Autonomic involvement * Proximal muscles affected more than the present : Cutaneous sensory deficits (eg. characterized by Postural distal ones loss of pain and temperature sensation) hypotension. episodes of * Ascending pattern of paralysis when present are usually mild. hypotension or hypeension * Cranial nerve involvement 9 : The * Bladder & Bowel rarely involved deg : and tachycardia. commonest involvement is bilateral Facial Bladder dysfunction may occur in severe and then Bulbar muscles. The patient has cases but is usually transient difficulty in swallowing, speech, etc. - If bladder dysfunction is a prominent * Areflexia Q .-Deep tendon reflexes usually feature and comes early, possibilities disappear within the first few days of onset. other than GBS should be considered. CSF Findings Nerve Conduction Studies - CSF shows albumino-cytological dissociation Q.i.e. Increased proteins with normal cells - CSF Pleocytosis with cells above 50/mm3 is against the diagnosis of.GBS. - API / 35 Nerve conduction studies show demyelination i.e. slow conduction velocity, distal latency, conduction block Prognosis - Recovery is usually remarkable in GBS, although all patients may not recover fully. - Approximately 85% of patients with GBS achieve a full functional recovery within several months to a year.-Harrison 15`72509\n\nSo the answer to this question is D"} {"instruction": "Enzyme of Pathway common to Glu- coneogenesis\nA. Pyruvate kinase\nB. PFK\nC. Hexokinase\nD. Phosphoglycerate kinase", "response": "Phosphoglycerate kinase (Pathway shown: Glycolysis)\n\nSo the answer to this question is D"} {"instruction": "Texas Statewide Preventive Dentistry program is also known as:\nA. Sharp Program\nB. Tattle Tooth Program\nC. Smile Train Program\nD. Theta Program", "response": "\"TATTLETOOTH PROGRAM\" - TEXAS STATEWIDE PREVENTIVE DENTISTRY PROGRAM\nThe Tattle tooth Program was developed in 1974-1976 as a cooperative effort between Texas Dental health professional organizations, the Texas Department Health and the Texas Education Agency through a grant from the Department of Health and Human Services to the Bureau of Dental Health. The program was pilot tested in 1975 and field-tested in spring 1976 in schools within the state of Texas.\nEssentials of preventive and community dentistry\nSoben Peter\n5th edition\npage no. 229\n\nSo the answer to this question is B"} {"instruction": "Left recurrent laryngeal nerve has a longer course because of which arch aery:\nA. 1st arch\nB. 2nd arch\nC. 4th arch\nD. 6th arch", "response": "The Left recurrent laryngeal nerve has a longer course to the neck than the right side. This is because it hooks under the left sixth arch aery which persists in extra-uterine life as the ductus aeriosus, a fibrous remnant. On the right side, neither the sixth nor fifth arch aeries persist and so the recurrent laryngeal nerve is restrained by the next most superior structure which is the fouh branchial arch aery (Right Subclan Aery). Rarely, the right fouh branchial arch aery does not develop in the adult and instead, the right dorsal aoa of the fetus persists to supply the same territories. Hence, the right recurrent laryngeal nerve is no longer restrained by a subclan aery and so it divides from the vagus more superiorly to run inferiorly on the larynx. This anomalous nerve (Non Recurrent Laryngeal nerve) may be transected during thyroid surgery. * The recurrent laryngeal nerve has differing courses oneach side. On the right, it loops under the subclanaery and on the left under the aoic arch. On bothsides it then ascends on the side of the trachea.\n\nSo the answer to this question is D"} {"instruction": "Most common symptom in buphthalmos is-\nA. Lacrimation\nB. Pain\nC. Photophobia\nD. Itching", "response": "Ans. is 'a' i.e., Lamination \"Commonest symptom is watering\" -- MukherjeeIn Buphthalmoso Most common symptom - Watering (lacrimation)o 2nd most common symptom - Photophobiao Most troublesome symptom - Photophobia (Child avoids light)o First sign - Corneal edema with wateringo Haab striaeo Large corneao Deep anterior chambero Lens antero-posteriorly flat\n\nSo the answer to this question is A"} {"instruction": "A newborn developed respiratory distress. Which of the following ors Respiratory distress syndrome?\nA. Onset of distress after 6 hrs of bih\nB. Air bronchogram on chest x-ray\nC. History of receiving antenatal coicosteroids\nD. Term bih", "response": "The chest x-ray of an infant with RDS is characterized by atelectasis, air bronchograms, and a diffuse reticular granular pattern commonly referred to as \"ground glass\". The chest x-ray may progress to a complete \"white out\" with severe disease. Reference: GHAI Essential pediatrics, 8th edition\n\nSo the answer to this question is B"} {"instruction": "Which is not a type HI hypersensitivity reaction\nA. TB\nB. Rheumatoid ahritis\nC. SIF\nD. Ahus reaction", "response": "Ans. is 'a' i.e., Tuberculosis Tuberculosis is a delayed hypersensitivity or type IV hypersensitivity reaction.\n\nSo the answer to this question is A"} {"instruction": "Which of the following antiglaucoma medications can Cause drowsiness?\nA. Latanoprost\nB. Timolol\nC. Brimonidine\nD. Dorzolamide", "response": "The most commonly repoed ADRs are oral dryness, ocular hyperaemia and burning/stinging, all occurring in 22 to 25% of patients. They are usually transient and not commonly of a nature serious enough to require discontinuation of treatment. Symptoms of ocular allergic reactions have been repoed to have occurred in 12.7% of subjects in clinical trials (causing withdrawal in 11.5% of subjects), with onset being between 3 and 9 months in the majority of patients. The following convention has been used for classification of frequency of undesirable effects: Very common : >=1 in 10. Common : >=1 in 100 and <1 in 10. Uncommon : >=1 in 1,000 and <1 in 100. Rare : >=1 in 10,000 and <1 in 1,000. Very rare : < 1 in 10,000. Not known (cannot be estimated from the available data) Within each frequency grouping, undesired effects are presented in order of decreasing seriousness. Cardiac disorders: Uncommon: Palpitations/arrhythmias (including bradycardia and tachycardia). Nervous system disorders: Very common: Headache, drowsiness. Common: Dizziness, abnormal taste. Very rare: Syncope Eye disorders: Very common : Ocular irritation including allergic reactions (hyperaemia, burning, stinging, pruritis, foreign body sensation, conjunctival follicles); blurred vision, allergic blepharitis, allergic blepharoconjuctivitis, allergic conjunctivitis, ocular allergic reaction and follicular conjunctivitis. Common: Local irritation (eyelid hyperaemia and oedema, blepharitis, conjunctival oedema and discharge, ocular pain and tearing); photophobia; corneal erosion and staining; ocular dryness; conjunctival blanching; abnormal vision; conjunctivitis. Very rare : Iritis (anterior uveitis); miosis. Respiratory, thoracic and mediastinal disorders: Common: Upper respiratory symptoms. Uncommon: Nasal dryness. Rare: Dyspnoea Gastrointestinal disorders: Very common: Oral dryness. Common: Gastrointestinal symptoms. Vascular disorders: Very rare: Hypeension, hypotension. General disorders and administration site conditions: Very common: Fatigue. Common: Asthenia. Immune system disorders: Uncommon: Systemic allergic reactions. Psychiatric disorders: Uncommon: Depression. Very rare: Insomnia. The following adverse reactions have been identified during post-marketing use of Brimonidine eye drops in clinical practice. Because they are repoed voluntarily from a population of unknown size, estimates of frequency cannot be made. Not known: Eye disorders Iridocyclitis (anterior uveitis) Eyelid pruritus Skin and subcutaneous tissue disorders Skin reaction including erythema, face oedema, pruritus, rash and vasodilation\n\nSo the answer to this question is C"} {"instruction": "Position of mid-inguinal point is ?\nA. Midpoint of Anterior Superior Iliac Spine (ASIS) and pubic tubercle\nB. Mid point of ASIS and pubic symphysis\nC. Mid point of both ASIS\nD. Mid-point of inguinal ligament", "response": "Ans-B\n\nSo the answer to this question is B"} {"instruction": "Which of the following statement is TRUE about spinocerebellar tract?\nA. Equilibrium\nB. Smoothes and coordinates movement\nC. Learning induced by change in vestibulo ocular reflex\nD. Planning and programming", "response": "The spinocerebellar pathway is organised into the ventral and dorsal tracts. Both these tracts transmits proprioceptive and exteroceptive impulses from the body. They occupy the periphery of the lateral aspect of the spinal white matter and carry proprioceptive and cutaneous information to the cerebellum for the coordination of movement and maintenance of posture. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 8. Somatosensory Neurotransmission: Touch, Pain, and Temperature. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.\n\nSo the answer to this question is B"} {"instruction": "Which of the following cranial structures are insensitive to pain:\nA. Dural sheath surrounding vascular sinuses\nB. Choroid Plexus\nC. Falx cerebri\nD. Middle meningeal Aery", "response": "Answer is B (Choroid plexus): Choroid plexus is a pain insensitive cranial structure. The ventricular ependyma, choroids plexus, pial veins and much of brain parenchyma are not pain producing'- Harrison's Pain Sensitive Intracranial Cranial venous sinuses with afferent veins Aeries at base of brain and aeries of dura including middle meningeal aery Dura around venous sinuses and vessels Falx Cerebri Extracranial Skin Scalp Appendages Periostium Muscles Aeries Mucosa Nerves Trigeminal (Vth) Facial (VIII) Vagal (X) Glossopharyngeal(IX) Second (II) & Third (IIIrd) C.N. Pain Insensitive Intracranial Brain parenchyma Ependyma Choroid plexus Piamater Arachnoid Dura over convexity of skull (Dura around vascular sinuses and vessels is sensitive to pain)\n\nSo the answer to this question is B"} {"instruction": "Acoustic shadow on USG is due to:\nA. Reflection\nB. Refraction\nC. Aefact\nD. Absorption of waves", "response": "Ans. Reflection\n\nSo the answer to this question is A"} {"instruction": "After splenectomy, the most common infection:\nA. Pneumococci\nB. E. coli\nC. Klebsiella\nD. Streptococcus", "response": "Splenectomy increases the risk of following infections:\n\nBacterial:\nPneumococcal\nH. influenzae\nSome Gram -ve enteric organism\nParasitic – Babesia\nViral – No ↑ in risk of viral infection\n\nSo the answer to this question is A"} {"instruction": "Which is the most frequent cause for Budd chiari syndrome?\nA. Hepatic vein thrombosis\nB. Poal vein thrombosis\nC. Malignancy\nD. Valves in hepatic veins", "response": "The Budd-Chiari syndrome results from the thrombosis of one or more major hepatic veins and is characterized by hepatomegaly ascites, and abdominal pain. All hypercoagulable states cause an increased risk of Budd chain's syndrome. Hepatic vein thrombosis is associated with myeloproliferative disorders (especially polycythemia vera), pregnancy, the postpaum state, the use of OCPs, paroxysmal nocturnal hemoglobinuria, and intra-abdominal cancers, paicularly hepatocellular carcinoma.\n\nSo the answer to this question is A"} {"instruction": "In Testicular Feminization syndrome Gonadectomy is indicated :\nA. As soon as it is diagnosed\nB. At pubey\nC. Only when Malignancy develops in it\nD. When hirsutism is evident", "response": "At pubey Patients of Testicular Feminization syndrome (Androgen insensitivity) are genotypically males (Karyotype 46XY) but phenotypically females (i.e. male pseudo hermaphroditism). Due to the presence of Y chromosome gonads are testis which remain intraabdominal and have a malignant potential (Most common = Gonadoblastoma, Dysgerminoma). Therefore testis should be removed in such patients. B/L Laparoscopic Gonadectomy is the preferred proceduredeg. As far as timing of Gonadectomy is concerned ? \"In patient with complete androgen insensitivity, the testis should be removed 'ter Pubeal developmen is complete to prevent malignant degeneration.\n\nSo the answer to this question is B"} {"instruction": "Hemodialysis can be performed for long periods from the same site due to\nA. Aeriovenous fistula reduces bacterial contamination of site\nB. Aeriovenous fistula results in aerialization of vein\nC. Aeriovenous fistula reduces chances of graft failure\nD. Aretiovenous fistula facilitates small bore needles for high flow rates", "response": "Ans. is 'b' i.e., Aeriovenous fistula results in aerialization of vein The tstu/a graft, or catheter hemodialvsis is often referred to as a dialysis access. A native fistula created by the anastomosis of an aery to a vein (e.g. the Bresica-Cimino fistula, in which the cephalic vein is anastomosed end-to-side to the radial aery) results in aerialization of the vein. This facilitates its subsequent use in the placement of large needles (typically 15 Gauge) to access the circulation. Fistulas have the highest long-term patency rate of all dialysis access options. The most impoant complication of aeriovenous grafts is thrombosis of the graft and graft failure, due principally to intimal hyperplasia at the anastomosis between the graft and recipient vein. Many patients undergo placement of an aeriovenous graft (i.e., the interposition of prosthetic material, usually polytetrafluoroethylene, between an aery and a vein) or a tunneled dialysis catheter.\n\nSo the answer to this question is B"} {"instruction": "Maximum endo-capillary proliferation is seen in :\nA. Membranous glomerulonephritis\nB. Mesangio-proliferative glomerulonephritis\nC. Focal segmental glomerulonephritis\nD. Post streptococcal GN", "response": "Ans. (d) Post streptococcal GNRef: Robbiris pathology 9th ed. /909-910* PSGN is characterized by enlarged hyper-cellular glomeruli.* There is also swelling of endothelial cells & combination of proliferation, swelling, leukocyte infiltration obliterates capillary lumen.* Endo-capillary proliferation is also seen in MPGN\n\nSo the answer to this question is D"} {"instruction": "Most common bony tumour of middle ear is:\nA. Adeno carcinoma\nB. Squamous cell carcinoma\nC. Glomus tumour\nD. Acoustic neuroma", "response": "(Squamous cell carcinoma) (107-8-D) (213-14-LT) (98- Maqbool 11th)* Squamous carcinoma is the commonest tumour of the middle earIt causes extensive bone destruction involving the facial nerve, labyrinth, the middle cranial fossa, temporomandibular joint and the base of the skull. It also involves the IXth, Xth, XIth, and XIIth cranial nerves and can extend along the eustachian tube into the nasopharynx (213-LT)* Glomustumour - is the most common benign neoplasm of middle ear, because its origin from glomus bodies.\n\nSo the answer to this question is B"} {"instruction": "Narrowest part of larynx in children-\nA. Supraglottic\nB. Subglottic\nC. Glottic region\nD. None", "response": "Ans. is 'b' i.e., Subglottico Narrowest part of larynx in children - Subglottic region,o Narrowest part of larynx in adults - Rima glottidis (glottis)\n\nSo the answer to this question is B"} {"instruction": "Prenatal diagnosis of Down Syndrome is by -\nA. Karyo typing\nB. Triple test\nC. Fetal ultrasonography\nD. All of above", "response": "Ans. is 'D' i.e., All of above o Screening for Down syndrome in pregnancy can be done by number of option like - Karyotyping by - Chorionic villus sampling at 10-12 weeks. Amniocentesis at 16-18 wreeks. Cordocentasis after 18 weeks. Maternal serum marker - PAPP-A and free ji HCG in first trimester. a-feto protein, HCG and estradiol (Triple test) in second trimester. Fetal USG - done in 2nd trimester to look for - Increased nuchal fold thickness. Short femur and humerus. Duodenal atresia.\n\nSo the answer to this question is D"} {"instruction": "Prophylactic iron and folic acid content according to RCH program during pregnancy:\nA. 500mg iron + 100 meg folic acid\nB. 100mg iron + 500mcg folic acid\nC. 100 mg iron + 100 meg folic acid\nD. 20 mg iron +100 meg folic acid", "response": "Ans. (b) 100mg iron + 500mcg folic acidRef: K. Park 23rded. /527* Adult iron+folic acid tablet given in pregnancy: 1 tab/ day x 100 days* Kids iron+folic acid tablet given: 1 tab/day x 100 days per year- 0 to 5 years of age.Iron and Folic acid tablet content IronFolic acidAdult tab100 mg500 megKids tab (l/5th)20 mg100 meg\n\nSo the answer to this question is B"} {"instruction": "Unilateral clubbing seen in -a) Samilial clubbingb) Pancoast tumorc) Pulmonary A-V fistula d) Aortic aneurysm (arch)e) Congenital cyanotic heart ds.\nA. bcd\nB. acd\nC. ac\nD. bd", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Inherited hyperammonemia is a result of deficiency of which enzyme of Krebs-Henseleit urea cycle?\nA. Malate dehydrogenase\nB. Isocitrate dehydrogenase\nC. N-acetyl glutamate synthetase\nD. Succinate dehydrogenase", "response": "Inherited hyperammonemias are a group of six diseases caused by inborn deficiencies of the enzymes of the Krebs-Henseleit urea cycle. The enzymes involved are: 1. N-acetyl glutamate synthetase 2. Arbamyl phosphate synthetase (CPS) 3. Ornithine transcarbamylase (OTC) 4. Argininosuccinic acid synthetase (citrullinemia) 5. Argininosuccinase deficiency 6. Arginase deficiency Most Severe Cases: In the most severe forms of the hyperammonemic disorders, the infants are asymptomatic at bih and during the first day or two of life, after which they refuse their feedings, vomit, and rapidly become inactive and lethargic, soon lapsing into an irreversible coma. Profuse sweating, focal or generalized seizures, rigidity with opisthotonos, hypothermia, and hyperventilation have been observed in the course of the illness. These symptoms constitute a medical emergency, but even with measures to reduce serum ammonia, the disease is usually fatal. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 37. Inherited Metabolic Diseases of the Nervous System. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.\n\nSo the answer to this question is C"} {"instruction": "Lipoprotein-associated with carrying cholesterol from periphery tissues to liver is\nA. HDL\nB. LDL\nC. VLDL\nD. IDL", "response": "METABOLISM OF HDL Synthesis: HDL is synthesized in Liver cells and also in intestinal mucosal cells. (a) Hepatic HDL * Apo-A and apo-C are synthesized by polysomes on the rough endoplasmic reticulum (ER). * They are assembled with lipids to form the nascent HDL which is released in the circulation. (b) Intestinal HDL * In a similar manner, apo-A is synthesized by polysomes on the rough endoplasmic reticulum (ER). * It is assembled with lipids to form the \"nascent\"- HDL which is released in circulation from intestinal mucosal cells. Difference of nascent intestinal HDL from \"nascent\" hepatic HDL * \"Nascent\" intestinal HDL contains only apo-A when it circulates, it acquires apo-C and apo-E. * \"Nascent\"-Hepatic HDL, on the other hand, contains both apo-A and apo-C. Note: Apo-C and apo-E are only synthesized in liver and not in intestinal mucosal cells. Scavenging action of HDL: Glomset (1968) has suggested that HDL plays a major role in the removal of cholesterol from peripheral extrahepatic tissues and transpo of this cholesterol to the liver where it is fuher metabolized. This has been called as scavenging action of HDL (reverse cholesterol transpo). METABOLISM OF HDL HDL Receptor Proteins and HDL Cycle Two types of HDL receptor proteins haven been described involved in HDL metabolism. They are: 1. HDL receptor protein--SR-B1 2. ATP-binding cassette transpoer A1 Protein (ABCA1) 1. HDL receptor protein SR-B1 The class B scavenger receptor B1 (SR-B1) has been identified recently as HDL receptor with a dual role in HDL metabolism. * In the liver, and steroidogenic tissues, it binds HDL apo-A1 and cholesteryl ester is selectively delivered to the cells, although the paicle itself, including apo-A1, is not taken up. * In the tissues: On the other hands, SR-B1 mediates the acceptance of cholesterol from the cells by HDL, which then transpos it to the liver for excretion the bile (either as cholesterol or after conversion to bile acids), the process known as reverse cholesterol transpo. Nascent HDL: Nascent HDL is made up of a bilayer of PL and free cholesterol arranged in disc-like form called as discoid HDL containing apoproteins. Formation of HDL3 by LCAT: Lecithin-cholesterol acyltransferase of plasma binds with nascent HDL discs and gets activated by A-1 and C-II apoproteins of HDL itself and transfers acyl groups from HDL-PL to the free cholesterol thus producing Lysophospholipids and cholesteryl-esters. Lysophospholipids thus formed are released from HDL to plasma where they bind to albumin and cholesteryl esters and transferred into the 'central core' of the HDL paicles. Thus by the above reactions 'Discoid HDL' is conveed to 'spherical' HDL which is called as HDL-3 paicle, which is bounded by a lipid layer with apoproteins and cholesteryl esters embedded in its core. Nascent HDL (discoidal) --- HDL-3 paicle (spherical)Ref: Textbook of Medical Biochemistry, Eighth Edition, Dr (Brig) MN Chatterjea, page no: 449\n\nSo the answer to this question is A"} {"instruction": "“Anhedonia” seen in schizophrenia is linked to which of the following neurotransmitter abnormality?\nA. Serotonin\nB. Norepinephrine\nC. Glutamate\nD. GABA", "response": "Norepinephrine\n(Ref : Kaplan Psychiatry Pg 290)\n\nSo the answer to this question is B"} {"instruction": "Pneumatosis cystoids intestinalis is\nA. Gas filled cysts in the subserosa or submucosa of the small intestine\nB. Gas filled cysts in the subserosa or submucosa of the duodenum\nC. An external fistula communicating with the caecum following operation of gangrenous appendicitis\nD. Fibrotic thickening of the intestinal walls with narrow lumen", "response": "(Gas-filled cysts are found in the subserosa or submucosa of the small intestine) (1182-LB)Pneumatosis cvstoids intestinalis - in which gas-filled cysts are found in the subserosa or submucosa of the intestine or colon.* Majority of cases are associated with COPD or the immunocompromised state (eg. AIDS, post transplantation; in association with leukemia, lymphoma, vasculitis, or collagen vascular disease, and in those patients taking chemotherapy or corticosteroids) other associated conditions include inflammatory, obstructive or infectious conditions of the intestine: iatrogenic conditions such as endoscopy and jejunstomy placement; ischemia and extra-intestinal disease such as diabetes.\n\nSo the answer to this question is A"} {"instruction": "Foster's test is used in the diagnosis of-\nA. Spastic type of cerebral palsy\nB. Hypotonic CP\nC. Choreo athetotic CP\nD. Myasthenia gravis", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Acyclovir is used for the following viral infection :\nA. Rabies virus\nB. Cytomegalovirus\nC. Herpes simplex virus\nD. Human immunodeficiency virus", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Disease which shows cyclical trend:-\nA. Malaria\nB. Diarrhea\nC. Measles\nD. Tuberculosis", "response": "Time Distribution of Disease: - Periodic fluctuations: 1. Cyclical Trend - Fluctuations in every few years Ex - Measles, Rubella, Influenza Measles every 2-3 years Rubella every 5-8 years Influenza show maximum cyclical trends d/t antigenic shift/drift 2. Seasonal Trend - Disease that increases every paicular season Ex - Malaria/Dengue in Rainy Season, I in winter Season 3. Epidemic Trend - Sho term fluctuations Ex-Food poisoning, Bhopal Gas tragedy 4. Secular Trend - Long term fluctuations Ex - Non-communicable disease ( CHD, HTN etc)\n\nSo the answer to this question is C"} {"instruction": "Bile acids consist of all EXCEPT\nA. Lithocholic acid\nB. Taurocholic acid\nC. Deoxycholic acid\nD. Chendeoxycholic acid", "response": "Taurocholic acidREF: Ganong 22' ed chapter26* The bile salts are sodium and potassium salts of bile acids, and all those secreted into the bile are conjugated to glycine or taurine, a derivative of cysteine. The bile acids are synthesized from cholesterolThe two principal (primary) bile acids formed in the liver are cholic acid and chenodeoxycholic acid.In the colon, bacteria conve cholic acid to deoxycholic acid and chenodeoxycholic acid to lithocholic acid. Since they are formed by bacterial action, deoxycholic acid and lithocholic acid are called secondary bile acids.\n\nSo the answer to this question is B"} {"instruction": "Which of the following is terminal group of axillary lymph node?\nA. Pectoral\nB. Apical\nC. Lateral\nD. Central", "response": "It receives lymphatic drainage from all other axillary nodes . The nodes of the apical or infraclaaicular group lie deep to the clavipectoral fascia, along the axillary vessels. They receive lymph from the central group, from the upper pa of the breast, and from the thumb and its web. The lymphatics from the thumb accompany the cephalic vein REF - BDchaurasia 6e p53\n\nSo the answer to this question is B"} {"instruction": "26 year old female patient wanted epidural for labor analgesia. She was given 12ml of 0.25% bupivacaine immediately after this she developed hypotension, bradycardia, respiratory difficulty. Which of the following explains condition of the patient.\nA. Vasovagal attack\nB. Systemic toxicity\nC. Total spinal anaesthesia\nD. Drug allergy", "response": "Total spinal is one of the dreaded complication of epidural anaesthesia. Accidental puncture of dura, while giving epidural will cause whole volume (10-20ml) of drug to enter subarachnoid space.\nThis can reach upto cranium producing total spinal block.\n\nSo the answer to this question is C"} {"instruction": "All of the following are true about the papovavirus except -\nA. They are non-enevloped icosahedral viruses\nB. Produce papilloma and was in human\nC. RNA virus\nD. SV - 40 is oncogenic", "response": "Popova viruses are small non enveloped icosahedral DNA virus REF:ANANTHANARYANAN TEXTBOOK OF MICROBIOLOGY 9EDITION PGNO.553\n\nSo the answer to this question is C"} {"instruction": "Arterial supply of tonsil is mainly:\nA. Tonsillar branch of facial artery\nB. Maxillary artery\nC. Middle meningeal artery\nD. Internal carotid artery", "response": "(a) Tonsillar branch of facial artery(Ref. Scott Brown, 8th ed., Vol 3; 742)The arterial supply to tonsil is by external carotid artery branches.Maxillary artery also supplies the tonsil but the main artery supplying is the tonsillar branch of facial.Middle meningeal artery, a branch of maxillary artery, does not supply the tonsil.\n\nSo the answer to this question is A"} {"instruction": "Abroviral infection(s) include -a) Chikungunya feverb) West nile feverc) JEd) Sandfly fevere) Malaria\nA. abcd\nB. acd\nC. bcd\nD. abd", "response": "None\n\nSo the answer to this question is A"} {"instruction": "A 7-year-old child from West Bengal presented with high grade fever with chills and rigor. Peripheral smear examination revealed Plasmodium vivax. He was given treatment for the same. But he again presented with jaundice, and a repeat peripheral smear showed following. What is your diagnosis?\nA. Viral Hepatitis\nB. Sickle cell Anemia\nC. Hemolytic uremic syndrome\nD. Glucose 6 Phosphate dehydrogenase deficiency", "response": "- Peripheral smear showing 'bite cells' after treatment with anti-malarials - suggests G6PD deficiency. G6PD deficiency: X-linked recessive disorder. Most common red cell enzyme deficiency. Hemolysis is seen d/t raised oxidative stress. FEATURES: Pallor, icterus, hemoglobinemia, hemoglobinuria, splenomegaly etc are seen Heinz bodies are seen DRUGS CAUSING OXIDATIVE STRESS IN THESE PATIENTS: Sulfonamides - sulfamethoxazole Anti-malarials - Primaquine, quinine Analgesics - Aspirin, NSAIDS, phenazopyridine (pyridium) Others - Nitrofurantoin, Dapsone, Methylene blue, Rasburicase, Toluidine blue, Nalidixic acid, Furazolidine, quinidine\n\nSo the answer to this question is D"} {"instruction": "Most common presentation of peutz jegher syndrome is\nA. Pancreatic Ca\nB. Melanoma\nC. Intussusception\nD. Malabsorption", "response": "Most common presentation of peutz jegher syndrome is intussusception. Mutation is STK 11 mutation.\n\nSo the answer to this question is C"} {"instruction": "Which is the precursor amino acid for selenocysteine\nA. Cysteine\nB. Cystine\nC. Serine\nD. Glycine", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Causative organism of rheumatic fever ?\nA. Group A Streptococci\nB. Staphylococci\nC. Group B Streptococci\nD. Group D Streptococci", "response": "Ans. is 'a' i.e., Group A StreptococciRheumatic fever :?Rheumatic fever (RF) is an acute, immunologically mediated, multisystem inflammatory disease classically occurring a few weeks after an episode of group A streptococcal pharyngitis; occasionally, RF can follow streptococcal infections at other sites, such as the skin.\n\nSo the answer to this question is A"} {"instruction": "Le Forte fracture having craniofacial dysjunction is\nA. Type-I\nB. Type-II\nC. Type-III\nD. None", "response": "(C) Type-III # They are classified into 3 types:> Le Fort I (transverse) fracture runs above and parallel to the palate. It crosses lower part of nasal septum, maxillary antra and the pterygoid plates.> Le Fort II (pyramidal) fracture passes through the root of nose, lacrimal bone, floor of orbit, upper part of maxillary sinus and pterygoid plates. This fracture has some features common with the zygomatic fractures.> Le Fort III (craniofacial dysjunction). There is complete separation of facial bones from the cranial bones. The fracture line passes through root of nose, ethmofrontal junction, superior orbital fissure, lateral wall of orbit, frontozygomatic and temporozygomatic sutures and the upper part of pterygoid plates.\n\nSo the answer to this question is C"} {"instruction": "4-year-old male child had febrile seizures, best prophylaxis –\nA. Paracetamol 6 hourly\nB. Paracetamol & diazepam\nC. Diazepam\nD. Phenobarbitone", "response": "Prophylaxis in febrile seizures \nProphylactic anticonvulsants are not given routinely in febrile seizures. They are required when -\n\nA febrile seizure is prolonged or complicated\nMedical reassurance fails to relieve family anxiety.\n\tProphylaxis may be continuous or intermittent\n\nIntermittent prophylaxis\n\nIt is currently the desirable form of therapy\nIt is used during episodes of fever\nIndicated during first three days of fever:\nDrugs that are used are - Diazepam and other benzodiazepines (these drugs are used because they attain desired levels quickly) Diazepam is given oral or rectal.\n\nContinuous prophylaxis -\n\nIt is used when\nIntermittent therapy has failed \nCentral nervous system disease \nDrugs used are → Sodium valproate or phenobarbitone.\nRecurrent atypical seizures\nThe family history of epilepsy\n\nNote - Carbamazepine and phenytoin are ineffective for prevention of recurrence.\n\nSo the answer to this question is C"} {"instruction": "Doppler ultrasonography in IUGR & Preeclampsia shows notch in which aery :\nA. Umbilical aery\nB. Uterine aery\nC. Internal iliac aery\nD. Vitiline aery", "response": "Uterine aery\n\nSo the answer to this question is B"} {"instruction": "Enterotest is used for diagnosis of\nA. E. histolytica\nB. N. fowleri\nC. T. Cruzi\nD. Giardia lambia", "response": "Stringtest / enterotest is done in Giardia lambia in which bile stained mucus is collected for examination of Trophozoites.\n\nSo the answer to this question is D"} {"instruction": "Paralysisof 3rd, 4th, 6th nerves with involvement of ophthalmicdivisionof5thnerve, localizes the lesion to\nA. Apex of orbit\nB. Brainstem\nC. Cavernous sinus\nD. Base of skull", "response": "Ipsilateral ophthalmoplegia causing diplopia occur due to 3rd, 4th & 6th cranial nerves.\n6th nerve passes through cavernous sinus and others are related to the lateral wall of cavernous sinuses.\n\nSo the answer to this question is C"} {"instruction": "In Hypertrophic pyloric stenosis which electrolyte should be replenished?\nA. Na+\nB. K+\nC. C1--\nD. HCO3--", "response": "ANSWER: (B) K+REF: With textHypertrophic pyloric stenosis presents with hyponatremic, hypokalemic, hypochloremic metabolic alkalosis with paradoxical aciduriaSchwartz 9th ed chapter 3, 39: Treatment includes replacement of the volume deficit with isotonic saline and then potassium replacement once adequate urine output is achieved. Fluid resuscitation with correction of electrolyte abnormalities and metabolic alkalosis is essential before induction of general anesthesia for operation. For most infants, administration of fluid containing 5% dextrose and 0.45% saline with 2 to 4 mEq/kg of added potassium at a rate of approximately 150 to 175 mL/kg for 24 hours will correct the underlying deficit. After resuscitation, a Fredet-Ramstedt pyloromyotomy is performedSabiston 18tk ed ch 71 states: The definitive treatment of choice is pyloromyotomy. But Before surgery, it is important that the infant is hydrated with IV fluids to establish a normal urine output. It is important that the underlying metabolic alkalosis is slowly corrected with normal saline. Potassium is not given until the intravascular volume has been restored and normal urine output has resumed.Nelson 's 18th ed ch:326.1 states that: The preoperative treatment is directed toward correcting the fluid, add-base, and electrolyte losses. Intravenous fluid therapy is begun with 0.45- 0.9% saline, in 5-10% dextrose, with the addition of potassium chloride in concentrations of 30-50 mEq/L. Fluid therapy should be continued until the infant is rehydrated and the serum bicarbonate concentration is <30 mEq/dL, which implies that the alkalosis has been corrected.\n\nSo the answer to this question is B"} {"instruction": "Partial agonist of opioid is -\nA. Pethidine\nB. Buprenorphine\nC. Morphine\nD. Butorphenol", "response": "Ans. is 'b > d' i.e., Buprenorphine > Butorphenol o An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and GIT.o So, opioids can be divided into:-1. Opioid agonists# These have only agonistic action on opioid receptors. Drugs are:1. Natural:- Morphine, codeine.2. Semisynthetic:- diacetylmorphine (Heroin), pholcodeine, hydromorphone, oxymorphone, hydrocodone, oxycodone.3. Synthetic:- Pethidine (mepridine), fentanyl, methadone, dextropropoxyphene, tramadol, sulfentanil, alfentanil, remifentanil, levorphenol, dextromoramide, dipipanone.2. Complex action opioid and opioid antagonists.# Relatively minor changes in the structure of an opioid can convert a drug that is primarily an agonist into one with antagonistic actions at one or more types of opioid receptors. Drugs are:1. Agonist-antagonists (k analgesics) - Nalorphine, Pentazocine, Butorphenol.2. Partial/weak p agonist + k antagonist - Buprenorphine.3. Pure antagonists - Naloxone, Naltrexone, Nalmefene.Nature of interaction of opioid ligands with the three major typesof opioid receptors, along with equivalent analgesic dosesLigandm (mu)k (kappa)d (delta)Analgesic dose (mg)1. MorphineAgo. (St)Ago. (W)Ago. (W)102. NalorphineAnta. (St)Ago. (M)--3. PentazocineP. Ago., Anta. (W)Ago. (M)-30-604. ButorphanolP. Ago. (W)Ago. (St)-1-35. BuprenorphineP. Ago.Anta. (M)-0-3-0-46. NaloxoneAnta. (St)Anta. (M)Anta. (W)-7. NaltrexoneAnta. (St)Anta. (M)Anta. (W)-8. Met/Leu enkephalinAgo. (M)-Ago. (St)-9. b-EndorphinAgo. (St)-Ago. (St)-10. Dynorphin A, BAgo. (W)Ago. (St)Ago. (W)-\n\nSo the answer to this question is B"} {"instruction": "Which among the following is a depolarizing muscle relaxant\nA. Decamethonium\nB. D tubocurarine\nC. Doxacurium\nD. Atracurium", "response": "(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.219)\n\nSo the answer to this question is A"} {"instruction": "Broncholithiasis means -\nA. Calcified lymphnodes eroding into bronchus\nB. Foreign body calcified in bronchus\nC. Lithium deposition in bronchial wall\nD. A hamartoma", "response": "Broncholithiasis is defined as a condition in which calcified or ossified material is present within the bronchial lumen. The most common cause of broncholithiasis is erosion by and extrusion of a calcified adjacent lymph node into the bronchial lumen, a finding usually associated with tuberculosis or histoplasmosis. Other causes of broncholithiasis include\n(a) aspiration of bone tissue or in situ calcification of aspirated foreign material and\n(b) erosion by an extrusion of calcified or ossified bronchial cartilage plates.\n\nSo the answer to this question is A"} {"instruction": "The person is disoriented to time and space in\nA. Hallucinations\nB. Illusion\nC. Delusion\nD. Delirium", "response": "Delirium It is the disturbance of consciousness in which the person is disoriented in time and space. It is a disorder of cognition. This occurs in clinical conditions eg, high fevers like typhoid or meningitis or datura poisoning. Another example is delirium tremens that occurs in chronic alcoholism. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 360\n\nSo the answer to this question is D"} {"instruction": "a married women died in unnatural conditions within 5yrs of marriage,her parents complained of frequent demand of dowry .her autopsy will be conducted under ?\nA. 174 crpc\nB. 176 crpc\nC. 302 ipc\nD. 304B ipc", "response": "dowry death is 304B ipc autopsy is under 176 crpc = magistrate inquest ref : narayanareddy 9th ed\n\nSo the answer to this question is B"} {"instruction": "Cause for renal vein thrombosis could be -a) Membranous nephropathyb) Lupus nephritisc) Membranoproliferative glomerulonephritisd) Post streptococcal glomerulonephritise) Renal amyloidosis\nA. acd\nB. ace\nC. cde\nD. ade", "response": "None\n\nSo the answer to this question is B"} {"instruction": "A 4-day-old baby boy has not defecated since coming home from the hospital even though feeding has been normal without any excessive vomiting. Rectal examination reveals a normal anus, anal canal and rectum. However, a large fecal mass is found in the colon and a large release of flatus and feces followsthe rectal examination. Which of the following conditions would be suspected?\nA. Imperforate anus\nB. Anal agenesis\nC. Anorectal agenesis\nD. Colonic aganglionosis", "response": "This baby boy suffers from colonic aganglionosis, or Hirschsprung disease, which results in the retention of fecal material, causing the normal colon to enlarge. The retention of fecal material results from a lack of peristalsis in the narrow segment of colon distal to the enlarged colon. A biopsy of the narrow segment of colon would reveal the absence of parasympathetic ganglion cells in the myenteric plexus caused by failure of neural crest migration.\n\nSo the answer to this question is D"} {"instruction": "All are true about warfarin except\nA. It inhibits the activation of vitamin K dependent clotting factors\nB. It's half life is 36hrs\nC. It can cross placenta\nD. It's dose is increased in liver disease", "response": "Refer Katzung 11/e p595 Warfarin is an oral anticoagulant that acts by inhibiting the gamma carboxylation of glutamate residues in vitamin K dependent clotting factors It has a long half life It readily crosses the placenta Liver disease reduces the synthesis of clotting factors thus increases the effect of warfarin\n\nSo the answer to this question is D"} {"instruction": "Which of the following is not used as a topical LA?\nA. Procaine\nB. Tetracaine\nC. Lidocaine\nD. Benzocaine", "response": "None\n\nSo the answer to this question is A"} {"instruction": "The pearl index indicates teh number of accidental pregnancies per -\nA. 1000 population\nB. 100 live bihs\nC. 100 women in the age group of 15 to 44 years\nD. 100 women years", "response": "park's textbook of preventive and social medicine 23rd edition. *pearl index is defined as the no of failure per 100 women year of exposure.\n\nSo the answer to this question is D"} {"instruction": "Visual hallucinations are most commonly seen in: PGI 09; FMGE 11\nA. Delusional syndrome\nB. Delirium\nC. Mania\nD. OCD", "response": "Ans. Delirium\n\nSo the answer to this question is B"} {"instruction": "Thaliomide is used in all except ?\nA. ENL\nB. HIV neuropathy\nC. HIV associated ulcer\nD. Behcet's syndrome", "response": "Ans. is 'b' i.e., HIV neuropathy\n\nSo the answer to this question is B"} {"instruction": "Antral puncture is done through-\nA. Superior meatus\nB. Inferior meatus\nC. Middle meatus\nD. All", "response": "Proof puncture (Antral puncture) \n\nThis procedure involves puncturing the medial wall of the maxillary sinus in the region of the inferior meatus and irrigating the sinus.\n\nIndications\n1) Chronic and subacute maxillary sinusitis with the dual purpose of :\n\nConfirming the diagnosis and\nWashing out the pus\n\n2) To collect the specimen of the antral contents for culture and sensitivity, or cytological examination to exclude early malignancy.\nContraindications\n\nChildren less than 12 years of age.\nAcute maxillary sinusitis as it may lead to osteomyelitis\nFracture of maxilla as fluid may pass through fracture line.\nDiabetes\n\nSo the answer to this question is B"} {"instruction": "Organelle that plays a pivotal role in apoptosis:\nA. Endoplasmic reticulum\nB. Golgi complex\nC. Mitochondria\nD. Nucleus", "response": "Mitochondrion must be recognized not only as an organelle with vital roles in intermediary metabolism and oxidative phosphorylation, but also as a central regulatory structure of apoptosis.\n\nSo the answer to this question is C"} {"instruction": "Erythromycin acts by interfering with:\nA. Translocation of 50S ribosome\nB. Translocation of 50S ribosome\nC. Transcription of 50S ribosome\nD. Signal transduction of 50S ribosome", "response": "ERYTHROMYCIN It was isolated from Streptomyces erythreus in 1952. Since then it has been widely employed, mainly as alternative to penicillin. Water solubility of erythromycin is limited, and the solution remains stable only when kept in cold. Mechanism of action Erythromycin is bacteriostatic at low but cidal (for ceain bacteria) at high concentrations. Cidal action depends on the organism concerned and its rate of multiplication. Sensitive gram-positive bacteria accumulate erythromycin intracellularly by active transpo which is responsible for their high susceptibility to this antibiotic. It is several fold more active in alkaline medium, because the nonionized (penetrable) form of the drug is oured at higher pH. Erythromycin acts by inhibiting bacterial protein synthesis. It combines with 50S ribosomes subunits and interferes with 'translocation' . After peptide bond formation between the newly attached amino acid and the nacent peptide chain at the acceptor (A) site the elongated peptide is translocated back to the peptidyl (P) site, making the A site available for next aminoacyl tRNA attachment. This is prevented by erythromycin and the ribosome fails to move along the mRNA to expose the next codon. As an indirect consequence, peptide chain may be prematurely terminated: synthesis of larger proteins is especifically suppressed. Essentials of medical pharmacology K D Tripathi Sixth edition Pg no 727\n\nSo the answer to this question is A"} {"instruction": "Nail patella syndrome is characterized by -a) Iliac hornb) Sacral hornc) Absent patellad) Knee deformitye) Dislocation of patella\nA. bce\nB. bde\nC. acde\nD. abde", "response": "The disease is characterized by :-\n\n\nUnduly small or absent patella\nNail dysplasia (nail dystrophy) most commonly in thumbnail\nRecurrent dislocation of patella\nPostero-lateral subluxation of radial head\nBony excrescences on lateral aspect of the ileum, i.e. iliac horns.\nGenu valgum\nCongenital nephropathy\n\nSo the answer to this question is C"} {"instruction": "A patient is passing stones recurrently in urine for past few years. All are due to be restricted in diet except\nA. Protein restriction\nB. Calcium restriction\nC. Salt restricted diet\nD. Phosphate restriction", "response": "Calcium restriction Calcium intake in stone Higher urine calcium is a common finding in stone formers, but restricting dietary calcium intake is not recommended unless it is excessive (more than 2000 mg/d). Although urine calcium excretion may decrease with restriction, the decrease in free intestinal calcium can lead to increased absorption of dietary oxalate and enhanced oxalate excretion, due to decreased binding of oxalate by calcium in the intestinal lumen. The net effect may be increased supersaturation of the urine with respect to calcium oxalate and an enhanced tendency to stone formation. Prevention of recurrent calcium stones (which are usually composed primarily of calcium oxalate) is aimed at decreasing the concentrations of the lithogenic factors (calcium and oxalate) and at increasing the concentrations of inhibitors of stone formation, such as citrate. - Achieving these goals may require both dietary modification and the administration of appropriate medications. Medical therapy (and metabolic evaluation) is usually undeaken in individuals who have formed more than one stone. Reduce animal protein intake Adverse changes in urinary calcium and citrate excretion can be induced by a high protein diet, since the metabolism of sulfur- containing amino acids increases the daily acid load by generating sulfuric acid. Animal protein is much more likely to induce this effect than vegetable protein, since it has a higher sulfur content and therefore generates more acid. Thus, lowering animal protein intake will produce ,orable changes in the urine. However, it has not been proven that this will reduce the incidence of stone .formation. In observational studies, a high animal protein diet was a risk factor.for renal stones in men, but not in women. In a randomized trial, reduced animal protein in association with higher dietary calcium and lower dietary sodium was associated with a reduced risk of stone recurrence, but the individual impact of animal protein could not be determined. Based on the available data, it would be prudent to avoid excessive animal protein intake. Increase fruit and vegetable intake Foods that are rich in potassium, paicularly fruits and vegetables, may be beneficial. Increasing intake of fruits and vegetables may reduce the risk of calcium oxalate stone formation, paicularly in patients who self-select a diet that is low in fruits and vegetables. This benefit is primarily the result of increasing citrate excretion. Limit dietary oxalate intake Some .foods contain very large amounts of oxalate and those should be avoided (eg spinach, rhubarb). In addition, some nuts and legumes are also high in oxalate and the intake should be limited (eg, peanuts, cashews, and almonds). However, there is scant evidence that low oxalate diets reduce the risk of stone formation. In prospective observational studies of individuals who had never had a stone, higher dietary oxalate only slightly increased the risk of incident stone formation in men and older women; there was no association in younger women. Because of the documented health benefits of many .foods that are traditionally considered high in oxalate (but still 10 mg or less per serving), strict oxalate restriction does not seem to be suppoed. As noted above, some foods traditionally believed to be high in oxalate, such as tea, do not increase the risk of stone formation. If a low oxalate diet is recommended, it should only be continued if there is documented evidence that the urine oxalate excretion has fallen. Limit sodium intake Calcium is reabsorbed passively in the proximal tubule down the .orable concentration gradient created by the reabsorption of sodium and water. Thus, a low sodium diet (to 80 to 100 meq/day) can enhance proximal sodium and calcium reabsorption, leading to a reduction in calcium excretion. In one study, for example, lowering sodium intake from 200 to 80 meq/day diminished calcium excretion by as much as 100 mg/day (2.5 mmol/day). Although the independent contribution of lowering dietary sodium intake on actual stone formation is unknown and higher sodium intake may be associated with higher urine volume, it is likely an impoant component of a regimen that has been demonstrated to reduce recurrent stone .formation. Limit sucrose and fructose intake Sucrose intake increases urine calcium independent of calcium intake and has been associated with an increased risk of stones. Fructose intake also increases the risk of stone .formation. Calcium intake Higher urine calcium is a common finding in stone forrners, but restricting dietary calcium intake is not recommended unless it is excessive (more than 2000 rued). Although urine calcium excretion may decrease with restriction, the decrease in .free intestinal calcium can lead to increased absorption of dietary oxalate and enhanced oxalate excretion, due to decreased binding of oxalate by calcium in the intestinal lumen. The net effect may be increased supersaturation of the urine with respect to calcium oxalate and an enhanced tendency to stone .formation. The ability to help prevent new stone formation with a normal calcium intake was shown in pa by a five year study that compared two diets among men with idiopathic hypercalciuria and recurrent calcium oxalate stones. - In this trial, 120 such men were randomly assigned to either a diet consisting of a normal amount of calcium (1200 mg/day ) and low amounts of animal protein (52 g/day) and salt (2900 mg/day of sodium chloride) or a diet containing a low amount of calcium (400 mg/day ). At .five years, a significantly lower risk of stone recurrence was observed among the group assigned to the normal calcium, low animal-protein, low-salt diet. - This selective benefit likely arose because of a decrease in urinary oxalate excretion compared to an increase with the low calcium diet; the urine calcium actually decreased in both treatment arms. However, the independent effect of calcium is unclear given that the amounts of animal protein and salt ingested among those in the low calcium diet differed from that of patients in the normal calcium diet group. Nonetheless, the low calcium intervention was not beneficial and is not recommended. -In addition to increasing stone formation, a low calcium diet may have a second deleterious effect in patients with idiopathic hypercalciuria: development of negative calcium balance. This extra loss of calcium can exacerbate the already diminished hone density in some of these patients, a complication that may be due to enhanced bone resorption. It should be noted that calcium supplements do not appear to be effective in preventing recurrent stones and may even slightly increase risk. - Ira patients with a history of stones who require calcium supplements (eg, .for the treatment of osteoporosis), a suggested approach is to measure urinary calcium excretion before and approximately one month after staing the calcium supplement. If there is a clinically impoant increase in urinary calcium excretion, then the addition of a thiazide diuretic may be useful to reduce urinary calcium excretion (and to help maintain bone density). Other factors High dose vitamin C appears to increases urine oxalate excretion in ceain individuals and the risk of stone .formation; thus, high dose supplements should be avoided in those with higher urine oxalate excretion. Phytate appears to decrease the risk of stones in women. Although not simply a matter of dietary intake, higher body mass index increases the risk of stone .formation, paicularly in women. Therefore, weight control may be helpful in preventing stone recurrence. Nothing has been mentioned about dietary phosphate restriction. - Most of the urinary phosphate is derived from dietary protein. - Dietary protein restriction results in decrease in phosphate in urine. Increase intake offluid - To reach this goal, the best strategy is to reconmzend how much additional fluid the patient should drink based on his or her 24 hour urine volume. As an example, if the total urine volume is 1.5 liters, then we recommend two additional 8 ounce (240 mL) glasses of .fluid each day to reach the goal of at least 2 liters of urine output per day. Limiting animal protein in the diet - Although it has not been proven that a low protein diet will reduce the incidence of stone formation, a high animal protein diet is a risk factor for renal stones in men, but not in women. Limiting dietary sodium to 100 meq/day - A low sodium diet can enhance proximal sodium and calcium reabsorption, leading to a reduction in calcium excretion. Increasing dietary potassium intake - As this substantially decreases risk in men and older women. Limiting dietary sucrose and fructose Limiting dietary oxalate and vitamin C in patients with calcium oxalate stones. - However, excessive limitation is not likely to be helpful; patients should continue to consume a wide variety of fruits and vegetables.\n\nSo the answer to this question is B"} {"instruction": "Submucosal plexus is -\nA. Myenteric plexus\nB. Auerbach's plexus\nC. Meissner's plexus\nD. Tympanic plexus", "response": "Ans. is 'c' i.e., Meissner's plexusInnervation of GITo The gastrointestinal tract has a nervous system all its own called the enteric nervous system. It lies entirely in the wall of the gut, beginning in the esophagus and extending all the way to the anus. The enteric nervous system is composed mainly of two plexus : -i) Myenteric plexus or Auerbach's plexusIt is an outer plexus lying between the longitudinal and circular muscle layer. The myenteric plexus controls mainly gastrointestinal motility, therefore, peristalsis requires an active myenteric plexus.ii) Meissner's plexus or submucosal plexusIt is an inner plexus that lies in the submucosa. The submucosal plexus controls mainly gastrointestinal secretion and local blood flow.o Extrinsic nerves (Parasympathetic and sympathetic) are connected to both myenteric and submucosal plexuses. The enteric nervous system can function independently of these extrinsic nerves and these extrinsic nerves only modify the activity of the enteric nervous system,\\o Therefore, peristalsis is present even if the intestine is deprived of extrinsic innervation.o Parasympathetic stimulation enhances GI motility and secretion whereas sympathetic stimulation inhibits motility and secretions.\n\nSo the answer to this question is C"} {"instruction": "Most characteristic Feature of lichen planus is:\nA. Thinning of nail plate is most common\nB. Non scarring alopecia\nC. Violaceous lesions on skin and mucous membrane\nD. Wickham striae", "response": "D i.e. Wickham Striae\n\nSo the answer to this question is D"} {"instruction": "All of the following take part in the pathogenesis of macular edema in diabetic retinopathy except:\nA. Retinal pigment epithelium dysfunction\nB. Oxidative stress\nC. VEGF\nD. Increased protein kinase-C", "response": "Ans. is 'a' i.e. Retinal pigment epithelium dysfunction [Ref: Harrison 17/e, p 2286-2287; Yanoff & Duker 2/e, p 877-880, Khurana 3/e, p 256-258; Parson's 20/e, p 294-298; http://care.diabetesjoumals.org/cgi/content/full/26/912653JDiabetic retinopathy (DR) & diabetic macular edema (DME) are one of the microvascular complications of diabetes mellitus (DM)DR & DM are leading causes of blindness in most of the developed countries.Chronic hyperglycemia is an important etiological factor leading to complications of DM & following is the proposed mechanism So retinal vascular pathology is behind DR. Retinal layers are not primarily involved in pathogenesis of DRJDME. Diabetic retinopathyDR is a progressive disease that has following stages:Non apparent DRNon proliferative DR Proliferative DR Pathogenesis of DR: * International clinical diabetic retinopathy disease severity scale Proposed disease severity levelDilated ophthalmoscopy findings* No apparent retinopathyNo abnormalities* Mild nonproliferative DRMicroaneurysms only* Moderate nonproliferative DRMore than just microaneurysm, but less than severe NPDR* Severe nonproliferative DRNo signs of PDR, with any of the following: More than 20 intraretinal hemorrhages in each of four quadrantsDefinite venous beading in two or more quadrantsProminent intraretinal microvascular anomalies in one or more quadrants* PDROne or more of the following:NeovascularizationVitreous or preretinal hemorrhageDiabetic macular oedema:DME can develop any time during progression of DR & involves retinal thickening in the macular area.DME occurs after breakdown of the blood-retinal barrier because of leakage of dilated hyperpermeable capillaries and micro aneurysms. Leakage can be diffuse or focal resulting in focal or diffuse macular edema. * Clinically significant macular edema (CSME) occurs when only NPDR is present.Definition of CSME: CSME is when any one of 3 criterias is present -Retinal thickening involving macula or area within 500 pm of it orHard exudates at or within 500 pm of macula with thickening of adjacent retina orA zone of retinal thickening one disc area or larger in size, any part of which is within one disc diameter of macula.Also know -Circinate retinopathy is due to chronic edema involving a considerable area of retina at and around macula with massive changes in retina itself.\n\nSo the answer to this question is A"} {"instruction": "A healthy 22-year-old female medical student with normal kidneys decreases her sodium intake by 50% for a period of 2 months. Which of the following parameters is expected to increase in response to the reduction in sodium intake?\nA. Aerial pressure\nB. Atrial natriuretic peptide release\nC. Extracellular fluid volume\nD. Renin release", "response": "A reduction in sodium intake leads to a decrease in extracellular fluid volume and therefore a decrease in aerial pressure. The decrease in aerial pressure stimulates renin release, which in turn leads to an increase in the formation of angiotensin II. The angiotensin II increases the renal retention of salt and water (ie, decreases sodium excretion, which returns the extracellular fluid volume nearly back to normal. Atrial natriuretic peptide is released from the two atria of the hea as a result of an increase in the extracellular fluid volume. Therefore, a decrease in sodium intake would tend to decrease the release of atrial natriuretic peptide.\n\nSo the answer to this question is D"} {"instruction": "During disaster management the following condition would be classified under international code green signal\nA. High priority treatment\nB. Medium priority treatment\nC. Ambulatory patient\nD. Dead patients", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Acute severe lung injury is characterised by-\nA. Hypotension\nB. Shunting\nC. Cardiac tamponade\nD. Cardiac irregularities", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Umami taste is due to:\nA. Glutamate\nB. B. Sodium\nC. H+\nD. K+", "response": "Ans. A. Glutamatea. Umami is one of the five basic tastes, together with sweet, sour, bitter and salty. The human tongue has receptors for L-glutamate, which is the source of umami flavor.b. Saltiness is a taste produced primarily by the presence of sodium ionsc. Sourness is the taste that detects acidity.d. Sweetness is produced by the presence of sugars and a few other substances. Sweetness is often connected to aldehydes and ketones, which contain a carbonyl group. Sweetness is detected by a variety of G protein coupled receptors coupled to the G protein gustducin found on the taste buds.\n\nSo the answer to this question is A"} {"instruction": "A 48-year-old female nurse is seen with complaints of cough. She has been treated for \"bronchitis\" without much improvement. On exam, she is afebrile and has crackles in the upper zones of the lung field. PPD is negative and sputum for AFB is negative. CXR is shown.All of the following findings may be seen in this patient except\nA. Uveitis\nB. Skin lesion\nC. Bony cysts\nD. Hypocalcemia", "response": "A bilateral upper zone interstitial pattern is seen with hilar and paratracheal adenopathy. Lung volumes are normal. Cardiac size is normal. The physical signs are inconsistent with an infectious process. The CXR shows hilar, paratracheal LN, and parenchymal disease. Sarcoidosis may be associated with uveitis, skin lesions, bony cysts, and hypercalcemia, which is due to abnormal vitamin D metabolism. Sarcoidosis is a systemic disease of unknown etiology characterized pathologically by widespread development of noncaseating epithelioid cell granulomas, which may resolve or conve to fibrous tissue. The disease most commonly affects hilar lymph nodes and lungs, but uveitis and involvement of other organs such as the liver, spleen, skin, bone, and salivary glands are not rare. Lab studies may show anemia, leukopoenia, elevated SED rates, blood eosinophilia, hypercalcemia, hypercalciuria, and elevated levels of serum angiotensin-conveing enzymes. Half of the cases are detected incidentally on chest radiograph. Patients with adenopathy alone are usually asymptomatic, althoughpatients with pulmonary involvement may experience weight loss, fatigue, fever, cough, or shoness of breath. Hemoptysis is rare unless it is associated with end-stage sarcoidosis and a superimposed mycetoma. The disease is most common in African Americans, Pueo Ricans, and West Indians. Women are more susceptible than men. Diagnosis is usually confirmed by transbronchial biopsy, which can demonstrate granulomas despite the absence of radiographic evidence of this peribronchial disease. Adenopathy is the most common manifestation. Symmetrical, hilar, and classically right paratracheal involvement is seen. Unilateral hilar adenopathy is seen in less than 5% of cases. Peripheral \"eggshell\" lymph node calcification is occasionally seen. Pleural effusion is rare. Radiographic staging of sarcoid is as follows: Stage 0: normal finding, 10% at presentation, with the primary problem being nonpulmonary Stage 1: adenopathy without pulmonary disease, 50% at presentation Stage 2: adenopathy with pulmonary disease, 30% at presentation Stage 3: pulmonary disease without adenopathy, 10% at presentation Stage 4: pulmonary fibrosis, usually as a sequel to stage 3, rare at presentation Stage 1 disease resolves within a few years in most patients, and less than one-third of patients with stage I disease develop lung disease. Adenopathy is usually present when there is pulmonary disease. The lung involvement results from deposition of noncaseating granulomas along the lymphatic lining of the bronchial vascular bundles and interlobular septa. Findings include small, irregular interstitial and subpleural nodules throughout the lungs. Confluent interstitial infiltrates may be asymmetric, and cavitation is rare. The midzone and upper zone are most commonly involved, whereas the lung periphery and the bases are generally spared. Pulmonary involvement usually resolves but does progress to fibrosis in less than 20% of the cases, with architectural distoion, traction, and pleural thickening. The distribution is often patchy, in contrast to the peripheral lower lobe distribution of IPF. Occasionally, pulmonary sarcoidosis may appear as ground-glass opacities, patchy consolidation, or rounded \"cannonball\" infiltrates described as alveolar sarcoid.\n\nSo the answer to this question is D"} {"instruction": "In traumatic myostis ossificans, following are true except:\nA. Hydroxyapatite deposition\nB. Common in elbow injury\nC. Periosteal hematoma & leakage\nD. All", "response": "A i.e. Hydroxypatite deposition\n\nSo the answer to this question is A"} {"instruction": "Content of Na' in ringer lactate is meq/1-\nA. 154\nB. 12\nC. 130\nD. 144", "response": "Ans. is 'c' i.e., 130\n\nSo the answer to this question is C"} {"instruction": "FESS means\nA. Factual endoscopic sinus surgery\nB. Functional endonasal sinus surgery\nC. Factual endonasal sinus surgery\nD. Functional endoscopic sinus surgery", "response": "Ans. d (Functional endoscopic sinus surgery), (Ref. Scott Brown, Otolaryngology, 6th ed., 12, 29)Functional Endoscopic Sinus Surgery (FESS) is based on the philosophical concept that function can be restored to the paranasal sinuses and normal structures can be preserved through removal of minimal amounts of tissue. This concept embodies a new understanding of the pathophysiology and development of sinus disease and requires a more delicate, minirealist approach to sinus surgery than the extirpative procedures of the past. These techniques were developed by Walter Messerklinger of Graz, Austria. Uncinectomy is 1st step of FESS.\n\nSo the answer to this question is D"} {"instruction": "All are pas of anterior segment of eye except?\nA. Lens\nB. Cornea\nC. Vitreous\nD. None", "response": "Ans. is 'c' i.e., Vitreous The eyeball is divided into two segments : ? Anterior segment Pa of eyeball anterior to posterior border of lens is called anterior segment. It consists of lens, and structures anterior to it, i.e., cornea, iris and two aqueous humor-filled spaces, i.e., anterior and posterior chambers. Anterior chambers : - It is bounded anteriorly by back of cornea and posteriorly by the iris & pa of ciliary body. It contains aqueous humor. Posterior chamber : - This triangular chamber is bounded anteriorly by the posterior surface of the iris & ciliary body and posteriorly by the lens and it zonules. It also contains aqueous humor. Thus, both anterior and posterior chambers are pa of anterior segment and both contain aqueous humor. Posterior segment Pa of eye ball posterior to lens is called posterior segment. It consists of vitreous humor, retina, choroid and optic disc.\n\nSo the answer to this question is C"} {"instruction": "The karyotype of a patient with Androgen Insensitivity Syndrome is:\nA. 46XX\nB. 46XY\nC. 47XXY\nD. 45X0", "response": "Androgen Insensitivity Syndrome is the largest single entity that leads to 46, XY undermasculinization. AIS is divided into three categories that are differentiated by the degree of genital masculinization: Complete Androgen Insensitivity Syndrome (CAIS) is indicated when the external genitalia is that of a normal female, Mild Androgen Insensitivity Syndrome (MAIS) is indicated when the external genitalia is that of a normal male, and Paial Androgen Insensitivity Syndrome (PAIS) is indicated when the external genitalia is paially, but not fully masculinized. Ref:Kligman, Behrman, Jenson, Stanton (2008), Chapter 589, \"Disorders of Sex Development\", In the book, \"Nelson's Textbook of Pediatrics\", Volume 2, 18th Edition, New Delhi, Page 1164\n\nSo the answer to this question is B"} {"instruction": "acute and chronic renal failure can be differentiated by?\nA. anemia in CRF\nB. hyperphosphatemia in CRF\nC. peripheral neuropathy in CRF\nD. d)", "response": "Ans c (peripheral neuropathy in CRF) ref: Harrison 17th ed 1755Findings that suggest chronic kidney disease include anemia, evidence of renal osteodystrophy (radiologic or laboratory), and small scarred kidneys, anemia may also complicate ARF ARF with hyperphosphatemia:rhabdomyolysisUrate nephropathytumor lysis syndromeNormal renal size with chronic renal disease-diabetic nephropathy, amy-loidosis, polycystic kidney disease, HIV associated nephropathy. Periph-eral neuropathy is unlikely in ARF.\n\nSo the answer to this question is C"} {"instruction": "All of the following statements about Emphysema are true. Except:\nA. Breathlessness is the charachteristic presenting symptom\nB. Diffusion rate of carbon monoxide is reduced\nC. Restrictive pattern on pulmonary function test is seen\nD. Long term bronchadilater therapy does not improve lung function", "response": "Answer is C (Restrictive pattern on pulmonary function test is seen): The hallmark of Emphysema is air flow obstruction and pulmonary function tests show an obstructive pattern Breathlessness (Dyspnea) is a charachteristic presenting symptom The three most common symptoms in COPD (emphysema) are cough, sputum production and exeional dyspnea Obstructive (and not Restrictive) pattern is seen on PFT The hallmark of Emphysema (COPD) is airflow obstruction. PFT shows airflow obstruction with a reduction in FEV i/FVC (< 0.7) Diffusion of carbon monoxide is Reduced (4DLCO) Three main categories of disease with Reduced DLCO are: Interstial Lung disease Emphysema Pulmonary vascular Disease Long term bronchodilater therapy does not improve lung; function `Bronchodilators do not alter the inexorable decline in lung function that is a hallmark of the disease' -CMDT 2008/219 The only drug therapy that is documented to improve the natural history (lung function) of COPD patients is supplemental oxygen in those patients with resting hypoxemia -CMDT 09/230 The only three interventions that influence the natural history of COPD patients Smoking cessation Oxygen therapy in chronically hypoxemic patients Lung volume reduction surgery in selected patients with emphysema\n\nSo the answer to this question is C"} {"instruction": "Enophthalmos is due to plasy of-\nA. Levator palpebrae superioris\nB. Superior tarsal muscle\nC. Orbitalis muscle\nD. Tenon's Capsule instability", "response": "*Tenon's capsule instability is a major cause of enophthalmos, as it forms all the major ligament of the orbit which suppo the globe in the orbit. Ref: Duane's Clinical ophthalmology, vol.2, chapter 48, p.5\n\nSo the answer to this question is D"} {"instruction": "Which of the following condition is associated with a loss of attenuation reflex?\nA. Stapedial palsy\nB. Glomus tumor\nC. Internal ear pathology\nD. Malingerers", "response": "In stapedial palsy, damage to the nerve result in a reduction in sound attenuation reflex resulting in sound being heard excessively loud in the affected ear (hyperacusis). Attenuation reflex: When very loud sound is transmitted through the ossicular system to CNS a reflex is initiated with a latent period of 40 to 80ms. This reflex causes contraction of tensor tympani and stapedius muscle. Contraction of these two muscles make the ossicular system rigid and therefore it fails to vibrate with the sound wave. Thus sound is not allowed to enter inner ear or its intensity is reduced by 30 to 40 decibels.\n\nSo the answer to this question is A"} {"instruction": "Shingles caused by infection with:\nA. Varicella zoster virus\nB. Herpes simplex virus\nC. Human papilloma virus\nD. Epstein-Barr virus", "response": "Ref. Robbins Pathology. 9th edition. Page. 358\n\nSo the answer to this question is A"} {"instruction": "The recommended level of fluorides in drinking water in this Country is accepted as\nA. 0.5 to 0.8 mg per litre\nB. 1 to 2 mg per litre\nC. 3 to 6 mg per litre\nD. 7 to 12 mg per litre", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Mitral valve vegetations do not embolise usually to\nA. Brain\nB. Liver\nC. Spleen\nD. Lungs", "response": "Ans. is 'd' i.e., Lungs o It is very simple question, vegetations from left side (mitral valve) embolize to systemic vasculatures as blood of from left side of hea goes to systemic circulation (not pulmonary circulation) o On the other hand, vegetations from right side (tricuspid valve) embolize to pulmonary vasculatures.\n\nSo the answer to this question is D"} {"instruction": "A 54-year-old man undergoes laparoscopic hernia repair. In spite of the small size of the incisions, he has poor wound healing. Further history reveals that his usual diet has poor nutritional value and is deficient in vitamin C. Synthesis of which of the following extracellular matrix components is most affected by this deficiency?\nA. Collagen\nB. Elastin\nC. Fibronectin\nD. Integrin", "response": "Vitamin C deficiency leads to scurvy, with reduced lysyl oxidase enzyme activity that helps cross-link fibrillar collagens to provide tensile strength. Though elastin is a fibrillar protein, it tends to regenerate poorly in scar tissue, even with the best of nutrition, explaining why a scar does not stretch like the skin around it. The other listed choices are glycoproteins that have an adhesive quality and are not vitamin C dependent.\n\nSo the answer to this question is A"} {"instruction": "Rotting fish urine odour is seen in?\nA. Hawkinsuria\nB. Phenylketonuria\nC. MSUD\nD. Trimethylaminuria", "response": "Maple syrup urine disease Maple syrup/Burnt sugar Hypermethioninemia Boiled cabbage Multiple carboxylase deficiency Tomcat urine Oasthouse urine disease Hopslike Phenylketonuria Mousy or musty Trimethyl aminuria Rotting fish Tyrosinemia Boiled cabbage, rancid butter\n\nSo the answer to this question is D"} {"instruction": "Dew drops on rose petal appearance is seen infection with -\nA. Varicella zoster virus\nB. Herpes genitalis\nC. Candida\nD. T. rubrum", "response": "Ans. is 'a' i.e., Varicella zoster virus Chickenpox - Varicella Zoster virus infectiono Etiology : Varicella-zoster virus,o Prodrome : Fever and malaise.o Morphology : Crops of papules with erythematous halo; rapidly become vesicular (dew drops on rose petal appearance), then pustular. Eruption at different stages present. Heal with minimal scarring unless complicated by secondary' infection or hemorrhagic lesions (as seen in immunocompromised). Adults usually have a more severe eruption.o Site : Centripetal distribution.o Prophylaxis : Live attenuated vaccine.o Treatment : Specific antiviral therapy (acyclovir 800 mg, five times daily x 7-10 days) in adults and in immunocompromised individuals. None needed in children.\n\nSo the answer to this question is A"} {"instruction": "Which of the following is not true about testicular tumor?\nA. About 95% are embryonal tumors\nB. 10% are bilateral\nC. Pulmonary metastases suggest that the tumor is teratoma\nD. Lymphatic spread is to retroperitoneal and intrathoracic lymph nodes", "response": "About 95% of testicular tumours are Germ cell tumours. Embryonal carcinoma is a type of non seminomatous germ cell tumour. Pure embryonal carcinoma constitutes 30% of germ cell tumours but areas of embryonal carcinoma are present in about 40% of germ cell tumours. Teratomas spreads mainly through blood ( to lungs, liver, brain etc) , less commonly through lymphatics.Lymphatic spread occurs to retroperitoneal, para-aoic, mediastinal and left supraclavicular nodes.Reference : page 1083 SRB's manual of surgery 5th edition and page 708 textbook of pathology Harshmohan 6th edition\n\nSo the answer to this question is A"} {"instruction": "A male patient 59 year old complains of multiple swellings in the neck, fever, and weight loss. He gives a history of hypertension treatment. General examination reveals painless lymph nodal enlargement in the neck and on blood investigation, anaemia is revealed. Lymph node biopsy shows typical owl eye-shaped appearance cells.\nWhat can be the most probable diagnosis for this patient?\nA. Multiple myeloma\nB. Hodgkin’s lymphoma\nC. Non-hodgkin’s lymphoma\nD. Burkitt’s lymphoma", "response": "Hodgkin lymphoma, like NHL, usually manifests as painless lymphadenopathy. Although a definitive distinction from NHL can be made only by examination of a tissue biopsy, several clinical features favor the diagnosis of Hodgkin lymphoma. After the diagnosis is established, staging is used to guide therapy and determine prognosis.\nYounger patients with more favorable subtypes tend to present with stage I or stage II disease and usually are free of so-called “B symptoms” (fever, weight loss, night sweats). Patients with advanced disease (stages III and IV) are more likely to exhibit B symptoms as well as pruritus and anemia.\nThe sine qua non of Hodgkin lymphoma is the Reed-Sternberg (RS) cell, a very large cell (15 to 45 µm in diameter) with an enormous multilobate nucleus, exceptionally prominent nucleoli, and abundant, usually slightly eosinophilic cytoplasm. Particularly characteristic are cells with two mirror-image nuclei or nuclear lobes, each containing a large (inclusion-like) acidophilic nucleolus surrounded by a clear zone, features that impart an owl-eye appearance.\n\nDifference between Hodgkin Lymphoma and Non-Hodgkin Lymphoma\n\nSo the answer to this question is B"} {"instruction": "All of the following drugs are used in hypertensive crisis except:\nA. Labetalol\nB. Pindolol\nC. Nitroprusside\nD. Nifedipine", "response": "Ans. B. PindololLabetalol is used as hypertensive emergency in pregnancy, nitroprusside is given in patients with aortic dissection. Nifedipine though rarely used, can be given as sublingual therapy for rapid control of blood pressure.\n\nSo the answer to this question is B"} {"instruction": "A 50 year old male presents with malignant hypeension. the drug of choices\nA. Sodium nitroprusside\nB. Sublingual nifedipine\nC. Furosemide\nD. Enalapril", "response": "It is a first choice drug for malignant hypeension Refer kDT 11e p185\n\nSo the answer to this question is A"} {"instruction": "Most common inherited thrombotic disorder is -\nA. Protein C deficiency\nB. Protein S deficiency\nC. Factor V leiden mutation\nD. tPA deficiency", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Epidemic typhus causes & vector\nA. R. typhi & mite\nB. Rickettessia prowazki & louse\nC. R. conori & tick\nD. R. akari & mite", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Sun ray appearance is seen in – a) Osteosarcomab) Ewing sarcomac) Osteoclastomad) Multiple myeloma\nA. ac\nB. ab\nC. ad\nD. bc", "response": "Sunray appearance is classically seen in osteosarcoma. It may also occur in metastases, Ewings sarcoma, Haemangioma, Meningioma and tuberculosis.\n\nSo the answer to this question is B"} {"instruction": "SAFE strategy for Trachoma includes all of the following except:\nA. Screening\nB. Antibiotic\nC. Face wash\nD. Environmental improvement", "response": "A i.e. Screening\n\nSo the answer to this question is A"} {"instruction": "Ring scotoma is seen in: September 2012\nA. Glaucoma\nB. Retinitis pigmentosa\nC. Sympathetic ophthalmia\nD. Vitreous hemorrhage", "response": "Ans. B i.e. Retinitis pigmentosa\n\nSo the answer to this question is B"} {"instruction": "A young female has the following lab values : MCV-70 Hb 10 gm% serum iron 60, serum feritin 100,the diagnosis is -\nA. Thalassemia trait\nB. Chronic iron deficiency anemia\nC. Megaloblastic anemia\nD. Anaemia of chronic infection", "response": "None\n\nSo the answer to this question is D"} {"instruction": "All arc atypical antipsychotic drugs except\nA. Clozapine\nB. Risperidone\nC. Olanzapine\nD. Loxapine", "response": "Atypical antipsychotic Clozapine Risperidone Olanzapine Quetiapine Aripiprazole Ziprasidone Other hetrocyclics Pimozide, Loxapine Ref: K D Tripathi 8th edition\n\nSo the answer to this question is D"} {"instruction": "Which of the following is not expected in a case of Microcytic Hypochromic anemia -\nA. Reduced serum Iron\nB. Reduced total RBC distribution width\nC. Normal Ferritin levels\nD. Increased TIBC", "response": "Ans. is 'b' i.e., Reduced total RBC distribution width o Microcytic hypochromic anemias are typically associated with a normal or High Red Cell distrubution width.MCV||||LowNormalHigh|||RDWRDWRDW|||||||||IncreasedNormalIncreasedNormalIncreasedNormalo Iron deficiencyo Thalassemiao Red cell fragmentationo Hemoglobin Ho Chronic diseaseo Heterogenous thalassemiao Myelofibrosis o Sideroblustic anemiao Chronic diseaseo Hemorrhageo Hemolysiso Transfusiono HbAc, Aso Hereditary spherocytosiso Folate or B12 deficiencyo Immunehemolytic anemiao WBC leukemiao Aplastic anemiao Preleukemia\n\nSo the answer to this question is B"} {"instruction": "Flaccid Bullae lesions with oral mucosal lesion. The finding in immunofluoscence is aEUR'\nA. Fish net IgG in epidermis\nB. Linear IgG in dermo epidermal junction\nC. Granular IgA in dermal papillae\nD. Linear IgA in reticular dennis", "response": "Fish net IgG in epidermis Child with multiple flaccid bullae along with oral mucosal lesions suggests pemphigus. All patients suspected of having pemphigus should be evaluated inzmunopathologically. Immunofluorescene findings in common billions disorders Direct immunotlorescence Indirect immunoflorescence * Petriphigig IgG intercellular depositsQ Circulating IgG to cell in epidermis \"(fish net pattern)\" surface of epidermal cells These titres correlate with disease activity. * MMus C3 and IgG linear hand at Circulating IgG (in 70% pemphigoid Dermoepidermal junction2 patients that hind to base? ment inenthrone. * Chronic hull ous IgA, linear band at denno- Low titre of circulating disease of child- epidennaljunctionQ IgA hood (Linear IgA dermatosis of childhood) * Dermatitis IgA (-1- 0), granular deposit Circulating immune herpetiformis at dermal papillary tipsdeg complexes in less than 50%\n\nSo the answer to this question is A"} {"instruction": "A child presents with lid lag and an enlarged cornea with a diameter of 13 mm. Examination of the eye reveals double contoured opacities concentric to the limbus. Which of the following is the most likely diagnosis?\nA. Superficial keratitis\nB. Deep keratitis\nC. Thyroid Endocrinopathy\nD. Congenital Glaucoma", "response": "Ans. (d) Congenital GlaucomaRef: Kanski 7/e, p. 374; Parson's 22/e, p. 304; Shields 6/e, p. 210, 223An enlarged globe with an enlarged corneal diameter > 13 mm along with characteristic Haabs striae (double contoured opacities concentric to limbus) suggests the diagnosis of congenital glaucoma.\n\nSo the answer to this question is D"} {"instruction": "During surgical exploration for hydatid cyst of the liver, any of the following agents can be used as scolicidal agent except -\nA. Hypeonic sodium chloride\nB. Formalin\nC. Cetrimide\nD. Povidone Iodine", "response": "Ans. is 'd' i.e., Povidone Iodine\n\nSo the answer to this question is D"} {"instruction": "Which of the following is TRUE about leiomyosarcoma of breast?\nA. Well encapsulated\nB. Radical mastectomy is treatment of choice\nC. Metastasize by lymphatic channel\nD. Axillary lymph node dissection is mandatory", "response": "Leiomyosarcoma: These primary soft tissue sarcomas of the breast represent less than 1% of all breasts malignancies. It includes malignant fibrous histiocytoma and angiosarcoma. Leiomyosarcoma are malignant tumors composed of cells showing smooth features. These tumors behave as sarcoma behave elsewhere in the body. They are locally aggressive tumors & when they metastasize, it is through a hematogenous route. Palpable axillary lymphadenitis is uncommon and when encountered usually represents reactive lymph nodes univolved by metastatic disease. A clinically negative axilla in presence of large tumors may be indicative of breast sarcoma. Tumor is well circumscribed or encapsulated. Simple mastectomy is gold standard of treatment. Axillary lymph node dissection is not indicated. Postoperative radiation may be used in patient undergoing mastectomy because chest wall recurrence are observed. Ref: Breast Carcinoma By Roses, 2/e, Page 707-08\n\nSo the answer to this question is A"} {"instruction": "Clinical manifestation of Schizophrenia are all of the following EXCEPT:\nA. Delusion\nB. Altered sensorium\nC. Auditory hallucinations\nD. Catatonia", "response": "Ans. (b) Altered sensoriumRef : Harrison 19th ed. / 2270-71* Schizophrenia is a formal thought disorder, characterized by third person hallucination & inappropriate emotion (affect)* Altered consciousness (sensorium) is a characteristic feature seen in delirium (not in szchizophrenia)Characteristics* Only 3rd person hallucinations are characteristic of schizophrenia.* Third person hallucination means: Two or more voices talking to one another, discussing about the patient; and giving a running commentary on his actions or thoughts.* Auditory hallucination is most characteristic of Schizophrenia.\n\nSo the answer to this question is B"} {"instruction": "Thoracotomy is indicated in all the following except\nA. Penetrating chest injuries\nB. Rapidly accumulating haemothorax\nC. Massive air leak\nD. Pulmonary contusion", "response": "Ans. d (Pulmonary contusion). (Ref. Bailey & Love, Short Practice of Surgery, 25th/pg. 341)CHEST INJURIES# Directly or indirectly involved in 50% of trauma deaths in the USA# About 80% of chest injuries can be managed closed# A chest radiograph is the investigation of first choice# A spiral CT scan provides rapid diagnosis in the chest and abdomen# A chest drain can be diagnostic as well as therapeutic# If there is an open wound insert a chest drain# Do not close a sucking chest wound until a drain is in place# If bleeding persists, the chest will need to be opened.# One of the most vital parts of management of patient with chest trauma is to identify any threat to life mentioned below. These are surgical emergencies & operative treatment required.Immediately life threatening injuriesPotentially life threatening injuries# Airway obstruction# Aortic injuries# Tension pneumothorax# Tracheobronchial injuries# Pericardial tamponade# Myocardial contusion# Open pneumothorax# Rupture of diaphragm# Massive haemothorax# Oesophageal injuries# Flail chest# Pulmonary contusion\n\nSo the answer to this question is D"} {"instruction": "Xanthurenic acid is produced in\nA. Tyrosine metabolism\nB. Tryptophan metabolism\nC. Cysteine metabolism\nD. Valine metabolism", "response": "In the metabolism of Tryptophan, Kynurenin is an intermediate step. The accumulated Kynurenine is shunted to Xanthurenic acid. So, in pyridoxal deficiency, Xanthurenic acid is excreted in the urine.Ref: DM Vasudevan - Textbook of Biochemistry, 7th edition, page no: 240\n\nSo the answer to this question is B"} {"instruction": "a patient was brought to psychiatry casuality with contraction of the neck , the patient told that it was painul. this symptom staed after the injection given at the psychiatry hospital for his psychosis. the type of side effect caused by the drug is\nA. dystonia\nB. neuroleptic malignant syndrome\nC. akathisa\nD. tardive dyskinesia", "response": "Acute dystonia * <48 hours of staing antipsychotics * M.C in======Younger black males * If a patient develops dystonia he is more prone for eps Patient considers this as an Allergic reaction , thereby may stop drugs Layryngeal dystonia is a Psychiatric emergency, should be treated with IV lorazepam TREATMENT * Diphenhydramine * Benztropine mesylate * Prophylactic anticholinergics helps Ref. Kaplonand sadock, synopsis of psychiatry, 11 th edition, page no. 925\n\nSo the answer to this question is A"} {"instruction": "For a survey a village is divided into 5 lanes then each lane is sampled randomly is an example is ?\nA. Simple random sampling\nB. Stratified random sampling\nC. Systemic random sampling\nD. All of the above", "response": "Ans. is 'c' i.e., Stratified random sampling Simple random sampling has been explained (See above explanation). Systematic random sampling In order to do systematic random sampling, the individuals in a population are arranged in a ceain way (for example, alphabetically). o A random staing point is selected and then every nth (for example 10th or 15th) individual is selected for the sample. o That is, after arranging the individuals in ceain pattern (e.g., alpabetically) a staing point is chosen at random, and choices thereafter at regular intervals. For example, suppose you want to sample 8 houses from a street of 120 houses. 120/8 = 15, So every 15th house is chosen after a random staing point between 1 and 15. If the random staing point is 11, then the houses selected are -4 11, 26, 41, 56, 71, 86, 101, and 116. o In contrast to simple random sampling, some houses have a larger selection probabily e.g., in this question 11, 26, 41, 56, 71, 86, 100 and 116. While the remaining number can not be selected. Stratified random sampling When sub-populations vary considerably, it is advantageous to sample each subpopulation (stratum) independently. o Stratification is the process of grouping members of the population into relative hemogenous subgroups before sampling. o The strata should be mutually exclusive, every element in the population must be assigned to only one stratum. o Then systematic random sampling method is applied within each stratum. Population Stratification -4 Systematic random sampling -4 Sample. o This often improves the representativeness of the sample by reducing sampling error. o For example, suppose in a population of 1000, sample of 100 is to be drawn for Hb estimation, first conve the population into homogenous striata (e.g., 700 males and 300 females), then draw 70 males and 30 females by doing systematic random sampling. Now see the question o First the village has been stratified into five lanes. o Then random sampling is done on each lane. o It is stratified random sampling. Multistage random sampling: o Is done in successive stages; each successive sampling unit is nested in the previous sampling unit o Advantage: Introduces flexibility in sampling. o For example, in large country surveys, states are chosen, then districts, then villages, then every 10th person in village as final sampling unit. Multiphase random sampling: Is done in successive phase; pa of information is obtained from whole sample and pa from the sub-sample. o For example, in a TB survey, Mantourx test done in first phase, then X-ray done in all Mantoux positive, then sputum examined in all those with positive X-ary findings.\n\nSo the answer to this question is C"} {"instruction": "Umbilical cord has -\nA. 1 vein and 2 aeries\nB. 2 vein and 2 aeries\nC. 1 vein and 1 aery\nD. 2 veins and 1 aery", "response": "Ans. is 'a' i.e., 1 Vein and 2 aeries\n\nSo the answer to this question is A"} {"instruction": "The overdrive mechanism observed during hyperventilation is due to\nA. image_question\nB. image_question\nC. image_question\nD. image_question", "response": "The ventral respiratory group contributes to the extra respiratory drive (overdrive mechanism) During quiet breathing: Expiration is a passive process and the neurons from the ventral respiratory group remain almost totally inactive during quiet respiration. Unlike the dorsal respiratory group (DRG; dorsal group of neurons), VRG (the ventral group of neurons) doesnot appear to paicipate in the basic rhythmic oscillations that control respiration. Extra-respiratory drive(overdrive mechanism) : When the reapiratory drive for increased pulmonary ventilation becomes greater than normal, for example, during exercise, respiratory signals spill over to VRG from DRG. So, VRG contributes to the extra respiratory drive (overdrive mechanism). The neurons of VRG contribute to both inspiration and expiration; especially, they are impoant in providing powerful expiratory signals to the abdominal muscles during very heavy expiration. Dorsal Respiratory group Ventral Respiratory group Location Nucleus Tractus Solitarius in medulla Nucleus Retro Ambigualis in medulla Function Inspiratory ramp signals- stimulates inspiration Inactive during quiet breathing; Active during forced expiration. Ref: Ganong&;s Review of Medical Physiology 26th edition Pgno: 645-657\n\nSo the answer to this question is D"} {"instruction": "The partial pressure of CO2 is lowest in:\nA. Arterial blood\nB. End tidal air\nC. Expired air\nD. Venous blood", "response": "Ref: Multiple sources, Guyton, 12th edition, Pages 487- 488. 502-503: Khurana, W F Ganong, Review of Medical Physiology, 23rd edition Explanation: Normal PO2 and PCO2 at various sites Atmosphere (sea level) (inspired air Alveoli Pulmonary vein Arterial blood Tissue Venous Pulmonary artery Etpurid Air pO2 160 149-160 100-105 95-100 100 40 40 40 120 pCO2 0.3 (Negligible) 0.3 (Negligible) 40 4O 40 46 45 45 27 *A11 values in 'mm Hg' Note: Expired air pCO2 - 27 (Ref: Guyton Table 39-1) Expired air pCO2 - 32 (Ref: Ganong Figure 34-15. Page 635. 24th edition)\n\nSo the answer to this question is B"} {"instruction": "Which of the following suppress the activity of osteoblasts?\nA. Vitamin D3\nB. T3 and T4\nC. Coicosterone\nD. Parathormone", "response": "Steroid causes inhibition of osteoblast function and potential increase in osteoblast apoptosis, resulting in impaired synthesis of new boneStimulation of bone resorption, probably as a secondary effectImpairment of the absorption of calcium across the intestine, probably by a vitamin D-independent effectIncrease of urinary calcium loss and induction of some degree of secondary hyperparathyroidismReduction of adrenal androgens and suppression of ovarian and testicular secretion of estrogens and androgensPotential induction of glucocoicoid myopathy, which may exacerbate effects on skeletal and calcium homeostasis, as well as increase the risk of falls.\n\nSo the answer to this question is C"} {"instruction": "Anaplastic cells often display the following morphologic features except --------.\nA. Nuclear-to-cytoplasmic ratio 1:1\nB. Retention of polarity\nC. Formation of tumor giant cells\nD. Quadripolar mitotic figures", "response": "Anaplastic cells often display the following morphologic features:\n\nPleomorphism (i.e., variation in size and shape).\nNuclear abnormalities, consisting of extreme hyperchromatism (dark-staining), variation in nuclear size and shape, or unusually prominent single or multiple nucleoli. Enlargement of nuclei may result in an increased nuclear-to-cytoplasmic ratio that approaches 1:1 instead of the normal 1:4 or 1:6. Nucleoli may attain astounding sizes, sometimes approaching the diameter of normal lymphocytes.\nTumor giant cells may be formed. \nAtypical mitoses, which may be numerous. Anarchic multiple spindles may produce tripolar or quadripolar mitotic figures. \nLoss of polarity.\n\nReference-Robbins BASIC PATHOLOGY 10th edition pg-193\n\nSo the answer to this question is B"} {"instruction": "Midgut is supplied by which artery -\nA. Superior mesenteric artery\nB. Middle colic artery\nC. Celiac trunk\nD. Inferior mesenteric artery", "response": "Ans. is 'a' i.e., Superior mesenteric artery Part of gutDerivativesArteryForegutPharynxLower respiratory tractEsophagusStomachDuodenum upto the opening of the main pancreatic ductLiverPancreasCeliac trunkMidgutDuodenum distal to the opening of the main pancreatic ductSmall intestineAppendixCecumAscending colonTransverse colon upto th junction of right 2/3 and left 1/3SupermesentericarteryHindgutLeft 1/3 of transverse colonDescending colonSigmoid colonRectumUpper part of anal canalInferior mesentericartery\n\nSo the answer to this question is A"} {"instruction": "Use of shakirs tape for measuring arm circumference is -\nA. Equitable distributin\nB. Community participation\nC. Intersectoral coordination\nD. Appropriate technology", "response": "Ans. is 'd' i.e., Appropriate technology * Appropriate technology is defined as 'technology that is scientifically sound, adaptable to local needs, and acceptable to those who apply it and those for whom it is used, and that can be maintained by the people themselves in keeping with the principles of self reliance with the resources the community and country can afford.'* Examples of appropriate technology -i) Use of coloured tapes (e.g. shakir tape) for measuring mid arm circumferenceii) Use of ORSiii) Growth chart maintenance for under-5 children\n\nSo the answer to this question is D"} {"instruction": "Collagen found in hyaline cailage is ?\nA. Type I\nB. Type II\nC. Type IV\nD. Type v", "response": "Ans. is 'b' i.e., Type II\n\nSo the answer to this question is B"} {"instruction": "Pinta is caused by:\nA. Treponema peenue\nB. Treponema carateum\nC. Treponema pallidum\nD. Treponema endemicum", "response": "Pinta Non-sexually transmitted spircohetal infection caused by Treponema carateum. Three sub-species of T. pallidum are known: T. pallidum, which causes syphilis T. endemicum, which causes bejel or endemic syphilis T. peenue, which causes venereal syphilis or yaws\n\nSo the answer to this question is B"} {"instruction": "Underdeveloped maxilla is seen in all except:\nA. Cleidocranial dysplasia.\nB. Treacher collins syndrome.\nC. Osteogenesis imperfecta.\nD. Achondroplasia.", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Golgi tendon is innervated by which nerve fibre?\nA. Ia\nB. Ib\nC. II\nD. III", "response": "Ans. B IbGOLGI TENDON ORGAN is embedded within the musculotendinous junction (90%) and in the tendon itself (10%).* They are stimulated by: Increased tension at muscle tendon* Afferent: Ib fiber (myelinated).* Mediates inverse stretch reflexExtra MileReflexAfferent fiberStimulusResponseGolgi tendon reflexIbMuscle contractionRelaxation of the muscleStretch reflexIaMuscle is stretchedContraction of the muscleFlexor - withdrawal reflexII, III, and IVPain, touchIpsilateral flexion, contralateral extension* Group III/IV afferent fibers are afferent arm of cardiovascular ventilatory reflex responses which are mediated in nucleus tractus solitarius and ventrolateral medulla. They facilitate central fatigue and are important in endurance sports.\n\nSo the answer to this question is B"} {"instruction": "A toddler has few drops of blood coining out of rectum. Probable diagnosis is:(AIIMS May 2013, May 2012)\nA. Juvenile rectal polyp\nB. Adenomatous Polyposis Coli\nC. Rectal ulcer\nD. Piles", "response": "Ans. a. Juvenile rectal polyp (Ref: Sabiston 19/e p1342; Schwartz 9/e p1043: Bailey 25/e p1228; Schackelford 7/e p2030; Harrison 19/e p537, 18/e p313, 352; 17/e p250)Most common cause of passage of few drops of blood per rectum in a toddler is Juvenile rectal polyp.Juvenile polypsJuvenile polyps are the MC type of colorectal hamartomasQOccur most commonly in children <5 years of ageQ.Up to 80% of juvenile polyps occur as a single lesion of the rectumQTypical symptoms are rectal bleeding, mucus discharge, diarrhea, and abdominal painQ.Also called retention polyps due to the inflammatory obstruction of the crypt necks that leads to cystic dilation of the mucus-filled glands.No increased risk of cancerQ\n\nSo the answer to this question is A"} {"instruction": "The following phase diagram (in which Liquid + Beta solid solution -----------→ Alpha solid solution) shows:\nA. Eutectic alloy\nB. Peritectic alloy\nC. Both\nD. None", "response": "The peritectic reaction is an invariant reaction that occurs at a particular composition and temperature. The reaction during the cooling process can be written as:\nLiquid + β solid solution → α solid solution \nFigure is the phase diagram for the Ag-Pt alloy system. The α phase is silver-rich, the β phase is platinum-rich, and the two-phase (α-plus-β) region results from the limited solid solubility of less than approximately 12% Ag in Pt at 700°C (point F) of silver in platinum. Figure shows that the equilibrium solid solubility of Pt in Ag is approximately 56% at 700°C. The peritectic transformation occurs at point P, where the liquid composition at B and the platinum-rich β phase (composition at point D) transform into the silver-rich α phase (composition at point P).\n\nSo the answer to this question is B"} {"instruction": "Disease spread by hard tick is: September 2007\nA. Rocky mountain spotted fever\nB. Epidemic typhus\nC. Murine typhus\nD. Scrub typhus", "response": "Ans. A: Rocky mountain spotted fever Hard Tick-borne diseases of concern include: Human Babesiosis is a protozoan infection that occurs infrequently. Babesiosis also have Lyme disease from the same deer tick bite. Rocky Mountain spotted fever. Tularemia is a potentially serious illness. It is caused by the bacterium rodents, rabbits, and hares). Viral hemorrhagic fever Tick paralysis Colarado tick fever Viral encephalitis\n\nSo the answer to this question is A"} {"instruction": "A female, Lalita, aged 26 yrs accidentally takes 100 tablets of paracetamol. What is treatment of choice:\nA. Lavage with charcoal\nB. Dialysis\nC. Alkaline diuresis\nD. Acetyl cystein", "response": "D i.e. Acetyl cysteine In cases of moderate to severe poisoning of paracetamol, N? acetyl cysteine (mucomyst) should be givenQ orally within 24 hours of overdose to prevent hepatic damage. Treatment of Paracetamol poisoning 1. Gastric lavage - useful in < 4 hours. 2. < 2.5 lit fluid daily, as pcm 1/t fluid retention 3. N-acetyl cysteineQ (Treatment of choice) 4. Hemodialysis for ARF\n\nSo the answer to this question is D"} {"instruction": "Which one is non-ionising radiation –\nA. MRI\nB. CT Scan\nC. X–ray\nD. Position emission scintigraphy", "response": "MRI is non-ionizing radiation.\n\nSo the answer to this question is A"} {"instruction": "Which of these is FALSE of vulvar carcinoma?\nA. Most common type is squamous cell carcinoma\nB. In situ vulvar cancer occurs more commonly in older females\nC. Basaloid or way type is associated with HPV\nD. Keratinising type is associated with lichen sclerois and occurs in older females", "response": "Most common histological type of ca vulva is squamous cell carcinoma In situ vulval cancer occurs more commonly in young females due to rising incidence of HPV infection. Basaloid or way types Keratinizing 40% of squamous 60 % of squamous Multifocal Unifocal Younger patients Older patients Related to HPV Not related to HPV, related to lichen sclerosis Usual VIN, immunosuppression, smoking related Differentiated VIN, chronic inflammatory dermatosis\n\nSo the answer to this question is B"} {"instruction": "RULE OF HALVES RELATED TO-\nA. OBESITY\nB. BURNS\nC. BLINDNESS\nD. HYPEENSION", "response": "REF:-PARK 25TH EDITION PGNO:-404. RULEOF HALVES:- HYPEENSION IS AN &;ICEBERG DISEASE&;.ONLY ABOUT HALF OF HYPEENSIVE SUBJECTS IN GENERAL POPULATION OF MOST OF THE DEVELOPED COUNTRIES ARE AWARE OF THE PROBLEM WERE BEING TREATED AND ONLY HALF OF THOSE TREATED WERE CONSIDERED ADEQUATELY TREATED. 1. The whole community 2. Normotensive subjects 3. Hypeensive subjects 4. Undiagnosed hypeension 5. Diagnosed hypeension 6. Diagnosed but untreated 7. Diagnosed and treated 8. Inadequately treated 9. Adequately treated.\n\nSo the answer to this question is D"} {"instruction": "If the coefficient of correlation between height and weight is 2.6, TRUE is -\nA. Positive correlation\nB. No association\nC. Negative correlation\nD. Calculation of the coefficient is wrong", "response": "None\n\nSo the answer to this question is D"} {"instruction": "A patient of rheumatic hea disease with mitral stenosis and atrial fibrillation is on oral warfarin. On one OPD visit, his INR is found to be 6. What is the action to be taken?\nA. Stop warfarin, and review\nB. Stop wairfarin, and administer fresh frozen plasma\nC. Stop wairfarin, and administer fresh frozen plasma\nD. Stop warfarin, and administer intramuscular vitamin K", "response": "People living with RHD need to be on medication to reduce the risk of blood clots which can cause stroke. Medication may be needed if you have a hea valve replacement operation or an abnormal hea rhythm (atrial fibrillation). The most common anticoagulation medicine is called warfarin An INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin for disorders such as atrial fibrillation or a blood clot in the leg or lung. If InR increases stop anti coagulation Medication and review the patient Ref Davidson 23rd edition pg 435\n\nSo the answer to this question is A"} {"instruction": "In which type of Schizophrenia is grimacing a feature of:\nA. Juvenile\nB. Hebephrenic\nC. paranoid\nD. Catatonic", "response": "D. i.e. Catatonic\n\nSo the answer to this question is D"} {"instruction": "Which of these is not a tributary of cavernous sinus -\nA. Sphenoparietal sinus\nB. Superior petrosal sinus\nC. Superficial middle cerebral vein\nD. Inferior ophthalmic vein", "response": "Superior petrosal sinus is a draining channel (not a tributary) of the cavernous sinus. \nTributaries (incoming channels) of the cavernous sinus\n\n\nSuperior ophthalmic vein\nA branch of an inferior ophthalmic vein or sometimes vein itself\nCentral vein of the retina (it may also drain into a superior ophthalmic vein)\nSuperficial middle cerebral vein\nInferior cerebral vein\nSphenoparietal sinus\nFrontal trunk of middle meningeal vein (it may also drain into pterygoid plexus or into sphenoparietal sinus)\n\nSo the answer to this question is B"} {"instruction": "Mondor's disease is:\nA. Thrombophlebitis of the superficial veins of breast\nB. Carcinoma of the breast\nC. Premalignant condition of the breast\nD. Filariasis of the breast", "response": "Mondor's disease is thrombophlebitis of the superficial veins of the breast and anterior chest wall, although it may also occur in the arm. Frequently involved veins: Lateral thoracic vein, thoracoepigastric vein, superficial epigastric vein. Benign, self-limited disorder. TREATMENT NSAIDs & application of warm compresses\n\nSo the answer to this question is A"} {"instruction": "Which of the following is a stimulant?\nA. Cocaine\nB. Alcohol\nC. Nicotine\nD. Cannabis", "response": "Stimulants Non stimulants Methylphenidate, dexmethylphenidate Atomoxetine Amphetamines Bupropion Modafinil Clonidine, Guanfacine Cocaine Venlafaxine Nicotine has dual action to stimulate or depress neural activity.\n\nSo the answer to this question is A"} {"instruction": "In b-thalassemia there is:\nA. Excess a-chain\nB. Reduced a-chain\nC. Excess b-chain\nD. Reduced b-chain", "response": "d. Reduced p-chain(Ref: Ne/sosn's 20/e p 2349, Ghai 8/e p 341)In beta-thalassemia there is reduced b chain and relatively excess chain.\n\nSo the answer to this question is D"} {"instruction": "In an adult man weighing 70 Kgs, the Total body water volume will be about -\nA. 42L\nB. 25L\nC. 15L\nD. 12L", "response": "Ans. A. 42L60% of body weight is composed of water. Therefore, total body water in a 70 Kg man would be 60% of 70 Kg, ie, 42 Kg, which is equivalent to 42 L.\n\nSo the answer to this question is A"} {"instruction": "Minimum number of sputums require to confirm diagnosis TB according to RNTCP guidelines:\nA. One\nB. Two\nC. Three\nD. Four", "response": "Ans. b. TwoAFB SPUTUMS SMEARS (SS) FOR DIAGNOSIS OF CASE OF TB (NEW GUIDELINES)TB suspect A person with productive cough >2 weeks with or without hemoptysis, fever for >2 weeks, chest pain, weight loss, night sweats, and loss of appetite is subjected to 2 SS examinationsNumber of specimens required for diagnosis of smear positive pulmonary Tuberculosis: TwoChances of detecting smear positive cases:With 1 sample: 80%With 2 sample: 93%\n\nSo the answer to this question is B"} {"instruction": "Drug of choice for diabetic diarrhea:\nA. Duloxetine\nB. Clonidine\nC. Domperidone\nD. Alosetron", "response": "(Ref: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, Volume 1; P 575)Diabetic diarrhea is seen in middle aged type 1 poorly controlled diabetic patients and is characterized by intermittent, brown, watery and voluminous stools which is occasionally accompanied by tenesmus.In these patients, GI adrenergic function is impaired in autonomic neuropathy. Therefore, any adrenergic agonist may further stimulate the intestinal absorption of fluid and electrolytes.Drugs used areAlpha 2 adrenergic agonist: Clonidine. Acts as adrenergic antagonist which acts by reversing the peripheral adrenergic resorptive abnormalities.# Because of autonomic neuropathies, these patients will not experience postural hypotension.# Moreover, clonidine doesn't alter diabetic control or renal function.Somatostatin analogue: Octreotide. Useful in refractory diabetic diarrheaCodeine, Diphenoxylate with atropine, Loperamide:Used for symptomatic treatment.Anti-diarrheal agentsDrugsMain uses ;Tryptophan hydroxylaseinhibitor: Telotristat ethylSevere diarrhea due tocarcinoid tumorsEnkephalinase inhibitor-RacecadotrilAcute diarrheaSafe in childrenOctreotide* Severe secretory diarrhea due to GI tumors* Postgastrectomy dumping syndromeCrofelemer (plant derived)HIV/AIDS diarrheaAlosetron* Diarrhea-predominant IBS in womenBile acid sequestrants:Cholestyramine, Colesevelam, ColestipiolBile salt induced diarrheaClonidineDiabetic diarrheaMOR agonists* Diphenoxylate, difenoxin, LoperamideAcute diarrheaChronic diarrheaTraveler's diarrheaAntibiotics--empiric therapy* Fluoroquinolone* Ciprofloxacin* Levofloxacin* Norfloxacin* OfloxacinAlternative antibiotics* Azithromycin* Rifaximin* Acute diarrhea* Traveler's diarrhea* Azithromycin: Preferred treatment for children with traveler's diarrhea* Rifaxamin: Preferred for diarrhea predominant IBS\n\nSo the answer to this question is B"} {"instruction": "Cultivation of virus in all of the following media are used for isolation of viruses from clinical samples, EXCEPT:\nA. Tissue culture\nB. Embryonated eggs\nC. Animals\nD. Chemically defined media", "response": "Demonstration of virus in appropriate clinical specimens by culture is used in establishing the diagnosis of viral diseases. Isolation of virus is considered as the gold standard for establishing viral etiology of a disease. Most of the viruses can be cultivated in experimental animals, embryonated eggs or tissue culture. Chemically defined media is not used for viral isolation. Ref: Textbook of Microbiology and Immunology By Parija, pages 471-3\n\nSo the answer to this question is D"} {"instruction": "All the following are the risk factors for cervical cancer except\nA. Young age at first intercourse\nB. Multiple sexual paners\nC. Low parity\nD. Low socioeconomic status", "response": "There are numerous risk factors for cervical cancer: Young age at first intercourse (younger than 16 years), Multiple sexual paners, Cigarette smoking, race, High parity, Low socioeconomic status, and Chronic immune suppression. Reference: Novak's gynaecology; 14th edition; Chapter 35; Uterine cancer\n\nSo the answer to this question is C"} {"instruction": "Most common infection of the hand is - (PGI 88)\nA. Acute paronychia\nB. Felon\nC. Web space infection\nD. Palmar abscess", "response": "Ans- A Hand Infections Arrangement of fascia and fascial septa in the hand is such that many spaces are formed. These spaces are of surgical important because they may become infected and distended with pus. Spaces are as follows: Palmar spaces - Pulp space of the fingers - Midpalmar space - Thenar space Dorsal spaces - Dorsal subcutaneous space - Dorsal subaponeurotic space The forearm space of Parona Pulp Space of Finger Fig: The digital pulp space. Tips of finger and thumb contain subcutaneous fat arranged and tight compartments formed by fibrous septa which pass from skin to the periosteum of the terminal phalanx. Infection of Pulp Spaces Infection of pulp spaces also known as FELON or WHITLOW. Caused by penetrating injury from a foreign body or from fingersticks: for medical reasons (e.g. hematocrit and blood sugar determination). Staph aureus is the commonest organism to cause this infection. Swelling redness, pain, typical of cellulitis initially are presented. The pulp abscess (felon) can extend into the periosteum, around the nail bed, or proximally through the periosteum, around the nail bed, or proximally through the fibrous curtain or through the skin to the exterior over the pulp. Treatment: Incision and Drainage Web Space Infection (Collar Button Abscess) Web space infection localizes in one of the three fat filled interdigital spaces just proximal to the superficial transverse ligament at the level of metacarpophalangeal joints. Infection begins beneath palmar calluses in labourers. It may begin near the palmer surface but because skin and fascia here are less yielding it may localize to drain dorsally. Mid Palmer and Thenar Space Infection Fig: Fascial Spaces of Hand iMid palmer abscess can cause severe systemic reaction local pain and tenderness inability to move long and ring fingers because of pain and generalized swelling of hand and fingers which resemble and INFLATED GLOVE. iThenar abscess causes similar symptoms but thumb web is more swollen. The index finger is held flexed and active motion of both the index finger and thumb is impaired because of pain. Space of Parona This space is border by pronator quadratus dorsally, flexor pollicis longus laterally, flexor carpi ulnaris medially and flexor tendons on palmar aspect. Abscess of these spaces usually result from spread of infection from other parts of hand typically from purulent flexor tenosynovial infections.\n\nSo the answer to this question is A"} {"instruction": "Glomerulonephritis is NOT a feature of:\nA. Granulomatosis with polyangiitis (Wegener's)\nB. Churg-Strauss syndrome\nC. Microscopic polyangiitis\nD. Polyaeritis nodosa", "response": "In Polyaeritis nodosa the pathology in the kidney is that of aeritis without glomerulonephritis. In patients with significant hypeension, typical pathologic features of glomerulosclerosis may be seen. Ref: Harrisons principles of internal medicine, 18th edition, Page: 2794.\n\nSo the answer to this question is D"} {"instruction": "Myosin and actin filaments are kept in place by ?\nA. Tropomyosin\nB. Troponin\nC. Actinin\nD. Titin", "response": "Ans. is 'd' i.e., TitinThe side-by-side relationship between the myosin and actin filaments is difficult to maintain.This is achieved by a large number of filamentous molecules of a protein called titin.Titin molecules act as a framework that holds the myosin and actin filaments in place so that the contractile machinery of the sarcomere will work.Impoant muscle proteins Myosin :- Myosin is the protein that constitutes the thick filaments. Myosin of skeletal muscle is myosin-IL Myosin paicipates in the contractile mechanism and also acts as an ATPase.Actin :- Actin is the major protein of thin filament. It is the actin which slides over myosin during contraction.Tropomyosin : - It is the other protein of thin .filament. It covers the active sites (myosin binding sites) on actin. When Ca+2 concentration of cytoplasm (sarcoplasm) is raised, it uncovers the active sites of actin and allow the contraction So, the 'cross-bridge cycling' is switched off or on by the tropomyosin molecule which slides on the actin molecule to cover or uncover the active sites on it.\n\nSo the answer to this question is D"} {"instruction": "An 8-month-old female child presented to emergency with a hea rate of 220/minute and features of congestive hea failure. Her hea rate comes down to normal after administering intravenous adenosine. What is the most likely diagnosis?\nA. Atrial fibrillation\nB. Atrial flutter\nC. Paroxysmal supraventricular tachycardia\nD. Ventricular tachycardia", "response": "Ans. is 'c' i.e., Paroxysmal supraventricular tachycardia o Adenosine is the DOS for PSVT.\n\nSo the answer to this question is C"} {"instruction": "Mutation of which of the following gene is most impoant in Paroxysmal Nocturnal Hemoglobinuria\nA. Decay accelerating factor (DAF)\nB. Membrane inhibitor of reactive lysis (MIRL)\nC. Glycosyl phosphatidyl inositol (GPI)\nD. CD8 binding protein", "response": ".\n\nSo the answer to this question is C"} {"instruction": "Renal biopsy demonstrates concentric, laminated thickening of aeriolar walls due to proliferation of smooth muscle cells. This process is BEST described by which of the following terms?\nA. Atherosclerosis\nB. Hyaline aeriolosclerosis\nC. Hyperplastic aeriolosclerosis\nD. Monckeberg's aeriosclerosis", "response": "The \"onion skinning\" morphology of these aerioles is a feature of hyperplastic aeriolosclerosis. Affected vessels may also show necrotizing aeriolitis with acute vessel wall necrosis accompanied by fibrin deposition. This type of vessel change is a hallmark of severe (malignant) hypeension, and can damage aerioles throughout the body, notably in the kidneys, intestine, and gall bladder.Atherosclerosis would produce luminal narrowing by plaques.Hyaline aeriolosclerosis would produce paial replacement of aerial walls by homogeneous, pink material.Monckeberg's aeriosclerosis is characterized by medial calcification of smaller aeries. Ref: Chandrasoma P., Taylor C.R. (1998). Chapter 20. The Blood Vessels. In P. Chandrasoma, C.R. Taylor (Eds), Concise Pathology, 3e.\n\nSo the answer to this question is C"} {"instruction": "Which of the following prevent lens opacity by free radical scavenging?\nA. Glutathione\nB. Catalase\nC. Vitamin A\nD. Vitamin E", "response": "Rediced glutathione is the most impoant anti-oxidant mechanism in lens. Ref: Yanoff ch.501; Biochemistry of Lens p.330; Parson 22nd/e p.261&20th/e p.248; Alder's Physiology 10th/e p.130.\n\nSo the answer to this question is A"} {"instruction": "Which of the following fluoroquinolones does not require dose adjustment in a patient with creatinine clearance of < 50mg/min -\nA. Ciprofloxacin\nB. Trovafloxacin\nC. Lomefloxacin\nD. Sparfloxacin", "response": "Ans. is 'b' i.e., Trovofloxacin Fluoroquinolones that are excreted primarily by non renal mechanism and for which adjustment is not needed in renal pathology include : Nalidixic acid 3. Trovafloxacin 5. Moxifloxacin Grepofloxacin 4. Pefloxacin Fluroquinolones that are primarily excreted by renal mechanisms and for which dose adjustment is needed include: 1. Ciprofloxacin 3. Gatifloxacin 5. Lomefloxacilin 7. Ofloxacin 2. Cinafloxacin 4. Levofloxacilin 6. Norfloxacin Sparfloxacin has 50% renal and 50% faecal route of excretion and hence dose adjustment may be required in renal pathology.\n\nSo the answer to this question is B"} {"instruction": "Culture media of leptospirosis -\nA. Korthof\nB. Perkin\nC. Tinsdale\nD. Baker's", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Transfusing blood after prolonged storage could lead to:\nA. Citrate intoxication\nB. Potassium toxicity\nC. Circulatory overload\nD. Haemorrhagic diathesis", "response": "Prolonged storage of blood can lead to hyperkalemia due to lysis of RBC. Citrate intoxication, circulatory overload & haemorrhagic diathesis results from massive blood trasfusion. Citrate intoxication - Hypocalcemia, manifested by circumoral numbness and/or tingling sensation of the fingers and toes. Circulatory overload - Transfusion-associated circulatory overload (TACO). Dyspnea, bilateral infiltrates on CXR with systolic hypeension and elevated levels of Brain natriuretic peptide (BNP). Haemorrhagic diathesis - Dilutional thrombocytopenia\n\nSo the answer to this question is B"} {"instruction": "The best diagnostic procedure of M.tuberculosis\nA. PCR\nB. Auramin rhodamin stain\nC. Sputum culture\nD. ESR", "response": "Ans. is 'c' i.e., Sputum culture \"Definitive diagnosis depends on isolation (culture) and identification of M. tuberculosis from a diagnostic sepcimen (most common specimen in sputum)\".\n\nSo the answer to this question is C"} {"instruction": "Regarding stapedial reflex, which of the following is true:\nA. It helps to enhance the sound conduction in middle ear\nB. It is a protective reflex against loud sound\nC. It helps in masking the sound waves\nD. It is unilateral reflex", "response": "Ans. is b i.e. It is a protective reflex against loud sounds Stapedius muscle helps to dampen very loud sound and thus prevents noise trauma to the inner ear. It is supplied by VII nerve (facial nerve). Lesions of facial nerve lead to loss of stapedial reflex and hyperacusis or phonophobia i.e. intolerance to loud sounds. For more details see chapter - physiology of hearing and assessment of hearing loss of the guide Stapedial reflex = Acoustic reflex\n\nSo the answer to this question is B"} {"instruction": "Cephalometrics was introduced by:\nA. Margolis and William Wilson in 1925\nB. Tweed and Mills in 1940\nC. Bjork and sassouni in 1995\nD. Broadbent and Hoftath in 1932", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Venoocclusive disease of the liver is caused by:\nA. Cyclophosphamide\nB. Melphalan\nC. Both\nD. None", "response": "Potential target for sinusoidal lining cells; when these are injured, such as by high-dose chemotherapeutic agents (e.g., cyclophosphamide, melphalan, busulfan) administered prior to bone marrow transplantation, venoocclusive disease can result. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 2560\n\nSo the answer to this question is C"} {"instruction": "Taper present in 20 number GT file is\nA. 0.06, 0.08, 0.10, 0.12\nB. 0.006, 0.008, 0.01, 0.012\nC. 0.6, 0.8, 1.0, 1.2\nD. 0.03, 0.04, 0.05, 0.06", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Ascorbic acid is a potent enhancer of iron absorption because it\nA. Enhances the absorption of heme iron\nB. Enhances the activity of heme oxygenase\nC. Is a reducing agent, thereby helping to keep iron in the ferrous state\nD. Decreases the production of ferritin by enterocytes", "response": "Ascorbic acid enhances iron absorption mostly by its reducing capacity, keeping iron in the ferrous state. Ascorbic acid does not enhance heme iron absorption, nor does it affect heme oxygenase activity or the produc on of ferritin or transferrin.\n\nSo the answer to this question is C"} {"instruction": "A child with a small head, minor anomalies of the face including a thin upper lip, growth delay, and developmental disability can have all of the following,except –\nA. A chromosomal syndrome\nB. A teratogenic syndrome\nC. A mendelian syndrome\nD. A polygenic syndrome", "response": "A syndrome with facial anomalies including a thin upper lip, growth delay and developmental disabilities is likely to result from either a teratogenic congenital malformation, a single gene defect (Mendelian) or a chromosomal disorder. A trait is called polygenic if multiple genes are thought to contribute to the phenotype and includes conditions like diabetes and hypertension. A polygenic disorder is the least likely diagnosis amongst the options provided and the single best answer of exclusion.\n\nSo the answer to this question is D"} {"instruction": "All are contents of the Femoral traingle except\nA. Femoral nerve\nB. Femoral vein\nC. Superficial inguinal lymphatics\nD. Nerve to pectineus", "response": "Femoral triangle : Lateral - Saorius Medial - Adductor longus Base - Inguinal ligament Contents - Femoral nerve, Femoral aery, Femoral vein,deep inguinal lymphatics, nerve to pectineus. Ref : Gray's Anatomy The Anatomical Basics of Clinical Practice 41 e pg 1362.\n\nSo the answer to this question is C"} {"instruction": "Patient with fixed dilated pupil, with iris atrophy and secondary glaucoma after penetrating keratoplasty is suggestive of:\nA. Benedict's syndrome\nB. Posner-Shlossman syndrome\nC. Kaufmann's syndrome\nD. Urrets Zavalia syndrome", "response": "Ans. d. Urrets Zavalia syndrome (Ref: style=\"font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif\">icles/PMC1770988)A fixed dilated pupil following penetrating keratoplasty is a well recognized if rare postoperative complication.The mydriasis following penetrating keratoplasty was first described by Castroviejo but it was Urrets-Zavalia who first published his observations on a series of six cases and suggested an association of fixed dilated pupil, iris atrophy, and secondary glaucoma.The pupil can become abnormally dilated following penetrating keratoplasty for keratoconus, particularly if dilating drops are used.In addition to the pupil and iris abnormalities, Urrets-Zavalia also described other features--iris ectropion, pigment dispersion, anterior subcapsular cataract and posterior synechiae.Urrets Zavalia SyndromeUrrets Zavalia Syndrome is characterized by triad of: Secondary glaucoma + Iris atrophy + Fixed dilated pupilQUrrets-Zavalia syndrome (UZS) consists of a fixed dilated pupil associated with iris atrophy.It is a poorly understood complication following penetrating keratoplasty for keratoconus.Posner Shlossman syndromeIt is also called as glaucomatocyclitic crisis.Episodic unilateral mild anterior uveitis, photophobia, reduced vision and colored rings around lights (from secondary corneal edema)Benedict's SyndromeIf red nucleus is involved, tremors and jerky movements occur in contralateral side of the body.This condition combined with ipsilateral 3rd nerve paralysis is called as Benedict's syndrome.McKusick-Kaufmann SyndromeMcKusick-Kaufman syndrome: A rare genetic disorder characterized by hydrometrocolpos (fluid buildup in vagina and uterus), extra fingers and congenital heart defects.\n\nSo the answer to this question is D"} {"instruction": "Relaxation volume of lung is documented as ?\nA. Functional residual capacity\nB. Residual volume\nC. Vital capasity\nD. Closing volume", "response": "Ans. is 'a' i.e., Functional residual capacity Relaxation volume The relaxation volume is the volume of the relaxed respiratory system, i.e., the volume at which net elastic recoil of he total respiratory system is zero (the elastic recoil of chest wall is equal and opposite to that of lungs). In healthy subjects, this occurs at the end of quiet expiration, i.e., at functional residual capacity. Therefore, in healthy adults at rest FRC is essentially equal to relaxation volume of respiratory system and FRC is usually treated as synonymous with relaxation volume. However, in real sense FRC and relaxation volume are not synonymous terms and, while the two volumes are some times equal, more often they are not, i.e., active or passive mechanisms often operate to make FRC different from relaxation volume. For example, neonates have a more compliant (less stiff) chest wall. The chest wall thus has less elastic recoil to balance that of lung, thus decreasing the relaxation volume of lung. FRC then is often maintained above relaxation volume by active mechanisms like inspiratory muscle activity and slowing of expiration. Another example where FRC and relaxation volume may differ is in obstructive lung disease where FRC is dynamically determined and may be considerably above relaxation volume.\n\nSo the answer to this question is A"} {"instruction": "Circumvallate papillae are associated with:\nA. Sweet taste.\nB. Sour taste.\nC. Bitter taste.\nD. All of the following.", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Most probable cause of red congested painful eye with mild dilated veically oval pupil is:\nA. Acute primary angle closure glaucoma\nB. Anterior uveitis\nC. Keratoconjunctivitis\nD. Eale's disease", "response": "Signs of acute primary angle closure glaucoma: Lids appears edematous Conjunctiva is chemosed and congested Cornea becomes oedematous and insensitive Anterior chamber is very shallow Angle of anterior chamber is completely closed as seen on gonioscopy Iris may be discoloured Pupil is semi dilated, veically oval and fixed. It is non-reactive to both light and accommodation. IOP is markedly elevated, usually between 40 and 70 mm of Hg Optic disc is oedematous and hyperemic Fellow eye shows shallow anterior and a narrow angle (latent angle closure glaucoma) Ref: Comprehensive Ophthalmology by A K Khurana, 4th edition, Page 229.\n\nSo the answer to this question is A"} {"instruction": "A 55 year old male presented with angina. Coronary angiography revealed a block in the right coronary aery. The condition is likely to cause a decrease in blood supply through all of the following blood vessels except\nA. Acute Marginal\nB. Posterior interventricular aery\nC. Aery to SA node\nD. Circumflex aery", "response": "Circumflex aery is not a branch of the right coronary aery. It is the branch of the left coronary aery. The branches of the right coronary aery are: Right coronary aery-It is the first branch of the right coronary aery. Aery of the SA node. Acute right marginal aery. Posterior interventricular aery (in 65% population) Atrial and anterior and posterior ventricular branches. Ref: Gray&;s Anatomy 41st edition Pgno: 1016\n\nSo the answer to this question is D"} {"instruction": "Which of the following muscle is blocked first by neuromuscular blocker:-\nA. Face\nB. Proximal limb\nC. Diaphragms and vocal cords\nD. Distal limb", "response": "Neuromuscular blockade usually sooner occur at well perfused centrally located muscles (diaphragm or vocal cords ) than at peripheral locations (hand or foot). Recovery occurs also in same sequence thus diaphragm and vocal cords , face, proximal limbs and distal limbs. Sequence of NM paralysis and recovery from paralysis is sameDiaphragm & vocal cords - Head & Neck - Upper Limb - Trunk - Lower Limb\n\nSo the answer to this question is C"} {"instruction": "Commonest variety of carcinoma stomach is:(1991)\nA. Squamous carcinoma\nB. Adenocarcinoma\nC. Colloid carcinoma\nD. None", "response": "Ans: b\n\nSo the answer to this question is B"} {"instruction": "True about anopheles mosquito-\nA. Larvae have siphon tube\nB. Larvae are surface feeder\nC. Larvae are bottom feeder\nD. Larvae tie at an angle to water surface", "response": "Anopheles mosquito: Eggs are laid singly, boat-shaped with lateral floaters Larvae rest parallel to the surface and are thus surface feeders, have no siphon tube, palmate hairs are present Adults at rest are inclined at an angle to the surface, wings are spotted, palpi are long in both sexes. Only option 2 is correct. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 831.\n\nSo the answer to this question is B"} {"instruction": "All are features of A-type 1 Except\nA. Renal stones\nB. Fanconi syndrome\nC. No anion gap\nD. Decreased potassium", "response": "The typical findings in acquired or inherited forms of classic distal A (type 1 A) include hypokalemia, non-AG metabolic acidosis, low urinary NH4+ excretion (positive UAG, low urine ), and inappropriately high urine pH (pH > 5.5). Most patients have hypocitraturia and hypercalciuria, so nephrolithiasis, nephrocalcinosis, and bone disease are commonReference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 66; Acidosis and Alkalosis\n\nSo the answer to this question is B"} {"instruction": "A patient with glaucoma is being treated with systemic beta blocker. All of the following can be given to the patient except?\nA. Brimonidine\nB. Dorzolamide\nC. Levobunolol\nD. Prostaglandin", "response": "Ans. c. Levobunolol (Ref: KDT 7/e p154, 6/e p144: 5/e p85)Brimonidine, dorzolamide and prostaglandin are topical anti-glaucoma drugs. These drugs do not have systemic side effects, while levobunolol (beta-blocker) is systemic anti-glaucoma drug given orally, having systemic side effects. That is why in patients with glaucoma treated with systemic beta blockers, levobunolol may add on the side effects of beta-blockers, hence, avoided in the above mentioned patient.Topical Anti-glaucoma DrugsAdrenergic agonistNon-selective: Epinephrine, DipivefrineAlpha2-selective: Apraclonidine, BrimonidineAdrenergic antagonistBeta-blocker (Non-selective): Timolol, Levobunolol, Carteolol, Metipranolol, AdapralolBeta 1-blocker: BetaxololMiotics (direct parasympatomimetics)Pilocarpine, PhysostigmineEcothiophate. Carbachol, DemacariumProstaglandin analoguesLatanoprostCarbonic anhydrase inhibitorsDorzolamideSystemic Antiglaucoma DrugsCarbonic anhydrase inhibitorsHyperosmotic agents* Acetazolamide* Dichlorphenamide* Methazolamide* Mannitol* Glycerol\n\nSo the answer to this question is C"} {"instruction": "Acute hemorrhagic conjunctivitis is caused by ?\nA. Enterovirus 70\nB. Adenovirus\nC. Poliovirus\nD. Hepadnavirus", "response": "Ans. is 'a' i.e., Enterovirus 70 Acute hemorrhagic conjunctivitis (AHC) may be caused by adenoviruses, but two enteroviruses, enterovirus 70 and coxsackie A24 variant, are the major causes.\n\nSo the answer to this question is A"} {"instruction": "Lambda phage true ist:\nA. Cause mad cow disease\nB. Lytic and lysogenic interconversion can't occur\nC. Lytic form incorporated within host DNA and multiply causing rupture of cell membrane\nD. Lysogenic form incorporates with host DNA and remains dormant", "response": "Ans. (a) Transduction Transmission of genetic material = gene transfer = acquisition of characteristic occur by four process. a. Transformation: - Transfer of genetic information (about 10-50 genes) through the free DNA. Seen mainly in pneumococci; bacillus species and Hemophilus influenza. Any characteristic may be transferred by transformation. b. Transduction: - Transfer of poion of DNA from one to other bacteria by agency of bacteriophage (acts only as vehicle). It may be generalised (when it involves any segment of donor DNA) or restricted (when specific bacteriophage transduces only a paicular genetic trait). It is most widespread mechanism of gene transfer among prokaryotes. Episomes and plasmids (e.g. plasmid determining Pn resistance in staphylococci) may also transduced. It is used in genetic engineering in the treatment of some inborn errors of metabolism. c. Conjugation Bacterial equivalent of sexual mating Described by Lederberg and Tatum in strain of E. coli (K12), e.g. Transfer of episomes and plasmids of drug resistance. d. Lysogenic conversion: - Phage DNA becomes integrated with bacterial chromosome as the prophage which codes for new characteristic, e.g. toxin production in C. diptheriae.\n\nSo the answer to this question is A"} {"instruction": "Which of the following is true of Wilson's disease all except -\nA. Autosomal recessive\nB. Serum ceruloplasmin level < 20 mg/d1\nC. Urinary coppor excretion < 100 microgram/c11\nD. Zinc acetate is used as maintence therapy", "response": "Urinary copper excretion <100 microgram/di Symptomatic pts. of Wilson disease invariably have urine copper levels > 100 pg per day. Wilson disease is an autosomal recessive disorder caused by mutation in the ATP 7B gene (a copper transpoing ATPase) Diagnosis - The gold standard for diagnosis is Liver biopsy with quantitative copper assayQ. Other diagnostic tests used are ? - Serum ceruloplasmin levelQ - KF rings(2 - Urine copper excretiono - DNA Helpful-ye analysisQ Serum copper values have no diagnostic value, since they may be low, normal or elevated depending upon the stage of evolution of disease. Table : Useful Diagnostic Tests for Wilson Disease Test Normal Value Wilson Disease Serum 180-350 mg/L ceruloplasmin (18-35 mg/d1) * Low in 85% * Present in 99% KF rings Absent - If neurologic or psychiatric symptoms present. * Present in 30-50% - in hepatic presentation and presymptomatic state * Urinary copper excretion is increased 24-h urine Cu 0.3-0.8 mmol - >1.6intn ol(>100mg) in symptomatic patients * 0.9 to > mmol (60 to > 100 mg) - in presymptomatic patients Liver Cu 0.3 -- 0.8 mmol/g * Liver copper is increased (20-50 mg) tissue * > 3.1 mmol (200 mg) Haplotype analysis 0 Matches 2 Matches Treatment Zinc is the treatment of choice for Wilson diseaseQ. It produces a negative copper balance - By blocking intestinal absorption of copper - By inducing hepatic metallothionein synthesis which sequesters additional toxic copper. Table : Recommended Anticopper Treatments for Wilson Disease Disease Status First Choice Second Choice Initial hepatic manifestations Zinc Trientine and zinc Trientine and zinc Hepatic transplantation Trientine Penicillainine and zinc Hepatic transplantation Trientine and zinc * Hepatitis or cirrhosis without decompensation * Hepatitis or Cirrhosis with decompensation - Mild - Moderate - Severe Initial neurologic/psychiatric Tetraioinolybdate and zinc Trientine and zinc Maintenance therapy Zinc Trientine Presymptomatic therapy Zinc Trientine Pediatric Zinc Trientine Pregnant Zinc Trientine\n\nSo the answer to this question is C"} {"instruction": "All of the following are known complication of pancreatitis except?\nA. Pancreatic abscess\nB. Colonic necrosis\nC. Pancreatic malignancy\nD. Pancreatic fistula", "response": "Pancreatic malignancy is not a complication of acute pancreatitis. The other complications of acute pancreatitis are pancreatic pseudocyst, intraperitoneal haemorrhage, pleural effusion, atelectasis, pneumonia, ARDS, DIC, peptic ulcer disease, erosive gastritis, poal vein thrombosis, oliguria, azotaemia, acute tubular necrosis, hyperglycaemia, hypocalcaemia, fat emboli, Puscher's retinopathy, hyperiglyceridaemia etc.\n\nSo the answer to this question is C"} {"instruction": "CURB 65 criteria include all except\nA. Age more than or equal to 65\nB. RR more than 30/min\nC. Systolic BP more than 90mmHg\nD. BUN level more than 7mmol/L", "response": "Image ref Davidsons 23e p563\n\nSo the answer to this question is C"} {"instruction": "BCR ABL gene mutation is seen in?\nA. CML\nB. AML\nC. CLL\nD. ALL", "response": "CML is distinguished from other myeloproliferative disorders by the presence of a chimeric BCR-ABL gene derived from the poions of BCR gene on chromosome 22 and ABL gene on chromosome 9.It directs the synthesis of a constitutively active BCR-ABL tyrosine kinase. Reference; Robbins and Cotran Pathologic basis of disease.South Asia Edition volume 1.page no. 616\n\nSo the answer to this question is A"} {"instruction": "Fasciotomy -all of the following are cut except:\nA. Skin\nB. Superficial fascia\nC. Deep fascia\nD. Muscles", "response": "Fasciotomy must release skin, superficial fascia and deep fascia. Fig. Forearm fasciotomy Fasciotomy is an emergency procedure used to release pressure in compament syndrome either due to trauma or infections.\n\nSo the answer to this question is D"} {"instruction": "One of them is NOT a principle of health education:\nA. Credibility\nB. Feedback\nC. Setting an example\nD. Utilization", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Pleomorphic adenoma is usually arise from\nA. Parotid gland\nB. Sub mandibular gland\nC. Minor salivary gland\nD. Superficial lobe", "response": "(Parotid gland) (546-HM) (584-Basic pathology 8th)Pleomorphic adenoma (Mixed salivary tumour) is the commonest tumour in the parotid gland and occurs less often in other major and minor salivary gland, common in females.\n\nSo the answer to this question is A"} {"instruction": "Ductus arteriosus closes in response to –\nA. Decrease in peripheral oxygen saturation\nB. Indomethacin therapy\nC. Prostaglandin E1\nD. Increase in pulmonary vascular resistance", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Gustafson's method used for age estimation of the tooth includes all except -\nA. Primary dentition\nB. Root resorption\nC. Root transparency\nD. Attrition", "response": "Gustafson's method includes :\n\n(i) Attrition, \n(ii) Paradentosis,\n(iii) Secondary dentin formation,\n(iv) Cementum apposition,\n(v) Root resorption and\n(iv) Transparency of the root.\n\nSo the answer to this question is A"} {"instruction": "Lesion of ventrolateral spinal cord will show:\nA. Loss of proprioception on the same side\nB. Loss of proprioception on the contralateral side\nC. Loss of pain and temperature on same side\nD. Loss of pain and temperature on contralateral side", "response": "None\n\nSo the answer to this question is D"} {"instruction": "The Kennedy classification that is more suitable for an\ninternal attachment is\nA. Class 1\nB. Class 2\nC. Class 3\nD. Class 4", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Regarding ribosome all is true except\nA. 16 S ribosome identifies shine- dalgamo sequence\nB. Cytosolic ribosomes synthesize proteins of peroxisome\nC. Large subunit catalyzes peptide bond formation\nD. Binding of aminoacyl tRNA uses 2ATP", "response": "D i.e. Binding of aminoacyl tRNA uses 2ATP- Component of 50s subunit are 23s & 5s; and components of 60s subunit are 28s, 5.8s and 5s.Ribosome is a highly conserved natural machine for protein synthesis that brings m-RNA & t-RNA togetherQ. It has 2 subunits the large subunit catalzes peptide bond formation whereas small subunit is responsibl for accuracy. 16s rRNA component of 30s subunit identifies & binds shine Dalgarno sequence. Binding of aminoacyl tRNA to A site uses 1 GTP. Free cytosolic ribosomes synthesize proteins required in cytosol, nucleus, mitochondria & peroxisomes. Whereas RER bound ribosome form proteins for various plasma membranes.\n\nSo the answer to this question is D"} {"instruction": "All of the following are taken into consideration in Kuppuswamy scale EXCEPT-\nA. Education status\nB. Occupational status\nC. Living/Housing conditions\nD. Per capita Income", "response": "Ans. is 'c' i.e., Living/Housing conditions\n\nSo the answer to this question is C"} {"instruction": "All are features of hemolytic uremic syndrome, EXCEPT:\nA. Thrombocytopenia\nB. Anemia\nC. Renal dysfunction\nD. Neuro-psychiatric disturbances", "response": "Neuro-psychiatric disturbances are not a feature of hemolytic uremic syndrome, but may be seen in TTP. HUS: Hemolytic-uremic syndrome (HUS) is a common cause of community acquired acute kidney injury in young children characterised by a triad of Microangiopathic Hemolytic anemia Thrombocytopenia Renal dysfunction In HUS, capillary and aerial endothelial injury in kidney leads to localized thrombosis. The entrapment of platelets in micro-thrombi formed in small blood vessels leads to thrombocytopenia. The consumption of clotting factors due to initiation of coagulation cascade leads to hypofibrinogenemia. Microangiopathic hemolytic anemia results from mechanical damage to red blood cells as they through the damaged and thrombotic microvasculature.\n\nSo the answer to this question is D"} {"instruction": "The following are indications for assisted ventilation in acute severe asthma EXCEPT?\nA. PEFR 50-60% of predicted value\nB. Rising PaCO2> 6kPa (45 mm Hg)\nC. Diminishing level of consciousness\nD. Falling PaO2< 8kPa (60 mm Hg)", "response": "PEFR of 50-60% indicates moderate asthma. Indication for intubation in asthma exacerbation is a poor response to oxygen with salbutamol nebulisation and oral steroids. The definition of poor response is: 1. FEV1< 40%. 2. PaCO2> 45mmHg. 3. Features of carbon dioxide narcosis. 4. Hypoxia defined as PaO2<60 mm Hg.\n\nSo the answer to this question is A"} {"instruction": "All of the following are true about Ewing's sarcoma, EXCEPT\nA. Responds well to radiotherapy\nB. Grows in diaphysis of long bones\nC. Common in 4th decade\nD. Has onion peel appearance on radiograph", "response": "(C) Common in 4th decade # Ewing sarcoma, a highly malignant primary bone tumor.> The tumor is derived from red bone marrow.> Most frequently, it is observed in children and adolescents aged 4-15 years and rarely develops in adults older than 30 years.> Ewing sarcoma is the second most common malignant bone tumor in young patients, and it is the most lethal bone tumor.> Typically, the periosteal reaction and new bone formation with an onionskin appearance may suggest the diagnosis of E wing sarcoma.> It is highly radiosensitive and it melts like ice but only to recur at a later date.\n\nSo the answer to this question is C"} {"instruction": "'Tram-track' calcification on skull radiograph is characteristic of\nA. Congenital CMV infection\nB. Congenital toxoplasmosis\nC. Sturge Weber syndrome\nD. Craniopharyngioma", "response": ".\n\nSo the answer to this question is C"} {"instruction": "Regarding HIV transmission to foetus all are true except –a) > 50% risk of transmission to foetusb) Can present as failure to thrivec) Greatest risk of transmission of in perinatal periodd) Cannot be diagnosed\nA. b\nB. ad\nC. ac\nD. ab", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Giving Benzathine penicillin in RHD is a type of -\nA. Primary prevention\nB. Secondary prevention\nC. Teiary prevention\nD. Primordial prevention", "response": "park's textbook of preventive and social medicine 23rd edition. *in children :Im injection of benzyl pencillin 600000 units. *in adult :1.2 million units. *this must be continued for 5 years or until the child reaches 18 years.\n\nSo the answer to this question is B"} {"instruction": "Which of the following is the LEAST likely physiological change in pregnancy?\nA. Increase in intravascular volume\nB. Increase in cardiac output\nC. Increase in stroke volume\nD. Increase in peripheral vascular resistance", "response": "Blood volume expansion begins early in the first trimester, increases rapidly in the second trimester, and plateaus at about the 30th week. Cardiac output increases approximately 40% during pregnancy, with maximum values achieved at 20-24 weeks' gestation. Stroke volume increases 25-30% during pregnancy, reaching peak values at 12-24 weeks' gestation. Vascular resistance decreases in the first trimester, reaching a nadir of approximately 34% below nonpregnancy levels by 14 to 0 weeks of gestation with a slight increase toward term. Ref: Flick A.A., Kahn D.A. (2013). Chapter 8. Maternal Physiology during Pregnancy & Fetal & Early Neonatal Physiology. In DeCherney A.H., Nathan L, Laufer N, Roman A.S. (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.\n\nSo the answer to this question is D"} {"instruction": "Nasal intubation is contra indicated in –\nA. CSF Rhinorrhea\nB. Fracture cervical spine\nC. Fracture inaudible\nD. Short neck", "response": "Nasal intubation is contraindicated in : Basal skull fracture, CSF rhinorrhea, coagulopathy, nasal polyp / abscess / foreign body and adenoid.\n\nSo the answer to this question is A"} {"instruction": "Which of the following favours filtration at the arteriolar end of the capillary bed\nA. Decrease in hydrostatic pressure of capillaries\nB. Increase in hydrostatic pressure of capillaries\nC. Increase in oncotic pressure of capillaries\nD. Decrease in oncotic pressure of interstitium", "response": "For filtration to take place at the capillaries, the hydrostatic pressure should be more in capillaries than the interstitium, or the oncotic pressure in capillaries should be less than that in the interstitium.\n\nSo the answer to this question is B"} {"instruction": "Residual auditory defect is a common complication in meningitis caused by -\nA. Staphylococcus\nB. Meningococcus\nC. Escherichia coli\nD. Hemophilus influenza", "response": "Ans. is 'd' i.e., Hemophilus influenzae\n\nSo the answer to this question is D"} {"instruction": "Magnesium sulphate potentiates the hypotensive action of -\nA. Methyldopa\nB. Nifedipine\nC. Enalapril\nD. Hydralazine", "response": "ans-B\n\nSo the answer to this question is B"} {"instruction": "Following is given with iron to increase its absorption ?\nA. Milk\nB. Antacids\nC. Citrus fruits\nD. Alkalies", "response": "Ans. is 'c' i.e., Citrus fruits Citrus fruits are good sources of vitamin C (ascorbic acid) which increases intestinal absorption of iron.\n\nSo the answer to this question is C"} {"instruction": "Thick ascending limb of loop of Henle has-\nA. Na+ K+ cotransporter\nB. Na+Cl- cotronsporter\nC. Na+ H+ cotronsporter\nD. Na+ K+ 2C1- transporter", "response": "Ans. is 'd' i.e., Na+ K+ 2C1- transporter Na+ reabsorptiono 60-70% in proximal tubule - by Na\" - H+ exchange, Na+ - Glucose contransport, Na+ - aminoacid cotransport, Na+ unitransport.o 30% in thick ascending limb of loop of Henle by Na+ - 2C1- - K+ cotransport.o 7% in early distal tubule - Na+ Cl- cotransporto 3% in late distal tubule and collecting duct - via ENaC channelso Na+ is reabsorbed in all segments of nephron except for thin descending limb of loop of Henle.\n\nSo the answer to this question is D"} {"instruction": "Most common affected by Blunt trauma abdomen?\nA. Spleen\nB. Intestine\nC. Liver\nD. Mesentery", "response": "Ans. (a) SpleenRef: Bailey & Love 26th ed./1087* The spleen is the most commonly injured viscus in blunt abdominal trauma and can result from the most trivial of traumas.* The classical presentation is that of a hemodynamically unstable patient with a history of trauma, with severe abdominal pain and signs of peritonitis.* The classic physical'findings of splenic rupture are left shoulder pain, left upper quadrant pain and tenderness, and Kehrs sign (left shoulder pain from irritation of inferior border of left diaphragm by hematoma).* Absence of one or more or even all of these signs does not rule out splenic injury. Diagnosis is based on a thorough physical examination and confirmed with the FAST examination\n\nSo the answer to this question is A"} {"instruction": "A 30 year old manic patient was prescribed haloperidol one week back. For the last two days, he has become restless and kept pacing in the room for a day. On examination, he was found to have tremors of hand. He is most likely suffering from -\nA. Anhedonia\nB. Dystonia\nC. Restless leg syndrome\nD. Akathisia", "response": "Restlessness and pacing in room within 1 week of antipsychotic (haloperidol) therapy suggest the diagnosis of Akathisia.\n\nSo the answer to this question is D"} {"instruction": "Lymphocyte phenotype test done for?\nA. Agammaglobinemia\nB. SCID\nC. Sepsis\nD. Acute leukemia", "response": "Ans. (b) SCID(Ref: HENRY'S Clinical Diagnosis and Management by Laboratory Methods; 22ned ed/ pg 944-945)Lymphocyte phenotyping for assessing immune deficiency includes CD3 (pan T cell), CD4 (T helper subset), CD8 (T cytotoxic/suppressor subset), CD 19 (pan B cell), CD 16/56 (pan NK cell) and other cell surface markers as required based on clinical data. This analysis is indicated in diagnosis and monitoring of immunodeficiencies and immunotherapy in children and adults\n\nSo the answer to this question is B"} {"instruction": "Eosinophilic pustular folliculitis a rare form of folliculitis that is seen with increased frequency in patients with ?\nA. ABPA\nB. Asthma\nC. Leukemia cutis\nD. HIV infection", "response": "Eosinophilic pustular Folliculitis is most prevalent in HIV infection and is seen in ~20% of patients. m/c in patients with CD4+ T cell counts <200 cells/mL Presents as multiple, uicarial perifollicular papules that may coalesce into plaque like lesions. Skin biopsy reveals an eosinophilic infiltrate of the hair follicle, which in ceain cases has been associated with the presence of a mite. Patients have an elevated serum IgE levels and may respond to treatment with topical antihelminthics.\n\nSo the answer to this question is D"} {"instruction": "Which of the following is the only reversible cataract:\nA. Senile cataract\nB. Cataract in galactosemia\nC. Congenital cataract\nD. None", "response": "Ans. Cataract in galactosemia\n\nSo the answer to this question is B"} {"instruction": "Uses of estrogen are all except -\nA. Senile vaginitis\nB. Carcinoma prostate\nC. Breast cancer\nD. Delayed pubey", "response": "Ans. is 'c' i.e., Breast cancer Antiestrogens (not estrogen) are used in breast cancer.\n\nSo the answer to this question is C"} {"instruction": "Which of the following is true in case of AIDS patient?\nA. Acute pain\nB. Diffuse red lesion of the attached gingiva\nC. Gingiva covered with pseudomembrane\nD. Gingival itching", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Thalidomide was once used for treating emesis of pregnancy. Later it was withdrawn from market due to side effects. But it was reintroduced for certain indications like multiple myeloma. All of the following are side effects of thalidomide except :\nA. Hypothyroidism\nB. Diarrhea\nC. Teratogenicity\nD. Deep Vein Thrombosis", "response": "None\n\nSo the answer to this question is B"} {"instruction": "M/C ovarian cancer associated with endometriosis:\nA. Endometroid tumor\nB. Clear cell tumor\nC. Germ cell tumor\nD. Brenner tumor", "response": "Ans. is b, i.e. Clear cell tumorM/C ovarian cancer associated with endometrial cancer: Endometrioid tumorM/C ovarian cancer associated with endometriosis: Clear cell carcinoma\n\nSo the answer to this question is B"} {"instruction": "The most common termination of lobar pneumonia is-\nA. Consolidation\nB. Resolution\nC. Abscess formation\nD. Empyema", "response": "In the usual course of pneumonia, the final stage is a resolution.\nHowever, in some neglected cases following complications may develop -\n\n(i) Abscess formation \n(ii) Organization\n(iii) Empyema\n(iv) Pleural effusion, pleuritis\n(v) Bacteremic dissemination → Brain abscess, endocarditis, meningitis, suppurrative arthritis.\n\nSo the answer to this question is B"} {"instruction": "True about Myeloma is all, EXCEPT\nA. Plasma cell clonal proliferation\nB. Common after 50 yrs of age\nC. Amyloidosis can occur\nD. Protein casts in urine are made up of complete Ig chains", "response": "Ans. is 'd' i.e., protein casts in urine are made up of complete Ig chains Protein casts in urine are made up of light chains only Complete Ig chain comprises of both heavy chain & light chain but in Multiple myeloma there is excess production of light chains over heavy chains. These light chains are eliminated in urine as Bence Jones Protein *.\n\nSo the answer to this question is D"} {"instruction": "All can take split thickness graft except -\nA. Fat\nB. Muscle\nC. Skull bone\nD. Deep fascia", "response": "\"The skin graft must be applied to a well-vascularized recipient wound bed. It will not adhere to exposed bone, cartilage, or tendon devoid of periosteum, perichendrium or peritenon, respectively, or devoid of its vascularized perimembranous envelope.\" - Sabiston 17/e p 2185\n\nSo the answer to this question is C"} {"instruction": "The appearance of this foot is most consistent with which one of the following diagnoses?\nA. Buruli ulcer\nB. Chromoblastomycosis\nC. Leishmaniasis\nD. Madura foot", "response": "Answer B. ChromoblastomycosisThe patient lived in a rural area and had walked barefoot for most of his life. Several nodular and verrucous lesions were seen in the distal region of the foot. Analysis of a skin-biopsy specimen revealed findings diagnostic for chromoblastomycosis. Chromoblastomycosis is a chronic, soft-tissue fungal infection commonly caused by Fonsecaea pedrosoi, Phialophora verrucosa, Cladosporium carrionii, or F. compacta. The infection occurs in tropical or subtropical climates and often in rural areas.\n\nSo the answer to this question is B"} {"instruction": "Which is not secreted by placenta ?\nA. HPL\nB. HCG\nC. Prolactin\nD. Progesterone", "response": "Prolactin\n\nSo the answer to this question is C"} {"instruction": "All are true about cartilage, hair hypoplasia syndrome except –\nA. Neutropenia\nB. Depigmentd hair\nC. Non functioning T cells\nD. None of the above", "response": "Cartilage-hair hypoplasia syndrome\n\nCartilage-hair hypoplasia is an unusual form of short-limbed dwarfism with frequent and severe infections.\nIt is an autosomal recessive condition.\n\nFeature of CHH\n\nShort limb dwarfism.\nVery fine thin light hairs and eyebrows.\nHyperextensible joints of hands and feet but an inability to extend.\nAbnormalities of the spine.\nNeutropenia\nDefective antibody-mediated immunity.\nSevere combined immunodeficiency and combined immunodeficiency.\nDecreased number of T cells and defective T cell proliferation, cell-mediated immunity is also decreased.\nNothing is written about the function of T cell, only their number is decreased.\n\nSo the answer to this question is C"} {"instruction": "Only drug used in pregnancy with syphilis ?\nA. Penicillin\nB. Clinadmycin\nC. Azithromycin\nD. Erythromycin", "response": "Ans. is'a'i.e., Penicillin[Ref: Harrisons 18th/e p. 1j871Management of Syphilis in Pregnancy:Penicillin is the only recommended agent for the treatment of syphilis in pregnancy.If the patient has a documented penicillin allergy, desensitization and penicillin therapy should be undeaken according to the CDC's 2010 guidelines.\n\nSo the answer to this question is A"} {"instruction": "A 44-year-old man with a stab wound was brought to the emergency depament and a physician found that the patient was suffering from a laceration of his right phrenic nerve. Which of the following conditions has likely occurred?\nA. Injury to only general somatic efferent fibers\nB. Difficulty in expiration\nC. Loss of sensation in the pericardium and mediastinal pleura\nD. Normal function of the diaphragm", "response": "Loss of sensation in the pericardium and mediastinal pleura because Phrenic nerve supply (sensory) central pa of diaphragm, pain from pericardium, mediastinal and diaphragmatic pleurae and peritoneum in the undersurface of diaphragm. Difficulty in inspiration on injury to phrenic nerve.\n\nSo the answer to this question is C"} {"instruction": "To achieve a NRR of 1, Couple protection rate should be: March 2005\nA. More than 30%\nB. More than 40%\nC. More than 50%\nD. More than 60%", "response": "Ans. D: More than 60% Couple protection rate is an indicator of the prevalence of contraceptive practice in the community. It is defined as the percent of eligible couples effectively protected against childbih by one or the other approved methods of family planning. CPR is based on the observation that 50-60% of bihs in a year are of bih order 3 or more. Thus attaining a 60% CPR will be equivalent to cutting off almost all third or higher order bihs, leaving 2 or less surviving children per couple So demographic goal of NRR=1 can only be achieved only if the CPR exceeds 60%.\n\nSo the answer to this question is D"} {"instruction": "Intraosseous line is placed in which bone in children?\nA. Femur\nB. Tibia\nC. ASIS\nD. Iliac crest", "response": "Ans. (b) TibiaRef.: Nelson's 18\" ed./ch. 66* If venous access is not available in an arrest situation within 1 min, an intraosseous line should be placed in the anterior tibia (with care taken to avoid traversing the epiphyseal plate)* The needle should penetrate the anterior layer of compact bone, with its tip advanced into the spongy interior of the bone.* Intraosseous needles are special rigid, large-bore needles that resemble those used for marrow aspiration. Current recommendations urge the use of intraosseous cannulation in patients for whom intravenous access proves difficult or unattainable, even in older children.* Once the patient has received initial drug and fluid therapy through the IO line, every effort should be made to obtain more conventional central venous access and remove the 10 line as soon as possible.* Alternative sites for intraosseous (IO) insertion include the distal tibia, distal femur, sternum, and humerusComplications of 10 Infusion* Extravasation of fluid is the most common complication and occurs when a needle is misplaced* Compartment syndrome is a risk with IO insertion.* Extravasation of hypertonic or caustic medications, such as sodium bicarbonate, dopamine, or calcium chloride, can result in necrosis of the muscle.* Infection and osteomyelitis are relatively rare complications and occur most commonly if aseptic technique is not followed during insertion.* Other possible complications include local hematoma, pain, fracture and growth plate injuries (with incorrect placement), and fat microemboli (not clinically significant) and compartment syndrome\n\nSo the answer to this question is B"} {"instruction": "Barr body was first detected in: DNB 08\nA. Buccal mucosa\nB. Brain\nC. Liver\nD. Skin", "response": "Ans. Brain\n\nSo the answer to this question is B"} {"instruction": "Microscopic Hematuria is defined as:\nA. >5 RBCs/high power field\nB. >10 RBCs/high power field\nC. >15RBcs/high power field\nD. >20RBCs/high power field", "response": "Ans. A. >5 RBCs/high power fieldPresence of blood in urine imparts it a colour, which includes various shades of deep red, smoky brown, cola colored and faint pink. Parents may even confuse very concentrated urine with hematuria. Hematuria can then be confirmed by presence of RBC in urine analysis. Presence of >5RBCs/HPF suggests hematuria.\n\nSo the answer to this question is A"} {"instruction": "Which of the following expectorant causes gastric irritation & reflex increase in bronchial gland secretions\nA. Ambroxol\nB. Guaifenesin\nC. Sodium cromoglycate\nD. Fosaprepitant", "response": "Guaifenesin, hypertonic saline & ammonium cloride are the expectorants that cause gastric irritation and also reflexly increase bronchial gland secretions.\n\nSo the answer to this question is B"} {"instruction": "LEAST diagnostic test for breast tumours: March 2013\nA. Chest X-ray\nB. Biopsy\nC. USG\nD. Mammography", "response": "Ans. A i.e. Chest X-ray\n\nSo the answer to this question is A"} {"instruction": "Commonest cause of intestinal obstruction in children is -\nA. Intussusception\nB. Volvulus\nC. Hernia\nD. Adhesions", "response": "Ans. is 'a' i.e., IntussusceptionIntussusceptiono Intussusception occurs when a poion of the alimentary tract is telescoped into an adjacent segment.o It is the most common cause of intestinal obstruction between 3 months and 6 year of age. o It is more common in males.o Intusssception may be --> i) Ileocolic (most common) ii) Cecocolic iii) Ileoilealo The upper poion of bowel that invaginates into lower poion is called intussusceptum. o Lower poion which recieves telescoped upper poion is called intussuscipiens.\n\nSo the answer to this question is A"} {"instruction": "True about hyperacute rejection in renal transplant:\nA. Occur within few days of transplant\nB. T cell involvement\nC. Blood vessel thrombosis\nD. Eosinophilic infiltration", "response": "Ans: C (Vessel thrombosis) HYPERACUTE REJECTION Harshmohan 7th/50Appears within minutes to hours of placing the transplantSt is mediated by preformed humoral antibodyThere are numerous neu trophils around dilated & obstructed capillaries which are blocked by fibrin & platelet thrombiIn acute rejection there is infiltration ofT&B cell\"- Harshmohan 7th/ 50HYPERACUTE REJECTION; Robbins9th/233This form of rejection occurs within minutes or hours after transplantation and can sometimes be recognized by the surgeon just after the graft vasculature is anastomosed to the recipient's.In contrast to the nonrejecting kidney graft, wrhich rapidly regains a normal pink coloration and normal tissue turgor and promptly excretes urine, a hyperacutely rejecting kidney rapidly becomes cyanotic, mottled, and flaccid and may excrete a mere few drops of bloody urine.Immunoglobulin and complement are deposited in the vessel wrall, and electron microscopy discloses early endothelial injury together with fibrin-platelet thrombi.There is also a rapid accumulation of neutrophils within arterioles, glomeruli, and peritubular capillaries. These early lesions point to an antigen-antibody reaction at the level of vascular endothelium.Subsequently, these changes become diffuse and intense, the glomeruli undergo thrombotic occlusion of the capillaries, and fibrinoid necrosis occurs in arterial walls.ACUTE REJECTION. Robbins 9th/233# This may occur within days of transplantation in the untreated recipient or may appear suddenly months or even years later, after immunosuppression has been employed and terminated. As suggested earlier, acute graft rejection is a combined process in wrhicb both cellular and humoral tissue injuries contribute. In any one patient, one or the other mechanism may predominate.Histologically, humoral rejection is associated with vasculitis, whereas cellular rejection is marked by an interstitial mononuclear cell infiltrate.Mechanisms of Recognition and Rejection ofAlografts Robbins 9th/231-32# Rejection is a process in wrhsch T lymphocytes and antibodies produced against graft antigens react against and destroy tissue grafts# Recognition of Graft Alloantigens by T and 8 Lymphocytes: The major antigenic differences between a donor and recipient that result in rejection of transplants are differences in HLA alleles.T CELL-MEDIATED REACTIONS Robbins 9th/233Acute cellular rejection, also called acute T cell-mediated rejection, is most commonly seen within the initial months after transplantation and is heralded by clinical and biochemical signs of organ failure.T cells also contribute to chronic rejection, ANTIBODY-MEDIATED REACTIONS Robbins9th/233Although T cells are pivotal in the rejection of organ transplants, antibodies produced againstalloantigens in the graft are also important mediators of rejection. Antibody mediated reactions can take three forms.Hyperacute rejection occurs when preformed antidonor antibodies are present in the circulation of the recipient. Such antibodies may be present in a recipient who has previously rejected a transplant.Acute antibody-mediated rejection is caused by antidonor antibodies produced after transplantation.Chronic antibody-mediated rejection usually develops insidiously, without preceding acute rejection, and primarily affects vascular components.\n\nSo the answer to this question is C"} {"instruction": "Paessure difference of 5 mm Hg between the two up per limbs occurs in which congenital heart disease\nA. TOF\nB. TGA\nC. HOCM\nD. Supra-valvular aortic stenosis", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Froment's sign is due to which nerve injury\nA. Intercostobrachial\nB. Radial\nC. Ulnar\nD. Median", "response": "froment's sign / book test : tests adductor pollicis muscle it is innervated by ulnar nerve. in ulnar nerve injury, when pt is asked to grasp a book firmly b/w thumb & other fingers of both hands, the terminal phalanx of thumb on paralysed side becomes flexed at interphalangeal joint (by flexor pollicis longus supplied by median nerve). The signs indicative of ulnar nerve palsy are as follows: Froment's sign: Jeanne's sign:\n\nSo the answer to this question is C"} {"instruction": "Major site for absorption of iron in GIT-\nA. Duodenum\nB. Ileum\nC. Jejunum\nD. Colon", "response": "Ans. is 'a' i.e., Duodenum * Iron is absorbed from upper small intestine mainly duodenum. In diet iron occurs in two forms, haeme iron and inorganic (non-haeme) iron. Flaem iron is better absorbed than inorganic iron, but the major fraction of diet is inorganic iron. Inorganic iron is mostly in ferric form; needs to be reduced to ferrous form because iron is absorbed in ferrous form.* After absorption ferrous form is once again oxidized to ferric form inside enterocytes. A fraction of absorbed iron is rapidly delivered to plasma transferrin. However, most of the iron is deposited in the enterocytes as ferritin, some to be transferred more slowly to plasma transferrin, and some to be lost when senescent mucosal cells (enterocytes) are sloughed into the intestine.* Iron absorption is regulated according to the demand, e.g., when there is iron deficiency, absorption increases. This regulation is mediated by uiron metabolism regulatory hormone\", i.e., hepcidin that inhibit iron absorption. When there is iron deficiency, concentration of hepacidin falls and there is increase iron absorption. Hepacidin also decreases release of iron from storage sites. Factors affecting iron absorptioni)Decreasing absorption* By complexing (forming chelate) with iron: Phytate, phosphate, milk, EDTA, tetracycline.* By opposing reduction of ferric to ferrous form : Antacids, alkalies, pancreatic secretions.2)Increasing absorption* By enhancing reduction of ferric to ferrous form : Ascorbic acid, HCL, gastric secretions, citric acid.\n\nSo the answer to this question is A"} {"instruction": "The histological features of the celiac disease include all of the following Except -\nA. Crypt hyperplasia\nB. Increase in thickness of the mucosa\nC. Increase in intraepithelial lymphocytes\nD. Increase in inflammatory cells in lamina propria", "response": "Pathological features\n\nIn celiac disease, the proximal intestine is commonly involved while in tropical sprue whole of the intestine is involved.\nBiopsy of the intestine in celiac sprue demonstrates.\n\n- Villous atrophy, loss of microvilli brush border\n- The crypts are hyperplastic and become elongated.\n- Presence of following cells on lamina propria → Plasma cells, Lymphocytes, Macrophages, Eosinophils, Mast cells\n- Remember that overall mucosal thickness remains same in celiac sprue\n\nCeliac disease is associated with dermatitis herpetiformis.\nIndividuals with celiac disease have a higher incidence of malignancy → enteropathy-associated T-cell lymphoma (most common), small intestine adenocarcinoma.\n\nSo the answer to this question is B"} {"instruction": "What is normal average IQ -\nA. 100\nB. 90\nC. 80\nD. 70", "response": "Ans. is 'a' i.e., 100 o An average normal IQ is considered to be 100. However, the range actually extends from 90-109.\n\nSo the answer to this question is A"} {"instruction": "One of the following diuretics does not require its presence in the tubular lumen for its pharmacological effects :\nA. Thiazide diuretics\nB. Loop diuretics\nC. Carbonic anhydrase inhibitors\nD. Aldosterone antagonists", "response": "Most of the diuretics act from the luminal side of the membrane in the nephron.\nThiazides, loop diuretics, carbonic anhydrase inhibitors and epithelial Na+channel blockers (e.g. amiloride and triamterene) are secreted in the proximal tubules through organic anion/cation transport process.\nOsmotic diuretics reach the lumen of proximal tubules via glomerular filtration.\nAldosterone antagonists like spironolactone do not act through luminal side rather they act from basolateral side of the membrane. Therefore, these agents do not require access to the tubular lumen.\n\nSo the answer to this question is D"} {"instruction": "Lamivudine belongs to which type of anti retroviral group of drugs ?\nA. Nucleotide reverse transcriptase inhibitor\nB. Non Nucleoside reverse transcriptase inhibitor\nC. Nucleoside reverse transcriptase inhibitor\nD. Non Nucleotide reverse transcriptase inhibitor", "response": "Ans. is 'c' i.e., Nucleoside reverse transcriptase inhibitor\n\nSo the answer to this question is C"} {"instruction": "Erythema nodosum is seen in all of the following except –\nA. Pregnancy\nB. Tuberculosis\nC. SLE\nD. Chronic pancreatitis", "response": "None\n\nSo the answer to this question is D"} {"instruction": "The electronic probing system \"Foster Miller Probe\" detects:\nA. Only the pocket depth\nB. Only the CEJ\nC. CEJ and pocket depth\nD. Furcation involvement", "response": "None\n\nSo the answer to this question is C"} {"instruction": "The Iron requirement in pregnant and non-pregnant women respectively:\nA. 40-50mg; 20-25mg\nB. 20-25mg; 15-20mg\nC. 15-20mg; 40-50mg\nD. 10-15mg; 15-20mg", "response": "The total content of iron in an adult body is 3-5 g. \nAbout 70% of this occurs in the erythrocytes of blood as a constituent of hemoglobin. \nAt least 5% of body iron is present in myoglobin of muscle. \nHeme is the most predominant iron-containing substance. \nlt is a constituent of several proteins/enzymes (hemoproteins, hemoglobin, myoglobin, cytochromes, xanthine oxidase, catalase, tryptophan pyrrolase, peroxidase). \nCertain other proteins contain non-heme iron e.g. transferrin, ferritin, hemosiderin.\n\nDietary requirements:\nAdult man - 10 mg/day\nMenstruating woman - 18 mg/day\nPregnant and lactating woman - 40 mg/day\nKey Concept:\nIron requirement for pregnant woman is around 40mg/day and in menstruating woman is around 18mg/day\nRef : Textbook of Biochemistry, Satyanarayana\n\nSo the answer to this question is A"} {"instruction": "Which is not true regarding superantigen?\nA. Bind T cells irrespective of antigen specificity of TCR\nB. Bind directly to both MHC II and T cell receptor causing T cell activation\nC. Bind to cleft (antigen binding groove) in the MHC II molecule\nD. Binds directly to lateral aspect of T cell receptor", "response": ".\n\nSo the answer to this question is C"} {"instruction": "Cell that can form the maximum number of other cells in the body is called?\nA. Totipotent\nB. Multipotent\nC. Pluripotent\nD. Lineage stem cells", "response": "Totipotent cells- can form maximum no of other cells in body e.g. cells of zygote Note: Totipotent cells gives rise to teratoma B - multipotent - gives rise to different types of cells, except cells of placental tissue. C - pluripotent: gives rise to cell belonging to more than one lineage e.g. hematopoietic stem cells\n\nSo the answer to this question is A"} {"instruction": "Chance of affected child to Autosomal recessive carrier parents is ?\nA. 10%\nB. 15%\nC. 25%\nD. 50%", "response": "ANSWER: (C) 25%REF: BRS Genetics by Ronald W. Dude page 31-33In autosomal recessive condition the risk of having an affected child when both parents are carriers is 25%, and the chance of having a child who is a carrier is 50%.GENETIC RISK ASSESSMENT IN AUTOSOMAL RECESSIVE INHERITANCE:The genetic risk associated with Autosomal recessive disorder is as followsAffected mother, normal fatherMother -AA| FatheraAaAaaAaAaConclusion: 100% carrier childCarrier mother, normal fatherMother -Aa| FatheraAaaaaAaaaConclusion: 50% carrier, 50% normal childCarrier mother, Carrier fatherMother -Aa| FatherAAAAaaAaaaConclusion: 25% affected, 50% carrier, 25% normal childCarrier mother, affected fatherMother -Aa| FatherAAAAaAAAAaConclusion: 50% affected, 50% carrier childNormal mother, affected fatherMother -aa| FatherAAaAaAAaAaConclusion: 100% carrier childAffected mother, affected fatherMother -AA| FatherAAAAAAAAAAConclusion: 100% affected child\n\nSo the answer to this question is C"} {"instruction": "Off label use of topiramate -\nA. Alcohol withdrawal\nB. Extrapyramidal symptoms on anti-psychotic use\nC. Opioid withdrawal\nD. Sedative agent", "response": "Ans. is 'a' i.e.. Alcohol withdrawalo Drugs used for alcohol dependence to prevent relapse are:NaltrexaneAcamprosateOndansetronNalmefeneDisulfiramTopiramateo Topiramate is an antiepileptic drug.o Mechanism of action in alcohol dependence is not well understood but is distinct from that of other drug used for dependence, suggesting it may provide a new and unique approach to pharmacotherapy of alcoholism.\n\nSo the answer to this question is A"} {"instruction": "Major basic proteins are produced by?\nA. Lymphocyte\nB. Eosinophil\nC. Neutrophil\nD. Basophil", "response": "Eosinophils have a granule that contains major basic protein (MBP)\nProteoglycan 2, (natural killer cell activator, eosinophil granule major basic protein), also known as PRG2, is a protein which in humans is encoded by the PRG2 gene.\nIt is a potent enzyme against helminths. The eosinophil major basic protein also causes the release of histamine from mast cells and basophils and activates neutrophils and alveolar macrophages.\n\nSo the answer to this question is B"} {"instruction": "Amiloride can cause hyperkalemia due to its action on:\nA. Potassium channel\nB. Sodium channel\nC. Na+ Cl- symporter\nD. H+K+ATP ase", "response": "Ans. B. Sodium channelAmiloride and triamterene are K+ sparing diuretic, they act by inhibiting epithelial Na+ channel. When they inhibit the sodium channel, there is no generation of electrical gradient and thus potassium and hydrogen are not excreted. They may be responsible for hyperkalemia.\n\nSo the answer to this question is B"} {"instruction": "Inflammation in the airways can be reduced by:\nA. Fluticasone\nB. Budesonide\nC. Theophylline\nD. Salbutamol", "response": "fluticasone an example of inhaled steroid coicosteroids suppress bronchial inflammation by stimulating lipocoin production and inhibiting phospholipase A2 after binding to intracellular receptors ESSENTIALS OF MEDICAL PHARMACOLOGY SEVENTH EDITION KD TRIPATHI PG NO.230\n\nSo the answer to this question is A"} {"instruction": "Standard detion is defined as: March 2009, March 2013 (a, c, f h)\nA. Value of middle observation when data is arranged in ascending order.\nB. Arithmetic mean\nC. Dispersion of values about the mean\nD. Most frequently occurring value", "response": "Ans. C: Dispersion of values about the mean The steps are: Compute the mean for the data set. Compute the detion by subtracting the mean from each value. Square each individual detion. Add up the squared detions. Divide by one less than the sample size. Take the square root. Standard detion gives us an idea of the spread of the dispersion; that the larger the standard detion, the greater the dispersion of values about the mean.\n\nSo the answer to this question is C"} {"instruction": "all of these are cluster A personality disorders except\nA. anakastic\nB. schizoid\nC. schizotypal\nD. paranoid", "response": "his is the most repeated question personality disorder are divided into several types and the knowledge of the classification of these disorders helps in answering a lot of questions CLUSTER A=== schizoid, paranoid, schizotypal CLUSTER B====histirionic, narcisstic, borderline, anti social CLUSTER C====anxious, anakastic, dependent Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no.742\n\nSo the answer to this question is A"} {"instruction": "Night blindness may be caused by all except\nA. Vitamin A deficiency\nB. Retinitis pigmentosa\nC. Syphilis\nD. Lattice degeneration", "response": "Ans. Lattice degeneration\n\nSo the answer to this question is D"} {"instruction": "Extrachorial placentation increases risk of\nA. Abruptio placenta\nB. Stillbirth\nC. Intra-partum fetal acidosis\nD. None of the above", "response": "Most cases with extra chorial placenta have normal outcome. Pre - term birth and antepartum hemorrhage is seen with circumvallate placenta.\n\nSo the answer to this question is D"} {"instruction": "Carcinosarcoma occurs in\nA. Uterus\nB. Liver\nC. Breast\nD. Lungs", "response": "Carcinosarcoma is the rare combination of malignant tumour of the epithelium (carcinoma) and of mesenchymal tissue (sarcoma) such as in thyroid, lung, and uterus. Refer robbins 9/e\n\nSo the answer to this question is A"} {"instruction": "Beta phage is seen in\nA. Bacillus anthracis\nB. Corynebacterium diptheriae\nC. Clostridium botulinum\nD. Peptostreptococcus", "response": "The toxigenicity of the diphtheria bacillus depends on the intracellular presence of corynephages (tox+), which acts as genetic controlling toxin production. Non-toxigenic strains are rendered toxigenic by infecting them with the beta or some other phages This is known as lysogenic or phage conversion. REF:Textbook of microbiology; Ananthanarayan and paniker's; 10th Edition; Pg: 240\n\nSo the answer to this question is B"} {"instruction": "Which of the following diseases needs not to be screened for, in workers to be employed in a dye industry in gujarat?\nA. Anemia\nB. Bronchial asthma\nC. Bladder cancer\nD. Precancerous lesion", "response": "Prepalcement examination in dye industries include asthma,skin and bladder,kidney diseases,precancerous lesion.Anemia comes under lead.(Ref.PARK'S textbook of preventive and social medicine 21st edition page no.753)\n\nSo the answer to this question is A"} {"instruction": "Uncontrolled flailing of an arm is a symptom of?\nA. Amyotrophic lateral sclerosis\nB. Lower motor neuron syndrome\nC. Dysdiadochokinesias\nD. Hemiballismus", "response": "Hemiballismus is associated with a lesion of the sub thalamic nucleus of the motor system. Lesions in this nucleus produce uncontrolled flailing and involuntary movement, especially of the upper extremity. Amyotrophic lateral sclerosis, a disease of the lower motor neurons, produces weakness in skeletal muscles, which may eventually lead to paralysis and muscle atrophy. Athetosis refers to slow writhing movements of the limbs. This finding is characteristic of lesions in areas of the basal ganglia that are not subthalamic.\n\nSo the answer to this question is D"} {"instruction": "Hypeension is associated with all of the following except: March 2010\nA. Excess salt\nB. Excess exercise\nC. Phaeochromocytoma\nD. Obesity", "response": "Ans. B: Excess exercise Modifiable risk factors: - Obesity - Excess salt intake Saturated fat in the diet - Environmental stress - Reduced physical activity Renovascular hypeension: It has two main causes: fibromuscular dysplasia and atheromatous stenosis. Hypeension secondary to other renal disorders: - Chronic renal failure - Kidney disease/renal aery stenosis: the normal physiological response to low blood pressure in the renal aeries is to increase cardiac output (CO) to maintain the pressure needed for glomerular filtration. - Renal segmental hypoplasia Hypeension secondary to endocrine disorders - Pheochromocytoma - caused by an excessive secretion of norepinephrine and epinephrine which promotes vasoconstriction - Hyperaldosteronism (Conn's syndrome) - Cushing's syndrome - an excessive secretion of glucocoicoids causes the hypeension Hyperparathyroidism - Acromegaly - Hypehyroidism -- Hypothyroidism Other causes: - Hormonal contraceptives - Atherosclerosis Liquorice (when consumed in excessive amounts) - Scieroderma - Neurofibromatosis - Drugs: In paicular, alcohol, nasal decongestants with adrenergic effects, NSAIDs, MAOIs, adrenoceptor stimulants, and combined methods of hormonal contraception (those containing ethinyl-estradiol) can cause hypeension while in use. - Malformed aoa, slow pulse, ischemia: these cause reduced blood flow to the renal aeries, with physiological responses as already outlined. - Coarcation of the aoa\n\nSo the answer to this question is B"} {"instruction": "Transverse myelitis usually presents\nA. 1 – 2 weeks\nB. 1 – 2 months\nC. 4 – 6 months\nD. 1 year", "response": "Usual time of onset of symptoms of post-radiation transverse myelitis is 12-24 months but can occur as early as 6 months after radiation.\n\nSo the answer to this question is D"} {"instruction": "Term Juvenile periodontitis was given by:\nA. Wearbaug\nB. Glickman\nC. Chaput and Buttler\nD. Gottlib", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Which of the following is not associated with peripheral neuropathy\nA. Uicaria pigmentosa\nB. Diabetes mellitus\nC. Nitrofurantion\nD. Infectious mononucleosis", "response": "Uicaria pigmentosa (also known as generalized eruption of cutaneous mastocytosis (childhood type) ) is the most common form of cutaneous mastocytosis. It is a rare disease caused by excessive numbers of mast cells in the skin that produce hives or lesions on the skin when irritated.not associated with peripheral neuropathy Ref Harrison20th edition pg 2478\n\nSo the answer to this question is A"} {"instruction": "Treatment of choice of 28 weeks size H mole In 40 years parous woman is :\nA. Vacuum extraction\nB. Hysterectomy\nC. Hysterotomy\nD. Vaginal delivery", "response": "Hysterectomy\n\nSo the answer to this question is B"} {"instruction": "Etiopathogenesis of diabetic foot include the following except -\nA. Myelopathy\nB. Osteoarthropathy\nC. Microangiopathy\nD. Infection", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Foot process effacement is seen on EM in -\nA. Minimal change disease\nB. Focal segmental Glomerulosclerosis\nC. IgA nephropathy\nD. Mesangial proliferative GN", "response": "Disease Pathogenesis Light Microscopy Fluorescence microscopy Electron microscopy Minimal-change disease podocyte injury Normal Negative Effacement of foot processes; no deposits Focal segmental glomerulosclerosis Unknown: reaction to the loss of renal mass. Focal and segmental sclerosis and hyalinosis Usually negative; IgM and C3 may be present in areas of scarring Effacement of foot processes; epithelial denudation Ref: ROBBINS BASIC PATHOLOGY 10th ed Pg no: 556\n\nSo the answer to this question is B"} {"instruction": "A 7-year-old female who is somewhat obese is brought to the emergency department because of a soft lump above the buttocks. Upon physical examination you note the lump is located just superior to the iliac crest unilaterally on the left side. The protrusion is deep to the skin and pliable to the touch. Which of the following is the most probable diagnosis?\nA. Tumor of the external abdominal oblique muscle\nB. Herniation at the lumbar triangle (of Petit)\nC. Indirect inguinal hernia\nD. Direct inguinal hernia", "response": "The lumbar triangle (of Petit) is bordered medially by the latissimus dorsi, laterally by the external abdominal oblique, and inferiorly by the iliac crest. The floor of Pettit's triangle is formed by the internal abdominal oblique, and this is a possible site of herniation. An indirect inguinal hernia is located in the inguinal canal of the anterior abdominal wall. A direct inguinal hernia is located in the Hesselbach's triangle of the anterior abdominal wall. A femoral hernia occurs below the inguinal ligament. Answer A is not the best answer because this lump is described as soft and pliable, which would not likely indicate a tumor, as tumors tend to be hard masses.\n\nSo the answer to this question is B"} {"instruction": "True statement regarding postmoem hypostasis is/are\nA. Also known as rigor mois\nB. Stas within 8 hours of death\nC. Present all over the body\nD. It is present on dependent pa", "response": "D i.e. It is present on dependant pa Post moem lividity does not develop in drowning in running waterQ (due to constantly changing position of body) and areas of contact flatteningQ (due to collapsed capillaries)\n\nSo the answer to this question is D"} {"instruction": "Parenteral Iron therapy is indicated only when:\nA. Oral Iron intolerance\nB. Pregnancy with Hemoglobin less than 8 g/dL\nC. Postpaum period with Anemia\nD. Emergency surgery suspected of severe blood loss", "response": "Parenteral Iron Therapy by injection is indicated only when : 1. Oral iron is not tolerated or Non compliance to it. 2. Severe GIT upset , Iron malabsorption (e.g Sprue, Sho-bowel syndrome) 3. In presence of severe deficiency with chronic bleeding. 4. Along with erythropoietin in chronic kidney disease (CKD) patients. 5. Routine supplement to Total Parenteral Nutrition. S/E : Parenteral Iron Therapy should be used only when clearly indicated because acute hypersensitivity, including anaphylactic and anaphylactoid reactions, headache, malaise, fever, generalized lymphadenopathy, ahralgias, uicaria and in some patients with Rheumatoid Ahritis, exacerbation of the disease.\n\nSo the answer to this question is A"} {"instruction": "Health status of a child under 5 years of age will be adversely affected by all of the following except-\nA. Malnutrition\nB. Low birth weight\nC. Maternal Hb of 11 gm%\nD. Infections", "response": "Maternal Hemoglobin does not have any direct effect on the health of a child under 5 years of age. A low maternal hemoglobin may indirectly affect 'child health by contributing to IUGR and/or low birth weight. A maternal hemoglobin of 11 is however not significant enough to have any direct or indirect effect on child health as the cut off point for diagnosis of maternal anemia in pregnancy is set at 11gm %.\n\nSo the answer to this question is C"} {"instruction": "Radio-luscent renal stones are composed of -a) Cysteineb) Calcium phosphatec) Uric acidd) Xanthine\nA. cd\nB. bc\nC. bd\nD. ac", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Following are true of Widal test except -\nA. High titre in first sample is diagnostic\nB. 'H' antigen is specific for serotyping\nC. Highly +ve H titre not diagnostic\nD. Maximum titre in third week", "response": "Ans. is 'a' i.e., High titre in first sample is diagnostic . High titre may be persent due to prior infection or immunization. It is the rising titre in two or more sequential samples which is suggestive of typhoid fever (not high titre in first sample). . The genus salmonella is fuher subdivided into serovars based on the detection of three major antigenic determinants. . Somatic antigen 0 . Surface antigen Vi . Flagellar antigen H . The titre increases steadily, reaching maximum in the 3\" or 4'h week.\n\nSo the answer to this question is A"} {"instruction": "The redistribution phenomena is seen in\nA. Halothane\nB. Ether\nC. Thiopentone\nD. All", "response": "Ref-KDT 6/e p119 Redistribution which describes the reversible transfer of a drug from one location to another within the body. Once a drug enters into systemic circulation by absorption or direct administration, it must be distributed into interstitial and intracellular fluids .\n\nSo the answer to this question is C"} {"instruction": "In 1990, for the first time, Michaele Blease and W. French Andresco of National Institute of Health, Bethesda, U.S.A. attempted gene therapy on a human patient. Which of the following disease was attempted to be cured?\nA. Cystic fibrosis\nB. Haemophilia\nC. Thalassemia\nD. Severe Combined Immunodeficiency Disease", "response": "The first convincing therapeutic effect from gene transfer occurred with : SCID Impoant types of defects in SCID: X-linked Severe Combined Immunodeficiency Disease (SCID): mutations in the gene (IL2RG). IL2RG encodes gc subunit of cytokine receptors. Inheritance pattern: X-Linked. Most common defect in SCID patientsQ. Most common cause of SCID is IL2R defect. Autosomal Recessive SCID: ADA (Adenosine Deaminase enzyme) deficiency. gene therapy is done for ADA deficiency SCID.\n\nSo the answer to this question is D"} {"instruction": "Hemoperfusion with charcoal is useful in poisoning with : -\nA. Phenytoin.\nB. Methanol\nC. Ethylene glycol\nD. All of the above", "response": "#NAME?\n\nSo the answer to this question is A"} {"instruction": "Schedule-3 of MCI includes -\nA. MBBS degree of indian universities\nB. DNB degree\nC. Diploma of CPS\nD. MBBS degree of foreign universities", "response": "Ans. is 'c' i.e., Diploma of CPS Schedules of MCI Acto MCI was established in 1934 and MCI act was revised in 1956,1964,1993,1999, and 2002. The schedules of MCI includes list of medical degrees recognized by MCI :-Schedule 1Includes list of recognised degrees awarded by Indian universities7^(tm)5 ll) and also DNB awardedby National Board of Examination, New Delhi.Schedule 2 Includes list of recognized medical degrees awarded by foreign universities^7^.Schedule 3 Includes list of medical qualifications awarded by Indian or foreign boards or societies, but are notincluded in schedule 1 or 2. It has two partsPart I: Includes list of recognized degrees other than MBBS awarded by Indian Societies and Boards, e.g LMPand diploma of CPS.Part II: Includes list of recognized degrees other than MBBS awarded by Foreign Societies and Boards.\n\nSo the answer to this question is C"} {"instruction": "A 33-year-old woman is seen for evaluation of infertility. She complains of dyspareunia. On vaginal examination, tender nodularity along the uterosacral ligaments is noted. What is the diagnosis?\nA. Adenomyosis\nB. Diethylstilbestrol (DES)-related disease\nC. Subserosal fibroids\nD. Endometriosis", "response": "Tender uterosacral ligament usually are a sign of endometriosis. Although the other conditions listed may be associated with some form of pelvic pain, they do not produce tender uterosacral ligaments.\n\nSo the answer to this question is D"} {"instruction": "In phlebography dye is injected into:\nA. Anterior tibial vein\nB. Great saphenous vein\nC. Dorsal metatarsal vein\nD. Sho saphenous vein", "response": "Ans. Dorsal metatarsal vein\n\nSo the answer to this question is C"} {"instruction": "All of the following are ture regarding cephalosporins except -\nA. Bactericidal agents\nB. Active against only gram negative bacteria\nC. IIIrd generation are resistant to beta-lactamases from gram negative bacteria\nD. Ceftriaxone is administered parenterally", "response": "Ans. is 'b' i.e., Active against olny gram negative bacteria Cephalosporins are active against gram positive as well as gram negative bacteria, and are bactericidal. o Ceftriaxone is a parentral cephalosporin. o Third generation cephalosporins are highly resistant to beta-lactamases from gram negative bacteria.\n\nSo the answer to this question is B"} {"instruction": "A neonate develops spastic contractions on the second post-partum day Laboratory studies show hypocalcemia. MRI studies demonstrate aplasia of the thymus and parathyroid glands. What is the appropriate diagnosis?\nA. Adenosine deaminase deficiency\nB. Common variable immunodeficiency\nC. DiGeorge syndrome\nD. Transient hypogammaglobulinemia of infancy", "response": "DiGeorge syndrome. DiGeorge syndrome is a chromosomal defect that results in developmental anomalies of the branchial (pharyngeal) pouches and organs that develop from these embryonic structures (thymus, parathyroids, and aortic arch). These children present with tetany caused by hypoparathyroidism and deficiency of cellular immunity. They also have characteristic facial features (\"angry look\"). In the absence of a thymus, T-cell maturation is interrupted at the pre-T stage. DiGeorge syndrome has been corrected by transplanting thymic tissue. None of the other choices are associated with thymic aplasia.Diagnosis: DiGeorge syndrome\n\nSo the answer to this question is C"} {"instruction": "What is the risk of downs syndrome in a 35-year-old pregnant woman?\nA. 1 in 75\nB. 1 in 100\nC. 1 in 250\nD. 1 in 1000", "response": "Age of the motherRisk of Down&;s syndrome351 in 250361 in 192371 in 149381 in 115391 in 89401 in 69Reference: William's obstetrics; 25th edition; Chapter 14; Prenatal Diagnosis\n\nSo the answer to this question is C"} {"instruction": "Maximum osmotic gradient is found in\nA. Outer medulla\nB. Inner medulla\nC. Outer coex\nD. Inner coex", "response": "In inner medulla osmotic gradient is high as 1200milliosmolarRef: Ganong&;s review of medical physiology; 24th edition; page no: 687\n\nSo the answer to this question is B"} {"instruction": "The following is not a feature of malignant transformation by culturedc\nA. Increased cell density\nB. Increased requirement for growth factors\nC. Alterations of cytoskeleton structure\nD. Loss of anchorage", "response": "Ref biology of the cell p357-364 Both normal cells and cancer cells can be cultured in-vitro , however they behave quite differently normal cell: show replicative senescence .is cells pass through limited number of cell division before they decline in vigor and die it may caused by inability to synthesise telomerase\n\nSo the answer to this question is B"} {"instruction": "Earliest sign of papilloedema -\nA. Less of pulsation\nB. Blurring of disc margin\nC. Obliteration of cup\nD. Cotton-wool spots", "response": "Early (incipient )papilloedema is characterised by, obscuration of disc margins (nasal margins involved first , then superior , inferior and temporal) blurring of peripapillary nerve fibre layer absence of spontaneous venous pulsations at the disc mild hypaeremia Refer comprehensive ophthalmology (6 th edition )A K Khurana, page no. 324\n\nSo the answer to this question is B"} {"instruction": "The following statement about pilonidal sinus is true:\nA. More common in females\nB. Mostly congenital\nC. Prognosis after surgery is poor\nD. Treatment of choice is surgical excision of sinus tract", "response": "Ans. (d) Treatment of choice is surgical excision of sinus tract* MC in males* Acquired due to entry of hair follicles into skin.* Prognosis is good after surgery* Recurrence is common but there are surgeries for recurrent Jeeper's bottom like - Limberg's flap and Bascom technique\n\nSo the answer to this question is D"} {"instruction": "Complication of blood transfusion can be all except -\nA. Hyperkalemia\nB. Citrate toxicity\nC. Metabolic acidosis\nD. Hypothermia", "response": "Ans. is 'c' i.e., Metabolic acidosis The question is most probably about complications of massive blood transfusion.Massive Blood Transfusion * Massive blood transfusion is generally defined as transfusion of one to two volumes of patient's own blood volumes (For most adults that is equivalent to 10-20 units.)Complications of Massive Blood TransfusionCoagulopathyThe most common cause of bleeding following massive blood transfusion is dilutional thrombocytopeniaClinically significant dilution of the coagulation factors is unusual in previously normal individuals.Citrate ToxicityCitrate is used as an anticoagulant in the stored blood.Citrate has a property to bind calcium, this calcium binding by the citrate preservative can become significant following transfusion of large volumes of blood or blood products.Hypocalcemia results in some patients after massive transfusion, to prevent this, the transfusion rate should not exceed 1 unit every 5 minutes.Citrate also has an affinity for magnesium ion and the occurrence of hypomagnesemia in the setting of massive transfusion is seen (rarely).HypothermiaBlood is stored at a temperature of 2degC-6degC. So massive blood transfusion can result in hypothermia.Massive blood transfusion is an absolute indication for warming all blood products and intravenous fluids to normal body temperature.Hypothermia due to massive transfusion can result in ventricular arrhythmia.Acid-Base BalanceThe stored blood is acidic for two reasons.Due to the citric acid (the anticoagulants) Due to release of metabolic products by the anaerobic glycolysis of red cells (CO2 and Lactate).Despite the Stored Blood Being Acidic, Significant metabolic acidosis due to transfusion is not common.- Once the resuscitation is complete and normal perfusion is restored, any metabolic acidosis present, typically resolves, and progressive metabolic alkalosis supervenes as citrate and lactate contained in transfusion and resuscitation fluids are converted to bicarbonate by the liver. The most consistent acid base abnormality after massive blood transfusion is postoperative metabolic alkalosis.Serum Potassium ConcentrationThe extracellular concentration of Potassium in stored blood steadily increases with time due to lysis of RBC's.The amount of extracellular potassium transfused with each unit is typically less than 4m Eq per unit. Hyperkalemia can develop regardless of the age of the blood when transfusion rate exceeded 100ml/min.Oxygen Affinity Changes * 2, 3 DPG is greatly reduced in RBC's after about 3 weeks of storage, this increases hemoglobin's affinity for oxygen and adversely affects oxygen delivery to tissues.Acute Respiration? Distress SyndromeCoagulation Factor Depletion\n\nSo the answer to this question is C"} {"instruction": "Frothy discharge with red ulceration in the vagina is seen with infection of :\nA. Trichomoniasis\nB. Moniliasis\nC. Chlamydia\nD. Bacterial vaginosis", "response": "Trichomoniasis\n\nSo the answer to this question is A"} {"instruction": "The advantage of bladder drainage over enteric drainage after pancreatic transplantation is better monitoring of:\nA. HBA1C levels\nB. Amylase levels\nC. Glucose levels\nD. Electrolyte levels", "response": "Ans. (b) Amylase levelsRef: Sabiston 19th edition, Pages 675-679* Amylase is measured easily in urine in bladder drainage* When urinary amylase decreases it's time to check for graft failure by taking biopsy* Similar amylase testing is difficult in Intestine drainage.\n\nSo the answer to this question is B"} {"instruction": "Decrease in weight for height indicates?\nA. Acute malnutrition\nB. Chronic malnutrition\nC. Both acute and chronic malnutrition\nD. Sho stature", "response": "Decrease in weight for height indicates Acute malnutrition Decrease in height for age indicates chronic malnutrition.\n\nSo the answer to this question is A"} {"instruction": "Precocious pubey may be seen in all of the following conditions except :\nA. Granulosa-cell tumour\nB. Head injury\nC. Coicosteroid in take\nD. Hypehyroidism", "response": "Causes of precocious pubey GnRH Dependent Constitutional Juvenile primary hypothyroidism Intracranial lesions: trauma, tumour, infection GnRH independent Ovary: Granulosa cell tumor, theca cell tumor, leydig cell tumor, androblastoma Adrenal: hyperplasia,tumor Liver: hepatoblastoma Iatrogenic: Estrogen and androgen intake D.C.DUTTA'S TEXTBOOK OFGYNAECOLOGY, Pg no:51, 6th edition\n\nSo the answer to this question is D"} {"instruction": "Prescription of simple myopic astigmatism:\nA. -0.5x180deg\nB. +0.5x180deg\nC. -3\nD. 2", "response": "Ans. a.-0.5x180degSimple myopic astigmatism is one in which one meridian is emmetropic and other meridian is myopic.Hence needs correction only in one meridian with concave (-ve) cylinders. So the answer is -0.5x180deg.ASTIGMATISM TYPES AND CORRECTIONTypes of astigmatismDescriptionOpticsCorrectionSimple myopic astigmatismOne of the foci falls upon the retina while the other falls in front of or behind the retinaConcave cylinder Ex: -0.5x180degConvex cylinder Ex: +0.5x180degSimple hyperopic astigmatismCompound myopic astigmatismNeither of the foci fall upon the retina but both are placed infront of or behind the retinaConcave sphere + Cylinder Ex: -0.5 D sphere, -0.5x180degConvex sphere + Cylinder Ex: +0.5 D sphere, +0.5x180degCompound hyperopic astigmatismMixed astigmatismOne focus is front of the retina while the other is behind so that the refraction is hypermetropic in one direction and myopic in other directionConcave/ConvexSphere+Convex and concavecylinderEx: -1D sphere, +2Dx180deg\n\nSo the answer to this question is A"} {"instruction": "Waxy flexibility is a feature of -\nA. Echopraxia\nB. Catatonia\nC. Stereotype\nD. Mannerism", "response": "Ans. is 'b' i.e., Catatonia Disorders of motor activityo Disorder of motor activity may beMannerism Odd, repetitive and goal directed movements, e.g., waving, saluting.Stereotype Odd, repetitive movements which are not goal directed e.g., rocking to and fro. Repetition of speechs (words, phrases) may also occur. Sterotype occur without any stimulus.Perseveration :- There is persistent repetition of movement or speech, beyond fulfilment of purpose. Patient is unable to stop the action or speech beyond fulfilment of purpose. Perseveration is goal directed and requires external stimulus (in contrast to stereotypy).Note : Sterotypy and perseveration may be seen either as speech disturbance or as motor activity disturbance, i.e., repetion of speech or movemnt.Echopraxia Patients senselessly repeat the movement of others around them (associated with echolalia).TIC Sudden, involuntary, rapid, recurrent non-rhythmic motor movements.Catatonia Catatonia is characterized by a marked disturbance of motor behaviour. Most common cause of catatonia is schizophrenia, However it may also occur in depression, Mania, conversion - dissociative disorders, reactive psychosis, hypnosis, anxiety disorders and many medical disorders. Catatonia may be of following typesCatatonic excitmentExcited, uncontrolled motor activity, not influenced by external stimuli.Catatonic posturing :- Voluntary adoption of an unusual or bizarre position that is then maintained for some time.Catatonic rigidity :- Maintaining a fixed position and rigidity resisting all attempts to be moved.Waxy flexibility (flexibilitas cerea or catalepsy) : - Maintaining of particular posture imposed on the patient by examiner, even if the posture is bizzare and uncomfortable, i.e., patient can be moulded like wax into a position that is then maintained.Catatonic stupor :- Patient is mute and immobile (akinetic mutism) but fully conscious.Catatonic negativism :- A seemingly motiveless resistance to all instructions or attempts to be moved.Automatic obedience :- Exactly reverse to negativism, i.e., unhesitating compliance to all instructions without apparent conscious control.\n\nSo the answer to this question is B"} {"instruction": "Major clinical use of nimodipine is in:\nA. Raynaud's phenomenon\nB. Hypertension\nC. Angina\nD. Subarachnoid haemorrhage", "response": "Nimodipine: \nIt is a short-acting DHP which penetrates blood-brain barrier very efficiently due to high lipid solubility and has high affinity for the cerebral blood vessels. \nIt is believed to selectively relax cerebral vasculature and is approved for prevention and treatment of neurological deficit due to cerebral vasospasm following subarachnoid haemorrhage or ruptured congenital intracranial aneurysms. \nSide effects are headache, flushing, dizziness, palpitation and nausea. \nReference: Essentials of Medical Pharmacology Eighth Edition KD TRIPATHI page no 596\n\nSo the answer to this question is D"} {"instruction": "Mastoid process antrum begins to develop in the\nA. 6th month\nB. 9th month\nC. 1st year\nD. 2nd year", "response": "*MASTOID* *ANTRUM* *DEVELOPEMENT* The antrum, which is the biggest of all mastoid air cells, stas its development between the 22nd and the 24th week of fetal life. It reaches its adult size on the 35th week The antrum develops at the center of the mastoid process on both sides of the petrosquamous fissure. The medial pa of the antrum, the petrous pa, develops from the saccus medius and the lateral pa, the squamous pa, develops from the saccus superior The fusion plane between the petrous pa and the squamous pa gives the petrosquamous fissure. Failure of complete fusion between the two sacci leads to a septation of the mastoid antrum by a bony paition called the Korner's septum Developmental arrest of the vestibule The antrum is well developed at bih and has a mean surface of 1 cm2 The size of the antrum does not change after bih; however, it undergoes medial displacement because of the growth of the mastoid process. The mastoid process continues to grow until pubey and even beyon REF : VISHRAM SINGH EMBRYOLOGY\n\nSo the answer to this question is A"} {"instruction": "All of these are antigen presenting cells (APC's) except-\nA. B cells\nB. T cells\nC. Dendritic cells\nD. Langerhans cells", "response": "Antigen-Presenting Cells(APCs): APCs implies to cells that present the antigenic peptide along with MHC class II to TH cells. They may be grouped into: * Professional APCs: e.g. 1.Macrophages, 2.Dendritic cells (Langerhans cells(LC) are members of the dendritic cells family, residing in the basal and suprabasal layers of the epidermis) 3.B-cells * Nonprofessional APCs: e.g. Fibroblasts (skin), Thymic epithelial cells, Pancreatic beta cells, Vascular endothelial cells, Glial cells (brain) and Thyroid epithelial cells.\n\nSo the answer to this question is B"} {"instruction": "The earliest symptom to occur in corneal ulcer is\nA. Pain\nB. Photophobia\nC. Loss of sensation\nD. Diminished vision", "response": "Ans. Pain\n\nSo the answer to this question is A"} {"instruction": "The following test is not used for diagnosis of leprosy :\nA. Lepromin test\nB. Slit skin smear\nC. Fine needle aspiration cytology\nD. Skin biopsy", "response": "A i.e. Lepromin test\n\nSo the answer to this question is A"} {"instruction": "Risk factors for PPH are all except:\nA. Macrosomia\nB. Twin pregnancy\nC. Nuliparity\nD. Previous H/O PPH", "response": "Ans. is c, i.e. NulliparityRef. JB Sharma Obs Pg 335Risk factors for PPHRisk factors for postpartum hemorrhageFactors in historyAntepartum factorsIntrapartum factorsMiscellaneous causes* Advanced maternal age* Overdistended uterus- Multiple pregnancy- Large-sized fetus- Polyhydramnios* Induction of labor* Sepsis* Multiparity, anemia, malnutrition* Antepartum haemorrhage* Prolonged labor * Previous PPH* Chorioamnionitis* Precipitate labor * Previous placenta previa or accrete* Instrumental delivery, operative manipulations* Bleeding and coagulation disorders* Rupture uterus* Fibroid uterus* Genital tract trauma* Non judicious use of oxytocics, sedatives, etc.\n\nSo the answer to this question is C"} {"instruction": "Which is MC genetic cause of mental retardation –\nA. Tuberous sclerosis\nB. Cri–du–chat syndrome\nC. Fragile–x–syndrome\nD. Angel's syndrome", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Which vitamin is supplied from only animal source:\nA. Vitamin C\nB. Vitamin B7\nC. Vitamin B12\nD. Vitamin D", "response": "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.\n\nSo the answer to this question is C"} {"instruction": "Which of the following is associated with Renal Papillary Necrosis\nA. Alcohol\nB. Heroine\nC. Morphine\nD. Tramadol", "response": "Answer is A (Alcohol) Chronic Alcoholism is an established cause of Renal Papillary Necrosis.\n\nSo the answer to this question is A"} {"instruction": "GABA is produced from:\nA. Alanine\nB. Glycine\nC. Glutamate\nD. Glutamine", "response": "Glutamate\n\nSo the answer to this question is C"} {"instruction": "Transport across nucleus is by all except?\nA. Caveolins\nB. Local signals\nC. Importins\nD. Rat proteins", "response": "Ans. d. Rat proteinsSource: InternetImportin - Type of karyopherinTransporting protein molecules into nucleus by binding to specific recognition sequences, called nuclear localization sequences (NLS).2 subunits, importin a and importin bCaveolinsFamily of integral membrane proteins that are principal components of caveolae membranes.Involved in receptor-independent endocytosis.Acts as scaffolding proteins within caveolar membranes by compart-mentalizing and concentrating signaling molecules.Rat proteins:Recombinant rat IFN--is a bioactive protein intended for use in cell culture applications.\n\nSo the answer to this question is D"} {"instruction": "Antibody found in patients of myaesthenia gravis is directed against -\nA. Acetycholine\nB. Acetycholine receptors\nC. Acetycholine vesicles in nerve terminal\nD. Actin-myosin complex of the muscle", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Most radio dense substance is -\nA. Fluid\nB. Soft tissue\nC. Brain\nD. Bone", "response": "Increasing order of radiodensity : AIR FAT WATER BONE METAL\n\nSo the answer to this question is D"} {"instruction": "Drugs used in alcohol dependence to prevent relapse are all except ?\nA. Nalmefene\nB. Topiramate\nC. Ondansetron\nD. Fluoxetine", "response": "Ans. is 'd' i.e., Fluoxetine Drugs used for alcohol dependence to prevent relapse are: Naltrexane Acamprosate Ondansetron Nalmefene Disulfiram Topiramate\n\nSo the answer to this question is D"} {"instruction": "A patient aged 50 years presented with a history of jaw expansion and enlargement of maxilla\nA. Paget's disease\nB. Acromegaly\nC. Fibrous dysplasia\nD. Hyperparathyroidism", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Role of sodium fluoride as a preservative for blood in viscera packing are all except\nA. It prevents glycolysis\nB. Acts as anti-coagulant\nC. Inhibits bacterial growth\nD. Inhibits enolase enzyme", "response": "Potassium oxalate - anti coagulant and 10 mg / ml Sodium or Potassium fluoride are used for blood preservation. Acts as preservative by following mechanism: - Prevents glycolysis - Inhibits bacterial growth - Inhibits enolase enzyme\n\nSo the answer to this question is B"} {"instruction": "Acute flaccid paralysis is reported in a child aged –\nA. 0–3 years\nB. 0–5 years\nC. 0–15 years\nD. 0–25 years", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Long term effect of for CNS tumor in children are all except\nA. Reduced IQ and learning\nB. Endocrine dysfunction\nC. Musculoskeletal problems\nD. Neuropsychological effects are independent of radiation dose", "response": "D i.e. Neuropsychological effects are independent of radiation dose\n\nSo the answer to this question is D"} {"instruction": "List the odd one out among the following\nA. Trisomy 18 (Noonan syndrome)\nB. Trisomy 21 (Downs syndrome)\nC. Trisomy 18 (Edwards synd.)\nD. Trisomy 13 (Patau synd.)", "response": "Trisomy 18 is Edward syndrome & not Noonan syndrome. Noonan syndrome occurs in both males and females with a normal karyotype(46,XX and 46,XY). Refer to the image below.\n\nSo the answer to this question is A"} {"instruction": "If a drug is active against the pre–erythrocytic stage of the malarial parasite it will be useful as a :\nA. Suppressive prophylactic\nB. Causal prophylactic\nC. Clinical curative\nD. Radical curative", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Which of the following is a component of deltoid ligament\nA. Talofibular ligament\nB. Tibiotalar ligament\nC. Talonavicular ligament\nD. Calcaneo-navicular ligament", "response": "Deltoid ligament has 4 components (all with prefix 'Tibia') : * Anterior tibiotalar ligament * Posterior tibiotalar ligament * Tibio-calcaneal pa* Tibio-navicular ligament - attaching to navicular bone at medial side of the foot. - Spring ligament / calcaneo-navicular ligament which connects navicular bone's plantar surface with sustentaculum of calcaneus is not a component of deltoid ligament fig:-Deltoid ligament of ankle\n\nSo the answer to this question is B"} {"instruction": "World Bank gives loan for -\nA. Economic growth\nB. Microbiological culture TB control\nC. Accident problems\nD. All", "response": "The bank gives loan for projects that will lead to economic growth.The projects are usually concerned with electric power, roads,railways,agriculture,water supply,education,family planning etc (refer pgno:923 park 23rd edition)\n\nSo the answer to this question is A"} {"instruction": "The phase of cell cycle, most sensitive to radiation isa) M Phase b) G2Phase c) S Phase d) Early G1 Phase e) G0Phase\nA. ac\nB. ab\nC. de\nD. cd", "response": "Cells are most radiosensitive in late G, and early M phase → especially G2M interphase.\n\nSo the answer to this question is B"} {"instruction": "All can be seen as Post-Diarrhoea complications except:\nA. HUS\nB. Nephritic syndrome\nC. Reactive ahritis\nD. Guillain Barre syndrome", "response": "Complications of Chronic diarrhea * Lactase deficiency * Small-bowel bacterial overgrowth * Malabsorption syndromes (tropical and celiac sprue) * Initial presentation or exacerbation of inflammatory bowel disease * Irritable bowel syndrome * Reactive ahritis (formerly known as Reiter's syndrome) * Hemolytic-uremic syndrome (hemolytic anemia, thrombocytopenia, and renal failure) * Guillain-Barre syndrome\n\nSo the answer to this question is B"} {"instruction": "What is the definition of society -\nA. System of social relationship between individuals\nB. Social relationship between families\nC. Interaction of individuals and people\nD. Relationship of individual family and the country", "response": "- society is an organisation of its member agents where each member has to conform to its norms. - impoant feature is a system of social relationship between its members. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:671 <\\p>\n\nSo the answer to this question is A"} {"instruction": "Which one of the following is the contraceptive method of choice for a commercial sex worker :\nA. OC pills\nB. IUCD\nC. Tubectomy\nD. Barrier method", "response": "Barrier method\n\nSo the answer to this question is D"} {"instruction": "A patient develops an infection of methicillin-resistant Staphylococcus aureus. Which of the following drug cannot be used to treat the infection:\nA. Vancomycin.\nB. Cotrimoxazole.\nC. Cefaclor.\nD. Ciprofloxacin.", "response": "Cefaclor is a second generation cephalosporin and is not active against MRSA.\n\nSo the answer to this question is C"} {"instruction": "Which preparation is used for retention in the incisal area of Class III amalgam?\nA. Vertically oriented grooves\nB. Horizontally oriented grooves\nC. Coves\nD. Skirts", "response": "Retention Grooves and Coves:\nVertically oriented grooves associated with the facial and lingual aspects of a proximal preparation are used to provide additional retention for the proximal portions of some Class II amalgam restorations. Horizontally oriented retention grooves are prepared in most Class III and V preparations for amalgam and in some root-surface tooth preparations for amalgam and composite resin. Small retentive indendations, referred to as “coves,” are utilized for retention in the incisal areas of Class III amalgams.\nReference: Sturdevant operative dentistry. 7th EDITION, Page No:131\n\nSo the answer to this question is C"} {"instruction": "A two year old child presents with persistent diarrhaea acidic stools and presence of one per cent of reducing substance in the fresh stools. What is the most probable diagnosis ?\nA. Cystic fibrosis\nB. Lactose intolerance\nC. Rotavirus induced diarrhoea\nD. Intestinal tuberculosis", "response": "DISACCHARIDASES DEFECIENCY Lactase defeciency diagnosis based on presence of more than .5%of reducing substance in the fresh stools acidic stools abnormal oral sugar tolerance test breath Hydrogen excretion of more than 11ppm following a loading dose of lactose enzyme assay on mucosal biopsies showing low levels of disaccharidases Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:274, 7th edition\n\nSo the answer to this question is B"} {"instruction": "Which of the following antimicrobials should not be given to a chronic asthmatic patient managed on theophylline therapy?\nA. Erythromycin\nB. Cefotaxime\nC. Cotrimoxazole\nD. Amoxicillin", "response": "Drugs which inhibit theophylline metabolism and increase its plasma level are -erythromycin, ciprofloxacin, cimetidine, oral contraceptives, allopurinol etc. Enzyme Inducers G - Griseofulvin P - Phenytoin R - Rifampicin S - Smoking Cell - Carbamazepine Phone - Phenobarbitone Enzyme Inhibitors Vit -Valproate K - Ketoconazole Can't -Cimetidine Cause - Ciprofloxacin Enzyme -Erythromycin Inhibition - Isoniazid\n\nSo the answer to this question is A"} {"instruction": "A 50 year old lady with history of jaundice in the past has presented with right upper quadrant abdominal pain. Examination and investigations reveal chronic calculous cholecystitis. The liver functions tests are within normal limits and on ultrasound examination the common bile ducts is not dilated. Which of the following will be the procedure of choice in her-\nA. Laparoscopic cholecystectomy\nB. Open choledocholithotomy with CBD exploration\nC. ERCP ± cholecystectomy followed by laparoscopic cholecystectomy\nD. Laparoscopic cholecystectomy followed by ERCP ± choledocholithotomy", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Chronologic hypoplasia occur due to:\nA. Exanthematous diseases.\nB. Rickets.\nC. Hypoparathyroidism.\nD. No specific causes.", "response": "None\n\nSo the answer to this question is D"} {"instruction": "The following are the myeloproferative disorders except-\nA. Polycythemia vera\nB. Essential thrombocytosis\nC. Chronic myeloid leukemia\nD. Hairy cell leukemia", "response": "Hairy cell leukemia is a B-cell malignancy characteised by the presence of hairy cells in the blood & bone marrow & splenomegaly. Myeloproliferative diseases include chronic myeloid leukaemia ,polycythaemia vera, essential thrombocythaemia,chronic idiopathic myelofibrosis,chronic neutrophilic leukaemia ,chronic eosinophilic leukaemia .Reference :Harsh mohan textbook of pathology 6th edition pg no 357 & 378.\n\nSo the answer to this question is D"} {"instruction": "Breast milk is maximum at –\nA. 1–2 months\nB. 3–4 months\nC. 5–6 months\nD. 7–8 months", "response": "Breast milk is maximum at 5-6 months of lactation -9 730 ml/day.\nIt is minimum at 37-38 months of lactation --> 345 ml/day.\n\nSo the answer to this question is C"} {"instruction": "Commonest cause of acute otitis media in children is\nA. H. inflenzae\nB. Strepto-pneumoniae\nC. Staph aureus\nD. Pseudomonas", "response": "Ans. is 'b' i.e Streptococcus pneumoniae Aetiology of ASOM in children:S. pneumoniae (35%)H. influenzae (25%)M. Catarrhalis (15%)Aetiology in adultsH. influenza (25%)*S. pneumonia (21%)\n\nSo the answer to this question is B"} {"instruction": "What is true about sentinel surveillance ?\nA. It monitors health situation in border districts\nB. It is an improved method of malaria surveillance\nC. It method of supplementing routine surveillance system\nD. It is an effective method of surveillance of sanitary condition", "response": "Ans. is 'c' i.e., It method of supplementing routine surveillance system Surveillance Surveillance is defined as \"the continous scrutiny of the factors that determine the occurrence and distribution of disease and other conditions of ill health\". Surveillance may be of following types :? 1. Passive surveillance Data is repoed itself to health system, e.g. a patient (clinical case) is coming to a doctor. Most of the national health programmes in India rely on passive surveillance for data collection. 2. Active surveillance Data is collected actively by health system, e.g. collection of blood slides every fonight from house to house to control malaria. Active surveillance in India is done in :- National leprosy elimination programme (modified leprosy elimination compaigns). National vector Borne disease control programme (NVBDCP) e.g. malaria. 3. Sentinel surveillance Sentinel surveillance helps in identifying missing cases and supplementing notified cases. Sentinel surveillance in India is done in national AIDS control programme.\n\nSo the answer to this question is C"} {"instruction": "Which cooking oil bast most PUFA?\nA. Safflower oil\nB. Coconut oil\nC. Butter\nD. Vanaspati", "response": "Ans. is 'a' i.e., Safflower oil\n\nSo the answer to this question is A"} {"instruction": "All are associated with Wernicke'S encephalopathy except-\nA. Cog wheel rigidity\nB. Alteration in mental function\nC. Vlth nerve palsy\nD. Ataxia", "response": "Ans. is 'a' i.e., Cog-wheel rigidity o Wernicke's encephalopathy is characterized by a triad of global confusion (alteration in mental function). Ophthalmoplegia (Bilateral 6th nerve palsy) and ataxia.Wernicke's encephalopathyo It is an acute neurological disorder characterized by a classical triad of ataxia, ophthalmoplegia and confusion. The clinical findings include : -Ocular : - Nystagmus, bilateral lateral rectus palsy, conjugate gaze palsies. The most common ocular abnormality is nystagmus, not complete ophthalmoplegia. Less frequently noted are pupillary abnormalities such as sluggishly reactive pupil, ptosis, scotomas, and anisocoria.CNS (encephalopathy) : - Global confusion, disinterest, inattentiveness or agitation. Rarely stupor and coma may occur.Gait ataxiaPeripheral polyneuropathy : - Weakness, foot drop, decreased proprioception.Other symptoms : - Autonomic dysfunction (tachycardia & postural hypotension). If there is coexisting cardiovascular beriberi; hypothermia; abdominal symptoms (nausea, vomiting, abdominal pain).\n\nSo the answer to this question is A"} {"instruction": "Sodium valproate: Drug of choice for all the following except\nA. Absence seizures\nB. Myoclonic seizures\nC. Atonic seizures\nD. Infantile spasms", "response": "DOC for status epilepticus is lorazepam Carbamazepine-DOC for simple and complex paial seizures. Valproate DOC for GTCS,Atonic,myoclonic,absence,LG syndrome,clonic,tonic seizures. Ref: Katzung 12th ed.\n\nSo the answer to this question is D"} {"instruction": "In splenic injury conservative management is done in\nA. Hemodynamically unstable\nB. Young patients\nC. Shattered spleen\nD. Extreme pallor and hypotension b", "response": "Most serious complications after splenectomy are OPSI (Oppounistic Post Splenectomy Infections) it is most common in young children and immunocompromised adults. \"Therefore it is essential to save the spleen in children.\" Now spleen salvage methods are the management of choice even in adults. Splenectomy is usually indicated under the following circumstances (Ref: Sabiston 18/e pi639 (17/e} p 1694) 1. the pt. is unstable 2. the spleen is extensively injured with continuous bleeding 3. bleeding is associated with hilar injury 4. other injuries require prompt attention SRB 5th edition page no. 672 & 671\n\nSo the answer to this question is B"} {"instruction": "Which of the following is a cerebro selective calcium channel blocker?\nA. Nimodipine\nB. Ziconotide\nC. Verapamil\nD. Diltiazem", "response": "Ans. (a) NimodipineRef KDT 6/e, p 172\n\nSo the answer to this question is A"} {"instruction": "\"Paraneoplastic Syndrome\" Not seen in RCC is:\nA. Acanthosis nigricans\nB. Amyloidosis\nC. Polycythemia\nD. SLE", "response": "SLE\n\nSo the answer to this question is D"} {"instruction": "Which of the following anesthetic is safe in heart failure -\nA. Etomidate\nB. Propofol\nC. Thiopentone\nD. Ketamine", "response": "Ans. is 'a' i.e., Etomidate Etomidateo It has a briefer duration of action 4-8 minutes.o It produces little cardiovascular and respiratory depression-->> Agent of choice for cardiovascular surgeries (bypass, aneurysms, valve surgery). Etomidate is most cardiostable inducing agent.o Coronary perfusion pressure is maintained when it is used with fentanyl.o Similar to thiopentone & propofol, etomidate is cerebroprotective - Decreases cerebral blood flow; metabolism, oxygen consumption and ICT.o Etomidate has the highest incidence of nausea and vomiting amongst inducing agents 30%-40%.o It can produce hiccups and myoclonus .o Superficial thrombophlebitis and pain on injection may occur - Pain can be reduced by using larger vein and injecting lidocaine just before etomidate.o Intraarterial injection is not associated with local or vascular complications.o The specific endocrine effects manifested by etomidate are a dose dependent reversible inhibition of enzyme 11-b-hydroxylase, which coverts I I-deoxycortisol to cortisol and a relative minor effect on 17a - hydroxylase,o There is decreased synthesis of adrenal corticoids with increase in precursors 11-deoxycortisol and 17- hydroxyprogesterone.o ACTH secretion increases due to loss of feed back inhibition,o l it 'CT supplementation restores cortisol levels to normal after use of etomidate.\n\nSo the answer to this question is A"} {"instruction": "Atypical (Second generation or newer) antipsychotics are -a) Aripiprazoleb) Risperidonec) Pimozided) Penfluridole) Olanzapine\nA. abc\nB. abe\nC. cde\nD. acd", "response": "A typical (second generation) antipsychotics are clozapine, Olanzapine, Risperidone, Questiapine, Aripiprazole, Ziprasidone.\n\nSo the answer to this question is B"} {"instruction": "True statement about fexofenadine is :\nA. It undergoes high first pass metabolism in liver\nB. Terfenadine is an active metabolite of this drug\nC. It does not block cardiac K+ channels\nD. It has high affinity for central H1 receptors", "response": "Fexofenadine is an active metabolite of terfenadine. It lacks K+ channel blocking property, therefore is devoid of arrhythmogenic potential. It is available as a separate second-generation H1 blocking agent.\n\nSo the answer to this question is C"} {"instruction": "A 24-year-old man is diagnosed with disseminated histoplasmosis after developing symptoms of fever, lymphadenopathy, hepatosplenomegaly and pancytopenia. Which of the following is the body's major immunologic defense against histoplasmosis?\nA. immunoglobulin G (IgG) antibodies\nB. mononuclear leukocytes\nC. complement\nD. immunoglobulin M (IgM) antibody", "response": "The major reaction to fungal infections such as histoplasmosis is delayed-type hypersensitivity. This is a reaction of T cells, which have been stimulated by antigen to react against infectious agents, grafts, and tumors. A classic example is the response to the tuberculin skin test in a person previously exposed to Mycobacterium tuberculosis organisms which occurs between 48 and 72 hours after antigen exposure.\n\nSo the answer to this question is B"} {"instruction": "Elongation arrest occurs due to\nA. SRP- R\nB. SRP\nC. Signal peptide\nD. Docking protein", "response": "B i.e. SRP\n\nSo the answer to this question is B"} {"instruction": "Which of the following is true regarding GLUT-5:\nA. Present in brain\nB. Present in Adipose tissue, skeletal muscle & skin\nC. Insulin mediated transpoer\nD. Sodium independent transpo", "response": "Ans. (D) Sodium independent transpoGLUT-5 is unusual in that it is the primary transpoer for fructose (instead of glucose) in the small intestine & the testes.Has sodium independent facilitated diffusion mechanism.\n\nSo the answer to this question is D"} {"instruction": "A pateint of Schizophrenia treated for 5 years developed perioral movem-ents. Likely diagnosis is:\nA. Tardive dyskinesia\nB. Muscular dystonia\nC. Akathasia\nD. Malignant neurolept syndrome", "response": "A i.e. Tardive dyskinesia\n\nSo the answer to this question is A"} {"instruction": "False regarding gouty arthritis is -\nA. Synovial fluid analysis is diagnostic\nB. Allopurinol is the treatment of choice in acute gout\nC. Arthritis occurs after long attack of hyperuricemia\nD. Level of uric acid in blood and severity of gout has good correlation", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Treatment of choice for annular pancrease is\nA. Division of pancreas\nB. Duodenoduodenostomy\nC. Duodenojejunostomy\nD. Roux-en-Y loop", "response": "Pancreatic ring surrounds the second or third pa of duodenum. The usual treatment is duodenoduodenostomy. Bailey & Love ,26th,1125\n\nSo the answer to this question is B"} {"instruction": "The triad of hypertension, bradycardia and irregular respiration is seen in:\nA. Cushing's reflex\nB. Bezold-Zarisch reflex\nC. Herring-Bruer reflex\nD. Bainbridge's reflex", "response": "Ans. a. Cushing's reflex (Ref: Ganong 24/e p607; Schwartz 9/e p1521; Bailey 25/e p483)The triad of hypertension, bradycardia and irregular respiration is seen in Cushing's reflex.'Elevated intracranial pressure, as caused by space occupying lesion like brain tumor or head trauma with associated intracranial bleeding (e.g. epidural /subdural/cerebral- haemorrhage), results in an increased systemic blood pressure (BP) and bradycardiaQ (rather than tachycardia) and irregular breathing. This response is called Cushing's reflex or phenomenon. 'Cushing's TriadIncrease in systolic blood pressureQ (Widening of pulse pressure)Reduction of the heart rateQ (bradycardia)Irregular respirationQ (caused by impaired brainstem function)Cushing ReflexCushing reflex (also referred to as the vasopressor response), is a physiological nervous system response to increased intracranial pressure (ICP) that results in Cushing's triad of increased blood pressure, irregular breathing, and a reduction of the heart rateQ.It is usually seen in the terminal stages of acute head injury and may indicate imminent brain herniationQ.These symptoms can be indicative of insufficient blood flow to the brain (ischemia) as well as compression of arteriolesQ.Etiology:It is a special CNS ischemic response that results from increased intracranial tension (or increased CSF pressure around the brain in cranial vault).Causes of increased ICT may be space occupying lesions such as brain tumorQ, cerebral abscess, head traumaQ with associated intra cranial bleeding (epidural/ subdural/ cerebral-haemorrhage)Pathophysiology:When the ICT or CSF pressure rises to equal the arterial pressure, it compresses the whole brain as well as the arteries in the brain and cuts off the blood supply to the brain, thereby activating the CNS ischemic responseCompromised blood supply, local hypoxia and hypercapnia of RVLM (rostral ventrolateral medulla) neurons or vasomotor area increase their discharge and evoke Cushing's reaction raising systemic arterial pressureQ.Cushing ReflexThe resultant rise in systemic arterial pressure (due to ischemic stimulation of vasomotor regions in medulla) tend to restore the blood flow to medulla, thereby protecting the vital centers of brain from loss of nutrition if ICT rises enough to compress cerebral arteries.The rise in BP is proportional to increase in intracranial tension (over a considerable range) and causes a reflex decrease in heart rate via the arterial baroreceptors. This is why bradycardia rather than tachycardia is characteristically seen in patients with increased intra cranial pressureQ.Bezotd-Jarisch reflex* In experimental animals, injections of serotonin, veratridine, capsaicin, phenyldiguanide. and some other drugs into the coronary arteries supplying the left ventricle cause apnea followed by rapid breathing, hypotension, and bradycardia (the coronary chemoreflex or Bezold-Jarisch reflex).* The receptors are probably C fiber endings, and the afferents are vagal.* The response is not produced by injections into the blood supply of the atria or the right ventricle.Hering-Bruer reflex* The Hering-Breuer inflation reflex is an increase in the duration of expiration produced by steady lung inflation, and the Hering-Breuer deflation reflex is a decrease in the duration of expiration produced by marked deflation of the lung.Bainbridge's reflex* Rapid infusion of blood or saline in anesthetized animals sometimes produces a rise in heart rate if the initial heart rate is low. This effect was described by Bainbridge in 1915, and since then it has been known as the Bainbridge reflex.\n\nSo the answer to this question is A"} {"instruction": "Amplifier host in Japanese encephalitis-\nA. Horse\nB. Pigs\nC. Dogs\nD. Monkey", "response": "Ans. is 'b' i.e., Pigs Japanese encephalitis* JE is caused by flavivirus, a group B arbovirus. It is a zoonotic disease infecting mainly animals and incidentally man.* In south, epidemics have occured in Karnataka, Andhra pradesh, Tamil-Nadu and Kerala. Now Gorakhpur district of U.P. contributes largest number of cases.* Main vector of JE transmission is culex mosquito (culex tritaeniorhynchus), a zoophilic rural mosquito that breeds in rice paddy fields, shallow ditches and pools. Other important vector species are culex vishnuii and culex gelidus.* Pigs are amplifier host i.e., infected pigs do not manifest overt symptoms but circulate the virus so that mosquito get infected and can transmit virus to man. Horses are the only domestic animals showing symptoms of JE. Man is an 'incidental dead-end host\\ there is no man-to-man transmission. 'Cattle and buffaloes' act as mosquito attractants, i.e. infected but are not the natural hosts. Herons (birds) are the reservoir hosts.* There are two natural cycles of JE virus :* i) Pig - mosquito - pig* ii) Ardeid bird - mosquito - Ardeid bird.* Most of the cases are subclinical, ratio of overt disease to inappearent infection varies 1:1000, i.e., cases show tip of iceberg. For clinical cases incubation period is 5-15 days. The disease passes through sequential stages of prodrome, acute encephalitis, and late stage with sequelae. There is no rash at the site of mosquito bite.* Case fatality rate is 20-40%. The endemicity of cases is 1-2 case per village.* The vast majoirty of cases (about 85%) occur among children < 15 years of age. But JE is infrequent in infancy.\n\nSo the answer to this question is B"} {"instruction": "A 55-year-old diabetic woman suddenly develops weakness of the left side of her face as well as of her right arm and leg. She also has diplopia on left lateral gaze. Where is the responsible lesion?\nA. Right cerebral hemisphere\nB. Left cerebral hemisphere\nC. Right side of the brainstem\nD. Left side of the brainstem", "response": "This patient has weakness of the left face and the contralateral (right) arm and leg, commonly called a crossed hemiplegia. Such crossed syndromes are characteristic of brainstem lesions. In this case, the lesion is an infarct localized to the left inferior pons caused by occlusion of a branch of the basilar artery. The infarct has damaged the left sixth and seventh cranial nerves or nuclei in the left pons with resultant diplopia on left lateral gaze and left facial weakness. Also damaged is the left descending corticospinal tract, proximal to its decussation in the medulla; this damage causes weakness in the right arm and leg. This classic presentation is called the Millard-Gubler syndrome. Hemispheric lesions cause motor and sensory loss all on the same side (contralateral to the lesion). A lesion in the median longitudinal fasciculus causes third and sixth cranial nerve dysfunction but not motor deficit of the face or body.\n\nSo the answer to this question is D"} {"instruction": "Which of the following parenteral anticoagulants is a dual coagulation factor inhibitor?\nA. Clavatadine\nB. Tifacogin\nC. Tanogitran\nD. Flovagatran", "response": "ClavatadineXla inhibitorTifacoginVIIa inhibitorTanogitranDual IIa/Xa inhibitorFlovagatranIIa inhibitor\n\nSo the answer to this question is C"} {"instruction": "Ureteric constriction in the following sites EXCEPT\nA. At the pelviureteric junction\nB. Crosses the internal iliac artery\nC. At bladder wall\nD. At mesentery", "response": "(At mesentery) (301 - BDC - 2) (370 - Snell 7th)URETERS - The ureter enters the pelvis by crossing the bifurcation of the common iliac artery in front of the sacroiliac joint. Each ureter then runs down the lateral wall of the pelvis infront of the internal iliac artery to the region of the ischial spine and turns forward to enter the lateral angle of the bladder. Near its termination. It is crossed by the vas deferens. The ureter passes obliquely through the wall of the bladder for about 0.75 in (1.9cm) before opening into the bladder.Three Constrictions (Snell)BDC(i) Where the renal pelvis joins the ureter in the abdomen(ii) Where it is kinked as it crosses the pelvic brim to enter the pelvis(iii) Where it pierces the bladder wall(i) At the pelvi ureteric Junction(ii) At the brim of the lesser pelvis(iii) At its passage through the bladder wall.\n\nSo the answer to this question is D"} {"instruction": "Tangier's disease is characterized by:\nA. Low or absence of HDL\nB. Low LDL concentration\nC. Raised chylomicrons\nD. Deficiency of LPL", "response": "Tangier's disease/ Familial alpha-lipoprotein deficiency/Hypo alpha lipoproteinemia. Defect in ABC-A 1 receptors which helps in giving cholesterol from peripheral tissue to HDL. HDL is not properly formed- HDL | Other lipoproteins are normal. | Apo A1. Cholesterol accumulates in reticulo endothelial system C/F : Peripheral neuropathy, Hepatosplenomegaly Large orange/ yellow tonsils.\n\nSo the answer to this question is A"} {"instruction": "A 17-year-old female was admitted to the hospital with a high fever. Following intravenous administration of antibiotics, a routine CT scan revealed a \"thoracic outlet\" syndrome. Which symptom would most likely result from this syndrome?\nA. Problems with respiration because of pressure on the phrenic nerve\nB. Reduced blood flow to the thoracic wall\nC. Reduced venous return from the head and neck\nD. Numbness in the upper limb", "response": "Thoracic outlet syndrome is characterized by the presence of a cervical rib, accessory muscles, or connective tissue bands that constrict the limited dimensions of the thoracic outlet. The cervical rib is usually located on the C7 vertebra and can impinge on the brachial plexus, resulting in loss of some feeling to the upper limb. There would be no impingement on the phrenic nerve because it leaves C3 to C5 directly parallel with the vertebral column. The syndrome does not include reduction of blood flow to the thoracic wall because of extensive anastomoses between the vessels that supply blood to the anterior thoracic wall. Venous return from the head and neck is mainly through the internal jugular vein and would not be affected because of this vein's location near the midline of the body; thus, it would not be occluded or distended.\n\nSo the answer to this question is D"} {"instruction": "Commonest site of Ivory osteoma -\nA. Frontal-Ethmodial region\nB. Mandible\nC. Maxilla\nD. Sphenoid", "response": "Ivory osteomas are most commonly seen in frontal sinus followed by ethmoid and maxillary sinus.\n\nSo the answer to this question is A"} {"instruction": "Where is the triglycerides stored in the human body?\nA. Nerve cells\nB. Adipose tissues\nC. Both\nD. None", "response": "Triglycerides are stored in adipose tissues.\n\nSo the answer to this question is B"} {"instruction": "Not TRUE statement regarding parotid gland is/are?\nA. Deep lobe contains deep lymphatics\nB. Divided into superficial and deep lobes by facial nerve\nC. Parotid duct opens opposite to the second upper molar\nD. Ectodermal in origin", "response": "Ans. is 'a' i.e., Deep lobe contains deep lymphatics Development:Parotid gland is the first salivary gland to appear, in early 6' week.It is ectodermal in origin and develops from the buccal epithelium just lateral to the angle of mouthStructures emerging from parotidThe following structures emerge from the parotid gland:Anterior border:Parotid duct3 Terminal branches of facial nerve:The zygomatic and buccal branches: toward the temporal region, eyelids and cheek, respectively.Mandibular branch : Run along the body of the mandibletowards the mouthApex:5th terminal branch of facial nerve: Cervical branch continues into the neck (to platysma).Anterior & posterior divisions of retromandibular veinPosterior border:Posterior auricular nervePosterior auricular aeryPosterior auricular veinAlong base:superficial temporal aerytemporal branch of facial nerveAuriculotemporal nerveSTRUCTURES WITHIN GLAND:Aeries:External carotid aery enters through posteromedial surfaceMaxillary aerySuperficial temporal vesselPosterior auricular aeryVeins:The retromandibular veins Facial NerveParotid Duct (Stenson's duct)The duct turns opens into the vestibule of the mouth (gingivo- buccal vestibule) opposite the crown of the upper 2nd molar toothNerve supply:PARASYMPATHETIC:auriculo temporal nerveSYMPTHETIC SUPPLY- plexus around the external carotid aery.SENSORY NERVES: auriculotemporal nerve, except for parotid fascia & overlying skin which are innervated by Great auricular nerve (C2, C3).\n\nSo the answer to this question is A"} {"instruction": "All of the following are seen in Homer's syndrome except: September 2005, March 2007\nA. Enophthalmos\nB. Hyperhydrosis\nC. Miosis\nD. Ptosis", "response": "Ans. B: Hyperhydrosis Homer's syndrome is characterized by an interruption of the oculosympathetic nerve pathway somewhere between its origin in the hypothalamus and the eye. The classic clinical findings associated with Homer's syndrome are: Ptosis, Pupillary miosis and Facial anhidrosis. Other findings may include apparent enophthalmos, increased amplitude of accommodation, heterochromia of the irides (if it occurs before age two), paradoxical contralateral eyelid retraction, transient decrease in intraocular pressure and changes in tear viscosity. In children Homer's syndrome sometimes leads to a difference in eye color between the two eyes (heterochromia).This happens because a lack of sympathetic stimulation in childhood interferes with melanin pigmentation of the melanocytes in the superficial stroma of the iris.\n\nSo the answer to this question is B"} {"instruction": "Secondary attack rate of chicken pox is\nA. 60\nB. 50\nC. 90\nD. 40", "response": "Chicken pox Agent- Human alpha herpes virus 3 Primary infection causes chicken pox Recovery from primary infection is commonly followed by establishment of latent infection in cranial nerves, sensory ganglia, spinal dorsal root ganglia When the cell mediated immunity wanes, the virus may reactivate in 10-30% cases Incubation period -15 days Distribution of rash:- Centripetal; Axilla affected; Rash seen mostly over flexor aspect Characteristics of rash:- Superficial; Unilocular-dew drops like appearance Rash pleomorphic- different stages of rash evident at one time An area of inflammation seen around vesicle Evolution of rash : very rapid Scab begins to form 4-7 days after the rash appears Fever- temperature rises with each fresh crop of rash Secondary attack rate-90% Reference: Park&;s textbook of Preventive and Social medicine, 23rd edition; Page no.144\n\nSo the answer to this question is C"} {"instruction": "Which of the following is a polar amino acid?\nA. Tryptophan\nB. Serine\nC. Valine\nD. Tyrosine", "response": "Note: Polar amino acids are hydrophilic and nonpolar amino acids are hydrophobic.\n\nSo the answer to this question is B"} {"instruction": "Which of the following is least commonly associated with renal cell carcinoma?\nA. Polycythemia\nB. Amyloidosis\nC. Cushing's syndrome\nD. Hypeension", "response": "Risk factors for Renal Cell Carcinoma : Smoking Hypeension Obesity Occupational exposure to Cadmium Chronic dialysis patient having acquired polycystic disease Patient with polycythemia Amyloidosis Cushing syndrome is the one having the least incidence in renal cell cancer out of the given options.\n\nSo the answer to this question is C"} {"instruction": "Prostacyclin is mainly produced by-\nA. Platelet\nB. Vascular endothelium\nC. Prostate\nD. Testis", "response": "Ans. is 'b' i.e., Vascular endotheliumArachidonic acid metabolites During inflammation, various biologically active lipid mediators are derived from membrane phospholipid. o Arachidonic acid is derived from dietry sources or by conversion from the essential fatty acid (linoleic acid).It does not occur free in cell but is normally esterified in membrane phospholipid.When phosphilipase A2 is activated, it releases arachidonic acid from membrane phospholipids.From arachidonic acid, mediators of inflammation are synthesized by two different pathway.\n\nSo the answer to this question is B"} {"instruction": "Middle superior alveolar nerve is a branch of\nA. Mandibular division of trigeminal nerve\nB. Palatine division of maxillary nerve\nC. Anterior nasal division of maxillary nerve\nD. Interior alveolar nerve", "response": "C i.e. Anterior nasal division of maxillary nerve\n\nSo the answer to this question is C"} {"instruction": "Positive Trendelenburg sign is seen in: March 2007\nA. Superior gluteal nerve palsy\nB. Inferior gluteal nerve palsy\nC. Obturator nerve palsy\nD. Ilihypogastric nerve palsy", "response": "Ans.A: Superior gluteal nerve palsy Trendelenburg's sign is found in people with weak abductor muscles of the hip. The Trendelenburg sign is said to be positive if, when standing on one le.g., the pelvis drops on the side opposite to the stance leg. The weakness is present on the side of the stance leg. The body is not able to maintain the center of gravity on the side of the stance leg. Normally, the body shifts the weight to the stance le.g., allowing the shift of the center of gravity and consequently stabilizing or balancing the body. However, here when the patient lifts the opposing le.g., the shift is not created and the patient cannot maintain balance leading to instability. Trendelenburg sign is caused by paralysis of the gluteus medius and minimus muscles. Para!ysis may arise due to nerve damage, namely, the superior gluteal nerve.\n\nSo the answer to this question is A"} {"instruction": "Infant with carnitine deficiency form hypoglycemia due to what reason?\nA. Decreased glycosis\nB. Decreased gluconeogenesis\nC. Increased utilization of glucose\nD. Reduced fatty acid oxidation and ketogenesis", "response": "Carnitine deficiency can occur paicularly in the newborn-- and especially in preterm infants--owing to inadequate biosynthesis or renal leakage. Losses can also occur in hemodialysis.This suggests a vitamin-like dietary requirement for carnitine in some individualsSymptoms of deficiency include hypoglycemia, which is a consequence of impaired fatty acid oxidation and lipid accumulation with muscular weakness.Treatment is by oral supplementation with carnitineReference: Harper biochemistry, 30th edition, page no 231\n\nSo the answer to this question is D"} {"instruction": "Glomerulonephritis in streptococcal infection is diagnosed by -\nA. Blood culture\nB. Throat culture\nC. ASO Titre\nD. PCR", "response": "Ans. is 'c' i.e., ASO Titre\n\nSo the answer to this question is C"} {"instruction": "In thymoma , all are seen except\nA. Hypogamma globulinemia\nB. Hyperalbuminemia\nC. Red cell aplasia\nD. Myaesthenia gravis", "response": "Thymoma is the most common Anterior mediastinal mass. Thymomas are seen to be associated with Myasthenia gravis Acquired hypogammaglobulinemia Pure red cell aplasia Grave's ds Pernicious anemia Dennatomyositis-polymyositis Cushing syndrome Ref : Robbins (big) 8/e p636\n\nSo the answer to this question is B"} {"instruction": "Most common site of intracranial hemorrhage in hepertensive hemorrhage is :\nA. Basal ganglia\nB. Brainstem\nC. Cerebellum\nD. Hippocampus", "response": "Ans. is 'a' i.e. Basal ganglia The most common sites of hypertensive Haemorrhage are:The basal ganglia (putamen, thalamus and adjacent deep white matter)Deep cerebellumPons\n\nSo the answer to this question is A"} {"instruction": "Which of the following is more likely associated with Klebsiella pneumoniae than Escherichia coli?\nA. A hospitalized patient who has pneumonia\nB. Endotoxic shock\nC. Hemolytic uremic syndrome in children\nD. An alcoholic who has lobar pneumonia", "response": "Klebsiella pneumoniae is more likely than Escherichia coli to be associated with lobar pneumonia in an alcoholic. K pneumoniae is a fat, nonmotile, gram-negative rod that is surrounded by a capsule that is responsible for its invasiveness. They characteristically produce moist mucoid colonies on culture. K pneumoniae is a weak pathogen and requires a host with weak defenses (e.g., alcoholics, diabetics) to infected tissue. It is more commonly associated with urinary tract infections than with pneumonia. However, it produces a lobar pneumonia, paicularly in alcoholics, diabetics, or those with weakened defenses. The pneumonia are characterized by blood-tinged mucoid sputum, a tendency for lung abscesses, and a moality in 20% of patients. In general, K pneumonia is susceptible to ceftriaxone. Escherichia coli is the most common cause of acute cystitis and pyelonephritis, spontaneous bacterial peritonitis in alcoholics, the enterotoxigenic strain of traveler's diarrhea, hemolytic uremic syndrome in children caused by eating undercooked hamburgers, endotoxic shock, and acute cholecystitis. It is a common pathogen in neonatal meningitis, pneumonia in hospitalized patients caused by colonization of the airways by the organism, enteropathogenic gastroenteritis in infants under 2 years of age, enteroinvasive gastroenteritis with bloody diarrhea, peritonitis, wound infections (paicularly in diabetics), and septicemia. Ref - Harrison's principles of internal medicine 20e pg 1155,1146\n\nSo the answer to this question is D"} {"instruction": "Digitalis has positive Inotropic effect-by the viue of its effect on:\nA. Na+K+ ATPase pump\nB. Na Glucose channels\nC. H+K+ ATPase pump\nD. Calcium pump", "response": "Ref:KDT 6/e p496 Digitalis is used clinically because it exes a positive inotropic effect and because it slows transmission in the AV node in patients with supraventricular tachyarrhythmias. The positive inotropic effect is due to inhibition of the sodium/potassium pump at the outer cell membrane.\n\nSo the answer to this question is A"} {"instruction": "Glaucoma is characterised by apoptosis of\nA. Bipolar cells\nB. Ganglion cells\nC. Retinal pigment epithelium\nD. Rods and Cones", "response": "Multifactorial optic neuropathy characterised by Retinal Ganglionic cell death by the apoptosis.\n\nSo the answer to this question is B"} {"instruction": "\"Spider leg\" deformity in excretory urogram occurs in\nA. Hydronephrosis\nB. Polycystic kidney\nC. Uretrocele\nD. Renal agenesis", "response": "polycystic kidney, an autosomal dominant disease, common in females; excretory urogram shows 'spider leg' pattern - elongated and compressed renal pelvis with narrowed and stretched calyces over the cysts. ( Reference: emedicine.medscape.com/aicle/983281-workup )\n\nSo the answer to this question is B"} {"instruction": "Whip lash injury occurs in\nA. Pedestrian hit from front\nB. Pedestrian hit from behind\nC. Occupant of a car\nD. Any of the above", "response": "Whiplash injury In Road traffic accidents, involving acceleration/ deceleration trauma. commonly sustained by the front seat occupant of a car with no or poorly adjusted head rest Sudden hyperextension & then hyperflexion of neck occurs Resulting in fatal contusion or laceration of spinal cord without fracture of spine.\n\nSo the answer to this question is C"} {"instruction": "If Hemoccult test is negative for screening of colonic cancer, no fuher test is done. If the hemoccult test is positive the individual will have a second stool sample tested with Hemoccult II test. If this second sample is positive for blood, the individual will be referred for more extensive evaluation. The effect of net sensitivity and net specificity of this method of screening is\nA. Net sensitivity and net specificity are both increased\nB. Net sensitivity is decreased and net specificity is increased\nC. Net sensitivity is increased and net specificity is decreased\nD. Net sensitivity remains the same and net specificity is increased", "response": "SCREENING TEST USED IN SERIES: A population is subjected to one screening test followed by a second screening test is applied on those individuals only who test positive on th e1st screening test. Combined sensitivity of 2 tests A and B in series: Sensitivity (A) * Sensitivity (B) Combined specificity of 2 tests A and B in series: Specificity (A) + Specificiity (B) - SCREENING TEST USED IN PARALLEL: A population is subjected to two or more screening tests at the both (or all) screening tests. Combined sensitivity of 2 tests A and B in parallel: Sensitivity(A) + Sensitivity (B) - Combines specificity of 2 tests A and B in parallel: Specificity(A)*Specificity(B) Test in series Tests in parallel Combined sensitivity Decreases Increases Combined specificity Increases Decreases Combined PPV Increases Decreases Combined NPV Decreases Increases Ref: Simple Biostatistics by Indrayan and Indrayan 1st edition Pgno: 56\n\nSo the answer to this question is B"} {"instruction": "A pronounced developmental groove is usually present on the mesial marginal ridge of a permanent:\nA. Mandibular third molar\nB. Mandibular second premolar\nC. Maxillary second molar\nD. Maxillary first premolar", "response": "None\n\nSo the answer to this question is D"} {"instruction": "In children fracture scaphoid is through rare but usually involves:\nA. Waist\nB. Proximal pole\nC. Neck\nD. Distal pole", "response": "D i.e. Distal pole\n\nSo the answer to this question is D"} {"instruction": "The extra - cellular polysaccharide synthesized by cariogenic streptococci in the presence of excess sucrose are best described as\nA. Mucopolysaccharide\nB. Dextran-like glucan\nC. Glycogen-like glucan\nD. Amylopectin", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Corpus luteum functions maximally without an implantaton for ...... days :\nA. 9\nB. 12\nC. 6\nD. 15", "response": "9 days After ovulation the ruptured graffian follicle develops into corpus luteum. The lile cycle ot corpus luteum has four stages viz : Proliferation Vascularisation Maturation Begression Corpus luteum reaches it maximum maturity by 22nd day of cycle (gze = 2 cms or more). Ovulation occurs on day 14 i.e. 8th days atter ovulation corpus luteum reaches its maximum maturity. Colour of corpus luteum in early stages is greyish yellowdeg due to presence of lipids and later is distinctive yellow due to pigment carotene.deg lf pregnancy does not occur corpus luteum stas degenerating from the eight post ovulatory day and forms coruous albicans. lf pregnancy occurs, HCG similar lo LH stimulates corpus luteum to secrete progesterone. it's groMh roaches a peak at 8th week ol gestation and it remains functionally active till 10-12 weeks of geNation, where by placenta takes over its lunction of producing progesterone. This is followed by degenerative changes in corpus luteum.\n\nSo the answer to this question is A"} {"instruction": "A 30 year old pregnant female was diagnosed with syphilis and 3 doses of injection Benzathine\nPencillin G 2.4 MU was advised. She was found to be allergic to pencillin. What is the next management?\nA. Continue the same after reassurance\nB. T.Doxycycline 100mg BD for 14 days\nC. T.Doxycycline 100mg BD for 21 days\nD. Desensitization", "response": "Even though she was allergic to pencillin, Doxycycline was not given as she is pregnant and Doxycycline has teratogenic effects.\nTherefore, desensitization should be done by giving repeated small doses of pencillin until the allergic response is subsided. If desensitization is not possible then Erythromycin / Azithromycin / Ceftriaxone is given.\n\nSo the answer to this question is D"} {"instruction": "Ferruginous bodies are commonly seen in:\nA. Silicosis\nB. Asbestosis\nC. Bagassosis\nD. Byssinosis", "response": "Inorganic paicles may become coated with iron containing proteinaceous material, these bodies are called ferruginous bodies. They mimic asbestos bodies and can be seen in patient with asbestosis but is not specific hence asbestosis is the best answer. Ferruginous bodies are most commonly seen in Asbestosis. Ref: Robbin's Illustrated Pathology, 7th Edition, Page 736 ; Concise Pathology By Chandrasoma P, Taylor C, 3rd Edition, Page 541\n\nSo the answer to this question is B"} {"instruction": "Intermittent proptosis is seen in?\nA. Orbital tumor\nB. Orbital cellulitis\nC. Orbital varices\nD. Cavernous sinus thrombosis", "response": "ANSWER: (C) Orbital varicesREF: Khurana 4th ed p. 381Causes of intermittent proptosis:Orbital varicesPeriodic orbital edemaRecurrent orbital hemmorrhageHighly vascular tumor\n\nSo the answer to this question is C"} {"instruction": "A non diabetic, non hypertensive patient has some extra beats in pulse. Doctor informed that is benign and no intervention required. But patient is worried that it is a serious cardiac disorder and is still going for repeated investigation & going from doctor to doctor. This is a type of:\nA. Conversion disorder\nB. Hypochondriosis\nC. Somatization\nD. Depression", "response": "Interpretation of benign symptom (extra beats) as a serious illness (cardiac disorder) is suggestive of Hypochondriosis.\n\nSo the answer to this question is B"} {"instruction": "pH of the whole blood is estimated in\nA. Plasma\nB. Serum\nC. RBC\nD. Whole blood", "response": "Ans: a (Plasma) Ref: Vasudevan 4th ed/p. 346.The pH of plasma is 7.4. The pH of plasma is maintained within a narrow range of 7.38 to 7.42\n\nSo the answer to this question is A"} {"instruction": "All are contents of femoral triangle except\nA. Femoral aery\nB. Femoral vein\nC. Superficial inguinal lymph nodes\nD. Nerve to pectineus", "response": "FEMORAL TRIANGLE:- Triangular depression on front of the upper one third of the thigh immediately below the inguinal ligament. BOUNDARIES:-1. Laterally: medial border of Saorius.2. Medially: medial border of adductor longus.3. Base: inguinal ligament.4. Apex: directed downwards.formed by the point where the medial and lateral boundaries cross.apex is continuous with the adductor canal.5. Roof: skin,superficial fascia and deep fascia. Superficial fascia contains superficial inguinal lymph nodes,femoral branch of genitofemoral nerve, branches of ilioinguinal nerve, superficial branches of the femoral aery with accompanying veins and the upper pa of the great saphenous vein.6. Floor: medially by adductor longus and pectineus, and laterally by the psoas major and iliacus. CONTENTS:-1. Femoral aery and its branches.- Superficial branches-superficial external pudendalSuperficial epigastric Superficial circumflex iliac Deep branches-profunda femoris, muscular branches and deep external pudendal 2. Femoral vein and its tributaries 3. Femoral sheath 4. Femoral nerve 5. Nerve to pectineus6. Femoral branch of genitofemoral nerve.7. Lateral cutaneous nerve of thigh.8. Deep inguinal lymph nodes. Vein is medial to aery (base)Vein posteromedial to aery (apex) {Reference:BDC 6E pg no. 45}\n\nSo the answer to this question is C"} {"instruction": "Type I Rapidly progressive glomerulonephritis is seen in\nA. SLE\nB. IgA nephropathy\nC. Henoch Schonlein purpura\nD. Good pasture syndrome", "response": "Rapidly progressive glomerulonephritis (RPGN) is a syndrome of the kidney that is characterized by a rapid loss of kidney function, (usually a 50% decline in the glomerular filtration rate (GFR) within 3 months) with glomerular crescent formation seen in at least 50% or 75% of glomeruli seen on kidney biopsies. Refer robbins 9/e\n\nSo the answer to this question is D"} {"instruction": "Ototoxicty and nephrotoxicity are the adverse effects of:-\nA. Vancomycin\nB. Azithromycin\nC. Clindamycin\nD. Penicillin", "response": "Drugs associated with ototoxicity as well as nephrotoxicity Vancomycin Aminoglycosides Cisplatin\n\nSo the answer to this question is A"} {"instruction": "The professional antigen presenting cells are\nA. Endothelial cells\nB. Dendritic cells\nC. T cells\nD. B cells", "response": "Professional APC Express MHC class II molecules Dendritic cells Immature dendritic cells (Langerhans cells) Macrophages B cells Non - professional APC Do not express MHC class II molecules Stimulated by cytokines like IFN Fibroblasts Thymic epithelial cells Thyroid epithelial cells Glial cells Pancreatic beta cells Endothelial cells\n\nSo the answer to this question is B"} {"instruction": "Acidic drugs bind to -\nA. Globulin\nB. a-1 glycoprotein\nC. Albumin\nD. None", "response": "Ans. is 'c' i.e., Albumin o Many natural substances circulate around the body partly free in plasma water and partly bound to plasma proteins, e.g. cortisol, thyroxine.o Similarly drugs circulate in protein bound and free states, and the significance is that the free fraction is pharmacologically active whereas the protein bound component is a reservoir of drug that is inactive because of this binding.o Acidic drugs generally bind to plasma albumin.o Basic drugs bind to a{ acid glycoprotein.o Binding to albumin is quantitatively more important.\n\nSo the answer to this question is C"} {"instruction": "what % of testicular carcinoma is associated with crytorchidism?\nA. 10%\nB. 30%\nC. 70%\nD. 90%", "response": "Testicular Tumours: Epidemiology and Risk Factors Of all primary testicular tumours, 90-95% are germ cell tumours (seminoma and nonseminoma) More common in whites and individuals of higher socioeconomic class Slightly more common on the right side than on the left, which parallels the increased incidence of cryptorchidism on the right side. Of primary testicular tumours, 1-2% are bilateral, and about 50% of these tumours occur in men with a history of unilateral or bilateral cryptorchidism Seminoma is the most common germ cell tumour in bilateral primary testicular tumours, while malignant lymphoma is the most common bilateral tumour of the testis The strongest association has been with the cryptorchid testis. Approximately 7-10% of testicular tumours develop in patients who have a history of cryptorchidism; seminoma is the most common form of tumor these patients have. However, 5-10% of the testicular tumors occur in the contralateral, normally descended testis. The relative risk of malignancy is highest for the intraabdominal testis (1 in 20) and is significantly lower for the inguinal testis (1 in 80) Orchipexy doesnot alter the malignant potential of the cryptorchid testis; however, it does facilitate examination and tumor detection Ref: Smith 18th edition Pgno: 380\n\nSo the answer to this question is A"} {"instruction": "Incubation period of Influenza is:-\nA. 1-3 days\nB. 7-10 days\nC. 10-14 days\nD. 1-6 hours", "response": "Incubation period :- Time interval b/w entry of organism till appearance of first sign / symptom. I.P of influenza is 1-3 days.( 18-72 hours)\n\nSo the answer to this question is A"} {"instruction": "Impoant in Herpes simplex involvement of the eye are all EXCEPT: September 2012\nA. Type of lesion\nB. Corneal anaesthesia\nC. Iridocyclitis\nD. Purulent discharge", "response": "Ans. D i.e. Purulent discharge Decreased corneal sensations, dendritic and geographical ulcers are characteristic features of Herpes simplex ocular disease\n\nSo the answer to this question is D"} {"instruction": "Appendix of testes is remnant of ?\nA. Mesonephric duct\nB. Paramesonephric duct\nC. paramesonephric tubule\nD. Mesonephric tubule", "response": "Male's derivatives of paramesonephric duct (Mullerian duct) are :-i) Appendix of testis (Hydatid of morgagm).ii) Prostatic utricle.\n\nSo the answer to this question is B"} {"instruction": "How many antenatal visits covering the entire period of pregnancy are minimum required?\nA. 3\nB. 4\nC. 7\nD. 13", "response": "Minimum no. of Antenatal visits required in Pregnancy : 4 1st visit - within 12 weeks, preferably as soon as the pregnancy is suspected, for registration of pregnancy and first antenatal check-up. 2nd visit between 14 and 26 weeks POG. 3rd visit - between 28 and 34 weeks POG. 4th visit - between 36 weeks - Delivery Recommended Antenatal visits: 13-14 0-7 months = once a month = 7 visits 8th month = twice a month = 2 visits 9th month onwards = one visit/ week =4-5 visits Post natal visits: 3-4 3 in institutional delivery- Day 3,7,42 4 in home delivery- Day 1,3,7,42\n\nSo the answer to this question is B"} {"instruction": "All of the following statements regarding total anomalous pulmonary connection are true except ?\nA. The total pulmonary venous blood reaches the right atrium\nB. Always associated with a VSD\nC. The oxygen saturation of the blood in the pulmonary aery is higher than that in the aoa\nD. Infracardiac type is always obstructive", "response": "Ans. is 'b' i.e., Always associated with VSD Hemodvnamics of TAPVC o TAPVC results in the pulmonary venous blood reaching the right atrium which also receives the systemic venous blood. o This results in volume overload to right atrium Right atrial enlargement. o Larger volume of blood reaches the right ventricle -f Right ventricle enlargement. o The blood flow to the left atrium is through patent foramen ovale or ASD. o Because there is mixing of unoxygenated blood from systemic circulation and oxygenated blood from pulmonary circulation in the right atrium --> The oxygen saturation of blood in pulmonary aery is higher or identical to that in Aoa. o TAPVC can be divided into : - i) TAPVC with pulmonary venous obstruction Pulmonary venous obstruction results in pulmonary aerial hypeension. Pulmonary obstruction T back pressure -4 T Pulmonary capillary pressure T Pulmonary aery pressure Because of pulmonary venous obstruction oxygenated blood cannot reach hea -4 Cyanosis and CHF during first week of life. ii) TAPVC without obstruction (more common) In TAPVC without obstruction, pulmonary blood flow is high. Patients develops CHF at around 6-8 weeks when the fetal pulmonary resistance falls maximally and pulmonary circulation reaches the maximum. o Infracardiac type of TAPVC is always obstructive whereas cardiac and supracardiac type may be obstructive or nonobstructive.\n\nSo the answer to this question is B"} {"instruction": "Apremilast is\nA. PDE 3 inhibitor\nB. PDE 4 inhibitor\nC. PDE 5 inhibitor\nD. PDE 6 inhibitor", "response": "Ustekinumab, a monoclonal antibody to the shared IL-23/IL-12p40 subunit, is an efficacious treatment for psoriasis and has shown promise in Psoriatic ahritis in clinical trials. Other newer drugs that have shown efficacy for both psoriasis and PsA include the anti-IL-17 pathway agents, such as secukinumab and brodalumab, and an oral phosphodiesterase-4 inhibitor, apremilast. Data on the oral Jak inhibitor, tofacitinib, has been very limited but promising. Ref: Harrison&;s Principles of Internal Medicine; 20th ed KD TRIPATHI 9th ed\n\nSo the answer to this question is B"} {"instruction": "A-H interval on ECG is for conduction -\nA. Through His-Purkinje system\nB. From AV node to bundle of His\nC. From Purkinje system to ventricular fibres\nD. Through ventricular fibers", "response": "Ans. is 'b' i.e., From AV node to bundle of Hiso Certain intervals are measured to provide information regarding AV block.PA interval: It is time taken from onset of P-wave to onset of deflection in atrial catheter. It is an index of intra-atrial conduction. Normal vlaue is less than 55 mS.AH interval : it represents conduction through AV node, i.e., conduction from AV node to bundle of His. Normal vlaue is less than 130 mS.HV interval : It represents conduction through His-Purkinje system, i.e., conduction from His-Purkinje system to ventricular muscle fibers. Normal value is less than 50 mS.\n\nSo the answer to this question is B"} {"instruction": "Barrett's esophagus is diagnosed by-\nA. Squamous metaplasia\nB. Intestinal metaplasia\nC. Squamous dysplasia\nD. Intestinal dysplasia", "response": "\"The definition of Barrett's esophagus (BE), has evolved considerably over the past decade. Traditionally, BE was identified by the presence of columnar mucosa extending at least 3 cm into the esophagus. It is now recognized that the specialized intestinal-type epithelium found in Barrett's mucosa is the only tissue predisposed to malignant degeneration. Consequently, the diagnosis of Barrett's esophagus is presently made given any length of endoscopically identifiable columnar mucosa that proves on biopsy to show intestinal metaplasia. While long segments of columnar mucosa without metaplasia do occur, they are uncommon and are probably congenital in origin. The hallmark of intestinal metaplasia is the presence of intestinal goblet cells.\" Ref : Schwaz 9/e p831\n\nSo the answer to this question is B"} {"instruction": "A short stature child's growth variation is normal but bone development is not according to chronological age. What is your diagnosis?\nA. Genetic short stature\nB. Dwarfism\nC. Constitutional delay\nD. Growth hormone deficiency", "response": "Ans. C. Constitutional delayShort stature children with normal growth variation include genetic (familial) short stature and constitutional delay. In genetic short stature bone development matches with the chronological age but not in constitutional delay in which bone development lags behind.\n\nSo the answer to this question is C"} {"instruction": "Features of liver damage are all except\nA. Decreased factor VII levels\nB. Raised prothrombin time\nC. Conjugated as well as unconjugated hyperbilirubinemia\nD. Decreased erythropoietin production", "response": "Ans. d (Decreased erythropoietin production). (Ref. Harrison's 18,h/Ch. 301., Robbins 6th/846, 1667)SIGNS OF LIVER FAILURE:# Intermediate metabolism of amino acids and carbohydrates# Synthesis and degradation of proteins and glycoproteins# Metabolism and degradation of drugs and hormones# Restriction of lipid and cholesterol metabolism# Coagulation factor# Bile, bile salts and impaired metabolism.\n\nSo the answer to this question is D"} {"instruction": "‘Himalayan P waves’ in ECG is characteristic of:\nA. Atrial septal defect\nB. Eisenmenger syndrome\nC. Tetralogy of Fallot\nD. Ebstein’s anomaly", "response": "12 – lead ECG\n\nRarely normal\nAbnormal P waves consistent with right atrial enlargement – ‘Himalaya P waves”.\nRBBB in 75-92%\nPR prolongation is common due to RA enlargment\nVentricular pre-excitation 10-30%\n\nSo the answer to this question is D"} {"instruction": "Budd Chiari syndrome is: March 2013\nA. Poal vein thrombosis\nB. Hepatic aery thrombosis\nC. Cystic aery thrombosis\nD. Hepatic vein thrombosis", "response": "Ans. D i.e. Hepatic vein obstruction\n\nSo the answer to this question is D"} {"instruction": "A 60-year-old woman is having symptoms of muscle weakness and fatigue. On examination, her blood pressure is 110/80 mm Hg, pulse 100/min, JVP 1 cm, heart sounds normal, and lungs clear. Her serum potassium level is 2.5 mEq/L, bicarbonate 15 mEq/L, and anion gap is normal. The urine potassium is 10 mEq/L.For the above patient with hypokalemia, select the most likely diagnosis.\nA. lower gastrointestinal (GI) losses\nB. prior use of diuretics\nC. RTA\nD. current use of diuretics", "response": "In lower GI loss (diarrhea), the blood pressure is normal, the urine potassium is low (< 25 mmol/F), and the bicarbonate is either normal or low.\n\nSo the answer to this question is A"} {"instruction": "The following is used for exocytosis\nA. Calcium\nB. Sodium\nC. Potassium\nD. All", "response": "Calcium plays an impoant role in exocytosis Exocytosis is an active vesicular transpo system\n\nSo the answer to this question is A"} {"instruction": "Velocity of conduction for A alpha fibers is\nA. 70-120 m/s\nB. 30-70 m/s\nC. 12-30 m/s\nD. 0.5-2 m/s", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Acrodermatitis enteropathica is due to deficiency of: March 2012, September 2012\nA. Iodine\nB. Zinc\nC. Copper\nD. Iron", "response": "Ans: B i.e. Zinc Acrodermatitis enteropathica is a rare inherited metabolic disease of zinc deficiency caused by a defect in the absorption in the absorption of zinc from the intestine.\n\nSo the answer to this question is B"} {"instruction": "Maximum cholesterol is seen in ?\nA. VLDL\nB. LDL\nC. HDL\nD. Chylomicrons", "response": "Ans. is 'b' i.e., LDL Maximum triglyceride content - ChylomicronsMaximum exogenous triglyceride - ChylomicronsMaximum endogenous triglyceride - VLDLMaximum cholesterol content - LDL\n\nSo the answer to this question is B"} {"instruction": "When treated with simple curettage which odontogenic tumour is most likely to recur\nA. Complex odontoma\nB. Compound odontoma\nC. Odontogenic myxoma\nD. Ameloblastic fibroma", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Maxillary sinus achieves maximum size at\nA. bih\nB. Primary dentition\nC. At secondary dentition\nD. At pubey", "response": "Maxillary sinus is the first sinus to develop at bih. It is completely developed by 9 years of agei.e approximately at secondary dentition Ref Maqbool 11/e,p148.\n\nSo the answer to this question is C"} {"instruction": "Contact lens is best used in:\nA. High myopia\nB. Irregular astigmatism\nC. Aphakia\nD. Regular astigmatism", "response": "Ans. Irregular astigmatism\n\nSo the answer to this question is B"} {"instruction": "Bacillary angiomatosis is caused by -\nA. B. Quintana\nB. B. bacilliformis\nC. B. henslae\nD. B. elizabethi", "response": "Ans. is 'c' i.e., B. henslae * Bacillary angiomatosis is caused by Bartonella henselae (most commonly) and B. quintana.\n\nSo the answer to this question is C"} {"instruction": "M.C. type of cutaneous T.B. is –\nA. Lupus vulgaris\nB. Scrofuloderma\nC. T.B. verruca cutis\nD. Erythema induratum", "response": "Common type of cutaneous tuberculosis\n\nLupus vulgaris (55%) \n Tuberculids (7%) \nTuberculous gumma (5%)\nScrofulodenna (25%)\nTB verrucosa cutis (5%)\nOther rare (3%)\n\nSo the answer to this question is A"} {"instruction": "Thyroglossal fistula develops due to -\nA. Developmental anomaly\nB. Injury\nC. Incomplete removal of thyroglossal cyst\nD. Inflammatory disorder", "response": "Thyroglossal fistula is never congenital. It follows infection or inadequate removal of a thyroglossal cyst.\n\nSo the answer to this question is C"} {"instruction": "Sorbitol acts in the prevention of dental caries by\nA. Microorganisms Lack the enzyme to metabolize sorbitol\nB. Lactic acid can not be produced\nC. Fermentation of sorbitol does not occur\nD. sorbitol is not a carbohydrate", "response": "None\n\nSo the answer to this question is A"} {"instruction": "All of the following are true about glucose transport in kidney except\nA. Sodium Glucose symport is an example of primary active transport\nB. GLUT - 2 receptors are present along basolaterl membrane\nC. Defective SGLT - 2 leads to isolated renal glycosuria\nD. Transport maximum for glucose is 2 oomg / dL", "response": "Sodium glucose linked transporter is an example of secondary active transport.\n\nSo the answer to this question is A"} {"instruction": "Staple food as maize causes?\nA. Xerophthalima\nB. Scurvy\nC. Beri-beri\nD. Pellagra", "response": "ANSWER: (D) PellagraREF: Harper 27th ed chapter 29, Parks 22 ed page 574Also see tryptophan metabolism in Biochemistry 2014 Session 1Maize is deficient is Tryptophan which is required for Niacin biosynthesis. Niacin deficiency causes pellagraFood rich in niacin and/or tryptophan are liver Kidney meat, poultry, fish Legumes and groundnut. Milk is a poor Source of niacin but its proteins are rich in tryptophan which is converted in the body into niacin (about 60 mg of tryptophan is required to result in 1 mg of niacin). In many cereals, especially maize, niacin occurs in \"bound\" form unavailable to the consumer.While pellagra is historically a disease of the maize eating population it was reported in India in the Telangana area of Andhra Pradesh in some segments of the population eating another cereal that is jowar (Sorghum vulgare).\n\nSo the answer to this question is D"} {"instruction": "Arrhythmias refractory to the treatment of lignocaine can be treated by\nA. Sotalol\nB. Diltiazem\nC. Amiodarone\nD. Quinidine", "response": "Katzung 11e p 241. Amiodarone is an antiarrhythmic medication used to treat and prevent a number of types of irregular heabeats. This includes ventricular tachycardia, ventricular fibrillation, and wide complex tachycardia, as well as atrial fibrillation and paroxysmal supraventricular tachycardia.\n\nSo the answer to this question is C"} {"instruction": "High calcium intake can lead to\nA. Osteoporosis\nB. Osteopotrosis\nC. Milk alkali syndrome\nD. Renal failure", "response": "Refer Robbins page no Milk alkali syndrome is due to excessive ingestion of calcium and absorbabke antacids such as milk or calcium carbonate .This is associated with the development of metastatic Calcification\n\nSo the answer to this question is C"} {"instruction": "Carvallo's sign is seen in\nA. Tricuspid stenosis\nB. Mitral stenosis\nC. Aoic stenosis\nD. Aoic regurgitation", "response": "Ref Harrison 19 th ed pg 1548 A prominent RV pulsation along the left parasternal region and a blowing holosystolic murmur along the lower left sternal margin, which may be intensified during inspiration (Carvallo's sign) and reduced during expiration or the strain phase of the Valsalva maneuver, are characteristic findings. The murmur of TR may sometimes be confused with that of MR unless attention is paid to its variation during the respiratory cycle and the extent of RV enlarge- ment is appreciated.\n\nSo the answer to this question is A"} {"instruction": "First manifestation of Alport syndrome is :\nA. Microscopic haematuria\nB. Proteinuria\nC. Oliguria\nD. Sensorineural deafness", "response": "Ans. is 'a' Microscopic hematuria (Ref Harrison, 17/e p 2469, 16/e, p 2331 (15/e, p 1595)).The first symptom of Alport's syndrome is not mentioned anywhere.But in Harrison it is written that patients with Alport's syndrome usually presents with microscopic hematuria, proteinuria (nephrotic range in 30%) and progressive renal insufficiency.So the first symptom of Alport's syndrome can be taken as microscopic hematuria.Common extra renal manifestations include:Sensorineural hearing loss* (60%).Bilateral anterior lenticonus SC (15-30%)Recurrent corneal erosions*.\n\nSo the answer to this question is A"} {"instruction": "Pinch purpura around eyelids is one of the most common finding in -\nA. Fabry's disease\nB. Primary systemic amyloidosis\nC. Porphyria cutanea tarda\nD. None of the above", "response": "Ans. is 'b' i.e.. Primary systemic amyloidosis o Purpura of the eyelids following pinching (pinch purpura) is a characteristicfeature of primary systemic amyloidosiso Pinch purpura of the eyelids are seen in about 30% of the cases ofprimary systemic amyloidoses.o It occurs due to involvement of cutaneous blood vessels in primary1 systemic amyloidosis.o The most common skin lesions are pete hie or ecchymoses due to amyloid deposition within blood vessel walls with subsequent fragility and dermal hemorrhage.o These are o ften seen at sites predisposed to trauma, such as the hands or intertriginous areas.o Pinching the skin gives charaterstic purpura lesions known as \"pinch purpura\".o Purpura around the eyes may occur spontaneously but is also seen following proctoscopy or vomiting (postproctoscopic purpura).o Dermatological involvement occur in about 30% - 40% patients with systemic amyloidosis.o Other dermatological manifestations include waxy or translucent papules and lets frequently tense hemorrhagic bullae.o Histopathology of the cutaneous lesions reveal amyloid deposits in the dermis.o Occular findings in primary generalized amyloidosis includes :Purpura of the eyelids.B/l symmetrical small amyloid papules of the skin of the eyelids.PtosisOphthalmalgia or evidence of amyloid neuropathes affective pupillary function or both.Subconjunctival hemorrhages.\n\nSo the answer to this question is B"} {"instruction": "Composition of Nova-T is _______\nA. Copper and silver\nB. Copper and aluminium\nC. Copper only\nD. Copper and selenium", "response": "Composition of Nova-T is copper and silver Copper carrying devices: In these, copper wire of surface area 200 to 250mm is wrapped round the veical stem of a polypropylene frame. Among these devices are copper T 200, Copper 7, Multiload copper 250, Cop-per T 380, Copper T 220 and Nova T. They have an effective life of about 3-5 years. It is estimated that about 50 mcg of copper is elute daily in the uterus. Copper T 380, known as Paraguard, has a lifespan of 1 years. Nova-T had silver added to the copper wire, thereby increasing its lifespan to 5 years. IUCDs are a good contraceptive choice for the following groups of women: Low-risk of STD. Multiparous woman Monogamous relationship Desirous of long-term reversible method of contraception, but not yet desirous of permanent sterilization Unhappy or unreliable users of oral contrception or barrier contraception Uses of IUCD: As a contraceptive Postcoital contraception (emergency contraception) Preferably avoid its use in unmarried and nulliparous patients because of the risk of PID and subsequent tubal infeility. Ref: Shaw&;s textbook of Gyaecology 17th edition Pgno: 258\n\nSo the answer to this question is A"} {"instruction": "In normal diurnal variation, intraocular pressure is:\nA. Highest on awakening and lowest during evening\nB. Lowest during morning and highest during evening\nC. Highest in the morning and evening\nD. Lowest in the morning and evening", "response": "Ans. Highest on awakening and lowest during evening\n\nSo the answer to this question is A"} {"instruction": "A 25-year-old male patient having seminiferous tubule dysgenesis was diagnosed as a case of Klinefelter&;s syndrome. All of the following are true about Seoli cells except\nA. Seoli cells are large, complex glycogen-containing cells stretching from the basal lamina of the tubule to the lumen\nB. Tight junctions between adjacent Seoli cells near the basal lamina form a blood-testis barrier\nC. The Seoli cells secrete androgen-binding protein (ABP), relaxin, and MIS\nD. They can produce estrogens", "response": "\"The walls of the seminiferous tubules are lined by primitive germ cells and Seoli cells, large, complex glycogen-containing cells that stretch from the basal lamina of the tubule to the lumen. Germ cells must stay in contact with Seoli cells to survive; this contact is maintained by cytoplasmic bridges. Tight junctions between adjacent Seoli cells near the basal lamina form a blood-testis barrier that prevents many large molecules from passing from the interstitial tissue and the pa of the tubule near the basal lamina. Spermatids mature into spermatozoa in deep folds of the cytoplasm of the Seoli cells. Mature spermatozoa are released from the Seoli cells and become free in the lumens of the tubules. The Seoli cells secrete the androgen-binding protein (ABP), inhibin, and MIS. They do not synthesize androgens, but they contain aromatase (CYP19), the enzyme responsible for the conversion of androgens to estrogens, and they can produce estrogens. ABP probably functions to maintain a high, stable supply of androgen in the tubular fluid. Inhibin inhibits follicle-stimulating hormone (FSH) secretion.\"\n\nSo the answer to this question is C"} {"instruction": "For radiotherapy an isotope is paced in or around canecr site. It is called as:\nA. Brachytherapy\nB. Tefetberapy\nC. External beam therapy\nD. Intensity Medulated radiotherapy", "response": "Ans: A (Brachytherapy) Types of radiotherapy Grainger & Allison's Diagnostic Radiology 6thfl 737-44External beam radiotherapy: It refer to any situation where the source of the radiation is located at a distance from the patient & the beam of radiation is then directed towards a defined treatment area. Approximately 85% of all therapeutic radiation exposures are delivered using externa! beam techniques.Conventional external beam radiotherapyThree dimensional conformal radiotherapyIntensity-modulated radiotherapy: In this the intensity of radiation beam is modulated across each treatment beamStereotactic body radiotherapy: The distribution of radiation beam is in 3-dimensions & not in two as in traditional radiotherapyBrachytherapy: 11 refers to situation in which a radioisotope is placed onto or inside the patient. The source can be placed into the target tissues or tumour itself such as prostate or breastfinterstitial brachytherapy, into a body cavity such as the uterine cavity, oesophagus or bronchus (intracavity/ intraluminal brachytherapy) otonto the skin surface to treat a cutaneous malignancyParticle therapy: Also known as Hadron therapy. It is an external beam radiation technique in which highly energetic particle such as protons, neutrons or positive ions are directed at the tumorTeletherapy: Treatment in which the radiation source is at a distance from the body. Linear accelerators & cobalt machines are used in teletherapy. Also called external beam therapy\"-'\"Brachy therapy: A type of radiation therapy is which radioactive materials are placed in direct contact with the tissue being treated. Broadly it is of two types- interstitial or intracavity\"- Review of Radiology by Sumer Sethi 6thfl 76Types of brachytherapyMold brachytherapy*3 Superficial tumours can be treated using sealed sources placed close to the skinInterstitial brachytherapy13 Here the sources are inserted into tissueIntracavitary brachytherapy13 places the sources inside a pre-existing body cavityIntravascular brachytherapy places a catheter inside the vasculature through which sources are sent and returnedElectronic brachytherapy places a miniature low energy (< SOkVp) x-ray tube source into a pre-positioned applicator within body/tumor cavities to rapidly deliver high doses to target tissues while maintaining low doses to distant non-target tissuesTHERAPEUTIC RADIATION Harrison 19thTherapeutic radiation is delivered in three ways: (1) teletherapy, with focused beams of radiation generated at a distance and aimed at the tumor within the patient; (2)brachytherapy, with encapsulated sources of radiation implanted directly into or adjacent to tumor tissues; and (3)systemic therapy, with radionuclides administered, for example, intravenously but targeted by some means to a tumor site.Teletherapy with x-ray or gamma-ray photons is the most commonly used form of radiation therapy.\n\nSo the answer to this question is A"} {"instruction": "Bone resorption markers are except:\nA. Taarate resistant alk. phosphatase (TRAP)\nB. Osteocalcin\nC. Cross linked-N-telopeptides\nD. Urine total free deoxypyridinoline", "response": "Osteocalcin Osteocalin is a non-collogenous protein secreted by osteoblasts. It is thought to play a role in mineralization and calcium ion hemostasis. \"Thus it is a bone formation marker i.e. osteoblastic marker\". A large number of studies have shown that the circulating level of osteocalcin reflects the rate of bone formation (not resorption). Biochemical markers of bone resorption Abbr. Name Mechanism Company NTX Aminoterminal cross-linking telepeptide of bone collagen Collagen-based Ostex (Osteomark) CTX Carboxyterminal cross-linking telopeptide of bone collagen Pyridinoline Collagen-based Collagen-based Cross-laps (Osteometer) PYD DPD Free Lysyl-pyridinoline (deoxypyridinoline) Collagen-based Metra (PyrilinksD) TRACP Tarate-resistant acid phosphatase Secreted by osteoclasts Hyp Hydroxy-proline (not very specific) Collagen-based Bone ALP Bone-specific alkaline phosphatase Secreted by osteoblasts Hybritech (Ostase) BAP Metra (Alkphase-B) Orion, Metra (Prolagen) PINP PICP Procollagen type IC propeptide Collagen-based Procollagen type 1 N propeptide Collagen-based Iscstar OC Osteocalcin (bone gla-protein) Secreted by osteoblasts Nichols, Cis Biointer national ALP Alkaline phosphatase (not very specific) Secreted by osteoblasts\n\nSo the answer to this question is B"} {"instruction": "Which of the following does not have a Tm value?\nA. Na+\nB. Urea\nC. Creatinine\nD. Glucose", "response": "Transpo maximum (Tm) or tubular maximum : is the maximum amount of a substance that can be transpoed across the tubule (reabsorbed or secreted) per unit time.E.g., glucose has a Tm value of 320 mg/min. Reabsorption or secretion of most substances is mediated by their respective carrier proteins in the wall of the tubules. Tm implies saturation of the carrier. Since Na+ reabsorption primarily involves the activity of Na+/K+ pump which does not exhibit saturation kinetics, Na+ reabsorption does not have a Tm value.\n\nSo the answer to this question is A"} {"instruction": "An 18 year old boy came to the Psychiatry OPD with a complaint of feeling changed from inside. He described himself as feeling strange as if he is different from his normal self. He was very tense and anxious yet could not point out the precise change in him. This phenomena is best called as -\nA. Delusional mood\nB. Depersonalization\nC. Autochthonous delusion\nD. Over valued idea", "response": "Feeling strange as if different from oneself, i.e. feeling of detached from self is seen in depersonalization disorder.\n\nSo the answer to this question is B"} {"instruction": "\"Crescents\" on histopathologic examination of glomerulus are seen in\nA. Minimal change disease\nB. Rapidly proliferative GN\nC. Membranous glomerulonephritis\nD. MPGN", "response": "Ans. b (RPGN). (Ref. Robbin, Pathology 8th ed., 545)Rapidly Progressive (Crescentic) Glomerulonephritis# RPGN is a clinical syndrome and not a specific etiologic form of GN.# Clinically, it is characterized by rapid and progressive loss of renal function with features of the nephritic syndrome, often with severe oliguria and (if untreated) death from renal failure within weeks to months.# Regardless of the cause, the histologic picture is characterized by the presence of crescents (crescentic GN).# These are produced in part by proliferation of the parietal epithelial cells of Bowman's capsule in response to injury and in part by infiltration of monocytes and macrophages.Type I (Anti-GBM Antibody)IdiopathicGoodpasture syndromeType II (Immune Complex)IdiopathicPostinfectious/infection relatedSystemic lupus erythematosusHenoch-Schonlein purpura/IgA nephropathyType III (Pauci-Immune) ANC A AssociatedIdiopathicWegener granulomatosisMicroscopic angiitis\n\nSo the answer to this question is B"} {"instruction": "Myosin and actin filaments are kept in place by\nA. Tropomyosin\nB. Troponin\nC. Actinin\nD. Titin", "response": "Titin keeps actin and myosin in place It povides elasticity It is present in skeletal and cardic muscles Ref:Guyton and Hall textbook of medical physiology 12th edition ,pag number:85,86,87\n\nSo the answer to this question is D"} {"instruction": "For reduction of cholesterol, the best management includes:\nA. Cholesterol restricted diet\nB. High fiber diet\nC. Diet with high unsaturated FA and low saturated FA\nD. Cholesterol restricted diet, high fiber and diet with low saturated FA to unsaturated FA ratio", "response": "D i.e. Cholesterol restricted diet, high fiber diet with low saturated FA to unsaturated FA ratio.\n\nSo the answer to this question is D"} {"instruction": "55 year old female a known case of thryotoxicosis in control posted for abdomino perineal resection during surgery there was sudden drop in B.P., and end tidal CO2 decreased from 40 to 10 mmHg. On auscultation there was a mill wheel murmur, what is the diagnosis –\nA. Thyroid storm\nB. Bleeding\nC. Hypoxia\nD. Air embolism", "response": "Presence of Mill wheel murmur and decrease in End tidal CO2 during surgery suggests Air embolism:-\n\"If air enters the vein in sufficient amount, it will go to the right heart and lung causing an air-lock obstruction in the pulmonary artery. This may result in a loud continuous precordial murmur, the so called \"Mill wheel murmur\".\n\nSo the answer to this question is D"} {"instruction": "Macrosomia is/are associated with:a) Gestational diabetes mellitusb) Maternal obesityc) Hypothyroidism d) Hyperbilirubinemia e) Fetal goitre\nA. ac\nB. a\nC. ad\nD. ab", "response": "The recommended definition is fetal (neonatal) weight exceeding two standard deviations or above 90th centile for the appropriate normal population.\nAccording to ACOG: birth weight of > 4500 gm is called as macrosomia.\nIn Indian context birth weight of > 4000 gm is called as macrosomia.\n\nSo the answer to this question is D"} {"instruction": "A person restricts himself to house and fears about trains, elevators, and shopping malls. It is a feature of\nA. Generalised Anxiety disorder\nB. Agoraphobia\nC. Claustrophobia\nD. Acrophobia", "response": "(B) Agoraphobia # Agoraphobia is an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives the environment to be unsafe with no easy way to get away.> These situations can include open spaces, public transit, shopping malls, or simply being outside the home. Being in these situations may result in a panic attack.> Symptoms occur nearly every time the situation is encountered and lasts for more than six months.> Those affected will go to great lengths to avoid these situations. In severe cases people may become unable to leave their homes.# Cause of agoraphobia is a combination of genetic and environmental factors. Condition often runs in families and stressful events such as the death of a parent or being attacked may be a trigger. In the DSM-5 agoraphobia is classified as a phobia along with specific phobias and social phobia. Other conditions that can produce similar symptoms include separation anxiety, posttraumatic stress disorder, and major depressive disorder. Those affected are at higher risk of depression and substance use disorder.> Treatment: Without treatment it is uncommon for agoraphobia to resolve. Treatment is typically with a type of counselling called cognitive behavioral therapy (CBT). CBT results in resolution for about half of people# Claustrophobia is the fear of having no escape and being in closed or small spaces or rooms.> It is typically classified as an anxiety disorder and often results in panic attack, and can be the result of many situations or stimuli, including elevators crowded to capacity, windowless rooms, and even tight-necked clothing.> Onset of claustrophobia has been attributed to many factors, including a reduction in the size of the amygdala, classical conditioning, or a genetic predisposition to fear small spaces.> Claustrophobia is typically thought to have two key symptoms: Fear of restriction Fear of suffocation> A typical claustrophobic will fear restriction in at least one, if not several, of the following areas: small rooms, locked rooms, cars, aeroplanes, trains, tunnels, cellars, elevators, caves.# Acrophobia is an extreme or irrational fear or phobia of heights, especially when one is not particularly high up.> It belongs to a category of specific phobias, called space and motion discomfort, that share both similar etiology and options for treatment.\n\nSo the answer to this question is B"} {"instruction": "The occlusal outline of the permanent mandibular first molar is usually similar to\nA. Circle\nB. Square\nC. Trapezoid\nD. Parallelogram", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Which of the following is not a modification for the class III cavity preparation to receive direct filling gold restorations?\nA. Ferrier design\nB. Loma Linda design\nC. Ingraham design\nD. Moustache extensions", "response": "Class V with unilateral or bilateral “moustache” extensions occlusally:\nSometimes surface defects occlusal to the height of contour are continuous with a gingival third lesion, necessitating their involvement in the Class V cavity preparation and their restorations. So one or two occlusal extensions are added to the basic trapezoidal Class V cavity preparation.\n\nSo the answer to this question is D"} {"instruction": "In case of vesicoureteric reflux which will be inv. Of choice -\nA. Micturating cystourethrogram\nB. IVP\nC. Cystography\nD. Radionucletide study", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Which of the following statements best describes the colon?\nA. The majority is derived from the primitive hindgut.\nB. It is usually invested with peritoneum on all sides.\nC. The hepatic flexure is related directly to the liver and right kidney.\nD. The ascending and descending colon are always retroperitoneal.", "response": "The hepatic flexure is directly in contact with the liver and the right kidney; it is therefore at risk in a right nephrectomy. The majority of the colon is derived from the midgut, which extends to a point just proximal to the splenic flexure. The descending colon and sigmoid are derived from the hindgut. The ascending and descending colon are usually in contact with the abdominal wall posteriorly and with peritoneum on the rest of the surface. The posterior pa is therefore free from peritoneum.\n\nSo the answer to this question is C"} {"instruction": "Renal artery lumen is reduced by half, what will be the blood flow?\nA. Reduce by 1/2\nB. Reduce by 1/4\nC. Reduce by 1/16\nD. Come to normal after autoregulation", "response": "Ans: C. Reduce by 1/16Option c is correct because the flow of fluids can be described by Poiseuille's Law.In which flow of liquid is directly proportional to R4, So if lumen is reduced to half then blood flow will get reduce by 1/16.Other points related to blood flow...Poiseuille's Law states that the flow (Q) of fluid is related to a number of factors:The viscosity (n) of the fluidThe pressure gradient across the vessel (P)Length (L) and diameter(r) of the vesselDiameter: Doubling the diameter of tube increases the flow rate by 16 fold (r4). The larger the vessels's diameter greater is the blood flow.Viscosity: Flow is inversely proportional to the viscosity of the fluid.Viscosity of blood increases with increasing hematocrit and decreasing temperaturePressure: Increasing pressure further maximizes flow as described by Poiseuille's equation.The relationship is given by Poiseuille-Hagen formula:F=(PA -PB )x(8p )x(e1 )x(Lr4 )WhereF = FlowPA - PB = Pressure difference between two ends of the tube q = Viscosity r = Radius of tube L = Length of tubeRelationship between arterial blood pressure and blood flow given in graph below:\n\nSo the answer to this question is C"} {"instruction": "Sterility in man is when sperm count falls below (in\nmillions)\nA. 20\nB. 40\nC. 60\nD. 80", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Which of the following muscles carries out shoulder abduction from 15 to 90 degrees?\nA. Suprapinatus\nB. Trapezius\nC. Deltoid\nD. Serratus Anterior", "response": "Ans. is 'c' i.e., Deltoid Abduction of shoulder* Abduction is initiated by supraspinatus, which is responsible abduction upto 15 degrees.* After that deltoid (acromial or middle fibers) is the major abductor upto 90 degrees of abduction. These two muscles, supraspinatus and deltoid are the prime movers for abduction.* Overhead abduction (> 90 degrees) is caused by trapezius and serratus anterior, which act by causing upward rotation of glenoid cavity.* In abduction, out of total 180 degree elevation, humerus moves 120o at the shoulder joint and the remaining 60 degree is done by rotation of scapula. In every 15o elevation, shoulder joint contributes lOo and scapular rotation 5o, in the ratio of 2:1. Rotation of scapula is facilitated by movements at sternoclavicularand acromioclavicular joints. In higher ranges of abduction there is lateral rotation of humerus. Lateral rotation of scapulaincreases the range of humeral elevation.\n\nSo the answer to this question is C"} {"instruction": "A 45 year old man presents to a physician with back pain and facial pain. Physical examination demonstrates coarse facial features and kyphosis. Laboratory examination is remarkable for elevated alkaline phosphatase. .X-ray studies demonstrate skull thickening with narrowing of foramina, and bowing of the femur and tibia. Bone biopsy reveals a mosaic pattern of bone spicules with prominent osteoid seams. Which of the following neoplasms occurs at an increased frequency in patients with this disorder?\nA. Astrocytoma\nB. Hodgkin's lymphoma\nC. Meningioma\nD. Osteosarcoma", "response": "The phrase \"mosaic pattern\" of newly formed woven bone is a specific tip-off for Paget's disease of bone, and is not seen in other bone conditions. The clinical and radiologic presentation are typical; an increased hat size may also be a clue. In its early stages, Paget's disease is characterised by osteolysis, producing patchwork areas of bone resorption with bizarre, large osteoclasts. In the middle stage of the disease, secondary osteoblastic activity compensates with new bone formation, producing the mosaic pattern. In late Paget's, the bones are dense and osteosclerotic. Paget's disease is suspected to be related to prior viral infection, but the cause remains mysterious. Complications include myelophthisic anemia, high output cardiac failure, pain secondary to nerve compression, deformities secondary to skeletal changes, and in about 1% of patients, osteosarcoma or other sarcoma, typically involving the jaw, pelvis, or femur. An increased incidence of astrocytomas is associated with tuberous sclerosis.Hodgkin's lymphoma is usually a disease of young adults, although older patients may have the lymphocyte-depleted form.Meningiomas are mostly benign tumors that affect adults, especially females. There may be an association with breast cancer, possibly related to high estrogen states. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 19. Pathology of the Bones and Joints. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture.\n\nSo the answer to this question is D"} {"instruction": "A police officer brings the aboed product of conception of size 2 cm and weight 10 gm. For all forensic purposes what will he the age of the fetus\nA. 2 weeks\nB. 4 weeks\nC. 6 weeks\nD. 8 weeks", "response": "Ans. c. 6 weeks Rule of Hasse Rule of Hasse is used to determine the age of fetus from crown to heel length in cm. During first five months, Length in cm = (Age in months)2 After age of >5 months, Age in months = (Length in cm)/5 Age of the Fetus End of first month Length 1 cm, weight two and half gram Eyes are seen as two dark spots and mouth as a cleft End of second month Length 4 cm, weight 10 gms Hands and feet are webbeddeg Anus is seen as a dark spot Age of the Fetus End of third month Length 9 cm, Weight 30 gms Eyes are closeddeg, pupillary membrane appears Nails appear and neck is formed End of fouh month Length 16 cm, weight 120 gmsdeg Sex can be recognized End of fifth month Length 25 cm, weight 400 gms Nails are distinct and softdeg Light hairs appear on headdeg End of sixth month Length 30 cm, weight 700 gms Eyebrow and eyelashes appeardeg Subcutaneous fat begins to be depositeddeg Testes are seen close to kidney End of seventh month Length 35 cm, weight 900-1200 gms Nails are thick Eyelids open and pupillary membrane disappearsdeg Testes found at external inguinal ringdeg End of eighth month Length 40 cm, weight one and half to two kg Nails reach the tips of fingersdeg Left testes in scrotumdeg End of ninth month Length 45 cm, weight two and half to three kg Scalp hair is dark and 4 cm longdeg Scrotum is wrinkled and contains both testesdeg End of tenth month Length 50-53 cm, weight 2.5-5 kg The nails project beyond the end of fingers but reach only the tip of the toes\n\nSo the answer to this question is C"} {"instruction": "NOT a sign of POTT's spine\nA. Tenderness\nB. Sensory loss\nC. Paravertebral muscle sparm\nD. Loss of Deep tendon reflexes", "response": "None\n\nSo the answer to this question is D"} {"instruction": "CA125 is used for?\nA. Follow up of ovarian cancer\nB. Diagnosis of pancreatic cancer\nC. Diagnosis of stomach cancer\nD. Diagnosis of ovarian cancer", "response": "ANSWER: (A) Follow up of ovarian cancerREF: Robbins pathology ch: 7Biochemical assays for tumor-associated enzymes, hormones, and other tumor markers in the blood cannot be used for definitive diagnosis of cancer; however, they contribute to the detection (screening) of cancer and in some instances are useful in determining the effectiveness of therapy or the appearance of a recurrence. Remember tumour markers are always used for screening or prognosis, never for diagnosis.Conditions associated with raised CA-125Best known tumour marker for ovarian ca. endometrial cancer, fallopian tube cancer, lung cancer, breast cancer and gastrointestinal cancer.CA-125 may also be elevated in a number of relatively benign conditions, such as endometriosis several diseases of the ovary, menstruation and pregnancy. It also tends to be elevated in the presence of any inflammatory condition in the abdominal area, both cancerous and benign.Role of CA-125 in ovarian carcinoma:[?] Early detection and prognosis[?] Monitor responses to chemotherapy, relapse, and disease progression.[?] Levels of CA125 can be elevated in the serum before clinical development of primary and recurrent ovarian carcinoma[?] An important characteristic of CA125 is the ability to reflect changes in tumor mass during chemotherapy or in the follow-up period after completion of therapy[?] The postoperative serum CA125 level is an independent prognostic factor in patients with invasive ovarian cancer\n\nSo the answer to this question is A"} {"instruction": "37 weeks primi with uterine contraction for 10 hours, cervix is 1 cm dilated and poorly effaced management is:\nA. Cesarean section\nB. Amniotomy\nC. Oxytocin drip\nD. Sedation and wait", "response": "Ans. is d, i.e. Sedation and waitRef. Fernando Arias 3/e, p 376The patient is presenting at 37 weeks with mild labor pains for 10 hours. Cervix is 1 cms dilated and is not effaced. Now this can either be a case of false labor pains or it can be prolonged latent phase of labor.False labor can be differentiated from latent phase of labor by therapetuic rest, i.e. patient is sedated with morphine.Patient in false labor|Sleeps for a few hours and wakes-up without contractionsPatient in latent phase|Continues contracting and show cervical changes following the restSo the correct option is Sedate and Wait.\n\nSo the answer to this question is D"} {"instruction": "A 9-year-old male comes in for a routine physical examination. The pediatrician notices that the right testis is enlarged and without tenderness. The examination reveals following finding: This fluid most likely occupies which space?\nA. D\nB. A\nC. B\nD. C", "response": "The image shows the classical finding of transillumination seen in hydrocoele. A- Epididymis B- Cremasteric layer C- Tunica vaginalis D- External spermatic fascia This patient most likely has a hydrocele, which is a fluid collection in the tunica vaginalis. This is a congenital condition formed when the testis descends through the inguinal canal together with some peritoneum. Peritoneal fluid sometimes accumulates in this space.\n\nSo the answer to this question is D"} {"instruction": "Sample collection for renal tuberculosis is\nA. Single early morning urine sample\nB. 24 hours urine collection\nC. 3 random urine collection\nD. 3 morning sample of urine", "response": "BACTERIOLOGICAL:- The diagnosis of genitourinary TB is confirmed on a tuberculin test or atleast three consecutive early morning samples of urine are collected and sent for microscopy (Ziehl-Neelsen staining), culture on Lowenstein-Jensen medium. RADIOGRAPHY:- A plain abdominal radiograph may show calcified lesions of CEMENT KIDNEY. INTRAVENOUS UROGRAPHY:-EARLY:-Normally clear cut outline of renal papillae may be rendered indistinct by presence of ulceration. TUBERCULOUS ABSCESS:-Appears as SOL , which causes adjacent calyces to splay out. LATE:- Dilatation of contralateral ureter from obstruction where the ureters passes through thickened and oedmatous bladder wall. CYSTOSCOPY:- GOLF-HOLE ureteric orifice. CXR:-Active Lung lesion. Reference : Bailey27th edition . chapter 76 , pg no: 1405\n\nSo the answer to this question is D"} {"instruction": "MAO inhibitors should not be used with -\nA. Buprenorphine\nB. Pethidine\nC. Pentazocin\nD. Morphine", "response": "Ans. is 'b' i.e., Pethidine o Nonselective MAO inhibitors interact with many food constituents and drugs : 1-Cheese reaction o Ceain varieties of cheese, beer, wines, picked meat and fish, yeast extract contain large quantities of tyramine, dopa. o In MAO inhibited patients these indirectly acting sympathomimetic amines escape degradation in the intestinal wall and liver --> reaching into systemic circulation they displace large amount of NA from adrenergic nerve endings Hypeensive crisis, cerebrovascular accidents. This can be treated by Lv. injection of a rapidly acting a-blocker eg, phentolamine. Prazosin and chlorpromazine are alternative. 2. Reserpine, guanethidine, tricyclic antidepressant. o Rise in BP and body temprature can occur when these drugs are given with MAO inhibits --> due to their initial NA releasing or uptake inhibiting action. 3. Levodopa Excitement and hypeension occur due to increase V\" of DA that is produced from levodopa. 4. Antiparkinsonism anticholinergic Symptoms of atropine poisoning occur. 5. Brabiturates, opoids, alcohol, antihistamininc o Action of these drugs is intensified and prolonged. 6. Pethidine o High fever, sweating, excitation, delirium, convulsion and respiratory depression occur. o This is due to excess production of norpethidine (normally it is minor metabolites). o MAO inhibitors inhibit hydrolysis but not detmethylation more norpethidine is produced. 7. SSRIs o MAO inhibitors produce serotonine syndrome when given with SSRIs.\n\nSo the answer to this question is B"} {"instruction": "Renal aery stenosis is caused by all except\nA. Atherosclerosis\nB. Fibromuscular dysplasia\nC. Takayasu aeritis\nD. Buerger's disease", "response": "Renal aery stenosis: aCauses- Atherosclerotic disease(most common cause) - Fibromuscular Dysplasia(FMD) - Extrinsic compression of the vessel a It is considered a specifically treatable \"secondary\" cause of hypeension a Pathogenesis: Critical levels of stenosis - reduction in perfusion pressure - Activation of the renin-angiotensin system and sympathetic adrenergic pathways - systemic hypeensiona LVH and renal fibrosis (later stages) a Renal aery stenosis is also labelled ischemic nephropathy; ARAS and SHT tend to affect both the poststenotic and contralateral kidneys, reducing overall (GFR) in ARAS Fibromuscular Dysplasia(FMD Atherosclerotic renal aery stenosis (ARAS) - Occurs in 3-5% of normal subjects - Presents clinically with hypeension in younger individuals (age 15-50), most often women. - lesions are frequently bilateral and, tend to affect more distal poions of the renal aery. - Usually does not affect kidney function, but may cause total occlusion and can be associated with renal aery aneurysms - Common in the general population, prevalence increases with age and in patients with CAD, PAD. - obstruction most commonly at the origin - If untreated may progress to total occlusion in 50% cases - It is a strong predictor of morbidity- and moality-related cardiovascular events a Evaluation: -Captopril renography with technetium 99m Tc meiatide (99mTc MAG3) a Normal study excludes renovascular hypeension-Nuclear imaging with technetium meiatide or technetium-labelled pentetic acid (DTPA)a Allows calculation of single-kidney GFR -Duplex ultrasonographyaInexpensive, non-invasive - Magnetic resonance angiographyaExpensive; not nephrotoxic but gadolinium toxicity excludes use in GFR<30 ml/min, unable to visualize stented vessels -computed tomographic angiographyaExpensive, potentially nephrotoxic, stents do not cause aefacts -Intra-aerial angiographyaConsidered \"gold standard\" for diagnosis of large vessel disease; Expensive, associated risk of atheroemboli, contrast toxicity, procedure-related complications, e.g., dissection a Treatment: -blockade of the renin-angiotensin system, attainment of goal blood pressures, cessation of tobacco, statins, and aspirin -percutaneous transluminal renal angioplasty (PTRA) (for FMD), endovascular stenting or surgical renal revascularization(for ARAS) Ref: Harrison's 18/e p2048\n\nSo the answer to this question is D"} {"instruction": "A child has respiratory distress, chest X-ray shows multiple air-filled space, the differential diagnosis is all except –\nA. Congenital lung cyst\nB. Congenital diaphragmatic hernia\nC. Congenital lobar aplasia of lung\nD. Congenital adenomatous malformation", "response": "Congenital lobar aplasia does not produce air-filled spaces on chest X-ray. All other three options produce air-filled space on chest X-ray.\n\nSo the answer to this question is C"} {"instruction": "Which of the following is false about WPW syndrome\nA. Accessory bundle between atria and ventricles without conduction delay\nB. Short PR interval\nC. Epsilon waves\nD. Wide QRS complexes", "response": "Delta waves are seen in WPW syndrome.\n\nSo the answer to this question is C"} {"instruction": "Commonest thyroid tumor in MEN (multiple endocrine neoplasia) -\nA. Follicular\nB. Papillary\nC. Anaplastic\nD. Medullary", "response": "Ans. is 'd' i.e., Medullary o Thyroid tumor is seen in MEN II, and is medullary carcinoma of thyroid.\n\nSo the answer to this question is D"} {"instruction": "Tetracycline inhibits protein synthesis by?\nA. Inhibiting initiation and causing misreading of mRNA\nB. Binding to 30 S subunit and inhibits binding of aminoacyltRNA\nC. Inhibiting peptidyltransferase activity\nD. Inhibiting translocation", "response": "Ans. is 'b' i.e., Binding to 30 S subunit and inhibits binding of aminoacyl tRNA Tetracycline interact with small ribosomal subunits, blocking access of aminoacyl- tRNA to the mRNA-ribosome complex.\n\nSo the answer to this question is B"} {"instruction": "Fetal middle cerebral artery Doppler is most useful in the evaluation of -\nA. intrauterine growth restriction\nB. Preeclampsia\nC. Fetal anemia\nD. Fetal metabolic disorders", "response": "Ans-CMCA - PSA for fetal anemia in Rh- pregnancy.\n\nSo the answer to this question is C"} {"instruction": "Most common muscle to be congenitally absent -\nA. Teres major\nB. Pectoralis major\nC. Gastrosoleus\nD. Semimembranosus", "response": "Congenital absence of Pectoralis major is the most common.\n\nSo the answer to this question is B"} {"instruction": "Ibalizumab was approved by FDA in 2018 April for ( REPEAT)\nA. HIV\nB. TB\nC. Leprosy\nD. Malaria", "response": "Ibalizumab was approved for HIV in 2018 Ibalizumab belongs to a new class of HIV drugs called post-attachment inhibitors. Post-attachment inhibitors work by attaching to CD4 receptor on the surface of the immune cells. When ibalizumab attaches to the CD4 receptor, HIV cannot attach to, enter, or infect the cell.\n\nSo the answer to this question is A"} {"instruction": "Sistrunk's operation is excision of\nA. Thyroglossal cyst.\nB. Thyroglossal fistula.\nC. Thyroglossal fistula along with thyroglossal tract.\nD. All of the above.", "response": "None\n\nSo the answer to this question is C"} {"instruction": "The child , Pretends in play at the age of __________\nA. 18 months\nB. 24 months\nC. 30 months\nD. 36 months", "response": "Emerging patterns of social behaviour from 1-5years of age 15months Indicates some desires or needs by pointing Hugs parents 18months Feeds self Seeks help when in trouble May complain when wet or soiled Kisses parent with pucker 24months Handles spoon well Often tells about immediate experiences Helps to undress Listens to stories when shown pictures 30months Helps put things away Pretends in play 36months Plays simple games (in \"parallel\" with other children) Helps in dressing (unbuttons clothing and puts on shoes) Washes hands 48months Plays with several children, with the beginning of social interaction and role-playing Goes to the toilet alone 60months Dresses and undresses Asks questions about the meaning of words Engages in domestic role-playing Ref: Nelson paediatrics; Table 11-1\n\nSo the answer to this question is C"} {"instruction": "The half-life of Amiodarone is\nA. 3-8 min\nB. 3-8 hours\nC. 3-5 weeks\nD. 3-8 weeks", "response": "After oral administration, amiodarone only has a bioavailability of 30%. It also has a half-life of approximately 50 days, so it can take weeks for therapeutic effects to appear.\n\nSo the answer to this question is D"} {"instruction": "A female patient is presenting with BP of 90/60 and pulse rate 150/minutes after blunt abdominal trauma. How would you assess the patient\nA. USG\nB. CT scan\nC. X-ray\nD. MRI", "response": "Answer- A. USGThe diagnosis of abdominal injury by clinical examination is unreliable. Blunt abdominal trauma requires dessive investigation and management:If patient is hemodynmically stable and can be shifted - CT scan is the best.If patient is hemoilynamically unstable (cannot be shifted) - USG is the investigation of choice.\n\nSo the answer to this question is A"} {"instruction": "The most common cause of hypovolemic shock is\nA. Haemorrhage\nB. Decreased RBC formation\nC. Bone marrow suppression\nD. None of the above", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Cardiac output is determined by\nA. Ratio of organ to total peripheral resistance\nB. Mean stroke volume\nC. Mean BP\nD. Contractility of hea", "response": "Cardiac o/p=stroke volume*Hea rate Therefore cardiac o/p is collectively regulated by Stroke volume and Hea rate Ref: Ganong's Review of Medical Physiology Twenty-Third Edition Page No: 514\n\nSo the answer to this question is B"} {"instruction": "Glue ear is\nA. Painful\nB. Painless\nC. Naf is useful\nD. Radical mastoidectomy is required", "response": "Otitis media with effusion/ Serous OM/Glue ear/Secretory OM is a painless condition following accumulation of non-inflammatory exudate in the middle ear. Commonly seen in children.OME is the commonest cause of conductive deafness in children, and due to adenoid hyperophyIn adults, Nasopharyngeal carcinoma is to be ruled out.Treatment of choice- Myringotomy with grommet inseion.Ref: Hazarika; 3rd ed; Pg 146\n\nSo the answer to this question is B"} {"instruction": "Which of the following markers is specific for gastro intestinal stromal /tumors (GIST)?\nA. CD 117\nB. CD34\nC. CD23\nD. S-100", "response": "Marker in GIST CD117-( c-kit)- 95% CD34-70% Smooth muscle Actin-5%\n\nSo the answer to this question is A"} {"instruction": "All of the following statements are true about Wiskott Aldrich syndrome, except:\nA. Autosomal recessive disorder\nB. Low serum IgM level\nC. Thrombocytopenia\nD. Eczema", "response": "Wiskott-Aldrich syndrome X-linked recessive disease Characterized by thrombocytopenia, eczema, and a marked vulnerability to recurrent infection Mutation in gene encoding Wiskott-Aldrich syndrome protein (WASP), which is located at Xp11.23. IgM levels in the serum are low, but levels of IgG are usually normal. Paradoxically the levels of IgA and IgE are often elevated. The only treatment is HSC transplantation.\n\nSo the answer to this question is A"} {"instruction": "A 38-year-old male presents with increasing weakness and is found to have a markedly elevated peripheral leukocyte count. Laboratory testing on peripheral blood finds a decreased leukocyte alkaline phosphatase (LAP) score, while chromosomal studies on a bone marrow aspirate find the presence of a Philadelphia chromosome. This abnormality refers to a characteristic chromosomal translocation that involves the oncogene\nA. bcl-2 erb-B\nB. c-abl\nC. c-myc\nD. erb-B", "response": "Chronic myeloid leukemia (CML) is one of the four chronic myeloproliferative disorders, but, unlike myeloid metaplasia or polycythemia vera, CML is associated with the Philadelphia chromosome translocation t(9;22) in over 90% of cases. This characteristic translocation, which involves the oncogene c-abl on chromosome 9 and the breakpoint cluster region on chromosome 22, results in the formation of a new fusion protein (P210) that is a non-receptor tyrosine kinase. In differentiating CML from a leukemoid reaction, several other features are impoant in addition to the presence of the Philadelphia chromosome: lack of alkaline phosphatase in granulocytes, increased basophils and eosinophils in the peripheral blood, and, often, increased platelets in early stages followed by thrombocytopenia in late or blast stages. Other well-known features of CML include marked splenomegaly, leukocyte counts greater than 50,000/uL, and mild anemia. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition.\n\nSo the answer to this question is B"} {"instruction": "Otitic barotrauma results due to\nA. Ascent in air\nB. Descent in air\nC. Linear acceleration\nD. Sudden acceleration", "response": "Otitic barotrauma is a nonsuppurative condition resulting from the failure of the eustachian tube to maintain middle ear pressure at ambient atmospheric level. The usual cause is rapid descent during an air flight, underwater diving or compression in a pressure chamber. Reference: Diseases of Ear, Nose and Throat, PL Dhingra, Shruthi Dhingra,7th edition, pg no.71\n\nSo the answer to this question is B"} {"instruction": "In terms of birth defect potential, the safest of the following drugs is\nA. Alcohol\nB. Isotretinoin (Accutane)\nC. Tetracyclines\nD. Progesterone", "response": "Alcohol is an enormous contributor to otherwise preventable birth defects. Sequelae include retardation of intrauterine growth, craniofacial abnormalities, and mental retardation. The occasional drink in pregnancy has not been proved to be deleterious. Isotretinoin (Accutane) is a powerful drug for acne that has enormous potential for producing congenital anomalies when ingested in early pregnancy; it should never be used in pregnancy. Tetracyclines interfere with development of bone and can lead to stained teeth in children. Progesterone have been implicated in multiple birth defects, but controlled studies have failed to demonstrate a significant association with increased risk. Patients who have inadvertently become pregnant while on birth control pills should be reassured that the incidence of birth defects is no higher for them than for the general population. Phenytoin (Dilantin) is used for epilepsy and can be associated with a spectrum of abnormalities, including digital hypoplasia and facial abnormalities.\n\nSo the answer to this question is D"} {"instruction": "Fastest method for diagnosis of TB ?\nA. Gene expe\nB. LI medium\nC. TB MGIT\nD. BAC IEC", "response": "Ans. is 'a' i.e., Gene expe\n\nSo the answer to this question is A"} {"instruction": "The oxygen buffer function of hemoglobin is related to\nA. Dissociation curve shape\nB. Haldane effect\nC. Bohr effect\nD. Respiratory exchange ratio", "response": "Acid and base shifts in the blood are largely controlled by three main buffers in blood: (1) proteins, (2) hemoglobin, and (3) the carbonic acid-bicarbonate system. Plasma proteins are effective buffers because both their free carboxyl and their free amino groups dissociate. The second buffer system is provided by the dissociation of the imidazole groups of the histidine residues in hemoglobin. In the pH 7.0-7.7 range, the free carboxyl and amino groups of hemoglobin contribute relatively little to its buffering capacity. However, the hemoglobin molecule contains 38 histidine residues, and on this basis--plus the fact that hemoglobin is present in large amounts--the hemoglobin in blood has six times the buffering capacity of the plasma proteins. In addition, the action of hemoglobin is unique because the imidazole groups of deoxyhemoglobin (Hb) dissociate less than those of oxyhemoglobin (HbO2), making Hb a weaker acid and therefore a better buffer than HBO.Ref: Ganong's Review of Medical Physiology Twenty-Third Edition Page no: 614\n\nSo the answer to this question is A"} {"instruction": "Which of the following is true about carcinoma of colon\nA. Left colon tumors usually present with anaemia which is severe & unyielding to treatment\nB. Mucinous carcinoma has excellent prognosis\nC. Duke 'A' stage tumours need adjuvant chemotherapy\nD. Solitary superficial hepatic metastasis is not a contraindication for resection", "response": ".* 40% of carcinoma colon spreads to liver poal veins. * Secondaries may be either solitary or multiple, present as liver with hard, umbilicated nodules. - Rarely it spreads to bone, lung, skin.* 20% of cases present as an acute intestinal obstruction. * 20% of colonic/colorectal cancer has stage IV disease at the time of first presentation. * Right sided growth commonly presents with anaemia, palpable mass in the right iliac fossa, which is not moving with respiration, mobile, nontender, hard, well localized with impaired resonant note. * Left sided growth presents with colicky pain, altered bowel habits (alternating constipation and diarrhoea), palpable lump, distension of abdomen due subacute/ chronic obstruction. Later may present like complete colonic obstruction. ref:SRB's manual of surgery,ed 5,pg no 907\n\nSo the answer to this question is D"} {"instruction": "Which one of the following organisms is the most frequent cause of acute pyogenic meningitis in adults:\nA. Streptococcus pneumoniae\nB. Neisseria meningitis\nC. Haemophilus influenza\nD. Listeria monocytogenes", "response": "Ans. (a) Streptococcus pneumoniaeRef: Dhingra 5th ed. /61y 81\n\nSo the answer to this question is A"} {"instruction": "Which of the following is the commonest tumour of thyroid -\nA. Anaplastic carcinoma\nB. Follicular carcinoma\nC. Papillary carcinoma\nD. Medullary carcinoma", "response": "Ans. is 'c' i.e., Papillary 'Papillary carcinoma accounts for 80% of all thyroid malignancies in iodine-sufficient areas and is the predominant thyroid cancer in children and individuals exposed to external radiation.\" - SchwartzIncidence of primary malignant tumors of thyroid gland (Harrison 17/e)Type of thyroid carcinomaApproximate PrevalencePapillary Carcinoma80-90%Follicular Carcinoma5-10%Medullary Carcinoma10%Anaplastic CarcinomaRareLymphomas1-2%* Also rememberThyroid carcinoma is the most common malignancy of the endocrine system (Ref: Harrison, 17/e, p 2243)\n\nSo the answer to this question is C"} {"instruction": "Cataract is NOT seen with\nA. Steroids\nB. Vitamin B12 deficiency\nC. Diabetes mellitus\nD. Homocystinuria", "response": "(B) Vitamin B12 deficiency # CAUSES OF CATARACT> Age: Age is the most common cause> Trauma: Blunt trauma, Electrical injuries> Radiation: Ultraviolet light: glassblowers, Lasers> Genetics Chromosome abnormalities associated with cataracts -- 1 q21.1 deletion syndrome, cri-du-chat syndrome, Down synd ome, Patau's syndrome, trisomy 18 (Edward's syndrome), and Turner's syndrome, and Neurofibromatosis type 2. Examples of single-gene disorder -- Alport's syndrome, Conradi's syndrome, myotonic dystrophy, and oculocerebrorenal syndrome or Lowe syndrome.> Skin diseases: Atopic dermatitis & Eczema: Ichthyosis (cuneiform cataracts); Basal-cell nevus & Pemphigus> Smoking and alcohol> Medications: Corticosteroids, Antipsychotics, Miotics> Post-operative: Vitrectomy, Cataract Surgery> Metabolic and nutritional diseases: Aminoaciduria or Lowe's syndrome, Diabetes mellitus, Fabry's disease, Galactosemia /galactosemic cataract, Homocystinuria, Hyperparathyroidism, Hypoparathyroidism, Hypervitaminosis D, Hypothyroidism, Hypocalcaemia, Mucopolysaccharidoses, Wilson's disease> Congenital: Congenital syphilis, Cytomegalic inclusion disease, Rubella, Cockayne syndrome\\> Genetic syndromes: Down syndrome, Patau syndrome, Edwards syndrome> Infections: Cysticercosis, Leprosy, Onchocerciasis, Toxoplasmosis, Varicella> Secondary to other eye diseases: Retinopathy of prematurity, Aniridia, Uveitis, Retinal detachment, Retinitis pigmentosa\n\nSo the answer to this question is B"} {"instruction": "In Caldwell- Luc operation the nasoantral window is made through-\nA. Superior meatus\nB. Inferior meatus\nC. Middle meatus\nD. None of the above", "response": "Caldwell-Luc operation is a process of opening the maxillary antrum through canine fossa by sublabial approach and dealing with the pathology inside the antrum.\nIn this surgery, antrum is reached through an incision in gingivolabial sulcus (from lateral incisor to 2nd molar) and then opening of antrum in this area.\nDuring the surgery a nose-antral window is made through the inferior meatus so that after the surgery, packing of sinus can be removed through this window.\n\nSo the answer to this question is B"} {"instruction": "True about E. coil is -\nA. Sereny test is done to diagnose Enterotoxigenic E.coli (ETEC)\nB. Enteropathogenic E. coli (EPEC) are also enteroinvasive\nC. UTI is caused by single serotype at a time usually\nD. E. coli is the most common causative organism to infect burn wounds", "response": "None\n\nSo the answer to this question is C"} {"instruction": "What is the basis of soing X-chromosome bearing and Y-chromosome bearing sperm?\nA. X-chromosome has 2.8% more DNA\nB. Y-chromosome has 2.8% more DNA\nC. X-chromosome has 0.28% more DNA\nD. Y-chromosome has 0.28% more DNA", "response": "Ans. is 'a' i.e.,X-chromosome has 2.8% more DNAA sperm-soing technology (the microso method) is the most effective procedure yet devised at separating X-bearing and Y-bearing sperm.X sperm have only 2.8% more DNA than those carrying a Y chromosome, fluorescent dye that attaches to DNA and glows under laser light in sperm soer then separates the sperm, sending X sperm down one tube and Y sperm into another.The soed sperm can then be placed in the woman's uterus (aificial insemination) or used for in vitro feilization.\n\nSo the answer to this question is A"} {"instruction": "Ranking students from the individual which the highest\ngrade — point average to the lowest is an example of a (an)\nA. Ordinal scale\nB. Nominal scale\nC. Interval scale\nD. Ratio scale", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Amyloid deposits in liver are initially seen in: March 2009\nA. Space of disse\nB. Hepatic parenchyma\nC. Intrahepatic ducts\nD. Poal tract", "response": "Ans. A: Space of disse Kidney-Histologically, the mesangium and capillary basement membrane of glomeruli are the most frequent renal sites of amyloid deposition, followed by involvement of aeriolar and aerial walls and peritubular interstitial tissues. As the extent of the amyloid deposition increases, the glomerular capillary tufts become obliterated and replaced by functionless spherical masses of amyloid material Liver- Microscopically, amyloid is initially deposited in the spaces (of Disse) between the hepatocytes and vascular sinusoids. As more amyloid accumulates, it compresses the hepatic cords and sinusoids. The hepatic cords undergo nutritional and pressure atrophy and become displaced or replaced by bands and nodules of amyloid. Spleen-Amyloidosis of the spleen has two different anatomical patterns. Most commonly, the amyloid deposition is limited to the splenic follicles, resulting in the gross appearance of a moderately enlarged spleen dotted with gray nodules (so called \"sago\" spleen). Alternatively, the amyloid deposits may spare the follicles and mainly infiltrate the red pulp sinuses, producing a large, firm spleen mottled with waxy discolorations (\"lardaceous\" spleen).\n\nSo the answer to this question is A"} {"instruction": "Patent vitello-intestinal duct should preferably be operated at:\nA. Bih\nB. 6 months of age\nC. 12 months of age\nD. 3 years of age", "response": "Patent Vitello-intestinal Duct The resulting umbilical fistula discharges mucus and rarely, feces A patent vitello-intestinal duct should be excised, together with a Meckel&;s Diveicula if present, preferably when the child is about 6 months old Ref: Bailey 27th edition Pgno : 1044\n\nSo the answer to this question is B"} {"instruction": "Acrodermatitis enteropathica is inherited as?\nA. X-linked recessive\nB. X-linked dominant\nC. Autosomal recessive\nD. Autosomal dominant", "response": "Answer- C. Autosomal recessiveAcrodermatitis enterooathica is inherited as an autosomal recessive disorder.Cystic fibrosisPhenylketonuriaGalactosemiaHomocystinuriaLysosomal storage disease.alpha 1-antitrypsin deficiencyWilson diseaseHemochromatosisGlycogen storage disordersAcrodermatitis enteropathica\n\nSo the answer to this question is C"} {"instruction": "Type Ad curve is seen in -\nA. Eustachian tube obstruction\nB. After stapedectomy\nC. Middle ear tumours\nD. Secretory otitis media", "response": "Ans. is 'b' i.e., After stapedectomy\n\nSo the answer to this question is B"} {"instruction": "Local anaesthetic usually used for retrobulbarblock?\nA. Bupivacaine\nB. Procaine\nC. Tetracaine\nD. Lidocaine", "response": "Ans. is 'a' i.e., Bupivacaine Retrobulbar anaesthesia In this technique local anaesthetic is injected behind the eye into the cone formed by extraocular muscles. Retrobulbar injection is given with a special needle which is having a rounded tip. This needle penetrates the lower lid at the junction of the middle and lateral one third of the orbit (usually. 5 cm medial to the lateral canthus). Choice of local anaesthetic varies, but lidocaine 2% and bupivacaine 0.75% are most common. To enhance the retrobulbar spread of local anaesthetic Hyaluronidase, a hydrolyzer of connective tissue polysaccharide is frequently added. A properly placed retrobulbar injection is effective within second and blocks all extraocular muscles except the superior oblique muscle, affects the ciliary ganglion (resulting in pupillary dilatation) and anesthetizes the entire globe.\n\nSo the answer to this question is A"} {"instruction": "Small vessel vasculitis are -a) Classical PANb) Wegner's granulomatosisc) Giant cell arteritis d) HSPe) Churg-strauss syndrome\nA. bde\nB. ade\nC. ace\nD. bce", "response": "a) Large vessel vasculitis: Giant cell arteritis (temporal arteritis), Takayasu arteritis, Cogan syndrome.\nb) Medium vessel vasculitis: PAN (classical PAN), kawasaki disease, Buerger’s disease.\nc) Small vessel vasculitis ; HSP, Wegner’s granulomatosis, microscopic polyangitis, churg strauss syndrome, Cryoglobulinemia, SLE, idiopathic crescentic glomerulonephritis, Bechet’s syndrome, renal limited vasculitis\n\nSo the answer to this question is A"} {"instruction": "In a population of 100000, 100 people have pulmonary tuberculosis. Out of 100 people, 10 died . What is the case fatality rate of TB-\nA. 5%\nB. 10%\nC. 0.50%\nD. 1%", "response": "Ans. is 'a' i.e., 5% CFR =Total no. of deaths due to a disease--------------------------------Total no. of cases of the same diseasex 100 CFR due to TB =5------100x 100 = 5%.\n\nSo the answer to this question is A"} {"instruction": "A patient admitted in casualty after RTA- shows bruising behind the mastoid- This sign is known as.\nA. Prehn sign\nB. Battle sign\nC. Catel Sign\nD. Dietel's sign", "response": "Ans. (b) Battle sign* Battle sign is due to Fracture of base of skull* Middle cranial fossa fracture is associated with Battle sign\n\nSo the answer to this question is B"} {"instruction": "A 24 years old primigravida wt = 57 kg, Hb 11.0 gm % visits an antenatal clinic during 2nd trimester of pregnancy seeking advice on dietary intake. She should be advised -\nA. Additional intake of 300 K. Cal\nB. Additional intake of 500 K. Cal\nC. Additional intake of 650 K. Cal\nD. No extra K. Cal", "response": "- the energy requirements of women are increased during pregnancy and lactation. - additional 350kcal daily is needed during pregnancy. Reference: Park's textbook of preventive and social medicine, 23rd edition, pg no:633 <\\p>\n\nSo the answer to this question is A"} {"instruction": "Which is not a feature of pancreatic Ascites\nA. Low protein\nB. Somatostatin is the drug of choice\nC. Communication with pancreatic duct is 80%\nD. Raised amylase levels", "response": "Pancreatic Ascites: Management Pancreatic ascites occurs from a pancreatic duct disruption or from a leaking pseudocyst High amylase levels are found in the ascitic fluid Initial treatment : Non operative (elimination of enteral feeding, institution of nasogastric drainage, and administration of somatostatin) Recent paracentesis may also be helpful Roughly 50%-60% of patients can be expected to respond to this treatment with resolution of pancreatic Ascites within 2 to 3 weeks Ref: Bailey and love 27th edition Pgno :1228\n\nSo the answer to this question is A"} {"instruction": "Xiphisternum is present at what level ?\nA. T5\nB. T6\nC. T9\nD. T10", "response": "Ans. is'c'i.e., T9(Ref. Keithl. Moore Clinically Oriented Anatomy Ple p. 84)Level of xiphisternum - T9\n\nSo the answer to this question is C"} {"instruction": "Which of the following is not a cause for multiple painful ulcers in tongue\nA. TB\nB. Sarcoidosis\nC. Herpes\nD. Behcet disease", "response": "The presence of sarcoidosis in the bones typically correlates with cutaneous lesions and progressive disease. When present, symptoms include focal pain, swelling and erythema in the subcutaneous tissue around the involved bone site. Painful mouth sores that look similar to canker sores are the most common sign of Behcet's disease. They begin as raised, round lesions in the mouth that quickly turn into painful ulcers. The sores usually heal in one to three weeks, though they do recur. Genital herpes can cause pain, itching and sores in your genital area. But you may have no signs or symptoms of genital herpes Multiple painful ulcers are not seen in TB Ref Harrison20th edition pg 1056\n\nSo the answer to this question is A"} {"instruction": "In which one of the following diseases are intestinal polyps associated with malignancy ?\nA. Ulcerative colitis\nB. Crohn's disease\nC. Gardner's colitis\nD. Peutz-jegher's syndrome", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Function of endonucleases:\nA. Cut DNA at specific DNA sequences\nB. To point out the coding regions\nC. Enhancers\nD. To find out antibiotic resistance", "response": "Ans. A. Cut DNA at specific DNA sequences(Ref: Harper 31/e page433)Restriction endonuclease cut DNA at specific palindromic sites.These enzymes are isolated from bacteria.They restrict the entry of phages into the bacteria.\n\nSo the answer to this question is A"} {"instruction": "Treatment of resistant depression is ?\nA. ECT\nB. SSRI\nC. TCAs\nD. Venalafexine", "response": "Ans. is 'a' i.e., ECT Treatment of depression Drugs : - The treatment of major depression usually requires staing pharmacotherapy with antidepressants. Antidepressants are : - Tricyclic antidepressants (TCAs) : - Imipramine, Amitriptyline, Trimipramine, Clomipramine, Desipramine, Noriptyline, Amoxapine, Reboxetine. SSRI (selective serotonin reuptake inhibitors) : - Fluoxetine, Paroxetine, sealine, Citalopram, Escitalopram. These drugs devoid of side effects seen with TCAs and are safe in elderly. Atypical antidepressants : - Trazodone, Mianserine, Mitrazapine, Venlafaxine, Duloxetine, Tianeptine, Amineptine, Bupropion.Not all patient recover completely after treatment; about 25% cases are refractory to treatment. Recurrence rate is 50% after 1st episode and 90% after 3rd episode. ECT (Electroconvulsive therapy) : - Indications of ECT in depression are : - Suicidal risk (AI1MS 01, 00, Al 94, MAHE 01) Depression with psychotic feature Resistant depression Severe agitated or stuporous depression with lack of self care. Psychotherapy : - Suppoive psychotherapy, connitive behavioral psychotherapy.\n\nSo the answer to this question is A"} {"instruction": "Investigation of choice in upper GI bleeding is\nA. Ba swallow\nB. X-ray\nC. Endoscopy\nD. Ultrasound", "response": "\"Upper endoscopy is the test of choice in patients with UGIB\" \"Whenever GI haemorrhage is thought to derive from a source proximal to the ligament of Treitz, or whenever the issue is in doubt, the first invasive diagnostic maneuvre should be upper GI flexible endoscopy. This technique has a diagnostic accuracy of approximately 95% and an overall complication rate of less than 1%. Endoscopy also allows a qualitative assessment of bleeding rate, provides prognostic information regarding rebleeding potential, and offers numerous therapeutic interventions for specific lesions\" - maingot's 10/e, p 291 Other investigations for Upper GI bleedingAngiography (Celiac axis angiography) it is rarely used, when upper endoscopy is unavailable or nonrevealing and the bleeding site still thought to be proximal to the ligament of Treitz. it also has the potential for therapeutic intervention by embolization of the feeding vessel. Barium study \"Barium contrast radiography is no longer peinent to the diagnosis of acute hemorrhage. It should be reserved for those patients with chronic or intermittent bleeding that probably is due to an ulcer or mass lesion.\" Ref : CSDT 13/e p494 , Harrison 17/e p259\n\nSo the answer to this question is C"} {"instruction": "A man with a history of fall presented with a deformity which is resembling 'a waiter who waits for receiving his tip'. This posture is characteristically seen in?\nA. Erb's paralysis\nB. Klumpke's paralysis\nC. Radial nerve paralysis\nD. Ulnar nerve paralysis", "response": "The upper trunk (C5 and C6) of brachial plexus is the most common area injured and results in the classic Erb palsy. It has been described as the \"waiter's tip posture\" and is characterized by shoulder weakness with internal rotation and adduction of the upper arm. The elbow is extended and the wrist flexed. There is good preservation of hand function.\n\nSo the answer to this question is A"} {"instruction": "A patient with obstructive jaundice due to pancreatic cancer might have all of the following clinical findings except\nA. A palpable gallbladder\nB. Pain is early in the course of the disease\nC. Pulmonary metastasis\nD. Thrombocytopenia", "response": "Carcinoma pancreas Symptoms include unexplained episodes of pancreatitis, painless jaundice, nausea, vomiting, steatorrhoea and unexplained weight loss. With fuher spread beyond the pancreas, these patients may note upper abdominal or back pain when peripancreatic nerve plexuses are involved and ascites when carcinomatous is or poal vein occlusion develops Ref: Sabiston 20th edition Pgno :1544\n\nSo the answer to this question is B"} {"instruction": "Elschnig's pearls are a sign of:\nA. Chronic uveitis\nB. Secondary cataract\nC. Cystoid macular oedema\nD. All of the above", "response": "Ans. Secondary cataract\n\nSo the answer to this question is B"} {"instruction": "Angiographically, the typical \"beaded\" or \"pile of plates\" appearance involving the internal carotid artery is seen in -\nA. Takayasu's Disease\nB. Non-specific aorto-arteritis\nC. Fibromuscular dysplasia\nD. Rendu-Osler-Weber Disease", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Which is not true about cystic hygroma\nA. Aspiration is diagnostic\nB. About 50% of them are present at bih\nC. Presents as posterior cervical swelling\nD. Sequestration of lymphatic tissue", "response": "Cystic hygroma Cystic hygroma is a swelling usually occurring in the lower third of the neck It is most commonly seen in the posterior triangle of the neck, but may also occur in axilla, groin & mediastinum It results due to sequestration of a poion of the jugular lymph sac from the lymphatic system. It usually manifests in the neonate or in early infancy (occasionally present at bih) The swelling is soft and paially compressible and invariably increases in size when the child coughs or cries. The characteristic that distinguishes it from all other neck swellings is that it is brilliantly translucent. The cysts are filled with clear lymph and are lined by endothelium. Mostly these are multiple cysts but occasionally they can be unilocular. It may show spontaneous regression. \"Roughly 50% to 65% of hygromas prsent at bih, with most becoming apparent by the second year of life.\" Ref : Sabiston 18/e p2052\n\nSo the answer to this question is A"} {"instruction": "All are the complications of hydatid cyst in the liver except\nA. Jaundice\nB. Suppuration\nC. Cirrhosis\nD. Rupture", "response": "Complications-- Rupture of the cyst into biliary tree ( most common) or bronchial tree Free rupture into peritoneal, pleural or pericardial cavities\n\nSo the answer to this question is C"} {"instruction": "What is true in case of perforation of pars flaccida -\nA. CSOM is a rare cause\nB. Associated with cholesteatoma\nC. Usually due to trauma\nD. All of the above", "response": "Tympanic membrane can be divided in 2 parts:\nParstensa : It forms most of the tympanic membrane. Its periphery is thickened to form fibro cartilaginous ring called as annulus tympanicus.\nPars Falccida : It is situated above the lateral process of malleus between the notch of Rivinus and the anterior and posterior malleolar fold.\nRef. Dhingra 6/e p59, 5/e p 78\n\nSo the answer to this question is B"} {"instruction": "Which of the following features in liver biopsy is seen in alpha 1 antitrypsin deficiency?\nA. PAS positive and diastase resistant globules are seen\nB. Cirrhosis of liver\nC. Mallory hyaline\nD. All", "response": "Ans. is 'a' i.e., PAS positive and diastase resistant globules are seen; 'b' i.e., Cirrhosis of liver; `c' i.e., Mallory hyaline\n\nSo the answer to this question is D"} {"instruction": "Eiosinophilic meningoencephalitis is causes by -\nA. Gnathostoma spinigerum\nB. Naegleria\nC. Toxocara canis\nD. Angiostrongylus cantonesis", "response": "The larva infects mollusc Human infection is acquired by eating infected molluscs The larva penetrate the gut and are carried to the brain There is an inflammatory reaction in the brain and meninges to produce meningoencephalitis (refer pgno:177 baveja 3 rd edition)\n\nSo the answer to this question is A"} {"instruction": "Howell-jolly bodies are seen in: September 2005\nA. Sickle cell anemia\nB. Splenectomy\nC. Both of the above\nD. None of the above", "response": "Ans. C: Both of the above Howell-Jolly bodies are histopathological findings of basophilic nuclear remnants (clusters of DNA) in circulating erythrocytes. During maturation in the bone marrow erythrocytes normally expel their nuclei, but in some cases a small poion of DNA remains Howell-Jolly bodies are present in some red cells due to asplenia. Common causes of asplenia are splenectomy due to trauma and autosplenectomy caused by sickle cell anemia.\n\nSo the answer to this question is C"} {"instruction": "Non-cardiac causes of raised central venous pressure include the following except -\nA. Abdominal compartment syndrome\nB. Tension pneumothorax\nC. Positive pressure ventilation\nD. Hypervolaemia", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Which of the following is true about menopausal hormonal change :\nA. LH/TSH |\nB. Gonadotropins |, estrogens |\nC. Estrogens and Gonadotropins both |\nD. Estrogens and Gonadotropins both |", "response": "Gonadotropins |, estrogens |\n\nSo the answer to this question is B"} {"instruction": "Frie's test is useful for diagnosis of\nA. Mycoplasma\nB. Rickettsia\nC. Sarcoidosis\nD. Chiamydia", "response": "None\n\nSo the answer to this question is D"} {"instruction": "The earliest immunoglobulin to be synthesized by the fetus is -\nA. IgA\nB. IgG\nC. IgE\nD. IgM", "response": "Option 1, 3, 4 IgM: IgM is the first immunoglobulin to be synthesized by a neonate in about 20 weeks of age. IgM is not transpoed across the placenta; hence, the presence of IgM in the fetus or newborn indicates intrauterine infection. The first immunoglobulin produced in response to an antigen is IgM. after 3 monts of bih class switching is staed and then other class of immunoglobulins are synthesised. IgM is secreted as a pentamer and is composed of five H2L2 units (similar to one IgG unit) and one moleculeof a J chain.. It is the most efficient Because its interaction with antigen can involve all 10 binding sites, it has the highest binding capacity and cross-linking of all the immunoglobulins. Option 2 IgG is the only immunoglobulin class to cross the placenta and therefore is the most abundant immunoglobulinin newborns.( this is not the the first to be synthesised in newborn)\n\nSo the answer to this question is D"} {"instruction": "Obnoxious smell and hallucination is seen in?\nA. Temporal lobe lesion\nB. Frontal lobe lesion\nC. Parietal lobe lesion\nD. Occipital lobe lesion", "response": "Temporal lobe lesion REP: Harrison's 17th ed chapter 30 Tumors and hamaomas may induce seizures with olfactory hallucinations, indicating involvement of the uncus of the temporal lobe.\n\nSo the answer to this question is A"} {"instruction": "Which of the following drug can cause Delayed Bone Marrow Suppression leading to Sustained Neutropenia?\nA. Vincristine\nB. Carboplatin\nC. Melphalan\nD. Carmustine", "response": "NITROSOUREAS : MOA: Alkylating agent DRUGS: CARMUSTINE, LOMUSTINE, SEMUSTINE. USES: Can cross BBB thereby used in Brain tumors. S/E: Delayed Bone Marrow Suppression resulting in Sustained Neutropenia.\n\nSo the answer to this question is D"} {"instruction": "Focal length of head mirror used in ENT OPD\nA. 9 Inch\nB. 10 Inch\nC. 11 Inch\nD. 12 Inch", "response": "Head mirror: It is a concave mirror used to reflect light from the Bull's eye lamp onto the pa being examined. It has a focal length of approximately 25 cm. The examiner sees through the hole in the centre of the mirror. Diameter of the mirror is 89 mm (3 1/2 \") and that of the central hole is 19 mm (3/4\") Ref: Dhingra 7e pg 427.\n\nSo the answer to this question is B"} {"instruction": "If a complete denture patient has genial tubercle at the Level of the crest of mandibular ridge, the denture base:\nA. Can cover them\nB. Should not cover them\nC. Should cover them but relief is not necessary\nD. Should cover them and relief is must", "response": "None\n\nSo the answer to this question is D"} {"instruction": "A 7-year-old child is taken to the emergency depament because he is feeling sho of breath. The episode began about an hour previously while the child was playing spos, when he abruptly developed paroxysms of wheezing and coughing. As the physician enters the room, he notes that the child is sitting leaning forward and is using his accessory respiratory muscles. Physical examination demonstrates tachypnea and tachycardia. On auscultation, a prolonged expiratory phase with relatively high-pitched wheezes through much of the respiratory cycle are heard. No fine crackles are heard. Which of the following medications will have the fastest onset if the 7-year-old child has an acute attack of his condition?\nA. Albuterol inhalation\nB. Beclomethasone inhalation\nC. Ephedrine oral\nD. Salmeterol inhalation", "response": "Albuterol is indicated for use in the treatment of acute signs and symptoms of asthma since its onset is in less than 5 minutes. Beclomethasone is a glucocoicoid agent, and not a sympathomimetic. It would not have the rapid onset of action required in this case. You should immediately recognize that any medication administered orally must be absorbed from the intestinal tract and then reach the site of action. Therefore, you should be able to conclude that oral ephedrine will not begin to work for at least 1/2 hour after administration. Salmeterol inhalation has an onset of action of around 20 minutes and has a duration of action of approximately 12 hours. Salmeterol is indicated for the \"chronic\" treatment/prevention of asthma signs and symptoms.\n\nSo the answer to this question is A"} {"instruction": "Which of the following is false regarding acute conjuctivitis\nA. Vision is not affected\nB. Cornea is infiltrated\nC. Topical antibiotics is the treatment of choice\nD. Pupil is not affected", "response": "Among all four options, option A seems the most appropriate as any corneal infiltration will lead to decreased vision though in conjunctivitis it is commonly reversible Refer: Khurana 6th edition page number 76\n\nSo the answer to this question is A"} {"instruction": "Which of the following is used for permanent interstitial implant brachytherapy –\nA. Boron\nB. Cesium – 131\nC. Phosphorus\nD. Iridium", "response": "Permanent implants of interstitial brachytherapy :- Cesium -131, Yttrium, Gold - 198 (Au - 198), 125I, Radon - 222 (Rn - 222), Pallidum -103 (Pd -103).\nTemporary implants of Interstitial brachytherapy :- Iridium - 192 (Ir - 192), Cesium - 137 (Cs - 137), Cobalt - 60 (Co - 60),\n\n Californium, Radium - 226 (Ra - 226), Tantolum.\n\nSo the answer to this question is B"} {"instruction": "Space of Disse is seen in-\nA. Spleen\nB. Liver\nC. Lung\nD. Heart", "response": "Ans. is 'b' i.e., Liver Histology of the Livero Liver is covered by Glisson's capsule.o Liver is divided into hexagonal lobules oriented around the terminal tributaries of the hepatic vein (Terminal hepatic veins), i.e. Terminal hepatic vein is in the centre of the lobule and area around the hepatic vein is called centriJobular zone.o At peripheri of lobule, lies the portal tract containing hepatic artery, bile duct and portal vein. Area around portal tract is called periportal zone.o Area between periportal zone and centrilobular zone is called midzonal area,o All around the central vein are the major parenchymal cells, i.e. hepatocytes.o Lobule contains sinusoid (sinusoidal capillaries) which have fenestrated endothelium covering the subendothelial space of Disse. This space contains stellate cell processes and hepatocellular microvilli,o Other important cells of liver are Kupffer cells, which belong to monocytic-macrophage sytem and function as phagocytic cells.\n\nSo the answer to this question is B"} {"instruction": "SIDA functions for\nA. Leprosy\nB. TB\nC. Blindness\nD. Agriculture", "response": "Swedish International Development Agency (SIDA) is assisting the National tuberculosis control programme. SIDA assistance is usually spent on procurement of supplies like X-ray unit, microscopes and anti-tuberculosis drugs.Park 23e pg: 924\n\nSo the answer to this question is B"} {"instruction": "Least common joint to be affected in ankylosing spondylitis is:\nA. Sacroiliac joint\nB. Temporomandibular joint\nC. Costovertebral joint\nD. Hip joint", "response": "Ans: B (Temporomandibular joint) Ref: Harrison's Principles of internal Medicine, 18th edExplanation:\"Sacroiliitis is often the earliest manifestations of AS\"AS primarily affects the axial skeleton and peripheral jointsCommon sites include the:Sacroiliac jointCostostemal junctionsSpinous processesIliac crestsGreater trochantersIschial tuberositiesTibial tuberclesHeelsArthritis in the hips and shoulders (\"root\" joints) occurs in 25-35% of patients.Severe isolated hip arthritis or bony chest pain may be the presenting complaint.\n\nSo the answer to this question is B"} {"instruction": "Substrate-level phosphorylation seen in reaction catalysed in:\nA. Succinate dehydrogenase\nB. Alfa-ketoglutarate dehydrogenase\nC. Succinyl CoA thiokinase\nD. Malate dehydrogenase", "response": "C i.e. Succinyl CoA thiokinase\n\nSo the answer to this question is C"} {"instruction": "In which of the following disorders, administration of barbiturates is contraindicated\nA. Anxiety disorders\nB. Acute intermittent porphyria\nC. Kernicterus\nD. Refractory status epilepticus", "response": "Barbiturates induce the rate-limiting enzyme δ-amino clavulanic acid synthase' in porphyrin synthesis. This increased synthesis of porphyrins can precipitate an acute attack of AIP.\n\nSo the answer to this question is B"} {"instruction": "The corpus luteum of menstruation presents for:\nA. 5 days\nB. 10 days\nC. 14 days\nD. 30 days", "response": "14 days\n\nSo the answer to this question is C"} {"instruction": "Mesothelioma associated with which variety of asbestos ?\nA. Serpentine\nB. Amphibole\nC. Both the above\nD. None of the above", "response": "Ans. is 'b' i.e., Amphibole Asbestos-Related DiseasesAsbestos is a family of proinflammatory crystalline hydrated silicates that are associated with pulmonary fibrosis, carcinoma, mesothelioma, and other cancers.There are two distinct geometric forms of asbestosi) Serpentine (chrysolite) - most of the asbestos used in industryii) Amphibole (crocidolite)Both serpentine and amphibole can cause all asbestos related diseases except for mesothelioma, which is usually associated with amphibole (crocidolite).\n\nSo the answer to this question is B"} {"instruction": "Acute hemorrhagic conjunctivitis occurs due to -\nA. Poliovirus\nB. Hepadnavirus\nC. Enterovirus 70\nD. Coxackie B virus.", "response": "Ans. is 'c' i.e., Enterovirus 70 o Enterovirus 70 causeso Coxsackie A-24 causeso Adenovirus causes---Acute hemorrhagic conjunctivitisAcute hemorhagic conjunctivitisEpidemic keratoconjunctivitisAcute Follicular conjunctivitisPharyngoconjunctival fever\n\nSo the answer to this question is C"} {"instruction": "A 56-year-old patient presents after 3 days of cataract surgery with a history of increasing pain and diminished vision after an initial improvement. The most likely cause would be –\nA. Endophthalmitis\nB. After cataract\nC. Central retinal vein occlusion\nD. Retinal detachment", "response": "Symptoms and signs of bacterial endophthalmitis are generally present between 48 and 72 hours after surgery and include: ocular pain, diminished vision, lid oedema, conjunctival chemosis and marked circumciliary congestion, corneal oedema, exudates in the pupillary area, hypopyon and diminished or absent red pupillary glow.\n\nSo the answer to this question is A"} {"instruction": "Congenital Rubella syndrome may have the following clinical features, except\nA. Intrauterine growth retardation\nB. Neonatal hepatitis\nC. Congenital cataract\nD. Hydrocephalus", "response": "Microcephaly is more common.\n\nSo the answer to this question is D"} {"instruction": "Kaposi sarcoma occurs with infection due to ?\nA. 1-1HV8\nB. HHV4\nC. HHV2\nD. HHV1", "response": "Ans. is 'a' i.e., HHV8 HHV 8 has been proposed in the etiology of Kaposi Sarcoma in AIDS patients\n\nSo the answer to this question is A"} {"instruction": "Impairment is defined as -\nA. Loss of anatomic structure\nB. Inability to perform activity\nC. Failure of fullfillment of normal role\nD. Abnormal condition in the body", "response": "Ans. is 'a' i.e., Loss of anatomic structure o According to WHO definitions,# Disease: Any abnormal condition of an individual that impairs function# Impairment'. Any loss or abnormality of psychological, physiological or anatomical structure or function# Disability: (Because of impairment,) any restriction or inability to perform an activity in a range considered normal for a human being# Handicap: A disadvantage for a given individual, resulting from an impairment/disability, that limits/prevents fulfillment of a role considered normal (depending on age, sex, social, cultural factors) for that individualFor example,EventClassification InterpretationAccidentDiseaseImpairs function of a personLoss of footImpairmentLoss of anatomical structure in the form of footCannot WalkDisabilityWalking is a normal routine daily activity of a human beingUnemployedHandicapLoses out his job because he cannot walk, so cannot fulfill his role in the society, i.e, earning for his family members\n\nSo the answer to this question is A"} {"instruction": "Following spinal subarachnoid block a patient develops hypotension. This can be managed by the following means except:\nA. Lowering the head end\nB. Administration of 1000 ml of Ringers lacate before the block\nC. Vasopressor drug like methoxamine\nD. Use of ionotrope like dopamine", "response": "A. i.e. Lowering the head end\n\nSo the answer to this question is A"} {"instruction": "Anemia is caused by deficiency of which micronutrient?\nA. Iron\nB. Potassium\nC. Phosphorus\nD. Nickel", "response": "ANSWER: (A) IronREF: Ganong 24th ed page 560, Guyton 12th ed pg 420Anemia is the deficiency of hemoglobin in the blood which can be caused by either too few red blood cells or too little hemoglobin in the cells. 30% of the world suffers from iron deficiency anemia, due to inadequate intake or absorption of iron from the diet. Iron is needed for the synthesis of hemoglobin. Deficiency caused due to inadequate intake or blood loss causes iron deficiency' anemia.\n\nSo the answer to this question is A"} {"instruction": "Lubiprostone is a:\nA. Chloride channel activator\nB. Chloride channel inhibitor\nC. Sodium channel activator\nD. Sodium channel inhibitor", "response": "Lubiprostone :- selectively stimulates type 2 chloride channels in epithelial cells thereby causing an efflux of chloride into the intestinal lumen. - The resultant fluid secretion into the gastrointestinal lumen provides a bolus effect that softens stool, increases intestinal transit, and improves symptoms of constipation. - Lubiprostone acts locally within the intestinal tract, is rapidly metabolized, and has very low systemic bioavailability.\n\nSo the answer to this question is A"} {"instruction": "A second para is admitted in advanced labor at a period of amenorrhea of 40weeks.she has a single fetus in transverse lie.The fetal hea beat is absent. On vaginal examination the cervix is fully dilated . The presenting pa is shoulder. What is the most appropriate management?\nA. Await spontaneous delivery of the dead fetus\nB. Perform a cesarean section immediately\nC. Perform a decapitation operation\nD. Perform an external cephalic version", "response": "In this case patient is presenting in advanced labor with IUD and transverse lie. Management is immediate cesaream section\n\nSo the answer to this question is B"} {"instruction": "Which of the following is not a feature of extramedullary syndrome?\nA. Root pain\nB. Sacral sparing\nC. Abnormal\nD. Early coicospinal tract involvement", "response": "Intramedullary tumors arising from the central pa of the cord often spare sensation over the sacral region (\"sacral sparing\") because of the somatotopic organization of the spinal cord, in which the sacral sensory fibers are at the most peripheral position within the spinal cord. Ref Davidson 23rd edition pg 455\n\nSo the answer to this question is B"} {"instruction": "Non-union is common in fracture of\nA. Scapula\nB. Talus\nC. Neck of femur\nD. Tibial fracture", "response": "The following are some of the clinical findings which suggest delayed union and non union : Persistent pain Pain on stressing the fracture Mobility (in non-union) Increasing deformity at the fracture site (in non-union). Ref essential ohopaedic maheshwari and mhaskar 9TH ED p 48\n\nSo the answer to this question is C"} {"instruction": "Web based program for monitoring TB is:\nA. Nikshay\nB. Nischay\nC. Nikusth\nD. e-DOTS", "response": "Ref. Foundations of Community medicine. Page. 740\n \nTo keep a track of the TB patients across the country, the Government of India has introduced a system called NIKSHAY.\n\nThe word is combination of two Hindi words NI and KSHAY meaning eradication of tuberculosis.\nNIKSHAY (www.nikshay.gov.in) is a web enabled application, which facilitates monitoring of universal access to TB patients data by all concerned.\nThe system has been developed jointly by the Central TB Division of the Ministry of Health and Family Welfare and National Informatics Centre (NIC) and it was launched by the Government of\nIndia in June 2012 with issue of required administrative directions from Central TB Division for use of NIKSHAY\n\nSo the answer to this question is A"} {"instruction": "A double headed monster is known as a:\nA. Diplopagus\nB. Dicephalus\nC. Craniopagus\nD. Heteropagus", "response": "Conjoined twins are always monozygotic and caused by incomplete division occurring after 13 days .They can be classified into thoracopagus,craniopagus,omphalopagus,pyopagus and ischiopagus depending upon the area of fusion.Prenatal diagnosis is impoant to councel patients regarding termination and to plan the type of delivery (reference pgno:185 sheila textbook of obstetrics 2 nd edition)\n\nSo the answer to this question is B"} {"instruction": "Health education is the responsibility of\nA. Health educationalist\nB. Doctor\nC. Paramedical staff\nD. Every health worker", "response": "None\n\nSo the answer to this question is D"} {"instruction": "All are features of hepatocellular carcinoma, except?\nA. Not common in Asian\nB. Liver biopsy is diagnostic\nC. Raised titre of HBV and HCV antibodies\nD. Fibrolameller type is having good prognosis", "response": "Ans. is 'a' i.e., Not common in Asians Hepatocellular carcinoma Primary hepatocellular carcinoma is especially prevalent in regions of Asia and Africa. The largest number of cases are found in Asia followed by Africa. o More than 85% of cases of HCC occurs in countries with high rates of chronic HBV infection. In these regions HBV carrier state begins in infancy following veical transmission of virus from infected mothers, conferring a 200 fold increased risk for HCC by adulthood. Other major etiological associations for liver carcinoma are ? o Chronic alcoholism o Tyrosinemia o Food contaminants (primarily aflatoxins derived from Aspergillus flavus) o Hereditary hemochromatosis Clinical features of hepatocellular carcinoma ? o The clinical manifestations of hepatocellular carcinoma are not characteristic of hepatocellular carcinoma. The symptoms of hepatocellular carcinoma are often masked by symptoms of chronic hepatitis or cirrhosis. o In most cases hepatocellular carcinoma presents as an ill defined upper abdominal pain and an abdominal mass. o Elevated level of serum alphafetoproteins are seen in 50 - 75% cases. o Hepatocellular carcinomas have a strong propensity for invasion of vascular channels. Extensive intrahepatic metastasis occurs and the tumour occasionally invades the poal vein or inferior venacava. o Unresected hepatocellular carcinoma has a very poor prognosis. Patients rarely survive beyond 4 months after the diagnosis. The 5 year survival rate after curative resection is 35% to 50%. o The fibrolamellar variant of the HCC is associated with a more ourable prognosis. It arises in otherwise healthy young adults and may be discovered while still amenable to surgical resection.\n\nSo the answer to this question is A"} {"instruction": "Busacca and Koeppe&;s nodules are characteristically seen in\nA. Residual uveitis\nB. Recurrent uveitis\nC. Granulomatous uveitis\nD. Non-granulomatous uveitis", "response": "Non-granulomatous uveitisGranulomatous uveitisBehcet disease HLA - B27 associated ankylosing spondylitis Reiter syndrome Inflammatory bowel disease Idiopathic Infections - Lyme disease, Kawasaki disease, rickettsia, mumps, measles, Chlamydia, influenza, adenovirusPsoriatic ahritis Secondary syphilis Trauma UGH syndrome Glaucomatocyclitic crisis Lens-induced uveitis Corneal graft rejection Sarcoidosis Sympathetic ophthalmitis Phacoanaphylaxis Vogt - Koyanagi - Harada syndrome Infections - Tuberculosis, Leprosy, Syphilis, Leptospirosis, Brucellosis, Herpes simplex, herpes zoster, varicella, systemic mycosisKoeppe' s nodules- situated at papillary border -posterior synechiae smaller in sizeBusacca' s nodules- situated at the collarette; larger in size(Refer: AH Khurana, Comprehensive Textbook of Ophthalmology,5thedition, pg no: 149)\n\nSo the answer to this question is C"} {"instruction": "Hardener among the following is:\nA. Sodium sulfite\nB. Ammonium sulfite\nC. Aluminium salts\nD. None of the above", "response": "None\n\nSo the answer to this question is C"} {"instruction": "What is the diagnosis in this patient who appeared sick, had a bull neck, and was tachycardic?\nA. Diphtheria\nB. Epiglottitis\nC. Infectious mononucleosis\nD. Rheumatic fever", "response": "Answer A. DiphtheriaThe patient's features are typical of diphtheria. Her throat culture was positive for Corynebacterium diphtheriae. The patient recovered after the initiation of treatment with penicillin.\n\nSo the answer to this question is A"} {"instruction": "A 70-years-old retired military person with good previous medical record complains of bi-temporal headache which is decreased in lying down position. He states that he gets relief by giving pressure over bilateral temples. The patient also complains of loss of appetite with feeling feverish. Diagnosis is:\nA. Chronic tension headache\nB. Temporal arteritis\nC. Migraine\nD. Fibromyalgia", "response": "Ans. a. Chronic tension headache (Ref: Harrison 19/e p107t, p2587t, 2593-2594, 18/e p122, 2849)Tension-type Headache:Tension-type headache (TTH) is commonly used to describe a chronic head-pain syndrome characterized by bilateral tight, bandlike discomfortQ.Pain typically builds slowly, fluctuates in severity, and may persist more or less continuously for many daysQ.Headache maybe episodic or chronic (present >15 days per month)Q.A useful clinical approach is to diagnose TTH in patients whose headaches are completely without accompanying features such as nausea, vomiting, photophobia, phonophobia, osmophobia, throbbing, and aggravation with movementQ.Such an approach neatly separates migraineTemporal arteritis:Women account for 65% of casesMigraine:Pain often preceded by auraQFibromyalgia:Fibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain and tenderness.Patients with FM have an increased prevalence of other syndromes associated with pain and fatigueQ.More common in womenQCommon Causes of HeadachePrimary HeadacheSecondary Headache* Tension-type (69%)* Migraine (16%)* Idiopathic stabbing (2%)* Exertional (1%)* Cluster (0.1%)* Systemic infection (63%)* Head injury (4%)* Vascular disorders (1%)* SAH (<1%)* Brain tumor (0.1%)Tension-Type Headache (TTH)Tension-type headache (TTH) is commonly used to describe a chronic head-pain syndrome characterized by bilateral tight, handlike discomfortQ.Pathophysiology:Pathophysiology is incompletely understoodQ.It seems likely that TTH is due to a primary disorder of CNS pain modulation alone, unlike migraine, which involves a more generalized disturbance of sensory modulation.Clinical Features:TTH: Chronic head-pain syndrome characterized by bilateral tight, bandlike discomfortQ.Pain typically builds slowly, fluctuates in severity, and may persist more or less continuously for many daysQ.Headache maybe episodic or chronic (present > 15 days per month)Q.A useful clinical approach is to diagnose TTH in patients whose headaches are completely without accompanying features such as nausea, vomiting, photophobia, phonophobia, osmophobia. throbbing, and aggravation with movementQ.Such an approach neatly separates migraine.Treatment: Tension-Type HeadacheAnalgesics (acetaminophen, aspirin, or NSAIDs).Behavioral approaches including relaxation can also be effective.Chronic TTH: Amitriptyline is the only proven treatmentQThere is no evidence for the efficacy of acupuncture.MigraineCluster Headache* LateralizedQ usually frontotemporal, can be generalized* All age groupsQ are affected* FemalesQ are affected more than males* Family history presentQPresentation:* Pain often preceded by auraQ* Builds up graduallyQ* May lasts for several hoursQ or longer* Usually throbbingQ but maybe dull* Onset is after awakeningQ and quietened by sleepQ* Lateralized, periorbitalQ or less commonly temporal* All ages >10 yearsQ with peak at 30-50 yrsQ* Male preponderanceQ (90%): Men affected 7-8 times more than females.* Hereditary factors usually absentQPresentation:* Pain (periodic attacks 1-2/day)* Begins without warningQ* Reaches crescendo within 5 minutesQ* Lasts for 45 minutesQAssociated symptoms:* Nausea, vomiting, diarrheaQ* Photophobia and visual disturbance in the form of photopsia and fortification spectraQ* Paraesthesia with tingling and numbnessQ* Other focal neurological symptoms such as clumsiness and weaknessQ.* Excruciating, deep, explosive pain but only rarely pulsatileQ* Commonly awakens patients from sleepQAssociated symptoms:* Homolateral lacrimationQ* Reddening of eyeQ* Nasal stuffinessQ* PtosisQ* NauseaQTemporal ArteritisAverage age of onset is 70 yearsQWomen account for 65% of cases.Typical presenting symptoms: Headache, polymyalgia rheumatica, jaw claudication, fever, and weight lossQ.Headache is the dominant symptom, often appears in association with malaise and muscle achesQ.Head pain maybe unilateral or bilateralQ and is located temporally in 50% of patients but may involve any and all aspects of the cranium.Pain usually appears gradually over a few hours before peak intensity is reached; occasionally, it is explosive in onset.The quality of pain is only seldom throbbing; it is almost invariably described as dull and boring, with superimposed episodic stabbing pains similar to the sharp pains that appear in migraine.Most patients can recognize that the origin of their head pain is superficial, external to the skull, rather than originating deep within the cranium (the pain site for migraineurs).Scalp tenderness is present, often to a marked degree; brushing the hair or resting the head on a pillow maybe impossible because of painQ.Headache is usually worse at night and often aggravated by exposure to coldQ.Additional findings may include reddened, tender nodules or red streaking of the skin overlying the temporal arteriesQ, and tenderness of the temporal or, less commonly, the occipital arteries.ESR is often, though not always, elevatedQ; a normal ESR does not exclude giant cell arteritis.A temporal artery biopsy followed by immediate treatment with prednisone 80 mg dailyQ for the first 4-6 weeks should be initiated when clinical suspicion is high.FibromyalgiaFibromyalgia (FM) is characterized by chronic widespread musculoskeletal pain and tenderness.Patients with FM have an increased prevalence of other syndromes associated with pain and fatigueQ.More common in womenQClinical Features:MC presenting complaint: \"Pain all over.\"QPain is typically above and below the waist on both sides of the body and involves the axial skeletonQ (neck, back, or chest).Pain is poorly localized, difficult to ignore, severe in its intensity, and associated with a reduced functional capacity.QFibromyalgia classification criteriaHistory of chronic widespread pain > 3 monthsQ>11 of 18 tender pointsQNeuropsychological Symptoms: Fatigue, stiffness, sleep disturbance, cognitive dysfunction, anxiety, and depressionQ.\n\nSo the answer to this question is A"} {"instruction": "In the reconstruction following excision of previously irradiated cheek cancer, the flap will be:\nA. Local tongue\nB. Cervical\nC. Forehead\nD. Pectoralis major myocutaneous", "response": "RECONSTRUCTION OF CHEEK: - For check reconstruction, mucosal flaps are used. - PMMC (pectoralis major myocutaneous) flap: Most widely used flap for head and neck reconstructionQ Males Females - Forehead flap based on anterior branch of superficial temporal aery can be used - Deltopectoral flap based on perforating branch of internal mammary aery is used.\n\nSo the answer to this question is D"} {"instruction": "All of the following are cariogenic substances except:\nA. Selenium.\nB. Vanadium.\nC. Lead.\nD. Magnesium.", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Nicotinic acid acts by -\nA. Nicotinic acid acts by -\nB. Inhibiting HMG-CoA synthatase\nC. Inhibiting HMG CoA reductase\nD. Decreasing absorption of cholesterol", "response": "Ans. is 'a' i.e., Inhibiting lipolysis o Niacin (Nicotinic acid) inhibits intracellular lipolysis by inhibiting hormone sensitive lipase --> intracellular FFA to liver --> triglyceride synthesis.\n\nSo the answer to this question is A"} {"instruction": "Tec 6 vaporizer is used with.........\nA. Halothane\nB. Desflurane\nC. Isoflurane\nD. Trielene", "response": "The most common such vaporizer is the Ohmeda Tec 6, designed specifically for use with desflurane. Desflurane has two physical propeies, making it unsuitable for use with a conventional vaporizer. First, it has a very high SVP (88.5 kPa at 20degC). A conventional vaporizer would require high fresh gas flows to dilute it to within clinically useful concentrations, making it uneconomical. Secondly, it has a low boiling point (23.5degC). At room temperature, it will intermittently boil resulting in large fluctuations in agent delivery. When boiling, there will be excessive agent delivery; however, it will then cool due to a large loss of latent heat of vaporization, resulting in an exponential decrease in SVP and under-delivery of agent. The Ohmeda Tec 6 overcomes these problems by using an electrical filament that heats the desflurane to 39degC, raising its SVP to 194 kPa, that is, nearly 2 atm. In addition to providing a stable SVP, this high pressure removes the need for a pressurized carrier gas--instead, the fresh or diluent gas is entirely separate from the vaporizing chamber\n\nSo the answer to this question is B"} {"instruction": "True is all except\nA. Renin - liver\nB. Renin- kidney\nC. Renin substrate - liver\nD. ACE- lung endothelium", "response": "A i.e. Renin - liver\n\nSo the answer to this question is A"} {"instruction": "First active metabolite of chloral hydrate is?\nA. Ethanol\nB. Dichloroethanol\nC. Trichloroethanol\nD. Monochloroethanol", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Malaria is transmitted in Rural areas by ?\nA. Anopheles stephensi\nB. Anopheles dirus\nC. Anopheles culicifacies\nD. None", "response": "Ans. is 'c' i.e., Anopheles culicifacies\n\nSo the answer to this question is C"} {"instruction": "All are true for gradenigo's syndrome except ?\nA. Associated with intermittent ear discharge\nB. Associated with conductive hearing loss\nC. Causes diplopia\nD. Leads to retro orbital pain", "response": "Ans. is 'a' i.e., Associated with intermittent ear discharge Gradenigo's syndrome, also called Gradenigo-Lannois syndrome, is a complication of otitis media and mastoiditis involving the apex of the petrous temporal bone. Symptoms Components of the syndrome include: retroorbital pain due to pain in the area supplied by the ophthalmic branch of the trigeminal nerve (fifth cranial nerve), abducens nerve palsy (sixth cranial nerve) otitis media Other symptoms can include photophobia, excessive lacrimation, fever, and reduced corneal sensitivity. The syndrome is classically caused by the spread of an infection into the petrous apex of the temporal bone.\n\nSo the answer to this question is A"} {"instruction": "Which statement regarding glaucoma is true?\nA. If recognized early, the optic neuropathy of glaucoma is reversible\nB. Topical B-adrenergic antagonists have few if any side effect due to their systemic absorption\nC. The initial symptom oh optic neuropathy due to glaucoma is loss of central vision\nD. None of the above", "response": "Glaucoma is the leading cause of irreversible blindness in the world. When sufficient axinal loss occurs, peripheral vision declines. Loss of central vision occurs much later in the disease process. Retinopathy due to glaucoma is irreversible. Treatment is focused on lowering intraocular pressure. Reduction in intracecular pressure has been demonstrated to protect against fuher damage to the optic nerve. Primary open-angle is by far the most common type of glaucoma in the United States. Closed-angle glaucoma is more common among Asians. The Schijltz tonometer, due to the fact that it is inexpensive, is the most frequently used device to measure intraoccular pressure in the United States. It is used in both hospitals and outpatient clinics. b-Adrenergic antagonists are one of the more commonly used drugs and are initially staed as a topical agent. Unfounately, excess drug drains through the nasolacrimal duct into the nose and is absorbed into the systemic circulation. Therefore systemic side effects can occur and may be severe. It is not unusual for patients to be treated with a bronchodilater drug for new-onset bronchospasms without the physician considering the use of topical b-adrenergic antagonist, used for glaucoma treatment, which may have contributed to the condition.\n\nSo the answer to this question is D"} {"instruction": "The time period that elapses between the physical emotional stress arid the hair loss is about -\nA. 21 days\nB. 30 days\nC. 3 months\nD. 6 months", "response": "Ans-C\n\nSo the answer to this question is C"} {"instruction": "Which is best for diagnosis of small intestinal mucosal disease?\nA. Small bowel Series using barium contrast\nB. Urinary D- xylose test\nC. Small intestinal mucosal biopsy\nD. Breath hydrogen test", "response": "Mucosal disease of small intestine : Infection (esp. Giardia, Whipple's disease, tropical sprue), inflammatory diseases (esp. Crohn's disease), radiation enteritis, eosinophilic enteritis, ulcerative jejunitis, mastocytosis, tropical sprue, infiltrative disorders (amyloidosis, scleroderma, lymphoma, collagenous sprue, microscopic colitis), biochemical abnormalities (gluten-sensitive enteropathy, disaccharidase deficiency, hypogammaglobulinemia, abetalipoproteinemia, amino acid transpo deficiencies), endocrine disorders (diabetes mellitus, hypoparathyroidism, adrenal insufficiency, hypehyroidism, Zollinger-Ellison syndrome, carcinoid syndrome) For some small intestinal disorders that are characterized by diarrhea or malabsorption, the biopsy findings may be distinctive and lead to a specific diagnosis. Whipple Disease- -PAS positive inclusions that is Schiff reagent positive inclusion inside the macrophages of lamina propria - Caused by bacteria - Tropheryma whipplei Note Gluten sensitive enteropathy is strongly associated with HLA DQ2 and HLA DQ8\n\nSo the answer to this question is C"} {"instruction": "An increase in which of the following parameters will shift the O2 dissociation curve to the left?\nA. Temperature\nB. Paial pressure of C02\nC. 2,3 DPG concentration\nD. Oxygen affinity of hemoglobin", "response": "Oxygen dissociation curve demonstrates the percentage of haemoglobin bound with oxygen (saturation) as the oxygen concentration increases. It represents the affinity of haemoglobin for oxygen. A shift of the curve to the left indicates increased affinity of hemoglobin for oxygen. Three impoant factors which affect the oxygen hemoglobin dissociation curve are pH, temperature and the concentration of 2,3 bisphosphoglycerate (2,3, BPG). Fall in temperature, low levels of 2,3 BPG and rise in pH cause shift of the curve to left. Fall in Pco2 result in an increase in pH and shift of the curve to left. Ref: Textbook of Medical Physiology By Guyton, 10th Edition, Page 466; Ganong's Review of Medical Physiology, 23rd Edition, Page 667-9.\n\nSo the answer to this question is D"} {"instruction": "Which is the most common type of female pelvis:\nA. Gynaecoid\nB. Anthropoid\nC. Android\nD. Platypelloid", "response": "Gynaecoid\n\nSo the answer to this question is A"} {"instruction": "Which is not a characteristic of a typical cervical vertebra?\nA. Has a triangular vertebral canal\nB. Has foramen transversarium\nC. Superior articular facet is directed backwards and upwards\nD. Has a large vertebral body", "response": "None\n\nSo the answer to this question is D"} {"instruction": "The following is true for Mycoplasmas except ?\nA. Multiply by binary fission\nB. Are sensitive to beta-lactam group of drugs\nC. Can grow in cell free media\nD. Require sterols for their growth", "response": "Ans. is 'b i.e., Are sensitive to beta lactam drugs\n\nSo the answer to this question is B"} {"instruction": "Whichof the following signs is seen in Crohn's disease?\nA. String sign of Kantor\nB. Strought's sign\nC. Pincer sign\nD. Inveed 3 sign", "response": "The term \"string sign\" may be applied to other narrowed loops of small bowel in Crohn's disease. Carcinoid tumors may produce similar findings in the ileum and \"string sign\" may be seen in an elongated and narrowed pylorus caused by hyperophic pyloric stenosis.\n\nSo the answer to this question is A"} {"instruction": "What is the complication of the diuretic phase of acute renal failure?\nA. Convulsion\nB. Hyperkalemia\nC. Increased sodium excretion in urine\nD. Metabolic Alkalosis", "response": "The recovery phase of ATN is characterized by regeneration of tubular epithelial cells. Abnormal diuresis occurs, causing salt and water loss and volume depletion. The urine output gradually returns to normal, but serum creatinine and urea levels may not fall for several more days. Tubular dysfunction may persist and is manifested by sodium wasting, polyuria unresponsive to vasopressin. The mechanism of the diuresis is not completely understood, but it may in pa be due to the delayed recovery of tubular cell function in the setting of increased glomerular filtration.\n\nSo the answer to this question is C"} {"instruction": "All of the following are seen in asbestosis except -\nA. Diffuse alveolar damage\nB. Calcified pleural plaques\nC. Diffuse pulmonary interstitial fibrosis\nD. Mesotheliomas", "response": "Diffuse alveolar damage is a characterstic feature of ARDS. As explained in the text, asbestos inhalation is associated with pleural plaque, interstitial fibrosis, bronchogenic cancer and mesothelioma.\n\nSo the answer to this question is A"} {"instruction": "Commonest carcinoma in men in tropical countries -\nA. Ca rectum\nB. Ca oral cavity\nC. Ca testis\nD. Ca bladder", "response": "Oral cancer is one of the ten most common cancers in the world Mostly due to Tobacco Alcohol Precancerous state Cultural pattern Ref- Park&;s textbook of Preventive and Social Medicine 24th edition.\n\nSo the answer to this question is B"} {"instruction": "Mechanism of action of beta-Lactam antibiotics would be\nA. Inhibition of bacterial protein synthesis by binding to subunit of bacterial ribosomes\nB. Inhibition of cell wall peptidoglycan synthesis by competitive inhibition of transpeptidases\nC. Reduced drug causes strand breaks in DNA.\nD. Inhibition of DNA synthesis by inhibiting DNA-Dependent RNA Polymerase", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Vital capacity is sum of\nA. Inspiratory reserve volume, Tidal volume and Expiratory reserve volume\nB. Tidal volume, Inspiratory reserve volume and Residual volume\nC. Expiratory reserve volume, Inspiratory reserve volume and Residual volume.\nD. Residual volume, Inspiratory volume, and Expiratory reserve volume.", "response": "Ans. a (Inspiratory reserve volume, Tidal volume and expiratory reserve volume) (Ref Ganong 23rd/593)Ganong 23rd/Fig. 35-7:# VC = 4700 ml = ERV + TV + IRVRespiratory volumes and capacities for an average young male.MeasurementTypicalDefinitionRespiratory volumes1Tidal volume (TV)500 mlAmount of air inhaled or exhaled in one breath during relaxed quiet breathing2Inspiratory reserve volume (IRV)3000 mlAmount of air in excess of tidal inspiration that can be inhaled with maximum effort3Expiratory reserve volume (ERV)1200 mlAmount of air in excess of tidal expiration that can be exhaled with maximum effort4Residual volume (RV)1200 mlAmount of air remaining in the lungs after maximum expiration; keeps alveoli inflated between breaths and mixes with fresh air on next inspirationRespiratory Capacities5Vital capacity (VC)4700 mlAmount of air that can be exhaled with maximum effort after maximum inspiration (ERV + TV + IRV); used to assess strength of thracic muscles as well as pulmonary function6Inspiratory capacity (1C)3500 mlMaximum amount of air that can be inhaled after a normal tidal expiration (TV + IRV)7Functional residual capacity (FRC) 2400 mlAmount of air remaining in the lungs after a normal tidal expiration (RV + ERV)8Total lung capacity (TLC)5900 mlMaximum amount of air the lungs can contain (RV + VC)Additional Educational points# In a healthy normal adult male, FVC is approximately 5.0 L, FEV, is approximately 4.0 L, and thus, the calculated FEV1/ FVC is 80%.# Obstructive disorders result in a marked decrease in both FVC and FEV1/FVC, whereas restrictive disorders result in a loss of FVC without loss in FEV1/FVC.# FEV1/FVC for obstructive (42%) versus restrictive (90%) patients defines the hallmark measurements in evaluating these two diseases.\n\nSo the answer to this question is A"} {"instruction": "Which of the following anti - glaucoma drug can likely cause black pigmentation on conjunctiva\nA. Adrenaline\nB. Latanoprost\nC. Beta blockers\nD. Pilocarpine", "response": "Adrenaline used in glaucoma can lead to conjunctival pigmentation because of adrenochrome.\n\nSo the answer to this question is A"} {"instruction": "Infant body weight is tripled by age of-\nA. 5 months\nB. 11 months\nC. 2 years\nD. 18 months", "response": "Ans. is 'b' i.e., 11 Months o The average bih weight of neonates is about 3 Kg. o During first few days after bih, the newborn loses extracellular fluid equivalent to about 10% of the body weight. o Most full term infants regain their bih weight by the age of 10 days. o Subsequently, they gain weight at a rate of approximately 25 to 30 gm per day for the first 3 months of life. o Thereafter they gain about 400 gm of weight every month for the remaining pa of first year. Age Weight Bih 3 Kg 5 months 6 Kg (2 x bih weight) 1 year 9 Kg (3 x bih weight) 2 years 12 kg (4 x bih weight) 3 years 15 kg (5 x bih weight) 5 years 18 kg (6 x bih weight) 7 years 21 kg (7 x bih weight) 10 years 30 kg (10 x bih weight) o A child gains about 2 kg every year between the age of 3 and 7 years and 3 kg per year after that till the pupeal growth spu begins.\n\nSo the answer to this question is B"} {"instruction": "The characteristic finding in diabetic nephropathy is-\nA. Diffuse glomerulosclerosis\nB. Nodular glomerulosclerosis\nC. Armani -Ebstein reaction\nD. Fibrin caps", "response": "Pathologically, the first changes in diabetic nephropathy coincide with the onset of microalbuminuria and include thickening of the glomerular basement membrane and accumulation of matrix material in the mesangium. Subsequently, nodular deposits (Kimmelstiel-Wilson nodule), pathognomic of diabetic kidney disease, and glomerulosclerosis develops which worsens as heavy proteinuria develops, until glomeruli are progressively lost and renal function deteriorates. Reference : page 830 Davidson's Principles and practice of Medicine 22nd edition\n\nSo the answer to this question is B"} {"instruction": "Which of the following muscle is derived from the 1st arch?\nA. Stylopharyngeus\nB. Tensor tympani\nC. Platysma\nD. Cricothyroid", "response": "Human embryology Tenth edition Inderbier Singh Page no 132 First arch: medial and lateral pterygoid, masseter, temporalis, tensor tympani, tensorpalati\n\nSo the answer to this question is B"} {"instruction": "Which isoenzyme of LDH is seen in hea\nA. LDH 1\nB. LDH 2\nC. LDH 3\nD. LDH 4", "response": "Ans. is 'a' i.e., LDH1\n\nSo the answer to this question is A"} {"instruction": "Urogenital Diaphragm is made up of all of the following, EXCEPT?\nA. Colle's fascia\nB. Sphincter urethrae\nC. Perineal membrane\nD. Deep transverse Perineal muscle", "response": "Urogenital diaphragm is a triangular musculofascial diaphragm situated in the anterior pa of perineum, filling in the gap of the pubic arch. It is formed by the sphincter urethrae, deep transverse perineal muscles enclosed between superior and inferior layer of fascia of urogenital diaphragm. Inferior layer of fascia is called perineal membrane.The closed space contained between the superficial and deep layers of fascia is called deep perineal pouch.\n\nSo the answer to this question is A"} {"instruction": "Post micturation dribbling is due to-\nA. Detrusor overactivity\nB. Dribbling decreases in case of urethral stricture\nC. Collection of Urine in U shaped curve of bulb of penis\nD. Neurogenic bladder", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Sensory supply to diaphragm is through -\nA. Phrenic nerve\nB. Intercostal nerves\nC. Both\nD. None", "response": "Ans. is 'c' i.e., Both o Nerve supply of diaphragm is as follows -i) Motor - Phrenic nerveii) Sensory - Phrenic nerve in central portion and lower six intercostal nerves in peripheral part.\n\nSo the answer to this question is C"} {"instruction": "All are true about hypospadias, except:\nA. Circumcision in infancy is contraindicated\nB. Avoid surgery till puberty\nC. No treatment required in glandular variety\nD. If associated chordee is present, 2 stage operation is done", "response": "Ans. (b) Avoid surgery till puberty* Surgery ideal age- 6 months to 1 year* Chordee 2 stage operation is known as Dennis Browne operation is done. First chordee is released. In 2nd stage we correct the opening.\n\nSo the answer to this question is B"} {"instruction": "22.Regarding ethmoidal polyp,which of the following is true:\nA. epitaxis\nB. Unilateral\nC. <10 years\nD. Associated with Bronchial asthama", "response": "Ref: Dhingra 7e pg 195.\n\nSo the answer to this question is D"} {"instruction": "The recommended daily requirement of vitamin A for pregnant woman is -\nA. 750 mcg\nB. 900 mcg\nC. 1200 mcg\nD. 1500 mg", "response": "Ref: Park 25th edition Pgno : 654\n\nSo the answer to this question is A"} {"instruction": "Yoke muscle for right superior rectus is\nA. Left superior oblique\nB. Left inferior oblique\nC. Left inferior rectus\nD. Left superior rectus", "response": "Yoke muscles Yoke muscles (contralateral synergists) are a pair of muscles (one from each eye) which contract simultaneously during version movements. Different pairs of yoke muscles are as follows: 1) Right medial rectus and left lateral rectus 2)\u0001Right lateral rectus and left medial rectus 3)\u0001Right superior rectus and left inferior oblique 4)\u0001Right inferior rectus and left superior oblique 5)\u0001Right superior oblique and left inferior rectus 6)\u0001Right inferior oblique and left superior rectus. Reference :- A K KHURANA; pg num:- 537\n\nSo the answer to this question is B"} {"instruction": "According to federation dental lower left canine is designated as-\nA. 32\nB. 33\nC. 42\nD. 43", "response": "According to FDI, left lower canine is designated as 33. Ref: K.S.Narayan Reddy's synopsis of Forensic Medicine and Toxicology ,29 th edition Chapter4.page no -60\n\nSo the answer to this question is B"} {"instruction": "Which of the following can be oxidized by b- oxidation pathway?\nA. Saturated fatty acids\nB. Mono saturated fatty acids\nC. Polyunsaturated fatty acids\nD. All of these", "response": "Ans. D. All of theseb- oxidation is defined as the oxidation of fatty acids on the b- carbon atom. It is a characteristic feature of all the fatty acid. Even chain fatty acids are degraded to form Acetyl CoA and Odd chain fatty acids are degraded to form propionyl CoA. Due to the presence of double bonds in unsaturated fatty acids, there reactions are little bit different than saturated fatty acids. This is solved by the two additional enzymes- an isomerase and an epimerase.\n\nSo the answer to this question is D"} {"instruction": "Most common cataract in new born is:\nA. Zonular\nB. Morganian\nC. Ant. Polar\nD. Post. Polar", "response": "A i.e. Zonular Punctate or blue dot cataract is the most common manifestationQ, & in minute degrees, is almost universal in occurrence. It usually forms in first two decades of life. Zonular or lamellar cataract accounts for 50% (most common) of all visually significant congenital cataract. Q On the basis of Parsons' and Kanski: Cataract Feature Punctate (Blue dot) Most common Cataract congenital cataracts Lamellar or Most common Zonular Cataract visually significant congenital cataracts Now lets see what a few other books have to say about these two varieties: Cataract Khurana Neema Punctate (Blue Usually forms in the 1st 2 It is very frequent. dot) Cataract decades of life. No comment on incidence. Lamellar or It is the most common type It is the most common type of Zonular Cataract of congenital cataract developmental cataract accounting for 50% of cases. accounting for 50% of cases Despite these obvious contradictions it would be preferable to go for Punctate (Blue dot) cataract as the most common variety, as is stated in the two of the most reputed books. Bilateral & symmetrical, round, grey-white circumferential lamellar shell of opacity around the clear fetal (embryonic) nucleus, which also is surrounded by clear zone (i.e. area within and around the cataract is clear) and coical riders (radial opacities or spoke of wheels) are characteristic features of lamellar (zonular/ perinuclear) cataract. Developmental Cataract may present - At bih (Congenital Cataract) - During fuher development: Infancy to Adulthood The location of the cataract in paicular layer of the lens is an indicator of the stage of development of the cataract i.e the earliest cataracts lie in the nucleus whereas the latest ones in the superficial coex.\n\nSo the answer to this question is A"} {"instruction": "Name of the procedure\nA. Z plasty\nB. Rhomboid flap\nC. V-Y advancement flap\nD. Rotation flap", "response": "This is V-to-Y advancement. Commonly used for fingeips and extremities.Ref: Bailey and love, 27e, page: 641\n\nSo the answer to this question is C"} {"instruction": "Which of the following is true about malignant hypehermia\nA. Hypernatremia\nB. Hypercalcemia\nC. Hyperkalemia\nD. Hypothermia", "response": "C i.e. Hyperkalemia\n\nSo the answer to this question is C"} {"instruction": "A malignant tumor of childhood, that metastsizes to bones most often, is\nA. Wilm's tumor\nB. Neuroblastoma\nC. Adrenal gland tumors\nD. Granulosa cell tumor of ovary", "response": "In neuroblastoma,metastasis is present in 60-70% of children,usually to the skeleton(facial bones,skull),bone marrow,also to lymph nodes. Reference:Essential pediatrics-Ghai,8th edition,page no:617.\n\nSo the answer to this question is B"} {"instruction": "Which one of the following is considered a primary ligament of the TMJ?\nA. Stylomandibular.\nB. Sphenomandibular.\nC. Stylohyoid.\nD. Temporomandibular.", "response": "None\n\nSo the answer to this question is D"} {"instruction": "True about acute ITP\nA. More common in female\nB. Specific anti platelet antibodies detected\nC. Viral infection predisposes as seen after vaccination\nD. 80% cases transforms to chronic", "response": "ITP is proposed to be secondary to antibodies directed against the platelate glycoprotein 2b/3a complex. mmune thrombocytopenia (ITP) is a disorder that can lead to easy or excessive bruising and bleeding. The bleeding results from unusually low levels of platelets -- the cells that help blood clot. Formerly known as idiopathic thrombocytopenic purpura, ITPcan cause purple bruises, as well as tiny reddish-purple dots that look like a rash. Children may develop ITP after a viral infection and usually recover fully without treatment. In adults, the disorder is often long term. If you don&;t have signs of bleeding and your platelet count isn&;t too low, you may not need any treatment. If your symptoms are more severe, treatment may include medications to boost your platelet count or surgery to remove your spleen. Reference : Ghai essential of pediatrics, eighth edition, p.no:351\n\nSo the answer to this question is B"} {"instruction": "In Wegner's glomerulonephritis, the characteristic features seen in\nA. Focal necrotizing glomerulonephritis\nB. Granulomas in the vessels wall\nC. Interstital granulomas\nD. Nodular glomerulosclerosis", "response": "Wegener's granulomatosis is a necro-inflammatory lesion having 4 components granulomas of the upper respiratory tract, granulomas of the lungs, systemic vasculitis (page 403) and focal necrotizing glomerulonephritis. Ref: Harsh Mohan textbook of pathology 6th edition page 495.\n\nSo the answer to this question is A"} {"instruction": "Successful alignment of the permanent incisors to overcome the incisor liability depends upon:\nA. Leeway space of Nance\nB. Broadbent phenomenon\nC. Increased intercanine width\nD. Increased intermolar width", "response": "For incisors to erupt in normal alignment, there is an obligate space requirement in the anterior part of both the arches which is termed as incisor liability. The total sum of the mesiodistal width of four permanent incisors is larger than that of primary incisors by 7.6 mm in maxilla and 6 mm in mandible (Wayne). This obligate space is provided by:\n\nInterdental physiologic spacing in the primary incisor region: 4 mm in maxillary arch; 3 mm in mandibular arch.\nIncrease in the intercanine arch width: Significant amount of growth occurs with the eruption of incisors and canines.\nIncrease in the anterior length of the dental arches: Permanent incisors erupt labial to the primary incisors to obtain an added space of 2-3 mm.\nChange in inclination of permanent incisors: Primary teeth are upright, but permanent teeth incline to the labial surface, thus decreasing the inter-incisal angle from about 150o in the deciduous dentition to 123o in the permanent dentition. This increases the arch perimeter.\n\nTextbook of Orthodontics, Gurkeerat Singh, 2nd ed Page 45-46\n\nSo the answer to this question is C"} {"instruction": "A premature infant is more likely than a full-term infant to –\nA. Suffer from jaundice of hepatic origin\nB. Maintain in normal body temperature in a cold environment\nC. Excrete urine with a uniform specific gravity\nD. Suffer from anaemia", "response": "The liver of premature (preterm) neonate is functionally immature that leads to hypoglycemia, hyperbilirubinemia (jaundice) and poor detoxification of drugs.\n\nProblems of preterm Premature babies\n\nBirth asphyxia \nHypothermia \nFeeding difficulties \nInfections \nRespiratory distress \nARDS (Hyaline membrane dis) \nHyperbilirubinemia \nApenia \nIntraventricular haemorrhage \nHypocalcemia \nNecrotising enterocolitis \nMetabolic acidosis\nHypoglycemia\nHypoproteinemia\n\nNote - Problems of preterm small for date babies include problems of both i.e. problems of preterm and problems of small for date.\n\nSo the answer to this question is A"} {"instruction": "Not true about varicocele is\nA. Commmon on the right side\nB. Can present as a late sign of renal cell carcinoma\nC. Has a bag of worms like feeling\nD. Can lead to infeility", "response": "Varicocele is seen on left side in 95% of cases Varicocele It is seen 95% of times on left side. Several anatomic features contribute to the predominance of left-sided varicoceles. The left internal spermatic vein is longer than the right; in addition, it usually joins the left renal vein at right angles. The right internal spermatic vein has a more oblique inseion into the inferior vena cava. This paicular anatomy in the standing man may cause higher venous pressures to be transmitted to the left scrotal veins and result in retrograde reflux of blood into the pampiniform plexus. Clinical picture Age - young adult Tall thin men are frequently affected* Bag of worms* like feel on palpation The veins empty in supine position (so examination is always done in standing position) Infeility: The varicocele is the most common cause of male infeility worldwide. In approximately 70% of patients with secondary infeility, a varicocele is an underlying cause. \"The World Health Organization concluded that varicoceles are clearly associated with impairment of testicular function and infeility.\" Varicocele may be secondary to renal cell carcinoma of the left kidney. The growth from renal cell carcinoma blocks the renal vein by venous permeation. So sudden onset of varicocele (left side) in middle-aged man should arouse suspicion of a renal cell carcinoma of the left side.\n\nSo the answer to this question is A"} {"instruction": "A Primi mother having 3 weeks male child, which is presenting with noisy breathing sound child is afebrile, sleeping & feeding well & on clinical examination, He is normal. Management protocol include -\nA. Begin IV antibiotics\nB. Reassure & give saline nasal drop\nC. Give recemic epinephrine\nD. Order for a chest X-ray", "response": "Ans. is 'b' i.e., Reassure & give saline nasal drop o This 3 weeks male child with noisy breathing does not have chest indrawing or fast breathing (as clinical examination is normal). So, this child is having simple cough or cold, no pneumonia. o Management includes : - i) Reassurance to mother ii) Frequent breast feeding iii) Keep the baby warm iv) Clear the nose\n\nSo the answer to this question is B"} {"instruction": "A 35 years old female presented with acne. She was treated for her acne but after the treatment, she developed pigmentation. Which drug is responsible for hyperpigmentation?\nA. Tetracycline\nB. Erythromycin\nC. Minocycline\nD. Doxycycline", "response": "Minocycline Oral antibiotics - most widely prescribed agents in acne Dose -100-200 mg daily Indicated for severe acne, moderate facial acne not responding to topical therapies and/or extensive truncal acne. Adverse effects with minocycline include drug hypersensitivity syndrome (DHS) - within 3 months of treatment initiation characterized by fever, malaise, ahralgia and a diffuse exanthematous skin eruption. lupus?like reaction Hyperpigmentation of skin & nails Melanonychia (dark nails)\n\nSo the answer to this question is C"} {"instruction": "Combined oral pill reduces the risk of ?\nA. Breast cancer\nB. Ovarian cancer\nC. Cervical cancer\nD. Vaginal cancer", "response": "Ans. is 'b i.e., Ovarian cancer Functional ovarian cyst o Endometrial carcinoma o Benign breast disease (fibroadenosis) Ovarian malignancy o Urerine fibroid o Premenstural tension & dysmenorrhoea Pelvic inflammatory disease o RA o Osteoporosis Ectopic pregnancy o Colon cancer o Acne\n\nSo the answer to this question is B"} {"instruction": "Appendicitis like syndrome is caused by:\nA. Y.pseudotuberculosis\nB. Pasteurella multocida\nC. Bacillus cereus\nD. Y.pestis", "response": "Yersinia pseudotuberculosis causes mesentric adenitis leading to Pseudoappendicitis.\n\nSo the answer to this question is A"} {"instruction": "Hormone replacement therapy (HRT) all are true EXCEPT\nA. Increases the risk for endometrial cancer\nB. Improves the cognitive preformance in healthy women\nC. May increase the risk of Alzheimer's disease\nD. Decreases the risk for major coronary heart disease", "response": "(D) Decreases the risk for major coronary heart disease # HRT may actually prevent the development of heart disease and reduce the incidence of heart attack in women between 50 and 59.> Unopposed estrogen (the supplementation of endogenous estrogens without a progestagen) can also result in endometrial hyperplasia, a precursor to endometrial cancer.> The extensive use of high-dose estrogens for birth control in the 1970s is thought to have resulted in a significant increase in the incidence of this type of cancer.> Hormone therapy taken soon after menopause may help protect against dementia, even though it raises the risk of mental decline in women who do not take the drugs until they are older.> Dementia risk was 1 % in women who started HRT early, and 1.7% in women who didn't, (e.g. women who didn't take it seem to have had--on average--a 70% higher relative risk of dementia).> This is consistent with research that hormone therapy improves executive and attention processes in postmenopausal women.\n\nSo the answer to this question is D"} {"instruction": "Programmed cell death without caspase activation\nA. Autophagy\nB. Necroptosis\nC. Pyroptosis\nD. Gangrene", "response": "Necroptosis is a hybrid of necrosis (consider this more) and apoptosis. It is a programmed cell death without caspase (cysteine- aspaic proteases) activation\n\nSo the answer to this question is B"} {"instruction": "Clostridium difficile infection risk increases on use of\nA. Ciprofloxacin\nB. Metronidazole\nC. Vancomycin\nD. Teicoplanin", "response": "Ciprofloxacin increases risk of C.difficile enterocolitis.Metronidazole, vancomycin, teicoplanin are effective agaist C. difficile in cases of pseudomembranous colitis.Ref: Bailey and Love 27e pg: 56\n\nSo the answer to this question is A"} {"instruction": "A completely charred body was brought for autopsy. You are examining the skull and cranial cavity. You find that there is a collection of blood in the epidural space. The presence of which of the following suggest the possibility of hematoma due to trauma:\nA. Carboxy hemoglobin in the hematoma\nB. Dark brown friable clot\nC. Radiating Fracture lines over the skull\nD. Diffuse Hematoma", "response": "Epidural hematoma (EDH) due to burns and blunt force (trauma) EDH due to trauma EDH due to burns( Heat hematoma) Cause Blunt force to the head Charring of the skull due to intense heat Situation adjacent to Syln fissure Anywhere Position unilateral Usually bilateral Characteristics Disc shaped,smooth,uniform, rubbery,reddish-purple in colour honeycomb appearance; granular, friable clot; chocolate brown in color Skull fracture Fracture line radiating from a skull defect present in temporal area circular defect without radiating fracture lines, seen above the temple Crossing of suture lines Hematoma do not cross sutures It may cross suture lines\n\nSo the answer to this question is C"} {"instruction": "All of the following are branches of celiac trunk EXCEPT\nA. Right gastric aery\nB. Inferior pancreaticoduodenal aery\nC. Cystic aery\nD. Left gastroepiploic aery", "response": "Inferior pancreatico-duodenal aery is a branch of the superior mesenteric (not celiac) aery.Celiac trunk is the aery of the foregut. It supplies all derivatives of the foregut that lie in the abdomen. Branches - 1. Left gastric aery - smallest of the three. It gives off-a. Two or three oesophageal branches at the cardiac end of the stomach. b. Numerous gastric branches along the lesser curvature of the stomach 2. Common hepatic aery - gives off-a. The gastroduodenal aery- the gastroduodenal aery runs downwards behind the first pa of duodenum and divides at its lower border into the right gastroepiploic aery and superior pancreaticoduodenal aeries. b. The right gastric aery c. The cystic aery 3. Splenic aery a. Pancreatic branches b. Sho gastric aeries c. Left gastroepiploic aeries\n\nSo the answer to this question is B"} {"instruction": "Mutation in Marfan's syndrome involves?\nA. Collagen I\nB. Collagen IV\nC. Fibrillin I\nD. Fibrillin II", "response": "Ans. is 'c' i.e., Fibrillin IMarfan syndrome results from inherited defect in an extracellular glycoprotein fibrillin - 1 on chromosome - 15. It has autosomal dominant inheritance.\n\nSo the answer to this question is C"} {"instruction": "Mechanism of action of metformin\nA. Increased peripheral glucose uptake\nB. Stimulate insulin release\nC. Decrease glucose resorption in intestine\nD. None of the above", "response": "(Refer: K. D. Tripathi's Essentials of Medical Pharmacology, 6th edition, pg no:269)\nIncreased peripheral glucose uptake\nOral hypoglycemic agents\n\nEnhance insulin secretion\n\nSo the answer to this question is A"} {"instruction": "Abnormal excretory function of hepatocytes assessed by -\nA. Increased FT\nB. Increased ALT\nC. Increased Alkaline Phosphatase\nD. Increased gamma GT", "response": "Serum alkaline phosphatase is produced by many tissues and is excreted in the bile.Elevation occurs in case of biliary tract obstruction Reference Harsh mohan page 595\n\nSo the answer to this question is C"} {"instruction": "The most impoant point of reference in the use of forceps is :\nA. The Plane of greatest dimension\nB. Posterior sagittal diameter\nC. Pelvic axis\nD. Station of biparietal diameter", "response": "Station of biparietal diameter\n\nSo the answer to this question is D"} {"instruction": "Nitroblue tetrazolium test is used for ?\nA. Phagocytosis\nB. Complement\nC. T cell\nD. B cell", "response": "Phagocytosis In the previous discussion we have seen that with phagocytosis neutrophils gets activated and there is rapid burst of oxygen consumption and activation of hexose monophosphate shunt. The rapid burst occurs due to rapid activation of the enzyme complex NADPH oxidase which oxidizes NADPH and in the process reduces oxygen to superoxide anion (0,-). It catalyzes the reduction of oxygen to superoxide anion which is then conveed to hydrogen peroxide and other toxic oxygen products (011-) (free radicals). H.,02 then combines with myeloperoxidase and halide to form an effective antibacterial compound. (HOCC-) Chronic granulomatous disorder Chronic granulomatous disease is a disorder of phagocytes. Patients suffering from chronic granulomatous disease have leucocytes that ingest microbes normally but lack the fully functional NADPH oxidase system, required to produce the superoxide anion. In these patients there is no respiratory burst due to lack of one of the four NADPH oxidase subunits in neutrophils. Thus, these patients are not able to generate superoxide, H202 and OH- ions (free radicals). (Thus the), are not able to kill the bacterias). Leucocytes from the patients of chronic granulomatous disease fail to reduce nitroblue tetrazolium during phagocytosis. This propey has been used as a screening method for the diagnosis of chronic granulomatous disease. More on chronic granulomatous disease:- Inheritence - X linked (more common) - Autosomal recessive There is increased incidence of bacterial infection. The bacterias involved in recurrent infections are catalase positive pyogenic pathogens such as staphylococci and colifonns. Catalase negative pathogens are handled normally There is excessive inflammation with granuloma formation. Clinical features are ? - Suppurative lyrnphadenopathy - Gingivitis - Aphthous ulceration - Seborrhic dermatitis - Obstruction of gastrointestinal or genitourinary system - Autoinimune complications - Immune thrombocytopenic purpura - Juvenile rheumatoid ahritis Tests for diagnosis Nitroblue tetrazolium test Dihydrorhodamine (DHR) oxidation test Immunoblot for NADPH oxidase components\n\nSo the answer to this question is A"} {"instruction": "Smoking is most strongly associated with which type of lung cancer?\nA. Small cell cancer\nB. Squamous cell carcinoma\nC. Adenocarcinoma\nD. Carcinoid tumor", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Erosion of joint is seen in all except\nA. SLE\nB. Osteoarthritis\nC. Psoriatic arthropathy\nD. Rheumatoid arthritis", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Microspherocytosis in peripheral blood smear are seen in-\nA. Congenital spherocytosis\nB. Autoimmune acquired haemolytic anaemia\nC. Thalassemia\nD. All of the above", "response": "Spherocytosis is characterized by presence of spheroidal rather than biconcave disc shaped red cells. Spherocytes are seen in hereditary spherocytosis ,autoimmune hemolytic anaemia and in ABO hemolytic disease of newborn like Thalassemia Reference: textbook of Pathology ,7th edition Author: Harsha Mohan, page number 269\n\nSo the answer to this question is D"} {"instruction": "A 1-week-old neonate presents to the pediatric emergency room with fever, irritability, poor feeding, and a bulging anterior fontanelle. Lumbar puncture is performed, and the cerebrospinal fluid (CSF) grows group B Streptococcus. Which of the following is the most likely pathogenic mechanism?\nA. Complement C5a, a potent chemoattractant, activates polymorphonuclear neutrophils (PMNs)\nB. In the absence of a specific antibody, opsonization, phagocyte recognition, and killing do not proceed normally\nC. The alternative complement pathway is activated\nD. The streptococci are resistant to penicillin", "response": "There has been speculation concerning the pathogenesis of GBS. This includes failure to activate complement pathways and immobilization of polymorphonuclear leukocytes due to the inactivation of complement C5a, a potent chemoattractant.\n\nSo the answer to this question is B"} {"instruction": "Nucleus ambiguus is not associated with which cranial nerve: March 2010, March 2013\nA. X\nB. XI\nC. IX\nD. XII", "response": "Ans. D: XIINucleus AmbiguusFunction:Motor innervation of ipsilateral muscles of the soft palate, pharynx, larynx and upper esophagus.Pathway:Axons of motor neurons in the nucleus ambiguus course with three cranial nerves: C.N. IX (glossopharyngeal), C.N. X (vagus), C.N. XI (rostral or cranial poion of spinoaccessory) to innervate striated muscles of the soft palate, pharynx, larynx and upper esophagus.Deficits:Lesion of nucleus ambiguus results in atrophy (lower motor neuron) and paralysis of innervated muscles, producing nasal speech, dysphagia, dysphonia, and detion of the uvula toward the opposite side (strong side).No affection of the Sternocleidomastoid or Trapezius. These muscles are innervated by cells in the rostral spinal cord (caudal poion C.N. XI).\n\nSo the answer to this question is D"} {"instruction": "Dawbarn sign\nA. Infraspinatus tendinitis\nB. Subacromial bursitis\nC. Achliles tendon injury\nD. None of the above", "response": "Subacromial bursitis Inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coracoacromial ligament, acromion, coracoid (the acromial arch) and from the deep surface of the deltoid muscle. The subacromial bursa helps the movement of the supraspinatus tendon of the rotator cuff in activities such as overhead work.Dawbarn sign - the pain of subacromial bursitis disappears when the arm is abducted.(Refer: GS Kulkarni Textbook of Ohopedics, 3rd edition, pg no. 1357)\n\nSo the answer to this question is B"} {"instruction": "Which are seen in endodermal sinus tumor?\nA. Schiller-duval bodies\nB. Reed-Sternberg cells\nC. Reinke's crystals\nD. Russell bodies", "response": "Ans. is a, i.e. Schiller-Duval bodiesRef: CGDT 9th/ed, p938; Shaw 13rd/ed, p362Call exner bodies are small cyst like spaces found in cases of granulosa cell tumor.FeatureAssociated tumorCall exner bodies & coffee bean nucleiGranulosa cell tumorSchiller duval bodiesEndodermal sinus tumorReinke's crystalHilus cell tumorPsammoma bodiesSerous epithelial tumorsWalthard cell nestBrenner tumorSignet ring cellKrukenberg tumorHobnail cellClear cell tumorLarge polygonal cell with lymphocyticInfiltration and fibrous septaDysgerminomaSkin, teeth, cartilageTeratoma\n\nSo the answer to this question is A"} {"instruction": "Heat loss at an ambient temperature of 21 degree takes place through\nA. Respiration\nB. Radiation\nC. Sweating\nD. Urine and faeces", "response": "Radiation is a process of heat transfer to or from the surroundings mediam . It doesn't require any conducter Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:863,864\n\nSo the answer to this question is B"} {"instruction": "Metabolic acidosis may result due to?\nA. Diabetic ketoacidosis\nB. Diarrhea\nC. Renal failure\nD. All of the above", "response": "Metabolic acidosis can occur because of an increase in endogenous acid production (such as lactate and ketoacids), loss of bicarbonate (as in diarrhea) or accumulation of endogenous acids (as in renal failure). Metabolic acidosis has profound effects on the respiratory, cardiac and nervous systems.\n\nSo the answer to this question is D"} {"instruction": "The following are related to face presentation except:\nA. The commonest position is LMA\nB. Engaging diameter is submentobregmatic\nC. The diameter distending the vulval outlet is mentovertical\nD. During moulding, there is elongation of occipitofrontal diameter", "response": "Face presentation:\n\nThe attitude of the fetus shows complete flexion of the limbs with extension of the spine. There is complete extension of the head so that the occiput is in contact with the back.\nThe denominator is mentum.\nThe commonest position is left mentoanterior (LMA).\nFace presentation present during pregnancy (primary) is rare, while that developing after the onset of labor (secondary) is common. It occurs more frequently seen in multiparae (70%), like other malpresentations.\nMost common maternal cause is platypelloid pelvis and most common fetal cause is anencephaly.\nThe diameter of engagement is the oblique diameter—right in LMA, left in RMA.\nThe engaging diameter of the head is submento-bregmatic 9.5 cm (3 3/4”) in fully extended head or submentovertical 11.5 cm (4 1/2”) in partially extended head.\nEngagement is delayed because of long distance between the mentum and biparietal plane (7 cm).\nThe head is born by flexion: (11.5 cm).\nVaginal delivery is possible in nentoanterior positions but not in persistent mentoposterior.\nIn mentoposterior during early stages of labor the policy of wait and watch should be adopted, in hope of mentoposterior getting converted to mentoanterior spontanelously. Persistent mentoposterior position is an indication for doing cesarean section.\n\nSo the answer to this question is C"} {"instruction": "Which one of the following is the most common cause of cyanotic hea disease-\nA. Dextrocardia\nB. Fallot's tetralogy\nC. Atrial septal defect\nD. Coarctation of aoa", "response": "Ans. is 'b' i.e., Fallot's tetralogy\n\nSo the answer to this question is B"} {"instruction": "Trendelenburg's procedure in treatment of varicose veins is:\nA. Ligation of short saphenous vein\nB. Stripping of superficial varicose veins\nC. Sapheno-femoral ligation\nD. Ligation of perforators", "response": "Ans: C (Sapheno-femoral ligation) Ref: Bailey & Love's Short Practice of Surgery, 25th Edition, pg. 929-932 and Sab is ton Textbook of Surgery,19th Edition pg. 1805-11 Explanation: Indications for Intervention in Varicose Veins Cosmos is Symptoms refractory to conservative therapy Bleeding from a varix Superficial thrombophlebitis Li podermato sclerosis Venous stasis ulcer The Principles are to: Ligate the point of communication, the sapheno- femoral and/or saphenopopliteal junctions. Remove the major part of the incompetent trunk to prevent connections to the tributaries. Individually remove tributaries by making minor cut-downs and teasing them out from under the skin (avulsions). Management of Great Saphenous Varicosity Surgery Saphenofemoral junction ligation and greater saphenous stripping Non Operative Methods Ultrasound Guided Foam Sclerotherapy Radiofrequency ablation Endovenous laser ablation Management of Short Saphenous Vein Varicosity Saphenopopliteal junction ligation and lesser saphenous stripping Management of Minor Varicosities Injection sclerotherapy using sodium tetradecyl sulphate Management of Perforator Incompetence Subfascial endoscopic perforator surgery Also Know CEAP Classification C Clinical signs (Grade 0-6), supplemented by \"A\" for asymptomatic and \"S\" for symptomatic presentation E Classification by cause {Etiology)-- congenital, primary, secondary A Anatomic distribution--superficial, steep, or perforator, alone or in combination P Pathophysiologic dysfunction--reflux or obstruction, alone or in combination CLASS FEATURES 0 No visible or palpable signs of venous disease 1 Telangiectasia, reticular veins, malleolar flare 2 Varicose veins 3 Edema without skin changes 4 Skin changes ascribed to venous disease (e.g., pigmentation, venous eczema, lipodermatosclerosis) 5 Skin changes as defined above with healed ulceration 6 Skin changes as defined above with active ulceration\n\nSo the answer to this question is C"} {"instruction": "All of the following are a features of mania except -\nA. Decreased need for sleep\nB. Elated mood\nC. Delusion of grandeur\nD. Decreased motor activity", "response": "Psychomotor activity is increased in mania.\n\nSo the answer to this question is D"} {"instruction": "At what stage of erythropoiesis does Hemoglobin appear?\nA. Reticulocyte\nB. Intermediate normobalst\nC. Early normoblast\nD. Erythroblast", "response": "a pronormoblast, also commonly called an proerythroblast or a rubriblast. This becomes a basophilic or early normoblast, also commonly called an erythroblast, then. a polychromatophilic or intermediate normoblast, then. an ohochromatic or late normoblast. At this stage the nucleus is expelled before the cell becomes. Ref: guyton and hall textbook of medical physiology 12 edition page number: 111,112,113\n\nSo the answer to this question is B"} {"instruction": "First antibody to appear in intrauterine life\nA. IgM\nB. IgA\nC. IgD\nD. IgE", "response": "Ans. (a) IgM\n\nSo the answer to this question is A"} {"instruction": "Iron absorption is increased by which of the following?\nA. Phytates\nB. Tannates\nC. Plant foods\nD. Ascorbic acid", "response": "- Site of iron absorption - duodenum and upper jejunum (proximal small intestine). - Iron absorption is increased by Acids Ascorbic acid (Vitamin C), citric acid Amino acids containing SH-group Sugars in the diet - Phytates, Tannates (found in tea), tetracyclines & Plant foods (non-heme iron) decreases iron absorption\n\nSo the answer to this question is D"} {"instruction": "S1 ejection click & severe pulmonary stenosis relation is-\nA. In severe pulmonary stenosis gap increases\nB. In severe pulmonary stenosis gap reduces\nC. In severe pulmonary'' stenosis no change\nD. In severe pulmonary stenosis ejection click comes before", "response": "Ans. is 'b' i.e., In severe pulmonary stenosis gap reduceso S1 occurs due to the closure of the A. V. valveEjection click occurs due to flow of blood through the pulmonary or the Aortic valve.The ejection of the blood does not begin immediately after the closure of A- V valve.The pulmonary valve opens when the right ventricular pressure exceeds the pressure in plumonary artery. The ejection of the blood begins only after, opening of the A V valve and is preceeded by the time it takes for ventricular pressure to sufficiently exceed the Aortic and pulmonary diastolic pressure therefore there is the time interval between S1 and ejection click.o The interval between the S1 and the pulmonary ejection sound is directly related to the right ventricular isovolumic contraction time which is usually prolonged in pulmonary hypertension explaining a relative late occurrence of the ejection sound in these patients.o With increasing severity of pulmonary valve stenosis, the isovolumetric contraction shortens and the pulmonary ejection sound therefore tend to occur soon after S1.o In patient with very severe pulmonary stenosis, the ejection sound can fuse with S1 and max not he recognized.In severe pulmonary stenosis ejection click may be absent or it is very close to S1 because in severe pulmonary stenosis the increased Right ventricular pressure keeps the pulmonary' valve open before ventricular systole begins.\n\nSo the answer to this question is B"} {"instruction": "Stool examination in a patient reveals the following finding. What is the likely route of infection of this parasite?\nA. Ingestion of food contaminated with the egg of larva\nB. Insect bite\nC. Improperly cooked beef\nD. Swimming in dirty water pool", "response": "Ans. a. Ingestion of food contaminated with egg of larva (Ref: Paniker's Parasitology 6/e p166;Jawetz 27/e p724;Harrison 19/e p1416)Elongated, barrel-shaped eggs with a polar 'plug' at each end shown here are characteristic of Trichuris egg, which causes trichuriasis via feco-oral transmission.NematodesFecal examinationTrichinella spiralisAdult wormQTrichuris trichiuraEggs (barrel shaped) QStrongyloidesRhabditiform larvaeQAncylostoma duodenale & Necator americanusEgg which may be hatched, so rhabditiform larvae can be seenEnterobius vermicularisUsually not usefulAscaris lumbricoidesEggs & adult wormQFilariasisNo roleDracunculus medinensisNo roleTrichuris trichiura (Whipworm)Adult female whipworms are approximately 30-50 mm in length; adult male worms are smaller.Anterior end of worms is slender & posterior end is thicker, giving it a \"buggy whip\" appearance, hence the name whipwormQ.Life cycle:Adult Trichuris worms reside in colon & cecum, the anterior portions threaded into superficial mucosaQ.Thousands of eggs laid daily by adult female worms pass with feces and mature in the soil.After ingestion, infective eggs hatch in the duodenum, releasing larvae that mature before migrating to the large bowelQ.The entire cycle takes ~3 months, and adult worms may live for several years.Clinical Features:Most infected individuals have no symptoms or eosinophilia.Heavy infections may result in anemia, abdominal pain, anorexia & bloody or mucoid diarrhea resembling inflammatory bowel disease.Rectal prolapse can result from massive infections in children, who often suffer from malnourishment & other diarrheal illnesses.Diagnosis:Characteristic 50-20-um lemon-shaped Trichuris eggs are readily detected on stool examinationQ.Barrel shaped structure seen with lightly stained mucus plugs at each poleQEgg-shell is stained brown & encloses light yellow stained unsegmented ovumQ\n\nSo the answer to this question is A"} {"instruction": "All of the following are impoant clinical manifestations of hepatocellular carcinoma except:\nA. Jaundice\nB. Abdominal pain\nC. Abdominal mass\nD. Ascitis", "response": "Answer is A (Jaundice): Jaundice is rare in hepatocellular carcinoma- Harrison Clinical manifestations of hepatocellular carcinoma: Abdominal pain and Abdominal mass - The most common presenting features are abdominal pain with detection of an abdominal mass I the right upper quadrant? Ascites - Blood tinged ascites occur in about 20% of cases - Harrison 16th/534 Friction rub or brui - A friction rub or brui may be over the liver Malaise, fatigue, weight loss Uncommon / inconstant features Jaundice - Jaundice is rare, unless significant deterioration of liver function or mechanical obstruction of bile duct occurs-Harrison 16th/534 Esophageal variceal bleeding - Gastrointestinal or esophageal variceal bleeding are inconstant findings - Robbins\n\nSo the answer to this question is A"} {"instruction": "Which of the following is the first site of appearance of Rigor mois after death?\nA. Jaws\nB. Eye lid\nC. Facial muscles\nD. Myocardium", "response": "Rigor mois first appears in the myocardium followed by eyelids, facial muscles, neck, upper limbs and lower limbs. The small muscles of the toes and fingers are affected last. The Rigor mois passes off in the same order of appearance. Ref: Textbook of Forensic Medicine and Toxicology by Narayan Reddy, Edition 23, Page 128-130\n\nSo the answer to this question is D"} {"instruction": "In Indoor air pollution, carbon monoxide is produced by –\nA. Combustion equipment\nB. Stove\nC. Gas heaters\nD. All of the above", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Which of the following is seen in osteoporosis:\nA. Low Ca, high PO4, high alkaline phosphatase\nB. Low Ca, low PO4, low alkaline phosphatase\nC. Normal Ca, normal PO4, normal alkaline phosphatase\nD. Low Ca, low PO4, normal alkaline phosphatase", "response": "Ans. is 'c' i.e normal Ca, P04, Alkaline phosphatase , Harrison 16/e, p 2272 (14/e, 2250)]* \"Laboratory findings in metabolic bone diseases\"*DiseaseSerum calciumSerum phosphorusAlkaline phosphataseParathormonei) OsteoporosisNNNNii) Osteomalacia (Rickets)DecreaseDecreaseIncreaseN (Increase)iii) Prim.HyperparathyroidismIncreaseDecreaseN (Increase)Increaseiv) Pagets diseaseNNIncreaseNv) Bone disease in renal failure with sec. Hyper parathyroidismN (Decrease)IncreaseIncreaseIncreasevi) Lytic bone neoplasm NN (Increase)N (Increase)N (Increase)N\n\nSo the answer to this question is C"} {"instruction": "A child comes with a circular 3cm x 3cm scaly patchy hair loss with itching in the lesions. The investigation of choice is\nA. Split skin smear\nB. KOH mount\nC. Gram stain\nD. Tzanck smear", "response": "Itchy lesions over head with hair loss likely suggestive of Tinea capitis and KOH mount of hairs is the investigation of choice.\n\nSo the answer to this question is B"} {"instruction": "Acanthosis means\nA. Loss of intracellular connections\nB. Abnormal premature keralinization\nC. Diffuse epidermal hyperplasia\nD. Thickening of stratum corneum", "response": "HISTOPATHOLOGIC TERMS Before describing the pathology of common skin diseases, the following pathologic terms in common use need to be defined for the understanding of Dermatopathology: Acanthosis: Thickening of the epidermis due to hyperplasia of stratum Malpighi. Acantholysis: Loss of cohesion between epidermal cells with formation of intraepidermal space containing edema fluid and detached epithelial cells. Dyskeratosis: Abnormal development of epidermal cells resulting in rounded cells devoid of their prickles and having pyknotic nuclei. Dyskeratosis is a feature of premalignant and malignant lesions and is rarely seen in benign conditions. Hyperkeratosis: Thickening of the horny layer. Parakeratosis: Abnormal keratinization of the cells so that the horny layer contains nucleated keratinocytes rather than the normal non-nucleate keratin layer. Spongiosis: Intercellular edema of the epidermis which may progress to vesicle formation in the epidermis. Pigment incontinence: Loss of melanin pigment from damaged basal cell layer so that the pigment accumulates in the melanophages in the dermis. Ref: Textbook of pathology (Harsh Mohan)6th edition, page no.769\n\nSo the answer to this question is C"} {"instruction": "All are associated with superior relation of uncinate process, EXCEPT:\nA. Ethmoid\nB. Nasal septum\nC. Lamina papyracea\nD. Middle turbinate", "response": "Uncinate process: The uncinate process is a superior extension of the lateral nasal wall (medial wall of the maxillary sinus). It attaches,anteriorly to the posterior edge of the lacrimal bone, and inferiorly to the superior edge of the inferior turbinate. Superior attachment of the uncinate process is highly variable, may be attached to the lamina papyracea, or the roof of the ethmoidal sinus, or sometimes to the middle turbinate. The gap between the ethmoid bulla and the free edge of the uncinate process is the hiatus semilunaris.\n\nSo the answer to this question is B"} {"instruction": "All are advantages of Zinc therapy for Wilson disease:\nA. It is nontoxic\nB. Produces positive copper balance\nC. Blocks intestinal absorption of copper\nD. Induces hepatic metallothionein synthesis", "response": "Zinc treatment in wilson disease: It is efficient in Wilson's disease Nontoxic Produces a negative copper balance by blocking intestinal absorption of copper It induces hepatic metallothionein synthesis, which sequesters additional toxic copper Ref: Harrison, E-18, P-3190.\n\nSo the answer to this question is B"} {"instruction": "In a population of pregnant female, Hb is estimated on 100 women with standard detion of lgm%. The standard error is -\nA. 1\nB. 0.1\nC. 0.01\nD. 10", "response": "Ans. is 'b' i.e., 0.1\n\nSo the answer to this question is B"} {"instruction": "The radiograph of a traumatized tooth is necessary to:\nA. Assess the stage of root development\nB. Determine the presence/absence of root fracture\nC. Have a base from which comparison can be made with future radiographs\nD. All of the above", "response": "None\n\nSo the answer to this question is D"} {"instruction": "A patient on a ventilator is having bilateral crepitations in all lung fields. CXR shows the presence of?\nA. Cardiogenic pulmonary edema\nB. Noncardiogenic pulmonary edema\nC. Neurogenic pulmonary edema\nD. Chemical pneumonitis", "response": "Cardiogenic pulmonary edema Non - cardiogenic pulmonary edema Increased CT ratio Kerley B lines Batwing configuration Normal CT ratio Diffuse bilateral infiltrates sparing costophrenic angle Absent Kerley B lines\n\nSo the answer to this question is B"} {"instruction": "Normal turnover time of epidermis (skin doubling time) is\nA. 2 weeks\nB. 4 weeks\nC. 6 weeks\nD. 8 weeks", "response": "B i.e. 4 weeks\n\nSo the answer to this question is B"} {"instruction": "Pleomorphic rash is a feature of -\nA. Chicken pox\nB. Small pox\nC. Erythema infectiosum\nD. Erythema subitum", "response": "Ans. is 'a' i.e., Chicken pox\n\nSo the answer to this question is A"} {"instruction": "A 29–day old child presents with features of congestive cardiac failure and left ventricular hypertrophy. Auscultation shows a short systolic murmur. Most likely diagnosis is –\nA. Rheumatic fever\nB. Tetralogy of Fallot\nC. Transposition of great arteries\nD. Ventricular septal defect", "response": "The answer is quite obvious.\nTOF and TGA are cyanotic heart diseases and\nRheumatic fever can be ruled out on basis of age. (Age group of rheumatic fever is 5-15 yrs)\n\nClinical manifestation of VSD \n\nThe patients become symptomatic around 6 to 10 weeks of age.\nAt this time CHF may develop.\nFrequent symptoms → Palpitation, dysnea on exertion and chest infections.\n\nSigns\n\nHyperkinetic precordium with a thrill at the left sternal border.\nPansystolic murmur at left sternal border.\nS1 & S2 are masked by pan-systolic murmur maximum intensity of murmur is at 3rd, 4th or 5th left interspace.\nS2 can be make out at the pulmonary area (upper left sternal border) where it is not masked by pan-systolic murmur → S2 is widely split with accentuation of P2\nS3 may be audible at the apex.\nA delayed diastolic murmur in mitral area.\nPulmonary systolic ejection murmur in pulmonary area.\n\nSo the answer to this question is D"} {"instruction": "A pt presented with pulsating varicose veins of the lower limb. Most probable diagnosis is\nA. Klippel Trenaunay syndrome\nB. Tricuspid regurgitation\nC. DVT\nD. Right ventricular failure", "response": "Ans. is 'a' ie Klippel-Trenaunay Syndrome Klippel- Trenaunay Syndrome :is characterized byCongenital AV fistulasCutaneous hemangiomasVaricose veinsHyperophy of involved extremityAbsence of deep venous system (so pathological superficial veins should not be removed without evidence of an intact deep system)*Another syndrome closely associated with A-V malformations is:Kasabach-Merritt syndrome characterised by:- thrombocytopenia* and- hemorrhagic manifestation *- d/t trapping & destruction of platelets* within the AV malformations*.\n\nSo the answer to this question is A"} {"instruction": "About standard Normal curve all is true except\nA. Area = 1\nB. Mean and Median = 1\nC. Bell shaped\nD. S.D. = 1", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Reverse cold chain is for-\nA. Measles\nB. Polio\nC. Rubella\nD. Peussis", "response": "Ans. is 'b' i.e., Polio \"Reverse cold chain\" is for transpo of ble poliovirus in stool to an investigation centre. To isolate polio virus from stool, the sample needs to be maintained at 4-8deg C or stored at - 20degC from the moment of collection, to processing in the laboratory. This process for maintaining the bility of polio virus is called 'Reverse cold chain'. o So, in reverse cold chain i) Temprature for transpoation --> + 2 to +8degC. ii) Temprature for storage --> -20degC. o Specific red vaccine carrier is used in reverse cold chain.\n\nSo the answer to this question is B"} {"instruction": "Saccular diveiculum of extrahepatic bile duct in choledochal cyst is classified as -\nA. Type I\nB. Type II\nC. Type III\nD. Type IV", "response": "Ans. is 'b' i.e., Type II\n\nSo the answer to this question is B"} {"instruction": "A factory worker presents with excessive salivation, blue line on gums, tremors, disturbed personality, insomnia and loss of appetite. Diagnosis\nA. Arsenic poisoning\nB. Lead poisoning\nC. Mercury poisoning\nD. Phosphorus poisoning", "response": "(Refer: Rajesh Bardale - Principles of Forensic medicine & Toxicology, 1st edition, pg no: 458)\nMercury poisoning:\n\nChronic Poisoning: Otherwise called as ‘Hydrargyrism’.\nMC poisonous salt of mercury is Chloride\nClassic Triad:Gingivitis, Salivation and Tremors.\nSigns & Symptoms:\n\n\nBlue lines on gums\nTremors (Danbury tremors) which starts in hands and then progresses to other parts of the body. When generalized, it is called as ‘Hatter’s Shake’, glassblowers shakes\nMost severe form called as ‘Concussio mercurialis’ where no activity is possible.\n‘Mercurial Erethism’ which occurs in worker of mirror industry where there is development of psychological symptoms\n‘Mercuria lentis’ is a peculiar eye change where brownish deposit of mercury seen on anterior lens capsule and this is due to exposure to mercury vapor. It has no effects on visual acuity\nAcrodynia ( Pink disease)\nIdiosyncratic hypersensitivity reaction, seen in children\nGeneralized erythematous, eczematous papular type of lesions mostly in hands & feet, accompanied by thickening & peeling of the skin.\n\n\nDimercaprol (BAL) is used in treatment of mercury poisoning.\n\nSo the answer to this question is C"} {"instruction": "Muscle relaxant associated with increased ICP is?\nA. Mivacurium\nB. Atracurium\nC. Suxamethonium\nD. Vecuronium", "response": "Ans. is 'c' i.e., Suxamethoneum * Sch causes increases in all pressures - intraocular, intracranial, BP, and intrabdominalSuccinylcholine (Suxamethonium)* SCh is a depolarising skeletal muscle relaxant.* It causes sustained partial depolarization of muscle end plate - Initially produce twitching and fasciculation followed by flaccid paralysis.* It is the shortest and fastest acting skeletal muscle relaxant.* It is the only muscle relaxant which stimulate autonomic ganglia and vagus - Bradycardia occurs due to vagal stimulation.* SCh is the most commonly used muscle relaxant for passing endotracheal tube (rapacuronium and rocuronium are alternatives).* SCh is rapidly hydrolysed by plasma cholinersterase, some patients have genetically determined abnormality or deficiency of pseudocholinesterase, in them, SCh causes phase II block (dual block).* It can cause muscle fasiculations and soreness, change in BP and HR, arrhythmia, histamine release and K+ effux from muscles.* Post-operative muscle pain (myalgia, muscle soreness) is a very common problem.* It can accentuate malignant hyperthermia caused by halothane - Succinylcholine is the most common cause of malignant hyperthermia.* Succinylcholine can cause dangerous hyperkalemia in patients with: -# Burn# Massive trauma# Crush injury# Severe intra-abdominal infection# Spinal cord injury# Hemiplegia/Paraplegia# Muscular dystrophy# GB syndrome# Rhabdomyolysis# Severe Parkinsonism# Tetanus# Polyneuropathy# Closed head injury# Stroke# Encephalitis# Mysthenia gravis* SCh causes increases in all pressures -> intraocular, intracranial, BP, and intrabdominal.* SCh can cause Trismus (masseter spasm) especially in patients susceptible for malignant hyperthermia.\n\nSo the answer to this question is C"} {"instruction": "Which of the following is not a cause of conductive hearing loss-\nA. CSOM\nB. Otosclerosis\nC. Presbycusis\nD. Serous otitis media", "response": "Ans. is 'c' i.e., Presbycusis Causes of conductive deafnessCongenital causeso Meatal atresiao Fixation of stapes footplateo Fixation of malleus heado Ossicular discontinuityo Congenital cholesteatomaAcquired causeso External ear:# Any obstruction in the ear canal, e.g. wax, foreign body, furuncle, acute inflammatory swelling, tumor, atresiao Middle ear :# Perforation of tympanic membrane (traumatic or infective)# Fluid in middle ear (ASOM, serous otitis media or haemotympanum)# Mass in middle ear (tumors)# Disruption of ossicles (Trauma, CSOM, cholesteatoma)# Fixation of ossicles (otosclerosis, tympanosclerosis, adhesive otitis media)# Eustachian tube blockage (retracted tympanic membrane, serous otitis media)\n\nSo the answer to this question is C"} {"instruction": "The commonest symptom post operatively seen is ?\nA. Depression\nB. Psychosis\nC. Euphoria\nD. None of the above", "response": "Ans. is 'd' i.e., None of the above Delirium is the commonest psychiatric problem postoperatively (1) Delirium - 20 % (2) Depression- 9% (3) Dementia- 3% (4) Functional Psychosis- 2%\n\nSo the answer to this question is D"} {"instruction": "Most common parasite causing myocarditis is -\nA. Trichinella\nB. Trypanosome\nC. Ascaris\nD. Plasmodium", "response": "There are 3 stages in the life cycle of trichinella spiralis stage of intestinal invasion Malaise,nausea , vomiting, diarrhoea,abdominal cramps .onset within 2-30 hours of ingestion of food. stage of muscle invasion fever, myalgia, periorbital edema ,hemorrhage in subconjuctiva, myocarditis, and encephalitis. stage of encystation:final stage All symptoms subside Ref: panickers textbook of medical parasitology 8th edition page 173.\n\nSo the answer to this question is A"} {"instruction": "All of the following are true about Zollinger Ellison Syndrome except -\nA. It is due to the presence of a gastrinoma\nB. Gastrin provocation tests are a part of diagnostic work up\nC. It might be associated with ulcers in unusual locations in stomach\nD. They may be associated with insulinomas", "response": "Ans. is 'd' i.e., They may be associated with insulinomas Zollinger Ellison syndromeo ZES is caused by gastrin secreting gut neuroendocrine tumors (gastrinomas), which result in hypergastrinemia and acid hypersecretion.o Clinical situations that create suspicion for ZES are -# ulcers in unusual locations# ulcers in second part of duodenum & beyond# ulcers refractory to standard medical therapy# ulcer recurrance after acid reducing surgery# ulcers presenting with frank complications (bleeding, perforation and obstruction)# ulcers in the absence of H. pylori or NS AID ingestion. - giant ulcers (> 2 cm)# multiple duodenal ulcers# ulcers associated with diarrhoea# ulcer patient with hypercalcemia or family h/o ulcers# ulcers with severe esophagitis.# ulcers associated with prominent gastric folds# ulcers with findings s/o MEN-1 (endocrinopathy, family h/o ulcers or endocrinopathy, nephrolithiasis)Diagnosis of ZES (gastrinoma)o The first step in evaluation of a patient suspected of having ZES or gastrinoma is to obtain as fasting gastrin level. All gastrinoma patients have a fasting gastrin level > 150 pg/mL.o The next step is to assess acid secretion by measuring basal acid output (BAO) which should be 15 meq/h (normal < 4 meq/h) A gastric pH of > 3.0 implies hypochlorhydria and excludes gastrinomao Gastrin Provocative tests# In a pt. with pH < 2.0 or BAO 15 meq/hr and fasting gastrin level > 1000 pg/mL, the diagnosis of ZES is confirmed.# With pH < 2.0 or BAO 15 meq/L and lower gastrin levels (150-1000 pg/mL), a secretin stimulation test is perforfmed to distinguish ZES from other causes of hypergastrinemia.# A rise of 200 pg/mL of serum gastrin level within 15 min of secretin injection, confirms ZES.\n\nSo the answer to this question is D"} {"instruction": "In case of Ca lung which among the following will be C/I for surgical resection -\nA. Malignant pleural effusion\nB. Hilar lymphadenopathy\nC. Consolidation of one lobe\nD. Involvement of visceral pleura.", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Urea is formed in:\nA. Brain\nB. Kidney\nC. Liver\nD. Intestine", "response": "C & A Harper, 26th ed, p. 244 & 25,h ed, p. 319\n\nSo the answer to this question is C"} {"instruction": "You are examining the liver biopsy specimen of a patient and you find Mallory hyaline in it. Which of the following would you exclude from the diagnosis?\nA. Alcoholic liver disease\nB. Hepatocellular Ca\nC. Hepatitis E\nD. Wilson's syndrome", "response": "Mallory hyaline bodies are eosinophilic cytoplasmic inclusions seen in degenerating liver cells, they also contain cytokeratin intermediate filaments. Some conditions showing Mallory hyaline are given below: 1. Wilson's disease2. Hepatocellular ca3. Primary biliary cirrhosis4. Indian childhood cirrhosis5. Alcoholic liver disease Ref: Robbins Illustrated Pathology, 7th Edition, Page 905\n\nSo the answer to this question is C"} {"instruction": "The most common complication of clavicle fracture is\nA. Injury to brachial plexus\nB. Malunuion\nC. Stiffness of shoulder\nD. Non union", "response": "B i.e. Malunion\n\nSo the answer to this question is B"} {"instruction": "Regarding uterine atony after delivery, treatment includes\nA. Fundal massage should be performed\nB. 20 units oxytocin bolus given i.v\nC. Oxytocin diluted in crystalloid solution at concentration of 200 IU / min should be given i.v\nD. All the above", "response": "Vigorous fundal massage can prevent post partum hemorrhage, if uterine atony is felt per abdomen.\n20 units of oxytocin in 1000mL of crystalloid solution will be effective given i.v at 10mL / min for a dose of 200 mU / min.\n\nSo the answer to this question is A"} {"instruction": "\"3 by 5\" initiative in AIDS control programme is -\nA. Providing 3 million people treatment by end of 2005\nB. Providing treatment to 3 out of 5 patients\nC. Reducing incidence of A I DS by 3% by 2005\nD. All of the above", "response": "Ans. is 'a' i.e., Providing 3 million people treatment by end of 2005 3 by 5 target o On lst December 2003, WHO and UN A IDS announced a detailed plan to reach the \"3 by 5 target\" of providing antiretroviral treatment (A) to three million people living with IIIIDS in the developing countries by the end of 2005. o Ultimate goal ()1 this strategy is to provide universal access to A to anyone who needs it. o It has five Pillars (focus areas of concerns) :? 1) Simptified standard tools to deliver A 2) A new service to ensure effective, reliable supply of medicines and diagnostics 3) Dissemination and application of new knowledge and successful strategy 4) Urgent, sustained suppo to countries 5) Global leadership. backed by strong panership\n\nSo the answer to this question is A"} {"instruction": "Pachydermia laryngitis - M/C site of involvement\nA. Vestibular fold\nB. Arytenoid cailage\nC. Anterior 1/3 commissure\nD. Posterior 1/3 and anterior 1/3 commissure", "response": "Pachyderma laryngitis affects the medial surface of arytenoid cailage, in paicular the vocal processes. Ref:- Scott&;s Brown 7th edition; pg num:- 2196\n\nSo the answer to this question is B"} {"instruction": "On Contrast radiography which among the following is false?\nA. Ileum is featureless\nB. Colon has haustrations\nC. Jejunum is feathery\nD. Distal part of duodenum has a cap", "response": "The first part of the duodenum has the duodenal cap or bulb and not the distal part.\nThe first part of the duodenum is visible as a triangular shadow on barium studies and is known as the duodenal cap.\nThe small intestine contains mucosal folds known as plicae circulares or valvulae conniventes that are visible on barium studies and help in the distinction between small intestine and colon. Colon instead can be identified by the presence of haustrations.\nValvulae conniventes are more prominent in the jejunum giving the 'feathery appearance' on barium. These mucosal folds are gradually reduced distally giving a 'featureless' appearance of the distal ileum.\n\nSo the answer to this question is D"} {"instruction": "Which of the following is a common side-effect of Cisplatin -\nA. Diarrhea\nB. Vomiting\nC. Pulmonary fibrosis\nD. Alopecia", "response": "Ans. is 'b' i.e., Vomiting Most common side-effect of Cisplatin is : Vomiting The most impoant dose dependent toxicity is renal impairment. o Amifostine is labelled for reduction of cisplatin induced nephrotoxicity.\n\nSo the answer to this question is B"} {"instruction": "Which of the following is a myofunctional appliance?\nA. Catalan's appliance\nB. Hawley's appliance\nC. Expansion screw\nD. Derichsweiler appliance.", "response": "Catalans or lower anterior inclined plane appliance is used to treat cross bites. The inclined plane has a 450 angulation, which forces the maxillary teeth in cross bite to a more labial position. It is teeth supported functional appliance. Expansion screw and Derichsweiler are expansion appliances.\n\nSo the answer to this question is A"} {"instruction": "High plasma protein binding of a drug results in:-\nA. Decreased glomerular filtration\nB. High volume of distribution\nC. Lowers duration of action\nD. Less drug interaction", "response": "* High plasma protein binding (PPB) of a drug decreases its distribution into tissue and thus lower the volume of distribution. * As only free drug can be metabolized or excreted, high PPB usually increases the duration of action. * With higher PPB, there is more chance of getting displaced by other drugs leading to more drug interactions. * Drugs with high plasma protein binding have lesser glomerular filteration as proteins cannot be filtered across the glomerulus.\n\nSo the answer to this question is A"} {"instruction": "Prolonged treatment with INH leads to deficiency of:\nA. Pyridoxine\nB. Thiamine\nC. Pantothenic acid\nD. Niacin", "response": "Ans. (A) Pyridoxine(Ref: Katzung 11th/e p825, KDT 8th/e p818)Isoniazid can cause peripheral neuropathy due to deficiency of pyridoxine.\n\nSo the answer to this question is A"} {"instruction": "Which of the following is treatment of Type I hypersensitivity -\nA. Histamine\nB. IgA immunoglobulin\nC. Sodium cromoglycate\nD. Interleukin 5", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Early mediators of allergic rhinitis are -a) Leukotrieneb) IL-4c) IL-5d) Bradykinine) PAF\nA. ab\nB. bc\nC. acd\nD. abcde", "response": "Allergic rhinitis is Type 1 hypersensitivity reaction\n\nSo the answer to this question is D"} {"instruction": "The nerve that supplies the marked structure\nA. Dorsal rami of CI\nB. Suprascapular\nC. subscapular\nD. dorsal scapular", "response": "marked structure is Levator scapulae Nerve supply C5 Dorsal scapular nerve supplies Levator scapulae and Rhomboids major/ remarks : brachial plexus is repeat topic ref : GRAYS ANATOMY AND BD CHAURASIA\n\nSo the answer to this question is D"} {"instruction": "Commonest diameter of fetal head engagement is\nA. Submentoveritcal\nB. Occipito frontal\nC. Suboccipito bregmatic\nD. Mentoveical", "response": "The commonest diameter for fetal head engagement is suboccipitobregmatic, as it leads to veex presentation for normal vaginal delivery. Fetal skull diameters Measurements Suboccipitobregmatic Biparietal diameter Submentobregmatic 9.5 cm Suboccipitofrontal 10cm Occipitofrontal Submentoveical 11.5 cm Mentoveical 14 cm\n\nSo the answer to this question is C"} {"instruction": "Vitreous haemorrhage is seen in all except\nA. CRAO\nB. CRVO\nC. Coat's disease\nD. Eales' disease", "response": "VITREOUS HAEMORRHAGE Vitreous haemorrhage usually occurs from the retinal vessels and may present as pre-retinal (sub-hyaloid) or an intragel haemorrhage. Causes : Causes of vitreous haemorrhage are as follows: 1. Spontaneous vitreous haemorrhage from retinal breaks especially those associated with PVD. 2. Trauma to eye, which may be blunt or perforating (with or without retained intraocular foreign body) in nature. 3. Inflammatory diseases such as erosion of the vessels in acute chorioretinitis and periphlebitis retinae primary or secondary to uveitis. 4. Vascular disorders e.g., hypeensive retinopathy, and central retinal vein occlusion. 5. Metabolic diseases such as diabetic retinopathy. 6. Blood dyscrasias e.g., retinopathy of anaemia, leukaemias, polycythemias and sickle-cell retinopathy. 7. Bleeding disorders e.g., purpura, haemophilia and scurvy. 8. Neoplasms. Vitreous haemorrhage may occur from rupture of vessels due to acute necrosis in tumours like retinoblastoma. 9. Idiopathic. Ref:- A K KHURANA; pg num:-246\n\nSo the answer to this question is A"} {"instruction": "Drug of choice for NSAID induced gastric ulcer is: September 2008, March 2012\nA. Miprinone\nB. Misoprostol\nC. Carboprost\nD. Miazapine", "response": "Ans.B: Misoprostol Misoprostol is a drug that is used for the prevention of non-steroidal anti-inflammatory drug (NSAID)-induced gastric ulcers, for early aboion, to treat missed miscarriage, and to induce labor. Pharmacologically, misoprostol is a synthetic prostaglandin El (PGE1) analogue\n\nSo the answer to this question is B"} {"instruction": "Indication for administration of AS V (Antisnake venom) in Viper bite?\nA. Renal failure\nB. DIC\nC. Soft tissue swelling crossing joint nearby the site of bite\nD. All of the above", "response": "Ans. d (All of the above) (Ref: Pilley Textbook of Toxicolgy 7th edition, p. 450; Harrison's 17th ed., p. 2742)Use of Acetylcholinesterase Inhibitors in Neurotoxic Snake Envenomation1. Patients with clear, objective evidence of neurotoxicity after snakebite (e.g., ptosis or inability to maintain upward gaze) should receive a trial of edrophonium (if available) or neostigmine.a. Pretreat with atropine: 0.6 mg IV (children, 0.02 mg/kg; minimum of 0.1 mg)b. Follow with:Edrophonium: 10 mg IV (children, 0.25 mg/kg) orNeostigmine: 1.5-2.0 mg IM (children, 0.025-0.08 mg/kg)2. If objective improvement is evident at 5 min, continue neostigmine at a dose of 0.5 mg (children, 0.01 mg/kg) every 30 min as needed, with continued administration of atropine by continuous infusion of 0.6 mg over 8 h (children, 0.02 mg/ kg over 8 h).3. Maintain vigilance regarding aspiration risk, and secure the airway with endotracheal intubation as needed.REID'S CRITERIA FOR ADMINISTRATION OF ASV# Leukocytosis > 13,000-15,000/cu mm# Thrombocytopenia < 80,000/cu mm# Renal failure# DIC# Soft tissue swelling involving or crossing joint nearby site of bite# Systemic symptoms/signs of neuroparalytic bite (vomiting, abdominal pain, giddiness, ptosis, etc).Dose of ASVLimb Area InvolvementDose< 1/3 of Limb area50 ml1/3-1/2 Limb area100 ml>50% of Limb area150-200 mlASV should be given within 2 days preferably can be given upto 5-7 days.Comparison of Antivenoms Recently Available for Treatment of Pit Viper Bites in the U Antivenin (Crotalidae) PolyvalentCroFabAvailable since19542000OriginEquineOvineSnakes used in manufactureCrotalus adamanteusC. adamanteus C. atroxC. atrox C. durissus terrificusC. scutulatus Bothrops atroxAgkistrodon piscivorusContainsSkin testing recommended byIgG, equine albuminFab fragmentsmanufacturerYesNoPretreatment with antihistaminesYesNoDry bite-doseNoneNoneMild - dose0 or 5 vials4 vialsModerate - dose10 vials4-6 vialsSevere - dose15-20 vials6 vialsRepeat dosingAs neededRepeat starting dose if patient fails to stabilize.After stabilization, give 2 vials q6h for 3 more doses. (Alternatively, re-dose on an as needed basis with close observation for recurrence of abnormalities.)Volume of diluent1000 mL250 mLAdminister over2 h1 hIncidence of anaphyiacticoid reacn23-56%14%incidence of delayed serum sickness18-86%3%\n\nSo the answer to this question is D"} {"instruction": "Aminoacyl – t- RNA is required for all except ?\nA. Hydroxyproline\nB. Methionine\nC. Cystine\nD. Lysine", "response": "- Hydroxyproline is a derived amino acid and there is no t-RNA available to transport derived amino acids: hydroxyproline and hydroxylysine are two examples of derived amino acid for which there is no t-RNA available.\n\nSo the answer to this question is A"} {"instruction": "Conjugated hyperbilirubinemia is seen in which of the following conditions?\nA. Breast milk jaundice\nB. Dubin-Johnson syndrome\nC. Crigler- Najjar syndrome\nD. Gilbe syndrome", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Koebner's phenomenon is characteristic of –\nA. Psoriasis\nB. Pemphigus vulgaris\nC. Pityriasis rosea\nD. Lupus vulgaris", "response": "Disorders showing koebner's phenomenon\n\nLichen planus Lichen nitidus Darrier disease (Keratosis follicularis)\nPsoriasis Molluscum contigiosum DLE\nVitiligo Warts Pityriasis rubra pilaris\n\nRare causes are\n\nErythema multiforme Necrobiosis lipoidica\nHailey-bailey disease Xanthoma\nLeukemia & Carcinoma Vasculitis\nLichen sclerosis\n\nSo the answer to this question is A"} {"instruction": "DPT vaccine is given -\nA. Intramuscular\nB. Subcutaneous\nC. Intradermal\nD. Intravenous", "response": "Ans. is 'a' i.e., Intramuscular DPT Vaccineo It contains components for immunization against three diseases, i.e., toxoid of diphtheria and tetanus, and killed B. pertussis. Pertussis component enhances the potency of diphtheria toxoid.o Aluminium salts (hydroxide or phosphate) are used as adjuvant to increase immunogenicity. Thiomersalis used as preservative.o Usual storage temperature for DPT vaccine in cold chain is +2 to+8degC, stored in refrigerator. It should never be stored in deep freezer (should not be frozen) and if it gets frozen accidently, vaccine should he discarded.o Exposure to sunlight should he avoided. Open vials which have not been fully used should be discarded at the end of sessiono Vaccine is given by intramuscular route in the middle third of anterolateral aspect of thigh.o Optimum age to start DPT vaccination is 6 weeks after birth.o Total three doses are given in primarly immunization with an interval of 4 weeks between three doses. First booster is given at 16-24 months with second booster at 5-6 years.DoseAgeDPT,6 weeks of ageDPT:10 weeks of ageDPT314 weeks of ageDP TBooster16-24 months of ageDPTBooster5 years of ageo Absolute valid contraindications to DPT vaccine are (i) Severe allergic reaction to previous dose, and (ii) progressive neurological deficit (i.e. active epilepsy). Epilepsy controlled on antiepileptic drugs is not a contraindication.\n\nSo the answer to this question is A"} {"instruction": "For Status epilepticus, treatment of choice is: September 2012\nA. Ethosuximide\nB. Sodium valproate\nC. Lamotrigine\nD. Lorazepam", "response": "Ans. D i.e. Lorazepam\n\nSo the answer to this question is D"} {"instruction": "Hyponatremia in multiple myeloma is\nA. TRUE\nB. Relative\nC. Absolute\nD. Pseudo", "response": "Pseudohyponatremia Patients with multiple myeloma also have a decreased anion gap because of the M component is cationic, resulting in retention of chloride This is often accompanied by hyponatremia that is felt to be aificial (pseudohyponatremia) because each volume of serum has less water as a result of the increased protein Ref: Harrison's 19th edition Pgno : 714\n\nSo the answer to this question is D"} {"instruction": "A woman with infertility receives an ovary transplant from her sister who is an identical twin. What type of graft it is?\nA. Xenograf\nB. Autograft\nC. Allograft\nD. Isograft", "response": "Ans. is 'd' i.e., Isograft (Ref: Ananthanarayan, 9th/e)\n\nSo the answer to this question is D"} {"instruction": "A young hypeensive patient has serum K+ 2.8 meq/L and Taldosterone level with Si-ed plasma rennin activity. The likely cause is:\nA. Renal aery stenosis\nB. Ectopic ACTH syndrome\nC. Diuretic therapy\nD. Conn's syndrome", "response": "Answer is D (Conn's syndrome): Increased Aldosterone levels (Hjperaldosteronism) in the presence of hypeension hypokalemia and decreased rennin activity suggests a diagnosis of Conn's syndrome.\n\nSo the answer to this question is D"} {"instruction": "Which one of the following statement is true regarding pathogenicity of Mycobacteria species -\nA. M. tuberculosis is more pathogenic than M.bovis to the humans\nB. M. Kansasii can cause a disease indistinguishable from tuberculosis\nC. M.Africanum infection is acquired from the environmental source\nD. M.Marinum is responsible for tubercular lymphadenopathy", "response": "“Mycobacterium kansasii produce human disease indistinguishable from tuberculosis”\nM. kansasii i is the most pathogenic non tuberculous mycobacterial species affecting the lung, and the clinical features of M. kansasii disease resemble those of tuberculosis. Harrison 17/e p1030\nNTM causing human infection- Refer chapter review.\n\nAbout Other Options:\n\nOption a: M.tuberculosis is equally pathogenic than M.bovis to the humans and Guinea pig. However, M.bovis but not M.tuberculosis is pathogenic to rabbit.\nOption c: M. africanum belongs to the members of Mycobacterium tuberculosis complex. It is commonly found in West African countries, causing up to a quarter of cases of tuberculosis in countries such as the Gambia. ‘It is an infection of humans only and is spread by an airborne route from individuals with open cases of disease.’ \nOption d: ‘M. marinum causes swimming pool granuloma/fish trank granuloma/ fish fancier’s finger. Secondary lesions appear along with dermal lymphatics.’ (Sporotrichoid spread)\n\nSo the answer to this question is B"} {"instruction": "Definitive host is one in which the follow ing lives -\nA. Larvae\nB. Asexual form\nC. Adult form\nD. None", "response": "Ans. is 'c' i.e., Adult form Definitive host In which the parasite utilises the sexual method of reproduction. o So, definitive host harbours adult worm. Intermediate host Herbours the larval stages (asexual multiplication). Paratenic (Carrier or transpo) host Where the parasite remains ble without fuher development.\n\nSo the answer to this question is C"} {"instruction": "True about rash of chicken pox-\nA. Deep seated\nB. Centripetal\nC. Affects palm & sole\nD. Slow evolution", "response": "Ans. is 'b' i.e., Centripetal Differences between smallpox and chickenpoxSmallpoxChickenpox1 Incubation:About 12 days(range : 7-17 days)About 15 days(range : 7-21 days)2. Prodromol symptoms :Severe.Usually mild.3. Distribution of rash:a) Centrifugalb) Palms and soles frequently involved.c) Axilla usually freed) Rash predominant on extensor surfaces and bony prominences.a) Centripetalb) Seldom affectedc) Axilla affectedd) Rash mostly on flexor surfaces.4. Characteristics of the rash:a) Deep-seatedb) Vesicles multilocular and umbilicatedc) Only one stage of rash may be seen at one time.a) Superficialb) Unilocular; dew-drop like appearance.c) Rash pleomorphic, i.e., different stages of the rash evident at one given time, because rash appears in successive crops.d) An area of inflammation is seen around the vesicles.d) No area of inflammation is seen around the vesicles.5. Evolution of rash:a) Evolution of rash is slow, deliberate and majestic, passing through definite stages of macule, papule, vesicle and pustule.b) Scabs begin to form 10-14 days after the rash appears.a) Evolution of rash very rapid.b) Scabs begin to form 4-7 days after the rash appears.6. Fever:Fever subsides with the appearance of rash, but may rise again in the pustular stage (secondary rise of fever).Temperature rises with each fresh crop of rash.\n\nSo the answer to this question is B"} {"instruction": "Syndrome characterized by proteinuria, hematuria and hypeension: March 2007\nA. Nephrotic syndrome\nB. Acute nephritis\nC. Renal cell carcinoma\nD. Nephroclacinosis", "response": "Ans. B: Acute nephritis Nephritic syndrome is characterized by; Proteinuria Hematuria Hypeension Variable renal insufficiency, with; -- Azotemia (elevated blood nitrogen) Oliguria (low urine output The main features are hypeension and RBC casts. Nephritic syndrome causes are usually grouped into 'focal proliferative' and 'diffuse proliferative' on the basis of histology (obtained by a renal biopsy). Focal proliferative IgA nephropathy Chronic liver failure Celiac sprue Dermatitis herpetiformis Henoch-Schoenlein purpura Alpo syndrome SLE Diffuse proliferative Focal glomerulosclerosis Membranoproliferative glomerulonephritis (malaria, hepatitis B, hepatitis C, chronic infection, sickle-cell disease, SLE, hemolytic uremic syndrome/thrombotic thrombocytopenic purpura) Cryoglobulinemia SLE Rapidly progressing glomerulonephritis (RPGNs) - several.\n\nSo the answer to this question is B"} {"instruction": "In a case of hyperophic pyloric stenosis, which of the following metabolic disturbance is found?\nA. Respiratory alkalosis\nB. Metabolic acidosis\nC. Metabolic alkalosis with paradoxical aciduria\nD. Metabolic alkalosis with alkaline urine", "response": "Due to vomiting of the gastric contents, infants develop a hypochloremic, hypokalemic metabolic alkalosis. The urine pH is high initially but eventually drops because hydrogen ions are preferentially exchanged for sodium ions in the distal tubule of the kidney as the hypochloremia becomes severe. Ref: Schwaz's Principles of Surgery, 9th Edition, Chapter 39\n\nSo the answer to this question is C"} {"instruction": "True about asthma -a) Increasing incidence day by dayb) Allergic asthma common in older patientsc) Increase in IgE in idiosyncratic asthmad) Bronchoconstriction\nA. b\nB. c\nC. ad\nD. ab", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Contact period of chlorination ?\nA. 1 hour\nB. 30 minutes\nC. 1 1\\/2 hour\nD. 2 hours", "response": "Contact period for chlorination is one hour. The presence of free residual chlorine for a contact period of one hour is necesary to kill pathogens. The residual chlorine is 0.5 mg/L.Parks textbook of preventive and social medicine.K Park. Edition 23.Pg no: 715\n\nSo the answer to this question is A"} {"instruction": "The mode of inheritance of incontinentia pigment is –\nA. Autosomal dominant\nB. Autosomal recessive\nC. X-linked dominant\nD. X-linked recessive", "response": "Incontinentia pigmenti is an X-linked dominant disorder\n\nSo the answer to this question is C"} {"instruction": "Primordial germ cells are seen in ------ by 3rd week of development?\nA. Neural crest\nB. Splanchnic mesoderm\nC. Genital ridge\nD. Yolk sac", "response": "Primordial germ cells originate in the epiblast, migrate through the primitive streak, and by the third week reside among endoderm cells in the wall of the yolk sac close to the allantois. Germ cells do not appear in the genital ridges until the sixth week of development Ref: Langman's embryology; Chapter 16; Pg no 243\n\nSo the answer to this question is D"} {"instruction": "For hysteroscopy, following are/is used:a) Distilled Waterb) Airc) Glycined) CO2\nA. ab\nB. cd\nC. bd\nD. ac", "response": "None\n\nSo the answer to this question is B"} {"instruction": "An elderly male patient presented with fever, chest pain and dry cough. On sputum culture growth on charcol yeast extract medium was identified. The organism is likely to be which of the following?\nA. H. influenza\nB. Moraxella caarrhahs\nC. Legionella\nD. Burkholderia cepacia", "response": "An elderly patient with fever, chest pain and non-productive (dry cough) are characteristic features of legionnaires disease (pneumonia), caused by Legionella pneumophila. Legionella pneumophila grows on buffered charcoal yeast agar. Hemophilus influenzae grows on blood agar, Moraxella catarrhalis grows on nutrient agar and Burkholderia cepacia needs selective media for its growth. Ref: Textbook of Microbiology, Ananthanarayan and Paniker, 7th Edition, Chapter 45, Page 409.\n\nSo the answer to this question is C"} {"instruction": "Lifespan of the fetal RBC approximately is\nA. 60 days\nB. 100 days\nC. 80 days\nD. 120 days", "response": "The lifespan of fetal red cells is 80 days and Rh factor is developed by 38 days.\n\nSo the answer to this question is C"} {"instruction": "Stored blood as compared to fresh blood has-\nA. More 2, 3 DPG\nB. High extracellular K+\nC. High extracellular Hb\nD. Increased platelets", "response": "None\n\nSo the answer to this question is B"} {"instruction": "In tubercular meningitis what is not seen?\nA. Low sugar\nB. Lymphocytic pleocytosis\nC. High protein\nD. Opening pressure is low", "response": "ANSWER: (D) Opening pressure is lowREF: Chandrasoma Taylor 3rd ed p. 915CSF changes in meningitisCSF parametersBacterial meningitisTB meningitisViral meningitisOpening pressureRaisedRaisedRaisedGross appearanceTurbidClear (may clot)ClearProtein (normal - 20-50 mg/dl)HighVery highSlightly highGlucose (40-70mg/dl)Very lowLowLowChloride (116-122 micro gram/dl)LowVery lowNormalCells > 5/microliterNeutrophilsPleocytosisLymphocytosis\n\nSo the answer to this question is D"} {"instruction": "Trochlear nerve\nA. Supplies the inferior oblique muscle of the eyeball\nB. Is the only cranial nerve to emerge from the dorsal aspect of the brainstem\nC. Has its nucleus of origin in the midbrain at the level of the superior colliculus\nD. Enters the orbit through the middle compartment of the superior orbital fissure", "response": "(B) Is the only cranial nerve to emerge from the dorsal aspect of the brainstem # TROCHLEAR NERVE emerges from the superior medullary velum near the frenulum veli just below the inferior colliculus.> Trochlear nerve is the only cranial nerve which emerges on the dorsal aspect of the brainstem.> When the trochlear nerve is damaged, diplopia occurs on looking downwards: vision is single so long as the eyes look above the horizontal plane.\n\nSo the answer to this question is B"} {"instruction": "A 25 year old male is undergoing incision and drainage of abscess under general anaesthesia with spontaneous respiration. Which of the following is the most efficient anaesthetic circuit which can be used in this patient?\nA. Mapleson A\nB. Mapleson B\nC. Mapleson C\nD. Mapleson D", "response": "The most efficient anaesthetic circuit which can used in this patient undergoing general anesthesia with spontaneous respiration is Mapelson A circuit. In Mapleson A or Magill circuit, free gas flow (FGF) enters the circuit near the reservoir bag and the APL valve is placed close to the patients face. This system is very efficient during spontaneous ventilation (SV), because the FGF needs to be only 0.7 to 1.0 times the patient's minute ventilation to avoid rebreathing. Use of this circuit is less efficient in case of rapid respiratory rate as in small children, and in controlled ventilation (CV). It should not be used in children less than 20kg because of the impoant apparatus dead space. Ref: Pediatric Anesthesia By Bruno Bissonnette, Page 635 ; Fundamentals of Anaesthesia By Tim Smith, Colin Pinnock, Ted Lin, 3rd Edition, Pages 843-44\n\nSo the answer to this question is A"} {"instruction": "The presence of multiple cavities in the lung with hematuria is suggestive of-\nA. Wegener's granulomatosis\nB. Tuberculosis\nC. Renal cell carcinoma\nD. Systemic lupus erythematosus (SLE)", "response": "Wegener's granulomatosis is characterised by granulomatous vasculitis of the upper and lower respiratory tracts together with glomerulonephritis.Lung involvement typically appear as multiple,bilateral,nodular cavitary infiltrates and clinically expressed as cough,hemoptysis,dyspnea,and chest discomfo.Renal involvement can appear as proteinuria,hematuria,and red blood cell casts,and progressing to renal functional impairment and renal failure. Ref:Harrison's medicine-18th edition,page no:2789,2790.\n\nSo the answer to this question is A"} {"instruction": "Electrocogulation is used for\nA. Gingivectomy\nB. Flap surgeries\nC. Mucogingival surgeries\nD. All of the above", "response": "None\n\nSo the answer to this question is A"} {"instruction": "ranulomatous mastitis is caused by all except -\nA. TB\nB. Fungus\nC. Staphylococcus\nD. Antibodies to milk antigens", "response": "Ans. is 'c' i.e., Staphylococcus Granulomatous mastitis Granulomatous inflammation is present in less than I% of all breast biopsy specimens. The causes include systemic granulomatous disease (e.g., Wegener granulomatosis or sarcoidosis) that occasionally involve the breast, and granulomatous infections caused by mycobacteria or fungi. Infections of this type are most common in immunocompromised patients or adjacent to foreign objects such as breast prostheses or nipple piercings. Granulomatous lobular mastitis is an uncommon breast-limited disease that only occurs in parous women. The granulomatous inflammation is confined to the lobules, suggesting that it is caused by a hypersensitivity reaction to antigens expressed by lobular epithelium during lactation.\n\nSo the answer to this question is C"} {"instruction": "A 5-year-old child presents with history of fever off- and-on for past 2 weeks and petechial spots all over the body and increasing pallor for past 1 month. Examination reveals splenomegaly of 2 cm below costal margin. The most likely diagnosis is:\nA. Acute leukemia\nB. Idiopathic thrombocytopenic purpura\nC. Hodgkin's lymphoma\nD. Aplastic anemia", "response": "- Pallor (anemia), petechial spot (thrombocytopenia), fever (infection due to neutropenia) with splenomegaly suggest the diagnosis of acute leukemia. - Splenomegaly eliminates aplastic anemia - Presence of anemia and recurrent infections, go against ITP\n\nSo the answer to this question is A"} {"instruction": "Histamine causes\nA. Hypeension\nB. Vasoconstriction\nC. Vasodilation\nD. Tachycardia", "response": "ref Robbins 7/e p64;9/e p73 As pa of an immune response to foreign pathogens, histamine is produced by basophils and by mast cells found in nearby connective tissues. Histamine increases the permeability of the capillaries to white blood cells and some proteins, to allow them to engage pathogens in the infected tissues.\n\nSo the answer to this question is C"} {"instruction": "Ehrlich phenomenon is seen in:-\nA. Proteus\nB. Mycobacterium TB\nC. Corynebacterium\nD. Staphylococcus", "response": "Ehrlich phenomenon is seen in Corynebacterium. Option 1, 2, 4 Proteus, Mycobacterium species and Staphyococcus species: Do not show Ehrlich phenomenon. Proteus shows Diene's phenomenon. Option 3 Difference due to the presence of toxin preparation of varying amounts of toxoid and antitoxin to combine in varying propoions is called Ehrlich phenomenon. Minimum lethal dose (MLD) of the diphtheria toxin as the least amount of toxin required to kill a guinea pig weighing 250 g within 96 hrs after subcutaneous inoculation. One unit of antitoxin is defined as the smallest amount of antitoxin required to neutralize 100 MLD of toxin.\n\nSo the answer to this question is C"} {"instruction": "Best quality proteins are found in highest quantities in -\nA. Rice\nB. Wheat\nC. Ragi\nD. Bajra", "response": "Cereals include rice and wheat while Bajra and ragi are included in millets. The protein content of rice varies from 6-9%.They are richer in lysine than the other cereal proteins, and hence for this reason, rice protein is considered to be of better quality. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 579)\n\nSo the answer to this question is A"} {"instruction": "Anticholinergic side effect is:\nA. Salivation\nB. Dryness\nC. GIT motility\nD. Sweating", "response": "Ans. (b) DrynessRef. Katzung'a Pharamacology 10th ed. Ch 7* Anti-cholinergic agent/Muscarinic antagonists are the class of drugs which competitively inhibit the effect of acetylcholine at muscarinic receptors. Therefore decreasing secretion from glands leading to DRYNESS.* Anti-cholinergic side-effect can be remembered by this mnemonic:# Hot as hare- increased temperature# Blind as bat- mydriasis# Dry as bone- Dry mouth, dry eye, dry skin# Red as beet- Flushed face# Mad as hatter: DeliriumAlso Know'* Cholinergic agents block acetylcholine esterase enzyme, thereby increasing the acetylcholine level.* The patient therefore will present with cholinergic symptoms: (Mn: SLUDGE)* Salivation, Lacrimation, increased urination, Diarrhea, GI distress, Emesis* DOC for this poisoning: ATROPINE\n\nSo the answer to this question is B"} {"instruction": "M/C time for embryo transfer after IVF is:\nA. 2 days\nB. 3 days\nC. 4 days\nD. 5 days", "response": "Ans. is b, i.e. 3 daysM/C time of embryo transfer = Day 3 (8 called Blastomere stage). Best result obtained with Day 5 transfer (Blastocyst transfer)\n\nSo the answer to this question is B"} {"instruction": "Shoest acting synthetic opioid is\nA. Fentanyl\nB. Remifentanil\nC. Alfentanil\nD. Sufentanil", "response": ".Remifentanil is a potent, sho-acting synthetic opioid analgesic drug. It is given to patients during surgery to relieve pain and as an adjunct to an anaesthetic. Remifentanil is used for sedation as well as combined with other medications for use in general anesthesia Ref Robbins 9/e pg 345\n\nSo the answer to this question is B"} {"instruction": "All of the following statements about purification of water are true, EXCEPT:\nA. Level of residual chlorine in water should be 0.5 mg / L\nB. Presence of Clostridium spores indicates recent contamination\nC. Coliforms must not be detectable in any 100 ml sample of drinking water\nD. Coliforms may be detected by multiple tube method and indole production", "response": "The presence of spores of Clostridium perfringens in a natural water suggests that faecal contamination has occured, and their presence in the absence of the coliform group, suggests that faecal contamination has occured at some remote time. Its presence in filtered supplies may indicate deficiency in filtration practice. These spores are capable of surviving in water for a longer time and usually resist chlorination. Ref: Park's Textbook of Preventive and Social Medicine By K. Park, 19th Edition, Pages 58-1; Two's Water Supply By Don D. Ratnayaka, 6th Edition, Pages 241-2, 247\n\nSo the answer to this question is B"} {"instruction": "CVS change in pregnancy -\nA. Slight right axis deviation in ECG\nB. Slight left axis deviation in ECG\nC. Diastolic murmur\nD. Pulse rate is decreased", "response": "Ans. is 'b' i.e., Slight left axis deviation in ECG Cardiovascular systemo Anatomical changes heart is pushed upwards & outward. Apex beat is shifted in 4th intercostals space. A systolic murmur can be heard in apical or pulmonary area. Mammary' murmur is a continuous hissing murmur audible over tricuspid area in left 2nd & 3rd intercostals space. ECG shows left axis deviation. S3 and rarely S4 can be heard.o Cardiac output starts to increase from 5th week of pregnancy, reaches its peak 40-50% at about 30-34 weeks. It is lowest in sitting or supine position & highest is the right or left lateral or knee chest position. CO further increases by 50% during labour and immediately following delivery. CO returns to pre labour values by one hour following delivery and to the pre-pregnant level by another 4 weeks,o Blood pressure systemic vascular resistance (SVR) decreases. Maternal BP is decreased,o Venous pressure femoral venous pressure is raised,o Supine hypotension syndrome (postural hypotension)o Regional distribution of blood flow uterine blood flow is increased from 50 ml per minute in non-pregnant state to 750ml near term. Pulmonary blood flow is increased by 2500 ml /minrenal blood flow increases by 400ml/min. The blood flow through skin and mucous membrane increases by 500ml/min.\n\nSo the answer to this question is B"} {"instruction": "What is the alternative drug for epinephrine in ACLS?\nA. Amiodarone infusion\nB. Atropine\nC. High dose vasopressin\nD. Adenosine", "response": "Ans. c. High dose vasopressinADVANCED CARDIAC LIFE SUPPORT ALGORITHMS\n\nSo the answer to this question is C"} {"instruction": "A fisherman presents with C/O chronic diarrhea and fatigue. His physician orders a P/S, which reveals a megaloblastic anemia. Most likely cause is\nA. Clonorchis sinensis\nB. D. latum\nC. E. granulosus\nD. T. saginata", "response": ".\n\nSo the answer to this question is B"} {"instruction": "Reactionary hemorrhage occurs within\nA. 1-2 days\nB. 2-7 days\nC. < 24 hours\nD. After 7 days", "response": "Reactionary haemorrhage commonly occurs in the first 24 hours after surgery, It may be caused by slippage of a ligature, displacement of blood clot, cessation of vasospasm, after coughing or increased mobility Bailey and Love 26th edition pg 19\n\nSo the answer to this question is C"} {"instruction": "Biological value is used for assessment of –\nA. Fat quality\nB. Protein quality\nC. Carbohydrate quality\nD. None of the above", "response": "Biological value (BV) \n\nIt is the percentage of absorbed nitrogen retained by the organism.\n\nBV = Retained nitrogen / Absorbed nitrogen x 100\n\nSo the answer to this question is B"} {"instruction": "Calorigenic hormone is\nA. Epinephrine\nB. Nor-epinephrine\nC. Thyroid hormones\nD. All of the above", "response": "Calorigenic hormones are hormones which producing or increasing production of heat or energy; increasing oxygen consumption.Epinephrin hormone secreted by the adrenal medulla that is released into the bloodstream in response to physical or mental stress, as from fear or injury. It initiates many bodily responses, including the stimulation of hea action and an increase in blood pressure, metabolic rate, and blood glucose concentration. Also called adrenaline.Norepinephrine hormone is secreted by the adrenal medulla and the nerve endings of the sympathetic nervous system and causes vasoconstriction and increase in hea rate, blood pressure, and the sugar level of the blood. Also called noradrenaline.Thyroid hormone, especially thyroxine or triiodothyronine, produced by the thyroid gland.Hormone produced by the thyroid glands to regulate metabolism by controlling the rate of oxidation in cells. Ref: Ganong&;s review of medical physiology,24th edition, page no:317\n\nSo the answer to this question is D"} {"instruction": "Fundoscopic features of papilledema include all the following except\nA. Ill-defined disc margin\nB. Deep physiological cup\nC. Absent venous pulsation\nD. Bending of blood vessels", "response": "B. i.e. Deep physiological cup Deep physiological cupQ on fundoscopy is seen in glucoma; where as in papilloedema, there is bluring of margins of optic disc (Pt sign) & reduction in size of physiological cup.Q\n\nSo the answer to this question is B"} {"instruction": "A 35-year-old woman presents with pancreatitis. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) reveals the congenital cystic anomaly of her biliary system illustrated in the film below. Which of the following statements regarding this problem is true?\nA. Treatment consists of internal drainage via choledochoduodenostomy\nB. Malignant changes may occur within this structure\nC. Most patients present with the classic triad of epigastric pain, an abdominal mass, and jaundice\nD. Cystic dilation of the intrahepatic biliary tree may coexist and is managed in a similar fashion", "response": "Choledochal cysts are congenital cystic dilations of the extrahepatic biliary ducts. Intrahepatic cystic dilation can coexist (Caroli's disease), but it represents a distinct problem and is managed differently. Patients may present with symptoms at any age, but the classic triad of epigastric pain, abdominal mass, and jaundice is not frequently seen. Rather, most patients present with other conditions such as cholecystitis, cholangitis, or pancreatitis. Ultrasonography or endoscopic retrograde cholangiopancreatography (ERCP) is helpful in demonstrating cysts. Nonsurgical treatment of these cysts results in high morbidity and mortality, and therefore surgery is advised in all cases. The present recommendation is for complete resection of the cyst and Roux-en-Y choledochojejunostomy. Since malignant changes in choledochal cysts have been frequently described, complete resection rather than the performance of an internal drainage procedure is preferred whenever the resection can be done safely.\n\nSo the answer to this question is B"} {"instruction": "Duration of second stage of labour in a multipara is\nA. 10 minutes\nB. 20 minutes\nC. 40 minutes\nD. l hour", "response": "Ans. is 'b' i.e., 20 minutes o Second stage begins with full dilatation of the cervix and ends with expulsion of the fetus.o Mean duration of second stage is 50 minutes for nullipara and 20 minutes in multipara. Prolonged second stage is diagnosed if the duration exceeds 2 hours in nullipara and 1 hour in multipara when no regional anaesthesia is usedo One hour or more is permitted in both the groups when regional anaesthesia is used during labour.\n\nSo the answer to this question is B"} {"instruction": "Amino acid with dissociation constant closest to physiological pH is:\nA. Serine\nB. Histidine\nC. Threonine\nD. Proline", "response": "Histidine has dissociaion constant close to physiologic pH of 7.4 Ref: Textbook of Biochemistry By DM Vasudevan, 3rd Edition, Page 15 ; Lippincott Biochemistry, 2nd Edition, Pages 9-10 ; Pulmonary Biology in Health and Disease By E. Edward Bittar, 2002, Page 277\n\nSo the answer to this question is B"} {"instruction": "Pulmonary fibrosis is an adverse effect of which of the following anti-cancer drugs?\nA. Mitomycin C\nB. Hydroxyurea\nC. Bleomycin\nD. Cisplatin", "response": "Anticancer drugs causing pulmonary fibrosis are Bleomycin Busulfan Methotrexate Cyclophosphamide Carmustine\n\nSo the answer to this question is C"} {"instruction": "Cobra head appearance is seen in:\nA. Ureterocele\nB. Wilm's Tumor\nC. Horse shoe kidney\nD. Vesicoureteral reflux", "response": "Ans: A (Ureterocele) Ref: Harrison is online. 18th edExplanation:Some Important Features in ContrastRadiographsSpider leg appearance -- Polycystic kidneyCobra head appearance -- UreteroceleFlower vase appearance of ureters -- Horse shoe kidneySandy patches -- Schistosomiasis of bladderSoap bubble appearance -- HydronephrosisApple core lesion on barium -- Ca colonClaw appearance on barium enema -- IntussusceptionSaw tooth appearance -- Diverticula of colonBirds beak appearance of esophagus on barium meal -- AchalasiaCork screw appearance of esophagus on barium meal -- Diffuse esophageal spasmString sign of kantor -- Crohn's disseaseThumb printing sign -- Ischemic colitisEGG SHELL CALCIFICATION------ Silicosis, Sarcoidosis. Scleroderma, Histoplasmosis, Amyloidosis, lymphoma following radiotherapy\n\nSo the answer to this question is A"} {"instruction": "Para amino benzoic acid of breast milk prevent the infection of –\nA. Plasmodium vivax\nB. Kleibsella-pneumonia\nC. Giardia\nD. E.coli", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Which muscle is responsible for abduction of vocal cord, in the given diagram\nA. A\nB. B\nC. C\nD. D", "response": "A - Lateral cricoarytenoid muscle. B - Inter arytenoid muscle C - Posterior cricoarytenoid muscle D - Cricothyroid muscle\n\nSo the answer to this question is C"} {"instruction": "A 10 year boy presents with discharge and hearing disturbance in the left ear. On examination of the left ear, a central perforation is noted. Which of the following is the surgical management of choice in this patient?\nA. Myringoplasty\nB. Modified radical mastoidectomy\nC. Radical mastoidectomy\nD. Clearance and antibiotics", "response": "Ans. A. Myringoplasty\n\nSo the answer to this question is A"} {"instruction": "Number of Golgi tendon organs per 100 extrafusal muscle fibres\nA. 20-Oct\nB. 200-400\nC. 50-60\nD. 80-100", "response": "About 1 golgi tendon organ is responsible for 10 to 20 extrafusal fibers Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:689\n\nSo the answer to this question is A"} {"instruction": "All of the following are seen in persisting vomitting EXCEPT\nA. Hypokalemia\nB. Decreased K+ in urine\nC. Elevated pH of blood\nD. Metabolic alkalosis", "response": "Presistant vomitting causes loss of hydrochloric acid, K+ Na+ ions and body fluids. Loss of HCl leads to metabolic alkalosis. Loss of K+ leads to hypokalemia which fuher increases the pH of blood (intracellular K+ ions come out in the ECF by exchanging with H+ ions of ECF). Hypokalemia should lead to decreased K+ in urine but this does not happen - Low Na+ and hypovolemia would lead to increased aldosterone secretion which would increase the reabsorption of Na+ ions in the distal renal tubular in exchange of K+ ions. Thus K+ ions excretion in urine is increased despite hypokalemia.\n\nSo the answer to this question is B"} {"instruction": "Uronic acid pathway is impoant for the formation of?\nA. GAG (glycosamine glycans)\nB. Glycoproteins\nC. Conjugation of bilirubin\nD. All of the above", "response": "UDP-glucuronate (a product of uronic acid pathway) is a donar of glucuronate residue for various conjugation and synthetic processes.\n\nSo the answer to this question is D"} {"instruction": "Most common site of bony metastases in Retinoblastoma-\nA. Skull bones\nB. Hip bones\nC. Ribs\nD. Veebrae", "response": "*Metastasis by blood stream occurs to skill bone and distal bones. Ref: AAO- Ophthalmic pathology and Intraocular Tumors, section 4, 2014-15 p.304.\n\nSo the answer to this question is A"} {"instruction": "Space of cloquet is phylogenetically related to -\nA. Hyaloid artery\nB. Central Retinal artery\nC. Central retinal vein\nD. Iris", "response": "Ans. is 'a' i.e., Hyaloid artery Cloquet's canalo It is the embryonic remnant of hyaloid artery.o It runs from the optic nerve, where it originates in shape of funnel and creates the peripappiiary space of Martegiani, and narrows as it passes through the central vitreous until it reaches the retrocrystalline lens zone,o The anterior vitreous space, or anterior hyaloid is inserted in the posterior capsule of crystalline lens forming a circular zone 8-9 mm in diameter known as Weigershyaioidocapsular ligament,o This ligament constitutes the union between the anterior hyaloid and the anteriormost portion of the Cloquet's canal, leaving a space between the two, called Berger's space.\n\nSo the answer to this question is A"} {"instruction": "Bleomycin toxcity is characterized by destruction of-\nA. Endothelial cells\nB. Type I pneumocytes\nC. Type II pneumocyutes\nD. Alveolar macrophages", "response": "Ans. is 'b' i.e., Type I Pneumocytes Bleomycin is well known to cause pulmonary toxicity.The incidence of bleomycin induced pulmonary toxicity is 5% for a total cumulative dose of450 units and 15% for higher dosages.Bleomycin is concentrated preferentially in the lung and is inactivated by hydrolase enzyme. This enzyme is relatively deficient in lung tissue.This may explain relative sensitivity of bleomycin to lung tissuePathological features of bleomycin toxicityEarly endothelial cell damageDestruction of type I pneumocytes^Migration of type II pneumocytes into alveolar spaces inducing interstitial changesType I epithelial cells are more vulnerable to bleomycin toxicity and are destroyed by bleomycin QFollowing destruction of type I pneumocytes repair is characterized by hyperplasia and dysplasia of type II pneumocytesFibroblast proliferation with subsequent pulmonary fibrosis is probably the basis for irreversible changes induced by bleomycin.Also knowHistopathology of lung in Bleomycin toxicityEndothelial cell edema and blebbingNecrosis of type I pneumocytesHyperplasia and metaplasia of type II pneumocytesInflammatory infiltrate with PMNProliferation of fibroblast and fibrosis\n\nSo the answer to this question is B"} {"instruction": "In non hemolytic jaundice, urobilinogen is seen in ?\nA. Obstructive jaundice\nB. Hepatic fibrosis\nC. Fatty liver\nD. Infective hepatitis", "response": "Ans. is 'd' i.e., Infective hepatitis\n\nSo the answer to this question is D"} {"instruction": "A 40-year-old intravenous drug user presents to the emergency depament with a 2 days history of right knee pain with associated swelling and erythema. The patient is febrile with a holosystolic murmur at the right lower sternal border. Complete blood count reveals leukocytosis. Blood and synol fluid cultures are sent, and broad-spectrum antibiotics are staed. Synol fluid analysis is pending. What is the most likely pathogen causing these symptoms\nA. Neisseria gonorrhoeae\nB. Pseudomonas aeruginosa\nC. Borrelia burgdorferi\nD. Staphylococcus aureus", "response": "Gram-positive bacteria remain the most common cause of septic ahritis. Staphylococcus aureus accounts for the majority of culture-positive septic ahritis, especially within ceain patient subgroups such as hemodialysis patients and intravenous drug abusers. The predominance of S. aureus in septic ahritis has remained unchanged for many years.\n\nSo the answer to this question is D"} {"instruction": "Which one of the following types of stomach cancers carries the best prognosis\nA. Superficial spreading type\nB. Ulcerative type\nC. Linitis plastic atype\nD. Polypoidal type", "response": "In early gastric carcinoma which has undergone good surgical resection and lymphadenectomy. has 5 yr survival rate and 95% overall cure rate. Reference SRB edition:5 page:847\n\nSo the answer to this question is A"} {"instruction": "Metaplasia occurs in all of the following except:\nA. Stem cells\nB. Squamous cells\nC. Columnar cells\nD. Transitional cells", "response": "Ref: Chapter 1. Cellular responses to stress and toxic insults; page: 11: Robbins and Cot ran Pathologic Basis of Disease: 8th editionExplanation:Metaplasia is the results of reprogramming of stem cells that are known to exist in normal tissues, or of undifferentiated mesenchymal cells present in the connective tissue.Metaplasia is a reversible adaptive change in which one differentiated epithelial cell type is replaced by another epithelial cell type of mature type.Example of columnar to Squamous Metaplasia: in chronic smokers, the normal ciliated columnar epithelial cells of trachea and bronchi are replaced by squamous cells.Example of Squamous to columnar Metaplasia: in Barrett esophagus, in which esophageal Squamous epithelium is replaced by intestinal like columnar cells under the influence of refluxed gastric acid.Transitional /uro-epithelium can also undergo Squamous Metaplasia by chronic irritation like in urinary bladder stones.Hence, Metaplasia is basically due to reprogramming of stem cells as adaptive mechanism.Metaplasia is basically classified into two types:- Epithelial Metaplasia- Mesenchymal Metaplasia.The epithelial cells can undergo Metaplasia due to chronic irritation, if they have stem cell reserve component.Mesenchymal Metaplasia is rare: example is Myositis Ossificans, where muscles will undergo chondroid Metaplasia due to improper fracture healing.\n\nSo the answer to this question is A"} {"instruction": "Which of the following type of RNA is involved in splicing?\nA. mRNA\nB. sn RNA\nC. r RNA\nD. t RNA", "response": "snRNA is involved in RNA splicing i.e removal of introns from hnRNA, regulation of transcription factors or RNA polymerase II and in the maintenance of telomeres. snRNA is a class of small RNA molecules that are found within the nucleus of eukaryotic cells. They are transcribed by RNA polymerase II or RNA polymerase III. Ref: Maternal, Fetal and Neonatal Physiology: A Clinical Perspective By Susan Tucker Blackburn, Page 5; Essentials of Pathophysiology: Concepts of Altered Health States By Carol Mattson Poh, Page 93\n\nSo the answer to this question is B"} {"instruction": "Axial reduction in a posterior three quarter crown imparts:\nA. Retention and Resistance\nB. Structural durability\nC. Periodontal preservation\nD. All of the above", "response": "None\n\nSo the answer to this question is D"} {"instruction": "A 6-year old child has an accident and had # elbow, after 4 years presented with tingling and numbness in the ulnar side of the finger, the fracture is -\nA. Supracondylar # humerus\nB. Lateral condylar # humerus\nC. Olecranon #\nD. Dislocation of elbow", "response": "This child has : -\n\n\nFracture around elbow\nTingling and numbness in ulnar nerve distribution after 4 years.\n\n\nThat means the child has developed tardy ulnar nerve palsy (late onset ulnar nerve palsy).\nNow you must be thinking option 'a, b & d' all can cause tardy ulnar nerve palsy, then why the answer is '13'.\nHere the age of the child, at the time of fracture, is 6 years.\nElbow dislocation occurs usually in adults and uncommon in children.\nThe age matches with both supracondylar fracture (5-7 years) and fracture lateral condyle (5-10 years).\nHowever, Tardy ulnar nerve palsy is more common in malunited fracture lateral condyle (cubitus valgus) and occurs only occasionally in malunited supracondylar fracture (cubitus varus).\nTherefore, answer of choice here is fracture lateral condyle humerus.\n\nSo the answer to this question is B"} {"instruction": "The most common hormone other than gastrin, contained in the gastrin-secreting islet cell tumor is -\nA. ACTH\nB. Glucagon\nC. Melanocyte stimulating hormone\nD. Growth hormone releasing factor", "response": "None\n\nSo the answer to this question is A"} {"instruction": "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?\nA. Emery-Dreifuss muscular dystrophy\nB. Becker muscular dystrophy\nC. Limb-girdle dystrophy\nD. Scapulofaciohumeral dystrophy", "response": "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.\n\nSo the answer to this question is D"} {"instruction": "Total iron binding capacity is increased in\nA. Iron deficiency anaemia\nB. Anaemia of chronic disease\nC. Sideroblastic anaemia\nD. β - thala ssemia", "response": "Iron deficiency anaemia.\nSerum ↓.\nSerum ferritin ↓.\nTIBC ↑.\n\nSo the answer to this question is A"} {"instruction": "Risk of malignancy in cold nodule of thyroid is\nA. 0.10%\nB. 2%\nC. 20%\nD. 30%", "response": "Risk of malignancy in hot nodule is 4%.\nRisk of malignancy in cold nodule is 20%.\n\nSo the answer to this question is C"} {"instruction": "Which of the following disorders mimic each other\nA. Iron deficiency anemia and sickle cell anemia\nB. Sickle cell anemia and Thalassemia\nC. Thalassemia and Iron deficiency anemia\nD. Iron deficiency anemia and vitamin B12 deficiency anemia.", "response": "Both present with microcytic hypochromic anemia.\nMentzer index is used to diffeentiate between the two. It is less than 13 in Thalassemia. (MCV / RBC Count).\n\nSo the answer to this question is C"} {"instruction": "Alkaline phosphatase contains\nA. Cobalt\nB. Zinc\nC. Iron\nD. Copper", "response": "ALP is a nonspecific enzyme which hydrolyzes aliphatic, aromatic or heterocyclic compounds. the pH optimum for the enzyme reaction is between 9 and 10.it is activated by magnesium and manganese. zinc is a constituent ion of ALP.Ref: DM Vasudevan Biochemistry, page no: 305\n\nSo the answer to this question is B"} {"instruction": "The example of syndesmosis type of joint is ?\nA. Sacroiliac\nB. Inferior tibiofibular\nC. Superior tibiofibular\nD. Mid tarsal", "response": "B i.e. Inferior tibiofibular\n\nSo the answer to this question is B"} {"instruction": "Charcot's triad\nA. Fever, abdominal pain, jaundice\nB. Fever, vomiting, jaundice\nC. Fever, jaundice, abdominal distension\nD. Fever, diarrhoea, jaundice", "response": "Charcot's triad is seen in cholangitis It is characterized by Abdominal pain Jaundice Fever Reynold's pentad Charcot's triad Altered mental status. Shock (hypotension) Ref: Sabiston 20th edition Pgno :1507\n\nSo the answer to this question is A"} {"instruction": "The magnetic field in an MRI machine is measured in -\nA. Housefield units\nB. Tesla\nC. MHz\nD. None", "response": "Strength of magnetic field used in MRI is measured by Telsa units CT attenuation values are measured by Hounsfield units. Frequency of sound waves used in USG are measured by MHz\n\nSo the answer to this question is B"} {"instruction": "Waste water from kitchen is:\nA. Sullage\nB. Sewage\nC. Garbage\nD. Kitchen water", "response": "The term \"sullage\" is applied to waste water which does not contain human excreta, e.g., waste water from kitchens and bathrooms.\nEssentials of preventive and community dentistry \nSoben Peter \n5th edition\n\nSo the answer to this question is A"} {"instruction": "A 10-year-old girl has exhibited muscular weakness since early childhood that has not worsened. She can ambulate unassisted but does not participate in strenuous physical activities. On examination, she has 4/5 motor strength in proximal muscles and 5/5 in distal muscles. There is no muscle pain on palpation. A biopsy of the deltoid muscle is obtained, and with Gomori trichrome stain, microscopic analysis shows subsarcolemmal aggregates of rod-shaped intracytoplasmic inclusions. Laboratory studies show a normal serum creatine kinase. Which of the following is the most likely form of muscle disease she has?\nA. Channelopathy\nB. Congenital myopathy\nC. Glycogen storage disease\nD. Inflammatory myopathy", "response": "Nemaline rod myopathy, one form of congenital myopathy, may present in infancy or childhood and maybe nonprogressive or slowly progressive. Congenital myopathies are often named for their characteristic histologic features. Channelopathies typically present as periodic paralysis with abnormalities in serum potassium. The two glycogen storage diseases most often affecting striated muscle include Pompe disease (type II) and McArdle disease (type V). There are increased glycogen deposits seen with periodic acid-Schiff (PAS) stain. Neuropathies affect muscle through denervation, leading to groups of atrophic muscle fibers. Polymyositis and dermatomyositis are inflammatory myopathies that are accompanied by myalgia and fiber degeneration with increased serum creatine kinase. Mitochondrial myopathies may appear in childhood but are usually progressive, and often other organs such as the heart or brain are involved.\n\nSo the answer to this question is B"} {"instruction": "Air travel in Pregnancy is permitted up to ________ weeks period of gestation:-\nA. 28\nB. 32\nC. 36\nD. 40", "response": "WHO IHR's guidelines for air travel in pregnancy upto 36 weeks of period of gestation with single baby.(If twins upto 32 weeks POG) After 28 weeks, mother should carry EDD ceificate.\n\nSo the answer to this question is C"} {"instruction": "In one of the following condition cavities filled with\nfluid is seen in the centre of spinal cord:\nA. Multiple sclerois\nB. Syringo myelia\nC. Tabes Dorsalis\nD. Meningovascular syphilis", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Largest lung volume is defined by\nA. Vital capacity\nB. Functional residual capacity\nC. Inspiratory capacity\nD. ERV+IRV", "response": "Ans: a (Vital capacity) Please go through diagram given below & make the facts clear. LUNG VOLUMES INSPIRATORY CAPACITY (IC)FUNCTIONAL RESIDUAL CAPACITYVITAL CAPACITYTOTAL LUNG CAPACITY= TV + IRV= ERV + RV= ERV + TV + IRV= ERV+ TV + IRV + RV. Male (L)Female (L)Residual volumeExpiratory reserve volume1.211.10.7Tidal volume0.50.5Inspiratory reserve volumeTotal lung capacity3.361.94.2 Respiratory minute volume= 6 LI minAlveolar ventilation= 4.2L/ minMaximum voluntary ventilation= 125-170 L/minMax work done in breathing=10 kg-m/breathNormal work done in breathing= 0.5 kg-m/ minTimed vital capacity / secFEV1=83% FEV3= 97%REMEMBERTotal lung capacity is measured by1) helium dilution method2) body plethismographyResidual volume is measured by1) N2 washout method.\n\nSo the answer to this question is A"} {"instruction": "Basic emergency obstetric services includes all, except:\nA. Parenteral oxytocics\nB. Antibiotics and anticonvulsants\nC. Manual extractions of the placenta\nD. Blood transfusions", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Red degeneration in uterine fibroid is most common in:\nA. Second trimester\nB. Third trimester\nC. Puerperium\nD. First trimester", "response": "Ans. is a, i.e. Second trimesterRef: Jeffcoate 7th/ed p502Read for yourself what - Ref: Dutta Obs. 6th/ed p309 has to say\"Red degeneration; It predominantly occurs in a large fibroid during the second half of pregnancy or puerperium.\"From the above statement answer could be second trimester, third trimester or puerperium.\"Red degeneration; manifests typically about mid pregnancy when the leiomyoma suddenly become acutely painful, enlarged and tender.\" - Ref: Jeffcoate 7th/edp502This clears the doubts and confirms our answer, i.e. red degeneration is most common during second trimester (mid pregnancy).You should also keep in mind the following important points regarding-Fibroids and pregnancy.* Most fibroids do not increase in size during pregnancy.* Only 5% females with fibroid have degeneration during pregnancy.\n\nSo the answer to this question is A"} {"instruction": "According to Scammon’s growth curves, which of the following tissues has a growth increase that can be used to help predict timing of the adolescent growth spurt?\nA. Neural tissues\nB. Lymphoid tissues\nC. Reproductive tissues\nD. None of the above", "response": "Reproductive tissues grow at the same time as the adolescent growth spurt, and the appearance of secondary sexual characteristics can be used to help predict the timing of growth.\n\nSo the answer to this question is C"} {"instruction": "Not included in Gredenigo syndrome\nA. Retro-orbital pain\nB. Ear discharge\nC. Nystagmus\nD. Diplopia", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Which one of the following in the characteristic feature of juvenile myoclonic epilepsy ?\nA. Myoclonic seizures frequently occur in morning\nB. Complete remission is common\nC. Response to anticonvulsants is poor\nD. Associted absence seizures are present in majority of patients", "response": "Ans. is 'a' i.e., Myoclonic seuzures frequently occur in morning Juvenile myoclonic epilepsy-is an epilepsy syndrome. Epilepsy syndromes are disorders in which epilepsy is a predominant feature and there is sufficient evidence to suggest a common underlying mechanism. Juvenile Mvoclonic Epilepsy o It is characterized by: Appearance in early adolescence Bilateral myoclonic jerks that may be single or repetitive Most frequent in morning after awakening Can be provoked by sleep deprivation Consciousness is usually preserved unless myoclonus is specially severe Association with generalised tonic-clonic seizures and absence seizures is seen Absence seizures occur in 1/3rd of patients Benign condition although complete remission is uncommon Seizure responds well to appropriate anticonvulsant medication Family history of epilepsy is common EEG show 4-6/s irregular spike Treatment is with valproate\n\nSo the answer to this question is A"} {"instruction": "Which of the following is the complimentary sequence of 5' TTAAGCTAC 3'?\nA. 5' GTACGCTTAA 3'\nB. 5' AATTCGCATG 3'\nC. 5' CATGCGAATT 3'\nD. 5' TTAAGCGTAC 3'", "response": "The complementary sequence of 5' TTAAGCTAC 3' is 3'AATTCGCATG 5'or 5' GTACGCTTAA 3'. Complementary sequence of 5'-3' end always proceeds from 3'- 5. In the double stranded DNA, the bases of one strand of DNA pairs with the bases of the second strand in such a way that Adenine (A) always pairs with Thiamine (T) and Cytosine (C) always pairs with Guanine (G). Ref: Harper Illustrated Biochemistry, 26th Edition, Chapter 35, Page 303 ; Lippincott's Illustrated Reviews: Biochemistry, 3rd Edition, Chapter 29, Page 395\n\nSo the answer to this question is A"} {"instruction": "An 81-year-old female falls and presents to the emergency department. What injury to this tissue or structure causes lower leg extremities to be externally rotated?\nA. Sacroiliac joint\nB. Neck of femur\nC. Lateral meniscus\nD. Intertrochanteric", "response": "Both subcapital and intertrochanteric fractures present with external rotation of the lower extremity. The lateral rotators are attached to the bone distal to the fracture line to cause this typical clinical sign. Trochanteric fractures have a better prognosis because the blood supply to the proximal segment remains intact.\n\nSo the answer to this question is C"} {"instruction": "Which of the following agents can be used in day care surgery\nA. Fentanyl, Midazolam, Propofol\nB. Morphine, Midazolam, Propofol\nC. Midazolam, Alfentanil, Propofol\nD. Morphine, Diazepam, ketamine", "response": "Drugs used for day care surgery are Desflurane Midazolam Sevoflurane Isoflurane Alfentanil Propofol Mivacurium\n\nSo the answer to this question is C"} {"instruction": "Investigation of choice for detection and characterization of interstitial lung disease is\nA. MRI\nB. Chest x-ray\nC. Venlaon perfusion scan\nD. High resoluon CT", "response": "High Resoluon CT (HRCT) is investigation of choice for interstitial lung disease as it can delineate the lung parenchyma upto the level of secondary pulmonary lobule.\n\nSo the answer to this question is D"} {"instruction": "Pityriasis rotunda is:\nA. Fungal infection\nB. Bacterial infection\nC. Pityriasis affecting nail\nD. Variant of Ichthyosis", "response": "Pityriasis rotunda - Pityriasis rotunda is described as a persistent, large, sharply defined circular patch of dry ichthyosiform scaling with no inflammatory changes. Variant of Ichthyosis Fixed, annular, scaling, dry-skin change More often seen in the African and Asian races Associated with neoplasia, paicularly Hepatocellular carcinoma.\n\nSo the answer to this question is D"} {"instruction": "Which of the following is not a component of thoracoscore ?\nA. Performance status\nB. Complication of surgery\nC. ASA grading\nD. Priority of Surgery", "response": "Complication of surgeryis not a component of THORACOSCORE Based on Thoracoscore , risk factors for in hospital moality in adult patients after thoracic surgery are: Variable Risk factors Age >55 yrs Gender Male ASA physical status >2 Performance statusclassification(WHO) >3 Dyspnea score(MRC) >3 Procedure class Pneumonectomy Surgical priority Urgent or emergency Diagnosis Malignant Comorbid diseases >3\n\nSo the answer to this question is B"} {"instruction": "Apple jelly nodules on the nasal septum are found in cases of -\nA. Tuberculosis\nB. Syphilis\nC. Lupus Vulgaris\nD. Rhinoscleroma", "response": "Characteristic feature of lupus vulgaris is the presence of apple- jelly nodules (Brown gelatinous nodules) in skin.\n\nSo the answer to this question is C"} {"instruction": "Antinuclear antibodies are seen in:\nA. SLE\nB. RA\nC. Sjogrens syndrome\nD. All", "response": "Ans: d (All) Ref: Harrison, 16th ed, p. 1563Antinuclear antibodies are directed against a variety of nuclear antigens and can be grouped into four antigens1. Antibodies to DNA2. Antibodies to histones3. Antibodies to non histone proteins bound to DNA4. Antibodies against nuc leolar antigensMost commonly used method to diagnose antinuclear antibodies - Indirect immunofluorescenceThey are associated with SLE as well as other autoimmune diseases basic patterns of ANA# Homogenous or diffuse nuclear staining - antibodies to histone chromatin# Rim or peripheral staining - antibodies to DS DNA# Speckled pattern - eg: Sm antigen, SS-A, SS-B# Nucleolar pattern - systemic sclerosis# Best screening test for sle - ANA# Most specific in sle - anti ds DNA# Autoantibody in sle with decreased risk of nephritis - anti ro, anti la# Autoantibody in drug induced sle - antihistone antibody ( aiims nov 2007)# Autoantibody associated with depression or psychosis in SLE - anti ribosomal p# Autoantibody associated with subcutaneous and neonatal lupus - anti ro antibody# Autoantibody in SLE correlating with active CNS lupus - antineuronal antibodyAntinuclear antibodies in various autoimmune diseases# Primary biliary cirrhosis- antimitochondrial antibody# Inflammatory myopathy- antihistidyl t-RNA synthetase (anti Jol)# Sjogrens syndrome- anti Ro and anti La# Diffuse scleroderma- anti topoisomerase antibody# CREST syndrome- anti centromere antibody # Celiac disease- antiendomysial antibody# Crohn disease- anti saccharomyces cervisea antibody# Ulcerative colitis- ANCA # Rheumatoid arthritis- anti ccp antibody\n\nSo the answer to this question is D"} {"instruction": "The occlusal surface of a primary mandibular first molar often has a prominent faciolingual ridge. This transverse ridge connects which two cusps?\nA. Buccal and distolingual.\nB. Mesiolingual and distobuccal.\nC. Mesiobuccal and mesiolingual.\nD. Distobuccal and distolingual.", "response": "Transverse ridge connecting MB and ML cusps.\n\nSo the answer to this question is C"} {"instruction": "All of the following are tumor necrosis factor blocking agents, except :\nA. Adalimumab\nB. Eternacept\nC. Infliximab\nD. Abciximab", "response": "None\n\nSo the answer to this question is D"} {"instruction": "True about endotoxin ?\nA. Protein\nB. Highly antigenic\nC. No enzymatic activity\nD. Produced by gram positive bacteria", "response": "Ans. is 'c' i.e., No enzymatic activity\n\nSo the answer to this question is C"} {"instruction": "Splenectomy is done to tide over the acute crises of uncontrollable:\nA. ITP\nB. TTP\nC. HUS\nD. All of the above", "response": "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.\n\nSo the answer to this question is A"} {"instruction": "Which of the following agent decreases cardiac afterload?\nA. Nicorandil\nB. Glyceryl trinitrate\nC. Isosorbide dinitrate\nD. None", "response": "Nicorandil reduces afterload and preload, while in the coronary circulation it dilates both the large epicardial and smaller resistance vessels. Because Nicorandil is an anteriolar dilator and hence primarily decrease after load. Hydralazine and minoxidil reduce afterload by relaxing aeriolar smooth muscle. The venodilators and diuretics are used to decrease preload. The venodilators include nitroglycerine and isosorbide dinitrite. Drugs that reduce both prelod and afterload include nitroprusside, prazosin, ACE inhibitors and angiotensin II receptor blockers.\n\nSo the answer to this question is A"} {"instruction": "True about Larynegeal mask airway – a) More reliable than face maskb) Prevent aspirationc) Alternative to Endotracheal tube (E.T.T)d) Does not require laryngoscope & visualisatione) Can be used in full stomach\nA. acd\nB. ad\nC. bc\nD. bde", "response": "LMA is intermediate between the face mask and Endotracheal intubation in terms of reliability, invasiveness and facilitation of gas exchance (face mask has minimum and endotracheal intubation has maximum).\nLMA does not prevent aspiration -4 should not be used in full stomach patients.\nLMA can be used as an alternative to endotracheal intubation for minor surgeries, where anaesthetist wants to avoid intubation.\nLMA is introduced blindly (without laryngoscopy).\n\nSo the answer to this question is A"} {"instruction": "Most common fungal infection in neutropenic patient is: September 2005\nA. Candidiasis\nB. Aspergillosis\nC. Histoplasmosis\nD. None of the above", "response": "Ans. A: Candidiasis The most common fungal pathogens associated with invasive disease in humans are oppounistic yeasts (e.g., Candida albicans) or filamentous fungi (e.g., Aspergillus spp.).\n\nSo the answer to this question is A"} {"instruction": "Posterior wall of Rectus sheath below Arcrate line is formed by\nA. Posterior lamina of Internal oblique aponeurosis and Transverse abdominis aponeurosis\nB. Fascial transversalis\nC. Transverse abdominis aponeurosis and Fascia transversalis\nD. Internal oblique Aponeurosis", "response": "None\n\nSo the answer to this question is B"} {"instruction": "A 24 week pregnant female developed gestational diabetes. Which of the following is the MOST characteristic congenital anomaly of diabetic pregnancy\nA. Multicystic kidneys\nB. Oesophageal atresia\nC. Caudal regression\nD. Duodenal atresia", "response": "Ans. is 'c' i.e. Caudal regression [Ref: Obstetrics Fernando Areas 2nd/e page 289; Williams Obstetrics 21st/e page 13691 Most common single organ system anomaly with diabetes Heart Most common congenital anomaly seen in diabetic mother anencephaly Most common heart anomaly associated with diabetes Transposition of great vessels The most characteristic or specific lesion associated with diabetes Caudal regression syndrome (sacral agenesis) Remember sacral agenesis or caudal regression syndrome is the lesion most specifically associated with diabetes. It is not the most common congenital anomaly seen in diabetic mother. The table given on page 1369, 21st/e Williams compares the incidence of congenital anomalies in diabetic mother with that of normal population.\n\nSo the answer to this question is C"} {"instruction": "Disc prolapse involving L4 nerve root typically presents with: (Repeat)\nA. Weakness of hip flexion\nB. Absent ankle jerk\nC. Weakness of hip extension\nD. Absent knee jerk", "response": "Ans: D (Absent ankle jerk) Ref: Harrison's Principles of Internal Medicine, 18th ed.Explanation:Lumbosacral Radiculopathy--Neurologic Features (Sec Table 16}Neurologic ExaminationDeep Tendon ReflexesL4 Nerve Root (L3-4 disc): Patellar Reflex or Knee jerkSI Nerve Root (L5-SI disc): Achilles Reflex or Ankle jerkMotor ExamL4 Nerve Root (L3-4 disc): Ankle dorsiflexionL5 Nerve Root (L4-5 disc ): Great toe dorsiflexion (extensor haihicis longus)S1 Nerve Root (L5-S l disc): Ankle plantar flexion (gastrocnemius-soleus complex)Sensory ExamL4 Nerve Root (L3-4 disc): Medial malleolusL5 Nerve Root (L4-5 disc): Dorsal third metatarsophalangeal jointSI Nerve Root (L5-S1 disc): Lateral heelRadicular patterns by disc herniation typeCentral Disk herniationNerve root affected is ABOVE the discExample: Central L3 di.,c herniation causes findings above the L2-3 Nerve rootParacentral disk herniationNerve root affected is AT the discExample: Paracentral ' ' disc herniation causes findings at the L2-3 Nerve rootLateral disk herniationNerve root affected is BELOW the disc (foraminal effects) Table 16Examination FindingsLumbosacral Nerve RootsReflex AbsentSensoryMotorPain DistributionL2--Upper anterior thighPsoas (hip flexion)Anterior thighL3--Lower anterior thigh Anterior KneePsoas (hip flexion) Quadriceps (knee extension} Thigh adductionAnterior thigh, kneeL4Quadriceps (Knee reflex)Medial calfQuadriceps (knee extension) Thigh adduction Tibialis anterior (foot dorsiflexion)Knee medial calf Anterolateral thighL5 Dorsal surface- foot Lateral calfPeroneii (foot eversion) Tibialis anterior (foot dorsiflexion) Gluteus medius (hip Auction) Tne dorsiflexorsLateral calf dorsal foot, teral thigh,buttocksS1Gastrocnemius/soleus (Ankle reflex)Plantar surface-- foot Lateral aspect -footGastrocnemius/soleus (foot plantar flexion) Abductor hallucis (toe flexors) Gluteus maximus (hip extension)Bottom foot, posterior calf, posterior thigh, buttocksExample: Lateral L3 disc herniation causes findings at the L3-4 Nerve root\n\nSo the answer to this question is D"} {"instruction": "Trials stage for experimentation of adverse drug reaction in large scale population is ?\nA. I\nB. II\nC. III\nD. IV", "response": "Ans. is 'd' i.e., IV o Long-term adverse effects on large number of patients -f Phase IV clinical trial.\n\nSo the answer to this question is D"} {"instruction": "In a population of 10,000, literate people are 4000. In same population 2000 are 0-6 years old. What is the literacy rate of that population -\nA. 30%\nB. 40%\nC. 50%\nD. 60%", "response": "Ans. is 'c' i.e., 50% * The term literacy rate is used for the population relating to seven years age & above.* In the given question, population 7 years 8c above is 8000. Out of which 4000 are literate thus literacy rate is 50%.\n\nSo the answer to this question is C"} {"instruction": "The most common cause of proptosis in adults is\nA. Preseptal cellulitis\nB. Orbital cellulitis\nC. Thyroid eye disease\nD. Capillary hemangioma", "response": "Proptosis:- Ref:- A K Khurana Comprehensive Ophthalmology 7th edition; pg num:- 398\n\nSo the answer to this question is C"} {"instruction": "Following is indication for colposcopy :\nA. Suspicious pap smear\nB. Obvious mass seen\nC. Suspected invasive carcinoma\nD. Patient who refuse biopsy", "response": "Colposcopy is a method of visualization of cervix under magnification While Pap smear detects abnormal cells, Colposcopy locates the abnormal lesion The aims of colposcopy are: To study the cervix when Pap smear detects abnormal cells To locate abnormal areas and take a biopsy To study the extent of abnormal lesion Conservative surgery under colposcopic guidance Follow-up of conservative therapy cases. Reference : Textbook of Gynaecology; Sheila balakrishnan; 2nd edition; Pg no:299,302\n\nSo the answer to this question is A"} {"instruction": "Spring water cyst is another name for –\nA. Hydatid cyst of lung\nB. Lung amoebic cyst\nC. Pleuropericardial cyst\nD. Enterogenous cyst", "response": "Pleuropericardial cyst has many synonyms: pericardial cyst, coelomic cyst, spring water cyst, serosal cyst, mesothelial cyst, parapericardial cyst, simple cyst, and hydrocele of the mediastinum.\n\nSo the answer to this question is C"} {"instruction": "A curvature of gingiva towards the roots found in the middle of the interproximal area between molars is termed as\nA. Col\nB. Self cleansing area\nC. Interproximal embrasure\nD. Cervix", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Arginine enters TCA Cycle by forming which substrate\nA. Fumarate\nB. α Ketoglutarate\nC. Oxaloacetabe\nD. Succinyl CoA", "response": "None\n\nSo the answer to this question is B"} {"instruction": "All are risk factors of preeclampsia except\nA. Diabetes in pregnancy\nB. Hydatidiform mole\nC. Primipara\nD. Previous history of pre eclampsia", "response": "Primiparous is at a higher risk than multiparous lady H.mole due to abnormal trophoblastic proliferation and uterine distension is at higher risk. Infact h.mole is associated with early onset preeclampsia. Previous h/o preeclampsia also increases risk.\n\nSo the answer to this question is A"} {"instruction": "Bimatoprost is used in -\nA. Glaucoma\nB. Barrett oesophagus\nC. Hyperichosis of eyelid\nD. NSAIDS ulcer", "response": "Ans. is 'a' i.e., Glaucoma o Lantanoprost, bimatoprost, travoprost and unoprostone are prostaglandin analogues used for glaucoma treatment.\n\nSo the answer to this question is A"} {"instruction": "Which symptom of schizophrenia respond earliest to treatment\nA. Negatavism\nB. Paranoid delusions\nC. Auditory hallucinations\nD. Apathy", "response": "C i.e. Auditory hallucinations\n\nSo the answer to this question is C"} {"instruction": "The use of long cone is adjunct in parallel technique:\nA. To minimize the superimposition of anatomical structures\nB. To prevent the shortening of image\nC. To prevent the distortion of image\nD. To prevent the elongation of image", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Factor present in final common terminal complement pathway\nA. C4\nB. C3\nC. C5\nD. Protein B", "response": "Ref Harrison 17/e p2030 _2032 C5a is a protein fragment released from cleavage of complement component C5 by protease C5-convease into C5a and C5b fragments. C5b is impoant in late events of the complement cascade, an orderly series of reactions which coordinates several basic defense mechanisms, including formation of the Membrane Attack Complex (MAC), one of the most basic weapons of the innate immune system, formed as an automatic response to intrusions from foreign paicles and microbial invaders. It essentially pokes microscopic pinholes in these foreign objects, causing loss of water and sometimes death. C5a, the other cleavage product of C5, acts as a highly inflammatory peptide, encouraging complement activation, formation of the MAC, attraction of innate immune cells, and histamine release involved in allergic responses\n\nSo the answer to this question is C"} {"instruction": "Candida is most often implicated in causation of\nA. Conjunctivitis\nB. Tinea capitis\nC. Dese rheumatism\nD. Thrush", "response": "Candida infection causes mucosal lesion like vaginitis and oral thrush. oral thrush found commonly in bottle-fed infants and aged and debilitated. This condition is characterised by creamy white patches appear on the tongue and buccal mucosa following removal, this leaves a red oozing surface. Tinea capitis is caused by dermatophytes. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition\n\nSo the answer to this question is D"} {"instruction": "Which of the following drugs should not be administered concomitantly with warfarin as it decreases the effect of oral anticoagulants ?\nA. Broad spectrum antibiotic\nB. Cimetidine\nC. Aspirin\nD. Oral contraceptive", "response": "None\n\nSo the answer to this question is D"} {"instruction": "All ICUD's are changed every 4-5 year except:\nA. Cu 280\nB. Cu 320\nC. Multiload devices\nD. Progestasert", "response": "None\n\nSo the answer to this question is D"} {"instruction": "A 5-year-old girl presents with difficulty breathing. On examination, of the oral cavity a 3 cm mass is found in the midline on the posterior aspect of the tongue. The most likely diagnosis is:\nA. Lingual tonsil\nB. Lingual thyroid\nC. Foreign body stuck to the tongue\nD. Dermoid", "response": "An ectopic thyroid gland can be located anywhere from the base of the tongue to the mediastinum. It often results in the failure of descent resulting in either a linginal thyroid or ectopic thyroid in the midline of the neck. The so called lateral aberrant thyroid is usually a metastasis from papillary carcinoma of the thyroid.Angioneurotic edema is an acute allergic reaction, which causes a sudden swelling of the whole tongue with airway obstruction.\n\nSo the answer to this question is B"} {"instruction": "Which of the following Lacks sexual phase\nA. Deuteromycota\nB. Basidiomycota\nC. Ascomycota\nD. Zygomycota", "response": "Deuteromycota (Fungi imperfectii) - sexual state is absent.\n\nSo the answer to this question is A"} {"instruction": "According to AHA/American college of cardiology which is not surgery with high risk in patients with known coronary aery disease-\nA. Emergency surgery\nB. Peripheral vascular surgery\nC. Carotid endaerectomy\nD. Aoic aneurysm Sx", "response": "Risk stratification Procedure examples Vascular (repoed cardiac risk >5%) Aoic and other major vascular surgery Peripheral vascular surgery Intermediate risk (repoed cardiac risk 1%-5%) Intraperitoneal and intrathoracic surgery Carotid endaerectomy Head and neck surgery Ohopedic Surgery Prostate surgery Low risk (repoed cardiac risk <1% Endoscopic procedures Superficial procedures Cataract surgery Breast surgery Ambulatory surgery\n\nSo the answer to this question is C"} {"instruction": "True about dual sex therapy is:\nA. Patient alone is not treated\nB. Uses sildenafil\nC. It treats sexual perversion\nD. It is used for people with dual gender identities", "response": "In dual sex therapy, the couple is treated and not an individual. It is also known as Masters and Johnson technique As per this therapy, sensory awareness between the couple needs to be improved to treat them . Communication also needs to be improved between the couple This therapy is used in cases of erectile dysfunction and premature ejaculation. Technique named as Sensate focus was given for sensory awareness\n\nSo the answer to this question is A"} {"instruction": "Apoptosis is characterized by all of the following EXCEPT\nA. DNA fragmentation\nB. Chromatin condensation\nC. Cell shrinkage\nD. Inflammation", "response": "(D) Inflammation # Cell undergoing apoptosis shows a characteristic morphology:> Cell shrinkage and rounding are shown because of the breakdown of the proteinaceous cytoskeleton by caspases.> Cytoplasm appears dense, and the organelles appear tightly packed.> Chromatin undergoes condensation into compact patches against the nuclear envelope (also known as the perinuclear envelope) in a process known as pyknosis, a hallmark of apoptosis,> Nuclear envelope becomes discontinuous and the DNA inside it is fragmented in a process referred to as karyorrhexis.> Nucleus breaks into several discrete chromatin bodies or nucleosomal units due to the degradation of DNA.> Cell membrane shows irregular buds known as blebs.> Cell breaks apart into several vesicles called apoptotic bodies, which are then phagocytosed.\n\nSo the answer to this question is D"} {"instruction": "Functional matrix theory revisited by Moss includes all except\nA. The role of mechanotransduction.\nB. The role of osseous connected cellular network\nC. The Genomic thesis\nD. The epigenetic thesis and the resolving synthesis", "response": "Functional matrix theory revisited by Moss includes 4 concepts\n\nThe role of mechanotransduction.\nThe role of an osseous connected cellular network.\nThe genomic thesis.\nThe epigenetic antithesis and the resolving synthesis.\n\nSo the answer to this question is D"} {"instruction": "True statement about inheritence of an X linked recessive trait is -\nA. 50% of boys of carrier mother are affected\nB. 50% of girls of diseased father are carrier\nC. Father transmits disease to the son\nD. Mother transmits the disease to the daughter", "response": "Ans. is 'a' i.e., 50% of boys of carrier mother are affected\n\nSo the answer to this question is A"} {"instruction": "Which of the following statements about Pseudohypoprathyroidismistrue-\nA. Caused by 'Gain of!ftmction' inherited mutation in Gsa subunit\nB. Decreased formation of cyclic GMP is observed\nC. Decreased formation of Inositol triphosphate is observed\nD. Decreased formation of c-AMP is observed", "response": "decreased urinary cyclic AMP responses to PTH , presumably with a post -GS alpha defect in adenyl cyclase stimulation ( Harrison 17 pg 2394)\n\nSo the answer to this question is D"} {"instruction": "Which of the following drug is commonly used in narcoanalysis ?\nA. Atropine sulfate\nB. Scopolamine hydrochloride\nC. Phenobarbitone\nD. Morphine", "response": "Controlled administration of intravenous hypnotics to obtain information from subjects who are unable or unwilling to provide it otherwise, is known as Narcoanalysis or Narcosynthesis.\nDrugs used for narcoanalysis are:\n\nEthanol\nScopolamine\nTemazepam\nBarbiturates like Thiopentone and Amobarbital\n\nThese drugs are also known as truth drug or truth serum.\n\nPhenobarbitone is not used, rather amobarbital is used for narcoanalysis.\n\nSo the answer to this question is B"} {"instruction": "Feature indicative of anti-moem drowning is -\nA. Cutis anserine\nB. Rigor mois\nC. Washerwomen feet\nD. Grass and weeds grasped in the hand", "response": "Reff: The synopsis of forensic medicine & Toxicology 28th edition pg:192 Cadaveric spasm: Presence of weeds, grass,sticks,twigs etc.,floating in water may be firmly grasped in the hands due to cadaveric spasm. It strongly suggest that the person was alive when drowned, because it indicates the struggle of the person for his life.\n\nSo the answer to this question is D"} {"instruction": "According to Labyrinthine reflex, when head is tilted backwards it will cause the:\nA. Back to stiffen or arch backwards\nB. Legs straighten and push together\nC. Arms to bend at elbows and hands to become fisted.\nD. All of the above.", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Vicarious responsibility peains to -\nA. Patient's contribution towards negligence\nB. Hospitals contribution towards patient's damages\nC. Responsibility for actions of a colleague\nD. Responsibility of senior for actions of Junior", "response": "Vicarious liability or respondeat superior is the doctrine that an employer is responsible not only for his own negligence but also of his employees. The conditions to be satisfied are there must be an employer-employee relationship, the employees' conduct must occur within the scope of employment and should occur while on the job. Liability will be fixed upon those actually at fault and those whose control over negligent is proved. REF: Dr.K.S.Narayana Reddys Synopsis of Forensic Medicine & Toxicology 29th edition Pg.26.\n\nSo the answer to this question is B"} {"instruction": "A 14 year old boy has difficulty in expressing himself in writing and making frequent spelling mistakes, does not follow instruction and cannot wait for his turn while playing a game. He is likely to be suffering from\nA. Mental retardation\nB. Lack of interest in studies\nC. Specific learning disability\nD. Examination anxiety", "response": "The Child may suffer from Specific learning disability If one find difficulty in expressing himself in writing and making frequent spelling mistakes, does not follow instruction and cannot wait for his turn while playing a game. Reference: GHAI Essential pediatrics, 8th edition\n\nSo the answer to this question is C"} {"instruction": "Triangular shaped heart is a radiological finding of\nA. Constrictive pericarditis\nB. Mitral incompetence\nC. TAPVC\nD. Ebstein's anomaly", "response": "Triangular shaped heart - Constrictive Pericarditis.\nPentagon shaped heart - Mitral incompetence.\n\nSo the answer to this question is A"} {"instruction": "Revised strategy for NPCB includes all except ?\nA. Fixed facility surgery\nB. TOL implantation for cataract\nC. Mobile surgical camps\nD. Uniform distribution", "response": "Ans. is 'c' i.e. Mobile surgical camps o The National Programme for Control of Blindness (NPCB) was launched in the year 1976 as a 100 per cent centrally sponsored programme and incorporates the earlier trachoma control programme. o Based on survey conducted during 1998-99 & 1999-2000, following measures were included under revised strategy. o Revised strategies - a)To make NPCB more comprehensive by strengthening services for other causes of blindness like corneal blindness (requiring transplantation of donated eves), refractive errors in school going children, improving follow-up services of cataract operated persons and treating other causes of blindness like glaucoma: To shift from the eye camp approach to a fixed facility surgical approach and from conventional surgery to 101., implantation for better quality of post operative vision in operated patients; b)To expand the World Bank project activities like construction of dedicated eye operation theatres, eye wards at district level, training of eye surgeons in modem cataract surgery and other eye surgeries and supply of ophthalmic equipments etc. to the whole country; c)To strengthen paicipation of Voluntary Organizations in the programme and to earmark geographic areas to NGOs and Government Hospitals to avoid duplication of effo and improve the performance of Government Units like Medical Colleges, District Hospitals, Sub Divisional Hospitals, community Health Centres, Primary Health Centres etc. d)To enhance the coverage of eye care services in tribal and other under-served areas through identification of bilateral blind patients, preparation of village-wise blind register and giving preference to bilateral blind patients for cataract surgery.\n\nSo the answer to this question is C"} {"instruction": "Diagnosis of x linked agammaglobulinamia should be suspected if\nA. Absent tonsils and no palpable lymph nodes on physical examination\nB. Female sex\nC. High iso hemagglutinin titers\nD. Low CD3", "response": "Ref Robbins 9/e p240-241 Classically, this disease is characterized by the following: * Absent or markedly decreased numbers of B cells in the circulation, with depressed serum levels of all classes of immunoglobulins. The numbers of pre-B cells in the bone marrow may be normal or reduced. * Underdeveloped or rudimentary germinal centers in peripheral lymphoid tissues, including lymph nodes, Peyer patches, the appendix, and tonsils * Absence of plasma cells throughout the body * Normal T cell-mediated responses\n\nSo the answer to this question is A"} {"instruction": "Collagen most abundant in Hyaline cailage ?\nA. Type I\nB. Type I I\nC. Type III\nD. Type IV", "response": "Ans. is `b' i.e., Type II\n\nSo the answer to this question is B"} {"instruction": "The efferent limb of the gag reflex is?\nA. Facial nerve\nB. Glossopharyngeal nerve\nC. Trigeminal nerve\nD. Vagal nerve", "response": "The gag reflex involves a brisk and brief elevation of the soft palate and bilateral contraction of pharyngeal muscles evoked by touching the posterior pharyngeal wall The vagus nerve (CN X) provides the efferent limb of the gag reflex (muscles of the soft palate). The glossopharyngeal nerve provides the afferent limb of the gag reflex.\n\nSo the answer to this question is D"} {"instruction": "Extended-spectrum beta-lactamases (ESBLs) are characterized by activity against all except :\nA. Penicillinases\nB. Cephalosporinases\nC. Oxyimino–cephalosporinases\nD. Carbapenems", "response": "Carbapenems like imipenem are the only beta-lactams reliably efficacious against ESBL producing bacteria.\n\nSo the answer to this question is D"} {"instruction": "In young permanent teeth the best method of sensitivity testing for traumatized teeth is Carbondioxide snow which can go up to temperature of\nA. —20°C\nB. —30°C\nC. —40°C\nD. —78°C", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Simple paial seizures DOC\nA. Phenytoin\nB. Valproate\nC. Barbiturate\nD. Carbamazepine", "response": "CBZ is used for simple paial seizures\n\nSo the answer to this question is D"} {"instruction": "Metabolic disorder leading to acute pancreatitis\nA. Hypoparathyroidism\nB. Hyperparathyroidism\nC. Hypothyroidism\nD. Hyperthyroidism", "response": "(B) Hyperparathyroidism# Causes of Acute Pancreatitis> Common Causes Gallstones (including microlithiasis) Alcohol (acute and chronic alcoholism); Hypertriglyceridemia Endoscopic retrograde cholangiopancreatography (ERCP), especially after biliary manometry Trauma (especially blunt abdominal trauma) Postoperative (abdominal and non-abdominal operations) Drugs (azathioprine, 6-mercaptopurine, sulfonamides, estrogens, tetracycline, valproic acid, anti-HIV medications) Sphincter of Oddi dysfunction> Uncommon causes Vascular causes and vasculitis (ischemic-hypoperfusion states after cardiac surgery) Connective tissue disorders and thrombotic thrombocytopenic purpura (TTP) Cancer of the pancreas Hypercalcemia Periampullary diverticulum Pancreas divisum Hereditary pancreatitis Cystic fibrosis Renal failure> Rare causes Infections (mumps, coxsackievirus, cytomegalovirus, echovirus, parasites) Autoimmune (e.g., Sjogren's syndrome)> Causes to consider in patients with recurrent bouts of acute pancreatitis without an obvious etiology Occult disease of the biliary tree or pancreatic ducts, especially microlithiasis, sludge Drugs Hypertriglyceridemia Pancreas divisum Pancreatic cancer Sphincter of Oddi dysfunction Cystic fibrosis Idiopathic\n\nSo the answer to this question is B"} {"instruction": "An adult patient with a Class II molar relationship and a cephalometric ANB angle of 2 degrees has which type of malocclusion?\nA. Class II dental malocclusion\nB. Class II skeletal malocclusion\nC. Class I dental malocclusion\nD. Class II skeletal malocclusion", "response": "The molars are Class II but the skeletal relationship described by a normal ANB measurement is normal, so the malocclusion is dental in origin.\n\nSo the answer to this question is A"} {"instruction": "An edentulous patient had carcinoma of the oral cavity infiltrating into the lower alveolar margin. All the following are possible treatment options except:\nA. Segmental mandibulectomy\nB. Marginal mandibulectomy with removal of outer table\nC. Radiotherapy\nD. Commando", "response": "(c) Radiotherapy(Ref. Cummings, 6th ed., 1372)Since radiation to the mandible carries risk of osteoradionecrosis, carcinoma lower alveolus/ mandible is dealt with surgically in all the stages.Chemotherapy may be given in T3 T4 tumours.\n\nSo the answer to this question is C"} {"instruction": "Prostaglandin that can be used to induce labour at term is\nA. PGE2\nB. PGF2\nC. PGI2\nD. PGD2", "response": "Ans. a. PGE2. (Katzung Clinical Pharmacology 11th edition./, Ch.l8/page 410)Dinoprostone, a synthetic prep of PGE2, is administered vaginally for oxytocic use. It is used for inducing abortion in the second trimester of pregnancy, for missed abortion, for benign hydatidiform mole, and for ripening of the cervix for induction of labor in patients at or near term. An analog of PGF2a (carboprost tromethamine) is also used in obstetrics - used to induce second-trimester abortions and to control PPH not responding to conventional methods of Rx.PROSTAGLANDINS# Have very short half-life.# Arachidonic acid is common precursor (acylic fatty acid derivatives).# The subscript numeral after the letter (e.g., PGE2) indicates degree of unsaturation.# PGF2 alpha acts predominantly on myometrium, while PGE2 on cervix due to its collagenolytic property. (Hint: F for fundus and E for effacement of cervix.).# Carboprost is effective in refractory cases of PPH.# Misoprostol is methyl ester of PGE1, rapidly absorbed and more effective than oxytocin and prostaglandins in induction of labour, also effective in treatment in NSAID induced peptic ulcer.# Inflammatory mediators from arachidonic are:- TxA2, PGD2, PGE2, PGF2 alpha, PGI2 (Cycloxygenase pathway) leukotrienes (Lipoxygenase)--LTB4 is a neutrophil chemotactic agent. LTC4, D4 and E4 (SRS-A) function in broncho-constriction, vasoconstriction, contractions of smooth muscle and increased vascular permeability.PgActionsPGE2Bronchoconstriction, platelet aggregation.PGE2Potent inducer of bone resorption and releases Ca++ from bones and cervical effacement.PGE2Bronchoconstriction, role in uterine and ovarian function (fundal contraction).PGI2Bronchodilation, vasoconstriction, and platelet aggregation.TXA2Bronchodilation, vasoconstriction, and platelet aggregation stimulation (Bradykinin and histamine are potent vasodilators)USES OF PROSTAGLANDINS IN OBSTETRICS# Induction of abortion (MTP and missed abortion); Antiprogestins (eg, mifepristone) have been combined with an oral oxytocic synthetic analog of PGE1 (misoprostol) to produce early abortion.# Induction of labour# Termination of molar pregnancy# Cervical ripening before induction of labour/abortion# Acceleration of labour# Management of atonic PPH# Management of tubal ectopic pregnancyActionArachidonic Acid Metabolites (Eicosanoids)VasodilationPGI2 (prostacyclin), PGE1, PGE2, PGD2VasoconstrictionThromboxane A2, leukotrienes C4, D4, E4Increased vascular permeabilityLeukotrienes C4, D4, E4Chemotaxis, leukocyte adhesionLeukotriene B4\n\nSo the answer to this question is A"} {"instruction": "In spinal anaesthesia the segmental level of:\nA. Sympathetic block is lower than the sensory block\nB. Sympathetic block is higher than the sensory block\nC. Motor block is higher than the sensory block\nD. Sympathetic, motor and sensory block has the same level", "response": "Spinal anaesthesia creates a zone of differential blockade in which sympathetic fibres are blocked two segments higher and motor fibres are blocked two segments lower than the level of sensory block.\n\nSo the answer to this question is B"} {"instruction": "Most common hymen tear in sexual assault is\nA. Posterolateral\nB. Anterior\nC. Anterolateral\nD. Posteromedial", "response": "Ans. is 'a' i.e., Posterolateral * In virgin rupture (tears) of hymen due to sudden stretching occurs in posterior half of membrane usually at the sides (i.e. posterolaterally) in 4 or 8'0 clock or 5 or 7'0 clock position, or in the midline of hymen (6'0 clock position).* Posterolateral rupture is more common than posterior rupture.Position of rupture of hymenReason of rupture5 - 7 O'clockSexual intercourse11-1 O'clockMasturbation\n\nSo the answer to this question is A"} {"instruction": "Sporulation occurs in which phase of bacterial growth curve:\nA. Stationary phase\nB. Lag phase\nC. Log phase\nD. Decline phase", "response": "Lag phase - Adaptation phase to culture media |sed Accumulate nutrient size Log(2)n - Exponential es in number Stationary phase - Sta of Accumulation of toxic metabolites = Dead Live -Sporulation occur in stationary phase (S-S) Decline: Complete accumulation of Toxin metabolites\n\nSo the answer to this question is A"} {"instruction": "HIV in children, characteristic finding is –\nA. Kaposi sarcoma is common\nB. Recurrent candidiasis\nC. Recurrent chest infection\nD. Cryptococcal diarrhoea is common", "response": "\" Pneumonia caused by pneumocystis carinii is the most common AIDS defining diagnosis in children with unrecognized HIV infection\"\n\nSo the answer to this question is C"} {"instruction": "Which among the following is increased during sleep induction ?\nA. | Acetyl choline\nB. | Histamine\nC. | Norepinephrine and serotonin\nD. | GABA", "response": "Stimulation cholinergic neurons in pontine reticular formation is responsible for sleep induction. When the activity of norepinephrine and serotonin containing neurons in locus coeruleus and raphe nuclei is increased, the activity of ACH-containing neurons in the pontine reticular formation decreases, leading to wakefulness. The reverse of this pattern leads to REM sleep. An even balance in the activity of these groups of neurons is associated with NREM sleep\n\nSo the answer to this question is A"} {"instruction": "A patient was staed on antihypeensive medications; developed renal failure, the drug offended is -\nA. Beta-blocker\nB. Alpha-blocker\nC. Calcium channel blocker\nD. ACE inhibitor", "response": "Ans. is 'd' i.e., ACE inhibitors o ACE inhibitors and angiotensin receptor antagonists can cause acute renal failure in patients with bilateral renal aery stenosis, stenosis of the aery to a single remaining kidney, hea failure, or volume depletion owing to diarrhea or diuretics.\n\nSo the answer to this question is D"} {"instruction": "In a Teritary level Lab it is observed that chronic, increased exposure to ionizing radiation results in damage to cellular DNA. As a consequence, a protein is now absent that would arrest the cell in the G1 phase of the cell cycle. Subsequent to this, the cell is transformed to acquire the propey of unregulated growth. The absent protein is most likely the product of which of the following genes?\nA. RAS\nB. VHL\nC. p53\nD. MYC", "response": "p53\n\nSo the answer to this question is C"} {"instruction": "Commonest variety of carcinoma stomach is\nA. Squamous carcinoma\nB. Adenocarcinoma\nC. Colloid carcinoma\nD. None", "response": "Ans. is 'b' i.e., Adenocarcinomao About 85% of stomach cancers are adenocarcinoma.o Louren classified gastric adenocarcinoma into two subtypes :?Intestinal Variant --> Composed of neoplastic intestinal gland resembling those of colonic adenocarcinoma.Diffuse variant - Composed of gastric type mucous cells, which generally do not form glands. The appearance of the cells is \"Signet ring\" appearance because the mucin in the cell pushes the nucleus to the periphery. It is seen more frequently with E-Cadherin mutation.Following information have been added in 81/e of Robbins o Overall incidence of gastric adenocarcinoma is falling. On the other hand, cancer of gastric cardia is on the rise. This is probably related to Barrett esophagus and may reflex the increasing incidence of chronic GERD and obesity.o The remarkable decrease in gastric incidence applies only to intestinal type. As a result, the incidences of intestinal and diffuse types of gastric cancer are now similar.\n\nSo the answer to this question is B"} {"instruction": "Treatment of choice in a perimenopausal woman with bleeding PV due to multiple fibroids Is :\nA. TAH with BSO\nB. TAH\nC. Vaginal hystrectomy\nD. Enucleation of fibroids", "response": "TAH\n\nSo the answer to this question is B"} {"instruction": "The most common symptom of AIDS in an infant is\nA. Gastrointestinal infection\nB. Persistent cough\nC. Failure to thrive\nD. Lymphadenopathy", "response": "Clinical features in an HIV infected infant is:Recurrent GI infection and oral thrush is commonly foundClinical features in older children:Growth failureFeverDiarrheaSecondary infection(Refer: OP Ghai's Textbook of Pediatrics, 8th edition, pg no. 202)\n\nSo the answer to this question is A"} {"instruction": "Most common metal in contact allergic dermatitis is-\nA. Gold\nB. Silver\nC. Aluminium\nD. Nickel", "response": "Ans. is 4d' i.e., Nickel Contact dermatitiso Contact dermatitis is localized rash or irritation of skin caused by contact with a foreign substance. Contact dermatitis is a localized disease, i.e., lesion occurs at the site of contact. However, in sever cases, the lesions may extend outside the contact area or it may become generalized (referred to as id eruption).o Contact dermatitis is mainly of two types : -Irritant contact dermatitisDue to direct irritant action of the material e.g. Solvents, Alkalis, Detergents. Most common sites are hands & forearms.Allergic contact dermatisIt is due to delayed hypersensitivity (type IV hypersensitivity) to a particular antigen in a sensitized individual. The most common allergens causing allergic contact dermatitis are pollen and metals : -Parthenium (Congress grass)Nickel\n\nSo the answer to this question is D"} {"instruction": "Testes completely descend in the scrotum by the aha of\nA. Ends of 7th month of intrauterine life\nB. End of 8th months of intrauterine life\nC. End of 9th months of intrauterine life\nD. After bih", "response": "Testis lies at superficial ring at 8th month and enters the scrotum at the beginning of 9th month. It reaches the final position in the scrotum just before bih.\n\nSo the answer to this question is C"} {"instruction": "True about Adrenal Pheochromocytoma\nA. Chromaffin negative\nB. Mostly malignant\nC. Bilateral in 10% of cases\nD. Unilateral", "response": ".\n\nSo the answer to this question is C"} {"instruction": "Which of the following drugs is useful for the treatment of advanced prostate cancer?\nA. Ganirelix\nB. Cetrorelix\nC. Abarelix\nD. Goserelin", "response": "US Brand Name Zoladex Goserelin is a hormone similar to the one normally released from the hypothalamus gland in the brain. It is used to treat a number of medical problems. These include: Cancer of the prostate in men Cancer of the breast in women if it develops before or around the time of menopause Endometriosis, a painful condition caused by extra tissue growing inside or outside of the uterus, and Thinning of the lining of the uterus before surgery on the uterus. When given regularly as an implant, goserelin works every day to decrease the amount of estrogen and testosterone in the blood. Reducing the amount of estrogen in the body is one way of treating endometriosis and cancer of the breast, and can help thin the uterus lining before surgery. Goserelin prevents the growth of tissue associated with endometriosis in adult women during treatment and for up to 6 months after treatment is discontinued. Reducing the amount of testosterone in the body is one way of treating cancer of the prostate. Suppressing estrogen can thin the bones or slow their growth. This is a problem for adult women whose bones are no longer growing like the bones of children. This is why goserelin is used only for up to 6 months in adult women treated for endometriosis. This medicine is to be given only by or under the supervision of doctor. REFERENCE: www.mayoclinic.org\n\nSo the answer to this question is D"} {"instruction": "The most specific immunohistochemical marker to rule out invasive ductal carcinoma would be?\nA. Ki-67\nB. p 63\nC. Desmin\nD. HER 2 / neu", "response": "p63 is a marker for myoepithelial cells. When neoplastic cells are identified outside the myoepithelial layer around the ducts, the lesion is said to be invasive. So p63 is most specific marker.\n\nSo the answer to this question is B"} {"instruction": "First investigation for solitary thyroid nodules is: (Or) Investigation of choice in discrete thyroid swelling is\nA. Thyroid scan\nB. CT scan\nC. MRI\nD. FNAC", "response": "None\n\nSo the answer to this question is D"} {"instruction": "In sickle cell anaemia, sickle shapes occur due to polymerization of\nA. Oxyhemoglobin\nB. Deoxyhemoglobin\nC. Methoxyglobin\nD. Cyanohemoglobin", "response": "The substitution of hydrophilic glutamic acid by hydrophobic valine causes a localized stickiness on the surface of the molecule. The deoxygenated HbS may be depicted with a protrusion on one side and a cavity on the other side, so that many molecules can adhere and polymerize.Ref: D M Vasudevan 7th edition Page no: 291,292\n\nSo the answer to this question is B"} {"instruction": "Meera is a 43-year-old woman with a body mass index (BMI) of 32. She presented with abnormal uterine bleeding to her gynecologist, who performed an endometrial biopsy that indicated endometrial cancer, specifically endometrial adenocarcinoma of endometrioid histology.Meera's family history is significant for colon cancer. Her mother was diagnosed with colon cancer at age 66. Her paternal aunt was diagnosed with endometrial cancer at age 67. Suspecting hereditary disease which of the following DNA repair mechanism is defective in Meera?\nA. Nucleotide excision repair\nB. Homologous recombination\nC. Mismatch repair\nD. Base excision repair", "response": "The following clinical scenerio suggests of LYNCH SYNDROME Mismatch repair is defective in Lynch syndrome also called Hereditary nonpolyposis colorectal cancer(HNPCC). It is an autosomal dominant genetic condition that is associated with a high risk of colon cancer as well as other cancers including endometrial cancer(second most common). Reference: Harpers illustrated biochemistry 30th edition\n\nSo the answer to this question is C"} {"instruction": "Which of the following is/are not included in management of intra aicular fracture: Ahrodesis Excision Aspiration K- wire Plaster of paris cast\nA. 1,2,3\nB. 2,4,5\nC. 1,2,3,4\nD. None", "response": "\"All listed methods are used in the management of intra aicular fracture\" Intra aicular fracture Intra aicular fracture are those in which the break crosses into the surface of a joint. They always result in some degree of cailage damage. Ideally the joint surface should be restored to their original position and held there strongly enough that movement may be staed in the early postoperative period. some permanent loss of motion is to be expected and joint may develop degenerative ahritis as a result of the injury. Principles of intra aicular fracture Immobilization of intra aicular fracture results in joint stiffness Immobilization of aicular fracture, treated by open reduction and internal fixation, results in much greater stiffness. Depressed aicular fragments, which do not reduce as a result of closed manipulation and traction, are impacted and will not reduced by closed means. Major aicular depression do not fill with fibrocailage and the instability which results from their displacement, is permanent. Anatomical reduction and stable fixation of aicular fragment is necessary to restore joint congruity. Immediate motion is necessary to prevent joint stiffness and to ensure aicular healing and recovery. This require stable internal fixation. Radius fracture treatment ( of distal end i.e. intra aicular pa) K wire fixation may be helpful for smaller fragments. cast immobilization is indicated for nondisplaced fracture, displaced fractures with a stable fracture pattern. The cast should be worn approximately 6 weeks or until radiographic evidence of union has occured. Ahrodesis In this operation, fusion is achieved between the bones forming a joint so as to eliminate any motion at the joint. An ahrodesis is used most often for a painful, stiff joint. It is also performed for grossly unstable joints in polio etc. It is also used for grossly unstable joint due to trauma. Excision and aspiration of hematoma excision of damaged poion of bone and aspiration of intra aicular hematoma, are also included in management of intra aicular fracture. Ref: AO principles of fracture management by Raudi, Page 106-09.\n\nSo the answer to this question is D"} {"instruction": "Southern blot is used to visualize\nA. RNA\nB. DNA\nC. Protein\nD. Antibody", "response": "A Southern blot is a method used in molecular biology for detection of a specific DNA sequence in DNA samples. Southern blotting combines transfer of electrophoresis-separated DNA fragments to a filter membrane and subsequent fragment detection by probe hybridization. Ref-D.M.Vasudevan 7/e p546\n\nSo the answer to this question is B"} {"instruction": "Which of the following types of multiple myeloma is maximally and most commonly associated with increased risk of hyperviscosity syndrome?\nA. IgM\nB. IgG\nC. IgD\nD. IgA", "response": "Ans. a (IgM) (Ref. H-17th/704; Robbin's 7th/680)Lymphoplasmacytic lymphoma is the tissue manifestation of Waldenstrom's macroglobulinemia. This type of lymphoma has been associated with chronic hepatitis C virus infection, and an etiologic association has been proposed. Patients typically present with lymphadenopathy, splenomegaly, bone marrow involvement, and occasionally peripheral blood involvement. The tumor cells do not express CD5. Patients often have a monoclonal IgM protein, high levels of which can dominate the clinical picture with the symptoms of hyperviscosity. Treatment of lymphoplasmacytic lymphoma can be aimed primarily at reducing the abnormal protein, if present, but will usually also involve chemotherapy. Chlorambucil, fludarabine, and cladribine have been utilized. The median 5- year survival for patients with this disorder is ~60%.HYPERVISCOSITY SYNDROME IN MULTIPLE MYELOMA (MM)# Hyperviscosity syndromes may develop in MM depending on the physical properties of the M component.# It is most common with IgM, IgG3, and IgA paraproteins.# Hyperviscosity is defined on the basis of the relative viscosity of serum as compared with water.# Normal relative serum viscosity is 1.8 (i.e., serum is normally almost twice as viscous as water).# Symptoms of hyperviscosity occur at a level of 5-6, a level usually reached at paraprotein concentrations of ~- 40 g/L (4 g/dL) for IgM,- 50 g/L (5 g/dL) for IgG3, and- 70 g/L (7 g/dL) for IgA.# Hypercalcemia may produce lethargy, weakness, depression, confusion, headache, fatigue, visual disturbances, and retinopathy.# Raynaud's phenomenon and impaired circulation may result if the M component forms cryoglobulins.# Note: Sensory neuropathy is also a side effect of thalidomide and bortezomib therapy.Additional Educational Points# Light chain disease is associated with Bence Jones proteinuria=m chain disease.# IgM type of lymphoplasmacytoid lymphoma = is most closely associated with monoclonal gammopathy.# Primary livedo reticularis with ulceration is also called atrophie blanche en plaque. The ulcers are painful and may take months to heal. Secondary livedo reticularis can occur with atheroembolism, SLE and other vasculitides, anticardiolipin antibodies, hyperviscosity, cryoglobulinemia, and Sneddon's syndrome (ischemic stroke and livedo reticularis).# Similar bihemispheral damage is produced by disorders that occlude small blood vessels throughout the brain; examples include cerebral malaria, thrombotic thrombocytopenic purpura, and hyperviscosity.# Blood viscosity increases logarithmically at hematocrits >55%.# Concern that the hemoglobin level may be abnormally high is usually triggered at 170 g/L (17 g/dL) for men and 150 g/ L (15 g/dL) for women. Hematocrit levels >50% in men or >45% in women may be abnormal. Hematocrits >60% in men and >55% in women are almost invariably associated with an increased red cell mass.# A decrease in the AG can be due to hyperviscosity and severe hyperlipidemia.\n\nSo the answer to this question is A"} {"instruction": "Dorsal column lesions are associated with loss of:\nA. Ankle jerk\nB. Knee jerk\nC. Proprioception\nD. Superficial abdominal reflexes", "response": "Ans: C (Proprioception) Ref: Harrison's Principles of Internal Medicine, 18th ed.Explanation:The posterior column (dorsal column)It refers to the area of white matter in the dorsomedial side of the spinal cord.It is made up of the fasciculus gracilis and fasciculus cuneatusIt is part of an ascending pathway that is important for well-localized fine touch and conscious proprioception called the posterior column-medial lemniscus pathway.Joint capsules, tactile and pressure receptors send a signal through the dorsal root ganglia up through the fasciculus gracilis for lower body sensory impulses and the fasciculus cuneatus for upper body impulses.Once the fasciculus gracilis reaches the nucleus gracilis and the fasciculus cuneatus reaches the nucleus cuneatus in the lower medulla, they begin to cross over the medulla as the internal arcuate fibers.When they reach the contralateral side, they become the medial lemniscus, which is the second part of the posterior column-medial lemniscus pathway.Lesions in this pathway can diminish oi completely abolish tactile sensations and movement or position sense below the lesionTests of sensationModalityPathwayLight touchLarge fast-conducting axonsProprioceptionDorsal columnsVibrationMedial lemniscusTwo-point discrimination Pinprick (superficial pain)Smaller slower-conducting axonsSpinothalamic tracts Deep painTemperature StereognosisParietal cortex (only valid if peripheral sensory function intact)GraphaesthesiaTwo-point discrimination\n\nSo the answer to this question is C"} {"instruction": "In which of the following condition is tardy ulnar nerve palsy seen?\nA. Malunited supra condylar fracture\nB. Malunited lateral condylar fracture\nC. Malunited medial condylar fracture\nD. Fracture both bones of forearm", "response": "Tardy ulnar nerve palsy may develop after malunited fractures of the lateral humeral condyle in children, displaced fractures of the medial humeral epicondyle, dislocations of the elbow and contusions of the nerve. Tardy ulnar nerve palsy may also develop in patients who have a shallow ulnar groove on the posterior aspect of the medial humeral epicondyle. Complications associated with pediatric lateral condylar fracture include cubitus varus, cubitus valgus, fishtail deformity, and tardy ulnar nerve palsy.\n\nSo the answer to this question is B"} {"instruction": "Which drug should be avoided in the management of traumatic hyphema in a dark race individual?\nA. Timolol\nB. Acetazolamide\nC. Atropine\nD. Steroids", "response": "Traumatic hyphema presents with raised intraocular pressure.Timolol will help to control raised IOP. Atropine will provide cycloplegic action and will provide relief from pain. Steroids will help to prevent rebleed. Acetazolamide is not given in dark race patients due to risk of sickling as a result of metabolic acidosis caused by acetazolamide.\n\nSo the answer to this question is B"} {"instruction": "Which among the following is a secondary brain injury?\nA. Coical lacerations\nB. Brainstem and hemispheric contusions\nC. Diffuse axonal injury\nD. Intercerebral haematoma with raised intracranial pressure", "response": ".Effects of Brain Injuries - 1. Brain oedema is accumulation of fluid, both intracellular and extracellular. It is due to congestion and dilatation of blood vessels. It may be diffuse or localized. 2. Brain necrosis is of severe variety with destruction and is due to haemorrhagic infarction. 3. Extradural haematoma occurs usually in temporoparietal region. It is commonly due to tear in middle meningeal veins and often middle meningeal aery. It causes intracranial hypeension, displacement, Kernohan's effect and often death. 4. Subdural haematoma is due to tear of veins between cerebrum and dura due to shearing forces. It is diffuse and commonly associated with cerebral injury. 5. Intracerebral haematoma can occur in different pas of cerebrum may be in frontal lobe, temporal lobe. ref:SRB&;s manual of surgery,ed 3,pg no 1038\n\nSo the answer to this question is D"} {"instruction": "A 54-year-old man has a total cholesterol of 272 and LDL level of 210. His therapy is initiated with dietary modification and an exercise regimen, but he is unresponsive and so is prescribed nicotinic acid (Niacin). Which of the following symptoms will this patient likely experience from this drug?\nA. Bradycardia\nB. Facial flushing\nC. Hypoalbuminemia\nD. Hypoglycemia", "response": "Niacin, or vitamin B3, is an agent that results in the following physiologic changes: LDL reductions tend to occur in 5-7 days with the maximal effect seen in 3-5 weeks; triglycerides and VLDL are reduced by 20% to 40% in 1-4 days; and HDL levels can increase by 20%. This agent is indicated as adjunctive therapy in patients with elevated cholesterol and triglycerides when diet and other nondrug therapies are inadequate. The most common adverse effect of this agent is generalized flushing with a sensation of warmth, especially in the facial area. This reaction may be so severe in some patients that they discontinue therapy. Other common adverse effects include hepatotoxicity, tachycardia, hypoalbuminemia, hyperglycemia, nausea, vomiting, hyperuricemia, glucose intolerance, pruritus, peptic ulcer disease, and dry skin.\n\nSo the answer to this question is B"} {"instruction": "Fracture of talus without displacement in x-ray would lead to -a) Osteoarthritis of ankleb) Osteonecrosis of head of talusc) Avascular necrosis of body of talusd) Avascular necrosis of neck of taluse) Non union\nA. ac\nB. bc\nC. ad\nD. b", "response": "Complicatiosn of Talar neck fracture\n\nMalunion \nAvascular necrosis (osteonecrosis) of body.\nNon-union \nSecondary osteoarthritis of ankle and subtalar joint.\n\nSo the answer to this question is A"} {"instruction": "Open neural tube defects are best detected by increase in which of the following enzyme ?\nA. Acetylcholinesterase\nB. Pseudocholinesterase\nC. AFP\nD. hCG", "response": "Spina bifida is defined as a defect in neural arch,which results in exposure of the contents of the neural canal.In case of open spina bifida, acetyl cholinestetase level is increased. Refer page no 487 of text book of obstetrics, sheila balakrishnan, 2nd edition.\n\nSo the answer to this question is A"} {"instruction": "Which biochemical reaction does not occur in the mitochondria:\nA. Kreb's cycle\nB. Urea cycle\nC. Gluconeogenesis\nD. Fatty acid synthesis", "response": "D i.e. Fatty acid synthesis\n\nSo the answer to this question is D"} {"instruction": "A 7 years girl, parents gave history of fever for which she was treated with Paracetamol following which the fever subsided. Later she developed seizures and altered sensorium. The urine examination revealed oxalate crystals on microscopy, Blood anion gap and osmolality were increased. The diagnosis is:\nA. Lactic acidosis\nB. Ethylene glycol poisoning\nC. Renal tubular acidosis\nD. Paracetamol poisoning", "response": "Ref: Harrison’s 18/e p367, 17/e p291\n \n\nIngestion of antifreeze causes high AG acidosis.\n Due to ethylene glycol and its metabolites oxalic acid, glycolic acid.\n Diagnosis is facilitated by presence of oxalate crystals in urine.\n\nSo the answer to this question is B"} {"instruction": "A 6 weeks pregnant primigravida is brought to the emergency depament with severe, acute abdominal pain. USG shows ectopic pregnancy. Which of the following has the LEAST risk of ectopic pregnancy?\nA. Tubectomy\nB. Infeility >1 year\nC. Copper T\nD. Condoms", "response": "Condoms reduces the incidence of tubal infeility and ectopic pregnancy. Risk factors of ectopic pregnancy: Prior ectopic pregnancy Prior tubal surgery Smoking >20 cigarettes per day Prior STD with confirmed PID by laparoscopy and/or positive test for Chlamydia trachomatis Three or more prior spontaneous miscarriages Age 40 years Prior medical or surgical aboion Infeility >1 year Lifelong sexual paners >5 Previous IUD use Ref: Textbook of Obstetrics by D C Dutta, 6th edition, Page 533.\n\nSo the answer to this question is D"} {"instruction": "Slow acetylators of isoniazid are more prone to develop :\nA. Failure of therapy\nB. Peripheral neuropathy\nC. Hepatotoxicity\nD. Allergic reactions", "response": "Acetylator status of a person determines the response of drugs metabolized by acetylation (e.g. isoniazid, sulfonamides, procainamide and hydralazine). Isoniazid is metabolized to acetyl-isoniazid and then to acetyl hydrazine. Accumulation of isoniazid is responsible for peripheral neuropathy whereas acetylhydrazine accumulation may cause hepatotoxicity. Thus, slow acetylators will not be able to metabolize the drug quickly and there can be an accumulation of parent drug (isoniazid in this case), leading to peripheral neuropathy. On the other hand, fast acetylators are more prone to develop hepatotoxicity.\n\nSo the answer to this question is B"} {"instruction": "Curschmann spirals and flattening of diaphragm is seen in:\nA. Asthma\nB. COPD\nC. Silicosis\nD. Pulmonary embolism", "response": "Ans. (a) AsthmaRef: Harrison 19th ed. /1675* Flattening of diaphragm is seen with obstructive airway diseases due to the process of air trapping.* The point that clinches the diagnosis in favor of asthma is the curschmann spirals which represent the cast of the airways formed by mucus plugs in small airways in these patients.\n\nSo the answer to this question is A"} {"instruction": "Dichotomy means -\nA. Erasure of name\nB. Disclosure of secrets of patients\nC. Fee-splitting\nD. Adultery", "response": "Dichotomy means fee splitting or bribery or commissioning.\nReceiving commissions on referral of a patient to a doctor or forwarding commissions, both are included under dichotomy.\nDichotomy is infamous conduct as defined under the rules and regulations of MCI, 2002.\nIf a doctor repeatedly indulges in dichotomy, a warning notice could be issued against him, if he still indulges in dichotomy, his name could be erased from the medical register and it is called as professional death sentence.\n\nSo the answer to this question is C"} {"instruction": "The best time to do chorionic villous sampling is:\nA. Between 6-8 weeks\nB. Between 7-9 weeks\nC. Between 9-11 weeks\nD. Between 11-13 weeks", "response": "Chorionic villus sampling prenatal diagnosis of genetic disorders transcervical done:at 10-12 weeks transabdominal done from 10 weeks to term diagnosis can be obtained by 24 hours complications like fetal loss,oromandibular limb deformities,vaginal bleeding are higher D.C.DUTTA'S TEXTBOOK OF OBSTETRICS,Pg no:107,7th edition\n\nSo the answer to this question is D"} {"instruction": "All are risk factors for the development of surgery associated chronic kidney disease, EXCEPT:\nA. Older age\nB. CCF\nC. Emergency procedures\nD. Spinal anaesthesia", "response": "Common risk factors for postoperative AKI include 1. Underlying chronic kidney disease, 2. Older age, 3. Diabetes mellitus, 4. Congestive hea failure 5. Emergency procedures. Cardiopulmonary bypass is a hemodynamic state characterized by nonpulsatile flow and exposure of the circulation to extracorporeal circuits. Longer duration of cardiopulmonary bypass is a risk factor for AKI. Ref: Harrison-E-18, P-2296.\n\nSo the answer to this question is D"} {"instruction": "Salivary protein, which prevents transmission of human immunodeficiency virus via saliva is:\nA. Sialoperoxidase\nB. Secretory IgA\nC. Salivary leukocyte proteinase inhibitor\nD. Histidine rich proteins", "response": "Secretory leukocyte protease inhibitor (SLPI) is found in human saliva, nasal secretions, tears, cervical mucus and seminal fluid. It is believed to be responsible for the anti-HIV properties of external secretions.\n\nSo the answer to this question is C"} {"instruction": "Which of the following is true about autosomal dominant:\nA. Variable age of onset\nB. Reduced penetrance\nC. Variable expressibility\nD. All of the above", "response": "Autosomal dominant disorders:\n\nVariable age of onset.\nReduced penetrance.\nVariable expressibility.\n\nSo the answer to this question is D"} {"instruction": "Cretinism is _____________\nA. Dispropoionate dwarfism\nB. Sho stature with long trunk\nC. Sho stature with sho trunk\nD. Long stature with long trunk", "response": "Congenital iodine deficiency syndrome, previously known as cretinism, is a condition of severely stunted physical and mental growth owing to untreated congenital deficiency of thyroid hormone (congenital hypothyroidism) usually owing to maternal hypothyroidism. Results in Dispropoionate dwarfism Reference: GHAI Essential pediatrics, 8th edition\n\nSo the answer to this question is A"} {"instruction": "Delayed eruption of teeth occurs in\nA. Craniofacial dysostosis\nB. Hyperthyroidism\nC. Cleidocranial dysostosis\nD. Osteitis deformans", "response": "None\n\nSo the answer to this question is C"} {"instruction": "IVP should be cautiously performed in:\nA. Multiple myeloma\nB. Bone secondaries\nC. Neuroblastoma\nD. Leukemia", "response": "Ans. Multiple myeloma\n\nSo the answer to this question is A"} {"instruction": "Blunting of affect is seen in\nA. Schizophrenia\nB. Depression\nC. Mania\nD. Delirium", "response": "Ans. a (Schizophrenia). (Ref. Harrison, Medicine, 15th ed., 2554; Psychiatry by Niraj Ahuja, 5th ed., 55)EUGEN BLEULER'S FUNDAMENTAL SYMPTOMS OF SCHIZOPHRENIA (4 A'S)# Ambivalence (marked inability to decide for or against)# Autism (withdrawal into self)# Affect blunting (disturbance of affect)# Association disturbances (loosening of association, thought disorder)\n\nSo the answer to this question is A"} {"instruction": "The characteristic changes in the radiographic appearance of the alveolar bone is seen in:\nA. Monostotic fibrous dysplasia\nB. Hemifacial hyperplasia\nC. Segmental odontomaxillary dysplasia\nD. Both 1 and 3", "response": "Fibrous dysplasia\nThe density and trabecular pattern of fibrous dysplasia lesions vary considerably. The variation is more pronounced in the mandible and more homogeneous in the maxilla. The internal aspect of bone may be more radiolucent, more radiopaque, or a mixture of these two variations compared with normal bone. The internal density is more radiopaque in the maxilla and the base of the skull.\nSegmental odontomaxillary dysplasia\nThe density of the maxillary alveolar process is increased, with a greater number of thick trabeculae that appear to be aligned in a vertical orientation.\nOral radiology White & Pharaoh 7th edition page no 402,624\n\nSo the answer to this question is D"} {"instruction": "The most common cause of superficial throm-bophlebitis is\nA. Intravenous catheters / infusion\nB. DVT\nC. Varicose veins\nD. Trauma", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Most common genetic cause of mental retardation is\nA. Down's syndrome\nB. Fragile X syndrome\nC. Frederich's ataxia\nD. Ataxia telangietasia", "response": "Most common cause of mental retardation is Down syndrome followed by Fragile X syndrome.\n\nSo the answer to this question is A"} {"instruction": "In hepatic cirrhosis, which of the following is increased -\nA. Alpha 1 globulin\nB. Alpha 2 globulin\nC. Gamma globulin\nD. All of the above", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Dehydration is the common concern in elderly edentulous patients because of\nA. Reduced ability to sense thirst\nB. Poor absorption of fluids\nC. Vitamin deficiency\nD. Osteopenia", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Crocodile tears are ssen in\nA. Frey's syndrome\nB. Conjunctivitis\nC. Ophthalmia neonatorum\nD. Abnormal facial nerve regeneration", "response": "Crocodile tear syndrome The mechanism appears to be a misdirection of regenerating gustatory fibers destined for the salivary glands, so that they become secretory fibers to the lacrimal gland and cause homolateral tearing while the patient is eating. A simple procedure, involving subtotal resection of the palpebral lobe of the involved lacrimal gland, proved to be an effective corrective measure in these cases.\n\nSo the answer to this question is D"} {"instruction": "A female at 37 wks of gestation has mild labour pain for 10 hours and cervix is persistently 1CM dilated but non effaced. What will be the next appropriate management?\nA. Sedation and wait\nB. Augmentation with syntocin\nC. Cesarean section\nD. Amniotomy", "response": "This is a nulliparous patient and is in latent phase of labor. Latent phase duration normally in a nulliparous female is less than 20hrs and in a multiparous female its is 14 hours. The optimal treatment for this patient is administer sedation and observe the patient. Prolonged latent phase occur when the duration exceeds the above parameters. It could be due to unripe cervix, false labor or sedation. Prolonged first stage of labor occur when cervix dilates less than 1 cm/hr in nulliparous women and less than 1.5cm/hr in multiparous women. Management of prolonged first stage includes observation, augmentation by amniotomy or oxytocin, and continuous suppo. Cesarean delivery is warranted if maternal or fetal status become non reassuring. Ref: Obstetrics and Gynecology edited by Charles R. B. Beckmann page 106\n\nSo the answer to this question is A"} {"instruction": "A known case of pancreatitis presents on Day 4 with breathlessness, basal crepitations. Diagnosis is:\nA. Lung collapse\nB. Pleural effusions\nC. ARDS\nD. Aspiration pneumonia", "response": "Ans. C ARDSPerihilar fluffy opacities - Bat wing opacitiesQ seen in pulmonary edema (cardiogenic/non-cardiogenic), ARDS. Common pulmonary complications of pancreatitis are ARDS, pleural effusion (mostly left sided) and consolidation.\n\nSo the answer to this question is C"} {"instruction": "Which of the following side effects are seen with etomidate-\nA. Myoclonus, Adrenal suppression, Haemodynomic imbalance(HI)\nB. Myoclonus, adrenal suppression, pain on IV injection\nC. Pain on IV injection, Adrenal suppression, HI\nD. Pain on IV injection, HI ,Myoclonus.", "response": "Etomidate a intravenous anaesthetic agent is Milky white in colour , imidazolone derivative, causes pain on iv injection. Major advantages over other intravenous agents is cardiovascular stability thus use cardiac compromised patients Routinely not in clinical use since it is adrenal suppressant. Other side effects myoclonus and increased nausea and vomiting.\n\nSo the answer to this question is B"} {"instruction": "A 40 year old male patient on long term steroid therapy for systemic disease, presents with recent onset of severe pain in the right hip. Imaging modality of choice for this problem is-\nA. CT scan\nB. Bone scan\nC. MRI\nD. Plain X-ray", "response": "Long term steroid therapy for systemic disease + severe pain in the right hip = AVASCULAR NECROSIS IOC for Avascular Necrosis: MRI Snow cap sign on plain radiograph: AVN of humerus or femur head Figure: snow cap sign due to AVN of humerus head\n\nSo the answer to this question is C"} {"instruction": "TTKG in hypokalemia is -\nA. < 3-4\nB. > 6-7\nC. > 9-10\nD. > 10-15", "response": "Answer- A. < 3-4A normal TTK in normal subjects on normal diet is 8-9Without other disease, hypokalemia should produce a TTKG <3\n\nSo the answer to this question is A"} {"instruction": "Opening of Eustachian tube in middle ear is in\nA. Medial wall\nB. Lateral wall\nC. Anterior wall\nD. Posterior wall", "response": "Anterior wall has 2 openings, the lower one for eustachian tube and the upper one for the canal of tensor tympani muscle. 2. Opening for Eustachian tube. Reference: Dhingra 6th edition\n\nSo the answer to this question is C"} {"instruction": "A dead body with suspected poisoning is having hypostasis of red brown in color. It is suggestive of poisoning due to: Maharashtra 08; DNB 10; PGI 07, 08, 10, 11\nA. Nitrites/Aniline\nB. CO\nC. Cyanides\nD. Hydrogen sulfide", "response": "Ans. Nitrites/Aniline\n\nSo the answer to this question is A"} {"instruction": "The half-life of oxytocin is\nA. 2-3 min\nB. 3-5 min\nC. 5-6 min\nD. 7-8 min", "response": "OxytocinIn general, oxytocin should be discontinued if the number of contractions persists with a frequency of more than five in a 10-minute period or more than seven in a 15-minute period or with a persistent nonreassuring fetal hea rate pattern.When oxytocin is stopped, its concentration in plasma rapidly falls because of the half-life is approximately 3 to 5 minutes.Ref: William&;s Obstetrics; 25th edition\n\nSo the answer to this question is B"} {"instruction": "Agnus Hunt traction used in\nA. Flexion deformity of hip\nB. Fracture femur shaft\nC. Fracture neck of femur\nD. Intertrochanteric fracture", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Drug that can be used against anaerobic: streptococci: March 2007\nA. Penicilin\nB. Erythromycin\nC. Vancomycin\nD. Clindamycin", "response": "Ans. D: Clindamycin Clindamycin is used primarily to treat infections caused by susceptible anaerobic bacteria, including infections of the respiratory tract, skin and soft tissue infections, and peritonitis. In patients with hypersensitivity to penicillins, clindamycin may be used to treat infections caused by susceptible aerobic bacteria as well. It is also used to treat bone and joint infections, paicularly those caused by Staphylococcus aureus. Topical application of clindamycin phosphate can be used to treat mild to moderate acne\n\nSo the answer to this question is D"} {"instruction": "Antitubercular drug which is least hepatotoxic: September 2010\nA. Rifampicin\nB. Pyrazinamide\nC. Ethambutol\nD. INH", "response": "Ans. C: Ethambutol The single biggest problem with TB treatment is drug-induced hepatitis, which has a moality rate of around 5%. Three drugs can induce hepatitis: PZA, INH and RMP (in decreasing order of frequency). It is not possible to distinguish between these three causes based purely on signs and symptoms.\n\nSo the answer to this question is C"} {"instruction": "Clinical evidence of dentinogenesis imperfecta is\nA. Defective enamel and dentine\nB. Defective dentine and obliterated pulp chamber\nC. Increased rate of caries\nD. Oligodontia", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Which of the following is true about direct filling gold\nA. Properly condensed mat gold has no voids\nB. Whatever may be the type voids are inherent\nC. Voids can be avoided with manual condensation\nD. None of the above", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Emergence delirium is characteristic of:\nA. Midazolam\nB. Ketamine\nC. Thiopentone\nD. Opioids", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Placido disc is useful for detecting:\nA. Microcornea\nB. Megalocornea\nC. Corneal scars\nD. Keratoconus", "response": "Placido disc Placido disc is a type of video-keratoscopy which helps understand details about the corneal surface and anterior curvature -In normal cornea , there is no distoion of reflected pattern - In keratoconus , there is distoion of reflected pattern\n\nSo the answer to this question is D"} {"instruction": "A 23-year old patient diagnosed with stage IA malignant ovarian germ cell tumor. Which of the following would be the standard treatment-\nA. Unilateral oophorectomy\nB. Bilateral oophorectomy and hysterectomy\nC. Unilateral oophorectomy followed by chemotherapy\nD. Ovarian biopsy followed by chemotherapy", "response": "Approximately 50% to 70% of Germ cell malignancies are stage 1. Since she is a young patient, Feility-sparing surgery ( USO ) is done Almost All germ cell malignancies require Postoperative Chemotherapy.\n\nSo the answer to this question is C"} {"instruction": "Mizou-Nakamura phenomenon in fundus is seen in:\nA. Congenital rod absence\nB. Congenital stationary night blindness\nC. Congential cone defect\nD. Best disease", "response": "Congenital stationary night blindness(CSNB) Infantile onset nyctalopia with non progressive retinal dysfunction. Fundus appearance can be normal or abnormal. CSNB with abnormal appearing fundus is known as Oguchi disease. The fundus in oguchi disease is unusual golden yellow in color in light adapted state which becomes normal in color after prolong dark adaptation. This phenomena is known as Mizou-Nakamura phenomena.\n\nSo the answer to this question is B"} {"instruction": "A female presents with persistent painful oral lesions, with acantholytic cells. Most likely diagnosis is –\nA. Pemphigus vulgaris\nB. Dermatitis herpetiformis\nC. Epidermolysis bullosa\nD. Bullous pemphigoid", "response": "Painful oral lesion with acantholysis suggests pemphigus vulgaris.\n\nSo the answer to this question is A"} {"instruction": "Drug used to perform stress ECHO –\nA. Thallium\nB. Dobutamine\nC. Adrenaline\nD. Adenosine", "response": "Stress echocardiography is done either by Physical stress (Exercise :- treadmill or cycling) or by pharmacological stress (dobutamine).\n\nSo the answer to this question is B"} {"instruction": "Normal weight of term placenta in gms -\nA. 300\nB. 500\nC. 700\nD. 1000", "response": "Ans. is 'b' i.e., 500 \"The placenta at term is almost circular disk with a diameter ofl5-20cms & thickness of about 3 cms at its centre5. It thins towards the edge. It feels spongy & weighs about 500gmsf the proportion of the weight of the baby being roughly 1:6 at term and occupies the 30% of the uterine wall \"\n\nSo the answer to this question is B"} {"instruction": "A feature of Renal vasculitis in children is -\nA. IgA raised\nB. Antinuclear antibody in serum\nC. Low complement level\nD. Cytoplasmic antinuclear Ab in serum", "response": "None\n\nSo the answer to this question is A"} {"instruction": "A teenage girl complained about increased growth of facial hair. Her menstrual cycle is regular and she has normal body weight. Following may be used in treatment of hirsutism, EXCEPT:\nA. Spironolactone\nB. Flutamide\nC. Cyproterone\nD. Mifepristone", "response": "Mifepristone does not used for hirsutism. Spironolactone is an aldosterone antagonist. It possesses anti androgenic propeies and exes its peripheral antiandrogenic effects in the hair follicle by competing for androgenic receptors and displacing dihydrotestosterone at both nuclear and cytosol receptors. Flutamide is a potent, highly specific, nonsteroidal antiandrogen with no intrinsic hormonal or anti gonadotropic activity. Although the exact mechanism of action is unknown, it competitively inhibits target tissue androgen receptor sites. Cyproterone acetate is the an androgen receptor antagonist. Antiandrogenic effects result from competitive displacement of dihydrotestosterone from its receptor and reduction of 5-reductase activity in the skin. Ref: Guess M.K., Andrew D.E., Gagliardi C.L., Emmi A.M. (2007). Chapter 57. Hirsutism. In A.H. DeCherney, L. Nathan (Eds), CURRENT Diagnosis & Treatment Obstetrics & Gynecology, 10e.\n\nSo the answer to this question is D"} {"instruction": "Cirrhotic ascites has all the features except(NOT RELATED-SURGERY)\nA. Straw colour\nB. Specific gravity < 1060\nC. Leucocyte count < 200/cu mm\nD. Serum ascitic albumin gradient <1", "response": "Serum-ascites albumin gradient g/dl > 1.1 in ascitic fluid caused by cirrhosis\n\nSo the answer to this question is D"} {"instruction": "Which of the following weakest phase of the set amalgam:\nA. Beta-2\nB. Gamma\nC. Gamma-1\nD. Gamma-2", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Lesion at which pa of visual pathway causes homonymous hemianopia?\nA. Optic tract\nB. Optic nerve\nC. Optic Chiasma\nD. Retina", "response": "A left homonymous hemianopsia can be caused by a lesion in the right optic tract or the right side of the brain. With a tract lesion, the pupillary reflex is lost if light is only projected from the blind hemifield; the pupil reacts when the lesion is posterior to the geniculate body in the optic radiations or occipital lobe. Transient homonymous hemianopsia may occur with migraine. Ref: LeBlond R.F., DeGowin R.L., Brown D.D. (2009). Chapter 7. The Head and Neck. In R.F. LeBlond, R.L. DeGowin, D.D. Brown (Eds), DeGowin's Diagnostic Examination, 9e.\n\nSo the answer to this question is A"} {"instruction": "Most common malignant tumour in childhood:\nA. Rhabdomyosarcoma\nB. Leukaemia\nC. Lymphangioma\nD. Neuroblastoma", "response": "(Leukemia) (561-G) (580 -Ghai 7th)* Leukemia is most common form of childhood malignancy* Descending order - Leukemia > Brain tumour > Lymphoma > Neuroblastoma > Wilm's tumour > Soft tissue sarcoma.* Most common cancer in children (1686-Nelson 17th)* Lymphohematopoietic (44%) > Nervous system (29%) > Embryoral (12%0 > Connective tissue (10%)\n\nSo the answer to this question is B"} {"instruction": "Which of these does not change or remains same throughout life\nA. Salmon patch\nB. Strawberry angiomas\nC. Portwine stain\nD. Capillary hemangiomas", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Torus aoicus is\nA. Bulge in the atria\nB. Bulge in aoa\nC. Aoic wall tear\nD. Septal defect", "response": "Torus aoicus is a bulge in the atria . Ref - medscape.com\n\nSo the answer to this question is A"} {"instruction": "Post term baby with tachypnea - commonest cause?\nA. Transient tachypnea of newborn\nB. Meconium aspiration syndrome\nC. Hyaline membrane disease\nD. Infection", "response": "Ans. is 'b' i.e., meconium aspiration syndrome Transient Tachypnea of the Newborn Transient tachypnea of the newborn is the most common cause of neonatal respiratory distress, constituting more than 40 percent of cases.1 A benign condition, it occurs when residual pulmonary fluid remains in fetal lung tissue after delivery o Respiratory Distress Syndrome Respiratory distress syndrome of the newborn, also called hyaline membrane disease, is the most common cause of respiratory distress in premature infants Immature type II alveolar cells produce less surfactant, causing an increase in alveolar surface tension and a decrease in compliant Meconium Aspiration Syndrome Meconium-stained amniotic fluid occurs in approximately 15 percent of deliveries, causing meconium aspiration syndrome in the infant in 10 to 15 percent of those cases, typically in term and post-term infants Infection Bacterial infection is another possible cause of neonatal respiratory distress. Common pathogens include group B streptococci (GBS), Staphylococcus aureus, Streptococcus pneumoniae, and gram-negative enteric rods. Pneumonia and sepsis have various manifestations, including the typical signs of distress as well as temperature instability\n\nSo the answer to this question is B"} {"instruction": "Under eradication of congenital rubella syndrome progarmme the first priority group for rubella vaccination is-\nA. All non pregnant women of age 15-34\nB. All adolescent non pregnant girls 15 to 24 years of age\nC. All female children at one year\nD. All non pregnant women", "response": "The priorities being first to protect women of child-bearing age (15-34 yrs of age) Then to interrupt transmission of rubella by vaccinating all children currently aged 1-14 yrs And subsequently all children at one year of age. Ref:PARK&;S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 23rd edition , Page:151\n\nSo the answer to this question is A"} {"instruction": "The coronary sinus -\nA. Lies in anterior part of the coronary sulcus\nB. Ends in right atrium\nC. Has venae cordis minimae as its tributaries\nD. Develops from right anterior cardinal vein", "response": "Development of coronary sinus is from the body and left horn of sinus venosus. It lies in the posterior part of the coronary sulcus and drains into the right atrium. Though the besian veins/ venae cordis minimae drain directly into the right atrium, the the besian valves are guarding the opening of coronary sinus into the right atrium.\n\nSo the answer to this question is B"} {"instruction": "Quetelet&;s index used to assess obesity, is represented as -\nA. Weight di vided by Height\nB. Height divided by weight\nC. Weight divided by square of Height\nD. Height divided by square of weight", "response": "Ans, is 'c' i.e., Weight divided by the square of Height Different indices use to determine obesity are : Body mass index, Quetelet's index - FAO/WHO recommends it's use internationally as reference stand-ard for assessing the prevalence of obesity in a community. Wt (kg) BMI = -------------------------- Ht2 (m) Height (cm) Ponderal index = -------------------------------- Cube root of body wt (kg) Broca index = Height (cm) - 100 Simplest index Actual weight Corpulence index = -------------------------- Desirable weight o This should not exceed 1[?]2 Ht (cm) - 150 Lorentz's formula = Ht(cm)-100 ------------------------ 2 (Female) or 4 (Male)\n\nSo the answer to this question is C"} {"instruction": "The following is a pro-apoptic factor\nA. Bax\nB. Bcl-2\nC. Bcl-xL\nD. Mci-1", "response": "Ans. (a) Bax (Ref: Robbins 9th/pg 55; 8th/pg 28)Proapoptotic: Apafl, cytochrome c, Bak, Bax, Bim, AIF, P53, Caspases, CD95 (FAS), TNF R1 and Smac/DiabloAntiapoptotic: Bcl2,BclxL ,Bclx ,FLIP,McL-1,IAP\n\nSo the answer to this question is A"} {"instruction": "The function of Phospholamban is\nA. Regulates Na+ K+ pump\nB. Transports calcium out of the mitrochondria\nC. Binds actin with myosin\nD. Inhibits Ca++ pump on sarcoplasmic reticulum", "response": "Phospholamban inhibits calcium pump on sarcoplasmic reticulum, thereby preventing uptake of Ca++ from the sarcoplasm. \nWhen it is phosphorylated, the Ca++ channels open up and uptake of Ca++ is increased into the sarcoplasmic reticulum.\n\nSo the answer to this question is D"} {"instruction": "Bannwah's syndrome develops secondary to infection with\nA. B. burgdorferi\nB. T. pallidum\nC. B.cereus\nD. afragilis", "response": "Answer- B. T. pallidumIt is also called neuroborrelisosis.It is secondary to infection with B. burgdorferi.Meningeal irritation may develop early in Lyme disease when erphema migrans is present.untreated patients develop frank neurologic abnormalities, including meningitis,subtle encephalitic signs, cranial neuritis (including bilateral facial palsy), motor or sensory radiculoneuropathy, peripheral neuropathy, mononeuritis multiplex, cerebellar ataxia, or myelitis.In Europe and Asia, the first neurologic sign is characteristically radicular pain, which is followed by the development of CSF pleocytosis (called meningopolyneuritis, or Bannwah's syndrome ); meningeal or encephalitic signs are frequently absent.\n\nSo the answer to this question is B"} {"instruction": "Which of the following is a remnant of ductus aeriosus?\nA. Ligamentum aeriosum\nB. Ligamentum teres\nC. Both of the above\nD. None of the above", "response": "On the right, when the distal pa of the sixth aoic arch and the fifth aoic arch disappear, the recurrent laryngeal nerve moves up and hooks around the right subclan aery. On the left, the nerve does not move up, since the distal pa of the sixth aoic arch persists as the ductus aeriosus, which later forms the ligamentum aeriosum Ref: Langman's embryology 11th edition Chapter 12.\n\nSo the answer to this question is A"} {"instruction": "Which among the following is not true about Octreotide?\nA. Somatostatin analogue\nB. Used in secretory diarrhea in AIDS\nC. Used in carcinoid\nD. An absorbent", "response": "Octreotide is an octapeptide analog of somatostatin (SST) that is effective in inhibiting the severe secretory diarrhea brought about by hormone-secreting tumors of the pancreas and the GI tract. Its mechanism of action appears to involve inhibition of hormone secretion, including 5-HT and various other GI peptides (e.g., gastrin, vasoactive intestinal polypeptide (VIP), insulin, secretin, etc.). Octreotide has been used off label, with varying success, in other forms of secretory diarrhea such as chemotherapy-induced diarrhea, diarrhea associated with human immunodeficiency virus (HIV), and diabetes-associated diarrhea. Its greatest utility, however, may be in the \"dumping syndrome\" seen in some patients after gastric surgery and pyloroplasty. A long-acting preparation of octreotide acetate enclosed in biodegradable microspheres is available for use in the treatment of diarrheas associated with carcinoid tumors and VIP-secreting tumors, as well as in the treatment of acromegaly. Ref :Sharkey K.A., Wallace J.L. (2011). Chapter 46. Treatment of Disorders of Bowel Motility and Water Flux; Anti-Emetics; Agents Used in Biliary and Pancreatic Disease. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.\n\nSo the answer to this question is D"} {"instruction": "In the normal human right eye, the peripheral field of vision is usually least:\nA. On the left side (nasally)\nB. In the downward direction\nC. In the upward direction\nD. On the right side (temporally)", "response": "The field of vision is 50 degree superiorly, 60 degree nasally, 70 degree inferiorly and 90 degree temporally. Ref: Textbook of Ophthalmology By Nema, 3rd Edition, Page 73; Comprehensive Ophthalmology By AK Khurana, 2nd Edition, Page 37\n\nSo the answer to this question is C"} {"instruction": "Which type of neurological defect is seen in a fetus of diabetic mother ?\nA. Caudal regression\nB. Neural tube defect\nC. Anencephaly\nD. All of the above", "response": "Major bih defects seen in infants of diabetic mothers: CNS & skeletal: Neural tube defects, anencephaly, microcephaly, sacral agenesis Cardiac: VSD, ASD, coarctation of aoa, transposition of great vessels, cardiomegaly Renal: Renal agenesis, hydronephrosis, ureteral duplication Gastrointestinal: Duodenal atresia, anorectal atresia Others: Single umbilical aery\n\nSo the answer to this question is D"} {"instruction": "All of the following cells are present in cerebellum, EXCEPT?\nA. Purkinje cells\nB. Stellate cells\nC. Pyramidal cells\nD. Basket cells", "response": "The pyramidal cells are seen in cerebral coex. The coex of the cerebellum consists of only three layers. They are, (1) an outer, molecular layer, (2) a middle, Purkinje layer, and (3) an inner, granular layer. The molecular layer has the least cellular density and consists of two types of neurons, stellate cells and basket cells. The stellate cells have relatively sho dendrites and basket cells have more extensive dendritic processes. Purkinje layer is relatively thin but consists of the densely packed cell bodies of the Purkinje cells. These cell bodies are the largest in the cerebellum and, with their unique dendritic trees, are probably the most distinctive cells in the entire CNS. Granular layer consists of the cell bodies of the very densely packed granular cells and Golgi type II cells.\n\nSo the answer to this question is C"} {"instruction": "False about GG drill is\nA. NO. 4 is 1.1 mm in size\nB. Operated at 750-1500 rpm\nC. Used for coronal flaring of root canal\nD. Used for preparing post space", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Drug used in the treatment of Congestive Heart Failure is\nA. ACE inhibitor\nB. Beta blocker\nC. Art blocker\nD. All the above", "response": "(D) All the above# First-line therapy for all heart failure patients is angiotensin-converting enzyme (ACE) inhibition. ACE inhibitors (i.e., enalapril, captopril, lisinopril, ramipril) improve survival and quality of life. If the patient is intolerant to ACEI they are replaced by ARB's.> Diuretics have been a mainstay of treatment for treatment of fluid accumulation, and include classes of diuretics such as loop diuretics, thiazide-like diuretic, and potassium-sparing diuretic.> Beta blockers are not given in acute heart failure as it exaggerates heart failure but given in chronic management, bisoprolol, carvedilol, metoprolol are usually used.\n\nSo the answer to this question is D"} {"instruction": "Study of designing equipment and devices that fit the human body, it&;s movements and it&;s cognitive abilities is\nA. Economics\nB. Ergonomics\nC. Bionomics\nD. Socionomics", "response": "Study of designing equipment and devices that fit the human body, it&;s movements and its cognitive abilities is ergonomics The object of ergonomics is \" to achieve the best mutual adjustment of man and his work, for the improvement of human efficiency and well-being\"Park 23e pg: 803\n\nSo the answer to this question is B"} {"instruction": "'Boiled lobster' appearance is seen in poisoning with: DNB 08\nA. Carbolic acid\nB. Boric acid\nC. Oxalic acid\nD. H2SO4 poisoning", "response": "Ans. Boric acid\n\nSo the answer to this question is B"} {"instruction": "Bile acid has a detergent action due to\nA. Formation of soap\nB. Formation of zwitter ion\nC. Amphipathic in nature\nD. Formation of medium chain triglycerides", "response": "Bile contains bile acids, which are critical for digestion and absorption of fats and fat-soluble vitamins in the small intestine. Many waste products, including bilirubin, are eliminated from the body by secretion into bile and elimination in feces. Ref: guyton and hall textbook of medical physiology 12 edition page number:437,438,439\n\nSo the answer to this question is C"} {"instruction": "Radioprotective drug(s) is/are :\nA. Amifostine\nB. Cyclophosphamide\nC. Methotrexate\nD. Paditaxe!", "response": "Ans: A (Amifostine) Radio Protective DrugsAmifostine (VVR 2721} has free SH group which scavenge the free radicals produced due to radio therapy.Free radical scavenger agents such as sulphydryl - containing compounds tend to make cells more resistant. They have also been shown to reduce chromosome abnormalities associated with radiation. This suggests a potential use in reducing treatment induced cancers. The thiol containing drug amifostine (WR 2721) is the best studied drug of this type. Randomized trial has shown that amifostine reduce treatment related toxicities, including radiation induced parotid damage (xerostmia) & dsplatin induced nephrotoxicity' - Devita 7th/ 275Also used for reducing S/E of radiomimeticdrug (dsplatin)Antiradiation agent for astonanats.Radioprotective agents are -* Amifostine (WR 2721)* IL-1* Zinc Oxide* GM-CSF* Pentoxyphyiline* Etramustine* Chlorhexidine* KI* Melatonin* Antioxidant (vit C, E, A)Factors | RadiosensitivityHypoxic environmentSlow or no divisionS-phase of cell cycleRadiation protectors (Amifostine)Chemotherapeutic agents are radiosensitizer not radioprotecter\n\nSo the answer to this question is A"} {"instruction": "Raised AFP is typically seen in -a) Hepatitisb) Serninomac) HCCd) All of the above\nA. a\nB. ac\nC. ad\nD. b", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Premature ovarian insufficiency is defined as hypogonadotropic hypogonadism and amenorrhea arising before the age of\nA. 40 years\nB. 45 years\nC. 50 years\nD. 55 years", "response": "Premature ovarian failure (POF), traditionally defined as hypogonadotropic hypogonadism and amenorrhea arising before the age of 40.Reference: Clinical gynecologic endocrinology; 10th edition; Chapter 9; Normal and Abnormal Sexual Development; Page no: 463\n\nSo the answer to this question is A"} {"instruction": "Treatment of acute neuritis in lepra I reaction is all except\nA. Dapsone\nB. Steroid\nC. Thalidomide\nD. Incision and drainage", "response": "Thalidomide has no role in Type 1 reaction.\nGlucocorticoids are given with antileprotic drugs (Dapson) for neuritis.\n\nIf neuritis results in formation of nerve abscess, incision and drainage is the treatment of choice\n\nSo the answer to this question is C"} {"instruction": "Gross feility rate is ?\nA. Number of children a women has during reproductive period\nB. Number of female children a woman has during reproductive period\nC. Number of male children a woman has during reproductive period\nD. Total number of live bih per 1000 women 1544 years age", "response": "Ans. is 'b' i.e., Number of female children a woman has during reproductive period Gross reproduction rate (GRR) : Average number of girls that would be born to a married woman if she experiences the current feility pattern throughout her reproductive span (15-44 or 49 year) assuming no moality.\n\nSo the answer to this question is B"} {"instruction": "Oculo-orogenital syndrome is a feature of\nA. Behcet's disease\nB. Lichen planus\nC. SLE\nD. Psoriasis", "response": "Ans. a. Behcet's diseaseBehcet's SyndromeClinical features of Behcet's diseaseRecurrence painful aphthous oral ulcersRecurrent painful genital ulcers leading to scarsOcular involvement: Posterior and Anterior uveitis, glaucoma, cataractOther manifestations: Arthritis, thrombophlebitis, Erythema nodosum with renal, cardiac and pulmonary manifestationsTreatmentSymptomatic managementSevere cases-corticosteroids, Dapsone, colchicine, thalidomide\n\nSo the answer to this question is A"} {"instruction": "Stripping naked a female patient for medical examination is punishable under\nA. S. 228 A IPC\nB. S. 354 IPC\nC. S.354 C IPC\nD. S.493 IPC", "response": "S. 228 A IPC - PRINTING OR PUBLISHING THE IDENTITY OF SEXUAL ASSAULT VICTIM S. 354 IPC - INDECENT ASSAULT S.354 C IPC - VOYEURISM S.493 IPC - COHABITATION\n\nSo the answer to this question is B"} {"instruction": "Nocturnal pruritis ani is characteristic of\nA. Ascaris\nB. Trichuris\nC. Ancylostoma\nD. Enterobius", "response": "Species Disease Form/Transmission Diagnosis Treatment Enterobius vermicularis PinwormLarge intestine,nocturnal perianalitching Eggs/person to personAutoinfection ** Cellophane tape prep of perianal area** Ova have flattened sidewith larvae inside Pyrantel, albendazoleTreat entire family Ref : Paniker's textbook of Medical Parasitology Pgno : 190-194\n\nSo the answer to this question is D"} {"instruction": "High serum uric acid, high serum phosphates and high serum creatinine in a patient will be observed in-\nA. Chronic lymphocytic leukemia\nB. Obstructive jaundice\nC. Status epilepticus\nD. Typhoid", "response": "Chronic lymphocytic leukemia (CLL) is the most commonly diagnosed adult leukemia in the USA and Western Europe. Kidney disease can present in patients with CLL as a manifestation of the disease process such as acute kidney injury with infiltration or with a paraneoplastic glomerular disease or as a manifestation of extra renal obstruction and tumor lysis syndrome. In the current era of novel targeted therapies, kidney disease resulting high serum creatinine ,uric acide andphospates can also present as a complication of treatment. Tumor lysis syndrome associated with novel agents such as the B-cell lymphoma 2 inhibitor venetoclax and the monoclonal antibody obinutuzumab are impoant nephrotoxicities associated with these agents. Here we review the various forms of kidney diseases associated with CLL and its therapies. Ref Davidson 23rd edition pg 1313\n\nSo the answer to this question is A"} {"instruction": "Sulcus bleeding index measures:\nA. Gingivitis\nB. Dental plaque\nC. Gingival bleeding\nD. Gingival recession", "response": "None\n\nSo the answer to this question is C"} {"instruction": "True about measles\nA. Rash appear first on leg\nB. Koplik spots are seen in retina\nC. Long term complication follows in form of SSPE\nD. Caused by DNA virus", "response": "Complications of measles are otitis media ,bacterial bronchopneumonia,respiratory complications like laryngitis, tracheitis ,bronchitis, giant cell pneumonia and bronchiectasis,GI complications like diarrhea ,appendicitis ,hepatitis, ileocolitis,acute encephalitis. Post measles encephalitis may occur after recovery. Fatal subacute sclerosing panecephalitis (SSPE)may occur after several yrs of infection. Koplik spots appear opposite the lower second molar of buccal mucosa on second or third day of illness. Rash appear first behind ear,along hairline and on posterior aspect of cheek. Image : Measles causes a red, blotchy rash that usually appears first on the face and behind the ears, then spreads downward to the chest and back and finally to the feet. Reference: Essential pediatrics,op ghai,9 th edition,pg no:209& 210\n\nSo the answer to this question is C"} {"instruction": "New infectious agents are -\nA. Nipah virus\nB. Pneumocystis jieruveci\nC. Corona virus\nD. SARS", "response": "A new genus Henipavirus has been recently identified with the Nipah and Henda viruses causing zoonotic outbreaks. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:515\n\nSo the answer to this question is A"} {"instruction": "All of the following are indications for eicosanoids or their inhibitors EXCEPT :\nA. Abortion\nB. Essential hypertension\nC. Patent ductus arteriosus\nD. Transposition of the great arteries", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Most common type of shock in surgical practice:-\nA. Cardiogenic\nB. Hypovolemic\nC. Neurogenic\nD. Septic shock", "response": "Most common type of shock in surgical practice is hypovolemic shock. HYPOVOLEMIC SHOCK Causes of hypovolemic shock: Blood lossQ(Trauma, bleeding) Loss of plasma due to extravascular fluid sequestration in burnsQ Loss of body sodium & water (diarrhea & vomitingQ)\n\nSo the answer to this question is B"} {"instruction": "Calcification of Posterior Longitudnal Ligament is best diagnosed by\nA. X-Ray\nB. CT\nC. MRI\nD. PET", "response": "* Calcifications are best seen on CT Scan images. * Calcification of Posterior Longitudnal Ligament is (OPLL) Ossified Posterior Longitudnal Ligament and was traditionally considered more frequent in Japan and common in cervical spine Figure: Illustration of OPLL Figure: OPLL On plain film Figure: OPLL on sagittal CT scan Calcification of Posterior Longitudnal Ligament is also known as Japan's Disease.\n\nSo the answer to this question is B"} {"instruction": "Irresistible urge to do a thing repeatedly is seen in\nA. Obsessive - compulsive disorder\nB. Schizophrenia\nC. Schizoaffective disorder\nD. Depression", "response": "An obsession is defined as an idea, impulse or image which intrudes into the conscious awareness repeatedly, patient tries to resist against it but is unable to . an obsession is usually associated with compulsion and a compulsion is defined as a form of behaviour which usually follows obsessions,the behaviour is not realistic and is either irrational or excessive compulsion may diminish the anxiety associated with obsession (Ref: a sho textbook of psychiatry, Niraj Ahuja, 7th edition, pg no 95)\n\nSo the answer to this question is A"} {"instruction": "In run-over accidents the following type of laceration is commonly seen:\nA. Split\nB. Cut\nC. Avulsion\nD. Stretch", "response": "In run over accidents, avulsion is seen AVULSION : - It is produced by shearing force delivered at tangential angle to tear off a poion of traumatized skin surface from their attachment. - In run over accidents, avulsion / flaying/ flapping is seen in which flap laid tells us about the direction of force. Split laceration : It occurs due to crushing of the skin in between two hard objects . Stretch laceration : It is due to over stretching of skin. It is seen in case of open fracture. Tear laceration: tearing (of skin or subcutaeus tissue) can occur due to localized impact by some hard and irregular object Cut lacerations: it can occur by a heavy sharp edged weapon which causes a deep and wide cut over the body tissues.\n\nSo the answer to this question is C"} {"instruction": "Which of the following is NOT a pa of hypopharynx\nA. Pyriform sinus\nB. Post cricoid region\nC. Anterior pharyngeal wall\nD. Posterior pharyngeal wall", "response": "HYPOPHARYNX or (LARYNGOPHARYNX) Clinically, hypopharynx is subdivided into three regions--the pyriform sinus, postcricoid region and the posterior pharyngeal wall. 1. Pyriform sinus (fossa):- It lies on either side of the larynx and extends from pharyngoepiglottic fold to the upper end of oesophagus. It is bounded laterally by the thyrohyoid membrane and the thyroid cailage and medially by the aryepiglottic fold, posterolateral surfaces of arytenoid and cricoid cailages. It forms the lateral channel for food. Foreign bodies may lodge in the pyriform fossa. Internal laryngeal nerve runs submucosally in the lateral wall of the sinus and thus is easily accessible for local anaesthesia. It is also through this nerve that pain is referred to the ear in carcinoma of the pyriform sinus. 2. Postcricoid region:- It is the pa of the anterior wall of laryngopharynx between the upper and lower borders of cricoid lamina. It is a common site for carcinoma in females suffering from Plummer-Vinson syndrome. 3. Posterior pharyngeal wall:- It extends from the level of hyoid bone to the level of cricoarytenoid joint. Ref:- Dhingra; pg num:-241\n\nSo the answer to this question is C"} {"instruction": "What is the approximate size of miRNA molecules produced by Dicer nuclease?\nA. 11 bp\nB. 22 bp\nC. 56 bp\nD. 75 bp", "response": "MicroRNAs : Small (22 nucleotides long) Endogenous, Non-coding RNAs Involved in regulation of gene expression by post-transcriptional gene silencing (PTGS)/RNA interference. Dicer is an endonuclease that trims small double-stranded RNA and generates sho, double stranded (ds) miRNA molecules that can block translation. Dicer cleaves the cytosolic dsRNA encoded by the genome or exogenously supplied into oligonucleotides miRNA or siRNA A single strand (the guide or antisense strand) of the ds miRNA associates with RNA-induced silencing complex, or RISC.\n\nSo the answer to this question is B"} {"instruction": "Angular pregnancy refers to:\nA. Ectopic pregnancy of Interstitial pa of FT\nB. Intrauterine pregnancy\nC. Heterotopic pregnancy\nD. Ectopic pregnancy of broad ligament", "response": "Angular pregnancy : It is defined as pregnancy implanted in one of the lateral angles of uterine cavity It may progress to term Ref: Dutta Obs 9e pg 168.\n\nSo the answer to this question is B"} {"instruction": "Permanent retainer is sometimes needed in cases of:\nA. Severe malocclusion\nB. Anterior cross bite\nC. Severe rotations\nD. Transposition", "response": "None\n\nSo the answer to this question is C"} {"instruction": "All arc true about Wiskott-Aldrich syndrome exccpt-\nA. Bloody diarrhea during infancy\nB. Low IgM and elevated IgA and IgE\nC. Large size platelets\nD. Atopic dermatitis", "response": "Wiskott-Aldrich syndrome (WAS) is a rare X-linked recessive disease characterized by eczema, thrombocytopenia (low platelet count), immune deficiency, and bloody diarrhea (secondary to the thrombocytopenia). The microthrombocytes seen in WAS patients have only been observed in one other condition, ARPC1B deficiency. In both conditions the defective platelets are thought to be removed from circulation by the spleen and/or liver, leading to low platelet counts. WAS patients have increased susceptibility to infections, paicularly of the ears and sinuses, and this immune deficiency has been linked to decreased antibody production and the inability of immune T cells to effectively combat infection. Genetics WAS is associated with mutations in a gene on the sho arm of the X chromosome (Xp11.23) that was originally termed the Wiskott-Aldrich syndrome protein gene and is officially known as WAS (Gene ID: 7454).X-linked thrombocytopenia is also linked to WAS mutations, although they differ from those that cause full-blown WAS. The rare disorder X-linked neutropenia has also been linked to a specific subset of WAS mutations. The protein product of WAS is known as WASp. It contains 502 amino acids and is mainly expressed in hematopoietic cells (the cells in the bone marrow that develop into blood cells). The main function of WASp is to activate actin polymerization by serving as a nucleation-promoting factor (NPF) for the Arp2/3 complex, which generates branched actin filaments. Several proteins can serve as NPFs, and it has been observed that in WAS platelets the Arp2/3 complex functions normally, indicating that WASp is not required for its activation in platelets. In T-cells, WASp is impoant because it is known to be activated T-cell receptor signaling pathways to induce coical actin cytoskeleton rearrangements that are responsible for forming the immunological synapse. The severity of the symptoms produced by WAS mutations correlate with their effects on WASp. Alleles that produce no or truncated protein have more severe effects than missense mutations. Although autoimmune disease and malignancy may occur with both types of mutations, patients with truncated WASp carry a higher risk. A defect in the CD43 molecule has also been found in WAS patients. Ref Davidson 23rd edition pg 936\n\nSo the answer to this question is C"} {"instruction": "Eisenmenger syndrome-True are All except ?\nA. Pulmonary veins are not distended\nB. RV & LV walls come back to normal size\nC. Dilatation of central pulmonary aery\nD. Peripheral pruning of pulmonary aeries", "response": "Eisenmenger syndrome right ventricle has concentric hyperophy. Ref : Ghai essential of pediatrics, eighth edition, p.no:428\n\nSo the answer to this question is B"} {"instruction": "Gamma knife is used in?\nA. Radiotherapy\nB. Chemotherapy\nC. Nuclear medicine\nD. Radioisotope scan", "response": "ANSWER: (A) RadiotherapyREF: Practical Radiotherapy physics and equipment Pam Cherry Angela M. Duxbury 2nd Edition page 132, http://en.wikipedia.org/wiki/RadiosurgeryRadiosurgery is a medical procedure that allows non-invasive treatment of benign and malignant tumors. It is also known as stereotactic radiotherapy, (SRT) when used to target lesions in the brain, and stereotactic body radiotherapy (SBRT) when used to target lesions in the body. Inaddition to cancer, it has also been shown to be beneficial for the treatment of some non-cancerous conditions, including functional disorders such as arteriovenous malformations (AVMs) and trigeminal neuralgia.\n\nSo the answer to this question is A"} {"instruction": "Birbeck granules are seen in the cytoplasm of\nA. Mast cells\nB. Langerhans cells\nC. Thrombocytes\nD. Myelocytes", "response": "Langerhans cell histiocytosis (LCH)*Langerhans cell is a dendritic cell which is an antigen presenting cell*LCH is a clonal histiocytic disorder*Birbeck granules are present in the cytoplasm of Langerhans cell.Characteristic features of LCHPresence of Birbeck granules - Electron microscopy ( Tennis racquet appearance)Presence of enzymes like 1. a- Naphthyl Acetate Esterase 2. a- Naphthyl Butyrate Esterase 3. Acid phosphatasePresence of markers S-100, CD1a positivity HLA- DR expressionThree clinicopathological entities1.Acute disseminated LCH2.Multifocal LCH3.Unifocal LCH *Earlier Histiocytosis x term was used. This includes-Letterer-Siwe disease (generalized disease)-Hand - Schuller- Christian disease-Eosinophilic granuloma (localized lesion) However now the term LCH is preferred.Acute disseminated LCH ( Letterer- Siwe disease) - Affects children < 2 yrs-Seborrhoeic type of skin rash on front & back of trunk and scalp-Moderate hepatomegaly-Few palpable lymph nodes-Pulmonary lesions- uncommon-Bone- Lytic lesions (> 80%)-Moderate degree fever-Otitis media & mastoiditis may be seen-CNS involvement due to contiguous spread-Hematologic findings: Pancytopenia-Bone marrow: Infiltration by histiocytesMultifocal LCH - Multiple lesion involving multiple systems-Prognosis better than disseminated LCH-Fever & rash-Involvement of posterior pituitary- Diabetes insipidus-Typical Hand- Schuller Christian disease= Triad of exopthalmus+ diabetes insipidus+ calvarial defectUnifocal LCH*Focal lytic lesion in bone*Excellent prognosis(Ref: Robbins 8/e p631, 7/e p701, 702)\n\nSo the answer to this question is B"} {"instruction": "Charcoat triad is seen in: September 2006\nA. Acute pancreatitis\nB. Acute appendicitis\nC. Acute hepatitis\nD. Cholangitis", "response": "Ans. D: Cholangitis Cholangitis is due to paial or complete obstruction of the biliary tree with resulting bile stasis and secondary bacterial or microbial infection of the biliary tree Causes ? Common bile duct stones Benign biliary stricture (primary sclerosing cholangitis) Malignancy (head of pancreas adenocarcinoma, ampulla of Vater, bile duct tumors) Chronic pancreatitis Prosthesis or stents in the common bile duct Features: Charcot's triad - right upper quadrant pain, fever, jaundice Reynolds' pentad - right upper quadrant pain, fever, jaundice, hypotension, and mental status changes (delirium, anxiety, and coma) Nausea and/or vomiting Right upper quadrant tenderness (mild to moderate)\n\nSo the answer to this question is D"} {"instruction": "Dupuytren's contracture mvolves-\nA. Dorsal fascia\nB. Palmar fascia\nC. Ulnar bursa\nD. Radial bursa", "response": "Ans. is 'b' i.e., Palmar fascia o Dupuytren's contracture is characterized in the established phase by flexion contracture of one or more fingers from thickening and shortening of palmar aponeurosis.o The exact etiology is unknow; However, the condition is more commonly associated with following conditionsi) Epileptics taking phenytoiniv) Alcoholic cirrhosisii) Diabetesv) AIDSiii) Smokingvi) Pulmonary TB o Often both hands are affected (Bilateral disease), one more than the other,o The earliest sign is a small thickened nodule in the mid-palm opposite the base of ring finger,o Gradually this extends distally to involve the ring or little finger.o There is a rare, curious association with fibrosis of the corpus Cavemosum.\n\nSo the answer to this question is B"} {"instruction": "A well-defined focal lesion in the cone of extraocular muscles of the eye with proptosis in a child. The diagnosis will be?\nA. Cavernous hemangioma\nB. Hemangioendothelioma\nC. Capillary angioma\nD. Retinoblastoma", "response": "Cavernous haemangioma is the commonest benign orbital tumour among adults. A tumour is usually located in the retrobulbar muscle cone. So, it presents as a slowly progressing unilateral axial proptosis in the second to fouh decade. It may occasionally compress the optic nerve without causing proptosis. Treatment. Surgical excision of a tumour is undeaken lateral orbitotomy approach. Since a tumour is well encapsulated, complete removal is generally possible. REFKhurana 4e pg: 394\n\nSo the answer to this question is A"} {"instruction": "Hydrogen peroxide is used in all of the following chemical tests for blood except:\nA. Benzedine test\nB. Phenophthalein test\nC. Ohotoluidine test\nD. Teichmann's test", "response": "D i.e. Teichman's test\n\nSo the answer to this question is D"} {"instruction": "Intestinal anastamosis strength provided by:\nA. Mucosa\nB. Submucosa\nC. Serosa\nD. Muscularis mucosa", "response": "Ref: American College of Surgeons text hook of Surgery, 6th edition. Chapter on Intestinal Anastamosis.Explanation:Strongest component of bowel wall is submucosa. due to the presence of collagen.The process of intestinal anastomotic healing mimics that of wound healing elsewhere in the bodyIt can be arbitrarily divided into an- Acute inflammatory (lag) phase- A proliferative phase- A remodeling or maturation phase.The strongest component of the bow el wall, the submucosa, owes most of its strength to the collagenous connective tissue it contains.Collagen is thus the single most important molecule for b. which makes its metabolism of particular interest for understanding anastomotic healing.Principles of Successful Intestinal Anastomosis* Well-nourished patient with no systemic illness* No fecal contamination, either within the gut or in the surrounding peritoneal cavity* Adequate exposure and access* Well - vaseu1arized tissues* Absence of tension at the anastomosis* Meticulous technique\n\nSo the answer to this question is B"} {"instruction": "Pseudotrichiasis is seen in:\nA. Entropion\nB. Ectropion\nC. Distichiasis\nD. Healed membranous conjunctivitis", "response": "Ans. Entropion\n\nSo the answer to this question is A"} {"instruction": "Radiological hallmark of primary tuberculosis in childhood is?\nA. Ghon's focus\nB. Normal chest Xray\nC. Lymphadenopathy\nD. Pleural effusion", "response": "Ans. is 'c' i.e., Lymphadenopathy Lymphadenopathy with or without parenchymal abnormality is the radiological hallmark of primary tuberculosis in childhood.\n\nSo the answer to this question is C"} {"instruction": "Abdominal pa of esophagus is supplied by:-\nA. Pulmonary trunk\nB. Bronchial aery and arch of aoa\nC. Right gastric aery and inferior phrenic aery\nD. Left gastric aery and inferior phrenic aery", "response": "Esophagus is a long tube with approximately 25cm in length, have 3 pas - cervical, thoracic and abdominal pa. PA OF ESOPHAGUS AERY SUPPLY CERVICAL Inferior thyroid aery THORACIC Descending thoracic aoa ABDOMINAL Left gastric and inferior phrenic aery\n\nSo the answer to this question is D"} {"instruction": "Sclerotic bodies 3-15u in size, multiseptate, chestnut brown colour seen in -\nA. Rhinosporidiosis\nB. Chromoblastomycosis\nC. Phaeohyphomycosis\nD. Histoplasmosis", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Which of the following statement about Bedaquiline is TRUE:\nA. Mycobacterial ATP synthase inhibitor\nB. Does not prolongs QT interval\nC. It should be given alone\nD. It has cross-resistance with rifampicin", "response": "Bedaquiline: - New antitubercular drug for MDR or XDR,- It act by inhibiting ATP synthase in mycobacteria- Food increases the bioavailability - Given along with base line antitubercular drug- Recent studies have shown cross resistance with clofazimine only. It is approved for use for 6 month. Side effect: - Derangement of LFT- Prolongs QT interval Pretomanid in combination withBedaquiline and Linezolid is approved by the FDA for the treatment of extensively drug-resistant, treatment-intolerant or nonresponsive multidrug-resistant pulmonary TB\n\nSo the answer to this question is A"} {"instruction": "Following vaginal delivery, a patient developed profuse bleeding due to uterine atony. The amount of blood loss in postpaum haemorrhage is more than:\nA. 200 mL\nB. 400 mL\nC. 500 mL\nD. 700 mL", "response": "Postpaum hemorrhage has been defined as the loss of 500 mL of blood or more after completion of the third stage of labor. Blood loss during the first 24 hours after delivery is early postpaum hemorrhage; blood loss between 24 hours and 6 weeks after delivery is late postpaum hemorrhage. Causes of postpaum hemorrhage include uterine atony, obstetric lacerations, retained placental tissue, and coagulation defects. Ref: Poggi S.B. (2013). Chapter 21. Postpaum Hemorrhage & the Abnormal Puerperium. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds),CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.\n\nSo the answer to this question is C"} {"instruction": "Community health guide is selected by:\nA. Block Development Officer\nB. ASHA\nC. Zila Parishad\nD. Medical officer - in - charge", "response": "Village community is requested to recommended 2-3 persons suitable to be Health guides Final selection is made by Medical offices of PHC jointly selection is made by Medical officers of PHC ficer and field staff of several government organizations.\n\nSo the answer to this question is D"} {"instruction": "In which of the following enzyme deficiencies there is steatorrhea with increased triglycerides?\nA. Pancreatic lipase\nB. Serum lipase\nC. Lipoprotein lipase\nD. Acetyl CoA carboxylase", "response": "Hyperiglyceridemia can cause pancreatitis and which will cause steatorrhoea. Lipoprotein lipase deficiency causes the Hyperiglyceridemia and eventually steatorrhoea. Lipoprotein lipase deficiency also causes hyperchylomicronemia Ref: Harrison, 16th Edition, Page 1503\n\nSo the answer to this question is C"} {"instruction": "Most common type of cell death due to sudden occlusion of blood suply-\nA. Coagulation necrosis\nB. Caseation necrosis\nC. Liquefactive necrosis\nD. Gangrene", "response": "Ans. is 'a' i.e., Cogulation necrosis\n\nSo the answer to this question is A"} {"instruction": "Stippled Epiphysis is seen in?\nA. Congenital Hypothyroidism\nB. Juvenile Rheumatoid Ahritis\nC. Scurvy\nD. Achondroplasis", "response": "Causes for Stippled Epiphysis Congenital hypothyroidism (cretinism) a group of skeletal dysplasias called chondrodysplasia punctate. Alcohol use during pregnancy Warfarin use during pregnancy Vitamin K deficiency\n\nSo the answer to this question is A"} {"instruction": "All muscles of the pharynx are supplied by pharyngeal plexus, EXCEPT:\nA. Inferior constrictors\nB. Salpingopharyngeus\nC. Stylopharyngeus\nD. None of the above", "response": "With the exception of stylopharyngeus, which is supplied by the glossopharyngeal nerve, the muscles are supplied by the cranial pa of the accessory nerve the pharyngeal plexus.Ref: Gray's anatomy 40th edition, Chapter 35\n\nSo the answer to this question is C"} {"instruction": "Which is the most common primary malignant bone tumor?\nA. Osteosarcoma\nB. Osteoclastoma\nC. Secondaries\nD. Multiple myeloma", "response": "Secondaries are the most common malignant bone tumor. But the most common primary malignant bone tumor is Multiple myeloma..\n\nSo the answer to this question is D"} {"instruction": "Enzyme replacement therapy is most commonly used for\nA. Gaucher's disease\nB. Fabry's disease\nC. Niemenn pick's disease\nD. Pompe disease", "response": "Gaucher disease is a multisystemuc lipidosis characterized by hematological abnormalities,organomegaly and,skeletal involvement.It has 3 clinical subtypes . It occurs due to the deficient activity of acid beta glucosidase . Thus glucosylceramide accumulate in reticule end I the loam cells. Treatment is mainly enzyme replacement therapy with recombinant acid beta glucosidase.Most extra skeletal symptoms are reversed by 60 IU/kg enzyme iv infusion every other week. Monthly maintenance improves skeletal manifestations. Reference: Nelsons TB of pediatrics 19th edit,pg 487\n\nSo the answer to this question is A"} {"instruction": "Sciatic nerve palsy may occur in the following injury-\nA. Posterior dislocation of hip joint\nB. Fracture neck of femur\nC. Trochanteric fracture\nD. Anterior dislocation of hip", "response": "*Injury to sciatic nerve:-The nerve is vulnerable to injury where it lies behind the posterior wall of acetabulum. Ref: Maheshwari 9th/e p.131 &4th/e p.127\n\nSo the answer to this question is A"} {"instruction": "In a 10 year old female patient of Asian ethnicity, which of the following methods would be the best approach to estimate the size of unerupted permanent teeth?\nA. Huckaba’s analysis\nB. Tanaka-Johnston analysis\nC. Tanaka-Johnston analysis\nD. Staley-Kerber method", "response": "The Moyers, Tanaka-Johnston and Staley-Kerber predictions are all based on data from white school children of northern European descent. If the patient fits this population group, the Staley-Kerber method will give the best prediction, followed by the Tanaka-Johnston and Moyers.\nOn the other hand, if the patient does not fit the population group, as an African or Asian child would not, direct measurement from the radiographs is the best approach.\n\nHuckaba analysis:\nThe formula recommended by Huckaba was used in all radiographic measurements: \nX = (y) (x1)/(y1) \nwhere X is the estimated size of the permanent tooth, x1 is the radiographic size of the permanent teeth, y is the size of the primary mandibular second molar on the cast and y1 is the radiographic size of the primary molar.\nContemporary orthodontics, William Proffit, 4th edition page 198\n\nSo the answer to this question is A"} {"instruction": "Epidemic of polio is due to -\nA. Type I virus\nB. Type II virus\nC. Type III virus\nD. Combine type II and III virus", "response": "Poliovirus tyoe 1 is responsible for most epidemics of paralytic poliomyelitis. Type 3 also causes but to a lesser extent. REF:ANANTHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:490\n\nSo the answer to this question is A"} {"instruction": "Which of the following statements is true about nitrates ?\nA. Acts by raising cGMP which causes dephosphorylation of MLCK\nB. Metabolized by glutathione reductase\nC. Used in achalasia cardia\nD. All of the above", "response": "None\n\nSo the answer to this question is D"} {"instruction": "The most definitive method of diagnosing pulmonary embolism is\nA. Pulmonary ateriography\nB. Radioisotope perfusion pulmonary scintigraphy\nC. EKG\nD. Venography", "response": "Pulmonary aeriography is the most definitive method of diagnosing pulmonary embolism.Chest CT with contrast has viually replaced invasive pulmonary angiography as a diagnostic test.A definitive diagnosis of PE depends on visualisation of an intraluminal filling defect in more than one projection.Secondary signs of PE include abrupt occlusion(\"cut-off\") of vessels,segmental oligemia or avascularity,a prolonged aerial phase with slow filling,and touous,tapering peripheral vessels. Reference:Harrison's medicine-18th edition,page no:2174.\n\nSo the answer to this question is A"} {"instruction": "Formication and delusion of persecution, both are together seen in:\nA. LSD psychosis\nB. Amphetamine psychosis\nC. Cocaine psychosis\nD. Cannabis psychosis", "response": "C. i.e. Cocaine psychosis - Cocaine blocks reuptake of norepinephrine, dopamine & serotonin; impairs nerve conduction (LA action) and Vt hypeensionQ. Cocaine causes no physical dependence but moderate/strong psychological dependence. It is unique in not producing significant toleranceQ. lnfact paranoid psychosis observed with cocaine abuse is produced by sensitization (or reverse tolerance)Q. Cocaine cause tactile hallucinations (Magnan's symptoms or formication or cocaine bugs or feeling of creeping insects) and paranoid psychosis (delusions & hallucinations)Q\n\nSo the answer to this question is C"} {"instruction": "As compared to cow's milk, human milk has a higher content of -\nA. Fat\nB. Sugar\nC. Protein\nD. Calcium", "response": "parks textbook of preventive and social medicine 23rd edition * mothers milk is especially rich in fats ,which represents between 35-50percent of total energy value human milk has low in protein content human milk has less in calcuim content than cows milk human milk has more of lactose content than most other milks .\n\nSo the answer to this question is A"} {"instruction": "Spleen originates following space of peritoneal cavity:\nA. Dorsal mesentry\nB. Ventral mesentry\nC. Left subhepatic space\nD. Infracolic compament", "response": "Dorsal mesentry\n\nSo the answer to this question is A"} {"instruction": "Ito cells are found in:\nA. Brain\nB. Kidney\nC. Liver\nD. Lung", "response": "Hepatic stellate cells are also known as perisinusoidallipocytes or Ito cells and are much less numerous than hepatocytes. They play a major role in pathological processes. In response to liver damage, they become activated and predominantly myofibroblast-like. They are responsible for the replacement of toxically damaged hepatocytes with collagenous scar tissue - hepatic fibrosis, seen initially in zone 3, around central veins. This can progress to cirrhosis, where the parenchymal architecture and pattern of blood flow are destroyed, with major systemic consequences.\n\nSo the answer to this question is C"} {"instruction": "The movement at the following joint permits a person to look towards the right or left :\nA. Atlanto-occipital joint\nB. Atlanto-axial joint\nC. C2-C3 joint\nD. C3-C4 joint", "response": "B. i.e. Atlanto - Axial Joint Atlanto - occipital (b/w skull & C1) joint permit nodding of head (as when indicating approval or yes)& Atlantoaxial joint permits the head to be turned from side to side i.e. rotation (as indicating disapproval, the no movement)\n\nSo the answer to this question is B"} {"instruction": "Which of the following conditions can cause bony ankylosis?\nA. Rheumatoid ahritis\nB. Pyogenic ahritis\nC. Osteo ahritis\nD. Traumatic ahritis", "response": "Pyogenic ahritis causes bony ankylosis.\n\nSo the answer to this question is B"} {"instruction": "In a child with foreign body in bronchus, next step is:\nA. Rigid bronchoscopy\nB. Chest X-ray\nC. Flexible endoscopy\nD. Direct laryngoscopy", "response": "In the question, child has already been diagnosed with bronchial foreign body. Hence next step would be its removal and treatment of choice in a child with foreign body in bronchus is Rigid bronchoscopy.\n\nSo the answer to this question is A"} {"instruction": "Resolution of inflammation caused by -\nA. TNF Alfa, IL-1 and CRP\nB. TNF beta, IL-6 and CRP\nC. TNF Alfa, IL 10 and IL 1 receptor antagonist\nD. TNF gamma", "response": "Processes involved in inflammation and its resolution. ILs, interleukins; TNF-a, tumor necrosis factor alpha; TGF-b, transforming growth factor beta; TIMPs, tissue inhibitor of metalloproteinases; MMPs, matrix metalloproteinases; ECM, extracellular matrix; LTs, leukotrienes; PGs, prostaglandins; LXs, lipoxins; RVs, resolvins; Pvs, protectins. Ref Robbins 9/e p40\n\nSo the answer to this question is C"} {"instruction": "Which of the following is an anterior deprogramming device\nA. Herbst appliance\nB. Hawley's appliance\nC. Lucus jig\nD. Lucia jig", "response": "None\n\nSo the answer to this question is D"} {"instruction": "In a child with retinoblastoma, which of the following is NOT a common finding in the X-ray: September 2012\nA. Intraocular calcification\nB. Intracerebral calcification\nC. Multiple calcified mass in cranium\nD. Widening of optic foramen", "response": "Ans. B i.e. lntracerebral calcification Retinoblastoma May be bilateral in 30-40% cases (paicularly familial ones), Knudsons hypothesis is related to Rb MC manifestation of Rb: Leukocoria/ Amaurotic cat's eye reflex Treatment of diffuse Rb: Enucleation (removal of eyeball with poion of optic nerve from orbit) Treatment of small Rb: Brachytherapy Treatment of bilateral Rb & metastatic disease: Chemotherapy\n\nSo the answer to this question is B"} {"instruction": "Mechanism of action of donepezil is:\nA. Centrally acting reversible anticholinesterase\nB. Centrally acting irreversible anticholinesterase\nC. Irreversible cholinergic action\nD. Reversible anticholinesterase", "response": "donepezil is a centrally acting anti cholinesterase which is reversible.other drugs in this category include rivastigmine Ref; KD Tripathi 8th ed.\n\nSo the answer to this question is A"} {"instruction": "The severity of mitral stenosis is assessed by\nA. Character of murmur\nB. Splitting of S\nC. Loudness of S,\nD. S2-OS interval", "response": "Mitral stenosis. A normal mitral valve will have an area of >4 cm2, but symptoms are usually only present once the stenosis is moderate-severe. Grading into mild, moderate, or severe disease is based on both the pressure needed to drive blood across the valve (mean pressure gradient) and the valve area. Ref Davidson 23rd edition pg 435\n\nSo the answer to this question is D"} {"instruction": "Cutaneous nerve supply of region marked X\nA. Superficial peroneal nerve\nB. Deep peroneal nerve\nC. Medial plantar nerve\nD. Saphenous nerve", "response": "1st web space is supplied by Deep peroneal nerve\n\nSo the answer to this question is B"} {"instruction": "The repolarization phase of an action potential is due to\nA. Increasing sodium permability and increasing potassium permeability\nB. Increasing sodium permeability and decreasing potassium permeability\nC. Decreasing sodium permeability and an immediate increasing potassium permeability\nD. Decreasing sodium permeability and a delayed increase potassium permeability", "response": "There is a decrease in sodium permeability (inactivation of the sodium channels) and a delayed increased in potassium permeability during the repolarization phase of the action potential. The pump plays no direct role in the action potential.\n\nSo the answer to this question is D"} {"instruction": "Methicillin-resistant S. aureus (MRSA) was isolated from 7 patients in a 14-bed intensive care unit. All patients were isolated and the unit closed to any more admissions. Which one of the following reasons best explains these rigorous methods to control MRSA?\nA. MRSA is inherently more virulent than other staphylococci\nB. The alternative for treatment of MRSA is vancomycin, an expensive and potentially toxic antibiotic\nC. MRSA causes toxic shock syndrome\nD. MRSA spreads more rapidly from patient to patient than antibiotic-susceptible staphylococci do", "response": "Oxacillin- and methicillinresistant S. aureus (MRSA) has been rapidly increasing in incidence. MRSA and methicillin-sensitive S. aureus (MSSA) coexist in heterologous populations. Treatment of a patient harboring this heterologous population may provide a selective environment for the MRSA. Prior to changing therapy, the susceptibility of the isolate should be determined. Vancomycin has often been used effectively for MRSA, but it is expensive and nephrotoxic. There is no evidence that MRSA is any more virulent or invasive than susceptible strains. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition\n\nSo the answer to this question is B"} {"instruction": "Acceptable noise level in hospital wards\nA. 20 - 35dB\nB. 35 - 40 dB\nC. 45-55dB\nD. 50-60dB", "response": "Ref:Park's Textbook of Preventive and Social Medicine 25th Ed\n\nSo the answer to this question is A"} {"instruction": "Generally speaking, the distal, burning, painful dysesthesias with reduced pinprick and thermal sensation but with sparing of proprioception and motor functions is seen in -\nA. Small fibre neuropathy\nB. Large fibre neuropathy\nC. Neuromuscular junction disease\nD. Anterior horn cell disease", "response": "None\n\nSo the answer to this question is A"} {"instruction": "External acoustic meatus is derived from\nA. Dorsal part of the first ectodermal cleft\nB. Ventral part of the first ectodermal cleft\nC. Dorsal part of the 2nd ectodermal cleft\nD. Ventral part of the 2nd ectodermal cleft", "response": "(Dorsal part of the 1st ectodermal cleft) (357-IBS 8th) (317-I.B.Singh 8th)External acoustic meatus is derived from the dorsal part of the first ectodermal cleft. However, its deeper part is formed by proliferation of its lining epithelium.FATE OF ENDODERMAL POUCHESA. First pouch(a) Its ventral part is obliterated by formation of the tongue(b) Its dorsal part receives a contribution from the dorsal part of the second pouch, and these two together form a diverticulum that grows towards the region of the developing ear. This diverticulum that grows towards the region of the developing ear. This diverticulum is called the trubotympanic recess. The proximal part of this recess gives rise to the auditory (pharyngotympanic) tube, and the distal part to the, middle ear cavity including the tympanic antrumB. Second Pouch(a) The epithelial of the ventral part of this pouch contributes to the formation of the tonsil(b) The dorsal part takes part in the formation of the tubotympanic recessC. Third Pouch- give rise to inferior parathyroid gland & ThymusD. Fourth Pouch- gives origin to the superior parathyroid glands and may contribute to the Thyroid glandE. Fifth or Ultimobranchial pouch- give rise to ultimobranchial body (some species) & caudal pharyngeal complex\n\nSo the answer to this question is A"} {"instruction": "Which of the following countries was the first to institute compulsory sickness insurance\nA. USA\nB. England\nC. France\nD. Germany", "response": "Germany led by the way to instituting compulsory sickness insurance in 1883. Ref : Park's Textbook of Preventive and Social Medicine; 23rd edition\n\nSo the answer to this question is D"} {"instruction": "Muscle NOT supplied by cranial nerve III:\nA. Superior oblique\nB. Superior rectus\nC. Inferior oblique\nD. Medial rectus", "response": "Ans. (a) Superior ObliqueRef.-.BDC 6th ed. Vol-III/360-62* Again remember the mnemonics LR6 S04 and all other by CN III* Superior oblique is supplied by CN IV (trochlear nerve).* Refer to above answer for more detailed explanation.\n\nSo the answer to this question is A"} {"instruction": "To which lymph nodes, the lymph from the umbilicus drain -\nA. Axillary and inguinal\nB. External and internal iliac\nC. Pre-and para-aortic\nD. Inter-aortocaval", "response": "The lymph from umbilicus drains into both axillary and inguinal lymph nodes.\n\nSo the answer to this question is A"} {"instruction": "Aery to bleed in duodenal ulcer haemorrhage -\nA. Splenic aery\nB. Gastroduodenal aery\nC. Left gastric aery\nD. Sup. mesenteric aery", "response": "Gastro duodenal aery is the most common aery involved in duodenal ulcer hemorrhage. Also, remember A peptic ulcer is the most common cause of massive upper gastrointestinal bleed (Duodenal ulcers > Gastric ulcers) Bleeding ulcers in the duodenum are usually located on the posterior surface of the duodenal bulb. Ref : Bailey & Love 25/e p1045\n\nSo the answer to this question is B"} {"instruction": "Vitamin B12 deficiency is likely to cause:\nA. Bitemporal hemianopia\nB. Binasal hemianopia\nC. Heteronymous hemianopia\nD. Centrocecal scotoma", "response": "D i.e. Cetrocecal scotoma Vitamin B12 deficiency is likely to cause optic neuritis; in which most common field defect is central or centro-caecal scotoma Q\n\nSo the answer to this question is D"} {"instruction": "In an epidemic first to be done is-\nA. Identity the cases\nB. Confirm the diagnosis\nC. Identify the prone people\nD. Identify the causative factors", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Painful loss of vision is seen in :\nA. Senile cataract\nB. Primary open angle glaucoma\nC. Primary angle closure glaucoma\nD. Anterior uveitis", "response": "C i.e Primary angle closure glaucoma\n\nSo the answer to this question is C"} {"instruction": "Hypeonic dysfunctional labour is generally characterised by:\nA. Rapid cervical dilatation\nB. Less pain In labour\nC. Responds ourably to oxytocin stimulation\nD. Needs adequate pain relief", "response": "Hypeonic state of uterus or Imcordinate uterine action : Patient is in agony with unbearable pain referred to back Oxytocin cause fetal tachycardia due to fetal stress Inappropriate dilatation of cervix Uterus is tender and gentle manipulation excites hardening of the uterus with pain. Ref: Dutta Obs 9e pg 337.\n\nSo the answer to this question is D"} {"instruction": "If the origin of the masseter muscle is more medial on the zygomatic arch (ramus perpendicular), the space in the distobuccal area is\nA. Decreases\nB. Remains the same\nC. Increases then decreases\nD. Increases", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Internal carotid artery crosses -\nA. Sigmoid sinus\nB. Straight sinus\nC. Cavernous sinus\nD. Sagittal sinus", "response": "Ans. C. Cavernous sinusThe internal carotid artery arises from the bifurcation of the common carotid artery, ascends in the neck and enters the carotid canal of the temporal bone. Its subsequent course is said to have petrous, cavernous and intracranial parts.Petrous parta. The petrous part of the internal carotid artery ascends in the carotid canal, curves anteromedially and then superomedially above the cartilage that fills the foramen lacerum, and enters the cranial cavity.b. It lies at first anterior to the cochlea and tympanic cavity, and is separated from the latter and the pharyngotympanic tube by a thin, bony lamella that is cribriform in the young and partly absorbed in old age. Further anteriorly, it is separated from the trigeminal ganglion by the thin roof of the carotid canal, although this is often deficient. The artery is surrounded by a venous plexus and by the carotid autonomic plexus, derived from the internal carotid branch of the superior cervical ganglion.c. The petrous part of the artery gives rise to two branches. The caroticotympanic artery is a small, occasionally double, vessel which enters the tympanic cavity by a foramen in the carotid canal and anastomoses with the anterior tympanic branch of the maxillary artery and the stylomastoid artery.d. The pterygoid artery is inconsistent: when present, it enters the pterygoid canal with the nerve of the same name, and anastomoses with a (recurrent) branch of the greater palatine artery.Cavernous parta. The cavernous part of the internal carotid artery ascends to the posterior clinoid process. It turns anteriorly to the side of the sphenoid within the cavernous sinus and then curves up medial to the anterior clinoid process, to emerge through the dural roof of the sinus. The oculomotor, trochlear, ophthalmic and abducens nerves are lateral to it within the cavernous sinus.b. This part of the artery gives off a number of small vessels. Cavernous branches supply the trigeminal ganglion, the walls of the cavernous and inferior petrosal sinuses and the nerves contained therein. A minute meningeal branch passes over the lesser wing of the sphenoid to supply the dura mater and bone in the anterior cranial fossa and also anastomoses with a meningeal branch of the posterior ethmoidal artery. Numerous small hypophysial branches supply the neurohypophysis, and are of particular importance because they form the pituitary portal system.Intracranial parta. After piercing the dura mater, the internal carotid artery turns back below the optic nerve to run between it and the oculomotor nerve. It reaches the anterior perforated substance at the medial end of the lateral fissure and terminates by dividing into the anterior and middle cerebral arteries.b. Several preterminal vessels leave the cerebral portion of the internal carotid. The ophthalmic artery arises from the anterior part of the internal carotid as it leaves the cavernous sinus, often at the point of piercing the dura, and enters the orbit through the optic canal.c. The posterior communicating artery runs back from the internal carotid above the oculomotor nerve, and anastomoses with the posterior cerebral artery (a terminal branch of the basilar artery), thereby contributing to the circulus arteriosus around the interpeduncular fossa.d. The posterior communicating artery is usually very small. However, sometimes it is so large that the posterior cerebral artery is supplied via the posterior communicating artery rather than from the basilar artery ('fetal posterior communicating artery'); it is often larger on one side only. Small branches from its posterior half pierce the posterior perforated substance together with branches from the posterior cerebral artery.e. Collectively they supply the medial thalamic surface and the walls of the third ventricle. The anterior choroidal artery leaves the internal carotid near its posterior communicating branch and passes back above the medial part of the uncus.f. It crosses the optic tract to reach and supply the crus cerebri of the midbrain, then turns laterally, recrosses the optic tract, and gains the lateral side of the lateral geniculate body, which it supplies with several branches. It finally enters the inferior horn of the lateral ventricle via the choroidal fissure and ends in the choroid plexus.g. This small, but important, vessel also contributes to the blood supply of the globus pallidus, caudate nucleus, amygdala, hypothalamus, tuber cinereum, red nucleus, substantia nigra, posterior limb of the internal capsule, optic radiation, optic tract, hippocampus and the fimbria of the fornix.\n\nSo the answer to this question is C"} {"instruction": "After taking some drug for acute attack of migraine, a patient developed nausea and vomiting. He also developed tingling and numbness on the tip of the finger that also turned blue. Which of the following is the most likely drug implicated in causing the above findings?\nA. Dihdroergotamine\nB. Sumatriptan\nC. Aspirin\nD. Butorphanol", "response": "This is a classical sign of ergot induced vasoconstriction. Dihydroergotamine can be used for acute attack of migraine and can result in these symptoms. Due to their vasoconstricing potential, ergot alkaloids are contra-indicated in a patient with peripheral vascular disease. These may also lead to development of gangrene. Contraindications for ergotamine : Peripheral vascular disease Coronary aery disease Uncontrolled hypeension Fever and/or sepsis Pregnancy Within 24 hours of using triptans\n\nSo the answer to this question is A"} {"instruction": "Epithelium of ureter develops from?\nA. Mesonephros\nB. Metanephros\nC. Pronephros\nD. Paramesonephric duct", "response": "None\n\nSo the answer to this question is A"} {"instruction": "148.Drug of choice for pregnancy-induced hypertension is:(AIIMS November 2015, May 2015)\nA. Atenolol\nB. Nitroprusside\nC. Enalapril\nD. Alpha-methyldopa", "response": "Ans. d. Alpha-methyldopa (Ref: Williams Obstetrics 24/e p100; Dutta 7/e p228: Goodman Giffman 12/e p773, 774: Katzung 12/e p176)Drug of choice for hypertension in pregnancy is methyldopa.\"Methyldopa is a centrally acting antihypertensive agent. It is a prodrug that exerts its antihypertensive action via an active metabolite. Although used frequently as an anti hypertensive agent in the past, methyldopa's significant adverse effects limit its current use largely to treatment of hypertension in pregnancy, where it has a record for safety. \"-- Goodman Gillman 12/e p773\"Methyldopa is a preferred drug for treatment of hypertension during pregnancy based on its effectiveness and safety for both mother and fetus. The usual initial dose of methyldopa is 250 mg twice daily, and there is tittle additional effect with doses >2 g/day. \"-- Goodman Gillman 12/e p774\"Methyldopa was widely used in the past but is now used primarily for hypertension during pregnancy. It lowers blood pressure chiefly by reducing peripheral vascular resistance, with a variable reduction in heart rate and cardiac output. Katzung 12/e p176Antihypertensives in PregnancySafeContraindicated* LabetaloQ* Alpha methyldopaQ* Calcium channel blockersQ* Hydralazine* Sodium nitroprusside* ACE inhibitorsQ* Reserpine* Loratidine Drug of Choice in PregnancyConditionDrug of Choice* DOC for malaria in pregnancy* ChioroquineQ* DOC for anticoagulation in pregnancy* HeparinQ* Antihypertensive of choice in pregnancy* Alpha-methyldopaQ* Antihypertensive of choice for hypertensive crisis in pregnancy* LabetalolQ* DOC for nausea in pregnancy* Doxylamine & pyridoxineQ* Analgesic of choice during pregnancy* AcitoaminophenQ* Anti-epileptic of choice during pregnancy* PhenobarbitoneQ\n\nSo the answer to this question is D"} {"instruction": "At the end of the year 1990, the population of primary health centre was 30,000 and there were 120 cases of pulmonary tuberculosis. At the end of the year 1991, the population was 30,600 and 30 new cases were detected and 2 cases had died. Based on this data all of the following rates can be calculated except\nA. incidence\nB. Prevalence\nC. Case fatality\nD. Propoional moality", "response": "Ref: Parks 23rd edition pg 58 Propoional moality rate from a specific disease = no. of deaths from the specific disease in a yr / total deaths from all causes in that yr x100. Here the denominator is unavailable. So can&;t be calculated.\n\nSo the answer to this question is D"} {"instruction": "Air pollution may cause -\nA. Dermatitis\nB. Carcinoma bronchus\nC. Bronchiectasis\nD. Pneumonia", "response": "Approximately 17% of annual premature lung cancer deaths in adults are attributed to exposure to carcinogens from household air pollution caused by cooking with solid fuels like wood charcoal and coal. Other effects: Respiratory tract infections Bronchial hyperactivity impaired lung defence bronchiolitis obliterans Asthma, COPD impaired neuropsychological development in paediatrics Park's Textbook of Preventive and Social Medicine, 25th edition, Page No. 797\n\nSo the answer to this question is B"} {"instruction": "False about the malignant ulcer of stomach is\nA. The mucosal folds do not reach the edge of the ulcer\nB. Mucosal folds are thickened and fused\nC. Ulcer crator is eccentric\nD. Margins of the ulcer are overhanging", "response": "widespread thickening of mucosal wall.Ulcers appear firm raised and nodular. margins of ulcers are heaped up beaded irregular ,base is ragged and necrotic. REF :GENERAL AND SYSTEMIC PATHOLOGY RAMDAS NAYAK PAGE 2ND EDITION NO 386 IMAGE REF: GENERAL AND SYSTEMIC PATHOLOGY RAMDAS NAYAK 2ND EDITION TABLE 13.7 PAGE 389\n\nSo the answer to this question is D"} {"instruction": "Which is a better preservative for urine in viscera packing\nA. Concentrated Hydrochloric acid\nB. Thymol\nC. Toluene\nD. Sodium fluoride", "response": "- Concentrated Hydrochloric acid, Thymol, Toluene, Sodium fluoride used to preserve urine - Of which, Toluene is better.\n\nSo the answer to this question is C"} {"instruction": "A 13 year old boy present with acute onset right scrotal pain. The pain is not relieved on elevation of the serotum and he has no fever or dysuria. The testis is enlarged and tender. His routine urinary examination is normal. There is no history of trauma. Which of the following is the most appropriate management -\nA. Immediate exploration\nB. Antibiotics\nC. Psychiatric evaluation\nD. Antibiotics and scrotal elevation", "response": "Ans. is 'a' i.e., Immediate exploration This is a case of torsion of testis Torsion of testis is a surgical emergency and needs immediate exploration if it cannot be relieved by manipulation.\n\nSo the answer to this question is A"} {"instruction": "False about a firearm Exit wound is\nA. Eveed edges\nB. Abrasion collar absent\nC. Sharply defined outwardly split edges\nD. Lead ring may be present", "response": "Grease or di ring may be present inner to or interwoven in the substance of abrasion collar in case of entry wounds , which may be demonstrable on micro-chemical or other tests in the laboratory. Not seen in exit wound Ref : Krishnan vij Textbook of Forensic medicine and Toxicology 5th edtion ; pg no - 249\n\nSo the answer to this question is D"} {"instruction": "Population covered by a community health centre-\nA. 5000\nB. 30,000\nC. 1000\nD. 100,000", "response": "As on 31 st march 2014 ,5,363 community health centers were established by upgrading the primary health centers,each community health center covering a population of 80,000 to 1.20 lakh(one in each community development block) with 30 beds and specialists in surgery,medicine,obstetrics and gynecology and paediatrics with x-ray and laboratory facilities (refer pgno:907 park 23 rd edition)\n\nSo the answer to this question is D"} {"instruction": "Which one one of the following acts to increase the release of Ca2+ from endoplasmic reticulum:\nA. Inositol triphosphate\nB. 4,Parathyroid hormone\nC. 1, 25-dihydroxy cholecalciferol\nD. Diacyglycerol", "response": "A i.e. Inositol triphosphate Inositol triphosphate diffuses to the endoplasmic reticulum, where it triggers the release of calcium into cytoplasm. Inositol triphosphate and diacylglycerol (DAG) both of which are second messengers, are associated with Gq subset of G protein mediated receptors.\n\nSo the answer to this question is A"} {"instruction": "Which of the following diuretic is used in the given condition?\nA. Furosemide\nB. Thiazide\nC. Acetazolamide\nD. Neomycin", "response": "Loop diuretics are 1st choice in hepatic cirrhosis associated edema along with aldosterone antagonist.Ref: Katzung 13thed.Pg 265\n\nSo the answer to this question is A"} {"instruction": "A viral organism was isolated from a painful blister on the lip of a teenage girl. The agent was found to double-stranded, linear DNA and was enveloped. The patient had a similar sore approximately 2 months ago. Which of the following is the most likely causative organism?\nA. Adenovirus\nB. Coxsackie virus\nC. Herpes simplex type 1 virus\nD. Herpes zoster virus", "response": "Herpes simplex is an enveloped, linear DNA virus that is a very common infectious agent; most adults will have anti-Herpes simplex antibodies in their serum, although many may not have ever had any clinical signs of disease. The hallmark of this disease is painful skin vesicles often called \"cold\" sores, or \"fever\" blisters to denote the precipitating event that preceded the appearance of the lesions. The virus has a propensity to become latent in the host, finding safe refuge in nervous tissue. Activation of the infection occurs following mild trauma (e.g., a visit to the dentist), hormonal changes (e.g., menses), and immunosuppression (e.g., following organ transplantation). Other, more serious, manifestations of disease include encephalitis, pneumonia, and hepatitis; these are paicularly likely to be seen in immunodeficient patients such as those with AIDS. Adenoviruses are naked, linear, double-stranded DNA viruses that cause acute, usually self-limiting, influenza-like illnesses occurring in winter. The symptoms include pharyngitis, fever, cough, and general malaise. Epidemic pharyngoconjunctivitis and pneumonia can occur in closed populations such as military installations. Coxsackie viruses are naked, single-stranded, polycistronic viruses with an RNA genome. They are divided into groups A and B based on their virulence in suckling mice. Coxsackie A group causes generalized myositis and flaccid paralysis, which is rapidly fatal to infant mice, whereas group B produces less severe lesions of the hea, pancreas, and central nervous system. In man, Coxsackie A causes herpangina and hand-foot-and-mouth disease, while Coxsackie B is seen in patients with pleurodynia, myocarditis, and pericarditis. Both groups cause upper respiratory infections, febrile rashes, and meningitis. Herpes zoster, the varicella virus, is an enveloped, double-stranded DNA virus that is a very common infectious agent in children. Chickenpox is a mild, self-limiting illness in children that is evidenced as a fever followed by a macular rash that progresses to papules, then vesicles of the skin and mucous membranes. Shingles is a recurrence of a previously latent varicella infection in which the virus has taken refuge in sensory ganglia of spinal or cranial nerves. Various factors that decrease the immune status of the patient contribute to the exacerbation of the infection. Severe dermatomal pain occurs with a vesicular eruption, fever, and malaise. Ref: Brooks G.F. (2013). Chapter 33. Herpesviruses. In G.F. Brooks (Ed), Jawetz, Melnick, & Adelberg's Medical Microbiology, 26e.\n\nSo the answer to this question is C"} {"instruction": "To obtain best long term result, which of the\nfollowing procedures for augmentation genioplasty is recommended:\nA. On lay bone graft\nB. Injection of silastic gel\nC. Insertion of silastic rubber implant\nD. Pedicled horizontal sliding osteotomy", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Nerve of inguinal canal is\nA. Genitofemoral nerve\nB. Obturator nerve\nC. Iliohypogastric nerve\nD. Ilioinguinal nerve", "response": "The inguinal canal is a passage in the anterior abdominal wall that in men conveys the spermatic cord and in women the round ligament of uterus. The inguinal canal is larger and more prominent in men. There is one inguinal canal on each side of the midline. ref -BDC 6e vol2 pg211-216\n\nSo the answer to this question is D"} {"instruction": "True about Post-Streptococcal Glomerulonephritis is:\nA. 50% of cases occur after pharyngitis\nB. Early treatment of Pharyngitis eliminates the risk of P.S.G.N.\nC. Glomerulonephritis, secondary to skin infection, is more common in summer\nD. Recurrence is seen", "response": "Answer is C (Glomerulonephritis secondary to skin infection is more common in Summer): 'During cold weather post streptococcal glomerulonephritis commonly follows streptococcal pharyngitis; whereas during warm weather, the G.N. generally follows streptococcal skin infection or pyoderma'. \"Early systemicantibiotic therapy of Streptococcal throat and skin infection will NOT eliminate the risk of glomerulonephritis\". Nelson 15th / 1488 \"Recurrence are extremely rare\" Nelson 15th / 1488 ......Immunity to strains causing G.N. is type-specific and long-lasting, and hence repeated infection and nephritis are rare. Post streptococcal glomerulonephritis may follow either pharyngitis or, skin infection (pyoderma) with a nephritogenic strain of group A beta haemolytic streptococci. I could not however, find what percentage of PSGN cases follow pharyngitis and what percentage follow skin infections. . All I could gather was that these incidences are relative, depending upon the climatic conditions of the area concerned such that in the tropics, skin infection is more impoant than pharyngitis as a cause. The epidemic forms, on the other hand, are seen in children of 2-6 years of age, and are secondary to pharyngitis. Thus no exact demarcation in terms of percentages can be made.\n\nSo the answer to this question is C"} {"instruction": "Hydrocution is ?\nA. Electric shock in water\nB. Cold water submersion\nC. Submersion in boiling water\nD. None", "response": "Hydrocution : (immersion syndrome ) Type of atypical drowning Mechanism -sudden dyspnoea and vagal inhibition -->hea stops immediately.( ventricular fibrillation has also been repoed.)\n\nSo the answer to this question is B"} {"instruction": "True about measles are all except -\nA. Koplik's spots is pathognomonic\nB. Source is a case\nC. Infectivity is low\nD. Affect age group 1 to 3 years", "response": "Ans. is 'c' i.e., Infectivity is low o Measles has high infectivity with secondary attack rate of 80%. o Other options are correct. Measles o Measles is caused by a RNA virus of paramyxovirus family, o Measles in also known as rubeola. o The only source of infection is a case of measles, carriers are not known to occur. o Infective period - 4 days before and 5 days after the appearance of rash. o Infective material - Secretions of nose, throat and respiratory tract o Age group - 6 month to 3 years. o Immunity - One attack of measles generally confer life long immunity'. o Transmission - 1) Droplet infection through respiratory' tract 2) Infection through conjuctiva. o Incubation period - 10 days from exposure to onset of fever. 14 days from exposure to appearance of rash. 7 days for live vaccine of measles. o Clinical manifestations Prodromal stage Begins 10 days after the infection and lasts until day 14. Characterized by fever, coryza with sneezing and nasal discharge, redness of the eyes, lacrimation and photophobia. A day or two before the appearance of rash, Koplik's spots appear on buccal mucosa opposite the 1st and 2nd lower molars. Koplik's spots are pathognomonic of measles. Eruptive phase Maculopapufar rash which begins behind the ear and spread rapidly in a few hour over the face and neck extends down the body. Post measles stage y Weight loss y Growth retardation y Diarrhea y Cancrum oris y Reactivation of pulmonary TB y Candidiasis\n\nSo the answer to this question is C"} {"instruction": "A 30 years old Mrs. X comes to opd with complaints of lethargy, anorexia, weight loss and secondary amenorrhea. She gives a history of postpaum haemorrhage and failed lactation. Which of the following is the most probable diagnosis?\nA. Sheehan's syndrome\nB. Empty sella syndrome\nC. Kallmann syndrome\nD. Asherman syndrome", "response": "Sheehan's SyndromeAcute infarction and ischemic necrosis of the pituitary gland resulting from postpaum hemorrhage and hypovolemic hypotension is known as Sheehan's syndrome and is one of the most common causes of hypopituitarism in underdeveloped or developing countries.Failed lactation after delivery is the classical presenting symptom. The rest of the clinical picture varies with the severity of the pituitary insult, ranging from severe hypopituitarism soon after delivery, manifesting as lethargy, anorexia, and weight loss, to secondary amenorrhea, loss of sexual hair, and less severe symptoms of fatigue that emerge weeks and months later.Deficiencies in GH, prolactin, and gonadotropins are most common, although the majority also exhibit ACTH and TSH deficiencies.The evaluation and treatment of Sheehan's syndrome is no different from that for other causes of hypopituitarismReference: Clinical gynecologic endocrinology; 10th edition; Chapter 9; Normal and Abnormal Sexual Development; Page no: 483\n\nSo the answer to this question is A"} {"instruction": "Most common congenital anomaly associated with face presentation is :\nA. Anencephaly\nB. Hydramnios\nC. Microcephaly Hydrocephalus\nD. Hydrocephalus", "response": "Anencephaly\n\nSo the answer to this question is A"} {"instruction": "Alfa blocker useful in BPH is?\nA. Phentolamine\nB. Prazosin\nC. Tolazoline\nD. Phenoxybenzamine", "response": "ANSWER: (B) PrazosinREF: Goodman and Gillman s 11TH edition page 172, 173, 183a BLOCKERSClassDrugsPharmacologicalActionsApplicationsUntoward EffectsNon selective/ classical a blockersPhenoxvbenzaminePhentolamineTolazolineDecrease in PVR and blood pressure VenodilationTreatment of catecholamine excess (Pheochromocytoma)Postural hypotension Failure of ejaculationSelective cq blockersPrazosinTerazosinDoxazosinTrimazosinAlfuzosinTamsulosinDecrease in PVR and blood pressure Relax smooth muscles in neck of urinary bladder and in prostatePrimary hypertension. Increase urine flow in BPHPostural hypotensionPrazosin, the prototypic quinazoline a blocker, is a potent and selective a receptor antagonist. In treating benign prostatic hyperplasia (BPH), doses from 1 to 5 mg twice daily typically are used. The twice-daily dosing requirement for prazosin is a disadvantage compared with newer a] receptor antagonists.\n\nSo the answer to this question is B"} {"instruction": "1 month old baby has microcephaly, hepatoslenomegaly. His urine stained with Giema shows owl's eye inclusion bodies. What is the diagnosis\nA. CMV\nB. EBV\nC. Herpes simplex\nD. Varicella zoster", "response": "OWL'S eye inclusion bodies are seen in CMV virus.\n\nSo the answer to this question is A"} {"instruction": "A death ceificate is given below, main underlying cause of death is :-\nA. Pulmonary embolism\nB. Secondary carcinoma shaft of femur\nC. Fracture of femur\nD. Malignant neoplasm of breast", "response": "Death ceificate consists of two pas. Pa I is divided into three sub pas - (a), (b) and (c). These are for disease processes that have led directly to death, (a) is a direct cause of death and is a consequence of (b), which in turn is due to (c). it is the disease in 1(c) or 1(d) that is the most impoant, as it is the primary pathological condition, the sta of the events leading to death. It is this disease that is the underlying cause of death. Pa I (c) and I(d) are the essence of death ceificate and denote the main underlying cause of death\n\nSo the answer to this question is D"} {"instruction": "In Corynebacterium diphtheria\nA. Deep invasion is not seen\nB. Elek’s test is done for toxigenicity\nC. Metachromatic granules are seen\nD. Toxigenicity is mediated by chromosomal change", "response": "• Diphtheria acts by its toxin and invasion is not seen.\n• Elekc gel precipitation test is done for determination of pathogenicity of diphtheria.\n• Metachromatic granules are seen also called as Babes earnest granules. Bacteriophages (extra-chromosomal) are responsible for toxigenicity by phage conversion.\n\nSo the answer to this question is D"} {"instruction": "All are true about Ebner glands, EXCEPT:\nA. Is an exocrine gland\nB. Situated on the dorsal surface of tongue\nC. Secrete an acid labile lipase\nD. Their secretion helps in digestion of fat", "response": "Ebner's Gland or Von Ebner Glands are exocrine glands located on the dorsal surface of tongue and are responsible for the secretion of lingual lipase. Lingual lipase is a acid stable lipase. Lingual lipase uses a catalytic triad consisting of Aspaatic Acid, Histidine, and Serine, to initiate the hydrolysis of a triglyceride into a diacyglyceride and a free fatty acid. Ref:Ganong's Review of Medical Physiology, 22nd Edition, Page 473\n\nSo the answer to this question is C"} {"instruction": "In which of the following arthritis erosions are not seen:\nA. Rheumatoid arthritis\nB. Systemic lupus erthematosus (SLE)\nC. Psoriasis\nD. Gout", "response": "Ans. is b' i.e., Systemic lupus erythematosus (SLE) About Musculoskeletal manifestation in SLE patients, Harrison writes -\"Poly arthralgias and polyarthritis eventually occur in 90% of SLE patients.The arthritis initially involve the small joints in hands, knees and wrists.Joint deformities develop in only 10%.Erosions on joint X-rays are rare, their presence suggest a non lupus inflammatory arthropathy such as rheumatoid arthritis.\"Joint erosion are well known in all the other three options.\n\nSo the answer to this question is B"} {"instruction": "Complications of elbow dislocation are all EXCEPT: March 2004\nA. Vascular injury\nB. Median nerve injury\nC. Myositis ossificans\nD. VIC", "response": "Ans. d i.e. VIC\n\nSo the answer to this question is D"} {"instruction": "Which of the following statements on lymphoma is not True?\nA. A single classification system of Hodgkin's disease is almost universally accepted\nB. HD tends to remain localized to a single group of lymph nodes and spreads by contiguity\nC. Several types of Non-Hodgkin's lymphoma may have a leukemic phase\nD. In general follicular NHL has worse prognosis compared to diffuse NHL", "response": "Ans. is 'd' i.e., In general follicular NHL has worse prognosis compared to diffuse NHL o Multiple classification system exist for Non-Hodgkin's lymphoma.o The prognosis of Non-Hodgkins lymphoma varies markedly with various histological types of Non Hodgkin's lymphoma, In general lymphomas with a follicular histological pattern are of lower grade {longer survival than those ofdiffuse pattern).Clinical difference between Hodgkins and Non Hodgkins LymphomaHodgkins lymphomaHon Hodgkins lymphomao More often localized to a single axial group of cervical mediastinal, para-aortic nodes.o Orderly spread by contiguityo More frequent involvement of multiple peripheral nodeso Waldeyer ring and mesenteric nodes commonly involvedo Mesenteric nodes and Waldeyerring rarely involvedo Extra-nodal involvement uncommono Extranodal involvement common\n\nSo the answer to this question is D"} {"instruction": "Adrenocoical suppression causing drugs are all except ?\nA. Prednisone\nB. Ketoconazole\nC. Mitotane\nD. Spironolactone", "response": "Ans. is 'd' i.e., Spironolactone Drugs causing adrenocoical suppression are: Steroids (prednisone, hydrocoisone, and dexamethasone) Aminoglutethimide Fludrocoisone Ketoconazole Megestrol Metyrapone Mitotane\n\nSo the answer to this question is D"} {"instruction": "Uremia occurs when total GFR is reduced by-\nA. 25%\nB. 50%\nC. 60%\nD. 80%", "response": "There is no specific time for the onset of uremia for people with progressive loss of kidney function. People with kidney function below 50% (i.e. a glomerular filtration rate between 50 and 60 mL) and over 30 years of age may have uremia to a degree. Ref: Wikipedia\n\nSo the answer to this question is B"} {"instruction": "Antigen presenting cells are all of the following EXCEPT:-\nA. Astrocytes\nB. Endothelial cells\nC. Epithelial cells\nD. Langerhans cells", "response": ". Astrocytes\n\nSo the answer to this question is A"} {"instruction": "Putrefaction is a :\nA. Perimoem sign of death\nB. Immediate sign of death\nC. Early sign of death\nD. Late sign of death", "response": "D i.e. Late sign of death\n\nSo the answer to this question is D"} {"instruction": "The dielectric constant of water is ___.\nA. 105\nB. 78.5\nC. 30\nD. 60", "response": "Water, a strong dipole, has high dielectric constant.\nThe dielectric constant for water is 78.5.\nIt decreases the force of attraction between charged and polar species relative to water free environments with lower dielectric constants.\n\nSo the answer to this question is B"} {"instruction": "Hodgkin's lymphoma caused for by\nA. EBV\nB. CMV\nC. HHV6\nD. HHV8", "response": "Ref Robbins 9/e p607 One clue stems from the involvement of EBV. EBV is present in the RS cells in as many as 70% of cases of the mixed-cellularity subtype and a smaller fraction of other \"classical\" forms of Hodgkin lymphoma. More impoant, the integration of the EBV genome is identi- cal in all RS cells in a given case, indicating that infection precedes (and therefore may be related to) transformation and clonal expansion. Thus, as in Burkitt lymphoma and B cell lymphomas in immunodeficient patients, EBV infection prob- ably is one of several steps contributing to tumor develop- ment, paicularly of the mixed-cellularity subtype. The characteristic non-neoplastic, inflammatory cell infil- trate is generated by a number of cytokines, some secreted by RS cells, including IL-5 (which attracts and activates eosin- ophils), transforming growth factor-b (a fibrogenic factor), and IL-13 (which may stimulate RS cells through an autocrine mechanism). Conversely, the responding inflammatory cells, rather than being innocent bystanders, produce additional factors such as CD30 ligand that aid the growth and survival of RS cells and contribute fuher to the tissue reaction.\n\nSo the answer to this question is A"} {"instruction": "Isoniazide is metabolized by ?\nA. Acetylation\nB. Oxidation\nC. Reduction\nD. Hydrolysis", "response": "Ans. is 'a' i.e., Acetylation Isoniazid is extensively metabolized in liver most impoant pathway being N - acetylation by NAT The acetylated metabolite is excreted in urine. Drugs metabolized by acetylation Sulfonamides (including dapson) Procainamide PAS INH Hydralazine\n\nSo the answer to this question is A"} {"instruction": "A 3-year-old child has presented with abdominal lump and aniridia shown below. All genes are responsible for development of this condition except?\nA. WT1\nB. P53\nC. Beta-catenin\nD. K-ras", "response": "Ans. (d) K-ras gene.GeneWilms tumor characteristicFrequencyWT1Inselected-20%P-cateninUnselected-15% Tumors with WT1 mutations (-20% of total)-50%p53Anaplastic histology (-5% of total)-80% Image Source:\n\nSo the answer to this question is D"} {"instruction": "Carcinoma of pancreas associated with -\nA. Hypoglycemia\nB. Syndrome of inappropriate secretion of ADH\nC. Erythropoeisis is due to erythropoietin\nD. Hypercalcemia", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Population growth is said to be less than adequate requirement when NRR is\nA. < 1\nB. 1\nC. > 1\nD. 0", "response": "Net reproductive rate is defined as the number of daughters a newborn girl will bear during her life time assuming fixed age specific feility and moality rates It is a demographic indicator NRR of 1 is equivalent to attaining approximately the 2 child norm If NRR is less than 1, then the reproductive performance of the population is said to below replacement level Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 489\n\nSo the answer to this question is A"} {"instruction": "Which of the following features distinguish Necrotizing Sialometaplasia from squamous Cell carcinoma?\nA. Majority of intraoral cases present with ulceration and pain in the later stages\nB. Varying degrees of lobar necrosis is seen\nC. Squamous metaplasia of excretory ducts and acini are noted\nD. Nests of squamous epithelium with several residual ductal lamina within them are noticed", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Currarino triad includes:\nA. Pre-sacral meningocele + Sacral defect + Tethered cord\nB. Ectopia vesicae + Anorectal malformation + Sacrococcygeal osseous defect\nC. Anorectal malformations + Sacrococcygeal osseous defect + Presacral mass\nD. Tethered cord + Anorectal malformations + Ectopia vesicae", "response": "Currarino triadorASP triad: - Anorectal malformation or congenital anorectal stenosis - Sacrococcygeal osseous defect (always present) - Classically, hemisacrum with intact first sacral veebra (\"sickle-shaped sacrum\") - Mild (hypoplasia) to severe (agenesis) of sacrum and coccyx - Presacral mass (various types) - Anterior sacral meningocele - Tumor, e.g. mature teratoma - Dermoid/epidermoid cyst\n\nSo the answer to this question is C"} {"instruction": "Typical silvery scales of psoriasis are absent in –\nA. Scalp\nB. Kee\nC. Groin\nD. Elbow", "response": "Scaling is absent or minimal\n\nFlexures (Groins, axillae, infra - mammary folds, vulva, gluteal cleft)\nGlans in uncircumcised patients (in circumcised patients scales are present on glans\nGuttate psoriasis\n\nSo the answer to this question is C"} {"instruction": "Colour coding of halothane , isoflurane, sevoflurane and desflurane is respectively\nA. red, purple, blue , yellow\nB. red , purple, yellow , blue\nC. red , yellow, purple, blue\nD. red, blue , purple, yellow", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Larva found in muscle is -\nA. Trichinella spiralis\nB. Ancylostoma duodenale\nC. Trichuris trichura\nD. Enterobius vermicularis", "response": "Larvae of trichinella spiralis becomes encysted in the striated muscle fiber and at the time of encystment measures 1mm in length by 36 micro metre in diameter. Larva in cyst is coiled and hence the name spiralis. Ref : panikers textbook of Medical parasitology 8th edition page 171\n\nSo the answer to this question is A"} {"instruction": "True about esophageal injury:\nA. Most common after penetrating injury\nB. Can lead to mediastinal collection\nC. Barium swallow is diagnostic\nD. All", "response": "Ans is All Most injuries to the esophagus are from penetrating trauma. Associated injuries are the rule.Symptoms include odynophagia (pain on swallowing foods or fluids), subcutaneous or mediastinal emphysema, pleural effusion, air in the retro-esophageal space and unexplained fever within 24 hours of injury. Mediastinal and deep cervical emphysema must be seen as evidence of an aerodigestive injury until proven otherwise.If the diagnosis is made early, primary surgical repair is generally possible. If the diagnosis is delayed for more than 24 hours, primary repair may be impractical, with diversion and drainage being the only alternative. The major morbidity and moality associated with esophageal injuries are the result of delay in diagnosis, which underscores the necessity to aggressively exclude esophageal injury during the initial evaluation of a patient with neck injury. \"The moality rate rises exponentially if treatment is delayed for more than 12-24 hours.\"- Bailey and LoveEsophagoscopy can be performed to evaluate the esophagus, but injuries have been missed with this technique alone. Therefore patients at risk should also undergo a soluble contrast esophagram looking for extravasation of contrast. If no extravasation is seen, a barium esophagram should be performed for greater detail. Failure to identify esophageal injuries leads to fulminant mediastinitis that is often fatal.Treatment consists of early debridement, primary repair, and drainage if identified within 24 hours after injury. Injuries diagnosed after 24 hours with mediastinal contamination are treated by cervical esophagostomy and distal feeding access. Esophageal resection is rarely needed but may be indicated in patients with esophageal necrosis or severe mediastinitis.. A drain should be left in place after all esophageal repairs.\n\nSo the answer to this question is D"} {"instruction": "Patient with MCV = 60, b = 5 gm % MCHC = 20 & PCV = 32 %, causes of anemia in him can be-a) Phenytoinb) Blind loop syndc) Hook worm infectiond) CRFe) Renal dialysis\nA. cd\nB. bc\nC. bd\nD. ac", "response": "None\n\nSo the answer to this question is A"} {"instruction": "A 15 year old girl with type 1 diabetes is brought to emergency complaining of dizziness. Laboratory findings include severe hyperglycemia, ketoacidosis and blood pH of 7.15. To achieve rapid control of severe ketoacidosis, appropriate drug is:\nA. Crystalline zinc insulin\nB. NPH insulin\nC. Tolbutamide\nD. Ultra lente insulin", "response": "Diabetic ketoacidosis must be managed by insulin preparations that can be given by intravenous route. Main insulin given intravenously is Regular insulin . Complication--> Hypoglycemia.\n\nSo the answer to this question is A"} {"instruction": "All of the following symptoms are seen in cystitis Except\nA. Fever\nB. Hematuria\nC. Dysuria\nD. Nocturia", "response": "In cystitis there will be increased frequency, pain, haematuria and pyuria. Pyrexia and rigors are not associated with simple UTI but are signs of upper tract infection or septicemia. Reference : Bailey &Love, 27th Edition, page no = 1442.\n\nSo the answer to this question is A"} {"instruction": "Tooth discoloration because of increase amount of bilirubin:\nA. Chlorodontia.\nB. Acrodontia\nC. Trochodontia\nD. None of the above", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Which of the following inhalational agents, is the induction agent of choice in children?\nA. Isoflurane\nB. Desflurane\nC. Sevoflurane\nD. Methoxyflurane", "response": "Sevoflurane is considered to be the inhalational induction agent of choice in children, since it has a pleasant, faster, and smooth induction with no significant systemic toxicity. Other drugs which can be used in children are are a mixture of oxygen and nitrous oxide or halothane. Ref: Synopsis of Pediatric Emergency Medicine By Gary Robe Fleisher, 4th Edition, Page 34; Textbook of Anesthesia for Postgraduates By T. K. Agasti, Page 799.\n\nSo the answer to this question is C"} {"instruction": "In a 60 year old adult, which of the following diseases cause expansile maxillary lesions?\nA. Paget's disease\nB. Acromegaly\nC. Fibrous Dysplasia\nD. Rickets", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Dysfunctional uterine bleeding (DUB) is seen in :\nA. Polycystic ovarian disease\nB. Endometrial tuberculosis\nC. Metropathia haemorrhagica\nD. Multiple fibroids", "response": "Metropathia haemorrhagica\n\nSo the answer to this question is C"} {"instruction": "Which feature would most likely be found in a patient with lepromatous leprosy?\nA. No bacteremia\nB. Macrophages with a foamy appearance in the dermis\nC. A positive lepromin reaction\nD. A high cell-mediated response against Mycobacterium leprae", "response": "The disease of leprosy is divided into two basic types: lepromatous and tuberculoid. The lepromatous form is an aggressive disease, whereas the tuberculoid form tends to be self-limiting. Individuals with lepromatous leprosy have an inflammatory skin infiltrate, which consists largely of macrophages that have a characteristic vacuolated or \"foamy\" appearance (caused by the accumulation of lipids within phagocytes) and intracellular acid-fast bacilli. In the lepromatous form, presence of organisms indicates impaired cellular immunity, unlike the tuberculoid type, which can effectively kill the bacteria.\n\nSo the answer to this question is B"} {"instruction": "Which of the following intravenous induction agent suppress steroidogenesis?\nA. Thiopentone\nB. Propofol\nC. Ketamine\nD. Etomidate", "response": "Etomidate causes adrenocoical suppression on long term use hence suppress steroidogenesis. All other drugs don&;t cause adrenocoical suppression. From padmaja 4th edition Page no 195\n\nSo the answer to this question is D"} {"instruction": "Erotomanic delusion is seen in\nA. de Clerambault's syndrome\nB. Cotard syndrome\nC. Couvade syndrome\nD. Othello syndrome", "response": "(A) de Clerambault's syndrome # EROTOMANIA is a type of delusion in which the affected person believes that another person, usually a stranger, high-stalus or famous person, is in love with him or her. The illness often occurs during psychosis, especially in patients with schizophrenia, delusional disorder or bipolar mania.During an erotomanic episode, the patient believes that a \"secret admirer\" is declaring his or her affection to the patient, often by special glances, signals, telepathy, or messages through the media. Usually the patient then returns the perceived affection by means of letters, phone calls, gifts, and visits to the unwitting recipient. Even though these advances are unexpected and unwanted, any denial of affection by the object of this delusional love is dismissed by the patent as a ploy to conceal the forbidden love from the rest of the world.> The term erotomania is often confused with \"obsessive love\", obsession with unrequited love, or hypersexuality. Obsessive love is not erotomania by definition. Erotomania is also called de Clerambault's syndrome, after the French psychiatrist Gaetan Gatian de Clerambault (1872-1934), who published a comprehensive review paper on the subject (Les Psychoses Passionelles) in 1921.\n\nSo the answer to this question is A"} {"instruction": "What is/are true about rat bite -a) Vaccinate with antirabies vaccineb) Give tetanus toxoidc) Rarely need rabies immunoglobulind) Wash with soape) Use antiseptic cream\nA. abd\nB. acd\nC. cde\nD. ade", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Which one of the following phenomena is closely associated with slow wave sleep:\nA. Dreaming\nB. Atonia\nC. Sleep walking\nD. Irregular hea rate", "response": "C i.e. Sleep walking\n\nSo the answer to this question is C"} {"instruction": "True about pseudocyst of pancreas\nA. Pancreatic fluid collection\nB. May be asymptomatic\nC. Amylase raised\nD. All of the above.", "response": "None\n\nSo the answer to this question is D"} {"instruction": "A doctor injected syringe which was used before on a patient, who turned out to be HIV positive later. Under which of the following IPCs will the doctor be booked for medical negligence?\nA. 166 B\nB. 202\nC. 203\nD. 269", "response": "S. 269 IPC: Punishment for Negligent act likely to spread infection of disease dangerous to life. S. 270:- Malignant act likely to spread infection of disease dangerous to life.\n\nSo the answer to this question is D"} {"instruction": "False about viruses is -\nA. Ribosomes absent\nB. Mitochondria absent\nC. Motility absent\nD. Nucleic acid absent", "response": "Ans. is 'd' i.e., Nucleic acid absent o Viruses contain nucleic acid, either RNA or DNA.Properties of viruseso V iruses are obligate intracellular parasites.o They lack enzymes necessary for protein and nucleic acid synthesis and are dependent for replication on the synthetic machinery of host cells --> so, they cannot grow in cell free culture media.o They do not have cellular organization.o They are unaffected by antibacterial antibiotics.o They contain only one type of nucleic acid, either RNA or DNA, never both.o They multiply by a complex process and not by binary fission,o The extracellular infections virus particle is called the virion.o With few exceptions, viruses are very heat labile.\n\nSo the answer to this question is D"} {"instruction": "All of the following muscles have dual nerve supply, EXCEPT?\nA. Brachialis\nB. Pectineus\nC. Flexor digitorum superficialis\nD. Flexor digitorum profundus", "response": "Flexor digitorum superficialis muscle primarily produces flexion at the wrist and at the metacarpophalangeal and proximal interphalangeal joints. Innervation is provided by the median nerve (C8-T1).The brachialis muscle is supplied by musculocutaneous nerve (C5-C6) and radial nerve (C7).The femoral nerve (L2 and L3) innervates pectineus muscle, with occasional branches from the obturator nerve.The lateral half of the flexor digitorum profundus muscle is innervated by the anterior interosseous nerve from the median nerve (C8-T1), and the medial half of the muscle is innervated by the ulnar nerve (C8-T1).\n\nSo the answer to this question is C"} {"instruction": "All of the following regarding papillary carcinoma thyroid is true except -\nA. Multicentric origin\nB. Seocndaries to lymphnodes\nC. Slowing growing\nD. Bony metastasis in early stage", "response": "None\n\nSo the answer to this question is D"} {"instruction": "All of the following are true regarding congenital dislocation of hip except-\nA. Assymetric Thigh folds may be seen\nB. Galleazi sign and Ortolanis test may be positive\nC. It may be bilateral\nD. Polyhydramnios is a known risk factor", "response": "Ans. is 'd' i.e., Polyhydramnios is a known risk factor Risk factors for DDH/CDHo Femaleso First bomso FamilialDDH is found in familieso Faulty intrauterine position (Breech presentation)o Hormone induced laxityo OligohydramnionClinical features of DDHo Girls are affected six times as often as boys. In one third of cases, bilateral affection occurs. Unless it is specially looked for in infancy - as it always should be - abnormality may not be noticed until the child begins to walk. The clinical findings in older child arei) Limitation of abduction and external rotationii) Limb is in adduction, internal rotation & flexion.iii) Asymmetrical thigh foldiv) Higher buttock fold on the affected side.v) Galeazzi's sign : The level of the knees are compared in a child lying with hip flexed to 70deg and knees flexed. There is a lowering of the knee on the affected sidevi) Ortolani's test may be positive.vii) Trendelenbug's test is positive: This test is performed in an older child. The child is asked to stand on the affected side. The opposite ASIS (that of the normal side) dips down .viii) The limb is short and slightly externally rotated. There is lordosis of the lumbar spine.ix) Telescopy positive : In a case of a dislocated hip, it will be possible to produce an up and down piston- like movement at the hip. This can be appreciated by feeling the movement of the greater trochanter under the fingers.x) A child with unilateral dislocation exhibits a typical gait in which the body lurches to the affected side as the child bears weight on it (Trendelenburg'sgait)An a child with bilateral dislocation, there is alternate lurching on both side (waddling gait).xi) There is compensatory genu valgum as patient tries to keep the foot out (to compensate adduction at hip).\n\nSo the answer to this question is D"} {"instruction": "Which type of fear is the most usually difficult to\novercome?\nA. Long standing objective fears\nB. Long standing subjective fears\nC. Short term objective fears\nD. Short term subjective fears", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Chances of veical transmission of Hepatitis B may be high as\nA. 25%\nB. 40%\nC. 60%\nD. 90%", "response": "Answer is D (90%) The rate of perinatal transmission of hepatitis B (HBV) essentially depends on the presence or absence of HBe Ag and viral replication. The rate of perinatal transmission of HBV may be as high as 90% in neonates born to mothers who are positive for HBe AG. 'The likelihood of perinatal transmission of HBV correlates with the presence of HBe Ag and high level viral replication. 90% of HBe Ag positive mothers but only 10-15% of Anti-HBe Ag negative mothers transmit HBV to their offspring' - Harrison 18th/2547 `Transmission of infection from an HBV carrier mother to her neonate accounts for the majority of new infections in the world today. Sixty to 90% of Hepatitis B surface antigen (HBs Ag) positive mothers who are Hepatitis B 'e' antigen (HBe Ag) positive transmit the disease to their offspring, whereas mothers who are positive for antibody to HBe Ag (Anti - HBe) do so less frequently (15-20%). -\n\nSo the answer to this question is D"} {"instruction": "A newborn has his leg inveed and the dorsum of his foot does not touch the front of tibia. What is the diagnosis of this condition?\nA. Congenital veical talus\nB. Congenital talipes equino varus\nC. Cerebral palsy\nD. Poliomyelitis", "response": "Congenital clubfoot (equinovarus foot; talipes equinovarus): It is characterized by fixed ankle plantar flexion (equinus), inversion and axial internal rotation of the subtalar (talocalcaneal) joint (varus), and medial subluxation of the talonavicular and calcaneocuboid joints (adductus). The typical radiographic findings of incompletely treated clubfoot include the following features: Presence of hind foot plantar flexion; Lack of the normal angular relationship between the talus and calcaneus (so-called parallelism of talus and calcaneus); and Residual medial subluxation or displacement of the navicular on the talus and the cuboid on the calcaneus. Ref: Rab G.T. (2006). Chapter 11. Pediatric Ohopedic Surgery. In H.B. Skinner (Ed), CURRENT Diagnosis & Treatment in Ohopedics, 4e.\n\nSo the answer to this question is B"} {"instruction": "'Heliotrope rash' over face is seen in\nA. Systemic sclerosis\nB. Dermatomyositis\nC. Systemic lupus erythematosus\nD. Rheumatoid ahritis", "response": "Dermatomyositis a. Heliotrope erythema and oedema of the periorbital skin are seen in dermatomyositis, b. Dermatomyositis is a well established cutaneous marker of interval malignancy. c. About 10% of all patients of dermatomyositis have an underlying malignancy. d. The most common malignancies associated with dermatomyositis are Lung, Ovary, breast, GIT and lymphoprol iterative disorders.\n\nSo the answer to this question is B"} {"instruction": "Contraindications for breast feeding are all except\nA. Hepatitis - B infection of mother\nB. Tetracycline treatment of mother\nC. Acute bacterial mastitis\nD. All", "response": "Ans. is a, b and c i.e. Hepatitis B infection of the mother; acute bacterial mastitis; and Tetracycline Breast feeding is not contraindicated in case of maternal hepatitis B infection as explained in previous question. Option '13' Lithium is contraindicated during pregnancy (see Answer 6) Option 'c' i.e. Acute bacterial mastitis. \"In case of acute bacterial mastitis breast feeding should be continued as it is helpful in avoiding abscess formation. If the infected breast is too tender to allow suckling, gentle pumping until nursing can be resumed is recommended.\" Option `d' Tetracycline : according to KDT \"Tetracycline is secreted in breast milk and can cause teeth discoloration and impaired growth in infants and children therefore is contraindicated during lactation.\" But all other books and extensive internet search (see Drug.com/Rxlist.com) says that tetracycline is not contraindicated during lactation but should be used cautiously in nursing mothers.\n\nSo the answer to this question is D"} {"instruction": "Beta blockers are indicated for all of the following conditions EXCEPT:\nA. Hypothyroidism\nB. Alcohol Withdrawal\nC. Poal hypeention\nD. Performance anxiety", "response": "Ref: KD Tripathi pharmacology 7th edition (page.no: 150) beta blockers used in thyrotoxicosis because Propranalol inhibit peripheral conversion of T4 to T3 Other uses are Hypeension, Phaeochromocytoma, Anxiety, Alcohol withdrawal ,Myocardial infarction, Angina pectoris, Poal hypeension etc\n\nSo the answer to this question is A"} {"instruction": "Refractive index of cornea is\nA. 1.37\nB. 1.33\nC. 1.42\nD. 1.45", "response": "Corneal refractive index is 1.376\n\nSo the answer to this question is A"} {"instruction": "All of the thyroid tumor arises from follicular epithelial cell except:\nA. Papillary carcinoma\nB. Follicular carcinoma\nC. Medullary carcinoma\nD. Anaplastic carcinoma", "response": "- Medullary Cancer arises from parafollicular cells or 'C' cells of thyroid associated with secretion of calcitonin. - Remaining all variants ; papillary, follicular, anaplastic thyroid cancers arise from follicular epithelial cells of thyroid\n\nSo the answer to this question is C"} {"instruction": "Which of the following structures contribute to development of Kidney?\nA. Metanephros\nB. Mesonephros\nC. Blastema\nD. All of the above", "response": "Kidney has two pas: The excretory system (true kidney) develops from the metanephric blastema. The collecting system develops from Mesonephric duct (ureteric bud). Ureteric bud penetrates metanephros to conve it into metanephric blastema, which later develops into true kidney. Sources for kidney development Source System Structure derived : Metanephric blastema Excretory system PCT, DCT, Bowman's capsule, Henle's loop Ureteric bud Collecting system Collecting ducts,major and minor calyces, renal pelvis.\n\nSo the answer to this question is D"} {"instruction": "A 4 1/2- year-old girl always had to wear warm socks even is summer season. On physical examination, it was noticed that she had high blood pressure and her femoral pulse was weak as compared to radial and carotid pulse, a chest radiograph showed remarkable notching of ribs along with their lower borders. This was due to:\nA. Femoral artery thrombosis.\nB. Coarctation of aorta.\nC. Raynaud's disease.\nD. Takayasu's arteritis.", "response": "Ans. is 'b' i.e. coarctation of Aorta. Cold extremities, high B.P. in upper extremity with marked diminution of pulsations and B.P. in lower extremity is characteristic of Coarctation of Aorta.More facts about Coarctation of AortaMost patients are asymptomatic.Symptomatic patients usually present with foilwing features.Headache dizziness *Epistaxis*Cold extremities and weakness in legs *Claudication with exercise. *Hypertension in upper extremities with marked diminution of pulsation in lower extremities.Mid systolic or continuous murmur over anterior part of chest and back.*Enlarged and pulsatile collateral vessels in intercostal spaces anteriorly in axilla or posteriorly in interscapular area.Upper extremity is more developed than the lower extremity. *Remember that the Cardiac output responds normally to exercise.*Most common site* of Coarctation of Aorta is just distal to origin of left subclavian artery.If it arises above subclavian artery, blood pressure elevation is evident only in right arm.Bicuspid aortic valve* is the most common abnormality associated with coarctation of Aorta.Radiographynotching of inferior surface of ribs*indentation of aorta at site of coarctation and '3' sign* on para mediastinal shadow.Complications:cerebral aneurysmleft ventricular failure*infective endocarditis\n\nSo the answer to this question is B"} {"instruction": "When a person has suspended himself by applying ligature around neck so that the point of suspension (knot) is situated in the region of the occiput. Such a hanging is called as:\nA. Typical\nB. Atypical\nC. Paial\nD. Incomplete", "response": "A i.e. Typical Hanging\n\nSo the answer to this question is A"} {"instruction": "A 65 year old retired accountant with a 60 pack year smoking history presents for his annual physical examination. He was last seen 3 years ago, when he presented with an episode of acute bronchitis. He repos that he has been coughing over the past several months with productive green sputum. He denies any dyspnea or limitation in his daily activities. On physical examination, his blood pressure is 126/62 mm Hg, pulse is 80/min, and respirations are 24/min. He has diffuse bilateral expiratory rhonchi with a markedly prolonged expiratory phase. His cardiac examination reveals a second hea sound that increases in intensity with inspiration. The liver edge is 14 cm into the midclavicular line and mildly tender to palpation. There is bilateral lower extremity edema to the knees. A chest x-ray film reveals hyperinflation of both lung fields, and pulmonary function tests reveal a diminished forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio. Routine laboratories are sent. Which of the following would most likely be expected?\nA. A hemoglobin of 9 g/dL\nB. A hemoglobin of 17 g/dL\nC. A platelet count of 84,000\nD. A platelet count of 102,000", "response": "A hemoglobin of 17 g/dL would be expected. The question describes a patient with chronic obstructive pulmonary disease (COPD) confirmed by his physical examination, which also suggests right-sided hea failure, loud P2, and hepatic congestion and peripheral edema due to right-sided hea failure. The pulmonary function tests are consistent with the diagnosis of obstructive airway disease. Given the long history of smoking, this patient most likely has COPD. Because of chronic hypoxia, these patients also develop erythrocytosis in an effo to increase the oxygen carrying capacity. The first choice would be seen in anemia. There is no reason for this patient to develop thrombocytopenia or leukopenia. Ref: Bates C.G., Cydulka R.K. (2011). Chapter 73. Chronic Obstructive Pulmonary Disease. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.\n\nSo the answer to this question is B"} {"instruction": "Expansile lytic lesion with fluid-fluid levels within the metaphysis of fibula seen on CT and MRI in an early adolescent female is typical of –\nA. Giant cell tumor\nB. Aneurysmal bone cyst\nC. Hemangioma\nD. Fibrous dysplasia", "response": "Amongst given options, fluid-fluid levels are seen in GCT and ABC.\nLesion in question is metaphyseal:-\n\n ABC → Metaphyseal\n GCT → Epiphyseal\n\nAge of the patient is early adolescent:-\n\n ABC → Before the age of 20 years\n GCT → 20 - 40 years\n\nSo, the answer to the question is ABC.\n\nSo the answer to this question is B"} {"instruction": "Which of the following statements about 'Low' Radial nerve palsy is not true:\nA. Loss of nerve supply to brachioradialis\nB. Loss of nerve supply to extensor carpi radialis brevis\nC. Loss of nerve supply to extensor pollicis brevis\nD. Loss of sensation over first dorsal web space", "response": "A i.e. Loss of nerve supply to brachoradialis - Mnemonic - \"TAB Long radial muscle\" i.e. Triceps, Anconeus, Brachialis and Brachioradialis & Extensor carpi radialis longus muscles are spared in low radial nerve lesions (i.e. lesions below the level of elbow.) - Lateral & posterior cutaneous nerves of arm and posterior cutaneous nerve of forearm are also spared in low radial nerve lesions.\n\nSo the answer to this question is A"} {"instruction": "Vitamin A should be staed at the age of :-\nA. 2 months\nB. 9 months\nC. 5-6 years\nD. None of the above", "response": "- Accordong to NIS Vit A should be staed at the age of 9 months & from then, should be given for every 6 months till 5yrs of age. - Hence, totally 9 doses of Vit A is given; i.e 17 lakh IU.\n\nSo the answer to this question is B"} {"instruction": "Which of the following is not a rapidly growing atypical mycobacteria causing lung infections -\nA. M. chelonae\nB. M.fortuitum\nC. M.abscessus\nD. M.kansasii", "response": "None\n\nSo the answer to this question is D"} {"instruction": "What is minimum of amount of taper that should be maintained for an ideal tooth preparation?\nA. 4 degree\nB. 5 degree\nC. 6 degree\nD. 12 degree", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Aminoacyl t-RNA is required for all except -\nA. Hydroxyproline\nB. Methionine\nC. Cystine\nD. Lysine", "response": "Hydroxyproline and hydroxylysine are not represented into genetic code, i.e. they to not have t-RNA capable of accepting them and inserting them into polypeptide chain. Therefore, they have to be synthesized post-translationally from proline and lysine residues in the polypeptides.\n\nSo the answer to this question is A"} {"instruction": "\"Macropolycytes\" in peripheral smear is a feature of which of the following red cell disorders?\nA. Hereditary spherocytosis\nB. Iron deficiency anemia\nC. Sickle cell anemia\nD. Megaloblastic anemia", "response": "Macropolycytes (large, hypersegmented polymorphonuclear cells/neutrophils) are a feature of megaloblastic anemia.\n\nSo the answer to this question is D"} {"instruction": "Which metabolic abnormality is seen in congenital hyperophic pyloric stenosis?\nA. Metabolic Acidosis\nB. Metabolic Alkalosis\nC. Respiratory Acidosis\nD. Respiratory Alkalosis", "response": "Repetitive vomiting leads to hypochloremic, hypokalemic metabolic alkalosis. The urine is alkaline initially but eventually it becomes acidic (paradoxical aciduria) Cause of paradoxical aciduria Initially the kidney compensate for metabolic alkalosis by reabsorbing hydrogen and chloride ions in exchange for sodium, potassium and bicarbonate. But gradually as the body stores of sodium and especially potassium become depleted, kidney stas retaining these ions in exchange of hydrogen ions, thus the urine becomes acidic and metabolic alkaline state is fuher aggravated. Reference: SRB edition: 5th page no:830\n\nSo the answer to this question is B"} {"instruction": "Physiological response to smoking, are all, except:\nA. Decreased HDL\nB. Increased hematocrit\nC. Increased hea rate and increased catecholamine release\nD. Decreased carboxyhemoglobin", "response": "Decreased carboxyhemoglobin Physiological effects of smoking The extent of the effects of smoking is related to the number of cigarettes smoked, smoking duration, the amount and type of smoke inhaled. Nicotine in tobacco and smoke stimulates the adrenal medulla, increasing plasma adrenaline and urinary catecholamines and their metabolites. Plasma glucose concentration is enhanced within min after the sta of smoking, often persisting for an hour or so after smoking ceases. Plasma insulin rises about an hour after smoking. Plasma growth hormone concentration may increase tenfold within 30 min after the smoking of one cigarette. Smoking increases the hea rate of smoker, both at rest and in exercise. There is an associated increase of both cardiac output and systemic blood pressure. These changes can be attributed to nicotine inducing release of the hormone noradrenaline. Cigarette smoking is associated with an increased risk and extent of advanced atherosclerotic vascular disease in peripheral as well as coronary aeries. The likelihood of claudication, amputation, stroke, abdominal aoic aneurysm, and failure of vascular reconstruction is higher in smokers than nonsmokers. Smoking exes its deleterious effects through many interactive mechanisms. Nicotine and carbon monoxide produce acute cardiovascular consequences, including altered myocardial performance, tachycardia, hypeension, and vasoconstriction. Smoking injures blood vessel walls by damaging endothelial cells, thus increasing permeability to lipids and other blood components. Among metabolic and biochemical changes induced by smoking are elevated plasma, free fatty acids, elevated vasopressin, and a thrombogcnic balance of prostacyclin and thromboxane A 2. Chronic smoking is associated with a tendency for increased serum cholesterol, reduced high density lipoprotein, and other lipid effects that contribute to atherosclerosis. Hematological changes from increased erythrocytes, leukocytes, and fibrinogen causes alterations in platelet aggregation and survival that produce thrombosis. Smokers have higher plasma beta-lipoprotein. cholesterol, and triglyceride concentrations than nonsmokers. Smoking increase total red blood cells, carboxyhemoglobin and leukocyes, but decreases blood paial pressure of oxygen in habitual smokers. The hematocrit is increased. Smoking affects the immune response, lowering serum IgA, IgG, and IgM but raising IgE.\n\nSo the answer to this question is D"} {"instruction": "ElekS Gel test is used in:(\nA. Influenza\nB. Diphtheria\nC. Brucellosis\nD. Cholera", "response": "Diphtheria\n\nSo the answer to this question is B"} {"instruction": "Which of the following prevents hyperextension of thigh\nA. Ischiofemoral ligament\nB. Iliofemoral ligament\nC. Pectofemoral ligament\nD. Puboischial ligament", "response": "B. i.e. Iliofemoral ligament\n\nSo the answer to this question is B"} {"instruction": "Which β1 selective blocker is used in glaucoma:\nA. Levobunolol\nB. Timolol\nC. Betaxolol\nD. Carteolol", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Which of the following hospital waste must be discarded in Blue bag?\nA. Plastic syringe\nB. Catheter\nC. Canula\nD. Medicine Ampoules and Vials", "response": "Ans- D Medicine Ampoules and Vials Ref- BMW guidelines 2016\n\nSo the answer to this question is D"} {"instruction": "WhiCh of the following drugs is most likely to be effective against multi drug resistant strains big M. Tuberculosis including those resistant to Streptomycin\nA. Amikacin\nB. Claruthromycin\nC. Gentamicin\nD. Spectinomycin", "response": "Refer KDT 6/e p 744 Amikacin is an aminoglycoside that us most resistant to inactivating enzymes. It is used as a second line antitubercular drug It can be used in MDR tuberculosis management\n\nSo the answer to this question is A"} {"instruction": "Height of a newborn doubles at: September 2005, March 2010\nA. 1 year\nB. 2 year\nC. 3 year\nD. 4 year", "response": "Ans. D: 4 year In general, length in normal term infants increases about 30% by 5 months and > 50% by 12 months; infants grow 25 cm during the 1st yr; and height at 4 yr is about double bih length.\n\nSo the answer to this question is D"} {"instruction": "Angular conjunctivitis is caused by -\nA. H. influenza\nB. Adenovirus type 32\nC. Moraxella axenfield bacillus\nD. Brahnmella", "response": "Moraxella axenfeld (moraxella lacunata) is the most common causative organism for angular conjunctivitis. Ref: Parson's 21st/e p.168\n\nSo the answer to this question is C"} {"instruction": "The melting point of titanium is ____________ degree celsius\nA. 1056\nB. 1560\nC. 1668\nD. 1886", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Most common cervical carcinoma: March 2007\nA. Adenocarcinoma\nB. Sarcoma\nC. Squamous cell carcinoma\nD. Small cell carcinoma", "response": "Ans. C: Squamous Cell Carcinoma Cervical cancer is typically composed of squamous cells. The most impoant risk factor in the development of cervical cancer is infection with a high-risk strain of Human papilloma virus. Women who have many sexual paners (or who have sex with men or women who had many paners) have a greater risk Risk factors for cervical cancer: HPV infection (16,18,31,33), HIV infection Smoking Chlamydia infection, Multiple pregnancies Exposure to the hormonal drug (DES) and a Family history of cervical cancer. Biopsy Procedures While the pap smear is an effective screening test, confirmation of the diagnosis of cervical cancer or pre-cancer requires a biopsy of the cervix. This is often done through colposcopy. Fuher diagnostic procedures are loop electrical excision procedure (LEEP) and conization. These are carried out if the biopsy confirms severe cervical intraepithelial neoplasia. Pathologic Types Cervical intraepithelial neoplasia, the precursor to cervical cancer, is often diagnosed on examiniation of cervical biopsies. Histologic subtypes of invasive cervical carcinoma include the following: Squamous cell carcinoma (about 80-85%) Adenocarcinoma (nearly 5%) Adenosquamous carcinoma Small cell carcinoma Neuroendocrine carcinoma Staging Cervical cancer is staged by the FIGO staging system Stage 0 - full-thickness involvement of the epithelium without invasion into the stroma (carcinoma in situ) Stage I - limited to the cervix - IA - diagnosed only by microscopy; no visible lesions IA1 - stromal invasion less than 3 mm in depth and 7 mm or less in horizontal spread IA2 stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less - IB - visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm IB1 - visible lesion 4 cm or less in greatest dimension IB2 - visible lesion more than 4 cm Stage II - invades beyond cervix - IIA - without parametrial invasion, but involve upper 2/3 of vagina - IIB - with parametrial invasion Stage III - extends to pelvic wall or lower third of the vagina - IIIA - involves lower third of vagina - IIIB - extends to pelvic wall and/or causes hydronephrosis or non-functioning kidney IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis IVB - distant metastasis Treatment Microinvasive cancer (stage IA) is usually treated by hysterectomy (removal of the whole uterus including pa of the vagina). For stage IA2, the lymph nodes are removed as well. Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or radiation therapy. Larger early stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and cisplatin/ Paclitaxel+Ifosamide+Mesna based chemotherapy, hysterectomy (which then usually requires adjuvant radiation therapy), or cisplatin/ Paclitaxel+Ifosamide+Mesna chemotherapy followed by hysterectomy. Advanced stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy. The use of a combination of two chemotherapy drugs, hycamtin and cisplatin for women with late-stage (IVB) cervical cancer treatment is recommended. Combination treatment has significant risk of neutropenia, anemia, and thrombocytopenia side effects.\n\nSo the answer to this question is C"} {"instruction": "Most common histopathological variety of carcinoma vulva -\nA. Squamous cell carcinoma\nB. Basal cell carcinoma\nC. Adenocarcinoma\nD. Lymphoma", "response": "Ans. is 'a' i.e., Squamous cell carcinoma Vulval cancerso They account for 2-4% of all malignancies of female genital tract.o They are seen mostly in the sixth or seventh deacde of life.o Younger patients with vulval cancer have associated HPV/HIV infection.o Smoking is a risk factor for the development of vulval cancer.o Vulval cancer is associated with cervical and ovarian cancer in 20% of the cases.o Squamous cell carcinomas are the most common histological type accounting for 85% of all vulval cancers.\n\nSo the answer to this question is A"} {"instruction": "This permanent tooth is\nA. Lower medial incisor\nB. Upper medial incisor\nC. First molar\nD. First premolar", "response": "First molar is the first permanent tooth to appear, 6-7 yrs\n\nSo the answer to this question is C"} {"instruction": "ED50 is used for determining\nA. Potency\nB. Efficacy\nC. Safety\nD. Toxicity", "response": "Ed 50 measures potency Ld 50 measures safety or fatality ed50- dose required to produce 50% of the maximum effect LD50- The dose that causes death in 50 percent of the subjects tested Pgno-54 K D Tripathi Seventh edition\n\nSo the answer to this question is A"} {"instruction": "Lisch nodule and somatostatinoma in pancreas is seen in?\nA. Neurofibromatosis\nB. Multiple endocrine neoplasia 2A\nC. Turcot syndrome\nD. Familial adenomatous polyposis", "response": "Ans. (a) Neurofibromatosis* Neurofibromatosis type 1/von Recklinghausen disease caused by inherited gene, the NF1 gene codes for the protein neurofibromin.* Patients with neurofibromatosis develop cafe-au-lait spots, and benign and malignant tumors of the nervous system.* Benign nervous system involvement include neurofibromas, and the malignant include peripheral nerve sheath tumor.* They can also develop distinctive eye lesions called Lisch nodules, and a small percentage develop somatostatinomas of the pancreas/duodenum* The most common cause of death is CNS tumors.Also Know* Turcot syndrome is characterized by intestinal polyposis and CNS tumors: most commonly glioblastoma or medulloblastoma* MEN2A sipple consists of parathyroid adenoma, medullary carcinoma thyroid, phaeochromocytoma.\n\nSo the answer to this question is A"} {"instruction": "Taste loss due to radiation therapy is recovered in:\nA. 2 weeks\nB. 60 - 120 weeks\nC. 60-120 days\nD. Not reversible", "response": "Salivary Gland\n\n60 mGy Xerostomia develops\nTaste Loss – Reversible – recovery 60 to 120 days\n\nSo the answer to this question is C"} {"instruction": "Adverse effects of hypothermia are all except:\nA. Cardiac arrhythmias\nB. Renal failure\nC. Decreased peripheral resistance\nD. Reversible coagulopathy", "response": "C i.e. Decreased peripheral resistance\n\nSo the answer to this question is C"} {"instruction": "A 57-year-old woman presents to the hospital with a 2-hour history of retrosternal chest pain and dyspnea. Her electrocardiogram (ECG) reveals an acute myocardial infarction pattern. Which of the following ECG patterns is consistent with that interpretation?\nA. tall P waves\nB. prominent U waves\nC. small QRS complex\nD. elevated ST segments", "response": "Early ischemic changes are tall, peaked T waves that then develop into inverted T waves. Elevated ST segments and Q waves also occur early.\n\nSo the answer to this question is D"} {"instruction": "SOAP note refers to\nA. Confidentiality of patient record\nB. Classification of patient\nC. Informed consent\nD. Classification of problem", "response": "None\n\nSo the answer to this question is D"} {"instruction": "It is 1:00 A.M. and a hard-working second-year medical student is intent on finishing her pathology reading assignment. Soon she begins to note that her concentration is fading because 7 hours have passed since she had dinner, and she is feeling famished. Having studied the chapter on ischemic heart disease, she decides to be prudent and forgoes her favorite chocolate cookies, and instead devours two apples, gulping them down with a glass of low-fat milk. Of the following substances, which one was most likely to have increased rapidly when she became hungry and decreased promptly after she finished her healthy snack?\nA. a-MSH\nB. Corticotropin-releasing factor (CRF)\nC. Ghrelin\nD. Leptin", "response": "Appetite and satiety are controlled by a complex system of short-acting and long-acting signals. The levels of ghrelin produced in the stomach increase rapidly before every meal and decrease promptly after the stomach is filled. Leptin released from adipocytes exerts long-term control by activating catabolic circuits and by inhibiting anabolic circuits. a-MSH is an intermediate in leptin signaling. TRH and CRF are among the efferent mediators of leptin signaling, and they increase energy consumption.\n\nSo the answer to this question is C"} {"instruction": "A patient with Barrett's esophagus underwent chromoendoscopy. Dye used in this patient for detection of cancer is:\nA. Gentian violet\nB. Toluidine blue\nC. Hematoxylin and eosin\nD. Methylene blue", "response": "Methylene blue dye is taken up by the cytoplasm or absorptive cells such as the normal epithelial cells of the colon and small intestine and goblet cells, which are present in Barrett's epithelium. It will not stain nonabsorptive normal epithelium of the stomach as is found in the cardia and fundus, or normal squamous mucosa of the esophagus. Also know: Chromoendoscopy is a technique for enhancing mucosal detail by spraying a variety of colored solutions. Agents used for chromoendoscopy are; Vital dyes Methylene blue Lugol's solution Toluidine blue Contrast agents Indigo carmine Dilute acetic acid solution Ref: Endoscopic Oncology: Gastrointestinal Endoscopy and Cancer Management edited by Douglas O. Faigel, Michael L. Kochman, 2006, Page 20.\n\nSo the answer to this question is D"} {"instruction": "Which of the following is not a premalignant condition oral cancer?\nA. Leukoplakia\nB. Erythroplakia\nC. Oral submucous fibrosis\nD. Systemic Sclerosis", "response": "Lesions with an increased risk of malignancy on oral cancerPremalignant condition:- Leukoplakia, Erythroplakia, speckled erythroplakia, chronic hyperplastic candidiasisConditions increasing risk:- Oral submucous fibrosis, syphilitics glossitis, sideropenic dysphagia (Peterson Kelly syndrome)The risk is doubtful:- Oral lichen planus, DLE, Dyskeratosis congenital.Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 253\n\nSo the answer to this question is D"} {"instruction": "Cheiloscopy is the study of prints of -\nA. Foot\nB. Fingers\nC. Palate\nD. Lips", "response": "Cheiloscopy is study of lipprints which are divided into 8 patterns. The fissures and grooves are characteristic for an individual. There are 24 characteristics. If 7 to 9 characters tally identification is established. Cheiloscopy is derived from Greek words cheilos -- lips and eskopein - see Lips are unique to one person, except in monozygotic twins Lip grooves are permanent and unchangeable It is possible to identify lip patterns as early as the sixth week of intrauterine life Resist many afflictions, such as herpetic lesions Pathologies that damage the lip subtract like burns seem to rule out cheiloscopy Dr.K.S.Narayana Reddys Synopsis of Forensic Medicine & Toxicology 27th edition pg. 48.\n\nSo the answer to this question is D"} {"instruction": "In Video assisted thoracoscooic surgery for better vision the space in the operative field is created by?\nA. Self retaining retractor\nB. CO2 insufflations\nC. Collapse of ipsilateral lung\nD. Rib spacing", "response": "Ans is 'c' i.e. collapse of ipsilateral lung In contrast to most laparoscopic techniques, the working space for VATs is created not by adding an insuffalation gas but rather by removing air from the ipsilateral lung parenchyma causing collapse of the ipsilateral lung.\n\nSo the answer to this question is C"} {"instruction": "Aminoacyl t-RN A is required for all except :\nA. Hydroxyproline\nB. Methionine\nC. Cystine\nD. Lysine", "response": "A i.e. Hydroxyproline\n\nSo the answer to this question is A"} {"instruction": "Nicoladoni sign is also known as\nA. Branham sign\nB. Murray sign\nC. Frei's sign\nD. Darrier's sign", "response": "In medicine, the Nicoladoni sign, also Branham sign and Nicoladoni-Israel-Branham sign, is the slowing of the hea rate in response to (manual) compression of an aeriovenous fistula. Robbins 9 th edition page no. 365 onwards\n\nSo the answer to this question is A"} {"instruction": "The outcome following resuscitation of cardiac arrest is worsened if during resuscitation patient is given:\nA. Ringer's lactate\nB. Colloids\nC. 5% Dextrose\nD. Whole blood transfusion", "response": "C i.e. 5% Dextrose Glucose containing solutions should not be used in I.V. lines during treatment of shock or cardiac arrestQ because the amount needed to maintain B.P. would cause pulmonary edema and congestive hea failure d/t volume overload. In high risk patients, I.V. glucose solutions should be avoided Q or used judiciously and blood glucose concentration should be maintained within the normoglycemic range until the patients have passed the period of high risk for hemodynamic compromise.\n\nSo the answer to this question is C"} {"instruction": "In proteins the α-helix and β-pleated sheet are examples of:\nA. Primary structure\nB. Secondary structure\nC. Tertiary structure\nD. Quaternary structure", "response": "The term “secondary structure” denotes the configurational relationship between residues, which are about 3–4 amino acids apart in the linear sequence.\nReference: Vasudevan 7th ed, pg 36\n\nSo the answer to this question is B"} {"instruction": "One unit of fresh blood raises Hb% ( Hemoglobin concentration ) by\nA. 0.1gm%\nB. 0.5 gm %\nC. 1gm%\nD. 2 gm%", "response": "Single unit of whole blood raises Hb by 1 gm% and Hematocrit by 3% More than 70% of transfused cells will be ble after 24 hours Ref: Harrison's 19th edition Pgno :138\n\nSo the answer to this question is C"} {"instruction": "Liver segment which is physiologically independent?\nA. Segment I\nB. Segment II\nC. Segment III\nD. Segment IV", "response": "Caudate lobe (segment I) is a physiological independent pa of liver, supplied by both right and left hepatic aeries; right and left branches of poal vein and drains bile into both right and left hepatic duct.\n\nSo the answer to this question is A"} {"instruction": "Rectal incontinence is due to involvement of :a) External anal sphincterb) Internal anal sphincterc) Ischiococcygeusd) Pubococcygeus\nA. acd\nB. bcd\nC. abc\nD. abd", "response": "Rectal continence depends solely on the anorectal ring and any damage to this ring results in rectal incontinence.\nThe anorectal ring is a muscular ring present at the anorectal junction, and formed by the fusion of -\n\nPuborectalis (a part of pubococcygeus which in turn is a part of levator ani)\nDeep external anal sphincter\nInternal anal sphincter\n\nThe puborectalis muscle appears to be the most important muscle for maintaining fecal continence.\n\nSo the answer to this question is D"} {"instruction": "Which of the following lesions is NOT an infection from human papilloma virus?\nA. Verruca vulgaris\nB. Focal epithelial hyperplasia\nC. Condyloma acuminatum\nD. None of the above", "response": "None\n\nSo the answer to this question is D"} {"instruction": "An 18-year-old man is found to have metabolic alkalosis and hypokalemia. What could this be secondary to?For the above patient with a medical problem, select the most likely diagnosis or renal impairment.\nA. polycystic kidney disease\nB. medullary sponge kidney\nC. medullary cystic disease\nD. Bartter syndrome", "response": "Bartter syndrome and Liddle syndrome can be inherited in an autosomal dominant fashion. Patients with Liddle syndrome have hypertension, whereas those with Bartter syndrome do not. In both syndromes, hypokalemia is prominent.\n\nSo the answer to this question is D"} {"instruction": "True statements about DNA structure\nA. All nucleotides are involved in linkage\nB. Antiparallel\nC. Parallel\nD. Bases are perpendicular to DNA", "response": "Nucleotides polymerise by forming bonds between the carbon of the sugar and an oxygen atom of the phosphate. The bases do not take pa in the polymerisation, so the chain is held together by a sugar-phosphate backbone with the bases extending off it. This means that the nucleotides can join together in any order along the chain. Many nucleotides form a polynucleotide. A polynucleotide has a free phosphate group at one end and a free OH group at the other end.\n\nSo the answer to this question is A"} {"instruction": "Commonest causative organism of corneal ulcer is:\nA. Pneumococci\nB. Streptococci\nC. Staphylococci\nD. Fungal", "response": "Ans. Staphylococci\n\nSo the answer to this question is C"} {"instruction": "Parkland formula is: (Repeat)\nA. %of burn area*body wt*4\nB. %of burn area*body wt / 4\nC. %of burn area*body surface area*4\nD. %of burn area*body surface area / 4", "response": "Ans: A (% of burn area* body wt*4) Ref: Nelson's Textbook of Pediatrics. 19th EditionExplanation:Parkland's FormulaTotal percentage body surface area x weight (kg) x 4 = volume (ml)Half this volume is given in the first 8 hours, and the second half is given in the next 16 hours\n\nSo the answer to this question is A"} {"instruction": "The long term objective of national programme for prevention and control of deafness is:-\nA. To reduce disease burden by 25% by end of XII five year plan\nB. To reduce disease burden by 50% by end of XII five year plan\nC. To reduce disease burden by 75% by end of XII five year plan\nD. To reduce disease burden by 100% by end of XIIfive year plan", "response": "Long term objective: To reduce disease burden by 25% by end of XI five year plan. National programme for prevention and control of deafness: OBJECTIVES :1. To prevent avoidable hearing loss on account of disease or injury.2. Early identification, diagnosis and treatment of ear problems responsible for hearingloss and deafness.3. To medically rehabilitate persons of all age groups, suffering with deafness.4. To strengthen the existing inter-sectoral linkages for continuity of the rehabilitationprogramme, for persons with deafness.5. To develop institutional capacity for ear care services by providing suppo forequipment, material and training personnel. Long term objective: To prevent and control major causes of hearing impairment anddeafness, so as to reduce the total disease burden by 25% of the existing burden by the endof 12th Five Year Plan\n\nSo the answer to this question is A"} {"instruction": "Fat necrosis is common in -\nA. Omentum\nB. Breast\nC. Retroperitoneal fat\nD. All of the above", "response": "There are 2 Types of Fat Necrosis 1. Enzymatic fat necrosis This is due to action of lipase on adipose tissue. It occurs most frequently in acute pancreatitis due to leakage of lipase. Depending on the severity of acute pancreatitis, fat necrosis may occur in : Adipose tissue contiguous to pancrease, i.e., retroperitoneal fat. Adipose tissue in anterior mediastinum. Bone marrow Omental and abdominal fat 2. Nonenzymatic or Traumatic fat necrosis Occurs due to trauma Is seen in subcutaneous tissue of breast, thigh, and abdomen.\n\nSo the answer to this question is D"} {"instruction": "A 29-year-old woman was found to have Hb of 7.8mg/dl with a reticulocyte count of 0.8%. The peripheral blood smear showed microcytic hypochromic anemia. On HPLC, Hb A2 and Hb F was 2.4% and 1.3% respectively. The serum iron and TIBC were 15mg/dl and 420 micro g/dl respectively. The most likely cause of anemia is:\nA. Iron deficiency anemia\nB. Beta thalassemia minor\nC. Sideroblastic anemia\nD. Anemia due to chronic infection", "response": "Here seum iron is reduced and TIBC is on the higher side. These are the first major pointers towards iron deficiency anaemia. This rules out Beta thalassemia minor and anemia due to chronic infection. Second pointer towards iron deficiency anemia is reduced Hb A2, which should haven been in a range of 4-9% in case of beta thalassemia trait. Sideroblastic anemia can be ruled out as it reveals a dimorphic blood picture. Parameter Iron deficiency anaemia Anaemia of chronic disease b Thalassaemia 1. MCV | N or | Markedly |sed 2. RDW | | or N | or N 3. Red cell morphology Microcytic hypochromic, pencil cells, anisocytosis Normocytic normochromic or microcytic hypochromic Microcytic hypochromic, basophilic stippling, target cells, polychromasia 4. Red cell count | | N 5. Serum iron | | N 6. TIBC | | N 7.Transferrin saturation | |or N | or N 8. FEP | | N 9. Serum TfR | N | 10. Serum ferritin decreases Increased or normal Normal 11. Hb electrophoresis Normal Normal HbA2>3.5% 12. Marrow haemosiderin Low or absent Normal or increased Normal\n\nSo the answer to this question is A"} {"instruction": "The most common tumor of the minor salivary gland is -\nA. Mucoepidermoid carcinoma\nB. Acinic cell carcinoma\nC. Adenoid cystic carcinoma\nD. Pleomorphic adeno carcinoma", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Drug of choice in Neonatal ITP is –\nA. Platelet transfusion\nB. Prednisolone\nC. Dexamethasone\nD. Gammaglobulin", "response": "Treatment of neonatal ITP\n\nPrenatal administration of corticosteroids to mother.\nIV immunoglobulin or sometimes corticosteroids to the infant after delivery.\n\nTreatment of ITP in children\n\nIV immunoglobulin is the treatment of choice.\nGlucocorticoids are often used in combination.\n\nSo the answer to this question is D"} {"instruction": "Oogonia are derived from\nA. Yolk sac\nB. Germinal epithelium\nC. Chorion\nD. Mesoderm", "response": "Inderbir Singh&;s; Human Histology; Seventh edition; Pg 346The stem cells from which ova are derived are called Oogonia. These are large round cells present in the coex of the ovary. Oogonia are derived from the primordial germ cells that are formed in the region of the yolk sac and migrate into the developing ovary\n\nSo the answer to this question is A"} {"instruction": "All of the following are true about liver transplantation except:\nA. MC indication of LT is alcoholic liver disease\nB. Two recipients are benefitted in split liver transplantation\nC. Choledocho-choledochostomy is preferred over choledochojejunostomy\nD. Sequence of anastomosis: 1. Supra hepatic IVC 2. Infra hepatic IVC 3. Poal vein 4. Hepatic aery 5. Bile duct", "response": "Split Liver transplantation: Brain dead cadaver - transplant Right lobe for Adult and Left Lobe for child. i.e Two recipients are benefited. Sequence of anastomosis in liver transplant; Donor's Bile duct anastomosed with recipients bile duct: Choledococholedostomy (preferred) If recipient's bile duct is diseased or cannot be used donor bile duct is attached to the jejunum: choledochojejunostomy\n\nSo the answer to this question is A"} {"instruction": "All of the following are the criteria for weaning the patient from ventilation except :\nA. Vital capacity: >10 mL/kg\nB. Tidal volume: 4-6ml/kg\nC. Minute ventilation: 10 L/min\nD. Rapid shallow breathing index: <120", "response": "Mechanical criteria for weaning or extubation : Inspiratory pressure: -20-30cm H2O Tidal volume: 4-6ml/kg Vital capacity: >10 mL/kg Minute ventilation: 10L/min Rapid shallow breathing index: <100\n\nSo the answer to this question is D"} {"instruction": "School water fluoridation is considered as the primary preventive service provided by the\nA. Community\nB. Individual\nC. Dental professional\nD. None of the above", "response": "None\n\nSo the answer to this question is A"} {"instruction": "All of the following anticancer agents cause bone marrow depression except -\nA. Chlorambucil\nB. Daunorubicin\nC. Doxarubucin\nD. Flutamide", "response": "Ans. is 'd' i.e., Flutamine Flutamide is a non steroidal drug having specific antiandrogenic, but no other hormonal activity. o Daunarubicin, Doxorubicin and chlorambucil are all known agents for bone marrow depression.\n\nSo the answer to this question is D"} {"instruction": "How many doses of vitamin A are required to treat deficiency -\nA. 1\nB. 2\nC. 3\nD. 4", "response": "Ans. is 'c' i.e., 3 o Treatment schedule as recommended bv WHOAgeDay 0 (immediately)Day / (next day)After 2 week to 4 week> 1 year (except women of reproductive age)2 lakh IU orallyor1 lakh IU inti2 lakh IU orallyor1 lakh IU imi2 lakh IU orallyor1 lakh IU imi< 1 year or any age but < 8 kg50.000 IU orally50,000 IU orally50,000 IU orallyo Treatment schedule applies to all stages of active xeropthalmiao Oral administration is the recommended method of treatmento Intramuscular injection schould be preferred in presence of repeated vomiting and severe diarrhea\n\nSo the answer to this question is C"} {"instruction": "What is the diagnosis demonstrated in the barium esophagogram?\nA. Achalasia\nB. Schatzki's ring\nC. Nut cracker esophagus\nD. Carcinoma esophagus", "response": "Barium oesophagram demonstrating advanced carcinoma with abrupt, irregular narrowing of the distal oesophagus, with more proximal dilation and an air-fluid level . ref - harrisons internal medicine 20e pg566,567\n\nSo the answer to this question is D"} {"instruction": "In follow up of BPH, a most impoant indication of surgery is\nA. Prostate size >75gm\nB. Single episode of UTI requiring 3 day antibiotics\nC. Cannot use medication due to hypeension\nD. Bilateral hydronephrosis", "response": "Surgery should be recommended for patients who continue to be bothered by their symptoms or who experience urinary retention despite medical therapy. Surgery should also be recommended for patients with upper tract dilation, renal insufficiency secondary to BPH, or bladder stones.\"- Schwaz 8/e p1530 About other options: Prostate Size: Treatment of BPH is primarily dictated by patient's symptoms and not by the prostate size. However the size of prostate can decide whether to go for endoscopic method of treatment or open surgical procedure. Open surgery is more effective than endoscopic methods for prostates weighing >100gm UTI: Recurrent episodes of UTI (and not a single episode) are an absolute indication for surgery of prostate. Hypeension: Alpha blockers which are first line medical therapy for BPH lower the blood pressure and thus are helpful in hypeensive persons. Management of BPH Management is primarily directed by symptoms. Mild symptoms can be managed with watchful waiting. More severe symptomatic patients are treated with medicines (alpha blockers, 5-alpha reductase inhibitors or combination of both). Surgery is recommended if the patient is having problems despite medical therapy. Absolute indications for surgery as listed in Smith's Urology is given below. Absolute indications for surgical treatment of BPH Refractory urine retention (failing at least one attempt at catheter removal) Recurrent UTI from BPH Bladder stones d/t BPH Renal insufficiency d/t BPH Large bladder diveicula secondary to BPH Recurrent gross hematuria from BPH Upper tract dilatation is an indication for surgery according to Schwaz. Medical therapy Alpha-blockers (terazosin, doxazosin, and tamsulosin) Alpha-blockers help is reducing the symptoms of BPH by blocking the alpha 1 adrenoreceptors present in human prostate and bladder base. 5-Alpha-reductase inhibitors (Finasteride, Dutasteride) - 5-alpha-reductase inhibitors block the conversion of testosterone to dihydrotestosterone. This thus results in reduction in the size of the gland and improvement in symptoms (after several months of use). Surgery Surgery for BPH is most commonly performed endoscopically; however, if the prostate gland is quite large (approx >100 g), an open prostatectomy should be performed. The standard endoscopic procedure for BPH is a transurethral resection (TUR) of the prostate. Conventional surgical methods: Transurethral resection of the prostate (most commonly used method) Transurethral incision of the prostate (TUIP) Open simple prostatectomy (simple suprapubic prostatectomy, simple retropubic prostatectomy) - When the prostate is too large to be removed endoscopically, an open enucleation is necessary. What constitutes \"too large\" is subjective and varies depending upon the surgeon's experience with TURP. Glands >100 g are usually considered for open enucleation. Open prostatectomy may also be initiated when concomitant bladder diveiculum or a bladder stone is present or if dorsal lithotomy positioning is not possible. Open prostatectomies can be done with either a suprapubic or retropubic approach. A simple suprapubic prostatectomy is performed transvesically and is the operation of choice in dealing with concomitant bladder pathology. Minimally invasive methods: Laser therapy (Nd:YAG and holmium:YAG ) Transurethral electro vaporization of the prostate Microwave Hypehermia Transurethral needle ablation of the prostate- High-intensity focused ultrasound for thermal tissue ablation Intraurethral stents--stents are endoscopically placed in the prostatic fossa and are designed to keep the prostatic urethra patent. They are usually covered by urothelium within 4-6 months after inseion. These devices are typically used for patients with limited life expectancy who are not deemed to be appropriate candidates for surgery or anesthesia. Ref : Schwaz 8/e p1528-31\n\nSo the answer to this question is D"} {"instruction": "Which of the following clinical conditions is not an indication for induction of labor?\nA. Intrauterine fetal demise\nB. Severe preeclampsia at 36 weeks\nC. Complete placenta pre\nD. Chorioamnionitis", "response": "(Cunningham, 21/e, p 470.) Placenta pre is a contraindication to labor because the placenta is ahead of the presenting pa covering the cervix and vaginal delivery would result in hemorrhage. Intrauterine fetal demise, preeclampsia, chorioamnionitis, are all indications to induce labor.\n\nSo the answer to this question is C"} {"instruction": "Three point bony relationship around the elbow is not disturbed in which of the following -\nA. Fracture supracondylar humerus\nB. Fracture medial condyle of distal humerus\nC. Fracture lateral condyle of distal humerus\nD. Posterior dislocation of elbow", "response": "Ans. is 'a' i.e., Fracture supracondylar humerus * The three prominent bony points around elbow are medial epicondyle, lateral epicondyle and tip of the olecranon. The relationship of these three bony points is important in the diagnosis of injuries around the elbow. Normally, In 90deg flexed position of elbow, these three bony points form a near Isoceles triangle. In extension all three lies in a straight horizontal line.* In elbow injuries, following is seen in three bony relationship : -A) Maintained# Three point bony relationship is maintained in supracondylar fracture humerus. This is easy to understand, as the fracture is above all these three bony point, relationship in themselves is maintained. So, if fracture is above or below these 3 points, their relationship will be maintained.B) Disturbed# If injury involves a region at or in between these three bony point, their relationship will be disturbed. Such injuries are : -1) With increased intercondylar distance* The distance between two epicondyles (intercondylar distance) is increased.* Obviously, the injury is involving the region anywhere from lateral epicondyle to medial epicondyle: -i) Fracture medial epicondyle and/or condyle.ii) Fracture lateral epicondyle and/or condyleiii) Fracture intercondylar region2) With maintained intercondylar distance* The distance between two epicondyles is maintained as the intercondylar region is not involved : -i) Fracture olecranon (i.e., Upper ulna)ii) Dislocation of elbow\n\nSo the answer to this question is A"} {"instruction": "Vision 2020 - The Right to Sight do not include :-\nA. Centres for Vision - 20\nB. Training Centres - 200\nC. Service Centres - 2000\nD. Vision Centres - 20,000", "response": "VISION 2020: The Right to Sight- was launched in 1999 - Centres of excellence-20 - Training centres-200 - Service centres-2000 - Vision centres-20,000 - Main aim of vision-2020 is to eliminate all causes of avoidable blindness, i.e Preventable blindness - Vit A deficiency , trachoma Curable blindness - cataract\n\nSo the answer to this question is A"} {"instruction": "All are tests to check eustachian tube patency except -\nA. Valsalva maneuver\nB. Fistula test\nC. Frenzel's maneuver\nD. Toynbee's maneuver", "response": "This question can be solved even if we dont know all tests for eustachian tube patency, because we know fistula test is for assessing vestibular functions and not for Eustachian tube patency. Still it is worth while knowing tests for eustachian tube patency.\n\nSo the answer to this question is B"} {"instruction": "Anterior wall of axilla is formed by\nA. Pectoralis major\nB. Humerus\nC. Latissimus dorsi\nD. Teres major", "response": "Anterior wall of axilla is formed by pectoralis major in front, clavipectoral fascia, and pectoralis minor. Upper pa of shaft of humerus in the region of bicipital groove forms a pa of lateral wall of axilla.Posterior wall of axilla is formed by latissimus dorsi below along with subscapularis and teres major.B D Chaurasia 7th edition Page no: 49\n\nSo the answer to this question is A"} {"instruction": "A 45 - year old cirrhotic patient presented with severe haematemesis. The management of choice is -\nA. Whole blood transfusion is the best\nB. Colloids are preferred over crystalloids\nC. Normal saline infusion\nD. IV fluid with diuretics", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Which of the following is the most significant risk factor for postoperative nausea and vomiting\nA. Female gender\nB. Smoking\nC. Age over 60 years\nD. Surgery on the breast", "response": "Postoperative nausea and vomiting is most common in women, young people, and patients who have received opioids during surgery. Surprisingly, perhaps the one advantage of smoking is that smokers tend to have less postoperative nausea and vomiting than nonsmokers. Similarly, the incidence of postoperative nausea and vomiting is lower in the geriatric population.\n\nSo the answer to this question is A"} {"instruction": "In uveitis, site of keratic precipitate is:\nA. Corneal endothelium\nB. Lens anterior pa\nC. Lens posterior pa\nD. Corneal stroma", "response": "Ant uveitis m/c - idiopathic 2n/m/c - ankylosing spondylitis Sign - 1. Circumciliary congestion 2. Cells - wbc, neutrophilic in a/c (earliest / hallmark) 3. Flare - protein deposition in aqueos humor 4. Keratic precipitate - neutrophils & lymphocytes in cornea 5. Iris nodules Koepp's - on pupillary margin Busaccas - surface of iris 6. Synechiae Ant - glaucoma Post - cataract Small pupil + low I.P Rx - topical steroid (D/O/C) Cycloplegic\n\nSo the answer to this question is A"} {"instruction": "All joints are involved in acute gout except:\nA. MTP\nB. Gleno-humeral joint\nC. Ankle joint\nD. Knee joint", "response": "Other than the great toe, the most common sites of gouty ahritis are the ankle, wrist, finger joints, and knee. In early gout, only 1 or 2 joints are usually involved. Consider the diagnosis in any patient with acute monoaicular ahritis of any peripheral joint except the glenohumeral joint of the shoulder.\n\nSo the answer to this question is B"} {"instruction": "A 50-year-old man has been having fainting \"spells\" for about 2 weeks. During the episodes, his ECG shows a ventricular rate of 25 beats/min and 100 P waves per minute. After about 30 seconds of fainting, a normal sinus rhythm recurs. What is his likely diagnosis?\nA. First-degree A-V block\nB. Second-degree A-V block\nC. Third-degree A-V block\nD. Stokes-Adams syndrome", "response": "Periodic fainting spells is known as Adams Stokes syndrome Reason: Fluctuating third degree AV block in heas with borderline ischemia of conductive system. Complete AV block -Brain cannot remain active for more than 4-7 sec without blood supply -fainting episode - ventricular escape from overdrive suppression occurs in 5-30 sec - rapid recovery from the faint and then to sustain the person. AV block types: 1. First degree block: prolonged P-Q or P-R interval >0.20, not actual blockage but delay of conduction. 2. Second degree block: a. Wenckebach or Mobitz type 1: progressive P-R prolongation followed by a dropped beat. Abnormality in AV node. b. Mobitz type 2: A fixed number of non-conducted P waves for every QRS complex. P-R interval constant. Ex: 3:1, 3:2, 2:1. Abnormality in bundle of His-Purkinje system. 3. Third degree hea block: Complete AV block. SA and AV node dissociation leading to idioventricular rhythm (ventricular escape as Purkinje fibres becomes new pacemaker, 15-40 beats/min).\n\nSo the answer to this question is D"} {"instruction": "Initial resuscitation of a trauma patient is best done by administration of which of the following?\nA. D5W\nB. D5W and 0.45% normal saline\nC. Ringer's lactate solution\nD. 5% plasma protein solution", "response": "- Initial resuscitation of a trauma patient is best done by administering Ringer's lactate, because it is isotonic, and it is similar to plasma in electrolyte composition. - There is no conclusive evidence that colloid solutions (albumin, plasma protein solution, or hydroxyethyl starch solution) improve the rate of resuscitation or eventual outcome. -D5W and 0.45% normal saline are hypotonic hence not used in this case. - Use of crystalloid solutions also aids in resuscitation of interstitial compament\n\nSo the answer to this question is C"} {"instruction": "Methanol toxicity causes blindness due to the formation of: March 2010\nA. Formic acid\nB. Formaldehyde\nC. Lactic acid\nD. Pyruvic acid", "response": "Ans. A: Formic Acid The initial step in the metabolism of methanol involves the enzyme alcohol dehydrogenase (ADH). First, methanol is slowly oxidized by ADH to yield formaldehyde. Next, formaldehyde is oxidized by formaldehyde dehydrogenase to yield formic acid (or formate, depending on the pH). This oxidation occurs rapidly so that little formaldehyde accumulates in the serum. Finally, formic acid is metabolized to carbon dioxide and water, which are excreted by the kidneys and lungs. The accumulation of formic acid is responsible for the presence of metabolic acidosis. Formic acid also inhibits cellular respiration leading to lactic acidosis. The ocular injury caused by methanol may be due to retinal injury, which results from intra-retinal metabolism of methanol and the accumulation of formic acid. Alternatively, it may be caused be the inhibition of normal metabolism in optic nerve calls.\n\nSo the answer to this question is A"} {"instruction": "Which of the following is not used in acute gout -\nA. Allopurinol\nB. NSAIDs\nC. Corticosteroid\nD. Colchicine", "response": "Ans. is 'a' i.e., Allopurinol o NSAIDs are the drug of choice for acute gout -They are prefered over colchicine because they are better toleratedo Indomethacin is often chosen because of its strong anti-inflammatory action and efficacy. - Laurence 9th/e 297Drugs used in acute gouti) NSAIDs - Drug of choiceii) Colchicineiii) Corticosteroidso Allopurinol and uricosuric drugs (sulfinpyrazone, probenacid) are not effective in acute gout because they will not relieve symptoms as they dont have antiinflammatory property.\n\nSo the answer to this question is A"} {"instruction": "Phacoemulsification includes\nA. Hydrodissection\nB. Hydrodeliniation\nC. Continuous curvilinear capsulorrhexis\nD. All of the above", "response": "PHACOEMULSIFICATION Steps: 1. Corneoscleral incision required is very small (3 mm). Therefore, sutureless surgery is possible with self-sealing scleral tunnel or clear corneal incision made with a 3 mm keratome. 2. Continuous curvilinear capsulorrhexis (CCC) of 4-6 mm. 3. Hydrodissection i.e., separation of capsule from the coex by injecting fluid exactly between the two is must for phacoemulsification in SICS. This procedure facilitates nucleus rotation and manipulation during phacoemulsification. Some surgeons also perform hydrodelineation 4. Nucleus is emulsified and aspirated by phacoemulsifier. Phacoemulsifier basically acts through a hollow 1-mm titanium needle which vibrates by piezoelectric crystal in its longitudinal axis at an ultrasonic speed of 40000 times a second and thus emulsifies the nucleus. 5. Remaining coical lens matter is aspirated with the help of an irrigation-aspiration technique. 6. Next steps i.e., IOL implantation, removal of viscoelastic substance and wound closure. Ref:- A K Khurana; pg num:-191,193\n\nSo the answer to this question is D"} {"instruction": "nerve of olfaction is ?\nA. 1\nB. 9\nC. 5\nD. all the above", "response": "nerves of olfaction = 1,7,9,5,10 OLFACTORY SYSTEM * Olfactory epithelium- receptor cells, suppoing cells and basal cells Receptor cells are bipolar neurons, distal process carries cilia that project into nasal cavity. Cilia have receptors for odoriferous molecules. Axons from the olfactory sensory neurons converge in the cy.. bulb to form clusters called glomeruli. These nerve fibers,are lacking in myelin sheaths. The glomerulus is a spherical structure located in the olfactory bulb of the brain where synapses form between the terminals of the tufted cell.and the dendrites of mitral, periglomerular and ref : guyton and hall\n\nSo the answer to this question is D"} {"instruction": "All of the following statements about Digoxin induced arrhythmia's are true, except:\nA. Bi ventricular Tachycardia\nB. Paroxysmal Atrial Tachycardia with variable AV block\nC. Ventricular Bigeminy\nD. May be used to treat Atrial Fibrillation", "response": "The most frequent disturbances of cardiac rhythm associated with digitalis intoxication are ventricular premature beats, bigeminy, ventricular tachycardia and rarely ventricular fibrillation. AV block and nonparoxysmal atrial tachycardia with variable AV block are characteristic of intoxication. Ref: Harrison's 16th Edition, Page 1375\n\nSo the answer to this question is A"} {"instruction": "which of the following is a tricyclic antidepressent\nA. seraline\nB. clomipramine\nC. bupropion\nD. fluvoxamine", "response": "TCA * MECHANISM This is an antidepressant with three rings. It acts by blocking the transpoers of neurotransmitters resulting in increased neurotransmitters in synapse DRUGS AMITRYPTILLINE IMIPRAMINE CLOMIPRAMINE DESIPRAMINE NORIPTILLINE DOXEPINE * USE AMITRYPTILLINE========PAIN WITH DEPRESSION IMIPRAMINE==========CHILDHOOD ENEURESIS CLOMIPRAMINE========OCD * SIDE EFFECTS ANTI HISTAMINERGIC==== sedation, weight gain ANTI MUSCURANIC=======dryness of mouth ANTI ADRENERGIC========hypotension, giddiness SWITCH TO MANIA when used in BIPOLAR DEPRESSION Ref. kaplon and Sadock, synopsis of psychiatry, 11 th edition, pg no 955\n\nSo the answer to this question is B"} {"instruction": "Nevirapine is -\nA. NRTI\nB. NNRTI\nC. E-TI\nD. FI", "response": "Ans is 'b' i.e., NNRTI o Nevirapine is NNRTIThese drugs inhibit reverse transcriptase by acting at a site (allosteric site) different from NRTIs.These are selective for HIV-1 and have no activity against HIV-2.Resistance to these drugs develops very rapidly.o NNRI drug groupEfavirenz, nevirapine, etravirtue and delavirdine,o Mechanism of action :These are nucleotide unrelated compounds which directly inhibit HIV reverse transcriptase without the need for intracellular phosphory-lation.Adverse effectsRashes (Steven Johnson Syndrome & Toxic epidermal necrolysis)NauseaHeadach, FeverRise in live enzyme (hepatotoxic)o Nevirapine is used in pregnancy to prevent vertical transmission.o It decrease transmission to 13% as compared to 21.5% by zidovudine.o NNRTI donot cause lipodystrophy like NRTIs and RTIs# Nevirapine and efavirenz are enzyme inducers and delaviridine is enzyme inhibitor.\n\nSo the answer to this question is B"} {"instruction": "Which of the following factors determines whether a patient develops acromegaly or gigantism?\nA. Sex\nB. Age at onset of the tumor\nC. Amount of available calcium\nD. Degree of function of the tumor", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Glassgow Coma scale of a patient with head injury- He is confused, able to localize on right side and does flexion on left side and Opens eye for painful stimuli on Sternum.\nA. 8 points\nB. 9 points\nC. 10 points\nD. 11 points", "response": "Ref. Sabiston Textbook of Surgery. Pg. 411\n\nSo the answer to this question is D"} {"instruction": "Superimposition technique is used in -\nA. Skull\nB. Pelvis\nC. Femur\nD. Ribs", "response": "Superimposition technique determines whether the skull is that of a person in a photograph or not.\n\nSo the answer to this question is A"} {"instruction": "The frequency of a disease or characteristic expressed per unit size of the population or group in which it is observed is\nA. Rate\nB. Ratio\nC. Proportion\nD. Average", "response": "None\n\nSo the answer to this question is A"} {"instruction": "All are tests for stoppage of circulation EXCEPT:\nA. Magnus test\nB. Winslow's test\nC. Icard's test\nD. Diaphanous test", "response": "Tests of respiration: Winslow’s test- No movement of reflection of light shone on mirror, or surface of water in bowl, kept on the chest. Tests of circulation: (1) Magnus test (ligature test): Fingers fail to show congestion & swelling to a ligature applied at their base. (2) Diaphanous test (transillumination test): Failure to show redness in the web-space between the fingers on transillumination from behind. (3) Icard’s test: Fluorescein dye on being injected at a given site in a dead body fail to produce yellowish-green discolouration in a dead body.)\n\nSo the answer to this question is B"} {"instruction": "Carotid sinus massage will terminate: March 2005\nA. Atrial flutter\nB. Atrial fibirillation\nC. Supraventicular arrythmia\nD. Suprventicular tachycardia", "response": "Ans. D: Suprventicular tachycardia Carotid sinus massage is a simple bedside maneuver that helps to clarify the type and sometimes also the mechanism of different rhythm disturbances. The major indication for carotid sinus massage is the diagnosis of tachyarrhythmias in which the atrial activity is either absent or intermittently present. Carotid sinus massage is also useful in altering conduction within the AV node. Vagal stimulation,such as occurs with the Vasalva maneuver or carotid sinus massage can slow conduction in the AV Node sufficiently to terminate AVN/ PSVT (aerioventricular nodal reentrant tachycardia). It is also helpful in some patients with normal hea rates; increased vagal tone may normalize a bundle branch block or localize the site of type I second-degree atrioventricular block and can be used for evaluation of the sensing function of permanent pacemakers. Carotid sinus massage is also an impoant diagnostic procedure in patients with suspected hypersensitivity of the carotid sinus. Massage of the carotid sinus is contraindicated in patients with diseased carotid aeries because of the risk of cerebrovascular accident. In rare instances, carotid sinus massage may initiate ventricular tachycardia.\n\nSo the answer to this question is D"} {"instruction": "Drug of choice for Acute Anterior Uveitis\nA. Topical Steroids\nB. Atropine\nC. Systemic Steroids\nD. NSAIDS", "response": "Atropine Is the Drug of choice for Acute Anterior Uveitis, due to\n\nRelieves of Ciliary spasm\nPreventing posterior synichae\nReduce candatis and reduces the signs\n\nSo the answer to this question is B"} {"instruction": "The embrasure areas in the following areas are continuous\nA. Labial and Lingual\nB. Lingual and Occlusal\nC. Incisal and Occlusal\nD. Labial and Occlusal", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Drug of choice in Acute central anticholinergic syndrome is -\nA. Neostigmine\nB. Physostigmine\nC. Tacrine\nD. 4-amino pyridine", "response": "Ans. is 'b' i.e., Physostigmine Physostigmine penetrates blood-brain barrier and antagonizes both central and peripheral actions of anticholinergics in acute anticholinergic poisoning (belladonna poisoning). About other options o Neostigmine does not cross blood brain barrier. Thus it is ineffective for central anticholinergic actions. o Tacrine is used for chronic central anti-cholinergic syndrome (Alzhiemer's disease).\n\nSo the answer to this question is B"} {"instruction": "True about carbamoyl phosphate synthase ?\nA. Mitochondria] enzyme\nB. Cytosolic enzyme\nC. Catalyzes condensation reaction\nD. All are true", "response": "Ans. is 'd' i.e., All are true There are two types of carbamoyl phosphate synthase (CPS) :?CPS - I:- catalyzes the condensation of CO2 and ammonia to form carbomoyl phosphate in urea cycle. It is a mitochondrial enzyme.CPS - II:- It is a cytosolic enzyme and paicipates in pyrimidine synthesis.\n\nSo the answer to this question is D"} {"instruction": "Whole-body iodine scan after total thyroidectomy is not recommended for which thyroid cancer ?\nA. Papillary thyroid cancer\nB. Anaplastic thyroid cancer\nC. Medullary thyroid cancer\nD. Follicular thyroid cancer", "response": "Whole-body iodine scan is recommended for differentiated thyroid cancer , which fulfill following conditions : Tumors - between 1cm-4cm Confined to the thyroid Do not have nodal or distant metastasis, Adverse histologic subtype (tall cell) Vascular invasion. =Unlike differentiated thyroid cancer, Medullary thyroid carcinoma cells do not concentrate radioactive iodine and are not sensitive to manipulation of thyroid-stimulating hormone.\n\nSo the answer to this question is C"} {"instruction": "The youngest lens fibres are present in:\nA. Central core of the lens nucleus\nB. Outer layer of the nucleus\nC. Deeper layer of the coex\nD. Superficial layer of the coex", "response": "Ans. Superficial layer of the coex\n\nSo the answer to this question is D"} {"instruction": "Which of the following is true regarding nerve injury?\nA. In all cases of open wound with clinical signs of nerve injury, nerve exploration should always be done.\nB. Nerve conduction velocity is best predictor within 48 hours of injury.\nC. Traction nerve injury should be repaired immediately.\nD. Postive Tinel's sign indicates the accurate location of the lesion.", "response": "None\n\nSo the answer to this question is A"} {"instruction": "A 30 yrs woman 2+0, hypertension have menorrhagia. Which is the best treatment for her -\nA. Combined pills\nB. MIRENA\nC. Hysterectomy\nD. Transcervical resection of endometrium", "response": "Ans. is 'b' i.e., MIRENA * The question does not give any clue regarding the etiology of menorrhagia, so most probably the women are havingD.U.B. i.e., dysfunctional uterine bleeding. When a woman present with menorrhagia, consideration must first be given to diagnosis.This requires an appropriate history and clinical examination completed by the suitable investigation.Anemia should be detected by full blood count and iron studies.Ultrasonography, sonohysterography, and hysteroscopy are additional investigations that may diagnose a structural problem and should be utilized depending on their availability and the experience of the surgeon.Common causes of menorrhagia include local pathologies such as fibroids, polyps, adenomyosis or infection.Rarer, but important causes include genital malignancy (cervical, endometrial or myometrial) and systemic disorders such as thyroid disease and bleeding disorders.In over 50% cases no cause is found and the diagnosis of dysfunctional uterine bleeding is made.Dysfunctional uterine bleeding requires the following criteria: -Complaint of excessive menstrual blood loss (menorrhagia).Adequate exclusion of pathology that may otherwise cause menorrhagia.Dysfunctional uterine bleeding may be ovulatory or nonovulatory.Anovulatory cycles result in menorrhagia with regular cycles were asOvulatory cycles result in menorrhagia with irregular cycles.Most of the cases of dysfunctional uterine bleeding are secondary to anovulation.Without ovulation, the corpus luteum fails to form resulting in no progesterone secretion.In the absence of progesterone, there is no lateral phase or the secretory phase.The anovulatory woman is always in the follicular phase of the ovarian cycle and in the proliferative phase of the endometrial cycle.The only ovarian steroidal signal the endometrium receives is through estrogen.Continuous stimulation of endometrium by estrogen produces a proliferation of the endometrium to abnormal levels where it becomes fragile without the growth limiting and organizing effect of progesterone.The endometrium finally outgrows its blood supply and degenerates. The end result is an asynchronous breakdown of the endometrial lining at different levels.We can conclude that bleeding in anovulatory cycle occurs due to unopposed action of estrogen in the absence of progesterone.Anovulatory menstrual cycle gives rise to irregular bleeding.On the other hand, ovulatory cycles give rise to regular menstrual bleeding.These patients ovulate regularly. These patients have both the phases of menstrual cycle i.e., follicular phase and the secretory phase.Research has shown that several abnormalities can occur in the endometrium of women with DUB's ovulary cycles, for example, increased fibrinolytic activity and increased production of prostaglandins.These observations provide the rational basis for treatment in these women i.e.,Antifibrinolytic Tranexamic acidProstaglandin inhibitor acidManagement of dysfunctional uterine bleeding.In D.U.B's there is no specific abnormality present, therefore, the choice of t/t must be considered in relation to several factors: -Factors influencing t/tPresence of ovulatory or anovulatory cycles.Need for contraceptionPatient preferenceContraindication to t/tHeavy periods |Require contraceptionYes -Combined oral contraceptive or levonorgestrel-releasing intrauterine systemNo |Regular cyclesNo-Combined oral contraceptives or cyclical progestinsYes |Dysmenorrhea significant symptomsYes-Non-steroidal anti-inflammatory drugsNo | Tranexamic acid Medical treatment can be conveniently divided into hormonal and non hormonal: -As there is no hormonal defect the use of hormonal therapy does not correct an underlying disorder but merely imposes an external control of the cycle.The two main first-line t/t for menorrhagias associated with ovulatory cycles are nonhormonal as the ovulatory cycles usually have no defect in the menstrual cycle.They have normal menstruation and regular cycle the abnormality usually lies in increased fibrinolysis and increased production of prostaglandin.First line drugs in ovulatory cycles (menorrhagia with regular cycles)Antifibrinolytic Q (Tranexamic acid)NSAIDSTranexamic acid reduces menstrual loss by half and NSAID reduces it by one third.Both have the advantages of only being taken during menstruation, and aid to compliance and are particularly useful in those women who either do not require contraception or do not wish to use a hormonal therapy.They are also of value in treating excessive menstrual blood loss associated with the use of the nonhormonal intrauterine contraceptive device.Hormonal therapy Progesterone Traditionally hormonal therapy for menorrhagia has been progesterone given during luteal phase of the cycle.Normally progesterone therapy will control anovulatory bleeding once uterine pathology is excluded.In women who do not ovulate but are more frankly hypogonadal cyclic progesterone therapy restores the normal sequence of steroid hormone stimulation, estrogen followed by estrogen plus progesterone followed by withdrawal bleeding.Progestins are usually not effective.Despite this, they remain the first choice of many general practitioners and gynecologists.Progesterone's are effective when given for 21 days in each cycle but the side effects are such that patient may not choose to continue with the t/t.Although progestins have the contraceptive effect they are not the best choice when contraception required. Combined contraceptive pillThey are popular first-line drugs for women who desire contraception.OCP's suppress pituitary gonadotropin release preventing ovulation.Like cyclical progestins, they are useful for anovulatory bleeding as they impose a cycle.Levonorgestrel intrauterine system (MIRENA)It is a T shaped intrauterine device which releases levonorgestrel at the rate of 20 mcg daily.This low hormone minimizes the systemic progestin side effects and more patients will continue this therapy than cyclic progesterone's.It exerts its clinical effect by preventing endometrial proliferation and consequently reduces both the duration of bleeding and the amount of menstrual loss.The levonorgestrel-releasing system is also advocated as an alternative to surgery. Endometrial ablation Vs Levonorgestrel IVDFor women who wish to stop using chronic medical therapy or have contraindications to medications, minimally invasive options include the LNG-IUD or endometrial ablation.A systematic review of six randomized trials and a subsequent randomized trial found that women with menorrhagia who were treated with either the LNG-IUD or endometrial ablation had similar reductions in menstrual blood loss at 6, 12, and 24 months, as well as similar improvements in quality of life.A meta-analysis of four randomized trials found that rates of dissatisfaction were similar for women treated with the LNG-IUD (17 percent) compared with endometrial ablation (18 percent) (OR 0.9, 95% Cl 0.5-1.8).The decision to use the LNG-IUD or endometrial ablation depends upon a patient's preferences regarding treatment at 6, 12, and 24 months, as well as similar improvements in quality of life.factors such as plans for fertility and contraception, convenience, and risks of anesthesia.- The LNG-IUD is a reversible contraceptive. - Pregnancy is contraindicated after endometrial ablation. but the procedure does not prevent pregnancy: thus. women will need to continue to use contraception following ablation. The LNG-IUD can be placed in an office setting for all women and requires no or local anesthesia.Endometrial ablation can also be done in an office by surgeons who are appropriately equipped but is often performed in an operating room under general anesthesia.If successful, endometrial ablation is performed once, while the LNG-IUD needs to be replaced every five.\n\nSo the answer to this question is B"} {"instruction": "Recommended duration of surveillance after completion of treatment of multibacillary leprosy?\nA. 6 months\nB. 1 year\nC. 2 years\nD. 5 years", "response": "Ans. is 'd' i.e., 5 years\n\nSo the answer to this question is D"} {"instruction": "Cabana procedure is done in:\nA. CA testis\nB. RPLND\nC. Sentinel LN biopsy in penile carcinoma\nD. ca penis", "response": "1st SLM Biopsy was performed by CABANA & Procedure was known as CABANA Procedure Diagnosis- IOC - Biopsy- IOC for staging -MRI Treatment- Circumcision for CA Penis involving prepuce- C.A involving distal pa* Paial penectomy with is 2cm margin- CA Penis involving proximal Pa * Total penectomy + perineal urethrostomy\n\nSo the answer to this question is C"} {"instruction": "Which of the following belongs to antifibrinolytic drugs\nA. Alteplase\nB. Urokinase\nC. Aprotinin\nD. Reteplase", "response": "Antifibrinolytic drugs promote blood clotting by preventing blood clots from breaking down. Some examples of antifibrinolytic drugs are aprotinin, tranexamic acid (TXA), epsilon-aminocaproic acid and aminomethylbenzoic acid. Doctors sometimes give these drugs to patients having surgery to prevent blood loss. Ref: KD Tripathi 8th ed.\n\nSo the answer to this question is C"} {"instruction": "Gegenhalten (paratonia) indicates lesion in\nA. Parietal lobe (dominant)\nB. Temporal lobe (dominant)\nC. Frontal lobe (dominant)\nD. Parietal lobe (non-dominant)", "response": "Ans. c (Frontal lobe) (Ref. Harrison 18th/Fig 370-9).PARATONIA: | tone that varies irregularly in a manner that may seem related to a degree of relaxation, is present throughout the range of motion, affects flexors and extensors equally, usually results from lesion of bilateral frontal lobes or dominant frontal lobe.RIGIDITY: | Tone, affects flexors and extensors equally; seen in extrapyramidal lesionsSPASTICITY: | tone, affects mainly extensors and seen in pyramidal tract lesions.Signs and symptomsStructures involved# Paralysis of opposite foot and leg# A lesser degree of paresis of opposite arm# Cortical sensory loss over toes, foot, and legMotor leg areaArm area of cortex or fibers descending to corona radiateSensory area for foot and leg# Urinary incontinenceSensorimotor area in paracentral lobule# Contralateral grasp reflex, sucking reflex, gegenhaiten (paratonic rigidity)Medial surface of the posterior frontal lobe; likely supplemental motor area# Abulia (akinetic mutism), slowness, delay, intermittent interruption, lack of spontaneity, whispering, reflex distraction to sights and soundsUncertain localization--probably cingulate gyrus and medial inferior portion of frontal, parietaland temporal lobes# Impairment of gait and stance (gait apraxia)Frontal cortex near leg motor area# Dyspraxia of left limbs, tactile aphasia in left limbsCorpus callosumDeficit/feature of lesion of a particular area of brainLobesImportant regionsDeficit after lesionFrontalPrimary motor and premotorFrontal eye fieldsBroca speech area*Contralatera spastic paresis (region depends on area of homunculusEyes deviate to ipsilateral sideBroca aphasia (expressive, nonfluent aphasia): patient can understand written and spoken language, but speech and writing are slow and effortful; patients are aware of their problem; often associated with contralateral facial and arm weaknessPrefrontal cortexFrontal lobe syndrome: symptoms can include poor judgement, difficulty concentrating and problem solving, apathy, inappropriate social behaviorParietalPrimary somatosensory cortexSuperior parietal lobuleInfrerior parietal lobuleContralateral hemihypesthesia (region depends on area homunculus affected)Contralateral asteroegnosis and sensory neglect, apraxiaGerstmann syndrome (if dominant hemisphere): right/left: confusion, dyscalculia and dysgraphia, finger agnosia, contralateral hemianopia or lower quadrantanopiaTemporalPrimary auditory cortexBilateral damage deafnessUnilateral leads to slight hearing lossWernicke area*Wernicke aphasia (receptive, fluent aphasia); patient cannot understand any form of language; speech is fast and fluent, but not comprehensibleHippocampusAmygdalaOlfactory bulb, tract, primary cortexMeyer loop (visual radiations)Bilateral lesions lead to inability to consolidate short-term to long-termKluver-Bucy syndrome: hyperphagia, hypersexuality, visual agnosia Ipsilateral anosmiaContralateral upper quadrantanopia (\"pie in the sky\")OccipitalPrimary visual cortexBlindnessAlso Remember: Parietal lobe lesions | | | Dominant lobe Non dominant lobe | | Multinodal complex motor activities affected Multinodal complex sensory disabilities | | # Ideational# Ideomotor# Alexia}Apraxia Visuospatial disorders(Hemiattention) AnosognosiaDressing and constructionalApraxia# Gerstamann's syndrome\n\nSo the answer to this question is C"} {"instruction": "All are calculated by Coho study, except ?\nA. Incidence\nB. Relative risk\nC. Odds ratio\nD. Attributable risk", "response": "Ans. is 'c' i.e., Odds ratio Characteristics Coho Study Case control Study Cross Sectional Study Design Prospective Retrospective One point in time Incidence Estimated Not estimated Not estimated Prevalence Not estimated Not estimated Estimated Calculations Incidence rates Relative risk Attributable risk Odds ratio\n\nSo the answer to this question is C"} {"instruction": "Highest amount of saturated fatty acid is seen in ?\nA. Soyabean oil\nB. Groundnut oil\nC. Palm oil\nD. Sunflower oil", "response": "Ans. is 'c' i.e., Palm oil Fatty- acids On the basis of presence or absence of double bond fatty acids are divided into :- 1.Saturated fatty acids Have no double bond. Examples --* Palmitie acid, lauric acid, stearic acid 2. Unsaturated fatty acids Have one or more double bonds i) Monounsaturated (Have single double bond) Oleic acid ii) Polyunsaturated (Have more than one double bonds) --) Linoleic acid. Linolenic acid,,4rachidonic acid, Eicosapentaenoic acid, Docosahexaenoic acid. Coming to question o Polyunsaturated are mostly found in Vegetal* oils and the saturated fatty acids mainly in animal fats. Q However, there are exceptions, as jOr example, coconut and palm oils, although vegetable oils, have on extremly high percentage of saturated acids on the other hand, fish oils, although they are not vegetable oils, contain poly and mono-unsaturated fatty acids.\n\nSo the answer to this question is C"} {"instruction": "Requirement of Potassium in child is\nA. 1-2 mEq/kg\nB. 4-7 mEq/kg\nC. 10-12 mEq/kg\nD. 13-14 mEq/kg", "response": "Requirement of potassium in child is 1-2 mEq/kg . Reference: GHAI Essential pediatrics, 8th edition\n\nSo the answer to this question is A"} {"instruction": "CT Scan of head showing a 'Tram track5 appearance in\nA. Neurofibroma\nB. Tuberous sclerosis\nC. Von Hippel Lindau disease\nD. Sturge weber syndrome", "response": "Ans. is 'd' i.e.,. Sturge Weber Syndrome. Sturge-Weber syndrome is characterized by -A large unilateral cutaneous angioma* (.Port wine stain*) of the faceA cerebral angioma involving the ipsilateral* cerebral hemisphere and meninges.Adrenal pheochromocytoma*.Cerebral angioma leads to cortical atrophy and epilepsy*.Characteristic tram track calcification* is seen on x-ray and CT head.\n\nSo the answer to this question is D"} {"instruction": "Nutrient artery to Femur is a branch of\nA. Inferior gluteal Artery\nB. 1st perforating Branch of profunda femoris artery\nC. 2nd perforating Branch of profunda femoris artery\nD. Lateral circumflex femoral artery", "response": "Femur gets its nutrient artery from 2nd perforating Branch arising from profunda femoris artery.\n\nSo the answer to this question is C"} {"instruction": "All of the following signs may be appreciated in a patient with early papilloedema except\nA. Mild hyperaemia of the disc\nB. Obliteration of physiological cup of the optic disc\nC. Obscuration of superior, inferior and nasal disc margins\nD. Absence of spontaneous venous pulsation", "response": "PAPILLOEDEMA Clinical features: Early (incipient) papilloedema : Symptoms are usually absent and visual acvity is normal. Pupillary reactions are normal. Ophthalmoscopic features of early papilloedema are: (i) Obscuration of the disc margins (nasal margins are involved first followed by the superior, inferior and temporal). (ii) Blurring of peripapillary nerve fibre layer. (iii) Absence of spontaneous venous pulsation at the disc (appreciated in 80% of the normal individuals). (iv) Mild hyperaemia of the disc. (v) Splinter haemorrhages in the peripapillary region may be present. Visual fields are fairly normal. Ref:- A K KHURANA; pg num:-299\n\nSo the answer to this question is B"} {"instruction": "Chromosome 21 is -\nA. Metacentric\nB. Submetacentric\nC. Acrocentric\nD. None", "response": "Ans. is 'c' i.e., Acrocentrico Each chromosome has two armsi) p arm (the shorter of two)ii) q arm (longer one)o Depending on the position of there junction (centromere) they can be classified into :1. Metacentric# The centromere is in the middle so that the two arms of chromosomes are almost equal.# These chromosomes are : chromosomes 1,2, 3 and X-chromosome.2. Submetacentric# p arm is short and q arm is long.# These chromosomes are : 4, 5, 6, 7, 8 and 9.3. Acrocentric# p (short) arm is so short that it is hard to observe, but still present.# There are six acrocentric chromosomes : 13,14,15,21,22 and Y chromosomes.\n\nSo the answer to this question is C"} {"instruction": "Which of the following monoclonal antibodies is a humanized antibody?\nA. Rituximab\nB. Palivizumab\nC. Infliximab\nD. Basiliximab", "response": "Nomenclature of monoclonal antibodies: * Their name ends with mab. * Before mab the two letters tell the source: - XI means Chimeric - ZU means humanized - U means completely human\n\nSo the answer to this question is B"} {"instruction": "Which of the following is NOT an adverse effect of heparin ?\nA. Bleeding\nB. Thrombocytopenia\nC. Hypokalemia\nD. Osteoporosis", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Fertilization occurs in -\nA. uterine cavity\nB. Ampulla of fallopian tube\nC. Infundibulum of fallopian tube\nD. Isthmus of tube", "response": "Ans. is 'b' i.e., Ampulla of fallopian tube * The uterine tubes, also known as oviducts or fallopian tubes, are the female structures that transport the ova from the ovary to the uterus each month. In the presence of sperm and fertilization, the uterine tubes transport the fertilized egg to the uterus for implantation.* The infundibulum gives rise to the fimbriae, fingerlike projections that are responsible for picking up the egg released by the ovary.* Fertilization takes place in the ampullary part of the fallopian tube.\n\nSo the answer to this question is B"} {"instruction": "Which of the following is associated with >20% risk of chromosomal anomalies?\nA. Cleft lip\nB. Gastroschisis\nC. Omphalocele\nD. Spina bifida", "response": "Omphalocele is a membrane-covered herniation of abdominal contents into the base of the umbilical cord; the incidence is 2 per 10,000 live bihs (0.02%). Over 50% of cases have either an abnormal karyotype or an associated syndrome. The sac may contain liver and spleen as well as intestine. Prognosis varies with the size of the lesion, with the presence of pulmonary hypoplasia and respiratory insufficiency, and with the presence of associated abnormalities. Ref: Thilo E.H., Rosenberg A.A. (2012). Chapter 2. The Newborn Infant. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.\n\nSo the answer to this question is C"} {"instruction": "Post - Vagotomy diarrhoea can be effectively managed by -\nA. Steroids\nB. Thyroxin\nC. Somatostatin analogue\nD. Parathormone", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Picket fence fever is a feature of -\nA. Acute mastoiditis\nB. Lateral sinus thrombophlebitis\nC. Bell's Palsy\nD. Atticoantral CSOM", "response": "Ans. B. Lateral sinus thrombophlebitis Ref: Dhingra Sth/e p. 95] Hectic Picket-Fence fi:pe of fever with rigor,\n\nSo the answer to this question is B"} {"instruction": "Which category of ICD is associated with mood disorders\nA. F0\nB. F1\nC. F2\nD. F3", "response": "ICD ICD mentions International classification of mental and behavioural disorders this was given by WHO( World health Organisation) ICD is used all over the world except America latest edition of ICD is ICD11 ICD 11 was released in 2018 DSM DSM mentions Diagnostic and Statistical manual of mental disorders this was given by APA( American Psychiatric Assosiation) DSM is used in America latest edition of DSM is DSM 5 ICD 11 was released in 2018 categorisation ofmental disorders in ICD 10 is mentioned below F00-F09 Organic, including symptomatic, mental disorders F10-F19 Mental and behavioural disorders due to psychoactive substance use F20-F29 Schizophrenia, schizotypal and delusional disorders F30-F39 Mood disorders ICD-10 Classification of Mental and Behavioural Disorders, World Health Organization, Geneva, 1992\n\nSo the answer to this question is D"} {"instruction": "Fungus not cultivable usually is\nA. Rhinosporidium\nB. Cryptococcus\nC. Dermatophytes\nD. Histoplasma", "response": "Histoplasma- SDA or brain hea infusion agar. Cryptococcus- SDA and Niger seed agar media( Brown colonies). Dermatophytes - sabouraud glucose neopeptone agar, sabouraud agar. Reference: Textbook of Microbiology; Baveja; 4th edition\n\nSo the answer to this question is A"} {"instruction": "Urinary tract infection exists when the bacterial count in 1 ml. of midstream specimen of urine is ?\nA. 100\nB. 1000\nC. 104\nD. 105 or over", "response": "Ans. is 'd' i.e., 105 or over\n\nSo the answer to this question is D"} {"instruction": "Bone Density is best studied by –\nA. CT scan\nB. DEXA scan\nC. MRI scan\nD. Bone scan", "response": "DEXA scan is the gold standard test for screening of bone density (to rule out asteoporosis).\n\nSo the answer to this question is B"} {"instruction": "A 45-year-old woman is undergoing chemotherapy for breast cancer. She presents 10 days after her last chemotherapy with fever (temperature >38.5), but no other symptoms except a sore throat and mouth. On examination, she looks well, there is oral mucositis, ears are normal, lungs are clear, and the central line site is clean. The CXR, urinalysis, and biochemistry are normal. Her WBC is 800/mL and the absolute neutrophil count is low (<500). Which of the following is the most appropriate next step in management?\nA. start empiric bacterial antibiotics\nB. start empiric antifungal and bacterial antibiotics\nC. acetaminophen alone until culture results are available\nD. start antiviral medications for HSV-1", "response": "Several antibiotic combinations could be used and may vary with the indigenous organisms. Aminoglycoside and cephalosporin are commonly used in combination. The antibiotic combination must cover both Gram-positive and Gram-negative organisms. Antifungal or viral agents are not empirically started unless there is an appropriate clinical fungal or viral infection. In some centers, empiric antifungal agents are started if the patient remains febrile on antibiotics after 5 days. Observation alone is not an option, since these individuals usually have some form of bacteremia causing the fever.\n\nSo the answer to this question is A"} {"instruction": "Hemodialysis related complications are all of the following except: September 2008\nA. Altered cardiovascular dynamics\nB. Anaphylactoid reaction\nC. Hypeension\nD. Muscle cramps", "response": "Ans. C: Hypeension Complication of hemodialysis: Fever- Bacteremia, water-borne pyrogens, overheated dialysate Hypotension - Excessive ultrafiltration, cardiac arrhythmia, air embolus, pericardial tamponade; hemorrhage (gastrointestinal, intracranial, retroperitoneal); anaphylactoid reaction Hemolysis- Inadequate removal of chloramine from dialysate, failure of dialysis concentrate delivery system Dementia- Incomplete removal of aluminum from dialysate water, prescription of aluminum antacids Seizure- Excessive urea clearance (first treatment), failure of dialysis concentrate delivery system Bleeding- Excessive heparin or other anticoagulant Muscle cramps- Excessive ultrafiltration\n\nSo the answer to this question is C"} {"instruction": "A 55-year-old man felt a lump near his shoulder 1 week ago. On physical examination, there is an enlarged, nontender, supraclavicular lymph node and enlargement of the Waldeyer ring of oropharyngeal lymphoid tissue. There is no hepato- splenomegaly. CBC is normal except for findings of mild anemia. A lymph node biopsy specimen shows replacement by a monomorphous population of lymphoid cells that are twice the size of normal lymphocytes, with enlarged nuclei and prominent nucleoli. Immunohistochemical staining and flow cytometry of the node indicates that most lymphoid cells are CD19+, CD10+, CD3-, CD15-, and terminal deoxynucleotidyl transferase negative (TdT-). A BCL6 gene mutation is present. Which of the following is the most likely diagnosis?\nA. Acute lymphoblastic lymphoma\nB. Chronic lymphadenitis\nC. Diffuse large B-cell lymphoma\nD. Hodgkin lymphoma", "response": "Diffuse large B-cell lymphoma occurs in older individuals and frequently manifests as localized disease with extranodal involvement, particularly of the Waldeyer ring. A third of cases have BCL6 rearrangements or mutations. The staining pattern indicates a B-cell proliferation (CD19+, CD10+). T-cell (CD3) and monocytic (CD15) markers are absent. TdT can be expressed in B lineage cells at an earlier stage of maturation. Lymphoblastic lymphoma is a T-cell neoplasm that occurs typically in the mediastinum of children. In chronic lymphadenitis, the lymph node has many cell types-macrophages, lymphocytes, and plasma cells. A monomorphous infiltrate is typical of non-Hodgkin lymphomas. Reed-Sternberg cells characterize Hodgkin lymphoma. Small lymphocytic lymphoma also is a B-cell neoplasm, but it manifests with widespread lymphadenopathy, liver and spleen enlargement, and lymphocytosis.\n\nSo the answer to this question is C"} {"instruction": "Most common nerve involvement in fracture surgical neck humerus:\nA. Axillary nerve\nB. Radial nerve\nC. Ulnar nerve\nD. Median nerve", "response": "A i.e. Axillary nerve Injury Common Nerve Involvement Anterior shoulder dislocation Fracture surgical neck humerus Axillary (circumflex humeral) nerveQ Axillary nerveQ Fracture shaft humerus Fracture supracondylar humerus Medial condyle humerus Radial nerveQ Radial or median nerve Ulnar nerve Monteggia fracture dislocation Posterior interosseous nerve Vockman's ischemic contracture Lunate dislocation Median nerve Median nerveQ Hip dislocation Sciatic nerve Knee dislocation Peroneal nerve\n\nSo the answer to this question is A"} {"instruction": "First line Treatment of Abnormal Uterine bleeding is\nA. Versapoint\nB. Novasure\nC. Medical mangement\nD. Surgical management", "response": "Managment of Abnormal uterine bleeding Medical management is the first line treatment, If medical therapy fails or is contraindicated, consider Mirena IUCD. If Mirena fails or side effects develop, go for ablative techniques. When the above methods fail, consider hysterectomy Versapoint- Bipolar electrosurgical system works in normal saline, is cheap, has excellent haemostasis NovaSure Impedance-controlled endometrial ablation is the latest and most safe procedure, taking just 90 sec. It uses bipolar radiofrequency and vaporizes endometrium upto myometrium.\n\nSo the answer to this question is C"} {"instruction": "In NREM stage 4, the EEG waves are\nA. d\nB. b\nC. K-spindles\nD. a", "response": "(A) 5 # There are two different kinds of sleep: rapid eye movement (REM) sleep and non-REM (NREM), or slow-wave sleep.> NREM sleep is divided into four stages. A person falling asleep first enters Stage 1, which is characterized by low-amplitude, high-frequency EEG activity. Stage 2 is marked by the appearance of sleep spindles. These are bursts of alpha-like, 10-14 Hz, 50 uV waves. In stage 3, the pattern is one of lower frequency and increased amplitude of the EEG waves. Maximum slowing with large waves is seen in Stage 4. Thus, the characteristic of deep sleep is a pattern of rhythmic slow waves, indicating marked synchronization.\n\nSo the answer to this question is A"} {"instruction": "Oculomotor nerve supplies all muscles of the eye except\nA. Inferior oblique\nB. Superior oblique\nC. Superior rectus\nD. Inferior rectus", "response": "(B) Superior oblique > Lateral rectus is supplies by the 6th cranial (abducent) nerve.> Oculomotor nerve supplies all extra ocular muscles of the eye except:> Superior oblique supplied by IV cranial nerve (SO IV).> Lateral rectus supplied by VI cranial nerve (LR VI).\n\nSo the answer to this question is B"} {"instruction": "All of these drugs are used in treatment of acute gout except:\nA. Allopurinol\nB. Steroids\nC. Colchicine\nD. Naproxen", "response": "Naproxen is used in acute gout . Steroids are used in case of NSAID hypersensitivity. Colchicine can also be used but not allopurinol which is used in chronic gout.\n\nSo the answer to this question is A"} {"instruction": "Clinical features of complicated cataract are all, EXCEPT –\nA. Polychromatic lusture\nB. Axial spread of opacity\nC. Opacity along sutures\nD. Posterior subcapsular opacity", "response": "Typically opacification starts in the posterior part of the cortex in the axial region (Posterior cortical cataract or posterior subcapsular cataract).\nOpacity along the suture lines is seen sutural cataract.\n\nSo the answer to this question is C"} {"instruction": "The activity of which of the following enzymes is increased in Diabetes Mellitus?\nA. CPT-1\nB. Phosphoenol Pyruvate carboxykinase (PEPCK)\nC. Glucose-6-Phosphatase\nD. All", "response": "Diabetic situation is same like fasting or starvation i.e. catabolic situation in the body. So, in Diabetes Mellitus, the activity of Catabolic enzymes is increased. Carnitine Palmitoyl Transferase-I (CPT-I) is an enzyme of b-Oxidation which is a Catabolic pathway. Therefore, it is increased in Diabetes. Option b & c - Phosphoenol Pyruvate Carboxykinase (PEPCK) and Glucose -6-Phosphatase are enzymes of Gluconeogenesis which is a Catabolic pathway and hence increased in Diabetes. So, answer is all.\n\nSo the answer to this question is D"} {"instruction": "Normal GFR is ?\nA. 125 ml/min\nB. 90 ml/min\nC. 60 ml/min\nD. 150 ml/min", "response": "Ans. is 'a' i.e., 125 ml/min In man, resting glomerular filtration rate is about 125 ml/min (180L/day), the renal plasma flow being about 600 ml/min. Thus about one-fifth (20%) of plasma passing through kidney is filtered, i.e., fraction of renal plasma flow that is filtered (filtration fraction) is 0-2.\n\nSo the answer to this question is A"} {"instruction": "Most common cause of neonatal diarrhea worldwide is:\nA. Rotavirus\nB. Adenovirus\nC. Norwalk virus\nD. Cholera", "response": "a. Rotavirus(Ref: Nelson's 20/e p 1616)In early childhood, the single most important cause of severe dehydrating diarrhea is rotavirus infection.\n\nSo the answer to this question is A"} {"instruction": "A patient is said to have chronic diarrhea if it is occurring for more than ...... weeks?\nA. 3\nB. 4\nC. 5\nD. 6", "response": "Ans. B. 4DiarrheaDefinition-It is defined according to symptoms as increase in liquidity, frequency and volume of stools; and according to sign as increase in stool weight of more than 200gm/day.Pseudo diarrhea-it is the frequent passage of small volume of stools. It is seen in irritable bowel syndrome and proctitis.Classification-It is classified according to duration asa. Acute-Duration less than 2 weeks.b. Persistent-Duration of 2-4 weeks.c. Chronic-Duration of more than 4 weeks.\n\nSo the answer to this question is B"} {"instruction": "All the following are features of achondroplasia EXCEPT:\nA. Diminished trunk length\nB. Brachycephaly\nC. Exaggerated lumbar lordosis\nD. Trident hand", "response": "Ans. A. Diminished trunk lengthAlthough the limbs are short in achondroplasia, trunk length (crown to pubis) is normal. The skull is brachycephalic, the face broad, and the bridge of the nose flattened, there is exaggeration of the normal lordotic curve of the lumbar spine. The digits of the hand are of equal length with the long and ring fingers spread forming a trident hand. Tibial and, less commonly, femoral bowing are also seen.\n\nSo the answer to this question is A"} {"instruction": "Vitamin A deficiency leads to metaplasia of?\nA. Squamous epithelium\nB. Columnar epithelium\nC. Both\nD. None", "response": "Ans. is 'a' i.e., Squamous epithelium Metaplasia* Metaplasia is a reversible change in which one differentiated cell type is replaced by another differentiated cell type.Metaplasia represents an adaptive substitution of cells that are sensitive to stress by cell types better able to withstand the adverse environment. Metaplasia may be of two types1. Epithelial metaplasia* Here one type of adult epithelium is replaced by another type of adult epithelium. It may be :-a) Squamous metaplasia# It occurs most frequently in respiratory tract as a result of chronic irritation by cigarette smoking. The columnar epithelium is replaced by squamous epithelium. This squamous metaplasia represents an attempt by the host to repair or prepare an epithelial tissue that has been damaged by environmental toxicants with a more resistant tissue.# Squamous metaplasia is also encountered in other location such as pancreatic duct (Vit A deficiency, stones in pancreatic duct), gall bladder (gall stones), urinary bladder (bladder calculi, Schistosomiasis), and in endocervix.# Though the metaplasia is reversible, if the influences that predispose to metaplasia is persistent, malignant transformation may occur in metaplastic epithelium.b) Glandular metaplasia# It is a change of the squamous epithelium to glandular (columnar) epithelium e.g. development of Barrett's esophagus, i.e., Stratified squamous epithelium of the esophagus is replaced by gastric columnar epithelium. It is due to reflux of acid contents of stomach into esophagus. This necessitates the replacement of susceptible squamous epithelium of the lower third of esophagus with gastric acid resistant glandular epithelium.2. Connective tissue metaplasia* This transformation occurs between the mesodermally derived tissues i.e., one type of connective tissue is replaced by another type of connective tissue. This is characterized by conversion of fibroblast-derived soft tissue into muscle, Cartilage or bone. Example-Bone formation in muscle i.e., myositis ossificans.\n\nSo the answer to this question is A"} {"instruction": "Transfusion of stored blood causes: (Repeat)\nA. Hyperkalemia\nB. Hyponatremia\nC. Hypercalcemia\nD. Hypokalemia", "response": "Ref: Harrison's 18th editionExplanation:The two important electrolyte disturbances caused by transfusion of stored blood areHyperkalemiaHypocalcemia.RBC leakage during storage increases the concentration of potassium in the unit.Neonates and patients in renal failure are at risk for hyperkalemia.Preventive measures, such as using fresh or washed RBCs. are warranted for neonatal transfusions because this complication can be fatal.Citrate, commonly used to anticoagulate blood components, chelates calcium and thereby inhibits the coagulation cascade.Hypocalcemia, manifested by circumoral numbness and tingling sensation of the fingers and toes, may result from multiple rapid transfusions.Because citrate is quickly metabolized to bicarbonate, calcium infusion is seldom required in this setting.If calcium or any other intravenous infusion is necessary, it must be given through a separate tine.\n\nSo the answer to this question is A"} {"instruction": "The following chemical mediator is a product of arachidonic add metabolite by cyclo oxygenase pathway\nA. LxA4\nB. LxB4\nC. 5-HETE\nD. PGH2", "response": "None\n\nSo the answer to this question is D"} {"instruction": "A young male presents with central scotoma in left eye. His right vision showed 6/6 vision. On examination, in the left eye, there was focal foveal detachment in fundoscopy. What would be the next step?\nA. Examine retrolental cells\nB. Inquire about the use of steroids\nC. Ask for history of tranuma in the other eye\nD. Examination under slit lamp", "response": "Using of steroids may cause detachment of focal fovea. Ref khurana 6/e\n\nSo the answer to this question is B"} {"instruction": "1 curie is equivalent to:\nA. 1.7 x 1010 disintegration/second\nB. 2.7 x 1010 disintegration/second\nC. 3.7 x 1010 disintegration/second\nD. 4.7 x 1010 disintegration/second", "response": "Ans. (C) 3.7 x 1010 disintegration/secondRadiology by S. Bhadury 2ndl197:Writes:1 Bq= 1 disintegration/second1 Curie (Ci)= 3.7 x 10 (10) disintegration/second1 Ci is equal to 37 gigabecquerel1 gray (Gy) = 100 rads 10 mGy = 1 rad 1 mGy = 100 mrad Gray (Gy) is the SI unit of absorbed dose.One gray is equal to an absorbed dose of 1 foule/kilogram (100 rads).\n\nSo the answer to this question is C"} {"instruction": "True about Ca cervix\nA. 90% associated with HPV\nB. Immunocompromised patients\nC. OCP\nD. All", "response": "Ans. is a, b and c i.e. 90% associated with HPV; OCP; and Immunocompromised Patients Risk factors for development of Ca cervix : Coitus before the age of 18 years.deg Multiple sex paners.deg Delivery of V baby before 20 years of age.deg Poor personal hygiene.deg Poor socioeconomic status. Smokingdeg, Alcohol, Drug abuse. Women with STDdeg, HIV infectiondeg, HSV-20, HPV infectiondeg or condyloma Immunocompromised individualsdeg Women with H/O Preinvasive lesionsdeg OCPdeg and progesterone use over long periods.deg \"HPV is central to the development of cervical neoplasia. HPV - DNA is found in 95% of all squamous cell carcinoma & 90% of all adenocarcinomas.\"\n\nSo the answer to this question is D"} {"instruction": "True regarding cardio pulmonary resuscitation is -\nA. Most common presentation in ECG is asystole\nB. Compression to ventilation ratio is 5:1\nC. Adrenaline is given if cardioversion fails.\nD. Calcuim gluconate is given immediately.", "response": "200 joules are given every 2 minutes after each cycle of cardiopulmonary resuscitation (CPR). During resuscitation, adrenaline(epinephrine, 1 mg i.v.) should be given every 3-5 minutes and consideration given to the use of intravenous amiodarone, especially if ventricular fibrillation or ventricular tachycardia reinitiates after successful defibrillation. Ventricular fibrillation of low amplitude, or 'fine VF', may mimic asystole. If asystole cannot be confidently diagnosed, the patient should be regarded as having 'fineVF' and defibrillated. If an electrical rhythm is present that would be expected to produce a cardiac output, 'pulseless electrical activity' is present. There are several potentially reversible causes that can be easily remembered as a list of four Hs and four Ts. Pulseless electrical activity is treated by continuing CPR and adrenaline (epinephrine) administration whilst seeking such causes. Asystole is treated similarly, with the additional suppo of atropine and sometimes external or transvenous pacing in an attempt to generate an electrical rhythm. ref:harrison&;s principles of internal medicine,ed 18,pg no 2231\n\nSo the answer to this question is C"} {"instruction": "Superficial inguinal ring in the female transmits:\nA. Broad ligament of uterus\nB. Round ligament of the uterus\nC. Cardinal ligament\nD. None of the above", "response": "The superficial inguinal ring is a triangular apeure in the aponeurosis of the external oblique muscle and is situated above and medial to the pubic tubercle. In the female, the superficial inguinal ring is smaller and difficult to palpate; it transmits the round ligament of the uterus.\n\nSo the answer to this question is B"} {"instruction": "Features of congenital syphilis are-\na) Snuffles is late manifestation\nb) Perforation in cartilaginous part of nose\nc) Mulberry molar\nd) Saddle nose deformity\nA. abc\nB. bcd\nC. acd\nD. abd", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Rubor in inflammation is due to - rpt Q24\nA. Dilation of aerioles\nB. Increased vascular permeability\nC. Increased viscocity of blood\nD. Edema", "response": "Harshmohan textbook of pathology 7th edition. persistent progressive vasodilatation seen in acute inflammatory response due to dilatation of aerioles but to a lesser extend affect other components of micro circulation like venules and capillaries. Vasodilatation result in increased blood volume in the microvascular bed of the area which is responsible for redness/ rubor and warmth at the site of acute inflammation. .\n\nSo the answer to this question is A"} {"instruction": "Physical examination of a 45 year old man who looks much older than his stated age demonstrates thin arms and legs, a swollen abdomen, red tongue, dry, thin, and slightly yellow skin, gynecomastia, testicular atrophy, multiple spider angiomas, tremor, yellow discoloration of sclera, and sho term memory loss. Which of the following conditions is most strongly suggested by these findings?\nA. Bronchogenic carcinoma\nB. Colon carcinoma\nC. Congestive hea failure\nD. Hepatic cirrhosis", "response": "The physical examination is typical for an advanced alcoholic with hepatic cirrhosis. It is impoant to recognize these symptoms, as these patients are notorious for \"underestimating\" and even denying their alcohol use. Bronchogenic carcinoma typically presents with cough and/or respiratory changes, but can present with mass effects in the chest or involvement of mediastinal nerves or vessels. Colon cancer typically presents with changes in the stool or bowel habits. Congestive hea failure is typically heralded by shoness of breath or peripheral edema, or both. Ref: Khalili M., Liao C.E., Nquyen T. (2010). Chapter 14. Liver Disease. In S.J. McPhee, G.D. Hammer (Eds), Pathophysiology of Disease, 6e.\n\nSo the answer to this question is D"} {"instruction": "Diabetes mellitus is present in all except-\nA. Fanconis anemia\nB. Noonans syndrome\nC. Ataxia telangiectasia\nD. Myotonic dystrophy", "response": "Type 1 diabetes *Immune-mediated *Idiopathic. Type 2 diabetes Other specific types *Geneticdefectsofb-cellfunction(seeBox21.6) *Geneticdefectsofinsulinaction(e.g.leprechaunism, lipodystrophies) *Pancreaticdisease(e.g.pancreatitis,pancreatectomy, neoplasticdisease,cysticfibrosis,haemochromatosis, f ibrocalculouspancreatopathy) *Excessendogenousproductionofhormonalantagoniststo insulin,e.g. Growthhormone-acromegaly Glucocoicoids-Cushing'ssyndrome Glucagon-glucagonoma Catecholamines-phaeochromocytoma Thyroidhormones-thyrotoxicosis *Drug-induced(e.g.coicosteroids,thiazidediuretics, phenytoin) *Uncommonformsofimmune-mediateddiabetes(e.g.IPEX (immunodysregulationpolyendocrinopathyX)syndrome) *Associatedwithgeneticsyndromes(e.g.Down'ssyndrome; Klinefelter'ssyndrome;Turner'ssyndrome;DIDMOAD (Wolfram'ssyndrome)-diabetesinsipidus,diabetesmellitus, opticatrophy,nervedeafness;Friedreich'sataxia;myotonic dystrophy). Gestational diabetes. DAVIDSON'S PRINCIPLES AND PRACTICE OF MEDICINE 22ND EDITION PAGE NO-807\n\nSo the answer to this question is A"} {"instruction": "Hemodialysis is used in poisoning with all except-\nA. Salicylates\nB. Methyl alcohol\nC. Diazepam\nD. Barbiturates", "response": "Hemodialysis is not useful in benzodiazepine (e.g. diazepam) poisoning.\n\nSo the answer to this question is C"} {"instruction": "True regarding vascularity of lung is\nA. Hypoxia causes vasodilation\nB. Pulmonary resistance is half of the systemic vascular resistance\nC. Perfusion is more in the apical lobe than in base\nD. Distended pulmonary veins in the lower lobe", "response": "In lungs, the lower lobes get perfused more due to the effect of gravity. So the lower lobe vessels are more distended.\n\nSo the answer to this question is D"} {"instruction": "A 60-year old female presented with decreased movements for the last 2 years with rigidity and vertical large square wave jerks. The most likely diagnosis is -\nA. Parkinson's disease\nB. Lewy body dementia\nC. Multisystem atrophy\nD. Progressive supranuclear palsy", "response": "None\n\nSo the answer to this question is D"} {"instruction": "APGAR stands for\nA. Appearance, Pulse rate, Growth, Activity, Respiratory rate\nB. Appearance, Pulse rate, Grimace, Activity, Respiratory rate\nC. Appearance, Pulse rate, Grimace, Activity, Respiratory effort.\nD. Activity, Pulse rate, Grimace, Activity, Respiratory effort.", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Which of the following is Tensor of the vocal cord\nA. Cricothyroid\nB. Inter arytenoid\nC. Posterior cricoarytenoid\nD. Lateral cricoarytenoid", "response": "Intrinsic muscles of larynx They may act on vocal cords or laryngeal inlet. (a) Acting on vocal cords:- * Abductors:- Posterior cricoarytenoid * Adductors:- Lateral cricoarytenoid , Interarytenoid (transverse arytenoid), Thyroarytenoid (external pa) * Tensors:- Cricothyroid , Vocalis (internal pa of thyroarytenoid). Ref:- Dhingra; pg num:-283\n\nSo the answer to this question is A"} {"instruction": "The most sensitive indicator of depletion of intravascular volume in an infant is –\nA. Cardiac output\nB. Stroke volume\nC. Heart rate\nD. Blood pressure", "response": "An increase in heart rate is the earliest and the most sensitive indicator to any reduction in intravascular volume.\nCardiac output and blood pressure are preserved initially because of compensatory mechanisms such as increase in heart rate and peripheral vasoconstriction.\nStroke volume is usually preserved in infants and compensatory increased in cardiac output is primarily achieved by increasing heart rate.\n\nSo the answer to this question is C"} {"instruction": "MELD score includes?\nA. Serum creatinine\nB. Transaminase\nC. Albumin\nD. Alkaline phosphatase", "response": "Model for End stage liver disease (MELD): Done to calculate the requirement of liver transplantation in case of Fulminant hepatic failure. If MELD sore > 14 Ohoptic liver Treatment Bilirubin INR Severe creatinine Child Pugh classification: Cirrhosis grading (helpful to know if shunt surgery required or not) NAZERS index: Used to determine the severity of damage and need for treatment of liver is WILSON'S disease.\n\nSo the answer to this question is A"} {"instruction": "Profuse watery diarrhea in an immune compromised child is due to\nA. Cryptococcus\nB. Amoeba\nC. Giardia\nD. Lactose intolerance", "response": ".Giardiasis caused by Giardia lamblia is a major cause of diarrhoea in children and travellers Individuals with malnutrition,humoral immunodefeciencies,and cystic fibrosis are paicularly susceptible. Features:acute diarrhoea with sudden onset of explosive,watery foul smelling stools, along with nausea and anorexia,abdominal distension,flatulence,epigastric camps and mild fever. ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:244,7th edition\n\nSo the answer to this question is C"} {"instruction": "A patient when asked about a paicular topic, stas speaking irrelevant details that is totally needed and finally reaches the goal. this type of formal thought disorder is called as\nA. loosening of assosiation\nB. circumstantiality\nC. flight of ideas\nD. clang assosiation", "response": "In normal individual when asked a question they will have a staing point and add some relevant details and then reach the goal. In circumstantial speech individual stas about a topic, adds minute irrelevant details , beats around the bush and finally reaches the goal. This is seen in ORGANIC BRAIN CONDITIONS In flight of ideas, the individual stas at a point, shifts the topic , subsequent thoughts will have some association but they will not reach goal. This is classical of MANIA In loosening of association, patient comes with random thoughts that is not connected to each other and the goal is not reached. This is classical of schizophrenia * Neologism= they will introduce new words that are not present in one's dictionary , seen in SCHIZOPHRENIA clang, ====subsequent words will have rhyming seen in MANIA Ref. Kaplon and sadock, synopsis of psychiatry, 11th edition, pg No.195\n\nSo the answer to this question is B"} {"instruction": "Auenbrugger's sign is seen in -\nA. Pericardial Effusion\nB. Constrictive pericarditis\nC. Aortic Regurgitation\nD. Mitral Stenosis", "response": "Ans. is 'a' i.e., Pericardial Effusion o Auenbruger 's sign is an epicardial bulging due to massive pericardial effusion.Auenbrugeer frsieno It represents bulging of the epigastrium that may be seen in case of severe pericardial effusion.o The auenbrugger s sign is seen in large pericardial effusion.o During a large pericardial effusion an epigastric bulge is present,o This represents large pericardial effusion extending subxiphoid.o Compression of this bulge may cause hemodynamic compromise and cardiac tamponade.Signs in pericardial effusion : -Sign PresentationFriedreich's sign-Sudden collapse inthe distended neck veins with diastole suggests pericardial tamponade.Pitres's sign-Anterior bidging of the lower sternum suggests pericardial effusion.Auenbrugger's sign-Protuberance/Bulging of the epigastrium suggests massive pericardial effusion (Sign on inspection).Sansom s sign-Percussible dullness in the left third intercostal space suggests large pericardial effusion.Greene's sign -Lateral displacement of the percussed cardiac border with expiration suggests a large pericardial effusions.Ebstein's sign A large pericardial effusion can blunt the percussible righ cardiomyopathic angle producing dullness along the lower right sternal border.Rotch's sign-Dullness at the right lower sternal border suggests large pericardial effusion.Moschcowitz s sign-In pericardial effusion, the transition on percussion from the lungs in the right heart border is abrupt.Ewart's sign-A large pericardial effusion produces egophony and bronchial breathing at the lower border of the left scapula.Ewart's second sign-A large pericardial effusion makes the first rib seen more prominent along the sternal border.Dressier 's sign-Is dullness to percussion of the lower one half of the sternum.The Dressier sound is aflat sound on percussion the lower half or two third of the sternum. In the absence of mitral stenosis, this finding 'should at once arouse suspicion of pericardial effusion '.Bamberger's sign-Dullness at the angle of the scapula that disappears when the patient leans forward is Bamberger s sign of pericardial effusion.Dullness at the left lower lung field is Ewart s sign ofpericardial effusion, while right-sided dullness is Conner s sign. Disappearance of Ewart s or Conner s signs when the patient sits up and leans forward is Bambeiger s sign of pericardial effusion.\n\nSo the answer to this question is A"} {"instruction": "Which of the following statements regarding the treatment of radiation accident victims is false?\nA. At doses less than 4 to 5 Gy, the patient is only treated in response to specific symptoms\nB. At doses 5-8 Gy, infection, bleeding and physical trauma are to be avoided during the period in which the circulating blood elements have a low concentration\nC. At doses 8-10 Gy, a bone-marrow transplant can be administrated\nD. At doses above 10 Gy, a bone-marrow transplant must always be administrated", "response": "If the radiation exposure is known to be less than 4 to 5 Gy (400-500 rad), most expes recommend that the patient is watched carefully but only treated in response to specific symptoms, such as antibiotics for an infection, fresh platelets for local haemorrhage, and so on. If the dose is known to have exceeded about 5 Gy (500 rad), then death from the hematopoietic syndrome 3 to 4 weeks later is a real possibility. In some countries, isolation and barrier nursing--that is, isolation from others so that they do not come in contact with possible infections while their blood count is low--is recommended. It has been shown in animals that the LD50 can be raised by a factor of about 2 by the use of antibiotics, and there is no reason to suppose that the same is not true in humans. The impoant things are to avoid infection, bleeding, and physical trauma during the period in which the circulating blood elements reach a nadir and to give the bone marrow a chance to regenerate. Below about 8 Gy (800 rad), an exposed person is likely to survive with careful nursing and an antibiotic screen because the LD50 can be approximately doubled by such conservative measures. In such cases, therefore, a transplant is not necessary. Above about 10 Gy (1,000 rad) death from the gastrointestinal syndrome is inevitable, and so a bone-marrow transplant is of no use. Reference: Eric J Hall Textbook of Radiobiology for Radiologist; 5th edition\n\nSo the answer to this question is D"} {"instruction": "Mitochondria gene (True statement)a) Paternal transmissionb) Maternal transmissionc) Mendelian inheritanced) Mitochondrial myopathy\nA. c\nB. bd\nC. ab\nD. ac", "response": "Mitochondrial DNA is always maternally inherited.\nImportant mitochondrial diseases are mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS), Leber hereditary optic neuropathy, myoclonic epilepsy with ragged-red fibers, Leigh syndrome, Pearson syndrome, keams-sajre syndrome, chronic progressive external ophthalmoplegia and NARP (neurogenic weakness with ataxia & retinitis pigmentosa).\n\nSo the answer to this question is B"} {"instruction": "NRHM involves\nA. VHG\nB. ASHA\nC. ANM\nD. HWM", "response": "Ans) b (ASHA) Ref park 20th ed pg 379-381The main aim of the national rural health mission (NRHM) is to provide accessible, affordable, accountable, effective and reliable primary health care and bridging the gap of rural health care through creation of a cadre of Accredited social health activist (ASHA)VHG is village health guide.ANM is Auxiliary nurse midwife.HWM is health worker male.\n\nSo the answer to this question is B"} {"instruction": "On exposure to cold, all are seen EXCEPT:March 2013\nA. Increased adrenaline\nB. Shivering\nC. Increased thyroxine\nD. Cutaneous vasodilation", "response": "Ans. D i.e. Cutaneous vasodilationHypothermiaIt is a condition in which core temperature drops below the required temperature for normal metabolism and body functions which is defined as 35.0 degC (95.0 degF).Symptoms may be sympathetic nervous system excitation:- Shivering,Hypeension,- Tachycardia,- Tachypnea, and- VasoconstrictionThese are all physiological responses to preserve heat. Cold diuresis, mental confusion, as well as hepatic dysfunction may also be present.\n\nSo the answer to this question is D"} {"instruction": "All of the following are Vitamin B6 dependent syndromes, EXCEPT:\nA. Pyridoxine dependent seizures\nB. Xanthurenic aciduria\nC. Cystanthioninuria\nD. Darier disease", "response": "Darier disease- autosomal dominant, characterized by greasy hyperkeratotic papules in seborrheic regions, nail abnormalities, and mucous membrane changes. Vitamin B6 dependence syndromes syndromes : pyridoxine-dependent epilepsy, a vitamin B6-responsive anemia, xanthurenic aciduria, cystathioninuria, and homocystinuria.\n\nSo the answer to this question is D"} {"instruction": "Leprosy is not targeted for global eradication because\nA. No effective vaccine\nB. Highly infectious but low pathogenicity\nC. Only humans are reservoir\nD. Long incubation period", "response": "Ans. d. Long incubation period\n\nSo the answer to this question is D"} {"instruction": "Which is not true about high copper amalgam alloys:\nA. Low tensile and compressive strength\nB. Low Hg: Alloy ratio\nC. High tensile strength\nD. Low creep", "response": "None\n\nSo the answer to this question is A"} {"instruction": "True regarding pre-exposure tetanus immunization are all except: September 2005\nA. If already immunized, a booster in the last trimester is advocated\nB. Vaccine is given intramuscularly\nC. Tetanus immunoglobulin is injected to the mother\nD. 2 doses are recommended", "response": "Ans. C: Tetanus Immunoglobulin is Injected to the Mother Administration of attenuated virus vaccines are contraindicated during pregnancy, this includes vaccines against measles, mumps, poliomyelitis, rubella, yellow fever, and varicella. MMR vaccination can be given during lactation and does not affect the baby. The CDC recommends that non-pregnant women who receive the MMR vaccine or varicella vaccination should wait four weeks before getting pregnant. In situations where inactivated virus or pas of a virus are administered, in general, there is no contraindication to immunization during pregnancy. Thus influenza vaccination is given to pregnant women at risk, as are vaccinations against hepatitis A and B. HPV vaccine was introduced in 2006. It is not to be used during pregnancy. BCG(Live attenuated bacterial) vaccine is used against tuberculosis and is contraindicated in pregnancy Inactivated bacterial vaccine is used during pregnancy for women who have a specific risk of exposure and disease. Vaccination against pneumococcus or meningococcus infections, or typhoid fever show no confirmed side effects regarding the fetus. Tetanus toxoids appear safe during pregnancy and are administered intramuscularly. 0.5 ml tetanus toxoid is given at 6 weeks interval for 2 such,the first one to be given between 16-24 weeks.. Immune globulins are used for post exposure prophylaxis. Such agents are considered in pregnant women exposed to hepatitis B, rabies, tetanus, varicella, and hepatitis A\n\nSo the answer to this question is C"} {"instruction": "A 47-year old woman was referred for bone pain and abnormal findings on radiography. The patient repoed that for the past 17 years, she has habitually consumed water from that area. She repoed a 5-years history ofpain in the lower back, arms, legs and hips, Because of brittleness, all her teeth had been extracted. Radiography ofthe forearm revealed interosseous membrane calcification and radiography ofthe spine revealed a rugger-jersey appearance (striated pattern of increased density in the upper and lower zones of the veebrae). The probable diagnosis is\nA. Silicosis\nB. Fluorosis\nC. Vitamin B toxicity\nD. Hypercalcinosis", "response": "Skeletal fluorosis is a bone disease caused by excessive accumulation of fluoride in the bones. In advanced cases, skeletal fluorosis causes painful damage to bones and joints. Symptoms are mainly promoted in the bone structure. Due to a high fluoride concentration in the body, the bone is hardened and thus less elastic, resulting in an increased frequency of fractures. Other symptoms include thickening of the bone structure and accumulation of bone tissue, which both contribute to impaired joint mobility. Ligaments and cailage can become ossified. Most patients suffering from skeletal fluorosis show side effects from the high fluoride dose such as ruptures of the stomach lining and nausea. Fluoride can also damage the parathyroid glands, leading to hyperparathyroidism, the uncontrolled secretion of parathyroid hormones. These hormones regulate calcium concentration in the body. An elevated parathyroid hormone concentration results in a depletion of calcium in bone structures and thus a higher calcium concentration in the blood. As a result, bone flexibility decreases making the bone more susceptible to fractures Mechanism of action The best way to view the mechanism of action by which fluorine breaks down bones and causes skeletal fluorosis is in a stepwise fashion. Fluoride enters the body by two paths: Ingestion or respiration. Both paths lead to corrosion of exposed tissue in high concentrations. Since the most likely form of fluoride to enter the body is hydrogen fluoride (HF) gas, this is what stas the process. Exposed tissues will be utilized by HF in neutralization reactions. This will leave F- free to pass fuher into the body. It reacts with the concentrated HCl in the stomach to form the weak acid, HF. This compound is then absorbed by the gastro-intestinal tract and passes into the liver the poal vein. Since elemental F is one of the strongest oxidizers currently known, the anion F- is immune to phase 1 metabolic reactions, which are generally oxidation reactions, in the liver. These reactions are the body's first line of defense to biotransform harmful compounds into something more hydrophilic and more easily excreted. The HF is now free to pass into the blood stream and be distributed to all tissues including bones. Bones are largely composed of Ca compounds, paicularly carbonated hydroxyapatite (Ca 5(PO 4) 3(OH)); the reaction of Ca2+ ions and HF forms an insoluble salt, CaF 2. This salt must be cleared by the body, which concomitantly leaches out some of the calcium that would be pa of the bone matrix. This process results in increased density, but decreased strength in bones As of now, there are no established treatments for skeletal fluorosis patients. However, it is reversible in some cases, depending on the progression of the disease. If fluorine intake is stopped, the amount in bone will decrease and be excreted urine. However, it is a very slow process to eliminate the fluorine from the body completely. Minimal results are seen in patients. Treatment of side effects is also very difficult. For example, a patient with a bone fracture cannot be treated according to standard procedures, because the bone is very brittle. In this case, recovery will take a very long time and a pristine healing cannot be guaranteed. However, fuher fluorosis can be prevented by drinking defluoridated water. It is recently suggested that drinking of defluoridated water from the ''calcium amended-hydroxyapatite'' defluoridation method may help in the fluorosis reversal. Defluoridated water from this suggested method provides calcium-enriched alkaline drinking water as generally fluoride contaminated water has a low amount of calcium mineral and drinking alkaline water helps in eliminating the toxic fluoride from the body Ref Davidson 23rd edition pg 715\n\nSo the answer to this question is B"} {"instruction": "A 15-year-old girl with short stature, neck webbing, and sexual infantilism is found to have coarctation of the aorta. A chromosomal analysis likely would demonstrate which of the following?\nA. Mutation at chromosome 15q21.1\nB. Trisomy 21\nC. XO karyotype\nD. Defect at chromosome 4p 16", "response": "Short stature, neck webbing, sexual infantilism, and a shield like chest with widely spaced nipples are signs of Turner syndrome, which is usually associated with an XO karyotype. Aortic coarctation occurs in about 15% to 20% of those with this disorder. Down syndrome is most commonly associated with endocardial cushion defects or VSD. Marfan syndrome (mutation 15q21.1) is associated with dilatation of the aorta and mitral and aortic regurgitation. Ellis-van Creveld syndrome (defect 4p16) is associated with ASD.\n\nSo the answer to this question is C"} {"instruction": "class III malocclusions can be seen in all except:\nA. Cleidocranial dysplasia.\nB. Craniofacial dysostosis.\nC. Pierre Robin syndrome.\nD. Achondroplasia.", "response": "None\n\nSo the answer to this question is C"} {"instruction": "The enzyme pseudocholinesterase acts on\nA. Decamethonium\nB. Tubocurarine\nC. Gallamine\nD. Suxamethonium", "response": "Refer Katzung 11/e p454 Suxamethonium is the other name of succinylcholine It is the shoest acting muscle relaxant due to metabolism by pseudocholinesterase\n\nSo the answer to this question is D"} {"instruction": "Which among the following is TRUE about Clomiphene?\nA. Anti-gonadotrophin\nB. Anti-progesterone\nC. Anti-oestrogen\nD. Anti-androgenic", "response": "Clomiphene is an antiestrogen. These compounds are distinguished from the Selective estrogen receptor modulators(SERMs) in that they are pure antagonists in all tissues studied. Clomiphene citrate is a potent anti-estrogen that primarily is used for treatment of anovulation in the setting of an intact hypothalamic--pituitary axis and adequate estrogen production (e.g., PCOS). By inhibiting the negative feedback effects of estrogen at hypothalamic and pituitary levels, clomiphene increases follicle-stimulating hormone (FSH) levels--typically by ~50%--and thereby enhances follicular maturation. Clomiphene s approved for the treatment of infeility in anovulatory women. Clomiphene increases gonadotropin secretion and stimulates ovulation. It increases the amplitude of LH and FSH pulses without changing pulse frequency. This suggests that the drug is acting largely at the pituitary level to block inhibitory actions of estrogen on gonadotropin release from the gland and/or is somehow causing the hypothalamus to release larger amounts of GnRH per pulse. Ref: Levin E.R., Hammes S.R. (2011). Chapter 40. Estrogens and Progestins. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.\n\nSo the answer to this question is C"} {"instruction": "The staging for pelvic inflammatory is described by-\nA. Jonathan\nB. Florence\nC. Gainesville\nD. Sartonini", "response": "Ans. is 'c' i.e., Gainesville Gainesville staging of pelvic inflammatory disease:o Acute salpingitis without peritonitiso Acute salingitis with peritonitiso Acute salpingitis with superimposed tubal occlusion or tube-ovarian complexo Ruptured tubo - ovarian abscesso Tubercular salpingitis\n\nSo the answer to this question is C"} {"instruction": "Neurocardiagenic syncope, the least useful investigation is :\nA. Tilt table\nB. Carotid sinus massage\nC. Carotid duplex scan\nD. Ohostatic blood pressure recording", "response": "Carotid duplex scan Neurocardiogenic syncope is also called vasovagal syncope or vasodepressor syncope. It is considered to be an abnormality in the complex neurocardiovascular interactions responsible for maintaining systemic and cerebral perfusion. Under normal circumstances, upright posture causes venoul polling and a transient decrease in aerial pressure, resulting in unloading of baroreceptors. Reflex augumentation of sympathetic activity and parasympathetic withdrawl results in peripheral aerial vasoconstriction, venoconstriction and an increase in hea rate and contractility. These adaptive mechanisms serve to maintain normal systemic and cerebral perfusion. Individuals susceptible to neurocardiogenic syncope are unable to maintain the adaptive neurocardiovascular response to upright posture for prolonged periods. In these patients due to incompletely understood mechanisms the cardiopulmonary mechanoreceptors are stimulated resulting in increased neural stimulus to vasomotor centre. This results in reflex paradoxical vasodilation and bradycardia. The final result is hypotension, cerebral hypopeifusion, cerebral hypoxia and syncope. Diagnosis of neurocardiogenic syncope : Tilt table study It is used to evaluate patients with neurocardiogenic syncope. In a tilt table study the patient is strapped to a table which is then mechanically tilted to an upright position. While monitoring the pulse, blood pressure, electrocardiogram and sometimes blood oxygen saturation, the patient is left in a 'motionless standing position' for 20 to 30 minutes. When the patient's syncope is reproduced during the test a \"positive\" tilt table study is said to have occurred. During an upright tilt, a patient's cardiovascular system has to adjust itself in order to prevent a significant poion of the blood volume from pooling in the legs. These adjustments consists of a mild increase in hea rate and a constriction of blood vessels in the legs. When a normal individual is placed in an upright tilt, these cardiovascular adjustments occur very quickly, and there is no significant drop in the blood pressure. However, in patients with neurocardiogenic syncope, these adjustments do not occur. Carotid sinus massage In patients with neurocardiogenic syncope, the symptoms can be elicited by carotid sinus massage. Ohostatic blood pressure recording Supine and upright blood pressure monitoring should be done in all patients with neurocardiogenic syncope. Carotid duplex scan Carotid duplex scan is a non-invasive study to estimate the presence and severity of carotid narrowing due to atherosclerosis. In neurocardiogenic syncope, no organic cause is present, so carotid duplex scan has no role.\n\nSo the answer to this question is C"} {"instruction": "General feility rate is a better measure of feility than the crude bih rate because the denominator includes\nA. 15 - 45 years of aged females\nB. Midyear population\nC. Total women population\nD. Married women population", "response": "General feility rate is the number of live bihs per 1000 women in the reproductive are group ( 15-44 or 49 years) in a given year GFR = number of live bih in an area during the year X 1000/ mid year female population age group 15-44 (or 49) in the same area in same year General feility rate is a better measure of feility than the crude bih rate because the denominator includes the number of women in the child bearing age rather than the whole population Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 488\n\nSo the answer to this question is A"} {"instruction": "Which of the following is false about Hemolytic Anemias\nA. Jaundice is the main clinical sign\nB. Shortend red cell life span\nC. Increased Recticulocyte count\nD. Decreased erythropoietin levels", "response": "Elevated erythropoietin leves are seen in Hemolytic anemias.\n\nSo the answer to this question is D"} {"instruction": "Wrong statement is –\nA. Mees line in arsenic poisoning\nB. Pterygium of nails in Lichen planus\nC. Onycholysis in Psoriasis\nD. Koilonychia in Megaloblastic Anemia (B12 def)", "response": "Koilonychia is seen in iron deficiency anemia (not in megaloblastic anemia).\nMees line is seen in Arsenic poisoning.\nPterygium is diagnostic for lichen planus.\nPsoriasis can cause onycholysis\n\nSo the answer to this question is D"} {"instruction": "Nutrient artery arises to fibula from -\nA. Peroneal artery\nB. Anterior tibial artery\nC. Dorsalis pedis\nD. Popliteal artery", "response": "Nutrient artery to fibula is peroneal artery branch of posterior tibial artery.\n\nSo the answer to this question is A"} {"instruction": "Which of the following is used for functional reline method of complete dentures?\nA. Short term denture liners\nB. Long term denture liners\nC. Lab processed denture liners\nD. None of the above", "response": "Short term denture liners also called as tissue conditioners, are highly plasticized acrylic resins, that are used for treatment of abused tissues. Functional reline method employs use of tissue conditioners.\n\nSo the answer to this question is A"} {"instruction": "L1 L2 L3 serovar of chlamydia trachomatis cause ?\nA. Trachoma\nB. Inclusion conjuctivitis\nC. NGU\nD. LGV", "response": "Ans. is 'd' i.e., LGV\n\nSo the answer to this question is D"} {"instruction": "Food with maximum cholesterol content\nA. Egg\nB. Coconut Oil\nC. Hydrogenated Fats\nD. Ghee (Hydrogenated)", "response": "Ans. a. Egg Food with maximum cholesterol content is egg. \"The yolks of eggs have the most cholesterol of any food with 1234 mg pr 100 gram serving or 411% of the DV. A single egg yolk will provide 210 mg (70% DV) of cholesterol, while a whole egg provides slightly more with 212 mg Impoant points about Egg All the cholesterol in egg is found in the yolkQ Egg white does not have any cholesteroldeg Egg contains all the nutrients except carbohydrates and vitamin CQ. Egg protein is considered the best among food proteins and is the standard against which the quality of other proteins is comparee. NPU of egg protein is 100Q\n\nSo the answer to this question is A"} {"instruction": "A Female patient aged 40 years comes for routine general examination. Full mouth radiographs are taken. Oval shaped radiolucent areas are seen in the root canals of maxillary central incisors Teeth are asymptomatic and show feeble response to vitality tests.\n\nWhat is your choice of medicament?\nA. Formocresol\nB. Calcium hydroxide\nC. CMCP\nD. MTA", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Besides its properties of decreasing intraocular pressure, timolol is preferred in the treatment of glaucoma because it:\nA. Produces no miosis\nB. Possess membrane stabilizing activity\nC. Increases outflow of aqueous humor\nD. Is a selective beta–adrenoceptor blocker", "response": "None\n\nSo the answer to this question is A"} {"instruction": "In DNA transfer the vectors used from smallest to largest is -\nA. Cosmids, Plasmids, Bacteriophage\nB. Plasmids, Bacteriophage, Cosmids\nC. Bacteriophage, Cosmides, Plasmids\nD. Cosmids, Bacteriophage, Plasmids", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Addison's disease is characterized by all except\nA. Hyperglycemia\nB. Hypotension\nC. Hyperkalemia\nD. hyponatremia", "response": "Ref - Davidson's medicine20e p672 ( Harrison 17 pg 2263)\n\nSo the answer to this question is A"} {"instruction": "Long term complication of live kidney donors are\nA. Hypeension\nB. HPV Infection\nC. Renal Carcinoma\nD. Pyelonephritis", "response": "Answer- A. HypeensionHypeentionCardiovascular risksPreoteinuriaEnd stage renal disease\n\nSo the answer to this question is A"} {"instruction": "Daily regularment of Vit A in children is -\nA. 40\nB. 400\nC. 1500\nD. 5000", "response": "Daily requirement in children is 400mcg. (1-6yrs) Ref : Park 25th edition Pgno : 653\n\nSo the answer to this question is B"} {"instruction": "All are lysosomal storage disorders except -\nA. I cell disease\nB. Hunter's disease\nC. Me Ardle's Disease\nD. Farber's disease", "response": "Ans. is 'c' i.e., Me Ardle's Disease* Lysosomal storage disorders is a group of metabolic disorders caused by a defect of lysosome. Lysosomes are sacs concerned with metabolising unwanted lipids, glycoproteins and mucopolysaccharides.* They are classified as# Lipid storage disorders* E.g., sphingolipidosis like Gml gangliosidosis caused by b galactosidase defect, GM2 gangliosidoses caused by hexosaminidase A defect, Fabry's disease caused by a galactosidase defect, Gaucher's disease caused by b glucosidase defect, Farber's disease caused by ceramidase defect (It is a granulomatous condition and it presents with painful subcutaneous nodules, hepatosplenomegaly and pulmonary involvement)# Mucopolysaccharidoses* E.g., Hurler syndrome caused by a defect of L-iduronidase, Hunter syndrome caused by a defect of L-iduronate sulfatase.# Glycoprotein storage disorders* E.g., Fucosidosis, Mannosidosis# Mucolipidosis* E.g., I cell disease - caused by a defect of GlcNAC phosphotransferase. Because of this defect, the lysosomal enzymes are not labelled with mannose 6 phosphate. Mannose 6 phosphate is required as a label for targeting lysosomal enzymes to lysosomes. In this condition, lysosomal enzymes do not reach lysosomes. They are secreted out. Lysosomes are empty bags. Hence all undigested glycoproteins and lipids accumulate within all cells as Inclusions, that is why the name I cell disease or Inclusion cell disease. This condition resembles hurler syndrome# Apart from this classification, there is also lysosomal transporter defects like cystinosis caused by a defect of efflux of cysteine from lysosomes. It is characterised by fanconi's syndrome, photophobia and characteristic cysteine crystals can be observed in cornea on slit lamp examination# All these disorders are autosomal recessive disorders except Hunter syndrome and Fabry's disease, both of which are X linked recessive disorders.# All lysosomal storage disorders present as hepatosplenomegaly, mental retardation, seizures with or without deafness and blindness.# Me Ardle's disease is not a lysosomal storage disorder. It is Glycogen Storage Disorder Type V (GSDIV). It is caused by Muscle Glycogen phosphorylase defect. It presents as exercise intolerance, intolerance to anaerobic exercises. Glycogen phosphorylase is not a lysosomal enzyme, it is a cytoplasmic enzyme.# The only Glycogen storage disorder which is also a Lysosomal Storage disorder is Type IIGSD or Pompe's disease, caused by alpha glucosidase defect.\n\nSo the answer to this question is C"} {"instruction": "Retinoblastoma is associated with-\nA. Osteosarcoma\nB. Hepatocellular\nC. SCC\nD. Osteoclastoma", "response": "Robbins basic pathology 9th edition page no 777 Pathogenesis Several mutations are associated with the devolopmeny of osteosarcoma. The patients with hereditory retinoblastomas have a thousand fold greater risk for devolopment of osteosarcoma.\n\nSo the answer to this question is A"} {"instruction": "A 60 year man had undergone cardiac bypass surgery 2 days back. Now he staed forgetting things and was not able to recall names and phone numbers of his relatives. What is the probable diagnosis?\nA. Depression\nB. Post traumatic psychosis\nC. Cognitive dysfunction\nD. Alzheimer's disease", "response": "C i.e. Cognitive dysfunction Post cardiac surgery delirium (similar to ICU syndrome) is fairly common disorder typically occurring after 24-48 hours of surgeryQ in fearful patients. It presents as cognitive dysfunction affecting information processin intellect, concentration retention, visuo-spatial organization and memoryQ.\n\nSo the answer to this question is C"} {"instruction": "An inhaled foreign body is likely to lodge in the right lung due to all of the following features except:\nA. Right lung is shoer & wider than left lung\nB. Right principal bronchus is more veical than the left bronchus\nC. Tracheal bifurcation directs the foreign body to the right lung\nD. Right inferior lobar bronchus is in continuation with the principal bronchus", "response": "A. i.e. Right lung is shoer and wider than left lung\n\nSo the answer to this question is A"} {"instruction": "The term catatonia is coined by -\nA. Kahlbaum\nB. Freud\nC. Maxwell jones\nD. Adler", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Which of the following immunosuppressant drugs is nephrotoxic?\nA. Azathioprine\nB. Cyclophosphamide\nC. Mycophenolate mofetil\nD. Tacrolimus", "response": "Tacrolimus and cyclosporine toxicity include nephrotoxicity, neurotoxicity, hyperglycemia, hypertension, hyperkalemia and GI complaints. Cyclosporine also cause hirsutism, which is not seen with tacrolimus use.\n\nSo the answer to this question is D"} {"instruction": "Recent influenza pandemic was due to which strain?\nA. H1N1\nB. H5N1\nC. H7N7\nD. H3N2", "response": "Influenza us cause by Ohomyxovirus 3 types: A, B, C - Type A:MC cause of outbreaks/ epidemics; only cause of pandemics Examples: H1 N1 (Type A) - Cause of Swine flu -Recent influenza pandemic H2 N2 (Type A) H5 N1 (Type A) -Cause of An influenza (Bird flu)\n\nSo the answer to this question is A"} {"instruction": "If TFR in a population is 4, then GRR would be (approx.)\nA. 2\nB. 4\nC. 8\nD. 16", "response": "- GRR or NRR= 1/2 TFR (approx.) - In given question, TFR is 4; hence GRR is half of 4 = 2\n\nSo the answer to this question is A"} {"instruction": "\"Founder effect\" describes the distribution of diseases on the basis of\nA. Occupation\nB. Environment\nC. Genetics\nD. All of the above", "response": "Ans. c (Genetics) (Ref. Park PSM 22nd/, p 680)GENETIC DRIFT AND FOUNDER PSEEE&# Founder effect refers to loss of genetic variation when a new colony is established by a very small number of individuals from a large population like antigenic drifting.# When people migrate to new regions, they may develop \"new\" disease or express \"old\" disease at higher frequencies.# This phenomenon reflects either new experiences or old genes expressed at altered frequencies in the settlers and the number of susceptible persons in the newly resident population after migration of \"founder\" depends on number of incoming mutant genes borne by the founders and the factors that favor their spread through the population.HARD Y-WEINBERG LAW# Concerns with population genetics.# It states that \"the relative frequency of each gene allele tends to remain constant from generation to generation\" in the absence of forces that change the gene frequencies.# Thus it assumes that human population is static.# But in reality, human population and gene pool is never static due to mutation, natural selection, population movements, breeding structures and public health measures.CHANGING GENE FREQUENCIESA rise in frequency of a particular phenotype (due to changing gene frequncies), may be cuased by one or more following5 factors, which disturb the Hardy-Weinberg equilibrium:# Non-random mating# Selection# Mutation# Heterozygote advantage# Genetic drift and \"founder\" effect.\n\nSo the answer to this question is C"} {"instruction": "which of the following is immediate anterior relation to uterus ?\nA. A) Urinary bladder\nB. B) Uterovesicle pouch\nC. C) Pubic symphysis\nD. D) Urogenital diaphragm", "response": "The anterior or vesical surface is flat and related to the urinary bladder. It is covered with peritoneum and forms the posterior or superior wall of the uterovesical pouch. SO, the immidiate anterior relation is uterovesical pouch. Ref : B D Chaurasia's Human Anatomy , Seventh Edition , Volume 2, pg. no., 420 ( figs.31.11a )\n\nSo the answer to this question is B"} {"instruction": "Fibrin is degraded by\nA. Plasminogen\nB. Plasmin\nC. Thromboplastin\nD. FD", "response": "Clotting also sets into motion a fibrinolytic cascade that moderates the ultimate size of the clot. Fibrinolysis is largely carried out by plasmin, which breaks down fibrin and interferes with its polymerization. The resulting fibrin split products (FSPs or fibrin degradation products) also can act as weak anticoagulants.\nElevated levels of FSPs (most notably fibrin-derived D-dimers) can be used for diagnosing abnormal thrombotic states including disseminated intravascular coagulation (DIC), deep venous thrombosis, or pulmonary thromboembolism.\nPlasmin is generated by proteolysis of plasminogen, an inactive plasma precursor, either by factor XII or by plasminogen activators. The most important of the plasminogen activators is tissue-type plasminogen activator (t-PA); t-PA is synthesized principally by endothelial cells and is most active when attached to fibrin.\n\nSo the answer to this question is B"} {"instruction": "In maple syrup urine disease FeCl3 test with urine gives ____ color –\nA. Green\nB. Blue\nC. Black\nD. Red", "response": "Diagnosis \n\nIs usually suspected because of the peculiar odour of maple syrup found in the body fluids - urine, sweat, cerumen etc.\nDiagnosis is continued by amino acid analysis showing marked elevation in plasma level of leucine, isoleucine, valine and alloisoleucine (a stereoisomer of isoleucine not normally found in blood) and depression of alanine. Leucine levels are usually higher than those of other three amino acids.\nUrine contains high levels of leucine, isoleucine and valine and their respective ketoacids.\nThe keto acids may be detected by adding a few drops 2-4 dinitrophenylhydrazine (DNPH) reagent which produces a yellow precipitate in a positive test.\nFerric chloride gives navy blue colour with the patient's urine.\n\nSo the answer to this question is B"} {"instruction": "All are true regarding folliculogenesis and ovulation except\nA. Follicular development and differentiation takes about 85 days\nB. AMH suppos monofollicular development\nC. First phase of follicular growth is gonadotropin insensitive\nD. Elevated and static level of estradiol is essential for ovulation", "response": "Ovulation The LH surge initiates the continuation of meiosis in the oocyte, luteinization of the granulosa, and synthesis of progesterone and prostaglandins within the follicle Progesterone enhances the activity of proteolytic enzymes responsible, together with prostaglandins, for digestion and rupture of the follicular wall The progesterone influenced midcycle rise in FSH serves to free the oocyte from follicular attachments, to conve plasminogen to the proteolytic enzyme, plasmin, and to ensure that sufficient LH receptors are present to allow an adequate normal luteal phase The onset of the LH surge appears to be the most reliable indicator of impending ovulation, occurring 34-36 hours prior to follicle rupture A reasonable and accurate estimate places ovulation approximately 10-12 hours after the LH peak and 24-36 hours after peak estradiol levels are attained Reference: Clinical Endocrinologic Gynecology and Infeility, Eighth edition; Chapter 6\n\nSo the answer to this question is D"} {"instruction": "Hassall's corpuscles are found in:\nA. Liver\nB. Spleen\nC. Kidney\nD. Thymus", "response": "Ans. (d) ThymusRef: Gray's 41st ed. / 619* CORPUSCLE means any small body.* Hassall's corpuscles are spherical or ovoid bodies found in the medulla of the thymus, composed of concentric arrays of epithelial cells which contain keratohyalin and bundles of cytoplasmic filaments.Also KnowSome other known corpuscles* Lamellated corpuscle a type of large encapsulated nerve ending found throughout the body, concerned with perception of sensations.* Malpighian corpuscles : Found in Nephrons (kidney) and in spleen (white pulp)* Meissner's corpuscle: A type of mediumsized I encapsulated nerve ending in the skin, chiefly in the palms and soles.* Paciniform corpuscles a type of rapidly adapting lamellated corpuscles responding to muscle stretch and light pressure.* Red corpuscle: Red Blood Cells* White corpuscle: White Blood Cells\n\nSo the answer to this question is D"} {"instruction": "Metabolically active layer of cornea is –a) Endotheliumb) Stromac) Descemet membrane d) Epithelium\nA. b\nB. c\nC. ad\nD. ab", "response": "The most actively metabolizing layers of the cornea are epithelium and endothelium.\n\nSo the answer to this question is C"} {"instruction": "Which of these are true of Gilbe's syndrome ?\nA. Increased liver transaminases\nB. Unconjugated hyperbilirubinemia\nC. Bleeding tendency\nD. Presence of auto-antibodies", "response": "Ans. is 'b' i.e., Unconjugated hyperbilirubinemia\n\nSo the answer to this question is B"} {"instruction": "All are true about neuropeptide 'Y’ excepta) Consist of 36 amino acidsb) Decreases thermogenesisc) Decreased in starvationd) Same effect like melanocorticotropin\nA. ab\nB. bc\nC. bd\nD. cd", "response": "Neuropeptide Y has 36 aminoacid residues. It stimulates appetite, reduces thermogenesis by decreasing the energy expenditure and also decreases the activity of MSH. During starvation it is secreted at increased levels.\n\nSo the answer to this question is D"} {"instruction": "Earliest change in atherosclerosis is\nA. Fatty streaks\nB. Fibrofatty plaque\nC. Calcification\nD. Gelatinous lesions", "response": "A. i.e. (Fatty streaks) (385- 86 - Harsh Mohan 5th) (349 - Basic pathology 8th)ATHEROSCLEROSIS - is an intima- based lesion organized into a fibrous cap and an atheromatous (gruel- like) core and composed by smooth muscle cells, endothelial cells inflammatory cells, lipids and necrotic debris* Atherosclerosis is a slowly evolving lesion usually requiring many decades to become significant. However acute plaque changes {eg rupture, thrombosis or hematoma formation) can rapidly precipitate clinical sequalae (so-called - Clinical Horizon)* Early lesions in the form of diffusal internal thickening, fatty streaks and gelatinous lesions*** Earliest light microscopic changesin MI is- Waviness of the fibres***Morphological features, pathogenic events and clinical complications* Most common cause of aortic aneurysm is - Athero sclerosis*** Most common site for MI is - Anterior wall of left ventricles*** Granulation tissue appears in acute MI - At 1 weeks*** Calcification of the aortic valve is seen in - Aortic stenosis** Me - Collum's patch is diagnostic of - Rheumatic endocarditis*** Osier's node, Janueway and Roth spot seen in Subacute Bacterial endocarditis*** Most common change in atherosclerotic vessel is - Dystrophic calcification* Atherosclerosis LDL is present in LDL monocytes**\n\nSo the answer to this question is A"} {"instruction": "The maximum sterilizing action is shown with which of the following anti-TB drug?\nA. Rifampicin\nB. Streptomycin\nC. INH\nD. Pyrazinamide", "response": "Pyrazinamide acts on slow-growing bacteria inside the macrophages causing maximum sterilization.Ref: katzung 13th edition; Pg: 819\n\nSo the answer to this question is D"} {"instruction": "10% Tumour is\nA. Pheochromocytoma\nB. Papillary Thyroid Carcinoma\nC. Follicular Thyroid Carcinoma\nD. Brown’s Tumor", "response": "Pheochromocytomas normally obey the “rule of 10”. Hence, they are also called the “10% tumor”. i.e. 10% of pheochromocytomas are: \n\nFamilial. \nMalignant. \nBilateral. \nExtra-adrenal. \nSeen in children\n\nSo the answer to this question is A"} {"instruction": "Not a criteria of a solitary benign pulmonary nodule on chest X-ray\nA. Less than 5cm size\nB. Peripheral Location\nC. Cavitation\nD. Concentric Calcification.", "response": "Ans. is 'c' ie Cavitation (Ref Sutton, 6/e, p 316; Harrison, 16/e, p 512, 516 (15/e, p 568))Even looking in a large no. of books including radiology books, I could not get a satisfactory explanation. But still I could give some help on a repeatedly asked topic - Solitary Pulmonary nodule (SPN)\"When apt: presents with an asymptomatic SPN (defined as an X-ray density of any shape usually 1 to 6 cm in greatest diameter) a decision to resect or to follow the nodule must be made.Approximately 35% of all such lesion in adults are malignant, most being primary lung cancer; while < 1% are malignant in nonsmokers under 35 years of age.If no diagnosis is immediately apparent the following risk factors would all argue strongly in favour of proceeding with resection to establish a histological diagnosis -a h/o Cigarette smokingage 35 year or oldera relatively large lesionlack of calcificationchest symptomsassociated atelectasis, pneumonitis or adenopathyAt present, only 2 radiographic criteria are reliable predictors of the benign nature of a solitary pulmonary noduleLack of growth over a period of 2 yrs.Certain characteristic pattern of calcification (calcification alone does not exclude malignancy). Calcification patterns which are highly suggestive of a benign lesion -a dense central nidusmultiple punctate focibulls eye (granuloma)popcorn calcification (hamartoma)When old X-ray are not available and the characteristic calcification patterns are absent the following approach is reasonable -Non smoking patients younger than 35 yrs can be followed and any significant growth should lead to its resection.\"For pts older than 35 yrs and all pts with smoking history, a histological diagnosis must be made.\" - Harrison 15/e, Size - Masses larger than 4 cm are predominantly primary malignancies. -Sutton, 6/eCavitation - common cavitating lesion are tuberculosis, staphylococcal inf & carcinoma.Peripheral location - The maximum I could get is that Metastasis have predilection for the periphery but they are usually multiple nodules (75%)So much of B.C., but still we are not certain of the answer, but this text will certainly help you for future questions on this imp. topic.Cavitation was the answer of consensus in my circle.\n\nSo the answer to this question is C"} {"instruction": "HSV-2 (Herpes simplex) causes -\nA. Oral ulcers\nB. Genital ulcers\nC. U.T.I.\nD. Pharyngitis", "response": "Ans. is 'b' i.e., Genital ulcerHERPES SIMPLEX VIRUS (HSV)HSV Type 1HSV Type 2o Cause lesion in and around mouthCause lesion around genital areao Transmitted by direct contact or droplet spreadUsually transmitted sexuallyo Replicate poorly in chick embryo fibroblast cellReplicate wello Relatively sensitive to antiviral agentsResistanto Less neurovirulentMore neurovirulento Infectivity is less temperature sensitiveMore temperature sensitiveo Site of latency-trigeminal gangliaSacral gangliao On chick embryo CAM. form smaller pockForm larger pock\n\nSo the answer to this question is B"} {"instruction": "The most common mediastinal tumor is-\nA. Neurogenic tumor\nB. Pericardial cyst\nC. Hernia\nD. Teratoma", "response": "Overall most common mediastinal masses are neurogenic tumors (20%) followed by thymomas (19%), primary cysts (18%), lymphomas (13%) and germ cell tumors (10%).\nMost of the mediastinal masses are located in the anterior mediastinum followed by the posterior (25%) and middle (19%).\n\nSo the answer to this question is A"} {"instruction": "\"Rain drop'skull is seen in -\nA. Burkitfs lymphoma\nB. Hodgkin's lymphoma\nC. Multiple myeloma\nD. Haemophilia", "response": "Ans. is 'c' i.e., Multipie Myeloma Pain film on chest x-ray in multiple mvelomaDiffused unexplained osteoporosis, especially in spineo Diffuse loss of densityo Thinning of corticeso Lower thoracic and lumbar regions most commonly involvedo Pathological vertebral collapse inevitable single or multiple# Vertebral plana# Wrinkled vertebra of myelomao Sharply circumscribed osteolytic defects (radiological hallmark of myeloma)# Punched out lesions (multiple round purely lytic)# Most common in skull, pelvis, long bones, clavicles, ribs in long bones diaphysis most commonly involved# Humerus andfermur most common sites# Widespread lesions of skull (rain drop skull)# Size of lesions tend to be fairly uniform : round or oval# No reactive sclerosis\n\nSo the answer to this question is C"} {"instruction": "Posterior styphayloma is a feature of ?\nA. Congenital myopia\nB. Simple myopia\nC. Pathological myopia\nD. Hypermetropia", "response": "Ans. is 'c' i.e., Pathological myopia Staphyloma Staphyloma is an abnormal protrusion of uveal tissue through a weak and thin poion of cornea or sclera. So, a staphyloma is lined internally by uveal tissue and externally by weak cornea or sclera. Staphyloma is divided anatomically into : ? 1) Anterior staphyloma : - Protrusion and adhesion of iris to ectatic cornea. The most common cause is a sloughing corneal ulcer which perforates and heals with the formation ofpseudocornea by the organization of exudates and laying down of fibrous tissue. It is lined internally by iris. 2) Intercalary staphyloma : - It occurs at the limbus. It is lined internally by the root of iris and the anterior most poion of the ciliary body. The causes are perforating injuries to limbus, marginal corneal ulcer, anterior scleritis, Scleromalacia perforans, Complicated cataract surgery, secondary angle closure glaucoma. 3) Ciliary staphyloma : - This affects the ciliary zone that includes the region upto 8 mm behind the limbus. The ciliary body is incarcerated in the region of scleral ectasia. Causes are Developmental glaucoma, Primary or secondary glaucoma end stage, scleritis, trauma to ciliary region. 4) Equatorial staphyloma : - This occurs at the equatorial region of the eye with incarceration of the choroid. Causes are scleritis, degenerative myopia and chronic uncontrolled glaucoma. Posterior staphyloma : - Occurs at posterior pole and is lined internally by choroid. Degenerative high axial myopia is the most common cause.\n\nSo the answer to this question is C"} {"instruction": "A 5-year-old girl is brought to the physician after her parents noticed red blood in her stool. Physical examination reveals mucocutaneous pigmentation. Small bowel radiography discloses multiple, small- to medium-sized polyps that are diagnosed pathologically as hamartomas. Which of the following is the most likely diagnosis?\nA. Congenital teratoma\nB. Hyperplastic polyp\nC. Peutz-Jeghers polyp\nD. Tubular adenoma", "response": "Peutz-Jeghers syndrome is an autosomal dominant, hereditary disorder characterized by intestinal hamartomatous polyps and mucocutaneous melanin pigmentation, which is particularly evident on the face, buccal mucosa, hands, feet, and perianal and genital regions. The polyps seen in Peutz-Jeghers syndrome are hamartomatous, characterized by a branching network of smooth muscle fibers continuous with the muscularis mucosa that support the glandular epithelium of the polyp. Congenital teratoma (choice A) does not involve the intestine. The other choices are principally colonic polyps that derive from the luminal epithelium.Diagnosis: Gastrointestinal polyp, Peutz-Jeghers polyp\n\nSo the answer to this question is C"} {"instruction": "High resolution is obtained with:\nA. Intraoral films with direct exposure\nB. Extraoral films with intensifying screen\nC. OPG\nD. All of the above", "response": "Intraoral dental X-ray film is made as a double-emulsion film—that is, both sides of the base are coated with an emulsion. With a double layer of emulsion, less radiation is required to produce an image. Direct exposure film is used for intraoral examinations, because it provides higher resolution images than screen-film combinations. Some diagnostic tasks, such as detection of incipient caries or early periapical disease, require this higher resolution.\nReference: White and Pharoah's Oral Radiology Principles and Interpretation 7th edition page no 64\n\nSo the answer to this question is A"} {"instruction": "Localised juvenile periodontitis is ________ type of disease\nA. Atrophic\nB. Inflammatory\nC. Degenerative\nD. None of the above", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Somatic efferent does not include\nA. Facial nerve\nB. Oculomotor nerve\nC. Abducent nerve\nD. Trochlear nerve", "response": "Somatic efferent nerves, also called as general somatic efferent (GSE) nerves, supply skeletal muscle of somatic origin ( muscles of eye and tongue).\nSomatic efferent nerves include,\n\nOculomotor nerve - 3rd nerve\nTrochlear nerve - 4th nerve\nAbducent nerve - 6th nerve\nHypoglossal nerve - 12th nerve\n\nSo the answer to this question is A"} {"instruction": "All of the features of Wilson's disease, EXCEPT:\nA. Haemolytic anaemia\nB. Testicular atrophy\nC. Chorea\nD. Chronic active hepatitis", "response": "Ans. is 'b' Testicular atrophy Basic defect in Wilson's disease is|Reduced biliary exception of copper*|Cu accumulates in hepatocytes resulting in liver damage (Manifest almost all types of hepatitis* including fulminant hepatitis)|Liver cells get saturated with Cu|Cu spilled in plasma|Gets deposited in following organsBasal ganglia - Spasticity, Rigidity, Chorea (dysphagia, dysarthria, positive Babinski, abdominal reflex absent).Eye - Kayser Fleischer ring* present in descemet's membrane* of cornea.Some frequently asked facts about Wilson's diseaseAssociated with Coombs (-ve) hemolytic anemia*Sensory symptoms are characteristically absent*Testis never involved*Ceruloplasmin deficiency is important marker of disease*\n\nSo the answer to this question is B"} {"instruction": "Commonest site of extramedullary relapse of ALL\nA. CNS\nB. Lung\nC. Liver\nD. Testis", "response": "Despite success of modern treatment,20-30% of children with ALL relapse.The main cause of treatment failure in leukemia is relapse of the disease.Common sites of relapse are the bone marrow(20%),central nervous system(5%),and testis(3%).Relapse in extramedullary sites,paicularly testes,is more ourable in terms of survival. Reference:Essential pediatrics-Ghai,8th edition,page no:604\n\nSo the answer to this question is A"} {"instruction": "The most common presentation of congenital CMV infection is -\nA. Hepatosplenomegaly\nB. Microcephaly\nC. Cerebarl calcification\nD. Chorioretinitis", "response": "This is a genaralised infection associated with Hepatosplenomegaly REF:ANANTHANARYANAN TEXT BOOK OF MICROBIOLOGY 9EDITION PGNO.473\n\nSo the answer to this question is A"} {"instruction": "Primary objective of use of atropine in anterior uveitis\nA. Rest to the ciliary muscle\nB. Increase supply of antibody\nC. Increase blood flow\nD. Prevents posterior synechia formation", "response": "A i.e. Rest to the ciliary muscle In inflamatory glaucoma (glaucoma with uveitis) pilocarpine (miotic) & prostaglandin analogue e.g. latanoprost are contraindicated Q because - Pilocarpine 1/t development of posterior synechiae - Prostaglandin analogue enhance breakdown of aqueous barrier and exacerbate cystoid macular edema.\n\nSo the answer to this question is A"} {"instruction": "Wrong about Mother and Child Health programme is – a) Useful for children upto 12 years of ageb) It's objective is to prevent against chronic diseasesc) 100% immunization to be done by 200 A.D. against six vaccine preventable diseasesd) To decrease acute respiratory infections\nA. ac\nB. ab\nC. ad\nD. bc", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Tissue suturing glue contains:-\nA. Cyanoacrylate\nB. Ethanolamine oleate\nC. Methacrylate\nD. Polychloroprene", "response": "Tissue glue Tissue glue is also available based upon a solution of n-butyl-2-cyanoacrylate monomer. When it is applied to a wound, it polymerizes to form a firm adhesive bond Wound does need to be clean, dry, with near perfect hemostasis and under no tension Specific uses: - closing a laceration on the forehead of a fraction child in accident and emergency thus dispensing with local anesthetic and sutures. Relatively expensive, it is quick to use, does not delay wound healing and is associated with an allegedly low infection rate\n\nSo the answer to this question is A"} {"instruction": "Nerve of Latarjet is seen in ?\nA. Thorax\nB. Neck\nC. Stomach\nD. Hea", "response": "Ans. is 'c' i.e., Stomach Nerve supply of stomach The stomach is supplied by sympathetic and parasympathetic system.The sympathetic nerves are derived from T6-T9 spinal nerve segments greater splanchnic nerves, and coeliac and hepatic plexus.Pain sensations from stomach are carried along sympathetic fibers.The parasympathetic nerves are derived from right vagus and left vagus which enter the abdomen as anterior vagal trunk (anterior gastric nerve) from left vagus and osterior vagal trunk (posterior gastric nerve) from right vagus. u Anterior vagal trunk gives : (i) Main gastric nerve of laterjet, (ii) Pyloric branch and (iii) Hepatic branch. u Posterior vagal trunk gives : (i) Nerve of Grassi to fundus, (ii) Coeliac branches, and (iii) Main gastric nerve of laterjet.\n\nSo the answer to this question is C"} {"instruction": "Sho 4th metacarpal is a feature of\nA. Hyperparathyroidism\nB. Hyperparathyroidism\nC. Pseudohypoparathyroidism\nD. Scleroderma", "response": "Ans. is `c' i.e., Pseudohypoparathyroidism Sho 41kmetacarpal/metatassal (metacarpal sign) Post - traumatic Post infection (from sickle cell anemia) Turner's syndrome Pseudohypoparathyroidism Pseudopseudohypoparathyroidism Hereditary multiple exostosis Chondroectodermal dysplasia (Ellis-vanCreveld syndrome)\n\nSo the answer to this question is C"} {"instruction": "Safest treatment of hyperthyroidism in pregnant women is:\nA. Radioactive iodine\nB. Methimazole\nC. Carbimazole\nD. Propylthiouracil", "response": "None\n\nSo the answer to this question is D"} {"instruction": "One virus particles prevents multiplication of 2nd virus. This phenomena is:\nA. Viral interference\nB. Mutation\nC. Supervision\nD. Permutation", "response": "Viral interference\nInterference in which infectionof a cell by one virus inhibits simultaneous or subsequent infection by another virus.\nMost important mediator of interference is interferon.\nInterference produced by destruction of cell receptors is seen with myxoviruses and enterovirus.\nIt is applied in the field in controlling poliomyelitis outbreaks by in controlling poliomyelitis outbreaks by introducing into the population, the live attenuated poliovirus vaccine.\n\nSo the answer to this question is A"} {"instruction": "Brighton's criteria is used for:\nA. Guillain Barre Syndrome\nB. Myasthenia Gravis\nC. Polymyositis\nD. Muscular dystrophy", "response": "(A) GBS# 'Brighton criteria also account for the level of diagnostic certainty based on the presenting findings at clinical and additional examinations, ranging from level 1 (highest level of diagnostic certainty) to level 4 (reported as Guillain-Barre syndrome, possibly due to insufficient data for further classification) as shown in below table.KEY BRIGHTON DIAGNOSTIC CRITERIA FOR GUILLAIN-BARRE SYNDROMEDiagnostic criteriaLevel of diagnostic certainty I1234Bilateral and flaccid weakness of limbs++++/-Decreased or absent deep tendon reflexes in weak limbs++++/-Monophasic course and time between onset-nadir 12 h to 28 days++++/-CSF cell count <50/ml++*-+/-CSF protein concentration > normal value++/-*-+/-Nerve conduction studies findings consistent with subtypes of GBS++/--+/-Absence of alternative diagnosis for weakness+++++ = Present; - = Absent; +/- = present or absent;*When CSF is not available, nerve electrophysiology results must be consistent with the diagnosis of Guillain-Barre syndrome. Level 1 is the highest level of diagnostic certainty, whereas Level 4 is the lowest level of diagnostic certainty\n\nSo the answer to this question is A"} {"instruction": "Differential diagnosis of Meniere's disease are all expect -\nA. Acoustic neuroma\nB. CNS disease\nC. Labyrinthitis\nD. Suppurative otitis media", "response": "Differential Diagnosis of Vertigo + Tinnitus + SNHL Deafness – Includes:\n\nMeniere’s disease (Endolymphatic hydrops)\nSyphilis\nLabyrinthitis\nLabyrinthine trauma due to fracture of temporal bone, postoperatively after stapedectomy\nCogan syndrome\nLabyrinthine hemorrhage due to blood dyscrasia\nAcoustic neuroma/meningioma (CP angle lesion),\nMultiple sclerosis,\nHypothyroidism/Hyperlipidemia\n\nNOTE\nIn serous otitis media these symptoms may be seen but then hearing loss will be of conductive variety and not SNHL.\n\nSo the answer to this question is D"} {"instruction": "Enzyme deficient in occulocutaneous albinism type 1 is ?\nA. Tyrosinase\nB. Pink protein\nC. Tyrosinase related protein 1\nD. Membrane associated transpo protein (MATP)", "response": "Ans. is 'a' i.e., Tyrosinase\n\nSo the answer to this question is A"} {"instruction": "Blood platelets in stored blood do not remain functional after ...... hrs. -\nA. 24\nB. 48\nC. 72\nD. 96", "response": "Ans. is 'a' i.e., 24\n\nSo the answer to this question is A"} {"instruction": "Primary osteoahritis affect all except:\nA. Hip Joint\nB. Knee joint\nC. Distal interphalangeal joint\nD. Matacarpophalangeal joint", "response": "Osteoahritis involves DIP and PIP with sparing of MCP. Rheumatoid ahritis involves PIP and MCP with sparing of DIP. Osteoahritis commonly involves knee joint in India. Hip joint is rarely involved in osteoahritis.\n\nSo the answer to this question is D"} {"instruction": "The vitamin present in the fatty acid synthase complex is\nA. Thiamine\nB. Folate\nC. Pantothenate\nD. Pyridoxine", "response": "Fatty acid synthase: In yeast, mammals, and birds, the synthetase enzyme system is called the fatty acid synthase complex--it is a multienzyme complex. It is made up of an ellipsoid dimer of two identical polypeptide monomeric units (monomer I and II), arranged in a \"head to tail\" fashion. Each monomeric unit contains six enzymes and an ACP molecule (Acyl carrier protein). Active Site * The ACP has an -SH group in the 4-phosphopantetheine moiety, referred as Pantothenic-SH (Pan-SH) * Another active -SH group present in the cysteine moiety of the enzyme ketoacyl synthase (condensing enzyme), referred as cysteinyl-SH (Cys-SH). The \"Pan-SH\" of one monomeric unit is in close proximity to the \"Cys-SH\" group of other monomeric unit and vice-versa.Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition, page no: 414\n\nSo the answer to this question is C"} {"instruction": "Which one of the following insecticides is not used as a larvicides ?\nA. Abate\nB. Paris green\nC. Fenthion\nD. Dichloros", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Which of the following local anaesthetics belongs to the ester group?\nA. Procaine\nB. Bupivacaine\nC. Lignocaine\nD. Mepivacaine", "response": "Procaine belongs to ester group. Since Ester links are more prone for hydrolysis than amide links generally esters have a shoer duration of action. Other three are amide group. From padmaja 4th edition Page no 199\n\nSo the answer to this question is A"} {"instruction": "What does Gettlers test detects ?\nA. Diatoms in drowning\nB. Chloride content of blood in drowning\nC. Weight in drowning\nD. None", "response": "Ans. is 'b' i.e., Chloride content of blood in drowning Gettler test estimates chloride content of blood from both sides of hea. It is done for drowning. Normally the chloride content is equal in the right and left chambers of the hea (600 mg/100 m1). In fresh water drowning due to hemodilution the chloride content is decreased and in salt water drowning due to hemoconcentration the chloride content is increased in left side of hea. A 25% difference in chloride is significant but the test is of doubtful value.\n\nSo the answer to this question is B"} {"instruction": "MAO inhibitors are contra-indicated in all the following conditions EXCEPT:\nA. With tricyclic antidepressants\nB. With indirectly acting sympathomimetics\nC. Cheese\nD. Aspirin", "response": "(Ref: KDT 6/e p458, 459) In first three conditions mentioned in the question, MAO inhibitors will lead to hypeensive crisis but these drugs do not interact with aspirin.\n\nSo the answer to this question is D"} {"instruction": "Brown atrophy is due to\nA. Fatty necrosis\nB. Lipofuscin\nC. Haemosiderin\nD. Ceruloplasmin", "response": "Ref, Robbins 8/e p10,532,7/e10,9/ep64\n\nSo the answer to this question is B"} {"instruction": "Agent which on addition to a colony inhibits its growth and on removal the colony regrows is -\nA. Bacteriostatic\nB. Bactericidal\nC. Antibiotic\nD. Antiseptic", "response": "They prevent the multiplication of bacteria but however they remain alive. Few antibiotics such as tetracycline,sulphomethoxazole REF:Textbook of microbiology, Ananthanarayan and Paniker. Page no.: 28 Tara textbook of pharmacology\n\nSo the answer to this question is A"} {"instruction": "Kiesselbach's plexus is formed by -a) Greater palatine arteryb) Septal branch of sphenopalatine arteryc) Posterior ethmoidal arteryd) Septal branch of superior labial arterye) Anterior ethmoidal artery\nA. abcd\nB. bcde\nC. abde\nD. ade", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Postmoem caloricity is seen in -\nA. Strychning poisoning\nB. Organophosphorus poisoning\nC. Dhatura poisoning\nD. Ergot poisoning", "response": "Postmoem caloricity is the condition in which temperature of body remains raised for first two hours after death. It can be due to breakdown of heat regulation as in sunstroke or increased heat production due to convulsion of muscles as in strychnine poisoning or excess bacteria as in cholera. Dr.Narayana Reddys Synopsis of Forensic Medicine and Toxicology 27th edition pg. 76.\n\nSo the answer to this question is A"} {"instruction": "Treatment of human brucellosis include following EXCEPT-\nA. Rifampicin\nB. Azithromycin\nC. Streptomycin/gentamicin\nD. Doxycycline", "response": "Drugs used in the treatment of brucellosis include doxycycline 100mg twice daily or orally for 6 weeks plus gentamicin 5mg/kg iv once daily for 7 days or doxycycline 100mg twice daily plus rifampicin 600-900mg orally once daily for 6 weeks. Aminoglycosides show synergistic activity with tetracyclines against brucellosis. Reference Harrison20th edition 1079\n\nSo the answer to this question is B"} {"instruction": "A female of 35 years old that has completed her family is having asymptomatic 10 weeks size f 1- broid. The most appropriate management is :\nA. Observation only\nB. Hysterectomy with bilateral salping000phorectomy\nC. Hysteroscopic myomectomy\nD. Myomectomy", "response": "Observation only\n\nSo the answer to this question is A"} {"instruction": "True about lateral corticospinal tract\nA. Crossed\nB. Uncrossed\nC. Stops in midthoracic region\nD. Crossed at midspinal level", "response": "Pyramids of medulla are made by crossing fibers of the lateral corticospinal tract. About 80% of lateral corticospinal tract cross.\n\nSo the answer to this question is A"} {"instruction": "Aniridia is associated with:\nA. Retinoblastoma\nB. Hepatoblastoma\nC. Nephroblastoma\nD. Medulloblastoma", "response": "Aniridia and Wilm's tumor (nephroblastoma) are components of a rare genetic syndrome - WAGR syndrome W - Wilm's tumor A - Aniridia G - Genitourinary problems R - Mental Retardation Aniridia is a condition of complete or paial iris hypoplasia and foveal hypoplasia, resulting in reduced visual acuity and nystagmus. It may be found in isolation or in association with other syndromes. PAX6 is present on band p13 of chromosome 11, and its mutation results in aniridia. Syndromes associated with Aniridia: Miller syndrome Aniridia associated wilm's tumor WAGR syndrome Wilm's tumor, aniridia, genital abnormalities and mental retardation Gillespie's syndrome Aniridia, mental retardation and cerebellar ataxia Axenfeld-Rieger syndrome Iris hypoplasia, corectopia and polycoria. Ref: Yanoff & Duker's Opthalmology, 3rd Edition, Page 1208.\n\nSo the answer to this question is C"} {"instruction": "Growth is generally completed\nA. First in head and last in depth of face\nB. First in head and last in width of face\nC. First in head and Last in height of face\nD. First in depth and Last in width of face", "response": "None\n\nSo the answer to this question is C"} {"instruction": "What are fly belts?\nA. Insecticide impregnated belts to ward off tse tse flies\nB. Regions infested with tse tse flies\nC. Sticky paper strips to catch flies\nD. None of the above", "response": "Regions of Africa are ravaged by tse tse flies. Such regions infested with flies are known as fly belts. Chapter: Environment and health Ref: Park 21st edition page: 716\n\nSo the answer to this question is B"} {"instruction": "Finish line prepared in full veneer crown is\nA. Buccal shoulder & lingually chamfer\nB. Lingually shoulder & buccally chamfer\nC. All shoulder\nD. All chamfer", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Elaboration of inactivating enzymes are the important mechanism of drug resistance among all of these antibiotics EXCEPT :\nA. Quinolones\nB. Penicillin\nC. Chloramphenicol\nD. Aminoglycosides", "response": "Resistance to fluoroquinolones is mediated by mutation in DNA gyrase.\n\nSo the answer to this question is A"} {"instruction": "A 4 year old child presented with a painful eruption affecting the flexures. Patient was hospitalised and O/E, there was erythema with peeling and blistering of the skin around the lips, eyelid, groin and natal cleft. A few small flaccid blisters were present at the margins of affected areas. The skin of the trunk showed faint erythema. Histological features were not conclusive. Immunofluorescence studies were awaited. What protein family is most likely to be affected by this disease?\nA. Desmocollins\nB. Desmogleins\nC. BPAg1\nD. BPAg2", "response": "Dx: Blistering Disorder- Linear IgA Disease MC protein involvement BPAg2 > BPAg1 Characteristic C/F: String of pearl appearance/cluster of jewel appearance Linear IgA diseaseIt is chronic, acquired sub-epidermal disease of children & adults with cutaneous & mucosal involvement. Two clinical syndromes seen1. Chronic bullous disease of childhood2. Adult linear IgA disease Auto antibodies are IgA (usually IgA1) Chronic Bullous disease of childhood. Linear IgA disease of Adults\n\nSo the answer to this question is D"} {"instruction": "Commonly used long bone for identification -\nA. Femur\nB. Radius\nC. Ulna\nD. Humerus", "response": "The best long bone for identification is femur. Ref: K.S.Narayan Reddy's synopsis of Forensic Medicine and Toxicology 29 th edition Chapter 4 page,43,45.\n\nSo the answer to this question is A"} {"instruction": "Fogarty’s catheteris used for:\nA. Drainage of urinary bladder\nB. Parenteral hyperalimentation\nC. Removal of embolus from blood vessels\nD. Ureteric catheterization", "response": "Fogarty catheter is like a ureteric catheter, with a balloon tip and is introduced until it is deemed to have passed the limit of the thrombus.\nThe balloon is inflated and the catheter is withdrawn slowly with the clot.\nRef.:Bailey and love’s sort practice of surgery- 934\n\nSo the answer to this question is C"} {"instruction": "Hoffman's elimination is feature of\nA. Pancuronium\nB. Thiopentone\nC. Vecuronium\nD. Atracurium", "response": "Ans. d (Atracurium) (Ref KDT 6th !345; Anaesthesia by Ajay yadav, 2nd ed., p. 90)The unique feature of atracurium is inactivation in plasma by spontaneous nonenzymatic degradation (Hofmann elimination) in addition to that by cholinesterases. Consequently its duration of action is not altered in patients with hepatic/renal insufficiency or hypodynamic circulation. It is the preferred muscle relaxant for such patients as well as for neonates and the elderly. Hypotension may occur due to histamine release.Cisatracurium, R-Cis, R-Cis enantiomer of atracurium is nearly 4 times more potent, slower in onset, but similar in duration of action. Like atracurium it undergoes Hofmann elimination, but in contrast it is not hydrolysed by plasma cholinesterase. Most importantly, it does not provoke histamine release.ATRACURIUM BESYLATE# Long acting and non-depolarising muscle relaxant.# Muscle relaxant of choice in renal failure or anephric patients.# pH of solution is 3.5.; Stored at 4degC.; Duration of action doubled at 25degC.# Metabolism mainly by Hofmann elimination (chemical degradation) and hydrolysis in plasma and elsewhere in body.# Major metabolite is laudanosine, which is CNS stimulant.# Cisatracurium is one of the ten isomers of atracurium and its active metabolites contain less laudanosine which causeless hypotension, central nervous system excitement, and seizures than that of atracurium.# It is considered an intermediate-acting agent in terms of duration of action.Notable features of Few muscle relaxantsPropertyMuscle relaxant (MR)Rapid onset of ActionShortest ActingLongest ActingSch (overall); Rocuronium (non-depolarising)Sch (overall); Mivacurium (non-depolarising)DoxacuriumExcreted in LiverRocuronium; VecuroniumNo placenta crossingd -TCHistamine released-TC (maximum) Atracuronium Mivacuronium SchLeast Histamine releaseVecuroniumMost CardiostableVecuroniumM.R. used to decrease BPd -TCM.R. Used to maintain BPPancuroniumM.R. Safe in asthmaVecronium; CisatracuroniumM.R. Causing epilepsyAtracurium; secondary LaunodocinM.R. Causing epilepsyCisatracurium; Atracurium\n\nSo the answer to this question is D"} {"instruction": "Which of the following is most common among all psychiatric disorders?\nA. Depression\nB. Anxiety disorder\nC. OCD\nD. Delusional disorder", "response": "Anxiety disorder are the most common among all psychiatric disorders and among the group of anxiety disorders, Phobias are the most common.\n\nSo the answer to this question is B"} {"instruction": "Injury to the superficial peroneal nerve will result in motor loss of which muscle?\nA. Extensor digitorum brevis\nB. Extensor hallucis longus\nC. Extensor digitorum longus\nD. Peroneus longus", "response": "The superficial peroneal nerve supplies the peroneus longus and brevis and sensation to the lateral aspect of the lower pa of the leg and the dorsum of the foot. Foot drop does not occur but eversion of the foot is lost. The deep peroneal nerve supplies the tibialis anterior, extensor hallucis longus, extensor digitorum longus, the peroneus teius, and sensation to the adjacent sides of the first and second toes. Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 37. Leg. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy.\n\nSo the answer to this question is D"} {"instruction": "All tracts passed through superior cerebellar peduncles except\nA. Tectocerebellar\nB. Ceruleocerebellar\nC. Olivo cerebellar\nD. Cerebellorubral", "response": "The olivocerebellar fibres pass through inferior cerebellar peduncle.The tracts passing through superior cerebellar peduncle are:AFFERENTAnterior spinocerebellarTectocerebellarTrigeminocerebellarCeruleocerebellarHypothalamocerebellarEFFERENT:CerebellorubralDentatorubral, dentatothalamicCerebello-olivaryCerebelloreticular(Ref: vishram singh textbook of clinical neuroanatomy second edition pg 118)\n\nSo the answer to this question is C"} {"instruction": "Which of the following is NOT an indication for surgical interventation in acute pancreatitis\nA. Acute fluid collection\nB. Pancreatic necrosis\nC. Pancreatic abscess\nD. Diagnostic dilemma", "response": ".Treatment of acute pancreatitis * Conservative, 70-90% * Surgical treatment when indicated, 10-30% * Management of complications like acute pseudocyst, abscess, fistula, haemorrhage; systemic complications like ARDS, renal failure, MODS Indications for Surgical Intervention (10% cases) -1. If condition of patient deteriorates in spite of good conservative treatment. 2. If there is formation of pancreatic abscess, or infected necrosis. 3. When diagnosis is in doubt. 4. In severe necrotising pancreatitis as a trial to save the life of the patient which has got very high moality. ref:SRB&;S manual of surgery,ed 3,pg no 618\n\nSo the answer to this question is D"} {"instruction": "Which of the following represent the commonest mode of inheritance of congenital hea disease?\nA. Autosomal dominant\nB. Autosomal recessive\nC. Sex linked dominant\nD. Multifactorial", "response": "Cardiovascular defects are the most common among all the bih defects. These malformations occur due to complex multifactorial genetic and environmental causes. In Ref: Harrison's Principle of Internal Medicine, 16th Edition, Page 1920\n\nSo the answer to this question is D"} {"instruction": "Which of the following is FALSE regarding a normal pregnancy?\nA. Fall in free T4/T3 in 3rd trimester\nB. TSH falls in the first and second trimester but increases in the third trimester\nC. TSH rises in the first and second trimester but falls in the third trimester\nD. There is an increase in Thyroid binding globulin", "response": "In pregnancy there is a relative iodine deficiency and increased renal excretion. Ref: Karla Philip, 33rd Edition, Page 304\n\nSo the answer to this question is C"} {"instruction": "Life span of mosquito is?\nA. 1 week\nB. 2 weeks\nC. 1 month\nD. 1 year", "response": "Under orable conditions of temperature and food supply, the life cycle from the egg to adult is complete in 7-10 days. Normally the adult mosquito lives for about 2 weeks. The males are generally sho-lived Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg\n\nSo the answer to this question is B"} {"instruction": "Reduced enamel epithelium is\nA. Thin layer laid by ameloblasts on tooth surface after they finish formation of enamel matrix\nB. Reduced epithelial enamel organ to a few layers of cells\nC. Once the tip of crown emerge, the reduced enamel cuticle\nD. All of the above", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Ptosis is due to damage of :\nA. Occulomotor nerve\nB. Abducens nerve\nC. Trochlear nerve\nD. Facial nerve", "response": "None\n\nSo the answer to this question is A"} {"instruction": "True statement of Buerger's desease is/are -a) Small and medium sized vessels involvedb) Commonly involves upper limb than lower limbsc) Common in maled) Common in female\nA. a\nB. bc\nC. ac\nD. b", "response": "Buerger's ds. may involve both upper or lower extremity. It is more common in lower limbs\n\nSo the answer to this question is C"} {"instruction": "'Physiologic programmed cell death' is termed as\nA. Apoptosis\nB. Lysis\nC. Autolysis\nD. Autopsy", "response": "None\n\nSo the answer to this question is A"} {"instruction": "All the following are true about measles vaccine except –\nA. Given subcutaneously\nB. High efficacy\nC. Given below 1 year of age\nD. Diluent not required", "response": "None\n\nSo the answer to this question is D"} {"instruction": "Most common symptom of thallium poisoning ?\nA. Neuropathy\nB. Abdominal pain\nC. Headache\nD. Visual disturbances", "response": "Ans. is 'B' i.e., Abdominal pain\"Most common symptom of acute thallium poisoning is abdominal pain with nausea 6- vomiting and diarrhea or constipation\".\n\nSo the answer to this question is B"} {"instruction": "Causes of anterior polar cataract –\nA. Diabetes\nB. Perforating corneal injury\nC. Irradiation\nD. Chalcosis", "response": "None\n\nSo the answer to this question is B"} {"instruction": "Occipitofrontal is muscle is present in which layer of scalp:\nA. Aponeurotic layer\nB. Subaponeurotic layer\nC. Dense connective tissue layer\nD. Loose connective tissue layer", "response": "Ans. A. Aponeurotic layerThe term scalp is applied to the soft tissues covering the vault of skull. It extends anteriorly up to the eyebrows (superciliary arches), posteriorly up to the superior nuchal lines, and laterally on each side up to superior temporal line. The scalp consists of five layers. From superficial to deep these are as follows:1. Skin. 2. Connective tissue (superficial fascia). 3. Aponeurosis (occipitofrontal is muscle and its aponeurosis). 4. Loose areolar tissue. 5. Pericranium.\n\nSo the answer to this question is A"} {"instruction": "Which of the following conditions needs emergency endotracheal intubation?\nA. GCS<7\nB. Tension pneumothorax\nC. Cardiac tamponade\nD. Bleeding gastric ulcer", "response": "Ans. is 'a' i.e., GCS < 7 o See above explanation\n\nSo the answer to this question is A"} {"instruction": "Patient with a history of fall presents weeks later with headache and progressive neurological deterioration. The diagnosis is:-\nA. Acute subdural hemorrhage\nB. Extradural hemorrhage\nC. Chronic subdural hemorrhage\nD. Fracture skull", "response": "Chronic Subdural Hematoma Chronic SDH: collection of blood breakdown products that is at least 3 weeks old Chronic SDHs often occur in patients without a clear history of head trauma, as they may arise from minor trauma . A chronic SDH >1 cm or any symptomatic SDH should be surgical drained .\n\nSo the answer to this question is C"} {"instruction": "Which of the following regarding stress ulcers is true?\nA. Cimetidine should be used prophylactically in intensive care patients to prevent stress ulcers\nB. Stress erosions take days to develop and resolve slowly\nC. Surgery is usually the best way to cure stress ulcers\nD. Stress ulcers most often involve the body and fundus of the stomach", "response": "Stress ulcersStress ulcers are single or multiple mucosal defects which can become complicated by upper gastrointestinal bleeding during the physiologic stress of serious illnessRisk factors Non-critically ill medical patients with 2 or more of the following: respiratory failure, sepsis, hea failure, hepatic encephalopathy, jaundice, renal failure, stroke, hypeension, previous gastrointestinal disease and treatment with coicosteroids, NSAIDS, heparin, or warfarin. In surgical critically ill patients, only those patients who are on a mechanical ventilator for more than 48 hours and/or those with a coagulopathyPathogenesisSite of ulcerationReduction in mucosal blood flow or a breakdown in other normal mucosal defense mechanisms in conjunction with the injurious effects of acid and pepsin on the gastroduodenal mucosaSuperficial ulcers confined to the mucosa and submucosa of stomach and duodenumDiagnosisUpper GI endoscopy TreatmentProphylaxisTreat the cause Hourly antacid administration to maintain intragastric pH above 4 H2 blockersAntacids, H2-receptor blockers, sucralfate, proton pump inhibitors (PPIs), prostaglandin analogs, and nutritionRefer: Harrison's Principles of Internal Medicine, 18th edition, pg no: 2203\n\nSo the answer to this question is D"} {"instruction": "Screening of prostate Ca is done by\nA. Transrectal USG\nB. Digital rectal exam\nC. PSA\nD. CT scan", "response": "Screening for malignancy according to America cancer society Recommendations for early detection of cancer in Average - Risk, Asymptomatic individuals Cancer site : Prostate Population : Men aged >= 50 years Test or procedure : Digital rectal examination (DRE) and prostate specific antigen (PSA) test. Frequency : Offer PSA test and DRE annually, staing at age 50,for men who have life expectancy of atleast 10 years Ref: Harrison's 19th edition Pgno : 481\n\nSo the answer to this question is B"} {"instruction": "Antral sign is seen in ?\nA. Juvenile angiofibroma\nB. CSOM\nC. Sinusitis\nD. Otoscelrosis", "response": "Investigations of JNA Following investigations are used in JNA :- i) Soft tissue lateral film of nasopharynx :- shows soft tissue mass in the nasopharynx. ii) X-rays paranasal sinus and base of skull :- findings have been explained in previous explanation. iii) CT scan of head with contrast :- is the investigation of choice. It shows the extent of tumour, bony destruction, or displacement. Anterior bowing of the posterior wall of maxillary sinus (antral sign or Hohnan-Miller sign) is pathgnomonic of JNA. iv) MR1 complementory to CT when soft tissue extensions are present intracranially, in infratemporal foss or in orbit. v) Carotid angiography :- shows extension of tumor, its vascularity and feeding vessels. Biopsy should be avoided as it can cause severe bleeding.\n\nSo the answer to this question is A"} {"instruction": "Depressed of skull results from:\nA. Heavy object with small striking surface\nB. Heavy object with large striking surface\nC. Fall over the ground\nD. Light object", "response": "A i.e. Heavy object with small striking surface\n\nSo the answer to this question is A"} {"instruction": "Salmonella typhi is the causative agent of typhoid fever. The infective dose of S. typhi is -\nA. One bacillus\nB. 1 08-1 01deg bacilli\nC. 102-105 bacilli\nD. 1-10 bacilli", "response": "Typhoid and paratyphoid (enteric) fevers Typhoid and paratyphoid fevers, which are transmitted by the faecal-oral route, are impoant causes of fever in the Indian subcontinent, sub-Saharan Africa and Latin America. Elsewhere, they are relatively rare. Enteric fevers are caused by infection with Salmonella Typhi and Salmonella Paratyphi A and B. After a few days of bacteraemia, the bacilli localise, mainly in the lymphoid tissue of the small intestine, resulting in typical lesions in the Peyer's patches and follicles. These swell at first, then ulcerate and usually heal. After clinical recovery, about 5% of patients become chronic carriers (i.e. continue to excrete the bacteria after 1 year); the bacilli may live in the gallbladder for months or years and pass intermittently in the stool and, less commonly, in the urine. Clinical features Typhoid fever The incubation period is typically about 10-14 days but can be longer, and the onset may be insidious. The temperature rises in a stepladder fashion for 4 or 5 days with malaise, increasing headache, drowsiness and aching in the limbs. Constipation may be caused by swelling of lymphoid tissue around the ileocaecal junction, although in children diarrhoea and vomiting may be prominent early in the illness. The pulse is often slower than would be expected from the height of the temperature, i.e. a relative bradycardia. At the end of the first week, a rash may appear on the upper abdomen and on the back as sparse, slightly raised, rose-red spots, which fade on pressure. It is usually visible only on white skin. Cough and epistaxis occur. Around the 7th-10thday, the spleen becomes palpable. Constipation is followed by diarrhoea and abdominal distension with tenderness. Bronchitis and delirium may develop. If untreated, by the end of the second week the patient may be profoundly ill. Salmonella enterica is a facultative anaerobe and is a gram negative, motile ... For enteric fever, the infectious dose is about 105 bacilli by ingestion Ref Harrison20th edition pg 1079\n\nSo the answer to this question is C"} {"instruction": "A patient of 47 XXY karyotype presents with features of hypogonadism; likely diagnosis is:\nA. Turners syndrome\nB. Klinefelter syndrome\nC. Edwards syndrome\nD. Down syndrome", "response": "KLEINELFELTER SYNDROME XXY male (XY male with an extra X chromosome) Enlarged breasts Sparse facial and body hair Small testes Azoospermia primary testicular failure Increase LH and FSH levels Androgen deficiency causes eunuchoid body propoions Absent facial, axillary, pubic, or body hair Gynecomastia Small testes and penis Diminished libido\n\nSo the answer to this question is B"} {"instruction": "A 25-year female presented with mild pallor and moderate hepatosplenomegaly. Her hemoglobin was 92g/L and fetal hemoglobin level was 65%. She has not received any blood transfusion till date. She is most likely to be suffering from:\nA. Thalassemia major\nB. Thalassemia intermedia.\nC. Hereditary persistent fetal hemoglobin, homozygous state.\nD. Hemoglobin D, homozygous state.", "response": "Ans. is 'b' Thalassemia intermedia The symptoms and the investigations of the patient point towards the diagnosis of thalassemia intermedia.Thalassemia intermedia (Geno type bdeg/b or b+/b+) :-Clinical FeaturesAnaemia (moderate to severe), seen after 2 years of age. The Hb level is usually (6-10%).Moderate hepatosplenomegaly can be seenAnisocytosis and poikilocytosisThe characteristic feature is that patient can survive without blood transfusions. Due to abnorm al synthesis of adult Hb (HbA), the level of HbA and Hb F is increased.Level of various Hemoglobin in thalassemia intermedia-HbA - reduced (20-40%)HbF - increased (60-80%)HbA2 - increasedSo it is clear that the diagnosis is Thalassemia intermedia.Now let's see the other options.Thalassemia :Thalassemia major can also have the same presentations but 2 important points rule it out.In thalassemia major the patient cannot survive without transfusions. Blood transfusion is a must for the survival of the patientThe fetal Hemoglobin level is greater than 90%.Hereditary persistence of fetal hemoglobin :This condition is characterized by continued synthesis of high level of HbF in adult life.No other abnormalities (ie. anemia or hepatosplenomegaly) are present in the patient even if the total Hb is replaced by Hb FHemoglobin D homozygous stateHemoglobin D is an abnormal hemoglobin and occurs in two forms:Homozygous state andHeterozygous state * Hemoglobin D heterozygous state- no abnormality is seen * Hemoglobin D homozygous state:In this condition 95% of the body's hemoglobin is HbDLevels of HbA2 and HbF remain normalClinically pt. presents with mild splenomegaly and mild anemia.\n\nSo the answer to this question is B"} {"instruction": "A 6 month old baby presents with bilateral cataract. A urine test is requested to suspect:\nA. Homocystinuria\nB. Galactosemia\nC. Hyperlysinemia\nD. Sulfite oxidase deficiency", "response": "Ans. (b) GalactosemiaRef: Parson's 22/e, p. 273Laboratory investigations for the diagnosis of bilateral, non- hereditary pediatric cataractBlood testSerum biochemistry for levels of blood glucose, calcium and phosphorusRed blood cell transferase and galactokinase levelsSerology for estimating the tiers of antibody for infections such as toxoplasmosis, rubella, cytomegalovirus and herpes simplex virus (TORCH) and hepatitis B virusUrine testUrine assay for the presence of reducing substances after milk feeding (for galactosaemia)Screening for amino acids in the urine (if Lowe syndrome is suspected)\n\nSo the answer to this question is B"} {"instruction": "Sensory nerve supply to Submandibular gland is by:\nA. Lingual nerve.\nB. Spinal accessory nerve.\nC. Mandibular branch of facial nerve.\nD. Hypoglossal nerve.", "response": "None\n\nSo the answer to this question is A"} {"instruction": "True regarding cytoplasmic m RNA?\nA. It is chiefly translated from nuclear DNA\nB. The sugar is deoxyribose\nC. Thymine is present in place of uracil\nD. Its MW is greater than heterogenous RNA", "response": "mRNA is chiefly transcribed from nuclear DNA\nMW of cytoplasmic mRNA is lesser than the heterogenous RNA .\nmRNA contain only uracil not the thymine .\nSugar is ribose moiety, not the deoxyribose moiety . Messenger RNA (mRNA) is a molecule of RNA that encodes a chemical \"blueprint\" for a protein product. mRNA is transcribed from a DNAtemplate, and carries coding information to the sites of protein synthesis, the ribosomes. In the ribosomes, the mRNA is translated into a polymer of amino acids: a protein. (This process is sometimes referred to as the central dogma of molecular biology.) Heterogeneous nuclear RNA (hnRNA) a diverse group of long primary transcripts formed in the eukaryotic nucleus, many of which will be processed to mRNA molecules by splicing.\n\nSo the answer to this question is A"} {"instruction": "Anatomical dead space is\nA. 1/3rd of tidal volume\nB. 2/5th of tidal volume\nC. 10 ml/kg of body weight\nD. 15 ml/kg of body weight", "response": "Dead space is the volume of air that is inhaled that does not take pa in the gas exchange, because it either remains in the conducting airways or reaches alveoli that are not perfused or poorly perfused. In other words, not all the air in each breath is available for the exchange of oxygen and carbon dioxide Ref: guyton and hall textbook of medical physiology 12 edition page number: 324,325,326\n\nSo the answer to this question is A"} {"instruction": "Nitric oxide is derived from which amino acid-\nA. Histidine\nB. Lysine\nC. Methionine\nD. Arginine", "response": "Ans. is 'd' i.e., Arginine Nitric oxide (NO)o Nitric oxide, also called endothelium-derived-relaxing factor (EDRF), is formed from amino acid arginine, by the action of the enzyme NO synthase, which is cytosolic.NO synthase Arginine [?][?][?][?][?][?][?][?][?][?][?]- Citrulline + NOo Three isoforms of NO synthase have been identified :- Neuronal NOS (nNOS or A'OS-1); (ii) Macrophage or inducible NOS (iNOS or NOS-2); and (iii) Endothelial NOS (eNOS or NOS-3). NOS-1 and NOS-3 are constitutive enzymes, whereas NOS2 is inducible in inflammatory conditions,o NOS-1 and NOS-3 are activated by Ca+2.o NO synthase is a very complex enzyme, employing five redox cofactors : NADPH. FAD, FMN, heme, and tetrahydrobiopterin.o The most important physiological source of NO is endothelial ceils.o NO has a very short half-life (approximately 3-4 seconds) in tissues because it reacts with oxygen and superoxide. The product of reaction with superoxide is peroxynitirite (ONOO), which decomposes to form the highly reactive OH radical. NO acts through group IIB hormonal mechanisms, i.e., through cGMPas the second messenger.\n\nSo the answer to this question is D"} {"instruction": "Casal's Necklace is seen in deficiency of\nA. Vitamin A\nB. Vitamin B3\nC. Vitamin B6\nD. Vitamin D", "response": "Pellagra Pellagra occurs due to Vitamin B3 (Niacin) deficiency Pellagra is characterized by by 4D's : 1.Diarrhoea 2.Dermatitis 3.Dementia 4.Death. Skin rash in Pellagra may appear as pigmented and scaly in areas exposed to sunlight. Especially neck when it is known as 'Casal's Necklace' Ref: Park 25th edition Pgno : 657 Harrison's 15th edition Pgno : 463\n\nSo the answer to this question is B"} {"instruction": "Cataracts and PDA in a newborn suggests in utero infection with which viral family? (NOT RELATED)\nA. Adenovirus\nB. Paramyxovirus\nC. Togavirus\nD. Picornavirus", "response": "This is seen in congenital rubella infection. Rubella virus belongs to the togavirus family. The infection is transmitted by the respiratory route. The rash of rubella occurs for only three days. Infected pregnant women can transmit the infection to the fetus.\n\nSo the answer to this question is C"} {"instruction": "which of the following is the course of donovanosis\nA. H Ducreyi\nB. K granulomatosis\nC. Leishmania donovani\nD. Treponema Pallidum", "response": "Donovanssis or granuloma inguinale is a STD caused by Klebsiella granulomatis ref : ananthanaryana\n\nSo the answer to this question is B"} {"instruction": "Retention appliance should be\nA. Retentive only\nB. Passive only\nC. Passive + retentive\nD. Active + retentive", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Most specific marker for neural tube defects is\nA. Alpha-fetoprotein\nB. Unconjugated estriol\nC. Acetylcholinesterase\nD. Pseudocholinesterase", "response": "Both alpha-fetoprotein and acetylcholinesterase in amniotic fluid are markers for neural tube defects. But acetylcholinesterase is the most specific marker. Ref : Dutta book of obstetrics 8th Ed\n\nSo the answer to this question is C"} {"instruction": "who gave the stage of insustry versus inferiority\nA. erikson\nB. lorenz\nC. freud\nD. bleuler", "response": "ERIC ERIKSON ERIC ERIKSON gave the psychosocail stages of development There are 8 psychosocial stages A person has to succesfully pass one stage to move to the next stage If he gets arrested in one stage he may develop some disorders Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pf no. 485\n\nSo the answer to this question is A"} {"instruction": "Caisson's disease is caused due to exposure to:\nA. Heat\nB. Cold\nC. Pressure\nD. Noise", "response": "Exposure to pressure causes Caisson's disease, air embolism. Ref: Park 21st edition page: 746.\n\nSo the answer to this question is C"} {"instruction": "A 43-year-old male high-level executive presents to his physician due to a persistent dizziness when standing quickly. He also has been exhibiting chronic fatigue, some muscle weakness, and an unusual craving for salty foods. The physician notices that the patient has a constant \"bronze tan,\" and blood obtained during the visit demonstrated not only normal cholesterol levels but also hypoglycemia, hyperkalemia, and hyponatremia. The underlying cause for these problems is which one of the following?\nA. Adrenal insufficiency\nB. Pituitary insufficiency\nC. Lack of insulin\nD. Lack of glucagon", "response": "The patient is exhibiting the symptoms of Addison disease, initiated by an adrenal insufficiency. Owing to the problem in the adrenal glands, cortisol and aldosterone cannot be produced and released. The lack of cortisol leads to hypoglycemia and fatigue. The lack of aldosterone leads to the alteration in salt balance in the blood and the craving for salt. The hyperpigmentation occurs because of excessive ACTH production, which gives rise to the MSH. The ACTH levels are high because of reduced repression of ACTH synthesis, which is caused by the lack of cortisol release from the adrenal cortex. A reduction of insulin levels would lead to diabetes, not the constellation of symptoms observed in this patient. A lack of GH (in the adult) would lead to increased body fat, high cholesterol, and reduced bone density. A lack of glucagon would lead to hypoglycemia, but not the other symptoms observed in this patient.\n\nSo the answer to this question is A"} {"instruction": "Which of the following condition is characterized by presence of hyaline deposits in alveolar walls?\nA. Interstitial lung disease\nB. Asthma\nC. Hyaline membrane disease\nD. Chronic bronchitis", "response": "Ref: Robbins 9th ed. P 672The immature lungs in hyaline membrane disease show eosinophilic hyaline membranes in alveoli, alveolar ducts and terminal bronchioles.The membranes contain necrotic epithelial cells admixed with extravasated plasma proteins.\n\nSo the answer to this question is C"} {"instruction": "Which of the following non ionizing radiations used in thermography?\nA. Visible light\nB. Microwaves\nC. Infrared\nD. Radio waves", "response": "Infrared thermography is the process of using a thermal imager to detect infrared radiation (heat) that is emitted by an object. Thermography detects the radiant heat of the body by using infrared rays. Breast cancers have higher blood flow to the mitotically active tumor cells and hence will have a difference in temperature than surrounding normal breast which can be detected using thermography.\n\nSo the answer to this question is C"} {"instruction": "Otosclerosis mostly affects:\nA. Malleus\nB. Stapes\nC. Incus\nD. Tympanic membrane", "response": "Otosclerosis is caused by immobility of the stapes. Its most distinctive feature is conductive hearing loss, but sensorineural hearing loss and veigo are also common; tinnitus is infrequent. Otosclerosis is suggested by a positive family history, a tendency toward onset at an earlier age, the presence of conductive hearing loss, or bilateral symmetric auditory impairment Treatment with a combination of sodium fluoride, calcium gluconate, and vitamin D may be effective. If not, surgical stapedectomy should be considered.\n\nSo the answer to this question is B"} {"instruction": "Glutamine in blood acts as-\nA. NH3 transpoer\nB. Toxic element\nC. Store energy\nD. Abnormal metabolite", "response": "Glutamine is the major form of transpo of ammonia\n\nSo the answer to this question is A"} {"instruction": "Lactose content of breast milk per 100 ml is –\nA. 3.5 gm\nB. 4.5 gm\nC. 6 gm\nD. 7 gm", "response": "None\n\nSo the answer to this question is D"} {"instruction": "A 58 years old woman, who had backache and recurrent chest infections for 6 months, develops sudden weakness of the legs and urinary retention. His investigations show a hemoglobin of 7.3 gm/dl, serum calcium 12.6 mg/dl, phosphate-2.5 mg/dl, alkaline phosphatase-100 u/1, serum albumin-3 gm/dl, globulin-7.1 gm/dl and urea-178 mg/d. What is the most likely diagnosis?\nA. Lung cancer\nB. Disseminated tuberculosis\nC. Multiple myeloma\nD. Osteoporosis", "response": "The above mentioned features are consistent with the diagnosis of mutiple myeloma. So multiple myeloma is the single best answer of choice. Ref: Harrison's Principles of Internal Medicine, 16th Edition Pages 657-60; Ferri's Clinical Advicer, 2009, Page 589.\n\nSo the answer to this question is C"} {"instruction": "A 30 year old male presents with severe pain chest, breathlessness, hypotension and ECG shows ST elevation in V3, V4 V5 and V6 leads. He will be best treated with\nA. Streptokinase\nB. t-PA\nC. Heparin\nD. PTCA", "response": "Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle.\n\nSo the answer to this question is D"} {"instruction": "An Anganwadi worker is paid a monthly amount of:\nA. 1000 rupees\nB. 1500 rupees\nC. 2000 rupees\nD. None of the above", "response": "An Anganwadi worker is selected from the community she is expected to serve. She is a pa time worker and is paid an honorarium of 1500 rupees per month for the services rendered by her. Ref: Park 21st edition page: 839.\n\nSo the answer to this question is B"} {"instruction": "Tinel's test is:\nA. Loss of sensation.\nB. Loss of 2 point discrimination.\nC. Percussion produces tingling sensation.\nD. Not associated with carpel tunnel syndrome.", "response": "None\n\nSo the answer to this question is C"} {"instruction": "Quantity of Hb catabolised every day in a normal adult:\nA. 8 gm\nB. 10 gm\nC. 12 gm\nD. 13.3 gm", "response": "8 gm\n\nSo the answer to this question is A"} {"instruction": "All can lead to development of ove anemia in patients with long standing compensated hemolytic anemia, EXCEPT:\nA. Pregnancy\nB. Renal failure\nC. Folate deficiency\nD. Hypothyroidism", "response": "A patient with a hemolytic condition may present without anemia (Compensated hemolytic anemia) It becomes decompensated in Pregnancy Folate deficiency Renal failure (Interfering with adequate EPO production) Also in Acute infections- which depresses erythropoiesis. The most dramatic example is parvovirus B19 infection, which may lead to aplastic crisis. Ref: Harrison, E-18, P-873.\n\nSo the answer to this question is D"} {"instruction": "Medullary thyroid carcinoma occurs due to the mutation of: (Repeat)\nA. RET oncogene\nB. P53 gene\nC. RAS H-RAS, K-RAS, N-RAS\nD. BRCA-I", "response": "Ans: A (RET oncogene) Ref: Robbins Pathologic Basis of Disease, 8th editionExplanation: (See table 10) Table 10 : Selected Oncogenes. Their Mode of Activationand Associated Human TumorsCategoryProto-oncoqeneAssociated Human TumorGROWTH FACTORSPDGF-b chainSIS (official name PBGFB.AstrocytomaOsteosarcomaFibroblast growthHST1Stomach cancerfactorsINT2 (official name FGF3)Bladder cancer Breast cancer MelanomaTGF-aTGFAAstrocytomas Hepatocellular carcinomasHGFHGFThyroid cancerGROWTH FACTOR RECEPTORSEGF-receptor familyERBB1 (EGFR). ERRB2Squamous cell carcinoma of lung, gliomasFMS-like tyrosine kmase 3FLT3Breast and ovarian cancersReceptor for neurotrophic factorsRETLeukemia Multiple endocrine neep asia 2A and B, fam lial medullary' thyroid carcinomasPDGF receptorPDGFRBGliomas. leukemiasReceptor for stem cell (steel) factorKITGastrointestinal stromal tumors, seminomas, leukemiasPROTEINS INVOLVED IN SIGNAL TRANSDUCTIONGTP-bmdsngKRASColon, lung, and pancreatic tumors HRASBladder and kidney tumors NRASMelanomas, hematoloqic malignanciesNonrec eptor tyrosineABLChrome myeloid leukemiakinase Acute lymphoblastic leu Kern iaRAS signal transductionBRAFMelanomasWNT signal transductionb-cateninHepatoblastomas, hepatocellular carcinomaNUCLEAR-REGULATORY PROTEINSTranscriptionalC-MYCBurkitt lymphomaactivatorsN-MYCNeuroblastoma, small-cell carcinoma of lung L-MYCSmall-cell carcinoma of lungCELL CYCLE REGULATORSCyclinsCyclin DMantle cell lymphoma Breast and esophageal cancers Cyclin EBreast cancerCyclin-dependent kinaseCDK4Glioblastoma, melanoma, sarcoma\n\nSo the answer to this question is A"} {"instruction": "Ifa Panchayat is dissolved, elections are to be held within?\nA. 1 month\nB. 3 months\nC. 6 months\nD. 1 year", "response": "Ans. is 'c' i.e., 6 months\n\nSo the answer to this question is C"} {"instruction": "A patient with microcytic hypochromic anemia, Hb-9%, serum iron is 20 ?/dl, ferritin level 800 mg/ ml, transferrin percentage saturation is 64. What is possible diagnosis -\nA. Atransferrinemia\nB. Iron deficiency anemia\nC. DMT 1 mutation\nD. Hemochromatosis", "response": "None\n\nSo the answer to this question is A"} {"instruction": "Rofecoxib was withdrawn due to:\nA. lschemic hea disease\nB. Renal complication\nC. Liver adenoma\nD. Gastric ulcer", "response": "celecoxib,etoricoxib,parecoxib are available in India.Rofecoxib and valdecoxib were withdrawn within a few years of marketing for increasing cardiovascular risk by increasing the levels of TXA2 which increases platelet aggregation ESSENTIALS OF MEDICAL PHARMACOLOGY;7TH EDITION;KD TRIPATHI;PAGE NO 205\n\nSo the answer to this question is A"} {"instruction": "Brucellosis can be transmitted by all of the following modes, except -\nA. Contact with infected placenta\nB. Ingestion of raw vegatable from infected farms\nC. Person to person transmission\nD. Inhalation of infected dust or aerosol", "response": "
Person to person transmission not occur. Mode of transmission of brucellosis are contact infection,food borne infection,air borne infection. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:290-291. <\\p>\n\nSo the answer to this question is C"}
{"instruction": "Not true regarding Argyll robeson pupil\nA. Accomodation reflex present\nB. Pupillary reflex present\nC. Pupillary reflex absent\nD. Seen in Tabes dorsalis", "response": "Pupillary reflex is absent in Argyll robeson pupil Argyll Robeson pupil Accomodation Reflex present Pupillary Reflex absent Seen in Tabes dorsalis, DM\n\nSo the answer to this question is B"}
{"instruction": "Diabetic gangrene is due to -\nA. Ischemia\nB. Increased blood glucose\nC. Altered defense by host and neuropathy\nD. All of the above", "response": "Ans. is 'd' i.e., All of the above\n\nSo the answer to this question is D"}
{"instruction": "CBNAAT stands for\nA. Caridge based nucleic acid amplification test\nB. Computer based nucleic acid amplification test\nC. Chromatograohy based new amino acid test\nD. Care based new Amino Acid test", "response": "Caridge-based nucleic acid amplification test (CBNAAT) is a recently introduced polymerase chain reaction (PCR) based method for detection of TB. It also detects rifampicin resistance as it targets the rpoB gene of mycobacteria. CBNAAT is a Mycobacterium tuberculosis-specific automated, caridge-based nucleic acid amplification assay, having fully integrated and automated amplification and detection using real-time PCR, providing results within 100 minutes. It is a highly specific test as it uses 3 specific primers and 5 unique molecular probes to target the rpoB gene of M. tuberculosis, which is the critical gene associated with rifampicin resistance.\n\nSo the answer to this question is A"}
{"instruction": "Which one of the following is a cyanotic congenital hea disease ?\nA. Patent ductus aeriosus\nB. Atrial septal defect\nC. Ventricular septal defect\nD. Tetralogy of Fallot", "response": "TOF is a cyanotic hea disease. Ref : Ghai essential of pediatrics, eighth edition, p.no:420\n\nSo the answer to this question is D"}
{"instruction": "Hypokalemia with hypertension is associated with following except\nA. Liddle's syndrome\nB. Conn's syndrome\nC. Bartter's syndrome\nD. Cushing's syndrome", "response": "Ans. c (Bartter's syndrome) (Ref H-18th/ table 284-2; 17th/1801; LB 25th / 811)The combination of hypokalemia and alkalosis in a normotensive, nonedematous patient can be due to Bartter's or Gitelman's syndrome, magnesium deficiency, vomiting, exogenous alkali, or diuretic ingestion. Bartter's syndrome is featured by Salt wasting and hypokalemia; while Gitelman's syndrome is characterized by Salt wasting, hypokalemia and hypomagnesemia.Presence of chronic hypertension and chronic hypokalemia in an alkalotic patient suggests either mineralocorticoid excess or that the hypertensive patient is receiving diuretics. Low plasma renin activity and normal urine and in a patient who is not taking diuretics indicate a primary mineralocorticoid excess syndrome. It should be noted that Bartter's syndrome is associated with normotension unlike other endocrine causes of hypokalemia (which are associated with hypertension): # Conn' syndrome, # Cushing's syndrome and # Liddle's syndrome.\n\nSo the answer to this question is C"}
{"instruction": "The Final Evaluation of the root surface smoothness after root planning is done by?\nA. Probe\nB. Explorer\nC. Scaler\nD. Curettes", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "35 years old man presenting with acute pancreatitis. Ideal fluid of choice\nA. Isotonic crystalloid\nB. Hypertonic crystalloids\nC. Hypotonic crystalloid\nD. Vasopressin", "response": "Ref. API Textbook of Medicine. Pg. 813\n \nMost imp consideration in the management of acute pancreatitis is conservative approach\n\nFluids >Pain >Nutrition >Inflammation\nIdeal fluid of choice is Isotonic crystalloids\n1st line management : NPO , IV Fluids ,IV antibiotics, IV anti inflammatory + Blood investigations (Amylase and lipase)\n\nSo the answer to this question is A"}
{"instruction": "Which of following is the most common cause of hypergonadotrophichypogonadism in nuk>>-\nA. Viral orchitis\nB. Klinefelter's syndrome\nC. Kallman's syndrome\nD. Noonan syndrome", "response": "Ans is option 2.. Klinefelter&;s syndrome Hypogonadism occurs if the hypothalamic pituitary axis is interrupted at any level. Hypergonadotrophic Hypogonadism occurs due to low testosterone and increased LH and FSH Most common cause of Hypergonadotrophic Hypogonadism in males is Klinefelter&;s syndrome In females turner syndrome Ref Harrison 17 /e p 2316 2317\n\nSo the answer to this question is B"}
{"instruction": "Which of the following drug increases the duration of orthodontic treatment?\nA. Phenytoin\nB. Aspirin\nC. Paracetamol\nD. Vitamin D", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "In a blast injury , which of the following organ is least vulnerable to the blast wave\nA. G .I tract\nB. Lungs\nC. Liver\nD. Ear drum", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "ECT is contraindicated in\nA. Pregnancy\nB. Seizure disorder\nC. Mania\nD. Raised Intracranial pressure", "response": "Raised intracranial pressure is the only absolute contraindication for ECT\n\nSo the answer to this question is D"}
{"instruction": "The need for vitamin B12 and folic acid inthe formation of red blood cells is related primarily of their effects on:\nA. Synthesis and release of erythropoietin from the kidney\nB. Absorption of iron from the gut\nC. DNA synthesis in bone marrow\nD. Hemoglobin formation in the red blood cell", "response": "Within 6-9 hours of treatment with vitamin B12 formation of nuclear DNA component promotes normoblastic reaction of the bone marrow. Folic acid also promotes the formation of nucleic acids.\n\nSo the answer to this question is C"}
{"instruction": "A 60-year-old otherwise healthy woman Presents to her physician with a 3-week history of severe headaches. A contrast CT scan reveals a small, circular, hypodense lesion with ring like contrast enhancement. Which of the following is the most likely diagnosis?\nA. High-grade astrocytoma\nB. Metastatic lesion\nC. Parenchymal Haemorrhage\nD. Brain abscess", "response": "Although these CT findings can be consistent with all the options given but in immunocompetent individual there is more incidence of it being a metastatic lesion. M/C cancers to metastasise to brain includes :- Lung CA, Breast CA, Melanomas, RCC, few GI tumours. These lesions become symptomatic due to mass effect from white matter edema. Rx- includes combination of Sx, radios, and whole brain radiation therapy. Immunocompromised patients are at increased risk for toxoplasmosis and central nervous system lymphomas.\n\nSo the answer to this question is B"}
{"instruction": "Best gas used for creating pneumoperitonium at laparoscopy is\nA. N2\nB. O2\nC. CO2\nD. N2O", "response": "Ans. (c) CO2Ref: Shaws 15th ed. 1492Pnenumoperitoneum in created with CO2 or nitrous oxide. CO2 is preferred because nitrous oxide can cause explosion in the presence of volatile anaesthetic drug.\n\nSo the answer to this question is C"}
{"instruction": "Calcification of soft tissue without any distrubances of calcium metabolism is called\nA. Inotrophic calcification\nB. Monotrophic calcification\nC. Dystrophic calcification\nD. Calcium induced calcification", "response": "Ref Robbins 9/e p65 Dystrophic Calcification Dystrophic calcification is encountered in areas of necrosis of any type. It is viually inevitable in the atheromas of advanced atherosclerosis, associated with intimal injury in the aoa and large aeries and characterized byaccumulation of lipids (Chapter 9). Although dystrophic calcification may be an incidental finding indicating insig- nificant past cell injury, it may also be a cause of organ dysfunction. For example, calcification can develop in aging or damaged hea valves, resulting in severely com- promised valve motion. Dystrophic calcification of the aoic valves is an impoant cause of aoic stenosis in elderly persons (Fig. 10-17, Chapter 10). The pathogenesis of dystrophic calcification involves initiation (or nucleation) and propagation, both of which may be either intracellular or extracellular; the ultimate end product is the formation of crystalline calcium phos- phate. Initiation in extracellular sites occurs in membrane- bound vesicles about 200 nm in diameter; in normal cailage and bone they are known as matrix vesicles, and in pathologic calcification they derive from degenerating cells. It is thought that calcium is initially concentrated in these vesicles by its affinity for membrane phospholipids, while phosphates accumulate as a result of the action of membrane-bound phosphatases. Initiation of intracellular calcification occurs in the mitochondria of dead or dyingcells that have lost their ability to regulate intracellular calcium. After initiation in either location, propagation of crystal formation occurs. This is dependent on the concen- tration of Ca2+ and PO4 - , the presence of mineral inhibitors, and the degree of collagenization, which enhances the rate of crystal growth.\n\nSo the answer to this question is C"}
{"instruction": "Mechanism of action of levosimendon include\nA. Na channel opener\nB. Potassium channel opener\nC. Beta blockers\nD. Beta 1 agonist", "response": "Mechanism of action Levosimendan exes its positive inotropic effect by increasing calcium sensitivity of myocytes by binding to cardiac troponin C in a calcium-dependent manner. ... The combined inotropic and vasodilatoryactions result in an increased force of contraction, decreased preload and decreased afterload. Refer katzung 11e p221\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is not a sequelae of trachoma?\nA. Proptosis\nB. Tylosis\nC. Pseudocyst\nD. Dacrocystitis", "response": "Proptosis REF: Khurana 4th ed p. 66 Sequelae of trachoma: Lids : entropion, tylosis, ptosis, madarosis , ankyloblepharon Conjuctiva: concretions, pseudocyst, xerosis, symblepharon. Cornea: opacity, ectasia, xerosis. Others: Dacrocystitis, chronic dacryoadenitis.\n\nSo the answer to this question is A"}
{"instruction": "Not a cause for Mikulicz's syndrome:-\nA. Leukemia\nB. Lymphosarcoma\nC. Sarcoidosis\nD. Diphtheria", "response": "Diphtheria is not a recognised cause for Mikulicz's syndrome Mikulicz's syndrome Bilateral symmetrical enlargement of lacrimal and salivary glands Causes Leukemia Lymphosarcoma Benign Lymphoid hyperplasia Hodgkin's disease Sarcoidosis Tuberculosis\n\nSo the answer to this question is D"}
{"instruction": "Only pure hinge movements of the mandible occur at:\nA. Centric occlusion\nB. Centric relation\nC. Lateral excursion\nD. Terminal Hinge Position", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Regarding transpo of substances through the cell membrane, all are true except\nA. Glucose is transpoed Via facilitated diffusion\nB. Active transpo is an energy driven proces\nC. Facilitated diffusion requires energy\nD. Facilitated diffusion requires carrier protein", "response": "Diffusion primarily depends on the concentration of molecules. Passage of ions or molecule from a region of higher concentration to lower concentration without the expenditure of energy is called diffusion. (REF: TEXTBOOK OF MEDICAL PHYSIOLOGY GEETHA N 2 EDITION, PAGE NO - 4)\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is not a cause of communicating hydrocephalus?\nA. Choroid plexus papilloma\nB. Vein of Galen malformation\nC. Achondroplasia\nD. Meningeal metastasis", "response": "- Vein of Galen causes Obstructive or Non-communicating hydrocephalus. Causes: COMMUNICATING HYDROCEPHALUS NON-COMMUNICATING HYDROCEPHALUS C - Choroid plexus papilloma A - Achondroplasia M - Meningeal malignancy or metastasis P - Post hemorrhagic M - Mass lesion (ICSOL) A - Abscess A - Aqueductal stenosis A - Arnold Chiari malformation D - Dandy walker malformations H - Hematoma I - Infections (Toxoplasma, mumps, Neurocysticercosis) V - Vein of Galen malformations\n\nSo the answer to this question is B"}
{"instruction": "Liquefactive action on necrotic tissue results in-\nA. Gangrene\nB. Embolism\nC. Infarct\nD. Caseation", "response": "infraction is the process of tissue necrosis usually coagulative type resulting from ischemia. In cerebral infract there is characteristic liquifactive necrosis. * Liquefactive necrosis is seen in focal bacterial or, occasionally, fungal infections, because microbes stimulate the accumulation of inflammatory cells and the enzymes of leukocytes digest (\"liquefy\") the tissue. For obscure reasons, hypoxic death of cells within the central nervous system often evokes liquefactive necrosis (Fig. 1-10). Whatever the pathogenesis, the dead cells are completely digested, transforming the tissue into a liquid viscous mass. Eventually, the digested tissue is removed by phagocytes. If the process was initiated by acute inflammation, as in a bacterial infection, the material is frequently creamy yellow and is called pus .ref Robbins 9/e p 10\n\nSo the answer to this question is C"}
{"instruction": "True regarding Oncogenes are all except ?\nA. Derived from protooncogenes\nB. Oncogenes code for specific protein\nC. Causes in vitro cell variation in animals\nD. Multiple growth factors govern the gene", "response": "Protooncogenes o These are physiological regulator of cell proliferation ando They act under proper physiological stimuli.o Without physiological stimuli they will be silent and there will be no replication.Oncogenes When, due to any cause (mutation or overexpression), protooncogenes become autonomous, i.e. they promote cell growth without any physiological stimulus.So, oncogenes is derived from protoncogens.o Infact oncogene and protooncogene is the same, in normal cell it acts as protooncogen while in cancer cell it acts as oncogene.Oncoproteins o Oncogenes encode proteins called Oncoproteins which resemble the normal products of protoncogenes with the exception that ?(a) Oncoproteins are devoid of impoant regulatory elements.(b) Their production in the transformed cells does not depend on growth factors or other external signals.Proto-oncogenes (Normal genes required for cell proliferation and differentiation) Oncogenes (Genes promoting autonomous cell growth in cancer cells) Oncoproteins (Proteins lacking regulatory control and responsible for promoting cell growth)\n\nSo the answer to this question is D"}
{"instruction": "To provide anesthesia to a patient in the third stage of labor, an obstetrician palpates the ischial spine transvaginally, then injects a local anesthetic. Injection of anesthetic at this approximate location will most likely block which of the following nerves?\nA. Inferior gluteal nerve\nB. Lateral femoral cutaneous nerve\nC. Obturator nerve\nD. Pudendal nerve", "response": "The pudendal nerve is often anesthetized to provide obstetric anesthesia (although epidural blocks are now more commonly used in preparation for delivery). The pudendal nerve arises from sacral segments 2, 3, and 4. It exits the pelvis by way of the greater sciatic foramen and then courses around the ischial spine (and sacrospinous ligament) to pass through the lesser sciatic foramen. It then runs through Alcock's canal to supply the muscles and skin of the perineal area. The inferior gluteal nerve leaves the pelvis by passing through the greater sciatic foramen to supply the gluteus maximus muscle. The lateral femoral cutaneous nerve courses by the anterior superior iliac spine and supplies the anterolateral skin of the thigh. The obturator nerve passes through the obturator foramen to supply muscles and skin in the medial thigh.\n\nSo the answer to this question is D"}
{"instruction": "Protapers of same tip diameter are\nA. Sx-S1\nB. S1-S2\nC. S2-F1\nD. Sx-S2", "response": "PROTAPER INSTRUMERNTS\n\nA unique feature of Pro Taper instructions is each one has changing percentage tapers over the length of the cutting blades.\nPro taper instruments have convex, triangular cross – sections, a changing helical angle and push over their cutting blades and a non-cutting, modified guiding tip.\nThe Pro Taper system is comprised of three Shaping and three Finishing instruments.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following are the markers of paediatric non accidental injury\nA. Abuse in sibling\nB. Perineal injury\nC. Repeated hospital visits for minor injuries\nD. All the above", "response": "Ans. is 'd' i.e., All the above Markers for non-accidental injury* Repeated hospital visits for minor injuries* Late presentations and multiple visits to different hospitals* Vague or inconsistent history from the child's parent or guardian and the child* Withdrawn behaviour of the child with resistance to examination* History of abuse in a sibling* Bite marks, finger marks, belt marks or cigarette burns* Multiple fractures of different ages* Perineal injury* Intracranial haemorrhage without a history of MVA\n\nSo the answer to this question is D"}
{"instruction": "Highly aggressive and lethal thyroid cancer:\nA. Papillary\nB. Follicular\nC. Medullary\nD. Anaplastic", "response": "Ans. (d) Anaplastic CancerRef: Bailey and Love 27th Edition, Page 820* Lethal almost always in 6 months.* It can arise de novo or dedifferentiation of a papillary or poorly differentiated carcinoma** RT and CT does not increase survival\n\nSo the answer to this question is D"}
{"instruction": "The most impoant constituent in soda lime for reabsorption of CO2 in a closed circuit\nA. Sodium hydroxide\nB. Barium hydroxide\nC. Calcium hydroxide\nD. Potassium hydroxide", "response": "Sodalime is most common Co2 absorbant . Indicators added to sodalime changes the color of sodalime . It contains 94% Ca(OH)2 , 5%NaOH,1% KOH.\n\nSo the answer to this question is C"}
{"instruction": "A thiy-year man presented with nausea, fever and jaundice of 5 days duration. The biochemical tests revealed a bilirubin of 6.7 mg/d1 (conjugated 5.0 mg/dl) with SGOT/ SGPT (AST/ALT) of 1230/900 IU/mi. The serological tests showed presence of HBs Ag. IgM anti-HBc and Hbe Ag. The most likely diagnosis is:\nA. Chronic hepatitis B infection with high infectivity.\nB. Acute hepatitis B infection with high infectivity\nC. Chronic hepatitis infection with low infectivity.\nD. Acute hepatitis B infection with low infectivity", "response": "Answer is B (Acute hepatitis B infection with high infectivity): Presence of Anti HB IgM and Hbs Ag indicates acute infection. Presence of Hbe Ag indicates high infectivity\n\nSo the answer to this question is B"}
{"instruction": "Contrast material used in the diagnosis of esophageal atresia is:\nA. Barium swallow\nB. Gastrograffin\nC. Conray\nD. Dianosil", "response": "Ans. Dianosil\n\nSo the answer to this question is D"}
{"instruction": "In cholangiography CBD stone appears as ?\nA. Meniscus sign\nB. Cut off sign\nC. Slight flow of dye from the sides of stone\nD. Chain of lake appearance.", "response": "Ans is a ie Meniscus sign\n\nSo the answer to this question is A"}
{"instruction": "The function of grit chamber in modern sewage plants is\nA. Formation of sludge\nB. Removal of floating large objects\nC. Settlement of heavy objects\nD. Formation of Zoogleal layer", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Pseudopolyps are features of -\nA. Crohn's disease\nB. Ulcerative colitis\nC. Celiac sprue\nD. Whipple's disease", "response": "Ulcerative colitis \n\nUlcerative colitis is an inflammatory bowel disease characterized by -\n\n\nInflammation involving only the mucosa and submucosa.\nFormation of pseudopolyps\nInvolvement is in a continuous fashion (absent of skip lesions which are characteristic of CD).\n\n\nUlcerative colitis involves the rectum and extends proximally in a retrograde fashion to involve the entire colon (pancolitis) in more severe cases.\nUC is associated with HLA-DR2, polymorphism in IL-10 gene and an abnormal T-cell response particularly of CD4 T-cells (T H2 cells).\n\nSo the answer to this question is B"}
{"instruction": "Pseudohypoparathyroidism is characterized by:\nA. Normal serum Ca++ and decreased serum PTH\nB. Decreased serum Ca++ and decreased serum PTH\nC. Decreased serum Ca++ and Increased serum PTH\nD. Normal serum Ca++ and Increased serum PTH", "response": "c. Decreased serum Ca++ and Increased serum PTH(Ref: Nelson's 20/e p 2695-2697, Ghai 8/e p 521-524)Pseudohypoparathyroidism (PHP)Parathyroid glands are normal or hyperplastic and they can synthesize and secrete parathyroid hormone (PTH)Serum levels of immunoreactive PTH are elevated even when the patient is hypocalcemic normocalcemicNeither endogenous nor administered PTH raises the serum levels of calcium or lowers the levels of phosphorus.\n\nSo the answer to this question is C"}
{"instruction": "Pyromania refers to an irresistible urge to -\nA. Set things on fire\nB. Eat out of proportion\nC. Sleep for long periods\nD. None", "response": "Ans. is 'a' i.e., Set things on fire\n\nSo the answer to this question is A"}
{"instruction": "Non-specific esterase is present in -\nA. Megakaryocytic leukaemia\nB. Lymphocytic leukaemia\nC. Erythroleukemia\nD. AML", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "The best sampling procedure that can be followed is\nA. Simple random\nB. Stratified random\nC. convenient\nD. Systematic", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "In carcinoma of lower lip secondaries are seen in\nA. Upper cervical LN\nB. Axillary LN\nC. Supraclavicular LN\nD. Mediastinal LN", "response": "Carcinoma Lip: Mostly, it is squamous cell carcinoma, often seen in males in the age group of 40-70 years. Lower lip is more often involved. Site of predilection is between the midline and commissure of the lip. Lesion is of exophytic or ulcerative type. Lymph node metastases develop late. Submental and submandibular nodes are the first to be involved; other deep cervical nodes may also get involved later. Treatment: It is surgical excision with adequate safety margin of healthy tissue and plastic repair of the defect. Lymph node metastases require block dissection. Radiotherapy also gives good results in early cases. Ref:- Dhingra; pg num:-226\n\nSo the answer to this question is A"}
{"instruction": "Which type of shift in intracranial content is common in children with progressive hydrocephalus-\nA. Transforam inal herniation\nB. Upward cerebellar herniation\nC. Unilateral transtentorial herniation\nD. Central transtentorial herniation", "response": "Ans. is 'd' i.e., Central transtentorial herniation o Central transtentorial (uncinate, mesial temporal) herniation occurs when the medial aspect of the temporal lobe is compressed against the free margin of tentorium cerebelli. o It can results in increased ICT and hydrocephalus.\n\nSo the answer to this question is D"}
{"instruction": "Hamburger phenomenon deals with the following:\nA. Chloride shift\nB. Oxygen uptake\nC. Cellular ATP levels\nD. Plasma potassium level", "response": "Chloride shift (Hamburger phenomenon) the HCO3- diffuses out of the RBCs into the plasma, the inside of the cells become less negatively charged. Because the RBC membrane is relatively impermeable to cation, so in order to neutralize this effect, negatively charged chloride ions diffuse from the plasma into the RBCs to replace the HCO3-. The movement of chloride ions into the RBCs is called chloride shift or Hamburger phenomenon. Ref: Essentials of Medical Physiology By Khurana, 2008, Page 256.\n\nSo the answer to this question is A"}
{"instruction": "Coagulation defect associated with increased coagulation are seen in\nA. Increased protein C\nB. Increased protein S\nC. Increased anti thrombin 3\nD. Protein C resistance", "response": "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\n\nSo the answer to this question is D"}
{"instruction": "Auditory impulse relays to\nA. Inferior geniculate ganglion\nB. Medial geniculate body\nC. Medial lemniscus\nD. Superior colliculus", "response": "(B) Medial geniculate body > The afferent fibers in the auditory division of the eighth cranial nerve end in dorsal and ventral cochlear nuclei.> From there, auditory impulses pass by various routes to the inferior colliculi, the centers for auditory reflexes, and via the medial geniculate body in the thalamus to the auditory cortex.> Other impulses enter the reticular formation. Information from both ears converges on each superior olive, and beyond this, nrnst of the neurons respond to inputs from both sides.> The primary auditory cortex is Brodmann's area 41. In humans, low tones are represented anterolaterally and high tones postero-medially in the auditory cortex.\n\nSo the answer to this question is B"}
{"instruction": "All of the following type of renal stones are seen in females, EXCEPT:\nA. Stones associated with Idiopathic hypercalciuria\nB. Renal stones in Distal renal tubular acidosis\nC. Renal stones in Primary hyperoxaluria\nD. Renal stones in Lesch-Nyhan syndrome", "response": "The HP gene is located on the X chromosome. Affected males are hemizygous for the mutant gene; carrier females are asymptomatic. A complete deficiency of HP, the Lesch-Nyhan syndrome, is characterized by hyperuricemia, self-mutilative behavior, choreoathetosis, spasticity, and mental retardation. A paial deficiency of HP, the Kelley-Seegmiller syndrome, is associated with hyperuricemia but no central nervous system manifestations. In both disorders, the hyperuricemia results from urate overproduction and can cause uric acid crystalluria, nephrolithiasis, obstructive uropathy, and gouty ahritis. Early diagnosis and appropriate therapy with allopurinol is needed. Ref: Harrisons Principles of Medicine, 18th Edition, Page 3185 See the Table 287-1 in 18th edition Harrison, Page 2383\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is vitamin B-complex disease\nA. Scurvy\nB. Pellegra\nC. Night blindness\nD. Rickets", "response": "(Pellegra): (535 - Harper 29th edition & Tryptophan)* Pellegra - caused by Niacin deficiency* Com is low in both niacin and tryptophan, com based diets can cause pellegra(i) Symptoms 3Ds - dermatitis, diarrhea, dementia(ii) Pellegra is frequently observed in Hartnup's disease(iii) Megadoses of niacin are useful in the treatment of hyperlipidemia* Retinoic acid has a role in the regulation of gene expression and tissue differentiation* Vitamin A deficiency is a major public health problem world wide* Vitamin E is the major lipid soluble antioxidant in cell membranes and plasma lipoproteins* Vitamin K is the coenzyme for carboylation of glutamate in post synthetic modification of calcium-binding proteins* Thiamine nutritional status can be assessed by erythrocyte transketolase activation* *** Viatamin B6 status is assessed by Assaying erythrocyte transaminases* Methyl malonyl CoA mutase, Leucine aminomutase and methionine synthase are three vitamin B12 dependant enzymes* Vitamin B12 deficiency causes functional folate deficiency - the \"Folate Trap\"* Folic acid supplements reduce the risk of Neural tube defects and hyperhomeocysteinemia & may reduce the incidence of cardiovascular disease & some cancers* Beta carotene, Vitamin E, Ascorbic acid and Lipoic acids serve as antioxidants and reduce the risk of heart attacks and cancers* Vitamin B6 is required for glycogen degradation by glycogen phosphorylase. A deficiency would result in fasting hypoglycemia, Additionally a deficiency of biotin (required by pyruvate carboxylase of gluconeogenesis) would also result in fasting hypoglycemia. (394- Lippincotts 6th)\n\nSo the answer to this question is B"}
{"instruction": "All are parts of anterior segment of eye except-\nA. Lens\nB. Cornea\nC. Vitreous\nD. None", "response": "Ans. is 'c' i.e., Vitreouso The eyeball is divided into two segments : -Anterior segmentPart of eyeball anterior to posterior border of lens is called anterior segment.It consists of lens, and structures anterior to it, i.e., cornea, iris and two aqueous humor-filled spaces, i.e., anterior and posterior chambers.Anterior chambers : - It is bounded anteriorly by back of cornea and posteriorly by the iris & part of ciliary body. It contains aqueous humor.Posterior chamber: - This triangular chamber is bounded anteriorly by the posterior surface of the iris & ciliary body and posteriorly by the lens and it zonules. It also contains aqueous humor.Thus, both anterior and posterior chambers are part of anterior segment and both contain aqueous humor.Posterior segmentPart of eye ball posterior to lens is called posterior segment.It consists of vitreous humor, retina, choroid and optic disc.\n\nSo the answer to this question is C"}
{"instruction": "Professional secrecy is A:\nA. Legal responsibility\nB. Ethical responsibility\nC. Social responsibility\nD. Implied term of contract between doctor and patient", "response": "(As per definition, Professional secrecy is an implied term of contract between a doctor and his patient. It is a DUTY of the doctor i.e. the doctor should keep secret whatever he has acquired as part of his professional work from the patient. If the doctor discloses anything then the patient can sue him for damages/fine in a court of law. The doctor should not disclose anything about the patient without the written consent of the patient; if he is a minor or an insane the parents/guardians should be informed of the patient’s illness. However in case of Notifiable diseases, the public health authorities should be informed about the patient’s illness. Doctor can be charged with Defamation for disclosing secrets of his patients.)\n\nSo the answer to this question is D"}
{"instruction": "NOT a content of superior mediastinum\nA. Pulmonary trunk\nB. Thymus\nC. Left superior intercostal aery\nD. Arch of aoa", "response": "Mediastinum refers to the space between two lungs in thorax. SUPERIOR MEDIASTINUM Space above 2nd costal cailage CONTENTS: thymus, arch of aoa, superior venacava, pulmonary aeries, esophagus, trachea, T1 - T4 veebra, PICA - 1, 2. INFERIOR MEDIASTINUM Space below superior mediastinum, again divided into anterior, middle and posterior mediastinum. CONTENTS: pulmonary trunk, bronchus, thymus, hea, ascending aoa, PICA 3 - 12 esophagus, descending aoa, T5 - T12 veebra. Angle between manubrium of sternum & body of sternum is called angle of louis, which is 1630.\n\nSo the answer to this question is A"}
{"instruction": "MOST common side effect of mycophenolate mophetil is:\nA. Marrow suppression\nB. Nephrotoxicity\nC. Diarrhea\nD. Glucose intolerance", "response": "Gastrointestinal side effects (diarrhea/cramps) are common with mycophenolate mophetil. Immunosupressive drugs and their common side effects. Glucocoicoids: Hypeension, glucose intolerance, dyslipidemia, osteoporosis Cyclosporine: Nephrotoxicity, hypeension, dyslipidemia, glucose intolerance, hirsutism/hyperplasia of gums Tacrolimus: Similar to Cyclosporine, but hirsutism/hyperplasia of gums unusual, and diabetes more likely. Azathioprine: Marrow suppression Mycophenolate mofetil (MMF): Diarrhea/cramps; dose-related liver and marrow suppression is uncommon Sirolimus: Hyperlipidemia, thrombocytopenia Ref: Harrisons principles of internal medicine, 18th edition, Page: 1369.\n\nSo the answer to this question is C"}
{"instruction": "Gout can be precipitated by -\nA. Calcium channel\nB. Omeprazole\nC. Thiazide diuretics\nD. Digitalis", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Impotence may be pleaded as a ground for defense in males in all the following conditions Except\nA. Divorce\nB. Rape\nC. Adultery\nD. Unnatural sexual offence", "response": "Impotence is not a ground for defense in a case of Rape. That is to say, that rape can be committed even if a person is impotent. Ref: Krishan Vij textbook of forensic medicine, 5th edition pg : 393\n\nSo the answer to this question is B"}
{"instruction": "Dosage of Albendazole given as per National deworming program in <2years old child.\nA. 200mg\nB. 400mg\nC. 500mg\nD. 2 tablets of 400 mg", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "What percentage of weight loss in infants constitutes severe dehydration?\nA. >10% loss of body weight\nB. > 6%' loss of body weight\nC. 5%' loss of body weight\nD. 7% loss of body weight", "response": "Ans: A (> 10% loss of body weight) Ref: Nelson s Textbook of Pediatrics. 19th Edition, Chapter on 'Deficit Therapy'. Page 245Explanation:In an older child with diarrhea, 6% loss of body weight amounts to Severe dehydration whereas 10% loss of body weight is required to cause the same in infants (Ref: Nelson).CLINICAL EVALUATION OF DEHYDRATIONMild dehydration (<5% in an infant: <3% in an older child or adult):Normal or increased pulseDecreased urine outputThirstyNormal physical findingsModerate dehydration (5-10% in an infant: 3- 6% in an older child or adult):TachycardiaLittle or no urine output: Irritable/lethargieSunken eyes and fontanelDecreased tearsDry mucous membranesMild delay in elasticity (skin turgor)Delayed capillary refill (>1.5 sec)Cool and paleSevere dehydration (>10% in an infant; >6% in an older child or adult):Peripheral pulses either rapid and weak or absentDecreased blood pressureNo urine outputVery sunken eyes and fontanelNo tearsParched mucous membranesDelayed elasticity (poor skin turgor)Very delayed capillary refill (>3 see)Cold and mottledLimp, depressed consciousness\n\nSo the answer to this question is A"}
{"instruction": "Drug causing maximum peripheral neuropathy is:\nA. Zidovudine\nB. Lamivudine\nC. Stavudine\nD. Didanosine", "response": "Stavudine :(d4T) It is a thymidine analogue which acts in the same way as AZT. By utilizing the same thymidine kinase for activation, AZT antagonises the effect of stavudine. Resistance to stavudine develops as for other Nis. It is well absorbed orally and rapidly metabolized(half life 1 .5 hr). The anti-HIV efficacy of stavudme IS comparable to AZT, and it is used in c_ombination regimens. Peripheral neuropathy, lipodystrophy and rarely pancreatitis are the serious toxicies which have restricted its use. zidovudine(AZT): triphosphate selectively inhibits viral reverse transcriptase (RNA-dependent DNA polymerase) in preference to cellular DNA polymerase. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:771,772\n\nSo the answer to this question is C"}
{"instruction": "Which among the following is contraindicated in myasthenia patient?\nA. Aminoglycosides\nB. Sulphonamides\nC. Penicillin\nD. All", "response": "Ref:KD Tripathi pharmacology 7th edition (page.no: 745) All aminoglycosides reduce ACh release from the motor nerve endings. They interfere with the mobilization of centrally located synaptic vesicles to fuse with the terminal membrane (probably by antagonizing Ca2+) as well as decrease the sensitivity of the muscle endplates to ACh. Myasthenic weakness is accentuated Aminoglycosides. Neuromuscular blockers should be used cautiously in patients receiving aminoglycosides.\n\nSo the answer to this question is A"}
{"instruction": "1,25-dihydroxycholecalciferol is secreted by:\nA. Adrenal coex\nB. Liver\nC. Proximal tubules of kidney\nD. Collecting ducts of kidney", "response": "It is the most active form of vitamin D(1,25-dihydroxycholecalciferol) / (calcitriol) When UV rays fall on the skin, 7-dehydrocholesterol in the skin is conveed into cholecalciferol. It goes to the liver, a hydroxyl group is attached to it, 25-(OH) cholecalciferol is formed. It then travels to kidneys. In the cells of the PCT, one more hydroxyl group is attached, to form the active metabolite 1,25-dihydroxycholecalciferol. Vit. D is considered a steroid hormone. It acts on the intestines, kidneys, and bone. Its chief function is to increase Ca2+ and PO42- in the ECF.\n\nSo the answer to this question is C"}
{"instruction": "Male with erythematous patch over penis after taking an over the counter medicine. Causal drug is:\nA. Azithromycin\nB. Ofloxacin\nC. Doxycycline\nD. Aceclofenac", "response": "Ans. D. AceclofenacRef: Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 7th/ed p498-99Explanation# Findings given in question are suggestive of 'fixed drug eruptions (FDE)'.# Among the given options ofloxacin, doxycycline and azithromycin are prescription only drugs hence most probably the answer is aceclofenac.# If in question 'over the counter' has not been mentioned then the answer will be doxycycline.# A FDE is an adverse cutaneous reaction to an ingested drug, characterized by the formation of a solitary (but at times multiple) erythematous patch or plaque.# If the patient is rechallenged with the offending drug, the FDE occurs repeatedly at the identical skin site (i.e., fixed) within hours of ingestion.# Usually asymptomatic. May be pruritic, painful, or burning.# Time to onset oflesion(s): Occur from 30 min to 8 h after ingestion of drug in previously sensitized individual.# Duration oflesion(s): Lesions persist if drug is continued. Resolve days to few weeks after drug is discontinued.* Tetracyclines (tetracycline, doxycycline, minocycline)* Sulfonamides, other sulfa drugs* Metronidazole, nystatin, salicylates, NSAIDs, phenylbutazone, phenacetin* Barbiturates* Oral contraceptives* Quinine (including quinine in tonic water), quinidine* Phenolphthalein* Food coloring (yellow): in food or medications\n\nSo the answer to this question is D"}
{"instruction": "After an endoscopy a technician kept the instrument for sterilization. Which of the following agent is used for sterilization of fibre optic instruments?\nA. Glutaraldehyde\nB. Chlorine\nC. Autoclave\nD. Phenol", "response": "Glutaraldehyde, which has two reactive aldehyde groups, is 10 times more effective than formaldehyde and is less toxic. It denatures proteins and nucleic acids. Both proteins and nucleic acids contain essential -NH2 and -OH groups, which are the main sites of alkylation. In hospitals, it is used to sterilize respiratory therapy equipment, endoscopes, and hemodialysis equipment. Ref: Levinson W. (2012). Chapter 13. Sterilization & Disinfection. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.\n\nSo the answer to this question is A"}
{"instruction": "None Not seen in alpha helix ?\nA. Alanine\nB. Leucine\nC. Proline\nD. Isoleucine", "response": "Ans. is 'c' i.e., Proline Proline is never found in a-helix as it has imino group (-NH) not amino (-N112).Thus it cannot provide hydrogen for hydrogen bonding, the major stabilizing force of a-helix.Glycine also tends to disrupt a-helix; because of its high flexibility and small size it often induces bends in a-helix.\n\nSo the answer to this question is C"}
{"instruction": "Insecticide of choice to prevent kala-azar-\nA. DDT\nB. HCH\nC. Malathione\nD. Paris green", "response": "Ans. is 'a' i.e., DDT * Resistance to DDT has not been demonstrated in sandflies* A single application of DDT or lindane has been found effective in reducing sandflies.* DDT residue may remain effective for a period of 1 to 2 years and lindane only for a period of 3 months.\n\nSo the answer to this question is A"}
{"instruction": "All of the following are true about fibrolamellar carcinoma of the liver except :\nA. More common in females\nB. Better prognosis than HCC\nC. AFP levels always greater than 1000\nD. Occur in younger individuals", "response": "Answer is C (AFP levels always greater than 1000) : Fibrolamellar variant has no AFP elevation - Chandrasoma Taylor Equal sex incidence - Robbins More common in Jetnales -Chandrasoma Taylor Although Robbins and Chandrasoma Taylor are contradicting each other as far us distribution of the tumor in the two sexes is concerned, elevation of AFP appears ceainly not to be so significant as to rise to levels greater than 1000. The single best answer is undoubtedly option 'C'.\n\nSo the answer to this question is A"}
{"instruction": "Under ICDS one Anganwadi is for:\nA. 1000\nB. 10000\nC. 3000\nD. 5000", "response": "Ans: a (1000) Ref: Park, 19th ed, p. 473The most important scheme in the field of child welfare is the ICDS scheme. It was initiated by the Govt.of India in The Ministry of Social and Women's Welfare in 1975.At present 5671 ICDS projects are sanctioned. One Anganwadi centre for 1000 persons in rural and urban areas, and one Anganwadi for 700 persons in tribal areas.Services delivered by ICDS are:1. Supplementary nutrition2. Immunization3. Health check up4. Medical referral services5. Nutrition and health education for women6. Non formal education of children up to the age of 6 years, and pregnant and nursing mothers in rural, urban and tribal areas.Services under ICDS are delivered through trained local woman called Anganwadi worker (AWW). Other functionaries are child development project officer (CDPO), who is in charge of 4 supervisors and lOOAWWs.\n\nSo the answer to this question is A"}
{"instruction": "In the study of latent finger prints, Poroscopy involves _____ level detail in individualization on ridge formations.\nA. First\nB. Second\nC. Third\nD. Fouh", "response": "Poroscopy is arrangement of sweat pores in between the ridges. Fingerprint study is done in different levels. Level I : study of different pattern. i) Loop ii) Whorls iii) Arch iv) Composite Level II : study of ridge islands i) Lates ii) Delta iii) Core Level III : every ridge is examined. i) Ridge bifurcation ii) Union iii) Ending\n\nSo the answer to this question is C"}
{"instruction": "Sperm capacitation takes place in -\nA. Testes\nB. Epididymis\nC. Female genital tract\nD. All of the above", "response": "Ans. is 'c' i.e., Female genital tract * After the ejaculation the sperm cells go through several essential physiological changes during their time in the female genital tract before they, at the end, are able to penetrate the oocyte membrane.* The first change in this cascade is capacitation. The sperm cells accomplish this during the ascension through the female genital tract (in contact with its secretions). It has to do with a physiological maturation process of the sperm cell membranes, which is seen as the precondition for the next step to follow, namely the acrosome reaction.* Capacitation is a functional maturation of the spermatozoon. The changes take place via the sperm cell membrane in which it may be that receptors are made available through the removal of a glycoprotein layer. The area of the acrosomal cap is also so altered thereby that the acrosome reaction becomes possible.* Through the membrane alterations, the motile properties of the spermatozoon also change. Discharging whipping movements of the tail together with larger sideways swinging movements of the head take place. This type of motility is designated as hyperactivity. One can therefore say that the visible consequences of capacitation consist in hyperactivity of the spermatozoon.\n\nSo the answer to this question is C"}
{"instruction": "Treatment of choice for polyuria in lithium induced diabetes insipidus is:\nA. Vasopressin\nB. Mineralocoicoid antagonist\nC. Amiloride\nD. Loop diuretic", "response": "Answer is C (Amiloride): Amiloride is currently the treatment of choice for polyuria in lithium induced diabetes insipidus. Amiloride a potassium-sparing diuretic is the drug of choice to treat polyuria and raise maximum urinary osmolality in lithium-treated patients. Amiloride blocks the cellular uptake of lithium ENaC, thus antagonizing the inhibitory effects of Lithium on Vasopressin induced water transpo\n\nSo the answer to this question is C"}
{"instruction": "Products of uronic acid pathway in human beings are all EXCEPT:\nA. Vitamin C\nB. Pentoses\nC. NADH\nD. Glucuronic acid", "response": "Humans cannot synthesize vitamin C due to deficiency of enzyme, L-Gulonolactone Oxidase Uronic acid pathway in humans\n\nSo the answer to this question is A"}
{"instruction": "Which of the following stones is hard to break by ESWL\nA. Calcium oxalate monohydrate\nB. Calcium oxalate dihydrate\nC. Uric acid\nD. Struvite", "response": "In general CYTINE , calcium phosphate,specifically Brushite ( Calcium phosphate Hydroxyapatite) and Calcium oxalate monohydrate stones , Matrix stones ( Protien rich stone) are most resistant to ESWL . All these are RADIO OPAQUE. Treatment of choice:- Renoscopic removal. The remainder of common stone type by order of increasing fragility are struvite , calcium oxalate dihydrate and finally uric acid stones.These are RADIO LUCENT ref :- Campbell - Walsh urology 11th edition .chapter 53 , pg no :- 1242 Bailey and Love 27th edition . chapter 76 , pg no 1408.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is used in the treatment of well differentiated thyroid cancer?\nA. 32 P\nB. 131 I\nC. 99mTc\nD. 131I-MIBG", "response": "I 131 is used in the treatment of well differentiated thyroid cancer and hypehyroidism. I 131 has a half life of 8 days and emits beta paicles as well as gamma rays. Radiation dose to thyroid is mainly due to the emitted beta paicles (90%) rather than gamma radiation. Ref: Oncology for Health-Care Professionals By V. Pervan, Page 262; Radiation in Medicine: A Need for Regulatory Reform By U.S. Nuclear Regulatory Commission, Page 74\n\nSo the answer to this question is B"}
{"instruction": "Corneal deposits are seen in all except –\nA. Reis–bucklers corneal dystrophy\nB. Endothelial dystrophy of fuchs\nC. Hunters disease\nD. Hurler's disease", "response": "Endothelial dystrophies cause corneal deposits (not epithelial dystrophies like Reis - Buckler's dystrophy).\nHunter's syndrome and Hurler syndrome are mucopolysaccharidosis:-\n\n\"In all the mucopolysacharidosis (except MPS III - Sanfilipoo syndrome), corneal deposition may occur\". — Pediatric Ophthalmology\n\nSo the answer to this question is A"}
{"instruction": "A 12-year-old girl presents to the emergency department following a skiing crash in which the left side of her mid torso hit a tree. She presents with left side lower chest and upper abdominal pain. She also complains of left shoulder pain. The most likely diagnosis is which of the following?\nA. Rib fractures\nB. Liver injury\nC. Ruptured diaphragm\nD. Splenic injury", "response": "The spleen is the most common solid organ injured by blunt trauma. Though gastric rupture could cause the clinical presentation described, it is very rare. Rib fracture in the mid torso alone generally does not cause the referred shoulder pain, because blood does not collect under the left diaphragm, as seen in splenic injuries.\n\nSo the answer to this question is D"}
{"instruction": "The most common dental procedure contributing to vertical root fracture is\nA. Prosthodontic treatment\nB. Endodontic treatment\nC. Periodontal treatment\nD. Orthodontic treatment", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Richest source of vitamin C ?\nA. Guava\nB. Lime\nC. Orange\nD. Tomato", "response": "Ans. is 'a' i.e., Guava The richest source of vitamin C is Indian goosebery (Amla). Impoant sources of vitamin C in decreasing order : - Amla > Guava > Cabbage > Amaranath > Lime > Cauliflower > Orange > Spinach > Tomato > Potato\n\nSo the answer to this question is A"}
{"instruction": "The Gold standard investigation for Gastro-Oesophageal reflux disease is:\nA. Endoscopy\nB. 24 hour esophageal pH recording\nC. Oesophageal manometry\nD. Measurement of length of lower oesophageal sphincter", "response": "24 hour Esophageal pH recording provides a quantitative & sensitive documentation of acidic reflux episodes.\n\nSo the answer to this question is B"}
{"instruction": "Digoxin toxicity is aggravated by?\nA. Hypokalemia\nB. Hyperkalemia\nC. Hypercalcemia\nD. Hypocalcemia", "response": "Digoxin toxicity causes hyperkalemia, or high potassium. The sodium/potassium ATPase pump normally causes sodium to leave cells and potassium to enter cells. Blocking this mechanism results in higher serum potassium levels (REF.Essentials of medical pharmacology K D TRIPATHI 8th Edition)\n\nSo the answer to this question is B"}
{"instruction": "Carbohydrate requirement in ideal balanced dict?\nA. 10-20% of total energy intake\nB. 20-30% of total energy intake\nC. 40-50% of total energy intake\nD. 50-70% of total energy intake", "response": "Ans. is 'd' i.e., 50-70% of total energy intake\n\nSo the answer to this question is D"}
{"instruction": "BPF (Brazilian purpuric fever) is caused by:\nA. H.influenzae biotype aegyptius\nB. V. cholerae\nC. Salmonella\nD. None of the above", "response": "H. aegyptius:\n→ Identical to non-capsulated H.influenza, now named as H.influenza biotype aegyptius.\n→ Causes highly contagious form of conjunctivitis (PINK EYE) and Brazilian purpuric fever. \n→ BPF (Brazilian purpuric fever): Conjunctivitis proceeding to fulminant septicemia in infants and children with high fatality.\n\nSo the answer to this question is A"}
{"instruction": "Stevens-Johnson syndrome is caused by:\nA. Herpes simplex\nB. CMV\nC. Chicken pox\nD. Toxoplasma", "response": "Ans: A (Herpes simplex) Reference: Thappa DM, edit to: Essentials in Dermatology, 2nd edn. NewDelhi: Jay peeExplanation: (See the following table)Stevens-Johnson Syndrome (SJS)Drug induced SJSPhenvtoinPhenobarbitoneSulfonamidesPenicillinsNS AIDSViral CausesHerpes simplex virus (Most Common cause)AIDSCoxsackievirusViral infectionsInfluenza HepatitisMumpsBacterial causesGroup A beta-hemolytic streptococciNail AbnormalitiesNail abnormalityDescriptionCausesKoilonychiaReverse curvature in the longtitudinal and transverse axisIron deficiency anemiaMacronychia/McronychiaToo small or large nails--OnycholysisDistal or lateral separation of the nail from nail bedPsoriasis, OnychomycosisPterygiumCentral fibrotic tongue like band from proximal nail fold joins the nail bed dividing the nail proximal!}1 into twoLichen planusSubungual hyperkeratosisExcessive collection of squamous debris under the free edge of nailPsoriasis OnychomycosisOnychogryphosisNail get thickened and grows upwards in a spiral mannerChronic traumaPachynychia congenitaHypertrophy of nails associated with nail bed and hyponychial hyperkeratosis--Beau's linesTransverse grooves on nailsTemporary cessation of nail formationChemotherapyHypocalcemiaNail infectionCoronary occlusionMalnutritionTerry's nailNail N white proximally hut normal distallyCongestive cardiac failureCirrhosisDiabetes mellitusPittingPunctate erosions on nail surfacePsoriasisAlopecia areataRed LunulaeNails show erythema of lunulaPsoriasis (Dotted red lunula) Congestive cardiac failure CirrhosisSLESplinter hemorrhagesLongiitudinal hemorrhages in nail bedPsoriasisDermatitisFungal infectionsInfective endocarditis SLEMycosis fungoidesRheumatoid arthritisMees linesWhitening or discoloration of the nail in bands or \"stria\" that run parallel the lunula (nail base)CirrhosisChemotherapyHeavy metal poisoning(Arsenic, Thallium)TraumaMuehrcke's nailsWhite lines (leukonychia) that extend all the way across the nail and he parallel to the lunula {half moon)Non-specificAssc with decreased protein synthesisHypoalbuminemiaNephrotic syndromeDiphtheriaBrucellosisLymphogranuloma venereumMycobacteriaMycoplasma pneumoniaeRicketsial infectionsTularemiaIt is common in children and young adultsThe disease is preceded by a nonspecific prodrome with fever, myalgia, rhinitis and coughSkin lesions occur abruptly and are purpuric macules, atypical target lesions and papulesBullous lesions may occur in oral, genital and anal mucosaUlcerative stomatitis with hemorrhagic crusting is the most characteristic featureCorneal erosions may lead to symhlepharan. synechiae and opacitiesConstitutional symptoms may be severe during active stagesThe treatment includes supportive care and steroids.SJS Vs TENSJS - Mucosal erosions and epidermal detachment below 10%Toxic epidermal necrolysis (TEN)- Mucosal erosions and epidermal detachment more than 30%\n\nSo the answer to this question is A"}
{"instruction": "Because of circle of least diffusion, the distant vision is comparatively good in:\nA. Simple myopic astigmatism\nB. Compound myopic astigmatism\nC. Mixed astigmatism\nD. Compound hypermetropic astigmatism", "response": "Ans. Mixed astigmatism\n\nSo the answer to this question is C"}
{"instruction": "Which is involve in processing of post-transcriptional modification of mRNA:\nA. Lariats formation\nB. Splicing\nC. Methylation\nD. All of the above", "response": "A i.e. Lariats formation; B i.e. Splicing; E i.e. Methylation\n\nSo the answer to this question is D"}
{"instruction": "Cause of \"bloody\" vomitus in a neonate\nA. Meckel's diveiculum\nB. Intussusception\nC. Malrotation\nD. Cholecystitis", "response": "Meckel&;s dieiculum may cause severe hemorrhage due to peptic ulceration. The blood is usually passed per rectum and is maroon in colour. it may cause bloody vomitus. Ref : BAILEY AND LOVE&;S SHO PRACTICE OF SURGERY,24 TH EDITION PG NO:1159\n\nSo the answer to this question is A"}
{"instruction": "Crystalline lens of the eye develops from\nA. Mesoderm\nB. Neural ectoderm\nC. Surface ectoderm\nD. Endoderm", "response": "Answer: c) Surface ectoderm (PARSON 22nd ED, P-5)NEURAL ECTODERMSURFACE ECTODERMMESODERM# Epithelium of iris# Epithelium of ciliary body# Constrictor and dilator pupillae# Retinal pigment epithelium and its 9 sensory layers# Optic vesicle and cup# Optic nerve fibres# Melanocytes# Secondary vitreous# Epithelium of Conjunctiva# Epithelium of cornea# Lacrimal glands# Tarsal glands# Conjunctival glands# Crystalline Lens# Sclera# Corneal stroma# Descemet's membrane# Corneal endothelium# Iris# Choroid# Ciliary muscle# Sheaths of optic nerve# Blood vessels of the eye# Extraocular muscles# Trabecular meshwork# Primary vitreous\n\nSo the answer to this question is C"}
{"instruction": "All are seen in Addison disease Except\nA. Hyponatremia\nB. Hyperkalemia\nC. Hypotension\nD. Metabolic alkalosis", "response": "An \"adrenal crisis\" or \"Addisonian crisis\" is a constellation of symptoms that indicates severe adrenal insufficiency. This may be the result of either previously undiagnosed Addison's disease, a disease process suddenly affecting adrenal function (such as adrenal hemorrhage), or an intercurrent problem (e.g., infection, trauma) in someone known to have Addison's disease. It is a medical emergency and potentially life-threatening situation requiring immediate emergency treatment. Characteristic symptoms are: Sudden penetrating pain in the legs, lower back, or abdomen Severe vomiting and diarrhea, resulting in dehydration Low blood pressure Syncope (loss of consciousness and ability to stand) Hypoglycemia (reduced level of blood glucose) Confusion, psychosis, slurred speech Severe lethargy Hyponatremia (low sodium level in the blood) Hyperkalemia (elevated potassium level in the blood) Hypercalcemia (elevated calcium level in the blood) Convulsions Fever Ref Harrison20th edition pg 288\n\nSo the answer to this question is D"}
{"instruction": "Commonly associated in tetralogy of Fallot is:\nA. Aberrant right subclavian artery\nB. Right sided aortic arch\nC. Aortopulmonary window\nD. Coarctation of aorta", "response": "Ans BAssociations of Tetralogy of Fallot (TOF) are:Cardiovascular associations#Right-sided aortic arch: seen in 25% of cases (Most common Q)#Pulmonary hypoplasia with or without atresia.#Atrial septal defect (ASD) or Patent ductus arteriosus (PDA) (termed pentalogy of Fallot)#Coronary artery anomalies.#Persistent left-sided superior vena cava.Extra-cardiovascular associations: in 15% of cases#Congenital lobar emphysema (CLE)#VACTERL association#Tracheo-esophageal fistula#DiGeorge syndrome#Prune belly syndrome#Fetal rubella syndrome\n\nSo the answer to this question is B"}
{"instruction": "Blue color of contusion is due to: Gujarat 07\nA. Bilirubin\nB. Hemosiderin\nC. Hematoidin\nD. Deoxyhemoglobin", "response": "Ans. Deoxyhemoglobin\n\nSo the answer to this question is D"}
{"instruction": "Which of the following drugs can be used for the treatment of chloroquine resistant malaria in children?\nA. Chloroquine\nB. Doxycycline\nC. Tetracycline\nD. Clindamycin", "response": "CHLOROQUINE It is a rapidly acting erythrocytic schizontocide against all species of plasmodia; controls most clinical attacks in 1-2 days with disappearance of parasites from peripheral blood in 1-3 days. Therapeutic plasma concentrations are in the range of 15-30 ng/ml. However, it has no effect on pre- and exo-erythrocytic phases of the parasite-does not prevent relapses in vivax and ovale malaria. Resistance in P. falciparum is associated with a decreased ability of the parasite to accumulate chloroquine. Veraparnil, a Ca2+ channel blocker, has been found to restore both the chloroquine concentrating ability as well as sensitivity to this drug. For pediatric patients, the treatment options are the same as for adults except the drug dose is adjusted by patient weight. The pediatric dose should never exceed the recommended adult dose. Pediatric dosing may be difficult due to unavailability of non-capsule forms of quinine. If unable to provide pediatric doses of quinine, consider one of the other three options. If using a quinine-based regimen for children less than eight years old, doxycycline and tetracycline are generally not indicated; therefore, quinine can be given alone for a full 7 days regardless of where the infection was acquired or given in combination with clindamycin as recommended above. In rare instances, doxycycline or tetracycline can be used in combination with quinine in children less than 8 years old if other treatment options are not available or are not tolerated, and the benefit of adding doxycycline or tetracycline is judged to outweigh the risk. If infections initially attributed to \"species not identified\" are subsequently diagnosed as being due to P. vivax or P. ovale, additional treatment with primaquine should be administered. ESSENTIALS OF MEDICAL PHARMACOLOGY, www.cdc.gov/malaria/diagnosis_treatment K.D.TRIPATHI SIXTH EDITION PAGE NO:785\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is not true regarding Gleason grading and scoring?\nA. It is used in prostate cancer\nB. Prostate specific antigen has score of 3\nC. It has score from 2 to 10\nD. It is a prognostic scoring system", "response": "It is pathological scoring system based on tumor morphology. Doesn't include PSA values\n\nSo the answer to this question is B"}
{"instruction": "Conversion of Fe+2 to F+3 reaction is called\nA. Haber weiss reaction\nB. Fenton's reaction\nC. Ne rns t reaction\nD. Donnan reaction", "response": "For Options A & B refer image. Option D :When two solutions containing ions are seperated by a membrane that is permeable to some of the ions and not to others an electrochemical equillibrium is established.\n\nSo the answer to this question is B"}
{"instruction": "Investigation of choice to demonstrate vesico ureteral reflux\nA. Isotope cystogram\nB. Contrast Micturating Cysto Urethrogram\nC. IVP\nD. Cystoscopy", "response": "B i.e. Contract MCU - Patients with suspected urolithiasis (stone) present with painful hematuria and /or recurrent UTI. Ultrasound and KUB X-ray are the initial screening modalityQ followed by unenhanced (i.e. non contrast) helical or spinal CT (imaging modality of choice) if screening is negative. However, IVU (intravenous urography) or IVP is still the best investigation if CT is not available. The test of choice at most centers for diagnosing an acute stone is a non contrast helical CT ScanQ. Helical CT (Non contrast) has the advantage of detecting uric acid stones in addition to the traditional radioopaques stones, and CT does not expose the patient to the risk of radio contrast agents. - Calcification is best detected by CTscanQ. MRI and PET scan have no role in diagnosing renal stone. Intravenous urography (IVP) is the only method which can detect early renal tuberculosis and papillary necrosis. It is the most sensitive and investigation modality of choice for early renal TB. However in advanced cases it should be integrated with cross sectional CT imagesQ. Micturating/Voiding cystourethrography is the best method to visualize posterior urethra, posterior urethral valve & vesico ureteric refluxQ. In post urethral valve,Voiding Cystourethrogram (VCU) shows dialation of prostatic urethra & filling defect corresponding to the valve. VU Reflux occurs when urinary bladder contracts so contrast studies of urinary bladder done during micturation is best way to see VU Reflux. Radionucleotide cystogram is Inv of 2nd choice. It's advantage is that it avoids the need for bladder catheterization. The disadvantage is its lack of anatomical detail. So it may be useful in follow up (not initial assessment).\n\nSo the answer to this question is B"}
{"instruction": "A patient with hereditary fructose intolerance is deficient in which of the following enzymes?\nA. Aldolase\nB. Fructokinase\nC. Triokinase\nD. All of above", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Storage form of free energy in the cell is:\nA. NADH\nB. ATP\nC. G-6-Phosphate\nD. Creatine phosphate", "response": "ATP is the storage form of free energy in most of the cells of the body. Creatine phosphate or Phospho-creatine is the immediate source of ATP in muscles for first 8-10 seconds. High energy compounds in biological systems are : ATP GTP UTP Creatine Phosphate Phosphoenol Pyruvate Coenzyme A 1,3-bisphospho glycerate Carbamoyl Phosphate\n\nSo the answer to this question is B"}
{"instruction": "The antibiotic that inhibits protein synthesis by premature chain termination and which structurally resembles an aminoacyl t-RNA is -\nA. Tetracycline\nB. Chloramphenicol\nC. Puromycin\nD. Erythromycin", "response": "Ans. is 'c' i.e., Puromycin o Puromycin is a tRNA analogue which combines with amino acid in place of tRNA and forms a complex with amino acid that prevents addition of fuher amino acids to polypeptide (i.e. causes premature chain termination).\n\nSo the answer to this question is C"}
{"instruction": "All are true about Adult laryngeal papilloma except -\nA. M>F\nB. Do not recur\nC. Posterior half of vocal cord\nD. Treatment is surgery", "response": "Ans. is 'c' i.e., Posterior half of vocal cordAdult-onset papillomao Single, smaller in size, less aggressive and do not recur after surgery,o Most common age affected is 30-40 years and is more common in males,o It arises from anterior half of vocal cord or anterior commissure.o Surgery is the primary modality' of treatment.o Endoscopic surgical removal is the preferred treatment (CO2 laser is the most commonly used modality).\n\nSo the answer to this question is C"}
{"instruction": "Sheela 26-year-old female, currently taking phenytoin for idiopathic grand mal epilepsy, and is consulting you because she wants to avoid pregnancy. She is on oral contraceptive pills (OCPs) for the time being. She has searched the internet and read that phenytoin could decrease the effectiveness of her OCPs. Which one of the followings is a suitable alternative?\nA. Carbamazepine.\nB. Lamotrigine\nC. Topiramate.\nD. Phenobarbitone.", "response": "Lamotrigine * Lamotrigine (Lamictal) is an excellent alternative in those who wish to avoid pregnancy while taking OCPs. * Topamirate (Topamax) decreases the effectiveness of OCPs; the rest are enzyme inducers that increase the catabolism of OCPs.\n\nSo the answer to this question is B"}
{"instruction": "Burr cell is seen in -\nA. Uremia\nB. Hepatocellular carcinoma\nC. Gastric carcinoma\nD. Ovarian carcinoma", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "The gene that regulates normal morphogenesis during development is :\nA. FMR-1 gene\nB. Homeobox gene.\nC. P-16\nD. FTEN.", "response": "Ans. is 'b' i.e. Homeobox gene Homeobox geneis associated with normal morphogenesis.Their expression results in the production of localized cellular condensation of primitive mesenchyme in the sites of future bones.They play an important role in patterning of limbs, vertebrae and craniofacial structures.Mutations in Homeobox gene produces an extra digit between 3rd and fourth fingers as well as some degree of syndactyly.About other optionsFMR geneIt is familial mental retardation gene mutation in this gene causes Fragile-X- syndromePTENIt is phosphatase and tensin homologue.It is frequently deleted in many human cancers such as Glioblastomas, Prostate cancers, endometrial cancers and Breast cancer.P-16It is a tumour suppressor gene.\n\nSo the answer to this question is B"}
{"instruction": "Professional misconduct -\nA. Association with non medical persons in medical procedures\nB. Dichotomy\nC. Issuing false ceificate\nD. All of the above", "response": "Professional misconduct is any conduct of the doctor which might reasonably be regarded as disgraceful or dishonorable. Conduct is judged by professional men of good repute and competence. The doctor may get a warning notice and his name can be erased from Medical Register if guilty. These offenses include mnemonic 6 A's 1 D. Adultery, unlawful Aboion, Adveising, Association with unqualified persons in professional matters, Addiction, Alcohol, and Dichotomy or fee splitting. REF: Dr.K.S.Narayana Reddys Synopsis of Forensic Medicine & Toxicology 29th edition Pg.15.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following organism is identified by interferon\nA. Staphylococcus\nB. Leptospira\nC. Campylobacter\nD. Tuberculosis", "response": "Interferon-gamma release assay: This test uses Mycobacterium tuberculosis antigen CFP10 which reacts with T-lymphocytes of the patient to release gamma interferon. This test is not very specific for pulmonary tuberculosis, hence is not recommended any longer. Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th edition; Pg: 360\n\nSo the answer to this question is D"}
{"instruction": "Investigation of choice to differentiate pericardial effusion and dilatation of hea:\nA. Echocardiography\nB. Angio cardiography\nC. MR!\nD. CT", "response": "Ans. Echocardiography\n\nSo the answer to this question is A"}
{"instruction": "Not seen with controlled ventilation set at:\nA. Barotrauma\nB. Alkalosis\nC. Pulmonary embolism\nD. Cardiac Temponade", "response": "D i.e. Cardiac Temponade Prolonged controlled ventilation may cause barotrauma & pulmonary embolismQ. And CO2 wash out causes alkalosisQ in controlled ventilation. Intermittent Positive Pressure Ventilation (IPPV) Pathophysiological change - AlkalosisQ dlt CO2 wash out Reduced cardiac outputQ due to decreased venous return because of elevated intrathoracic pressure Increased physiological dead spaceQ because gas flow is directed to more compliant, non dependent areas while blood flow ours dependent areas Complication BarotraumaQ dlt high peak inflation pressure VolutraumaQ dlt repetitive collapse & expansion of lung - PneumothoraxQ Pulmonary embolismo\n\nSo the answer to this question is D"}
{"instruction": "An 11 year old female patient complains that her lips remain open and gums can be seen. Extra-oral examination reveals a short upper lip, whereas the intra-oral examination shows normal inclination of the incisors. Which of the following statements regarding this patient's chief complaint is false?\nA. Growth of lips trail behind the growth of jaws\nB. The lip separation seen is normal\nC. Gingival display will reduce with age\nD. The lip separation will increase with age", "response": "Growth of the Lips\nThe lips trail behind the growth of the jaws prior to adolescence, then undergo a growth spurt to catch up. Because lip height is relatively short during the mixed dentition years, lip separation at rest (often termed lip incompetence) is maximal during childhood and decreases during adolescence. Because the lips move downward relative to the lips and teeth during adolescence (and continue to do so as the face ages), what looks like too much display of gingiva prior to and in adolescence can look perfectly normal in a young adult.\nContemporary orthodontics, William Proffit, 4th edition page 47\n\nSo the answer to this question is D"}
{"instruction": "The best treatment of contaminated wound of leg\nA. Debridement and antibiotics\nB. Hyperbaric oxygen\nC. Amputation\nD. None", "response": "Ans. (a) Debridement and antibiotics(Ref: Bailey 26th 279)* Treatment of contaminated wound includes antibiotics or even a wound wash out. Dead tissue needs to be excised.\n\nSo the answer to this question is A"}
{"instruction": "Which one of the following neurological conditions is not inherited in autosomal dominant pattern\nA. Neurofibromatosis\nB. Friedreich's ataxia\nC. Marfan's syndrome\nD. None", "response": "Friedreich ataxia Gene :FXN,locus:9q21.1 ; protein :frataxin; repeat GAA; normal: 7-34 ; Disease :34-80 (pre); >100 (full) Friedreich ataxia is an inherited condition that affects the nervous system and causes movement problems.This condition is caused by mutations in the FXN gene and is inherited in an autosomal recessive pattern Ref Robbins 9/e pg 168\n\nSo the answer to this question is B"}
{"instruction": "Which is the safest contraceptive method for a woman with sickle-cell anaemia ?\nA. Intrauterine device\nB. Low dose progesterone pill\nC. Condom or diaphragm\nD. Low dose oestrogen-progesterone", "response": "Condom or diaphragm\n\nSo the answer to this question is C"}
{"instruction": "Drug contraindicated in G6PD deficiency ?\nA. Chloroquine\nB. Primaquine\nC. Quinine\nD. All", "response": "Ans. is `b > c > a' i.e., Primaquine > Quinine > Chloroquine o Among antimalarial drugs, primaquine, quinine and occasionally chloroquine can cause hemolytic anemia in G6PD deficiency. But, primaquine has the highest potential to cause hemolytic anemia in patients with G6PD deficiency and, the patients with G6PD dificiency are highly senstive to primaquine. o The hemolytic potential in G6PD deficiency patients - Primaquine (maximum) > Quinine > Chloroquine (rare).\n\nSo the answer to this question is D"}
{"instruction": "Basal layer of cell in stratified squamous epithelium is\nA. Squamous\nB. Transitional\nC. Cuboidal- columnar\nD. Pseudostratified", "response": "C i.e. Cuboidal - Columnar\n\nSo the answer to this question is C"}
{"instruction": "Goldenhar syndrome is associated with which prominent ocular manifestation:\nA. Microcornea\nB. Megalocornea\nC. Sclerocornea\nD. Epibulbar dermoids", "response": "Ans. Epibulbar dermoids\n\nSo the answer to this question is D"}
{"instruction": "All are true regarding fetal hydantoin syndrome except :\nA. Digital hypoplasia\nB. Macrocephaly\nC. Microcephaly\nD. Cleft lip", "response": "Macrocephaly is not a feature of fetal hydantoin syndrome Fetal hydantoin syndrome Phenytoin is teratogenic Features : Hypoplastic phalanges Cleft palate Harelip Microcephaly Due to arene-oxide metabolite\n\nSo the answer to this question is B"}
{"instruction": "Following admission to the emergency department, a 26-year-old woman with severe menorrhagia states that both her father and sister have a bleeding disorder. The hemostatic disorder transmitted by autosomal-dominant mode is which of the following?\nA. Factor X deficiency\nB. von Willebrand's disease\nC. Factor VIII deficiency (true hemophilia)\nD. Factor IX deficiency (Christmas disease)", "response": "von Willebrand disease is the most common hemostatic disorder transmitted by autosomal- dominant mode. Other disorders transmitted by this mode are hereditary hemorrhagic telangiectasia and factor XI deficiency. Diseases transmitted by an autosomal-recessive mode are factor X, factor V, factor VII, and factor I deficiencies. Factor VIII (true hemophilia) and factor IX (Christmas disease) deficiencies are sex-liked recessive.\n\nSo the answer to this question is B"}
{"instruction": "Chang staging is used for -\nA. Retinoblastoma\nB. Medulloblastoma\nC. Ewing's sarcoma\nD. Rhabdomyosarcoma", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Most common site of intra peritoneal abscess is\nA. Right superior intra peritoneal space\nB. Left superior intra peritoneal space\nC. Right inferior intra peritoneal space\nD. Left inferior intra peritoneal space", "response": "Most common site of abscess in lying and dependent positive - Right inferior intra peritoneal space.\n\nSo the answer to this question is C"}
{"instruction": "The common cause of bilateral internuclear ophthalmoplegia is:\nA. Multiple sclerosis\nB. Lead toxicity\nC. Diphtheria\nD. Diabetes mellitus", "response": "Ans. Multiple sclerosis\n\nSo the answer to this question is A"}
{"instruction": "If a fibrinolytic drug is used for the treatment of acute myocardial infarction, the adverse effect most likely to occur is :\nA. Acute renal failure\nB. Development of antiplatelet antibodies\nC. Encephalitis secondary to liver dysfunction\nD. Hemorrhagic stroke", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Gold standard treatment in a patient intractable aspiration with incompetent larynx due to complete laryngeal paralysis is:\nA. Type I Thyroplasty\nB. Tracheostomy\nC. Feeding jejunostomy\nD. Tracheal division & Permanent Tracheostoma", "response": "TREATMENT OF COMPLETE LARYNGEAL PALSY: Tracheostomy Gastrostomy Epiglottopexy Vocal cord plication Total laryngectomy Diversion procedures-Laryngotracheal separation, Laryngeal closure& permanent tracheostome Bilateral medialization i.e. Type I thyroplasty for aspiration requires adduction of the entirevocal cord. The technique works in carefully selectedcases of mild aspiration as it does not prevent all aspiration and risks patients requiring a tracheostomy,\n\nSo the answer to this question is D"}
{"instruction": "Which of the following would be expected to contain relatively high numbers of functional hematopoietic cells?\nA. Adult liver\nB. Umbilical cord blood\nC. Adult circulating blood\nD. Adult spleen", "response": "Ans. B. Umbilical cord blooda. Umbilical cord blood, derived from the circulating blood of newborn infants, possesses high levels of hematopoietic progenitors.b. Levels of circulating progenitors rapidly decrease after birth, depleting the progenitor content within the circulating blood of adults.c. The spleen of adult human's functions as a hematopoietic organ in certain disease states, such as leukemia.d. However, in other animals and in developing human fetuses, the spleen plays an important role in the hematopoietic response.e. While the liver and the thymus are important in hematopoiesis and immune reconstitution prior to birth, these organs are not involved in hematopoiesis in adult humans.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following conditions is not considered\nas premalignant\nA. Erosive lichen planus\nB. Syphilitic glossitis\nC. Leukoedema\nD. Leukoplakia", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Height to weight is a/an -\nA. Association\nB. Correlation\nC. Propoion\nD. Index", "response": "Ans. is 'a' i.e., Association First read about these two related terms :? o Association ---> Association may be defined as the concurrence of two variables more often than would be expected by chance. That mean 2 variables exist simultaneously. o Correlation --> Correlation indicates the degree (strength) of association between two variables, i.e. relationship between two quantitative variables. o Height to weight is an association and the strength of this association is indicated by correlation.\n\nSo the answer to this question is A"}
{"instruction": "Inverse agonist of GABA receptor is\nA. Benzodiazepines\nB. Flumazenil\nC. β- Carboline\nD. None of the above", "response": "β - Carboline is the inverse agonist.\nBenzodiazepines are full agonists that open chloride channels by acting on GABA receptors.\nFlumazenil is antagonist for Benzodiazepines given to treat toxicity.\n\nSo the answer to this question is C"}
{"instruction": "All of the following statements regarding amyloidosis are true except -\nA. Multiple myeloma - shows AL type deposits\nB. Secondary amyloidosis - shows AA type deposits\nC. Renal amyloidosis - shows AA type deposits\nD. Renal amyloidosis commonly presents with mild proteinuria", "response": "Ans. is 'c' i.e., Renal Amyloidosis commonly presents with Hypeension Most common presentation is proteinuria. o Hypeension may occur but it is not common, it occurs in 20-50% of the patients. \"Although earlier it was thought that hypeension was an infrequent complication, more recently up to 50% of patients have been detected hypeensives\".\n\nSo the answer to this question is C"}
{"instruction": "Delayed tuberculin test response is due to-\nA. B lymphocytes\nB. T lymphocytes\nC. Monocytes\nD. Histiocytes", "response": "Tuberculin test is type IV hypersensitivity reaction. Delayed or cell mediated hypersensitivity is a cell mediated response. The antigen activates specifically sensitised CD4 & CD8 T lymphocytes leading to the secretion of lymphokines and phagocyte accumulation. Reference : Anathanarayan & paniker's 9th edition, pg no: 162 <\\p>\n\nSo the answer to this question is B"}
{"instruction": "A 31-year-old woman has had vulvar pruritus along with a thick, whitish, odorless, globular vaginal discharge for the past week. On pelvic examination, the cervix appears erythematous, but there are no erosions or masses. A Pap smear shows budding cells and pseudo hyphae. No dysplastic cells are present. Which of the following infectious agents is most likely to produce these findings?\nA. Candida albicans\nB. Chlamydia trachomatis\nC. Neisseria gonorrhoeae\nD. Trichomonas vaginalis", "response": "The presence of the budding cells with pseudo hyphae indicates a fungal infection with Candida. Candidal (monilial) vaginitis is common; this organism is present in about 5% to 10% of women. Recurrent episodes of vaginal candidiasis may be associated with non-albicans species. The inflammation tends to be superficial, and there is typically no invasion of underlying tissues. Urea plasma is a bacterial agent, as is Chlamydia, and both can produce cervicitis. Neisseria gonorrhoeae, a gram-negative diplococcus, is the causative agent of gonorrhea. Infection with Trichomonas vaginalis can produce a purulent vaginal discharge, but the organisms are protozoa and do not produce hyphae.\n\nSo the answer to this question is A"}
{"instruction": "Most suitable method of treating 4 inch size episiotomy hematoma is by :\nA. Evacuation\nB. Magsulf compression\nC. Cold compress\nD. Marsupialisation", "response": "Evacuation\n\nSo the answer to this question is A"}
{"instruction": "The component responsible for allergy in dental casting alloys is\nA. Cobalt\nB. Nickel\nC. Copper\nD. Titanium", "response": "Nickel is the most allergenic metal known, with an incidence of allergic reactions between 10% and 20%. Reactions to nickel are more common among women, presumably because of the chronic exposure to nickel through jewellery.\nRef: Phillip’s 12th edition page 127.\n\nSo the answer to this question is B"}
{"instruction": "Most common site of tear in Boerhaave syndrome?\nA. Lower end of Esophagus\nB. At Gastroesophageal junction\nC. Upper esophagus\nD. Mid Esophagus", "response": "Boerhaave syndrome Sudden rise in intraluminal esophageal pressure produced during vomiting, as a result of neuromuscular incoordination causing failure of the cricopharyngeus muscle to relax. Associated with overindulgence in food and/or alcohol. At the left posterolateral wall of the lower third of the esophagus, 2-3 cm proximal to the gastro-esophageal junction, along the longitudinal wall of the esophagus. 2nd most common site of rupture is in the subdiaphragmatic or upper thoracic area Vomiting, retching, or vigorous coughing can cause transmural tear at the gastroesophageal junction known as Mallory Weiss tear. Instrument perforation(iatrogenic)typically occurs in the hypopharynx or at the gastroesophageal junction.\n\nSo the answer to this question is A"}
{"instruction": "In poal venous system, valves are present at\nA. The junction of superior mesentric aery with the splenic aery\nB. Within the poal vein only\nC. In the intrahepatic poion of poal vein\nD. The whole system is valveless", "response": "D i.e. The whole system is valvelessLike vena Cava, the poal vein and its tributaries are without valvesQ. The normal pressure in poal vein is 3-5 mmHg and the increase in venous pressure is distributed throughout the splanchenic circulation.\n\nSo the answer to this question is D"}
{"instruction": "Paul Bunnell test is seen in -\nA. Infections mononucleosis\nB. Syphilis\nC. Typhoid\nD. RA", "response": "Ans. is 'a' i.e., Infections mononucleosis Serological TestsTypeUse to diagnosePaul Bunnell testTube agglutinationInfectious mononucleosisWasserman reactionComplement fixation testsyphilisRose waaler testPassive hemagglutinationRheumatoid arthritisWidal testTube agglutinationTVpboidVDRLSlide precipitationSyphilisKahn s flocculation testTube precipitationSyphilisWeil Felix testHeterophile tube agglutinationationRickettsiaeLancejield testRing precipitationGroup of streptococciAscoli's testRing precipitationAnthrax\n\nSo the answer to this question is A"}
{"instruction": "An 8-year-old boy presented with a skin tumor on his left cheek. He had always avoided exposure to sunlight because it made his skin blister. His skin had scattered areas of hyperpigmentation. He mostly have:\nA. Thymidine dimers\nB. Trinucleotide repeats\nC. Sugar changes\nD. Defective DNA repair", "response": "Xeroderma pigmentosum (XP) is a rare autosomal recessive condition in which the mechanisms for repair of DNA subsequent to damage by UV irradiation are defective. This arises because of mutations in the genes encoding components of the nucleotide excision pathway of DNA repair. Ref: Murray R.K., Grossc P.L. (2011). Chapter 57. Biochemical Case Histories. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.\n\nSo the answer to this question is D"}
{"instruction": "Most common type of mesentric cyst is\nA. Entergenous cyst\nB. Chelolymphalic cyst\nC. O mental cyst\nD. Urogenital cyst", "response": "Chelolymphalic cyst :\n\nIt is commonest type of mesentric cyst.\nIt has congenital misplaced lymphatic tissue.\n\nSo the answer to this question is B"}
{"instruction": "Local anaesthetics act on\nA. Inactivated voltage gated sodium channels\nB. Inactivated ligand gated potassium channels\nC. Resting ligand gated potassium channels\nD. Resting voltage gated sodium channels", "response": "Local anaesthetics act on open state > inactivated state > resting state, votage gated sodium channels.\n\nSo the answer to this question is A"}
{"instruction": "Which among the following is false about case fatality rate?\nA. It is a ratio\nB. Not useful for acute infectious disease\nC. Not useful in chronic disease\nD. Related to virulence", "response": ". case fatality rate represents the killing power of a disease.it is simply the ratio of deaths to cases.the time interval is not specified.it is usually used in the case of acute infections such as food poisoning,cholera,measles etc.its usefulness to chronic diseases is limited.because the period from onset to death is long and variable.the case fatality rate for the same disease may very in epidemics.it is closely related to VIRULENCE. REF:park&;s textbook ,ed22,pg no 55\n\nSo the answer to this question is B"}
{"instruction": "True about allosteric inhibition is-\nA. Substrates of an enzyme mediate allosteric inhibition\nB. Citrate and ATP inhibiting PFK-1 is a classical example\nC. The allosteric inhibitor directly binds to the active site of the enzyme\nD. It is only homotropic allosteric regulation", "response": "Ans. is 'b' i.e., Citrate and ATP inhibiting PFK-1 is a classical example* Allsoteric inhibition is mediated, when a regulator binds to a site, other than the catalytic site. This site is called as allosteric site, (alio means other than). Hence the allosteric regulator never binds to the active site of an enzyme.* This binding of regulator to allosteric site brings about a change in the conformation of the enzyme.* Asa result of change in conformation of the enzyme, affinity of the enzyme for the substrate in the active site is reduced.* It is a form of heterotropic allosteric regulation. Hence allosteric inhibition is not a form of homotropic allosteric regulation.* In homotropic allosteric regulation, the substrate acts as an allosteric regulator as well. Substrates always bring about allosteric stimulation, not inhibition.* Allsoteric inhibition is most commonly an exemplification of feed back inhibition or product inhibition.* Examples for allosteric inhibition are-# Citrate and ATP inhibiting Phosphofructokinase-1 (PFK-1)* PFK-1 is the rate limiting enzyme of glycolysis* ATP and citrate are products of glycolysis* Hence the products Citrate and ATP in a feed back mechanism mediate allosteric inhibition of PFK-1\n\nSo the answer to this question is B"}
{"instruction": "Acitomycin D interferes with enzyme induction by combining with -\nA. TRNA\nB. DNA\nC. R-RNA\nD. Repressor protein", "response": "B i.e. DNA\n\nSo the answer to this question is B"}
{"instruction": "Mechanism of action of maraviroc:\nA. Cyt P 450 inhibitor\nB. GP 41 inhibitor\nC. CCR5 inhibitor\nD. GP 120 inhibitor", "response": "Ans. (c) CCR5 inhibitorRef: Mosby drug reference for health professionals 2015 ed / 996* Maraviroc is an anti HIV drug which comes under fusion inhibitor category.* This drug binds to the receptor and inhibits the fusion stage of virus and hence inhibits their speed of replication.* There are two types of fusion inhibitors:Drugs which bind to CCR5 receptorDrugs which bind to GP 41 receptorMaraviroc: active against CCR5 tropic virus.Enfuvirtide: prevents entry of virus into host cell.Can be given orally.Can only be given in s.c. injection form.\n\nSo the answer to this question is C"}
{"instruction": "A 35 year old athlete has height 184 cm , arm span 194 cm, pulse rate 64/min , BP 148/64 mm Hg . Chest auscultation reveals long Diastolic murmur over right 2nd intercostal space on routine examination. The probable diagnosis is\nA. Aoic regurgitation\nB. Atrial septal defect\nC. Ebstein anomaly\nD. Coarctation of aoa", "response": "Ref Harrison 19 th ed pg 1536 Arm span greater than height is suggestive of MarfansM syndrome. Aoic regurgitation is a feature associated with Marfan's as well as consistent with a diastolic murmur is second right intercostal space.\n\nSo the answer to this question is A"}
{"instruction": "Rests of Malassez have potential to form:\nA. Epithelial tubes.\nB. Epithelial Diaphragm.\nC. Epithelial lining of Dental Cyst.\nD. All of the Above.", "response": "Surrounding connective tissue by a basal lamina, known as the epithelial cell rests of Malassez.\nIn adults these epithelial cell rests persist next to the root surface within the periodontal ligament. Although apparently functionless, they are the source of the epithelial lining of dental cysts that develop in reaction to inflammation of the periodontal ligament.\n\nSo the answer to this question is C"}
{"instruction": "A 42-year-old man complains of head¬ache when he wakes up in the morning. It lasts into the afternoon and then subsides. Headache has been present for a few months. CT scan shows a frontal lobe mass with focal areas of calcification. You strongly suspect the pa¬tient has\nA. An astrocytoma\nB. A pinealoma\nC. A meningioma\nD. An oligodendroglioma", "response": "A frontal headache when waking up in the morning and a computerized tomography (CT) scan showing a frontal lobe mass with focal areas of calcification are characteristic findings in oligodendrogliomas, which commonly involve the frontal lobe. These are tumors derived from oligodendrocytes that frequently locate in the cerebral hemispheres of adults 30 to 50 years of age. Calcifications are visible on routine skull films or CT in 90% of cases. They commonly have an admixture with other types of glial tumors, such as an astrocytoma (50%). Overall, oligodendrogliomas have a good prognosis but a high recurrence rate.\n\nSo the answer to this question is D"}
{"instruction": "Most common site of ectopic pregnancy in fallopian tube: March 2005\nA. Infundibulum\nB. Ampulla\nC. Isthmus\nD. Interstitium", "response": "Ans. B: Ampulla The vast majority of ectopic pregnancies implant in the Fallopian tube. Pregnancies can grow in the infundibulum (18% of all ectopics), the ampullary section (55%), the isthmus (25%), and the interstitial pa of the tube (20%). Moality of a tubal pregnancy at the isthmus or within the uterus (interstitial pregnancy) is higher as there is increased vascularity that may result more likely in sudden major internal hemorrhage.\n\nSo the answer to this question is B"}
{"instruction": "True statement regarding this fetal parameter is?\nA. Best parameter for dating pregnancy\nB. Can be measured till 10 weeks only\nC. Accuracy for gestational age estimation is (+-) 7 to 10 days\nD. Fetus is measured from head to toe", "response": "Ans. A. Best parameter for dating pregnancyCRL - Crown Rump lengtha. 1st trimester CRL is the best parameter for dating pregnancy. If carefully performed it has a variance of 3 - 5 days.b. Ideal time to perform CRL is between 7 to 10 weeks but can be done up till 14 weeks (till the embryo is 85mm long)c. The fetus is measured in the mid-sagittal plane from crown to the rump.\n\nSo the answer to this question is A"}
{"instruction": "All are true about rheumatic fever, EXCEPT :\nA. Common in poor socioeconomic group\nB. Develops after streptococci pharyngitis\nC. Communicable disease\nD. Seen in 5- 15 year of children", "response": "Ans. is 'c' Communicable disease Rheumatic feverThe incidence of rheumatic fever has declined in developed countries while in developing countries it remains a significant problem.Etiology - Rheumatic fever is associated with infection of the Pharynx and Tonsils by Group A beta hemolytic streptococcus*.Peak age of Incidence is 5-15 years. *It is not a communicable disease.Rheumatic fever occurs as a result of immunological hypersensitivity* (type II or type III) to streptococcal antigens.\n\nSo the answer to this question is C"}
{"instruction": "A 5 yr. old male child has multiple hyperpigmented macules over the trunk. On rubbing the lesion with rounded end of pen, he developed urticarial wheal, confined to border of lesion, most likely diagnosis is:\nA. Fixed drug eruption\nB. Lichen planus\nC. Urticaria pigmentosa\nD. Urticarial vasculitis", "response": "Ans. C. Urticaria pigmentosa* It is urticaria pigmentosa.* It is cutaneous mastocytosis presenting with pigmented lesions.* On rubbing the lesions mast cells degranulate releasing histamine.* This produces the wheal and flare of the lesion. It is known as Darier's sign.Epidermal acantholysis in mid epidermis with \"dilapidated or crumbling brick wall\" appearance. Darier's disease is associated with ATP2A2 defect\n\nSo the answer to this question is C"}
{"instruction": "What is the amount of fluid to be given to a 2 year child weighing 12 Kg with severe dehydration in the first half an hour of IV rehydration?\nA. 120 ml\nB. 240 ml\nC. 360 ml\nD. 840 ml", "response": "AGE First give 30 ml/ Kg in Then give 70 ml/ Kg in Infants (< 12 months) 1 hour 5 hours Older children 30 minutes 2.5 hours In the above question, amount of fluid needed = 30 ml/ Kg x12=360 ml Ref: Park 21st edition, page 204.\n\nSo the answer to this question is C"}
{"instruction": "Nigro protocol is for management of -\nA. Rectal carcinoma\nB. Anal canal carcinoma\nC. Gastrinoma\nD. Renal cell carcinoma", "response": "Ans. is 'b' i.e., Anal canal carcinoma * Nigro protocol includes combined radiation and chemotherapy with 5FU and mitomycin C. It is commonly used in management of anal canal carcinoma.\n\nSo the answer to this question is B"}
{"instruction": "Commonest salivary gland to get stones :\nA. Parotid\nB. Submandibular\nC. Minor salivary gland\nD. Sublingual", "response": "Ans. is 'b' ie. Submandibular Gland [Ref. Bailey & love, 25/e p755 (24/e p. 723, 23/e. p 655)) \"Eighty percent of all salivary stones occur in the submandibular gland, 10% occur in parotid, 7% in the sublingual and the remainder occurs in minor salivary glands Bailey & love 23/e\n\nSo the answer to this question is B"}
{"instruction": "Eating disorder with normal weight is?\nA. Anorexia nervosa\nB. Bulimia nervosa\nC. Binge eating disorder\nD. None of the above", "response": "Ans. B. Bulimia nervosaAnorexia nervosa - Under weightBulimia nervosa - Normal WeightBinge eating disorder - Over weight.\n\nSo the answer to this question is B"}
{"instruction": "A 27 year old obese woman is presenting with oligomenorrhoea, infeility and hirsuitism. What is the most likely diagnosis?\nA. Polycystic ovaries\nB. Endometriosis\nC. Pelvic inflammatory disease\nD. Turner's syndrome", "response": "PCOS is a syndrome manifested by amenorrhea, hirsuitism and obesity associated with enlarged polycystic ovaries. Patients presents with obesity, hirsuitism, oligomenorrhea or amenorrhea and infeility. Investigations reveals LH:FSH >3:1, reduced level of SHBG and sex hormone binding globulin, elevated levels of androstenedione and serum insulin level, marginally elevated levels of serum testosterone and DHEAS. Transvaginal ultrasonography shows enlarged ovary with peripherally arranged cysts. Ref: Textbook of Gynecology By DC Dutta, 4th Edition, Pages 285, 405, 421-3\n\nSo the answer to this question is A"}
{"instruction": "Which of the following drugs is known to cause granuloma in the liver -\nA. Allopurinol\nB. Nifedipine\nC. Tetracycline\nD. Methyl testosterone", "response": "Ans. is `a' i.e., Allopurinol Drugs causing granuloma in liver - o Phenylbutazone o Allopurinol o Diltiazem o Sulfonamides o Quinidine o Carbamazepine.\n\nSo the answer to this question is A"}
{"instruction": "Most pathognomonic sign of irreversible cell injury:\nA. Amorphous densities in mitochondria\nB. Swelling of the cell membrane\nC. Ribosomes detached from endoplasmic reticulum\nD. Clumping of nuclear chromatin", "response": ". Amorphous densities in mitochondria\n\nSo the answer to this question is A"}
{"instruction": "Which of the following autoantibody is least likely associated with SLE\nA. Anti ds- DNA\nB. Anti Sm\nC. Anti topoisomerase\nD. Anti histone", "response": "Ref Robbins 9/e p219 Anti topoisomerase is least commonly associated with SLE amongst the given options .The following is a modified table for a reference from Robbins Autoantibody (Specificity) Major Disease Association(s) Likely Role(s) in Disease Anti-dsDNA (double-stranded DNA) SLE* Formation of immune complexes Anti-Sm (ribonuclear core protein, Sm antigen) SLE* Formation of immune complexes Anti-RNP U1 (ribonuclear protein) SLE, mixed connective tissue disease Formation of immune complexes Anti-SS-A (Ro), anti-SS-B (La) (ribonucleoproteins) Sjogren syndrome, SLE Role in Sjogren syndrome not known Anti-Scl-70 (DNA topoisomerase I) Systemic sclerosis* Unknown Anti-histones (histone proteins) SLE Formation of immune complexes Anti-centromere (centromere proteins) Limited scleroderma, systemic sclerosis* Unknown Antiphospholipid (phospholipid-protein complexes involved in blood coagulation) Antiphospholipid syndrome, SLE Thrombotic episodes Anti-Jo1 (histidyl tRNA ligase) Inflammatory myopathies* Unknown Anti-mitochondrial Primary biliary cirrhosis* Unknown Anti-eTg (transglutaminase) Dermatitis herpetiformis Unknown Anti-neutrophil cytoplasmic antibody (ANCA) (proteins in neutrophil cytoplasm) Various vasculitides* Formation of immune complexes? Neutrophil degranulation? Anti-smooth muscle Chronic autoimmune hepatitis Unknown\n\nSo the answer to this question is C"}
{"instruction": "Kleptomania means -\nA. Irresistable desire to set fire\nB. Irresistable desire to steal things\nC. Compulsive hair pulling\nD. Pathological gambling", "response": "Ans. is 'b' i.e., Irresistabie desire to steal thing impulse control disordero These disorders are characterized by failure to resist an impulsive behavior that may be harmful to self or others.There may be a feeling of release of tension by doing the act and a feeling of guilt after the act is over. Important impulse control disorder are : -i) Pyromania (Pathological fire setting)Kleptomania (Pathological stealing)Trichotillomania (Compulsive hair pulling)Pathological gamblingIntermittent explosive disorderImpulse control disorder not otherwise specifiedOniomania (Compulsion to shop/buying)Internet compulsion (Internet addiction)Cellular or Mobile phone compulsionCompulsive sexual behavior (sexual addiction).\n\nSo the answer to this question is B"}
{"instruction": "Grievous hurt include the following except\nA. Emasculation\nB. Permanent privation of hearing\nC. Privation of any member/joint\nD. Disability to follow one's ordinary1 pursuits for a period of a week", "response": "Ans. is 'd' i.e., Disability to follow' one's ordinary pursuits for a period of a w eek o Grievous injuries areEmasculation (cutting of the penis, castration; or causing loss of power of erection due to spinal injury ).Permanent privation of the sight of either eye.Permanent privation of the hearing of either ear.Privation of any member (part, organ, limb) or joint.Destruction or permanent impairing of powers of any member or joint.Permanent disfiguration of head or face.Fracture or dislocation of a bone or a tooth.Any hurt which endangerous life or which causes the sufferer to be, during the space of twenty days in severe bodily pain, or unable to follow his daily routine.\n\nSo the answer to this question is D"}
{"instruction": "A 35-year-old HIV positive patient comes with intractable diarrhea, crampy, abdominal pain and vomiting. Biopsy of small intestine was taken which shows cyst <10 um as given below. What is the appropriate diagnosis?\nA. CMV\nB. Isospora belli\nC. Cryptosporidium parvum\nD. Giardia lamblia", "response": "- Kinyoun stain positive and clinical features like diarrhea in a immunocompromised individual highly suggestive of organism - Cryptosporidium parvum. - Its oocyst is of size 2-6 micron and it is pink coloured. - Cryptosporidium, microsporidia, and Isospora belli are the most common oppounistic protozoa that infect the GI tract and cause diarrhoea in HIV-infected patients. - Diarrhoea is accompanied by crampy abdominal pain, nausea and/or vomiting. - Diagnosis- stool Cryptosporidium examination or biopsy of the small intestine. - Diarrhoea is noninflammatory, and the characteristic finding is the presence of oocysts that stain with acid-fast dyes. - Treatment: - 2000 mg/d of nitazoxanide (NTZ)\n\nSo the answer to this question is C"}
{"instruction": "Which is the enzyme responsible for adipocere formation?\nA. Collagenase\nB. Catalase\nC. Lecithinase\nD. Coagulase", "response": "Lecithinase enzyme produced by clostridium welchi is the main enzyme responsible for adipocere formation.\n\nSo the answer to this question is C"}
{"instruction": "A Normal anion gap metabolic acidosis occurs in patients with?\nA. Diabetic ketoacidosis\nB. Methyl alcohol poisoning\nC. Diarrhea\nD. Acute kidney injury", "response": "Diarrhea and Renal tubular acidosis (A) are two impoant causes of normal anion gap metabolic acidosis.\n\nSo the answer to this question is C"}
{"instruction": "'Bear-Claw' appearance on CECT abdomen is seen in:\nA. Hepatic laceration\nB. Pancreatic laceration\nC. HCC\nD. RCC", "response": "HEPATIC INJURY MC organ injured in blunt abdominal trauma: Spleen> liver. Most liver injury bleeding is venous, and therefore low pressure, tamponade is readily performed. Diagnosis Unstable patient explored for the finding of free fluid on FAST examination. Stable patient - CECT abdomen. Bear claw laceration: Multiple Linear laceration of liver on CECT .\n\nSo the answer to this question is A"}
{"instruction": "Antihypeensive which can be used in gout, with diabetes mellitus is -\nA. Thiazide\nB. Enalapril\nC. Propranolol\nD. Diazoxide", "response": "Ans. is 'b' i.e., Enalapril o ACE inhibitors (enalapril) are the most appropriate antihypeensive in patients having DM and gout.\n\nSo the answer to this question is B"}
{"instruction": "Resistance to isoniazid, the likely mechanism for resistance is\nA. b-Lactamase\nB. Mutations in the katG gene\nC. Alterations in the rpoB gene\nD. Mutations in the DNA gyrase gene", "response": "Strains of M. tuberculosis resistant to individual drugs arise by spontaneous point mutations in the mycobacterial genome that occur at low but predictable rates (10-7-10-10for the key drugs). Resistance to rifampin is associated with mutations in the rpoB gene in 95% of cases; That to isoniazid with mutations mainly in the katG (50-95% of cases) and inhA (up to 45%) genes; That to pyrazinamide in the pncAgene (up to 98%); That to ethambutol in the embB gene (50-65%). Because there is no cross-resistance among the commonly used drugs, the probability that a strain will be resistant to two drugs is the product of the probabilities of resistance to each drug and thus is low.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is the presenting symptom of fallopian tube carcinoma :\nA. Watery discharge per vaginum\nB. Haemorrhage\nC. Pain\nD. Sepsis", "response": "Fallopian tube carcinoma: The tumour occurs in menopausal women, 50% of them are nulliparous. The early symptom is a watery discharge per vaginum, which may at times be amber-coloured. Sooner or later, postmenopausal bleeding develops. A lump may be too small to be felt on clinical examination. Pain is a late symptom Reference : Shaw's Textbook of Gynaecology 16th edition page no 519\n\nSo the answer to this question is A"}
{"instruction": "MC gene involved in endometrial carcinoma\nA. PTEN\nB. BRAF\nC. KRAS\nD. Mismatch repair genes", "response": "PTEN - Phosphatase & tensin homologue Cowden syndrome - AD disorder with tumours of skin appendages & increased incidence of Breast, Endometrium, Prostate & thyroid cancer Acts as TSG by serving as a break in the pro-growth PI3K/AKT pathway (MCly mutated p/w in human ca) By phosphorylating a number of substrates like BAD and MDM2, AKT enhances cell survival.\n\nSo the answer to this question is A"}
{"instruction": "Amyloidosis mostly affects\nA. Liver\nB. Tounge\nC. Colon\nD. Hea", "response": "Hea. Amyloidosis of the hea may occur either as iso- lated organ involvement or as pa of a systemic distribution. When accompanied by systemic involvement, it is usually of the AL form. The isolated form (senile amyloidosis) usually is confined to older persons. The deposits may not be evident on gross examination, or they may cause minimal to moder- ate cardiac enlargement. The most characteristic gross find- ings are gray-pink, dewdrop-like subendocardial elevations, paicularly evident in the atrial chambers. On histologic examination, deposits typically are found throughout the myocardium, beginning between myocardial fibers and eventually causing their pressure atrophy Ref Robbins 9/e pg 157\n\nSo the answer to this question is D"}
{"instruction": "Which MRI sequence is best suited for this lesion?\nA. T2W\nB. Chemical shift imaging MRI\nC. DWI\nD. D STIR", "response": "Ans. B. Chemical shift Imaging MRI* This is a post contrast axial CT scan of the upper abdomen which shows a mildly enhancing lesion in right adrenal.* This lesion could be an adenoma; however, the other differentials include serious entities like metastases or carcinomas.* Differentiating between them is vital and more emphasis is on imaging as adrenals are small retroperitoneal organs which are surrounded by vascular structure thus obtaining an image guided biopsy becomes difficult.* There are various techniques used to differentiate between them, one of which is in and out phase imaging which is based on the premise that adrenal adenomas are rich in their lipid contents whereas other lesions like carcinoma and metastases are lipid poor.* The characterization of a lesion as an adenoma relies on the ratio of a decreased relative signal intensity from in phase to opposed phase images and the ratio of adrenal mass and various organs on T2-weighted and chemical shift images. Sometimes at the interface of water and fat the adenoma can give rise to dark bands - India ink artefacts.* Other commonly used indices include the relative and absolute washout values of CT scan which used HU values of CT of same area in unenhanced, enhanced and delayed scans.\n\nSo the answer to this question is B"}
{"instruction": "In pelvis fracture, the amount of blood loss is around?\nA. 1-4 units\nB. 2-4 units\nC. 2-6 units\nD. 4-8 units", "response": "In pelvic fracture intrapelvic haemorrhage is by far, the most serious complication. Haemorrhage frequently results from fracture surfaces and small vessels in the retroperitoneum. Amount of blood loss is around 4-8 units. It must be emphasised, however, that these cases may need transfusion of very large quantities of blood. It is not uncommon for the amount of blood transfused to be in excess of the patient's total blood volume. In case of hemodynamic instability, an external fixator should be applied immediately to decrease motion at fracture sites as well as to decrease pelvic volume and generate tamponade of the pelvic venous plexus. Ref: Rockwood & Green's fracture in Adults 6/e, Page 1600-04; Watson Jones: Fracture & Joint Injuries 6/e, Page 866; Campbell's Operative Ohopedics 10/e, Page 2962-63.\n\nSo the answer to this question is D"}
{"instruction": "The pharyngeal diverticulum is a protustion of mucosa between-\nA. The two parts of inferior constrictor musice of the pharynx\nB. The two parts of middle constrictor musice of the pharynx\nC. The two parts of the superior constrictor muscle of the pharynx\nD. Cricopharyngeal and posterior part o suprahyoid membrane", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Action of cholecystokinin include all of the following except:\nA. Contraction of gall bladder\nB. Secretion of pancreatic juice rich in enzymes\nC. Increases the secretion of enterokinase\nD. Stimulated gastric emptying", "response": "Ans. D. Stimulated gastric emptying(1) Distribution: -a. CCK8 and CCK12 - secreted by duodenum and duodenum.b. CCK-4 - by enteric nerves and pancreatic nervesc. CCK58 and CCK8 - found in brain ~ especially in cerebral cortex, where involved in the regulation of food intake, anxiety and analgesia.(2) Function of CCK: -a. Contraction of gall bladderb. Secretion of the pancreatic juice rich in enzymec. Augments the action of secretin producing secretion an alkaline pancreatic juice.d. Inhibits gastric emptyinge. Exerts a trophic effect on the pancreas,f. Increases the secretion of enterokinaseg. Enhance the motility of the small intestine.h. Augments the contraction of pyloric sphincteri. CCK and gastrin - stimulate glucagon secretion.3) Secretion of CCK is increased by: -a. Contact of the intestinal mucosa with the products of digestion particularly peptides, and amino acidsb. By the presence of fatty acids containing more than 10 carbon atoms in duodenum.\n\nSo the answer to this question is D"}
{"instruction": "Treatment of congenital ptosis with poor elevation is\nA. Levator resection\nB. Frontalis sling\nC. FS operation\nD. None of the", "response": "Ans. is 'b' i.e., Frontalis sling Surgeries for ptosis Depending upon the LPS action, three main types of techniques are available. If levator action is good :- LPS is shoened, i.e, resection of LPS. The operations are Blaskovics operation, Everbusch operation and Fasanella - servat operation. Fasanella - servat operation is indicated in Homer syndrome. If LPS is paralysed Superior rectus muscle is used to lift the lid. The operation is called Motais operation. If both LPS and superior rectus are paralysed Frontalis sling/suspension operation (Hess's operation) is done. It is indicated in Marcus Gunn jaw winking syndrome, blepharophimosis syndrome, total 3rd nerve palsy, Aberrant regeneration of Yd nerve.\n\nSo the answer to this question is B"}
{"instruction": "All of the following may be causes of precocious puberty in girls except –\nA. Hypothalamic harnartoma\nB. Mc Cuone Albright syndrome\nC. Granulosa cell tumor of human ovary\nD. Congential 21–α hydroxylase deficiency", "response": "Congenital 21 hydroxylase deficiency causes precocious puberty in male due to excess of androgens.\nIn female, it results in virilization.\n\nSo the answer to this question is D"}
{"instruction": "Laser Endometrial ablation is done in abnormal uterine bleeding in all cases except\nA. Women not preferring surgery\nB. Small uterine fibroids\nC. Women preferring reproductive function\nD. Failed medical treatment", "response": "Females who desire future pregnancy should not be offered endometrial ablation for AUB.\n\nSo the answer to this question is C"}
{"instruction": "The \"gp 120\" in HIV helps in:\nA. Virus attachment\nB. Virus replication\nC. Virus penetration\nD. Virus dissemination", "response": "Virus attachment\n\nSo the answer to this question is A"}
{"instruction": "Most definitive diagnosis of sinusitis is by\nA. X- ray PNS\nB. Proof puncture\nC. Sinuscopy\nD. Transillumination test", "response": "Sinuscopy is a method of Endoscopic sinus observation or surgery using Nose telescope. It involves the evaluation of nasal and sinus passages using the endoscope called Sinuscope. The Sinuscope has a narrow tube with a built-in camera so that the physician can see the internal details of the sinuses. By observing the sinus, it is possible to diagnose the problems and treat properly.\n\nSo the answer to this question is C"}
{"instruction": "A 40 year old patient it comes with right upper quadrant pain from last 48 hours. Ultrasound reveals calculous cholecystitis. What is the preferred treatment\nA. cholecystectomy\nB. Antibiotics alone\nC. Antibiotics and interval cholecystectomy\nD. Analgesics", "response": "If symptomatic cholecystitis patients comes within 72 hours emergency cholecystectomy is preferred.\nIf patient comes late then interval cholecystectomy is done after 6 weeks.\n\nSo the answer to this question is A"}
{"instruction": "All are true about Menetrier's disease except:\nA. Protein loss\nB. Hyperchlorhydria\nC. Cobblestone appearance of mucosa\nD. Associated with CMV and H. pylori", "response": "Ans. (b) HyperchlorhydriaRef: Sabiston 19th Edition, Page 1222Infections causing Menetrier's Disease:* CMV in children* H. pylori in adults\n\nSo the answer to this question is B"}
{"instruction": "Fasciculations are seen in:\nA. Motor neuron disease\nB. Duchenne's muscular dystrophy\nC. Polymyositis\nD. None of the above", "response": "Answer is A (Motor neuron disease): Fasciculation is a visible or palpable twitch within a single muscle due to spontaneous discharge of one motor unit. Disease of motor neurons are associated with fasciculations' - Harrison's\n\nSo the answer to this question is A"}
{"instruction": "Renshaw inhibition\nA. Feedback facilitation\nB. Feed forward inhibition\nC. Feed forward facilitation\nD. Feedback inhibition", "response": "The feedback inhibition, also known as Renshaw cell inhibition, is known to occur in spinal alpha motor neurons through an inhibitory inter-neuron. In feedback inhibition, a neuron inhibits that very neuron (s) that excite it. In this way, firing of an action potential by a motor neuron of the spinal cord is followed by a phase of hyperpolarization (inhibition) of not only the same motor neuron but also many others in the neighborhood. The feedback inhibition is thus basically a post-synaptic inhibition but is classified separately because the inhibitor Renshaw cells are activated by collateral of the ventral horn cell rather an afferent neuron. This type of feedback inhibition is also seen in other pas of CNS as well. It serves to limit the excitability of the motor neurons. Ref: guyton and hall textbook of medical physiology 12 edition page number: 677,678,679\n\nSo the answer to this question is D"}
{"instruction": "Brown macular pigmentation in the malar area in a pregnant female is due to -\nA. Acne rosacea\nB. Chloasma\nC. Acanthosis nigricans\nD. Urticaria pigmentosa", "response": "Ans. is 'b' i.e., Chloasma Chloasma (Melasma) o Melasma (Chlosma) is the most common cause for facial pigmentation in Indian patients. There is Brown macular pigmentation on the malar area of face, forehead and sometimes chin. It usually affects young and middle-aged women. When melasma results from pregnancy it is referred as chloasma. o Two major etiological factors are : - Hormonal (estrogen) - Appears in pregnancy or in person on OCPs. Sun exposure - Especially UVB. o For treatment - Combination of topical hydroquinone (2-4%), retinoic acid and topical corticosteroids. Other drugs are - Glycolic acid (4-10%), Azelaic acid, topical vitamin C.\n\nSo the answer to this question is B"}
{"instruction": "What procedure was most recently performed on this patient?\nA. Mitral-valve repair\nB. Pancreatectomy\nC. Roux-en-Y gastric bypass\nD. Thyroidectomy", "response": "Answer A. Mitral-valve repairThe peripheral-blood smear showed schistocytes, spherocytes, and polychromasia suggestive of hemolytic anemia. Following mitral-valve repair, some patterns of the regurgitant flow disturbances associated with high shear stress are responsible for the hemolysis. Transesophageal echocardiography in this patient showed a jet of mild transvalvular mitral regurgitation. The hemolysis resolved after mitral-valve replacement.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not an incision in autopsy?\nA. I - shaped incision\nB. Y - shaped incision\nC. Modified Y - shaped incision\nD. J - shaped incision", "response": "Ans. is 'd' i.e., J - shaped incision * Types of primary skin incisions of autopsy are1) I-shaped incision : Extending from the chin straight down to symphysis, passing to the side the umbilicus.2) Y-shaped incision: Begins close to acromion process and then extends down below the breast across to xiphoid process from where it is carried downwards to the symplysis pubis.3) Modified Y-shaped incision rlncision is made from suprasternal notch to symphysis pubis. The incision extendsfrom suprasternal notch over the clavicle to its center on both sides and then passes upwards over the neck behind the ear.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following drug is used for reversal of cerebral vasospasm and infarct following subarachnoid hemorrhage?\nA. Nimodipine\nB. Amlodipine\nC. Diltiazem\nD. Verapamil", "response": "Calcium Channel Blockers (CCBs) These are the drugs that block L-type of voltage gated calcium channels present in blood vessels and hea. Three groups of CCBs include phenylalkylamines (verapamil, nor-verapamil), benzothiazepines (diltiazem) dihydropyridines (nifedipine, nicardipine, nimodipine, nisoldipine, nitrendipine, isradipine, lacidipine, felodipine and amlodipine). By inhibiting the calcium channels, these agents result in vasodilation and decreased activity of the hea (decrease hea rate, AV conduction and contractility). Dihydropyridine (DHP) group has little direct cardiac activity and acts mainly on blood vessels, therefore are also called peripherally acting CCBs. Verapamil and diltiazem have strong direct cardiodepressant (verapamil > diltiazem) activity. CCBs tend to cause reflex tachycardia (because of their vasodilatory action), which is nullified by the direct depressant action on the hea (except DHPs). Nicardipine is longest acting parenteral calcium channel blocker and is drug of choice for hypeensive emergencies. It is combined with beta blockers to avoid tachycardia. Nimodipine is a relatively cerebro-selective vasodilator, thus used to reverse the compensatory vasoconstriction after sub-arachnoid hemorrhage. Verapamil has maximum depressant action on the hea and it causes vasodilation by causing blockade of calcium channel. It is indicated for the treatment of angina, PSVT, hypeension and hyperophic obstructive cardiomyopathy (HOCM). Diltiazem has lesser effect on the hea than verapamil and is also indicated for these conditions. CCBs are especially suitable for elderly patients, patients with low renin hypeension, patients with diseases like asthma, migraine or peripheral vascular disease and in cases of isolated systolic hypeension. DHPs are safe in pregnancy. CCBs (verapamil and diltiazem) should be avoided in conditions involving decreased conductivity of the hea like sick sinus syndrome, CHF and along with beta blockers (both cause myocardial depression). Clevidipine is an ultrasho acting DHP, recently approved for hypeensive emergencies.\n\nSo the answer to this question is A"}
{"instruction": "All of the following factors fascilitate non union except:\nA. Haematoma formation\nB. Periosteal injuries\nC. Absence of nerve supply\nD. Chronic infection", "response": "A i.e. Hematoma formation Fracture healing process passes through several stages. In which the, first is stage of hematoma formationQ and the last is stage of remodelingQ Fracture Healing Bone is a unique tissue because it heals by the formation of normal bone, as opposed to scar tissue. Infact it is considered a nonunion when a bone heals by fibroblastic response. The majority of fractures heal by secondary (callus) healing through a combination of intramembranous - ossification (hard callus formation) & endochondral ossificaion (soft callus formation). Bone healing can be divided into following phases depending on the biological events. * There are two sources of repair tissues (callus), medullary & periosteal. The former is most marked in cancellous hone, while the later predominates in diaphyseal fracture. Periosteal callus may be of two types - primary callus (from DOPC) & external bridging callus (from IOPC), its appearance is inhibited by rigid fixation as plate and is predominant form of healing in cast immobilization &intramedullary nailing. (i.e. micromovements present) * Late medullary callus is more dependent on intramedullary vascularity (not on external soft trissue) and is impoant in fractures immobilized by rigid plating (i.e. no micrmovements)* Phenomenon of Creeping Substitution occurs in cancellous bone (i.e. blood vessels invading the trabeculae of bone directly causing bone apposition)* The modification of previously undifferentiated soft tissue cells in to osteogenic cells (IOPC) is termed bone induction.\n\nSo the answer to this question is A"}
{"instruction": "Which one of the following conditions is associated with an exudative pleural effusion?\nA. Cirrhosis\nB. Nephrotic syndrome\nC. Congestive hea failure\nD. Bronchogenic carcinoma", "response": "Among the options given bronchogenic carcinoma is associated with exudative effusion. Exudative pleural effusions are distinguished from transudative by measuring the lactate dehydrogenase (LDH) and protein levels in the pleural fluid. Exudative pleural effusion is diagnosed by the presence of one or more of the following criteria: 1. Pleural fluid protein/serum protein >0.5 2. Pleural fluid LDH/serum LDH >0.6 3. Pleural fluid LDH more than two-thirds normal upper limit for serum Ref: Harrison's Internal Medicine, 18th Edition, Chapter 263\n\nSo the answer to this question is D"}
{"instruction": "A 30 year old male presented with insidious onset of diarrhea, steatorrhea, abdominal pain, weight loss, migratory large joint ahropathy, fever and dementia. The most probable diagnosis is:\nA. Chronic calcific pancreatitis\nB. Whipple's disease\nC. Tropical sprue\nD. Celiac sprue", "response": "Whipple's disease is a chronic multisystem disease caused by tropheryma whipplei bacteria. Dementia is a late symptom. Diagnosed by PAS positive macrophages in small intestinal biopsy. DOC is double strength trimethoprim / sulfamethoxazole. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2479\n\nSo the answer to this question is B"}
{"instruction": "All about warfarin are true EXCEPT?\nA. Half-life is 36 hours\nB. Crosses placenta\nC. Contraindicated in hepatic failure\nD. Inhibits all vitamin K dependent clotting factors", "response": "Ans. is 'c' i.e., Contraindicated in hepatic failure o Liver disease requires dose reduction, but is not a contraindication. Effect of liver disease on warfarin o In liver diseases the dose of oral anticoagulats needs to be decreased because in liver disease the hepatic synthesis of clotting factors is reduced. o Thus there is already a deficiency of clotting factors (i.e. there is preexisting anticoagulant state). o Administration of warfarin is this state increases the risk of bleeding. About other options o Warfarin is an indirectly acting anticoagulant, i.e. it inhibits vitamin K which in turn inhibits coagulation factors. o T1/2 of warfarin is 36 hrs. o Warfarin can cross placenta and cause fetal warfarin syndrome. Therefore it is contraindicated pregnancy. Patient is switched to heparin from warfarin during pregnancy.\n\nSo the answer to this question is C"}
{"instruction": "Most common cause of hyponatremia in surgical practice\nA. Small intestinal obstruction\nB. Duodenal fistula\nC. Pancreatic fistula\nD. Intussuception", "response": "Ans. a (Small intestinal obstruction) (Ref. Bailey and Love Short textbook of surgery 24th ed., p 56)The most frequent cause of sodium depletion in surgical practice is obstruction of the small intestine.SODIUM BALANCE# Sodium is the principal cation content of the extracellular fluid.# On average it is 1 mmol/kg sodium chloride or 500 mL of isotonic 0.9 % saline solution. An equivalent amount is excreted daily, mainly in the urine and some in the faeces.Sodium Depletion (syn.Hyponatremia)Etiology# Small intestinal obstruction (most frequent cause in surgical practice).# Duodenal, total biliary, pancreatic and high intestinal external fistulae.# Severe diarrhea will cause hyponatremia with acidosis.# Hyponatremia with elevated potassium would suggest adrenocortical insufficiency.# SIADH.Potassium Depletion# It occurs most frequently in diabetic coma treated by insulin and prolonged infusion of saline solution.# Diuretics.# The diarrhoea from ulcerative colitis, villous tumours of the rectum and the loss from external fistulae of the alimentary tract are also common causes (e.g., duodenal fistula, ileostomy);Clinical features# risk of cardiac arrhythmias.# Symptoms of severe hypokalemia include listlessness and slurred speech, muscular hypotonia, depressed reflexes and abdominal distension as a result of a paralytic ileus.# ECG:Prolonged QT interval, depression of ST segment and flattening or inversion of the T-wave.Rx# Oral potassium. Potassium can be given in the form of milk, meat extracts, fruit juices and honey. However, in hospital practice, effervescent tablets of potassium chloride 2 g can be given by mouth 6-hourly.# IV potassium. Rapid IV supplementation (especially when renal function is impaired) carries the risk of dysrhythmias and cardiac arrest if the serum concentration rises to a dangerous level.# When there is no associated alkalosis, potassium deficit can be restored by adding 40 mmol KCL to each litre of 5% glucose, glucose-saline or 0.9 % saline solution, given 6-8-hrly.Sodium Excess (syn. Hypernatremia)Etiology# excessive amount of 0.9% saline solution given intravenously during the early postoperative period.Clinical Features# Slight puffiness of the face is the only early sign.POTASSIUM BALANCE# Potassium is almost entirely intracellular.# No less than 98% is intracellular, and only 2% is present in the extracellular fluid.# Three-quarters of the total body potassium (approximately 3500 mmol) is found in skeletal muscles.\n\nSo the answer to this question is A"}
{"instruction": "In which of the following patient, there is 10-20 fold increased risk of leukemia during infancy?\nA. Pierre Robin syndrome\nB. Fragile X syndrome\nC. Down syndrome\nD. None", "response": "Children suffering from Down Syndrome\n\nThese children (10%) are mentally retarded moderate to severe and require appropriate treatment.\nIncidence of cardiac disease associated with Down syndrome is 40% and will require adequate prophylaxis.\nIncreased incidence of leukemia and acute and chronic infections of the upper respiratory tract can also alter treatment.\nChildren are generally affectionate and cooperative and present no special problems during management.\nNitrous oxide analgesia or TSD in mildly apprehensive patients can be used; general anesthesia in severe resistance to dental treatment.\nPreventive procedures along with chlorhexidine mouthwash may be beneficial.\nPulp treatment in deciduous teeth are contraindicated in patients with cardiac problems because of the risk of bacteremia, whereas in permanent teeth, it can be considered if an adequate apical seal can be obtained.\n\nKey Concept\n\nIncreased incidence of leukemia and acute and chronic infections of the upper respiratory tract can also alter treatment.\nThere are 10-20 times increased risk of leukemia in infants suffering from Down syndrome.\n\nPediatric Dentistry / Shobha Tandon - 2nd Ed P: 541\n\nSo the answer to this question is C"}
{"instruction": "Which is the stage of sleep in which we spend maximum time?\nA. Stage N1\nB. Stage N2\nC. Stage N3\nD. REM", "response": "Ans. B. Stage N2Sleep is scored in epochs of 30 seconds, with stages of sleep defined by visual scoring of 3 parameters: electroencephalogram (EEG), electrooculogram (EOG) & electromyogram (EMG) recorded beneath chin.1. NREM:* Stage 1: 1st stage, light sleep, loss of alpha waves (eyes closed but awake) and predominant theta waves* Stage 2: maximum time spent. Findings in EEG include- Sleep spindles: bursts of waves of frequency of 11-16Hz- K-complexes: high voltage spikes, negative sharp waves followed by positive waves* Stage 3: Deepening of sleep, appearance of delta waves.* Stage 4: Deep sleep characterized by delta waves- New NREM stages: N1 (stage 1), N2 (stage 2), N3 (stage 3+4)2. REM sleep: (aka paradoxical sleep)* EEG: beta wave (similar to awake state), alpha wave\n\nSo the answer to this question is B"}
{"instruction": "Drug of choice for prophylaxis of Mania is\nA. Diazepam\nB. Lithium\nC. Haloperidol\nD. Fluoxetin", "response": "B i.e. Lithium Condition Drug of choice Acute mania Prophylaxis of bipolar disorder Lithium (Li)Q LiQ Rapid cyclers ValproateQ or Li & L-T3 > Carbamazepine\n\nSo the answer to this question is B"}
{"instruction": "Gastrin is produced by\nA. Greater sac\nB. Lesser sac\nC. First part of the duodenum\nD. Pyloric antrum", "response": "D. i.e. (Pyloric antrum) (443-Ganong 23rd) (484 - Ganong 22nd)* GASTRIN - is produced by cells called G-cells in the lateral walls of the glands in the antral portion of the gastric mucosa. It is polypeptide** containing* G-14, G-17 or G-34 amino acids. Found in pituitary gland, hypothalamus, medulla oblongata, vagus and sciatic nerves* SECRETIN is produced by S. cells of mucus membrane in duodenum and jejunum Stimuli that Increases gastrin secretion (a) luminal peptides and amino acids, Distension (b) Neural- increased vagal discharge via GRD (c) blood borne - calcium, Epinephrine Stimuli that inhibit gastrin secretion (a) Luminal acid, somatostatin** (b) Blood borne - secretin** GIP,VIP Glucagon**, Calcitonin* GASTRINOMA are gastrin producing tumours which can occur in stomach or duodenum or pancreatic tumour of d cells (Zollinger- Ellision Syndrome). These tumours secrete large amounts of gastrin which causes excessive secretion of HC1 and predisposes to peptic ulcer.\n\nSo the answer to this question is D"}
{"instruction": "Patient is diagnosed with BPH. Which of the following drug provides symptomatic relief?\nA. Terazosin\nB. Desmopressin\nC. Finasteride\nD. Sildenafil", "response": "Ans. A. TerazosinSelective Alpha 1 blocker provide symptomatic relief but do not effect the disease .5 alpha reductase like finasteride slow the disease progression.\n\nSo the answer to this question is A"}
{"instruction": "Thanatology is the science that deals with :\nA. Death in all its aspects\nB. Solving paternity of the child\nC. Identification of the living\nD. Detection of lie", "response": "Ans. is 'a' ie death in all its aspects. Reddy writes- \"Thanatology deals with death in all its aspects\"\n\nSo the answer to this question is A"}
{"instruction": "Carcinoma of buccal mucosa commonly drain to the following lymph nodes sites -\nA. Submental\nB. Submandibular\nC. Supraclavicular\nD. Cervical", "response": "Nodal involvement occurs in 50% cases of tumors of buccal mucosa.\nMost common lymph node involved : Submandibular lymph nodes.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is seen in Addison's disease: September 2007\nA. Hypernatremia\nB. Hypokalemia\nC. Hyperglycemia\nD. Hypercalcemia", "response": "Ans. D: Hypercalcemia Routine investigations in Addison disease may show: Hypercalcemia Hypoglycemia, low blood sugar (worse in children due to loss of glucocoicoid's glucogenic effects) Hyponatraemia due to loss of production of the hormone aldosterone Hyperkalemia due to loss of production of the hormone aldosterone Eosinophilia and lymphocytosis Metabolic acidosis (increased blood acidity), also due to loss of the hormone aldosterone because sodium reabsorption in the distal tubule is linked with acid/hydrogen ion (H+) secretion. Low levels of aldosterone stimulation of the renal distal tubule leads to sodium wasting in the urine and H+ retention in the serum. In suspected cases of Addison's disease, one needs to demonstrate that adrenal hormone levels are low even after appropriate stimulation (called the ACTH stimulation test) with synthetic pituitary ACTH hormone tetracosactide .\n\nSo the answer to this question is D"}
{"instruction": "Puerperal sepsis/infection occurs up to?\nA. 1 week\nB. 2 week\nC. 3 week\nD. 4 week", "response": "Ans- B 2 week PUERPERAL SEPSIS DEFINITION Puerperal sepsis is any bacterial infection of the genital tract which occurs after the birth of a baby. It is usually more than 24 hours after delivery before the symptoms and signs appear. Some of the most common bacteria are: streptococci staphylococci escherichia coli (E.coli) clostridium tetani clostridium welchii chlamydia gonococci SYMPTOMS AND SIGNS are fever (temperature of 38degC or more) chills and general malaise lower abdominal pain tender uterus subinvolution of the uterus purulent, foul-smelling lochia. light vaginal bleeding shock. RISK FACTORS Some women are more vulnerable to puerperal sepsis, including anaemia and/or malnourished, protracted labour, prolonged rupture of the membranes, frequent vaginal examinations, a traumatic delivery, caesarean section and retained placental fragments, PPH, diabetes all predispose to puerperal infection. SITES The most common site of infection in puerperal sepsis is the placental site. Other sites of infection are abdominal and perineal wounds following surgery and lacerations of the genital tract, e.g. cervix, vagina and perineum. Following delivery, puerperal sepsis may be localized in the perineum, vagina, cervix or uterus. Infection of the uterus can spread rapidly if due to virulent organisms, or if the mother's resistance is impaired. It can extend beyond the uterus to involve the fallopian tubes and ovaries, to the pelvic cellular tissue causing parametritis , to the pelvic peritoneum, causing peritonitis , and into the blood stream causing septicaemia DIFFERENTIAL DIAGNOSIS Fever in the puerperium can also be caused by: urinary tract infection (acute pyelonephritis) wound infection (e.g. scar of caesarean section) mastitis or breast abscess thrombo-embolic disorders, e.g. thrombophlebitis or deep vein thrombosis respiratory tract infections\n\nSo the answer to this question is B"}
{"instruction": "100% recurrence of disease in Down's syndrome\nA. Translocation of 15 + 21 chromsome\nB. Mosaic pattern\nC. Trisomy - (21, 21 translocation)\nD. Non Dysjunction", "response": "100% recurrence of disease in Down's syndrome is due to balanced translocation (21 : 21).\n\nSo the answer to this question is C"}
{"instruction": "Kviem siltzbach test is used in the diagnosis of\nA. Tuberculosis\nB. Sarcoidosis\nC. Histoplasmosis\nD. Leishmaniasis", "response": "Ans. is'b'i.e., Sarcoidosis Kveim-Siltzbath skin test It is a useful intradermal diagnostic test The antigen is prepared from involved lymph node or spleen is injected intradermally In a positive test, nodular lesions appears in 3-6 weeks at the inoculation site, which on microscopic examination shows presence of noncaseating granulomas (sarcoidosis like lesions) The kviem siltzbath material is no longer available and with the use of transbronchial biopsy to obtain lung parenchvm for diagnostic purposes, the kviem siltzbath test is only of historic interest. Laboratory anomalies Common abnormalities in the blood include Lymphocytopenia, mild eosinophilia Increased E.S.R., hyperglobulinemia Elevated level of ACE False positive tests for rheumatoid factor or ANA's Hypercalccmia or an elevated 24 hr urine calcium level The lung function abriormalties of sarcoidosis are typical for interstitial Lung diseaseQ and include decreased lung volumes with and diffusing capacity with a normal or supernormal ratio of the forced expiratory volume in is to the forced vital capacity. Also know Sarcoidosis of the lung is primarily an interstitial lung disease in which the inflammatory process involves the alveoli, small bronchi and small blood vessesls. Pleura is involved in 1-5% of cases almost always manifesting as unilateral pleural effitsionso. The effusions usually clear within a few week. Pneumothorax of hydropneumothorax is observed in sarcoidosis but is very rare.\n\nSo the answer to this question is B"}
{"instruction": "In antral lavage, approach is through\nA. Medial wall\nB. Roof\nC. Posterior wall\nD. Canine fossa", "response": "This procedure involves puncturing the medial wall of maxillary sinus in the region of inferior meatus and irrigating the sinus. Antral Puncture- Ref- Dhingra, 6th edition, page 408.\n\nSo the answer to this question is A"}
{"instruction": "Koplik spots are pathognomic of ?\nA. Measles\nB. Diphtheria\nC. Donovanosis\nD. Gonorrhoea", "response": "Ans. is 'a' i.e., Measles Koplik spots Koplik spots, the pathognomonic enanthem of measles, begin as small, bright red macules that have a 1-2-mm blue- white speck within them. They are typically seen on the buccal mucosa near the second molars in 1-2 days before and lasting 2 days after the onset of the rash.\n\nSo the answer to this question is A"}
{"instruction": "Which among the following is considered as a hallmark of the fibrogenic repair:\nA. Granulation tissue\nB. Neovascularization\nC. Neutrophilic infiltration\nD. All of the above", "response": "Granulation tissue is the hallmark of the fibrogenic repair.\n\nSo the answer to this question is A"}
{"instruction": "In-situ DNA nick end labeling can quantitate\nA. Fraction of cells in apoptotic pathways\nB. Fraction of cells in S phase\nC. p53 gene product\nD. bcr/abl gene", "response": "In situ DNA nick end – labeling is an in-situ method for detecting areas of DNA which are nicked during apoptosis.\nTerminal deoxynucleotidyl transferase mediated dUTP–biotin nick end labeling (TUNEL) is a method for detecting apoptotic cells that exhibit DNA fragmentation.\n\nSo the answer to this question is A"}
{"instruction": "Tachypnea in a 4-month-old child is respiratory rate more than\nA. 30/min\nB. 40/min\nC. 50/min\nD. 60/min", "response": "Ans, c (50/min). (Ref Nelson, 17th ed., 280) AgeHR (per min)BP (mm Hg)RR (per min)1Premature120-17055-75/35-4540-7020-3 months100-15065-85/45-5535-5533-6 months90-12070-90/50-6530-4546-12 months80-12080-100/55-6525-4051-3 years70-11090-105/55-7020-3063-6 years65-11095-110/60-7520-2576-12 years60-95100-120/60-7514-22812 years55-85110-135/65-8512-10\n\nSo the answer to this question is C"}
{"instruction": "Natural killer cell is:\nA. MHC restricted\nB. Antibody dependent\nC. Null cells\nD. B-lymphocytes", "response": "Ans. c. Null cells\n\nSo the answer to this question is C"}
{"instruction": "The dual cure cements should not be used with light transmitting prostheses thicker than:\nA. 1.0 mm\nB. 1.5 mm\nC. 2.0 mm\nD. 2.5 mm", "response": "Dual-cure cements require mixing similar to that for the chemical-cure systems. Static mixing and trituration of capsules have largely replaced the need for hand mixing. \nCuring proceeds slowly until the cement is exposed to the curing light, at which point the cement hardens rapidly. These dual-cure cements should not be used with light-transmitting prostheses thicker than 2.5 mm; anything thicker than 2.5 mm should be bonded with chemical-cure cement. \nRemoval of excess cement may be performed after seating or after waiting for a specific period as indicated in the manufacturer’s directions for use.\n\nRef: Phillip’s 12th edition page 330\n\nSo the answer to this question is D"}
{"instruction": "Classical Meig syndrome is associated with which of the following ovarian tumour :\nA. Fibroma\nB. Serous cystadenoma\nC. Thecoma\nD. Endometroid tumour", "response": "Fibroma\n\nSo the answer to this question is A"}
{"instruction": "Chronic Burrowing ulcer is caused by\nA. Microaerophilic streptococci\nB. Peptostreptococcus\nC. Streptococcus viridans\nD. Streptococcus pyogenes", "response": "Microaerophilic streptococci (Burrowing ulcer / Maleny's ulcer is caused by synergistic infection of microaerophilic non hemolytic streptococci and aerobic hemolytic streptococci)\n\nSo the answer to this question is A"}
{"instruction": "In case of malpractice punishment is given by :\nA. State medical council\nB. MCI\nC. IMA\nD. High cou", "response": "D i.e. High cou\n\nSo the answer to this question is D"}
{"instruction": "Mechanism of action Tianeptin in the brain is -\nA. Selective scrotonin reuptake inhibition\nB. Selective norepinephrine reuptake inhibition\nC. Selective serotonin reuptake enchancer\nD. Selective dopamine reuptake inhibition", "response": "Ans. is 'c' i.e., Selective serotonin reuptake enhancer o Tianeptine is an atypical antidepressant. o It increases the uptake of serotonin (Action opposite to SSRI).\n\nSo the answer to this question is C"}
{"instruction": "A women is diagnosed to have breast carcinoma, the other breast requires-\nA. Random FNAC\nB. No investigation\nC. Mammography\nD. Clinical breast examination", "response": "Ans. is 'c' i.e., Mammography o Annual screening mammography is recommended for patients writh personal H o DCIS or invasive cancer in one breast irrespective of age.\n\nSo the answer to this question is C"}
{"instruction": "Second most common malignancy in a patient with retinoblastoma is:\nA. Nephroblastoma\nB. Osteosarcoma\nC. Neuroblastoma\nD. Craniopharyngioma", "response": "Retinoblastoma: It is the most common primary intraocular malignancy of childhood. The mutation occurs in the retinoblastoma gene (Rb) at chromosome 13q14. This is a tumor suppressor gene. One mutated copy may be inherited in an autosomal dominant fashion (germline mutation). If a second mutation spontaneously occurs in any cell, tumorigenesis is likely. Individuals with a germinal mutation are at risk for the development of tumors other than retinoblastoma (pineal tumors, osteosarcoma, and other soft tissue sarcomas). Ref: Braverman R.S. (2012). Chapter 16. Eye. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following pa of the ear is most commonly involved in otosclerosis?\nA. Oval window\nB. Round window\nC. Tympanic membrane\nD. Malleus", "response": "While otosclerosis may potentially involve any pa of the bony labyrinth, it carries a distinct predilection for the region near the anterior border of the oval window (fissula ante fenestram).\n\nSo the answer to this question is A"}
{"instruction": "Pasteurized milk is most commonly tested by\nA. Phosphatase test\nB. Standard plate count\nC. Coliform Count\nD. Holder method", "response": "Phosphatase test - widely used test.\n\nSo the answer to this question is A"}
{"instruction": "Pugilistic attitude is most common in woman dying with -a) Antemortem burnsb) Post mortem burnsc) Asphyxiad) Carbon monoxide poisoning\nA. ac\nB. ab\nC. ad\nD. bc", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Disease under international surveillance by WHO-\nA. Measles\nB. Relapsing fever\nC. Typhoid\nD. Rubella", "response": "Ans. is 'b' i.e., Relapsing fever * At the international level, the following diseases are notifiable to WHO in Geneva under International health regulation -i) Choleraii) Plagueiii) Yellow fever} -These are notifiable diseases as well as under surveillance* Few other diseases are also subjected to international surveillance -i) Lause - born typhus feveriii) Poliov) Malariavn) Salmonellosisii) Relapsing feveriv) Influenzavi) Rabies\n\nSo the answer to this question is B"}
{"instruction": "Statutory body (shown in symbol) has been established under the act passed in\nA. 2000\nB. 2002\nC. 2006\nD. 2013", "response": "2006\n\nSo the answer to this question is C"}
{"instruction": "Anti Snake Venin (ASV) should be given in all these situations with further lab investigations in a child presenting at 4 am except :\nA. Severe pain abdomen but no fang marks\nB. Local swelling with fang marks\nC. External opthalmoplegia\nD. Ptosis with head flexed without bite marks", "response": "Ans: B (Local swelling with fang marks) Ref: The Pediatric Management of Snakebite: The National Protocol, Indian Pediatrics; 43: 173-6 and Snake Site: Indian Guidelines and Protocol. The Association of Physicians of India Chapter 24 Pg 423 and Clinical Profile of Snake Bite in Children in Rural India. Iran J Pediatr, 2013 Dec; 23(6): 632-636. and Achar Textbook of Pediatrics, 4th edition, Pg: 127Explanation:\"Among the neuroparalytic bites 60% patients presented with abdominal pain which was the main presenting complaint.\"Ref: Clinical Profile of Snake Bite in Children in Rural IndiaAnti-Snake VenomAnti-snake venom (ASV) is the mainstay of treatment.in India, polyvalent ASV, i.e. effective against all the four common species:o Russell's vipero Common Cobrao Common Kraito Saw-scaled ViperIndications for ASV administrationEvidence of systemic envenomationProlonged 20 min whole blood clotting time { >20 WBCT).Signs of spontaneous bleeding.Thrombocytopenia (Platelets < 1 lakh/cumm.Neurological symptomso Ptosiso Opthalmoplegiao Respiratory paralysiso Bulbar paralysiso Cardiac signsRenal problemso Oliguriao UremiaHemoglobinuriaMyoglobinuriaSevere Local SymptomsSwelling rapidly crossing joint.Swelling involving half of bitten limb.Swelling increasing rapidly after removal of tourniquet.Development of Enlarged tender regional lymph node.Features of Krait bite:Unique clinical presentation.Movements are mainly nocturnal.Abdominal pain - Most common initial symptom.Often No Pain.No fang mark.No local swelling.Neurological Symptomso Progressive paralysiso Ptosiso Respiratory muscle failure.Note:ASV should NOT be used without evidence of systemic envenomation or severe local swelling.Purely local swelling is Not an Indication for administering ASV.\n\nSo the answer to this question is B"}
{"instruction": "Iv glucose tolerance is done in -\nA. Children\nB. Pregnancy\nC. Gastrectomy\nD. Old age", "response": "The IV Glucose Tolerance Blood Test helps determine glucose levels in blood, after intravenous administration of a 50% solution of glucose. It is used to diagnose diabetes, cancers, and metabolic disordersThis test is more sensitive than the oral glucose tolerance blood test because the glucose sample does not have to go through the digestive system. It also allows for individuals who cannot eat or tolerate glucose to measure their glucose tolerance . Following are the clinical indications for performing the IV Glucose Tolerance Blood Test: Monitoring glucose levels of individuals with diabetes Inability to eat or tolerate glucose (else, the oral glucose tolerance blood test may be performed) Family history of diabetes Extensive surgery or injury Frequent urination Increased thirst Fatigue Blurry vision Rapid weight loss Tingling and numbing in the extremities Giving bih to a baby over 9 pounds Obesity History of cardiovascular disease It is done in gastrectomy paitents as they are unable to consume glucose orally and not able to undergo OGTT. Ref -\n\nSo the answer to this question is C"}
{"instruction": "Blood agar is an example of ?\nA. Enriched media\nB. Indicator media\nC. Enrichment media\nD. Selective media", "response": "Ans. is 'a' i.e., Enriched media\n\nSo the answer to this question is A"}
{"instruction": "Which of the following adverse effects of levodopa is not minimized even after combining it with carbidopa?\nA. Involuntary movements\nB. Nausea and vomiting\nC. Cardiac arrhythmia\nD. 'On-off' effect", "response": "(Ref: KDT 6/e p419) Carbidopa can decrease all the adverse effects of levodopa except Involuntary movements Behavioural effects\n\nSo the answer to this question is A"}
{"instruction": "Which one of following is Polysaccharide vaccine:-\nA. Peussis\nB. Hepatitis B\nC. Meningococcal\nD. Yellow fever", "response": "Polysaccharide vaccines are: Typhim-Vi Pneumococcal vaccine Meningococcal vaccine Hib.\n\nSo the answer to this question is C"}
{"instruction": "CBD microliths are diagnosed by\nA. ERCP\nB. EUS\nC. HIDA\nD. CT", "response": "CBD stones IOC is MRCP\nMicro stones are detected by EUS.\n\nSo the answer to this question is B"}
{"instruction": "A patient delivers a twin gestation in which one infant has blood group O and one has blood group B. The patient and her husband are both type O. Discordant blood types is explained by\nA. It involves fertilization of one ovum that splits into two during the same menstrual cycle.\nB. It involves fertilization of two ova within same menstrual cycle, but not at the same coitus.\nC. It involves fertilization of two ova separated in time by an interval as long as or longer than a menstrual cycle.\nD. This does not occur spontaneously in humans.", "response": "The clinical Scenario describes suferfecundation.\n\nSo the answer to this question is B"}
{"instruction": "Light-bulb sign in X-ray shoulder is seen in:\nA. Fracture of neck of humerus with glenoid\nB. Anterior dislocation of shoulder\nC. Posterior dislocation of shoulder\nD. Fracture of scapula", "response": "Ans-CKef: Apleys System of Orthopaedics and Fractures, 9th editionExplanation:Eight-bulb appearance - Seen due to internal rotation of the humeral head in posterior dislocation of the shoulder.Anterior dislocation of shoulder occurs from the excessive external rotation of the shoulder (especially in abduction).Risk factors of posterior shoulder dislocation of the shoulder occur from:o Excessive internal rotationo Following seizure episodeo Following electrocutiono In both seizure and electrocution, excessive contraction of the stronger muscles of the upper back causes pull of the humeral head backward causing dislocation.* Normal appearance of the shoulder in X-ray.Eight-bulb appearance of the humeral head in X-ray due to internal rotation of the humeral head in posterior dislocation.NOTE associated with anterior shoulder dislocation - Fracture of the greater tuberosity. associated with posterior shoulder dislocation - Fracture of the lesser tuberosity.\n\nSo the answer to this question is C"}
{"instruction": "Severe ptosis in a new born should be operated at the age of:\nA. 1 year\nB. 3 years\nC. 5 years\nD. Earliest possible", "response": "Ans. Earliest possible\n\nSo the answer to this question is D"}
{"instruction": "Antiepileptic drug implicated in causing toxic epidermal necrolysis is :\nA. Felbamate\nB. Gabapentin\nC. Lamotrigine\nD. Vigabatrin", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "All statements are true regarding non-ST elevation acute coronary syndromes (NSTE-ACS) and ST elevation myocardial infarctions (STEMI) except ?\nA. The relative incidence of NSTEMI is rising due to the increasing burden of diabetes and chronic kidney disease in an aging population.\nB. Pump failure is now the primary cause of in-hospital death from STEMI\nC. Infarction of >=60% of the left ventricle usually results in cardiogenic shock\nD. PCI is the treatment of choice for patients with acute coronary syndromes", "response": "Epidemiologic studies indicate there is a shift in the pattern of AMI over the last 15 years with more patients with NSTEMI than STEMI.The relative incidence of NSTEMI is rising due to the increasing burden of diabetes and chronic kidney disease in an aging population, while STEMI is declining due to greater use of aspirin, statins, and less smoking. Among patients with NSTE-ACS, the propoion with NSTEMI is rising while that with UA is falling because of the wider use of troponin assays with higher sensitivity to detect myocyte necrosis, thereby reclassifying UA as NSTEMI. Infarction of >=40% of the left ventricle usually results in cardiogenic shock. Pump failure is now the primary cause of in-hospital death from STEMI PCI is the treatment of choice for patients with acute coronary syndromes\n\nSo the answer to this question is C"}
{"instruction": "4 drugs in AKT used because -\nA. Decrease in resistance by mutation\nB. Decrease in resistance by conjugation\nC. To cure disease early\nD. None", "response": "\n\nSo the answer to this question is C"}
{"instruction": "What is this teeth abnormality?\nA. Mulberry molars\nB. Natal teeth\nC. Hutchinson's teeth\nD. Supernumerary teeth", "response": "c. Hutchinson's teethNotched incisors, as seen in this image are known as Hutchinson's teeth. They are seen in congenital syphilis.\n\nSo the answer to this question is C"}
{"instruction": "An eight month old child will be able to do which of the following:\nA. Pincer grasp\nB. Sitting stably\nC. Stand without support\nD. Says mama - baba", "response": "Ans: b\n\nSo the answer to this question is B"}
{"instruction": "Suppositous child is?\nA. Child bom out of wedlock\nB. Child fictitiously claimed by a woman\nC. Second bom of a twin pregnancy\nD. None", "response": "Ans. is 'b' i.e., Child fictitiously claimed by a woman o Suppositious child: Child presented by the mother to have been delivered by her, though she has not delivered, i.e. fictious claim of child.\n\nSo the answer to this question is B"}
{"instruction": "Tinel sign is seen in -\nA. Nerve degeneration\nB. Nerve regeneration\nC. Muscle degeneration\nD. Muscle regeneration", "response": "Ans. is 'b' i.e., Nerve regenerationPathological changes after nerve injuryo After nerve injury, nerve first degenerates and then tries to regenerate.Nerve degenerationo The part of the neurone distal to the point of injury undergoes secondary or Wallerian degeneration-, the proximal part undergoes primary or retrograde degeneration upto a single node.Nerve regenerationo As regeneration begins, the axonal stump from the proximal segment begins to growr distally. If the endoneural tube with its contained Schwrann cells is intact, the axonal sprout may readily pass along its primary course and reinnerv ate the end-organ. The rate of recovery of axon is 1 mm per day. The muscles nearest to the site of injury recovers first, followed by others as the nerve reinnervates muscles from proximal to distal, the so-called motor march.o When the skin over the nerve is percussed gently from distal to proximal, the patient gets a tingling sensation if the nerve is recovering. This is called Tinel's sign and is a sign of recovery.\n\nSo the answer to this question is B"}
{"instruction": "Mizuo phenomenon is seen in:\nA. Fundus albipunctatus\nB. Oguchi's disease\nC. Fundus amaculateus\nD. Choroidermia", "response": "Ans. b. Oguchi's disease Mizuo phenomenon is seen in Oguchi \\ disease.\"In Oguchis disease the characteristic golden yellowish metallic sheen (color) of posterior pole (fundus) in light adapted state reverts to normal after prolonged dark adaptation, a phenomenon described by and named after Japanese ophthalmologist Mizuo Re-exposure to light results in the return of golden yellow metallic sheen.** Female carriers of X-linked (XL) retinitis pigmentosa may have normal fundi or show a golden metallic (tapetal) reflex at macula and/or small peripheral patches of hone spicule pigmentation. The inverse Mizuo phenomenon seen in XL-RP is characterized by appearance of golden sheen in dark (hut no golden sheen in light).\"Oguchi's Disease* Oguchi's disease is a rare autosomal recessive trait characterized by congenital stationary night blindness and a unique morphological and functional abnormality of the retina.* Show Mizuo phenomenon^* Mizuo phenomenon: Fundus is golden yellow in light adapted state which becomes normal after prolonged dark adaptation. Reexposure to light results in the return of the metallic y ellow sheeny.* Rod function is absent after 30-minutes of dark adaptation but recovers to a near normal level after a long period of dark adaptation (i.e. -- normal rod thresholds reached only after 4 hours or longer instead of normal 30 minutes).Etiopathogenesis:* A null allele in genes for each of rhodopsin kinase and arrestin (proteins responsible for terminating phototransduction cascade) is responsible for Oguchi's disease.* Therefore, the persistent low level of light may desensitize the rods continually.* Mizuo phenomenon suggest an abnormality in rod pigment, rhodopsin.* Cone function is normal because cone adaptation, final cone thresholds and photopicERG response are normal.* Rod function is abnormal with delayed dark adaptation and scotopic ERG showing only a small electronegative response, even when the rod threshold have reached normal.Clinical Features:* Patients have non-progressive night blindness since young childhood writh normal day vision, but they often claim improvement of light sensitivities w hen they remain long in the dark environment* The fundus oculi presents a most peculiar appearance.\n\nSo the answer to this question is B"}
{"instruction": "A 6 year old boy presenting with palpable abdominal mass in the epigastrium. The clinical diagnosis is (There is no bile in vomitus)-\nA. Duodenal Atresia\nB. Choledochal cyst\nC. Pyloric stenosis\nD. Oesophageal Atresia", "response": "Ans. is 'c' i.e., Pyloric stenosisDiagnosis of congenital hyperophic pyloric stenosis o History of vomiting without bile (nonbilious vomiting).o Physical examination ?i) Palpable mass in the epigastriumii) After feeding, visible gastric peristatic wave that progresses across the abdomen.USG confirm the diagnosis Criteria --> Pyloric thickness > 4 mm or an overall pyloric length > 14 mm.o Contrast studies ?i) Shoulder sign A bulge of the pyloric muscle into the antrum.ii) Double tract sign -> Parallel streaks of barium in the narrowed channel.iii) Elongated pyloric channel.So the boy is having pyloric stenosis. The only problem is age of boy i.e 6 yrs. The hyperophic pyloric stenosis which we know of, makes its clinical presentation in early infancy (3rd to 6th weeks of life)o But the problem in solved once you know that there is a similar disease in adults - Hyperophic pyloric stenosis of adults. (Bailey & Love, 22th/e, p 675).\n\nSo the answer to this question is C"}
{"instruction": "In which case cystometric study is indicated -\nA. Neurogenic bladder\nB. Stress incontinence\nC. Fistula\nD. Urge incontinence", "response": "Cystometric studies are urodynamic studies in which the pressure changes in the bladder is simultaneously measured with bladder filling and during micturition.\nIt helps in accurate assessment of detrusor and sphincter activity especially if a neurogenic abnormality is suspected.\nThough it is also used in stress incontinence but the aim here is to rule out any neurogenic cause.\n\nSo the answer to this question is A"}
{"instruction": "All are true about Prostatic venous plexus , except\nA. Drains into vesicourethral plexus of veins\nB. Dorsal vein of penis drains into it\nC. Located beneath false capsule\nD. Communicates with the pudendal and vesical plexuses", "response": "The prostatic veins form a well-marked prostatic plexus which lies paly in the fascial sheath of the prostate and paly between the sheath and the prostatic capsule. It communicates with the pudendal and vesical plexuses. The prostatic venous plexus drains into the internal iliac vein which connects with the veebral venous plexus, this is thought to be the route of bone metastasis of prostate cancer. Ref - BDC 6e vol2 pg403-406\n\nSo the answer to this question is A"}
{"instruction": "\"Incest' term used in sexual relationship with\nA. A girl age less than 16 years\nB. Divorced wife\nC. Blood relationship\nD. Sex with hijra", "response": "C. i.e. (Blood relationship) (5.46 Parikh 6th)INCEST - This is the act of sexual intercourse by a man with woman within a certain degree of blood relationship* In India incest per se is not a cognizable offence and police cannot take any notice of it unless the offence can be brought into any of the penalizing sections such as 376 and 497 IPC* Common example is the father and daughter, brother and sister* Medical examination is concerned with demonstrating evidence of habitual intercourse rather than of fresh defloration.Bestiality (bestio - sexuality) means sexual intercourse by a human being with a lower animal** either through the anus or the vagina (Punishible under the section 377. IPC)**Fetichism - is a perversion in which sexual gratification is associated with contact and sight of certain parts of the female body or even clothing or other articles known as fetish objects** (Corned - 08)Transvestism is a perversion in which the personality is dominated by the desire to be identified with opposite sex. The fantasy indulged in is clearly \"being a women\" if a male and 'being a man' if a female. It is also known as EONISM**Irresistible sexual desire in males is known as Satyriasis**\n\nSo the answer to this question is C"}
{"instruction": "Which of the following has to be present for diagnosis of major depressive disorder\nA. Loss of interest or pleasure\nB. Recurrent suicidal tendency\nC. Insomnia\nD. Indecisiveness", "response": "In typical depressive episodes of all three varieties described below (mild, moderate, and severe), the individual usually suffers from depressed mood, loss of interest and enjoyment, and reduced energy leading to increased fatigability and diminished activity. Reference: International classification of diseases 10, page 119.\n\nSo the answer to this question is A"}
{"instruction": "Bosniak classification is for?\nA. Renal tuberculosis\nB. Renal cysts\nC. RCC\nD. VUR", "response": "The Bosniak classification system of renal cystic masses divides renal cystic masses into five categories based on imaging characteristics on contrast-enhanced CT. It is helpful in predicting a risk of malignancy and suggesting either follow up or treatment. Classification: Bosniak I -Simple cyst , imperceptible wall; Work up:nil; Percentage malignant: ~0% Bosniak 2 - Minimally complex, a few thin <1 mm septa or thin calcifications (thickness not measurable); non-enhancing high-attenuation (due to proteinaceous or haemorrhagic contents) renal lesions of less than 3 cm are also included in this category; these lesions are generally well marginated; Work-up: nil; Percentage malignant: ~0% Bosniak 2F - Minimally complex, increased number of septa, minimally thickened with nodular or thick calcifications there may be perceived (but not measurable) enhancement of a hairline-thin smooth septa hyperdense cyst >3 cm diameter, mostly intrarenal (less than 25% of wall visible); no enhancement; Requiring follow-up: needs ultrasound/CT follow up - no strict rules on the time frame but reasonable at 6 months; Percentage malignant: ~ 5% Bosniak 3 - Indeterminate thick, nodular multiple septa or wall with measurable enhancement, hyperdense on CT; Work-up: paial nephrectomy or radiofrequency ablation in elderly or poor surgical candidates; Percentage malignant: ~55% Bosniak 4 - Clearly malignant solid mass with a large cystic or a necrotic component; Treatment: paial or total nephrectomy; Percentage malignant: ~100%.\n\nSo the answer to this question is B"}
{"instruction": "Fibroadenoma of the breast are\nA. Fixed mass\nB. Diffuse mass\nC. Multiple duffuse mass\nD. Solitary mobile mass", "response": "Ans. is 'd' i.e. Solitary mobile mass\n\nSo the answer to this question is D"}
{"instruction": "A 30-year-old male presents with pain on the right flank and hematuria. A CECT abdomen reveals a large 8 x 8 cm sized solid mass in the right kidney and 3 x 3 cm solid mass occupying the upper pole of the left kidney. The most appropriate surgical treatment for this pt is -\nA. Bilateral radical nephrectomy\nB. Right radical nephrectomy and biopsy of the mass from opposite kidney.\nC. Right radical nephrectomy and left paial nephrectomy\nD. Right radical nephrectomy only.", "response": "This male pt. with flank pain, hematuria and demonstration of a solid renal mass is having renal cell carcinoma (in clinical practice any solid renal mass is considered RCC until proved otherwise) For patients with bilateral RCCs, paial nephrectomy with an adequate parenchymal margin is the preferred approach for kidney with the smaller lesion. Paial nephrectomy or Nephron-sparing procedures are found to be equally effective on radical nephrectomy if the tumor size is less than 4 cms. Ref : Smith's Urology 17/e p336\n\nSo the answer to this question is C"}
{"instruction": "Blood platelets in stored blood do not remain functional after hrs. -\nA. 24\nB. 48\nC. 72\nD. 96", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Basanti, a 28 years aged female with a history of 6 weeks of amenorrhoea presents with pain in abdomen; USG shows fluid in pouch of Douglas. Aspiration yields dark color blood that fails to clot. Most probable diagnosis is:\nA. Ruptured ovarian cyst\nB. Ruptured ectopic pregnancy\nC. Red degeneration of fibroid\nD. Pelvic abscess", "response": "Ans. is b, i.e. Ruptured ectopic pregnancyRef. Dutta Obs. 7/e, p 182; Williams Obs. 22/e, p 258, 259, 23/e, p 242, 243The picture given in the question classically represents a case of ruptured ectopic pregnancy.The women in the question is presenting with amenorrhea of 6 weeks and pain in abdomen.On USG - fluid is seen in POD and aspiration of dark coloured blood which fails to clot - all these features leave no doubt of ectopic pregnancy.\"Sonographic absence of uterine pregnancy, a positive pregnancy test (b-hCG), fluid in cul-de-sac and an abnormal pelvic mass, ectopic pregnancy is almost certain--Williams Obs. 22/e p 259Also Know:D/D of fluid in POD:1. Mid cycle2. PID3.Tubal abortion (ectopic)Culdocentesis:It is a simple technique used to identify hemoperitoneum.Fluid is aspirated from cul-de-sac via posterior fornix with the help of a needle.If non clotting blood is obtained, it is indicative of an intraperitoneal bleed and probably a ruptured ectopic.Note: If the aspirated blood clots, it may have been obtained from an adjacent blood vessel rather than from bleeding ectopic pregnancy.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following has to be present for a diagnosis of major depressive disorder -\nA. Loss of interest or pleasure\nB. Recurrent suicidal tendency\nC. Insomnia\nD. Indecisiveness", "response": "One of the following two should be present essentially : -\n\n\nDepressed mood\nMarkedly diminished interest or pleasure in all or almost all activities.\n\nSo the answer to this question is A"}
{"instruction": "Regarding outpatient hysteroscopy, all are true except\nA. Abnormal uterine bleeding is an indication\nB. Normal saline as distension medium can be used\nC. It is not reliable to exclude endometrial carcinoma\nD. It is less accurate than saline infusion sonography (SIS)", "response": "Description:\n\n\nHysteroscopy is the gold standard investigation for evaluation of the uterine cavity\nCan be both diagnostic and therapeutic\nNormal saline can be used as a distension medium but not suitable for monopolar electrosurgery. Other media: Carbon dioxide, Glycine, Mannitol\nIndications: Abnormal uterine bleeding, Infertility, Mullerian anomalies, Recurrent haemorrhage, Misplaced IUCD, Chronic pelvic pain\nSonohysterography or Saline infusion sonography includes installation of saline in the uterine cavity and study with Transvaginal sonography.\n\nSo the answer to this question is D"}
{"instruction": "Osteoblasts produce -\nA. Collagen\nB. Calcium\nC. Pyrophosphate\nD. Monosodium urate", "response": "Osteoblast-Derived Proteins\nType 1 collagen\nCell adhesion proteins \n osteopontin, fibronectin, thrombospondin\nCalcium-binding proteins\n Osteonectin, bone sialoprotein\nProteins involved in mineralization\n Osteocalcin \nEnzymes\n Collagenase, alkaline phosphatase\nGrowth factors\n IGF-1, TGF-β, PDGF\nCytokines\n Prostaglandins, IL-1, IL-6, RANKL\nProteins Concentrated from Serum\nβ2-microglobulin\nAlbumin\n\nSo the answer to this question is A"}
{"instruction": "Maximum risk of death is seen in which week of the neonatal period?\nA. First week\nB. Second week\nC. Third week\nD. Fouh week", "response": "The major causes of neonatal moality are prematurity/low bihweight (LBW) and congenital anomalies.Moality is highest during the 1st 24 hr after bih.Neonatal moality accounts for about two-thirds of all infant deaths (deaths before 1 yr of age).(Refer: Nelson, Chapter 93; pg no. 789)\n\nSo the answer to this question is A"}
{"instruction": "Feature of osteoahritis is\nA. Heberden node\nB. Increased ESR\nC. Onycholysis\nD. Z deformity", "response": "Joint involvement in OACommon joints: Knee, Hip, Spine (cervical, lumbosacral), Hand (PIP, DIP, first carpometacarpal), first tarsometatarsalUncommon joint: ShoulderSpared: Wrist, elbow, ankle, metacarpophalangealIn osteoahritis of hand:Distal interphalangeal joint:- Heberden's nodeProximal interphalangeal joint: bouchard's node(Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 88, 101, 127)\n\nSo the answer to this question is A"}
{"instruction": "A 19-year-old girl develops sudden-onset non-bloody diarrhea. She was previously well and is not taking any medications or traveled anywhere recently. Her abdomen is soft and nontender on examination, and the anion gap is normal.For the above patient with new symptoms, select the most likely acid base disorder.\nA. metabolic acidosis\nB. metabolic alkalosis\nC. respiratory acidosis\nD. respiratory alkalosis", "response": "She has a non-anion gap metabolic acidosis because of bicarbonate loss from the diarrhea. The anion gap is calculated as the sodium concentration minus the chloride plus the bicarbonate concentration. Other causes of bicarbonate loss with normal anion gap include proximal RTA and primary hyperparathyroidism.\n\nSo the answer to this question is A"}
{"instruction": "Co enzyme for dopa decarboxylase?\nA. Biotin\nB. Vitamin B6\nC. Vitamin C\nD. B12", "response": "Ans. is 'b' i.e., Vitamin B6All decarboxylases require pyridoxin (vitamin B6)\n\nSo the answer to this question is B"}
{"instruction": "Cat scratch disease is -\nA. Associated with positive Frei skin test\nB. Caused by a DNA virus\nC. Associated with a pathognomonic histological picture\nD. All", "response": "Ans. is 'c' i.e., Associated with a pathognomonic histological picture Cat scratch disease (CSD) . Caused by Baonella henselae --) a gram negative bacteria. . Domestic cat is the animal reservoir . The flea acts as a vector in the cross-infection of cats, but its role in human infection is not clear. . Man is infected by a cat scratch . Clinical manifestations - Localized papule, pustule - Tender regional lymphadenopathy - Systemic symptoms -3 malaise, anorexia and weight loss - No fever - Encephalitis, meningitis, seizures, transverse myelitis - Granulomatous hepatitis, splenitis, osteomyelitis - Perinaud's oculoglandular syndrome. Pathology - The histopathologic hallmark of CSD is granulomatous inflammation with stellate necrosis but no evidence of angiogenesis. - Biopsy samples stained with wahin-starry silver. Remember Infection with B. henselae produces two entirely different pathologic reaction, depending on the immune status of the host : Granulomatous inflammation --> Cat scratch disease Angiogenesis --> Bacillary angiomatosis\n\nSo the answer to this question is C"}
{"instruction": "Which among the following is not formed by kidney?(Repeat Q. 45 2009)\nA. Erythropoietin\nB. Renin\nC. Vitamin D\nD. Aldosterone", "response": "Ans: d (Aldosterone)Ref: Ganong 22nd ed Pg. 454)Aldosterone - is produced by Zona glomerulosa of adrenal cortex.Erythropoietin - by the interstitial cells in the peritubularcapillaries in kidneys (85%) and perivenous hepatocytes of liver (15%).Renin - by the juxta glomerular cells of the kidney.Kidney produces 3 hormones1) 1,25 (OH) cholecalciferol (vitamin D)2) Renin3) ErythropoietinAldosterone: is produced by Zona Glomerulosa of adrenal cortex.Erythropoietin: by the interstitial cells in the peritubular capillaries in kidneys (85%) and perivenous hepatocytes of liver (15%).Renin: by the juxta glomerular cells of the kidney.Renin Angiotensin SystemAngiotensinogen (from liver) - found in alpha 2 globulin fraction of plasma Renin (from JG cells)Angiotensin I ACE (Angiotensin converting enz. from Pulm. endothelium)Angiotensin IIMetabolism of vitamin D\n\nSo the answer to this question is D"}
{"instruction": "Best investigation for optic nerve damage amongst the following is:\nA. Opthalmoscopy\nB. Flourscence angiograhy\nC. Ultrasound\nD. Perimetry", "response": "D i.e. Perimetry Investigations for Optic Nerve Disease Perimetry : Visual field defects are best detected by Goldmann kinetic perimetry (full-field) & Humphery automated threshold perimetry MRI: Best investigation for imaging of optic nerves Visually evoked potential Fluorescein angiography: Occasionally helpful in differentiating papilloedema(showsdisc leakage) from optic disc drusen (no leakage). Ophthalmoscopic appearance of the disc may vary considerably from normal to elevated to arophied, so they may not help in diagnosis, though may be useful in differential diagnosis. USG is not used for evaluation of optic nerve but for retinal function and structure.\n\nSo the answer to this question is D"}
{"instruction": "Ans. is 'a' i.e., Infant parasite index is a poor index for assessment for transmission of malaria in the community\nA. Chlorquine\nB. Primaquine\nC. Chloraquine + Primaquine\nD. None", "response": "Ans. is 'c' i.e., Chloroquine + Primaquine o Previously presumptive treatment to suspected cases of malaria was used (Chloroquine + Primaquine). o But policy has changed now. - Read below Guidelines for diagnosis and treatment of Malaria - 2010 (Added in 22/e of Park) o According to the revised drug policy, there is no scope of presumptive treatment in malaria control. The new drug policy gives emphasis on complete treatment in diagnosed cases of malaria rather than one single dose presumptive treatment to suspected cases of malaria (waiting for the diagnosis) to avoid chloroquine resistance in P. falciparum. o All fever cases should be investigated for malaria either by microscopy or by Rapid diagnostic Test (RDT) for both vivax & falciparum, i.e., combo RDT. o Fuher treatment is as follows : - 1)For plasmodium vivax : - 3 days chlorquine plus 14 days Primaquine. 2) For plasmodium falciparum : ? All cases should be given Aemisinin combination therapy (ACT) which includes Aesunate (for 3 days) along with sulfadoxin-pyrimethamine (on day 0) plus single dose primaquine. 3) Treatment of mixed infection : - Should be treated as falciparum malaria. 4) When microscopy results are not available within 24 hours or if RDT for only falciparum is used : - a)P. falciparum RDT positive --> Treat as falciparum malaria (as above). b)P. falciparum RDT negative --> Send blood slide to laboratory, and give chloroquine for 3 days, and await microscopy results : - i) +ve for vivax --> Primaquine for 14 days. ii) +ve for falciparum --> Treatment of falciparum malaria as above. 5)Treatment of severe malaria : - Severe manifestations (e.g., Unconsciousness, Convulsions, Coma, Metabolic acidosis etc) can develop in P. falciparum infection. Treatment is as follows : - i) Sta with parentral aimisinin derivative (aesunate, aemether, aeether) or quinine. ii)Once patient can take oral therapy : ? a) Patients receiving parentral quinine should be treated with oral quinine along with doxycyclin for 7 days. In pregnant women clindamycin is given instead of doxycyclin. b)Patients receiving aemisinin derivatives should get full course of oral ACT. Treatment of malaria in pregnancy has also been included in 22n4/e of Park Treatment in pregnancy i) Falciparum malaria : - ACT in 2nd & 3rd trimester; quinine in first trimester. ii) Vivax malaria : - chloroquine\n\nSo the answer to this question is C"}
{"instruction": "Best time to do quadruple test\nA. 8-12 weeks\nB. 11-15 weeks\nC. 15-20 weeks\nD. 18-22 weeks", "response": "* The quad screen is done in the second trimester, usually between 15 and 20 weeks of pregnancy. * Ideally, the test should be performed in conjunction with first-trimester screening tests. REF : DUTTA BOOK OF OBSTETRICS\n\nSo the answer to this question is C"}
{"instruction": "The frontal TMJ projection is called as:\nA. Transcranial projection\nB. McQueen Dell technique\nC. Zimmer projection\nD. Infracranial projection", "response": "The frontal TMJ projection that shows medial displacement of fracture of condyle and fracture of neck of condyle is called transorbital or Zimmer's projection.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is not true for hemophilia A\nA. Hemophilia A is due to deficiency of factor VIII\nB. In hemophilia A females are carriers\nC. Desmopressin is useful in the management of hemophilia A\nD. Levels of factor VIII Less than 50% are associated with spontaneous hemorrhage", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "&;Snow ball&; opacities near the ora serrata are pathognomonic of\nA. Diabetic retinopathy\nB. Pars planitis\nC. Anterior choroiditis\nD. Fungal endophthalmitis", "response": "INTERMEDIATE UVEITIS (PARS PLANITIS) It is inflammation of pars plana pa of ciliary body and most peripheral pa of the retina. Etiology: It is an idiopathic disease usually affecting both eyes (80 percent) of children and young adults. Clinical features Symptoms: Most of the patients present with history of floaters. Some patients may come with defective vision due to associated cystoid macular oedema. Signs: Slit-lamp examination may show: mild aqueous flare, and fine KPs at the back of cornea. Anterior vitreous may show cells. Fundus examination with indirect ophthalmoscope reveals the whitish exudates present near the ora serrata in the inferior quadrant. These typical exudates are referred as snow ball opacities. These may coalesce to form a grey white plaque called snow banking. Ref:- A K KHURANA; pg num:-161\n\nSo the answer to this question is B"}
{"instruction": "An 8 days old child presents with yellow selera, whitish stool and turmeric colour urine on 3rd day of septicemia on broad spectrum antiboitics, the likely diagnosis is\nA. Galactosidase deficiency\nB. Ammonia toxicity\nC. Galactose 1-4 phosphatase uridyl transferase deficiency\nD. All", "response": "Ans. is 'c' i.e., Galactose 1-4 phosphatase uridyl transferase deficiency o Feature of conjugated bilirubinemia on the 3rd day accompanied by sepsis in a neonate suggests diagnosis of Galactosemia. o Due to accumulation of galacticol, damage to nerve tissue and liver occurs which cause. Hepatic parenchymal disease- jaundice, hepatomegaly and ascites Mental retardation Cataract Seizures Hypoglycemia Vitreous hemorrhage Acidosis Splenomegaly o Fanconi syndrome --> Aminoaciduria, proteinuria and phosphaturia. o The symptoms of the severe from of the disease are similar to the symptoms of the patient child in the Question -3 Jaundice, hepatomegaly vomiting and septicemia (due to E. coli).\n\nSo the answer to this question is C"}
{"instruction": "PQLI includes:\nA. Infant mortality, Life expectancy and Literacy\nB. Maternal mortality, Life expectancy and Literacy.\nC. Disability rate, Pregnancy rate and GNP\nD. Longevity, Knowledge and Income", "response": "Ans. A. Infant mortality, Life expectancy and Literacy. (Ref. Park's Textbook of PSM 22nd/pg.l6) INDEXKEY POINTS1Physical Quality of Life Index (PQLI) include# Infant mortality,# Literacy,# Life expectancy at age one.# The ultimate obj is to attain PQLI of 100.2Human Development Index (HDI) include# Longevity (Life expectancy at birth),# Knowledge (adult literacy rate & mean years of schooling), and# Income (Per capita GDP). India - 0.612 rank 1283Human Poverty Index (HPI- I & II) includes# I - a long and healthy life, knowledge and a decent standard of living# II - a long and healthy life, knowledge and a decent standard of living, social exclusion.# India - 28%. rank 88.4Gender Related Development Index (GDI)# India- 97.1% -# Reflect achievements in basic human development adjusted for gender inequalities.5Gender Empowerment Measure (GEM)# Measure gender inequalities in economic & political opportunities.\n\nSo the answer to this question is A"}
{"instruction": "Facial bevel, proximal flare and chamfer finish line in a posterior three quarter crown imparts:\nA. Marginal integrity\nB. Structural durability\nC. Retention and resistance\nD. All of the above", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Flexner-Wintersteiner rossette is seen in?\nA. Hepatoblastoma\nB. Nephroblastoma\nC. Neuroblastoma\nD. Retinoblastoma", "response": "Ans. is 'd' i.e., Retinoblastoma\n\nSo the answer to this question is D"}
{"instruction": "What enhances multiplication of T cells in culture\nA. Phytohemagglutinin\nB. Chemotactic factor\nC. Leukotrienes\nD. Prostaglandins", "response": "Option 1, 2, 3, 4 Mitogens like Phytohemagglutinin (PHA), Concanavalin (Con A), and Anti CD-3 induces T-cell blast transformation (multiplication). Option 2 Eosinophil chemotactic factor (ECF-A)- Eosinophil chemotaxis Neutrophil chemotactic factor (NCF-A)- Neutrophil chemotaxis Option 3, 4 Various cells and complement components of innate immunity cordinate and exe their effects through the production of soluble mediators. These mediators include cytokines, prostaglandins, and leukotrienes. Mediators released from activated macrophages and other cells include prostaglandins and leukotrienes. These inflammatory mediators regulate changes in local blood vessels such as vasodilataion During dilation, plasma escapes and accumulates in the area of injury. Fibrin is formed which occludes the lymphatic channels, limiting the spread of organisms. Prostaglandins and leukotrienes in Type I Hypersensitivity: Prostaglandins and leukotrienes are newly formed mediators derived from arachidonic acid the cyclooxygenase pathway. Prostaglandins induce edema and bronchoconstriction. Leukotriene B4 is a chemoattractant that activates and recruits leukocytes to the site of injury. Leukotrienes C4 and D4 cause vasodilation and vascular permeability. These mediators, along with TNF-a and IL-4, are referred to as secondary mediators of a type I reaction.\n\nSo the answer to this question is A"}
{"instruction": "Internal fistula is most common between gall bladder and -\nA. Colon\nB. Duodenum Ist Pa\nC. Jejunum\nD. Transverse colon", "response": "Biliary fistula is a complication of gallstone (90% of Biliary fistulas are due to gallstone). The inflamed gall bladder becomes adherent to adjacent stomach, duodenum, colon and necrosis develops at the site leading to the development of fistulas. Most common site of fistula is duodenum 2nd most common site is colon. Ref : Hamilton Bailey, 10/e, p 432\n\nSo the answer to this question is B"}
{"instruction": "The position of hand during application of POP cast for fracture scaphoid has been clasically described as\nA. Boat shaped position\nB. Clenched fist position\nC. Tumbler holding position\nD. Boxing position", "response": "In Scaphoid fracture, the cast is applied to maintain dorsi-flexion of the wrist area. This is called the Glass holding position/Tumbler holding position. In Colle&;s fracture, POP is applied to keep it in palmar flexion and ulnar detion. This is called Shake hand position. ref : maheswari 9th ed\n\nSo the answer to this question is C"}
{"instruction": "Spinal cord compression may be caused by ?\nA. Cysticercosis\nB. Ankylostomiasis\nC. Echinoccus Granulosus\nD. Visceral larva migrans", "response": "Ans. is 'a' i.e., Cysticercosis Amongst the given options spine is involved only in cysticercosis.\n\nSo the answer to this question is A"}
{"instruction": "A 70-year-old man presented to medicine emergency with worsening cough and difficulty in breathing especially at night. On physical examination, raised JVP is noted with bipedal edema. Abdominal examination reveals hepatomegaly. USG was done which reveals hepatomegaly ms. 16.8 cm. USG guided biopsy was carried out. The patient could not be resuscitated. The gross and HPE is shown below. What is the most common eitiology for the patient's clinical condition? Right hea failure Hepatitis A Riedel lobe of liver Metabolic disease of liver.\nA. Right hea failure\nB. Hepatitis A\nC. Riedel lobe of liver\nD. Metabolic disease of liver.", "response": "Nutmeg liver: Centri-lobular region is depressed (cell death) with adjacent parenchymal accentuation giving this appearance. HPE: Centri-lobular hemorrhage, with variable degree of hepatocyte necrosis and drop outs. Most common cause is right hea failure (increases IVC pressure, that increases central venous pressure and congestion in liver) and left hea failure ( hypoperfusion and ischemia) Right-sided hea failure leads to passive congestion of the liver. On gross examination: liver is mildly enlarged and cyanotic. It often has rounded edges. Microscopically there is congestion of centrilobular sinusoids. Later, hepatocytes become atrophic, resulting in markedly attenuated liver cell plates. Left-sided hea failure or shock: causes liver hypoperfusion and hypoxia, leading to ischemic coagulative necrosis of hepatocytes in the central region of the lobule which is the centrilobular necrosis. Clinically evident as transient elevation of serum aminotransferases or jaundice\n\nSo the answer to this question is A"}
{"instruction": "An elderly male admitted for pneumonia presents with diarrhoea and gripping abdominal pain five days after discharge from hospital. Drug which is likely to benefit is\nA. Imodium\nB. Metronidazole\nC. Diphenoxylate\nD. Levofloxacin", "response": "The macrolides (especially azithromycin) and the respiratory quinolones are now the antibiotics of choice and are effective as monotherapy. Compared with erythromycin, the newer macrolides have superior in vitro activity, display greater intracellular activity, reach higher concentrations in respiratory secretions and lung tissue, and have fewer adverse effects. The pharmacokinetics of the newer macrolides and quinolones also allow once- or twice-daily dosing. Quinolones are the preferred antibiotics for transplant recipients because both macrolides and rifampin interact pharmacologically with cyclosporine and tacrolimus Ref Harrison 19th edition pg 1017\n\nSo the answer to this question is D"}
{"instruction": "All are true regarding Plummer Vinson syndrome,except -\nA. Oesophageal web\nB. Predisposes to malignancy\nC. Koilongchia\nD. Common in elderly males", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Earliest & characteristic radiological finding of leukemia\nA. Translucent transverse metaphyseal bands\nB. Metaphyseal Osteosclerosis\nC. Periosteal reaction\nD. Metaphyseal cortical erosions", "response": "All the above are the findings of leukemia. But Earliest & characteristic finding is option A.\n\nSo the answer to this question is A"}
{"instruction": "A 52-year-old woman presents with polyuria, polydypsia, constipation, and fatigue. She has no significant past medical history, and she is not on any medications. She was recently diagnosed with hyperparathyroidism.Select the characteristic ECG findings.\nA. shortened PR interval\nB. lengthened PR interval\nC. lengthened QU interval\nD. shortening of the QT interval", "response": "With severe hypercalcemia, the QT interval is markedly shortened. There is a correlation between the length of QT interval and the degree of hypercalcemia.\n\nSo the answer to this question is D"}
{"instruction": "Kartagener's syndrome is characterized by all EXCEPT\nA. Dextrocardia\nB. Bronchiectasis\nC. Bronchitis\nD. Sinusitis", "response": "(Bronchitis) (11, 18-LT) (409-Maqbool 1lth)Kartagener's syndrome (immobile cilia). These patients have a constantly runny nose, secretory otitis media, chronic sinusitis, bronchiectasis and often sinus inversus (Dextrocardia) Cystic fibrosis of pancreas.\n\nSo the answer to this question is C"}
{"instruction": "Variation in eruption in permanent dentition\nA. 4-5 months\nB. 7-9 months\nC. 1-2 months\nD. 12-18 months", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Anti - T.T.G. antibodies are seen in:\nA. Giardia malabsorption\nB. Gluten enteropathy\nC. Lactose deficient\nD. Bile acid malabsorption", "response": "Anti-endomysial antibodies of the immunoglobulin A (IgA) type can detect celiac disease with a sensitivity and specificity of 90% and 99%, respectively. Serology for anti-T.T.G antibodies was initially repoed to have a higher sensitivity (99%) and specificity (>90%) for identifying coeliac disease. However, it is now thought to have similar characteristics to anti-endomysial antibody. Modern anti-TTG assays rely on a human recombinant protein as an antigen. TTG testing should be done first as it is an easier test to perform\n\nSo the answer to this question is B"}
{"instruction": "Which of the following features on mammogram would suggest malignancy?\nA. Well defined lesion\nB. A mass of decreased density\nC. Areas of spiculated microcalcifications\nD. Smooth borders", "response": "Ans. is 'c' i.e. Areas of spiculated microcalcifications Distinguishing features between benign and malignant lesions on mammogram:- BenignMalignantOpacitySmooth marginIII defined margin, Irregular stellate, spiculated margin, comet tail Low densityHigh density HomogeneousIn homogeneous Thin halowide haloCalcificationMacrocalcification (> 5mm inMicrocalcification (< 5 mm in diameter)diameter)Breast ParenchymaNormalArchitectural distortionNipple/areola+- Retracted+- RetractedSkinNormalthickenedCooper ligamentsNormalthickened, increase numberDuctsNormalfocal dilatationSubcutaneous retro mammary spaceNormalobliterated\n\nSo the answer to this question is C"}
{"instruction": "A 45-year-old man presents to his physician with hematuria. Renal biopsy demonstrates a focal necrotizing glomerulitis with crescent formation. The patient has a history of intermittent hemoptysis and intermittent chest pain of moderate intensity. A previous chest x-ray had demonstrated multiple opacities, some of which were cavitated. The patient also has chronic cold-like nasal symptoms. Which of the following is the most likely diagnosis?\nA. Aspergillosis\nB. Polyaeritis nodosa\nC. Renal carcinoma metastatic to the lung\nD. Wegener's granulomatosis", "response": "While in real life, other diseases (or combinations of diseases) may occasionally cause concurrent pulmonary, sinus, and renal involvement, if you see this pattern on a test question, you should immediately think of Wegener's granulomatosis. This is a rare focal necrotizing vasculitis of still unclear etiology, which also features prominent granulomas, some of which are centered on the vascular lesions. The vasculitis and granulomatous can involve the entire respiratory tract, and an easily obtained nasal biopsy may sometimes yield the diagnosis. The renal involvement is usually in the form of a necrotizing glomerulonephritis. The disease typically affects middle aged men, and its formerly poor prognosis has been improved by coicosteroid and cyclophosphamide therapy. Note: Aspergillosis can cause prominent lung disease, but does not usually have renal involvement. Polyaeritis nodosa is a possibility, but usually spares the lungs. Renal cell carcinoma might cause lung nodules, but there is no evidence of tumor in the kidney.\n\nSo the answer to this question is D"}
{"instruction": "Otolith organs are concerned with the function of?\nA. Oculovestibular reflex\nB. Rotary nystagmus\nC. Linear acceleration\nD. Angular acceleration", "response": "Otolith organs: Utricle and saccule are the otolith organs. Their Sensory epithelium is called maculae.\nThey are concerned with linear acceleration-deceleration. They sense the position of the head with respect to gravity. Otoliths: They are crystals of calcium carbonate located on the otolithic membrane present in the maculae. Also called the otoconia.\n\nSo the answer to this question is C"}
{"instruction": "Difference between postmoem staining and contusion are all, except: PGI 10; NEET 14\nA. Bluish in color\nB. Disappear on pressure\nC. Margins are regular\nD. Extravasation is found", "response": "Ans. Extravasation is found\n\nSo the answer to this question is D"}
{"instruction": "Non-immune hydrops fetalis is due to all except :\nA. Chromosome defect\nB. Alpha thalassemia major\nC. Parvo B - 19 virus\nD. ABO incompatibility", "response": "ABO incompatibility\n\nSo the answer to this question is D"}
{"instruction": "A 24-year-old woman presents 6 months after the delivery of her first child, a healthy girl, for evaluation of fatigue. She suspects that the fatigue is related to getting up at night to breastfeed her baby, but she has also noticed cold intolerance and mild constipation. She recalls having a tremor and mild palpitations for a few weeks, beginning 3 months after delivery. On examination, her BP is 126/84 and her pulse rate is 56. The thyroid gland is two times normal in size and nontender. The rest of the physical examination is normal. Laboratory studies reveal a free T4 level of 0.7 ng/mL (normal 0.9-2.4) and an elevated thyroid-stimulating hormone (TSH) at 22 microU/mL (normal 0.4-4). What is the likely course of her illness?\nA. Permanent hypothyroidism requiring lifelong replacement therapy\nB. Eventual hyperthyroidism requiring methimazole therapy\nC. Recovery with euthyroidism\nD. Infertility", "response": "This patient has postpartum thyroiditis, a condition that follows 5% to 8% of all pregnancies. Like other forms of destructive thyroiditis (including subacute or de Quervain thyroiditis), this illness is triphasic. Initially there is hyperthyroidism due to inflammation and release of preformed thyroid hormone from the inflamed follicles; this phase usually lasts 2 to 4 weeks. In subacute thyroiditis, the initial phase is usually noticed because of pain and tenderness over the thyroid gland, but in postpartum thyroiditis the thyroid is usually painless, and the hyperthyroid phase may be overlooked. This phase is then followed by transient hypothyroidism, usually lasting 1 to 3 months. The third phase is resolution and euthyroidism. Whereas Hashimoto thyroiditis usually leads to permanent autoimmune hypothyroidism, most patients with destructive thyroiditis have a full recovery. Some will be symptomatic enough to require thyroid supplementation for 1 to 3 months until the process resolves. Although the initial hyperthyroid phase can suggest Graves' disease, in thyroiditis the absence of infiltrative ophthalmopathy and a suppressed radioiodine uptake will make the distinction.Antithyroid drug treatment of thyroiditis is ineffective and puts the patient at unnecessary risk of toxicity such as agranulocytosis. Although hypothyroidism can cause amenorrhea and hence impair fertility, the hypothyroid phase of postpartum thyroiditis is transient. Low-level radiation exposure, but not thyroiditis, increases the risk of subsequent development of thyroid cancer. Interestingly, therapeutic radioactive iodine, such as is given for Graves' disease, does not increase the long-term risk of cancer, probably because the thyroid cells are destroyed.\n\nSo the answer to this question is C"}
{"instruction": "The incisor over-jet is increased for a class II case that is undergoing treatment. The reason is\nA. Loss of anchorage\nB. Arch collapse\nC. Crowding in the lower arch\nD. None of the above", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "What is the most common ECG finding for pulmonary embolism?\nA. Sinus tachycardia\nB. S1 Q3 T3\nC. T wave inversion\nD. Epsilon waves", "response": "M/C ECG abnormality in pulmonary embolism- Sinus tachycardia M/C symptom is unexplained breathlessness. Screening test - D-dimer test. Most specific finding is S1Q3T3. The classic findings of right hea strain and acute cor pulmonale are tall, peaked P waves in lead II (P pulmonale); right axis detion; right bundle-branch block and S1Q3T3 pattern.\n\nSo the answer to this question is A"}
{"instruction": "The mechanism that protects normal pancreas from autodigestion is :\nA. Secretion of biocarbonate.\nB. Protease inhibitors present in plasma.\nC. Proteolytic enzymes secreted in inactive form.\nD. The resistance of pancreatic cells.", "response": "Ans. is 'c' i.e. proteolytic enzymes secreted in inactive form The pancreatic enzymes have the capability of digesting the pancreas itself (mainly proteases)(Auto digestion of pancreas is considered to be the main pathogenic mechanism for pancreatitis)Normally, auto digestion of pancreas is prevented by several means :The enzymes are synthesized as inactive pro enzymes (with the exception of amylase and lipase)They are sequestered in membrane bound zymogen granules in acinar cellsActivation of pro enzymes requires conversion of inactive trypsinogen to active trypsin by duodenal enteropeptidaseTrypsin inhibitors are present within acinar and ductal secretionsIntra pancreatic release of trypsin activates an enzyme or enzymes that degrades other enzymes to inert products.Lysosomal enzymes are capable of degrading zymogen granules when normal acinar secretion is impaired or blocked.Acinar cells are remarkably resistant to the action of trypsin, chymotrypsin and phospholipase A2Regarding option V pancreatic enzymes require alkaline medium for their activity so bicarbonate secretion will help in their activity.\n\nSo the answer to this question is C"}
{"instruction": "Vertebral plana is a finding in a child with\nA. Hyperparathyroidism\nB. Osteomalacia\nC. Eosinophilic granuloma\nD. None of the above", "response": "Ans. (c) Eosinophilic granuloma.Vertebra plana or pancake vertebra is the term given when a vertebral body has lost almost its entire height anteriorly and posteriorly, representing a very advanced crush fracture. It can occur with a variety of settings, including:1. Trauma2. Osteoporosis3. Eosinophilic granuloma (LCH)4. Osteogenesis imperfecta5. Leukemia6. Vertebral metastases7. Multiple myeloma8. Lymphoma9. Osteomyelitis\n\nSo the answer to this question is C"}
{"instruction": "Not states responsibility -\nA. Enpower women\nB. Protect children against exploitation\nC. Protect children from abuse\nD. Raising level of nutrition", "response": "Ans. is 'a' i.e., Enpower women State responsibility The responsibility for health does not end with the individual and community effo. In all civilized societies, the state assumes responsibility for the health and welfare of its citizens. The consititution of india provides that health is a state responsibility. The relevant poions are to be found in the directive principles of state policy, which are as below - The state shall, in paicular, direct the policy towards securing - ...that the health and strength of workers, men and women and the tender age of children are not abused and that citizens are not forced by economic necessity to enter ovocations unsuited to their age or strength. ...that childhood and youth are protected against exploitation and against moral and material abandonment. The state shall, within the limits of its economic capacity and development, make effective provision for secruring the right to work, to education and to public assistance in cases of unemployment, old age, sickness and disablement, and in other cases of undesrved want. The state shall make provision for securing just and humane conditions of work and maternity relief The state shall regard the raising of the level of nutrition and standard of living of its people and the improvement of public health as among its primary duties. -- The constitution of India; Pa IV\n\nSo the answer to this question is A"}
{"instruction": "Which of the following drug is not a component of triple drug therapy for helicobacter pylori: March 2008\nA. Lansoprazole\nB. Clarithromycin\nC. Metronidazole\nD. Cimetidine", "response": "Ans. D: Cimetidine Triple therapy is considered to be the standard treatment for children. A proton pump inhibitor combined with two antibiotics has been shown to be very effective in clearing H pylori from the stomach. The current recommendation is treatment with amoxicillin, clarithromycin, and a proton pump inhibitor (lansoprazole) for 2 weeks.\n\nSo the answer to this question is D"}
{"instruction": "Propoional moality rate is :-\nA. Rate\nB. Ratio\nC. Propoion\nD. None", "response": "Propoional Moality Rate (PMR) x 100. Numerator is a pa of the denominator & expressed in %. Hence, it is a propoion. Rate Ratio Propoion IMR Incidence Crude death rate MMR Sex ratio Relative risk Prevalence Case fatality rate Survival rate Propoional moality rate\n\nSo the answer to this question is C"}
{"instruction": "Thyroxine can be given in which thyroid carcinoma: September 2009\nA. Papillary\nB. Medullary\nC. Anaplastic\nD. Undifferentiated", "response": "Ans. A: Papillary On the basis that most of the tumours are TSH depedent it is a standard practice to prescribe thyroxine for all patients after operation for differentiated thyroid carcinoma (papillary and follicular type) to suppress endogenous TSH production.\n\nSo the answer to this question is A"}
{"instruction": "Most common cause of abortion in first trimester is-\nA. Genetic\nB. Maternal\nC. Immunologic\nD. Anatomic abnormalities", "response": "Ans. is 'a' i.e., GeneticCauses of first trimester abortiono Genetic: Majority (50%) of the early miscarriages are due to the chromosomal abnormality of the conceptus.Autosomal trisomy is the commonest cytogenetic abnonnality. Trisomy 16 is the most common.o Endocrine and metabolic (10 - 15%)Luteal phase defect, deficient progesterone, thyroid abnormalities, diabetes mellitus. o Anatomical abnormalities (10 - 15%)Cervico - uterine factors (mostly related to second trimester abortion) - cervical incompetence and congenital malformation of the uterus.o Infections: (5%)Can cause early as well as late abortions.o Immunological disorders (5- 10 %)o Blood group incompatibilityo Premature rupture of membraneso Environmental: Cigarette smoking, alcoholo Unexplained.\n\nSo the answer to this question is A"}
{"instruction": "The enzyme marker of electron transpo system is\nA. Cytochrome reductase\nB. Fumarase\nC. Pyruvate\nD. Malate dehydrogenase", "response": "Complex III: CoQ-Cyt.C Reductase Functions as * Proton pump, and * Catalyses transfer of electrons SECTION TWO This system catalyses transfer of electrons from CoQ.H2 to Cyt-c Cyt-b and Cyt-c1. The electrons from CoQ.H2 is first accepted by Cyt-b566 and then transferred to Cyt-b562, which reduces Co.Q.H2 CoQ Fe+++ accepts electron and is oxidised to Fe++. The system also acts as a proton pump. It is believed that 4 (four) protons are pumped across the mitochondrial membrane during the oxidation. The energy change permits ATP formation (Site II). Role of Q cycle and Rieske FeS in complex III Electrons are passed from Q.H2 to cytochrome C complex III-Q cytochrome C oxidoreductase: Q. H2 + 2 Cyt C + 2H+ - Q + 2 CytC + 4H+ Oxidised matrix reduced membrane space The process is believed to involve cytochromes C1, b1 and bHH and a Rieske FeS. Rieske FeS is an unusual FeS in which one of the Fe atoms is linked to two histidine -SH groups rather than two cysteine -SH groups and is called as the Q cycle. Q may exist in three forms: * Oxidised quinone, * Reduced quinol, or * Semiquinone. The semiquinone is formed transiently during the cycle, one turn of which results in the oxidation of 2Q.H2 to Q, releasing 4H+ into the intermembrane space, and the reduction of one Q to QH2, causing 2H+ to be taken up from the matrix. Note It is to be noted that while Q carries two electrons, the cytochromes carry only one, thus the oxidation of one Q.H2 is coupled to the reduction of two molecules of cytochrome C the Q. cycle. Other options are not paicipating in ETC.Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition, page no: 142\n\nSo the answer to this question is A"}
{"instruction": "Side effects of a drug arise due to interactions of the drug to molecules other than the target.These effects of the,drug can be minimized by its high:\nA. Specificity\nB. Solubility\nC. Affinity\nD. Hydrophobicity", "response": "If a drug is more specific in action, it acts only in that paicular organ so no systemic side effects will be seen and targeted cancer therapy using nanopaicles is also bases on this approach Ref; KD Tripathi pharmacology 7 th edition (page no; 84)\n\nSo the answer to this question is A"}
{"instruction": "Adenocarcinoma cervix is associated with all, except:\nA. HPV 11\nB. HPV 16\nC. HPV 18\nD. HPV 51", "response": "HPV strains for carcinoma cervix are HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56 & 58 Ref: Novak's Gynaecology, 14th Edition, Page 568\n\nSo the answer to this question is A"}
{"instruction": "In Indoor air pollution, carbon monoxide is produced by\nA. Combustion equipment\nB. Stove\nC. Gas heaters\nD. All of the above", "response": "(All of the above) (593 - Park 19th) (642-Park 20th)Sources of Indoor air pollutantsPollutantSources* Respirable particle* Carbon monoxide* Nitrogen - dioxide* Sulphur dioxide* Formaldehyde* Ozone* Radon and daughters* Asbestos* Mineral fibresTobacco smoke, stove, Aerosol spraysCombustion equipment, stove, Gas heatersGas cookers, cigarettesCoal combustionParticle board, carpet adhesives insulationElectric arcing, UV light sourcesBuilding materialInsulation, fire proofingAppliances\n\nSo the answer to this question is D"}
{"instruction": "Which is not heterophile agglutination test?\nA. Weil-Felix test\nB. Widal test\nC. Paul-Bunnel, test\nD. Streptococcus MG", "response": "Ans. (b) Widal Test Ref. Ananthanarayan 8/e, p 93 The same or closely related antigen may sometimes occur in different biological species/classes, etc. It is called heterogenetic or heterophile antigen, e.g. Forssman antigen for Pneumococcus, Salmonella. Weil Felix reaction (between proteus and Rickettsia). Paul Bunnell test in infectious mononucleosis. Cold agglutination test in primary atypical pneumonia. Streptococcus MG agglutination. Antigen between E. coli and human RBC of B. Remember Widal test is tube agglutination test.\n\nSo the answer to this question is B"}
{"instruction": "A man comes to emergency depament after alcohol binge the previous night and sleeping on arm chair. In the morning he is unable to move his hand and diagnosis of ulnar palsy is made. What is the next line of management?\nA. Knuckle bender splint\nB. Do EMG study after 2 days\nC. Immediately operate and explore the nerve\nD. Wait and watch", "response": "The first procedure to be adopted in every case of nerve injury is to splint the limb in position which will most effectively relax the affected muscles. Since this patient has developed ulnar nerve palsy Knuckle bender splint should be used. Here EMG after 2 days is useless since changes begin to appear in EMG after 2 weeks of a nerve injury. Also there is no need of open exploration since in a case of neurapraxia transmission of impulses is physiologically interrupted for some time, but recovery is complete in a few days or weeks. Splints used for various nerve injuries: Axillary nerve paralysis : Aeroplane splint Radial nerve palsy : Cock up splint Sciatic or common peroneal nerve palsy : Foot drop splint\n\nSo the answer to this question is A"}
{"instruction": "What is the color-coding of bag in hospitals to disposeoff human anatomical wastes such as body pas -\nA. Yellow\nB. Black\nC. Red\nD. Blue", "response": "Ans. is 'a' i.e., Yellow Human anatomical wastes such as human tissues, organs, and bodv pas are classified as Waste Category No. 1 They are disposed in 'plastic bags' with a 'yellow color code' and treated by 'Incineration or deep burial'.\n\nSo the answer to this question is A"}
{"instruction": "Remission with SSRI or TCA patient again havingrelapse. There may be deficiency of ?\nA. Pyridoxine\nB. Cobalamine\nC. Ascorbate\nD. Retinol", "response": "Ans. is `b' i.e., Cobalamine Subjects with vitamin B 12deficiency and depression may present with history of past episodes with spontaneous remission or response to treatment with antidepressants and later recognition or development Budeficiency\" Studies have found that some people with depression may have low levels of folic acid, vitamin B12 or vitamin D.\n\nSo the answer to this question is B"}
{"instruction": "Drug of choice for Acute Adrenal Crisis is:\nA. Norepinephrine\nB. Hydrocoisone\nC. Dexamethasone\nD. Fludrocoisone", "response": "Answer is B (Hydrocoisone): The treatment of choice for acute adrenal insufficiency is Glucocoicoid Replacement Therapy. Hydrocoisone is the preferred steroid fir Glucocoicoid replacement therapy in acute adrenal crisis since it has both glucocoicoid and mineralocoicoid actions. In cases where the diagnosis of acute adrenal insufficiency is suspected (not confirmed) Dexamethasone is preferred as the initial steroid of choice because Dexamethasone does not compete with the coisol assay. 'Glucocoicoid replacement should be initiated by bolus injection of 100 mg Hydrocoisone, followed by the administration of 100-200mg hydrocoisone over 24 hours either by continuous infusion or provided by several IV or IM Injections. Mineralocoicoid replacement can be initiated once the daily hydrocoisone dose has been reduced to less than 50 mg because at higher doses hydrocoisone provides sufficient stimulation of glucocoicoid receptors'\n\nSo the answer to this question is B"}
{"instruction": "Which of the following statements about mollaret meninigitis is true -\nA. Caused by herpes simplex 2 in most of the cases\nB. Is a recurrent, benign septic meningitis\nC. Is also referred to as4 'Benign recurrent neutrophilic meningitis\"\nD. Does not resolve without treatment", "response": "Ans. is 'a1 i.e., Caused by herpes simplex 2 in most of the cases Recurrent (Mollaret 's ') meningitiso Mollaret s meningitis is a form of recurrent benign lymphocytic meningitis (RBLM), an uncommon illness characterized by greater than three episodes of fever and meningismus lasting two to five days, followed by spontaneous resolution.There is a large patient-to-patient variation in the time course to recurrence that can vary' from weeks to years.One-half of patients can also exhibit transient neurological manifestations, including seizures, hallucinations, diplopia, cranial nerve palsies, or altered consciousness.o The most common etiologic agent in Mollaret's meningitis is HSV-2\n\nSo the answer to this question is A"}
{"instruction": "Bimodal distribution is seen in -\nA. Thyroid carcinoma\nB. Hodgkins lymphoma\nC. Renal carcinoma\nD. Liver carcinoma", "response": "Ans. is 'b' i.e., Hodgkins lymphoma * One important phenomenon in age distribution is bimodality, i.e. some disease show two peaks in different age groups. Diseases showing bimodality are Hodgkin's disease, leukaemia, and female breast cancer.\n\nSo the answer to this question is B"}
{"instruction": "Broca's area situated in:\nA. Inferior frontal gyrus\nB. Superior temporal gyrus\nC. Angular gyrus\nD. None of the above", "response": "Ans. a. Inferior frontal gyrusMotor speech area of Broca (areas 44 and 45 of Brodmann)The motor speech area of Broca is located in the pars triangularis (area 45) and pars opercularis (area 44) of inferior frontal gyrus of frontal lobe of left hemisphere (dominant hemisphere) in most of the individuals, and the persons are right handed.However, in 30% cases it is present in the right hemisphere and persons are left handed.Brocas area is responsible for the production of expressive speech/vocalization.It brings about the formation of words by its connections with the adjacent primary motor area, which in turn appropriately stimulate the muscles of the larynx, mouth, tongue, soft palate, and the respiratory muscles.It connected to Wernicke speech area by the arcuate fasciculus.Broca AphasiaResults from lesions in Broca speech area.Also called motor, expressive, nonfluent, or anterior aphasia.Causes patients to speak slowly (nonfluent) and with effort; however, they have good comprehension of spoken and written language.Frequently accompanied by contralateral weakness of the lower face and arm and a sympathetic apraxia of the left hand (the inability to write with the nonparalyzed hand).\n\nSo the answer to this question is A"}
{"instruction": "Which one of the following is not included in Jone's Major criteria aEUR'\nA. Pan carditis\nB. Chorea\nC. Subcutaneous nodule\nD. High ESR", "response": "High E.S.R. * The Jones criteria for rheumatic fever: Major criteria Minor cieria * Carditise * Migratory polyahritise * Sydenham's chorea0 * Subcutaneous nodulese * Erythema marginaturne Clinical * Fever0 * Ahralgiae Laboratory * Elevated acute phase reactants0 * Prolonged PR interval PLUS * Suppoing evidence of a recent group A Streptococcal infection (e.g. positive throat culture or rapid antigen detection test; and or elevated or increasing streptococcal antibody test).\n\nSo the answer to this question is D"}
{"instruction": "Maximum dose of lignocaine given with adrenaline for infiltration anaesthesia is:\nA. 3 mg/kg\nB. 5 mg/kg\nC. 7 mg/kg\nD. 10mg/kg", "response": "KD Tripathi essentials of medical pharmacology; edition7 ;pgs no-368 Dilute solutions or LA is infiltrated under the skin in the areas of operation-blocks sensory nerve endings.onset of action is almost immediate and duration is shoer than that after nerve block, e.g.lidocaine 30-60 min, bupivacaine 120-180 min. Infiltration is used for minor operations, e.g. incisions,excisions, hydrocele, herniorrhaphy, etc. when the area to be anaesthetized is small. Relatively large amount of LA is required compared to the area anaesthetised, but motor function is not affected\n\nSo the answer to this question is C"}
{"instruction": "Veebral level of body of sternum is\nA. T3 to T4\nB. T4 to T5\nC. T5 to T7\nD. T5 to T9", "response": "Veebrae level of body of sternum is T5-T9. Ref - medscape.com\n\nSo the answer to this question is D"}
{"instruction": "Name the condition in which blood by passes the liver through an abnormal connection between poal vein and hepatic vein\nA. Sturge weber syndrome\nB. Abernethy Malformation\nC. Couvorier syndrome\nD. Stockholm syndrome", "response": "Congenital absence of the poal vein (CAPV) is a rare malformation of the splanchnic venous system. No gross anatomical connections between the poal and the hepatic veins within the liver normally. In CAPV, blood carried by the superior mesenteric vein and splenic vein bypasses the liver and drains into a systemic vein and it is known as 'The Abernethy Malformation'.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is not a pa of Kubler Ross Stages of impending death?\nA. Depression\nB. Bargain\nC. Aggression\nD. Anger", "response": "Aggression REF: Kaplan & Sadock's Synopsis of Psychiatry: 10th Edition, page 62, 63 Stages of Death and Dying:Elisabeth Kubler-Ross, M.D. (July 8, 1926 - August 24, 2004) was a Swiss-born psychiatrist, a pioneer in Near-death studies and the author of the groundbreaking book On Death and Dying (1969), where she first discussed what is now known as the Kiibler-Ross modelStage 1: Shock and DenialStage 2: AngerStage 3: BargainingStage 4: DepressionStage 5: Acceptance\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is true regarding gastrulation:\nA. Establishes all the three germ layers\nB. Occurs at the caudal end of the embryo prior to its cephalic end.\nC. Involves the hypoblastic cells of inner cell mass\nD. Usually occurs at 4 weeks", "response": "A i.e. Establishes all 3 germ layers in embryo\n\nSo the answer to this question is A"}
{"instruction": "The highest malignant potential is seen in -\nA. Crohn's disease\nB. Ulcerative colitis\nC. Familial polyposis\nD. Infantile polyp", "response": "“Colorectal cancer develops in 100% of untreated FAP patients often before the age of 30”.\n\nSo the answer to this question is C"}
{"instruction": "A 45-year-old woman presents with a 6-month history of fatigue and swelling in her neck. Physical examination shows a goiter. A CBC discloses megaloblastic anemia and a normal reticulocyte count. Additionally, there is an elevated serum level of TSH and antithyroid antibodies. Needle aspiration of the left lobe of the thyroid reveals benign follicular cells and numerous lymphocytes. Anemia in this patient is most likely caused by antibodies directed to which of the following targets?\nA. Chief cells\nB. Intrinsic factor\nC. Paneth cells\nD. TSH receptor", "response": "This patient has chronic lymphocytic thyroiditis (Hashimoto thyroiditis) and pernicious anemia. Pernicious anemia is a megaloblastic anemia that is caused by malabsorption of vitamin B12 due to a deficiency of the intrinsic factor. In many cases, pernicious anemia is associated with other autoimmune diseases (e.g., Hashimoto thyroiditis, Graves disease, Addison disease, or diabetes mellitus type 1). Circulating antibodies to parietal cells, some of which are cytotoxic in the presence of complement, occur in 90% of patients with pernicious anemia. Two thirds of patients display an antibody to the intrinsic factor that prevents its combination with vitamin B12 thereby preventing formation of the complex that is later absorbed in the ileum. Half of all patients with pernicious anemia have circulating antibodies to thyroid tissue.Diagnosis: Pernicious anemia, Hashimoto thyroiditis\n\nSo the answer to this question is B"}
{"instruction": "Best test to differentiative between medical and surgical jaundice is\nA. Akaline phosphatase\nB. Bilirubin and serum enzymes\nC. Enzymes\nD. Ultrasound", "response": "Investigations for Obstructive Jaundice 1. Serum bilirubin. A normal value is less than 1.0 mg%. Both direct and indirect bilirubin are assessed. Direct is increased in obstructive jaundice, i.e. conjugated hyperbilirubinaemia. van den Bergh's test is done. 2. Serum albumin, globulin and A: G ratio. Normal S. albumin is more than 3.5 gm%. 3. Prothrombin time. A normal value is 12-16 seconds. It is significant if it is more than 4 from the control or more than one and half times the control. It is corrected by injection vitamin K, 10 mg IM OD for 5 days or by FFP--5-10 units. 4. Serum alkaline phosphatase, SGPT, SGOT, 5' nucleotidase. 5. U/S abdomen. 6. ERCP to visualise the site of obstruction, brush biopsy, bile sample for analysis. 7. MRCP--Non-invasive diagnostic tool. Ref: SRB&;s manual of surgery,3 rd ed, pg no 588\n\nSo the answer to this question is D"}
{"instruction": "For which of the following has the cytoxic effect of vitamin on human lymphocytes in vitro at high concentration been repoed -\nA. Vitamin A\nB. Vitamin D\nC. Vitamin E\nD. Vitamin K", "response": "VITAMIN E (Tocopherol) Vitamin E is the generic name for a group of closely related and naturally occurring fat soluble compounds, the tocopherols. Of these alpha-tocopherol is biologically the most potent. Vitamin E is widely distributed in foods. By far the richest sources are vegetable oils, cotton-seed, sunflower seed, egg yolk and butter. Foods rich in polyunsaturated fatty acids are also rich in vitamin E. The usual plasma level of vitamin E in adults is between 0.8 and 1.4 mg per 100 ml. While there is no doubt that man requires tocopherol in his diet, there is no clear indication of dietary deficiency. The role of vitamin E at the molecular level is little understood. The current estimate of vitamin E requirement is about 0.8 mg/g of essential fatty acids. This roughly works out to 8-10 mg tocopherol per day depending on the edible oil used. Recently the cytotoxic effect of vitamin E on human lymphocytes in vitro at high concentrations has been repoed. This being so, caution should be exercised against the mega-dose consumption of vitamin E in clinical practice. Ref : Park 25th edition Pgno : 657\n\nSo the answer to this question is C"}
{"instruction": "Cause of clostridium difficle associated diarrhea ?\nA. Trauma\nB. Dairy products\nC. Fried rice\nD. Antibiotic use", "response": "Ans. is 'd' i.e., Antibiotic use\n\nSo the answer to this question is D"}
{"instruction": "Which of the following passes through the foramen magnum -\nA. Vertebral Artery\nB. Sympathetic chain\nC. XIth cranial nerve\nD. Internal carotid Artery", "response": "Structures passing through foramen magnum are :\n\n\nAnterior part:- Apical ligament of dens, membrane tectoria, vertical band of the cruciate ligament.\nPosterior part:- the Lowest part of the medulla oblongata, three meninges (dura, arachnoid and pia mater).\nSubarachnoid space:- Spinal accessory nerves, vertebral artery and sympathetic plexus around it, posterior spinal arteries, anterior spinal arteries.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not a treatment method for fissure in ano?\nA. Sitz bath\nB. Botox injection\nC. Diltiaem gel\nD. Seton’s procedure", "response": "Seton’s procedure is done for fistula in ano.\n\nSo the answer to this question is D"}
{"instruction": "All of the following mechanisms might account for a reduce-risk of upper genital tract infection in users of progestin - releasing lUDs, except:\nA. Reduced retrograde menstruation\nB. Decreased ovulation\nC. Thickened cervical mucus\nD. Decidual changes in the endometrium", "response": "Decreased ovulation does not protect from upper genital tract infection. Also it doesn't inhibit ovulation in all women. THE TEXTBOOK OF GYNAECOLOGY SHEILA BALAKRISHNAN SECOND EDITION PAGE NO 379\n\nSo the answer to this question is B"}
{"instruction": "Infective endocarditis is not seen in one of the following condition :\nA. PDA\nB. ASD\nC. TOF\nD. VSD", "response": "Ans. is 'b' Atrial Septal defect .Repeat\n\nSo the answer to this question is B"}
{"instruction": "The Epwoh scale is used for assessing -\nA. Body mass index\nB. Vital capacity in post-operative patients\nC. Sleep apnea\nD. Risk of embolism in perioperative patient", "response": "Answer- C. Sleep apneaThe Epwoh Sleepiness Scale-Obstructive sleep apneaNarcolepsyIdiopathic hypersomnia\n\nSo the answer to this question is C"}
{"instruction": "All of the following are true of pulmonary embolism except:\nA. Sudden onset of pleuritic pain and hemoptysis and hypotension.\nB. ECG shows evidence of acute left ventricular stress.\nC. Pulmonary angiography is gold standard\nD. CTPA is imaging modality of choice", "response": "Classic Findings in Pulmonary Embolism:- Right Hea strain and Acute Cor Pulmonale - sudden onset of pleuritic chest pain, hemoptysis and hypotension - Tall, peaked P waves in lead II (P pulmonale) - Right axis detion - Right bundle-branch block - S1Q3T3 pattern. On Xray :- Hampton's hump, Westermark sign (areas of relative oligemia secondary to decreased caliber of regional pulmonary aeries) and Palla's sign (Enlarged right descending pulmonary aery )are seen. - CTPA is imaging modality of choice - It shows Rt. ventricular stress instead of left ventricular stress.\n\nSo the answer to this question is B"}
{"instruction": "A patient committed suicide by shooting a bullet into his right temple. On post-moem examination, the skull was burst open. There was charring and cherry red discoloration along the track of bullet and the weapon was firmly clasped in the right hand of deceased. The bullet was fired from what distance\nA. Contact shot\nB. Close shot at a distance of one feet from hand\nC. Shot within range of smoking\nD. Shot within range of tattooing", "response": "Ans. a. Contact shot In a contact shot, the discharge from the muzzle, consisting of flame, powder grains, metallic paicles, and hot gases are blown into the track of the bullet. This leads to charring of the track inside and pink coloration owing to formation of carboxyhemoglobin. Gases entering the track in a contact shot are under high pressure, which may lead to 'bursting fracture' of skull\n\nSo the answer to this question is A"}
{"instruction": "A 17 year old female presented with primary amenorrhea, well developed breast and scanty axillary and pubic hair. ultrasonography of the patient shows absence of the uterus and vagina. Genotype of the patient is most likely to be:\nA. 46 XX\nB. 45 XO\nC. 46 XY\nD. 47XXY", "response": "Patient has Testicular-feminizing syndrome. It is most common form of male intersex. Genotype is 46 XY There are functional testes which secrete androgens but since there is androgen insensitivity, external feminisation occurs In this external genitalia appears female breast are well developed, clitoris is normal in size axillary and pubic hair are scanty, due to insensitivity to androgen NOTE: the answer could also have been MRKH with XX normal karyotype, however, scanty pubic hair points more towards androgen insensitivity, in MRKH breast development, axillary and pubic hair are normal\n\nSo the answer to this question is C"}
{"instruction": "Dabigatran toxicity is treated by\nA. Protamine sulphate\nB. Andexanet alfa\nC. Idarucizumab\nD. Argatroban", "response": "Idarucizumab is a monoclonal antibody used to treat Dabigatran toxicity.\n\nSo the answer to this question is C"}
{"instruction": "Swelling of deep lobe of parotid gland presents as swelling in:-\nA. Parapharyngeal space\nB. Cheek\nC. Temporal region\nD. Below the ear", "response": "Swelling of deep lobe of parotid gland presents as swelling in parapharyngeal space. The parotid gland is the most common site for salivary tumours. Most tumours arise in the superficial lobe and present as slow-growing, painless swellings below the ear, in front of the ear or in the upper aspect of the neck. Less commonly, tumours may arise from the accessory lobe and present as persistent swellings within the cheek. Rarely, tumours may arise from the deep lobe of the gland and present as a parapharyngeal mass. Symptoms include difficulty in swallowing and snoring. Clinical examination reveals a diffuse firm swelling in the soft palate and tonsil.\n\nSo the answer to this question is A"}
{"instruction": "A 45-year-old woman who smokes is found to have a splenic artery aneurysm. It was most likely caused by:\nA. Atherosclerosis\nB. Trauma\nC. Medial dysplasia\nD. Pancreatitis", "response": "Splenic artery aneurysms in women are almost always caused by medial dysplasia of the artery. It may be the cause of rupture in pregnancy and can be life-threatening if not treated promptly by laparotomy. Aneurysms may be caused by atherosclerosis, trauma, and pancreatitis (when complicated by pseudocyst formation). Portal hypertension is not a cause of aneurysm.\n\nSo the answer to this question is C"}
{"instruction": "Most common type of bladder cancer is\nA. Squamous cell carcinoma\nB. Urothelial carcinoma\nC. Adenocarcinoma\nD. Carcinoid", "response": "Types of bladder cancers*Epithelial tumours: (95%)*Urothelial ( Transitional ) carcinomas- Most common*Squamous cell carcinoma*Adenocarcinoma Rare types*Small cell carcinoma*Mesenchymal tumours: (5%)*Sarcomas\n\nSo the answer to this question is B"}
{"instruction": "Oral incretin analogue\nA. Semaglutide\nB. Dulaglutide\nC. Exenatide\nD. Liraglutide", "response": "GLP analogues are usually given by SC route but now recently oral analogue was prepared-semaglutide. Ref: Ktzung 12 th ed.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following variables is measured on the ordinal scale-\nA. Type of anemia\nB. Severity of anemia\nC. Hemoglobin\nD. Serum ferritin", "response": "When data is ranked e.g. mild, moderate, severe → ordinal scale is used. Therefore the severity of anemia is measured on the ordinal scale.\nType of anemia can be divided into qualitative categories (Macrocytic/microcytic, hemolytic/non-hemolytic) → Nominal scale is used.\nSerum ferritin and hemoglobin are quantitative variables with a possible absolute zero value → Ratio scale is used.\n\nSo the answer to this question is B"}
{"instruction": "Brain contains which neurotransmitter:\nA. Tyrosine\nB. Glutamate\nC. Serine\nD. Tryptophan", "response": "Ans. (b) GlutamateRef.: Lange medical physiology by Ganong 23rd ed., ch. 15* Glutamate is the most abundant excitatory neurotransmitter in the vertebrate nervous system.* At chemical synapses, glutamate is stored in vesicles. Nerve impulses trigger release of glutamate from the presynaptic cell. Glutamate acts on ionotropic and metabotropic (G-protein coupled) receptors.* Because of its role in synaptic plasticity, glutamate is involved in cognitive functions such as learning and memory in the brain.* Excitotoxicity due to excessive glutamate release and impaired uptake occurs as part of the ischemic cascade and is associated with stroke, autism, some forms of intellectual disability, and diseases such as amyotrophic lateral sclerosis, lathyrism, and Alzheimer's disease.* In contrast, decreased glutamate release is observed under conditions of classical phenylketonuria\n\nSo the answer to this question is B"}
{"instruction": "Incubation period of scabies is:\nA. 7 days\nB. 2 weeks\nC. 4 weeks\nD. 2-3 days", "response": "Scabies - Causative agent: Sarcoptes Scabies Var Hominis Incubation Period: 3-4 weeks after the infection is acquired. If pt. reinfested- ICP is 2 days\n\nSo the answer to this question is C"}
{"instruction": "Diuretic that is useful in mild to moderate hypertension is:\nA. Loop diuretics\nB. Thiazides\nC. Osmotic diuretics\nD. Potassium sparing diuretics", "response": "Ans. (B) Thiazides(Ref: Harrison 19th/e p1623)Thiazides are not only diuretics of choice for mild to moderate hypertension but also the first line antihypertensive drugs in these patients.\n\nSo the answer to this question is B"}
{"instruction": "A 13 year old male patient complains of pain in upper front teeth region and gives a history of fall on the ground while playing. Intra-oral examination reveals grade I mobility with maxillary left central incisor. Radiologic finding is suggestive of root fracture with 21. Which of the following could be the least favourable form of repair for this tooth?\nA. Healing with calcified tissue\nB. Healing with interposition of connective tissue, in which the fractured root surfaces are covered by cementum with connective tissue fibers joining the two fragments.\nC. Healing with interposition of bone and connective tissue, in which a bony bridge and connective tissue are positioned between the fragments.\nD. Interposition of granulation tissue", "response": "Root fractures that occur in the apical half of the tooth are more likely to undergo repair. Fractures in the apical third are often repaired without treatment. In fact, many apparently are undetected until evidence of a calcified repair is seen radiographically sometime after the injury.\nAndreasen has described four tissue reactions after root fracture: \n(1) Healing with calcified tissue, which is characterized by a uniting callus of hard tissue that may consist of dentin, osteodentin, or cementum.\n(2) Healing with interposition of connective tissue, in which the fractured root surfaces are covered by cementum with connective tissue fibers joining the two fragments.\n(3) Healing with interposition of bone and connective tissue, in which a bony bridge and connective tissue are positioned between the fragments.\n(4) Interposition of granulation tissue. \nThe last is the least favorable form of attempted repair, and the fracture will not heal spontaneously. \nThe teeth usually present unfavorable symptoms that may be accompanied by fistulas resulting from necrosis of the coronal portion and also sometimes the apical portion of the pulp. These teeth require follow-up endodontic treatment or extraction.\n\nSo the answer to this question is D"}
{"instruction": "Affinity chromatography deals with the\nA. Specific binding of a protein constituents for another molecule\nB. Protein - protein interaction\nC. Protein - carbohydrate interaction\nD. None of the above", "response": "Methods for Separating and Purifying Biomolecules1Salt fractionation (eg, precipitation of proteins with ammonium sulfate)Chromatography: Paper, ion exchange, affinity, thin-layer, gas-liquid, high-pressure liquid, gel filtrationElectrophoresis: Paper, high-voltage, agarose, cellulose acetate, starch gel, polyacrylamide gel, SDS-polyacrylamide gelUltracentrifugationAffinity chromatography exploits the high selectivity of most proteins for their ligands. Enzymes may be purified by affinity chromatography using immobilized substrates, products, coenzymes, or inhibitors. In theory, only proteins that interact with the immobilized ligand adhere. Bound proteins are then eluted either by competition with free, soluble ligand or, lessselectively, by disrupting protein-ligand interactions using urea, guanidine hydrochloride, mildly acidic pH, or high salt concentrations. Commercially available stationary phase matrices contain ligands such as NAD+ or ATP analogs. Purification of recombinantly expressed proteins is frequently facilitated by modifying the cloned gene to add a new fusion domain designed to interact with a specific matrix-bound ligand\n\nSo the answer to this question is A"}
{"instruction": "Cold agglutinins are seen in?\nA. Influenza\nB. PAN\nC. Multiple myeloma\nD. SLE", "response": "Ans is 'a' i.e. Influenza Cold agglutinin hemolytic anemiao This form of hemolytic anemia is caused by cold agglutinin IgM antibodies. Antibodies react with RBC at 0deg to 4degC. Both intravascular and extravascular hemolysis may occuro Causes of cold agglutinin immunohemolytic anemiaMycoplasma infection, IMN, CMV, Influenza, HIV, Malignant lymphoma.Important causes of warm antibody autoimmune hemolytic anemiao Autoimmune disorders - SLE, RA, Ulcerative colitis, Scleroderma, Antiphospholipid antibodieso Chronic lymphocytic leukemia (CLL), Hodgkin disease, Non-Hodgkin lymphomao Multiple myelomao Thymomao Drugs - Methyldopa, penicillin, Cephalosporine, quinidine.o PAN\n\nSo the answer to this question is A"}
{"instruction": "In atresia of cardiac end of stomach, X-ray chest is best done with:\nA. Conray 240\nB. Urograffin\nC. Barium sulphate\nD. Dianosil", "response": "Ans. Dianosil\n\nSo the answer to this question is D"}
{"instruction": "All are true about emphysema except:\nA. Cyanosis\nB. Barrel-shaped chest\nC. Associated with smoking\nD. Type 1 respiratory failure", "response": "OPTION A) CLINICAL FEATURE OF EMPHYSEMA SYMPTOMS; The three most common symptoms in COPD are cough, sputum production, and exeional dyspnea. Activities involving significant arm work, paicularly at or above shoulder level, are paicularly difficult for many patients with COPD . the principal feature is worsening dyspnea on exeion with increasing intrusion on the ability to perform vocational or avocational activities. In the most advanced stages- patients are breathless doing simple activities of daily living. CLINICAL FEATURE OF COPD - EMPHYSEMA The classic presentation of emphysema with no \"bronchitic\" component. Patients barrel-chested and dyspneic, with prolonged expiration, sitting forward in a hunched-over position. In these patients, air space enlargement is severe and diffusing capacity is low. Dyspnea and hyperventilation are prominent, so that until very late in the disease, gas exchange is adequate and blood gas values are relatively normal. Because of prominent dyspnea and adequate oxygenation of hemoglobin, these patients sometimes are sometimes called \"pink puffers.\" CHRONIC BRONCHITIS -emphysema with pronounced chronic bronchitis and a history of recurrent infections. Dyspnea usually is less prominent, and in the absence of increased respiratory drive the patient retains carbon dioxide, becoming hypoxic and often cyanotic .such patients tend to be obese--hence the designation \"blue bloaters.\" OPTION 2) ON PHYSICAL EXAMINATION Early stages of COPD, patients usually have an entirely normal physical examination. More severe disease, the physical examination - prolonged expiratory phase and may include expiratory wheezing. Signs of hyperinflation 1) barrel chest and enlarged lung volumes with poor diaphragmatic excursion as assessed by percussion. 2)Patients with severe airflow obstruction -use of accessory muscles of respiration, sitting in the characteristic \"tripod\" position to facilitate the actions of the sternocleidomastoid, scalene, and intercostal muscles. 3 CYANOSIS if emphysema with chronic bronchitis Patients may develop cyanosis, visible in the lips and nail beds. 4) SIGN OF ADVANCED COPD cachexia ,significant weight loss, bitemporal wasting, anddiffuse loss of subcutaneous adipose tissue. Clubbing of the digits is not a sign of COPD. The development of lung cancer is the most likely explanation for newly developed clubbing. OPTION C) RISK FACTORS CIGARETTE SMOKING AIRWAY RESPONSIVENESS AND COPD RESPIRATORY INFECTIONS OCCUPATIONAL EXPOSURE. D)COMPLICATION OF COPD- progressive disease is marked by the development of pulmonary hypeension, sometimes leading to cardiac failure, recurrent infections; and ultimately respiratory failure.\n\nSo the answer to this question is A"}
{"instruction": "Epiglottitis in a 2-year-old child occurs most commonly due to infection with:\nA. Influenza virus\nB. Staphylococcus aureus\nC. Haemophilus influenzae\nD. Respiratory syncytial virus", "response": "Though the introduction of Hib vaccine has reduced the annual incidence of acute epiglottitis but still most of the pediatric cases seen today are due to haemophilus influenzae B. --Harrison 17th/ed p212 In adults it can be caused by group A streptococcus, S. pneumoniae, S. aureus and Klebsiella pneumoniae\n\nSo the answer to this question is C"}
{"instruction": "Placental abnormality related to PPH is-\nA. Placenta accreta\nB. Placenta percreta\nC. Retained placental\nD. All the above", "response": "Ans. is 'd' i.e., All the above Causes of Post partum hemorrhage (PPH)o Atonic - 80% commonesto Traumatico Retained tissueso Blood coagidopathyConditions which contribute to the development of atonic PPHo Grand multiparao Overdistention of uteruso Malnutrition and anemiao Antepartum hemorrhageo Prolonged labouro Anesthesiao Iniatiation or augmentation of the delivery by oxytocino Malformation of the uteruso Uterine fibroido Mismanaged third stage of labouro Placenta: morbidly adherent placenta (accrete, percreta), partially or completely separately separated placenta but with retained bits of placental tissue leads to PPH.o Precipitate labour\n\nSo the answer to this question is D"}
{"instruction": "Complications of tuberular meningitis include all except-\nA. Hydrocephalus\nB. Cortical venous thrombosis\nC. Cerebral Artery Thrombosis\nD. Cranial Nerve Palsy", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "The paraneoplastic syndrome associated with Hodgkin's disease is -\nA. Nephrotic syndrome\nB. Retinopathy\nC. Cerebellar degenerative disease\nD. Acanthosis nigricans", "response": "Ans. is 'c' i.e., Cerebellar degenerative disease CNS Paraneoplastic syndromes:SyndromeTargetTumour* Subacute cerebellar degenerationPurkinje cellHodgkin lymphoma, Breast, Ovary, Small cell Ca lung, Neuroblastoma* Limbic encephalitisVarious neuronsSCLC, Neuroblastoma* Brainstem encephalitisIn mesial temporal lobe, brainstemTesticular, others* Subacute sensoryDorsal root ganglionSCLC,neuropathyneuronNeuroblastoma* Opsoclonus myoclonusUnknown (presumed brain stem)Neuroblastoma,Breast* Retinal degenerationPhotoreceptorsSCLC* Stiff-man syndromeSpinal interneuronBreast* Lambert-Eaton myasthenic syndromePresynaptic terminals at neuromuscular junctionSCLC\n\nSo the answer to this question is C"}
{"instruction": "Insulin resistance in pregnancy is because of:\nA. Human placental lactogen\nB. Progesterone\nC. Estrogen\nD. All the above", "response": "During pregnancy, insulin levels are increased because of increased insulin secretion as well as increase in insulin resistance due to number of contra insulin factors. These are Estrogen Progesterone Human placental lactogen Coisol Prolactin The main hormone responsible for insulin resistance is HPL. Ref:Dutta Obs 9e pg 55.\n\nSo the answer to this question is D"}
{"instruction": "The origin of thyroglossal duct is\nA. Foramen caecum\nB. Tuberculum impar\nC. Rathke's pouch\nD. Rosenmuller's fossa", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Vi polysaccharide vaccine is a parenteral vaccine consisting of purified Vi polysaccharide from the bacterial capsule. Which of the following is TRUE statement regarding Vi polysaccharide vaccine?\nA. Has a high incidence of local reactions\nB. Has significant adverse effects\nC. Contraindicated in hepatitis\nD. Can be given along with yellow fever and hepatitis vaccines", "response": "Both the oral (Ty21a) and parenteral (Vi polysaccharide) vaccines are well tolerated, and adverse reactions are uncommon and usually self-limited. Vi polysaccharide vaccine can be given with other vaccines such as Meningococcal, Hepatitis B, Tetanus, Yellow fever and Hepatitis A. There is no contraindication other than prior severe reactions to vaccine components. Ref: Daley M.F., O'Leary S.T., Simoes E.A., Nyquist A. (2011). Chapter 9. Immunization. In W.W. Hay, M.J. Levin, J.M. Sondheimer, R.R. Deterding (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 20e.\n\nSo the answer to this question is D"}
{"instruction": "Which of these doesn't present with granulomatous Vasculitis?\nA. Polyarteritis nodosa\nB. Wegeners\nC. Churg strauss syndrome\nD. Microscopic polyangitis", "response": "Ans. (d) Microscopic polyangitisRef: Harrison 19th ed. / 2186* MPA is characterized by pauci-immune, necrotizing, small vessel vasculitis without clinical or pathological evidence of granulomatous inflammation* The family of vasculitic granulomatoses comprise# Wegener s granulomatosis# Necrotising sarcoidal granulomatosis# Churg-Strauss syndrome# Lymphomatoid granulomatosis# Polyarteritis nodosa# Bronchocentric granulomatosis# Giant cell arteritis# Systemic lupus erythematosus.\n\nSo the answer to this question is D"}
{"instruction": "A patient presents with Thrombocytopenia, eczema and recurrent infection. The most probable diagnosis is:\nA. Wiskott Aldrich syndrome\nB. Chediak-Higashi syndrome\nC. Job's syndrome\nD. Bruton's Agammaglobulinemia", "response": "Answer is A (Wiskott Aldrich syndrome) Thrumbocytopenia, Eczema and Recurrent Infections (Immunodeficiency) represents the charachteristic triad of Wiskott - Aldrich syndrome.\n\nSo the answer to this question is A"}
{"instruction": "True about end plate potential (EPP) is:-\nA. It occurs as a result of altered permeability for Na+ and K+\nB. It is a self-regenerative change\nC. It results from release of a single transmitter vesicle\nD. It exhibits all-or-none propey", "response": "Non-specific cation channel (same channels allow Na+ to come in & same channel allows K+ to go out) are acetylcholine-gated channels which opens and causes the electrical potential inside the fiber at the local area of the end plate to increase in the positive direction as much as 50 to 75 millivolts, creating a local potential called the end plate potential. EPP is a graded response. It doesn't obey all or none propey. Its amplitude decreases over distance and it can be summated. EPP develops conves into one AP. This action potential then travels.\n\nSo the answer to this question is A"}
{"instruction": "Wolff-chaikoff effect is ?\nA. Reduced thyroxine synthesis by radiotherapy\nB. Reduced thyroxine synthesis by propylthiouracil\nC. Reduced thyroxine synthesis by iodides\nD. None of the above", "response": "Ans. is 'c' i.e., Reduced thyroxine synthesis by iodides Iodine and Iodides Iodine is the fastest acting thyroid inhibitor. Most impoant action is inhibition of hormone release (thyroid constipation); but all facets of thyroid synthesis may be affected. Excess iodide inhibits its own transpo in thyroid cells and may alter the redox potential of cells, thus interfering iodination -reduced TIT3 synthesis ( Wolffichaikoff effect).\n\nSo the answer to this question is C"}
{"instruction": "Schwannoma of 8th cranial nerve site is\nA. Intra — petrous\nB. Intracanalicular\nC. Cisternal\nD. Parotid", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "ORS contains how much potassium -\nA. 20\nB. 30\nC. 40\nD. 10", "response": " ORS Aim of oral rehydration therapy is to prevent dehydration and reduce moality. Oral fluid therapy is based on the observation that glucose given orally enhances the intestinal absorption of salt and water and is capable of correcting electrolyte and water deficit. At first the composition of oral rehydration salt recommended by WHO was sodium bicarbonate based. Inclusion of trisodium citrate in place of sodium bicarbonate made the product more stable and it resulted in less stool output especially in high output diarrhoea, probably because of direct effect of trisodium citrate in increasing intestinal absorption of sodium and water. More recently an improved ORS formulation has been developed which is safe and effective as the original in preventing and treating diarrhoeal dehydration. It is focussed on reducing the osmolarity of ORS solution to avoid adverse effects of hypeonicity on net fluid absorption by reducing the concentration of glucose and sodium chloride in the solution. Decreasing the sodium concentration of ORS solution to 75 mOsm/l improved the efficacy of ORS regimen for children with acute non cholera diarrhoea. Reduced osmolarity ORS:-(g/L) Sodium chloride- 2.6 Glucose,anhydrous- 13.5 Potassium chloride- 1.5 Trisodium citrate,dihydrate-2.9 Total =20.5 g/L Reduced osmolarity ORS:-(mmol/L) Sodium-75 Chloride-65 Glucose,anhydrous-75 Potassium-20 Citrate-10 Total = 245 mmol/L {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.224} -Krukenberg tumor is diagnosed only if it conforms to the following pattern ; Almost bilateral Smooth surfaces Freely mobile in pelvis It retains the shape of normal ovary. The tumors are secondary growth in the ovary and most often arise from a primary carcinoma of the stomach(70%). Histologically, the tumor has a cellular or myxomatous stroma amongst which are scattered large signet ring cells. Reference : Shaw&;s textbook of gynaecology, 16th edition, pg no:524 <\\p>\n\nSo the answer to this question is A"}
{"instruction": "Excessive eating of non-nutritive substances is known as?\nA. PICA\nB. Anorexia nervosa\nC. Bulimia\nD. Trichoteliomania", "response": "Ans. a (PICA). (Ref. O.P Ghai, 6th/pg.p 58)PICA# PICA is a disorder involving repeated or chronic ingestion of non-nutritive substances including plaster, charcoal, clay, wood, ashes and earth.# PICA after 2nd year of life needs to be investigated.# MR, lack of parental nurturing, autism, and behavior disorders like Kleine-Terin syndrome, family disorganization, low socioecomy.# Geophagia (earth eating) is seen with pregnancy.# Here patient develops craving for substance such as- Starch (amylophagia),- Ice (pagophagia) &- Clay (geophagia) these symptoms are peculiar i.e. Characteristic of iron deficiency.# Some of these materials such as starch & clay bind iron in the gastrointestinal tract, worsening the deficiency.# The basis of this bizarre behavior is unknown.# A particularly invidious consequence of iron deficiency, is increased by intestinal absorption of lead.# Children from impoverished families who often have both iron deficiency & pica are at greatest risk of developing lead poisoning.# The toxicity of lead is at least in part due to a disruption of hemesynthesis in neural tissue, a process abetted by iron deficiency.# Thus, these children are at increased risk of lead poisoning, iron deficiency anemia and parasitic infection.\n\nSo the answer to this question is A"}
{"instruction": "Torsades de pointes causes ?\nA. Eide QRS\nB. Short QRS\nC. Wide QT\nD. Short QT", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Cretinism is -\nA. Dispropoionate dwarfism\nB. Sho stature with long trunk\nC. Sho stature with sho trunk\nD. Long stature with long trunk", "response": "Ans. is 'a' i.e., Dispropoionate dwarfism Note - Patient has sho stature with sho limbs.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is known to be severely pruritic?\nA. Lichen planus\nB. Psoriasis\nC. Icthyosis\nD. Secondary syphilis", "response": "Purple polygonal papules marked by severe pruritus; lacy white markings, especially associated with mucous membrane lesions is feature of lichen planus. Psoriasis is variably pruritic. Icthyosis: characterised by severe dryness, fish like scales. There are 5 P in Lichen Planus:Plain, Purple, Polygonal, Pruritic, Papule/ Plague\n\nSo the answer to this question is A"}
{"instruction": "Crescents are characteristic of\nA. Membranous nephropathy\nB. PSGN\nC. MPGN\nD. RPGN", "response": "Crescents are histological characteristic of RPGN.\n\nSo the answer to this question is D"}
{"instruction": "In PT test, the addition of Ca2+ & tissue thromboplastin activates which pathway?\nA. Extrinsic\nB. Intrinsic\nC. Fibrinolytic\nD. Common", "response": "Ans. (a) ExtrinsicTo PT we add of Ca2+ & tissue thromboplastin which activates extrinsic pathway, while to test for aPTT we add kaolin, silica which activates intrinsic pathway.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not an exception to Meyer Oveon rule\nA. Non anaesthetics\nB. Non immobilizer\nC. cut off effect\nD. Hydrophobic site", "response": "Meyer-Oveon correlation of anesthetic potency with solubility in olive oil interpreted by the majority of researchers as an indicator that lipids are likely the anesthetic target. This interpretation focused attention on anesthetic effects on the bulk physical propeies of cell membranes, which were known at that time to consist primarily of lipid molecules. Such nonspecific or \"lipoid-based\" anesthetic theories dominated the field from the 1960s to the 1980s. Moreover, the simple elegance of the relationship between MAC and lipid solubility graphically illustrated Meyer and Oveon's conclusion that \"All chemically indifferent substances that are soluble in fat are anesthetics ... their relative potency as anesthetics will depend on their affinity to fat on the one hand and water on the other hand, that is, on the fat/water paition coefficient. This was interpreted as oring lipids as the primary targets of anesthetics and a single nonspecific theory to explain anesthesia. Objections to the outdated lipid hypotheses: 1. Stereoisomers of an anesthetic drug Stereoisomers that represent mirror images of each other are termed enantiomers or optical isomers (for example, the isomers of R-(+)- and S-(-)-etomidate). Physicochemical effects of enantiomers are always identical in an achiral environment (for example in the lipid bilayer). However, in vivo enantiomers of many general anesthetics (e.g. isoflurane, thiopental, etomidate) can differ greatly in their anesthetic potency despite the similar oil/gas paition coefficients. For example, the R-(+) isomer of etomidate is 10 times more potent anesthetic than its S-(-) isomer 2. Non-immobilizers According to the Meyer-Oveon correlation, the anesthetic potency of the drug is directly propoional to its lipid solubility, however, there are many compounds that do not satisfy this rule. These drugs are strikingly similar to potent general anesthetics and are predicted to be potent anesthetics based on their lipid solubility, but they exe only one constituent of the anesthetic action (amnesia) and do not suppress movement (i.e. do not depress spinal cord functions) as all anesthetics do. These drugs are referred to as non-immobilizers. 3. Temperature increases do not have an anesthetic effect 4. Effect vanishes beyond a ceain chain length According to the Meyer-Oveon correlation, in a homologous series of any general anesthetic (e.g. n-alcohols, or alkanes), increasing the chain length increases the lipid solubility, and thereby should produce a corresponding increase in anesthetic potency. However, beyond a ceain chain length, the anesthetic effect disappears. For the n-alcohols, this cutoff occurs at a carbon chain length of about 13 and for the n-alkanes at a chain length of between 6 and 10, depending on the species. 5. Non-hydrophobic anesthetics. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e\n\nSo the answer to this question is D"}
{"instruction": "Selective alpha 2 agonist is\nA. Tizanidine\nB. Prazosin\nC. Adrenaline\nD. Propanolol", "response": "Ref: HL Sharma 3rd ed pg no:180 Clonidine, methyldopa, tizanidine, relminidine are central alpha 2 agonists\n\nSo the answer to this question is A"}
{"instruction": "Hypospadias in the baby is caused by maternal use of which of the following drug?\nA. Diethylstilbestrol\nB. Tolbutamide\nC. Clomiphene\nD. Clobazam", "response": "Clomiphene is antiestrogens. It can cause hypospadias in the baby- in which the opening of the urethra is on the underside of the penis instead of at the tip Clomiphene, a drug used to induce ovulation, is chemically related to diethylstilbestrol (DES). DES is associated with vaginal adenocarcinoma among daughters and with hypospadias among second-generation male offspring. (REF. Essentials of medical pharmacology K D TRIPATHI 6 Edition, Page No 312)\n\nSo the answer to this question is C"}
{"instruction": "Antibody mediated enhancement is a feature of\nA. Yellow fever\nB. Dengue heomorrhagic fever\nC. Omsk heomorrhagic fever\nD. Japanese encephalitis", "response": "Antibody mediated enhancement is non-neutralizing antibody produced against the first serotype will combine, cover and protect the second serotype from host immune responce.seen in dengue hemorrhagic fever.\n\nSo the answer to this question is B"}
{"instruction": "In direct pulp capping cases most important for the formation of dentinal bridges by dentinogenesis is:\nA. Calcium hydroxide and pulp interaction.\nB. Extracellular Matrix.\nC. De occlusion of involved teeth.\nD. Lack of pulpal inflammation.", "response": "Though there is no direct reference in book about dentinal bridge formation but bridge formation definitely occurs only after interaction between calcium hydroxide & cells of pulp tissue.\n\nSo the answer to this question is A"}
{"instruction": "MC orbital tumor in adult is -\nA. Nerve sheath tumor\nB. Hemangioma\nC. Lymphoma\nD. Meningioma", "response": "Ans. is 'b' i.e., Hemangiomao Most common orbital tumor- Cavernous hemangioma.o Most common malignant orbital tumor- Lymphoma.IMPORTANT FACTSo Most common intraocular tumor in adults is metastasis. Metastasis is particularly common from carcinoma of breast and lung.o Most common primary intraocular tumor in adults is uveal melanoma. Most of the uveal malignant melanoma arise in choroid.o Most common primary intraocular tumor is children is retinoblastomao Most common orbital tumors in adults are benign vascular tumors - Cavernous hamangiomao Most common malignant orbital tumor in adult - lymphomao Most common orbital tumors in children are benign tumors - Dermoid cyst > capillary hemangiomao Most common malignant orbital tumor in children - rhabdomyosarcomao Overall most common primary malignant tumor of eye is malignant melanoma followed by retinoblastomao Most common malignant eyelid tumor - Basal cell carcinomao Most common epithelial tumor of lacrimal gland - Pleomorphic adenoma (benign mixed tumor)o Overall most common tumor of lacrimal gland Lymphoid tumour and inflammatory pseudo - tumorso Most common malignant tumor of conjunctiva - Squamous cell carcinomao Most common malignant tumor of cornea - Squamous cell carcinoma\n\nSo the answer to this question is B"}
{"instruction": "Chalazion of lid is:\nA. Caseous necrosis\nB. Chronic nonspecific inflammation\nC. Chronic lipogranulomatous inflammation\nD. Liposarcoma", "response": "Chronic lipogranulomatous inflammation\n\nSo the answer to this question is C"}
{"instruction": "Administrative unit of ICDS project in rural area is\nA. PHC\nB. Community development block\nC. Zilla parishad\nD. Gram panchayat", "response": "The administrative unit of an ICDS project is the community development block in rural areas, the tribal development block in tribal areas and a group of slums in urban areas.Park 23e pg: 592\n\nSo the answer to this question is B"}
{"instruction": "Claviceps fusiformis is responsible for\nA. Neurolatyrism\nB. Ergotism\nC. Epidemic dropsy\nD. Endemic ascites", "response": "Ergot Unlike Aspergillus, ergot is not a storage fungus, but a field fungus. Foodgrains such as bajra, rye, sorghum, and wheat have a tendency to get infested during the flowering stages by the ergot fungus (Claviceps purpurea). Fungus grows as a blackish mass and the seeds become black and irregular and are harvested along with food grains. Consumption of ergot infested grain leads to ergotism. Sporadic outbreaks of ergot poisoning in human population have been repoed from time to time in areas where bajra is consumed as a staple. The symptoms are acute but rarelyfatal and include nausea, repeated vomiting, giddiness and drowsiness extending sometimes for periods upto 24 to 48 hours after the ingestion of ergoty grain. In chronic cases, painful cramps in limbs and peripheral gangrene due to vasoconstriction of capillaries have been repoed. However, the long-term effects of consuming small amounts of the Toxin are not known. A disquieting feature is that the recently introduced high-yielding varieties of bajra are more susceptible to infestation. Ergot-infested grains can be easily removed by floating them in 20 per cent salt water. They can also be removed by hand-picking or air floatation. The upper safe limit for the ergot alkaloids has been estimated to be 0.05 mg per 100 grams of the food material. Ref: Park 25th edition Pgno : 694\n\nSo the answer to this question is B"}
{"instruction": "Winging of scapula is seen in paralysis of which muscle-\nA. Serratus anterior\nB. Supraspinatus\nC. Pectoralis major\nD. Infraspinatus", "response": "Ans. is 'a' i.e., Serratus anterior Winging of scapulao In this condition the vertebral border of scapula becomes more prominent when patient tries to push against wall.o It occurs in paralysis of the serratus anterior muscle in long thoracic nerve palsy.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not true, regarding abutment selection for overdenture fabrication?\nA. Abutment should have healthy periodontal tissues\nB. If bone loss is present, teeth should not be selected as overdenture abutments\nC. A circumferential band of attached gingiva should be present\nD. If a tooth has grade III mobility, it should not be selected as overdenture abutment", "response": "If mild to moderate bone loss is present, change in crown:root ratio can make the tooth suitable as an overdenture abutment.\n\nSo the answer to this question is B"}
{"instruction": "The most common type of tracheoesophageal fistula is\nA. Esophageal atresia with out tracheosophageal fistula\nB. Esophageal atresia with proximal tracheosophageal fistula\nC. Esophageal atresia with distal tracheoesophageal fistula\nD. Esophageal atresia with proximal and distal tracheosophageal fistula", "response": "The most common type of TRACHEO-OESOPHAGEAL FISTULA(TOF) is Atresia with distal TOF constituting 85% of all. It is also known as type C according to Gross classification of TOF. Reference : SRB's Manual of Surgery, 6th Edition, page no = 794.\n\nSo the answer to this question is C"}
{"instruction": "Persistent coarse crepitations in the chest are diagnostic of?\nA. Pulmonary TB\nB. Pulmonary edema\nC. Cavity lesion\nD. Bronchiectasis", "response": "Fine crackles Coarse crackles Soft, high-pitched and very brief Louder, lower in pitch and last longer Indicates an interstitial process- pulmonary fibrosis or congestive hea failure. Indicates an airway disease- bronchiectasis.\n\nSo the answer to this question is D"}
{"instruction": "False about Budd-Chiari syndrome\nA. Associated with coagulopathy\nB. Cirrhosis may occur\nC. Ascites may be present\nD. Hepatic aery involved", "response": "Budd-Chiari syndrome in its pure form consists of slowly developing thrombosis of the hepatic veins and the adjacent inferior vena cava . ETIOLOGY.: idiopathic in one third, in the remaining cases various causes associated with increased thrombotic tendencies are attributed to polycythaemia vera, paroxysmal nocturnal haemoglobinuria, oral contraceptives, pregnancy, postpaum state, intra-abdominal cancers (e.g. hepatocellular carcinoma), chemotherapy, radiation and myeloproliferative diseases. Formation of membranous webs, probably congenital or as a consequence of organised thrombosis, in the suprahepatic poion of inferior vena cava is another impoant cause. MORPHOLOGIC FEATURES. Grossly, the liver is enlarged, swollen, red-purple and has a tense capsule. Histologically, the changes in sudden hepatic vein occlusion are those of centrilobular congestion, necrosis and rupture of sinusoids into the space of Disse. In slowly developing thrombosis, the changes are more chronic and include fibrosing reaction in the centrilobular zone that may progress to cardiac cirrhosis. CLINICAL FEATURES : acute form -abdominal pain, vomiting, enlarged liver, ascites and mild icterus. chronic form - the patients present with pain over enlarged tender liver, ascites and other features of poal hypeension. The acute form of illness leads to acute hepatic failure and death, whereas in chronic form the patient may live for months to a few years. TEXT BOOK OF PATHOLOGY 6TH EDITION HARSH MOHAN PGNO.603 IMAGE REF:\n\nSo the answer to this question is D"}
{"instruction": "Transfer of genetic material by bacteriophage is -\nA. Transduction\nB. Transformation\nC. Transcription\nD. Integration", "response": "Ans. is 'a' i.e., Transduction Transduction* The transfer of a portion of DNA from one bacterium to another by a bacteriophage (virus).* Bacteriophages are viruses that parasite bacteria and consist of nucleic acid core and a protein coat.* Transduction may be1. Generalised - When it involves any segment of donor DNA2. Restricted - When a specific bacteriophage transduces only a particular genetic trait eg. prophage lambda in E coli K 12 (Gal +gene - Determines fermentation of galactose)* Transduction is not confined to transfer of chromosomal DNA, episomes and plasmid may also be transduced.* The plasmid determining penicillin resistance in staphylococci are transferred from cell to cell by transduction.* Transduction appears to be the most widespread mechanism of gene transfer among prokaryotes.* Transduction is an excellent tool for the genetic mapping of bacteria.* Transduction has been proposed as a method of genetic engineering in the treatment of some inborn errors of metabolism.Lysogenic conversion* In lysogenic conversion the phage DNA itself is the new genetic element as it becomes integrated with the bacterial host DNA with which it multiplies and is transferred to daughter cells, e.g. diptheriae corynebacterium.T ransformation* This is the transfer of genetic material through the agency of free DNA (May involve taking up of soluble DNA with host DNA and codes new species through the cell wall).* Transformation was the first example of genetic exchange (horizontal gene transfer) in bacteria to have been discovered.* It was demonstrated in Streptococcus pneumoniae by Griffith in 1928.* Other organisms in which transformation has been studied are Bacillus, Haemophilus and BPH.Conjugation* Bacterial conjugation is the transfer of genetic material between bacteria through direct cell to cell contact or through a bridge- like connection between two cells.* Conjugation is process where by a donor (male) bacterium makes physical contact with a recipient (female) bacterium.* Donor status is determined by the presence of plasmid.* This plasmid codes for specialized fimbria (sex pilus) and for self transfer.* Sex pilus (conjugation tube) helps in transfer of genetic material from male bacterium to female bacterium.* The plasmid is known as transfer factor (sex factor or fertility factor).* Plasmid may be Rfactor, which codes for transferable multiple drug resistance.* The DNA of the plasmid replicates during transfer so that each bacterium receives a copy - Recipient becomes donor and the donor retains its donor status.SummaryGene transfer in bacteriaa) Transformation-Transfer of genetic material through the agency of free DNA (may involve taking up soluble DNA fragments across their cell wall from other species).b) Transduction-Transfer of a portion ofDNA by bacteriophage (a virus).c) Conjugation-Transfer of genetic material by physical contact.d) Lysogenic conversion-Incorporation of phage DNA into host DNA.\n\nSo the answer to this question is A"}
{"instruction": "All are seen in Gigantism EXCEPT:\nA. Mental retardation\nB. Visceromegaly\nC. Large foot\nD. Cardiovascular damage", "response": "ANSWER: (A) Mental retardationREF: Harrisons 17th ed chapter 338In children and adolescents, initiation of GH hypersecretion prior to epiphyseal long bone closure is associated with development of pituitary gigantism,Soft tissue swelling results in increased heel pad thickness, increased shoe or glove size, ring tightening, characteristic coarse facial features, and a large fleshy nose.Other commonly encountered clinical features include hyperhidrosis, deep and hollowsounding voice, oily skin, arthropathy, kyphosis, carpal tunnel syndrome, proximal muscle weakness and fatigue, acanthosis nigricans, and skin tags.Generalized visceromegaly occurs, including cardiomegaly, macroglossia, and thyroid gland enlargement.The most significant clinical impact of GH excess occurs with respect to the cardiovascular system, Coronary heart disease, cardiomyopathy with arrhythmias, left ventricular hypertrophy, decreased diastolic function, and hypertension occur in about 30% of patients.Upper airway obstruction with sleep apnea occurs in more than 60% of patients and is associated with both soft tissue laryngeal airway obstruction and central sleep dysfunction,Diabetes mellitus develops in 25% of patients with acromegaly, and most patients are intolerant of a glucose load (as GH counteracts the action of insulin).Acromegaly is associated with an increased risk of colon polyps and mortality from colonic malignancy; polyps are diagnosed in up to one-third of patients\n\nSo the answer to this question is A"}
{"instruction": "Apoprotein for chylomicron remnant:-\nA. Apo E\nB. Apo C1\nC. Apo A2\nD. Apo A1", "response": "APOPROTEIN -PROTEIN PRESENT IN LIPOPROTEIN Lipoprotein Protein Chylomicron APO B48 Chylomicron remnant APO B48 + APO E VLDL APO B100 IDL APO B100 + APO E LDL APO B 100 + APO E HDL APO A, C, E\n\nSo the answer to this question is A"}
{"instruction": "Placenta previa should be suspected in 3rd trimester in case of\nA. Painless vaginal bleeding\nB. Unengaged Head\nC. Painful uterine bleeding\nD. Painful vaginal bleeding", "response": "Ans-A (Painless vaginal bleeding)Ref: William's Obstetrics, 23rd ed. chapter 35Placenta previa is used to describe a placenta that is implanted over or very near the internal cervical os.There are several possibilities: total placenta previa, marginal placenta previa, partial placenta previa.The most characteristic event in placenta previa is painless hemorrhage, which usually does not appear until near the end of the second trimester or after. However, bleeding may begin earlier, and some abortions may result from such an abnormal location of the developing placenta.Digital cervical examination is never permissible unless the woman is in an operating room with all the preparations for immediate cesarean delivery--even the gentlest digital examination can cause torrential haemorrhage.The simplest, safest, and most accurate method of placental localization is provided by transabdominal sonography. Accordingly, the average accuracy is 96 percent, and rates as high as 98 percent have been obtained. False-positive results are often a result of bladder distension. Therefore, scans in apparently positive cases should be repeated after emptying the bladder.Cesarean delivery is necessary in practically all women with placenta previa. Most often, a transverse uterine incision is possible. However, because foetal bleeding may result from a transverse incision into an anterior placenta, a vertical incision is sometimes employed. But, even when the incision extends through the placenta, maternal or fetal outcomes are rarely compromised.\n\nSo the answer to this question is A"}
{"instruction": "In Downs syndrome there is?\nA. Translocation\nB. Mutations\nC. Paternal nondisjunction\nD. Maternal nondisjunction", "response": "Ans. (d) Maternal nondisjunction(Ref: R 9th/pg 161)Down's syndrome is most commonly caused by Maternal nondisjunction Q > Translocation > Mosaicism\n\nSo the answer to this question is D"}
{"instruction": "Massive splenomegaly with pancytopenia -\nA. CLL\nB. Pure red cell aplasia\nC. CML\nD. Myelofibrosis", "response": "Ans. is 'd' i.e., Myelofibrosiso Massive splenomegaly is referred to as extension of spleen greater than 8 cm below the left costal margin or weight of spleen more than 1 Kg.o Causes of massive Splenomegaly are - CML Polycythemia vera Autoimmune hemolytic anemia Lymphomas Gaucher's disease Diffuse splenic hemangiomatosis Hairy cell leukemia CLL Myelofibrosis Sarcoidosiso Amongst these conditions pancytopenia is seen in i.e., massive splenomegaly with pancytopenia : - o Hairy cell leukemia Myelofibrosis Gaucher's disease\n\nSo the answer to this question is D"}
{"instruction": "Cresentic glomerular deposits are seen in -\nA. Wegener's granulomatosis\nB. Polyarteritis nodosa\nC. Thromboangiitis obliterans\nD. All of the above", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "A 42-year-old woman presents to the clinic complaining of dry skin, fatigue, and weight gain over the past 3 months. She is not on any medications and there is no significant medical history.On physical examination, her blood pressure is 110/70 mm Hg, pulse 52/min, and heart and lungs are normal. Her skin feels rough and dry, but the rest of the examination is normal. Her biochemistry is normal but the thyroid-stimulating hormone (TSH) level is 39 mU/L (0.5-5 mU/L). Which of the following is the most likely cause for her elevated TSH?\nA. trauma\nB. radioactive iodine ingestion\nC. autoimmune hypothyroidism\nD. parathyroid surgery", "response": "Autoimmune hypothyroidism is the most common cause of hypothyroidism in adults. It is several times more common in women than in men and occurs most often between the ages of 40 and 60. Post ablative hypothyroidism (radiation or surgery induced) can also occur if the patient has a history of thyroid surgery or neck radiotherapy. Medications such as amiodarone or lithium can also cause hypothyroidism as a side effect of their use if there is a history of such medication use.\n\nSo the answer to this question is C"}
{"instruction": "A patient presents with unconjugated hyperbilinibinemia and presence of urobilinogen in urine. Which amongst the following is the least likely diagnosis-\nA. Hemolytic jaundice\nB. Crigler Najjar syndrome type 1\nC. Gilbe s syndrome\nD. crigler najjar syndrome type 2", "response": "Hemolytic jaundice results from excessive RBC destruction.there is increased release of Hb that leads to overproduction of bilirubin. Hyperbilirubinemia develops whn the capacity of liver to conjugate large amt of bilirubin is exceeded. There is also increased urinary excretion of urobilinogen. Ref.Harsh mohan page no.598 6th edition\n\nSo the answer to this question is A"}
{"instruction": "Tensile strength of wound after laparoscopic cholecystectomy in a 30 years old woman depends upon:\nA. Replacement of type 3 collagen\nB. Extensive crosslinking of tropocollagen\nC. Macrophage activity/invasion\nD. Granulation tissue", "response": "The recovery of tensile strength results from the excess of collagen synthesis over collagen degradation during the first 2 months of healing, and, at later times, from structural modifications of collagen fibers (cross-linking, increased fiber size) after collagen synthesis ceases.\n\nSo the answer to this question is B"}
{"instruction": "The most potent and longest acting anaesthetic agent is :\nA. Dibucaine\nB. Tetracaine\nC. Bupivacaine\nD. Lignocaine", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "When do progesterone levels rise to their highest point during the female hormonal cycle?\nA. Between ovulation and the beginning of menstruation\nB. Immediately before ovulation\nC. When the blood concentration of LH is at its highest point\nD. When 12 primary follicles are developing to the antral Stage", "response": "The corpus luteum is the only source of progesterone production, except for minute quantities secreted from the follicle before ovulation. The corpus luteum is functional between ovulation and the beginning of menstruation, during which time the concentration of LH is suppressed below the level achieved during the preovulatory LH surge\n\nSo the answer to this question is A"}
{"instruction": "Unnatural sexual offences is/are - (\nA. Sodomy\nB. Adultery\nC. Rape\nD. Incest", "response": "Ref:Textbook of Forensic medicine and toxicology (V.V.Pillay) 17th edition, page no.404 As per sec.377IPC \"Whoever voluntarily has carnal intercourse against the order of nature with any man, woman,or animal shall be punished with imprisonment for life, or with imprisonment of either description for a term which may extend to ten years, and shall also be libale to fine.\"this section covers all offence which have come to be clubbed under the trem\"Unatural Sexual offences\".examples are sodomy, buccal coitus, bestiality etc.\n\nSo the answer to this question is A"}
{"instruction": "Most detrimental methods of brusing causing damage to tooth soft tissues and hard tissues is:\nA. Side to side\nB. Bass\nC. Up and down\nD. Roll", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Relaxation volume of lungs is equal to-\nA. FRC\nB. RV\nC. VC\nD. TLC", "response": "Ans. is 'a' i.e., FRC Relaxation volume* The relaxation volume is the volume of the relaxed respiratory system, i.e., the volume at which net elastic recoil of he total respiratory system is zero (the elastic recoil of chest wall is equal and opposite to that of lungs). In healthy subjects, this occurs at the end of quiet expiration, i.e., at functional residual capacity. Therefore, in healthy adults at rest FRC is essentially equal to relaxation volume of respiratory system and FRC is usually treated as synonymous with relaxation volume.* However, in real sense FRC and relaxation volume are not synonymous terms and, while the two volumes are some times equal, more often they are not, i.e., active or passive mechanisms often operate to make FRC different from relaxation volume. For example, neonates have a more compliant (less stiff) chest wall. The chest wall thus has less elastic recoil to balance that of lung, thus decreasing the relaxation volume of lung. FRC then is often maintained above relaxation volume by active mechanisms like inspiratory muscle activity and slowing of expiration.\n\nSo the answer to this question is A"}
{"instruction": "Saffron coloured meconium is seen in :\nA. Post maturity\nB. TB\nC. Breech\nD. Normal in appearance", "response": "Post maturity\n\nSo the answer to this question is A"}
{"instruction": "Micro Munro abscess is seen in\nA. Dermal tissue\nB. Stratum corneum\nC. Stratum basale\nD. Stratum malphigi", "response": "Munro micro abscesses are seen in psoriasis it is the collection of neutrophils in stratum corneum. IADVLtextbook of dermatology page 1041\n\nSo the answer to this question is B"}
{"instruction": "Neuromuscular disorder is related to which type of lung cancer?\nA. Adeno carcinoma\nB. Squamous cell carcinoma\nC. Small cell carcinoma\nD. Bronchoavelolar carcinoma", "response": "ANSWER: (C) Small cell carcinomaREF: Harrison 18th ed chapter 89, table 96-1\n\nSo the answer to this question is C"}
{"instruction": "Features of SLE include all of the following except:\nA. Recurent aboion\nB. Sterility\nC. Coomb's positive hemolytic anemia\nD. Psychosis", "response": "Answer is B (Sterility): Systemic Lupus Erythematosus. Recurrent Aboions in SLE may be seen as a manifestation of Antiphospholipid Antibody syndrome. Small propoion of patients with SLE may have a Coomb's Positive Haemolytic anemia. Psychosis is a known neurological manifestation of SLE.\n\nSo the answer to this question is B"}
{"instruction": "A patient has subclinical folate deficiency. All of the following drugs can precipitate megaloblastic anemia in this patient except:\nA. Alcohol\nB. Phenytoin\nC. Chloroquine\nD. Sulfasalzine", "response": "Ans. (C) Chloroquine(Ref: Harrison 17/e p649)Megaloblastic anemia can be caused by deficiency of folic acid or vitamin B12 . The drugs that can result in deficiency of folic acid include alcohol, phenytoin and sulfonamides\n\nSo the answer to this question is C"}
{"instruction": "The following are used for treatment of postoperative nausea and vomiting following squint surgery in children except:\nA. Ketamine\nB. Ondansetron\nC. Propofol\nD. Dexamethasone", "response": "Ketamine is not used for treatment of postoperative nausea and vomiting. In fact ketamine use is itself associated with nausea and vomiting and requires prophylaxis. Ref: Lee's Synopsis of Anaesthesia, 12th Edition, Page 192; Textbook of Anaesthesia By Aitkinhead, 4th Edition, Pages 176, 244-49\n\nSo the answer to this question is A"}
{"instruction": "Mechanism of action of oral contraceptive pill can be all except ?\nA. Hostile to sperm penetration\nB. Anovulatory cycle\nC. Failure of blastocyst implantation\nD. Blockade of fimbrial ostia", "response": "Ans. is 'd' i.e., Blockade of fimbrial ostia Mechanism of action of OCPs 1nihibition of gonadotropin release from pitutary by reinforcement of normal feedback inhibition - No prevulatory LH surge - No ovulation This is the most impoant mechanism. Thickening of cervical mucus secretion (due to progesterone) - hostile to sperm penetration. Even if ovulation and feilization occur, the blastocyte fails to implant because endometrium is either hyperproliferative or hypersecretory - not suitable for nidation - Impoant in case of postcoital pill. Uterine and tubal contractions may be modified to disour feilization. Postcoital pills may dislodge a just implated blastocyte or may interfere feilization/implantation.\n\nSo the answer to this question is D"}
{"instruction": "Least chances of complication like dumping syndrome and diarrhoea are seen in the following condition:\nA. Parietal cell vagotomy\nB. Truncal vagotomy & Gastrojejunostomy\nC. Antrectomy with truncal vagotomy\nD. Vagotomy with pyloroplasty", "response": "Vagal denervation of just the parietal cell area of the stomach is called parietal cell vagotomy or proximal gastric vagotomy. The technique spares the nerves of Latarjet but divides all vagal branches that terminate on the proximal two thirds of the stomach. Parietal cell vagotomy appears to have about the same effectiveness as truncal or selective vagotomy for curing the ulcer disease, but dumping and diarrhea are much less frequent. It is probably the procedure of choice for intractable and perforated duodenal ulcers and is relatively less useful for obstructing and bleeding ulcers. The principal disadvantage is recurrent ulceration in about 10% of patients. Ref: Dohey G.M., Way L.W. (2010). Chapter 23. Stomach & Duodenum. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.\n\nSo the answer to this question is A"}
{"instruction": "Thiamine deficiency may be seen in all of the following except: March 2009\nA. Homocystinemia\nB. Chronic alcoholism\nC. Hea failure patients on diuretics\nD. Starvation", "response": "Ans. A: Homocystinemia Causes of thiamine deficiency: Lack of thiamine intake : - Diets consisting mainly of the following: Food containing a high level of thiaminases, including milled rice, raw freshwater fish, raw shellfish, and ferns Food high in anti-thiamine factor, such as tea, coffee, and betel nuts Processed food with a content high in sulfite, which destroys thiamine - Alcoholic state - Starvation state Increased consumption states - Diets high in carbohydrate or saturated fat intake - Pregnancy - Hypehyroidism - Lactation - Fever - severe infection - Increased physical exercise Increased depletion - Diarrhea - Diuretic therapies - Peritoneal dialysis - Hemodialysis - Hyperemesis gravidarum Loss of thiamine through renal excretion can occur with most, if not all, diuretics. It has been seen with the use of such diuretics as mannitol, acetazolamide, chlorothiazide, amiloride, and loop diuretics. Thiamine loss is associated with the increase in urine flow rate, but it is not related to sodium excretion. This suggests that patients with polyuria, even if the condition is unrelated to diuretics, may benefit from thiamine supplementation.\n\nSo the answer to this question is A"}
{"instruction": "The following are the risk factors for inguinal hernia:\nA. Family history of inguinal hernia\nB. Weight lifter\nC. COPD\nD. All", "response": "Ans. is ' a ' , ' b ' , ' c Family history of inguinal hernia, Weight lifter, COPD 2 factors are responsible for causing any hernia:a. weakness of abdominal muscleb. chronically increased intraabdominal pressureWeakness of abdominal muscles1. Patent processus vaginalis2. Patent canal of Nuck causes indirect inguinal hernia in females3. Connective tissue disorders like Ehlers Danlos syndrome4. Congenital condition like Exstrophy of bladder, Prune belly syndrome5. Advancing age and chronic debilitating diseasesIncreased abdominal pressureMarked obesityAbdominal strain from heavy exercise or liftingChronic cough in bronchitis, tuberculosis etc. (Whoopic cough in children)Chronic constipation with straining at stoolEnlarged prostate with straining at micturitionPregnancyCirrhosis with ascites8.Chronic ambulatory peritoneal dialysis9.Intraabdominal tumors10. Chronically enlarged pelvic organsOther risk factorsFamily history -[Ref: - Indirect inguinals are more common in boysPreterm babiesHistory of hernia - h/o of hernia on one side is risk factor for the other side.\n\nSo the answer to this question is D"}
{"instruction": "During the following procedure, optimum interval between uterine incision and delivery should be less than ______ seconds.\nA. 30 seconds\nB. 45 seconds\nC. 60 seconds\nD. 90 seconds", "response": "Ans. D 90 secondsRef: Datta, 8th ed. pg. 673The image shows LSCS being performed, with the head being delivered by hooking fingers carefully between the lower uterine flap. The head is delivered by elevation and flexion using the palm as fulcrum and the optimum time between the uterine incision and delivery should be less than 90 seconds.\n\nSo the answer to this question is D"}
{"instruction": "Debucain number refers to\nA. Ach cholinestrase activity derangement\nB. Potency of muscle relaxants\nC. Potency of general anaesthetics\nD. None", "response": "DIBUCAINE NUMBER * The Dibucaine Number is a measure of the qualitative activity of Pseudo cholinesterase and is the percentage of inhibition of the enzyme by the local anesthetic Dibucaine. * It is used to differentiate individuals who have substitution mutations of the Butryl cholinesterase enzyme\n\nSo the answer to this question is A"}
{"instruction": "Swimming pool conjunctivitis is caused by\nA. Picorna virus\nB. Chlamydia trachomatis\nC. Adenovirus type 8\nD. Gonococcus", "response": "ADULT INCLUSION CONJUNCTIVITIS Etiology : Inclusion conjunctivitis is caused by serotypes D to K of Chlamydia trachomatis. The primary source of infection is urethritis in males and cervicitis in females. The transmission of infection may occur to eyes either through contaminated fingers or more commonly through contaminated water of swimming pools (hence the name swimming pool conjunctivitis). Reference :- A K KHURANA;6th edition , page:- 68\n\nSo the answer to this question is B"}
{"instruction": "A patient was hospitalized after a road accident. The wounds became infected and the patient was treated with tobramycin, carbenicillin, and clindamycin. Five days after antibiotic therapy was initiated, the patient developed severe diarrhoea and pseudomembranous enterocolitis. Antibiotic associated diarrhoea and the more serious pseudomembranous enterocolitis can be caused by\nA. Clostridium sordellii\nB. Clostridium perfringens\nC. Clostridium difficile\nD. S. aureus", "response": "Pseudomembranous enterocolitis and antibiotic-associated diarrhea are caused by an anaerobic Gram-positive rod, Clostridium difficile. Patients treated with antibiotics develop diarrhea that, in most cases, is self-limiting. However, in some instances, paicularly in those patients treated with ampicillin or clindamycin, a severe, life-threatening pseudomembranous enterocolitis develops. This disease has characteristic histopathology, and membranous plaques can be seen in the colon by endoscopy. It has been recently shown that C. difficile produces a protein toxin with a molecular weight of about 250,000. The \"toxin\" is, in fact, two toxins, toxin A and toxin B. Both toxins are always present in fecal samples, but there is approximately one thousand times more toxin B than toxin A. Toxin A has enterotoxic activity--that is, it elicits a positive fluid response in ligated rabbit ileal loops-- whereas toxin B appears to be primarily a cytotoxin.\n\nSo the answer to this question is C"}
{"instruction": "Glomerular filtration rate stas declining at what age?\nA. 10-15 years\nB. 30-40 years\nC. 45-55 years\nD. 55-65 years", "response": "Glomerular filtration rate (GFR) is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman&;s capsule per unit time.The normal range of GFR, adjusted for body surface area, is 100-130 ml/min/1.73m2 in men and women. In children, GFRmeasured by inulin clearance is 110 ml/min/1.73m2 until 2 years of age in both sexes, and then it progressively decreases. After age 40, GFR decreases progressively with age, by about 0.4 - 1.2 mL/min per yearRef: Ganong&;s review of medical physiology; 24th edition; page no; 679\n\nSo the answer to this question is B"}
{"instruction": "Most common CNS tumor associated with NF-1 is?\nA. Optic nerve glioma\nB. Meningioma\nC. Medulloblastoma\nD. Ependymoma", "response": "Ans. is 'a' i.e., Optic nerve glioma * Optic nerve glioma is one of the diagnostic sign of NF-1.\n\nSo the answer to this question is A"}
{"instruction": "High FMA angle indicates which of the following?\nA. Poor prognosis\nB. Good bone growth\nC. Class III relation\nD. Good prognosis", "response": "High FMA angle indicates that the patient has more vertical growth pattern. This angle is large in case of mandibular retrognathism and less in mandibular prognathism. This angle can be influenced by orthopaedic or orthodontic therapy. If angle is more, then the facial pattern is of vertical type and mandible is placed more posteriorly, so to bring the mandible to normal relationship with maxilla is quite difficult. So, such cases are difficult to treat and pose poor prognosis.\nKey Concept:\nIf angle is more, then the facial pattern is of vertical type and mandible is placed more posteriorly, so to bring the mandible to normal relationship with maxilla is quite difficult. So, such cases are difficult to treat and pose poor prognosis.\nReference: Textbook of orthodontics 2nd ed Gurkeerat Singh page no 502\n\nSo the answer to this question is A"}
{"instruction": "Levels of which of the following hormones are increased in post menopausal women:September 2011, March 2013\nA. Estrogen\nB. FSH\nC. Progesterone\nD. Coisone", "response": "Ans. B: FSHThe ovarian changes in menopause are not due to lack of anterior pituitary gonadotropins (FSH and LH) which actually increase, as negative effect of estrogen and progesterone is reduced.Ovaries no longer secrete 17-beta-pestradiolMenopauseThe stages of the menopause transition have been classified according to a woman's repoed bleeding pattern, suppoed by changes in the pituitary follicle stimulating hormone/ FSH levels.In younger women, during a normal menstrual cycle the ovaries produce estradiol, testosterone and progesterone in a cyclical pattern under the control of FSH and luteinising hormone (LH) which are both produced by the pituitary gland.Blood estradiol levels remain relatively unchanged, or may increase approaching the menopause, but are usually well preserved until the late perimenopause.This is presumed to be in response to elevated FSH levels.Menopause is based on the natural or surgical cessation of estradiol and progesterone production by the ovaries, which are a pa of the body's endocrine system of hormone production, in this case the hormones which make reproduction possible and influence sexual behavior.After menopause, estrogen continues to be produced in other tissues, notably the ovaries, but also in bone, blood vessels and even in the brain.However the dramatic fall in circulating estradiol levels at menopause impacts many tissues, from brain to skin.In contrast to the sudden fall in estradiol during menopause, the levels of total and free testosterone, as well as dehydroepiandrosterone sulfate (DHEAS) and androstenedione decline more or less steadily with age.\n\nSo the answer to this question is B"}
{"instruction": "According to Transplantation of Humans Act, all of the following specialist are authorized for pronouncing brain death except:\nA. Neurosurgeon\nB. Doctor performing the liver transplant\nC. Doctor attending the patient\nD. RMP in charge of the hospital", "response": "Ans. (B). Doctor performing the liver transplantAccording to THOA, Brain stem death is certified by a board of medical experts consisting of all of the followingRegistered Medical Practitioner (RMP) in charge of hospital where brain death has occurredQRMP treating the patientQA Neurologist/Neurosurgeon nominated by panelQAn independent RMP - a specialistQAs per latest amendment, if neurologist is not available, any surgeon, physician, anaesthetist or intensivist, nominated by medical in-charge of the hospital may certify brain death.Transplant Surgeon should never be a part of the team.\n\nSo the answer to this question is B"}
{"instruction": "A contrast enema is performed on a one-day-old infant presenting with bilious emesis and abdominal distension. Based on the findings, which of the following is the MOST likely diagnosis?\nA. Hirschprung Disease\nB. Meconium Plug Syndrome\nC. Meconium ileus\nD. Small Left Colon Syndrome", "response": "The examination shows a microcolon, which is a term applied to an unused colon; this happens in infants with congenital distal bowel obstruction. A. Patients with Hirschsprung disease should demonstrate a zone of transition between normal caliber colon distally, and dilated colon proximally. Such findings are not present in this case. B. Patients with meconium plug syndrome do not have a microcolon. The colon is normal in caliber, and demonstrates a large filling defect representing the meconium plug. C. There is microcolon with dilated proximal small bowel loops. Multiple filling defects are consistent with inspissated meconium. D. In patients with small left colon syndrome, the left colon and often poions of the sigmoid are small, similar to a microcolon; however, unlike the findings in the test case, the remainder of the colon, including the rectum, is normal in caliber. Therefore this answer is not correct.\n\nSo the answer to this question is C"}
{"instruction": "International red cross was founded by-\nA. Henry dunant\nB. Claude bernard\nC. samuel hahnemann\nD. Gergar mendel", "response": "Ans. is 'a' i.e., Henry dunant* The international committee of the Red Cross (ICRC) is a private humanitarian institution founded in 1863 Geneva, Switzerland, by Henry Dunant and Gustave Moynier. Its 25-member committee has a unique authority under international humanitarian law to protect the life and dignity of the victims of international and internal armed conflicts. The ICRC was awarded the Nobel Peace Prize on three occasions (in 1917, 1944 and 1963)\n\nSo the answer to this question is A"}
{"instruction": "In intravenous pyelography, one contracted kidney indicates:\nA. Hydronephrosis\nB. Polycystic kidney\nC. Chronic glomerulonephritis\nD. Chronic pyelonephritis", "response": "Ans. Chronic pyelonephritis\n\nSo the answer to this question is D"}
{"instruction": "Fine needle aspiration cytology is not able to detect which of the the following\nA. Papillary carcinoma\nB. Hashimotos thyroiditis\nC. Follicular cancer\nD. Medullary cancer", "response": "Refer Robbins page no 1094 Because of the beer for evaluating capsular integrity the definitive diagnosis o Adenoma can be made only aferr6 careful histologic examination o Te respected specimen .Suspected Adenoma of thyroid are therefore removed surgically to exclude malignancy\n\nSo the answer to this question is C"}
{"instruction": "One of the following is not a malignant feature\nA. Aplasia\nB. Anaplasia\nC. Abnormal mitosis\nD. Pleomorphism", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Corduroy appearance on X-ray is seen in?\nA. Osteoclastoma\nB. Osteosarcoma\nC. Hemangioma\nD. Ewing's sarcoma", "response": "Corduroy cloth appearance/ jail bar sign (veical striations in veebrae)-Hemangioma Hemangioma result of the replacement of normal cancellous by thickened veical trabeculae surrounded by fat marrow or vascular lacunae in veical intraosseous hemangiomas. It is a benign tumor and consists of vascular channels. It is seen commonly in middle-aged patients The spine is the commonest site Note: Polka Dot sign seen on CT scan\n\nSo the answer to this question is C"}
{"instruction": "Which organism causes hemolytic uremic syndrome\nA. Neisseria\nB. Salmonella\nC. Pseudomonas\nD. E. Coli", "response": "Hemolytic uremic syndrome (HUS) is a type 3 hypersensitivity reaction associated with small vessel vasculitis.\n• Organisms causing HUS is E.Coli (particularly EHEC) and shigella dysenteriae.\n\nSo the answer to this question is D"}
{"instruction": "Chocolate Brown postmoem staining is seen in -\nA. KCI Poisoning\nB. Opium Poisoning\nC. H S Poisoning\nD. Cyanide poisoning", "response": "In poisoning by nitrites, potassium chlorate, nitrobenzene, potassium bicarbonate and aniline the colour of postmoem hypostasis is chocolate brown due to methhemoglobinemia. Dr.Narayana Reddys Synopsis of Forensic Medicine and Toxicology 27th edition pg. 76.\n\nSo the answer to this question is A"}
{"instruction": "Deficiency of which element can lead to the syndrome of growth failure, anemia, and hypogonadism?\nA. Calcium\nB. Copper\nC. Zinc\nD. Magesium", "response": "Zinc deficiency is characterized by growth retardation, loss of appetite, and impaired immune function. In more severe cases, zinc deficiency causes hair loss, diarrhea, delayed sexual maturation, impotence, hypogonadism in males, and eye and skin lesions. Reference: GHAI Essential pediatrics, 8th edition\n\nSo the answer to this question is C"}
{"instruction": "Which cancauseprofoundhyperlipidemia ?\nA. Hyperinsulinemia\nB. Hypothyroidism\nC. Hyperparathyroidism\nD. Hypehyrodism", "response": "Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:687-688 CAUSES OF HYPERLIPIDAEMIA The following conditions predispose to the development of these exacerbations: a. Poorly controlled diabetes mellitus b. Alcoholism c. Oestrogen containing contraceptive pills d. Hypothyroidism. There is an increased prevalence of obesity and diabetes in these people.\n\nSo the answer to this question is B"}
{"instruction": "Plasma cells are mostly seen in one of the stages of gingivitis\nA. Initial lesion\nB. Early lesion\nC. Established lesion\nD. Advanced lesion", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "28 year old female presents with irregular slight bleeding after taking combined OCPs 3 months for heavy menstrual bleeding. What is your advice\nA. Endometrial sampling to rule out neoplasia.\nB. Change over to progestin only preparations.\nC. Reassure the patient as it is break through bleeding.\nD. Discontinue OCPs.", "response": "With hormone replacement therapy, irregular spotting or bleeding is side effect. There is no need to sample endometrium, as this is seen only in early months of use.\n\nSo the answer to this question is C"}
{"instruction": "Percentage of T4 and T3 released from thyroid gland?\nA. 50% T4 ; 50% T3\nB. 25% T4 ; 75% T3\nC. 80% T4 ;20% T3\nD. 1000% T4 ;0% T,", "response": "Ans. is 'c' i.e., 80% T4 ;20% T3 ,(Ref: Elsefier's medical laboratory science examination review p.246)Approximately 80% of secreted hormone is T4 & 20% T3 ,\" .\n\nSo the answer to this question is C"}
{"instruction": "When hypothyroidism is caused by pituitary dysfunction (Central hypothyroidism), the following profile is present\nA. Goitre present, raised TSH, low T3, T4\nB. No goitre, reduced TSH, low T3, T4\nC. No goitre, raised TSH, low T3, T4\nD. Goitre present, reduced TSH, low T3, T4", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "flouroquilones C/I in liver diseases is ?\nA. pefloxacin\nB. levofloxacin\nC. oflaxacin\nD. lomefloxacin", "response": "PEFLOXACIN : WELL ABSORBED IN GIT NO EFFECT KIDNEYS C/I IN LIVER FAILURE REF : KD TRIPATHI 8TH ED\n\nSo the answer to this question is A"}
{"instruction": "A 71 year old man comes to the emergency depament because of blurry vision and blood tinged urine. He states that he has a long history of hypeension treated with a beta blocker, an ACE inhibitor and a calcium channel blocker. He repos that he has had 3 days of blurry vision and urine that is \"cola\" colored. The symptoms began when he ran out of his medications 3 days ago and he has \"not had the time\" to get the prescriptions refilled. His physical examination is remarkable for a blood pressure of 200/110 mmHg in both arms, and funduscopic examination showing flame hemorrhages and papilledema. Urinalysis shows red blood cells and some dysmorphic red blood cell casts. He has an abdominal bruit. Which of the following is the most appropriate next step in management?\nA. Order an ECG and observe the patient\nB. Order an abdominal CT scan to rule out aoic aneurysm\nC. Give the patient his usual daily doses of BP medications and observe him\nD. Give the patient intravenous medication to reduce his BP", "response": "This patient has a hypeensive emergency, as evidenced by both the presence of elevated systolic and diastolic blood pressure, as well as evidence of end- organ damage. The blood pressure numbers themselves are a good reason for urgency, but the presence of increased intracranial pressure and renal failure require that this patient be triaged as an emergency. Elevated blood pressure alone, in the absence of symptoms or end organ damage, rarely requires emergency therapy. The therapy for a hypeensive emergency requires IMMEDIATE LOWERING of the blood pressure by approximately 20-30 mm Hg by intravenous administration of medication. The blood pressure should not be reduced to normotensive levels because of the risk of watershed cerebral infarcts with such a dramatic reduction. Ordering an ECG and observing the patient is incorrect. Observation is ceainly warranted, but not without intervention. Giving the patient his usual daily doses of blood pressure medications and observing him would not achieve a rapid enough reduction of the blood pressure, given the presence of end-organ damage on physical examination. Ordering an abdominal CT scan to rule out aoic aneurysm is not an appropriate intervention in the case of an active hypeensive emergency. Ref: Lepe M., Varon J. (2012). Chapter 252. Hypeensive Urgencies. In G.V. Lawry, J. Matloff, D.D. Dressler, D.J. Brotman, J.S. Ginsberg (Eds), Principles and Practice of Hospital Medicine.\n\nSo the answer to this question is D"}
{"instruction": "Predominant constituent of hyaline membrane is\nA. A. Albumin\nB. B. Anthracotic pigment\nC. C. Fibrin rich pigment\nD. D. None of the above", "response": "The membranes are largely made up of fibrinogen and fibrin admixed with cell debries derived chiefly from necrotic type -2 pneumocytes There is remarkable paucicity in neutrophilic inflammation reaction associated with necrosis\n\nSo the answer to this question is C"}
{"instruction": "Umbilical cord has:\nA. 1 vein and 2 aeries\nB. 2 vein and 2 aeries\nC. 1 vein and 1 aery\nD. 2 veins and 1 aery", "response": "CONTENTS OF UMBILICAL CORD: - 2 Umbilical aeries - 1 Umbilical vein - Rudimentary allantois - Remnant of omphalomesenteric / vitellointestinal duct - Whaon's jelly\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is the most common cause of meningoencephalitis in children -\nA. Mumps\nB. Arbovirus\nC. HSV\nD. Enterovirus", "response": "Ans. is 'd' i.e., Enterovirus \"Enteroviruses are the most common cause of meningoencephalitis\"\n\nSo the answer to this question is D"}
{"instruction": "The dye used for OCG is:\nA. lopanoic acid\nB. Sodium diatrozite\nC. Biligraffin\nD. Meglumine iodothalamate", "response": "Ans. lopanoic acid\n\nSo the answer to this question is A"}
{"instruction": "Maximum visual impairment occurs in:\nA. Leukoma adherens at periphery\nB. Centrocaecal leucoma\nC. Nebular corneal opacity\nD. Med peripheral Leucoma", "response": "Nebular corneal opacity has maximal visual disability. Type of corneal opacities Nebular: Superficial layers involving upto superficiial stroma. It do more disability of vision owing to the irregular astigmatism. Macular: Upto mid stroma is involved as opacity Leucomatous: Full thickness stromal opacity. Adherent leucoma is iris tissue incarcerated in opacity, seen normally after perforation. Peripheral, mid peripheral and centrocaecal leucomas will not affect the visual axis and hence would not produce visual disability. However a central leucoma would not allow light to pass through and hence would cause maximum visual problems.\n\nSo the answer to this question is C"}
{"instruction": "Mechanism of action of vincristine in the treatment of all is\nA. Inhibition of topoisomerse II to cause breaks in DNA standards\nB. Alkylation and cross linking DNA standards\nC. Inhibition of DNA mediated RNA synthesis\nD. Inhibition of polymerization of tubulin to form microtubes", "response": "Ref-KDT 6/e 824,825 Vincristine is a chemotherapy drug that belongs to a group of drugs called vinca alkaloids. Vincristine works by stopping the cancer cells from separating into 2 new cells. So, it stops the growth of the cancer by polymerization\n\nSo the answer to this question is D"}
{"instruction": "Which one of the following postural reflexes/reaction requires intact coex?\nA. Tonic neck reflex\nB. Neck righting reflex\nC. Magnet reaction\nD. Optical righting reflex", "response": "Posture is regulated or acquired by reflex redistribution of tone in various muscle groups. Magnet reaction, also known as positive suppoing reaction, is seen in the spinal animal; Centre - Spinal cord Tonic neck reflex is seen in the decerebrate animal;Center - Vestibular nuclei. Neck righting reflex is seen in the midbrain or thalamic animal. Center - Midbrain nuclei/red nucleus. Optical righting reflex ~ When a person is falling, the surrounding objects will be seen tilted; and, from this visual input the upright posture will be retained. Center - Visual coex. Thus, intact coex is required for this reaction. Postural Reflexes and their centres Reflexes Integrated in Stretch reflex Positive suppoing reaction Negative suppoing reaction Spinal cord Tonic labyrinthine and tonic neck reflexes Medulla Righting reflexes (except optical righting reflexes) Labyrinthine righting reflexes Neck righting reflexes Body on head righting reflexes Body on body righting reflexes Midbrain Conditioned reflex Optical righting reflexes Hopping and placing reaction Coex\n\nSo the answer to this question is D"}
{"instruction": "All of the following statements about Phenytoin are true, Except:\nA. Follows saturation kinetics\nB. Is teratogenic\nC. Is highly protein bound\nD. Stimulates Insulin secretion", "response": "Phenytoin inhibits the release of insulin and cause hyperglycemia. Ref: Essentials of Medical Pharmacology By KD Tripathi, 5th Edition, Page 372, 373.\n\nSo the answer to this question is D"}
{"instruction": "About lidocaine all are true, except\nA. Dose need to altered in renal failure\nB. Loading dose before infusion\nC. It is little effected by heat & pH\nD. Prolongs refractory period", "response": "Local anaesthetics are poorly water-soluble and this limits their renal excretion to less than 5%. For treating ventricular arrhythmias initial loading dose is to be followed by infusion. The amides are so stable that they are not effected even by autoclaving. Effective refractory period (of cardiac tissue) is prolonged by local anaesthetics.\n\nSo the answer to this question is A"}
{"instruction": "Which aery is responsible for epistaxis after ligation of external carotid aery?\nA. Ethmoidal aery\nB. Greater palatine aery\nC. Ascending pharyngeal aery\nD. Superior labial aery", "response": "Ethmoidal aery is a branch of internal carotid aery while rest of the aeries provided in the options are branches of external carotid aeries, thereby after ligation of external carotid aery, ethmoidal aery is the only aery which can cause epistaxis.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not true about amoebiasis-\nA. ALA in 10% cases in tropics\nB. Portal system efficient filter\nC. Abscess due to suppuration\nD. Abscess wall good for culture", "response": "Amoebic liver abscess\n\nPus in amoebic liver abscess is not due to suppuration but is a mixture of sloughed liver tissue and blood.\nIt is chocolate brown in colour and thick in consistency (anchovy sauce pus)\nIn the tropics, 2-10% of the individuals infected with Entamoeba histolytica suffer from hepatic complications. The trophozoites are carried from the large intestine to the liver by the portal vein. In the liver, the capillary system acts as an efficient filter and holds these parasites.\nIn the case of an amoebic liver abscess, the diagnostic aspiration is done from the abscess wall because the trophozoites are confined to the periphery.\n\nSo the answer to this question is C"}
{"instruction": "Reactionary hemorrhage occur within: March 2010\nA. 24 hours\nB. 1-2 days\nC. 2-4 days\nD. 4-6 days", "response": "Ans. A: 24 hoursAccording to the \"time of appearence\" hemorrhage can be classified in to:Primary hemorrhage - Is one which occur at the time of injury or operation.Reactionary hemorrhage - In majority of cases reactionary occur within 4 to 6 hours. Such bleeding may also occur due to:- Restlessness- Coughing- Vomiting with raises the venous pressure.Secondary hemorrhage -This occurs usually after 7 to 14 days of injury or operation. This is usually due to infection and sloughing of a pa of the aerial wall.\n\nSo the answer to this question is A"}
{"instruction": "Common symptoms of panic attacks include the all of following except?\nA. Fear of dying\nB. Fear of losing control\nC. Fear of going crazy\nD. Suicidal thoughts", "response": "Suicidal thought is not common symptom of panic attack. Patient has a feeling of impeding doom. There is feeling of going crazy , losing control and dying.\n\nSo the answer to this question is D"}
{"instruction": "A blood donor is not considered for safe transfusion if he has-\nA. Anti HBsAg +ve\nB. Anti HBsAg and HBcAg (+)ve\nC. HBsAg +ve and IgM anti HBc+ve\nD. Anti HBc +ve", "response": "it indicate acute hepatitis.so patirnt cant trandfuse blood REF:<\\p> MICROBIOLOGY ANANTHA NARAYANAN NINTH EDITION PAGE.546\n\nSo the answer to this question is C"}
{"instruction": "A twitch of motor unit is called\nA. Myoclonic jerk\nB. Tremor\nC. Fasciculation\nD. Chorea", "response": "Fasciculations are jerky, visible contractions of groups of muscle fibres as a result of pathological discharge of spinal motor neurons. (REF TEXTBOOK OF MEDICAL PHYSIOLOGY GEETHA N 2 EDITION, PAGE NO - 50)\n\nSo the answer to this question is C"}
{"instruction": "In non zinc containing dental amalgam alloy, the percentage of zinc present is\nA. Less than 0.02%\nB. Less than 0.1%\nC. Less than 0.01%\nD. None of the above", "response": "The ANSI/ADA specification also includes a notation about the presence of zinc in amalgam alloys, with more than 0.01% zinc classified as zinc containing and those with less than 0.01% as non-zinc alloys. Zinc has been included in amalgam alloys as an aid in manufacturing; it helps produce clean, sound castings of the ingots used for producing lathe-cut alloys. The presence of contamination within the amalgam must be avoided because it can degrade the integrity of the restoration.\n\nSo the answer to this question is C"}
{"instruction": "The commonest cranial nerve palsy in tabes dorasalis is:\nA. III nerve\nB. IV nerve\nC. VI nerve\nD. Total ophthalmoplegia", "response": "Ans. III nerve\n\nSo the answer to this question is A"}
{"instruction": "QT prolongation is caused by:-\nA. Quinidine\nB. Omeprazole\nC. Lidocaine\nD. Penicillin", "response": "Drugs causing QT prolongation are: Cisapride Astemizole Terfanidine Class 1A anti-arrythmic drugs: Quinidine, Procainamide. Class 3 anti-arrythmic drugs: Bretylium, Ibutilide\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not a fundamental aspect of Disaster Management?\nA. Disaster response\nB. Disaster mitigation\nC. Disaster awakening\nD. Disaster preparedness", "response": "Ans. C. Disaster awakening. (Ref. Park's Textbook of PSM 22nd/pg. 741)Discussion:A disaster can be defined as \"any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area.A \"hazard''can be defined as any phenomenon that has the potential to cause disruption or damage to people and their environment.DISASTER MANAGEMENTThere are three fundamental aspects of disaster management: -# Disaster response,# Disaster preparedness,# Disaster mitigation.Response# Response after disaster.# Include rescue, first aid, triage etc.# Note that triage is the only approach that can provide max benefit to the greatest no. of injured in major disaster situations. Red indicates high priority Rx or transfer, yellow signals medium priority, green indicates ambulatory patients and black for dead or moribund patients.Preparedness# Objective to ensure that appropriate systems, procedures and resources are in place to provide prompt effective assistance to disaster victims.Mitigation# Measures to prevent hazards or lessen likely effect of emergencies.\n\nSo the answer to this question is C"}
{"instruction": "WRONG about ileum as compared with jejunum is\nA. Sho club shaped Villi\nB. Long vasa recta\nC. More lymphoid nodules\nD. More fat in mesentery", "response": "Jejunum has long and sparse vasa recta as compared to ileum. Jejunum are thick walled and peritoneal windows are transparent as compared to ileum. Peyer patches are present in ileum which are absent in jejunum. Jejunum have 1 or 2 rows of aerial arcades whereas ileum have 4 to 5 aerial arcades Ileum have sho club shaped villi. Ileum have more fat in mesentry.\n\nSo the answer to this question is B"}
{"instruction": "Preload is determined by -\nA. Enddiastolic volume\nB. Endsystolic volume\nC. Ventricular ejection volume\nD. None of the above", "response": "Ans. is 'a' i.e., Enddiastolic volume Factors affecting cardiac outputo Cardiac output is the product of stroke volume and heart rate. Hence any factor which affects either the stroke volume or the heart rate or both affects the cardiac output.A) Factors affecting stroke volume# Stroke volume, which is the amount of blood pumped by the heart during one stroke, depends mainly on three factors : -1) Preload (Degree of ventricular fdling during diastole) : - Cardiac preload is represented by volume of venous blood that distends the ventricle, i.e., venous return determines the preload. An increase in preload, i.e., increase in venous return results in a higher end-diastolic volume (Preload). This results in stretching of myocardial fiber and this increase in length of myofibril increases the strength of cardiac contraction in accordance with the Frank-Star ling law or Starling rs taw of the heart. According to Starling's law, greater the initial length of muscle fiber, greater is the force of contraction. The initial length of muscle fiber (length of fiber at the initiation of contraction/systole) refers to length of the fiber at the end of the diastole, i.e., end-diastolic fiber length. Thus, the factors which improve venous return increase the cardiac output by increasing end-diastolic ventricular volume and length, i.e., preload. Opposite is true for factors which decrease venous return.| Stroke volume| Stroke volumeFactors increasing end-diastolic ventricular muscle fiber length (Factors increasing venous return or preload)#Increased total blood volume#Increased venous tone#Increased pumping action of skeletal muscle#Increased negative intrathoracic pressure (e.g. inspiration)o Lying down from sitting or standing position# Sympathatic discharge causing decrease in venous capacitance by decreasing venous complianceFactors decreasing end-diastolic ventricular muscle fiber length (Factors decreasing venous return or preload)o Decreased total blood volumeo Decreased venous toneo Decreased pumping action of skeletal muscleso Less negative or positive intrathoracic pressure (expiration)o Sitting or standing (venous pooling of blood)Contractility of ventricle : - If the contractile strength of ventricle increases, stroke volume increases. Contractility is increased by increase in sympathetic discharge or circulating catecholamines (epinephrine), for example during exercise.After load (resistance offered to ventricular pumping action): - Left ventricle has to pump out blood against aortic resistance. Increased aortic resistance (e.g., high BP) tends to decrease stroke volume. Decreased peripheral resistance increases cardiac output e.g., in exercise, AVfistula or shunt, severe anemia (due to vasodialtion by anemic hypoxia), thyrotoxicosis (due to vasodilation caused by in- creased O2 consumption), and wet beri-beri.B) Factors affecting heart rate# Heart rate is predominantly under neurohumoral influence. Sympathetic stimulation increases heart rate and therefore cardiac output. Thus, sympathetic stimulation increases cardiac output massively by : (i) Increasing stroke volume by increasing contractility, and (ii) Increasing heart rate; but without increasing the end-diastolic volume.\n\nSo the answer to this question is A"}
{"instruction": "Commonest type of Anal canal Ca is -\nA. Sq. cell Ca\nB. Adeno Ca\nC. Adenoacanthoma\nD. Papillary type", "response": "Mainly 3 types of malignant neoplasm are seen in anal canal\n\nSquamous cell Ca (MC)\nBasal cell Ca (IInd mc)\nMelanoma\n\nRemember\n\nMC type of rectal & colon Ca → Adenocarcinoma*.\n\nSo the answer to this question is A"}
{"instruction": "Herpes zoster is commonly seen in –\nA. Cervical region\nB. Thoracic region\nC. Lumber region\nD. Geniculate ganglion", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Veebral aeries are derived from:\nA. Axillary aery\nB. Subclan aery\nC. Internal carotid aery\nD. None of the above", "response": "The veebral aeries are derived from the subclan aeries. They ascend through the neck in the foramina transversaria of the upper six cervical veebrae and enter the cranial cavity through the foramen magnum, close to the anterolateral aspect of the medulla Ref: Gray's anatomy 40th edition, Chapter 17.\n\nSo the answer to this question is B"}
{"instruction": "The blood pressure measured by a sphygmomanometer\nA. Is lower than the intraaerial pressure\nB. Is higher than the intraaerial pressure\nC. Is same as the intraaerial pressure\nD. Is the same with different cuff sizes", "response": "At the point at which systolic pressure in the aery just exceeds the cuff pressure, a spu of blood passes through with each heabeat and, synchronously with each beat, a tapping sound is heard below the cuff.Ref: Ganong&;s Review of Medical Physiology 25th Edition. Page: 577\n\nSo the answer to this question is B"}
{"instruction": "Risk factors of pulmonary embolism\nA. 30 yrs female on OCP's\nB. Pregnancy\nC. Leg paralysis\nD. All", "response": "Ans. is 'a' i.e. 30 yrs female on OCP's, 'b' i.e. Pregnancy, 'c' i.e. Leg paralysis\n\nSo the answer to this question is D"}
{"instruction": "A married middle aged female gives history of repeated aboions for the past 5 years. The prenatal karyogram of the conceptus is given below: This karyogram suggests the following:\nA. Klinefelter's syndrome\nB. Turner's syndrome\nC. Down's syndrome\nD. Patau's syndrome", "response": "Karyogram shows 3 chromosomes at 21 instead of a pair. It is called Trisomy 21. Trisomy 21 Synonymous with Down's syndrome Most common of the chromosomal disorders. Major cause of mental retardation. -Other trisomies Edward syndrome (Trisomy 18) Patau syndrome (Trisomy 13) Turners syndrome (45 X0)\n\nSo the answer to this question is C"}
{"instruction": "Sucheta, a 29-year-old nulliparous women complains of severe menorrhagia and lower abdominal pain for 3 months. On examination, there was a 14 weeks size uterus with fundal fibroid. The treatment of choice is:\nA. Myomectomy\nB. GnRH analogs\nC. Hystrectomy\nD. Wait and watch", "response": "First, let us see whether we would like to go for medical management or surgical intervention.\nThe patient is presenting with:\n\nSevere menorrhagia\nChronic lower abdomen pain\nThese indications are strong enough for surgical intervention. Earlier size of fibroid >12 weeks was also an indication for surgery but nowadays it is not.\nNow comes the question - whether myomectomy or hysterectomy should be done.\n\nAn indication of Myomectomy:\n\nMyomectomy is specifically indicated in an infertile woman or woman desirous of bearing child and wishing to retain her uterus.\n\nSo the answer to this question is A"}
{"instruction": "Tissue f r om rat used for detection of antinuclear antibodies\nA. Kidney\nB. Brain\nC. Stomach\nD. Liver", "response": "Serum antinuclear antibodies bind to corresponding antigents present in the rat liver section.the antigen-antibody complexes are detected by means of fluorescent labeled anti human immunoglbulin .and visualised with the aid of a fluorescence microscopy ref Robbins 9/e immunity chapter p131 and internet\n\nSo the answer to this question is D"}
{"instruction": "Main MOA brimonidine in glaucoma -\nA. Decreased aqueous secretion\nB. Increased trabecular outflow\nC. Increased uveoscleral outflow\nD. Reduce vitreous volume", "response": "Brimonidine (0.2% : 2 times/day). It is a selective alpha-2-adrenergic agonist and lowers IOP by decreasing aqueous production. Because of increased allergic reactions and tachyphylaxis rates it is not considered the drug of first choice in POAG. It is used as second drug of choice and also for combination therapy with other drugs. Ref.AK Khurana 4th edition page no 223\n\nSo the answer to this question is A"}
{"instruction": "Which one of the following blood fractions is stored at - 40degC?-\nA. Cryprecipitate\nB. Human albumin\nC. Platelet concentrate\nD. Packed red cells", "response": "Ans. is 'a' i.e., Cryprecipitate\n\nSo the answer to this question is A"}
{"instruction": "A patient of acute myocardial infarction being treated in intensive care unit developed left ventricular failure with raised central venous pressure. It was decided to use nitroglycerine. Which route of administration would be most suitable ?\nA. Sublingual\nB. Oral\nC. Intravenous bolus injection\nD. Slow intravenous infusion", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Capnography is used for assessment of\nA. Oxygen saturation of blood\nB. Amount of CO2 transpoed in blood\nC. Ventilation of lung after intubation\nD. Myocardial perfusion", "response": "Capnography is the method of determining CO2 levels in exhaled gases (PACO2) but NOT blood.It is the ideal confirmatory method of endotracheal intubation(VENTILATION OF LUNG AFTER INTUBATION) Aeral blood gas analysis is used to measure CO2 levels in Blood (PaCO2) Pulse oxymetry is used to measure oxygen saturation of blood and hea rate.\n\nSo the answer to this question is C"}
{"instruction": "Quarantinable disease\nA. Diphteria\nB. Yellow fever\nC. Infectious TB\nD. All of the above", "response": "Quarantinable diseases\nSARS\nYellow fever\nDiphtheria\nPlague\nInfectious TB\nSmall pox\nViral hemorrhagic fever\n\nSo the answer to this question is D"}
{"instruction": "Max Joseph&;s space is a histopathological feature of\nA. Psoriasis vulgaris\nB. Lichen planus\nC. Pityriasis rosea\nD. Parapsoriasis", "response": "Max Joseph's space is a characteristic histological finding seen in lichen planus. These are small clefts formed due to dermoepidermal separation and basal cell degeneration character histopathology in lichen planus basal cell degeneration interface lymphocyte infiltration compact hyperkeratosis wedge shaped hypergranulosis- wickham straie saw tooth appearence Civattee bodies/ hyaline bodies-apoptosis basal cells. IADVL textbook of dermatology page 1078\n\nSo the answer to this question is B"}
{"instruction": "Owl' eye nucleus is seen in which type of lymphoma?\nA. Non- Hodgkin's lymphoma\nB. Hodgkin's lymphoma\nC. Burkitt's lymphoma\nD. Cutaneous T-cell lymphoma", "response": "Ans is 'b' i.e., Hodgkin's lymphoma o \"Owl's eye\" appearance of entire nucleus is seen in Reed-Sternberg cells.o Reed-Sternberg cells are giant cells with multinucleated or have a bilobed nucleus with prominent eosinophilic inclusion-like nucleoli (thus resembling an \"owl's eye\"appearance). These are positive for CD 15 and CD 30, and also PAX-5 (B-cell transcription factor).o Hodgkin's disease is characterized by presence of Reed-sternberg cells (Classical Reed-sternberg cells) and its variants.o They can also be found in reactive lymphadenopathy (such as infectious mononucleosis immunoblasts which are RS like in appearance], carbamazepine associated lymphadenopathy) and very rarely in other types of non-Hodgkin lymphofnas. Anaplastic large cell lymphoma may also show RS like cells.\n\nSo the answer to this question is B"}
{"instruction": "All are true about gout except -\nA. Is caused by purine metabolism disorder\nB. Causes scleritis\nC. Causes tophi in the extraocular muscle tendon\nD. Is directly related to alcohol consumption", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Oral candidiasis is divided into primary and\nA. Secondary infections\nB. Subsidiary infections\nC. Subclinical infections\nD. All of the above", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "All of the following cinical features are seen in acute intermittent porphyria, EXCEPT:\nA. Abdominal pain\nB. Photosensitivity\nC. Seizures\nD. Constipation", "response": "Photosensitivity of porphyrias is due to the accumulation of porphyrins which can absorb light. However, in Acute intermittent porphyria metabolic block is earlier to the production of porphyrins. Porphobilinogen accumulated in this condition do not contain a conjugated double bond system so it can't absorb light. So, there is no photosensitivity In Acute intermittent porphyria, the accumulation of ALA and PBG block the action of GABA hence produce neurological symptoms such as excitation of visceral pain fibers leading to acute pain crisis, abdominal pain, vomiting, constipation, hypeension and tachycardia\n\nSo the answer to this question is B"}
{"instruction": "Plasma cells are activated:\nA. B cells\nB. T cells\nC. Macrophages\nD. Monocytes", "response": "Ans: a (B cells) Ref: Robbins,7th ed, p. 199; Ananthanarayan, 7th ed, p. 125When B lymphocytes are activated by antigens (protein/non-protein) they get differentiated into antibody secreting cells, called plasma cells.Plasma cells:Cartwheel appearanceLifespan-2-3 daysMakes Ab of single specificity, single Ig clan & allotype.Immune mechanism: Produce only a single light chain only.B lymphocytes-plasma cells- ImmunoglobulinT lymphocytes- lymphokine production - Cell mediated immunity.Differentiation between B lymphocyte and T lymphocyte.* T cells form E rosette/SRBC rosette; B cells form EAC rosette* B cells carry Ig on their surface; T cells have T cell receptors (TCR)* B cell blast transformation with bacterial endotoxin, staph, aureus, EBV; T cell blast transformation with phytohemagglutinin, concanavalin A\n\nSo the answer to this question is A"}
{"instruction": "All are components of Cushing triad Except\nA. Hypeension,\nB. Raised ICP\nC. Bradycardia\nD. Irregular respiration", "response": "The rapid increase in intracranial pressure (as in trauma) which accompanies the exhaustion of compensation mechanisms ultimately results in herniation of brain tissue. The uncus of the temporal lobe may herniate over the tentorium resulting in pupil abnormalities, usually occurring first on the side of an expanding haematoma.Cerebellar tonsillar herniation through the foramen magnum compresses medullary vasomotor and respiratory centres, classically producing Cushing's triad ofhypeension, bradycardia and irregular respiration.**Raised ICP causes Cushing&;s triad, but it is not a componentBailey and Love 26e pg: 310\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is NOT an important/ frequent/well-known manifestation of an adverse drug reaction?\nA. Agranulocytosis\nB. Aplastic anaemia\nC. Haemolysis\nD. Leukaemia", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Which vitamin deficiency is seen in vegetarians especially -\nA. Vitamin B12\nB. Vitamin B6\nC. Vitamin B3\nD. Vitamin B2", "response": "Ans. is 'a' i.e., Vitamin B12* Dietary sources of vitamin B12 are of animal origin only and include meat, eggs, milk, diary products, fish, poultry etc. Vitamin B12 is absent in plant foods. Small amount of vitamin B12 is synthesized in the intestine by the action of intestinal flora.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not a typical feature of autoimmune hepatitis?\nA. Interface hepatitis\nB. Emperipolesis\nC. Hepatic rosette formation\nD. Ground glass hepatocytes", "response": "\"Ground glass\" hepatocytes are seen in chronic hepatitis B. Diagnostic features of autoimmune hepatitis: Autoantibodies (ANA or ASMA or LKM > 1 : 80) IgG (or gammaglobulins) level >1.10 times normal limit Liver histology typical for autoimmune hepatitis Interface hepatitis, lymphocytic/lymphoplasmacytic infiltrates in poal tracts and extending in the lobule emperipolesis (active penetration by one cell into and through larger cell) hepatic rosette formation Absence of viral hepatitis\n\nSo the answer to this question is D"}
{"instruction": "Green colour blindness is called -\nA. Protanopia\nB. Deuteranopia\nC. Tritanopia\nD. Dyschromatopsia", "response": "(B) (Deuteranopia) (347-Nema 6th) (326 Khurana 5th)* Protanopia - ie Complete red colour defect* Deoteranopia - ie Complete defect for green colour* Tritanopia - ie Absence of blue colour apreciationTESTS FOR COLOUR VISION1) Pseudo-isochromatic charts (Ishihara's plate, Hardy - Rand Rittler plates, American optical colour plates).2) Farnsworth munsell 100 hue test3) Edridge Green lantern test4) City university colour vision test5) Nagel's anomaloscope6) Holmgren's wool testA maurosis fu2ax - sudden temporary and painless monocular visual loss occurring due to transient failure of etinal circulation.\n\nSo the answer to this question is B"}
{"instruction": "Quaer of postnatal mother death is caused by ?\nA. Infection\nB. Bleeding\nC. Eclampsia\nD. Anemia", "response": "Ans. is `b' i.e., Bleeding o 25% of maternal death are caused by severe bleeding, generally occuring post-paum.\n\nSo the answer to this question is B"}
{"instruction": "The drug that is not useful in congestive hea failure is:\nA. Adrenaline\nB. Digoxin\nC. Hydrochlorothiazide\nD. Enalapril", "response": "Ref:KDT 6/e p493,503-504 Medications Diuretic Increases urine production to get rid of excess salt and water. Beta blocker Slows hea rate and decreases blood pressure. When taken in eye-drop form, it reduces eye pressure. ACE inhibitor Relaxes blood vessels, lowers blood pressure and prevents diabetes-related kidney damage. Antihypeensive drug Lowers blood pressure. Dietary supplement Works alone or in conjunction with other treatments to promote health. Blood pressure suppo Helps increase blood pressure when it's too low. Vasodilator Widens blood vessels. Hea Medication Helps reduce chest pain or pressure caused by blockages in the aeries of the hea.\n\nSo the answer to this question is A"}
{"instruction": "During the delivery, it is necessary to cut an episiotomy. The tear extends through the sphincter of the rectum, but the rectal mucosa is intact. How would you classify this type of episiotomy?\nA. First degree\nB. Second degree\nC. Third degree\nD. Fouh degree", "response": "A first-degree tear involves the vaginal mucosa or perineal skin, but not the underlying tissue. In a second-degree episiotomy, the underlying subcutaneous tissue is also involved, but not the rectal sphincter or rectal mucosa. In a third-degree tear, the rectal sphincter is affected. A fouh-degree episiotomy involves a tear that extends into the rectal mucosa. Ref:Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 23. Forceps Delivery and Vacuum Extraction. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.\n\nSo the answer to this question is C"}
{"instruction": "Best for prevention of risk factor:\nA. Primordial prevention\nB. Primary prevention\nC. Secondary prevention\nD. Tertiary prevention", "response": "Ans. (a) Primordial preventionRef : K. Park 23rd ed. / 41, 21sted. 139-40* Primordial level of prevention is defined as prevention of emergence or development of risk factors in countries or population groups in which disease entity is not yet appeared, or population group which are not yet exposed.* Modes of intervention:# Individual education# Mass education* Primordial level is considered as best level of prevention for non-communicable diseases\n\nSo the answer to this question is A"}
{"instruction": "The plasma half life of aspirin:\nA. Is independent of dose\nB. Is longer for anti-inflammatory doses compared to that for analgesic dose\nC. Is shoer for anti-inflammatory doses compared to that for analgesic dose\nD. Can be increased by alkalinizing the urine", "response": "Aspirin and other salicylates show saturation kinetics (zero order) and thus, their half life is not constant. Clearance at high doses (anti-inflamatory) is lesser than at low (analgesic) doses. Thus t1/2 is more for anti-inflammatory dose than for analgesic dose.\n\nSo the answer to this question is B"}
{"instruction": "A patient with Crohn's disease was opened for and an inflammed appendix found. The treatment of choice is?\nA. Appendicectomy\nB. Ileocolic resection and anastamosis\nC. Close the abdomen and sta medical treatment\nD. None of the above", "response": "Ans. is 'a' i.e., Appendicectomy Sabiston writes - \"Patients who undergo exploration for presumed appendicitis and have evidence of Crohn's disease should undergo appendectomy. Although there is theoretical concern for the development of an enterocutaneous fistula, this is extremely rare. Moreover appendectomy prevents fuher diagnostic confusion.\"\n\nSo the answer to this question is A"}
{"instruction": "A 35 yr. old male presented with a 15 day history of proptosis in his right eye and pain on eye movement. There is difficulty in upwards and down wards gaze movements. CT scan showed a cystic lesion with a hyperdense opacity within it, located in the superior oblique muscle. Most probable diagnosis is :\nA. Dermoid\nB. Hemangioma\nC. Pseudotumor\nD. Cysticercosis cellulosae", "response": "Ans. is 'd' ie Cysticercosis cellulosae [Ref Kanski, 4/e, p572, General ophthalmics, 15/e, p 239; Parson 19th/e, p 512Let's see each option one by oneDermoidit can be easily ruled out as it is not found within the musclesIt is located subcutaneously along the embryonic lines of closure*Hemangiomacan be of two typesCapillary orCavernousCapillary hemangiomasare seen in the infants (90% of them present before the age of 6 months)The cavernous hemangiomamay present in the middle life but in slow growing and would not present so rapidly (within 15 days) as in this patientIt is mostly located within the muscle conePseudotumoralso k/a Idiopathic orbital inflammatory disease (IOID)Though it's a frequent cases of proptosis in adults and children, its signs and symptom easily rule it out.It is non-infections, non-neoplastic inflammatory condition characterized by :periorbital swellingchemosis andconjunctival inflammationophthalmoplegiaCysticercosis cellulosaeThough cysticercosis cellulosae commonly lodges in the subretinal space causing retinitis, but may also invade the extraocular muscles.On CT scan it appears as a cystic lesion with a hyperdense scolex inside.Orbital USG - Demonstration of a cystic lesion with a central hyperechoic highly reflective scolex is diagnostic.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following condition is most commonly associated with cholesteatoma formation?\nA. Central perforation\nB. Attico-antral perforation\nC. Tubo-tympanic disease\nD. Otosclerosis", "response": "Atticoantral type of CSOM is most commonly associated with cholesteatoma, granulations or osteitis. It is associated with an attic or marginal perforation. Tubotympanic type of CSOM is associated with central perforation.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is false for the given specimen?\nA. Bilateral in 10% to 15%\nB. About 10% undergo malignant transformation\nC. Unilocular cysts\nD. Common during the active reproductive years.", "response": "The specimen is of a Dermoid cyst.Most benign teratomas are cystic and are often referred to as dermoid cysts because they are almost always lined by skin-like structures. Cystic teratomas are usually found in young women during the active reproductive years.Benign teratomas are bilateral in 10% to 15% of cases.Characteristically they are unilocular cysts containing hair and sebaceous material. In most cases, tissues from other germ layers can be identified, such as cailage, bone, thyroid, and neural tissue. About 1% of the dermoids undergo malignant transformation, most commonly to squamous cell carcinoma, but also to other cancers as well (e.g., thyroid carcinoma, melanoma).Robbins pathology 9e 1029\n\nSo the answer to this question is B"}
{"instruction": "Posterior communicating aery is branch of\nA. Internal carotid aery\nB. External carotid aery\nC. Middle cerebral aery\nD. Posterior cerebral aery", "response": "Posterior communicating aery arises close to the termination of internal carotid aery. Other branches of cerebral pa internal carotid aery are: Ophthalmic aery Anterior cerebral aery Middle cerebral aery Anterior choroidal aery Posterior cerebral aery is a branch of basilar aery. (Ref: Vishram Singh textbook of clinical neuroanatomy 2nd edition, pg- 176)\n\nSo the answer to this question is A"}
{"instruction": "Sulcular membrane acts as a semipermeable membrane through which:\nA. Bacterial products pass into gingiva\nB. Fluid from gingiva seeps into sulcus\nC. Both of the above\nD. None of the above", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Barriers to communication are all Except\nA. Cultural\nB. Environmental\nC. Psychological\nD. Mobile devices", "response": "Barriers to communication can be : Physiological, Psychological, Environmental, and cultural.Park 23e pg: 856\n\nSo the answer to this question is D"}
{"instruction": "Cervical was are seen with which HPV ?\nA. 11,13\nB. 6, 11\nC. 17,18\nD. 5, 8", "response": "Ans. is 'b' i.e., 6, 11\n\nSo the answer to this question is B"}
{"instruction": "Mechanism of action of clonidine is mediated by which of the following receptors?\nA. Alpha 1\nB. Alpha 2\nC. Beta 1\nD. Beta 2", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Patient presents with severe hearing loss. For the amount of decibel loss he has, which of the following sound can be heard by him?\nA. Rustling of leaves\nB. Sta of car engine at 10 feet\nC. Sound of Niagara falls\nD. Noisy environment night street", "response": "WHO CLASSIFICATION Till 25 dB Hz Normal 26 - 40 dB Hz Mild 41 - 60 dB Hz Moderate 61 - 80 dB Hz Severe Over 81 dB Profound Source Decibels Anything on the verge of being Audible 0 Whisper 30 Normal conversation 60 Busy traffic 70 Niagara Falls 90 Train 100 Construction noise 110 Rock conce 120 Machine gun 130 Jet take off 150 Rocket take off 180\n\nSo the answer to this question is C"}
{"instruction": "Which type of Resin Bonded FPD is shown in the colour plate?\nA. Rochette Bridge\nB. Maryland Bridge\nC. Cast Mesh FPD\nD. Virginia Bridge", "response": "Cast mesh fixed partial denture \nA nylon mesh is placed on the palatal/ lingual surface of the abutment die and the pattern is fabricated over this mesh. The mesh gets incorporated and following casting provides retention for resin to metal.\n\nSo the answer to this question is C"}
{"instruction": "Lesion in occipital lobe will cause?\nA. Binasal hemianopia\nB. Bitemporal hemianopia\nC. Homonymous superior quadrantonopia\nD. Homonymous hemianopia with macular sparing", "response": "Ans. (d) Homonymous hemianopia with macular sparingRef.: Harrisons 19th ed. /198-199Please look at the diagram carefully to understand the visual pathway and its corresponding pathology.* Unilateral optic nerve lesion: Unilateral blindness* Binasal hemianopia: Bitemporal optic chiasma lesion. Two different lesions compressing the chiasma from the lateral parts.* Bitemporal hemianopia: Binasal retinal damaged optic chiasmal lesion. Commonest lesion is pituitary adenoma.* Homonymous hemianopia: lesion at optic tract AND optic radiation* Homonymous superior quadrantonopia: All superior quadrantonopia goes to the temporal lobe (pie in the sky).* Homonymous inferior quadrantonopia: All inferior quadrantonopia goes to the parietal lobe (Pie on the floor).* Homonymous hemianopia w/ macular sparing: Lesion in occipital cortex les\n\nSo the answer to this question is D"}
{"instruction": "Rate limiting step of glycogenolysis is:\nA. Phosphorylase\nB. Glucan transferase\nC. Debranching enzyme\nD. Glucose-6-phosphatase", "response": "Harper -145,146, 147\nGlycogen phosphorylase catalyzes the rate-limiting step in glycogenolysis by promoting the phosphorolytic cleavage by inorganic phosphate of the 1-4 linkages of glycogen to yield glucose-1-phosphate. The terminal glucosyl residues from the outermost chains of the glycogen molecule are removed sequentially until approximately four glucose residues remain on either side of the 1,6 branch. Another enzyme( glucan transferase) transfers a trisaccharide unit from one branch to the other, exposing the 1,6 linkages requires the debranching enzyme. Further phosphorylase action can then proceed. The combined action of phosphorylase and these other enzymes leads to the complete breakdown of glycogen.\n\nSo the answer to this question is A"}
{"instruction": "maximum air volme in the lu ng -\nA. 1200 ml\nB. 2400ml\nC. 3000ml\nD. 5900ml", "response": "Ans. is 'd* i.e., 5900 ml.# Total lung capacity (TLC): - It is the maximum volume of air in the lung at the end of maximal inspiration, i.e,, maximum amount of air the lung can contain. In other words, TLC = TV + 1RV + ERV + RV or TLC = VC + RV (because VC = TV + IRV + ERV). TLC is about 5900 ml.\n\nSo the answer to this question is D"}
{"instruction": "Albans test is an example of\nA. Caries activity test\nB. Acid producing test\nC. Caries susceptibility test\nD. None of the above", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "The most common complication seen in hiatus hernia is\nA. Esophagitis\nB. Aspiration pneumonitis\nC. Volvulus\nD. Esophageal stricture", "response": "Ans. is 'a' i.e. Esophagitis There are 4 types of hiatal herniaType I : Sliding hernia (most common type -- 70 - 80%)Type II : Paraesophageal or rolling herniaType III : MixedType IV : these hernias are distinguished by the presence of other abdominal viscera wihin the defect i.e. omentum, transverse colon.Type I or Sliding hiatal hernia- this is characterized by upward dislocation of the cardioesophageal junction into the posterior mediastinum.Type II or Rolling Paraesophageal hernia- the cardioesophageal junction is undisplaced the whole or pa of stomach herniates into the thorax immediately adjacent and to the left of the undisplaced cardioesophageal junction.- since the normally located gastroesophageal junction functions normally in most of these hernias, reflux is uncommon\n\nSo the answer to this question is A"}
{"instruction": "In a child, non-functioning kidney is best diagnosed by:\nA. Ultrasonography\nB. IVU\nC. DTPA renogram\nD. Creatinine clearance", "response": "In order to assess function of an apparent non-functioning kidney, the best modality would be DTPA renogram. About other options: a. Ultrasonography: initial modality for imaging of the kidney and urinary tract. Good for anatomic details and not functional details of kidneys ureter and bladder. b. IVP (Intravenous pyelography) gives valuable information about renal anatomy and function. But due to the risk of anaphylaxis with the contrast material use of IVP has declined following the availability of radionuclide imaging. d. 24 hrs creatinine clearance can be calculated by collecting a timed urinary specimen and taking a blood sample around the mid-collection period. In children, in addition to problem with urine collection, this overestimates the actual GFR and can't be used to assess isolated kidney function.\n\nSo the answer to this question is C"}
{"instruction": "Myelofibrosis leading to a dry tap on bone marrow aspiration is seen with ach of the following condition\nA. Burkitt's lymphoma\nB. Acute erythroleukemia\nC. Acute megakaryocytic leukemia\nD. Acute myelomonocytic leukemia", "response": "Ans. c. Acute megakaryocytic leukemia Bone marrow maybe difficult to aspirate in Acute megakaryocytic leukemia and more than 2/3rd of patients have significant fibrosis caused by release of fibrogenic cytokine Erythroleukemia (M6) FAB Bone marrow findings: Usually hypercellular with megaloblastic changesdeg - Erythroid precursors commonly have multicentricity (65%), karyorrhexis (53%), morulae (25%) and cytoplasmic inclusionsdeg. MC immunophenotypic marker for erythroleukemia: Glycoprotein 7 and transferring receptor (CD-71 Acute Megakaryocytic Leukemia (M7) FAB Bone marrow findings: Bone marrow maybe difficult to aspirate and more than 2/3' of patients have significant fibrosisdeg caused by release of fibrogenic cytokine Burkitt's Lymphoma Bone marrow findings: When the bone marrow is involved, aspirates reveal tumor cells with slightly clumped nuclear chromatindeg, 2-5distinct nucleoli and royal blue cytoplasm containing clear cytoplasmic vacuole Acute Myelomonocytic Leukemia (M4) FAB Bone marrow findings: Ultra-structures are present in association with monocytosis and myeloblastic/monoblastic infiltration of bone\n\nSo the answer to this question is C"}
{"instruction": "All of the following are true about incontinentia pigmenti, except:\nA. Ocular involvement is seen in almost 100% cases and is typically unilateral\nB. Avascularity of peripheral retina\nC. Primary skin abnormality\nD. X-linked dominant", "response": "Ocular involvement is seen in about 20-35 percent of the cases of incontinentia pigmenti but not in 100 percent cases as mentioned in the option. Incontinentia pigmenti is a X-linked dominant primary skin disease that leads to avascularity of the retina. Ref: Rook's Textbook of Dermatology 7th Edition, Pages 39.20-3.22; The Retinal Atlas By Lawrence A. Yannuzzi, Page 38\n\nSo the answer to this question is A"}
{"instruction": "Popliteal aery injury is commonly seen in which type of traumatic knee dislocation?\nA. Anterior dislocation\nB. Posterior dislocation\nC. Medial dislocation\nD. Lateral dislocation", "response": "*Make it very clear in your mind that popliteal aery injury can occur with both anterior and posterior dislocation of knee. But it is more common in posterior dislocation. Clinical evaluation : (vascular exam) -Measure Ankle-Brachial Index (ABI) if ABI >0.9 >>>> then monitor with serial examination if ABI <0.9 >>>> -If pulses are absent or diminished confirm that the knee joint is reduced or perform immediate reduction and reassessment - Immediate surgical exploration if pulses are still absent following reduction &;schema time >8 hours has amputation rates - If pulses present after reduction then measure ABI then consider observation vs. angiography Clinical evaluation : (vascular exam) -Priority is to rule out vascular injury on exam both before and after reduction serial examinations are mandatory. - Palpate the dorsalis pedis and posterior tibial pulses if pulses are present and normal , >> it does not indicate absence of aerial injury. Ref: Campbell's 13th/e p.2257\n\nSo the answer to this question is B"}
{"instruction": "What is the most likely cardiac lesion in a young adult who complains of headache, dizziness and intermittent claudication with exercise?\nA. TOF\nB. ASD\nC. PDA\nD. Coarctation of aoa", "response": "The symptoms relating to this patient are suggestive of Coarctation of aoa. i.e; Intermittent claudication, dizziness and headache. Ref: Clinical Echocardiography By Michael.Y.Henein, Mary Sheppard, Page 227 ; Harrison's Internal Medicine, 18th Edition, Page 1925\n\nSo the answer to this question is D"}
{"instruction": "A 30 year-old male was bought to the emergency depament after a car accident. He sustained a severe injury to the anterior chest wall from the impact caused by the steering wheel. X-ray revealed fracture of the body of the sternum. Which of the following pa of the hea is most likely to be injured.\nA. Left atrium\nB. Left Ventricle\nC. Right Ventricle\nD. Right atrium", "response": "The area posterior to the sternum is occupied by the right ventricle and hence is most likely to be injured in this case. The convex anterosuperior surface of the right ventricle makes up a large pa of the sternocoastal aspect of the hea, and is seperated from the thoracic wall only by the pericardium. Ref: Gray&;s Anatomy 41st edition Pgno: 1001\n\nSo the answer to this question is C"}
{"instruction": "Lenalidomide co-administration with which another drug increases the risk of thrombosis?\nA. Alcohol\nB. Barbiturates\nC. Glucocoicoids\nD. Antibiotics", "response": "Recently, combination regimens incorporating lenalidomide plus dexamethasone or prednisone have been shown to be more effective as first-line therapy. Lenalidomide was approved by the Food and Drug Administration (FDA) in late 2005 as a consequence of trials that showed its effectiveness in the treatment of the myelodysplastic syndrome with the chromosome 5q31 deletion. Clinical trials using lenalidomide to treat newly diagnosed as well as relapsed or refractory multiple myeloma showed similar efficacy, leading to FDA approval for myeloma as well. Its side effect profile is similar to that of thalidomide, although with less teratogenic effect and fewer thromboembolic events.\n\nSo the answer to this question is C"}
{"instruction": "Investigation of choice for bronchiectasis is-\nA. X-ray\nB. Endoscopy\nC. M.R.I.\nD. HRCT", "response": "Ans. is 'd' i.e., HRCT * HRCT is the investigation of choice for bronchiectesis* The CT criteria for diagnosis include 'signet -ring' sign (bronchus being larger than accompanying vessel), bronchial wall thickening, and bronchi visible within 1 cm of the pleura.* Three types are described according to Their appearance :-A. Cylindrical:- Mild diffuse dilatation of the bronchi. Radiologically there is Tram - Trank appearance, i.e. lack of peripheral tapering.B. Varicose:- Cystic bronchial dilatation interrupted by focal areas of narrowing, giving radiological appearance of'String of pearl (string of beads).C. Saccular (cystic):- Clusters of bronchi with marked saccular dilatation. Cystic bronchiectasis in any region is easily recognized as clusters of rounded lucencies, often containing air - fluid levels; this appearance has been linked to a 'cluster of grapes'.Investigations of choice in respiratory systemDiseaseInvestigation* Interstitial lung disease* HRCT* Bronchiectasis* HRCT (1st choice)* Bronchography (2nd choice)* Pulmonary embolism* CT with i.v. Contrast (1st choice)* V/Q scan (2nd choice)* Solitary pulmonary nodule* CT scan* Calcification* CT scan* Pulmonary malignancy* CT scan (except in superior sulcus or pancoast tumor)* Superior sulcus or pancoast tumor* MRI\n\nSo the answer to this question is D"}
{"instruction": "Source of aerial supply to testis:\nA. Internal pudendal aery\nB. Deep external pudendal aery\nC. Superficial external pudendal aery\nD. Testicular aery", "response": "Blood supply of testesThe testicular aery is a branch of the abdominal aoa given off at the level of L2.The testicular veins emerge from the testis and the epididymis as a venous network, the pampiniform plexus.This becomes reduced to a single vein as it ascends through the inguinal canal. The right testicular vein drains into the inferior vena cava, and the left vein joins the left renal vein.\n\nSo the answer to this question is D"}
{"instruction": "All of the following cranial nerves traverse through the cavernous sinus, EXCEPT?\nA. Occulomotor\nB. Trochlear\nC. Maxillary division of trigeminal\nD. Abducens", "response": "The cranial nerves traversing the cavernous sinus are oculomotor, trochlear, abducens and ophthalmic division of the trigeminal nerve together with trigeminal ganglion. Cavernous sinuses are seen on either side of the sella turcica. They receive drainage from ophthalmic and facial veins and blood leaves the cavernous sinuses the petrosal sinuses.\n\nSo the answer to this question is C"}
{"instruction": "Sensation transmitted by pacinian corpuscles is:\nA. Cold\nB. Warmth\nC. Touch\nD. Vibration", "response": "Ans. D. VibrationSENSE ENDINGS ACTIVATEDPain Cutaneous nociceptorsTemperature, heat Cutaneous thermoreceptors for hotTemperature, cold Cutaneous thermoreceptors for coldTouch Cutaneous mechanoreceptors, also naked endingsVIBRATION Mechanoreceptors, especially PACINIAN CORPUSCLES (Pressure also) QJoint position Joint capsule and tendon endings, muscle spindles\n\nSo the answer to this question is D"}
{"instruction": "Drug commonly used in the treatment of iridocyclitis is\nA. Phenylephrine\nB. Atropine\nC. Darifenacin\nD. Solifenacin", "response": "Atropine is used in iridocyclitis to break adhesions in the uveal tract Ref: KDT 6th ed pg 116\n\nSo the answer to this question is B"}
{"instruction": "How to differentiate ASD from VSD in X-ray:\nA. Enalrged LA\nB. Normal LA\nC. Pulmonary Congestion\nD. Aoic shadow", "response": "B i.e. Normal LA Characteristic findings of ASD include enlarged hea, RA, RV, PA and PV with normal LA & LV and decreased aoa and SVCQ Characteristic findings of VSD include enlarged hea, RA, RV, PA, PV and LAQ. So pulmonary overcirculation/congestion occurs both in ASD & VSD but LA remains normal in ASD & enlarges in VSDQ. Atrial Septal Defect (ASD) In atrial septal defect (ASD), there is a defect between both atrium leading to left to right (L-->R) shunt from left atrium to right atrium, to right ventricle (RV), pulmonary aery (PA) and then pulmonary circulation. Increased blood flow through pulmonary circulation causes hilar dance (increased pulsations of central pulmonary aery), pulmonary plethoraQ, increased size of pulmonary veins & anteries with size larger than accompanying bronchus (kissing cousin sign), dimeter of right descending pulmonary aery > trachea just above aoic knob, enlarged hilar vessels and visualization of vessels below 10th posterior rib (all indicating prominent pulmonary vasculature d/t over circulation). ASD may show cardiomegaly, normal sized left atrium & left ventricle and enlarged right atrium, right ventricle and main pulmonary aeryQ. Due to RV hyperophy, there is clockwise rotation of hea lit loss of visualization of superior venacava (S VC) and small appearing aoa with normal aoic knob. - Pulmonary pressure remains normal for decades and usually after 40 years of age onset of pulmonary hypeension causes increased R-sL shunting (Eisenmenger syndrome). Ventricular Septal Defect (VSD) - In VSD, there is a defect between both ventricles leading to L-sR shunt from left ventricle (LV) to right ventricle (RV) to pulmonary aery (PA) --> pulmonary vein -s left atrium (LA) -*LV. So all these chambers enlarge with pulmonary vessels being affected last - In nonrestrictive large shunts (>75% of aoic diameter) pulmonary aery hypeension Eisenmenger syndrome develops early. Calcification of PA is vathognomic of PAH.\n\nSo the answer to this question is B"}
{"instruction": "Which of these is not true regarding guttapercha?\nA. 60-70% Gutta Percha\nB. It can't be heat sterilized\nC. Can stain the crown\nD. 25 size cone is used for sinus tracing", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "All of the following are properties of synovial fluid except :\nA. It is a pale yellow , clear and sufficiently viscous fluid that droplets expelled from a needle tip fall in a long string\nB. It is a Non Newtonian fluid\nC. It doesn’t clot since it lacks in fibrinogen\nD. Normal WBC count in synovial fluid is 350 – 3500 / mm3", "response": "Normal WBC Count - 0-300 / ml of synovial fluid\n\nSo the answer to this question is D"}
{"instruction": "A baby presents with diarrhea and perianal diaper area redness. Diagnosis is\nA. Lactose intolerance\nB. Shigella diarrhea\nC. Salmonella\nD. Fungal", "response": "In Lactose intolerance, there is a deficiency of the enzyme lactaseSo there is no natural breakdown of lactose - a carbohydrate present in milkThis causes diarrheaThe stool contains reducing sugar which causes perianal excoriation(Refer: Nelson's Textbook of Pediatrics, SAE, 1st edition, pg no. 1876)\n\nSo the answer to this question is A"}
{"instruction": "All of the following paranasal sinuses are present at birth EXCEPT:\nA. Maxillary sinus\nB. Ethmoid sinus\nC. Sphenoid sinus\nD. None", "response": "Ans. (c) Sphenoid sinusRef: Dhingra 5th Ed. / 203Development and Growth of paranasal sinusesSinusesStatus at the birthGrowthFirst radiologic evidenceMaxillaryPresent at birthRapid growth from birth to 3 years and from 7-12 years. Adult size-15yrs4-5 months after birthEthmoidPresent at birthReach Adult size by 12 years1 yearsFrontalNot presentInvades frontal bone at the age of 4 years. Size increases until teens6 yearsSphenoidNot presentReaches sella turcica by the age of 7 years.Reaches full size between 15 years to adult age4 years\n\nSo the answer to this question is C"}
{"instruction": "In a child with acute liver failure, the most important abnormal serum biochemical test that indicates poor prognosis:\nA. Increasing transaminases\nB. Increasing bilirubin\nC. Increasing prothrombin time\nD. Reversal of serum albumin-globulin ratio", "response": "C. Increasing prothrombin time(Ref: Nelson's 20/e p 1967)Hepatic synthetic function is reflected in serum albumin and protein levels and in the PT or INRUnresponsiveness of PT to vitamin K suggests severe hepatic diseasePersistently low levels of factor VII are evidence of a poor prognosis in fulminant liver diseaseSerum aminotransferase activities do not correlate well with the severity of the illness.\n\nSo the answer to this question is C"}
{"instruction": "A 25 year old male after road traffic accident was brought to emergency depament. On examination, the patient was moaning with inability to speak but patient was able to understand what he wanted to speak. Which of the following marked area of brain is involved in this?\nA. A\nB. B\nC. C\nD. D", "response": "Inability to speak - Motor aphasia Stroke of superior division of MCA i.e. Broca's area affected. A = Contraversive eye center B = Broca's area- inferior frontal gyrus - MCA: sup. division C = Wernicke's area -superior Temporal gyrus - MCA: inf division D = Occipital coex\n\nSo the answer to this question is B"}
{"instruction": "A lady presents with swelling of hands with shiny skin. She has a history of fracture radius and kept on the POP cast for 4 weeks after which she develops this. Give the most likely diagnosis -\nA. Myositis ossification\nB. Rupture of external pollicis longus tendon\nC. Reflex sympathetic dystrophy\nD. Malunion", "response": "Swelling of hands with shiny skin and history of trauma (fracture radius) suggest the diagnosis of RSD.\n\nSo the answer to this question is C"}
{"instruction": "A testicular tumor in a man aged 60 years is ; most likely to be:\nA. Germ cell tumor\nB. Seoli cell tumor\nC. Teratocarcinoma\nD. Lymphoma", "response": "A testicular mass in a male > 50 yrs should be regarded as lymphoma until proven otherwise. Ref: Harrison's Internal Medicine, 18th Edition, Page 806; Bailey and Love's Sho Practice of Surgery, 23rd Edition, Page 1278.\n\nSo the answer to this question is D"}
{"instruction": "Terminal branches of facial nerve are all EXCEPT:\nA. Mandibular nerve\nB. Marginal branch\nC. Temporal\nD. Cervical", "response": "After it gives off the posterior auricular nerve, the facial nerve divides within the parotid gland into its terminal branches. The terminal branches are; Temporal Zygomatic Buccal Marginal (along the mandible) Cervical (A traditional mnemonic device for the five terminal branches of the facial nerve is, \"Ten Zebras Bit My Cat\")\n\nSo the answer to this question is A"}
{"instruction": "Urachus fistula is :\nA. Patent allantois\nB. Ectopic hernia\nC. Patent vitello-intestinal tract\nD. Meckel's diveicum", "response": "A i.e. Patent allantoisUrorectal septum separates cloaca into (anterior) primitive urogenital sinus and (posterior) primitive anorectal canalQ. Urachzis fistula develops from patent allantoisQ.\n\nSo the answer to this question is A"}
{"instruction": "The flying range of Aedes aegypti is\nA. 100 meters\nB. 200 meters\nC. 300 meters\nD. 400 meters", "response": "Flight range studies suggest that most female Ae. aegypti may spend their lifetime in or around the houses where they emerge as adults and they usually fly an average of 400 metres. This means that people, rather than mosquitoes, rapidly move the virus within and between communities and places. * Different sources may have given a different distance, WHO mentions it as 400 meters Ref: Park 23rd edition Pgno : 771\n\nSo the answer to this question is D"}
{"instruction": "Parietal peritoneum is lined by\nA. Simple squamous\nB. Stratified squamous\nC. Cuboidal\nD. Columnar", "response": "SIMPLE SQUAMOUS EPITHELIUM - The cells of this epithelium are flattened. In sections they appear so thin that bulgings are produced on the surface by nuclei. In surface view the cells have polygonal outlines that interlock with those of adjoining cells. A simple squamous epithelium lines the alveoli of the lungs, the free surfaces of peritoneum, pleura and pericardium. Here it is given the name mesothelium. It also lines the inside of blood vessels,where it is called endothelium, and Of the hea where it is called endocardium. REF : Inderbir Singh's Textbook of Human Histology, seventh edition, pg.no., 2.\n\nSo the answer to this question is A"}
{"instruction": "Compared to high molecular weight heparin following is true about low molecular weight heparin ?\nA. Monitoring is not needed for low molecular weight heparin\nB. Daily two subcutaneous doses are essential\nC. They are easily filtered at the glomerulus\nD. They do not interact with plasma proteins", "response": "Ans. is 'b' i.e., Daily two subcutaneous doses are essential Advantages of LMWH Longer, more consistent and predictable response --> Single daily dose is sufficient by subcutaneous route. o Lower risk of osteoporosis and HIT syndrome. Bleeding chances are less : LMW heparins have a different anticoagulant profile. They selectively inhibit factor Xa with little effect on antithrombin and coagulation in general. They act only by inducing conformational change in AT III. They appear to have lesser antiplatelet action. As a result they have a small effect on a PTT and whole blood clotting time. Since a PTT/clotting times are not prolonged (much) laboratory monitoring is not needed, and the incidence of haemorrhagic complication is less. They are easily filtered from glomerular capillaries because of there smaller molecular weight. LMW heparins do not interact with plasma proteins.\n\nSo the answer to this question is B"}
{"instruction": "Section of the vagus nerve results in\nA. Increased rate of respiration\nB. Decreased depth of respiration\nC. Irregular breathing patterns\nD. Increases in breath - holding time", "response": "Vagus nerve causes contraction of bronchial muscle helping in expiration. Section of vagus nerve leads to difficulty in expiration and therefore increasing breath holding time. Ref: Ganong&;s review of medical physiology; 23rd edition; pg: 267; table 17-1.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is the treatment of choice for Atrial fibrillation in patients with WPW syndrome who are hemodynamically unstable\nA. Procainamide\nB. Digoxin\nC. DC Cardioversion\nD. Radio-frequency ablation of the bypass tract", "response": "Administration of AV nodal-blocking agents including oral or intravenous verapamil, diltiazem, beta block- ers, intravenous adenosine, and intravenous amiodarone are contra- indicated. Preexcited tachycardias should be treated with electrical cardioversion or intravenous procainamide or ibutilide, which may terminate or slow the ventricular rate. Ref Harrison 20th edition pg 1532\n\nSo the answer to this question is C"}
{"instruction": "Type of collagen fibres found in the pulp is:\nA. Type 1 & Type 4\nB. Type 1 & Type 3\nC. Type 2 & Type 3\nD. Type 2 & Type 4", "response": "Pulp has type 1 and type 3 collagen.\nNote: All oral hard and soft (gingival) tissues have type 1 (predominantly) and type 3 collagen.\n\nSo the answer to this question is B"}
{"instruction": "Following sensory impairments occur in extensive damage to somatosensory area of cerebral coex. EXCEPT-\nA. Pressure\nB. Sensory localization\nC. Exact weight determination\nD. Pain", "response": "Damage to the sensory coex results in decreased sensory thresholds, an inability to discriminate the propeies of tactile stimuli or to identify objects by touch. The secondary somatosensory coex (SII; area 40) is in the lower parietal lobe Somatosensory Coex Primary somatosensory coex (SI; areas 3,1,2) is located in the post central gyrus. This receives somatotopic input from the VPL and VPM of the thalamus. Histologically, this area would consist of granular coex. The sensory homunculus includes coical representation of the body based on the degree of sensory innervation. There are actually four submaps, one each in area 3a, 3b, 1 and 2. Very sensitive areas such as the lips and the fingeips have a huge representation. Neurons within each coical site (paicularly layer IV) are arranged in columns representing specific body regions. If a region is amputated (such as a finger) there is reorganization with neurons responding to stimulation of adjacent body pas. This can also happen as the result of increased use of a body pa. Damage to the sensory coex results in decreased sensory thresholds, an inability to discriminate the propeies of tactile stimuli or to identify objects by touch.but the pain sensation is less effected . The secondary somatosensory coex (SII; area 40) is in the lower parietal lobe. This receives connections from the primary sensory coex and also less specific thalamic nuclei. This responds to sensory stimuli bilaterally, although with much less precision than the primary coex. Nonetheless, lesions to this area may impair some elements of sensory discrimination. The somatosensory association coex (areas 5 and 7) is directly posterior to the sensory coex in the superior parietal lobes. This receives synthesized connections from the primary and secondary sensory coices. These neurons respond to several types of inputs and are involved in complex associations. Damage can affect the ability to recognize objects even though the objects can be felt (tactile agnosia). Coical damage, paicularly in the area of coex where the posterior parietal lobe meets the anterior occipital and the posterior, superior temporal lobe, can cause neglect of the contralateral side of the world. This typically happens with nondominant hemisphere lesions since this hemisphere appears necessary to distribute attention to both sides of the body. The dominant hemisphere appears to only \"pay attention\" to the associated (usually right) side of the world. Therefore, neglect usually involves the left side and can be so severe that the individual even denies that their left side belongs to them. Ref Harrison20th edition pg 2456\n\nSo the answer to this question is D"}
{"instruction": "When planning home care for a client with hepatitis A, which preventive measure should be emphasized to protect the client’s family?\nA. Keeping the client in complete isolation\nB. Using good sanitation with dishes and shared bathrooms\nC. Avoiding contact with blood-soiled clothing or dressing\nD. Forbidding the sharing of needles or syringes", "response": "Hepatitis A is transmitted through the faecal-oral route or from contaminated water or food. \nMeasures to protect the family include good handwashing, personal hygiene and sanitation, and the use of standard precautions. \nComplete isolation is not required. Avoiding contact with blood-soiled clothing or dressings or avoiding the sharing of needles or syringes are precautions needed to prevent transmission of hepatitis B.\n\nSo the answer to this question is B"}
{"instruction": "The mainstay of treatment of vitiligo is?\nA. PUVA\nB. Imiqinod\nC. Acyclovir\nD. Coal tar", "response": "Ans. is 'a' i.e., PUVA\n\nSo the answer to this question is A"}
{"instruction": "Threshold radiation dose for hematological syndrome is?\nA. 2 Gy\nB. 6 Gy\nC. 15 Gy\nD. 50 Gy", "response": "Ans. is'a'i.e., 2 GyBone marrow or hematological syndrome:- Full syndrome occurs with a dose between 0.7 and 3 Gy (70-300 rads).The destruction of bone marrow cells results in pancytopenia.\n\nSo the answer to this question is A"}
{"instruction": "Predictable and dose related drug induced hepatic injury is seen with all, EXCEPT:\nA. Carbon tetrachloride\nB. Acetaminophen\nC. INH\nD. Oral contraceptive agent", "response": "There are two major types of chemical hepatotoxicity Direct toxicity-Predictable with sho latent period Idiosyncratic-Not predictable and it can happen at any time Examples of direct hepatotoxic effects Carbon tetrachloride Acetaminophen OCP INH causes idiosyncratic type reaction Hepatitis is infrequent and unpredictable Ref: Harrison, Edition-18, Page-2558\n\nSo the answer to this question is C"}
{"instruction": "Rupture of Berry aneurysm causes\nA. Extradural hemorrhage\nB. Subdural hemorrhage\nC. Subarachnoid hemorrhage\nD. Intracerebral hemorrhage", "response": "Subarachnoid hemorrhage Rupture of sacular Berry aneurysm which is usually located in one of the vessels in the Circle of Willis. Berry aneurysm occurs due to congenital defect or degenerative change in the muscle layer and internal elastic lamina. Only the initimal layer and adventitia of the aery form the dome of the aneurysm. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 174\n\nSo the answer to this question is C"}
{"instruction": "Double Bubble sign is seen with:\nA. Pyloric stenosis\nB. Duodenal atresia\nC. Ileal atresia\nD. Esophageal atresia", "response": "Ans is 'b' i.e. Duodenal atresia \"The ultrasound hallmark of duodenal atresia is the 'double bubble sign'. This consists of two adjacent, fluid-filled cavities in the upper abdomen: a lateral and usually somewhat larger cavity representing the dilated stomach, and a medial cavity representing the distended proximal duodenum between the pylorus and the stenosis.\"- Ultrasound in obstetrics and gynecology By Eberhard Merz, F. Bahlmann 2/e p298Double bubble sign:The double bubble sign is a finding observed on radiographs of newborns and infants. It is reproducible with a variety of other imaging modalities, including upper gastrointestinal studies and prenatal sonography. The finding depicts two air-filled structures in the upper abdomen, with little or no air distally. Horizontal-beam radiographs will demonstrate air and fluid levels in both bubbles.The first bubble (proximal and left sided) is - stomachThe second bubble (to the right of the midline) is - duodenumThe detection of the double bubble sign leads to suspicion of a number of structural anomalies, all of which cause duodenal obstruction.Causes:Intrinsic causes areExtrinsic causes are- duodenal atresia,- annular pancreas,- duodenal stenosis,- malrotation of the gut with obstruction produced byandmidgut volvulus or by Ladd bands, and- duodenal webs;- preduodenal position of the portal vein.The specific duodenal structural anomaly causing the obstruction determines the appearance, prominence, and presence of air distal to the obstruction. Duodenal atresia produces complete obstruction, partially obstructing anomalies, such as duodenal web or duodenal stenosis, allow passage of some air distal to the obstruction and a less dramatic double bubble.\n\nSo the answer to this question is B"}
{"instruction": "Hashimoto's thyroiditis,all are TRUE except-\nA. Neutrophilic infiltration\nB. Maximum incidence in children\nC. Pain in hyoid\nD. None of the above", "response": "In Hashimoto's thyroiditis, there is a marked lymphocytic infiltration of the thyroid with germinal center formation, atrophy of the thyroid follicles accompanied by oxyphil metaplasia, absence of colloid, and mild to moderate fibrosis. Its incidence increases with age (mean age at diagnosis is 60 yrs). Patients with Hashimoto's thyroiditis may present because of goiter rather than symptoms of hypothyroidism. The goiter may not be large, but it is usually irregular and firm in consistency. Reference : page 2290-91 Harrison's Principles of Internal Medicine 19th edition\n\nSo the answer to this question is D"}
{"instruction": "Which of the following type of hypersensitivity reaction is found in the given condition?\nA. Anaphylactic type\nB. Cytotoxic type\nC. Type III hypersensitivity\nD. Cell mediated hypersensitivity", "response": "*ADCC (Antibody dependent cellular cytotoxicity) - NK cells by identifying Fc receptors of antibody*Clinical examplesOTransfusion reactionsOErythroblastosis fetalis OAutoimmune hemolytic anemia\n\nSo the answer to this question is B"}
{"instruction": "In osteoarthtitis, Bouchard nodes and Heberden's nodes seen respectively,\nA. DIP and PIP\nB. PIP and DIP\nC. Palm and DIP\nD. DIP and MCP", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "In which of the following conditions, MTP can be indicated -a) Pregnancy caused by rapeb) Husband is willing but mother is not agreeingc) If maternal health is in dangerd) Pregnancy after contraceptive failuree) Pregnant women have received cytotoxic drugs\nA. bce\nB. bde\nC. acde\nD. abde", "response": "Pregnancy due to rape, danger to maternal health, receiving cytotoxic drugs (can cause fetal damage and risks of a born child with physical/mental abnormalities) and pregnancy due to contraceptive failure are indications for abortion under MTP act.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is true of lepromatous leprosy a) Bacterial index + to ++ b) Involvement of earlobes c) Symmetrical involvement d) Only a few bacilli are seen in the lesion e) Loss of eyebrows\nA. abc\nB. bce\nC. ade\nD. cde", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Endolymph is seen in ?\nA. Scala vestibule\nB. Scala media\nC. Scala tympani\nD. Helicotrema", "response": "Ans. is 'b' i.e., Scala media * The scala vestibuli and scala tympani are filled with perilymph and the scala media is filled with endolymph.\n\nSo the answer to this question is B"}
{"instruction": "Pin index system for oxygen\nA. 1,5\nB. 2,5\nC. 4,5\nD. 3,5", "response": "Ans: (b) 2,5Ref: Miller's Anaesthesia 7th ed. / 675* Pin index for oxygen is 2, 5.* Cylinder of oxygen is black body with white shoulder.GasColor CodePin index positionBodyShoulderOxygenBlackWhite2,5Nitrous oxideBlueBlue3, 5CO2GrayGray1,6HeliumBrownBrown2,5AirGreyWhite/black quartered1,5\n\nSo the answer to this question is B"}
{"instruction": "Extensor carpi radialis longus is a/an -\nA. Wrist extensor\nB. Wrist adductor\nC. Extensor of MCP joint\nD. Extensor of IP joint", "response": "Ans. is 'a' i.e., Wrist extensoro Extensor carpi radialis longus causes :-i) Extension of wristii) Abduction of wristo It is supplied by radial nerve.\n\nSo the answer to this question is A"}
{"instruction": "A 50-year-old patient with ischemic hea disease develops chest pain. ECG shows ST segment elevation and Q waves. Myocardial necrosis in this patient can be best demonstrated by:\nA. Technetium 99 tetrofosmin\nB. Sestambi scan\nC. Technetium 99 Pyrophosphate\nD. Thallium 201", "response": "Myocardial infarct imaging: Tc99m pyrophosphate is used to localize the area of infarct in hea. Area of infarct On thallium scan (Perfusion image) Cold spot Pyrophosphate scan (Infarct image) Hot spot\n\nSo the answer to this question is C"}
{"instruction": "Acinar cells of the Exocrine Pancreas secrete\nA. Glucagon\nB. Lysozyme\nC. Insulin.\nD. Proteases", "response": "Several Proteases are synthesized by Pancreatic Acinar Cells and are delivered the Pancreatic Duct to the Duodenum\n\nSo the answer to this question is D"}
{"instruction": "A 30-year-old pregnant woman and her 2-year-old child are residing in high altitude area. The child is sho in stature, has a potbelly and enlarged protruding tongue, and is developmentally delayed. Iodine is prescribed for mother and child, with the hope of preventing mental retardation in the developing fetus. All are true about oxidation of iodide except\nA. Conversion of iodide to iodine\nB. Promoted by enzyme peroxidase\nC. Iodide transpoed to follicular lumen by Na-I sympoer\nD. Propylthiouracil blocks this step", "response": "Conversion of iodide ions to an oxidized form of iodine, either nascent iodine (I0) or I3-, which is then capable of combining directly with the amino acid tyrosine. This oxidation of iodine is promoted by the enzyme peroxidase and its accompanying hydrogen peroxide, which provide a potent system capable of oxidizing iodides. Iodide exit from the thyrocyte across the apical membrane to access the colloid is mediated by a Cl-/I- exchanger known as pendrin. The mechanism of action of propylthiouracil is paly to block the peroxidase enzyme that is required for iodination of tyrosine and paly to block the coupling of two iodinated tyrosines to form thyroxine or triiodothyronine. Reference: Guyton; 13th edition; Page no: 953, 960Reference: Ganong's Review of Medical Physiology; 25th edition; Page no: 339\n\nSo the answer to this question is C"}
{"instruction": "Most common cause of renal papillary necrosis is\nA. Analgesic nephropathy\nB. Sickle cell disease\nC. Diabetes mellitus\nD. Chronic pyelonephritis", "response": "Renal papillary necrosis is a form of nephropathy involving the necrosis of the renal papilla. Lesions that characterize renal papillary necrosis come from an impairment of the blood supply and from subsequent ischemic necrosis that is diffuse. In terms of cause, almost any condition that involves ischemia can lead to renal papillary necrosis. A mnemonic for the causes of renal papillary necrosis is (POSTCARDS: pyelonephritis, obstruction of the urogenital tract, sickle cell disease, tuberculosis, cirrhosis of the liver, analgesia/alcohol abuse, renal vein thrombosis, diabetes mellitus, and systemic vasculitis.) Often, a patient with renal papillary necrosis will have numerous conditions acting synergistically to bring about the disease. Refer robbins 9/e936\n\nSo the answer to this question is C"}
{"instruction": "The component of vitreous humour that is most useful in determining time since death:\nA. Sodium\nB. Potassium\nC. Magnesium\nD. Calcium", "response": "Ans. b (Potassium). (Ref. Parikh's textbook of FMT, 6th ed., 2.66)The relationship between the rise of potassium concentration in the vitreous humour and the time since death has been studied by several workers. To improve the accuracy of the method cases with possible ante-mortem electrolyte disturbances can be excluded. Having eliminated these cases with possible ante-mortem electrolyte imbalance, there is a linear relationship between potassium concentration in vitreous and time after death up to 120 hours, but the 95% confidence limits are +- 22 hours.\n\nSo the answer to this question is B"}
{"instruction": "In burns management, which of the following is the medium of choice:\nA. Dextrose 5%\nB. Normal saline\nC. Ringer lactate\nD. Isolyte-M", "response": "Ans. C: Ringer lactate\n\nSo the answer to this question is C"}
{"instruction": "C wave in JVP is due to -\nA. Atrial contraction\nB. Tricuspid valve bulging into right atrium\nC. Right atrial filling\nD. Rapid ventricular filling", "response": "Atrial pressure rises during atrial systole and continues to rise during isovolumetric ventricular contraction when the AV valves bulge into the atria. When the AV valves are pulled down by the contracting ventricular muscle, pressure falls rapidly and then rises as blood flows into the atria until the AV valves open early in diastole. The return of the AV valves to their relaxed position also contributes to this pressure rise by reducing atrial capacity. The atrial pressure changes are transmitted to the great veins, producing three characteristic waves in the record of jugular pressure . The a wave is due to atrial systole. As noted above, some blood regurgitates into the great veins when the atria contract. In addition, venous inflow stops, and the resultant rise in venous pressure contributes to the a wave. The c wave is the transmitted manifestation of the rise in atrial pressure produced by the bulging of the tricuspid valve into the atria during isovolumetric ventricular contraction. The v wave mirrors the rise in atrial pressure before the tricuspid valve opens during diastole. The jugular pulse waves are superimposed on the respiratory fluctuations in venous pressure. Venous pressure falls during inspiration as a result of the increased negative intrathoracic pressure and rises again during expiration. Ref Harrison 20th edition pg 1436\n\nSo the answer to this question is B"}
{"instruction": "Uterine bleeding at 12 weeks gestation without any cervical dilation is an indication of\nA. Incomplete aboion\nB. Threatened aboion\nC. Missed aboion\nD. Inevitable aboion", "response": "Bleeding occurs in about 30 to 40%of human gestations before 20 weeks of pregnancy, with about half of these pregnancies ending in spontaneous aboion. A threatened aboion takes place when this uterine bleeding occurs without any cervical dilation or effacement\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is not a complication of EALE's disease?\nA. Rubeosis iridis\nB. Retinal detachment\nC. Neurovascular glaucoma\nD. Optic neuritis", "response": "Eale's diseaseis a nonspecific inflammation of veins of the peripheral retina. Optic neuritis does not occur as a complication of Eale's disease. Common eye manifestations includes retinal hemorrhage, vitreous hemorrhage, retinal detachment, rubeosis iridis, complicated cataract and neovascular glaucoma. Reference: Textbook of Ophthalmology By H V Nema, 6e page 311.\n\nSo the answer to this question is D"}
{"instruction": "All of the following statement regarding measles are true except -a) Rash appears first on legb) Koplik spot are seen on retinac) Long term complication may be seen in form of SSPEd) Caused by RNA viruse) I-P is 2-3 days\nA. abc\nB. bcd\nC. cde\nD. abe", "response": "Measles \n\nMeasles is caused by a RNA virus of paramyxovirus.\nMeasles in also known as rubella\nThe only source of infection is a case of measles, carriers are not known to occur.\nInfective period → 4 days before and 5 days after the appearance of rash.\nInfective material → Secretions of nose, throat and respiratory tract\nAge group → 6 month to 3 years.\nImmunity → One attack of measles generally confers lifelong immunity. \nTransmission → \n\n\nDroplet infection through respiratory tract\nInfection through conjunctiva.\n\n\nIncubation period →\n\n\n10 days from exposure to onset of fever.\n14 days from exposure to appearance of rash.\n7 days for live vaccine of measles.\n\nClinical manifestations\n1) Prodromal stage\n\nBegins 10 days after the infection and lasts until day 14.\nCharacterized by fever, coryza with sneezing and nasal discharge, redness of the eyes, lacrimation and photophobia.\nA day or two before the appearance of rash, Koplik's spots appear on buccal mucosa opposite the 1st and 2nd lower molars.\nKoplik's spots are pathognonzonic of measles.\n\n2) Eruptive phase\n\nMaculopapular rash which begins behind the ear and spread rapidly in a few hour over the face and neck extends doWn the body.\n\n3) Post measles stage\n\nWeight loss \nGrowth retardation \nDiarrhea\nCancrum oris \nReactivation of pulmonary TB \nCandidiasis\n\nSo the answer to this question is D"}
{"instruction": "Cause of Farmer's lung –\nA. Cotton dust\nB. Grain dust\nC. Sugarcane dust\nD. Iron", "response": "Farmer's lung is caused by Hay or grain dust.\n\nSo the answer to this question is B"}
{"instruction": "High frequency audiometry uses frequency higher than the frequency region required to understand speech. It is used to monitor which of the following?\nA. Otosclerosis\nB. Ototoxicity\nC. Otospongiosis\nD. Meniere's disease", "response": "High-frequency audiometry is specifically for ototoxicity monitoring, comprises air conduction thresholds from 10,000 to 20,000 Hz. Most ototoxic hearing losses will first occur in that frequency region, which is higher than the speech range.\n\nSo the answer to this question is B"}
{"instruction": "\"Sycosis barbae\" is caused by\nA. Streptococcus aureus\nB. Pseudomonas\nC. Trichophyton rubrum\nD. Staphylococcus aureus", "response": "It is the repeated infection of bearded region by Staphylococcus.aureus.\n\nSo the answer to this question is D"}
{"instruction": "Type of graft, best suited for renal transplantation ?\nA. Allograft\nB. Autograft\nC. Xenograft\nD. Isograft", "response": "Ans is 'd' i.e., Isograft Although the best graft is autograft, a renal graft can obviously not be an autograft. So the best renal graft is an isograft.\n\nSo the answer to this question is D"}
{"instruction": "An increased incidence of cholangiocarcinoma is seen in all of the following except\nA. Hydatid cyst of liver\nB. Polycystic disease of liver\nC. Sclerosing cholangitis\nD. Liver flukes", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Excessive desire for substance abuse in a drug addict is: called:\nA. Craving\nB. Impulse\nC. Dependence\nD. Compulsion", "response": "Ans: A (Craving) Ref: Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 9th editionExplanation:AddictionIt is a lay-man term no longer preferred in medical literature.There is a range in the use of any substance (here \"substance\" is the term denoting anything which has some effect on body, usually brain) viz., - misuse (excessive, unwarranted use of medicines). harmful use (persistent use despite adverse health problems due to substance), abuse (persistent use despite adverse social/financial consequences).DependenceIt is a broader term covering above plus others.Two types of dependence noted:o Psychico PhysicalPsychic dependence is characterised by:o Craving: Craving denotes excessive,''persistent desire to use the substance,o Loss of control.Physical dependence is characterised by:o Tolerance (higher amount of substance needed to produce the original effect/kickl).o \"Withdrawal symptoms'\" (unique for each substance),o Dependence is a syndrome covering all (as per ICD-10, 3/6 criteria is enough for it).CompulsionIt is a repeated activity mostly due to an obsession.It is seen in OCD. where the person considers his compulsion as irrational (ego-dystonic)ImpulseIt is an irresistible urge to do something (usually harmful to self/others).Impulse- control disorders (ICD) are a group of disorders characterised by repetitive impulsive behaviour like pyromania, pathological gamblingCompulsion Vs ImpulseThe key difference between compulsion and impulse is the aim of the act- in compulsion the aim is to get rid of the anxiety and in impulse - no aim at all or a pleasure.Even though \"repetitive\" behaviour is common and central theme in all these three (Substance abuse, OCD, ICD) compulsion and impulse are not used in substance psychology widely and that too in same meaning.\n\nSo the answer to this question is A"}
{"instruction": "A hyperplastic mass containing neuroendocrine cells in an area of chronic inflammation and scarred tissue of lung is called?\nA. Carcinoid\nB. Tumorlet\nC. Hamartoma\nD. Teratoma", "response": "Ans. (b) Tumorlet(Ref: Robbins 9th/pg 719-720; 8th/pg 729)Benign tumorlets of lungs are small, insignificant, hyperplastic nests Q of neuroendocrine cells seen in areas of scarring or chronic inflammation Q\n\nSo the answer to this question is B"}
{"instruction": "A patient with history of chronic pancreatitis comes to you for regular follow up. Which vitamin deficiency can be expected in the patient\nA. Vit B1\nB. Vit K\nC. Vit B6\nD. Vit B3", "response": "Chronic pancreatitis is associated with malabsorption and steatorrhea and can lead to deficiency.\nFat soluble vitamins (A, D, E, K) though it is rare.\n\nSo the answer to this question is B"}
{"instruction": "A 58-year-old female smoker with end-stage chronic obstructive pulmonary disease and osteoarthritis is on ipratropium bromide and albuterol inhalers, and hydrocodone-acetaminophen. She presents with respiratory distress for 2 days accompanied by increased thick, yellow sputum production, low grade fever, and increasing confusion. On examination she is mildly obtunded but arousable, BP 160/100, pulse 115/min, RR 30/min, O2 saturation 84% on her usual 3 L/min nasal cannula oxygen. She is using accessory muscles to breath, has diffuse wheezing and rhonchi bilaterally, a prolonged expiratory phase, distant but regular heart sounds, and no peripheral edema.Arterial blood gases (ABGs) on arrival are as follows:pH: 7.20,PO2: 70 mm HgPCO2: 65 mm Hgcalculated HCO3 29 mEq/L.Electrolytes return shortly thereafter as follows:Na: 140 mEq/LK: 5.1 mEq/LHCO3: 29 mEq/LCl: 100 mEq/LBUN 20 mg/dL creatinine 1.5 mg/dLglucose 89 mg/dL.After prompt initiation of noninvasive positive pressure ventilation (Bi-pap), blood cultures, toxicology screen, intravenous fluids, and IV antibiotics, you have time to consider the patient's metabolic situation. Choose the answer which best describes the acid-base condition and its etiology.\nA. The patient has acute, severe respiratory acidosis caused by the sudden deterioration in her respiratory status.\nB. The patient has an underlying metabolic acidosis caused by her renal insufficiency now compounded by a respiratory alkalosis.\nC. The patient ingested abundant amounts of aspirin which caused a severe metabolic acidosis and respiratory failure.\nD. The patient has a baseline chronic respiratory acidosis with metabolic compensation, now with a superimposed further respiratory acidosis caused by decreased ventilation.", "response": "Patients with severe COPD often have a baseline chronic respiratory acidosis with a PCO2 in the 50 to 60 mm Hg range. They are unable to ventilate sufficiently to correct the acidotic situation this creates. The kidney then compensates by retaining HCO3 . This results in a new steady state in which the patient has a near-normal pH on their blood gas despite the chronically elevated CO2 . In this question the further deterioration in the patient's respiratory status due to COPD exacerbation has caused further CO2 retention and a superimposed acute respiratory acidosis on top of the chronic respiratory acidosis. Salicylate overdose normally causes an anion gap acidosis and the AG is normal here. Volume depletion, especially due to recurrent vomiting, can lead to a contraction alkalosis, but this patient's acidosis indicates that the elevated bicarbonate level is caused by renal compensation for her chronic CO2 retention.\n\nSo the answer to this question is D"}
{"instruction": "All of the following antiepileptic agents act Na+ channel except -\nA. Vigabatrin\nB. Phenytoin\nC. Valproate\nD. Lamotrigine", "response": "Ans. is 'a' i.e., Vigabatrin Mechanism of action of different antiepileptics. Prolongation of Na+ channel inactivation Facilitation of GABA mediated Cl- channel opening Inhibition of T type Ca++ current Decrease of excitatory neurotransmission o Phenytoin o Carbamazepine o Valproate o Lamotrigine o Topiramate o Zonisamide o Barbiturates o Benzodiazepine o Vigabatrin o Valproate o Gabapentin o Tiagabine o Ethosuximide o Trimethadione o Valproate o Felbamale\n\nSo the answer to this question is A"}
{"instruction": "Best treatment of the large cyst:\nA. Enucleation\nB. Marsupialisation\nC. Marsupialisation followed by Enucleation\nD. Enucleation followed by marsupialisation", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "HPV type least commonly associated with carcinoma cervix :\nA. 6\nB. 35\nC. 16\nD. 18", "response": "HPV High oncongenicity: Types 16,18, 31, 33, 35, 45, 56 Low oncogenecity: Types 6,11, 42, 43 Ref: D.C.DUTTA&;S TEXTBOOK OF GYNAECOLOGY; 6th edition; Pg no:323\n\nSo the answer to this question is A"}
{"instruction": "Index case refers to\nA. First case of a communicable disease introduced into the population unit being studied\nB. First case to come to attention of investigator\nC. Developing from contact with primary case\nD. An individual who has signs and symptoms connected to the suspected pathogens", "response": "First case of a communicable disease introduced into the population unit being studied Primary case First case to come to attention of investigator Index case Developing from contact with primary case Secondary case An individual who has signs and symptoms connected to the suspected pathogens Suspect case\n\nSo the answer to this question is B"}
{"instruction": "Which of the following cell does not have cytotoxic activity ?\nA. NK cells\nB. Cytotoxic T-cells\nC. Helper T-cells\nD. Antibody dependent cells", "response": "Ans. is 'c' i.e.,Helper T-cells\n\nSo the answer to this question is C"}
{"instruction": "The term \"balanced anaesthesia\" has been given by?\nA. Simpson\nB. Fischer\nC. Lundy\nD. Moan", "response": "Ans. is 'c' i.e., Lundy Term 'balanced anaesthesia' was introduced by Lundy in 1926. Balanced anaesthesia The cardinal feature of general anaesthetics are : ? Loss of all sensations, especially pain Sleep (unconciousness) and amnesia Immobility and muscle relaxation Abolition of reflexes In modern practice of balanced anaesthesia these modalities are achieved by using combination of inhaled and iv.drugs.\n\nSo the answer to this question is C"}
{"instruction": "Test tube baby is produced by:\nA. Sperm and ovum are directly implanted into fallopian tube\nB. Sperm and ovum are fertilized in test tube and implanted\nC. Fetus is grown in test tube\nD. Only sperm is transferred", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following statement regarding typhoid in children is false?\nA. Splenomegaly may be seen\nB. Neutropenia may be present\nC. Urine and stool culture may show the organism after 2 weeks of illness\nD. Relative bradycardia is invariably seen in children", "response": "Relative bradycardia is not always present in a child with typhoid fever. Typhoid is diagnosed using blood culture which is positive during the 1st week of illness, urine culture during 2nd or 3rd week or using widal test during 3rd week of illness. Ref: Textbook of Microbiology By Ananthanarayan, 8e page 296.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is most suggestive of neonatal small bowel obstruction -\nA. Generalized abdominal distension\nB. Failure to pass meconeum in the first 24 hours\nC. Bilious vomiting\nD. Refusal of feeds", "response": "Generalized abdominal distention is more indicative of large bowel obstruction. In small bowel obstruction the distention is mild to massive depending on the site of obstruction (minimal or absent in proximal & mild to massive in distal) and is usually central and not generalized.\nFailure to pass meconium in the first 24 hrs is a feature of obstruction as in Hirschprung's disease.\nRefusal to feed is a common but nonspecific symptom.\nThe most common symptom suggestive of small bowel obstruction is bilious vomiting.\n\nSo the answer to this question is C"}
{"instruction": "A drug that blocks the uptake of dopamine and norepinephrine into presynaptic nerve terminals and also blocks sodium channels in the axonal membrane is:\nA. Cocaine\nB. Ephedrine\nC. Imipramine\nD. Fluoxetine", "response": "It is a local anaesthetic agent (acts by inhibiting Na+ channel in the axonal membrane) that also possesses indirect sympathomimetic activity.\n\nSo the answer to this question is A"}
{"instruction": "Initial 2cm of Duodenum does not get arterial supply by\nA. Right gastric artery\nB. Superior pancreaticoduodinal artery\nC. Right Gastroepiploic artery\nD. Common hepatic artery", "response": "Initial 2cm of Duodenum ( Duodenal Cap) is not supplied by Superior pancreaticoduodinal artery.\n\nSo the answer to this question is B"}
{"instruction": "A 31-year-old woman has experienced increasing malaise for the past 4 months. Physical examination yields no remarkable findings. Laboratory studies show total serum protein of 6.4 g/dL, albumin of 3.6 g/dL, total bilirubin of 1.4 mg/dL, AST of 67 U/L, ALT of 91 U/L, and alkaline phosphatase of 99 U/L. Results of serologic testing for HAV, HBV, and HCV are negative. Test results for ANA, anti-liver kidney microsome-1 and anti-smooth muscle antibody are positive. A liver biopsy is done; microscopically, there are minimal portal mononuclear cell infiltrates with minimal interface hepatitis and mild portal fibrosis. What is the most likely diagnosis?\nA. a1-Antitrypsin deficiency\nB. Autoimmune hepatitis\nC. Chronic alcoholism\nD. HDV infection", "response": "Autoimmune hepatitis is a chronic liver disease of unknown cause in which antibodies to hepatocyte structural components cause progressive necrosis of hepatocytes, leading to cirrhosis and liver failure. Patients tend to improve with glucocorticoid therapy. a1 -Antitrypsin deficiency and Wilson disease can lead to chronic hepatitis and cirrhosis, but autoimmune markers are absent. Chronic alcoholism is not associated with the formation of autoantibodies. Because this patient does not have evidence of HBV infection, there can be no superinfection with HDV. Isoniazid may cause acute or chronic hepatitis, but without autoantibodies. Patients with primary biliary cirrhosis often have antimitochondrial antibody (which also can be seen in autoimmune hepatitis), but the bilirubin concentration and alkaline phosphatase level would be much higher in primary biliary cirrhosis.\n\nSo the answer to this question is B"}
{"instruction": "In a case of glomerulonephritis (GN) , C3 is normal in all the following except?\nA. Diffuse lupus nephritis\nB. Good pasteur's syndrome\nC. IgA nephropathy\nD. HSP", "response": "Low C3 nephritis is observed in: Post-infectious GN, MPGN(Membranoproliferative GN) SLE Subacute bacterial endocarditis Cryoglobulinemia, shunt nephritis\n\nSo the answer to this question is A"}
{"instruction": "Protein content in 100 grams of cow milk\nA. 4.3\nB. 3.2\nC. 2.2\nD. 1.2", "response": "Ans. is 'b' i.e., 3.2\n\nSo the answer to this question is B"}
{"instruction": "Neurogenic cause of dysphagia includes following except:\nA. Multiple sclerosis\nB. Tetanus\nC. Parkinsons's disease\nD. Tetany", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "All of the following statement are true regarding Q fever except-\nA. it is zoonotic disease\nB. Human disease is characterized by an interstitial pneumonia\nC. No rash is seen\nD. Weil felix reaction is very useful for diagnosis", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "A mother is HB&;sAg positive at 32 weekds of pregnancy. What should be given to the newborn to prevent neonatal infection -\nA. Hepatitis B vaccine + immuniglobulins\nB. Immunoglobulins\nC. Hepatitis B vaccine only\nD. immunoglobulin followed by vaccine 1 month later", "response": " Hepatitis B vaccine and immunoglobulins are given to the newborn to prevent infection. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:216. <\\p>\n\nSo the answer to this question is A"}
{"instruction": "Schwaz operation is done in\nA. CSOM\nB. Serous otitis media\nC. Otosclerosis\nD. Acute mastoiditis", "response": "Coical mastoidectomy, known as simple or complete mastoidectomy or Schwaz operation It is complete exenteration of all accessible mastoid air cells and conveing them into a single cavity. The posterior meatal wall is left intact and Middle ear structures are not disturbed. INDICATIONS 1. Acute coalescent mastoiditis. 2. Incompletely resolved acute otitis media with reservoir sign. 3. Masked mastoiditis. Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition; Pg no: 401\n\nSo the answer to this question is D"}
{"instruction": "Which of the following condition is associated with hypokalemic metabolic alkalosis with hypeension:\nA. Liddle's syndrome\nB. Bater syndrome\nC. Gitelman syndrome\nD. Renal tubular acidosis", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Endodontic therapy should preferably be initiated within______ post trauma.\nA. 2-3weeks\nB. 3-4weeks.\nC. 2 months\nD. 4 months.", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "True about saphenous vein\nA. 1cm anterior to medial malleolus process\nB. 1cm inferior to medial malleolus process\nC. 1cm posterior medial malleolus process\nD. 1cm superior to medial malleolus process", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Leukoerythroblastic reaction is seen in following, except:\nA. Secondaries in bone\nB. Multiple myeloma\nC. Hemolytic anemia\nD. Lymphoma", "response": "Lymphoma\n\nSo the answer to this question is D"}
{"instruction": "True about primary lymphoedema\nA. Lymphangiosarcoma may occur\nB. A/W Milroy's disease\nC. Onset b/w 2-35 years indicates lymphoedema tarda\nD. Onset > 35 years indicates praecox variety", "response": " Lymphoedema Accumulation of fluid in extracellular and extravascular fluid compament , commonly in subcutaneous tissue. Classification: 1. Primary - without any identifiable disease. 2. Secondary- acquired due to definitive cause. Primary lymphoedema:- Affects commonly females. Common in lower limb and left side. It can be familial , syndromic ( Turners , Klinefelter&;s , Down&;s, Klipple Trenauy weber) It can be 1. Lymphoedema congenital : present at bih (<2yrs). Familial type is called Nonne- Milroy disease. 2. Lymphoedema praecox- present at pubey (2-35 years). Familial type is called Letessier- Meige&;s syndrome. 3. Lymphoedema tarda- present in adult life after 35 years. Complications: Skin thickening, abscess, maggot formation. Recurrent cellulitis Lymphangiosarcoma Recurrent streptococcal infection. {Reference: SRB&;s manual of surgery, 5th edition , page no. 247}\n\nSo the answer to this question is A"}
{"instruction": "Bilirubin is absent in urine because it is?\nA. Distributed in the body fat\nB. Conjugated with glucoronide\nC. Not filterable\nD. d) Lipophilic", "response": "Bilirubin in the blood is normally almost all unconjugated and, because it is not water soluble, is bound to albumin and does not pass into the urine. Bilirubin is conjugated in hepatocytes. Reference : Davidson, 23rd Edition, page no : 851\n\nSo the answer to this question is C"}
{"instruction": "Chronic Active Hepatitis is most reliably distinguished from chronic Persistent hepatitis by the presence of\nA. Extrahepatic manifestation\nB. Significant titre of antismooth muscle antibody\nC. Characteristic liver histology\nD. Hepatitis B surface antigen", "response": "Minimal chronic hepatitis (previously called chronic persistent hepatitis).\nThe portal chronic inflammation is mild and is restricted to the portal triads without extension into the Liver lobule across the limiting plate.\nChronic active hepatitis → characterized by continuing necrosis of Liver cells. The severe inflammation disrupts the limiting plate.\n\nSo the answer to this question is C"}
{"instruction": "The structures passing posterior to diaphragm are all except:\nA. Aoa\nB. Azygous vein\nC. Thoracic duct\nD. Greater splanchnic nerve", "response": "D i.e. Greater splanchnic nerve\n\nSo the answer to this question is D"}
{"instruction": "Bowler hat sign is seen in\nA. Sigmoid volvulus\nB. Midgut volvulus\nC. Intussusception\nD. Sessile colonic polyp", "response": "BOWLER HAT SIGN: Cup shaped filled defect seen on air contrast barium enema that represents POLYP if it points towards lumen. The \"bowler-hat sign\" represents the appearance of a sessile colonic polyp observed at an oblique angle on a double contrast barium enema. The bowler-hat sign is formed by a ring of barium adjacent to the base of the polyp surrounding a domed layer of barium coating the surface of the polyp.\n\nSo the answer to this question is D"}
{"instruction": "Schwannoma arises most frequently from:\nA. Vestibular Nerve\nB. Trigeminal nerve\nC. Cochlear Nerve\nD. Facial Nerve", "response": "A schwannoma (also known as acoustic neuroma, acoustic neurinoma, or acoustic neurilemoma) is a benign, usually slow-growing tumor that develops from the vestibular nerves supplying the inner ear. The tumor comes from an overproduction of Schwann cells--the cells that normally wrap around nerve fibers like onion skin to help suppo and insulate nerves. As the vestibular schwannoma grows, it presses against the hearing and balance nerves, usually causing unilateral (one-sided) or asymmetric hearing loss, tinnitus (ringing in the ear), and dizziness/loss of balance. It comprises 5-10% of all intracranial neoplasms in adults. Incidence peaks in the fifth and sixth decades and both sexes are affected equally.\n\nSo the answer to this question is A"}
{"instruction": "The pathogenesis of acute proliferative glomerulonephritis -\nA. Cytotoxic T-cell mediated\nB. Immune complex mediated\nC. Antibody mediated\nD. Cell-mediated (Typer IV)", "response": "Ans. is 'b' i.e., Immune complex mediated o Postinfectious acute proliferative glomerulonephritis is due to immune-complex mediated (Type III) hypersensitivity.Rapidly progressive glomerulonephritiso Rapidly progressive glomerulonephritis (RPGN) is a syndrome associated with severe glomerular injury and does not denote a specific etiology form of glomerulonephritis,o RPGN is defined by 2 criteria.Presence of epithelial crescentsOccurrence of rapidly progressive renal failure.o In most cases, the glomerular injury is immunologically mediated,o RPGN is divided into three groupsType I (Anti-GBM antibody)Characterized by the presence of autantibodies directed against the glomerular basement membrane (GBM).It is also called anti-GBM glomerulonephritis.The antibodies are directed against a particular protein found in GBM, type IV collegen, specifically the noncollagenous region of its a3 chain.Type II (Immune complex)Caused by deposition of immune complex.Thus immune complex disease causes type II RPGN.Type III (Pauci-immune)Most common type of RPGN.Defined by the lack of anti-GBM antibodies or immune complex.Instead, the glomeruli are damaged in an undefined manner, perhaps through activation of neutrophils in response to anti-neutrophilic cytoplasmic antibodies (ANCA).RAPIDLY PROGRESSIVE GLOMERULONEPHRITISTypeIRPGN(anti GBM antibody)o Idiopathico Goodpasture syndromeTypelIRPGN(Immune complex)o Idiopathico Post infectiouso Systemic lupus erythematouso Henoch schonlein purpurao IgA nephropathyo Membranoproliferative GNo CryoglobulinaemiaType III RPGN(Pauci immune)o ANCA associatedo Idiopathico Wegener granulomatosiso Microscopic PANo Microscopic polyangitis Note - Post infectious glomerulonephritis may be post streptococcal or post infective endocarditis.\n\nSo the answer to this question is B"}
{"instruction": "What is the microscopic finding of cervical mucus during post-ovulatory period?\nA. Shows pattern on drying\nB. Is thick\nC. Is thin and cellular\nD. Is thin and alkaline", "response": "Dried cervical mucus examined microscopically has characteristic patterns dependent on the stage of the ovarian cycle. Mucus crystallization necessary for the production of the fern pattern is dependent on an increased sodium chloride concentration. Cervical mucus is relatively rich in sodium chloride when estrogen, but not progesterone, is being produced. Thus, during post-ovulatory cycle from approximately the 7th to the 18th day of the cycle, a fernlike pattern is seen. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 8. Prenatal Care. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.\n\nSo the answer to this question is A"}
{"instruction": "A 25 year old married nullipara undergoes laproscopic cystectomy for ovarian cyst which on histopath reveals ovarian serous cisadeno-carcinoma. What should be the next management?\nA. Serial Ca-125 measurement and follow up\nB. Hysterectomy and bilateral ping000phorectomy\nC. Hysterectomy + Radiotherapy\nD. Radiotherapy", "response": "Here the patient is 25 years old nullipara and cystectomy sample shows serous cysadenocarcinoma - Probably the disease is limited to the ovary removed, hence to be called stage Ia.\nDoing an oophorectomy here will suffice as the patient is young and nullipara. Next step is to follow the patient with regular CA 125 estimations. Though the levels of CA 125 are not specific but in this condition where the follow up is after a known cause there is ample sensitivity.\n“Fertility preservation in early stage ovarian cancer - The uterus and the contralateral ovary can be preserved in women with stage Ia, grade 1 to 2 disease who desire to preserve fertility. The conditions of the women should be monitored carefully with routine periodic pelvic examination and determinations of serum CA 125 levels. Generally, the other ovary and the uterus are removed at the completion of childbearing.”\n\nSo the answer to this question is A"}
{"instruction": "What does PACS in medical imaging stands for?\nA. Planned archiving common system\nB. Planned archiving computerized system\nC. Picture archiving and communication system\nD. Picture archiving or computerized system", "response": "Historically, radiographic images were printed on film. However, with widespread adoption of PACS (picture archiving and communications system), images can be electronically processed and viewed on computer work screens. These images then can be transmitted anywhere electronically the Internet. Ref: Wasserman P.L., Pope T.L. (2011). Chapter 7. Imaging of Joints. In M.Y. Chen, T.L. Pope, D.J. Ott (Eds), Basic Radiology, 2e.\n\nSo the answer to this question is C"}
{"instruction": "Atypical pneumonia is caused by all except\nA. Mycoplasma\nB. Adeno virus\nC. Chlamydia\nD. Hemophilus", "response": "Haemophilus influenza causes lobar pneumonia .it is one of the frequent cause of fatal pneumonia in the pandemic of influenza in 1918 _1919 where as atypical pneumonia is not as serious as typical pneumonia Ref:anantnarayan and paniker's microbiology 10th edition\n\nSo the answer to this question is D"}
{"instruction": "False statement regarding Red Cross sign:\nA. Can be used by army medical services\nB. Punishable to use it without permission\nC. Used by members of Red Cross\nD. Can be used by doctors and ambulances", "response": "Red Cross emblem can be used only by members of army medical services. Usage of Red Cross emblem by doctors is Punishable with fine & forfeiture of Propey.\n\nSo the answer to this question is D"}
{"instruction": "All of the following are true regarding LMWH (Low Molecular Weight Heparin) except :\nA. It has higher and predictable bioavailability\nB. It inhibits both factor IIa and Xa\nC. PT; aPTT monitoring is not required\nD. It has more favorable pharmacokinetics", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Drug of choice for infantile spasms in a patient with tuberous scleosis is -\nA. Vigabatrin\nB. Tiagabine\nC. Lamotrigine\nD. Levetiracetam", "response": "Ans. is 'a' i.e., Vigabatrin\n\nSo the answer to this question is A"}
{"instruction": "Most common cause of bone malignancy\nA. Secondaries\nB. Osteosarcoma\nC. Ewings sarcoma\nD. Osteoclastoma", "response": "Metastatic bone disease is the most commonest malignancy of bones and is much more than primary bone tumors Metastatic Bone Diseases(MBD) Cancer that begins in an organ, such as the lungs. breast, or prostate, and then spreads to bone is called metastatic bone disease (MBD). More than 1.2 million new cancer cases are diagnosed each year. Approximately 50% of these tumours can spread (metastasize) to the skeleton. With improved medical treatment of many cancers --especially breast. lung, and prostate -- patients are living longer. However, the primary cancers in more of these patients are spreading to bone. The tumours that result are called bone metastases. Organs involved in MBD * The most common cancers that arise from organs and spread to bone include: * Breast * Lung * Thyroid * Kidney * Prostate Pathophysiology of MBD : MBD causes pain in the area of spread. damages and weakens bone, and puts the patient at a greater risk for broken bones. It can make it hard to paicipate in daily activities. The biggest concern for patients with MBD is the general loss in quality of life. How much of an effect MBD has on a patient will vary and is associated with how much the cancer has spread. which bones are affected, and how severe the bone damage is. There are a range of treatment options, however. that can help patients manage pain and maintain their independence and activity levels. After the lung and the liver, the skeleton is the most common site of spread of cancers that begin in organs. Metastases to the lung and liver are often not detected until late in the course of disease because patients experience no symptoms. In contrast. bone metastases are generally painful when they occur. Cancer most commonly spreads to these sites in the skeleton: Spine Pelvis Ribs Skull Upper arm Symptoms Pain. The most common symptom of MBD is pain. Patients may have pain in the spine, pelvis, or extremities because the bone has been weakened by the tumour. Fractures. Weakened bones break more easily. A fracture from a minor injury is another possible sign of MBD. Anaemia. The most common sites of spread -- spine, pelvis, ribs, skull, upper arm, and long bones of the leg --correspond to areas of bone marrow that produce high levels of red blood cells, the cells responsible for carrying oxygen to tissues in the body. Anaemia (decreased red blood cell production) is a common blood abnormality in patients with MBD. A cancer patient who experiences any pain, especially in the back, legs, and arms, should notify his or her doctor immediately. Pain that occurs without activity (i.e., walking or lifting an object) is paicularly concerning. Refer Apleys 9th/e p 216\n\nSo the answer to this question is A"}
{"instruction": "An antiepileptic drug 'A' can also be used for the treatment of post–herpetic neuralgia and pain due to diabetic neuropathy. Which of the following can be the agent 'A' ?\nA. Carbamazepine\nB. Gabapentin\nC. Lamotrigine\nD. Primidone", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which virus causes hepatocellular carcinoma ?\nA. Arbo\nB. Herpes\nC. Hepatitis-A\nD. Hepatitis-B", "response": "Ans. is 'd' i.e., Hepatitis-B Hepatitis-B and hepatitis-C can cause hepatocellular carcinoma.\n\nSo the answer to this question is D"}
{"instruction": "Cataracta brunescens result due to deposition of\nA. Copper\nB. Iron\nC. Melanin\nD. Keratin", "response": "Nuclear senile cataract: The usual degenerative changes are intensification of the age- related nuclear sclerosis associated with dehydration and compaction of the nucleus resulting in a hard cataract. It is accompanied by a significant increase in water insoluble proteins. However, the total protein content and distribution of cations remain normal. There may or may not be associated deposition of pigment urochrome and/or melanin derived from the amino acids in the lens. The nucleus may become diffusely cloudy (greyish) or tinted (yellow to black) due to deposition of pigments. In practice, the commonly observed pigmented nuclear cataracts are either amber, brown (cataracta brunescens) or black (cataracta nigra) and rarely reddish (cataracta rubra) in colour. Ref:- A K Khurana; pg num:- 176,178\n\nSo the answer to this question is C"}
{"instruction": "Neuroendocrine lesions of the lung are -\nA. Carcinoid tumor\nB. Alveolar carcinoma\nC. Hamartoma\nD. Asthma", "response": "The normal lung contains neuroendocrine cells within the epithelium as single cells or as clusters, the neuroepithelial bodies.\nNeuroendocrine lesions of the lung may be of following types -\n\nA. Non-Neoplastic\n(i) Reactive neuroendocrine cell hyperplasia in response to inflammation or scarring.\n(ii) Idiopathic pulmonary neuroendocrine cell hyperplasia → a precursor lesion of tumorlets and carcinoids.\n\nB. Neoplastic\n(a) Benign\n(i) Tumorlets → Small, inconsequential hyperplastic neuroendocrine cells seen in areas of scarring or chronic inflammation.\n\n(b) Malignant\n(i) Carcinoid tumor\n(ii) Small cell carcinoma of the lung\n(iii) Large cell neuroendocrine carcinoma of the lung.\n\nSo the answer to this question is A"}
{"instruction": "NK cells kill the viral infected cells due to:\nA. Increased expression of MHC class I molecules\nB. Decreased expression of MHC class I molecules\nC. Increased expression of MHC class II molecules\nD. Decreased expression of MHC class II molecules", "response": "Ans. (a) Increased expression of MHC class I molecules Features of target cell killing by NK cell: Inversely related to target cell expression of MHC class I molecule. So, it kills the cell that expresses little or no HLA class I molecule (provide immunosurveillance) such as virus infected cells, ceain tumor cells and allogenic cells. Non-immune, i.e. without previous sensitization, MHC unrestricted and non-antibody mediated. It kills host cell infected with intracellular bacteria, e.g. Mycobacteria, TB. Listeria, monocytogens. Do not kill cells which express class I MHC (all normal nucleated cells express it).\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is the most likely cause of a woman presenting with shock in immediate post paum period\nA. PPH\nB. Post paum eclampsia\nC. Uterine inversion\nD. Amniotic fluid embolus", "response": "The question has been discussed in many ways since the exact choice asked was not recalled properly: In the aforementioned format, The most frequent cause of obstetrical hemorrhage is failure of the uterus to contract sufficiently after delivery and to arrest bleeding from vessels at the placental implantation site Data from Al-Zirqi, 2008; Berg, 2010; Chichakli, 1999; Zwa, 2008 If the question was 'sudden un explained death', then an amniotic fluid embolism can be the answer The true incidence of AFE is unknown, but has been repoed to range from 1:8 000 to 1:80 000 pregnancies. Amniotic fluid embolism (AFE) it as a syndrome of sudden peripaum shock. This is a catastrophic obstetric emergency that can present as sudden, profound, and unexpected maternal collapse associated with hypotension, hypoxaemia, and disseminated intravascular coagulation (DIC). It occurs when amniotic fluid, fetal cells, hair, or other debris enter the maternal circulation. Risk Factors: Advanced maternal age; multiparity; meconium stained liquor; intrauterine fetal death; polyhydramnios; strong frequent or tetanic uterine contractions; maternal history of allergy or atopy; chorioamnionitis; AFE is caused by fetal antigens in the amniotic fluid stimulating a cascade of endogenous immune mediators, producing a reaction similar to anaphylaxis\n\nSo the answer to this question is A"}
{"instruction": "The posterior focal point of the reduced eye situated on the retina is how many millimetre behind the anterior surface of cornea:\nA. 22.9 mm\nB. 24.4 mm\nC. 23 mm\nD. 21 mm", "response": "Ans. 24.4 mm\n\nSo the answer to this question is B"}
{"instruction": "Lisch nodules in neurofibromatosis are -\nA. Iris pearls\nB. Hamartomas\nC. Granulomas\nD. None of the above", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which is not a feature of Apoptosis:\nA. Cellular shrinkage.\nB. Nuclear compaction.\nC. The plasma membrane is disturbed\nD. The plasma membrane is intact.", "response": "Apoptosis vs Necrosis:\n\nSo the answer to this question is C"}
{"instruction": "All of the following are components of urogenital diaphragm except:\nA. Sphincter urethrae\nB. Superficial transverse perineii\nC. Deep transverse perineii\nD. Superficial fascia of urogenital diaphragm", "response": "Between the 2 fascial layers (fatty/ superficial and deep/ Colle's fascia) of the urogenital diaphragm lie deep transverse perineii; superficial to the proximal urethral sphincter mechanismUrogenital diaphragmIt is a triangular musculo fascial diaphragm situated in the anterior pa of perineum filling the gap of the pubic arch.Components of urogenital diaphragm:- Deep transverse perinei musclesSphincter urethrae- Superior/ superficial fascia of urogenital diaphragm- Inferior/ deep fascia of urogenital diaphragm (Perineal membrane)Colles fascia does not form a pa of urogenital diaphragm, but it is attached to the posterior border of urogenital diaphragm\n\nSo the answer to this question is B"}
{"instruction": "Vulvar atrophy and itching are treated by-\nA. Estrogen ointment\nB. Antihistamines\nC. Tamoxifen\nD. Oral antifungal treatment", "response": "Vulvar atrophy and itching in menopausal age group are due to deficiency of estrogen that cause dryness of vulva which causes itching. Ideal treatment of this manifestation of post menopausal urogenital atrophy is some form of Hormone Replacement. Topical estrogen is most effective with minimal systemic side effects\n\nSo the answer to this question is A"}
{"instruction": "The peri-orbital view is carried out for ?\nA. Petrous apex\nB. Mastoid process\nC. Bilateral mastoid pathologies\nD. Internal auditory meatus", "response": "Ans. is 'd' i.e., Internal auditory meatus The posteroanterior periorbital projection enables the best evaluation of the internal auditory canal in its full length.\n\nSo the answer to this question is D"}
{"instruction": "For untreated Myocardial infarction condition, select the blood or urine value that best distinguishes Myocardial infarction condition from the others. All values are measured after an overnight fast and are compared with those of a normal individual.\nA. Increased troponin I\nB. Increased blood ketone bodies\nC. Decreased creatinine in the urine\nD. Decreased blood lactate", "response": "Tissues contain characteristic isozymes or mixtures of isozymes. Enzymes, such as lactate dehydrogenase and creatine kinase (CK), differ from one tissue to another. Lactate dehydrogenase contains four subunits. Each subunit may be either of the heart (H) or the muscle (M) type. Five isozymes exist (HHHH, HHHM, HHMM, HMMM, and MMMM). CK contains two subunits. Each subunit may be either of the muscle (M) or the brain (B) type. Three isozymes exist (MM, MB, and BB). The MB fraction is most prevalent in heart muscle.Troponin I is found in large amounts in muscle cells. When a tissue is damaged, cellular enzymes leak into the blood. Heart muscle will release cardiac troponin I into the blood in response to a heart attack. In the absence of insulin, a person with type 1 DM will behave metabolically like a person undergoing prolonged starvation, except that blood glucose levels will be elevated. Lipolysis in adipose tissue will produce fatty acids, which will be converted to ketone bodies in the liver if the diabetes is left untreated. Because the blood glucose levels are also elevated, the brain continues to use glucose as a fuel, and the ketone bodies accumulate in the blood. Hepatitis and chronic alcoholism damage the liver, which would interfere with the urea cycle, leading to decreased BUN and increased ammonia in the circulation. Renal failure would display reduced creatinine in the urine and elevated creatinine in the blood.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following statements is true\nA. Chronic myeloid leukemia occurs beyond 50 years of age\nB. Hairy cell leukemia in less than 50 years has a good prognosis\nC. Acute lymphoid leukemia in less than 1 year has a poor prognosis\nD. Chronic lymphocytic leukemia occurs in less than 50 years of age", "response": "There are 4 main types of leukemia, based on whether they are acute or chronic, and myeloid or lymphocytic: Acute myeloid (or myelogenous) leukemia(AML) Chronic myeloid (or myelogenous) leukemia(CML) Acute lymphocytic (or lymphoblastic) leukemia (ALL) Chronic lymphocytic leukemia (CLL)\n\nSo the answer to this question is C"}
{"instruction": "Which of the following causes decrease in BP\nA. Thromboxane A2\nB. Vasopressin\nC. NO\nD. PGF2", "response": "NOSubstances which cause vasodilatation can cause fall in BP.Substances which cause vasoconstriction can cause a rise in BP.Among the given options only NO (nitric acid) is vasodilator (causes fall in BP). Other three options cause vasoconstriction (cause rise in BP).\n\nSo the answer to this question is C"}
{"instruction": "Drug of choice for treatment of infections caused by MRSA is :\nA. Metronidazole\nB. Vancomycin\nC. Imipenem\nD. Clindamycin", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "An electrode of a cochlear implant is placed in\nA. Horizontal semicircular canal\nB. Scala media\nC. Scala tympani\nD. Scala vestibule", "response": "Pas of the implant: External pa- Microphone, Speech processor, and Transmitter coilInternal pa- Receiver stimulator, Electrode arrayThe electrode array is inseed into the scala tympani by widening the round window (Cochleostomy)Ref: Hazarika; 3rd ed; Pg: 87\n\nSo the answer to this question is C"}
{"instruction": "Hennebert's Sign is seen in-\nA. Congenital Syphilis\nB. AcousticNeuroma\nC. Glomus Tumour\nD. Otosclerosis", "response": "Ans. is 'a' i.e., Congenital Syphiliso Repeat from previous sessions.\n\nSo the answer to this question is A"}
{"instruction": "Regarding vaginal candidiasis which of the following is FALSE:\nA. Cottage cheese like secretions are seen\nB. Intense pruritus\nC. Occuring in pregnancy is classified as uncomplicated candidiasis\nD. Budding yeast cells and pseudohyphae are seen in KOH preparation", "response": "CANDIDIASIS caused by Candida albicans which thrives in an acidic medium with an abundant supply of carbohydrates. Classification of Vulvovaginal Candidiasis Uncomplicated Complicated Sporadic or infrequent in occurrence Recurrent symptoms Mild to moderate symptoms Severe symptoms Likely to be Candida albicans Non-albicans Candida Immuno-competent women e.g., diabetic women Immuno-compromised, diabetic, pregnant SYMPTOMS vulvar pruritus associated with vaginal discharge that typically resembles cottage cheese. The discharge can vary from watery to homogeneously thick. Vaginal soreness dyspareunia vulvar burning and irritation External dysuria (\"splash\" dysuria) may occur when micturition leads to exposure of the inflamed vulvar and vestibular epithelium to urine. DIAGNOSIS A presumptive diagnosis can be made in the absence of fungal elements confirmed by microscopy A fungal culture is recommended to confirm the diagnosis. A 10% KOH smear shows the buds and hyphae of the Candida organism. Pregnancy is a classical situation where the pH is still acidic and the immuno-suppression will actually lead to more resistant type of candidiasis manifestation.\n\nSo the answer to this question is C"}
{"instruction": "Most common neuroendocrine tumour of pancreas is\nA. Insulinoma\nB. Gastrinoma\nC. Non-functional tumours\nD. VIPoma", "response": "TumourIncidence%Insulinoma70-80Gastrinoma20-25Non-functional tumours30-50VIPoma4Glucagonoma4Somatostatinoma<5Carcinoid<1ACTHoma<1GRFoma<1Ref: Bailey and Love 27e pg: 846\n\nSo the answer to this question is A"}
{"instruction": "A 24 year old female working in a office thinks his boss is secretly in love with her. Even though he denies the facts, she feels he is hiding it from her. This disorder is suggestive of\nA. Declerembault syndrome\nB. Cotard syndrome\nC. Othello syndrome\nD. Capgrass syndrome", "response": "Declerembault syndrome also called as Erotomania is where a female usually of lower socioeconomic status believes that a high profile male is secretly in love with her.\n\nCotard syndrome : Delusion of Nihilism.\nOthello syndrome : Delusion of Infidelity.\nCapgrass syndrome : Delusion of Doubles.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not a method for providing enteral nutrition?\nA. PEG\nB. PICC\nC. Sip feeding\nD. Nasojejunal tube", "response": "PICC stand for Peripherally inseed central venous catheter It is not a method for providing enteral nutrition instead it provides parenteral nutritionthrough an peripherally inseed catheter in one of the central veins. Enteral feeding refers to delivery of nutrients into the GIT by means of following techniques: Sip feeding Nasogastric/Ryle's tubes Surgical or Percutaneous endoscopic gastrostomy.\n\nSo the answer to this question is B"}
{"instruction": "A new born presented with jaundice. Most diagnostic investigation of choice is –\nA. Total and Direct bilirubin\nB. Conjugated bilirubin\nC. Serum, Bilirubin\nD. Uroporphyrin levels", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "What is the normal pH of the blood\nA. 7.30–7.40\nB. 7.35–7.45\nC. 7.20–7.30\nD. 7.45–7.55", "response": "Option B: The normal blood pH is tightly regulated between 7.35 and 7.45.\n\nSo the answer to this question is B"}
{"instruction": "Critical temperature for liquid nitrogen is ?\nA. 36.5degC\nB. -20degC\nC. -147degC\nD. -242degC", "response": "Ans. is 'c' i.e., -147deg C Critical temperature (Tc) of a substance is the temperature at and above which vapour of that substance can not be liquified, no matter how much pressure is applied (Note : Below critical temprature a substance can exist as a liquid or gas depending on pressure). Critical temperature of N2 is -146.9deg C; that means N2 can be liquified below -146.9deg C --> So, liquid nitrogen must be stored below -146.9deg C.\n\nSo the answer to this question is C"}
{"instruction": "Pre-exposure prophylaxis for rabies with HDVC involves how many doses of vaccine\nA. 1\nB. 2\nC. 3\nD. 4", "response": "New Recommended regimens/Schedules (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 Ref: Park 25th edition Pgno : 296\n\nSo the answer to this question is C"}
{"instruction": "A 68 years old lady thinks that she has done a sin, she is not worth to live this world, she is also having anorexia and insomnia, she is suffering from -\nA. Exogenous depression\nB. Endogenous depression\nC. Neurotic depression\nD. Dissociate disorder", "response": "Diagnostic criteria for Major depression \n\nFive or more of the following symptoms for at least 2 weeks.\n\n\nDepressed mood\nLoss of interest or pleasure in all \nDecreased or increased appetite\nInsomnia or hypersomnia\nPsychomotor retardation or agitation\nFatigue or loss of energy\nFeeling of worthlessness or excessive guilt\nDiminished concentration\nSuicidal thoughts or attempts\n\nDiagnosis of Minor depression\n\nIf less than five but more than two (i.e. 2-4) of the above symptoms are present for at least 2 weeks then the diagnosis is minor depression.\n\nComing to question\n\nThis patient has:-\n\ni) Excessive guilt (she has done a sin)\nii) Suicidal thoughts (not worth to live this world)\n iii) Anorexia (decreased appetite)\n iv) Insomnia\n\n\nSo, this patient has less than 5 symptoms but more than 2 symptoms but more than 2 symptoms Diagnosis is minor depression.\nNow the question arises, which type of depression is it?\n\n\nEndogenous depression :- No external precipitating event or stressors.\nReactive (neurotic/exogenous) :- Precipitated by external events or stressors, e.g. loss of a loved one, failure in love etc.\n\n\nAs no external precipitating factor has been mentioned in the question, this patient is having endogenous depression.\nSo, the final diagnosis is endogenous minor depression. (If the symptoms would have been 5 or more --> endogenous major depression).\n\nSo the answer to this question is B"}
{"instruction": "An 8-month-old male infant is admitted to the hospital because of a bacterial respiratory infection. The infant responds to appropriate antibiotic therapy, but is readmitted several weeks later because of severe otitis media. Over the next several months, the infant is admitted to the hospital multiple times for recurrent bacterial infections. Workup reveals extremely low serum antibody levels. The infant has no previous history of viral or fungal infections. The most likely diagnosis for this infant is\nA. Isolated IgA deficiency\nB. X-linked agammaglobulinemia of Bruton\nC. Chronic granulomatous disease\nD. DiGeorge's syndrome", "response": "In X-linked agammaglobulinemia of Bruton, B cells are absent but numbers and function of T cells are normal. This abnormality results from defective maturation of B lymphocytes beyond the pre-B stage. This maturation defect leads to decreased or absent numbers of plasma cells, and therefore immunoglobulin levels are markedly decreased. Male infants with Bruton's disease begin having trouble with recurrent bacterial infections at about the age of 9 months, which is when maternal antibodies are no longer present in the affected infant. Therapy for Bruton's disease consists primarily of IV gamma globulin. Isolated deficiency of IgA is probably the most common form of immunodeficiency. It is due to a block in the terminal differentiation of B lymphocytes. Most patients are asymptomatic, but some develop chronic sinopulmonary infections. Patients are prone to developing diarrhea (Giardia infection) and also have an increased incidence of autoimmune disease, such as Hashimoto's thyroiditis. In patients with chronic granulomatous disease (CGD), the neutrophils and macrophages have deficient H2O2production due to abnormalities involving the enzyme NADPH oxidase. These individuals have frequent infections that are caused by catalase-positive organisms, such as S. aureus, because the catalase produced by these organisms destroys the little hydrogen peroxide that is produced DiGeorge's syndrome is a T cell-deficiency disorder that results from hypoplasia of the thymus due to abnormal development of the third and fouh pharyngeal pouches. The parathyroid glands are also abnormal, and these individuals develop hypocalcemia and tetany. Congenital hea defects are also present. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition.\n\nSo the answer to this question is B"}
{"instruction": "What is not a part of triad of Renal Cell Carcinoma?\nA. Loin Mass\nB. Hematuria\nC. Loin Pain\nD. Oliguria", "response": "Ans. is 'd' i.e., Oliguria o The three classical diagnostic features (classical triad) of renal cell carcinoma are costovertebral pain, palpable mass and hematuria. The most reliable of three is hematuria.Signs and Symptoms of Renal Cell Carcinoma (In decreasing order of frequency)o Hematuriao Flank Masso Anaemiao Hypertensiono Hypercalcemiao Neuromyopathyo Increased ESRo Flank Paino Weight losso Fevero Abnormal Liver functiono Erytjhrocytosiso Amyloidosis\n\nSo the answer to this question is D"}
{"instruction": "Which of the following enzyme acts by a 'Ping-Pong' mechanism?\nA. Alanine amino transferase\nB. Hexokinase\nC. Lactate Dehydrogenase\nD. Pyruvate Dehydrogenase", "response": "Ping pong displacement: One or more products are released before all the substrate binds the enzyme\n\nSo the answer to this question is A"}
{"instruction": "Transitional cell carcinoma of bladder is associated with -\nA. Schistosomiasis\nB. Naphthylamine\nC. Smoking\nD. All", "response": "Ans 'a' Schistosomiasis; 'b' Naphthylamine ; 'c' Smoking Risk factors for Transitional cell ca of Bladder 1) Cigarette smoking - is the main etiological factor and accounts for about 50% of bladder cancers. 2) Occupational exposures to chemicals the following compounds may be carcinogenic - 2 naphthylamine - combustion gases and soot from coal - 4-aminobiphenyl - chlorinated aliphatic hydrocarbons - 4-nitrobiphenyl - ceain aldehydes such as acrolein - 4-4-diaminobiphenyl (benzidine) - aniline dyes - 2-ami-1 -naphthol Occupation repoed to be associated with increased risk of bladder cancer - autoworkers - metal workers - painters - textile worker - truck drivers - dye workers drill press operator - petrol workers leather workers rodent exterminators & sevage workers 3) Schistosoma haemotobium - it's a risk factor for both transitional cell ca & squamous cell ca. 4) Drugs such as phenacetin & chlornaphazine 5) Cyclophosphamide therapy 6) Pelvic irradiation Vitamin A supplements appear to be protective.\n\nSo the answer to this question is D"}
{"instruction": "Aseptate hyphae are seen in -\nA. Phycomycetes\nB. Ascomycetes\nC. Basidiomycetes\nD. Deutromycetes", "response": "- Lower fungi (Phycomycetes or Zygomycetes) - Aseptate hyphae - Mucor, Rhizopus and Absidia etc. - Higher fungi (Ascomycetes, Basidiomycetes, Deutromycetes) - Septate hyphae - Dermatophytes, Aspergillus, etc.\n\nSo the answer to this question is A"}
{"instruction": "What is amethocaine:\nA. It is ester local anesthetic\nB. It is other name of tetracaine\nC. It is also typically very effective on local application\nD. All are true", "response": "Amethocaine is an ester local anaesthetic tetracaine. It is a very effective surface anesthetic. Tetracaine, also known as amethocaine, is a local anesthetic used to numb the eyes, nose, or throat. It may also be used before staing an intravenous to decrease pain from the procedure. Typically it is applied as a liquid to the area.\n\nSo the answer to this question is D"}
{"instruction": "Following are precursors of endometrial carcinoma except :\nA. Atypical adenomatous hyperplasia\nB. Atrophic endometrium\nC. Adenocarcinoma in situ\nD. Cystic hyperplasia", "response": "Endometrial atrophy is the most common cause of post menopausal bleeding Reference :Textbook of Gynaecology; Sheila balakrishnan; 2nd edition; Pg no:245\n\nSo the answer to this question is B"}
{"instruction": "Which of the following diagnostic procedure is not done in dilated pupil?(AIIMS November 2014, May 2014)\nA. Gonioscopy\nB. Fundus examination\nC. Laser inferometry\nD. Electroretinography", "response": "Ans. a. Gonloscopy (Ref: Khurana5/e 578; Basics and Clinical Science Course, American Academy of Ophthalmology, 2012-13; Sec 10, p46)Gonioscopy is not done in a dilated pupil. (AllMS May 2014 repeat)Gonioscopy is done in dark room with minimum slit lamp light. Pupil contraction will falsely open up the angle. Likewise pupillary dilatation will cause crowding of the iris at angle and angle appears as closed.'By gonioscopy angle structures are assessed, especially relationship of root of iris and trabecular mesh work in normal physiological state. To avoid pupillary contraction, it is done in dark room with minimum slit lamp light.' - Basics and Clinical Science Course, American Academy of Ophthalmology, 2012-13; Sec 10, p46\n\nSo the answer to this question is A"}
{"instruction": "Fulminant hepatic failure can be caused by\nA. Halothane\nB. Isoflurane\nC. Nitrous oxide\nD. Phenobarbitone", "response": "The first modern halogenated volatile anesthetic, halothane, was introduced in 1955. Clinical exposure to halothane is associated with two distinct types of hepatic injury. Subclinical hepatotoxicity occurs in 20% of adults who receive halothane. It is characterized by mild postoperative elevations in alanine aminotransferase and aspaate aminotransferase, but is reversible and innocuous. Anaerobic halothane reduction by CYP2A6 to a 2-chloro-1,1,1-trifluoroethyl radical is thought to mediate this mild hepatic injury. The fulminant form of hepatotoxicity, commonly known as halothane hepatitis, is characterized by elevated alanine aminotransferase, aspaate aminotransferase, bilirubin, and alkaline phosphatase levels, massive hepatic necrosis following the administration of halothane. Halothane hepatitis is rare (1 in 5000 to 35,000 administrations in adults), but is fatal in 50% to 75% of these cases. Because of the potential for fatal hepatitis, halothane is no longer used in adult patients in many countries. Halothane hepatitis is caused by a hypersensitivity reaction associated with the oxidative metabolism of halothane. The highly reactive trifluoroacetyl chloride metabolite of halothane oxidation can react with nearby liver proteins. In most patients who developed hepatic necrosis after halothane anesthesia, antibodies against TFA-modified proteins were detected, suggesting that the hepatic damage is linked to an immune response against the modified protein, which acts as a neoantigen. Accordingly, patients who develop halothane hepatitis often have a history of prior exposures to halothane or other volatile anesthetics, together with symptoms suggestive of immune reactivity, such as fever, rash, ahralgia, and eosinophilia. A current hypothesis is that TFA-protein adducts induce a cytotoxic T cell reaction in sensitized individuals, which leads to liver damage. However, the immune responses observed in halothane hepatitis might not mediate liver injury. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e\n\nSo the answer to this question is A"}
{"instruction": "Long term steroid therapy can lead to suppression of hypothalamic-pituitary-adrenal axis. lt can be overcome by using alternate day therapy with coicosteroids. Which of the following steroids are unsuitable for alternate day therapy for such purpose?\nA. Coisol\nB. Prednisolone\nC. Betamethasone\nD. Hydrocoisone", "response": "(Ref: KDT 6/e p282, 287) Steroids with long half life like betamethasone and dexamethasone cannot be used for alternate day therapy because even in alternate day therapy there will be sufficient blood levels of these steroids to cause suppression of HPA axis.\n\nSo the answer to this question is C"}
{"instruction": "FALSE about Leprosy eradication programme is –\nA. Early detection of cases\nB. Disability limitation\nC. Long term multi drug therapy\nD. Health education", "response": "In leprosy eradication programme the multidrug therapy is not long term but short term therapy.\nShorter therapy has added advantage of patient compliance, cost-effectiveness and decreased work load\n\nSo the answer to this question is C"}
{"instruction": "Pin code index of nitrous oxide is: March 2013 (c)\nA. 1, 6\nB. 2, 5\nC. 2, 6\nD. 3, 5", "response": "Ans. D i.e. 3, 5\n\nSo the answer to this question is D"}
{"instruction": "Acute osteomyelitis of long bones commonly affects the\nA. Epiphysis\nB. Diaphysis\nC. Metaphysis\nD. Aicular surfaces", "response": "Metaphysis of long bones is the earliest and most common site involved in osteomyelitis. x ray showing acute osteomyliyis of long bones ref : maheswari 9th ed\n\nSo the answer to this question is C"}
{"instruction": "Krebs cycle and Urea cycle are linked at\nA. Ornithine\nB. Fumarate\nC. Oxaloacetate\nD. Arginine", "response": "Reference: Harpers illustrated biochemistry 30th edition\n\nSo the answer to this question is B"}
{"instruction": "A 32-year-old patient received a badly placed intramuscular injection to the posterior part of his gluteal region. The needle injured a motor nerve in the area. Later, he had great difficulty rising to a standing position from a seated position. Which muscle was most likely affected by the injury?\nA. Gluteus maximus\nB. Gluteus minimus\nC. Hamstrings\nD. Iliopsoas", "response": "The gluteus maximus is innervated by the inferior gluteal nerve, and this muscle is responsible for extension and lateral rotation of the thigh. It is the primary muscle used to rise from a seated position. The gluteus minimus is innervated by the superior gluteal nerve and is responsible for abduction of the thigh. Hamstring muscles are innervated by the tibial portion of the sciatic nerve, and these are responsible for extension of the thigh and flexion of the leg. The iliopsoas muscle is innervated by L1 and L2 and the femoral nerve, and it flexes the thigh. The obturator internus is innervated by the nerve to the obturator internus and is a lateral rotator of the thigh.\n\nSo the answer to this question is A"}
{"instruction": "Troglitazone i? the drug used in the treatment of:\nA. Petit mal epilepsc\nB. Type 2 diabetes meliitus\nC. Hyperlipidaemia\nD. D. Osteoporosis", "response": "Ans: B (Type 2 diabetes meliitus) Ref: Goodman tfi Gillman v Tin Pharmacological Basis of Therapeutics 2011, 12th Edition, McGrow Hill. Burton LL.P 1261-62Explanation:TroglitazoneAs a Monotherapy it is not useful in Type 1 diabetes beeause it needs presence of insulin for its action.Troglitazone is withdrawn from the market because it is known to cause severe fatal hepatic failure.The newer thiazolidenidiones like Pioglitazone and rosiglitazone are known to cause CHF as a result of fluid retention.Rosiglitazone is found to be associated with increased risk of cardiovascular events.Pioglitazone can reduce the TG levels by 10- 15% because of its action on PPARA\n\nSo the answer to this question is B"}
{"instruction": "Gum hyperophy is seen in which type of AML?\nA. Myelogenous leukaemia\nB. Myelomonocytic leukaemia\nC. Megakaryocytic leukaemia\nD. Erythroleukemia", "response": "Infiltration of the gingivae, skin, soft tissues, or the meninges with leukemic blasts at diagnosis is characteristic of the monocytic subtypes (M4 and M5). Significant gastrointestinal bleeding, intra-pulmonary hemorrhage, or intracranial hemorrhage occur in M3 AML. Bleeding associated with coagulopathies occur in M5 AML.\n\nSo the answer to this question is B"}
{"instruction": "Sandhoff's disease is d/t absence of which enzyme?\nA. Beta-hexosaminidase\nB. Beta-glucuronibase\nC. Aryl sulphatase\nD. Alpha galactosidase", "response": "It is a lipid storage disease.Due to deficiency of hexaminidase.Leads to accumulation of globoside (Table;14.4)Ref: DM Vasudevan, 7th edition, page no: 193\n\nSo the answer to this question is A"}
{"instruction": "Which laboratory determinations would be most helpful in distinguishing iron deficiency anemia from anemia of chronic disease?\nA. Erythrocyte: granulocyte ratio in bone marrow\nB. Presence or absence of polychromatophilic target cells\nC. Presence or absence of stippled erythrocytes\nD. Serum ferritin", "response": "This is a common clinical scenario in real life. Serum ferritin is markedly decreased in iron deficiency anemia and is normal to modestly elevated in anemia of chronic disease. This difference makes this test very useful in this setting. You should be aware that serum ferritin may behave like an acute phase reactant. Therefore, in an acute inflammatory situation, erythrocyte ferritin may be more reliable if serum ferritin is equivocal. Also, do not forget that iron deficiency anemia can complicate the anemia of chronic disease (e.g., gastrointestinal bleeding can complicate gastrointestinal cancers); in this situation, most physicians treat the apparent iron deficiency anemia and see to what degree the anemia corrects. The erythrocyte: granulocyte ratio in bone marrow is slightly decreased in both iron deficiency anemia and anemia of chronic disease, but may be markedly increased in sideroblastic anemias. Polychromatophilic target cells and stippled erythrocytes are absent in both iron deficiency anemia and anemia of chronic disease, but may be present in sideroblastic anemias and other iron-utilization anemias. Ref - Harrison's principles of internal medicine 20e pg 685,686,688\n\nSo the answer to this question is D"}
{"instruction": "Ivermectin is a\nA. Cysticide\nB. Taenicide\nC. Filaricide\nD. Anti-amoebic", "response": "Ivermectin is the drug of choice for Strongyloides and Onchocerca volvulus. It is a filaricide (effective against W. bancrofti and malayi).Ivermectin, a semisynthetic macrocyclic lactone, a mixture of avermectin B1a and B1b. It is derived from the soil actinomycete Streptomyces avermitilisIvermectin is used only orally in humans. The drug is rapidly absorbed, reaching maximum plasma concentrations 4 hours after a 12mg dose. Ivermectin appears to paralyze nematodes and ahropods by intensifying g-aminobutyric acid (GABA)-mediated transmission of signals in peripheral nervesReference: Katzung Pharmacology; 13th edition; Chapter 53; Clinical Pharmacology of the Antihelminthic Drugs\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is false regarding cell free DNA\nA. Detected in maternal blood\nB. Prenatal diagnosis of Down's syndrome can be made\nC. Used for liquid biopsy\nD. It is one of the invasive techniques for prenatal diagnosis of certain genetic diseases", "response": "Prenatal diagnosis can be made by invasive and non invasive techniques.\nInvasive techniques include aminocentesis, chorionic villous sampling, cord blood sampling. Cell free DNA is a non invasive method.\n\nSo the answer to this question is D"}
{"instruction": "Epithelioid hemangioendothelioma of nose is -\nA. Carcinoma\nB. Sarcoma\nC. Carcinosarcoma\nD. Hamartoma", "response": "Ans. is 'b' i.e., Sarcomao Soft tissue sarcoma arise from mesenchyme, like muscles (myoma), endotha/ialcells (endothelioma) and cartilage (chondroma)o Epithelioid hemangioendothelioma (EHE) is a soft tissue sarcoma.o It arises from distinct type of endothelial cells which exhibit epitheloid morphology.\n\nSo the answer to this question is B"}
{"instruction": "All of the following statement about &;yaws&; are true, except -\nA. Caused by Treponema peenue\nB. Transmitted non venerally\nC. Secondary yaws can involve bone\nD. Late stages of yaws involve hea and nerves", "response": "Late stages of yaws includes destructive lesions of the skin and bone. Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 359\n\nSo the answer to this question is D"}
{"instruction": "Ring scotoma is a feature of:\nA. Blue dot cataract\nB. Diabetic retinopathy\nC. Nuclear cataract\nD. Retinitis pigmentosa", "response": "D i.e. Retinitis pigmentosa\n\nSo the answer to this question is D"}
{"instruction": "Autoclaving is done at what temperature for 15 minutes: March 2010\nA. 118 degree C\nB. 121 degree C\nC. 126 degree C\nD. 134 degree C", "response": "Ans. B: 121 degree C\n\nSo the answer to this question is B"}
{"instruction": "Histopathology of a lung cancer shows 'Clara cells' probable diagnosis is -\nA. Squamous cell cancer\nB. Bronchio alveolar cancer\nC. Large cell cancer\nD. Papillary carcinoma", "response": "Bronchioloalveolar carcinoma \n\nIt is a histological type of adenocarcinoma.\nIt occurs in the pulmonary parenchyma in the terminal bronchioloalveolar pattern.\nThe tumor is almost always in the peripheral portion of the lung.\nMore often it occurs as multiple diffuse nodules that sometimes coalesce to produce a pneumonia-like consolidation.\nThe key feature of bronchioloalveolar carcinomas is their growth along preexisting structures without destruction of the alveolar architecture. This growth pattern has been termed \"lepidic\" an allusion to the neoplastic cells resembling butterflies sitting on a fence.\nStromal, vascular or pleural invasion is characteristically absent.\nBronchioloalveolar carcinoma consists of mucin-secreting bronchiolar cells, Clara cells, or rarely type II pneumocytes.\nThese tend to have aerogenous spread and patient usually dies of suffocation (not by metastatic spread).\nBronchioloalveolar carcinoma has two subtypes -\n\ni) Non-mucinous → Rare aerogenous spread and therefore amenable to surgical resection.\nii) Mucinous → Tend to spread aerogenously, forming satellite tumors.\n\nSo the answer to this question is B"}
{"instruction": "Following are causes of papulosquamous lesions except:\nA. Seborrheic dermatitis\nB. Parapsoriasis\nC. Lichen nitidus\nD. Congenital syphilis", "response": "PAPULOSQUAMOUS SKIN DISORDERS Psoriasis Parapsoriasis Lichen planus Lichen nitidus Pityriasis rosea Pityriasis rubra pilaris Secondary syphilis NOT Congenital syphilis. Nummular eczema Drug eruptions Seborrheic dermatitis Reiter's syndrome Acrodermatitis enteropathica\n\nSo the answer to this question is D"}
{"instruction": "The minimum age for giving consent for medical termination of pregnancy is :\nA. 16 years\nB. 18 years\nC. 20 years\nD. 24 years", "response": "18 years\n\nSo the answer to this question is B"}
{"instruction": "Radiological appearance of rickets include all except\nA. Fraying\nB. Cupping\nC. Splaying\nD. Pelkan spur", "response": "Radiological findings in rickets : cupping of metaphysis splaying of metaphysis Fraying of metaphysis widening of growth plate widening of epiphysis coical thining generalised osteopenia Triradiate pelvis Note : Pelkan spur is a radiological feature of Scurvy\n\nSo the answer to this question is D"}
{"instruction": "All of them are true about the 4th nerve EXCEPT\nA. The only nerve to emerge from the dorsal aspect of brain\nB. The only nerve to cross over to opposite side\nC. It is the thickest cranial nerve\nD. It has the fewest axons of any cranial nerve", "response": "The trochlear nerve has several features that make it unique from the other cranial nerves: Thinnest cranial nerve. Is the only nerve to exit from the dorsal surface of the brain. Is the only nerve in which all the lower motor neuron fibers decussate. Has the longest intracranial course. Has the smallest number of axons.\n\nSo the answer to this question is C"}
{"instruction": "Abdominal surgery under LA, patient suddenly felt pain due to\nA. Liver\nB. Gut\nC. Parietal peritoneum\nD. Visceralperitoneum", "response": ".pas of peritoneum mainly includes 1. Parietal peritoneum: It lines the inner surface of the abdominal wall, under surface of diaphragm and pelvic wall. It is loosely attached to the overlying walls and can be easily stripped off. It is innervated by the somatic nerves, so pain sensitive. Anterior peritoneum is most sensitive when compared to pelvic peritoneum. 2. Visceral peritoneum: It lines the outer surface of the abdominal viscera, firmly adherent, cannot be stripped off. It is innervated by autonomic nervous system; hence not pain sensitive. ref:SRB&;s manual of surgery,ed 3,pg no 498\n\nSo the answer to this question is C"}
{"instruction": "Tension band wiring is used for?\nA. Fracture humerus\nB. Olecranon fracture\nC. Fracture tibia\nD. Fracture spine", "response": "ANSWER: (B) Olecranon fractureREF: Apley's orthopedics 8th e p. 607Treatment plan for fracture olecranonNon displaced transverse fracture : cast immobilization for 2-3 weeksComminuted fracture with triceps intact: sling for a weekDisplaced oblique fractures : tension band wiringOld non united fracture, non-articular fracture : excision of fragment and triceps repair\n\nSo the answer to this question is B"}
{"instruction": "The right coronary artery supplies all of the following parts of the conducting system in the heart except -\nA. SA node\nB. AV node\nC. AV bundle\nD. Right bundle branch", "response": "Area supplied by right coronary artery\n- SA node (in 65%)\n- Conducting system (AV bundle, bundle of His, part of left bundle branch) except RBB and part of left branch of AV bundle.\n- Posterior 1/3rd of interventricular septum\n- Right ventricle except part adjoining anterior interventricular groove and small part of left ventricle adjoining posterior interventricular groove.\n Area supplied by left coronary artery\n- Left atrium\n- Left ventricle including apex\n- Part of right ventricle adjoining anterior interventricular groove.\n- Anterior 2/3rd of interventricular septum\n- RBB, LBB\n- SA node (in 35%)\n\nSo the answer to this question is D"}
{"instruction": "Anesthetic drug of choice in asthmatic: ( Repeat )\nA. Ketamine\nB. Propofol\nC. Etomidate\nD. Propofol", "response": "Ans: B (Ketamine) Ref: Miller '? Anesthesia, 7th ed. & Ajay YadavExplanation:KetamineCauses Dissociative anesthesiaPhencyclidine derivativeNMDA receptor agonistAnesthetic PropertiesOnset of Action: 30 - 60 secondsEarly regain of consciousness after 15 - 20 min due to RedistributionElimination half life: 2-3 hoursStrong analgesic propertyMetabolised in Liver and products exreted in urineNot a muscle relaxantPrimary site of action - Thalamo-neo-cortical projectionsCardiovascular SystemIncreases arterial BP,Increases heart rate &Increases cardiac outputIV agent of choice in SHOCKRespiratory SystemPotent BronchodilatorGood induction agent for asthmaticsUpper airway reflexes remain largely intactIncreases salivatory & Tracheo bronchial secretionsUsing glycopyrollate or atropine becomes necessaryCentral Nervous SystemIncreases Intracranial pressure and can precipitate seizuresEmergence reactions:These are seen at emergenceVivid dreamingIllusionsExtracorporeal experiences like floatingExcitementConfusionEuphoriaFearHallucinations:Auditory and Visual hallucinations (Most common side effect of Ketamine)Treated with BenzodiazepineOther SystemsEyeIncrease intraocular tensionPupils dilate moderatelyNystagmusGITIncreases intragastric pressureSalivary secretions increasedMuscluarIncreases muscle toneIncreased non-puposeful movementsDoseCan be given IV. IM, oral. Rectal and intrathecal routeIV -- 2mg/kgIM- 5-10mg/kg AdvantagesInduction Agent of Choke inAsthmaticsShock (HYPOTENSION)Children ( Now Sevoflurance is DOC)Constrictive pericarditisCardiac tamponadeCan be used as SOLE agentCan be used safely at remote places and in inexperienced hands since does not depress heart or respirationPreferred agent when patient is in FULL STOMACH (Preserves laryngo- pharyngeal reflexes)Contraindicated inHead injuryICSOLEye injuryOpthal pathologyIschemic heart diseaseVascular aneurysmPsychiatric diseasesDrug addictsHypertensives\n\nSo the answer to this question is A"}
{"instruction": "True about Sentinel Lymph node biospy ?\nA. Special OT is requried\nB. Blue dyes injected\nC. Contraindicated if axillary LN is involved\nD. All", "response": "Ans. is 'b' i.e. Blue dyes injected No special OT is required, SLN biopsy is usually done intraoperatively by using isosulphan blue dye (lymphazurin) or radioactive colloid. Accuracy in detection of SLN is best when both the methods are combined. When radioactive colloid is used, the SLN is detected by a gamma-camera. The blue dye colours the afferent lymphatics and the SLN, hence aids in the identification SLN Biopsy (for breast ca) is contraindicated in : palpable lymphadenopathy prior axillary surgery, chemotherapy or radiation therapy multifocal breast cancers\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is single most impoant indicator of likilihoodness of progresion of hepatitis to liver cirrhosis -\nA. Etiology\nB. Associated serological findings\nC. Presence of bridging necrosis\nD. Presence of mallary hyaline", "response": "Ans. is 'a' i.e., Etiologyo The single most indicator of the likelihoodness of rapid progression chronic hepatitis to cirrhosis is underlying etiology.\n\nSo the answer to this question is A"}
{"instruction": "Index case is the ?\nA. First case in a community\nB. Case getting infection from primary case\nC. Case getting infection from secondary case\nD. First case detected by investigator", "response": "Ans. is 'd' i.e., First case detected by investigator Primary case - First case of communicable disease introduced into the population. Index case - First case to come to attention of the investigator. It is not always necessary that primary case will be index case : - When the first case noticed by the investigator is also the first case of the population - Primary case and index case are the same. When the first case nociced by the investigator is not the first case of the population (primary case) - Index case and primary case are different. Secondary cases - Cases those developing from contact with primary case.\n\nSo the answer to this question is D"}
{"instruction": "Average incubation period of typhoid is?\nA. 2-3 days\nB. 5-8 days\nC. 10-15 days\nD. 15-30 days", "response": " Typhoid fever:- Typical continuous fever for 3-4 weeks,relative bradycardia with involvement of lymphoid tissue. Without effective treatment, typhoid kills over 10% of those infected. Causative agent- Salmonella typhi. S.paraA and S.paraB are infrequent. Reservoir- man Case - a case is infectious as long as bacilli appear in stools /urine. Carriers:- 1. Convalescent carriers-excrete bacilli for 6-8 weeks,after which their number dimnishes rapidly. 2. Chronic carriers- persons who excrete bacilli for more than a year after a clinical attack. In most chronic carriers,the organism persists in gall bladder and in biliary tract. Source of infection- faeces and urine of cases/carriers. Age group involved mostly is 5-19 yrs old. Males affected more than females. Incubation period- 10-14 days. Mode of transmission: faecal oral route/ urine oral routes. Treatment of carriers:- Intensive course of ampicillin/ amoxycillin (4-6g/day) together with probenecid for 6 weeks. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.235} NOW azythromycin, earlier Furazolidone. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:233. <\\p>\n\nSo the answer to this question is C"}
{"instruction": "Acute phase reactant include all except -\nA. C reactive protein\nB. Ferritin\nC. Ceruloplasmin\nD. Hemoglobin", "response": "Hemoglobin is the O2 carrying pigment in RBCs. Acute phase proteins are those proteins that are raised in response to acute inflammation. Basic Pathology, Robbins. Page no.: 57\n\nSo the answer to this question is D"}
{"instruction": "Lucid interval is classically seen in -\nA. Intracerebral haematoma\nB. Acute subdural haematoma\nC. Chronic subdural haematoma\nD. Extradural haematoma", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "35-year-old c/o fever, severe abdominal pain in epigastrium radiating to the back with a h/o binge drinking. Pulse is 120 bpm, BP is 90/60 mm Hg. CT Abdomen (P+C) was done. Most likely diagnosis is(AIIMS 2016)\nA. Peptic ulcer\nB. Acute pancreatitis\nC. Chronic calcific pancreatitis\nD. Acute cholecystitis", "response": "Ans. B Acute pancreatitisObserve a bulky pancreas with fuzzy margins and adjacent fat stranding - s/o Acute pancreatitis. CE-CT scan is IOC. Balthazar grading systemQ and CT Severity Index (CTSI)Q are used for prognosis.\n\nSo the answer to this question is B"}
{"instruction": "Regarding the established risk factors for breast cancer, all are true, EXCEPT:\nA. Occurrence in Indian women is about a decade earlier than in western women\nB. Breast cancer is common in higher socioeconomic groups\nC. Prior breast biopsy of benign breast disease is associated with a decreased risk of Ca breast\nD. 40 or more years of menstruation doubles the risk of Ca breast as compared with 30 years", "response": "Prior breast biopsy for benign breast disease is associated with an increased risk of Ca breast. History of Ca breast in 1st degree relative, nulliparity, high fat diet, OCP and radiation are also associated with increased risk of Ca breast. The rest of the statements regarding breast cancer given in the question are true. Ref: Park, Edition 21, Page 359\n\nSo the answer to this question is C"}
{"instruction": "which of th efollowing tyrosine kinase inhibitor is used in carcinoma of lung ?\nA. afatinib\nB. ceritinib\nC. erlotinib\nD. all of the above", "response": "tyrosine kinase inhibitors : stop the cell division of cancer cells . as tyrosine kinase is a insulin growth factor that promotes the cellular divison drugs used in lung carcinoma : afatinib erlotinib ceritinib gefitinib ref : kd tripati 8th ed\n\nSo the answer to this question is D"}
{"instruction": "Best view to seen pneumoperitoneum is\nA. Chest X-ray in erect position\nB. X-ray abdomen\nC. USG abdomen\nD. FAST", "response": "Best view to seen pneumoperitoneum - Chest x-ray in erect position.\nIf unable to stand - Left lateral decubitus View.\n\nSo the answer to this question is A"}
{"instruction": "A baby on examination shows unilateral Moro's reflex with positive palmar grasp reflex. The site of lesion is –\nA. C3–C4\nB. C5–C6\nC. C8–T1\nD. C1–C2", "response": "Moro's reflex is a neonatal reflex which develops by 28th wk of gestation and disappears by 3-6 months of age.\nMoro reflex is obtained by placing the infant in a semi-upright position. then the head is momentarily allowed to fall backwards with immediate re-support by the examiner's hand.\nThe child symmetrically abducts and extends the arms and flexes the thumbs, followed by flexion and adduction of upper extremities.\n\nUnilateral Moro's reflex is seen in :\n\nErb's palsy (C5-C6) damage \nSpastic hemiplegia \nFracture of humerus or clavicle. \nShoulder dislocation \nExaggerated Moro's reflex is seen in - cerebral damage.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following opioid analgesics is most likely to cause central nervous system (CNS) disturbance?\nA. heroin\nB. morphine\nC. meperidine\nD. fentanyl", "response": "Meperidine has a half-life of 3 hours, but it has an active metabolite, normeperidine, which has a half-life of 15-20 hours. Therefore, accumulation of normeperidine with toxicity is common. The drug should not be used for prolonged periods (over 48 hours), and probably should not be used at all in those susceptible to delirium (e.g., the elderly).\n\nSo the answer to this question is C"}
{"instruction": "Which of the following may be seen in children with Vitamin C excess?\nA. Alopecia\nB. Oxaluria\nC. Peripheral neuropathy\nD. Benign intracranial hypeension", "response": "Vitamin C is a precursor of oxalate, liable to produce hyperoxaluria . ... In malabsorption, Ca chelates with fatty acids, generating enteric hyperoxaluria Ref ganong's review of medical physiology 25e p436\n\nSo the answer to this question is B"}
{"instruction": "If a patient with a suspected fracture of the pelvis has some bleeding from the urethra and is unable to pass urine. What should be the next appropriate step in the management?\nA. He should be encouraged to pass urine after being given antibiotics and analgesics\nB. He should be immediately catheterized in the ward\nC. A hot water bottle should be given followed by injection of carbachol\nD. He should be prepared for surgery and catheterization attempted in the O.T.", "response": "Urogenital injuries are common in pelvic fractures (5-10%), especially in men. These injuries should be suspected in conscious patients Who is unable to void or who has gross hematuria Bloody urethral discharge Swelling or ecchymosis of the penis or perineum High riding or floating prostate on rectal examination Management No attempt should be made to pass a catheter, as this could conve a paial to a complete tear of urethra. A retrogram should be obtained before attempting to introduce a foley's catheter. Retrograde urethrogram positive: When a paial or complete urethral disruption is diagnosed on retrograde urethrogram then suprapubic cystotomy should be performed. Retrograde urethrogram negative: Catheterization can be safely undeaken Ref: Current Diagnosis & Treatment in Ohopedics 3/e, page 151; Apley's 8/e, page 672-73; Rockwood & Green's fracture in Adults 6/e, Page 1618-1; Watson Jones: Fracture & Joint Injuries 6/e, Page 867.\n\nSo the answer to this question is D"}
{"instruction": "Helper cells belong to\nA. T cells\nB. Macrophages\nC. B cells\nD. Monocytes", "response": "1. CD4+ T cells: CD4 cells are also known as helper T (Th) cells. They constitute about 65% of peripheral T cells and are found mainly in the thymic medulla, tonsils, and blood. CD4 displayed on the surfaces of these T cells recognize a nonpeptide-binding poion of MHC class II molecules. Hence, CD4+ T cells are restricted to the recognition of MHC class II complexes. Helper T lymphocytes are involved in the induction and regulation of immune responses. 2. Main function of helper T cells: 1. Help in the antigen-specific activation of B cells and effector T cells. 2. Th-1 cytokines activate cytotoxic inflammatory and delayed hypersensitivity reactions. 3. Th-2 cells help in the production of interleukins which encourage production of antibodies especially IgE. 4. Th-2 cytokines are associated with regulation of strong antibody and allergic responses.\n\nSo the answer to this question is A"}
{"instruction": "Period of onset in tetanus refers to the time between-\nA. First injury to spasm\nB. First symptom to spasm\nC. First spasm to death\nD. Trismus to laryngeal spasm", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Mummification refers to:\nA. Hardening of muscle following death\nB. Colliquative putrifaction\nC. Saponification of subcuatenous fat\nD. Desiccation of dead body", "response": "Ans: D (Desiccation of dead body) Ref: The Essentials of Forensic Medicine ami Toxicology by KS Narayan Reddy. 29th edition. 2010Explanation:MummificationIt is dessication/dehydration or drying and shriveling of body tissue and viscera after deathCommon in infants (neonates and still births)ideal conditions for its formation are:High temperatureDevoid of moistureFree circulation of air around the bodyChronic arsenic or antimony poisoning favour mummificationFirst involves exposed body parts like lips. nose. Fingers, toes etcThe natural appearances and body features are preserved, but face is grossly distorted due to shrinkage of skin.The skin is contracted, shruken and dry (rusty brown in colour)The body is odourless and helps in estimation of time since death\n\nSo the answer to this question is D"}
{"instruction": "The following physical appearance is seen in which of the following condition\nA. Nephroblastoma\nB. Retinoblastoma\nC. Neuroblastoma\nD. Osteoblastoma", "response": "This is Raccoon eyes seen in Neuroblastoma.\n\nSo the answer to this question is C"}
{"instruction": "Mark true in following?\nA. Hanta virus pulmonary syndrome is caused by inhalation of rodent urine and faeces\nB. Kyasanur forest disease is caused by bite of wild animal\nC. Lyssavirus is transmitted by ticks\nD. None", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Pneumothorax could be a complication of:\nA. Staphylococcal pneumonia\nB. Pneumococcal pneumonia\nC. Klebsiella pneumonia\nD. Viral pneumonia", "response": "a. Staphylococcal pneumonia(Ref: Nelson's 20/e p 2088-2093, Ghai 8/e p 379-381)Pneumothorax could be a complication of Staphylococcal pneumonia, due to rupture of pneumatoceles.\n\nSo the answer to this question is A"}
{"instruction": "Most common cause of breech presentation:\nA. Contrcted pelvis\nB. Hydramnios\nC. Prematurity\nD. Oligohydramnios", "response": "Prematurity\n\nSo the answer to this question is C"}
{"instruction": "The minimum mesiodistal space required for placement of two standard diameter implants (4.0 mm diameter) between teeth is\nA. 8 mm\nB. 20 mm\nC. 10 mm\nD. 14 mm", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Antihypeensive drug which is beneficial or neutral in the lipid metabolism is\nA. Prazosin\nB. Propanolol\nC. Fursemide\nD. Chlohiazide", "response": "Refer kDT 6/e p488_545 drugs-lipid metabolism 1.Prazosin and clonidine-ourable effect 2.ARB and ACE inhibitor -no significant effect in plasma lipid profile 3.beta blockers-unourable effect 4.diuretics- dyslipideamia 5.CCBs- no effect\n\nSo the answer to this question is A"}
{"instruction": "N.K cell and cytotoxic cells are differentiated by -\nA. Interferons reduce N.K cell activity\nB. Antibody specificity\nC. Receptor fo IgG\nD. Presence in spleen", "response": "NK cells are unique, however, as they have the ability to recognize stressed cells in the absence of antibodies and MHC, allowing for a much faster immune reaction. They were named \"natural killers\" because of the initial notion that they do not require activation to kill cells that are missing \"self\" markers of MHC class 1.Cytotoxic Tells are antibody specific. Reff: Ananthanarayanan & Panikers textbook of microbiology 9th edition pg:137\n\nSo the answer to this question is B"}
{"instruction": "Subodontoblastic zone is\nA. Cell rich zone\nB. Cell free zone\nC. Odontoblastic zone\nD. Core", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Contraindication of Enteral nutrition :a) Intestinal obstructionb) Severe Pancreatitisc) Severe diarrhoead) IBDe) Intestinal fistula\nA. abce\nB. abc\nC. acd\nD. ace", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Most common malignant tumour of thyroid:\nA. Papillary\nB. Folliclar\nC. Medullary\nD. Anaplastic", "response": "Ans: a (Papillary) Ref: Schwartz, 8th ed, p. 1417; Harrison, 16th ed, p. 2122TYPE OF THYROID CARCINOMAAPPROXIMATE PREVALENCEPapillary CA80-90 %Follicular CA5-10%Medullary CA10%Anaplastic CARareLymphoma1-2%Histological features of Papillary CA1. Papillary projections - PTC contains branching papillae of cuboidal epithelial cells.2. Orphan annie nulei - Nucleus of PTC contain finely dispersed chromatin which imparts an optically clear or empty appearance giving rise to term ground glass or orphan annie nuclei. In addition invagination of cytoplasm in cross sections give the appearance of intranuclear inclusions or grooves - Diagnosis of papillary Ca is is based on these nuclear characteristics.3. Psammoma bodies - These are concentrically calcified structures.\n\nSo the answer to this question is A"}
{"instruction": "Aerial supply of tonsil is mainly by?\nA. Tonsillar branch of facial aery\nB. Maxillary aery\nC. Middle meningeal aery\nD. External carotid aery", "response": "The tonsil is supplied by five aeries : 1. Tonsillar branch of the facial aery. This is the main aery. 2. Ascending pharyngeal aery from external carotid. 3. Ascending palatine, a branch of the facial aery. 4. Dorsal lingual branches of the lingual aery. 5. Descending palatine branch of the maxillary aery. (Ref: Diseases of ear, nose and throat and head and neck surgery, PL Dhingra 7th edition, Pg no. 291)\n\nSo the answer to this question is A"}
{"instruction": "All are true about streptococcus preumoniae except:\nA. Capsule aids in infection\nB. Commonent infection is otitis media\nC. Respiratory tract of carriers is most impoant source of infection\nD. Meningitis caused by S. pneumoniae is milder than others", "response": "Ans. (d) i.e. Meningitis caused by S. pneumoniae is milder than others Moality in Bacterial Meningitis Cause 3-7% H. I nfluenzae, Meningococci, Group B streptococci 3-7% Listeria meningitis 15% S. pneumococci 20% E. coli > 20% Others options have already been explained. Note: Pneumococci is the most common cause of pneumonia, meningitis, otitis media. Otitis media is the most common infection of Pneumococci.\n\nSo the answer to this question is D"}
{"instruction": "The uterus becomes pelvic organ after delivery in:\nA. 10-12 days\nB. 12-14 days\nC. 14-16 days\nD. 16-18 days", "response": "Uterus begins to shrink in size 2 days following delivery and it becomes a pelvic organ after 2 weeks. By 6 weeks uterus regains its nonpregnant size. During involution of uterus there is no loss of myometrial cells. It occurs due to diminution of size of myometrial cells as a result of enzymatic autolysis of cytoplasm. There is augmentation of protease activity. Each myometrial cell measuring about 500-800ml in late pregnancy shrinks to less than 100ml. Ref: Donald School Manual of Practical Problems in Obstetrics edited by Narendra Malhotra page 581.\n\nSo the answer to this question is B"}
{"instruction": "White gold alloy predominantly is:\nA. Gold added with palladium\nB. Gold added with calcium\nC. Gold with much of chromium\nD. Gold with silver", "response": "These alloys were introduced as a cheaper alternative to gold alloys.\nIt is predominantly silver in composition. Palladium (at least 25%) is added to provide nobility and resistance to tarnish. They may or may not contain copper and gold. They are white in color.\nThe current trend is to avoid the display of metal. At the same time, increase in the platinum, palladium and silver content of modern alloys have resulted in whiter colored gold alloys. Thus, there are ‘yellow gold alloys’ and ‘white gold alloys’. The rise in gold prices has also led to the availability of alloys with low gold content. These are the ‘low golds’.\nRef: Mannapalli 3 ed page no 273\n\nSo the answer to this question is A"}
{"instruction": "Commonest cause of uniocular diplopia\nA. Cataract\nB. Subluxated lens\nC. Third nerve palsy\nD. Astigmatism", "response": "In Unilocular diplopia an object appears double from the affected eye even when the normal eye is closed. CAUSES Subluxated clear lens. Subluxated intraocular lens. Keratoconus (irregular refraction from corneal surface) Double pupil (congenital / large iridectomy / iridodialysis) Incipient cataract (this usually causes polyopia - due to irregular refraction due to multiple water clefts within the lens) Ref;A.K.Khurana; 6th edition; Page no:344\n\nSo the answer to this question is B"}
{"instruction": "DT 104 strain is belongs to which of the following bacteria-\nA. Salmonella Gallinarum\nB. Salmonella Typhi\nC. Salmonella Enteritidis\nD. Salmonella Typhimurium", "response": "Ans. is `e' i.e., Salmonella Typhimurium DT 104 is a strain of Salmonella Typhimurium which emerged in early 1990s. It is multidrug resistant strain & associated with an increased risk of bloodstream infection and hospitalization. Acquisition is associated with exposure to ill farm animals and to various meat products, including uncooked or undercooked ground beef.\n\nSo the answer to this question is D"}
{"instruction": "A previously healthy 20-year-old man is admitted to a hospital with acute onset of left-sided chest pain. The electrocardiographic findings are normal but chest x-ray shows a 40% left pneumothorax. Treatment consists of which of the following procedures?\nA. Observation\nB. Barium swallow\nC. Thoracotomy\nD. Tube thoracostomy", "response": "Spontaneous pneumothorax usually results from the rupture of subpleural blebs in young men (age 20-40), which is often signaled by a sudden onset of chest and shoulder pain. Pneumothorax of more than 25% requires placement of a chest tube; thoracotomy with bleb excision and pleural abrasion is generally recommended if spontaneous pneumothorax is recurrent. Small pneumothoraxes in patients with minimal symptoms usually resolve and therefore can be observed. A spontaneous perforation of the esophagus (Boerhaave syndrome) can result in hydropneumothorax as well as the more usual pneumomediastinum but would not present with an isolated 40% pneumothorax. Barium swallow is an appropriate diagnostic test for evaluation of a suspected leaking esophagus.\n\nSo the answer to this question is D"}
{"instruction": "The first scientist to observe bacteria and other microscopic organisms was: September 2004\nA. Syndenham\nB. Virchow\nC. Harvey\nD. Van Leeuwenhoek", "response": "Ans. D i.e. Van Leeuwenhoek Leeuwenhoek October 24, 1632 - August 26, 1723 He was a Dutch tradesman and scientist from Delft, Netherlands. He is best known for his work on the improvement of the microscope and for his contributions towards the establishment of microbiology. Using his handcrafted microscopes, he was the first to observe and describe single-celled organisms, which he originally referred to as animalcules, and which are now referred to as microorganisms.\n\nSo the answer to this question is D"}
{"instruction": "Froments sign is seen -\nA. Ulnar nerve palsy\nB. Median nerve palsy\nC. Anterior interosseous nerve palsy\nD. Radial nerve palsy", "response": "Ans. is 'a' i.e., Ulnar nerve palsy [Ref: BDC 5th/e Volume 1 p. 136}NERVESRELEVANT TESTSUlnar Nerve PalsyBook test (Froment sign)Card testEgawa's testMusician's NerveMedian Nerve PalsyPointing index fingerPen testBenediction testOschner clasp testApe thumbLabourer's NerveRadial Nerve PalsyWrist dropFinger drop\n\nSo the answer to this question is A"}
{"instruction": "Most common mode of treatment for laryngomalacia is -\nA. Reassurance\nB. Medical\nC. Surgery\nD. Wait & Watch", "response": "In most patients laryngomalacia is a self-limiting condition.\nTreatment of laryngomalacia is reassurance to the parents and early antibiotic therapy for upper respiratory tract infections.\nTracheostomy is required only in severe respiratory obstruction.\nSurgical intervention (supraglottoplasty i.e. reduction of redundant laryngeal mucosa) is indicated for 10% of patients. Main indications for surgery are:\n\nSevere stridor\nApnea\nFailure to thrive\nPulmonary hypertension\nCor pulmonale.\n\nSo the answer to this question is A"}
{"instruction": "True about pearl index:\nA. Population study\nB. Family planning\nC. Contraceptive methods\nD. Contraceptive failure", "response": "Ans. (d) Contraceptive failureRef: Park's PSM 21sted. 1472* Pearl index is used to measure the contraceptive efficacy/ contraceptive failure.* It is defined as the number of failures per 100 women- years (HWY) of exposure.P/ =Total accidental pregnancies------------------------Total months of exposurex 1200* Another method used to measure contraceptive failure/ efficacy is life table analysis.* Life table analysis: calculates failure rates for each month of use.\n\nSo the answer to this question is D"}
{"instruction": "Devi, a 28 year female, has diarrhoea, confusion, high grade fever with bilateral pneumonitis. The diagnosis is :\nA. Legionella\nB. Neisseria meningitis\nC. Streptococcus pneumoniae\nD. H. influenza", "response": "Answer is A (Legionella): Pneumonia in association with clinical clues in the form of high grade fever, confusion and diarrhea suggests a diagnosis of Legionnaire's pneumonia Legionnaire's disease : Legionnaires disease presents as an 'atypical pneumoniaQ where a gram stained smear of sputum does not show organisms (Caused by Legionella). Legionella Legionella is a gram negative Q,motile Q,non-encapsulated bacilli Q,classified under a miscellaneous group Man to Man transmission does not occur with Legionella. Q. No animal reservoirs occur. Q Disease is limited to humans. Q Legionella survive and multiply inside free living amoeba and protozoa, distributed in natural reservoirs such as stagnant waters Q,mud and hot spring. Human infection is typically acquired by inhalation of aerosols, which form the only source of infection.2 Smoking and immunocompromised status.are known risk factors. The disease occurs with unusual frequency among patients with hairy cell leukemia but not among patients with other types of leukemia Common Risk factors for Legionnaires disease Advancing age Immunocompromised patients: - Transplant recipients, HIV, Glucocoicoid recipients - Hairy cell leukaemia (monocyte deficiency and dysfunction) Chronic lung disease Smokers Diabetes mellitus (Javetz) Presents as mild cough slightly productive sputum, sometimes streaked with blood, along with high fever and nonspecific symptoms such as malaise, fatigue, anorexia & headache. Think about the diagnosis as Legionaire's disease whenever the question talks about a pneumonia like picture along with any of the these : Occurrence of illness in immunocompromised e,smokers Q or those with chronic lung disease Q,or Occurance of illness in an environment where potable water supply is known to be contaminated with Legionella Onset of symptoms within 10 days of discharge from a hospital (1.P. 2 to 10 day), or High fever, Q or Gastrointestinal difficulties like diarrhea, Q or Neurological abnormalities like confusion or altered Sensorium, Q or Numerous neutrophils but no organisms revealed by gram staining of respiratory secretions, or Hyponatremia Q is more common in Legionnaire's, than in any other form of pneumonia, or Failure to respond to p-lactam drugs e (penicillin or cephalosporins) and aminoglycosids antibiotics.\n\nSo the answer to this question is A"}
{"instruction": "A 50-year-old female patient presented with swelling of the right jaw. The swelling was painless and covered with exudate. She also gave a history of trauma to the same area. The pus was sent for culture. On macroscopic examination, a Sulphur granule was found in the exudate. The gram stain of the exudate is given below. What is the drug of choice of the above condition: -\nA. Penicillin\nB. Azithromycin\nC. Doxycycline\nD. Streptomycin", "response": "This is a case of cervicofacial actinomycosis. The image shows a discharging sinus, a characteristic feature of actinomycosis. Gram stain shows branching gram-positive bacilli, characteristic of actinomyces. Actinomycosis occurs most frequently at an oral, cervical, or facial site. It usually occurs as a soft tissue swelling, abscess, mass, or ulcerative lesion. It is often mistaken for a neoplasm. Dental diseases or procedures are common precipitating factors. The angle of the jaw is generally involved. The Drug of choice for the above condition is penicillin.\n\nSo the answer to this question is A"}
{"instruction": "High FMA angle indicates\nA. Good prognosis\nB. Bad prognosis\nC. Good bone growth\nD. Class III relation", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Glomus tumor arises from\nA. Modified smooth muscle cells\nB. Modified skeletal muscle cells\nC. Merkel discs\nD. Melanocytes", "response": "Ans. is 'a' i.e., Modified smooth muscle cells Glomus tumors (Glomangioma)* Glomus tumors are benign but exquisitely painful tumors arising from modified smooth muscle cells of the glomus bodies, arteriovenous structures involved in thermoregulation.* Although they may superficially resemble hemangiomas, glomangiomas arise from smooth muscle cells rather than endothelial cells.* They are most commonly found in the distal portion of the digits, especially under the fingernails.* Excision is curative.\n\nSo the answer to this question is A"}
{"instruction": "Which antibodies in mother with SLE is responsible for congenital heart disease in child-\nA. Anti-histone\nB. Anti-Ro & Anti-LA\nC. Anti ds DNA\nD. Anti-centromere", "response": "Most sensitive → Antinuclear antibody (ANA)\nMost specific → Anti-double stranded antibody and the antibody against Smith (Sm)\nAssociated with neonatal lupus and congenital heart block → Anti Ro, Anti LA antibody\nAssociated with lupus psychosis → Anti P antibody\n\nSo the answer to this question is B"}
{"instruction": "Most common nerve used for monitoring during anesthesia :\nA. A. Ulnar nerve\nB. B. Facial nerve\nC. C. Radial nerve\nD. D. Median nerve", "response": "Most common nerve used in neuromuscular monitoring is Ulnar nerve stimulation (recording contractile responses of thumb muscle, adductor pollicis) Second most common nerve used for monitoring is facial nerve (orbicularis oculi)\n\nSo the answer to this question is A"}
{"instruction": "Stocker's line is seen a –\nA. Pinguecula\nB. Pterygium\nC. Congenital Ocular Melanosis\nD. Conjunctival epithelial melanosis", "response": "Stocker's line is a line of iron deposition in the corneal epithelium seen adjacent to the head of the pterygium.\n\nSo the answer to this question is B"}
{"instruction": "Topical antifungal used in corneal fungal infection -\nA. Silver sulfadiazine\nB. Neomycin\nC. Natamycin\nD. Griseofulvin", "response": "Topical antifungal eyedrops should be used for long period(6-8 weeks),these include:Natamycin,Amphotericin B and either fluconazole or miconazole. Reference:Comprehensive ophthalmology,AK Khurana,6th edition,page no.107\n\nSo the answer to this question is C"}
{"instruction": "Gleason's staging is used in:\nA. Ca prostate\nB. Ca bladder\nC. Ca pancreas\nD. Ca colon", "response": "Ans: A (Ca prostate) Ref: Bailey & Love s Short Practice of Surgery, 25th Edition & Internet SourcesExplanation:The Gleason Grading SystemIt is used to help evaluate the prognosis of men with prostate cancer.It also predicts prognosis and helps guide therapy.Scoring based upon its microscopic appearance on histopathology.Cancers with a higher Gleason score are more aggressive and have a worse prognosis.The pathologist assigns a Gleason score based on the sum ot' two numbers:The first number is the grade of the most common tumor pattern.The second number is the grade of the second most common pattern.If there are three patterns the first number is the most common and the second is the one with the highest grade.\n\nSo the answer to this question is A"}
{"instruction": "Emergency operation done in cases of\nA. Volvulus\nB. Obstructed hernia\nC. Appendicular perforation with paralytic ileus\nD. Toxic megacolon", "response": "Surgery is required to prevent or relieve ischaemia.When a removable lesion is found in the caecum, ascending colon, hepatic flexure or proximal transverse colon, an emergency right hemicolectomy should be performed. Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1191,1200\n\nSo the answer to this question is A"}
{"instruction": "All are used in treatment of endometriosis except:\nA. Medroxyprogesterone acetate\nB. Tibolone\nC. OCP\nD. Danazol", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "False positive fistula test is associated with -\nA. Perilymph fistula\nB. Malignant sclerosis\nC. Congenital syphilis\nD. Cholesteatoma", "response": "False Positive Fistula Test–Hennebert Sign\n\nFistula test is positive without the presence of fistula.\nIt is seen in case of congenital syphilis and Meniere’s disease\nIn congenital syphilis, stapes foot plate is hypermobile while in meniere’s disease there is a fibrous band connecting utricular macula to the stapes footplate.\nIn both these conditions, movements of stapes result in stimulation of utricular macula which will cause nystagmus and vertigo leading to false positive fistula test. This is called as Hennebert sign.\n\nRef. Dhingra 5/e, p 47\n\nSo the answer to this question is C"}
{"instruction": "Fulminant Amoebic meningoencephalitis caused by-\nA. Acanthamoeba\nB. N.fowleri\nC. E.Histolytica\nD. E. Coli", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A Scatter diagram is drawn to study\nA. Trend of a variable over a period of time\nB. Frequency of occurrence of events\nC. Relationship between two given variables\nD. Mean & median values of the given data", "response": "SCATTER DIAGRAM\n• Also known as ‘Correlation diagram’ or ‘Dot diagram’\n• Is used to depict ‘correlation (relationship) between 2 quantitative variables’\n• The vertical axis in the scatter diagram: should be the dependent or the outcome variable\n• In a scatter diagram, 2 imaginary lines are drawn along the distribution of dots/scatter\n\nSo the answer to this question is C"}
{"instruction": "A 50-year-old male patient gives history of STD acquired 20 years back, now complaints of headache, seizures, confusion and numbness in extremities. Which of the following will be true about the pupillary response of the above patient?\nA. Light reflex and accomodation reflex absent\nB. Light reflex and accomodation reflex present\nC. Light reflex absent and accommodation reflex present\nD. Light reflex present and accommodation reflex absent", "response": "Ans. (c) Light reflex absent and accommodation reflex presentRef: Kanski 7/e, p. 815STD with neurpsychiatric symptoms hints towards patient having Neurosyphilis.Argyll Robertson pupil is seen in Neurosyphilis, which presents withIrregular, small pupil in dim lightIn bright light, neither pupil constricts (Light reflex absent)On accommodation both pupil constrict (Accomodation reflex absent)\n\nSo the answer to this question is C"}
{"instruction": "Receptor for inverse stretch reflex?\nA. Golgi tendon organ\nB. Ruffines end organ\nC. Neuromuscular junction\nD. Muscle spindle", "response": "Ans. a (Golgi tendon organ). (Ref. Ganong, Physiology, 21st ed. 133)The harder a muscle is stretched, the stronger is reflex contraction however, when tension becomes great enough contraction suddenly ceases & muscle relaxes. This relaxation in response to stronger stretch is inverse stretch reflex or autogenic inhibition.REFLEXES:.Sr. no.MonosynapticDisynapticPolysynaptic1.Stretch reflexInverse stretch reflexWithdrawal reflex (crossed extensor); all superficial reflexes2.Receptors in intrafusal fibresReceptors in golgi tendon organ-3.Afferent thro lalphaAfferent thro lb-4.NT-glutamateNT-glutamate-(Note -- Intrafusal fibres are nuclear bag and nuclear chain fibres)\n\nSo the answer to this question is A"}
{"instruction": "BCR-ABL fusion gene is detected by?\nA. Flow cytometry\nB. FISH\nC. Karyotyping\nD. RT-PCR", "response": "Ans. (b) FISH(Ref: Robbins 9th/pg 616-618)Flow cytometry: is used for immunophenotyping in Leukemias & LymphomasFISH- used for detecting submicroscopic chromosomal aberrations of BCR-ABL fusionKaryotyping: Used for detecting chromosomal defects of at least 5 mb size (low sensitivity)RT-PCR: used for quantitative DNA estimation\n\nSo the answer to this question is B"}
{"instruction": "A 50 year old diabetic female presents with intense pruritis and discharge from vagina. Smear of the discharge shows budding yeast cells. What is the most likely causative agent?\nA. Candida albicans\nB. Trichomonas vaginalis\nC. Mobilincus\nD. Chlamydia trachomatis", "response": "For mucocutaneous candidiasis, a wet mount, scrapings or smears obtained from skin, nails, or oral or vaginal mucosa are examined under the microscope for hyphae, pseudohyphae, or budding yeast cells. Trophozoites of Trichomonas vaginalis are pyriform and 7-30 um long. They have five flagella. The large nucleus is usually located at the wider, anterior end and contains many chromatin granules and a small karyosome. The cytoplasm also contains many granules, but these are often not seen in Giemsa-stained specimens. Mobiluncus is a genus of gram-positive, anaerobic, rod-shaped bacteria. C. trachomatisis a Gram-negative bacteria, therefore its cell wall components retain the counter-stain safranin and appear pink under a light microscope.\n\nSo the answer to this question is A"}
{"instruction": "A female child with virilization, hypertension with low plasma renin diagnosis is :\nA. 21α hydroxylase deficiency\nB. 11 β hydroxylase deficiency\nC. 3β hydroxylase deficiency\nD. Conn’s syndrome", "response": "9] Congenital adrenal hyperplasia represents a group of autosomal recessive inherited, metabolic errors,\neach characterized by decency or total lack of a particular enzyme involved in the biosynthesis of cortical steroids,\nSteroidogenesis is then channelled into other pathways leading to increased production of androgens,\nwhich accounts for virilization.\nSimultaneously, the decency of cortisol results in increased secretion of ACTH resulting in adrenal hyperplasia.\nFollowing enzymes are implicated in the congenital adrenal hyperplasia 21 α hydroxylase decency (partial or complete) 17 α hydroxylase deficiency 11β hydroxylase\ndeficiency 21 α hydroxylase deficiency\n• Two forms of this deficiency include -\nA. Salt-wasting adrenogenital ism\nB. Simple Virilizing adrenogenital ism\nA) Salt-wasting syndrome (complete lack) The salt wasting syndrome results from complete lack of 21 hydroxylases.\nThere is no synthesis of mineralocorticoids and glucocorticoids in the adrenal cortex.\nDecreased mineralocorticoids causes marked sodium loss in the urine, resulting in hyponatremia, hyperkalemia, acidosis and hypotension.\nBecause of the enzyme block, there is increased formation of 17 - hydroxyprogesterone, which is then shunted into the production of testosterone.\nThis may cause virilism (pseudo-hermaphroditism) in female infants.\nThat is (XX) Female with 21 hydroxylase deficiency develops ovaries,\nfemale ductal structures and external male genitalia. But in the male child, the effect of increased testosterone will not be manifested at the time of birth.\nThe complete21 hydroxylase deficiency or salt wasting syndrome usually comes to light only after the birth because in utero the electrolytes and uids\ncan be maintained by maternal kidneys. Males with this disorder comes to clinical attention 5 to 15 days later because of salt losing crisis while\nfemales come to attention soon after the birth because of the virilization.\nB) Simple Virilizing adrenogenital syndrome (Partial deficiency) Occurs in individuals\nwith partial deficiency of 21 hydroxylases Less severe deficiency of mineralocorticoid, is sufficient for salt reabsorption, but the lowered glucocorticoid fails to cause\nfeedback inhibition of ACTH secretion.\nThus level of aldosterone is mildly reduced, testosterone is increased and ACTH elevated with resultant adrenal hyperplasia.\n11B hydroxylase deficiency-. Rare Leads to decreased cortisol and increased ACTH.\nThis, in turn, leads to the accumulation of DOC (deoxycorticosterone) and 11 deoxycortisol\nboth of which are strong mineralocorticoids. This results in increased sodium retention by the kidneys and hypertension, hypokalemia.\nPatients also develop virilization due to androgen excess. 17 α hydroxylase deficiency - Patients with deficiency of 17 hydroxylases also have impaired cortisol production,\nincreased ACTH and secondary increased DOC.\nThese patients, however, cannot synthesize normal amount of androgens and estrogens.\nThis is because the gene that codes for 17 α hydroxylase is the same for the enzyme in the adrenal cortex and the gonads and the decency is same in both organs.\nBecause of decreased sex hormones, genotypic females develop primary amenorrhoea and fail to develop secondary sex characteristics while genotypic\nmales will present as pseudohermaphrodite.\n3 β hydroxylase deficiency 3-β hydroxylase deficiency is a rare genetic disorder of steroid biosynthesis that results\nin decreased production of all three groups of adrenal steroids which include mineralocorticoid, glucocorticoid and sex steroids.\nDecreased mineralocorticoid secretion\nresults in varying degrees of salt wasting in both males and females.\nDecent androgen production results in ambiguous genitalia in males\nThe usual presentation is a male child with ambiguous genitalia and severe salt wasting. Sometimes it may also occur in females\n\nSo the answer to this question is B"}
{"instruction": "Reservoir of hookworm\nA. Human being\nB. Soil\nC. Faces\nD. Monkeys", "response": ".man is the only impoant reservoir of human hookworm infection.faeces containing the ova of hookworms is the infective material.as long a sthe person harbours the parasite ,the infectivity of the disease continues. ref:park&;s textbook,ed 22,pg no 221\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not a pox virus -\nA. Cow pox\nB. Molluscum contagiosum\nC. Small pox\nD. Chicken pox", "response": "Chickenpox caused by varicella come under Herpesviruses. Other 3 come under poxviruses. REF:ANATHANARAYAN AND PANIKER'S TEXTBOOK OF MICROBIOLOGY 9TH EDITION PAGE NO:471 and 461\n\nSo the answer to this question is D"}
{"instruction": "Radioisotope used systemically in Polycythemia rubra vera.\nA. 32p\nB. 131I\nC. Strontium-89\nD. Rhenium-186", "response": "32p - Polycythemia rubra vera.\nRhenium -186; Painful bone metastasis.\n\nSo the answer to this question is A"}
{"instruction": "Most common type of intracranial haemorrhage in boxers -\nA. Intra ventricular\nB. Extradural\nC. Subdural\nD. Cerebellar", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "A contraindication to the use of ciprofloxacin is a history of :\nA. Epilepsy\nB. Deep vein thrombosis\nC. Gout\nD. G–6 PD deficiency", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Other than the spleen, occlusion of the splenic aery at its origin will most likely affect the blood supply to\nA. Jejunum\nB. Head of the pancreas\nC. Fundus of the stomach\nD. Duodenum distal to the entrance of the common bile duct", "response": "The sho gastric aeries arise from the Splenic aery at the hilum of the spleen and pass forward in the gastrosplenic omentum (ligament) to supply the fundus of the stomach.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following occurs in Charcot's triad ?\nA. Pain abdomen\nB. Fever and chills\nC. Jaundice\nD. All", "response": "Ans. (a) Pain abdomen (b) Fever and chills; (c) Jaundice\n\nSo the answer to this question is D"}
{"instruction": "Childhood osteopetrosis is characterized by – a) B/L frontal bossingb) Multiple # (fracture)c) Hepatosplenomegalyd) Cataracte) Mental retardation\nA. bc\nB. c\nC. ac\nD. ad", "response": "Osteopetrosis \n\nOsteopetrosis is an autosomal recessive heredofamilial disorder in which partly calcified cartilaginous intercellular ground substance is not regularly reabsorbed & replaced by regular osteoid tissue & bone.\nManifested by :\nIncreased bone density masking the distinction between cortex & medulla, bone within bone appearance (Marble's bone).\nBrittle bone & easily fracturability\nFracture healing satisfactory resulting in skeletal deformities.\nMyelophthisic anemia\nHepatosplenomegaly & presence of immature leukocytes & normoblasts in the peripheral blood.\nGrowth retardation,Macrocephaly.\nThickening of cranial foramina & thus causing pressure on optic nerve & optic atrophy.\nDeafness & blindness\nDental problems & osteomyelitis of the mandible.\nLearning disorder but may have normal intelligence despite hearing & visual loss.\n\nSo the answer to this question is A"}
{"instruction": "Ectopic mucosa of Meckel's diveiculum is diagnosed by:\nA. Tc-99 radionuclide scan\nB. Angiography\nC. CT\nD. Endoscopy", "response": "MECKEL'S DIVEICULUM Diagnosis Most accurate diagnostic test in children: Scintigraphy with sodium 99m Tc-peechnetate. The 99mTc-peechnetate is preferentially taken up by the mucus-secreting cells of gastric mucosa and ectopic gastric tissue in the diveiculum. (sensitivity-85%, specificity-95% and an accuracy-90 in the pediatric age group) Pentagastrin, H2 blockers and glucagon- enhance detection of ectopic gastric mucosa in Meckel's diveiculum by Tc-peechnate scan. Glucagon- relaxes the smooth muscles of GIT and decreases peristalsis. Pentagastrin- potent stimulator of gastric secretions, increases uptake and secretion of peechnetate by the gastric mucosa and stimulates gastrointestinal motility. Histamine H2 blockers (Cimetidine) block secretion from the cells and increase gastric mucosa uptake Less accurate in adults because of the reduced prevalence of ectopic gastric mucosa. In adult with normal nuclear medicine findings, barium studies should be performed.\n\nSo the answer to this question is A"}
{"instruction": "Common age for otosclerosis is\nA. 5-10 years\nB. 10-20 years\nC. 20-30 years\nD. 30-45 years", "response": "Hearing loss usually stas between 20 to 30 years of age and is rare before 10 and after 40 years. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 95)\n\nSo the answer to this question is C"}
{"instruction": "True/false statements about inflammatory bowel disease- pending Mucosal granularity is earliest finding seen in ulcerative colitis Coomb sign is seen in UC. Lead pipe colon is seen in UC. Fibrosis and strictures are more common in UC. Apthous ulcers are earliest finding seen in CD.\nA. T,F,T,F,T\nB. T,F,F,T,F\nC. F,T,T,F,T\nD. T,F,F,F,F", "response": "Inflammatory bowel Disease: Crohn's disease Ulcerative colitis - Terminal ileitis - Rectum - Skip areas - Continuous - Backwash ileitis - has transmural involvement - has superficial involvement - Signs seen Target sign / halo sign Comb sign Rose thorning sign Creeping fat sign String sign of kantor - Sign Seenv Mucosal granularityv Lead pipe appearance Collar button signv Loss of haustration - Earliest finding Aphthous ulcer - gives cobblestone Appearance in bowel Note: Cobblestone appearance in oesophagus-Candida - Earliest finding Mucosal granularity - Has Pseudo sacculation - Has rectal sparing / fibrosis / strictures / Gut shoening - Has Pseudo polyps & crypt abscesses\n\nSo the answer to this question is A"}
{"instruction": "The bacterial drug resistance in tuberculosis results from :\nA. Transduction\nB. Transformation\nC. Plasmid mediated\nD. Mutation", "response": "Resistance to INH occurs due to point mutation in inhA or katG genes.\nResistance to rifampicin occurs due to point mutation in rpoB genes.\nResistance to ethambutol is due to mutations resulting in overexpression of the embB gene.\n\nSo the answer to this question is D"}
{"instruction": "Hepatitis E infection spreads by:\nA. Feco-oral route\nB. Parenteral\nC. Blood transfusion\nD. Rectal", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "As absolute contraindication of MRI is:\nA. Pacemaker\nB. Prosthetic cardiac valves\nC. Insulin pump\nD. Cochlear implants", "response": "Pacemaker\n\nSo the answer to this question is A"}
{"instruction": "Subepidermal bullae is seen in\nA. Pemphigus vulgaris\nB. Darriers disease\nC. Bullous pemphigoid\nD. HSV infection", "response": "Bullous pemphigoid is an autoimmune pruritic skin disease preferentially in elderly people, that may involve the formation of blisters (bullae) in the space between the epidermal and dermal skin layers. The disorder is a type of pemphigoid. It is classified as a type II hypersensitivity reaction, with the formation of anti-hemidesmosome antibodies Pathophysiology: The bullae are formed by an immune reaction, initiated by the formation of IgG autoantibodies targeting Dystonin, also called Bullous Pemphigoid Antigen 1, and/or type XVII collagen, also called Bullous Pemphigoid Antigen 2, which is a component of hemidesmosomes. A different form of dystonin is associated with neuropathy. Following antibody targeting, a cascade of immunomodulators results in a variable surge of immune cells, including neutrophils, lymphocytes and eosinophils coming to the affected area. Unclear events subsequently result in a separation along the dermoepidermal junction and eventually stretch bullae. Diagnosis: Diagnosis consist of at least 2 positive results out of 3 criteria (2-out-of-3 rule): (1) pruritus and/or predominant cutaneous blisters, (2)linear IgG and/or C3c deposits (in an n- serrated pattern) by direct immunofluorescence microscopy (DIF) on a skin biopsy specimen, and (3)positive epidermal side staining by indirect immunofluorescence microscopy on human salt-split skin (IIF SSS) on a serum sample. Routine H&E staining or ELISA tests do not add value to the initial diagnosis. Treatment: Treatments include class I topical steroids (clobetasol, halobetasol, etc.) , systemic prednisone and powerful steroid-free immunosuppressant medications, such as methotrexate, azathioprine or mycophenolate mofetil. Some of these medications have the potential for severe adverse effects such as kidney and liver damage, increased susceptibility to infections, and bone marrow suppression. Antibiotics such as tetracycline or erythromycin may also control the disease, paicularly in patients who cannot use coicosteroids. The anti-CD20 monoclonal antibody rituximab has been found to be effective in treating some otherwise refractory cases of pemphigoid. Ref Harrison 20th edition pg 1278\n\nSo the answer to this question is C"}
{"instruction": "Self-stimulation is experimentally done from which pa of brain\nA. Medial forebrain bundle\nB. Area around aqueduct of sylvius\nC. PV region of hypothalamus\nD. Radical radiotherapy", "response": "Ans. a. Medial forebrain bundleMedial forebrain bundle is one of the areas responsible for self-stimulationResponsible Centres for Self-stimulationVentral tegmentumdegMedial forebrain bundleQNucleus accumbensQFrontal coex0Drugs that block post-synapticin creases it. The main site D3 receptors dopaminergic reduces the rate of self-stimu ation. Dopamine agonist of the relevant receptor is the nucleus accumbens located at striatum base.\n\nSo the answer to this question is A"}
{"instruction": "A 38-year-old man with a history of fever associated with abdominal pain of 3-week duration presents now with a sudden onset of abdominal pain and copious vomiting. Plain abdominal x-rays reveal air under a diaphragm. A CT scan shows mesenteric lymphadenopathy and splenomegaly is found. Laparotomy is performed and 3 feet of ileum resected. The luminal aspect of the resected bowel shows marked ulceration of Peyer's patches. What is the most likely diagnosis?\nA. Typhoid enteritis\nB. Tuberculosis enteritis\nC. Crohn's disease\nD. Primary peritonitis", "response": "Typhoid fever typically presents with initial symptoms. Small intestine complications are related to involvement of Peyer's patches of the small intestine, which result in bleeding and/or perforation in the second and third week after symptoms are noted.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following indicates the most severe form of fetal distress -\nA. Decreased S/D ratio\nB. Reversal of diastolic flow\nC. Absent diastolic flow\nD. Increased S/D ratio", "response": "Ans. is 4b' i.e.. Reversal of S/D ratio Umbilical artery Dopplero It is used in the surveillance of the fetal well being in the third trimester of pregnancy.o Abnormal umbilical artery Doppler is the marker of uteroplacental insufficiency, and consequent IUGR and suspected pre - eclampsia.o Normal umbilical artery waveform shows a saw tooth pattern with flow always in the forward direction.Normal promotvpe waveform of the umbilical artery dopptero The highest point of the peak of each waveform denotes the Peak Systolic Velocity (PSV) while the lowest point of the trough represents the End Distolic Velocity (EDV) and TAV represents the Average i.e. Timed Average Velocity (TAV).o While analyzing the umbilical artery Doppler one should keep in mind that the normal flow in the umbilical artery is from fetal to maternal circulation the systolic and the diastolic phases studied are in relation to the fetal heart and the downstream vessel to the umbilical artery is the placenta and thematernal circulationo The commonly used parameters in the umbilical artery doppler are:SD ratio: systolic velocity/diastolic velocity.Pulsatility index (PI) (Gosling index): (PSV- EDV)/ TAVResistive index (RI) (Pourcelot index): (PSV - EDV) / PSVo Normally the parameters mentioned above should decrease progressively as the pregnancy advancesr as there is increase in the end diastolic velocity due to growth and dilatation of umbilical circulation.o Any deviation in the parameters is suggestive of either IUGR or pre - eclampsia ,o Thus, during progressive monitoring of the umbilical artery Doppler, as the severity of the disease increases, we observeFirst the decreased velocity in the end diastolic phase,Then absent flow in the end diastolic phase followedBy reversal of flow in the end diastolic phase.o Thus Reversal of diastolic flow is the indicator of most severe form offetal distress.\n\nSo the answer to this question is B"}
{"instruction": "The following eye finding is not seen in which of the following diseases?\nA. Galactosemia\nB. Diabetes\nC. Phenylketonuria\nD. Wilson disease", "response": "The given picture shows bilateral cataract, can be seen in: Galactosemia Diabetes mellitus Wilson disease Peroxisomal disorders So, answer is option 3- phenylketonuria\n\nSo the answer to this question is C"}
{"instruction": "All are true about type 1 renal tubular acidosis except:\nA. Renal stones\nB. Hypokalemia\nC. Sodium bicarbonate requirement >4 mg/day\nD. Urine pH > 5.5", "response": "Ans. c. Sodium bicarbonate requirement Renal Tubular Acidosis Feature Type I(Distal) Type II(Proximal) Type IV Normal anion gap Yes Yes Yes Minimum urine pH >5.5deg <5.5deg <5.5 A filtered bicarbonate excreted <10 >15 <10 Serum potassium Low Low Highdeg Fanconi's syndrome No Yesdeg No Stones/Nephrocalcinosis Yesdeg No No Daily acid excretion Low Normaldeg Low Urinary anion gap Positive Positive Positive Type 1 (Distal) A In distal A, the kidneys are unable to acidify the urine to pH Treatment Early initiation of alkali replacement at doses equivalent to 1-3 mmol/kg per day of bicarbonate in divided doses will usually correct the acidosis, hypokalemia, and hypocitraturia, maintaining growth and preventing bone disease in early-onset dA. Citrate is generally tolerated better than sodium bicarbonate and can be given as the potassium or sodium salt, depending on the severity of hypokalemia. In patients who present later with kidney stones. large fluid intake and sufficient alkali to restore normal acid-basebalance, correct the hypocitraturia and reduce hypercalciuria, thereby inhibiting the formation of new stones Treatment of Type 2 (Proximal) A It is difficult to restore normal acid-base balance in patients with proximal A despite large amounts of alkali. This is the case because they continue to waste bicarbonate (fractional excretion >15%) until the serum level falls below a threshold, usually about 15-17 mmol/L, at which time bicarbonate is completely reabsorbed distally and the urine is maximally acidified with pH <5.5. When the serum bicarbonate concentration is raised above the threshold with alkali therapy, bicarbonate wasting recurs and causes hypokalemia as potassium is secreted to maintain luminal electroneutrality. Thus, treatment of pA requires 5-15 mmol/kg per day of bicarbonate together with supplemental potassium\n\nSo the answer to this question is C"}
{"instruction": "Non hormonal drug to prevent post menopausal osteoporosis is :\nA. Alendronate\nB. Estrogen\nC. Raloxifene\nD. Parathyroid", "response": "Ans. is a i.e. Alendronate Alenderonate, Etidronate, Pamidronate, Ibandronate are bisphosphonates which inhibit bone resorption, and are very effective for both osteoporosis prevention and treatment. Uses : * Postmenopausal osteoporosis Paget's disease Osteolytic bone metastasis. Caution : Patient should be instructed to take these drugs on an empty stomach with a large glass of water and then to remain upright for atleast 30 minutes as its major side effect is GI upset. Route of administration : Oral or I.V. infusion of Alendronate and risedronate can be given once weekly, whereas ibandronate is given once in a month. Now lets have a look at other options : Raioxitene : is a selective Estrogen receptor modulator which is also useful in management of osteoporosis. Parathyroid horrnope . is a novel therapy for osteoporosis. Unlike most of the treatments for osteoporosis that inhibit bone resorption, parathyroid hormone stimulates new bone formation. Parathyroid hormone is given by daily subcutaneous injection. Also know : Other non hormonal drugs used for treatment of osteoporosis : Calcium Vitamin D Calcitonin Slow releasing sodium fluoride.\n\nSo the answer to this question is A"}
{"instruction": "Selective medium for Gonococci -\nA. Thayer - martin medium\nB. LJ medium\nC. DCA medium\nD. MacConkey's medium", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Meaning of baby has 15th percentile of head circumference is-\nA. 15% of children will have HC more than that\nB. 15% of HC, the child is having\nC. 15% of children will have HC less than that\nD. None.", "response": "Ref:Parks 23rd edition Means 15% of children have HC less than that.\n\nSo the answer to this question is C"}
{"instruction": "Natural uncoupler is ?\nA. Thermogonin\nB. 2, 4 nitrophenol\nC. 2, 4 Dinitrophenol\nD. Oligomycin", "response": "Ans. is 'a' i.e., Thermogenin Amongst the given options, a, b and c are uncouplers.However, only thermogenin, among these three is a natural (physiological) uncoupler.UncouplesAs the name suggests, these componds block the coupeling of oxidation with phosphorylation. These compounds allow the transfer of reducing equivalents in respiratory chain but prevent the phosphorylation of ADP to ATPdeg by uncoupling the linkage between ETC and phosphorylation. Thus the energy instead of being trapped by phosphorylation is dissipated as heat. Uncouplers may be :-Natural :- Thermogenin, thyroxineSynthetic :- 2, 4-dinitrophenol (2, 4-DNP), 2, 4-dinitrocresol (2, 4-DNC), and CCCP (chlorocarbonylcyanidephenyl hydrazone).\n\nSo the answer to this question is A"}
{"instruction": "Emile Durkheim is linked with work on which condition in psychiatry?\nA. Suicide\nB. Obsessive compulsive disorder\nC. Anxiety disorder\nD. Schizophrenia", "response": "Ans. A. SuicideSuicide (French: Le Suicide)It was a groundbreaking book in the field of sociology.It was written by French sociologistEmile Durliiheim and pubtshed in 1897.It was ostensibly a case study of suicide, a publication unique for its time that provided an example of what the sociological monograph should look like.\n\nSo the answer to this question is A"}
{"instruction": "Man is the only reservoir for\nA. Salmonella\nB. Campylobacter jejuni\nC. E. histolytica\nD. Y. enterocolitica", "response": "Entamoeba histolytica is predominantly found in primates (including humans) and occasionally in dogs, cats, cattle and pigs. \nThe parasite has a worldwide distribution and is prevalent in tropical and subtropical countries.\nSalmonella - The most common are animal reservoirs are chickens, turkeys, pigs, and cows; dozens of other domestic and wild animals also harbor these organisms.\nCampylobacter jejuni - C. jejuni is carried by most of these animal reservoirs and is the predominant species isolated from chickens and cattle.\nY. Enterocolitica - dogs, sheep, wild rodents, and environmental water may also be a reservoir of pathogenic Y. enterocolitica strains.\nRef : http://parasite.org.au/para-site/text/entamoeba-text.html#:~:text=Host%20range%3A%20Entamoeba%20histolytica%20is,in%20tropical%20and%20subtropical%20countries\n\nSo the answer to this question is C"}
{"instruction": "Normal diurnal variation of intraocular pressure is:\nA. 0-2 mm of Hg\nB. 2-3 mm of Hg\nC. 3-6 mm of Hg\nD. 6-8 mm of Hg", "response": "Ans. 3-6 mm of Hg\n\nSo the answer to this question is C"}
{"instruction": "Bipolar II disorder includes\nA. Cyclothymic disorder\nB. Dysthemia\nC. Single manic episode\nD. Major depression & hypomania", "response": "D i.e. Major depression & hypomania\n\nSo the answer to this question is D"}
{"instruction": "Frotteurism:\nA. Pleasure in watching intercourse\nB. Pleasure in using article of opposite sex\nC. Pleasure in touching opposite sex\nD. Pleasure in wearing opposite sex clothes", "response": "Ans. (c) Pleasure in touching opposite sexRef: The Essentials ofFSM by K.S. Narayan Reddy 31st ed. / 404* FROTTEURISM: rubbing the genitalia with the body of the person of other sex for sexual satisfaction.* Paraphilias: Abnormal 8c unorthodox sex play by using unusual objects or parts are know as paraphilia eg. Sadomasochism, Transvestism, Bestiality, Frotteurism, Homosexuality etc.* Bisexuality means hermaphrodite; an individual with both ovary 8c testis 8c external genitals of both sexes.Different Paraphilias/PerversionSexual perversionMode of sexual pleasureSadismPleasure in giving pain to sexual partnerMasochismPleasure on receiving painful stimulus from sexual partnerBondageSadism + masochism are found togetherFetischismSexual gratification by article of opposite sexFrotteurismSexual gratification by contact. Ex: rubbing genitalia on another personExhibitionismSatisfaction in exhibition of genitals with or without mastutbationTransvestism/ EonismPleasure in wearing clothes of opposite sexUranismSexual gratification by fingering, fellatio, cunnilingus etc.Buccal coitus or Sin of GomorrahFellatio is oral stimulation of penis by male or femaleCunnilingus is oral stimulation of female genitalsVoyeurism/ ScotophiliaAlso known as Peeping tomDesire to watch sexual intercourse or toobserve genitals of othersTrolismExtreme degree of voyeurism. Ex: A perverted husband enjoy watching his wife having sexual intercourse with another man.Urolangia/ CoprophiliaSexual excitement by sight or odor of urine or faeces.Tribadism/ LesbianismGratification of sexual desire of a women by another womenSodomy or Buggery of Greek Love* Anal sex* Gerantophilia -when passive agent is adult* Paederasty - when the passive agent is young boy (catamite)IncestSexual intercourse with close relativeBestialitySexual intercourse by a human being with a lower animal\n\nSo the answer to this question is C"}
{"instruction": "True about incentives given to ASHA worker in Janani Shishu Suraksha Karyakram:\nA. 400 INR to ASHA and 1000 INR to mother in rural area in high performing states\nB. 400 INR to ASHA and 1000 INR to mother in rural area in low performing states\nC. 400 INR to ASHA and 1000 INR to mother in urban area high performing states\nD. 400 INR to ASHA and 1000 INR to mother in urban area low performing states", "response": "Janani Shishu Suraksha Karyakram (JSSK) Incentives Category Rural area Urban area Mother's ASHA Mother's ASHA LPS 1400 600 1000 400 HPS 700 600 600 400\n\nSo the answer to this question is D"}
{"instruction": "Which of the following statements about romosozumab is FALSE?\nA. It is a monoclonal antibody against RANK ligand\nB. It acts by inhibiting osteoclast\nC. It acts by stimulating osteoblast\nD. It is indicated in post menopausal osteoporosis", "response": "Romosozumab is a monoclonal antibody against sclerostin. Denosumab is monoclonal antibody against RANK ligand. Romosozumab has dual action in osteoporosis. It stimulates osteoblast as well as inhibits osteoclast. It is used for treatment of post menopausal osteoporosis.\n\nSo the answer to this question is A"}
{"instruction": "Most common type of esophageal atresia is:\nA. Type A\nB. Type B\nC. Type C\nD. Type D", "response": "The most commonly seen variety is EA with distal TEF (type C), which occurs in approximately 85% of the cases in most series. The next most frequent is pure EA (type A), occurring in 8 to 10% of patients, followed by TEF without EA (type E). The latter occurs in 8% of cases and is also referred to as an H-type fistula, based on the anatomic similarity to that letter. EA with fistula between both the proximal and distal ends of the esophagus and trachea (type D) is seen in approximately 2% of cases, and type B, EA with TEF between the proximal esophagus and trachea, is seen in approximately 1% of cases. Ref: Schwaz's principle of surgery 9th edition, chapter 39.\n\nSo the answer to this question is C"}
{"instruction": "A 38-year old homeless male develops sudden onset hematemesis following a bout of severe vomiting and retching. He had no complaints prior to the onset of his symptoms. On examination, he is pale and looks anxious. The vital signs are normal. Laboratory investigations show normal liver function tests, a low Hb and high MCV, chest X-ray is normal. The above problem on endoscopy would appear as -\nA. Dilated veins in lower esophagus\nB. Growth in the lower esophagus\nC. Linear tear in the OG junction\nD. Whitish plaques in esophagus", "response": "Potential Mechanisms for Mallory-Weiss Tears A Mallory-Weiss tear likely occurs as a result of a large, rapidly occurring, and transient transmural pressure gradient across the region of the gastroesophageal junction. Acute distention of the nondistensible lower esophagus can also produce a linear tear in this region Ref Davidson 23rd edition pg821\n\nSo the answer to this question is C"}
{"instruction": "True about development all except:\nA. Parathyroid glands develop from 3rd & 4th branchial arch\nB. Tongue muscles develop from occipital myotome\nC. Superior parathyroid gland develops from 4th branchial arch\nD. Inferior parathyroid gland develop from 2nd branchial arch", "response": "D. i.e. Inferior parathyroid gland develop from 2^d branchial arch\n\nSo the answer to this question is D"}
{"instruction": "MOST common mutation seen in heriditary hemochromatosis is:\nA. C282Y\nB. H63D\nC. TFR2\nD. SLC11A3", "response": "The most common mutation in hereditary hemochromatos is a homozygous G to A mutation resulting in a cysteine to tyrosine substitution at position 282 (C282Y). Another relatively common mutation (H63D) results in a substitution of histidine to aspaic acid at codon 63. Mutations like transferrin receptor 2 TFR2 mutation and ferropoin 1 gene, SLC11A3 mutation are rare. Ref: Harrisons principles of internal medicine, 18th edition, Page: 3162\n\nSo the answer to this question is A"}
{"instruction": "The drug of choice for status epilepticus is ?\nA. Propofol\nB. Lorazepam\nC. Thiopentone\nD. Haloperidol", "response": "Ans. is 'b' i.e., Lorazepam\n\nSo the answer to this question is B"}
{"instruction": "A 52 year old man presented with dysphagia diagnosed of having adenocarcinoma of esophagus. It mostly seen in:\nA. Middle esophagus\nB. Upper esophagus\nC. Barrett's ulcer\nD. None of the above", "response": "Barrett esophagus secondary to long-standing reflux disease is the single most impoant risk factor for adenocarcinoma. Patients with Barrett esophagus are 30 to 125 times more likely to have adenocarcinoma of the esophagus than the general population. Microscopically, adenocarcinoma almost always originates in metaplastic Barrett's mucosa, and resembles gastric cancer. Ref: Jobe B.A., Hunter J.G., Peters J.H. (2010). Chapter 25. Esophagus and Diaphragmatic Hernia. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.\n\nSo the answer to this question is C"}
{"instruction": "Which rtf the following is true about Lambda phage?\nA. It cause mad cow disease\nB. Lysogenic to lytic conversion cannot occur\nC. Lysogenic form incorporates in host DNA and remain dormant\nD. Lytic phase incorporates in host DNA proliferate and causes rupture of cell", "response": "Ans. c. Lysogenic form incorporates in host DNA and remain dormant In the lysogenic phage the phage virus does not immediately cause the lysis of the cell, instead it integrates into the host genome.\"In (he lysogenic phase the phage virus does not immediately cause the lysis of the ceil, instead it integrates into the host genome. The phage D.XA in this repressed state is called a prophage (because it is not a phage but it has the potential to produce phage). The integrated state of phage D.XA is termed prophage, whereas, the process is known as tysogency and the bacteria harbouring the prophage are called lysogenic bacteria.\"Lambda Phage life Cycle in the HostVirulent or Lytic phaseLysogenic phase* The phage virus takes over the cellular machinery of the host and starts producing viral proteins necessary for the synthesis of new viruses.* In the lysogenic phase the phage virus does not immediately cause the lysis of the cell, instead it integrates into the host genome.* The phage DNA in this repressed state is called a prophage (because it is not a phage but it has the potential to produce phage). Lambda Phage life Cycle in the HostVirulent or Lytic phaseLysogenic phase* New viruses assemble in the host cell and the host bacteria lyse and release progencv virions.* The integrated state of phage DNA is termed prophage, whereas, the process is known as lysogencv and the bacteria harbouring the prophage are called lysogenic bacteria.* It replicates synchronously with the host virus causing no harm to it.* Two new daughter cells are formed each containing the host cell gene and the prophage gene.* On exposure to ultraviolet light or other agents the lysogenic phase undergoes induction, i.e. The phase DNA is excised from the host cell and it undergoes lytic cycle.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is cariostatic?\nA. Selenium\nB. Magnesium\nC. Cadmium\nD. Molybdenum", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Storage form of energy in liver is -\nA. Glycogen\nB. Triacylglycerol\nC. Cholesterol ester\nD. Protein", "response": "Ans. is 'a' i.e., Glycogen* Humans carry supplies of fuel within their body. Calories are stored in the body as fat (triglycerides), glycogen and some protein.Provider of energyGramsKilocaloriesPlasma glucose1248Hepatic glycogen70280Muscle glycogen2801120Fat (Triglyceride) in adipose tissue13,000117, 000Muscle protein10,00040,000* Thus, fat in the adipose tissue is the largest reserve of energy in the body, i.e. adipose tissue is the storehouse in the body. However, liver glycogen is the first main provider of energy, for example after absorptive period (when all the dietary glucose is utilized), liver glycogen is the first source of energy. Liver glycogen maintains the blood glucose level between meals.\n\nSo the answer to this question is A"}
{"instruction": "Laboratory, test for lead poisoning?\nA. Lead in urine\nB. ALA in urine\nC. Coproporphyrin in urine\nD. All of the above", "response": "Ans. is 'd' i.e., All of the above Lead Poisoning ? Most common mode of absorption of lead is inhalation of fumes and dust of lead or its comppunds. Other less common mode of absorption are ingestion and absorption through skin (especially tetraethyl lead). A blood level 70 g/100 ml or more is generally associated with clinical symptoms. Lead exes its toxic action by combining with essential SH - groups of ceain enzymes. Lab tests for lead poisoning Coproporphyrin in urine (CPU) -4 In non exposed persons, it is less than 150 g/L. Amino levulinic acid (ALA) in urine If it exceeds 5 mg/litre it indicates clearly lead absorption. Lead in blood and urine : Lead in blood and urine are quantitative indicators of exposure. Lead in urine of over 0.8 mg/litre indicates lead exposure. Blood level of 70 micro g/100m1 is associated with clinical symptoms Basophilic stipling of RBC Is a sensitive parameter of the hematological response.\n\nSo the answer to this question is D"}
{"instruction": "All of the following are seen in rickets except: September 2009\nA. Frenkels line\nB. Widening of epiphysis- diaphysis distance\nC. Cupping and splaying of metaphysis\nD. Rarefaction", "response": "Ans. A: Frenkels Line In rickets, the skeletal effects are due to lack of calcification of osteoid. The first changes of rickets appear in rapidly growing distal ends of ulna & radius (wrist & knee are commonly involved due to more use). Rarefaction of provisional zone of calcification with widening of epiphysis- diaphysis distance is first to appear. The most obvious change are at 'metaphysis'- where rapid growth is occurring. First change to appear is a 'loss of normal zone of provisional calcification' adjacent to metaphysis. This begins as an indistinctness of the metaphyseal margin, progressing to a 'frayed' appearance with widening of the growth plate, due to lack of calcification of metaphyseal bone. Weight bearing & stress on uncalcified bone gives rise to 'splaying' Sr 'cupping' of metaphysis. A similar but less marked effect occurs in subperiosteal layer, which may cause lack of distinctness of coical margin. Eventually a generalized reduction in bone density is seen. In the epiphysis - there may be some haziness of coical margin. Thus all findings in Rickets occur due to failure of calcification & abnormal demineralization i. Skull changes - Pronounced calvarial demineralization - Basilar Invagination - Indistinct sutural margin - Delayed tooth eruption Premature craniostenosis - Craniotabes - Calvarial thickening following treatment ii. Spine changes - Scoliosis - Biconcave veebral bodies - Triradiatic pelvis.\n\nSo the answer to this question is A"}
{"instruction": "A 27-year-old male painter is admitted to the hospital after falling from a ladder. Physical examination reveals that the patient is unable to abduct his arm more than 15deg and cannot rotate the arm laterally. A radiographic examination reveals an oblique fracture of the humerus. He has associated sensory loss over the shoulder area. Which of the following injuries will most likely correspond to the symptoms of the physical examination?\nA. Fracture of the medial epicondyle\nB. Fracture of the glenoid fossa\nC. Fracture of the surgical neck of the humerus\nD. Fracture of the anatomic neck of the humerus", "response": "Fracture of the surgical neck of the humerus often injures the axillary nerve, which innervates the deltoid and teres minor muscles. Abduction of the humerus between 15deg and the horizontal is performed by the deltoid muscle. Lateral rotation of the humerus is mainly performed by the deltoid muscle, teres minor, and the infraspinatus. The deltoid and teres minor are both lost in this case. Fracture of the glenoid fossa would lead to drooping of the shoulder. Fracture of the anatomic neck of the humerus will similarly lead to a drooping of the shoulder but would not necessarily affect abduction of the humerus. It is also quite unusual. Fracture of the middle third of the humerus would most likely injure the radial nerve. The ulnar nerve would be potentially compromised in a fracture of the medial epicondyle of the humerus.\n\nSo the answer to this question is C"}
{"instruction": "70 M presented to AIIMS OPD with fatigue. Fasting sugar was 110 mg%, PP was 180 mg%, Hbalc was 6.1 %. What is your diagnosis?\nA. Prediabetes\nB. Stress induced\nC. Normal\nD. Diabetes", "response": "Ans. (a) Prediabetes(Ref: Robbins 9th/pg 1106; 8th 1131)Diagnostic criteria according to ADA and WHO: Presence of any 1 or more of the following-CriteriaDiabetesImpaired glucose tolerance (pre-diabetes)* Fasting plasma glucose>=126mg/dLbetween 100 and 125mg/dL* Random plasma glucose>=200mg/dL-* 2-hour plasma glucose during oral glucose tolerance test (OGTT) with 75 g>=200mg/dLbetween 140 and 199mg/dL* Glycated hemoglobin (HbA1C) level>=6.5%between 5.7% and 6.4%.\n\nSo the answer to this question is A"}
{"instruction": "What is the location of stricture in the given RGU?\nA. Membranous urethra\nB. Bulbar urethra\nC. Penile urethra\nD. Prostatic urethra", "response": "- IOC for diagnosing posterior urethral stricture - MCU- IOC for diagnosing anterior urethral stricture- RGU- Adequate evaluation of posterior and anterior urethral stricture- RGU+ MCU Retrograde urethrogram\n\nSo the answer to this question is B"}
{"instruction": "Which of the following drugs does not cross placenta?\nA. Heparin\nB. Warfarin\nC. Dicumarol\nD. Nicoumalone", "response": "Heparin due to its large molecular size does not cross the placental barrier therefore can be used in pregnancy. From medical pharmacology padmaja 4th edition Page no 335\n\nSo the answer to this question is A"}
{"instruction": "Primary prevention in coronary heart diseases-\nA. Salt restriction\nB. BP monitoring\nC. Exercise in high risk area\nD. Statins", "response": "primary prevention- health promotion and specific protection. Regular physical activity should be a part of normal daily life. It particularly important to encourage the children to take up physical activity that they can continue through out their life.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following drugs lack vasodilatory properties that is effective in angina?\nA. Metoprolol\nB. Verapamil\nC. Isosorbide dinitrate\nD. Nifedipine", "response": "Metoprolol: It is the prototype of cardioselective (β1) blocker; nearly 50 times higher dose is needed to block isoprenaline induced vasodilation. Some measure of inverse agonistic activity on β1 receptors has also been demonstrated. It is less likely to worsen asthma, but is not entirely safe. It may be preferred in diabetics receiving insulin or oral hypoglycaemics. Patients who complain of cold hands and feet while on propranolol, do better on metoprolol.\nFirst pass metabolism of metoprolol is less marked than propranolol, but 90% or more is ultimately hydroxylated by CYP2D6 before excretion. There are 'extensive' and 'poor' hydroxylators of metoprolol (CYP2D6 alleles); the latter may require a lower dose.\nSide effects of metoprolol are milder. It is generally given orally for hypertension, angina and CHF, but i.v. injection (5-15 mg) has been used in myocardial infarction provided bradycardia is absent.\nKey concept:\nBeta-blockers do not cause vasodilation.\nReference: Essentials of Medical Pharmacology Eighth Edition KD TRIPATHI page no 162\n\nSo the answer to this question is A"}
{"instruction": "Radiological investigation shows sun ray appearance;diagnosis is -\nA. Osteosarcoma\nB. GCT\nC. Osteomyelitis\nD. Ewing's sarcoma", "response": "In exams like AIIMS and AI, only best option has to be chosen and here osteosarcoma is best option.\n\nSo the answer to this question is A"}
{"instruction": "Most common cause of Abdominal aneurysm is:\nA. Atherosclerosis\nB. Trauma\nC. Marfan's syndrome\nD. Congenital", "response": "Answer is A (Atherosclerosis) Atherosclerosis is the major etiological factor in abdominal aoic aneurysm - Robbins Remember: Atherosclerotic aneurysms most frequently occur in the Abdominal aoa.Q Most common site of abdominal aoic aneurysm is above the bifurcation of aoa and below the renal aeries.Q Most common age group for abdominal aoic aneurysm depends is elderly(> 50 years). Risk' of rupture of an abdominal aoic aneurysm depends upon its size (aneurysm larger than 5 cm are classified as dangerousQ) Most common source of infection in a Mycotic abdominal aoic aneurysm is Bacteremia Q from a primary Salmonella gastro-enteritis.Q (Mycotic aneurysm are abdominal aoic aneurysm that have become infected by lodgment of circulating organisms in the wall)\n\nSo the answer to this question is A"}
{"instruction": "Fever in burnt patient is caused by:a) Due to hypermetabolismb) Toxin released by dead tissuec) Infectiond) Dead tissue products\nA. a\nB. ac\nC. ad\nD. b", "response": "Long: Principles and Practice of Pediatric Infectious Diseases, (3rd ed chapter 91) writes-\n\"Diagnosis of infectious complications in a burn victim is challenging. Although fever and elevated peripheral white blood cell count with a left shift are usual indicators of infection, their positive predictive value for diagnosis of infectious complications in burn victims is very low because they are commonly seen in uninfected burned children whose wounds are uncovered. Neither severity of fever (frequently > 39°C) nor response to antipyretic therapy is a reliable indicator of infection. Peak fever in burned children without infection usually occurs on the second day after the burn, with a second peak around the sixth and seventh days. Fever is probably the result of an increase in metabolic rate and an alteration of hypothalamic temperature regulation. Fever usually subsides without specific therapy, coincident with re-epithelialization of the burn wound or successful grafting of all open areas. Thus, fever alone in the burned child is not a reliable indicator of infection or of the need to investigate for infection or prescribe antibiotic therapy.\"\n\nSo the answer to this question is B"}
{"instruction": "In which pa of Henle loop is tubular fluid hypotonic with plasma/GFR?\nA. Thin descending limb\nB. Thin ascending segment/limb.\nC. Thick ascending segment/limb.\nD. Thick descending segment/limb.", "response": "Thick ascending segment/limb.REABSORPTION IN THICK ASCENDING LIMB:Water reabsorption:Totally impermeable to water.Ascending segment also referred \"Diluting\" segment:Due to sodium & solute absorption without water.Resulting in tubular fluid dilution.Hence, Tubular fluid is hypotonic.Sodium, Potassium & Chloride reabsorption:By \"Secondary active transpo\" Through Na2+-K+-2Cl-- carrier transpoer.Transpos one Na2+, one K+, & two Cl-.Active sodium absorption occurs.30% filtered Na2+ reabsorbed.\n\nSo the answer to this question is C"}
{"instruction": "Lithium directly affects which\nA. Sodium\nB. Potassium\nC. Magnesium\nD. Calcium", "response": "Ans. is 'a' i.e., Sodium Diuretics (paicularly thiazides) decrease the renal excretion of lithium and thus may result in toxicity. This is due to increased reabsorption of Na+ and lithium ions (as a compensatory response to excessive loss of Na+).\n\nSo the answer to this question is A"}
{"instruction": "All of the following are true about the Herd Immunity for infectious diseases except :\nA. It refers to group protection beyond what is afforded by the protection of immunized individuals\nB. It is likely to be more for infections that do not have a sub-clinical phase\nC. It is affected by the presence and distribution of alternative animal hosts\nD. In the case of tetanus it does not protect the individual", "response": "Occurrence of clinical and subclinical infection in a community is responsible for herd immunity. Herd immunity is more for infections that have a subclinical phase. Ref: Park's Textbook Of Preventive And Social Medicine By K. Park, 19th Edition, Page 96; Park's Textbook Of Preventive And Social Medicine By K. Park, 18th Edition, Page 95\n\nSo the answer to this question is B"}
{"instruction": "A 19-year-old man working as a driver comes to Psychiatrist with excessive anxiety and fear. He repos that every time he drives over a bump in the road, he is convinced that he has accidentally run over a small child. He has to pull over and check underneath his car for blood and retrace his driving route to look for any injured children. As a result, he is always late for work.He also has intrusive thoughts about stabbing his coworkers.He prays to try to erase these thoughts from his mind, but this rarely helps. First-line pharmacological treatment of this patient's condition primarily affects which of the following neurotransmitters?\nA. Acetylcholine\nB. Dopamine\nC. Norepinephrine\nD. Serotonin", "response": "Patient's behavior is suggestive of Obsessive Compulsive Disorder. Although multiple neurotransmitters and regulatory mechanisms are thought to contribute to the clinical expression of OCD ,serotonin is the primary pharmacological target. First-line treatment is a selective serotonin reuptake inhibitor(SSRI) antidepressant.\n\nSo the answer to this question is D"}
{"instruction": "Loss of pulmonary surfactant in premature infant ?\nA. Pulmonary edema\nB. Collapse of alveoli\nC. Elastic recoil of lungs\nD. All", "response": "Ans. is 'a' i.e., Pulmonary edema; 'b' i.e., Collapse of alveoli & 'c' i.e., Elastic recoil of lungs Effects of surfactant deficiency o Decreased compliance Increased elastic recoil o Atelectasis o Interstitial edema o Hyaline membrane formation\n\nSo the answer to this question is D"}
{"instruction": "Hotspot on Tc-99 is seen in which parotid tumour?\nA. Pleomorphic adenoma\nB. Adenoid cystic carcinoma\nC. Acinic cell tumour\nD. Wahin tumour", "response": "Wahin tumour, or papillary cystadenoma lymphomatosum, is the second most common benign parotid tumour and occurs most often in older white men. Because of the high mitochondrial content within oncocytes, the oncocyte-rich Wahin tumour and oncocytomas incorporate technetium-99m and appear as hot spots on radionuclide scans.Ref: Sabiston, 20e, page no: 830\n\nSo the answer to this question is D"}
{"instruction": "All are cholinergic agents except I\nA. Galantamine\nB. Donepezil\nC. Tacrine\nD. Memantine", "response": "Refer kDT 6/e p 472,473 Donepazil, rivastigmine, gallantamine and tacrine are cholinergic drugs( due to inhibition of cholenesterase enzyme)useful for Alzheimer's disease Memantine is an NMDA blocker, used for Alzheimer's disease\n\nSo the answer to this question is D"}
{"instruction": "A 13-year-old male presents with bilateral enlargement of his breasts. Physical exam is otherwise unremarkable, and the breast enlargement is thought to be a normal variation at pubey. Histologic sections of breast tissue would most likely reveal\nA. Proliferation of ducts in hyalinized fibrous tissue with periductal edema\nB. Atrophic ductal structures with increased numbers of lipocytes\nC. Dilated ducts filled with granular, necrotic, acidophilic debris\nD. Granulomatous inflammation surrounding ducts with numerous plasma cells", "response": "Gynecomastia (enlargement of the male breast) histologically reveals epithelial hyperplasia within the ducts that is surrounded by hyalinized fibrous tissue. It is caused by an increase in the estrogen-to-androgen ratio. This abnormality may sometimes be found in males at the time of pubey. Other causes of gynecomastia include Klinefelter's syndrome (decreased secretion of testosterone), testicular feminization (androgen insensitivity), testicular tumors, cirrhosis of the liver, alcohol abuse, increased gonadotropin levels (such as choriocarcinoma of the testis), increased prolactin levels, drugs (such as digoxin), or hypehyroidism. Testicular neoplasms that are associated with gynecomastia are tumors that secrete human chorionic gonadotropin (hCG), which increases the synthesis of estradiol. Testicular tumors associated with the production of hCG include germ cell tumors (choriocarcinoma and seminoma), Leydig cell tumors, and Seoli cell tumors Gynecomastia Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition\n\nSo the answer to this question is A"}
{"instruction": "Veical transmission is by-\nA. Mosquitoes\nB. Direct contact\nC. Droplet\nD. Placenta", "response": "When the infectious agent is transmitted veically from infected female to her progeny in the vector is known as transovarial transmission.Transmission of the disease agent from one stage of the life cycle to another as for example nymph to adult is known as transstadial transmission (refer pgno:98 park 23rd edition)\n\nSo the answer to this question is D"}
{"instruction": "According to ADA specification #1 for amalgam, what is the acceptable dimensional change?\nA. -20 to +20 micron/cm\nB. -10 to +10 micron/cm\nC. -20 to +10 micron/cm\nD. -10 to +20 micron/cm", "response": "According to ADA specification #1 for amalgam, the acceptable dimensional change is -20 to +20 micron/cm.\nReference: Marzouk Operative dentistry, pg-108\n\nSo the answer to this question is A"}
{"instruction": "Which of the following skull fractures is called a Motorcyclist's fracture -\nA. Ring fracture of base of skull\nB. Hinge fracture of base of skull\nC. Comminuted fracture of skull\nD. Depressed fracture of skull", "response": "A transverse fracture across the floor of the skull, usually called a \"hinge fracture\", is sometimes referred to as motorcyclist fracture. At autopsy, the base of the skull may be appreciated to have divided into two halves, each moving independently of each other like a hinge, the so-called motorcyclist fracture.\n\nSo the answer to this question is B"}
{"instruction": "Iron absorption is increased in -a) Iron deficiency anemiab) Pregnancyc) All types of anemiad) Malignancye) Macrocytic anemia\nA. acd\nB. bcd\nC. abd\nD. ab", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "A lymph node from a 10-year-old boy reveals large pleomorphic lymphocytes with CD30 positivity, frequent mitoses, and scattered cells bearing kidney-shaped nuclei. Which of the following statements is true?\nA. t(2;5) translocation impas a worsened prognosis.\nB. ALK protein immunostaining is seen in a minority of cases.\nC. This tumor occurs exclusively in children\nD. Hallmark cells are a feature.", "response": "This patient has anaplastic large cell lymphoma (ALCL). The constituent cells are positive for CD30. Scattered cells showing kidney or donut-shaped nuclei with an eosinophilic region adjacent to the nucleus are known as \"Hallmark cells.\" The majority of cases in children shows a t(2;5) translocation which correlates with ALK positivity and improved survival. Bimodal incidence.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following statements about contrast in radiography is true -\nA. Ionic monomers have three iodine atoms per two paicles in solution\nB. High osmolar contrast agents may be ionic or non ionic\nC. Gadolinum may cross the blood brain barrier\nD. Iohexol is a high osmolar contrast media", "response": "option A is correct : Ionic monomers have three iodine atoms per two paicles in solution Ionic dimers and non ionic monomers have three iodine atoms per one paicle in solution Non ionic dimers have six iodine atoms per one paicle in solution option B is incorrect : High osmolar agents (ionic monomers) are only ionic low osmolar agents may be ionic or non ionic iso osmolar agents are only non ionic option C is incorrect : Gadolinium does not cross Blood brain barrier (BBB) option D is incorrect : Iohexol is low osmolar (non ionic monomer)\n\nSo the answer to this question is A"}
{"instruction": "Bruxism causes the following Except\nA. Attrition of primary & permanent teeth\nB. TMJ disorder\nC. Muscular tenderness\nD. Caries", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Deep vein thombosis occurs most commonly after:\nA. Total hip replacement\nB. Gastrectomy\nC. Prostatic operation\nD. Brain surgery", "response": "Ans. is 'a' ie Total hip replacement * \"Pts receiving t/t in hospital are at increased risk of venous thrombosis. This includes pts being treated surgically or for medical conditions. The factors which result in increased risk of venous thrombosis include advancing age and greater complexity of surgical treatment. Orthopedic operations on the lower limbs (hip and knee replacements) are especially likely to result in venous thrombosis.\"\n\nSo the answer to this question is A"}
{"instruction": "Cadaveric spasm affects the following muscles\nA. Voluntary\nB. Involuntary\nC. Both\nD. None", "response": "(A) Voluntary > Cadaveric Spasm or Instantaneous Rigor: Cadaveric spasm (cataleptic rigidity) is a rare condition.> In this, the muscles that were contracted during life become stiff and rigid immediately after death without passing into the stage of primary relaxation.> This is usually limited to a limited group of voluntary muscles and frequently involves hands> The whole body can be involved in soldiers who are involved in a war\n\nSo the answer to this question is A"}
{"instruction": "Bi-zygomatic width divided by 16 gives approximate mesiodistal width of\nA. Upper central incisor\nB. Lower central incisor\nC. Upper anterior teeth\nD. Lower anterior teeth", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "A 22-year-old man with AIDS complains of persistent cough, night sweats, low-grade fever, and general malaise. A chest X-ray reveals an area of consolidation in the periphery of the left upper lobe, as well as hilar lymphadenopathy. Sputum cultures show acid-fast bacilli. Which of the following is the most likely diagnosis?\nA. Bronchopneumonia\nB. Pulmonary abscess\nC. Sarcoidosis\nD. Tuberculosis", "response": "Tuberculosis. Tuberculosis represents infection with Mycobacterium tuberculosis, although atypical mycobacterial infections may mimic it. The Ghon complex includes parenchymal consolidation and enlargement of ipsilateral hilar lymph nodes and is often accompanied by a pleural effusion. The sputum contains M. tuberculosis, which is acid-fast in smears stained by the Ziehl-Neelsen technique. After resolution of primary tuberculosis, reemergence may occur (secondary tuberculosis). None of the other choices feature acid-fast organisms.Diagnosis: Tuberculosis, Mycobacterium tuberculosis\n\nSo the answer to this question is D"}
{"instruction": "Typhoid in first week of illness is best diagnosed by:-\nA. Serum widal test\nB. Stool culture\nC. Urine test\nD. Blood culture", "response": "Laboratory diagnosis of typhoid : 'BASU' mnemonic Test of diagnosis Time of diagnosis Remarks Blood culture 1st week Mainstay of diagnosis Antibodies (widal test) 2nd week Moderate sensitivity & specificity Stool culture 3rd week Useful for carries Urine test 4th week Useful for carries\n\nSo the answer to this question is D"}
{"instruction": "The matrix band for restoring a Class-I with lingual extension is\nA. Tofflemire\nB. Ivory No.8\nC. Barton\nD. T band", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Latest (most recent) oral direct thrombin inhibitor is -\nA. Ximelagatran\nB. Indraparinux\nC. Dabigatran\nD. Fondaparinux", "response": "Ans is 'c' i.e. Dabigatran o Ximelagatran was the first oral direct thrombin inhibitor approved; however, it was subsequently withdrawn from the market because of repos of liver failure. o Recently a new oral direct inhibitor, dabigatran, was approved for use in Europe for prevention of various thromboembolism in patients who have undergone hip or knee replacement surgery.\n\nSo the answer to this question is C"}
{"instruction": "In beta thalassemia, there is –\nA. Increase in beta chain, decrease in alpha chain\nB. Decrease in beta chain, increase in alpha chain\nC. Decrease in beta chain, decrease in alpha chain\nD. Increase in beta chain, increase in alpha chain", "response": "Beta - thalassemia \n\nThe abnormality common to all P-thalassemias is diminished synthesis of structurally normal β-globin chains, coupled with unimpaired synthesis of α-chain.\nThe reduced supply of (β-globin chain diminishes production of hemoglobin tetramers, causing hypochromic and microcytic anemia.\nThe haematological consequences of diminished synthesis of one globin chain stem not only from low intracellular hemoglobin, but also from a relative excess of the unimpaired chain.\n\nConsequences of thalassemia\n\nIn (β-thalassemia, anemia is produced by two mechanisms\n\n\nDeficit in HbA synthesis produce hypochromic microcytic anemia.\nExcess free α-chains aggregate into insoluble inclusions within red cells and their precursors (normoblasts). These inclusions cause membrane damage that results in apoptosis of normoblasts in the marrow → ineffective erythropoiesis. The red cells which escape death in bone marrow are prone to splenic sequestration and destruction due to cell membrane damage and decreased deformability, leading to extravascular hemolysis.\n\n\nThe second mechanism is more important in producing anemia.\nAnaemia leads to several additional problems -\n\n\nIncreased erythropoietin secretion in response to anemia leads to massive erythroid hyperplasia in bone marrow that results in expansion of bone marrow and skeletal deformities.\nErythropoietin also induces extramedullary erythropoiesis in liver and spleen -p Hepatosplenomegaly.\nExcessive absorption of iron (in response to ineffective erythropoiesis) along with repeated blood transfusion in severe β-thalassemia results in iron overload and secondary hemochromatosis → iron overload in heart, liver, endocrine glands, spleen -4 cardiac failure / endocrine deficiency → Death.\n\nSo the answer to this question is B"}
{"instruction": "Riders cataract is seen in\nA. Blue dot\nB. Zonular\nC. Anterior capsule\nD. Coronary", "response": "Lamellar or Zonular cataract It is a developmental cataract in which the opacity occupies a discrete zone in the lens. It is the most common type of congenital cataract presenting with visual impairment. Characteristic features. Typically, this cataract occurs in a zone of foetal nucleus surrounding the embryonic nucleus. The main mass of the lens internal and external to the zone of cataract is clear, except for small linear opacities like spokes of a wheel(riders) which may be seen towards the equator. Occasionally two such rings of opacity are seen. It is usually bilateral and frequently causes severe visual defects. Ref;A.K.Khurana; 6th edition; Page no:184\n\nSo the answer to this question is B"}
{"instruction": "Cell to cell permeability occurs through\nA. Occludin\nB. Zona adherens\nC. Connexins\nD. Zonulin", "response": "Ans. (c) Connexins(Ref: Robbins 9th/ pg 11)*Communicating junctions (Gap junctions): mediate the passage of chemical or electrical signals from one cell to another.*Consists of pores called connexions and formed by hexamers of transmembrane proteins called connexins\n\nSo the answer to this question is C"}
{"instruction": "False about Barrett's oesophagus is\nA. In sho - segment Barrett's there is less than 3 cm of columnar epithelium\nB. Barrett's ulcer occurs just above the squamocolumnar junction\nC. If a peptic stricture occurs in Barrett's oesophagus it always occurs at the new squamocolumnar junction\nD. It is a premalignant condition", "response": "Barrett's ulcer is an ulcer in the columnar-lined poion of Barrett's oesophagus.These are distinct from the more usual erosions of reflux oesophagitis that always occur at or just above the squamocolumnar junction.\n\nSo the answer to this question is B"}
{"instruction": "Commonest cutaneous eruption in systemic L.E. is:\nA. Palmar erythema\nB. Discoid lesions\nC. Erythema of light exposed area\nD. Diffuse morbiliform erythema", "response": "Erythema of light exposed area\n\nSo the answer to this question is C"}
{"instruction": "Dorsum of first webspace is supplied by nerve\nA. Superficial peroneal\nB. Deep peroneal\nC. Sural\nD. Posterior tibial", "response": "Nerve supply to lower limb Thigh: Anterior compament - femoral nerve Medial compament - obturator nerve Posterior compament - tibial nerve (Sciatic nerve) Leg: Anterior - Deep Peroneal Nerve (DPN) Lateral - Superficial peroneal nerve (SPN) Posterior- Tibial nerve Foot: Dorsum of foot (except first web space)- superficial peroneal nerve Dorsum of first web space - Deep peroneal nerve (DPN) Plantar surface - Medial and lateral plantar nerve (terminal division of tibial nerve) Middle malleolus - Saphenous nerve (branch of femoral nerve) Lateral margin - Sural nerve\n\nSo the answer to this question is B"}
{"instruction": "This cream is appropriate for all of the following procedures Except\nA. Venipuncture\nB. Laceration repair\nC. Lumbar puncture\nD. Myringotomy", "response": "EMLA (eutectic mixture of local anesthetics) is a eutectic mixture of 5 percent lidocaine and prilocaine that is used to produce anesthesia over intact skin. Its primary use is to produce anesthesia before venipuncture and lumbar puncture. In other settings, this cream has been used for anesthesia of split-thickness graft donor sites, curettage of molluscum contagiosum, cautery of genital was, and myringotomy. EMLA is not recommended for topical anesthesia of lacerations because it induces an exaggerated inflammatory response, thereby damaging host defenses and inviting the development of infection.\n\nSo the answer to this question is B"}
{"instruction": "Characteristic features of Rokitansky -- Kuster Hauser syndrome are all of the following except :\nA. Absent uterus\nB. Absent vagina\nC. Anovulation\nD. 46 -- XX", "response": "Anovulation Mayer Rokitansky Kuser Syndrome (MRKH) is the complete failure in the development of the mullerian ducts resulting in absence of the fallopian tubes, uterus and most of vaginadeg (as of vagina is formed by Mullerian duct). Mayer Rokitansky-Kuster Hauser syndrome Karyotype = 46 XXdeg Phenotype = Female Associated abnormalities are : Renal ectopy and agenesis (Horse shoe shaped kidney)deg Skeletal abnormalitiesdeg (most common - scoliosis) Cardiac anomalies.deg Clinical features : Patient present between 15-18 years of age with primary amenorrhoea.deg (eugonadotropic amenorrhea). Secondary sexual characteristics are normaldeg as ovaries are normal (because of their separate embryonic origin, so ovulation is also normal.) P/V = Vagina is felt like a blind pouch and uterus is absent.deg Findings are confirmed by USG.deg Ideal method for demonstrating Uterine malformations is MRI.deg Management : Repair of vaginal agenesis done either by frank dilatation or vaginoplasty. Vaginoplast should onl be performed when the girls is just married or about to be marripri Frank Dilatation : This non-surgical procedure consists of a woman applying gradual pressure with progressively increasing dilators over the mullerian pit for 15 minutes twice a day. An indentation is created by the end of 3 to 6 month. Some have satisfactory intercourse, but in many, vaginal size is inadequate and they need a surgical procedure eventually. Surgical management : Vaginoplasty either by Mc Indoe operation Differential Diagnosis : Testicular feminization syndrome. Mayer Rokitansky-Kuster Hauser syndrome can be differentiated from testicular feminizing syndrome on the basis of :\n\nSo the answer to this question is C"}
{"instruction": "Age estimation from teeth can be done by all the following methods, except: NEET 14\nA. Gustafson's method\nB. Miles' method\nC. Boyde's method\nD. Frame's method", "response": "Ans. Frame's method\n\nSo the answer to this question is D"}
{"instruction": "The basis of Korotkoff sound is related to\nA. Aoic valve closure\nB. Production of hea sound\nC. Aerial turbulence\nD. Aerial valve expansion", "response": "At the point at which systolic pressure in the aery just exceeds the cuff pressure, a spu of blood passes through with each heabeat and, synchronously with each beat, a tapping sound is heard below the cuff. The cuff pressure at which the sounds are first heard is the systolic pressure. As the cuff pressure is lowered fuher, the sounds become louder, then dull and muffled. These are the sounds of Korotkoff. The sounds of Korotkoff are produced by turbulent flow in the brachial aery. Ref: Ganong&;s Review of medical physiology 25th edition. Page:577\n\nSo the answer to this question is C"}
{"instruction": "Sarcoidosis causes all except -\nA. Osteomalacia\nB. Addison's disease\nC. Diabetes insipidus\nD. Hypercalcemia", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Maximum shoening of lower limb is seen in:\nA. shaft femur\nB. Neck femur\nC. interochanter\nD. Transcervical", "response": "A i.e. Shaft femur Lower limb injures associated with maximum shoening are posterior dislocation of hip and fracture shaft femurQ\n\nSo the answer to this question is A"}
{"instruction": "Abbey Estlander flap is based on:\nA. Lingual artery\nB. Facial artery\nC. Labial artery\nD. Internal maxillary artery", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Carcinoma cervix presents with\nA. Postcoital bleed\nB. Abnormal vaginal bleed\nC. Purulent discharge per vaginum\nD. All of the above", "response": "Carcinoma cervix has a bimodal peak one at 30-35 yrs and a second peak at 50-55 yrs. Presentation is typically abnormal vaginal bleeding --- in reproductive age group with metrorrhagia and in postmenopausal women with postmenopausal bleeding. There can be a cervical growth which can lead to postcoital bleeding. If it undergoes necrosis then there can be purulent discharge per vaginum. Sometimes cancer cervix can present with VVF and with also with features of uraemia.\n\nSo the answer to this question is D"}
{"instruction": "Substance that is completely reabsorbed from the PCT -\nA. Na+\nB. K+\nC. Urea\nD. Glucose", "response": "Ans. is 'd' i.e, Glucose Important educational points* 60-70% of glomerular filtrate is reabsorbed in proximal tubule.* Na+ reabsorption occurs in all segments of nephron excepting descending limb of loop of Henle. 60% (60-70%) of filtered Na+ is reabsorbed in proximal tubule. About 30% of filtered Na+ is reabsorbed in thick ascending limb of loop of Henle. About 7% of filtered Na+ is reabsorbed in early distal tubules and about 3% of filtered sodium is reabsorbed in late distal tubule and collecting duct.* About 65% (60-70%) of water is reabsorbed in the proximal tubule and about 15% of water is reabsorbed in the thin descending limb. Remaining 20% of water enters the distal tubules and is absorbed from distal tubule and collecting duct according to the homeostatic requirements of the body, under the control of ADH.* All substances (Na+, K+, HCO3, Cl -, Phosphate, Protein, Glucose, water) are maximally absorbed in proximal tubule.* Glucose and amino acids are completely absorbed from proximal tubules along with Na+ as secondary active transport contransport (symport).* H+ is not absorbed by nephrons anywhere it is only secreted (in proximal tubule, late distal tubule and cortical collecting tubules).* Substances which are both secreted and reabsorbed are K+, uric acid and creatinine.* On a normal diet maximum solutes are reabsorbed almost completely : Glucose : 100%, Aminoacids 100%, HCO3-: 100%, Water : 99.4%, Na+: 99.4%, Cl-: 99.2%, Uric acid: 98%, K+ : 93.3%, Urea: 53%, and Total solutes : 98.9%* Amount secreted per day of different filtered contents are : Na+ : 150 mEq/d, K+ : 90 mEq/d, Cl : 150 mEq/d, Glucose : 0, Amino acid : 0, HCO3 : 0, Uric acid: 5 mmol/d, Creatinine: 12 mmol/d, Urea: 410 mmol/d, Water: 1-1.5 L/d; and total solutes : 700 mOsm/d.\n\nSo the answer to this question is D"}
{"instruction": "Cystoscopes and bronchoscopes are sterilized by\nA. Orthophthaldehyde\nB. Glutaraldehyde\nC. Formaldehyde\nD. Isopropylalchol", "response": "Both orthophthaldehyde and Glutaraldehyde are used\nBut Orthophthaldehyde > Glutaraldehyde.\n\nSo the answer to this question is A"}
{"instruction": "Hypehermia\nA. Temperature > 41.5\nB. > 40 with autonomic dysfunctuion\nC. >37.5-38.3 degC\nD. 36.5-37.5 degC", "response": "Hypehermia is elevated body temperature due to failed thermoregulation that occurs when a body produces or absorbs more heat than it dissipates. Extreme temperature elevation then becomes a medical emergency requiring immediate treatment to prevent disability or death.Hypothermia<35.0 degC (95.0 degF)Normal36.5-37.5 degC (97.7-99.5 degF)Fever>37.5-38.3 degC (99.5-100.9 degF)Hypehermia>37.5-38.3 degC (99.5-100.9 degF)Hyperpyrexia>40.0-41.5 degC (104-106.7 degF)Ref: Ganong&;s review of medical physiology-24th edition; page no-317\n\nSo the answer to this question is C"}
{"instruction": "Cilastatin is given in combination with Imipenem because:-\nA. Cilastatin prevents degradation of Imipenem in kidney\nB. Cilastatin increase absorption of Imipenem\nC. Inhibits the enzymes that digest Imipenem in stomach\nD. Reduces side effects of Imipenem", "response": "Carbapenems are synthetic Beta lactam antibiotic. Imipenem is compounded with cilastatin to protect it from metabolism by renal dehydropeptidase. Cilastatin is a dehydropeptidase inhibitor. High level of imipenem may provoke seizure, however other carbapenem like:- Meropenem Eapenem Doripenem Are less likely to do\n\nSo the answer to this question is A"}
{"instruction": "Amphibolic cycle is ?\nA. Citric acid cycle\nB. Glycolysis\nC. Protein synthesis\nD. Lipolysis", "response": "Ans. is 'a' i.e., Citric acid cycleMetabolic pathways fall into three categories :?Anabolic pathways:- Involved in synthesis of larger and more complex compounds from smaller precursors, e.g. synthesis of protein from amino acids, triglyceride synthesis, cholesterol synthesis, etc.Catabolic pathway:- Involved in the breakdown of larger molecules, commonly involving oxidative reaction. They are exothermic reactions producing reducing equivalents and mainly the ETC, ATP. Example are glycolysis, 13-oxidation of fatty acid etc.Amphibolic pathway:- occur at the \"crossroads\" of metabolism, acting as links between the anabolic and catabolic pathways, eg. the citric acid cycle.\n\nSo the answer to this question is A"}
{"instruction": "Hyperuricemia is seen with\nA. Acetazolamide\nB. Chlorthiazide\nC. Mannitol\nD. Triamterene", "response": "Chlorthiazide is a thiazide diuretic which can lead to hyper uricema, as Thiazide diuretics competitively inhibit excretion of uric acid.\n\nSo the answer to this question is B"}
{"instruction": "Grey Turner's sign (flank discoloration) is seen in\nA. Acute pylonephritis\nB. Acute cholecystisis\nC. Acute pancreatitis\nD. Acute peritonitis", "response": "Sign seen due to enzyme seep across etroperitoneum causing hemorrhagic spots and ecchymosis in the flanks SRB,5th,683.\n\nSo the answer to this question is C"}
{"instruction": "Burkitt's lymphoma is associated with which of the following gene anomaly -\nA. t (9:22)\nB. del. 5q\nC. t (8:14)\nD. t (17:15)", "response": "Ans. is 'C' i.e., t(8:14) o t(8:14) is the most common translocation seen in association with Burkitt's Lymphoma. # Demonstration of very high proliferative fraction and the presence of the t (8:14) or one of its variants t (2:8) or t(8:22) can be confirmatory of Burkiti s lymphoma/leukemia Translocation in Burkitt's Lymphoma Burkitts lymphoma/leukemias are associated with reciprocal translocations involving the c-myc gene on chromosome 8 | | | Most common translocation (70%cases) Less common translocations t (8:14): c- may gene on chromosome 8 and lgH heavy chain on chromosome 14 t (8 : 22) c- myc gene on chromosome 8 and l-light chain on chromossome 22 t (2 :8): c- mye gene on chromosome 8 and k-light chain on chromosome -2\n\nSo the answer to this question is C"}
{"instruction": "Rough and Irregular surface produced on the impression is because of?\nA. Improper application of pressure during impression making\nB. Air incorporated during mixing\nC. Too rapid polymerization\nD. Presence of moisture in impression area", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Respiratory depression is caused by NE\nA. Opium\nB. Barbiturate\nC. Strychnine\nD. Gelsemine", "response": "C i.e. Strychnine Strychnine is a CNS and respiratory stimulantQ. Alcohol, barbiturates, opioidsQ, benzodiazepines, chloral hydrate, paraldehyde, mandrax (melsedine), heroin (brown sugar), general anesthetics, sedative & hypnotics are CNS depressants. (However few may initially stimulate CNS). Hallucinogens (LSD = peyote = mescaline = phencyclidine), ecstasy, khat (catha edulis), cocaine and amphetamine are CNS stimulants (psychotropics).\n\nSo the answer to this question is C"}
{"instruction": "Which of the following sources of cholesterol is most impoant for sustaining adrenal steroidogenesis when it occurs at a high rate for a long time\nA. De novo synthesis of cholesterol from acetate\nB. Cholesterol in LDL paicles\nC. Cholesterol in the plasma membrane\nD. Cholesterol in lipid droplets within adrenal coical cells", "response": "Cholesterol esters in LDL are the most impoant source of cholesterol for sustaining adrenal steroidogenesis when it occurs at a high rate over a long time. This cholesterol can be used directly after release from LDL and not stored. De novo synthesis of cholesterol from acetate is a minor source of cholesterol in humans.Ref: Harper&;s Biochemistry; 30th edition\n\nSo the answer to this question is B"}
{"instruction": "Comprehension in intact with aphasia in\nA. Wernicke's\nB. Broca's\nC. Global aphasia\nD. Transcoical sensory", "response": "Ans. is 'b' i.e., Broca's\n\nSo the answer to this question is B"}
{"instruction": "Technique of Cu-T inseion: March 2010\nA. Surgery under local anaesthesia\nB. Surgery under general anaesthesia\nC. Pushing\nD. Laparotomy", "response": "Ans. C: Pushing A thorough inspection of the pelvis is a must before IUCD inseion. The device is mounted on the introducer and stop is adjusted according to the length of uterine cavity. Introducer is pushed through the cervix and the plunger is pressed home.\n\nSo the answer to this question is C"}
{"instruction": "Calcium channel blockers are used in all, except-\nA. Angina\nB. Supraventricular tachycardia\nC. Sick sinus syndrome\nD. Hypertension", "response": "Ans. is 'c' i.e., Sick sinus syndrome The electrophysiological properties of Verapamil enables it be used as an antiarrhythmic.Electrophysiological effects of verapamilo The basic action of verapamil is to depress Ca2+ mediated depolarization. This result in following actions -Decrease S.A. node automaticityDecrease ventricular automaticityIncrease A. V nodal ERP (This is the most consistent action of Verapamil and due to this A-V conduction is markedly slowed however intraventricular conduction is not slowed).Use of Verapamil as an antiarrhythmic -1.PSVT-It is effective in 80% casesIt should not be used if PSVT is accompanied with hypotension or CHF.2.To control ventricular rate in Atrial flutter or Atrial fibrillation (May be used as an alternative to or in addition to Digitalis).Verapamil is contraindicated in following arrhythmias-1 Ventricular arrhythmias - Injection of verapamil has precipitated ventricular fibrillation, therefore contraindicated.2 Digitalis toxicity - Verapamil is contraindicated in Digitalis toxicity because additive A-V block may occur.3.Heart block and sick sinus.Other uses of verapamil:Angina pectoris- All CCB's are effective in reducing frequency and severity of classical as well as variant angina.It is beneficial in angina in the following wayClassical angina - Reduces cardiac work, mainly as a result of reduced afterload.Variant angina - Prevent arterial spasm.HypertensionHypertrophic cardiomyopathySuppress nocturnal leg crampsMigraine\n\nSo the answer to this question is C"}
{"instruction": "True statement regarding fracture base of the skull are all of the following except: March 2008\nA. Prophylactic antibiotics are usually not required\nB. Associated with 8 cranial nerve palsy\nC. Early surgery is indicated for optimal outcome\nD. May present with CSF otorrhoea", "response": "Ans. C: Early surgery is indicated for optimal outcome\n\nSo the answer to this question is C"}
{"instruction": "Which one of the following is not an adverse effect of ACE inhibitors ?\nA. Cough\nB. Hypokalemia\nC. Angioneurotic edema\nD. Skin rash", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A patient has IDDM diagnosed at age of 15 years. The most reliable indicator for diabetic nephropathy is -\nA. Urine albumin <50 mg per day in 3 consecutive samples\nB. Urinary protein >550 mg per day for 3 consecutive samples\nC. Development of diabetic retinopathy\nD. Hematuria", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A female child has recently learned to eat with spoon without spilling; to dress and undress herself with supervision and to understand that she is a girl. These skills are FIRST mastered between the ages: September 2012\nA. 2 and 3 years\nB. 3 and 4 years\nC. 4 and 5 years\nD. 5 and 6 years", "response": "Ans. A i.e. 2 and 3 years Impoant milestones Copies circle: 3 years Crawls: 11 months Child smiles at familiar persons: 2 months Head control: 3 month Sits with own suppo/ tripod fashion: 6 months Sits without suppo: 8 months Transfer object from one hand to other: 6 months Says mama dada: 10 months Self decisions: 7 years Walks alone: 13-14 months Knows age & sex: 3 years Can draw a rectangle: 4 years Can draw a triangle: 5 years\n\nSo the answer to this question is A"}
{"instruction": "Oncocytes are found in all except -\nA. Thyroid\nB. Panereus\nC. Pituitary\nD. Pineal", "response": "Ans. is 'd' i.e., Pineal Oncocytes are present in the acini and ducts of normal salivary gland.o They are also present in some benign tumors of salivary glands, thyroid, parathyroid, kidney, lung and pituitary -\n\nSo the answer to this question is D"}
{"instruction": "Which one of the following is not a treatment of gastroesophageal variceal hemorrhage\nA. Sclerotherapy\nB. Sengstaken tube\nC. Transjugular intra hepatic poocaval shunt\nD. Gastric freezing", "response": "Treatment consists of beta blockers Treatments include beta blockers, medical procedures to stop bleeding, and in rare cases, liver transplant. Medications-Beta blocker, Synthetic hormones, Antibiotics, and Blood transfusion Medical procedure-Nasogastric intubation, Rubber band ligation, Therapeutic endoscopy, Sclerotherapy, Transjugular intrahepatic poosystemic shunt, and Balloon tamponade Suppoive care-IV fluids Ref: Sabiston 20th edition Pgno : 1444\n\nSo the answer to this question is D"}
{"instruction": "Manganese deficiency leads to?\nA. Parkinsonism\nB. Impaired skeletal growth\nC. Impaired glucose tolerance\nD. Anaemia", "response": "Ans. (b) Impaired skeletal growthRef: Harrison /96e-9* Manganese deficiency leads to impaired growth and skeletal development whereas toxicity leads to parkinsonism like features. Impaired glucose tolerance is seen with chromium deficiency.Deficiencies and Toxicides of MetalsElementDeficiencyToxicityManganeseImpaired growth and skeletal development, reproduction, lipid and carbohydrate metabolism; upper body rashParkinsonism like symptomsEncephalitis-like syndromeCalciumReduced bone mass, osteoporosisRenal insufficiency (milk-alkali syndrome), nephrolithiasisCopperAnemia, growth retardation, defective keratinisation and pigmentation of hair, degenerative changes in aortic elastin, osteopeniaVomiting, diarrhea, hepatic failure, tremor, mental deterioration, haemolytic anemia, renal dysfunctionChromiumImpaired glucose toleranceOccupational: Renal failure, dermatitis,FluorideT Dental cariesDental and skeletal fluorosis, osteosclerosisIodineThyroid enlargement, nF T4, cretinismThyroid dysfunction, acne-like eruptionsSeleniumCardiomyopathy, heart failure, striated muscle degenerationAlopecia, nausea, vomiting, abnormal nails, emotional lability, peripheral neuropathy, lassitude, garlic odor to breath, dermatitisOccupational: Lung and nasal carcinomasZincGrowth retardation, >1 taste and smell, alopecia, dermatitis, diarrhea, immune dysfunction, failure to thrive, congenital malformationsReduced copper absorption, gastritis, sweating, fever, nausea, vomiting\n\nSo the answer to this question is B"}
{"instruction": "Which are the cells of olfactory bulb that act as local integrator?\nA. Sustentacular cells\nB. Hair cells\nC. Granular cells\nD. Mitral cells", "response": "Ans. is 'd' i.e., Mitral cellsIn olfactory bulb axons of olfactory nerve synapse with dendrites of mitral cells to form the olfactory glomeruli.Mitral cells are the principal output neurons of olfactory bulb anil their axons form the olfactory tract\n\nSo the answer to this question is D"}
{"instruction": "In trauma patient safe airway maneuver is:\nA. Chin lift.\nB. Head tilt.\nC. Jaw thrust\nD. Both A& C", "response": "Chin lift and jaw thrust don't lead to neck movement hence safe in trauma patient.\nAmong both the process jaw thrust is safest.\n\nSo the answer to this question is D"}
{"instruction": "Not true about first referral unit\nA. Covers 1 lakh population\nB. Has 30 beds\nC. Provides secondary care\nD. Community health officer is medical graduate or post graduate", "response": "Use of Shakir's tape for meassuring arm\nCircumference\nEquitable distribution\nIntersectoral co-ordination\nCommunity participation\nAppropriate technology\n\nSo the answer to this question is D"}
{"instruction": "A poison which is luminescent and waxy and have a garlic smell: Al 11\nA. Alphos\nB. Ammonium bromide\nC. Opium\nD. Yellow phosphorous", "response": "Ans. Yellow phosphorous\n\nSo the answer to this question is D"}
{"instruction": "Reactivation of TB is almost exclusively a disease of-\nA. Bone\nB. Lymph nodes\nC. Lung\nD. Brain", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "An 8-year old child was brought to you for a high grade fever of 3 days duration with vomiting headache and decreased responsiveness. Examination revealed a distressed child , in shock with maculopapular and ecchymotic rashes on the skin with bleeding from venepuncture sites and hepatomegly. Investigation showed PCV = 65%, WBC 4000, platelet 25000 & mildly prolonged PT. CXR revealing left sided pleural effusion. Diagnosis is ?\nA. Meningococcemia with DIC\nB. Dengue heamorrhagic fever\nC. Leptosporisis\nD. Complicated malaria", "response": "Generalized body aches, high grade fever followed by clinical deterioration and bleeding diathesis with raised hematocrit (65%) and low platelet and leucopenia strongly suggest dengue haemorrhagic fever, although meningococcemia is always a close diagnosis and many times requires serological confirmation. Complicated malaria usually has anemia and splenomegaly Leptospirosis may occur in icteric as well as nonicteric form. In nonicteric form shock and skin rashes are uncommon. Prominent features are severe myalgias and exquisite tenderness.\n\nSo the answer to this question is B"}
{"instruction": "In patient of head injuries with rapidly increasing intracranial tension without hematoma, the drug of choice for initial management would be\nA. Lasix\nB. Steroids\nC. 20% Mannitol\nD. Glycine", "response": "Mannitol Mannitol is widely used to reduce ICP Commonly used preparation : 20% solution, 0.25-1 gm/kg is given IV as bolus Serum osmolality should not be allowed to go >320 mOsm/L, to avoid systemic acidosis and renal failure. Uses of mannitol To reduce increased ICT or intra ocular tension To maintain GFR and urine flow in impending renal failure Forced diuresis in hypnotic or other poisoning To counteract low osmolality of plasma/ECF due to rapid hemolysis or peritoneal dialysis Contraindications of Mannitol Acute Tubular Necrosis Anuria Pulmonary edema Acute left ventricular failure CHF Cerebral hemorrhage Ref :Harrison's 19th edition Pgno :1779-1780\n\nSo the answer to this question is C"}
{"instruction": "Minimum antenatal visit as per MCH is ?\nA. 1\nB. 2\nC. 3\nD. 4", "response": "Ans. is 'd' i.e., 4\n\nSo the answer to this question is D"}
{"instruction": "Two antihistaminics terfenadine and astemizole were withdrawn from the market following the occurrence of cardiac arrhythmias when they were present in high levels in the blood. These effects were explained by the fact :\nA. Use of these drugs by addicts\nB. Genetic predisposition to metabolize succinylcholine slowly\nC. Concurrent treatment with phenobarbital\nD. Treatment of these patients with erythromycin, a macrolide antibiotic", "response": "Astemizole and terfenadine are metabolized by microsomal enzymes. Erythromycin inhibits these enzymes and raises the plasma concentration of these drugs. At high levels, these agents block cardiac K+ channels leading to arrhythmias.\n\nSo the answer to this question is D"}
{"instruction": "Chromosome for ABO gene is?\nA. 9q\nB. 10p\nC. 11q\nD. 12p", "response": "Ans is 'a' i.e. 9q * The ABO gene (Histo-blood group ABO system transferase enzyme) resides on chromosome 9 at the band 9q34.2.Also know* Gene for Rh antigen is located on Chromosome-1\n\nSo the answer to this question is A"}
{"instruction": "In the international death certificate, one of the following is not true\nA. Part I of of the certificate deals with the immediate cause and also the underlying cause\nB. Part I of the certificate deals with the immediate cause only\nC. Part II records significantly associated diseases\nD. The certificate has been recommended by the WHO for international use", "response": "International Death Certificate:\n\nRecommended by WHO for international use.\n2 parts:\nPART 1: deals with immediate cause, and the underlying cause which started the whole trend of events leading to death. The underlying cause of death is recorded on line (c).\nPART 2: any significant associated diseases that contributed to the death but did not directly lead to it.\n\nSo the answer to this question is B"}
{"instruction": "Definitive treatment of choice for Transposition of great vessels (TGA) is\nA. Atrial switch\nB. Aerial switch\nC. Atrial septostomy\nD. Medical management", "response": "The aerial switch operation is now established as the treatment of choice for TGA and most centers endeavour to offer this procedure for all infants with TGA. In this operation, the pulmonary aery and aoa are transected. The distal aoa is anastomosed to the proximal pulmonary stump (neo-aoic root) and the pulmonary aery to the proximal aoic stump (neopulmonary aery). The coronary aeries are moved along to the neo-aoic root along with a cuff of aoic tissue to allow suturing without compromise of coronary blood flow. There is a limited window of time for performing the aerial switch for TGA. Infants with TGA and intact septum should ideally undergo this procedure within the first 2-4 weeks of life. As pulmonary vascular resistance falls after bih the left ventricle regresses rapidly. In 1-2 months the left ventricle has the ability to adjust to the elevated systemic vascular resistance after the aerial switch through hyperplasia of the available muscle. After this, it is difficult for the left ventricle to adapt to an aerial switch. Later in infancy, the atrial switch operation (Senning operation) is the only option for TGA with intact ventricular septum. This is not an ideal long-term option because the right ventricle remains as the systemic ventricle for life. Over time, right ventricle dysfunction and severe tricuspid regurgitation sets in. Additionally, extensive restructuring of atria predisposes to atrial rhythm disturbances. Reference: Essential Paediatrics; O.P. Ghai; Page no: 426\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is true about Riedel's thyroiditis -\nA. Fibrosis involves the thyroid and surrounding neck structures\nB. Patient presents with hard fixed thyroid mass\nC. It may be associated with retroperitoneal fibrosis\nD. All the above", "response": "Ans. is 'd' i.e. All the above Riedel thyroiditiso A rare disorder characterized by extensive fibrosis involving the thyroid and contiguous neck structures,o The presence of a hard and fixed thyroid mass clinically simulates a thyroid carcinoma.o It may be associated with fibrosis in other sites in the body, such as the retroperitoneum, and appears to be another manifestation of a systemic autoimmune IgG4-related disease, which is associated with fibrosis and tissue infiltration by plasma cells producing IgG4.\n\nSo the answer to this question is D"}
{"instruction": "Transitional epithelium is seen in\nA. Esophagus\nB. Vagina\nC. Urinary bladder\nD. Trachea", "response": "INDERBIR SINGH&;S TEXTBOOK OF HUMAN HISTOLOGY-PAGE NO:320\n\nSo the answer to this question is C"}
{"instruction": "The ability to detect two points simultaneously applied to the skin is based on which physiologic mechanism?\nA. Presynaptic inhibition\nB. Feed-back inhibition\nC. Feed-forward inhibition\nD. Lateral inhibition", "response": "Lateral inhibition is the basis of ability to detect two points simultaneously applied to the skin. Every sensory pathway, when excited, gives rise simultaneously to lateral inhibitory signals; these inhibitory signals spread to the sides of the excitatory signal and inhibit adjacent neurons. Presynaptic inhibition: decrease release of excitatory neurotransmitter. Endogenous analgesia system Feed-forward inhibition: when excitatory neurons exciteinhibitorycells, which theninhibit a group of postsynaptic excitatory neurons. Seen in cerebellum (Cerebellar learning) Recurrent/Renshaw cell inhibition: Sho inhibitory interneuron Collaterals excites renshaw cell which in turn inhibits the same neuron Purpose: delays muscle fatigue, sharpens the signal to muscle\n\nSo the answer to this question is D"}
{"instruction": "Material used in verterbroplasty is :\nA. Isomethyl methacrylate\nB. Isoethyl methacrylate\nC. Polyethyl methacrylate\nD. Polymethyl methacrylate", "response": "Ans. is 'd' i.e. Polymethyl methacrylate Vertebroplasty and kyphoplasty are interventional radiologic procedures for the treatment of the intense pain refractory to medical management or bracing caused by vertebral compression fracture associated with osteoporosis, tumors, and trauma.Vertebroplasty and kyphoplasty involve intraosseous injection of acrylic cement- polymethyl methacrylate under local anesthesia and fluoroscopic guidance.Pain reduction or elimination is immediate, and the risk of complications is low. Neither vertebroplasty nor kyphoplasty are intended for the treatment of intervertebral disc disease or arthritis.Vertebroplasty may also be applied prophylactically to an at-risk vertebra between 2 other abnormal vertebrae.Vertebroplasty does not restore the height of the compressed vertebral body. A related procedure, kyphoplasty, is intended to restore lost height by inflating a balloon pump within and between the fracture fragments prior to the infusion of the cement. Both procedures result in similar relief of pain due to vertebral compression fractures.The risks of the procedure are low and include extravasation of cement into the epidural space causing myelopathy, or fatal pulmonary embolism from extension of cement into paraspinous veins.\n\nSo the answer to this question is D"}
{"instruction": "NARP syndrome is a pa of which of the following group of disorders?\nA. Mitochondrial diseases\nB. Glycogen storage diseases\nC. Lysosomal storage diseases\nD. Lipid storage diseases", "response": "NARP syndrome Neuropathy, ataxia, and retinitis pigmentosa Related to changes in mitochondrial DNA. Mutations in the MT-ATP6 gene cause NARP syndrome. This gene is located within mitochondrial DNA (mtDNA).\n\nSo the answer to this question is A"}
{"instruction": "Periaicular calcification is seen in -\nA. RA\nB. Pseudogout\nC. OA\nD. None of the above", "response": "Ans. is 'b' i.e., Pseudogout Periaicular soft tissue calcification Haematoma Crystal ahropathy (Gout, Pseudogout) Dermatomyositis Tumoral calcinosis Myositis ossificans Scleroderma Synol osteochondromatosis Synol sarcoma\n\nSo the answer to this question is B"}
{"instruction": "The preferred drug for controlling an acute exacerbation of ulcerative colitis is:\nA. Prednisolone\nB. Sulfasalazine\nC. Mesalazine\nD. Vancomycin", "response": "- Coicosteroids are the mainstay of treatment of acute exacerbation of ulcerative colitis. - so, among the given options prednisolone is best to be used in controlling acute exacerbation of ulcerative colitis\n\nSo the answer to this question is A"}
{"instruction": "Maximum damage to pulp occurs during:\nA. Intrusion\nB. Avulsion\nC. Both\nD. None", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "LRS Institute of Tuberculosis and respiratory diseases is located at-\nA. Chennai\nB. Bangalore\nC. Delhi\nD. Chengalpettu", "response": "Tuberculosis Research Centre is located in Chennai. National Tuberculosis institute is in Bangalore.\n\nSo the answer to this question is C"}
{"instruction": "A set of statements for monitoring progress towards goal completion is referred to as:\nA. Targets\nB. Objective\nC. Programme\nD. Procedure", "response": "Programme\n\nSo the answer to this question is C"}
{"instruction": "Asymptomatic carriage of gonococcal infection in female is commonly seen in:\nA. Endocervix\nB. Vagina\nC. Urethra\nD. Fornix", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Antirheumatoid drug has specific act on the T-cell is\nA. Etanercept\nB. Infliximab\nC. Rituximab\nD. Abatacept", "response": "(Abatacept) (514-Lippincott's pharmacology 4th)Abatacept is a costimulation -modulator that inhibits the activation of T-cells (629- Katzung 11th)* ABATACEPT - T. lymphocytes needs two interactions to become activated (1) The antigen- presenting cells (i.e. Macrophages or B cells) must interact with the receptor on the T cell (2) The CD80/CD86 protein on the antigen presenting cell must interact with the C.D 28 protein on the T.cell. the result activated T. lymphocytes responsible for the release of pro inflammatory cytokines and maintenance of inflammation in RAAbatacept is a soluble recombinant fusion protein made up of the extracellular domain of human CTLAA and it competes with CD28 for binding on CD80/ CD86 protein thereby preventing full T-cell activationUses- in moderate to severe RA who had an inadquate respose to DMARDs such as mothotrexate or TNa inhibitors* RITUXIMAB - B- lymphocyte are derived from the bone marrow and are necessary for efficient immune response however in RA, B-cell can perpetuate the inflammatory process in the synovium by1. activating T-lymphocytes 2. producing autoantibodies such as anti CCP (anti-cyclic citrullinated peptide antibody) and rheumatoid factor and3. producing pro-inflammatory cytokines such as TNF a and IL-1Rituximab is a genetically engineered chimeric murine (human monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B.lymphocytes resulting in B.cell depletionRituximab has been shown to reduce joint erosion and joint space narrowing in these patientsRituximab is a chimeric monoclonal antibody that targets CD20-B lymphocytes (632-Katzung 11th)Etanercept. Infliximab - TNFa- inhibitorsLEFLUMQMIDE - Immunomodulatory agent* Leflunomide is rapidly converted in tfye body to an active metabolite which inhibits dihydroarotate dehydrogenase and pyrimidine synthesis in actively dividing cells. Antibody production by B. cell may be depressed (204-KDP 6th)* Teratogenic in experimental animals and therefore is contraindicated in pregnancy and in women of child bearing potentialLeflunomide inhibits - T-cell proliferatin and production of autoantibodies by B-cellsImportant Points* COX-2 inhibitors show similar analgesic and anti inflammatory activity compared to traditional NSAIDs. They do not affect platelets - Like NSAIDs. COX-2 inhibitors may cause the development of ARF due to renal vasoconstriction. COX-2 inhibitors have the potential for increasing the risk of myocardial infarction*** DMARDs - the effects may take 6 weeks to 6 months to become evident although some biologies are effective within 2 weeks; generally they are slow-acting compared with NSAIDS\n\nSo the answer to this question is D"}
{"instruction": "a 70 year old women refused to take influenza vaccine , dveloped flu. death happend 1 week after pneumonia.most common cause of post influenza pneumonia\nA. staphyloccocus aureus\nB. measles\nC. legionella\nD. cmv", "response": "m/c organism in post influenza decondary pneumonia is staph .auerus Staphylococcus aureus pneumonia * S. aureus is an impoant cause of secondary bacterial pneumonia in children and healthy adults after viral respiratory illnesses (e.g., measles in children and influenza in both children and adults). * Staphylococcal pneumonia is associated with a high incidence of complications, such as lung abscess and empyema. * Staphylococcal pneumonia occurring in association with right-sided staphylococcal endocarditis is a serious complication of intravenous drug abuse. ref : ananthanaryana 9th ed\n\nSo the answer to this question is A"}
{"instruction": "Target health indicators of 12th five year plan are all except -\nA. Reduce MMR to 100\nB. Reduce TFR to 2.1\nC. Reduce IMR to 20\nD. Reduce prevalence of leprosy to < 1/10000", "response": "Ans. is 'c' i.e., Reduce IMR to 20 The twelfth plan will work towards national health outcome goals with following target health indicators :?Reduction of infant moality rate to 25.Reduction of maternal moality rate to 100.Reduction of total feility rate to 2.1.Prevention and reduction of under-nutrition in children under 3 years to half of NFHS-3 (2005-06) level.Prevention and reduction of anaemia among women aged 15-19 years to 28%.Raising child sex ratio in 0-6 years age group from 914 to 950.Reduction of poor household's out-of-pocket expenditure.viii)Prevention and reduction of burden of communicable and non-communicable diseases and injuries.\n\nSo the answer to this question is C"}
{"instruction": "Judge can ask questions: Punjab 07\nA. During cross-examination\nB. Examination-in-Chief\nC. Any time during trial\nD. Re-examination", "response": "Ans. Any time during trial\n\nSo the answer to this question is C"}
{"instruction": "Krukenberg tumour is most commonly from:\nA. Lung\nB. Breast\nC. Stomach\nD. Colon", "response": "Ans: c (Stomach) Ref:Shaw, 13th ed, p. 401Krukenberg ovarian tumoursPrimary sites - Stomach (70%),Breast (6%),Colon (15%)Involvement of ovary by - Retrograde lymphaticsAlways bilateral with smooth surface.Maintaining the shape of ovaryNo tendency of adhesion (i.e. capsule remain intact).Histology: Signet ring cellsBRIDGE:signet ring cells are seen in Krukenberg tumour but sideroblasts are seen in v myelodysplatic syndrome.\n\nSo the answer to this question is C"}
{"instruction": "Post exposure prophylaxis is given in A/E\nA. Rabies\nB. Measles\nC. Pertusis\nD. Hepatitis B", "response": "Ans. is 'c' i.e., Pertussis Active immunoprophylaxis after exposure to disease is recommended for:RabiesTetanusHepatitisMeasles (within three days of exposure)*VaricellaMeasles vaccine can be given post exposure (within three days of exposure) because incubation period of measles is 7 days when the respiratory tract is bypassed (as with vaccine which is given subcutaneously) whereas normal incubation period is 10 days* from exposure to onset of fever (and 14 days to appearance of rash).\n\nSo the answer to this question is C"}
{"instruction": "Red degeneration in uterine fibroid is most common in-\nA. Second trimester\nB. Third trimester\nC. Puerperium\nD. First trimester", "response": "Ans. is 'a' i.e.. Second trimester\n\nSo the answer to this question is A"}
{"instruction": "Neurologic abnormalities have been noted in about one-third of patients with AIDS. Which of the following is NOT seen in HIV involvement of CNS?\nA. Perivascular giant cell\nB. Vacuolar degeneration of post column\nC. Microglial nodule formation\nD. Inclusion bodies", "response": "The main cell types that are infected in the brain in HIV infection are the perivascular macrophages and the microglial cells. A diffuse and multifocal rarefaction of the cerebral white matter accompanied by scanty perivascular infiltrates of lymphocytes and clusters of a few foamy macrophages, microglial nodules, and multinucleated giant cells. Vacuolar degeneration of posterior column is associated with the AIDS dementia complex. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 33. Viral Infections of the Nervous System, Chronic Meningitis, and Prion Diseases. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is used to differentiate race in seminal stains?\nA. Serum alkaline phosphatase\nB. MHS 5\nC. Peptidase A\nD. Choline", "response": "Enzyme Typing: Enzyme markers commonly used in genetic profiling of semen are phosphoglutamase (PGM) and peptidase (Pep A). Pep A is polymorphic in many racial groups and is commonly employed as a racial discriminator. PGM is polymorphic in all populations and can be subdivided into 10 distinct subgroups.\n\nSo the answer to this question is C"}
{"instruction": "Hyperophy is -\nA. Increase in cell number\nB. Increase in cell size\nC. Decrease in cell number\nD. Decrease in cell size", "response": "Ans. is 'c' i.e., Increase in cell size Hyperophy o Hyperophy refers to an increase in the size of cells without increase in the number, resulting in an increase in the size of tissue. o Hyperophy involves cell enlargement without cell division. o So, hyperophied organ has just larger cells, but no new cells (by contrast, in hyperplasia there is increase in number of new cells without increase in size). o Nuclei in hyperophied cells have a higher DNA content than in normal cells because the cells arrest in the cell cycle without undergoing mitosis. o Myocardium (hea muscle) and skeletal muscle undergo hyperophy. o The most common stimulus for hyperophy is increased workload. Mechanism of hyperophy o The increase in cell size is due to synthesis of more structural proteins. o The genes that are induced during hyperophy include those encoding transcription factors (C-fos, C-jun), growth factors (TGF-(3, TGF- 1, FGF); and vasoactive agents (a-agonists, endothelin-1, angiotensin II). o There may also be a switch of contractile proteins from adult to fetal or neonatal forms, e.g., during myocardial hyperophy, the a-myosin heavy chain is replaced by 13-form of the myosin heavy chain, which leads to decrease myosine ATPase activity and a slower, more energetically economical contraction. o In addition, some genes that are expressed only in embryonic life are re-expressed in hyperophied myocardium, e.g., in the embryonic hea, the gene for Atrial natriuratic peptide (ANP) is expressed in both atrium and ventricle. After bih, ventricular regulation of the gene is down regulated. Myocardial hyperophy is associated with reinduction of ANF gene expression. ANP induces salt excretion by kidney L blood volume & pressure, decrease work load. Why do these changes occur ? o As already explained, the most common stimulus for myocardial hyperophy is increased workload. o All the above morphological changes that occur in hyperophy either increase muscle activity (to handle the increased workload) or decrease the workload to hea.\n\nSo the answer to this question is C"}
{"instruction": "Periodic acid whiff stain shows block positiveity In -\nA. Myeloblasts\nB. Lymphoblasts\nC. Monoblasts\nD. Megakaryoblasts", "response": "Answer is option 2, lymphoblasts. Reevaluation of the periodic acid-Schiff stain in acute leukemia with immunophenotypic analyses. Snower DP1, Smith BR, Munz UJ, McPhedran P. Author information Abstract To determine the sensitivity and specificity of the periodic acid-Schiff (PAS) stain in the diagnosis of acute leukemia in light of the finer characterization of this disorder now available through immunophenotyping, we examined the blasts from 51 patients with newly diagnosed acute leukemia by morphological, cytochemical, and immunophenotypic analyses. The 51 patients represented every new case of acute leukemia subjected to cytochemical stains and flow cytometry between July 1987 and February 1989. By cell-surface marker analysis, 29 exhibited lymphocytic lineage, while 21 were myelocytic. One was mixed lineage. The PAS positivity, defined by the presence of blocks or coarse granules in 5% or more of the blasts, was found in 15 of 29 lymphoblastic leukemias and in four of the myeloblastic leukemias. However, PAS-positive lymphoblastic leukemias were negative with the other cytochemical stains: myeloperoxidase, Sudan black B, and alpha-naphthyl butyrate esterase. The PAS-positive myeloblastic leukemias were positive with at least one other stain. Three cases of myeloblastic leukemia exhibited greater than 10% PAS-positive blasts, with all three being acute monoblastic leukemia. Thus, the sensitivity and specificity of the PAS stain alone for lymphoblastic leukemia was 52% (15 true positives of 29) and 81% (four false positives), respectively.\n\nSo the answer to this question is B"}
{"instruction": "Professional disclosure is an offence in:\nA. India and Pakistan\nB. USSR\nC. China\nD. None of the above", "response": "Ans: a (India and Pakistan) Ref: Reddy, 27th ed, p. 28In India a doctor should not discuss the illness of the patient with others without the consent of the patient.It is called professional secrecy.Previlaged communication: These are exceptions to general rule of professional secrecy.In some conditions a doctor can disclose about the illness of patient without his/her consentExamplesA railway engine driver with colour blindness.A cook with infectious diseases like cholera\n\nSo the answer to this question is A"}
{"instruction": "True about aphthous ulcer -a) Viral predispositionb) Recurrent ulcerc) Deep ulcersd) Involves the mucosa of the hard palatee) Steroids given as treatment\nA. abe\nB. bcd\nC. cde\nD. acd", "response": "Aphthous ulcer (Canker sores) \n\nAphathous ulcers are small ulcer craters in the lining of mouth that are frequently painful and sensitive.\nExact etiology is not known; it may be autoimmune process, nutritional deficiency (vitamin B1„ folic acid, iron), viral or bacterial infection, food allergies or due to hormonal changes or stress.\nAphathous ulcers typically starts in childhood or adolescence.,\nCharacterized by recurrent, small, round or oval ulcers with circumscribed margins, erythematous haloes, and yellow or gray floor.\nThey resolved spontanously in third decade.\nThe lesiosn may be single or multiple and usually involve movable mucosa, i.e., inner surface of lips, buccal mucosa, tongue, floor of mouth and soft palate, while sparing mucosa of hard palate and gingivae.\n\nTreatment : - If lesions do not resolve spontaneously, topical steroid and cauterization of base with 10% silver nitrate can be tried. In severe cases tetracycline mouth rinse can be given. For pain lignocaine viscous may be used.\n\nSo the answer to this question is A"}
{"instruction": "Most cardiotoxic local anesthetic is:\nA. Bupivacaine\nB. Lignocaine\nC. Lidocaine\nD. Ropivacaine", "response": "Ref: L Mather LE, Chang DM. Cardiotoxicity with modem local anaesthetics: is there a safer choice ? Drugs. 2001;61(3):333-42. 2. Lied jam JJ. de la Coassay e JE, Bassoul B. Brugada J.Mechanisms of the cardiac toxicity of bupivacaine. Ann Fr Anesth Reanim. 1988; 7(3):204-10Explanation:Bupivacaine is the most cardiotoxic of all the local anaesthetics.Associated with sudden increase in the plasma concentration of bupivacaine.It involves both electrical and mechanical structures within the heart.The main site of action on cardiac conduction tissue is the Vmax of phase 0 of the action potential of fast-reacting structures tlNa current).Bupivacaine, like lidocaine and the other class I antiarrhythmic drugs, blocks the sodium channels, this block being more slowly reversible.The disturbance of sodium channels throughout the heart leads to a decreased conduction speed throughout the conduction system, thus explaining possible acute conduction disturbances originating below the bundle of His.The ventricular dysarrhythmias are due to a re-entry circuit secondary to a slowing in conduction speed.The sinus bradycardias and junctional disturbances seen in toxic accidents are probably due to an inhibition of the slow current of the atrial and atrio-ventricular nodes (Isi current!.Bupivacaine, at toxic levels, has a direct effect on contractility.The negative inotropic effects seem to be due to a fall in the intracytoplasmic calcium concentration on wrhich depends the excitation- contraction couple, as well as disturbed cellular energetic events dependent on the contraction.Bupivacaine is disproportionately more cardiotoxic than its shorter-acting counterparts like ropivacaine and levobupivacaine.While all local anaesthetics can cause direct negative inotropic effects, ropivacaine and levobupivacaine are less cardiotoxic than bupivacaine.\n\nSo the answer to this question is A"}
{"instruction": "In precocious females, menstruation occurs :\nA. After 13 years of age\nB. At 13 years of age\nC. Less than 10 years of age\nD. Below 12 years of age", "response": "Less than 10 years of age\n\nSo the answer to this question is C"}
{"instruction": "Which of the following acts as coenzyme, not as co-factor?\nA. Ascorbic acid\nB. Biotin\nC. Thiamine\nD. Folic acid", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Saw tooth retepegs are seen in\nA. Lichen planus\nB. Leukoplakia\nC. Pamphigus vulgaris\nD. Psoriasis", "response": "Histology of Lichen planus:\n\nSo the answer to this question is A"}
{"instruction": "30 years old primipara in labour with transverse He- Treatment of choice is:\nA. Internal cephalic version\nB. Emergency cesarean section\nC. Wait and watch\nD. External cephalic version", "response": "caesarian is the best option in most cases of transverse lie.It is also indicated when external version fails or is contraindicated.If the membranes are intact a low transverse incision is usually possible.There may be difficulty in delivery of the baby at caesarian section in cases done late in labour after the liqour has drained away (refer pgno:385 sheila textbook of obstetrics 2 nd edition)\n\nSo the answer to this question is B"}
{"instruction": "Cytokine that have pyrogenic activity is:\nA. IL-6\nB. IL-8\nC. TGF beta\nD. IL-3", "response": "Ref. Robbins Pathology. 9th edition. Page. 99\n \nEasy and a straight forward question.\nMost important interleukins are listed below\n\nSo the answer to this question is A"}
{"instruction": "Which of the following characterizes pathological jaundice?\nA. Jaundice on 3rd day\nB. Jaundice upto the trunk\nC. High colored urine\nD. Jaundice accompanied by yellow stools", "response": "c. High colored urine(Ref: Nelson's 20/e p 871-879, Ghai 8/e p 172-176)Pathological Jaundice:May appear in 1st 24 hoursMay stain palms and solesHigh coloured urine and clay colored stools may be presentMay persist beyond 3 weeks\n\nSo the answer to this question is C"}
{"instruction": "Macrophages are major source of?\nA. IL-1\nB. IL-5\nC. IL-7\nD. IFN- y", "response": "IL-1 REF: Jawett's microbiology, 24th edition chapter 8 Immunology Table 8-3 See APPENDIX-19 for list of \"CYTOKINES\"\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is an activator of LCAT\nA. Apo B 100\nB. Apo B 48\nC. Apo E\nD. Apo AI", "response": "Apo-Al \n\nApo A-I is an activator for lecithin : cholesterol acyl transferase (LCAT).\n\nSo the answer to this question is D"}
{"instruction": "Crucible indicated for casting base metal alloys is:\nA. Carbon crucible\nB. Clay crucible\nC. Quartz crucible\nD. High melting plastic crucible", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which of the following drug is most likely to precipitate angina:\nA. Diltiazem.\nB. Verapamil.\nC. Amlodipine.\nD. Nifedipine.", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "All of the following are true about apolipoprotein, EXCEPT:\nA. Apo A1 activates LCAT\nB. Apo CI activates lipoprotein lipase\nC. Apo CII activates lipoprotein lipase\nD. Apo CII inhibits lipoprotein lipase", "response": "Apo CII is not an inhibitor of lipoprotein lipase rather it is an activator of lipoprotein lipase. Apo AII and Apo CIII acts as an inhibitor of enzyme lipoprotein lipase.\n\nSo the answer to this question is D"}
{"instruction": "In Klinefelter syndrome, all are true except\nA. Negative feedback on FSH and LH are lost\nB. Decreased Androstenedione levels\nC. Hypoplastic male external genitalia\nD. Most common cause of primary testicular failure", "response": "In Klinefelter syndrome, since testosterone levels are decreased, negative feedback on FSH and LH is lost.\nIncreased FSH stimulates Leydig cells, thereby causing elevated levels of Androstenedione.\n\nSo the answer to this question is B"}
{"instruction": "What is the survival rate in patients with unresectable gallbladder carcinoma?\nA. 2-6 months\nB. 8-10 months\nC. 1 yr 8-10 months\nD. 12-24 months", "response": "Survival rate in patients with unresectable gall bladder carcinoma is 2 - 6 months and therefore operative exploration should be avoided in such patients. In such patients palliative therapy can be given. Narcotics can be given, percutaneous celiac ganglion block helps in reducing the need for narcotics. Chemical splanchnicectomy can be performed in patients with unresectable lesions found at the time of surgery.\n\nSo the answer to this question is A"}
{"instruction": "A man is given continuous testosterone.It would lead to:\nA. azoospermia\nB. increased sperm motility\nC. increased spermatogenesis\nD. increased gonadotrophins", "response": "azoospermia [Ref: Katzung Pharmacology 10/e p675; Guyton 11/e p1066; KDT 5/e p2911 \"Replacement therapy in men may cause acne, sleep apnea, erythrocytosis, gynecomastia, and azoospermia. Supraphysiologic doses of androgens produce azoospermia and decrease in testicular size, both of which may take months to recover after cessation of therapy.\"\n\nSo the answer to this question is A"}
{"instruction": "In sickle cell trait, number of bands found in Hb\nA. 2\nB. 1\nC. 4\nD. 5", "response": "Ans. is 'a' i.e., 2 In hemoglobin electrophoresis, various types of hemoglobin move at varying speed. In sickle cell trait (heterozygous state), there are two types of hemoglobin - HbS (40%) and HbA (60%). So, on electrophoresis two different bands are produced. In Homozygous state, almost all hemoglobin is HbS. So, single band is produced. Laboratory findings of sickle cell anemia Moderate to severe anaemia o Peripheral smear will show Sickle cells Howell - Jolly bodies because of autosplenectomy Target cells o A positive sickling test with a reducing substance like sodium metabisulfite.\n\nSo the answer to this question is A"}
{"instruction": "Tubulointerstitial disease are all except\nA. Hypokaelemic nephropathy\nB. Lupus nehpritis\nC. Hypercalcemic nephropathy\nD. Analgesic nephropathy", "response": "Refer Robbins 9/e pg 929 iety of renal lesions and clinical presentations. The clinical manifestations can include recurrent microscopic or gross hematuria, the nephritic syndrome, rapidly progressive glomerulonephritis, the nephrotic syndrome, acute and\n\nSo the answer to this question is B"}
{"instruction": "Length of naso lacrimal duct is:\nA. 10 mm\nB. 11 mm\nC. 12 mm\nD. 9 mm", "response": "Ans. 12 mm\n\nSo the answer to this question is C"}
{"instruction": "Eosinophilic abscess in lymph node is characteristically\nA. Kimura disease\nB. Hodgkins lymphoma\nC. Tuberculosis\nD. Sarcoidosis", "response": ".\n\nSo the answer to this question is A"}
{"instruction": "What is the action of anconeus?\nA. Primary elbow extensor\nB. Assists Extension of elbow\nC. Wrist extension\nD. Thumb Abduction", "response": "Ans. is 'b' i.e., Assists Extension of elbow Anconeus* Anconeus originates on the posterior surface of the lateral epicondyle of the humerus and inserts distally on the posterior surface of the ulna.* Anconeus is innervated by a branch of the radial nerve* Its role in elbow extension is trivial in humans. It assists in extension of the elbow, where the triceps brachii is the principal agonist, and supports the elbow in full extension.* It also prevents the elbow joint capsule being pinched in the olecranon fossa during extension of the elbow.\n\nSo the answer to this question is B"}
{"instruction": "The first test to become positive in patients with Hemochromatosis is:\nA. Increased Serum Iron\nB. Increased Serum Ferritin\nC. Increased Transferrin Saturation\nD. Increased Liver Enzymes", "response": "Answer is C (Increased Transferrin Saturation):Transferrin Saturation is the first blood test to become elevated in Hemochromatosis.The first biochemical manifestation of hemochromatosis is an increase of transferring saturation, which reflects an uncontrolled influx of iron into the blood stream .from enterocytes and macrophages.The serum transferrin saturation and serum ferritin levels are the two most impoant indicators of hemochromatosis and body iron stores.Elevation of transferrin levels precedes elevation offerritin levels.The first biochemical manifestation of hetnochromatosis is an increase in serum transferrin saturation.Serum iron concentration per se is not a good indicator for iron overload states like Hemochromatosis.Liver Enzymes may be normal or elevated depending on the extent of hepatocyte damage.They are usually normal or only mildly elevated in the early stages of hemochromatosis.Laboratory findings in HemochromatosisTransferrin saturation is the first blood test to become elevated in hemochromatosis homozygotesThe sensitivity of elevated transferring saturation to identify a patient with hemochromatosis is 94 to 98% and its specificity is 70 to 98%.Transferrin saturation is usually > 60% in symptomatic men and >50% in symptomatic womenUnboundSerumLiverDNA testing by polymerase chain reaction may he used to detect mutations of the HFE gene.\n\nSo the answer to this question is C"}
{"instruction": "A 26 year old female patient complains of tooth sensitivity while eating ice-cream. Intra-oral examination reveals Class V lesion with 23. She also gives a history of bruxism. Microfilled composite is most useful in this patient due to:\nA. Increased viscosity\nB. Low modulus of elasticity\nC. Low filler content\nD. None of the above", "response": "The low modulus of elasticity of microfilled composites allow them to flex with tooth and protect the bonding interface. This is most useful in bruxism, clenching and stressful occlusion where flexure forces are high.\nReference- Sturdevant 4th ed P:257\n\nSo the answer to this question is B"}
{"instruction": "The most important clinical fmding in a case of head injury is -\nA. Pupillary dilatation\nB. Level of consciousness\nC. Focal neurological deficit\nD. Fracture skull", "response": "Conscious level determined on Glasgow coma scale.\n\nSo the answer to this question is B"}
{"instruction": "Lalloo 50 yrs, a chronic smoker presents with a history of hemoptysis. He was having truncal obesity and hypertension. He had an elevated ACTH level which was not suppressible with high dose dexamethasone. What would be the most probable diagnosis -\nA. Bilateral adrenal hyperplasia\nB. Adrenal adenoma\nC. Pituitary tumor\nD. Ectopic ACTH producing lung cancer", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "In case of hepatic porphyria the safe anticonvulsant is\nA. Clonazepam\nB. Paraldehyde\nC. Phenytoin\nD. Carbamazepine", "response": "(A) Clonazepam > Seizures can be due to neurologic effects or to hyponatremia.> Treatment of seizures is difficult because virtually all antiseizure drugs (except bromides) may exacerbate> AIP (clonazepam may be safer than phenytoin or barbiturates).\n\nSo the answer to this question is A"}
{"instruction": "Function of hepatic stellate cells are\nA. Vitamin A storage\nB. Formation of sinusoids\nC. Increase blood perfusion\nD. Phagocytosis", "response": "The hepatic cells are of mesenchymal origin , found in space of Dessie. The stellate cells play a role in the storage and metabolism of vitamin A and are transform into collagen producing myofibroblast when there is inflammation and Fibrosis of liver. Refer 9/e p436\n\nSo the answer to this question is A"}
{"instruction": "Maximum fat is found in -\nA. Buffalo milk\nB. Goat milk\nC. Human milk\nD. Cow milk", "response": "Ans. is 'a' i.e., Buffalo milkNutritive value of milks compared (value per 100 grams) BuffaloCowGoatHumanFat(g)6[?]54[?]14[?]53[?]4Protein(g)4[?]33[?]23[?]31[?]1Lactose(g)5[?]14[?]44[?]67[?]4Calcium(mg)21012017028Iron(mg)0[?]20[?]20[?]3 Vitamin C(mg)1213Minerals(g)0[?]80[?]80[?]80[?]1Water(g)8108786[?]888Energy(kcal)117677265o Fat content of milt. Buffalo > Goat > Cow > Human.o Protein content of milk: Buffalo > Goat > Cow > Human,o Lactose content of milk: Human > Buffalo > Goat > Cow.o Energy> content of milk: Buffalo > Goat > Cow > Human.\n\nSo the answer to this question is A"}
{"instruction": "According to resistance apex locators, the resistance offered by periodontal ligament and oral mucous membrane is:\nA. 6.5 K ohms\nB. 5.5 K ohms\nC. 4.4 K ohms\nD. 3.5 K ohms", "response": "FIRST-GENERATION APEX LOCATORS (RESISTANCE APEX LOCATORS)\nThey are also known as resistance apex locators that measure opposition to the flow of direct current, that is, resistance. It is based on the principle that resistance offered by periodontal ligament and oral mucous membrane is the same, that is, 6.5 K ohms. Initially, Sono-Explorer was imported from Japan by Amadent, (Port Jefferson, New York) but nowadays, first-generation apex locators are off the practice. Blood, pus, chelating agents, irrigants, and other materials used within the canal can give false readings.\n\nSo the answer to this question is A"}
{"instruction": "Increased LAP score is seen in:\nA. Chronic myeloid leukemia\nB. Myelofibrosis\nC. PNH\nD. Megaloblastic anemia", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which one of the following characterizes a poal system of blood vessels?\nA. The absence of a capillary bed, thus shunting aerial blood directly to venules\nB. A capillary bed supplied and drained by a larger, non capillary vessel\nC. Two capillary beds connected by a larger blood vessel\nD. A continuous capillary bed that extends from one organ to another", "response": "A poal system of blood circulation is defined as two capillary beds that are joined by an aerial or venous blood vessel. An example is the poal vein connecting the mucosal capillaries of the small intestine to the sinusoids (i.e., capillaries) of the liver. While capillary beds may connect pas of an organ (e.g., adrenal coex, pancreatic islet), capillaries do not extend between organs. Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 10. Midgut and Hindgut. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy.\n\nSo the answer to this question is C"}
{"instruction": "Lesion in Wernicke's area results in:\nA. Global aphasia\nB. Non-fluent aphasia\nC. Conduction aphasia\nD. Failure of comprehension of spoken or written words", "response": "The two areas concerned with language and speech are: (i) Wernicke's area (the sensory area for speech) in the superior temporal lobe and (ii) Broca's area (the motor area for speech) in the inferior frontal lobe. Wernicke's area: After understanding and comprehension of the word, the impulses are sent, arcuate fasciculus, to the Broca's area. Lesion: Speech production is normal (since motor area that finally produces actual words is not damaged). However, patients talk excessively; what they say is full of jargon and neologisms that make little sense. Patient fails to comprehend the meaning of spoken or written words. This is called fluent aphasia.\n\nSo the answer to this question is D"}
{"instruction": "Parietal branch of middle meningeal artery, which is closely related to cerebrum, it's involvement results:\nA. Hemiplagia of contralateral side.\nB. Ipsilateral drafness.\nC. Contalateral deafness\nD. All of the above.", "response": "Middle meningeal artery enters the middle cranial fossa through the foramen spinosun. In middle cranial fossa, it has an extradural course and divides into anterior frontal branch and posterior parietal branch.\nThe frontal branch is closely related to the motor area of cerebral cortex. It is the commonest source of extradural hemorrhage, and results in hemiplegia of opposite side. The parietal branch is closely related to cerebrum and its involvement results in contralateral deafness.\n\nSo the answer to this question is C"}
{"instruction": "All are true about intermittent claudication except\nA. Most common in calf muscle\nB. Pain is positional\nC. Atherosclerosis is impoant predisposing factor\nD. relieved by rest", "response": " Intermittent claudication: Crampy pain in the muscles seen in limbs. Due to aerial occlusion, metabolites like lactic acid and substance P accumulate in the muscle and cause pain. Site of pain depends on site of aerial occlusion. Most common site is calf muscles. Pain in foot is due to block in lower tibial and plantar vessels. Pain in calf is due to block in femoropopliteal segment. Pain in thigh is due to block in superficial femoral aery. Pain in buttock is due to block in common iliac aery. Pain commonly develops when muscles are exercising and relieved on rest. Beta blockers may aggravate claudication. {Reference: SRB&;s manual of surgery, 5th edition , page no. 170}\n\nSo the answer to this question is B"}
{"instruction": "Oligohydramnios is seen in :\nA. Renal agenesis\nB. Oesophageal atresia\nC. Exomphalos\nD. Neural tube defect", "response": "Ans. is a i.e. Renal agenesis Oligohydramnios is a condition where liquor amnii is deficient (< 200 ml at term). Sonographically it is defined as : Absence of amniotic fluid pocket.deg Maximum veical diameter of amniotic fluid pocket less than 2 cm.deg Amniotic fluid index less than 5 cms.deg Causes of oligohydramnios : Mnemonic : Dil Mein Ppaar (read as pyaar) Dil - Drug( Prostaglandin Synthetase inhibitors and ACE inhibitors). IUGR Leaking of fluid following amniocentesis or chorionic villus sampling. Mein - Maternal conditions like hypeension and preeclampsia. Ppaar - Post term pregnancy - Premature rupture of membrane - Abruptio-chronic - Amnion Nodosum.deg - Renal anomalies of fetus(leading to decreased urine production) : Renal agenesisdeg Urethral obstruction (Posterior urethral valve) Prune Belly syndrome Bilateral Multicystic dysplastic kidneys. Also know : Non Renal Fetal anomalies leading to oligohydraminos : Triploidy Thyroid gland agenesis Congenital hea block Skeletal dysplasia Note : Most common complication of Oligohydramnios - Pulmonary hypoplasiadeg.\n\nSo the answer to this question is A"}
{"instruction": "The best prognosis in carcinoma stomach is with -\nA. Superficial spreading type\nB. Ulcerative type\nC. Linitis plastica type\nD. Polypoidal type", "response": "Gastric Carcinoma is classified on the basis of →\n1) Depth of invasion\n2) Growth pattern \n3) Histologic subtype\n\nThe depth of invasion -\n\nThe morphological feature having the greatest impact on clinical outcome ( prognosis) is the depth of invasion.\nOn the basis of the depth of invasion, stomach cancers are divided into -\n\nA. Early gastric carcinoma (superficial spreading type)\n\nLesions are confined to the mucosa and submucosa regardless of the presence or absence of perigastric lymph node metastasis.\nHas the best prognosis.\n\nB. Advanced gastric carcinoma\n\nA neoplasm that has extended below the submucosa into the muscular wall and spread more widely.\n\nGrowth pattern -\n\nBased on a growth pattern, gastric carcinoma is divided into:-\n\n\nExophytic → Protrusion of tumor mass into the lumen\nFlat or depressed → There is no obvious tumor mass within the mucosa\nExcavated (ulcerative) → Erosive crater is present in the wall of the stomach .\n\n\nAll the three types may be evident at early or advanced stage --> If evident at an advanced stage, prognosis is poor, and if evident at early stage prognosis is good.\nAn uncommon fourth type of growth pattern is:-\n\nD. Linitis plastica ( Scirrhous Ca) → Abroad region of the gastric wall or entire stomach is extensively infiltrated by malignancy, creating a rigid, thicked leather bottle stomach. It has the worst prognosis.\nHistologic subtypes -\n\nThe two most important histologic subtypes are\n\nA. Intestinal type → Composed of neoplastic intestinal glands resmbling those of colonic adenocarcinoma.\nB. Diffuse variant → Composed of gastric type of mucous cells, which generally do not form glands. The appearance of the cells is \"Signet ring\" appearance because the mucin in the cell pushes the nucleus to the periphery. It is seen more frequently with E-Cadherin mutation.\n\nSo the answer to this question is A"}
{"instruction": "On electromyography, all of the following features suggest denervation, EXCEPT:\nA. Less inseional activity is observed in denervated muscles\nB. Giant polyphasic potentials arise from motor units\nC. Presence of positive sharp waves\nD. Spontaneous firing of motor units", "response": "Inseional activity refers to the burst of action potentials that is usually observed when the EMG needle is inseed into the muscle. Increased inseional activity is observed in denervated muscles. Relaxed muscle normally is electrically silent except in the end plate region, but abnormal spontaneous activity occurs in denervation or inflammatory changes in affected muscle. Giant polyphasic potentials arise from motor units containing more than the usual number of muscle fibers that are spread out over a greatly enlarged territory within the muscle. Fibrillation potentials and positive sharp waves (which reflect muscle fiber irritability) and complex repetitive discharges are most often. Ref: Waxman S.G. (2010). Chapter 23. Electrodiagnostic Tests. In S.G. Waxman (Ed), Clinical Neuroanatomy, 26e.\n\nSo the answer to this question is A"}
{"instruction": "Prologed Post-op ileus is best treated by -\nA. Long tube insertion\nB. Calcium pentonthenate\nC. Laporotomy and exploration\nD. Peristaltic stimulants", "response": "Most patients develop a transient ileus after a major abdominal operation. Most of these cases resolve within 3 to 5 days.\nConditions like-extensive operative manipulation, major small bowel injury, heavy narcotic use, intraabdominal infection and pancreatitis - can prolong the ileus to 5 to 7 days. Ileus prolnged beyond this period is viewed with suspicion.\n\n\nManagement of post op. ileus\n\nThe essence of treatment is prevention, with the use of nasogastric suction and restriction of oral intake until bowel sounds and passage of flatus return.\nElectrolyte abnormality, if any is corrected.\nA battery of laboratory tests are conducted to look for primary cause, which if found is treated.\n\"If paralytic ileus is prolonged and threatens life, a laparotomy should be considered to exclude a hidden cause and facilitate bowel decompression\" - Bailey\n\nSo the answer to this question is C"}
{"instruction": "All are causes of dynamic intestinal obstruction except\nA. Gall stones\nB. Intussusception\nC. Mesentric vascular occlusion\nD. Bands", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Swollen neurons that contain numerous lysosomes filled with lipid are typical of\nA. Amyloidosis\nB. Huntington Disease\nC. Kuru\nD. Tay-Sachs Disease", "response": "Swollen neurons that exhibit marked vacuolization of the perikaryon and contain lysosomes filled with lipid are found in TaySachs disease but could occur in other lipid-storage diseases as well. The correct diagnosis can be established by biochemical analysis of the stored material or identification of intermediary metabolites and missing enzymes. The other diseases listed do not produce such neuronal changes. Ref - Harrison's internal medicine 20e pg 3007\n\nSo the answer to this question is D"}
{"instruction": "Hyperbaric Oxygen is not useful in\nA. CO poisining\nB. Veigo\nC. Gas gangrene\nD. compament syndrome", "response": "Hyperbaric oxygen is not useful in veigo.\n\nSo the answer to this question is B"}
{"instruction": "The following are DDT resistant except -\nA. Phlebotomus\nB. Culex fatigans\nC. Anopheles stephenci\nD. Musca domestica", "response": "Resistance to DDT has not been demonstrated in Phlebotomus. Organochloride resistance is divided into Resistance to DDT and analogues Resistance to HCH-Dieldrin group of insecticides Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 845\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is a risk factor for developing Type 1 Diabetes mellitus?\nA. Male Gender\nB. Old age\nC. Gestational diabetes\nD. HLA DR3", "response": "Ref: Nelson's Textbook of Pediatrics. 19th EditionExplanation:Pathophysiology and Risk factors for Type I Diabetes mellitusType l DM is the culmination of lymphocytic infiltration and destruction of insulin -secreting beta cells of the islets of Langerhans in the pancreas.As beta-cell mass declines, insulin secretion decreases until the available insulin no longer is adequate to maintain normal blood glucose levels.After 80-90% of the beta cells are destroyed, hyperglycemia develops and diabetes may be diagnosed.Autoimmunity - Major determinantViral infection may stimulate the production of antibodies against a viral protein that trigger an autoimmune response against antigenically similar beta cell molecules.Approx 85% of type 1 DM patients have circulating islet cell antibodies, and the majority also has detectable anti-insulin antibodies before receiving insulin therapy.The most commonly found islet cell antibodies are directed against glutamic acid decarboxylase (GAD). an enzyme found within pancreatic beta cells.The prevalence is increased in other autoimmune diseases, such as:Graves diseaseHashimoto thyroiditisAddison diseasePolymorphisms of the class II human leukocyte antigen (HIA) genes that encode DR and I)Q are the major genetic determinants.Approximately 95% of patients with type 1 DM have either HLA-DR3 or HLA-DR4.HLA-DQs are also considered specific markers of type 1 DM susceptibility.Some haplotypes (eg, HLA-DR2) confer strong protection against type 1 DMRisk Factors for Type 2 Diabetes MellitusFamily history of diabetes (i.e., parent or sibling with type 2 diabetes)Obesity (BMI >25 kg/m2)Physical inactivityRace/ethnicity (e.g.. African American. Latino, Native American. Asian American. Pacific Islander)Previously identified with IFG, IGT, or an A1C of 5.7-6.4%History of GDM or delivery of baby >4 kg (9 lb)Hypertension (blood pressure >140/90 mmHg)HDL cholesterol ievel <35 mg/dL {0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)Polycystic ovary syndrome or acanthosis nigricansHistory of cardiovascular disease\n\nSo the answer to this question is D"}
{"instruction": "0.1 to 0.2 mm nebular corneal opacity is treated by –\nA. Penetrating keratoplasty\nB. Lamellar keratoplasty\nC. Enucleation\nD. Evisceration", "response": "Central nebular opacity is treated by phototherapeutic keratectomy with an excimer laser (treatment of choice) or lamellar keratoplasty.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is not a feature of Sipple syndrome?\nA. Pheochromocytoma\nB. Medullary carcinoma thyroid\nC. Hyperthyroidism\nD. Hyperparathyroidism", "response": "Ans. is 'c' i.e., Hyperthyroidism Multiple endocrine neoplasia (MEN)1) MEN-1 (Wermer syndrome)# It involves primarily three glandsa) Parathyroid (parathyroid hyperplasia/adenoma): Most common manifestation.b) Pituitary: Prolactinoma is the most common type of pituitary tumor in MEN-I.c) Pancreas: There is let cell hyperplasia/adenoma.# Less common findings are pheochromocytoma, foregut carcinoid, lipomas and dermal angiofibroma.2) MEN-IIA (sipples syndrome)# It consists of medullary carcinoma thyroid, parathyroid hyperplasia/adenoma and pheochromocytoma of adrenal medulla.3) MEN-1IB# It consists of medullary carcinoma thyroid, pheochromocytoma, GIT neuromas and marfanoid features.\n\nSo the answer to this question is C"}
{"instruction": "Investigation of choice for invasive amebiasis is:\nA. Indirect heamagglutination\nB. ELISA\nC. Counter immune electrophoresis\nD. Microscopy", "response": "Answer is B (ELISA) In Extra-intestinal amebiasis, antibody detection by ELISA is the most sensitive test - Ghai 5th/221. ELISA : This test is positive in more than 90% of patients and it usually reves to normal with in 6-12 months. IHA : May also be done in invasive Amoebiasis or liver abscess. The interpretation of the IHA is however more difficult because titres may remain positive for as long as 10 years.\n\nSo the answer to this question is B"}
{"instruction": "Ataxia telangiectasia is characterised by all of the following except –\nA. Chronic sinopulmonary disease\nB. Decreased level of α–fetoprotein\nC. Chromosomal breakage\nD. IgA deficiency", "response": "\"Persistence of very high levels of oncofetal proteins, including alpha-fetoproteins and carcinoembryonic antigens is of diagnostic value\" - Harrison\n\nAtaxia telangiectasia \n\nAtaxia Telangiectasia (AT) is an autosomal recessive disorder.\nIt is due to mutation of AT gene located on chromosome 11.\nThere is defective DNA repair that results in multiple chromosomal breaks.\n\nClinical manifestations\n\nPresent in the first decade of life.\nFeature are : -\n\n\nOculocutaneous telengiectasia\nNeurological → Ataxia, dysarthria, extensor plantar response, myoclonic jerks, are flexia, distal sensory deficit.\nImmunodeficiency →Thymic hypoplasia with cellular and humoral (IgA and IgG2) immunodeficiency.\nRecurrent pulmonary infections\nEndocrine disorders → Type I DM\nPremature ageing\nMalignancies → Lymphoma, Hodgkin's disease, acute T cell leukemia, breast cancer.\n\n\nα-feto protein and carcino-embryonic antigen are increased\n\nSo the answer to this question is B"}
{"instruction": "Most common type of psoriasis is\nA. Plaque\nB. Guttate\nC. Pustular\nD. Inverse", "response": "Psoriasis is one of the most common chronic inflammatory skin disease charecterised by well defined erythematous plaque with silvery white scales. the distribution is variable, but mostly symmetrical and seen extensor areas. The scales are loosely adherent and on complete removal of scales, a red moist surface ( Burkeley membrane) is seen. On fuher scraping, punctate bleeding points are seen due to suprapapillary thinning and capillary dilation. it is called auspitz sign. Occasionally a surrounding zone of hypopigmentation is seen usually associated with treatment.It is called woronoff's ring and it is the first sign that patient is responding to treatment. The most common variety of psoriasis is called plaque-type. The other types are guttate psoriasis, inverse or flexural psoriasis ,pustular psoriasis, scalp psoriasis, palmoplantar psoriasis, nail psoriasis. Inverse psoriasis affects the interiginous regions, including the axilla, groin, submammary region, and navel; it also tends to affect the scalp, palms, and soles. Guttate psoriasis (eruptive psoriasis) is most common in children and young adults. It develops acutely in individuals without psoriasis or in those with chronic plaque psoriasis. Patients present with many small erythematous, scaling papules, frequently after upper respiratory tract infection with b-hemolytic streptococci pustular psoriasis, patients may have disease localized to the palms and soles, or the disease may be generalized. Regardless of the extent of disease, the skin is erythematous, with pustules and variable scale. Localized to the palms and soles, it is easily confused with eczema. Ref: Harrison 19e pg: 347\n\nSo the answer to this question is A"}
{"instruction": "The following anti T.B. drug should not be given to AIDS patient :\nA. Rifampicin\nB. Ethambutol\nC. Streptomycin\nD. Pyrazinamide", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "D.latum transmitted by ?\nA. Cercaria through cyclops\nB. Cercaria through fish meal\nC. Plerocercoid through fish meal\nD. Metacercaria in cyclops", "response": "Ans. is 'c' i.e., Plerocercoid through fish meal\n\nSo the answer to this question is C"}
{"instruction": "Commonest site of liquifactive necrosis is\nA. Brain\nB. Kidney\nC. Liver\nD. Spleen", "response": "Ans. a (Brain). (Ref. Robbins, Pathologic Basis of Disease, 8th/pg.7-13)NECROSIS# Enzymatic degradation of a cell resulting from exogenous injury.# Characterized by enzymatic digestion and protein denaturation, with release of intracellular components.# Morphologically occurs as coagulative (heart, liver, kidney), liquefactive (brain), caseous (tuberculosis), fat (pancreas), fibrinoid (blood vessels), or gangrenous (limbs, GI tract).# Kidney infarct exhibiting coagulative necrosis will be seen with loss of nuclei and clumping of cytoplasm but with preservation of basic outlines of glomerular and tubular architecture.# Liquefactive necrosis in the kidney can be caused by fungal infection, which will be seen filled with white cells and cellular debris, creating a renal abscess that obliterates the normal architecture.IRREVERSIBLE INJURY AND CELL DEATHMORPHOLOGIC PATTERNCHARACTERSTICSCOAGULATIVE NECROSISMost common type (e.g. Heart, liver, kidney)LIQUEFACTIVE NECROSISAbscesses, brain infarcts, pancreatic necrosisCellular destruction by hydrolytic enzymesCASEOUS NECROSISSeen in tuberculosisCombination of coagulation and liquefaction necrosis soft, friable, and \"cottage-cheese-like\" appearanceFAT NECROSISCaused by the action of lipases on fatty tissue (e.g. with pancreatic damage)Chalky white appearanceFIBRINOID NECROSISEosinophilic homogenous appearance - resembles fibrinGANGRENOUS NECROSISCommon sites: lower limbs, gallbladder, Gl tract and testesDry gangrene - coagulative necrosisWet gangrene - liquefactive necrosisAPOPTOSISA specialized form of programmed cell death, an active process under genetic control.Executed in mitochondria.Mediated by a cascade of caspases (digest nuclear and cytoskeletal proteins and active endonucleases).\n\nSo the answer to this question is A"}
{"instruction": "Symbol 'X' denotes\nA. Air conduction threshold for right ear\nB. Bone conduction threshold for right ear\nC. Air conduction threshold for left ear\nD. Bone conduction threshold for left ear", "response": ".An \"O\" often is used to represent responses for the right ear and an \"X\" is used to represent responses for the left ear. A key on the audiogram, similar to one found on a map, identifies what the different symbols mean Hence, indicates air conduction test for left year Ref physiology textbook A. K Jain.. 3e\n\nSo the answer to this question is C"}
{"instruction": "Trochlear nerve all true except-\nA. Longest intracranial course.\nB. Arises from the dorsum of the brainstem.\nC. Supply ipsilateral superior oblique muscle\nD. Enters orbit through sup. orbital fissure outside annulus of Zinn", "response": "Ans is 'c' i.e. Supplies ipsilateral superior oblique muscle Trochlear nerve is a crossed cranial nerve. The nucleus of the trochlear nerve supplies the contralateral superior oblique muscle. The trochlear nerve has certain unique features: It is the only cranial nerve whose fibers originate totally from the contralateral nucleus. It is the only cranial nerve to emerge from the dorsal surface of the brain stem. It is the smallest (thinnest) of the cranial nerves, (largest is trigeminal) It has the longest intracranial course and is thus highly susceptible to increased intracranial pressure, (shortest cranial nerve is olfactory) It supplies only one muscle- i.e. superior oblique (Abducent cranial nerve also supplies only one muscle i.e. Lateral rectus) Course: As the trochlear nerve emerges from the brainstem, it curves around the cerebral peduncle and proceeds anteriorly within the lateral wall of cavernous sinus to pass into the orbit via the lateral part of superior orbital fissure. Structures passing through the Superior orbital fissure Lateral part (lateral to the annulus of Zinn ) Middle part Medial part Lacrimal nerve Frontal nerve Trochlear nerve Superior ophthalmic vein Recurrent meningeal branch of Lacrimal artery Anastomotic branch of the middle meningeal artery {which anastomoses with the recurrent branch of the lacrimal artery) Oculomotor nerve (both upper and lower divisions) Nasociliary nerve (lies in between the two divisions of the oculomotor nerve) Abducent nerve Inferior ophthalmic vein Sympathetic nerves from the plexus around the internal carotid artery Structures passing through superior orbital fissure Also know Inferior orbital fissure transmits Zygomatic branch of maxillary nerve Rami of pterygopalatine ganglion Infraorbital nerve Infraorbital vessels Communicating vein b/w inferior phthalic vein & pterygoid plexus of veins\n\nSo the answer to this question is C"}
{"instruction": "Half- life of cobalt-60:\nA. 53 years\nB. 5.3 years\nC. 0.53 years\nD. 7.8 years", "response": "Ans. (b) 5.3 yearsRef: Basics radiological physics 2nd ed. /180* Iridium-192, emits gamma rays. It has energy of 0.4MeV.* Tl/2 of iridium 192: 74 daysImportant Half Life of Radionuclides* Gold-198: 2.7 days* Iodine- 123: 13.3 hours* Iodine-131: 8 days* Phosphorus-32: 14.3 days* Yttrium 90: 64 hours* Cobalt-60: 5.26 years* Caesium-137: 30 years* Radium-226: 1620 years\n\nSo the answer to this question is B"}
{"instruction": "Topical glucocorticoids in eyes causes:\nA. Glaucoma\nB. Optic atrophy\nC. Retinal detachment\nD. Corneal ulcer", "response": "Ans: A (Glaucoma) Ref: Parson's Diseases of the Eye Pg:358: Basok Diseases of the Eye 5th edition, pg no 50Explanation:STEROIDSSystemic and topical steroids - causes. Posterior subcapsular cataractTopical steroids - causes, Open angle glaucomaThere is no safe dosageWho is Steroid responder?After 6 weeks of topical steroids, if the IOP>30mmHg - high responders22-30mmHg - moderate respondersNo change - non respondersStrong steroids (dexamethasone. betamethasone, prednisolone] - more potent in increasing the IOPFluoromethalone - lesser propensity to increase IOPDifluprednate - strong steroid but least potent to increase IOPOther Local Side Effects:Increased risk of super infectionDelayed wound healingCorneal meltingIndications of steroids in eye:Sterile ocular inflammationDisciform keratitisEpiscleritisScleritisUveitisOptic neuritisAllergic problemsPhlyctenVernal catarrahAllergic blepharoconjunctivitisPost operativeFollowing cataract surgeryKeratoplastyVitrectomyTrabeculectomy\n\nSo the answer to this question is A"}
{"instruction": "The blood supply of Anterior Cruciate Ligament (ACL) is primarily derived from:\nA. Superior medial genicular aery\nB. Descending genicular aery\nC. Middle genicular aery\nD. Circumflex fibular aery", "response": "The primary blood supply to the Anterior cruciate ligament comes from the middle genicular aery which pierces the posterior capsule and enters the intercondylar notch near the femoral attachment. Ref: Campbell's Operative Ohopaedics, 11th Edition, Page 2497;Operative Ahroscopy, 3rd Edition, Pages 67, 68; Current Concepts in ACL Reconstruction By Freddie Fu, 2008, Chapter 2, Page 28\n\nSo the answer to this question is C"}
{"instruction": "The most common form of fetal traumatic injury incurred during breach extraction is:\nA. Rupture of the liver\nB. Rupture of the spleen\nC. Intraadrenal hemorrhage\nD. Intracranial hemorrhage", "response": "bih trauma intracranial haemorrhage due to uncontrolled delivery of the head and rupture of the veins of Galen or tentorial or falx tears Skull fractures Fracture dislocation of cervical veebra and atlantoaxial dislocation (refer pgno:377 sheila textbook of obstetrics 2 nd edition)\n\nSo the answer to this question is D"}
{"instruction": "All of the following statements about Botulism are true except :\nA. Botulism is caused by endotoxin\nB. Honey ingestion causes infant botulism\nC. Constipation is seen\nD. Detection of antitoxin in the serum can aid in diagnosis", "response": "Cl. botulinum produce exotoxin (since endotoxin is usually produced by gram-negative bacteria) which differs from other exotoxin in that it is produced intracellularly and appears in the medium only on death/autolysis of cell.\nToxin production is determined by bacteriophage at least in types C and D toxin.\nAll toxin are neurotoxin except C toxin, which is cytotoxin.\nToxin acts by blocking production or release of Ach at synapse and Neuromuscular junction (= parasympatholytic = effect of atropine) so cause constipation, paralysis, etc.\nHuman disease is caused by type A, B, E and rarely F.\nMC Type of botulism is ‘Infant botulism’ which is produced by eating of honey containing spores so toxin is produced inside.\nFoodborne botulism and wound botulism are produced by preformed toxin.\nDiagnosis may be confirmed by demonstration of bacillus or toxin in food or feces.\nA retrospective diagnosis may be made by detection of antitoxin in the patient serum but it may not be seen in all cases.\n\nSo the answer to this question is A"}
{"instruction": "All is true about flumazenil except:\nA. Antagonist of benzodiazepines\nB. Treat barbiturate poisoning\nC. Given intravenously\nD. Act GABA channel", "response": "Ans. B. Treat barbiturate poisoningFlumazenil is the competitive antagonist of benzodiazepines receptor. It acts as specific antidote of benzodiazepines poisoning. It is given intravenously and it inhibits GABA facilitatory action.\n\nSo the answer to this question is B"}
{"instruction": "A 45-year-old was given steroids after renal transplant. After 2 years he had difficulty in walking and pain in both hips. Which one of the following is most likely cause?\nA. Primary Osteoarthritis\nB. Avascular necrosis\nC. Tuberculosis\nD. Aluminum toxicity", "response": "Ans. B. Avascular necrosisMnemonic for causes of avascular necrosis other than fracture - SCLERAa. S-Steroidsb. C-Caisson's diseasec. LE - Lupus Erythematosusd. R-Radiatione. A-Alcohol\n\nSo the answer to this question is B"}
{"instruction": "Most common causative organism of acute pyelonephritis in pregnancy is?\nA. E.coli\nB. Klebsiella pneumonia\nC. Enterobacter\nD. Staphylococcus group", "response": "ANSWER: (A) E.coliREF: Dutta's textbook of obstetrics 6th ed page 296Incidence of pyelonephritis in pregnancy 1-3%Previous history of urinary tract infection increases chance by 50%Organisms associated are: E:coli (70%), Klebsiella (10%), Enterobacter, Proteus pseudomonas, Staphylococcus aureus\n\nSo the answer to this question is A"}
{"instruction": "Lesion of Globus pallidus causes -\nA. Chorea\nB. Ballismus\nC. Athetosis\nD. Akinesia", "response": "Ans. is 'c' i.e., Athetosis Diseases of Basal gangliao Three distinct biochemical pathways in the basal ganglia normally operate in a balanced fashion : - 1 ) Nigrostriatal dopaminergic systemQ; 2) Intrastriatal cholinergic system; 3) GABAergic system which projects from the stratum to globus pallidus and substantia nigra.o When one or more of these pathways become dysfunctional, characteristic motor abnormalities occur. There may be two types of disorder: -Hyperkinetic: - There is excessive and abnormal movement, e.g., Chorea, athetosis and ballism.Hypokinetic : - There is paucity of movement, e.g., Akinesia and Bradykinesia.o The classical example of Basal ganglia disease is Parkinsonism in which there is degeneration of dopaminergic neurons in the substantia nigra pars compacta. The fibers to putamen are most severely affected. A patient with parkinsonism have both hypokinetic and hyperkinetic features : -Hypokinetic : - Bradykinesia, AkinesiaHyperkinetic : - Cogwheel rigidity, Resting tremorQ.DiseasePart of Basal ganglia involvedParkinsonismSubstantia nigra pars compacta - Nigrastriatal pathwayHuntington choreaStriatum (mainly caudate nucleus; may be putamen)BallismSubthalamic nucleiAthetosisGlobus pallidus (mainly)Q and Subthalamic nucleus.\n\nSo the answer to this question is C"}
{"instruction": "Retrosternal goiter:\nA. Causes stridor\nB. Obtains its blood supply from thoracic vessels\nC. Characteristically malignant\nD. Must be removed by thoracotomy", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "All of the following are temporary social groups except:\nA. Crowd\nB. Mob\nC. Herd\nD. Band", "response": "TEMPORARY SOCIAL GROUPS (1) The Crowd : When a group of people come together temporarily, for a sho period, motivated by a common interest or curiosity (e.g., to witness a football match), it is known as a crowd. The crowd lacks internal organization and leadership. When the interest is over, the crowd disperses. (2) The Mob : The mob is essentially a crowd, but has a leader who forces the members into action. There may be a symbol in the shape of a flag or slogan. The mob is more emotional than a crowd. Like the crowd, it is unstable and without internal organization. When the purpose of the mob is achieved, the group disperses. (3) The Herd : This is also a crowd with a leader. Here the members of the group have to follow the orders of the leader without question, e.g., the tourist group under a guide. PERMANENT SPATIAL GROUPS (1) The Band: It is the most elementary community of a few families living together. Here the group has organized itself and follows a pattern of life e.g., gypsies in India. (2) The Village : The village is a small collection of people permanently settled down in a locality with their homes and cultural equipments. (3) The Towns and Cities : From a sociological point of view, a city or town may be defined as a relatively large, dense and permanent settlement of socially heterogeneous individuals. (4) The State: The state is an ecological social group * based on territory. It is more stabilized andformalized. It is heterogeneous in nature. The Indian Union is a large State.\n\nSo the answer to this question is D"}
{"instruction": "Duration of immunity after typhoid vaccination is for -\nA. 3 years\nB. 5 years\nC. 7 years\nD. 6 months", "response": " Vi polysaccharide vaccine:- Composed of purified Vi capsular polysaccharide from Ty2 S. Administration- subcutaneous/ intramuscularly. Age group more than 2 years. Only one dose required. Confers protection 7 days after injection. Efficacy-85% Duration of immunity-3yrs. To maintain protection,revaccination recommended every 3 years. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.237} BCG Aim- To induce a benign,aificial primary infection which will stimulate an acquired resistance to possible subsequent infection with virulent tubercle bacilli, and thus reduce the morbidity and moality from primary tuberculosis among those most at risk. WHO recommends the &;Danish 1331&; strain for vaccine production. Stable for several weeks at ambient temperature in a tropical climate and for upto 1 year if kept away from direct light and stored in a cool environment below 10 deg celcius. Vaccine must be protected from light ( wrapped up in a double layer of red/ black cloth). Normal saline is recommended as diluent for reconstituting the vaccine as distilled water may cause irritation. Reconstituted vaccine may be used within 3 hours. Dosage-0.1 mg in 0.1 ml volume. The dose of newborn below 4 weeks is 0.05 ml. Administered intradermally using tuberculin syringe. Injected slightly above the inseion of left deltoid. If injected too high / too low adjacent lymph nodes may become involved and tender. The vaccine must not be contaminated with an antiseptic/detergent. If alcohol is used to swab the skin , it must be allowed to evaporate before the vaccine is given. Phenomenon after vaccination:/ 2-3 weeks after a correct intradermal injection of a potent vaccine, a papule develops at the site of vaccination. It increases slowly in size and reaches a a diameter of about 4-8 mm in 5 weeks. It then subsides or breaks into a shallow ulcer but usually seen covered by a crust. Healing occurs within 6-12weeks leaving a permanent,tiny, round scar (4-8 mm in diameter).This is a normal reaction. Normally the individual become mantoux postive after 8 weeks has elapsed. Adverse reactions: prolonged severe ulceration at the site of vaccination, suppurative lymphadenitis, osteomyelitis and disseminated BCG infection. Contraindications: BCG should not be given to patients with generalised eczema, infective dermatosis, hypogammaglobulinemia , those with history of deficient immunity, patients under immunosuppressive treatment and in pregnancy. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.196} DEPIGMENTING AGENTS:- Include agents like hydroquinone(2%-5%),azelaic acid (10%-20%), glycolic acid (6%-12%) and monobenzene. They act by inhibiting tyrosinase enzyme. Hydroquinone is most commonly used.It can be combined with steroids and retinoids in the treatment of melasma. Kligmans regimen- 5% hydroquinone+0.1% tretinoin +0.1% hydrophilic ointment. Newer agents-Arbutin and kojic acid.They lighten hyperpigmented patches. Used in melasma, freckles. {Reference: IADVL textbook of dermatology, vishalakshi Vishwanath pg no.379} Essential fatty acids: Those that cannot be synthesised by humans.They can be derived from food only. The most impoant essential fatty acid is linoleic acid, which serves as the basis for production of other essential fatty acids( linolenic and arachidonic acid) . Not all PUFA are essential fatty acids. Linoleic acid:- dietary source and per cent content . Safflower oil- 73 Corn oil- 57 Sunflower oil-56 Soyabean oil-51 Sesame oil-40 Ground nut oil-39 Mustard oil -15 Palmoil- 9 Coconut oil- 2 Eichosapentanoic acid: Fish oil: 10 % present. Linolenic acid : Soyabean oil-7 {Reference: Park&;s textbook of community medicine 23 rd edition, pg no. 611}\n\nSo the answer to this question is A"}
{"instruction": "A sexually active, long distance truck driver&;s wife comes with vaginal discharge. Under Syndromic Approach, which drug should be given?\nA. Metronidazole, Azithromycin, Fluconazole\nB. Metronidazole\nC. Azithromycin\nD. Metronidazole and Fluconazole", "response": " Metronidazole,azythromycin,fluconazole. It is syndromic management of vaginal discharge for symptomatic paner. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:334. <\\p>\n\nSo the answer to this question is A"}
{"instruction": "A patient was suffering from hepatorenal syndrome. A urine sample was obtained from the patient and was examined under the microscopy. Which of the following technique is being used to make the organism visible?\nA. Dark field microscopy\nB. Routine microscopy with negatively stained background\nC. Phase contrast microscopy\nD. Compound light microscopy", "response": "Picture is showing spiral shaped bacterium ( having hooks ) suggestive of member of spirochetes Organism causing hepato-renal syndrome is Leptospira interrogans which cause ictero hemorrhagic fever/Weil's disease. Dark field microscopy- reflected light is used instead of transmitted light Dark field condenser with central circular stop illuminates the object with cone of light Light rays falling on object are reflected or scattered on to objective lens- object appears self luminous against dark background\n\nSo the answer to this question is A"}
{"instruction": "Neutropenia is seen in all except:\nA. Scurvy\nB. Aplastic anemia\nC. Typhoid fever\nD. Chloramphenicol", "response": "Ans: A (Scurvy) Ref: Harrison's Principles of Internal Medicine, 18 ed.Explanation:Severity of neutropenia based on the absolute neutrophil count (ANC) measured in cells per microliter of blood:Mild neutropenia (1000 < ANC < 1500) minimal risk of infectionModerate neutropenia (500 < ANC < 1000) -- moderate risk of infectionSevere neutropenia (ANC < 500) -- severe risk of infection.Causes of NeutropeniaCauses can be divided into the following groups:Decreased production in the bone marrow due to:Aplastic anemiaArsenic poisoningCancer, particularly blood cancersHereditary disorders (e.g. Congenital neutropenia. cyclic neutropenia)RadiationVitamin B 12, Folate or copper deficiency.Increased destruction:Autoimmune neutropenia.Chemotherapy treatments, such as for cancer and autoimmune diseasesMarginalisation and sequestration:HemodialysisMedications:ChloramphenicolPhenytoinIndomethacinPropylthiouracilCarbimazoleChlorpromazineTrimethoprim/sulfamethoxazoleClozapineTiclodipineInfectionsTuberculosisTyphoid feverBrucellosisTularemiaMeaslesInfectious mononucleosisMalariaViral hepatitisAIDS\n\nSo the answer to this question is A"}
{"instruction": "A 12-year-old with fever, unilateral post auricular pain and mastoid bulging with displacing the pinna forward and outwards with loss of bony trabeculae. This patient has a history of chronic persistent pus discharge from the same ear. Treatment of choice is\nA. Antibiotics only\nB. Incision and drainage\nC. Antibiotics with incision and drainage\nD. Mastoidectomy with incision and drainage and antibiotics", "response": "Swelling behind the ear displacing pinna indicate mastoiditis It is treated by mastoidectomy Aim of coical mastoidectomy is to exenterate all the mastoid air cells and remove any pockets of pus. Adequate antibiotic treatment must be continued at least for 5 days following mastoidectomy. Ref: Dhingra 7e pg 86.\n\nSo the answer to this question is D"}
{"instruction": "Drug of choice in Acute migraine is\nA. Ergotamine\nB. Sumatriptan\nC. Dihydroergotamine\nD. Propranol", "response": "(Sumatriptan) (170-17l-KDT6th) (523-LP 3rd)Triptans (Sumatriptan, naratriptan, eletriptan, almotriptan, zolmitriptan)* \"Triptans rapidly and effectively abort or markedly reduce the severity of migraine headaches in about 80% of patients\"* Sumatriptan is an effective and better tolerated than ergotamine* Somatriptan is the first selective 5HT 1B/1D receptor agonist\"Propranol is drug of choice for prophylaxis in migraine\"\n\nSo the answer to this question is B"}
{"instruction": "In narcolepsy, the polysomnographic recording typically shows which of the following patterns?\nA. REM intrusion during inappropriate periods\nB. An absence of REM sleep in midcycle\nC. Spike-and-wave EEG recording\nD. Extreme muscular relaxation", "response": "REM intrusion during inappropriate periods\n\nSo the answer to this question is A"}
{"instruction": "Which of the following embryonic structures gives rise to the adrenal coex?\nA. Ectoderm\nB. Endoderm\nC. Mesoderm\nD. Mesonephros", "response": "Mesoderm\n\nSo the answer to this question is C"}
{"instruction": "In a lady at 32 weeks pregnancy is given an injection of dexamethasone to prevent which of the following in the newborn ?\nA. Respiratory Distress Syndrome\nB. Neonatal convulsion\nC. Neonatal jaundice\nD. Cerebral palsy", "response": "The lung maturity occurs at 34 weeks of gestation and this is ceified by checking the L:S ratio which should be > 2:1 or appearance of Phosphatidyl glycerol in the amniotic fluid. Maternal administration of coicosteroid is advocated where the pregnancy is less than 34 weeks. This helps in fetal lung maturation so that the incidence of RDS, Intra Ventricular Hemorrhage , Necrotising Enterocolitis , and Patent Ductus Aeriosus are minimized. Respiratory distress of newborn often results in multiple debility in the fetus if not prevented.\n\nSo the answer to this question is A"}
{"instruction": "Intracellular receptors are present for -\nA. Estrogen\nB. Vitamin D\nC. Thyroxine\nD. All of the above", "response": "Ans. is 'd' i.e., AH of the above TYPES OF RECEPTORSMembrane receptorso Present on the cell membrane.o Their drug/hormone binding domain is extracellular and effector domain is intracellular.These are:1. G protein coupled receptors - It may act through.Adenylvl cyclase| cAMP - TSH, FSH, LH, ACTH, glucagon, PTH, adrenaline, calcitonin, vasopressin (V2).| cAMP - PRIH (Dopamine)IP.-DAG (Ca2- and protein kinase 'c') - Vasopressin (V1), oxytocin.Channel regulation (Ca+2, K+ Na+)2. Receptor with Intrinsic ion channels - (Na+, K+, Ca+2 or Cl-)3. Enzyme linked receptorsIntrinsic enzyme receptors (tyrosine kinase receptors) - Insulin.JAK-STAT kinase binding receptors Growth hormone. Prolactin.Intracellular receptors (transcription factors)o Present inside the cell and induce synthesis of specific protein by increasing the expression of specific gene.1. Cytoplasmic - Glucocorticoids, Mineralocorticoids, Androgens, Progestins.2. Nuclear - Thyroxine, Triiodothyronine, Estrogen, retinoic acid, Vit D.\n\nSo the answer to this question is D"}
{"instruction": "Hepatic encephalopathy is caused by an increase of -\nA. Urea\nB. Glutamate\nC. Ammonia\nD. Fattyacid", "response": "Ans. is 'c' i.e., Ammonia* Hepatic encephalopathy is characterized by altered level of consciousness, caused by liver disorder.* Liver disorder is characterized by elevation of ammonia. As liver is considered with detoxification of ammonia to form urea, in liver failure ammonia level is elevated.* Hepatic encephalopathy basically presents with manifestations of CNS depression* Pathogenesis:# Ammonia crosses Blood Brain Barrier and is taken up astrocytes. Astrocytes contribute to 30% of cells in the Central Nervous System. Within astrocytes, as pKa of ammonia is very high, it sequestrates hydrogen ions to form ammonium ions. Ammonium ions are positively charged. Additionally, ammonia reacts with glutamate to form glutamine. Glutamine is also positively charged. Both ammonium ions and glutamine, being positively charged, they attract water (Ammonium and glutamine are osmotically active). This causes astrocytes swelling. Neuronal swelling in respiratory centre causes hyperventilation and the person presents with repiratory alkalosis.# As glutamate levels are low, the neuronal activity is reduced. This explains depression, coma and EEG abnormalities (characteristic slowing of waves with high amplitude)* Hence, all features of hepatic encephalopathy are explained by hyperammonemia.\n\nSo the answer to this question is C"}
{"instruction": "Management of typical febrile seizures include all the following except :\nA. Tepid sponging\nB. Paracetamol and ibuprofen\nC. Intermittent diazepam\nD. Prophylactic phenobarbitone", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Bile gets concentrated in?\nA. Pancreas\nB. Liver\nC. Gall bladder\nD. Stomach", "response": "Gall bladderStorage & concentration of bileStorage of Bile:Bile is continuously secreted by liver. Released intermittently into intestine Most stored in gallbladder.Concentration of Bile:Bile is concentrated during its gallbladder storage.Gallbladder mucosa rapidly reabsorbs water & electrolytes.Calcium & potassium, bile salts, bile pigments, cholesterol, and lecithin are not reabsorbed. Hence their bile concentration increases 5 to 10 times.\n\nSo the answer to this question is C"}
{"instruction": "In Korsakoff's Psychosis, the following in not seen\nA. Memory disturbances\nB. Suicidal tendencies\nC. Loss of recent memory\nD. Pshycosis", "response": "Suicidal tendencies\n\nSo the answer to this question is B"}
{"instruction": "Which of the following statements about paial mole is false?\nA. Usually associated with Triploidy\nB. Rarely causes Persistent Gestational Trophoblastic Neoplasia\nC. Usually present as Missed Aboions\nD. Can be reliably diagnosed by USG in early gestation", "response": "Paial mole cannot be diagnosed by ultrasonography at a very early gestational ages, before the chorionic villi have attained vesicular pattern. Ref: Williams Gynaecology, 1st Edition, Page 758; Novak's Textbook of Gynecology, 14th Edition, Pages 1588, 1582; Obstetrics and Gynecology By Beckmann, 6th Edition, Page 360; Textbook of Obstetrics By DC Dutta, 6th Edition, Page 201.\n\nSo the answer to this question is D"}
{"instruction": "Baby born prematurely at 29 weeks on examination at 42 weeks with ROP both eyes shows stage 2 zone I \"plus' disease, how will you manage the patient?\nA. Examine the patient after 1 week\nB. Laser photocoagulation of both eyes\nC. Laser photocoagulation of worse eye, follow up of other eye\nD. Vitreoretinal surgery", "response": ". Ans. b. Laser photocoagulation of both eyes According to ETROP (early treatment for ROP cooperative group) the high risk pre threshold disease (i.e. zone / any stage plus (A)disease; or zone 1/stage 3: or zone 2, stage 2/3 plus ROP) is treated by laser photocoagulation.\"Retrolental fibroplasia/ Retinopathy of prematurity is a bilateral proliferative retinopathy occurring in premature infants (<32 weeks / <1.5 kg) exposed to high concentration of 0,, during the first 10 days of life. All the babies fulfilling above criteria should be screened with indirect ophthalmoscopy between 32-36 weeks post conceptionQ. The goal of treatment of threshold ROP is to prevent any retinal detachment or scarring and optimization of visual outcome. So laser photocoagulation of avascular immature retina is recommended in infants with threshold disease. According to ETROP (early treatment for ROP cooperative group) the high risk pre threshold disease (i.e. zone 1 any stage plus (+)disease; or zone 1/stage 3; or zone 2, stage 2/3 plus ROP) is treated by laser photocoagulation.\"Management of Retinopathy of Prematurity (ROP)Classification of ROP by Anatomic Location (Zone)* For the purpose of defining the anteroposterior (AP) location of ROP the retina is div ided into 3 concentric zones centred on optic disc.* The centre of retinal map for ROP is optic disc not the mcula as in other maps.* Since there is a direct correction between severity of disease and amount of avascular retina the location of the border between vascularized and avascular retina is an important prognostic sign.* The most anterior normal retinal vascularization is identified and is assigned a zone.Zone IMost posterior circular zone with optic disc as centre and twice the disc- fovea (or centre of macule) distance as radius.Any ROP in this zone is very severe because of large peripheral areas of avascular retina.Zone IIIt is a doughnut shaped region that extends concentrically from the anterior border of zone 1 to within 1 disc diameter of the ora serrata nasally and to anatomic equator temporallyIts radius extends from centre of disc to the nasal ora-serrata. A circle is drawn with optical disc as centre and disc to nasal ora-serrata as radius. The area between zone 1 and this boundary is zone IIZone IIIIt encompasses the residual temporal crescentshaped retina anterior to zone 2. Clinical Assessment/Classification based on Severity (Stage) of diseaseStageFeature1(1)* Demarcation line: It is appearance of a thin, flat, white (grey) tortuous line (border) at the junction of mature vascularized retina posteriorly and immature avascular retina anteriorly. * It runs roughly parallel with the ora-serrata and is more prominent in temporal periphery.* It is seen at the edge of vessels dividing the vascular from avascular retina i.e. the abnormal branching or arcading of vesseiss lead upto the line.II (2)* Ridge: Demarcation line acquires a volume to form a pink or white elevation or ridge of thickened tissue that has height, width and extends above the plane of retina.* Blood vessels enter the ridge and small isolated neovascular tufts (popcorns) may be seen posterior to it.III (3)* Extraretinai fibre vascular proliferation (vessels growth into and above the ridge) characberizes stage 3.* The fibrovascular proliferation may extend from the ridge into the overlying vitreous and cause vitreous haemorrhage.IV (4)* Partial or subtotal retinal detachment: due to traction exerted from contraction of fibrovascular proliferation.* 4A = Extra foveal (without fovea 1 involvement)* 4B = Foveal (with foveal involvement)V (5)* Total funnel shaped retinal detachment* In premature infants weighing < 1200 gm, PaO. of umbilical artery should be monitored, levels of50-100 mmHg being safe.* Premature infants should not be placed in incubator with an O, concentration of more than 30%* If minor signs of ROP are noticed, examination should be repeated at 1, 3, and 6 months and every 4 months upto the age of 4 years with the aim of diagnosing early retinal holes or retinal detachment.* Treatment involves ablation of avascular retina by laser photo coagulation {instrument of choice: and a standard of treatment in management of other vasoroliferative retinopathies associated with diabetes, sickle cell anemia and retinal vascular occlusion also).* Laser therapy has largely replaced cryotherapy because of superior visual and anatomical outcomes and induces less myopia.* Few indications for cryotherapy (over laser) include poor fundus visibility, lack of laser availability and physician's unfamiliarity with indirect laser retinoplexy procedure.* Intravitreal anti-VEGF agents as bevacizumab are also tried.Stage, ActivityManagementStage 1, 2 and 3 included in low risk (type 2) prethreshold ROP* Weekly or biweekly screeningStage 1, 2 and 3 included in high risk (type 1) prethreshold and /or Threshold ROP* Laser photocoagulatton (Treatment of choice) CryotherapyStage 4A* Laser or cryotherapy + sclera bucklingStage 4B and 5* Lens sparing pars plana vitrectomy\n\nSo the answer to this question is B"}
{"instruction": "Post polio, a child has gastronemius power - Grade 2, peroneus longus- Grade 3, tibialis anterior - Grade 4. Deformity present is:\nA. Calcaneo valgus\nB. Calcaneo varus\nC. Equino valgus\nD. Equino varus", "response": "Ans: a (Calcaneo valgus)Ref: Textbook of Orthopaedics - Ebenezar, 4th ed.Tibialis anterior and peroneus longus which are the primedorsiflexor and evertor position the foot in calcaneo valgusdue to unequal muscle pull in the above case.Calcaneo valgus - Dorsiflexion at ankle and (eversion) at subtalar joint.Calcaneo varus - Dorsiflexion at ankle and varus (inversion) at sub talar joint.Equino valgus - Plantar flexion at ankle and valgus at subtalar jointEquino varus - Plantar flexion at ankle and varus at subtalar joint.\n\nSo the answer to this question is A"}
{"instruction": "50 year old male with positive family history of prostate cancer has come to you for a screening test. Which is the most sensitive screening test to pickup prostate cancer ?\nA. DRE\nB. PSA\nC. DRE + PSA\nD. Endorectal Coil MPJ with T, W and T2W images", "response": "The combination of digital rectal examination and PSA levels are the most sensitive screening test to pick up prostate cancer. Diagnosis of prostate cancer is based on symptoms, an abnormal DRE, a change or an elevated serum PSA levels. Ref: Harrison's Principles Of Internal Medicine, 16th Edition, PAge 544, 545/ 18th edition chapter 95; Current Surgical Diagnosis and treatment, By Gerard M Dohey, 12th Edition, Page1045, 46\n\nSo the answer to this question is C"}
{"instruction": "Clinical wastes in hospitals are to be disposed in which colour bags\nA. Yellow\nB. Black\nC. Green\nD. Red", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Which is true of malaria -\nA. Rods forms are seen in P. malariae\nB. RBC size is more in P. vivax\nC. Relapse seen in P. falciparum\nD. Male and female mosquito transmit disease", "response": "RBCs shape and size malaria: P. vivex - Enlarged, Round and Bizarre form P. falciparum - Normal in size P. malariae - Normal in size P. ovale - Enlarged, Oval and Fimbriated margin Relapse: Seen in P. vivax and P. ovale Recrudescence: Seen in P. falciparum and P. malariae infections Definitive host: Female Anopheles mosquitoes (not male anopheles) Intermediate host: Man. Rod forms are seen in P. falciparm not in P. malaiae\n\nSo the answer to this question is B"}
{"instruction": "ELISA test has sensitivity of 95% and specificity of 95%. Prevalence of HIV carries is 5%. The predictive value of positive test is-\nA. 95%\nB. 50%\nC. 100%\nD. 75%", "response": "Ref:Parks 23rd edition pg 139 Construct a 2x2 table using the above data. 4.75 4.75 0.25 9.25 PPV = TP / (TP + FP) = 4.75/(4.75+4.75)=0.5\n\nSo the answer to this question is B"}
{"instruction": "Mallory bodies are seen in\nA. Viral hepatitis\nB. Toxic hepatitis\nC. Alcholholic hepatitis\nD. All", "response": "Refer Robbins page no 843\n\nSo the answer to this question is C"}
{"instruction": "Coagulation factor VII is\nA. Thromboplstin\nB. Accalerin\nC. Proconvein\nD. Antihaemophilic factor", "response": "Factor VII (EC 3.4.21.21, blood-coagulation factor VIIa, activated blood coagulation factor VII, formerly known as proconvein) is one of the proteins that cause blood to clot in the coagulation cascade. It is an enzyme of the serine protease class. Ref: guyton and hall textbook of medical physiology 12 edition page number:146,147,148\n\nSo the answer to this question is C"}
{"instruction": "In infant, bone marrow biopsy is done from ?\nA. Sternum\nB. Iliac crest\nC. Tibia\nD. All of above", "response": "Ans. is 'c' i.e., Tibia Sternum : --> Hematopoitically active Site in cooperative patient like adult Ilium : Apprehesive patient Useful in older children & adult Tibia : Useful in newborn & infant and children below 2 year of age.\n\nSo the answer to this question is C"}
{"instruction": "Which is a fructosan\nA. Pectin\nB. Chitin\nC. Inulin\nD. Glycogen", "response": "The polysaccharide of glucose (glucosan or glucan):- starch, glycogen, cellulose, dextrin, dextran, chitin\nThe polysaccharide of fructose (fructosan) :- Inulin\n\nSo the answer to this question is C"}
{"instruction": "A middle aged chronic alcoholic man complains of burning sensation in the mouth. On examination he has thickened, dry, smooth tongue with absence of the filliform papillae. MCV is 100. Which of the following should be first line of approach in the management of this patient?\nA. Estimation of Vitamin B12 levels\nB. Brush biopsy\nC. Sta Antifungal therapy\nD. Incisional biopsy", "response": "The above given scenario is likely a case of Vitamin B12 deficiency hence estimation of Vitamin B12 levels should be the first step in management. Its deficiency may cause a bilateral peripheral neuropathy or degeneration (demyelination) of the cervical and thoracic posterior and lateral (pyramidal) tracts of the spinal cord. Other clinical features include: Anorexia - weight loss Diarrhea or constipation. Glossitis Angular cheilosis Jaundice (unconjugated) Reversible melanin skin hyperpigmentation Thrombocytopenia The anemia and low leukocyte count may predispose to infections, paicularly of the respiratory and urinary tracts. Glossitis\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not a rapidly growing atypical mycobacteria causing lung infections ?\nA. M. chelonae\nB. M.fouitum\nC. M.abscessus\nD. M.kansasii", "response": "Ans. is 'd' i.e., M.kansasii\n\nSo the answer to this question is D"}
{"instruction": "True about Hirshprug's disease –\nA. Aganglionic segment is contracted not dilated\nB. Descending colon is most common site\nC. Barium enema is diagnostic\nD. Barium enema shows calcification", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Diagnosis of the given condition is:\nA. Episcleritis\nB. Bitot spots\nC. Pterygium\nD. Pinguecula", "response": "ANS. CGiven image is that of pterygium.# Pinguecula Bitot's spots episceritis* Pinguecula: Degenerative condition of conjunctiva characterized by triangular yellowish white patch on the bulbar conjunctiva near limbus.* Pterygium: Growth of conjunctiva--wing-shaped fold of conjunctiva encroaching onto cornea, Stockers line.\n\nSo the answer to this question is C"}
{"instruction": "A patient presenting with hemoptysis and renal failure with anti-basement membrane antibodies has-\nA. Good pasture's\nB. Wegener's\nC. Churg Strauss\nD. Henoch-scholein purpura", "response": "Goodpasture syndrome, the prototype disorder of this group, is an uncommon but intriguing condition characterized by a proliferative, usually rapidly progressive glomerulonephritis and hemorrhagic interstitial pneumonitis. Both the renal and the pulmonary lesions are caused by antibodies targeted against the noncollagenous domain of the a3 chain of collagen IV. These antibodies can be detected in the serum of more than 90% of persons with Goodpasture syndrome. Ref: Robbins book of pathology. 9th edition. Page 485\n\nSo the answer to this question is A"}
{"instruction": "Appearance of which of the following correlates with high levels of hepatitis B virus replication -\nA. HBsAg\nB. HBeAg\nC. Anti HBc\nD. IgM Anti HBc", "response": "Ans. is 'b' i.e., HBeAg Serological marker and lab diagnosis* Serological markers for HBV infection are1) HBs Ag (surface antigen or Australia antigen): It is the first marker which appears in the serum. It is the epidemiological marker for HBV infection.2) HBc Ag (core antigen): It is not demonstrable in serum because it is enclosed by HBsAg coat.3) HBe Ag (envelope antigen): It is marker of active replication and high injectivity. It is qualitative marker of replication. HBs Ag carrier mothers who are HBe Ag positive almost invariably (> 90%) transmit hepatitis B infection to their offspring, where as HBs Ag carrier mothers with anti HBe rarely (10 to 15%) infect their offspring.4) Anti-HBc Ag: It is the first antibody appears in serum. IgM anti-HBc Ag is a marker of acute or recent infection. IgG anti-HBc Ag indicates remote infection.5) Anti-HBs Ag: It is protective antibody. It is the only serological marker present after vaccination. After an infection, its presence indicates recovery and end of period of communicability.6) Anti-HBe Ag: Its presence indicate stopage of replication and low infectivity.7) HBV DNA: It is quantitative marker of HBV replication.* HBe Ag - Qualitative marker of replication.* HBV DNA - Quantitative marker of replication. HBs AgAnti HBs AgHBe AgAnti HBe AgAnti HBc AgAcute HBV (high infectivity)+-+ IgMAcute HBV (low infectivity)+- +IgMChronic HBV (high infectivity)+-+ IgMChronic HBV (low infectivity)+- +IgMRecovery-+-+IgMImmunized-+-\n\nSo the answer to this question is B"}
{"instruction": "In haemolytic glaucoma the mechanisms are all except:\nA. Siderosis of trabeculae\nB. Deposition of haemosiderin\nC. RBC clogging the trabeculae\nD. Inflammation", "response": "Ans. Inflammation\n\nSo the answer to this question is D"}
{"instruction": "Primary Hypothyroidism is seen in all EXCEPT\nA. Iodine deficiency\nB. Iodine excess\nC. Lithium\nD. Bexarotene", "response": "(D) Bexarotene # Causes of Hypothyroidism> Secondary.* Hypopituitarism: tumors., pituitary surgery or irradiation, infiltrative disorders, Sheehan's syndrome, trauma, genetic forms of combined pituitary hormone deficiencies.* Isolated TSH deficiency or inactivity.* Bexarotene treatment.* Hypothalamic disease: tumors, trauma, infiltrative disorders, idiopathic.\n\nSo the answer to this question is D"}
{"instruction": "Sex reassignment surgery is done in ?\nA. Gender identity disorder\nB. Premature ejaculation\nC. Erectile dysfunction\nD. Orgasmic dysfunction", "response": "Ans. A. Gender identity disorderMany persons with gender identity disorder have sought sex-reassignment surgery, that is, physical change that is constant with their cross sexual identity.\n\nSo the answer to this question is A"}
{"instruction": "All are seen in drowning except :\nA. Miosis\nB. Wet heavy lungs\nC. Water and weeds in stomach and lung\nD. Froth from mouth", "response": "A i.e. Miosis In drowning pupils are dilatedQ Other impoant signs of drowning are -fine copious persistant leathery froth from mouth & nose, weeds in tightly clenched hands, water in stomach & intestine, diatoms in brain & bone marrow, emphysema aquosum (wet heavy lungs), cutis anserina (goose skin), washer woman hands and Paltauf's haemorrhage.Q\n\nSo the answer to this question is A"}
{"instruction": "Which of the following will decrease the physiologic dead space?\nA. Emphysema\nB. Neck flexion\nC. Increase in tidal volume\nD. IPPV", "response": "Neck flexion decreases the volume of anatomic dead space and thus the total or physiologic dead (which includes anatomic dead space) will decrease. Physiologic dead space includes those alveoli which do not receive perfusion, making it a wasted ventilation in those alveoli. Physiologic dead space increases in emphysema. Increase in tidal volume increases anatomic dead space & thus physiologic dead space In IPPV, the positive pressure ventilation increases alveolar pressure, which in turn compresses vessels. This will decrease the blood flow to some regions of the lung.\n\nSo the answer to this question is B"}
{"instruction": "All are macrophages except -\nA. Histocytes\nB. Kupffer cells\nC. Osteoclasts\nD. Lymphocytes", "response": "Ans. is 'd' i.e., Lymphocytes Mononuclear macrophages Blood macrophages --> Monocytes Tissue macrophages --> Histocytes Lung --> Alveolar macrophages Brain --> Microglia Liver --> Kupffer cells Bone --> Osteoclasts Kidney --> Mesangial cells Placenta --> Hofbouer cells Spleen --> Littoral cells About option 'd' Lymphocytes Lymphocytes are the major cells in both antibody mediated (humoral) and cell mediated immunity. They also have some role in nonimmune inflammation. Antigen-stimulated lymphocytes (T & B cells) use various adhesion molecules and chemokines to migrate into inflammatory sites. Lymphocytes and macrophages interact in biderectional way, and these reactions play an impoant role in chronic inflammation. Macrophages process and present antigen to T-cells and also produce IL-2 that stimulate T cells. Activated T-cells produce IFN-y, a major activator of macrophages.\n\nSo the answer to this question is D"}
{"instruction": "Karyotyping of foetus may be done from all of the following Except\nA. Lymphocyte\nB. Monocyte\nC. Amniocyte\nD. Fibroblast", "response": "For Karyotyping, the cell needs to be arrested in the Metaphase stage for separating the chromosomes. The monocytes do not divide and therefore, they cannot be used for Karyotyping).\n\nSo the answer to this question is B"}
{"instruction": "Absolute contra -- indication of Norplant :\nA. Acute thrombophiebitis\nB. Hypeension\nC. Diabetes mellitus\nD. Hypercholesterolemia", "response": "Acute thrombophiebitis\n\nSo the answer to this question is A"}
{"instruction": "A man presented with fractures of 4th to 10th ribs and respiratory distress after a Road Traffic Accident (A). He is diagnosed to have flail chest and a PaO2, of\nA. Tracheostomy\nB. IPPV with oral intubation\nC. Fixation of ribs\nD. Strapping of chest", "response": "Flail chest occurs when three or more contiguous ribs are fractured in at least two locations. Paradoxical movement of this free-floating segment of chest wall may be evident in patients with spontaneous ventilation, due to the negative intrapleural pressure of inspiration. The decreased compliance and increased shunt fraction caused by the associated pulmonary contusion that is typically the source of postinjury pulmonary dysfunction. Pulmonary contusion often progresses during the first 12 hours. Resultant hypoventilation and hypoxemia may require presumptive intubation and mechanical ventilation. Ref: Cothren C., Biffl W.L., Moore E.E. (2010). Chapter 7. Trauma. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.\n\nSo the answer to this question is B"}
{"instruction": "Dilated pupil with coma is seen in which poisoning -\nA. Opium\nB. Dhatura\nC. Mushroom\nD. Pilocarpus", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Commonest cause of pulmonary embolism is: CMC (Vellore) 09\nA. Fat\nB. Amniotic fluid\nC. Thrombus\nD. Air", "response": "Ans. Thrombus\n\nSo the answer to this question is C"}
{"instruction": "Corneal transparency is due to all except:\nA. Na. - K+ pump\nB. Normal IOT\nC. Hypercellular stroma\nD. Peculiar arrangement of lamella", "response": "C i.e. Hypercellular stroma\n\nSo the answer to this question is C"}
{"instruction": "ROME (reorientation of medical education) scheme was introduced consequent to the recommendation of: March 2011\nA. Shrivastav committee\nB. Chaddah committee\nC. Mukerjee committee\nD. Kaar Singh committee", "response": "Ans. A: Shrivastav committee Shrivastav committee was set up in 1974 to suggests steps for improving the existing medical educational processes as to provide due emphasis on the problems paicularly relevant to national requirements SHRIVASTAV COMMITTEE. 1975. This committee was set up in 1974 as \"Group on Medical Education and Suppo Manpower\" to determine steps needed to - Reorient medical education in accordance with national needs and priorities and - Develop a curriculum for health assistants who were to function as a link between medical officers and MPWs. It recommended immediate action for: - Creation of bonds of paraprofessional and semiprofessional health workers from within the community itself. - Establishment of 3 cadres of health workers namely - multipurpose health workers and health assistants between the community level workers and doctors at PHC. - Development of a \"Refferal Services Complex\" - Establishment of a Medical and Health Education Commission for planning and implementing the reforms needed in health and medical education on the lines of University Grants Commission. - Acceptance of the recommendations of the Shrivastava Committee in 1977 led to the launching of the Rural Health Service.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following virus is shed in stool ?\nA. Herpangina\nB. Influenza\nC. Varicella\nD. Small pox", "response": "Ans. is 'a' i.e., Herpangina . Amongst the given options only Herpangina is caused by enterovirus (Coxsackie group A) and the diagnosis is made by virus isolation from the lesions or from feces. . All other are respiratory viruses and are shed in respiratory secretions. Common Sites of Isolation of Picornaviruses Enteroviruses Rhinovirus Polio Coxsackie A & B Echo Entero Nose 0 0 0 0 + Throat + + + + + Lower Intestine + + + + 0\n\nSo the answer to this question is A"}
{"instruction": "Which one of the following test is used to detect malingering?\nA. Stenger test\nB. Bing test\nC. Weber test\nD. Rinne test", "response": "(a) Stenger test(Ref. Cummings, 6th ed., 2067)Bing, Weber and Rinne tests are for the detection of conductive and SN hearing loss.\n\nSo the answer to this question is A"}
{"instruction": "A 10 month child weighing 5 kg and 65 cm presents with cough and cold. He was found to have a respiratory rate of 48 per minute with no retractions, grunting, cyanosis. There is no history of convulsions. Which is true ?\nA. No pneumonia, only cough and cold\nB. Child has pneumonia\nC. Severe pneumonia\nD. Very severe disease", "response": "SIGNS AND SYMPTOMS CLASSIFICATION THERAPY WHERE TO TREAT cough or cold no fast breathing no chest indrawing No pneumonia home remedies home respiratory rate/min .>60 in<2 months age >50 in2-12 months >40 in1-5 years chest indrawing pneumonia cotrimoxazole home chest indrawing cyanosis severe pneumonia IV/IM Penicillin hospital Ref : ESSENTIAL PEDIATRICS,O.P.GHAI,PG NO:356,7th edition\n\nSo the answer to this question is A"}
{"instruction": "During conversion of glycerol to pyruvic acid, the first glycolytic intermediate to form is:\nA. 2 - phospho glyceric acid\nB. 3 - phospho glyceric acid\nC. 3 - phospho glyceraldehyde\nD. Dihydroxy acetone phosphate", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Commonest cause of post paum hemorrhage is:\nA. Atonic uterus\nB. Traumatic\nC. Combination of atonic and traumatic\nD. Blood coagulation disorders", "response": "Atonic uterus\n\nSo the answer to this question is A"}
{"instruction": "What is the name of this skin lesion seen in Tuberous sclerosis?\nA. Adenoma sebaceum\nB. Ash leaf macules\nC. Confetti skin lesions\nD. Shagreen patches", "response": "The skin lesion shown in the picture is shagreen patch, which has orange peel like appearance. skin manifestations of Tuberous sclerosis\n\nSo the answer to this question is D"}
{"instruction": "Following features seen are characteristic of\nA. Aplastic anemia\nB. Megaloblastic anemia\nC. Iron deficiency anemia\nD. Leukemia", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following sites represents the location of Bezold abscess?\nA. Diagastric triangle\nB. Sternocleidomastoid muscle\nC. Infra temporal region\nD. Sub mandibular region", "response": "Ans. (b) sternocleidomastoid muscleRef: Dhingra's ENT 6th ed/ 78* Mastoid tip is in relation to two muscles:# Sternocleidomastoid muscle# Digastric muscle (posterior belly)* If there is abscess from:# SCM muscle: Bezolds abscess# Digastric area: Citelli s abscess.Also KnowDifferent MASTOID ABSCESSESAbscessLocationWild's abscessSubperiosteal mastoid abscessBezold's abscessDeep to Sternomastoid muscleLuc's abscessUnder periosteum of the roof of bony canalCitelli's abscessDigastric triangle (along posterior belly of digastrics muscle)\n\nSo the answer to this question is B"}
{"instruction": "A three years old boy presents with poor urinary stream. Most likely cause is :\nA. Stricture urethra.\nB. Neurogenic bladder.\nC. Urethral calculus.\nD. Posterior urethral valve.", "response": "Ans. is 'd' i.e. Posterior urethral valve Poor urinary stream in 3 years old boy suggests urinary tract obstruction (usually infravesical) and the most common cause of obstructive uropathy in a male child is posterial urethral valve.Posterior urethral valveThese are symmetrical folds of urothelium extending distally from prostatic urethra to external urinary sphincter.It most commonly lies just distal to the verumontanum or at the verumontanum*It occurs only in males.It behaves as flap valves so, although urine does not flow normally a urethral catheter can be passed without difficulty.Sometimes, the valves are incomplete and the patient remains without symptoms until adolescence or adulthood.Approximately 30% of patients experience end stage renal diseaseVesicoureteral reflux occurs in 50% of patients.Diagnosis is made byvoiding cystourethrogram* &endoscopyBoth of these investigations clearly depict the site of obstruction.The diagnosis can be established prenatally by ultrasound.*ManagementFirst a small polyethylene feeding tube is inserted in the bladder and left for several days. Then further management is done according to serum creatinine level.with normal serum creatinine - transurethral ablation of the valve leaflets. *With increased serum creatinine and the worsening of condition - vesicostomy to bypass the obstruction and when normal creatinine levels are achieved, transurethral ablation is done.\n\nSo the answer to this question is D"}
{"instruction": "Pentose phosphate pathway (HMP shunt pathway) produces\nA. ATP\nB. ADP\nC. NADH\nD. NADPH", "response": "HMP shunt pathway gives NADPH and ribose-5-phosphate.\n\nSo the answer to this question is D"}
{"instruction": "A patient aged 50 years, with Down's syndrome, presents with difficulty in speech, what is the diagnosis?\nA. Cerebrovascular accident\nB. Lacunar infarct in cerebellum\nC. Senile dementia Alzheimer's type\nD. Alzheimer with prion", "response": "(C) Senile dementia Alzheimer's type\n\nSo the answer to this question is C"}
{"instruction": "A healthy young athlete is sitting at the edge of the table with knee at 90-degree flexion. He fully extends it. What will happen?\nA. Movement of tibial tuberosity towards centre of the patella\nB. Movement of tibial tuberosity towards lateral border of patella\nC. Movement of tibial tuberosity towards medial border of patella\nD. No change in position", "response": "In full extension the knee gets locked, which involves lateral rotation of tibia (since foot is off the ground). Hence, tibial tuberosity moves laterally towards the lateral border of patella. Physiological Knee locking happens in the last 30deg of knee extension and involves the rotation of either bone femur or tibia. a. It involves medial rotation of femur on tibia if the foot is fixed to the ground (weight bearing leg). b. If the foot is off the ground (as sitting on a table) then tibia has to rotate opposite (laterally) to lock the knee joint. Knee locking happens when we stand straight or straighten our lower limb in the air (e.g., during some exercise) a. It is the most stable position of the knee joint b. Femur & tibia are locked on to each other and there is maximum congruency between the two. c. Almost all ligaments are tightened and provide maximum stability to the joint. IV. Quadriceps femoris leads to knee extension and knee locking happens due to the continued action of quadriceps femoris. V. Unlocking of knee joint is carried out by popliteus muscle. a. It involves the rotation of any of the two bones (femur/tibia) in opposite direction to locking. b. Popliteus muscle is a very small muscle at the floor of popliteal fossa and is supplied by the tibial nerve. c. Popliteus has intracapsular origin. Pathological knee locking: It is an ohopaedic problem where patient has some meniscal injury and he finds difficulty in carrying out knee extension fully. Ref - The physiology of the joints (5th Ed.) ,Vol-2 Pg. 102,103 .\n\nSo the answer to this question is B"}
{"instruction": "Most common site for secondary metastasis in a case of Hypemephroma:\nA. Adrenal\nB. Lungs\nC. Brain\nD. Bones", "response": "Answer is B (Lungs) 'The most common site of distant metastasis (in RCC) is the lung'\n\nSo the answer to this question is B"}
{"instruction": "What is the GFR (mL/min per 1.73m2) of a patient who is in stage IV of chronic kidney disease?\nA. 60 - 89\nB. 30 - 59\nC. 15 - 29\nD. < 15", "response": ".\n\nSo the answer to this question is C"}
{"instruction": "Complement component involved in both classical and alternate pathway:\nA. C1\nB. C2\nC. C3\nD. C5", "response": "Ans. C. C3a. C3 is involved in both classical and alternate complement pathways.b. Activation of C3 is the central process in complement cascade.c. Activation of C3 is achieved by C42 (classical C3 convertase) in classical pathway.d. The activation of C3 without prior participation of C142 is known as alternate pathway.\n\nSo the answer to this question is C"}
{"instruction": "Drug useful in breast cancer is ?\nA. Tamoxifen\nB. Cyproterone\nC. Testosterone\nD. Chlorambucil", "response": "Ans. is 'a' i.e., Tamoxifen Pharmacotherapv of breast cancer Many breast carcinomas possess estrogen receptors Estrogen promotes their growth. Drugs which decrease the action of estrogen on breast CA by one or other mechanisms, can be used in breast CA. Drugs used in Breast cancer Selective estrogen receptor modulators (SERMs) - Tamoxifen, Tromifene. Selective estrogen receptor down regulators (SERDs) - Fulvestrant Aromatase inhibitors - Letrozole, anastrozole, exemestone LHRH (GnRh) analogues Aminoglutethemide High doses progesterones - Megastrol acetate.\n\nSo the answer to this question is A"}
{"instruction": "Carey coombs murmur, which is false –\nA. Delayed diastolic murmur\nB. Seen in rheumatic fever\nC. Can be associated with A.R.\nD. Low pitched murmur", "response": "A short, mid-diastolic murmur is rarely heard during an episode of acute rheumatic fever (Carey-Coombs murmur) and probably is due to flow through an edematous mitral valve. An opening snap is not present in the acute phase, and the murmur dissipates with resolution of the acute attack. Complete heart block with dyssynchronous atrial and ventricular activation may be associated with intermittent mid- to late diastolic murmurs if atrial contraction occurs when the mitral valve is partially closed. Mid-diastolic murmurs indicative of increased tricuspid valve flow can occur with severe, isolated TR and with large ASDs and significant left-to-right shunting. Other signs of an ASD are present ( Chap. 236 ), including fixed splitting of S 2 and a mid-systolic murmur at the mid- to upper left sternal border. TTE is indicated for evaluation of a patient with a mid- to late diastolic murmur.\n\nSo the answer to this question is A"}
{"instruction": "MMR is expressed as a rate per\nA. 100 live bihs\nB. 1000 live bihs\nC. 10000 live bihs\nD. 100000 live bihs", "response": "Ref:Park's Text book of Preventive and Social Medicine 25th ed\n\nSo the answer to this question is D"}
{"instruction": "All of these cells are found in small intestine, EXCEPT?\nA. Enterochromaffin cells\nB. Goblet cells\nC. Neck cells\nD. Paneth cells", "response": "Mucous neck cells are present in clusters or as single cells among the other cells in the necks of gastric glands and include many progenitor and immature surface mucous cells. The major cell types in the epithelium of the small intestine are absorptive enterocytes, mucous cells, Paneth cells, endocrine cells, and M cells. Absorptive enterocytes are responsible for absorption; they arise from continually proliferating undifferentiated cells in the crypts of Lieberkuhn. Mucous cells originate in crypts and migrate to the tips of villi also; mature mucous cells are termed goblet cells. Enterochromaffin cells are the most numerous; N cells (containing neurotensin), L cells (glucagon), and other cells containing motilin and cholecystokinin are also present.\n\nSo the answer to this question is C"}
{"instruction": "Primary idiopathic polymyositis does not involve:-\nA. Pelvic girdle muscles\nB. Neck muscles\nC. Ocular muscles\nD. Pharyngeal muscle", "response": "Answer is C (Ocular muscles): 'Ocular muscles are almost never affected' - Harrison. Occular muscles are spared, even in advanced untreated cases - Harrison Primary idiopathic polymyositis: Condition of autoimmuneQ etiology in which skeletal muscle is damaged by non suppurative inflammatory process) dominated by Lymphocytic infiltration!) It is characterized by: Symmetrical weakness of proximal limb muscles especially hips and thigh (pelvic girdle) and later shoulder girdle. Weakness of flexor muscles of neck Involvement of striated muscles of pharynx (dysphagia) Involvement of respiratory muscles (late) \"Ocular muscles are almost never affected except in a rare case associated with myasthenia gravis. 'Facial muscles are unaffected in Polymyositis'. - Harrison\n\nSo the answer to this question is C"}
{"instruction": "Minnsesota tube is used for the control of variceal bleeding in portal hypertension has -\nA. One lumen\nB. Two lumen\nC. Three lumen\nD. Four lumen", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Lipoprotein X is most likely to be seen with in -\nA. Cholestasis\nB. Gilbe syndrome\nC. Increased intake of trans fatty acids\nD. Increased intake of PUPA", "response": "Lipoprotein X is an abnormal lipoprotein that appears in the serum samples of patients with obstructive jaundice and is a marker of cholestasis. Lipoprotein X is primarily responsible for the unusual lipid composition and characteristic plasma lipid concentrations in obstructive jaundice Ref Davidson 23rd edition pg 908\n\nSo the answer to this question is A"}
{"instruction": "Non-selective serotonin and nor-adrenaline reuptake inhibitor is:\nA. Sertraline\nB. Citalopram\nC. Venlafaxine\nD. Paroxetine", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "A married woman died in unnatural conditions within 5 years of her marriage. Her parents complained of frequent demand of dowry. Her autopsy will be conducted under which section: AI 10; Punjab 10\nA. Sec. 174 CrPC\nB. Sec. 176 CrPC\nC. Sec. 302 IPC\nD. Sec. 304B IPC", "response": "Ans. Sec. 176 CrPC\n\nSo the answer to this question is B"}
{"instruction": "TRUE about renal aerial system\nA. Anastomosis lies between arcuate branches\nB. Anastomosis lies at lobar level\nC. Branches are end aeries\nD. Medulla has more supply than coex", "response": "Renal aery(end aery) gives 5 segmental branches 4 from its anterior division 1 from its posterior division Segments are apical, upper, middle & lower in anterior aspect, on posterior aspect segments seen are posterior & pas of apical & lower segments Coex have more blood supply than medulla As shown above, renal aerial system has no anastomosis.\n\nSo the answer to this question is C"}
{"instruction": "Enteric fever is caused by: September 2005\nA. Salmonella typhi\nB. Salmonella paratyphi A\nC. Salmonella paratyphi B\nD. All of the above", "response": "Ans. D: All of the above Typhoid fever is caused by Salmonella typhi. Paratyphoid fever is caused by Salmonella paratyphi A, B and C. The term enteric fever encompasses both typhoid and paratyphoid fevers.\n\nSo the answer to this question is D"}
{"instruction": "pH of synovial fluid is:\nA. Basic in resting.\nB. Acidic on movement.\nC. Neutral.\nD. Both A& B", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Sinuses are not seen in\nA. Kidney\nB. Spleen\nC. Endocrine glane\nD. Liver", "response": "Kidneys do not have any sinuses\n\nSo the answer to this question is A"}
{"instruction": "Most common variety of lung carcinoma in women and children is?\nA. Small cell carcinoma\nB. Adenocarcinoma\nC. Squamous cell carcinoma\nD. Large cell carcinoma", "response": "Ans. is 'b' i.e., Adenocarcinoma Remember* Adenocarcinoma is the overall most common type of lung carcinoma.* Adenocarcinoma is the most common type of lung carcinoma in non-smokers and females.* Squamous cell (epidermoid) carcinoma is the most common type of lung carcinoma in India.* Squamous cell carcinoma is the most common type of lung carcinoma in smokers and males.* M.C Variety in young Patients - Adenocarcinoma* Histological Variety that cavitates - Squamous cell Ca* M.C Histological variety to metastasize - Small cell Ca* Ca which metastasize to opposite lung - Adenocarcinoma* Clubbing least common in which Ca - Small cell Ca* Gynaecomastia is seen in which type of Ca - Large Cell Ca* Thrombophlebitis is seen with which Ca -Adenocarcinoma* Most common site for metastasis from ca lung - Brain* Lung Ca with worst prognosis - Small cell Ca* Variety most responsive to chemotherapy - Small cell Ca* Variety most responsive to radiotherapy - Small cell Ca* M.C Endocrine Gland to be involved by metastasis - Adrenal* Variety with best prognosis - Squamous cell Ca* Variety that is central in location - Squamous cell & small cell Ca* Variety that is peripheral in location - Adenocarcinoma* Most common variety with Cushings syndrome - Small cell Ca* Most common variety with Hypercalcemia d/t PTH like substance Secretion ^ Squamous cell Ca\n\nSo the answer to this question is B"}
{"instruction": "From vitreous humor, estimation of time since death is done by: WB 11; NEET 13\nA. K+- level\nB. Na+ level\nC. Glucose level\nD. Urea level", "response": "Ans. K+- level\n\nSo the answer to this question is A"}
{"instruction": "Dangerous perforation of eardrum is located at:\nA. Center\nB. Attic\nC. Paracentrally\nD. All", "response": "Ans. b (Attic).(Ref. Diseases of ENT by PL Dhingra, / 3rd/pg.91)CHOLESTEATOMA can involve any area of the middle ear, hypotympanum, protympanum, epitympanum, and mastoid.Since most cases of cholesteatoma arise from a retraction of the tympanic membrane, it follows that most cases involve the middle ear space in some form. Pars flaccida retractions are the most common.These cholesteatomas typically invade Prussack space, which is the area between the pars flaccida laterally, and the malleus neck and the lower portion of the head medially. From here, the cholesteatoma can invade the middle ear inferiorly, the attic, and then the mastoid superiorly.\n\nSo the answer to this question is B"}
{"instruction": "Endoplasmic reticulum is not involved in ?\nA. Protein synthesis\nB. Steroid synthesis\nC. DNA synthesis\nD. Triglyceride synthesis", "response": "Ans. is 'c' i.e., DNA synthesis Endoplasmic reticulum are involved in :-Rough ER : Protein synthesis (hormones, enzymes etc.)Smooth ER: Triglyceride synthesis, steroid synthesis, cholesterol synthesis, Phospholipid synthesis, fatty acid chain elongation.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following can cause secondary brain injury\nA. Hypoxia\nB. Intracranial pressure > 30mm Hg\nC. Hypotension\nD. All of the above", "response": "Causes of secondary brain injury\n- Hypoxia: PO2 < 8 kPa\n- Hypotension: systolic blood pressure (SBP) < 90 mmHg\n- Raised intracranial pressure (ICP): ICP > 20 mmHg\n- Low cerebral perfusion pressure (CPP): CPP < 65 mmHg\n- Pyrexia\n- Seizures\n- Metabolic disturbance\n\nSo the answer to this question is D"}
{"instruction": "A patient presents with complains of sciatica. On radioligical examination there was sclerotic lesions on his skull. Which of the following is most likely to be elevated in this patient -\nA. CEA\nB. Prostate specific antigen\nC. Alkaline phosphatase\nD. Alpha 1 antitrypsin", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A 40-year-old gardener C/O several subcutaneous nodules on his right hand, where he had cut himself on rose thorns. Physical exam reveals several erythematous fluctuant lesions. Which organism is most likely responsible for his condition\nA. Aspergillus\nB. Malassezia\nC. Onchocerca\nD. Sporothrix", "response": "S schenckii, a dimorphic fungus causes sporotrichosis, a chronic granulomatous infection. The conidia or hyphal fragments of S schenckii are introduced into the skin by trauma. Patients frequently recall a history of trauma associated with outdoor activities and plants. The initial lesion is usually located on the extremities The initial episode is typically followed by a secondary spread with the involvement of the draining lymphatics and lymph nodesBiopsy of the tissue shows cigar-shaped yeast cells.Jawetz 27e pg: 670\n\nSo the answer to this question is D"}
{"instruction": "Malleus develops from\nA. 1st arch\nB. 2nd arch\nC. 3rd arch\nD. Otic Capsule", "response": "Malleus and Incus develop from 1st arch.\nFootplate of stapes develop from otic capsule.\n\nSo the answer to this question is A"}
{"instruction": "ORS should be discarded\nA. After 6 hours 13.\nB. After 12 hours\nC. After 24 hours\nD. After 36 hours", "response": "After 24 hours\n\nSo the answer to this question is C"}
{"instruction": "A 43-year-old man develops chronic hepatitis, which was attributed to a complication resulting from multiple blood transfusions for sickle cell anemia. He complains of chronic sweating, palpitation, and hunger attacks. What would be the most likely cause of these symptoms?\nA. Hepatogenic hypoglycemia\nB. Hemolytic anemia\nC. Jaundice\nD. Spontaneous hyperglycemia", "response": "The liver plays a role in glucose formation from various glucogenic amino acids and other substances. Hepatic disease removes this source of glucose supply. In insulin hypoglycemia, there is enhanced rapid uptake of glucose by fat tissue and muscle.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is nucleotide reverse transcriptase inhibitor ?\nA. Indinavir\nB. Nelfinavir\nC. Tenofovir\nD. Lopinavir", "response": "Ans. is 'c' i.e., Tenofovir Antiretroviral drugs Nucleoside reverse transcriptase inhibitors (NIs) ? Zidovudin, Didanosine, Zalcitabine, Stavudine, Lamivudine, Abacavir. Nucleotide reverse transcriptase inhibitor- Tenofovir (Katzung 10th/e) Nonucleoside reverse transcriptase inhibitors (NNIS) - Nevirapine, Eirenz, Delavirdine, Etravirine. d)Protease inhibitors - Ritonavir, Indinavir, Nelfinavir, Saquinavir, amprenavir, Lopinavir, Fosamprenavir, Atazanavir, Darunavir, Tipranavir. Fusion inhibitor - Enfuviide, Maraviroc. Integrase inhibitors - Roltegravir, Elvitegravir.\n\nSo the answer to this question is C"}
{"instruction": "Most abundant form of pro-vitamin A is:-\nA. Beta carotene\nB. Alpha-carotene\nC. Retinol\nD. Retinaldehyde", "response": "Carotenoids are provitamins of vitamin A which are present in plants. Most impoant carotenoid is beta carotene , which consists of two molecules of retinal joined end to end. ADDITIONAL READING ON VITAMIN A: There are three biologically active forms of Vitamin A: Retinol: necessary for reproductive system Retinal: involved in vision Retinoic acid: involved in growth and cellular differentiation Retinoids are all-natural/ synthetic compounds with Vitamin A like activity.\n\nSo the answer to this question is A"}
{"instruction": "A 55-year-old male presented to emergency with complains of upper GI bleed. The doctor on duty stabilized the patient. He underwent upper GI endoscopy, that was found to be normal. An extra-luminal mass found on CECT abdomen. CECT is given below, Then CT guided biopsy was taken for histopathological examination revealed the diagnosis as follows. Studies revealed DOG-1 marker positivity and SDH-1 gene mutation. What of the following drugs can be given in the above condition: -\nA. Imatinib\nB. Sorafenib\nC. Bevacizumab\nD. None", "response": "This is a case of GIST with SDH-1 mutation mean it is resistant to tyrosine kinase inhibitors. The image spindle shaped neoplastic cells - suggestive of GIST. Upper GI bleeding is the most common clinical manifestation of GISTs, manifesting as hematemesis or melena. Bleeding occurs because of pressure necrosis and ulceration of the overlying mucosa with resultant hemorrhage from disrupted vessels. Most common site of GIST is stomach. Upper GI endoscopy is usually normal because of extraluminal mass so usually detected on CT scan. CECT Is IOC for GIST. BUT for recurrent GIST IOC Is PET Scan. Most specific marker is DOG-1 > CD117. Imatinib shows the highest activity in GISTs that contain the mutation in exon 11 of KIT. Most GISTs with PDGFRA gene mutations respond to imatinib. GISTs with mutations in the succinate dehydrogenase (SDH) gene that result in deficiency of SDH are also generally resistant to TKI therapy. Surgical resection is the mainstay of treatment for localized tumors in these patients\n\nSo the answer to this question is D"}
{"instruction": "Pulp therapy which sweet name associated with\nA. Formocresol pulpotomy\nB. Beech wood cresol pulpotomy\nC. Non vital pulpotomy\nD. Pulpectomy", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "In Zollinger Ellison syndrome what is raised?\nA. Insulin\nB. VIP\nC. Gastrin\nD. Glucagon", "response": "Ans. is 'c' i.e., Gastrin Zollinger Ellison syndrome ? Severe peptic ulcer disease secondary to gastric acid hypersecretion due to unregulated gastrin release from a non 13 cell endocrine tumour (gastrinoma), defines the components of Zollinger Ellison syndrome. Pathophysiology of Zollinger Ellison syndrome The driving force responsible for clinical manifestations of Zollinger Ellison syndrome is hypergastrinemia originating from Gastrinoma (autonomus neoplasm, non [3 cell neoplasm) Gastrinoma Hyper gastrinemia Hyper acidemia Peptic ulcer, erosive esophagitis and diarrhoea Other impoant characteristic of Gastrinoma o Over 80% of these tumours are seen in Gastrinoma triangledeg (triangle formed between duodenum and pancreas) most of them are seen in the head of pancreas. o About 2/3'of these tumours are malignantdeg. o About one half of these tumours are multipledeg. o About one fouh of the patients have multiple endocrine neoplasia (MEN I) syndrome with tumours of parathyroid, pituitary and pancreatic islets being present. Remember : Most common site of gastrinoma's is - Duodenum (50-70%), (Pancreas 20-40%) Most common hormone to be secreted - ACTH besides gastrin is Most common site of peptic ulcers produced is - ls' pa of Duodenum. Most valuable provocative test in - The Secretin injection tests. identifying patients with ZES is Basal acid output is greater than 60% of out pu - BAO> MAO induced by maximal stimulation The term pancreatic endocrine tumour is misnomer because these tumours can occur either almost exclusively in the pancreas or at both pancreatic and extrapancreatic sites\n\nSo the answer to this question is C"}
{"instruction": "Normal Cup : disc ratio of optic disc is\nA. 0.3 to 0.4\nB. 0.2 to 0.3\nC. 0.5 to 0.6\nD. 0.1 to 0.3", "response": "Normal Cup : disc ratio of optic disc 0.3 to 0.4.\n\nSo the answer to this question is A"}
{"instruction": "Structure which is not present deep to hyoglossus is:\nA. Glossopharyngeal nerve.\nB. Genioglossus\nC. Hypoglossal nerve.\nD. Lingual artery.", "response": "Structures present deep to hyoglossus are\n\nGlossopharangeal nerve.\nLingual artery\nStylohyoid ligament\nGenioglossus\nIntrinsic muscles of tongue\n\nSo the answer to this question is C"}
{"instruction": "The action of acetylcholine at the neuromuscular junction is terminated primarily by:\nA. Diffusion into the surrounding extracellular fluid\nB. Uptake into the nerve ending\nC. Uptake into the muscle\nD. Enzymatic breakdown by acetylcholinesterase", "response": "The action of acetylcholine at the neuromuscular junction is terminated primarily by enzymatic breakdown by acetylcholinesterase. The acetylcholinesterase is attached to the basal lamina that fills the synaptic trough. There is no uptake of acetylcholine at the neuromuscular junction. A small amount of the acetylcholine will diffuse into the surrounding extracellular fluid but this is not the primary method by which its action is terminated.\n\nSo the answer to this question is D"}
{"instruction": "Adjuvant used in DPT vaccine is\nA. Zinc\nB. Aluminium\nC. Copper\nD. Magnesium", "response": "Ans. is 'b' i.e. Aluminium DPT vaccine is of two types : plain & adsorbedAluminium phosphate or Aluminium hydroxide is used as adsorbent.Adsorption increases the immunological effectiveness.WHO recommends use of only adjuvant DPT vaccines in immunization programmes?Also know - Pertussis component in DPT vaccine enhances the potency of the diphtheria toxoid.\n\nSo the answer to this question is B"}
{"instruction": "The largest volume of water is reabsorbed in the nephron at the\nA. Collecting duct\nB. Proximal convoluted tubule\nC. Ascending loop of Henle\nD. Descending loop of Henle", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Gene amplification is by\nA. Polymerase Chain Reaction\nB. Ligase chain reaction\nC. DNA hybridization\nD. In situ hybridization", "response": "PCR is an in-vitro DNA amplification procedure in which millions of copies of paicular sequence of DNA can be produced within a few hoursRef: DM Vasudevan, 7th edition, page no: 638\n\nSo the answer to this question is A"}
{"instruction": "Contraindication of rota virus vaccine is\nA. SCID\nB. Intussusception\nC. Severe allergic raction\nD. All of above", "response": "Ans. is 'd' i.e., All of above\n\nSo the answer to this question is D"}
{"instruction": "Eiken test is which type of reaction used for E. coli?\nA. Precipitation\nB. Agglutination\nC. Toxin antitoxin assay\nD. CFT", "response": "Eiken test is a precipitation reaction. Option 1 Eiken Precipitation test Precipitation in Gel (Immunodiffusion). Detect heat labile (LT) enterotoxin. +ve for heat labile (LT) enterotoxin of E.coli. -ve for heat stable (ST) enterotoxin of E.coli. Types of immunodiffusion reactions: 1. Single diffusion in one dimension (Oudin procedure) 2. Double diffusions in one dimension (Oakley-Fulthorpe procedure) 3. Single diffusion in two dimensions (Radial immunodiffusion) 4. Double diffusion in two dimensions (Ouchterlony procedure) Elek's test (diphtheria toxin) Eiken test (E.coli toxin) Option 2 Agglutination is more sensitive than precipitation test and the clumps are better visualized and interpreted. Option 3 Examples of Neutralization Test: Viral neutralization test: Detects viral neutralizing antibodies. Plaque inhibition test: Done for bacteriophages. Toxin-antitoxin neutralization test. Option 4 CFT (complement fixation test) detects complement fixing antibodies in the patient's serum.\n\nSo the answer to this question is A"}
{"instruction": "Normal parent with 2 siblings having osteogenesis imperfecta. Pattern of inheritance is\nA. Mutation\nB. Anticipation\nC. Genomic imprinting\nD. Germline mosacism", "response": "D i.e. Germline mosacism Differential expression of same gene depending on parent of origin is referred to as genomic imprinting. Germline (Gonadal) mosaicism results from a mutation only affecting cells destined to form gonads - postzygotically during early embryonic development. So the individual (parent) is phenotypically normal but can transmit the disease to offsprings through mutant gametesQ. And because the progenitor cells of gametes carry mutation, there is a high possibility that more than 1 child of such parent would be affected.\n\nSo the answer to this question is D"}
{"instruction": "Blumberg's sign is\nA. Rebound tenderness during abdominal palpation\nB. Board-like rigidity of abdomen\nC. Pressure over left iliac fossa causing pain in right iliac fossa\nD. Pressure over right iliac fossa causing pain in left iliac fossa", "response": "Positive Blumberg's sign or rebound tenderness or Release sign is indicative of peritonitis which can occur in diseases like appendicitis, perforated peptic ulcer and may occur in ulcerative colitis with rebound tenderness in the right lower quadrant etc. Rebound tenderness on abdominal palpation is d/t the fact that the parietal peritoneum which has already been inflamed due to the presence of underlying inflamed organ also springs back along with the abdominal muscles. < p> Reference : page 458 A manual on clinical surgery Das 10th edition\n\nSo the answer to this question is A"}
{"instruction": "Which among the following is the most common cause of stroke associated with moality?\nA. Embolic\nB. Thrombotic\nC. Hemorrhagic\nD. Absess", "response": "Strokes are classified as either hemorrhagic or ischemic. Acute ischemic stroke refers to stroke caused by thrombosis or embolism and is more common than hemorrhagic stroke. Cardiogenic emboli are a common source of recurrent stroke. They may account for up to 20% of acute strokes and have been repoed to have the highest 1- month moality. Thrombotic strokes are caused by in situ occlusions on atherosclerotic lesions in the carotid, veebrobasilar, and cerebral aeries, typically proximal to major branches. Embolus from the hea is a usual cause of stroke in people with hea disease.\n\nSo the answer to this question is A"}
{"instruction": "Agoraphobia is:\nA. Fear of getting caught in places from where escape would be difficult\nB. Fear of heights\nC. Fear of animals\nD. Fear of closed spaces", "response": "Fear of getting caught in places from where escape would be difficult - Fear of open spaces Fear of crowded places Fear of enclosed places Fear of travelling alone Fear of public transpo Patient is usually home bound Agarophobia and panic disorder are usually comorbid Fear of heights is Acrophobia Fear of closed spaces is Claustrophobia Fear of animals is Zoophobia\n\nSo the answer to this question is A"}
{"instruction": "Most Basic amino acid is\nA. Lecuine\nB. Istidine\nC. Arginine\nD. Glutamic acid", "response": "(C) Arginine # Aminoacid can be acidic, basic or neutral depending up on their side chain.> The lower the Pka of the R gp, the more acidic will be the amino acids, so aminoacid with the highest Pka of the RGP will be most basic.Basic Amino AcidPka of 'R' group* Arginine12.5* Lysine10.8* Histidine6.0\n\nSo the answer to this question is C"}
{"instruction": "Sustained neutropenia is seen with?\nA. Vinblastine\nB. Cisplatin\nC. Carmustine\nD. Cyclophosphamide", "response": "Carmustine belongs to the group of alkylating agents. It interferes with the growth of cancer cells, which are eventually destroyed. Since the growth of normal body cells may also be affected by carmustine, other effects may occur. Carmustine injection is used alone or together with other medicines to treat ceain type of brain tumors (e.g., glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, and metastatic brain tumors), cancer of the lymph system (e.g., Hodgkin&;s disease, non-Hodgkin&;s lymphoma), and a ceain type of cancer in the bone marrow (e.g., multiple myeloma). Marked neutropenia is frequently observed following administration of this drug REFERENCE: www.mayoclinic.org\n\nSo the answer to this question is C"}
{"instruction": "Pleomorphic adenoma usually arises from-\nA. Parotid gland\nB. Sub mandibular gland\nC. Minor salivary gland\nD. Superficial lobe", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Transient erythroid hypoplasia in hereditary spherocytosis is caused by:\nA. Epstein Barr virus\nB. Parvovirus B19\nC. CMV\nD. Hepatitis B", "response": "Parvovirus B 19 can cause transient red cell aplasia in patients with hemolytic disorders. It can cause aplastic crisis. Ref: Harrisons principles of internal medicine, 18th edition, Page 874.\n\nSo the answer to this question is B"}
{"instruction": "A 16 years old girl failed in her final examination. Disgusted with life , she cut across the front of wrist at the flexor retinaculum . She was rushed to hospital and the surgeon noticed that the cut was superficial. All the following structures would have been damaged by this cut EXCEPT?\nA. Ulnar nerve\nB. Median nerve\nC. Palmar cutaneous branch of median nerve\nD. Superficial branch of radial aery", "response": "Median nerve lies deep to the flexor retinaculum and is not damaged by cuts which are superficial. Structures crossing superficial to flexor retinaculum are:From medial to lateral:Superficial branch of ulnar nerve and ulnar aeryTendon of palmaris longusPalmar cutaneous branch of median nerveOrigin of the thenar musclesStructures passing deep to flexor retinaculum are:Median nerveTendons of flexor digitorum superficialisTendon of flexor digitorum profundusTendon of flexor pollicis longusUlnar bursa and radial bursa\n\nSo the answer to this question is B"}
{"instruction": "In \"Jiggling type\" of trauma, the occlusal force cause\nA. Funnel shaped destruction of socket wall\nB. Distinct pressure and tension sides within periodontal Ligament\nC. No changes in socket wall\nD. Has no effect on periodontal ligament space", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Mouse nibbled appearance of vocal cords is seen in:\nA. Tb larynx\nB. Syphilis\nC. Achalasia Cardia\nD. Lupus", "response": "Ref: Diseases of the Ear Nose and Throat by PL Dhingra .5th edn .2010 page. 312Explanation:TB LarynxTb larynx is almost secondary to pulmonary lbSeen mostly in middle aged malesBacilli reach the larynx by bronchogenic (via sputum) and hematogenous routeMost commonly posterior part of the larynx is affected i.e. arytenoids, inter arytenoids areaClinical FeaturesWeakness of voice (earliest symptom)Pain radiating to ear due to ulcerationOdynophagiaExamination FindingsMonocorditis - hyperemia of the vocal cord with impairment of adduction (earliest sign)Swelling in the inter arytenoids area giving it a niamiJated appearanceUlceration of the vocal cord - mouse nibbled appearanceUlceration and granulation over the arytenoids and inter arytenoid areaPsuedoedema of the epiglottis - Turban epiglottisPale mucosaSwelling of the false cord and aryepiglotticDiagnosis is by chest x-ray and sputum AFB examinationShould take a biopsy to rule out malignancy in suspected casesTreatment is with ATTLupusAffects the anterior part of larynxFirst epiglottis is affectedPainless and mostly asymptomaticGood prognosisTreatment is with ATTSyphilisCan affect any part any part of larynxLarynx generally affected in the tertiary stageDiagnosed with biopsy and serologyComplication - laryngeal stenosis\n\nSo the answer to this question is A"}
{"instruction": "A patient with homonymous hemianopia is found to have asymmetric optokinetic nystagmus. The location of the lesion is\nA. Parietal lobe\nB. Occipital lobe\nC. Temporal lobe\nD. Lateral geniculate body", "response": "Optokinetic nystagmus (OKN), elicited with a rotating striped optokinetic drum, useful in localizing cause of an isolated homonymous hemianopia. Physiological OKN involves smooth pursuit of a target, followed momentarily by a saccade in the opposite direction to fixate on the next target. If a homonymous hemianopia is due to a lesion in the parietal lobe, smooth pursuit pathways towards the side of the lesion are likely to be affected, making this component of OKN defective. OKN will therefore be asymmetrical: erratic when the drum is rotated towards the side of the lesion, but regular when the drum is rotated away from the side of the lesion. If the lesion is in the occipital lobe, smooth pursuit pathways are intact and OKN will be symmetrical - this is the Cogan dictum, which also states that the parietal lobe lesion is more likely to be a tumour and the occipital lesion an infarction. optokinetic drum\n\nSo the answer to this question is A"}
{"instruction": "Horner syndrome causes all of the following signs, EXCEPT:\nA. Enophthalmos\nB. Mydriasis\nC. Anhidrosis\nD. Narrowed palpebral fissure", "response": "Horner's syndrome occur secondary to a lesion of the sympathetic system. Features of Horner's syndrome are miosis, ptosis, facial anhidrosis,enophthalmos and heterochromia iridis. Three types of Horner's syndrome are: Central: Lesion is located between hypothalamus and the ciliospinal center of Bodge. Pre ganglionic: Lesion is located from C8 to T2 and the superior cervical ganglion. Post ganglionic: Lesion involves the third order neurons from the superior cervical ganglion to the dilator pupillae. Ref: Textbook of Ophthalmology edited by Sunita Agarwal, page 306.\n\nSo the answer to this question is B"}
{"instruction": "Urease positive organism -\nA. Proteus\nB. Streptococcus\nC. Vibrio cholera\nD. Pseudomonas", "response": "Ans. is 'a' i.e., ProteusUrease positive bacteria* Proteus* Staph aureus* Morganella* Klebseilla* Nocardia* H. Pylori* Y. pseudotuberculosis* Y. enterocolitica* Cryptococcus (fungus)* Diphtheroids* Mycobacteria except MAC\n\nSo the answer to this question is A"}
{"instruction": "Episodic vertigo, tinnitus and normal hearing is characteristic feature of -\nA. Acoustic neuroma\nB. Meniere's disease\nC. Vestibular neuritis\nD. All of the above", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Most common organic cause of erectile dysfunction\nA. Atherosclerosis\nB. Multiple sclerosis\nC. Penile fibrosis\nD. Peyronie's disease", "response": "M/c organic cause of ED is Atherosclerosis.\n\nSo the answer to this question is A"}
{"instruction": "Pagets disease increases the risk of\nA. Osteoma\nB. Osteosarcoma\nC. Fivrosarcoma\nD. All", "response": "Osteosarcoma Osteosarcomas are bulky tumors that are gritty, gray-white, and often contain areas of hemorrhage and cystic degeneration (Fig. 26-24). The tumors frequently destroy the surrounding coices and produce soft tissue masses. They spread exten- sively in the medullary canal, infiltrating and replacing hemato- poietic marrow. Infrequently, they penetrate the epiphyseal plate or enter the joint. When joint invasion occurs, the tumor grows into it along tendoligamentous structures\n\nSo the answer to this question is B"}
{"instruction": "By spirometry, one can measure\nA. Residual volume\nB. FRC\nC. TLC\nD. Tidal volume", "response": "Most lung volumes are measured by Spirometer. Residual volume, total lung capacity, and functional residual capacity cannot be measured with a spirometer.Ref: Ganong review of medical physiology 23rd edition Page no: 593\n\nSo the answer to this question is D"}
{"instruction": "Regarding CSF all the following statements are true except\nA. Its pH is less than blood\nB. No neutrophils present normally\nC. Formed by arachnoid villi\nD. Persistent leakage can cause headache", "response": "C i.e. Formed by arachnoid villi\n\nSo the answer to this question is C"}
{"instruction": "The inclination of teeth towards Frankfort horizontal plane in Simon's classification is\nA. Attraction\nB. Protraction\nC. Retraction\nD. Distraction", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "In myasthenia gravis, antibodies are present against:September 2012\nA. Muscarinic receptor proteins\nB. Nicotinic receptor proteins\nC. Protein actin\nD. Protein myosin", "response": "Ans. B i.e. Nicotinic receptor proteinsMyasthenia gravisIt is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigability.It is an autoimmune disorder, in which weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular junction, inhibiting the excitatory effects of the neurotransmitter acetylcholine on nicotinic receptors throughout neuromuscular junctions.Myasthenia is treated medically with acetylcholinesterase inhibitors or immunosuppressants, and, in selected cases,thymectomy.\n\nSo the answer to this question is B"}
{"instruction": "Hernia with hydrocele is ______ hernia:\nA. Gibbon's\nB. Fruber's\nC. Dobson's\nD. leobel's", "response": "Gibbon&;s hernia Hernia with Hydrocele Berger&;s hernia Hernia into pouch of Douglas Beclard&;s hernia Femoral hernia through opening of saphenous vein Amyand&;s hernia Inguinal hernia containing appendix Oglive&;s hernia Hernia through the defect in conjoint tendon just lateral to where it inses with the rectus sheath Stammer&;s hernia Internal hernia occuring through window in the transverse mesocolon after retrocolic gastrojejunostomy Peterson hernia Hernia under Roux limb after Roux-en-y gastric bypass Velpeau hernia Hernia infront of femoral vessels Holthouse hernia Inguinal hernia with extension of the loop of intestine along inguinal ligament Ref: Bailey 27th edition Pgno: 1252\n\nSo the answer to this question is A"}
{"instruction": "ALL of the following are true about trigeminal neuralgia\nEXCEPT\nA. it is unilateral\nB. it is of throbbing nature\nC. it is triggered by touching cheeks, mucosa etc\nD. occurs in bouts", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Emergency contraception contains-\nA. Cyproterone\nB. Desogestrel\nC. LNG\nD. Medroxyprogesterone", "response": "Ans. is 'c' i.e., LNG * Two methods of emergency contraception are available now:1) Hormonal and2) Mechanical (IUD)* There are two types of hormonal emergency contraception (emergency window = 72 hours)1) LNG-only pills (most commonly used)# One tablet of 0.75 mg LNG pill should be taken as soon as possible after unprotected intercourse, followed by a same dose taken 12 h later; both doses must be taken within 72 h of intercourse.# Single 1.5 mg dose of LNG is as effective for emergency contraception as two 0.75 mg doses of LNG taken 12 h apart.# Failure rate (pregnancy rate) = 0-1%2) Combined Estrogen and Progestogen Pills (Also Known as the Yuzpe Regimen)# High-dose pills contain 50 pg of EE and 250 pg LNG (or 500 pg norgestrel). Two pills should be taken as soon as possible, but not later than 72 h of unprotected coitus; this must be followed by two other pills 12 h later.# When only low-dose pills containing 30 pg of EE and 150 pg of LNG (300 pg of norgestrel) are available, four pills should be taken as the first dose within 72 h of unprotected intercourse, followed by four more pills after 12 h.# Main side effect is nausea and vomiting# Failure rate = 0-2%* The mechanism of action of emergency contraceptive pills has not been clearly established. They may act through (1) inhibition or delay of ovulation, (2) prevention of implantation in the altered endometrium (interception = main action), and (3) prevention of fertilization due to quick transport of sperms or ova. They cannot interrupt already established pregnancy.\n\nSo the answer to this question is C"}
{"instruction": "Varicose vein surgery is contraindicated in -\nA. Varicose ulcers\nB. Deep vein Thrombosis\nC. Pigmentation Over limb\nD. Hemorrhoides", "response": "Ans. is 'b' deep vein Thrombosis Ref Bailey & love, 24/e, p 963 (23/e, p 245)Surgical treatment of varicose vein is widely used and is effecive in removing varicose veins of the main saphenous trunks, as well as their tributaries, down to a size of about 3 mm. Veins smaller than this are best treated by Sclerotherapy. Surgical removal of varices is inappropriate where these form a major part of the venous drainage of the limb, for example where a deep vein thrombosis has destroyed the main axial limb veins and the pt. relies on the superficial veins.\" - Bailey & Love\n\nSo the answer to this question is B"}
{"instruction": "The chances of acquiring HIV infection following needle prick is:\nA. 0.30%\nB. 3-0%\nC. 0-30%\nD. 0.00%", "response": "Ans. a. 0.3%\n\nSo the answer to this question is A"}
{"instruction": "A 69-year-old man is informed that the cause of his dysphagis is a benign lesion. The barium swallow is shown in (Figure below). What should he be told regarding benign tumors and cysts of the esophagus?Leiomyoma of esophagus. Note smooth rounded density causing extrinsic compression of esophageal lumen\nA. They occur more commonly than malignant tumors.\nB. They are symptomatic at an early age.\nC. Diagnosis is best confirmed on chest x-ray.\nD. Leiomyoma is the most common benign tumor encountered in the esophagus.", "response": "Leiomyoma is the most common benign tumor encountered in the esophagus. Malignant transformation is thought to be rare. Less than 10%. of alimentary tract leiomyomas are found in the esophagus. They are composed of spindle cells and grow slowly and may progressively cause obstructive symptoms. Leiomyomas are not referred to as a benign GIST. Other benign lesions are congenital or acquired cysts, adenomatous polyps, papillomas, lipomas, neurofibromas, and hemangiomas.\n\nSo the answer to this question is D"}
{"instruction": "Which of the followig is a derivative of otic capsule?\nA. Membraneous labyrinth\nB. Perilymphatic labyrinth\nC. Bony labyrinth\nD. Ossicles", "response": "Ans. is'c'i.e., Bony labyrinthRef Dhingra 4h/e p. 86; Langmann 317Otic capsule or the bony labyrinth ossifies from 14 centres, the first one appears in the region of cochlea at 16 weeks and the last one appears in the postero lateral pa of posterior semicircular canal at 20d week\n\nSo the answer to this question is C"}
{"instruction": "All of following are the Cellular Components of Taste Buds except:-\nA. Zymogenic Cells\nB. Basal Cell\nC. Sustentacular Cells\nD. Gustatory Cells", "response": "Three different types of cells can be identified in taste buds: The Suppoing or Sustentacular Cells are elongated and exhibit a Darker Cytoplasm and Slender, Dark Nucleus. The Taste Cells or Gustatory cells exhibit a Lighter Cytoplasm and a more Oval, Lighter Nucleus. The Basal Cells are located at periphery of taste bud near the basement membrane. The Basal Cells give rise to both taste and suppoing cells. Zymogenic cells are seen in Gastric Glands.\n\nSo the answer to this question is A"}
{"instruction": "Hydroxyurea mechanism of action in cancer is by inhibiting the enzyme -\nA. Ribonucleoside diphosphate reductase\nB. Ribonucleotide oxidase\nC. DNA lyase\nD. DNA synthetase", "response": "Ans. is 'a' i.e., Ribonucleoside diphosphate reductase Hydroxyureao It blocks the conversion of ribonucleotides to deoxyribonucleotides by inhibiting the enzyme ribonucleoside diphosphate reductase; thus inhibits the DNA synthesis; S phase specific,o Myelosuppression is the major toxicity. GI disturbances and cutaneous reactions (pigmentation) also occur,o It is used in CML, psoriasis, polycythemia vera and some solid tumors.o It is also used as radiosensitizer before radiotherapy and is a first line drug for sickle cell disease in adults.\n\nSo the answer to this question is A"}
{"instruction": "Constituents of a typical embalming solution are all except -\nA. Phenol\nB. Glycerine\nC. Formalin\nD. Ethanol", "response": "Embalming solution contains formalin, methanol, phenol. Formalin one and half litres, sodium citrate 900g, sodium chloride 800g, sodium borate 600g, glycerine 600ml and one percent eosin 30 ml in ten litres water. Dr. Narayana Reddys Synopsis of Forensic Medicine & Toxicology 27 th edition pg. 87.\n\nSo the answer to this question is D"}
{"instruction": "There have been many recent advances in TIVA compared to inhalational anesthesia. Which of the following is true about TIVA\nA. Reduces cerebral metabolism (CMR) and CBF\nB. Smooth induction with high incidence of post operative nausea and vomiting\nC. Propofol inhibits pulmonary vasoconstriction d/t hypoxia, and is a/w increased pulmonary toxicity, malignant hypehermia and enhanced N20 effects\nD. Higher chances of nephrotoxity", "response": "A i.e. Reduces cerebral metabolism (CMR) and CBF - TIVA (with propofol) provides extremely clear-headed awakening (which is useful after neurosurgery for patient evaluation) and reduced incidence of post operative nausea and vomiting (PONVP compared to volatile anesthesia. It can be safely used in patient susceptible to malignant hyperpyrexiaQ and reduces release of scavenged anesthetic gases into the atmosphere. The paralysis is not always required, avoiding reversal agents and emergence is rapidQ (especially when propofol TIVA is used with remifentanil).\n\nSo the answer to this question is A"}
{"instruction": "Vaccine not given in Adolescents\nA. MMR\nB. Tetanus\nC. Rotavirus\nD. HPV", "response": "Adolescence ranges from 10 to 19 yrs Early ( 10-13yrs); Mid(. 14-16yrs); Late( 17-19yrs) DPT vaccine is given at 10-12 yrs, once every 10 yrs thereafter. HPV vaccine - 2 doses( if 9-14 yrs). 3 doses( if beyond 15 yrs) Influenza vaccine- Annually Rota virus vaccine presently is given in 4 states (AP, HP, Haryana, Odisha).It is given to prevent diarrhoea caused by rota virus. Three kinds of live attenuated oral vaccines ; Rotatrix( monovalent ) 2 doses:10 &14 wks Rotateq( pentavalent)3doses:6,10,14 wks Rotovac( monovalent recombinant )3doses Immunization of rotavirus vaccine should be completed by 8 months of age. Adolescents affected with rotavirus show mild symptoms in comparison to infants and toddlers Ref: Ghai, 9th edition, Chap 5 & 10.\n\nSo the answer to this question is C"}
{"instruction": "Standard site for primary bone graft -a) Pelvisb) Greater trochanterc) Medial malleolusd) Lateral melleoluse) Fibula\nA. a\nB. b\nC. ab\nD. ae", "response": "Standard site for primary cancellous bone graft → Iliac crest of pelvis.\nStandard site for primary cortical bone graft → fibula.\n\nSo the answer to this question is D"}
{"instruction": "Not a feature of diabetes mellitus in pregnancy\nA. Postdatism\nB. Hydramnios\nC. Neonatal hyperglycemia\nD. congenital defect", "response": "Neonatal complications Respiratory distress syndrome Hypoglycemia Polycythemia Hyperbilirubinemia Hyperviscosity Cardiomyopathy Bih trauma Reference: Textbook of Obstetrics; Sheila Balakrishnan, 2nd edition; Page no: 241\n\nSo the answer to this question is C"}
{"instruction": "Recptors for vibration sense-\nA. Merkel's disc\nB. Ruffini's end organ\nC. Paccinian corpuscle\nD. Meissner's corpuscle", "response": "Ans. is 'c' i.e., Paccinian corpuscle Tactile (touch) receptors* For touch (superfical touch) :- Meissner's corpuscle (detect texture of surface, i.e. rough or smooth), Merkel's disc (detect two point discrimination).* For pressure (deep touch) :- Ruffini's end organ (slowly adapting).* Vibrations :- Detected by Pacinian corpuscle (rapidly adapting).\n\nSo the answer to this question is C"}
{"instruction": "Which of these scoring systems is helpful in assessing severity of wound infection and is used for research and surveillance?\nA. Southampton grading scale\nB. ASA classification\nC. Glasgow score\nD. APGAR", "response": "- Commonly using grading system: Southampton grading scale Asepsis score Southampton Wound Grading System 0: Normal healing Ia: Some bruising Ib: Considerable brusing Ic: Mild erythema I: Normal healing with mild bruising or erythema IIa: At one point IIb: Around sutures IIc: Along wound IId: Around wound II: Erythema plus other signs of inflammation IIIa: At one point only (<2cm) IIIb: Along wound (> 2 cm) IIIc: Large volume IIId: prolonged (>3 days) IV: Pus IVa: At one point only (<2 cm) IVb: Along wound (>2cm)\n\nSo the answer to this question is A"}
{"instruction": "RMP of smooth muscle is\nA. -50mv\nB. -75mv\nC. -90mv\nD. -35mv", "response": "Average RMP value is approx -50mV. (Ref: Textbook of physiology AK Jain 5th edition page no.188)\n\nSo the answer to this question is A"}
{"instruction": "A 32 yr old man present to ER with history of high-grade fever, dyspnea and fatigue. On physical examination reveals a new holosystolic murmur that is best heard over cardiac apex. Skin examination shows following skin lesion. What is most likely diagnosis?\nA. Rheumatic hea disease\nB. Infective endocarditis\nC. Libman sack endocarditis\nD. Kaposi sarcoma", "response": "Janeway lesion are nontender, macular and erythematous lesions on palms and soles of patient with acute infective endocarditis. Osler nodes are tender, violaceous nodules typically located in pulp of fingers and toes seen in patient with infective endocarditis. Libman Sack endocarditis occurs in up to 25% of patient with SLE. This condition can cause small cardiac valvular vegetations on wither side of a valve, resulting in fibrotic valve thickening in fibrotic valve thickening anf deformity. SLE may cause an acute coronary syndrome at young age even with angiographically normal coronary aeries. Rheumatic fever can lead to mitral stenosis, which is characterize by a late, rumbling, diastolic murmur at cardiac apex. Numerous symptoms are associated with acute rheumatic fever, these can be: fever, erythema marginatum, valvular damage, increase ESR, joint pain, Subcutaneous nodule and Sydenham chorea. Erythema marginatum is a nonpruritic, circular, pink eruption on the trunk that is present in few cases of acute rheumatic fever. Kaposi sarcoma: a vascular tumor that is the most common neoplasm in patients with AIDS.The lesions of KS are characterized by the proliferation of spindle-shaped cells that express markers of both endothelial cells (vascular or lymphatic) and smooth muscle cells.\n\nSo the answer to this question is B"}
{"instruction": "Myofibroblast is seen in -\nA. Normal connective tissue\nB. Muscle septa\nC. Wound margin\nD. Bronchus", "response": "Ans. is 'c' i.e., Wound margin\n\nSo the answer to this question is C"}
{"instruction": "True about epidural opioids are all except?\nA. Act on dorsal horn substantia gelatinosa\nB. Can cause Itching\nC. Function of the intestine is not affected\nD. Can cause respiratory depression", "response": "Epidural opiate administration is routinely used by many anaesthesiologists involved in obstetric anaesthesia. Epiduralinjection of a local anaesthetic combined with an opioid generates a more rapid onset of more profound analgesia with little motor blockade. Thus pain relief lasts longer than after either drug alone. Ref: KD Tripathi 8th ed.\n\nSo the answer to this question is C"}
{"instruction": "Number of carpal bones seen in a radiograph of an infant is:\nA. 0\nB. 2\nC. 3\nD. 5", "response": "b) 2 ref: Sutton 7th/e p. 1848 fig A3\n\nSo the answer to this question is B"}
{"instruction": "Malignant Otitis externa is most commonly caused by-\nA. P. aeruginosa\nB. S. aureus\nC. St.penumoniae\nD. S. epidermidis", "response": "Ans. is 'a' i.e., P. aeruginosaMalignant otitis externao Malignant otitis externa, also called necrotizing external otitis. is a misnomer as it is not a neoplastic condition, rather it is an infectious condition. Malignant otitis externa is a disorder involving inflammation and damage of the bones and cartilage at the base of skull in temporal bone as a result of spread of infection from outer ear. Malignant otitis externa is often caused by difficult to treat bacteria such as pseudomonas aeruginosa. Only rare cases of malignant otitis externa due to S.aureus, Proteus mirabilis and Aspergillus fumigatus have been reported. The infection spreads from the floor of the ear canal to the nearby tissues and into the bones at the base of the skull. The infection and inflammation may damage or destroy the bones. The infection may spread more and affect the cranial nerves, brain, or other parts of the body.Predisposing factors for malignant otitis externao Elderly diabetics (most common predisposing factor)o Individuals with altered immune function (immunodeficiency )o ChemotherapyClinical features of malignant otitis externao Severe pain inside the ear and may get worse when moving head.o Granulation tissue in the external auditory canal, at the junction of bony and cartilagenous part,o Drainage from the ear - yellow, yellow - green, foul smelling, persistent.o Fevero Itching of ear or ear canalo Troubled swallowing & weakness of face.Complicationso Cranial nerve palsies most commonly facial nerve is involved. Other cranial nerves can also be involved (glossopharyngeal, vagus, spinal accessory, hypoglossal, abducens, trigeminal),o Jugular venous thrombosiso Cavernous sinus thrombosiso MeningitisTreatment of malignant otitis externao In all cases, the external ear canal is cleansed and a biopsy specimen of the granulation tissue sent for culture. IV antibiotics is directed against the offending organism. For Pseudomonas aeruginosa, the most common pathogen, the regimen involves an antipseudomonalpenicillin or cephalosporin (3rd generation piperacillin or ceftazidime) with an aminoglycoside. A fluoroquinolone antibiotic can be used in place of the aminoglycoside. Ear drops containing antipseudomonal antibiotic e.g. ciproflaxacin plus a glucocorticoid is also used. Early cases can be managed with oral and otic fluoroquinolones only. Extensive surgical debridement once an important part of the treatment is now rarely needed.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following DMARD acts by increasing adenosine extracellularly?\nA. Methotrexate\nB. Sulfasalazine\nC. Azathioprine\nD. Leflunomide", "response": "Ans. (A) Methotrexate(Ref: Katzung 13/e p627)Major mechanism of methotrexate at low doses used in rheumatoid arthritis is inhibition of AICAR (Aminoimidazole carboxamide ribonucleotide) transformylase and thymidylate synthase enzymes. This results in accumulation of AICAR in the cells. AICAR is a competitive inhibitor of AMP deaminase resulting in accumulation of AMP. Later is converted to adenosine which is a powerful anti-inflammatory compound.\n\nSo the answer to this question is A"}
{"instruction": "A chromosomal anomaly associated with alzheimer's dementia is -\nA. Trisomy 18\nB. Patau syndrome\nC. Trisomy 21\nD. Turners syndrome", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Hoffman-Rigler sign for enlargement of the left ventricle is seen on:\nA. PA view of the chest\nB. AP view of the chest\nC. Apicogram of the chest\nD. Lateral view of the chest", "response": "Ans DThe Hoffman-Rigler sign Q is a sign of left ventricular enlargement Q inferred from the distance between the inferior vena cava and left ventricle. On a lateral chest radiograph Q, if the distance between the left ventricular border and the posterior border of IVC exceeds 1.8 cm, at a level 2 cm above the intersection of diaphragm and IVC, left ventricular enlargement is suggested. Hoffman-Rigler sign should not be confused with Rigler sign, Rigler triad or Rigler notch sign.\n\nSo the answer to this question is D"}
{"instruction": "The volume in question mark is after:\nA. Maximum inspiration\nB. Maximum expiration\nC. Normal inspiration\nD. Normal expiration", "response": "Ans. (b) Maximum expiration(Ref: Ganong, 25th ed/p.629)It is residual volumeIt is the volume of air left in lungs after forced expiration\n\nSo the answer to this question is B"}
{"instruction": "All of the following drugs are approved for treatment of Psoriasis except ?\nA. Methotrexate\nB. Alefacept\nC. Infliximab\nD. Tofacitinib", "response": "1. DOC for PSORIATIC AHRITIS : METHOTREXATE 2. DOC for EHRODERMIC PSORIASIS :METHOTREXATE 3. MONOCLONAL ANTIBODIES used in psoriasis : 1. TNF ALPHA inhibitors - Infliximab, Adalimumab, Etanercept, Ceolizumab 2. ANTI-IL-17A- Ixekizumab, Secukinumab 3. Blockers of IL-17 receptor - Brodalumab 4. ANTI-IL-23 - Guselkumab, Risankizumab, Tildrakizumab 5. ANTI-IL-12 AND IL-23 - Ustekinumab 6. ANTI-LFA-1 - Alefacept 7. ANTI-LFA-3 - Efalizumab 8. ANTI-CD-6 - Itolizumab NOTE : TOFACITINIB is a JAK 1 and 3 inhibitor and is used in treatment of rheumatoid ahritis (not psoriasis).\n\nSo the answer to this question is D"}
{"instruction": "Which of the following statements regarding corneal transplantation is true?\nA. Whole eye needs to be preserved in tissue culture\nB. Donor not accepted if age > 60 years\nC. Specular microscopy analysis is used to assess endothelial cell count\nD. HLA matching is mandatory", "response": "Ans. (c) Specular microscopy analysis is used to assess endothelial cell countRef: Textbook of Ophthalmology by Sunita Agarwal (Jaypee) Is'* Corneoscleral button needs to be preserved, though whole eye can also be preserved.* Age is not a criteria for donor eye.* HLA matching is not mandatory as the cornea is immunologicaly previliged.\n\nSo the answer to this question is C"}
{"instruction": "A 25-year-old woman is G5, P0, Ab4. All of her previous pregnancies ended in spontaneous abortion in the first or second trimester. She is now in the 16th week of her fifth pregnancy and has had no prenatal problems. Laboratory findings include maternal blood type of A positive, negative serologic test for syphilis, and immunity to rubella. Which of the following laboratory studies would be most useful for determining a potential cause of recurrent fetal loss in this patient?\nA. Amniocentesis with chromosomal analysis\nB. Genetic analysis of the CFTR gene\nC. Maternal serum antibody screening\nD. Maternal serum a-fetoprotein determination", "response": "Multiple fetal losses earlier in gestation suggest the likelihood of a chromosomal abnormality - the mother or father may be the carrier of a balanced translocation. Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations may lead to cystic fibrosis, and like most inborn errors of metabolism, with appearance of findings postnatally. The maternal serum level of a-fetoprotein can help identify fetal neural tube defects, but these defects are not a cause of early fetal loss. Maternal HIV infection is not a cause of significant fetal loss. Because the mother is blood type A positive, fetal loss with erythroblastosis fetalis is unlikely, although other blood group incompatibilities potentially may result in erythroblastosis fetalis.\n\nSo the answer to this question is A"}
{"instruction": "Lucio phenomenon is treated with\nA. Steroids\nB. Lenalidomide\nC. Clofazimine\nD. Exchange transfusion", "response": "Answer- D. Exchange transfusionLucion phenomenon is a very rare comcomplication of leprosy.It presents as sudden necrotizing vasculopathy in Patients with longstanding, untreated lepromatous leprosy.TreatmentOptimal wound care and therapy for bacteremia are indicated. Ulcers tend to be chronic and heal poorly.In severe cases exchange transfusion is indicated.\n\nSo the answer to this question is D"}
{"instruction": "The distance between tympanic membrane and medial wall of middle ear at the level of centre is:\nA. 3 mm\nB. 4 mm\nC. 6 mm\nD. 2 mm", "response": "(d) 2mm(Ref. BD Chaurasia, Human Anatomy 6th ed., Vol 3, page 277)Part of the middle ear cavityDistance from lateral to medial wallEpitympanum6mm (widest)Mesotympanum (centre)2mm (narrowest)Hypotympanum4mm\n\nSo the answer to this question is D"}
{"instruction": "A 50 year old male presents with a 3 year history of irritability, low mood, lack of interest in surroundings and general dissatisfaction with everything. There is no significant disruption in his sleep or appetite. He is likely to be suffering from-\nA. Major depression\nB. No psychiatric disorder\nC. Dysthymia\nD. Chronic fatigue syndrome", "response": "Irritability, low mood (low self esteem, pessimism, hopelessness) and lack of interest for 3 years suggest the diagnosis of dysthymia (for details, see the table of diagnostic criteria in text).\n\nSo the answer to this question is C"}
{"instruction": "Clinical testing of the function of the long thoracic nerve is done by?\nA. Adduct the arm abducted to 90 degree against resistance\nB. Hold the arm in abducted position against resistance\nC. Initiate abduction of the arm from the side against resistance\nD. Raise the arm above the head on the affected side", "response": "Injury to the long thoracic nerve or nerve to serratus anterior leads to inability to raise the arm beyond 90 degree i.e. overhead abduction. Serratus anterior rotates the inferior angle of scapula laterally during abduction of the arm above the head. Winging of scapula is another classical feature of long thoracic nerve injury.\n\nSo the answer to this question is D"}
{"instruction": "Adson&;s test is positive in -\nA. Cervical rib\nB. Cervical spondylosis\nC. Cervical fracture\nD. Cervical dislocation", "response": "Adson&;s test is a provocative test for Thoracic Outlet Syndrome accompanied by compression of the Subclan aery by a cervical rib or tightened anterior and middle scalene muscles. Ref : Bailey and love surgery text book 27th Ed.\n\nSo the answer to this question is A"}
{"instruction": "In aoic dissection blood enters in -\nA. Intima\nB. Media\nC. Adventitia\nD. Any of the above layer", "response": "Ans. is `b' i.e., MediaAoic dissection o Aoic dissection is a catastrophic illness characterized by dissection of blood between and along the laminar planes of aoic media.o Blood enters inside the aerial wall (in the media layer) and leads to formation of blood filled channels within the aoic wall, which often ruptures outward causing massive hemmorrhage.o The most frequent preexisting histologically detectable lesion is cystic medial degeneration.o In aoic dissection, there is an intimial tear through which the blood enters into the media.o Usually, the tear is within 10 Cms of aoic valve.o The dissecting hematoma spreads characteristically along the laminar planes of the aoa, usually between the middle and outer third.Some times, blood reruptures into the lumen distally, i.e. there is a second tear distally. So that a complete new vascular channel is formed inside the media of aoic wall --> Blood enters from proximal tear into the media and comes out into the lumen from distal tear.o This is called double - barrel aoa with a false-channel in the media.Later on this false channel becomes endothelized --> chronic dissection.\n\nSo the answer to this question is B"}
{"instruction": "A 20 year old female repos that she was raised by an abusive father when she was young. Although he has changed and is no longer abusive towards her, she still becomes anxious as soon as she sees him. What is the best explanation for her anxiety based on psychological theory?\nA. Classical conditioning\nB. Operant conditioning\nC. Free association\nD. Reaction formation", "response": "The father is a conditioned stimuli and abuse is an unconditioned stimuli. The fear is the conditioned response. Even without the abuse, the patient is fearful of the father. This is known as classical conditioning.\n\nSo the answer to this question is A"}
{"instruction": "Human colostrum contains more of the following nutrients than mature human milk, except –\nA. Lactose\nB. Minerals\nC. Proteins\nD. Vitamin A", "response": "Sugar is less in clostrum.\n\nSo the answer to this question is A"}
{"instruction": "All of the following are side effects of valproic acid, except-\nA. Alopecia\nB. Hepatitis\nC. Nephrotoxicity\nD. Skin rash", "response": "Ans. is 'c' i.e., Nephrotoxicity\n\nSo the answer to this question is C"}
{"instruction": "Occult thyroid malignancy with nodal metestasis is seen in -\nA. Medullary carcinoma\nB. Follicular ca\nC. Papillary ca\nD. Anaplastic ca", "response": "Ans is C ie Papillary ca A small percentage of cancers present with enlarged lymph nodes in the jugular chain or pulmonary metastases with no palpable abnormality of the thyroid. The primary tumor may be no more than a few millimeters in size and is termed occult. Such primary foci of papillary carcinoma may also be discovered in thyroid tissue resected for other reasons. The term occult was formally applied to all papillary carcinomas less than 1.5 cm in diameter but the preferred terminology now is microcarcinoma for cancers less than 1 cm in diameter. These have an excellent prognosis although those presenting with nodal or distant metastases justify more aggressive therapy\".\n\nSo the answer to this question is C"}
{"instruction": "DNS may be associated with all the following except:\nA. Recurrent sphenoiditis\nB. Acute otitis media\nC. Hyperophy of the inferior turbinate\nD. Recurrent maxillary sinusitis", "response": "In deted nasal septum, the nasal chamber on the concave side of the nasal septum is wide and shows compensatory hyperophy of turbinates and not atrophy. The sphenoid sinus opens in the sphenoethmoid recess near the roof of nasal cavity and this opening is not affected by DNS.\n\nSo the answer to this question is A"}
{"instruction": "Patch test is done to document\nA. Type I hypersensitivity\nB. Delayed type hypersensitivity\nC. Autoimmune disease\nD. Immunocomplex deposition", "response": "Patch test is done to determine delayed (type 4) hypersensitivity for the suspected contact allergen. IADVL textbook of dermatology,page 789\n\nSo the answer to this question is B"}
{"instruction": "True about mosquito preventive nets are all except?\nA. Hole size < 0.0475\nB. 150 holes per square inch\nC. Best pattern in circular\nD. There should be no rent", "response": "Ans. is 'c' i.e.,Best pattern is circular The best pattern of mosquito net is the rectangular net.There should not be a single rent in the net.The Size of openings in the net is of utmost impoance, the size should not exceed 0.0475 inch in any diameter.The number of holes in one square inch in usually 150..\n\nSo the answer to this question is C"}
{"instruction": "Serum alkaline phosphatase level increases in:\nA. Hypothyroidism\nB. Carcinoma of prostate\nC. Hyperparathyroidism\nD. Myocardial infarction", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Primary amenorrhea, absent uterus, normal pubic hair. Diagnosisis -\nA. Mullerian agenesis\nB. Testicular feminization syndrome\nC. WNT 4 syndrome\nD. Hand foot genital syndrome", "response": "Ans. is 'a' i.e., Mullerian agenesis o MRKH syndrome is also known as MURCS syndrome (Mullerian agenesis, Renal aplasia and cervicothoracic somite dysplasia).o MRKH (Mayer Rokitansky Kuster Hauser) syndrome has a karyotype of 46, XX. So the gonads present are ovaries in contrast to Androgen Insensitivity Syndrome where testes are presento Vagina in its upper 2/3rds is absent, but lower one - third of vagina is present as it develops from the urogenital sinus.Characteristic findingsMRKH/ MURCSIsolated vaginal atresiaWNT 4 syndromeAndrogen insensitivityUpper vaginaAbsentVariableAbsentAbsentUterusAbsentPresentAbsentAbsentGonadsOvaryOvaryMasculinized ovaryTestisBreast developmentNormalNormalNormalNormalPubic hair developmentNormalNormalNormalSparseHyperandrogenismNoNoYesNoKaryotype46, XX46, XX46, XX46,XY\n\nSo the answer to this question is A"}
{"instruction": "Telecanthus means-\nA. Widened interpupillary distance\nB. Widened root of nose with normal interpupillary distance\nC. Widely separated medial orbital wall\nD. Widely separated nose and medial canthi", "response": "Telecanthus Vs hypeelirism *Telecanthus is an increased distance between two inner canthi seen clinically as widened root of nose, but the inter- pupillary distance is normal. *Hypeelorism is an increased distance between two orbits often measured clinically as increased interpupillary distance. Ref: Kanski 6th/e p.756\n\nSo the answer to this question is B"}
{"instruction": "In Dent's disease, which of the following is seen on laboratory evaluation ?\nA. Hypercalciuria\nB. Hypokalemia\nC. Hypernatremia\nD. Hypomagnesemia", "response": "Ans. is 'a' i.e., Hypercalciuria Dent's disease o Dent disease is a chronic kidney disease that occurs almost exclusively in males. In affected individuals, kidney problems result from damage to proximal tubules. Signs and symptoms of this condition appear in early childhood and worsen over time. o The most frequent sign of Dent disease is the presence of an abnormally large amount of proteins in urine (tubular proteinuria). o Other common signs of the disorder include:- - Excess calcium in the urine (hypercalciuria) - Calcium deposits in the kidney (nephrocalcinosis) and - Kidney stones (nephrolithiasis) o Kidney stones can cause abdominal pain and blood in the urine (hematuria). o Patient presents with end stage renal disease in early complications such as rickets or osteomalacia may occur, o The disease is caused by a mutation in either CLCN5 (Dent disease I) or OCRJL (Dent disease 2). o The phenotype of Dent's disease is explained by the predominant expression of CLC-5 in the proximal tubule segments of the kidney. o Diagnosis is based on the presence of all of the following three criteria Low molecular weight proteinuria. Hypercalciuria and At least one of the following Nephrocalcinosis Kidney stones Hematuria Hypophosphatemia Renal insufficiency\n\nSo the answer to this question is A"}
{"instruction": "Train of four response is shown by all of the following neuromuscular blockers except:-\nA. Succinyl choline\nB. Mivacurium\nC. Vacuronium\nD. Rocuronium", "response": "Depolarizing neuromuscular blockers show no fade on Train of Four stimulus thus with succinylcholine there would be no train of four response. Non depolarizing neuromuscular blocker shows fade on train of four stimulus.\n\nSo the answer to this question is A"}
{"instruction": "Ketanserin is :\nA. 5HT1B antagonist\nB. 5HT2 antagonist\nC. 5HT1A agonist\nD. 5HT1D antagonist", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Desmoplakin is the target antigen in:\nA. Pemphigus vulgaris\nB. Drug induced pemphigus\nC. Paraneoplastic pemphigus\nD. Pemphigus foliaceous", "response": "Paraneoplastic pemphigus is a severe variant of pemphigus, associated with an underlying neoplasm - most frequently non hodgkin's lymphoma, chronic lymphocytic leukemia, thymoma, and castleman disease. Tumor antigens are hypothesized to evoke an immune response that leads to the development of an autoimmune response to intercellular adhesins (plakins). This autoantibody response leads to blistering in mucosa and other epithelia.\nRef: Neville's oral and maxillofacial pathology 4th edition page 717-718\n\nSo the answer to this question is C"}
{"instruction": "Cause of alpha thalassemia:\nA. Deletion of alpha genes\nB. Deletion of beta genes\nC. Excess of alpha genes\nD. Single amino acid substitution in alpha chain", "response": "Ans. a. Deletion of alpha genesCause of alpha thalassemia is deletion of alpha genes.\"The a-thalassemias are caused by inherited deletions that result in reduced or absent synthesis of a-globin chains.Normally, there are four a-globin genes, and the severity of a-thalassemia depends on how many a-globin genes are affected. As in b-thalassemias, the anemia stems both from a lack of adequate hemoglobin and the effects of excess unpaired non-a. chains (b, g, and d), which vary in type at different ages. In newborns with a-thalassemia, excess unpaired g-globin chains form g4 tetramers known as hemoglobin Barts, whereas in older children and adults excess b-glohin chains form b4 tetramers known as HbH. Since free b and g chains are more soluble than free a chains and form fairly stable homo tetramers, hemolysis and ineffective erythropoiesis are less severe than in b-thalassemias. A variety of molecular lesions give rise to a-thalassemia, but gene deletion is the most common cause of reduced a -chain synthesis. \"- Robbins 9/e p64Ia-THALASSEMIASClinical SyndromesGenotypeClinical FeaturesMolecular GeneticsSilent carrier-/a a/aAsymptomatic; no red cell abnormalityMainly gene deletions0a-Thalassemia trait-/- a/a (Asian)Asymptomatic, like b-thalassemia minor -/a -/a (black African, Asian) HbH disease-/- -/aSevere; resembles b-thaiassemia intermedia Hydrops fetalis-/- -/-Lethal in utero without transfusions\n\nSo the answer to this question is A"}
{"instruction": "Which of the following hormone is not secreted by kidney:\nA. 1,25 dihydroxycholecalciferol\nB. Angiotensin I\nC. Renin\nD. Erythropoietin", "response": "Ans. B. Angiotensin IThe kidney produces three hormones:a. 1,25 dihydroxycholecalciferolb. Reninc. erythropoietinAngiotensinogen is found in the D2 globulin fraction of the plasma. It is synthesized in the liver and is converted to angiotensin I by renin which is further converted to angiotensin II by the action of ACE in lungs.\n\nSo the answer to this question is B"}
{"instruction": "Stem cells are taken from?\nA. Skin\nB. Bone marrow\nC. Oral mucosa\nD. Elementary tract", "response": "ANSWER: (B) Bone marrowREF: Harrison s 18th ed ch: 65, 66, 67Stem cells are biological cells found in all multicellular organisms, that can divide (through mitosis) and differentiate into diverse specialized cell types and can self-renewT to produce more stem cellsThere are three accessible sources of autologous adult stem cells in humans:Bone marrow, which requires extraction by harvesting, that is, drilling into bone (typically the femur or iliac crest),Adipose tissue (lipid cells), which requires extraction by liposuction, andBlood, which requires extraction through pheresis, wherein blood is drawn from the donor (similar to a blood donation), passed through a machine that extracts the stem cells and returns other portions of the blood to the donor.Stem cells can also be taken from umbilical cord blood just after birth. Of all stem cell types, autologous harvesting involves the least risk. By definition, autologous cells are obtained from one's own body, just as one may bank his or her own blood for elective surgical procedures.\n\nSo the answer to this question is B"}
{"instruction": "Cracked nipple may be-\nA. Due to syphilitic chancre\nB. Cause of retention cyst\nC. Pagets disease of nipple\nD. Forerunner of breast abscess", "response": "• This may occur during lactation and be the forerunner of acute infective mastitis.\n• If the nipple becomes cracked during lactation, it should be rested for 24–48 hours and the breast should be emptied with a breast pump.\n• Feeding should be resumed as soon as possible.\n\nSo the answer to this question is D"}
{"instruction": "What is not a feature of Sturge-Weber syndrome?\nA. Rail track appearance\nB. Hemiatrophy of the brain\nC. Convulsion\nD. Empty sella", "response": "Ans. (d) Empty sellaRef: Bailey 261 e p 599Sturge weber syndrome:* Sporadic usually* Large cutaneous angioma unilaterally (Port wine stain)* Brain angiomas* Focal seizures typically opposite to side of lesion* Adrenal Pheochromocytoma* Cortical atrophy.* Angiomas can be seen \"Rail road\" or \"Tram track\" calcification in Occipital region.\n\nSo the answer to this question is D"}
{"instruction": "Piles occurs at-\nA. Superior rectal vein\nB. Inferior rectal vein\nC. Superior Hemorrhoidal aery\nD. None", "response": "Answer- A. Superior rectal veinInternal hemorrhoids in association with superior rectal vessels are located at 3, 7 and 11 O'clock positions corresponding to left, right posterior and right anterior branches of these vessels.\n\nSo the answer to this question is A"}
{"instruction": "Recurrent laryngeal nerve is in close association with:\nA. Superior thyroid artery\nB. Inferior thyroid artery\nC. Middle thyroid vein\nD. Superior thyroid vein", "response": "Ans. is 'b' i.e. Inferior thyroid arteryRef: B.D. C 2nd/e Vol III page 137 & 138, Repeat Inferior thyroid artery is a branch of the thyrocervical trunk. During its course it passes behind the carotid sheath and the middle cervical sympathetic ganglion and its terminal part is related to the recurrent laryngeal nerve.More Questions about arterial supply of the thyroid glandThe thyroid gland in supplied by the following arteriesSuperior thyroid artery a branch of the external carotid arterylies in close association with the external laryngeal nerve.Inferior thyroid artery a branch of the thyrocervical trunk (which arises from the subclavian artery)- its terminal part is intimately related to the recurrent laryngeal nerve. Accessory thyroid arteriesarise from tracheal and esophageal arteriesThyroidea ima artery (or the lowest thyroid artery)found in only about 3% of individualsarises from the brachicephalic trunk or directly from the arch of aorta.During thyroidectomy the superior thyroid artery is ligated near to gland (to save the external laryngeal nerve); and the inferior or thyroid artery is ligated away from the gland (to save the recurrent laryngeal nerve)Questions on venous drainage of thyroid glandThe thyroid gland is drained by the following veinsSuperior thyroid vein.Drains in the internal jugular vein orthe common facial veinMiddle thyroid veinAlso drains in the internal jugular veinInferior thyroid veinDrains into the left brachiocephalic veinA fourth thyroid vein (of Kocher), may emerge between middle and inferior veins and drains into the internal jugular vein\n\nSo the answer to this question is B"}
{"instruction": "Aificial rupture of membrane is contraindicated in :\nA. Hea disease\nB. Diabetes\nC. Pregnancy induced hypeension\nD. Intrauterine death", "response": "Intrauterine death\n\nSo the answer to this question is D"}
{"instruction": "Ramkali bai, a 35 year old female presented with one year history of menstrual irregularity and galactorrhea. She also had off-and-on headache. Her examination revealed bitemporal superior quadrantopia. Her fundus examination showed primary optic atropy. Which of the following is the most likely diagnosis in this case :\nA. Craniopharyngioma\nB. Pituitary macroadenoma\nC. Ophthalmic ICA aneurysm\nD. Chiasmal glioma", "response": "Answer is B (Pituitary macroadenoma): Presence of long standing endocrinopathies (menstrual irregularities and galactorrhea) in an adult suggests a diagnosis of pituitary adenoma over craniopharyngiomas as the latter are primarily tumours of childhood. Visual field defects and optic atrophy suggest local mass effects which are associated with 'macroadenomas' and hence the most likely diagnosis is a pituitary macroadenoma. Note 'Pituitary adenomas are the most common cause of pituitary hormonal syndromes in adults - Harrison 'The functional tumors often produce clinical symptoms of endocrinopathies when they are still small (microadenomas) and restricted to sella. When a tumor grows outside the sella (macroadenoma) it compresses the optic chiasma and nerves and produces a variety of visual defects, the most common being a complete or incomplete bitemporal hemianopia'- API As the tumor progresses it may result in optic atrophy and blindness. Optic gliomas occur mainly in childhood and presentation is usually with visual loss and not endocrinal manifestations. Opthalmic ICA aneurysm is unlikely to present with long standing endocrinopathies over a year prior to appearance of visual symptoms. Craniopharyngiomas can be excluded as in the previous question.\n\nSo the answer to this question is B"}
{"instruction": "Topic : Thyrotoxicosis 1. Amiodarone can cause thyrotoxicosis 2. Plummer's nails are seen 3. Pretibial myxoedema is a feature 4. Ferritin is usually elevated 5. Initial investigation is TSH and free T3\nA. 1, 2 - True & 3, 4, 5 - False\nB. 3, 4 - True & 1, 2, 5 - False\nC. 1, 2, 3, 4 - True & 5 - False\nD. 4, 5 - True & 1, 2, 3 - False", "response": "Initial investigation in a case of thyrotoxicosis includes estimation of TSH and unbound T4 levels. Amiodarone is associated with thyrotoxicosis without hypehyroidism. Other causes of thyrotoxicosis without hypehyroidism are subacute thyroiditis, silent thyroiditis and factitious thyrotoxicosis. Skin manifestations of hypehyroidism are 10Ps such as : Pretibial myxedema, Palmar erythema, Periorbital swelling, Persistent facial flush, Poor hair growth, Pink papules and plaques, Pigmentation increased, Propotosis, sweaty Palms and Plummer's nails. Ferritin levels are increased in thyrotoxicosis due to direct stimulation of ferritin synthesis by thyroid hormones.\n\nSo the answer to this question is C"}
{"instruction": "To which of the following cell types do 'hea-failure' cells belong?\nA. Myocytes\nB. Macrophages\nC. Adipocytes\nD. Pacemaker cells", "response": "Left-sided hea failure leads to pulmonary congestion and edema. There is extravasation of red cells and plasma proteins in the alveoli which are phagocytosed and digested by macrophages The accumulated iron from ingested red cells is stored as hemosiderin. These hemosiderin-laden macrophages are also known as hea failure cells and are telltale signs of previous episodes of pulmonary edema. The common causes of left-sided cardiac failure Ischemic hea disease (IHD) Systemic hypeension Mitral or aoic valve disease Primary diseases of the myocardium (e.g., amyloidosis)\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is NOT a CONTRAINDICATION for laparoscopic surgery: March 2013\nA. Severe cardiac compromise\nB. Hiatus hernia\nC. Bowel herniation\nD. Endometriosis", "response": "Ans. D i.e. Endometriosis Routine laparoscopy in women with unexplained infeility ?nay reveal endometriosis in 10% of cases\n\nSo the answer to this question is D"}
{"instruction": "True about bronchial adenoma\nA. 10-15% of all lung tumour\nB. Mostly malignant\nC. Recurrent haemoptysis\nD. Peripherally located", "response": "Ans. is 'c' i.e., Reccurrent haemoptysis\n\nSo the answer to this question is C"}
{"instruction": "Misoprostol is a :\nA. Prostaglandin E1 analogue\nB. Prostaglandin E2 analogue\nC. Prostaglandin antagonist\nD. Antiprogestin", "response": "Natural prostaglandin in body is PGE2 whereas misoprostol and alprostadil are synthetic PGs which are PGE1 analogs.\n\nSo the answer to this question is A"}
{"instruction": "A 45 years old male presented with recurrent attacks of cholangitis. MRCP and ERCP findings are given below. What is the treatment of choice for this condition?\nA. ERCP with stenting\nB. High dose ursodeoxycholic acid\nC. High dose prednisolone\nD. Liver transplantation", "response": "Primary sclerosing cholangitis. More common in males Smoking is protective Associated with ulcerative colitis. IOC - MRCP Gold standard - ERCP TOC is liver transplantation | if not available High dose ursodeoxycholic acid (to control inflammation).\n\nSo the answer to this question is D"}
{"instruction": "OC pills intake cause psychiatric symptoms, and abdominal pain. Diagnosis is :\nA. Acute intermittent porphyria\nB. Systemic lupus\nC. Thromobosis\nD. Anemia", "response": "Ans. is a i.e. Acute intermittent Porphyria Patient taking OCP's and presenting with abdominal pain and psychiatric problem, diagnosis is undoubtedly Acute Intermittent Porphyria as OCP's can precipitate porphyria Some drugs which precipitate Porphyria are : Barbiturates * Sulfonamide antibiotics Meprobamate * Gluthemide Phenytoin * Carbamazepine Valproic acid * Pyrazolones Griseofulvin * Ergots Synthetic estrogen/progestogen (OCP) * Danazol Alcohol * Succinimide\n\nSo the answer to this question is A"}
{"instruction": "While performing a lumbar puncture, a snap is felt just before entering into the epidural space. This is due to piercing of which structure?\nA. Ligamentum flavum\nB. Supraspinous ligament\nC. Duramater\nD. Posterior longitudinal ligament", "response": "Ans. a. Ligamentum flava (Ref: Gray's 40/e p729, Snell's 9/e p705)While performing a lumbar puncture, a snap is felt just before entering into the epidural space. This is due to piercing of ligamentum flava.Lumbar PunctureThe depth to which the needle will have to pass varies from 2.5 cm or less in a child to as much as 10 cm in obese adults.In caudal anesthesia, needle pierces skin & fascia & sacrococcygeal membrane that fills in the sacral hiatus.The membrane is formed of dense fibrous tissue & represents fused supraspinous & interspinous ligaments as well as ligamentum flavum. A distinct feeling of 'give' is felt when the ligament is penetratedQ.During lumbar puncture, the needle passes through the following anatomic structures before it enters the subarachnoid space:SkinQSubcutaneous tissueQSupraspinous ligamentQInterspinous ligamentQLigamentum flavumQDura materQArachnoid materQ\n\nSo the answer to this question is A"}
{"instruction": "Contra-Indications of phenytoin\nA. Hirsutism\nB. Hepatotoxicity\nC. Osteomalacia\nD. All the above", "response": "Phenytoin ADRs-hirsutism,gingival hyperplasia,hemolysis-Megaloblastic anemia (folic acid def),hepatotoxic,osteomalacia,hypersensitivity,hyperglycemia,lymphadenopathy-pseudolymphoma Fetal hydantoin syndrome-cleft lip, cleft palate, microcephaly. Rerf: KD TTripathi 8th ed.\n\nSo the answer to this question is D"}
{"instruction": "Rotterdam criteria are used to evaluate -\nA. CA Breast\nB. Aberrations in normal development and involution\nC. PCOS\nD. CA Cervix", "response": "Answer- C. PCOSRotterdam criteriaTwo of the following three criteria are required :Oligo/anovulationHyperandrogenismClinical (hirsutism or less commonly male pattern alopecia) orBiochemical (raised FAI or free testosterone)Polycystic ovaries on ultrasound\n\nSo the answer to this question is C"}
{"instruction": "A male 25 years old presents to the dental clinic with a black spot. He also gives the history of previous dental treatments of other teeth as well and wants gold to be filled in his tooth. On examination, it is revealed that 16 no. tooth has pit and fissure caries. Which preparation is used for retention in this restoration?\nA. Vertically oriented grooves\nB. Horizontally oriented grooves\nC. Coves\nD. Skirts", "response": "Skirts.\n Skirts are preparation features used in cast gold restorations that extend the preparation around some, if not all, of the line angles of the tooth. When properly prepared, skirts provide additional, opposing vertical walls that increase retention of the restoration. The placement of skirts also enables increased resistance to fracture by allowing the envelopment of the remaining compromised tooth structure with the restorative material.\nSturdevant operative dentistry 7th E D I T I O N, Page No:131\n\nSo the answer to this question is D"}
{"instruction": "All of the following agents may be used for post coital contraception except:\nA. Danazol\nB. CuT\nC. RU - 486\nD. High dose estrogen", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Van Gogh Syndrome is seen in\nA. Mania\nB. Depression\nC. Schizophrenia\nD. OCD", "response": "C i.e. Schizophrenia\n\nSo the answer to this question is C"}
{"instruction": "Virilisation of the female is present in all, EXCEPT\nA. 17-α hydroxylase deficiency\nB. 21-α hydroxylase deficiency\nC. 11-α hydroxylase deficiency\nD. 11-α hydroxysteroid deficiency", "response": "Congenital adrenal hyperplasia -\nIs commonly caused by following 3 enzyme deficiencies \n\n21 α hydroxylase deficiency (complete)\n21 α hydroxylase deficiency (partial)\n11 α Hydroxylase deficiency\n17 α hydroxylase deficiency\n\n17 α hydroxylase deficiency\n\nHypertension\nNo virilization in females (because the gene that codes for 17 α also codes for the enzyme in adrenal cortex).\nPrimary amenorrhoea and failure of development of secondary sexual characteristic in females.\nMale pseudohermaphrodites\n\n21 α hydroxylase deficiency Complete (Salt losing virilizing syndrome) \n\nHypotension\nVirilization (& Precocious puberty in males)\n\n21α hydroxylase deficiency Partial (Simple virilizing)\n\nNormal B.P.\nVirilization (& Precocious puberty in males)\n\n11 β hydroxylase deficiency\n\nHypertension\nVirilization (& Precicous puberty in males)\n\nSo the answer to this question is A"}
{"instruction": "CA-125 is a marker antigen for the diagnosis of\nA. Colon cancer\nB. Breast cancer\nC. Brain cancer\nD. Ovarian cancer", "response": "(D) Ovarian Carcinoma MARKERSMucins & other GlycoproteinsAssociated Cancers* CA-125Ovarian cancer* CA-19-9Colon cancer, pancreatic cancer* CA-15-3Breast cancer\n\nSo the answer to this question is D"}
{"instruction": "Neoadjuvant chemotherapy is used in all except :\nA. Esophageal carcinoma\nB. Breast carcinoma\nC. Thyroid carcinoma\nD. Non–small cell carcinoma of lung", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Toxic epidermal necrolysis is also called as\nA. Lyell's syndrome\nB. Duhring's disease\nC. Sweet's syndrome\nD. Hailey and Hailey's disease", "response": "Other name for toxic epidermal necrolysis is Lyell s. Syndrome Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, potentially life-threatening, severe mucocutaneous adverse reactions characterized by extensive epidermal detachment, erosion of mucosae and severe constitutional symptoms Ref Harrison20th edition pg 1278\n\nSo the answer to this question is A"}
{"instruction": "A CKD patient on haemodialysis complains of chest pain and back pain after five minutes of dialysis initiation. On reassurance by nurse he feels gradually better and the symptoms resolve on their own. What is the cause?\nA. Anxiety due to the procedure\nB. Type B anaphylactoid reaction to dialyser\nC. Anaphylaxis to ethylene dioxide used for sterilization of dialysis machine\nD. Febrile non-haemolytic transfusion reaction", "response": "OPTION B- Type B anaphylactoid reaction to dialysis- release of cytokine due to chemical composition of dialysis OPTION C. Anaphylaxis to ethylene dioxide can be very lethal and cannot resolve by its own. OPTION D. Febrile non-hemolytic transfusion reaction is related to blood transfusion not dialysis.\n\nSo the answer to this question is B"}
{"instruction": "Prolonged calcium hydroxide therapy for root resorption causes risk of:\nA. Cervical root fracture.\nB. Apical third fracture.\nC. Middle third fracture.\nD. None of the above.", "response": "Cervical root resorption is the best answer among the option but if in options vertical root fracture is given then go for vertical root fracture.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following amino acid can produce oxaloacetate directly in a single reaction?\nA. Alanine\nB. Cysteine\nC. Threonine\nD. Aspaate", "response": "Alanine, Cysteine and Threonine can also produce oxaloacetate but pyruvate only. Aspaate can directly produce oxaloacetate in a single step, i.e. transamination reaction.\n\nSo the answer to this question is D"}
{"instruction": "K-complex is seen in -\nA. REM\nB. Stage 1 NREM\nC. Stage 2 NREM\nD. Stage 3 NREM", "response": "Ans is 'c' i.e., Stage 2 NREM Repeat from all India Dec 2015 of this book\n\nSo the answer to this question is C"}
{"instruction": "Hundred day glaucoma is associated with:\nA. Neovascular glaucoma\nB. CRAO\nC. CRVO\nD. Steroid-related glaucoma", "response": "Ans. C: CRVO Occurrence of neovascular glaucoma in many patients with CRVO is observed in a span of three months, or 100 days, from the onset of occlusion. Diabetes is a primary risk factor for CRVO, along with elevated blood cholesterol, and high blood pressure. CRVO is an acute event\n\nSo the answer to this question is C"}
{"instruction": "ICDS meals for pregnant women provides ?\nA. 300 calories & 10 grams protein\nB. 500 calories & 15 grams protein\nC. 600 calories & 10 grams protein\nD. 600 calories & 20 grams protein", "response": "Ans. is d i.e., 600 calories & 20 grams protein Under ICDS Scheme supplementary nutrition is given to: Children below 6 yrs Nursing mothers Expectant mothers The aim is to supplement nutritional intake for Each child 6-72 months of age 500 calories and 12-15 grams of protein (financial norm of Rs 6.00 per child per day). Severely malnourished child 6-72 months of age - 800 calories and 20-25 grams protein (financial norm of Rs 6.00 per child per day). Each pregnant and nursing woman - 600 calories and 18-20 grams of protein (financial norm of Rs 5.00 per beneficiary per day). Under the revised nutritional and feeding norms for supplementary nutrition, State goverments/UTs have been mandated to provide more than one meal to the children who come to AWCs, which include providing a morning snack in the form of milk/banana/egg/seasonal fruit/micronutrient foified food followed by a hot cooked meal. For children below 3 years of age and pregnant & lactating mothers, \"take home ration\" is to be provided. Supplementary nutrition is given for 300 days a year.\n\nSo the answer to this question is D"}
{"instruction": "Child survival index is the percentage of children surviving till the age of -\nA. 1 year\nB. 3 years\nC. 5 years\nD. 15 years", "response": "park's textbook of preventive and social medicine 23rd edition. *child survival index:the basic measurement of infant and child survival is the under 5 moality.A child survival rate per 1000 bih can be simply calculated by subtracting the under 5 moality rate from 1000 dividing this figures by 10 shows the percentage of those who survive to the age of 5 year.\n\nSo the answer to this question is C"}
{"instruction": "True about cardiac muscles are all except:\nA. Propey of spontaneous and rhythmic contraction\nB. Cardiac muscle exhibits cross striations\nC. Cardiac muscle cells are linear and longitudinal\nD. Cardiac muscle is supplied by autonomic nerve fibers", "response": "Cardiac muscle consists of striated muscle fibers that branch and unite with each other. It forms the myocardium of the hea.Its fibers tend to be arranged in whorls and spirals, and they have the propey of spontaneous and rhythmic contraction. Specialized cardiac muscle fibers form the conducting system of the hea.Cardiac muscle is supplied by autonomic nerve fibers that terminate in the nodes of the conducting system and in the myocardium.\n\nSo the answer to this question is C"}
{"instruction": "Most common cranial nerve involved in CSOM is ?\nA. V\nB. VII\nC. IX\nD. XI", "response": "Ans. is 'b' i.e., VII\n\nSo the answer to this question is B"}
{"instruction": "IT Based TB monitoring\nA. e DOTS\nB. Nischay\nC. Nikshay\nD. Ujjwala", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "All of the following are TRUE regarding myoglobinuria, EXCEPT:\nA. Myoglobin is present in striated skeletal and cardiac fibers\nB. 200 g of muscle must be destroyed to color the urine visibly\nC. Benzidine tests performed on urine is positive\nD. The serum is deep red in color", "response": "The red pigment myoglobin, responsible for much of the color of muscle, is an iron-protein compound present in the sarcoplasm of striated skeletal and cardiac fibers. Destruction of striated muscle, regardless of the cause liberates myoglobin, and because of its relatively small size, the molecule filters through the glomeruli and appears in the urine, impaing to it a burgundy-red color. Because of the low renal threshold for myoglobin, excretion of the pigment is so rapid that the serum remains uncolored. It is estimated that 200 g of muscle must be destroyed to color the urine visibly. As with hemoglobinuria, the guaiac and benzidine tests performed on urine are positive if myoglobin is present. Myoglobinuria should thus be suspected when the urine is deep red and the serum is normal in color. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 45. Electrophysiologic and Laboratory Aids in the Diagnosis of Neuromuscular Disease. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.\n\nSo the answer to this question is D"}
{"instruction": "Pregnancy which continues following threatened abortion is likely to have increased incidence of;\nA. Preterm labor\nB. Fetal malformation\nC. IUGR\nD. All of the above", "response": "Ans. is d, i.e. All of the aboveRef. Dutta Obs 7/e p161Prognosis of threatened abortionIn about two-third, the pregnancy continues beyond 28 weeks. In the rest, it terminates either as inevitable or missed miscarriage. If the pregnancy continues, there is increased frequency of preterm labor, placenta previa, intrauterine growth restriction of the fetus and fetal anomalies.\n\nSo the answer to this question is D"}
{"instruction": "An individual with megaloblastic anemia is found to have a significant folate deficiency. Erythropoiesis is hampered in this man due to his inability to perform which type of enzymatic reaction?\nA. Acyl transfer\nB. Carboxylation\nC. Decarboxylation\nD. Methylation", "response": "Folic acid is a pteridine vitamin that exists as tetrahydrofolate (TH4) in its most reduced form. TH4 can accept methyl, methylene, or formyl carbons and transfer them as methyl groups. This function is vital in nucleotide and amino acid synthesis. Pantothenic acid is a key vitamin in acyl transfer reactions. It forms pa of coenzyme A, which transfers acyl groups in thiol esters as acetyl CoA, succinyl CoA, and other acyl CoA forms. Impoant vitamins in carboxylation reactions include biotin and vitamin K. Biotin carries the carboxyl group in the pyruvate carboxylase and acetyl CoA carboxylase reactions, and vitamin K is utilized in post-translational carboxylation of amino acid residues in blood clotting factors. Oxidative decarboxylation reactions require thiamine (vitamin B1). Examples include the pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase complexes. Ref: Janson L.W., Tischler M.E. (2012). Chapter 5. Enzymes and Amino Acid/Protein Metabolism. In L.W. Janson, M.E. Tischler (Eds), The Big Picture: Medical Biochemistry.\n\nSo the answer to this question is D"}
{"instruction": "With increase in age which of the following is true for lungs\nA. Pulmonary compliance increases\nB. Residual volume decreases\nC. Mucocillary clearance increases\nD. The alveolar dead space decreases", "response": "Ageing and Lung Changes * Decreased chest wall compliance is counter balanced by a loss of elastic recoil of the lungs (increased lung compliance), which is due to a decrease in the number of parenchymal elastic fibers. * Chest wall and thoracic spine deformities which leads to increase work of breathing. * Dilation of air spaces: \"senile emphysema\". * Respiratory muscle strength decreases with age and this impairs effective cough, which is impoant for airway clearance. * Clearance of paicles from the lung through the mucociliary elevator is decreased and associated with ciliary dysfunction. * The alveolar dead space increases with age, affecting aerial oxygen without impairing the carbon dioxide elimination. * The airways receptors undergo functional changes with age and are less likely to respond to drugs used in younger counterpas * Decreased sensation of dyspnea and diminished ventilatory response to hypoxia and hypercapnia, making them more vulnerable to ventilatory failure during high demand states (ie, hea failure, pneumonia, etc) * Decreases in the volume of the thoracic cavity and reduced lung volumes. Hence Residual volume increases. Ref:- Relationship between chest wall and pulmonary compliance and age Charles Mittman, Norman H. Edelman, Ahur H. Norris, and Nathan. Pg num:- 202\n\nSo the answer to this question is A"}
{"instruction": "A luminal cell membrane Na+ channel is the main pathway for Na+ reabsorption in:\nA. Proximal tubule cells\nB. Thick ascending limb cells\nC. Distal convoluted tubule cells\nD. Collecting duct principal cells", "response": "Ans D. Collecting duct principal cellsNa+ reabsorption by collecting duct principal cells occurs via a Na+ channel called ENaC (epithelial sodium channel). Na+ reabsorption in proximal tubule cells is coupled to transport of solutes via cotransport (e.g., Na-glucose) and antiport (e.g., Na+/H+ exchanger) mechanisms. Na+ reabsorption in the thick ascending limb involves a Na-K-2Cl cotransporter and, in the distal convoluted tubule, a Na-Cl cotransporter. Collecting duct intercalated cells are primarily concerned with acid-base, not Na+, transport.\n\nSo the answer to this question is D"}
{"instruction": "Calculus is most common in which salivary gland?\nA. Submandibular\nB. Sublingal\nC. Parotid\nD. Minor salivary glands", "response": "Ans. is 'a' i.e., Submandibular Salivary calculio Calculi may form in the ducts of the submandibular or parotid glands.o They are formed by the deposition of calcium phosphate on the organic matrix of mucin or cellular debris,o About 90% of the stones are seen in the submandibular and 10% in the parotid glands,o Stones my form in the duct or parenchyma of the gland.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following dorsiflexes the foot -\nA. Tibialis posterior\nB. Tibialis anterior\nC. Peroneus brevis\nD. Extensordigitorum brevis", "response": "Ans. is 'b' i.e., Tibialis anterior Ankle movementPrincipal musclesAccessory musclesDorsiflexionTibialis anteriorEDL, EHL, Peroneus tertiusPlantar flexionGastrocnemius, SoleusPlantaris. Tibialis posterior, FDL, FHL\n\nSo the answer to this question is B"}
{"instruction": "The size of actual focal spot is:\nA. 1x3 mm\nB. 1x1 mm\nC. 1x4 mm\nD. 1X2 mm", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Which of the following structures is common to all sphingolipids?\nA. Carnitine\nB. Ceramide\nC. Diacylglycerol\nD. Sphingomyelin", "response": "Sphingolipids are a class of lipids that are structural components of membranes. Ceramide is a component of sphingolipids. Ceramide is composed of sphingosine, a long-chain amino alcohol with a saturated fatty acid linked to the amino group. Sphingolipids can be differentiated on the basis of the \"X\" group that is esterified to the terminal hydroxyl group of ceramide. Carnitine is involved in the oxidation of fatty acids. Carnitine is impoant in transferring fatty acids from the cytoplasm into the mitochondria (the carnitine shuttle). Diacylglycerol is the alcohol common to all phospholipids. The second alcohol (e.g., choline, ethanolamine, serine) contributes the polar head that distinguishes the different classes of phospholipids. Like sphingolipids, phospholipids are found in membranes. Sphingomyelin is a sphingolipid with phosphocholine as its \"X\" group. It is a component of the myelin sheath. Ref: Botham K.M., Mayes P.A. (2011). Chapter 24. Metabolism of Acylglycerols & Sphingolipids. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.\n\nSo the answer to this question is B"}
{"instruction": "Brain damage in phenylketonuria is due to accumulation of-\nA. Tyrosine\nB. Phenylalanine\nC. Tryptophan\nD. None", "response": "Ans. is 'b' i.e., Phenylalanine \"The primary symptom of untreated phenylketonuria (i.e. mental retardation) is the result of consuming foods that contain phenylalanine, which is toxic to brain tissue \"Phenviaketonuriao It is an autosomal recessive disorder due to deficiency of phenylalanine hydroxylase.o As a result phenylalanine is not metabolized by hydroxylase, and metabolism is shifted to alternative pathvway and there is increased concentration of phenylalanine, phenylpyruvate, phenylacetate and phenyl-lactate.o Because phenylalanine is not converted into tyrosine, tyrosine becomes art essential amino acid.o Classical phenylketonuria is due to deficiency ofphenylalanine hydroxylase. Milder form may be caused by deficiency of dihydrobiopterin reductase that produces tetrahydrobiopterin, a cofactor for phenylalanine hydroxylase.Clinical presentationo The babies are normal at birth but may present with vomiting. Gradually mental retrardation and growth retardation develop. Baby has light complexion with blue iris. Other features are microcephaly, rash, hypertonia, seizures, exaggerated tendon reflex, wide spaced teeth, enamel hypoplasia and hyperactivity.o There is musty or mousy odour of urine and other body secretions due to presence of phenylketones.o Pregnant females with increased pheynlalanine (maternal phenylketonuria) may cause mental retardation, microcephaly, growth retardation and CHDs in babies.Diagnosiso Elevated phenylalanine levelso Elevated blood tyrosine levelo Presence of urinary metabolites of phenylalanineo Guthrie's Test - It detects the presence of phenylalanine in serumo FeCl3 - It detects the presence of phenylalanine in urine. FeCl3 is added to patients urine. If it contains phenylalanine, it will turn green.o 2-4 Dinitrophenol hydrazine - gives yellow precipitate with old urine.Treatmento Administration of low phenylalanine is the mainstay of treatment (but phenylalanine should not be completely restricted as it is necessary for growth). Tetrahydrobiopterin can be used in milder form.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is the sign of increased intracranial tension in skull x-ray in an infant?\nA. Separation of the sutures\nB. Tense anterior fontanelle\nC. Macewen's sign\nD. All of the above", "response": "In increased intracranial tension (ICT), there is separation of the cranial sutures, wide fontanels and increased head circumference. The Macewen's or crackpot sign indicates raised intracranial pressure after sutures and fontanel have closed. Papilledema is unusual in infant unless the increase in intracranial pressure is very rapid. Ref: Ghai Essential Pediatrics, 6th edition, Page 525.\n\nSo the answer to this question is D"}
{"instruction": "Delayed afterdepolarization implies-\nA. Increased intracellular Ca2+\nB. Excessive catecholamines\nC. Digitalis toxicity\nD. All of the above", "response": "Ans. is 'd' i.e., All of the above Triggered Activity* Triggered activity occurs when abnormal action potentials are triggered by a preceding action potential, and can result in either atrial or ventricular tachycardia. The abnormal impulses are seen as spontaneous (yet triggered) depolarizations that occur during either phase 3 or 4 of an action potential (called \"afterdepolarizations\"). Triggered activity is more likely to occur when the action prolonged action potential manifested as a long Q-T interval on the electrocardiogram (long Q-T syndrome). Drugs that prolong the action potential duration, such as potassium-channel blockers (class III antiarrhythmics) can sometimes precipitate triggered activity.* After depolarizations can be either early or delayed. Early afterdepolarizations occur during late phase 2 or phase 3 and can lead to a salvo of several rapid action potentials or a prolonged series of action potentials. This form of triggered activity is more likely to occur when the action potential duration is increased. Therefore, drugs that decrease action potential duration (e.g., lidocaine) are often effective against tachyarrhythmias generated by this mechanism. Calcium channel blockers, by decreasing gCa++ can also be effective in their treatment.* Delayed afterdepolarizations occur in late phase 3 or early phase 4 when the action potential is nearly of fully repolarized. The mechanism is poorly understood; however, this type of arthythmia is found to be associated with high intracellular Ca++ concentrations as occurs with digitalis toxicity or excessive catecholamine stimulation. The triggered impulse can lead to a series of rapid depolarizations (i.e. a tachyarrhythmia).\n\nSo the answer to this question is D"}
{"instruction": "False about paial mole\nA. Caused by triploidy\nB. Can be diagnosed very early by USG\nC. Can present as missed aboion\nD. Rarely causes persistent GTD", "response": "Ans. is b i.e. can be diagnosed very early by USG Paial moles Paial moles or incomplete molar pregnancy means that along with the hydatidiform changes some element of fetal tissue is present They have a triploid karyotype (69 chromosomes)deg, the extra haploid set of chromosomes usually is derived from the fatherdeg. Characteristic pathological features of paial mole Chorionic villi of varying sizes with focal hydatiform swelling, cavitation and trophoblastic hyperplasia Marked villous scalloping Prominent stromal trophoblastic inclusions Identifiable embryonic or fetal tissue. Clinical features -- hey generally do not have the dramatic clinical features characteristic of complete pt general these patients have the signs and symptoms of incomplete or missed aboion, and paial mole can be diagnosed after histologic review of tissue obtained by curettage\". Features like hyperemesis, hypehyroidism and Theca lutein cysts are rare in paial mole. Prognosis \"The risk of persistent trophoblastic disease after a paial mole is substancially lower than following a complete molar pregnancy. Moreover, persistent disease is seldom a choriocarcinoma.\" The risk of persistent trophoblastic disease in a case of paial mole is 1-5% wherease with complete mole, it is 15-20% Hence option d i.e. it rarely causes persistent trophoblatic disease is paially correct Diagnosis -- of paial mole by USG is not that easy as is in the case of complete mole because it does not give the characteristic vesicular & ultrasonographic appearance like a complete mole. \"Sonographic features of a paial mole include a thickened, hydropic placenta with fetal tissue. Impoantly, in early pregnancy, sonographv will demon t te the rho raeristic appearance in as few as third of women with a paial mole\" ... Williams Obs 23/ed pg-260 Hence Option b i.e. it can be diagnosed very early by USG is incorrect Remember - - The USG criteria for diagnosis of paial mole is Presence of focal cystic areas in the placental tissues . Increase in transverse diameter of gestational sac. The combination of above two criterias have a positive predictive value of 90% for paial moles . (This means USG can diagnose paial mole but not in early pregnancy) The nonble fetus associated with a triploid paial mole typically has multiple malformations, like syndactyly and hydrocephaly and have symmetrical growth retardation. 13 hcg levels > 200 m IU/rni, after evacuation of paial mole in the third through the eighth week are associated with a 35% risk of persistent trophoblastic disease. Extra edge The most significant recent development in the pathological analysis of H. mole is the use of P57kip2 immunostaining to make a definitive diagnosis of androgenetic complete H. Mole as opposed to an hydropic aboion or a paial mole. P57kip2 is a paternally imprinted gene. which is maternally expressed. The absence of maternal genes in androgenetic complete mole means that the gene cannot be expressed in a complete mole cytotrophoblast Hence V kip2 staining is negative in complete mole in contrast to paial moles, hydropic aboion & normal placenta. This technique is well validated, easy and inexpensive to perform.\n\nSo the answer to this question is B"}
{"instruction": "Least mobile metatarsal of foot\nA. 1st metatarsal\nB. 2nd metatarsal\nC. 3rd metatarsal\nD. 4th metatarsal", "response": "2nd metatarsal is longest and least mobile among all metatarsals, hence more prone for March fracture\n\nSo the answer to this question is B"}
{"instruction": "Long term fluctuation is\nA. Secular\nB. Cyclical\nC. Seasonal\nD. Periodic fluctuation", "response": "Ans. is 'a' i.., Secular\n\nSo the answer to this question is A"}
{"instruction": "Function of I cells of kidney -\nA. Na+ reabsorption\nB. Cl- reabsorption\nC. H+ secretion\nD. K+ secretion", "response": "Ans. is'c'i.e., H+ secretionCollecting duct has :-Principal cells (P cells), which are involved in Na+ reabsorption and ADH stimulated water reabsorption.Intercalated cells (I cells) which are concerned with acid (H.) secretion and HCO transPo\n\nSo the answer to this question is C"}
{"instruction": "Ileocecal tuberculosis is associated with\nA. Megaloblastic anemia\nB. Iron deficiency anemia\nC. Sideroblastic anemia\nD. Normocytic normochromic anemia", "response": ".* Abdominal pain is the most common symptom (90%). It is dull in mesenteric type; colicky in intestinal type. * Common in 25-50 years age group. Equal in both sexes. * Anaemia,megaloblastic type , loss of weight and appetite (80%). * Diarrhoea--10-20%. * Fever--50-70%. ref:SRB&;s manual of surgery,ed 3,pg no 514\n\nSo the answer to this question is A"}
{"instruction": "Specific role of endoplasmic reticulum\nA. Lipid biosynthesis\nB. Lipid catabolism\nC. Maintenance of calcium store\nD. Pentose phosphate pathway", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "A boy presented with weakness in lower limbs, calf hyperophy, positive Gower's sign and an elevated CPK value of 10,000. The most likely diagnosis is:\nA. Duchenne Muscular Dystrophy\nB. Spinal Muscular Atrophy\nC. Myotonia congenita\nD. Myotonic Dystrophy", "response": "A male child presenting with lower limb weakness, calf hyperophy, Postive Gower's sign associated with high levels of CPK suggests the diagnosis of DMD. Ref: Essential of Pediatrics By O P Ghai, 6th Edition, Page 547-548\n\nSo the answer to this question is A"}
{"instruction": "Udai Pareek scale does not include\nA. Education\nB. Family members\nC. House\nD. Income", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Secondary deposits from prostatic carcinoma is commonest in -\nA. Bone\nB. Kidney\nC. Liver\nD. Brain", "response": "Ans. is 'a' i.e., Bone\n\nSo the answer to this question is A"}
{"instruction": "Interferon interferes with replication of virus at the time of:\nA. Protein synthesis\nB. DNA/RNA replication\nC. When virus enters the cell\nD. Uncoating of the virus protein capsule", "response": "Interferons are proteins that can induce a nonspecific resistance to viral infection by several mechanisms, including the inhibition of protein synthesis, inactivation of viral RNA, and enhancement of phagocytic and cytotoxic mechanisms.\n\nSo the answer to this question is A"}
{"instruction": "Not involved in damage to cerebellum:March 2010\nA. Posture\nB. Equilibrium\nC. Asthenia\nD. Tone", "response": "Ans. C: AstheniaSigns of Cerebellar DisordersAtaxia, Reeling, wide-based gait- decomposition of movements, Inability to correctly sequence fine, coordinated actsDysahria-Inability to aiculate words correctly, with slurring and inappropriate phrasingDysdiadochokinesia-Inability to perform rapid alternating movementsDysmetria-Inability to control range of movementHypotonia-Decreased muscle toneNystagmus-Involuntary, rapid oscillation of the eyeballs in a horizontal, veical, or rotary direction, with the fast component maximal toward the side of the cerebellar lesionScanning speech-Slow enunciation with a tendency to hesitate at the beginning of a word or syllableTremor-Rhythmic, alternating, oscillatory movement of a limb as it approaches a target (intention tremor) or of proximal musculature when fixed posture or weight bearing is attempted (postural tremor)Asthenia: (Weakness/Lack of energy and strength/Loss of strength). It is a prominent pa of myasthenia gravis\n\nSo the answer to this question is C"}
{"instruction": "Tuberculous arthritis of a joint in sites other than the spine in advanced cases leads to whcih of the following -\nA. Bony ankylosis\nB. Fibrous ankylosis\nC. Loose joints\nD. Charcot's joints", "response": "Ans- B Fibrous ankylosis is usual outcome of healed tuberculosis of joints except in spine where bony ankylosis takes place.\n\nSo the answer to this question is B"}
{"instruction": "End product of catecholamine metabolism is -\nA. Metanephrine\nB. Vanillyl Mandelic Acid\nC. Normetanephrine\nD. Dihydroxyphenyl glycol", "response": "Ans. is 'b' i.e., Vanillyl Mandelic Acid* Catecholamines are monoamines with amino group attached to dihydroxybenzene.* They include Epinephrine , Norepinephrine and Dopamine* They are specialised products obtained from the two aromatic aminoacids - phenylalanine and tyrosine.* Dopamine is acted upon by Monoaminooxidase (MAO) in the dopaminergic nerves first and then by catecholamine O methyl transferase (COMT) in liver to form Homovandellic acid.* Norepinephrine of noradrenergic nerve endings are also acted upon by Monoamine Oxidase to form Dihydoxyphenylglycol. Dihydroxyphenyl glycol reaches liver, where it is converted by Catecholamine - O Methyl transferase to form Vanillyl Mandelic Acid.* Epinephrine and norepinephrine of adrenal medullary chromaffin cells are acted upon by catecholamine O methyl transferase and is converted to metanephrine and normetanephrine. Metanephrine and normetanephrine through circulation reach liver. In liver, metanephrine and normetanephrine are acted upon monoamine oxidase and are converted to Vanillyl Mandelic Acid (VMA).\n\nSo the answer to this question is B"}
{"instruction": "An eight years old boy presents with progressive swelling around the knee joint of two months duration following mild trauma . Local examination reveals an irregular bony swelling over the upper end of tibia, with raised local temperature and of variable consistency and defined margins. The most likely diagnosis is -\nA. Giant cell tumour\nB. Ewing's sarcoma\nC. Osteogenic sarcoma\nD. Secondary metastasis", "response": "The clinical presentation in question can occur both in Ewing's sarcoma and osteosarcoma.\n\n\nHistory of trivial trauma\nProgressive swelling\nRaised local temperature\nVariable consistency\nill defined margins.\n\n\nHowever, swelling is around the knee joint at upper end of tibia, which favours the diagnosis of osteosarcoma (metaphyseal lesion).\nEwing's sarcoma usually occurs in the diaphysis of the bone (middle of the shaft).\n\nSo the answer to this question is C"}
{"instruction": "Sentinel lymph node biopsy is used for ?\nA. Melanoma\nB. Basal cell carcinoma\nC. Squamous cell carcionoma\nD. Thyroid carcinoma", "response": "Ans. is 'a' i.e., Melanoma Sentinel lymph node biopsy is used for breast carcinoma and melanoma.\n\nSo the answer to this question is A"}
{"instruction": "What is Laser tubes-\nA. It is tube made up of PVC wrapped in two layers, one metallic and other non - reflective layer\nB. It is tube made up of red rubber\nC. It is a metallic tube to prevent any airway fire\nD. It is tube made up of laser resistant material", "response": "Like standard endotracheal tubes, laser tubes are made of polyvinylchloride (PVC), which is flammable in the presence of oxygen and an ignition source, i.e. laser light.The PVC core of the laser tubes is therefore wrapped in two layers, one metallic foil layer which protects the actual tube from the laser light, and an outer non-reflective layer. It is used for Laser surgery.\n\nSo the answer to this question is A"}
{"instruction": "L–Thyroxine is used in:\nA. Thyroid storm\nB. Cretinism\nC. Endemic goiter\nD. Grave's disease", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of these fatty acids is found exclusively in breast milk\nA. Linoleic acid\nB. Linolenic acid\nC. Palmitic acid\nD. Docosahexaenoic acid", "response": "Docosahexaenoic acid\n\nUp to 5-10% of fatty acids in human milk are polyunsaturated. Most of these are linoleic acid with smaller amounts of linolenic acid.\nDocosahexaenoic acid is found in human milk and brain lipids and is required for the development of our nervous system and visual abilities during the first six months of life.\nLack of sufficient docosahexaenoic acid may be associated with impaired mental and visual functioning as well as attention deficit hyperactivity disorder.\n\nSo the answer to this question is D"}
{"instruction": "Hard palate contains:\nA. Keratinized, submucosa, minor salivary gland\nB. Keratinized, absent submucosal layer, minor salivary gland\nC. Nonkeratinized, submucosal layer, minor salivary gland\nD. Nonkeratinized, absent submucosa, minor salivary gland", "response": "Ref. Gray’s anatomy. 41st edition. Page. 510\nHard Palate\n\nThe hard palate is located on the roof of the oral cavity, posterior and medial to the alveolar process of the maxilla.\nThe bony structure is formed by the palatine processes of the maxilla and the horizontal plates of the palatine bones.\nThe periosteum is covered by a firmly attached mucosa centrally, although a submucosa is apparent laterally containing vessels. The hard palate is continuous with the soft palate posteriorly.\n\nMacroscopic Features\nThe hard palate is typically a pale pink colour and may have an orange peel appearance from the palatine salivary glands (more common posteriorly).\nMicroscopy\nThe hard palate is lined with a keratinising stratified squamous epithelium, tightly bound to the underlying periosteum of the palatine bone/maxilla. There is minimal submucosa, which becomes more prominent posteriorl\n\nSo the answer to this question is A"}
{"instruction": "Which type of RPD definitely requires an indirect retainer?\nA. Class I,II R.P.D\nB. Class II, IV R.P.D\nC. Class I & IV R.P.D\nD. Class III & IV R.P.D", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Patch on tonsil is not caused by:\nA. Vincent's angina\nB. Candida\nC. Staphylococcus\nD. Ludwig's angina", "response": "(d) Ludwig's angina(Ref. Scott Brown, 8th ed., Vol 3; 550)Ludwig's angina does not involve tonsil. The other options can lead to patch/pseudomembrane on the tonsil.\n\nSo the answer to this question is D"}
{"instruction": "Maximum oxygen is transpoed in blood\nA. In dissolved form\nB. By albumin\nC. By hemoglobin\nD. By WBC", "response": "About 99% of the O2 transpoed combines with the O2carrying protein hemoglobinRef: Ganong's Review of Medical Physiology Twenty-Third Edition Page No:609\n\nSo the answer to this question is C"}
{"instruction": "In which of these patients can a medial episiotomy be considered superior to a medio lateral episiotomy during delivery of fetus?\nA. Nulligravida with thick perineum\nB. Second stage arrest\nC. Second gravida with moderate anemia\nD. Before application of forceps", "response": "A midline episiotomy is associated with higher risk of third and fouh degree lacerations and following factors are associated with an increased risk.: Nulliparity Second-stage arrest of labor Persistent occiput-posterior position, Midorlowforceps Use of local anesthetics Asian race. A medio lateral episiotomy should beperformed in these mentioned situations A multiparous patient with anemia does not have increased risk for third or fouh degree laceration and since the patient is anemic, with a midline episiotomy, blood loss is less and healing is better, making it a better option.\n\nSo the answer to this question is C"}
{"instruction": "The pin diameter of Minim (inch/mm) is:\nA. 0.019/0.48\nB. 0.024/0.61\nC. 0.015/0.38\nD. 0.027/0.78", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Nipple confusion means?\nA. Baby fed with a bottle finding it difficult and confusing to suckle at breast\nB. Baby not able to suckle with bottle\nC. Baby not able to feed with spoon\nD. Baby not able to feed with paladin", "response": "Ans. (a) Baby fed with a bottle finding it difficult and confusing to suckle at breastRef: OP Ghai 8th ed./153* A problem that may beset a bottlefed baby in which it forgets how to nurse on mother' nipple* Breastfeeding requires far more vigorous mouth and tongue motions and greater muscle coordination than bottlefeeding.* On bottle nipples or even pacifiers, a newborn can forget how to nurse properly.* This confusion can lead to diminished or discontinued nursing. Nipple confusion is usually not a concern after the early weeks, once the baby is nursing well.\n\nSo the answer to this question is A"}
{"instruction": "Which type of RNA has the highest percentage of modified base?\nA. mRNA\nB. tRNA\nC. rRNA\nD. snRNA", "response": "The transfer RNAs show extensive internal base pairing and acquire cloverleaf-like structureThey contain significant propoion of unusual basesThese include dihydrouracil, pseudouridine, and hypoxanthineRef: DM VASUDEVAN, 7th edition, page no: 596,597\n\nSo the answer to this question is B"}
{"instruction": "Resolution of corpus luteum occurs because of:\nA. Increased levels of progesterone\nB. Increased levels of estrogen\nC. Decreased levels of LH\nD. Decreased levels of FSH", "response": "Continued corpus luteum function depends on continued LH production. In the absence of this stimulation, the corpus luteum will invariably regress after 12 to16 days and form scar-like corpora albicans. In the absence of pregnancy, the corpus luteum regresses, and estrogen and progesterone levels wane. If pregnancy occurs, HCG from the placenta will mimic LH action and the corpus luteum continues to secrete progesterone.\n\nSo the answer to this question is C"}
{"instruction": "All are indications of methotrexate except?\nA. Leukemia\nB. Breast cancer\nC. Rheumatoid ahritis\nD. Renal failure", "response": "Ans. is 'd' i.e., Renal failure o MTX, usually in combination with other drugs, is effective against acute lymphocytic leukemia, choriocarcinoma, Burkitt's lymphoma in children, breast cancer, and head neck carcinomas.\n\nSo the answer to this question is D"}
{"instruction": "Measures of central tendency is given by all, EXCEPT:\nA. Mean\nB. Median\nC. Range\nD. Mode", "response": "Measures of central tendency is given by mean, median & mode. Range gives measure of dispersion.\n\nSo the answer to this question is C"}
{"instruction": "If stage lb cervical cancer is diagnosed in a young woman, while performing radical hysterectomy which structure would you not remove\nA. Uterosacral and uterovesical ligament\nB. Pelvic Lymph nodes\nC. periureteral tissues\nD. Upper third of vagina", "response": "Ovaries are not removed in radical hysterectomy if not diseased Types of Hysterectomy Type I : Extrafascial Hysterectomy Simple total abdominal hysterectomy with or without bilateral salpingo-oophorectomy Type II: Modified Radical Hysterectomy Removes the medial half of cardinal and uterosacral ligaments Type II differs From Type III by Uterine aery is transected at the level of ureter; Preserving the ureteral branch to the ureter Cardinal ligament is divided close to the midpoion near the ureteral dissection Anterior vesicouterine ligament is divided but posterior vesicouterine ligament is conserved Smaller margin of vagina is removed Type III Removal of most of the uterosacral, cardinal ligaments and upper one-third of the vagina Associated with Pelvic lymphadenectomy Extended Radical Hysterectomy Type IV: Additional structures removed Periureteral tissue Superior vesicle aery Three fouhs of vagina Type V: Poions of distal ureter and bladder are resected Reference: Berek and Novak's Gynecology; 15th edition; Chapter 36\n\nSo the answer to this question is C"}
{"instruction": "Birth rate is -\nA. Live birth/1000 mid yr. population\nB. Birth/1000 mid yr population\nC. Live birth/10000 mid yr. population\nD. Live birth/10,000 population of reproductive age group (15-45)", "response": "Fertility \n\nBy fertility is meant the actual bearing of children.\nA woman's reproductive period is roughly from 15 to 45 years - a period of 30 years.\nMeasurement of fertility are :-\n\n\nBirth rate \nGeneral fertility rate (GFR) \nGeneral marital fertility rate (GMFR) \nAge specific fertility rate (ASFR) \nAge specific marital fertility rate (ASMFR) \nTotal fertility rate (TFR) \nTotal marital fertility rate (TMFR)\nGross reproduction rate (GRR)\nNet reproduction rate (NRR)\nChild woman ratio\nPregnancy rate\nAbortion rate\nAbortion ratio\nMarriage rate\n\nBirth rate\n\nBirth rate defined as \"the number of live birth per 1000 estimated mid yr. populations in a give yr.\"\n\nBirth rate = Number of live birth during the year / Estimated mid year population x 1000\n\nSo the answer to this question is A"}
{"instruction": "Treatment for poosystemic encephalopathy is all except\nA. High protein diet\nB. Lactulose\nC. Oral neomycin\nD. Enema", "response": "It most often results from high gut protein or acute metabolic stress (eg, GI bleeding, infection, electrolyte abnormality) in a patient with poosystemic shunting. Symptoms are mainly neuropsychiatric (eg, confusion, asterixis, coma). Diagnosis is based on clinical findings. Ref Davidson edition23rd pg 864\n\nSo the answer to this question is A"}
{"instruction": "Most common cause of cerebrovascular accident is:\nA. Embolism\nB. Arterial thrombosis\nC. Venous thrombosis\nD. Hemorrhage", "response": "Ans. (a) Embolism* MC cause of cause of CVA- Ischemia (85% cases) due Embolism (75%) > Thrombosis (25%)* CVA may also be due to hemorrhage (<15%) - Parenchymal, Subarachnoid, Epidural or Subdural hemorrhage* Stroke in young women in India are predisposed by Cortical venous thrombosis due to OCP consumption.\n\nSo the answer to this question is A"}
{"instruction": "The most common source of pulmonary embolism\nA. Amniotic fluid embolism\nB. Renal artery embolism\nC. Large veins of leg\nD. Cardio thoracic surgery", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "AH of the following are true about lymphocyte depletion variety of HL except:\nA. Least common\nB. CD 20 expression\nC. CD 15 & CD 30 expression\nD. Pleomorphic RS cell", "response": "Ans: b (CD 20 expression) Ref: Robbins, 7th ed, p. 688CD20 expression is classical of lymphocyte predominant variety of HL and not lymphocyte depletion variety.L & H variant is seen in lymphocyte predominant variety of HL and it classically expresses CD20 and germinal centre transcription factor BCL 6.HODGKIN LYMPHOMA (REAL CLASSIFICATION)|||Classical subtypes1) Nodular sclerosis2) Mixed cellularity3) Lymphocyte rich4) Lymphocyte depletionLymphocyte predominance(Distinct immunophenotype) SubtypesMorphologyImmunophenotypeNodular sclerosisLacunar variantsOccasional RS cellsCD 15 (+), CD 30(+)Mixed cellularityMononuclear variantRS cells (+)CD 15(+),CD 30(+)Lymphocyte richMononuclear variantRS cells (+)CD 15(+),CD 30(+)Lymphocyte depletionReticular variant(Pleomorphic variant)CD 15(+),CD 30(+)LymphocytepredominanceL&H (Popcorn cells)CD20 (+)CD 15(-),CD 30(-)\n\nSo the answer to this question is B"}
{"instruction": "Rhinolith can cause?\nA. Nasal obstruction\nB. Epistaxis\nC. Epiphora\nD. All the above", "response": "Rhinoliths are more common in adults. The presentation is usually unilateral nasal obstruction and foul smelling discharge which is very often bloodstained. Frank epistaxis and neurologic pain may result from ulceration of the surrounding mucosa mass are seen between the septum and nasal turbinates, the mass surface is irregular and brittle, may break off. Maybe surrounded by granulations also. Ref - PL DHINGRA diseases of ear nose and throat, 6th edition, page no 161\n\nSo the answer to this question is D"}
{"instruction": "A 34 year old patient presented with thyroid nodule. Ultrasonography of the thyroid nodule shows foci of calcification. Histological features are shown in the diagram below, what is your likely diagnosis?\nA. Follicular carcinoma\nB. Medullary carcinoma\nC. Papillary carcinoma\nD. Anaplastic carcinoma", "response": "Given histopathological slide shows branching papillae having a fibrovascular stalk covered by a single to multiple layers of cuboidal epithelial cells. These features along with given history point towards papillary carcinoma of thyroid. Nuclei of papillary carcinoma cells contain finely dispersed chromatin, which impas optically clear / empty appearance, giving rise to ground-glass nuclear appearance or Orphan annie eye nuclei. In addition, invagination of cytoplasm may give appearance of intranuclear inclusions (\"pseudo-inclusions\") / intranuclear grooves. These nuclear features are sufficient for diagnosis of papillary carcinoma,even in absence of papillary architecture. Concentrically calcified structures termed Psammoma bodies are often present, usually within cores of papillae.\n\nSo the answer to this question is C"}
{"instruction": "Which among the following is a typical intercostal nerve?\nA. First\nB. Second\nC. Third\nD. Seventh", "response": "Typical intercostal nerves are the ones that are confined to their own intercostal spaces in the thoracic wall. The course of the third, fouh, fifth, and sixth intercostal nerves can be regarded as typical. They run forwards in the intercostal spaces lying between the second and third layers of the muscles. A typical intercostal nerve has four major branches. The first branch is made up of the unmyelinated postganglionic fibers of the gray rami communicantes, which interfaces with the sympathetic chain. The second branch is the posterior cutaneous branch, which innervates the muscles and skin of the paraspinal area. The third branch is the lateral cutaneous division, which arises in the anterior axillary line. It provides most of the cutaneous innervation of the chest and abdominal wall. The fouh branch is the anterior cutaneous branch supplying innervation to the midline of the chest and abdominal wall.\n\nSo the answer to this question is C"}
{"instruction": "Chief extensor of thigh at hip joint is supplied by:\nA. Inferior gluteal nerve\nB. Superior gluteal nerve\nC. Sciatic nerve\nD. Peroneal nerve", "response": "Ans. A Inferior gluteal nerveRef: Netter's Clinical Anatomy, 3rd ed. pg. 279-280* The chief extensor of thigh at hip joint is gluteus maximus and helps in rising from sitting position.* It is supplied by inferior gluteal nerve (L5, S1, S2). (mnemonic: M.I.G- 512)* Gluteus medius are minimus are powerful abductor of thigh and are supplied by superior gluteal nerve (L4, 5, S1).\n\nSo the answer to this question is A"}
{"instruction": "Biological value is used for assessment of -\nA. Fat quality\nB. Protein quality\nC. Carbohydrate quality\nD. None", "response": "-the net protein utilisation is considered of more practical value for evaluation of protein because it is the product of biological value and digestibility coefficient divided by 100. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:610 <\\p>\n\nSo the answer to this question is B"}
{"instruction": "After tonsillectomy, secondary haemorrhage occurs\nA. Within 24 hours\nB. After 2 weeks\nC. 5-10 post operative days\nD. After a month", "response": "After tonsillectomy primary haemorrhage occurs during surgery reactionary bleeding with in 24 hrs, secondary haemorrhage between 5-10 days Secondary haemorrhage is the result of sepsis and premature separation of the membrane Simple measures like removal of clots, application of adrenaline or hydrogen peroxide usually suffice. For profuse bleeding, electrocoagulation is done Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition; Pg no: 430\n\nSo the answer to this question is C"}
{"instruction": "After suffering a severe bout of pneumonia, a 46-year-old renal transplantation patient develops a lung abscess. She has been receiving immunosuppression therapy since her last kidney transplantation 3 years ago. What is the most appropriate treatment?\nA. Needle aspiration\nB. Urgent thoracotomy\nC. Antituberculous therapy\nD. Antibiotics and vigorous attempts to obtain bronchial drainage", "response": "Antibiotics and vigorous attempts to obtain bronchial drainage will treat the abscess adequately in the majority of cases. Lung abscesses commonly are associated with aspiration pneumonia, where the abscess is found posteriorly. In the presence of an unexplained lung abscess, bronchoscopy is essential to exclude a foreign body or tumor that could cause bronchial obstruction.\n\nSo the answer to this question is D"}
{"instruction": "Cereal protein is deficient in which amino acid\nA. Leucine\nB. Lysine\nC. Phenylalanine\nD. Tryptophan", "response": "Ans. is 'b' i.e., Lysine Supplementary action of proteins Cereals are deficient in essential amino acid Lysine & threonine. Pulses are deficient in essential amino acid Methionine. So if cereals are eaten with pulses, their proteins complement each other & provide a more balanced and complete protein intake.\n\nSo the answer to this question is B"}
{"instruction": "Radio graphically Mental foramen lies between the roots of\nA. Canine and first premolar\nB. First and second premolars\nC. Second premolar and first molar\nD. In the incisor region", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Squamous cell carcinoma spreads commonly via -\nA. Implantation\nB. Hematogenous spread\nC. Lymphatic spread\nD. Trancoelomic spread", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which of the following connections are found between Odontoblasts in Odontoblastic layer?\nA. Zonula adherence\nB. Zonula occludence\nC. Nexus\nD. All of the above", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Regarding rabies, true is:\nA. Incubation period depends on the site of bite\nB. Diagnosis is by eosinophilic intranuclear inclusion\nC. It is a DNA virus\nD. Caused only by dogs", "response": "Ans. is 'a' i.e., Incubation period depends on the site of bite(Ref: PSM Park, 19th/e, p. 228)Variability of Incubation Period* Incubation period of rabies depends on:- The site of bite.- Number of wounds.- Species of biting animal.- Severity of bite.- Amount of virus injected.- Protection provided by clothing and treatment undertaken.ABOUT OTHER OPTIONS* Pathognomonic Negri bodies are intracytoplasmic (not intranuclear) eosinophilic inclusion bodies. Q* Rabies virus is a RNA virus.* It can be caused by many wild animals (not only by dogs).\n\nSo the answer to this question is A"}
{"instruction": "Treatment of CMV retinitis in AIDS patient is -\nA. Amantadine\nB. Fludrabine\nC. Oseltamivir\nD. Valganciclovir", "response": "Ans. is 'd' i.e. Valganciclovir o CMV retinitis is the most common ophthalmic manifestation of CMV, occuring as a congenital infection in infants or an opportunistic infection in the immunocompromised hosto Adults commonly affected include those individuals with acquired immunodeficiency syndrome (AIDS), oncology patients, and patients on immunosuppresive therapy. There is characteristic hemorrhagic, full thickness retinitis. In early stage there are yellow-white exudates (areas of retinal necrosis) associated with areas of vasculitis and retinal hemorrhage. There may be exudative retinal detachment and ultimately, there occurs total retinal atrophyo Treatment of CMV retinitis -# HAART.# Valganciclovir- pro-drug of ganciclovir that is taken orally and is as effective for both induction (900 mg twice daily for up to 3 weeks) and maintenance (900 mg daily). Neutropenia is a common side effect due to bone marrow suppression, but can be effectively treated with filgrastim (granulocyte colony-stimulating factor.# Ganciclovir, foscamet and cidofovir given intravenously were formerly key therapeutic agents.# Ganciclovir slow-release intravitreal implant.\n\nSo the answer to this question is D"}
{"instruction": "True about apoptosis is all except?\nA. Considerable apoptosis may occur in a tissue before it becomes apparent in histology\nB. Apoptotic cells appear as round mass of the intensely eosinophilic cytoplasm with dense nuclear chromatin fragments\nC. Apoptosis of cells induce inflammatory reaction\nD. Condensation of chromatin", "response": "Ans. (c)Apoptosis of cells induce inflammatory reactionRef: Robbin's pathology 9th ed. 152-53Remember Important Features of Apoptosis* Formation of cytoplasmic blebs and apoptotic bodies* Cell shrinkage: The cells are smaller in size and the cytoplasm is dense* Chromatin condensation: This is the most characteristic feature of apoptosis* Absence of inflammation* Gel Electrophoresis of DNA shows 'Step ladder Pattern.\n\nSo the answer to this question is C"}
{"instruction": "Intramuscular route is precluded during the medication of:\nA. Anti-hypertensives\nB. Anti-diabetics\nC. Anticoagulants\nD. Anti-fibrinolytics", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Danger space of pharynx is bounded by\nA. Buccopharyngeal fascia anteriorly and alar fascia posteriorly\nB. Preveebral fascia anteriorly and veebral body posteriorly\nC. Alar fascia anteriorly and preveebral fascia posteriorly\nD. Tonsils anteriorly and superior constrictor muscle posteriorly", "response": "Ref:- Dhingra; pg num:-268\n\nSo the answer to this question is C"}
{"instruction": "A learned behaviour which is permanent and consistent but liable to change –\nA. Attitude\nB. Knowledge\nC. Practice\nD. Cultural belief", "response": "Practice/Habit → Liable to change by motivation\nAttitude → Not liable to change by motivation\n\nSo the answer to this question is C"}
{"instruction": "A patient with recent–onset primary generalized epilepsy develops drug reaction and skin rash due to phenytoin sodium. The most appropriate course of action is :\nA. Shift to clonazepam\nB. Restart phenytoin sodium after 2 weeks\nC. Shift to sodium valproate\nD. Shift to ethosuximide", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "A person had an episode of dengue serotype 1, after 2 years with serotype 2. What will be effect of this episode?\nA. Mild ds d/t neutralizing abs present\nB. Increased chances of DHF\nC. No chances of DHF\nD. No effect on present illness", "response": "Ans. b. Increased chances of DHFPATHOGENESIS OF DENGUE VIRUSPrimarily dengue infection occurs when a person is infected with dengue virus for the first time with any one serotype.Months to years later, a more severe form of dengue illness may appear (Called secondary dengue infection) due to infection with another second serotype which is different from the first serotype causing primary infection.The severity of secondary dengue infection occurs due to a unique immunological phenomenon called antibody dependent enhancement (ADE), i.e. non-neutralizing antibody produced against the first serotype will combine, cover and protect the second serotype from host immune response.ADE is remarkably observed when serotype 1 infection followed by serotype 2, which also claims to be the most severe form and prone to develop into Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS).Serotype 2 is more apparently more dangerous than other serotype.\n\nSo the answer to this question is B"}
{"instruction": "What would tend to decrease GFR by more than 10% in a normal kidney?\nA. Decrease in renal aerial pressure from 100 to 85 mm Hg\nB. 50% decrease in afferent aeriolar resistance\nC. 50% decrease in efferent aeriolar resistance\nD. 50% increase in the glomerular capillary filtration coefficient", "response": "50% reduction in efferent aeriolar resistance would cause a large decrease in GFR--greater than 10%. A decrease in renal aery pressure from 100 to 85 mm Hg would cause only a slight decrease in GFR in a normal, autoregulating kidney. A decrease in afferent aeriole resistance, a decrease in plasma colloid osmotic pressure, or an increase in the glomerular capillary filtration coefficient would all tend to increase GF\n\nSo the answer to this question is C"}
{"instruction": "False about Marbel bone disease\nA. Associated with Type II Renal Tubular Acidosis\nB. Pancytopenia\nC. Mandible osteomyelitis\nD. Treated with bone marrow transplantation", "response": "Osteopetrosis / Marbel bone disease is associated with Type IRTA\n\nSo the answer to this question is A"}
{"instruction": "Clindamycin acts by inhibiting -\nA. Cell wall synthesis\nB. Protein synthesis\nC. Cell membrane synthesis\nD. Glucose utilization", "response": "Ans. is 'b' i.e., Protein synthesis o It inhibits protein synthesis by binding to 50-S ribosome.\n\nSo the answer to this question is B"}
{"instruction": "Direct Coomb's test detects:\nA. Antibodies attached to RBC Surface\nB. Antibodies in the serum\nC. Antigens attached to RBC Surface\nD. Antigens in the serum", "response": "Answer is A (Antibodies attached to RBC Surface) Direct Coomb's test detects IgG Antibodies (or complements) attached to the surface of RBCs. Indirect Coomb's test detects IgG antibodies in the serum (e.g. Anti-D Antibodies).\n\nSo the answer to this question is A"}
{"instruction": "True regarding myocardial O2 demand?\nA. Inversely related to heart rate\nB. Has constant relation to external cardiac work\nC. Directly proportional to duration of systole\nD. Is negligible at rest", "response": "Oxygen demand depends on the work being done. The work done is to pump the blood which is in the ventricles (preload) against the resistance in the aorta (afterload).\n So, myocardial oxygen demand depends on\n\nRate - Directly proportional\nContractility - Directly proportional\nIntramyocardial tension - Directly proportional\nAfter load - Directly proportional\nPreload - Directly proportional\nWall thickness - Inversely proportional\n\nThe oxygen demand of myocardium is not having the same change with varying external works.\n\nSo the answer to this question is C"}
{"instruction": "26 year old female patient presents to OPD with inability to focus on close objects, but can clearly see the distant objects . Most likely damage to which structure will lead to following condition ?\nA. Ciliary ganglion and oculomotor nerve\nB. Oculomotor nerve and long ciliary nerve\nC. Sho ciliary nerves and ciliary ganglion\nD. Oculomotor and trochlear nerve", "response": "Damage to parasympathetic ciliary ganglion and parasympathetic fibres in sho ciliary nerve impairs the ability to focus on close objects (accommodation). Because the patient can move his eyeballs normally, the oculomotor nerve is not damaged even if this nerve contains preganglionic parasympathetic fibres. Patient can see distant objects clearly because the long ciliary nerve also carries sympathetic fibres to the dilator pupillae. Ability to move eyeball normally indicates that the oculomotor, trochlear, and abducens nerves are intact.\n\nSo the answer to this question is C"}
{"instruction": "Swollen belly syndrome is caused by\nA. Strongyloides stercoralis\nB. Stongyloides fuelleborni\nC. Necator Americanus\nD. Ancyclostoma duodenale", "response": "Strongyloides Fuelleborni causes swollen belly syndrome.\n\nSo the answer to this question is B"}
{"instruction": "Metastasis of ca buccal mucosa goes to\nA. Hea\nB. Brain\nC. Regional lymph node\nD. Lungs", "response": "Tumors in this area have a propensity to spread locally and to metastasize to regional lymphatics . Lymphatic metastasis of Buccal ca go to submandibular and later upper jugular nodes. MC type of Buccal ca - Squamous cell ca Commonest site of origin - angle of mouth or the line of occlusion of upper and lower teeth\n\nSo the answer to this question is C"}
{"instruction": "All are features of nephrotic syndrome in children except -\nA. Lipiduria\nB. Hyperlipidemia\nC. Hyperalbuminemia\nD. Proteinuria", "response": "Ans. is 'c' i.e., Hyperalbuminemia Nephrotic syndrome o Nephrotic syndrome is a group of disease having different pathogenesis and characterized by 1) Proteinuria (> 3.5 gm/day) 4) Hyperlipidemia 2) Hypoalbuminemia 5) Lipiduria --> lipid casts Edema 6) Hypercoagulability\n\nSo the answer to this question is C"}
{"instruction": "A female at 37 week of pregnancy comes with grade 3 placenta pre, bleeding per vaginum with uterine contractions. What is the MOST appropriate management in this patient?\nA. Dexamethasone and nifedipine\nB. Bed rest and sedation\nC. Wait and watch\nD. Emergency LSCS", "response": "The best management in this patient presenting with grade 3 placenta pre, bleeding per vagina and uterine contraction is emergency LSCS. Also know: Other indications of LSCS in patients with placenta pre are: Severe degree of placenta pre (type II posterior, type III, type IV) Lesser degree of placenta pre when amniotomy fails to stop bleeding or fetal distress appears. Complicating factors associated with lesser degrees of placenta pre where vaginal delivery is unsafe. Ref: Textbook of Obstetrics By D.C Dutta, 6th edn, page 252\n\nSo the answer to this question is D"}
{"instruction": "Evans's syndrome refers to which of the follwoing?\nA. Autoimmune hemolytic anemia with autoimmune neutropenia\nB. Autoimmune hemolytic anemia with autoimmune thrombocytopenia\nC. Autoimmune hemolytic anemia with marked bone marrow suppression\nD. Autoimmune hemolytic anemia with hypersplenism", "response": "In some cases, Autoimmune hemolytic anemia (AIHA) can be associated with autoimmune thrombocytopenia (Evans's syndrome). Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 881\n\nSo the answer to this question is B"}
{"instruction": "Ifosfamide belong to which class?\nA. Alkylating agent\nB. Antimetabolite\nC. Taxanes\nD. Antibiotics", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "The most significant adverse effect of ACE inhibition is:\nA. Hypotension\nB. Hypertension\nC. Hypocalcemia\nD. Hypercalcemia rate", "response": "Ans. is 'a' i.e. Hypotension [Ref: KDT 5th/e, p 449 _First dose hypotension is a significant adverse effect of ACE inhibitorA steep fall in blood pressure may occur following the first dose of an ACE inhibitor particularly in patients with elevated peripheral resistance.Care should be exercised in patients who are salt depletedbeing treated with multiple antihypertensive drugs having congestive heart failure on diureticsIn the above mentioned situations, t/t should be initiated with very small doses of ACE inhibitors or salt intake should be increased and diuretics should be withdrawn before beginning the therapy.Other adverse effects of ACE inhibitorsHyperkalemiaIs an important risk factor in patients withimpaired renal functionon K+ sparing diureticsCoughPersistent brassy coughCaused by inhibition of bradykininRashes, urticaria Angioedema DysgeusiaReversible loss of taste sensationMore common with captoprilFetopathicTeratogenic when given in 2nd trimesterSafe in first half.Granulocytopenia and proteinuria Acute renal failureIt is precipitated by ACE inhibitors in patients with bilateral renal artery stenosis due to dilatation of efferent arterioles and fall in glomerular filtration pressure.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following does not present antigens:\nA. NK cells\nB. Dendritic cells\nC. Langerhans cells\nD. Macrophages", "response": "APC (Antigen-presenting cell): \n\nMost common APC → Immature dendritic cell.\nThe most potent stimulator of native T cell → Mature dendritic cell.\nAPCs are – Dendritic cells, Langerhan’s cells, B-cell.\n\nSo the answer to this question is A"}
{"instruction": "What is the recommended duration of quarantine for yellow fever?\nA. 3 days\nB. 6 days\nC. 9 days\nD. 12 days", "response": "A traveller should be placed in a mosquito proof ward for 6 days from the date of leaving an infected area. Ref: Park 21st edition, page 259.\n\nSo the answer to this question is B"}
{"instruction": "Treatment of choice for glue ear is -\nA. Conservative\nB. Myringotomy with cold knife\nC. Myringotomy with ventilation tube insertion\nD. Myringotomy with diode laser", "response": "Ans. is 'c' i.e. Myringotomy with ventilation tube insertion Treatment of choice for glue ear is - Myringotomy and aspiration of effusion with placement of ventilation tube.Glue ear or Otitis media with effusion (OME)(also k/a Serous otitis media, secretory otitis media, Mucoid otitis media)OME is characterized by a non-purulent effusion of the middle ear that may be either mucoid or serous.Symptoms usually involve hearing loss or aural fullness but typically do not involve pain or fever. In children hearing loss is generally mild and is often detected only with an audiogram.The fluid is nearly sterile.The condition is commonly seen in school-going children. It is the leading cause of hearing loss in children. PathogenesisTwo main mechanisms are thought to be responsible.Eustachian tube dysfunctionIncreased secretory activity of middle ear mucosa TreatmentTreatment may be medical or surgicalMedical measures are controversial and involveDecongestantsAntiallergic measuresAntibioticsMiddle ear aerationValsalva manoeuvrepolitzerisation or eustachian tube catheterizationchewing gumSurgicalMyringotomy and aspiration of fluidGrommet or ventilation tube insertionSurgical t/t of causative factor - adenoidectomy, tonsillectomy, and/or wash out of maxillary antra.\n\nSo the answer to this question is C"}
{"instruction": "An 8 month female baby presented with 1 day h/o lethargy. She had vomited several times. Her drug addict mother said she appeared \"intoxicated\".O/E: baby was obtunded but she was easily arousable and muscle tone was normal. RR = 60/min. Pupils are normal. BP was 112/62.Ix: Na+= 135 K+ = 4.2 ,Glucose 5.9 mmol/l , Cl- = 116 ,Urinalysis: pH = 5.0; negative for glucose & ketones, positive for calcium oxalate crystals. ABG: pH = 7.19, pCO2 = 20, PO2 = 100 , HCO3 = 6.2 ?\nA. Metabolic acidosis compensated\nB. Metabolic acidosis paially compensated\nC. Metabolic alkalosis compensated\nD. Metabolic alkalosis paially compensated", "response": "Impoant points in history: * Drug addict mother * Tachypnea * Pupils normal - no CNS depression by opioids * Calcium oxalate crystal - d/t ethylene glycol poisoning Ethylene glycol poisoning - leads to - acute tubular necrosis ABG: pH = 7.19, pCO2 = 20, PO2 = 100 , HCO3 = 6.2 Calculation: Anion gap: Na - (Cl- + HCO3) = 135-(116+6) = 135-122 = 13 pH is 7.19 acidic.(normal pH 7.35-7.45) pCO2 is 16( low )that cannot explain acidotic PH (normal pco2 40) HCO3 is 6.2 which is low that explain low pH. therefore acidic pH is metabolic problem.i.e.metabolic acidosis in this CASE compensation is going on which is hyperventilation leading to CO2 washout.low PCo2 since is PH is not normalised so paial compensation From ABG: metabolic acidosis paially compensated. expected PCO2 =15+HCO3=15+6=21 actual PCO2 is almost equal to expected value this implies compensation is going fine.\n\nSo the answer to this question is B"}
{"instruction": "Untoff phenomenon is\nA. Worsening of symptom with cold\nB. Relief of symptom with cold\nC. Worsening of symptom with heat and exeion\nD. Palsy of symptom with heat and excretion", "response": "Harrison's principles of internal medicine 17th edition. *U/l visual blurring may occur following a hot shower or with physical exercise. Uhthoff's phenomenon (also known as Uhthoff's syndrome, Uhthoff's sign, and Uhthoff's symptom) is the worsening of neurologic symptoms in multiple sclerosis (MS) and other neurological, demyelinating conditions when the body gets overheated from hot weather, exercise, fever, or saunas and hot tubs. Ref Harrison20th edition pg 2345\n\nSo the answer to this question is C"}
{"instruction": "Drug of choice in nocturnal enuresis is\nA. Imipramine\nB. Diazepam\nC. Amoxapine\nD. Reboxetine", "response": "(Imipramine) (449-KDT 6th)Enuresis - In children above 5years, imipramine at bed time is effective, but bed wetting may again start when the drug is stopped* Elderely subjects with bed wetting have also benefittcd* Imipramine is most likely and nortriptyline is least likely to cause orthostatic hypotension (145-LP3rd)\n\nSo the answer to this question is A"}
{"instruction": "Chest X-ray, most common view is -\nA. AP\nB. PA\nC. RAO\nD. LAO", "response": "Ans. is 'b' i.e., PA o Posteroanterior view of the chest is most commonly used view for chest X-ray.\"The best view of the chest is the postero-anterior view with the patient standing and lung fully expanded\"--Toriano\n\nSo the answer to this question is B"}
{"instruction": "What is epicolic node?\nA. Node draining colon\nB. Adjacent to aoa\nC. Epitracheal node\nD. None", "response": ".Lymphatic Drainage of colon * Mucosa contains no lymph channels, so mucosal cancers rarely metastasize. * Nodes are epicolic (located in the colonic wall), paracolic (located along the inner margin), intermediate (located near mesenteric vessels), principal (located near main mesenteric vessles). ref:SRB&;s manual of surgery,ed 3,pg no 818\n\nSo the answer to this question is A"}
{"instruction": "Which of the following should not be used in the ROSACEA?\nA. Isoetretin\nB. Metronidazole\nC. Steroids\nD. Benzoyl peroxide", "response": "ROSACEA is a Vascular disorder predominantly affecting flush areas of face manifesting as erythema and telangiectasia, punctuated with episodes of inflammation during the episodes of inflammation papules, pustules and swelling develop. It has a chronic course. Treatment: a. Oral tetracyclines are drug of choice. b. Topical erythromycin and benzoyl peroxide are also helpful. c. Topical metronidazole is also effective. oral doxycycline and minocycline can also be given. d. The role of topical steroids is limited. e. With halogenated steroids rebound phenomenon and perioral dermatitis is known to occur. Hence their use is not justified. f. Isotretinoin can be used if no response to above drugs. The use of the topical steroid should be limited to the condition. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) does not necessary prevent steroid induced rosacea. Similar conditions have been seen with both Elidel and Protopic, possibly from immunosuppression and Demodex or bacterial growth. Ref Robbins 9 e pg 456\n\nSo the answer to this question is C"}
{"instruction": "Vidian nerve passes through\nA. Inferior orbital fissure\nB. Incisive foramen\nC. Tympanomastoid fissure\nD. Pterygoid canal", "response": "In the anterior pa of the foramen lacerum,the greater petrosal nerve unites with the deep petrosal nerve to form the nerve of the pterygoid canal(the vidian nerve)which leaves the foramen by entering the pterygoid canal in the anterior wall of the foramen lacerum. REF.BDC VOL.3,FIFTH EDITION\n\nSo the answer to this question is D"}
{"instruction": "Gluteus medius muscle is supplied by -\nA. Obturator artery\nB. ilio-inguinal artery\nC. Superior gluteal artery\nD. Inferior gluteal artery", "response": "Superior gluteal artery supplies gluteus medius and gluteus minimus. Inferior gluteal artery supplies gluteus maximus.\n\nSo the answer to this question is C"}
{"instruction": "Males and females show difference in the age of onset of pubey. The difference in the age of onset of pubey amongst males may be explained by\nA. Increased Activin - A levels\nB. Decreased Follistatin levels\nC. Increased Inhibin levels\nD. Easily releasable FSH pool", "response": "One of several proteins that paicipate in differentiation and growth. Two glycoproteins, inhibin A and inhibin B, are secreted by Seoli cells in the testis and granulosa cells in the ovary, inhibiting FSH secretion by direct action on the pituitary.Ref: Ganong&;s review of medical physiology; 24th edition; page no:-427\n\nSo the answer to this question is C"}
{"instruction": "Spontaneous regression though rare is seen in\nA. Burkits lymphoma\nB. Wilms tumor\nC. Neuroblastoma\nD. Melanoma", "response": "Neuroblastoma is a cancer often found in the small glands on top of the kidneys (adrenal glands). It can develop in the stomach, chest, neck, pelvis and bones. Children aged five or younger are most commonly affected. Most children with neuroblastoma in Noh America have been treated according to the In the previous COG risk system, each child was assigned to a low-risk, intermediate-risk, or high-risk group (refer to Tables INSS stage. Age. International Neuroblastoma Pathologic Classification (INPC). Ploidy. Amplification of the MYCN oncogene within tumor tissue.[Other biological factors that influenced treatment selection in previous COG studies included unbalanced 11q loss of heterozygosity and loss of heterozygosity for chromosome 1p.[Generally, treatment is based on whether the tumor is classified as low, intermediate, or high risk, as follows: Low risk. For patients with low-risk tumors, the approach is either observation or resection, with chemotherapy restricted to symptomatic patients with low-risk biology. Five-year overall survival (OS) was 97% in a large COG study.[Intermediate risk. For patients with intermediate-risk tumors, chemotherapy is often given before definitive resection, and the number of chemotherapy cycles is based on clinical and tumor biological risk factors and response to therapy. In recent studies, select patients have been observed without undergoing chemotherapy or attempted resection. The 3-year OS rate for intermediate-risk patients was about 96% in a large COG study.[High risk. For high-risk patients, treatment has intensified to include chemotherapy, surgery, radiation therapy, myeloablative therapy and stem cell transplant (SCT), isotretinoin, and immunotherapy, resulting in survival rates of about 50%. Statistically significant improvement in survival was observed in a randomized phase III COG study ( COG Risk-Group Assignment Treatment Options COG = Children's Oncology Group; GM-CSF = granulocyte-macrophage colony-stimulating factor; 131I-MIBG = iodine I 131-metaiodobenzylguanidine; SCT = stem cell transplant. Recurrent Neuroblastoma Locoregional recurrence in patients initially classified as low risk Metastatic recurrence in patients initially classified as low risk Locoregional recurrence in patients initially classified as intermediate risk Metastatic recurrence in patients initially classified as intermediate risk Recurrence in patients initially classified as high risk Recurrence in the central nervous system . Refer robbins 8/e p477\n\nSo the answer to this question is C"}
{"instruction": "Best prognosis in nerve injury\nA. Neuropraxia\nB. Axonotemesis\nC. Neurotemesis\nD. Complete transaction", "response": "Neurapraxia is a disorder of the peripheral nervous system in which there is a temporary loss of motor and sensory function due to blockage of nerve conduction, usually lasting an average of six to eight weeks before full recovery.Ref: Ganong&;s review of medical physiology 23rd edition\n\nSo the answer to this question is A"}
{"instruction": "The most characteristic eye lesion in diabetes is:\nA. Flame haemorrhages\nB. Papilledema\nC. Capillary aneurysm\nD. Cataracts", "response": "Ans. Capillary aneurysm\n\nSo the answer to this question is C"}
{"instruction": "Miliaria arises from obstruction of ?\nA. Eccrine sweat glands\nB. Apocrine sweat glands\nC. Sebaceous glands\nD. Ectopic sebaceous glands", "response": "Ans. is 'a' i.e., Eccrine sweat glands Milliria Occur as a result of either obliteration or disruption of the eccrine sweat duct. Three forms :- Miliaria crystallina- Clear, thin-walled vesicles, 1-2 mm in diameter, without an inflammatory areola, are usually symptomless and develop in crops, mainly on the trunk. Miliaria rubra- erythematous papules especially in areas of friction with clothing, and in flexures, produce intense pricking sensation. Miliaria profunda- This nearly always follows repeated attacks of miliaria rubra, o Complications :- Secondary infection and disturbance of heat regulation\n\nSo the answer to this question is A"}
{"instruction": "Methotrexate is used in high doses in -\nA. Osteosarcoma\nB. Retinoblastoma\nC. Rhabdomyosarcoma\nD. Ewig's sarcoma", "response": "Ans. is 'a' i.e., Osteosarcoma o High dose methotrexate with leucoverin is indicated for chemotherapy in osteosarcoma.\n\nSo the answer to this question is A"}
{"instruction": "Nicotinic acid is useful in all types of hyperlipoproteinemias, EXCEPT:\nA. Type-I\nB. Type-II\nC. Type-Ill\nD. Type-IV", "response": "Niacin is a drug (Vitamin B3) that causes a decrease in LDL cholestrol, VLDL and triglycerides along with an increase in HDL cholesterol. It acts by inhibiting lipolysis in the adipose tissue. Fuher, it can also decrease lipoprotein(a) and fibrinogen. It is useful for type IIb, III and IV hyperlipoprotein disorders. Also Know: Niacin is the best agent available for increasing HDL-C (30-40%). In patients with diabetes mellitus, niacin should be used cautiously because niacin-induced insulin resistance can cause severe hyperglycemia. Niacin also elevates uric acid levels and may reactivate gout. A history of gout is a relative contraindication for niacin use. Ref: Bersot T.P. (2011). Chapter 31. Drug Therapy for Hypercholesterolemia and Dyslipidemia. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e\n\nSo the answer to this question is A"}
{"instruction": "A child is able to build blocks of 5 Cubes developmental age is -\nA. 12 months\nB. 15 months\nC. 18 months\nD. 24 months", "response": "Ans. is 'c' i.e., 18 month\n\nSo the answer to this question is C"}
{"instruction": "A person has poor performance in front of his seniors in public place, has tachycardia when he has to deliver a lecture, avoids going to parties. The diagnosis is -\nA. Panic disorder\nB. Schizophrenia\nC. Social phobia\nD. Avoidant personality", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "All of the following are true about intestinal motility except\nA. Increased by distension\nB. Depends on gastric motility\nC. Increased by cholecystokinin\nD. Increased by secretin", "response": "\"Peristaltic activity of the small intestine is greatly increased after a meal. This increased activity is caused paly by the beginning entry of chyme into the duodenum, causing stretch of the duodenal wall. In addition, peristaltic activity is increased by the so-called gastroenteric reflex that is initiated by distention of the stomach and conducted principally through the myenteric plexus from the stomach down along the wall of the small intestine.\" \"In addition to the nervous signals that may affect small intestinal peristalsis, several hormonal factors also affect peristalsis. These factors include gastrin, CCK, insulin, motilin, and serotonin, all of which enhance intestinal motility and are secreted during various phases of food processing. Conversely, secretin and glucagon inhibit small intestinal motility.\" Reference: Guyton Physiology, 13th ed, Page: 813\n\nSo the answer to this question is D"}
{"instruction": "Polyuria is defined as?\nA. 30 ml / Kg/ day\nB. 40 ml / Kg/ day\nC. 50 ml/ kg / day\nD. 60 ml/ kg / day", "response": "Polyuria 40 ml/kg/day Polydipsia >100 ml/kg/day\n\nSo the answer to this question is B"}
{"instruction": "All of the following statements regarding ductus deference are true except\nA. The terminal pa is dilated to form ampulla\nB. It crosses ureter in the region of ischial spine\nC. It passes lateral to inferior epigastric aery at deep inguinal ring\nD. It is separated from the base of bladder by the peritoneum", "response": "The ductus deferens is the continuation of the tail of the epididymis and runs in the spermatic cord through the scrotum, inguinal canal and into the abdominal cavity, where it is extra-peritoneal. There it travels laterally through the pelvis, passing anterior to the ureter and inferior to the bladder, where it unites with the duct of the seminal vesicle to form the ejaculatory duct in the prostate In the prostate, the ejaculatory duct empties into the prostatic urethra. Ref - BDC 6th edition Vol2 pg227\n\nSo the answer to this question is D"}
{"instruction": "A patient with alkaline urine which is cloudy with plenty of pus cells is suffering from:\nA. E. coli\nB. Proteus\nC. TB\nD. None", "response": "Ans: b (Proteus)Ref: Bailey & Love, 24th ed, p. 1324 & 23rd ed, p. 1191Proteus and Staphylococcus split urea, forming ammonia which makes the urine alkaline and promotes formation of calculi.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following drugs has been found to be useful in acute severe asthma ?\nA. Magnesium Sulphate\nB. Anti-leukotrine\nC. Cromolyn Sodium\nD. Cyclosporine", "response": "A high concentration of oxygen should be given by face mask to achieve oxygen saturation of >90%.Magnesium sulfate given intravenously or by nebulizer has been found to be effective in acute severe asthma,when added to inhaled beta2 -agonists & is well tolerated.It can provide additional bronchodilation in patients whose presenting PEF(peak ejection fraction)is below 30% predicted. Reference:Harrison's medicine-18th edition,page no:2113;Davidson's medicine-22nd edition,page no:672.\n\nSo the answer to this question is A"}
{"instruction": "Bajaj committee in 1986 proposed?\nA. Multipurpose health worker\nB. Manpower and planning\nC. Rural Health Service\nD. Integrated health services", "response": " Manpower and planning. Reference:India health repo 2010,page no;132. <\\p>\n\nSo the answer to this question is B"}
{"instruction": "Kveim test is used for-\nA. Tuberculosis\nB. Systemic lupus erythematosis tissue\nC. Sarcoidosis\nD. Cystic fibrosis", "response": "The Kveim test, Nickerson-Kveim or Kveim-Siltzbach test is a skin test used to detect sarcoidosis, where pa of a spleen or lymphnode from a patient with known sarcoidosis is injected into the skin of a patient suspected to have the disease. If non caseating granulomas are found (4-6 weeks later), the test is positive . Ref - pubmed.com\n\nSo the answer to this question is C"}
{"instruction": "Most common cause of diarrhea in children of developing countries is:\nA. EHEC\nB. ETEC\nC. EAEC\nD. EIEC", "response": "ETEC Most frequent bacterial cause of diarrhea in children of developing countries. Most common cause of traveler's diarrhea. EPEC Cause infantile diarrhea (outbreaks) Rarely sporadic diarrhea in adults.\n\nSo the answer to this question is B"}
{"instruction": "Snowstorm appearance in Ultrasound is seen in:\nA. Hydatiform mole\nB. Twins\nC. Hydronephrosis\nD. Downs syndrome in fetus", "response": "Explanation:On ultrasound, the Hydatiform mole resembles a bunch of grapes ('cluster of grapes\" or ''honeycombed uterus\" or \"snow-storm appearance) (See table below) Partial and Complete Hydatiform Mole PARTIAL MOLECOMPLETE MOLEFetus, Fetal vessels, PlacentaPresentAbsentKaryotype69 XXY (triploid)46 XXHydropic changesFocalMarkedMalignant potentialRare1 5-20%Ultrasound featuresFocal cystic spaces in placentaFetus and placenta are seenTransverse diameter of uterus increasesSnowstorm appearance\n\nSo the answer to this question is A"}
{"instruction": "Incomplete uterine rupture is defined as?\nA. Disruption ofpa ofscar\nB. Disruption of entire length of scar\nC. Disruption of scar including peritoneum\nD. Disruption of scar with peritoneum intact", "response": "Ans. is'd' i.e., Disruption of scar with peritoneum intact Incomplete rupture :In an Incomplete uterine rupture, the mother's peritoneum remains intact.The peritoneum is the membrane that lines the abdominal cavity to suppo abdominal organs.It also acts as a channel for blood vessels and nerves.An incomplete uterine rupture is significantly less dangerous with fewer complications to the delivery process.Complete rupture:During a Complete uterine rupture, the peritoneum tears and the contents of the mother's uterus can spill into her peritoneal cavity.The peritoneal cavity is the fluid-filled gap that separates the abdomen walls and its organs.It is suggested that delivery cesarean section (C- section) should occur within approximately 10 to 35 minutes after a complete uterine rupture occurs.The fetal morbidity rate increases dramatically after this period.\n\nSo the answer to this question is D"}
{"instruction": "A G2P1 on warfarin presents at 38 weeks in labor: Next step\nA. Stop warfarin, proceed with vaginal delivery\nB. Stop warfarin, proceed with caesarean section\nC. Replace warfarin with heparin and proceed with vaginal delivery\nD. Replace warfarin with heparin & proceed with cesarean section", "response": "Ans. is b i.e. Stop warfarin, proceed with caesarean sectionSince the patient is presenting in labor on warfarin, now management is to stop her warfarin and do caesarean section.Note: If patient is on warfarin at the time of labor or within 2 weeks of labour, then caesarean section should % be done\n\nSo the answer to this question is B"}
{"instruction": "All are true about scrub typhus, Except\nA. Causative organism is O. Tsutsugamoshi\nB. Vector is trombiculide mite\nC. Adult female feeds on veebrate hosts\nD. Tetracycline is the drug of choice", "response": "\"Mite feeds on serum of warm blood animals only during there larval stage (chiggers) and adult mites feed only on plants\"Scrub typhus :Caused by O. tsutsugamushiTransmitted by trombiculid mite which also shows transovarian spreadClinical features:Fever, headache, myalgia, cough and GI symptoms.Classic case includes an eschar, regional lymphadenopathy, and a maculopapular rash.Tetracycline is the drug of choice\n\nSo the answer to this question is C"}
{"instruction": "BIRADS stands for\nA. Breast Imaging Repoing and Data System\nB. Best Imaging Repoing and Data System\nC. Brain Imaging Repoing and Data System\nD. Blood Imaging Repoing and Data System", "response": "Category 1 Incomplete assessment, need additional imaging evaluation Category 2 Negative, routine mammogram in 1yr is recommended Category 3 Benign findings, routine management in 1 year is recommended Category 3 Probably benign findings, sho term follow up suggested Category 4 Suspicious abnormality, biopsy should be considered Category 5 Highly suggestive of malignancy, appropriate action should be taken Category 6 Known biopsy - proven malignancy\n\nSo the answer to this question is A"}
{"instruction": "A 25 years old female comes to your clinic for evaluation of infertility. A hysterosalpingogram reveals Asherman's syndrome. What symptoms will the patient have?\nA. Menorrhagia\nB. Oligomenorrhea\nC. Polymenorrhea\nD. Hypomenorrhea", "response": "Ans. is d, i.e. HypomenorrheaThe typical presenting symptom in adenomyosis is hypomenorrhea, i.e. less blood loss during menstruation.\n\nSo the answer to this question is D"}
{"instruction": "IPC 319 deals w ith -\nA. Definition of hurt\nB. Voluntarily causing hurt\nC. Definition of grievous hurt\nD. Voluntarily causing grievous hurt", "response": "Ans. is 'a' i.e.. Definition of hurt Section of IPCDescription319Defines hurt320Defines grievous hurt321Voluntarily causing hurt322Voluntarily causing grievous hurt323Punishment for voluntarily causing hurt324Voluntarily causing hurt by dangerous weapons or means325Punishment for voluntarily causing grievous hurt326Voulntarily causing grievous hurt by dangerous weapon or means\n\nSo the answer to this question is A"}
{"instruction": "The longest transit time in GIT is seen in\nA. Stomach\nB. Jejunum\nC. Colon\nD. Ileum", "response": "The longest transit time is seen in the colon. Average Transmit Time Segment Transit time Esophagus 2-3 seconds Stomach 2-5 hours Small intestine 3-6 hours Caecum 4 hours First third of colon 6 hours Second third of colon 9 hours Sigmoid colon 12 hours Ref: Ganong&;s Review of medical physiology 26th edition pgno: 493-494\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is not an inflammatory mediator\nA. Tumor necrosis factor\nB. Myeloperoxidase\nC. Interferons\nD. Interleukins", "response": "steps: (1) migration and proliferation of fibroblasts into the site of injury and (2) deposition of ECM proteins produced by these cells. The recruitment and activation of fibroblasts to syn- thesize connective tissue proteins are driven by many growth factors, including PDGF, FGF-2 (described earlier), and TGF-b. The major source of these factors is inflamma- tory cells, paicularly macrophages, which are present at sites of injury and in granulation tissue. Sites of inflamma- tion are also rich in mast cells, and in the appropriate chemotactic milieu, lymphocytes may be present as well. Each of these cell types can secrete cytokines and growth factors that contribute to fibroblast proliferation and activation. As healing progresses, the number of proliferating fibroblasts and new vessels decreases; however, the fibro- blasts progressively assume a more synthetic phenotype, so there is increased deposition of ECM. Collagen synthe- sis, in paicular, is critical to the development of strength in a healing wound site. As described later, collagen syn- thesis by fibroblasts begins early in wound healing (days 3 to 5) and continues for several weeks, depending on the size of the wound. Net collagen accumulation, however, depends not only on increased synthesis but also on diminished collagen degradation (discussed later). Ulti- mately, the granulation tissue evolves into a scar composed of largely inactive, spindle-shaped fibroblasts, dense collagen, fragments of elastic tissue, and other ECM com- ponents (Fig. 2-30, B). As the scar matures, there is proA A gressive vascular regression, which eventually transforms the highly vascularized granulation tissue into a pale, largely avascular scar. Growth Factors Involved in ECM Deposition and Scar Formation Many growth factors are involved in these processes, including TGF-b, PDGF, and FGF. Because FGF also is involved in angiogenesis, it was described earlier. Here we briefly describe the major propeies of TGF-b and PDGF. * Transforming growth factor-b (TGF-b) belongs to a family of homologous polypeptides (TGF-b1, -b2, and -b3) that includes other cytokines such as bone morphogenetic proteins. The TGF-b1 isoform is widely distributed and is usually referred to as TGF-b. The active factor binds to two cell surface receptors with serine-threonine kinase activity, triggering the phosphorylation of transcription factors called Smads. TGF-b has many and often oppo- site effects, depending on the cell type and the metabolic state of the tissue. In the context of inflammation and repair, TGF-b has two main functions: TGF-b stimulates the production of collagen, fibro- nectin, and proteoglycans, and it inhibits collagen degradation by both decreasing proteinase activity and increasing the activity of tissue inhibitors of pro- teinases known as TIMPs (discussed later on). TGF-b is involved not only in scar formation after ref Robbins 9/e p83\n\nSo the answer to this question is B"}
{"instruction": "Wrist X-ray is given below. What is the probable diagnosis:\nA. Rickets\nB. Colles fracture\nC. Scaphoid fracture\nD. Osteoporosis", "response": "Fig. X-ray wrist--rickets Fig. Rickets knee RADIOGRAPHIC FINDINGS The characteristic feature of rickets are thickening and widening of growth plate (physis). Indistinct and hazy metaphysis that is abnormally wide (splaying) with cupping or flaring (Brush like appearance). Bowing of diaphysis, with thinning of coices. Looser's zone in 20%. Persistent hypocalcemia may cause secondary hyperparathyroidism.N NOTE:Lower limb deformities appear when the child stas to walk. Hence, bowing of legs will be less commonly seen in infants.\n\nSo the answer to this question is A"}
{"instruction": "The most common type of anorectal malformation is\nA. Imperforate anus\nB. Anal agenesis\nC. Anorectal agenesis\nD. Rectal atresia", "response": "The most common type of malformation involving the anal canal and rectum is anorectal agenesis, in which the rectum ends as a blind sac above the puborectalis muscle. The anal canal may form normally but does not connect with the rectum. This malformation is accompanied by various fistulas.\n\nSo the answer to this question is C"}
{"instruction": "Newborn commonly has following except-\nA. Milia\nB. Mongolian spots\nC. Epstein pearls\nD. None of the above", "response": "Ans. is 'd' i.e., None of the above o There are some minor clinical problems which can occur in normal newborn and require no treatment. o The problems are ? 1. Mina White dots on nose and face due to distended sebaceous glands. These diseappear spontaneously. 2. Erythema toxicum Erythematous papules on trunk & face. Appear on 2nd & 3rd day and disappear spontaneously. 3. Mongolian spots Bluish spots on the buttocks and trunk. Disappear before first bihday. 4. Stork bites Pinkish gray capillary hemangiomas on the nape of neck, upper eyelids, forehead & nose. These disappear spontaneously. 5. Peeling of skin More frequent in post-term infants, but can also occur in term infants. 6. Subconjuctival hemorrhages Disappear spontaneously 7. Breast engorgment Due to transplacentally acquired maternal hormones. Seen on 3rd or 4th day. 8. Epstein pearl Epithelial inclusion cysts, which appear as whitish spots. These are of two types - i) Palatal --> On hard palate or on either side of median raphe. ii)Prepucial --> At the tip of prepuce at 6 '0' clock position. 9. Pre-deciduous (natal) teeth Supernumerary teeth in the lower incisor position. These are shed before the primary dentition. 10. Vaginal bleeding On 3rd to 7th day Due to withdrawl of maternal hormones after bih. 11. Vaginal mucoid discharge Because of transplacentally acquired estrogen on vaginal mucosa. Hymenal tags --> around margins of hymen Physiological phymosis\n\nSo the answer to this question is D"}
{"instruction": "Thyroplasty Type I is done for vocal cord.........\nA. Medialisation\nB. Lateralisation\nC. Shortening\nD. Lengthening", "response": "Ans: a (Medialisation) Ref: Dhingra, 3rded, p. 364 & 4thed, p. 278Laryngeal frame work surgery - Isshiki's classificationType I thyroplastyType II thyroplastyType III ThyroplastyType IV thyroplasty- Medial displacement- Lateral displacement- Shortening (relaxation)- Elongation (tensioning) Indications: Type III thyroplastyIndications: Type IV thyroplasty1) Adductor spasmodic dysphonia2) Mutational falsetto3) Gender transformation (female to male)1) Androphonia2) Post surgical defects3) Gender transformation (male to female)\n\nSo the answer to this question is A"}
{"instruction": "The most serious complication of acute hemolytic anemia in G6PD deficiency is:\nA. Acute renal failure\nB. Congestive cardiac failure\nC. Cerebral infarction\nD. Acute liver failure", "response": "The most serious threat from acute hemolytic anemia is the development of ARF. Ref: Harrison's principles of internal medicine, 18th edition ; Page :879\n\nSo the answer to this question is A"}
{"instruction": "In follicular carcinoma chromosomal translocation is?\nA. PAX8 -PPARrl\nB. RET - PTC\nC. ALK -NMP1\nD. JAK - TEL", "response": "Ans. is 'a' i.e., PAX8- PPARrl Various genes involved in thyroid carcinomas arePapillaryo Tyrosine kinase receptors RET or NTRK1o RAS mutationo BRAF oncogeneFollicularo RAS oncogene (NRAS, HRAS and KRAS)o PAX8- PPARrl translocationMedullaryo RETprotooncogne.\n\nSo the answer to this question is A"}
{"instruction": "Muscle attached to navicular tuberosity is\nA. Tibialis anterior\nB. Tibialis posterior\nC. Peroneous longus\nD. Extensor hallucis longus", "response": "Navicular bone Medial surface has a blunt and prominent tuberosity directed downwards.The tuberosity is separated from the plantar surface by a groove. Tuberosity receives the inseion of Tibialis posterior.The groove below the tuberosity transmits a pa of the tendon of this muscle to another bones. According to the Hasenclever prognostic index for advanced Hodgkin lymphoma,risk factors are - age>45yrs,male gender,stage 4 disease(diffuse involvement of one or more extralymphatic tissues with/without constitutional symptoms ),lymphopenia etc. Lymphocyte depletion is having poor prognosis . Reference :Davidson&;s principles & practice of medicine 22nd edition pg no1043. Most common type of presentation in twin pregnancy is both twin veex(50%) Reference:DC Dutta&;s textbook of obstetrics,8th edition, page no:243 <\\p>\n\nSo the answer to this question is B"}
{"instruction": "A child comes with steroid resistant nephrotic syndrome secondary to FSGS, not responsive to methylprednisolone. What next should be given\nA. Oral cyclophosphamide\nB. Oral cyclosporine\nC. Oral mycophenolate\nD. IV cyclophosmaphid", "response": "When child with nephrotic syndrome is restaurant to steroids then calcineurin inhibitors such as cyclosporine and tacrolimus the first drug of choice. Reference: GHAI Essential pediatrics, 8th edition\n\nSo the answer to this question is B"}
{"instruction": "Decreased ability to smell is\nA. Anosmia\nB. Hyposmia\nC. Phantosmia\nD. Hyperosmia", "response": "(B) Hyposmia # Hyposmia: Hyposmia is a state of decreased sensation of smell> Disorders of the Sense of Smell: Transport losses - Rhinitis, polyps/neoplasms of nasal cavity Sensory losses - Drugs, radiation therapy, toxin exposure Neural losses - Alps, alcoholism, Alzheimer's, Kallman syndrome, hypothyroidism etc.,> Treatment: There is no proven treatment for sensorineural olfactory losses. Fortunately, spontaneous recovery often occurs.> Zinc and vitamin therapy (especially with vitamin A) are advocated by some.> Profound zinc deficiency can produce loss and distortion of the sense of smell but is not a clinically important problem except in very limited geographic areas\n\nSo the answer to this question is B"}
{"instruction": "Normal color of healthy gingiva in children:\nA. Pink\nB. Red\nC. Coral pink\nD. Pale (light) pink", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Ifosfamide belongs to which Group of anticancer drugs\nA. Alkylating agent\nB. Antimebolites\nC. Mitotic inhibitors\nD. Topoisomerase inhibitors", "response": "Refer principles of Pharmacology 1st /869 KDT 6/e p 819 Ifosfamide is an alkyatingg agent\n\nSo the answer to this question is A"}
{"instruction": "Whipple triad is seen in:\nA. Glucogonoma\nB. Insulinoma\nC. Gastrinoma\nD. Ca pancreas", "response": "Ans: b (Insulinoma) Ref: Bailey, 24th ed, p. 1131Whipple triad is the classic diagnostic criteria for insulinoma.Whipple triad- Signs & symptoms of hypoglycaemia during fasting.- Blood glucose below 2.8 mmol/ltr (50 mg/dl) during symptomatic episodes.- Relief of symptoms by administration of glucose.Insulinomass-cell endocrinal tumours of pancreasArise from whole pancreasSymptoms are due to excessive secretion of insulin causing hypoglycaemia.Most are solitary & benign.Only 10- 15% are malignant.LocalizationMore sensitive test is intraoperative USGHigh resolution CT & MRIEndoscopic USGSelective arteriographyTreatmentSurgical excision is treatment of choice.\n\nSo the answer to this question is B"}
{"instruction": "All except one is true regarding hyoid bone\nA. Hyoid bone lies at level of 3rd cervical vertebra\nB. It develops from 3rd and 4rd branchial arches\nC. Fracture of hyoid bone strongly suggest strangulation\nD. Lesser cornea provides attachment to stylohyoid ligament", "response": "Hyoid bone develops from 2nd and 3rd branchial arches.\n\nSo the answer to this question is B"}
{"instruction": "Advantage of using chemically activated resin for repairing is:\nA. They can be polymerized at room temperature\nB. They are easy to manipulate\nC. Easy to handle\nD. Cheap in cost", "response": "ADVANTAGES AND DISADVANTAGES\n\nBetter initial fit, which is because the curing is carried out at room temperature. Thus there is less thermal contraction.\nColor stability is inferior to that of heat cure resin, due to subsequent oxidation of the tertiary amine.\nSlightly inferior properties because the degree of polymerization of self curing acrylics is less than that of heat cured ones.\nFor repairing dentures, self curing resins are preferable to heat cured resins as heat curing causes warpage.\n\nSo the answer to this question is A"}
{"instruction": "All the following affects absorption of calcium, EXCEPT\nA. Citric acid\nB. Retinoic acid\nC. Phytates\nD. Oxalates", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Low dose radiotherapy is given for:\nA. Seminoma\nB. Malignant melanoma\nC. Osteosarcoma\nD. Chondrosarcoma", "response": "Ans. Seminoma\n\nSo the answer to this question is A"}
{"instruction": "Lymphohistocytic variant of Reed Sternberg seen in which subtype of Hodgkin lymphoma:\nA. Nodular sclerosis\nB. Lymphocyte rich\nC. Lymphocyte predominant\nD. Lymphocyte depleted", "response": "Ref. Robbins Pathology. 9th edition. Page. 601\nDirect picture from Robbins\n\nSo the answer to this question is C"}
{"instruction": "Major End Product of fatty acid synthesis is:\nA. Acetyl CoA\nB. ATP\nC. Citrate\nD. Palmitate", "response": "Ref. Textbook of Biochemistry for Medical Students. Page. 198\n \nExcess dietary glucose can be converted to fatty acids in the liver and subsequently sent to the adipose tissue for storage.\nAdipose tissue synthesizes smaller quantities of fatty acids.\nInsulin promotes many steps in the conversion of glucose to acetyl CoA in the liver:\n\nGlucokinase (induced)
\nPFK-2/PFK-1 (PFK-2 dephosphorylated)
\n\nPyruvate dehydrogenase (dephosphorylated)\nBoth of the major enzymes of fatty acid synthesis are also affected by insulin:\n\nAcetyl CoA carboxylase (dephosphorylated, activated)\nFatty acid synthase (induced)\n\nFinal end product is Palmitate, after which fatty acid elongation happens. Look at the belwo diagram for steps\n\nSo the answer to this question is D"}
{"instruction": "Deficiency of Copper causes\nA. Anemia\nB. Wilson's disease\nC. Hypothyroidism\nD. Obtundation", "response": "(A) Anemia\n\nSo the answer to this question is A"}
{"instruction": "Child with \"Intracranial Calcification, Chorioretinitis\" most appropriate cause is:\nA. Toxoplasmosis\nB. Herpes simplex\nC. CMV\nD. Syphilis", "response": "Toxoplasmosis\n\nSo the answer to this question is A"}
{"instruction": "Mutually protected occlusion; TRUE is\nA. Is an occlusal scheme in which the posterior teeth prevent excessive contact of the anterior teeth in maximum intercuspation\nB. Posterior teeth function most effectively in stopping the mandible during closure\nC. Anterior teeth function most effectively in guiding the mandible during eccentric movements\nD. All of the above", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Which of the following product is primarily filtered with little secretion or re - absorption in renal tubules?\nA. Sodium\nB. Creatinine\nC. Glucose\nD. Amino acids", "response": "Ans. (b) Creatinine(Ref: Ganong, 25th ed/p.679)Substances like inulin and creatinine are useful to estimate GFR because they are freely filtered, neither resorbed, nor secreted\n\nSo the answer to this question is B"}
{"instruction": "The leukotriene receptor antagonist used in bronchial asthma is:\nA. Zafirleukast\nB. Zileuton\nC. Ketotifen\nD. Omalizumab", "response": "Among the options given only Zafirleukast is leukotriene receptor antagonist. Zileuton is a 5-Lipoxygenase inhibitor, Ketotifen is an antihistaminic (H1) and Omalizumab is a recombinant humanized monoclonal anti-IgE antibody. Ref: Bronchial Asthma: A Guide for Practical Understanding and Treatment, Springer, 2011, Page 193; Current Review of Asthma, By Michael A. Kaliner - Page 216; Essentials of Medical Pharmacology, KD Tripathi - 5th Edition, Page 205-206; Katzung & Trevor's Pharmacology 10th Edition, Page 325.\n\nSo the answer to this question is A"}
{"instruction": "Antral puncture is done through:\nA. Superior meatus\nB. Inferior meatus\nC. Middle meatus\nD. All", "response": "In proof puncture or antral lavage, the lateral wall of inferior meatus is punctured with Lichtwitz trocar and cannula. This site is selected as bone is very thin here.\n\nSo the answer to this question is B"}
{"instruction": "Pathognomic of measls -\nA. Koplik spot\nB. Rash\nC. Fever\nD. Conjuctivitis", "response": "Ans. is 'a' i.e., Koplik spot Measleo Caused by RN A virus.o Highly contagious droplet spread from secretion of nose and throat 4 day before and 5 days after rash,o Secondary attack rate >90% in contact.o Prodromal phase - characterized by fever, rhinorrhea, conjuctival congestion and dry hackig cough,o Koplik spots bluish-gray specks or ''grains of sand\" on a red base-develop on the buccal mucosa opposite the second molarsGenerally appear 1 -2 days before the rash and fast 3-5 daysPathognomonic for measles, but not always presento Rash appears on D4 first behind pinna on neck the spread of face, thrunk and abdomen,o SSPE is long term complication seen in measls.\n\nSo the answer to this question is A"}
{"instruction": "If 25 persons are working on a project for 30 years. There is how many person-years of employement.\nA. 75\nB. 750\nC. 120\nD. 1200", "response": "Ans. is 'b' i.e.,750 \"10000 people working for 1 year would lead to 1000 person years of employment\"Thus, 25 persons working for 30 years will lead to 750 person-years of employment.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following metabolic complications is not seen in Chronic Renal Failure:\nA. Hyperkalemia\nB. Hyponatremia\nC. Hypercalcemia\nD. Hyperphosphatemia", "response": "Answer is C (Hypercalcemia) Chronic Renal Failure is associated with Hypocalcemia and not hypercalcemia.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is primary cell line ?\nA. Chick embryo fibroblast\nB. Hela cells\nC. Vero cells\nD. WI-38", "response": "Ans. is 'a' i.e., Chick embryo fibroblast Chick embryo fibroblast is primary cell culture.\n\nSo the answer to this question is A"}
{"instruction": "Drug Induced Lupus is caused by all except\nA. Sulphonamides\nB. Hydralazine\nC. Isoniazid\nD. Procaine", "response": "Drugs metablized by acetylation can cause drug induced lupus: \"D.SHIP\"\n\nDapsone\nSulphonamides\nIsoniazid\nProcainamide (not Procaine).\n\nSo the answer to this question is D"}
{"instruction": "The voice in a patient with Bilateral abductor paralysis of the larynx is\nA. Puberphonia\nB. Phonasthenia\nC. Dysphonia plicae ventricularis\nD. Normal or good voice", "response": "The vocal cord vibrates during speech to produce speech. These vibrations occur due to subglottic airflow when the cord is in adduction (Median & paramedian).\nDuring normal phonation the vocal cords are in median position and during strong whisper vocal cords are in paramedian position.\nSo, for proper voice, the vocal cords should be in median or paramedian position.\nSame occurs in bilateral recurrent laryngeal nerve paralysis, where the vocal cords are in median or paramedian position → Voice is less likely to be impaired.\n\nNow, the question comes to the mind immediately : - Why the voice is affected in unilateral paralysis, in which the cord is in median or paramedian position. The answer is : -\n\nIn unilateral vocal cord paralysis, one cord is paralysed and vibrates abnormally or does not vibrate at all, therefore cannot coordinate with the other side (normal) vocal cord. This results in voice problems.\nIn bilateral paralysis, both vocal cords vibrate abnormally but coordinate with each other, therefore voice is less affected.\n\nSo the answer to this question is D"}
{"instruction": "All of the following are true for retinopathy of prematurity except:\nA. Occurs in premature infants due to late crying\nB. Due to hypoxia there occurs neovascularization followed by fibroproliferation\nC. End result is bilateral blindness\nD. Blindness can be prevented by early diagnosis and ablation of vascular premature retina with cryotherapy or photocoagulation", "response": "Ans. Occurs in premature infants due to late crying\n\nSo the answer to this question is A"}
{"instruction": "Primary ciliary dyskinesia is associated with all except -\nA. Sterility in males\nB. Hypothyroidism\nC. Sinusitis\nD. Respiratory infection", "response": "Ans. is 'b' i.e., Hypothyroidism Kartagener's syndrome is characterized bv triad ofo Situs inversuso Chronic sinusitiso BronchiestasisIt is a subset of primary ciJiarv dyskinesiaPrimary ciliary dyskinesiao Primary ciliary dyskinesia (PCD, also called the immotile-cilia syndrome) is characterized by congenital impairment of mucociliary clearance (MCC).o Clinical manifestations includeChronic coughChronic rhinitis andChronic sinusitisOtitis and otosalpingitis (common in childhood)Nasal polyposis and agenesis of ike frontal sinusesClinical features of primary ciliary dyskinesiaPulmonaryRhinosinusitisOtitisCentral nervous systemFertilityo Mild respiratory distresso Runny nose ando Chronic secretoryo Chronic sinusitiso Infertilityo Increased incidence ofround the yearotitis media withcauses fatigue and(immoiilerespiratory infectionsnasal congestionrecurrent episodesheadachespermatozoawith chronic cough ando Nasal polyposisof acute otitis mediao Hydrocephalus duemotileexpectoration of Sitns inversusto impairedspermatozoa),mucopurluent sputum o Complete reversalfunction of o Bronchiestasis of the circulatoryependymal cilia | system and viscera Associated abnormalities o No adverse health o A number of congenital consequence abnormalities are : * Transposition of great vessels * Pyloric stenosis * Epispadias\n\nSo the answer to this question is B"}
{"instruction": "Succinyl Co-A is formed by:\nA. Histidine\nB. Leucine\nC. Valine\nD. Lysine", "response": "Succinyl COA is formed by Valine, Isoleucine, Methionine.\n\nSo the answer to this question is C"}
{"instruction": "What is false about pertussis -a) Maternal antibody provides protection in infantsb) Fomites play a small role in spread of diseasec) Commonly seen in infantsd) Males and females both are equally affected\nA. b\nB. ad\nC. ac\nD. ab", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "All are causes of prolapse of cervix EXCEPT: March 2013\nA. Many MTP\nB. Chronic cough\nC. Menopause\nD. Delivery of a big baby", "response": "Ans. A i.e. Many MTP\n\nSo the answer to this question is A"}
{"instruction": "Maximum incidence of impotance is seen in the patients with following anti hypeensive drug\nA. CCBs\nB. Beta blockers\nC. ARBs\nD. ACE inhibitor", "response": "Common side effects of beta blockers include: Dizziness. Weakness. Drowsiness or fatigue. Cold hands and feet. Dry mouth, skin, or eyes. Headache. Upset stomach. Diarrhea or constipation. Refer kDT 6/e p139\n\nSo the answer to this question is B"}
{"instruction": "Coronary Ligament is present in:\nA. Shoulder Joint\nB. Hip Joint\nC. Knee Joint\nD. Ankle Joint", "response": "Ans. C. Knee JointThe coronary ligaments of the knee (also known as meniscotibial ligaments) are portions of the joint capsule which connect the inferior edges of the fibrocartilaginous menisci to the periphery of the tibial plateaus.\n\nSo the answer to this question is C"}
{"instruction": "The antidote of poisoning due to Arninanita muscaria is\nA. Physostigmine\nB. Amyl nitrate\nC. Methylene blue\nD. Atropine", "response": "D i.e. Atropine Amanita muscaria & Amanita phalloides are poisonous mushrooms with parasympathetic (Cholinergic) symptoms. So AtropineQ is used as antidote in severe cases; but avoided in mild case as it excerhates delirium.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following structure in spermatic cord doesn't come during surgery for vasectomy?\nA. Testicular aery\nB. Ilioinguinal nerve\nC. Autonomic nerves\nD. Testicular vein", "response": "The ilioinguinal nerve (L1) passes through pa of the inguinal canal but not a pa of spermatic cord.A vasectomy is a simple procedure in that it only requires an incision through the skin and layers of each spermatic cord to cut the ductus deferens. The spermatic cord contains the same muscular and fascial layers as the anterior abdominal wall because the testis descends through the abdominal wall to the scrotum during embryonic development. The spermatic cord contains the following structures:Ductus deferensTesticular (gonadal) aeryTesticular (gonadal) veinAutonomic neuronsRef: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 7. Anterior Abdominal Wall. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy.\n\nSo the answer to this question is B"}
{"instruction": "A patient sustained a hyperextension injury to his knee. Which of the following ligament prevents excess - anterior gliding movement of femur on tibia?\nA. Anterior cruciate ligament\nB. Posterior cruciate ligament\nC. Medial collateral ligament\nD. Lateral collateral ligament", "response": "*ACL- prevents anterior gliding of tibia on femur *PCL- prevents posterior gliding of tibia on femur Ref: spos medicine 4th/e p.83\n\nSo the answer to this question is B"}
{"instruction": "Wolffian duct structures do not develop in all except\nA. Swyers syndrome\nB. Testicular feminization syndrome\nC. Incomplete AIS\nD. Turners syndrome", "response": "In incomplete Androgen insensitivity syndrome, there is little responsiveness to testosterone.\nSo Wolffian duct derivatives are present.\n\nSo the answer to this question is C"}
{"instruction": "All of the following are components of Horner's syndrome except -\nA. Ptosis\nB. Exophthalmos\nC. Anhidrosis\nD. Loss of cilio- spinal reflex", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is not a reducing sugar?\nA. Fructose\nB. Galactose\nC. Sucrose\nD. Maltose", "response": "Sucrose contains glucose and fructose .sucrose is not a reducing sugar, and it will not form osazone. is because the linkage involves first carbon of glucose and second carbon of fructose, and free reducing groups are not available.Ref: DM Vasudevan, 7th edition, page no: 77\n\nSo the answer to this question is C"}
{"instruction": "All of the following vitamins are involved in sulphur containing amino acid metabolism except?\nA. Vitamin B3\nB. Vitamin B6\nC. Vitamin B9\nD. Vitamin B12", "response": "Vitamin B6, B9 and B12 are involved in sulphur containing amino acid metabolism. Vitamin B6 (Pyridoxine) is the co-enzyme of cystathionine b synthase. Vitamin B9 (Folic acid) and B12 (Cobalamin) are involved in the conversion of homocysteine to methionine by methionine synthase. Clinical impoance: Reference: Harpers illustrated biochemistry 30th edition\n\nSo the answer to this question is A"}
{"instruction": "Good prognostic factor for AML are all except -\nA. Age less than 2 years\nB. Acute promyelocytic leukemia\nC. Acute megakaryoblastic leukemia\nD. Associated with down syndrome", "response": "Ans. is 'c' i.e., Acute Mega karyoblastic leukemia Good Prognostic factors for children with AMLo Prognostic factors are not quite as important in predicting outcome or in guiding treatment for AML as they* are for ALL.o Age at diagnosis: Children younger than age 2.o Initial white blood cell (WBC) count; Children with AML whose WBC count is less than 100,000 cells per cubic millimeter Down syndrome: Children with Down syndrome who develop AML tend to have a good outlook.o Subtype of AML: the acute promyelocytic leukemia (APL) M3 subtype tends to have a good outlook while undifferentiated AML (MO) and acute megakaryoblast ic leukemia (M7) are harder to treat.o Chromosome changes: Children with leukemia cell translocations between chromosomes 15 and 17 or between 8 and 21, or with an inversion (rearrangement) of chromosome 16 have a better chance of being cured.o Response to treatment: Children whose leukemia responds quickly to treatment.o Body weight: Children within the normal weight range tend to do better than children who are underweight or overweight.\n\nSo the answer to this question is C"}
{"instruction": "The method of presenting data of geographic distribution is:\nA. Histogram\nB. Pie chart\nC. Frequency polygon\nD. Cartogram", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Chlorhexidine as a root canal irrigant is\nA. Active against gram +ve , gram –ve bacterias and to some extent Virus with lipid envelop.\nB. Normally used at 2% conc\nC. A poly biguinide\nD. All of the above", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "The smallest caranial nerve is the-\nA. Olfactory\nB. Oculomotor\nC. Trochlear\nD. Accessry", "response": "C i.e. Trochlear\n\nSo the answer to this question is C"}
{"instruction": "In low doses, aspirin inhibits which of the following mediators?\nA. Lipoxygenase\nB. Cyclo-oxygenase\nC. Thromboxane A2\nD. Prostaglandin I2", "response": "Arachdonic acid metabolites are formed by two classes of enzymes such as Cycloxygenases and Lipoxygenases. Cycloxygenase pathway is mediated by COX1 and COX2 enzymes leading to the formation of Prostaglandins and Thromboxanes. In low doses, aspirin inhibit cycloxygenase irreversibly by acetylating one of its serine residues. Return of cycloxygenase activity depends upon synthesis of fresh enzyme. Ref: Essentials of Medical Pharmacology, 5th Edition, Pages 168, 173-4.\n\nSo the answer to this question is B"}
{"instruction": "Transmission of hepatitis A virus occurs -\nA. one week before and one week after onset of symptom\nB. 2 weeks before onset of symptoms\nC. 2 weeks after onset of symptoms\nD. 1 week after onset of symptoms", "response": "The viruses shed in feces during the late incubation period and prodromal phase of illness REF:ANANTHANARAYANAN TTEXTBOOKOF MICROBIOLOGY 9EDITION PGNO.541\n\nSo the answer to this question is B"}
{"instruction": "Investigation of choice in traumatic paraplegia is:\nA. MRI\nB. CT scan\nC. Ultrasound\nD. Beta rays", "response": "Ans. MRI\n\nSo the answer to this question is A"}
{"instruction": "Subacute bacterial endocarditis is caused by\nA. Streptococcus viridans\nB. Haemolytic streptococci\nC. Staphylococcus aureus\nD. Nisseria", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "A 60 year old woman presents with generalized edema, skin ulceration and hypeension. Urine examination shows subnephrotic proteinuria (< 2gm) and microscopic haematuria. Serum complement levels are decreased and she is positive for anti- hepatitis c antibodies. The likely diagnosis is -\nA. PSGN\nB. Essential mixed cryoglobulinemia\nC. Membrano proliferative glomerulonephritis\nD. Focal segmental glomerulosclerosis", "response": "Essential mixed cryoglobulinemia is characterized by joint pains and swelling (ahritis), enlargement of the spleen, skin vasculitis with purplish patches, and nerve and kidney disease. This can lead to recurrent pain in the abdomen, hea attack, and bleeding in the lungs Essential mixed cryoglobulinemia is treated with combinations of medications which reduce inflammation and suppress the immune system. Medications used include nonsteroid antiinflammatory drugs (ibuprofen, aspirin, and others), steroids (prednisone, prednisolone), cyclophosphamide (Cytoxan), chlorambucil (Leukeran), and azathioprine (Imuran). Plasmapheresis (hemapheresis), a procedure whereby the blood's serum is filtered to remove the cryoglobulins, is also performed for severe symptoms. Ref Harrison20th edition pg 287\n\nSo the answer to this question is B"}
{"instruction": "The after coming head of the baby in a breech delivery can be arrested by all of the following except:\nA. Extended head\nB. Hydrocephalus\nC. Placenta pre\nD. Incomplete dilatation of the cervix", "response": "If a whole baby can make its way from breech onwards till the head, then even if there is a placenta pre, it will not obstruct the fetal head to come though since there was no obstruction to the whole fetus.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is the most reliable method of identification of an individual?\nA. Scars\nB. Anthropometry\nC. Dactylography\nD. Handwriting", "response": "Dactylography - The finger print system is the most reliable method of identification of an individual. Fingerprints are impressions of pattern formed by papillary or epidermal ridges of the finger prints. The ridge pattern of fingers appear between 12 -16 weeks of intrauterine life and the formation is completed by 24 weeks. Finger print patterns are classified as loops, whorls, arches and composite. Commonly used powder for lifting fingerprints is grey powder (chalk+Hg) & white powder (French chalk + PbCO3). Ref:The Essentials of Forensic Medicine and Toxicology By Dr K S Narayan Reddy, Pages 75-6\n\nSo the answer to this question is C"}
{"instruction": "Koilocytes with perinuclear halo on pap smear is pathognomic of?\nA. HPV infection\nB. Metaplasia\nC. Dysplasia\nD. Bacterial vaginosis", "response": "ANSWER: (A) HPV infectionREF: Shaw's Gynecology 13th ed p- 78, The pap test by Richard M. DeMay page 49-50\"Koilocytes, dyskeratocytes, macrocytes, etc. are some of the cytologic findings that are characteristic of condylomas (HPV). Koilocytes with perinuclear halo is pathognomonic of HPV infection\"ConditionType of cellEstrogen dominated uterusNormal cornified cellsProgesterone dominated uterusIntermediate cellspregnancyIntermediate cells , Navicular cellsmenopausalBasal, parabasalHPVKoilocytes, dyskeratocytes, macrocytes with perinuclear halo.\n\nSo the answer to this question is A"}
{"instruction": "According to American society of Anaesthelogists the physical status of a patient with severe incapacitating systemic disease that is a constant threat to life may be classified as:\nA. ASA 1\nB. ASA 2\nC. ASA 3\nD. ASA 4", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Derivatives of HINDGUT are all except:\nA. Urinary Bladder\nB. Rectum\nC. Uterus\nD. Anal Canal", "response": "Ans. C. UterusDerivatives of the three parts of the primitive gutForegut* Floor of mouth* Tongue* Pharynx* Derivatives of pharyngeal pouches* Thyroid* Esophagus* Respiratory system* Stomach* Proximal (upper) half of the duodenumMidgut* Liver* Pancreas* Extrahepatic biliary system* Distal (lower) half of the duodenum* Jejunum* Ileum* Cecum and appendix* Ascending colon* Right two-third of transverse colonHindgut* Left one-third of transverse colon* Descending colon* Sigmoid (pelvic) colon* Rectum* Upper part of the anal canal\n\nSo the answer to this question is C"}
{"instruction": "Pancytopenia with hypercellular marrow may be seen due to all of the following except:\nA. Myelodysplasia\nB. Paroxysmal Nocturnal Hemoglobinuria\nC. Dyskeratosis congenita\nD. Sarcoidosis", "response": "Answer is C (Dyskeratosis Congenita ) Dyskeratosis congenita (constitutional aplastic anemia) is associated with Pancytopenia and a Hypocellular bone marrow Myelodysplasia, PNH and Sarcoidosis may all be associated with Pancytopenia and a cellular bone marrow\n\nSo the answer to this question is C"}
{"instruction": "A 15 year old child presents with falling school grades and development of abnormal posture. On examination dystonia and increase muscle tone is noted. Slit lamp examination shows presence of KF ring. Liver biopsy for copper will be stained by which of the following stain?\nA. Perl stain\nB. Rubeanic acid\nC. Supravital stain\nD. Schmorl's method", "response": "Rubeanic acid and Rhodamine stains are utilized to detect the cytoplasmic accumulation of copper in the liver. Schmorl's method is used for detecting melanin and uses the reducing propeies of melanin to stain granules blue-green. It is also used to detect lipofuscin.\n\nSo the answer to this question is B"}
{"instruction": "A married middle aged female gives history of repeated aboions for the past 5 years. The given below is conceptions pre-natal karyogram. This karyogram suggests the following -\nA. Klinefelter's syndrome\nB. Turner's syndrome\nC. Down's syndrome\nD. Patau's syndrome", "response": "Ans. is 'c' i.e., Down's syndrome Most common chromosomal abnormalies causing aboion are chromosomal trisomy. Trisomy 21 is synonymous with down's syndrome and is the most common of the chromosomal disorders Trisomy 21 DOWN SYNDROME Trisomy 18 EDWARD SYNDROME Trisomy 13 PATAU SYNDROME\n\nSo the answer to this question is C"}
{"instruction": "The normal P wave is inveed in lead :\nA. LI\nB. LII\nC. aVF\nD. aVR", "response": "Answer is D (aVR) The normal P wave is negative (inveed) in lead aVR. Characteristics of a Normal P Wave P wave results from spread of electrical activity through the atria (Atrial Depolarization) A normal p wave indicates that the electrical impulse responsible for the p wave originated in the sinus node and the normal depolarization of the right and left atria has occurred Normal P Wave is rounded, neither peaked nor notched. Width or duration of the P wave in time is 0.10 seconds or 2.5 small squares Height of the P wave is 2.5 mm (2.5 small squares) Sinus P waves are best seen in Lead II and V1 P wave is upright in most leads, mainly L1 L11 and aVF P Wave is inveed in aVR (and occasionally in aVL) P wave in VI may be biphasic with equal upward and downward deflection, notched and wide. Activation of right atrium produces positive component and activation of left atrium produces negative component. There should be one p wave preceding each QRS complex. More than one p wave before a QRS complex indicates a conduction disturbance.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is associated with destruction of myenteric plexus?\nA. Hirschsprung disease\nB. Secondary Achalasia\nC. HPSS\nD. GIST", "response": "12 Ans. is 'b' i.e., Secondary achlasia * Secondary achalasia may arise in Chagas disease, in which Trypanosoma cruzi infection causes destruction of the myenteric plexus, failure of peristalsis, and esophageal dilatation.\n\nSo the answer to this question is B"}
{"instruction": "A chronic alcoholic presenting with bleeding gums and petechiae is more likely to have deficiency of:\nA. Vitamin B12\nB. Vitamin C\nC. Thiamine\nD. Pyridoxine", "response": "Ans: B (Vitamin C) Ref: Harrison's Principles of Internal Medicine, 18th edExplanation:Principal Clinical Findings of Vitamin MalnutritionNutrientClinical FindingDietary Level per Day Associated with Overt Deficiency in AdultsContributing Factors to DeficiencyThiamine* Beriberi* Neuropathy* Muscle weakness* Wasting* Cardiomegaly* Edema* Ophthalmoplegia* Confabulation<0.3 mg/1000 kcalAlcoholism,chronic diuretic use hyperemesisRiboflavin* Magenta tongue* Angular stomatitis* Seborrhea* Cheilosis<0.6 mg Niacin* Pellagra* Pigmented rash of sun-exposed areas* Bright red tongue* Diarrhea* Apathy* Memory toss* Disorientation<9.0 niacin equivalentsAlcoholismVitamin B6 deficiency Riboflavin deficiency Tryptophan deficiencyVitaminB6* Seborrhea* Glossitis* Convulsions* Neuropathy* Depression* Confusion* Microcytic anemia: <0.2 mgAlcoholismIsoniazidFolate* Megaloblastic anemia* Atrophic glossitis* Depression* | Homocysteine<100 mcg/dAlcoholism.Sulfasalazine PyrimethamineTriamtereneVitaminB12* Megaloblastic anemia* Loss of vibratory and position sense* Abnormal gait* Dementia* Impotence* Loss of bladder and bowel control* | Homocysteine* |Methylmalonic acid<1.0 mcg/dGastric atrophy (pernicious anemia) terminal ileal disease, strict vegetarianism, acid- reducing drugs (e.g., H2. blockers)Vitami n C* Scurvy* Petechias* Ecchymosis* Coiled hairs* Inflamed and bleed, ng gums* Joint effusion* Poor wound healing<10 mg/dSmokingAlcoholismVitamin A* Xerophthalmia* Night blindness* Bitot's spots* Follicular hyperkeratosis* Impaired embryonic development* Immune dysfunction<300 mcg/dFat malabsorption.InfectionMeaslesAlcoholismProtein-energymalnutritionVitamin D* Rickets* Skeletal deformation* Rachitic rosary* Bowed legs* Osteomalacia<2 0 mcg/dAging, lack of sunlight exposure, fat malabsorption, deeply pigmented skinVitamin E* Peripheral neuropathy* Spinocerebellar ataxia* Skeletal muscle atrophy* RetinopathyNot described unless underlying contributing factor is presentOccurs only with fat malabsorption or genetic abnormalities of vitamin E metabolism/transportVitamin K* Elevated prothrombin time* Bleeding<10 mcg/dFat malabsorption, fiver disease, antibiotic use\n\nSo the answer to this question is B"}
{"instruction": "A 5-year-old girl is admitted to your Paeds ward. The parents give the history that the child has had recurrent, intermittent episodes of fever and respiratory distress over the past 1.5 years, including cough, wheezing, and dyspnea lasting for 3-4 days. With every episode, hemoptysis is present. Now she is diagnosed with Right lower lobe pneumonia which improves upon treatment. On physical examination, the patient is pale, icteric with digital clubbing. Which of the following is the most appropriate next Investigation?\nA. Modified barium swallow study to evaluate for aspiration\nB. Bronchoalveolar lavage\nC. Nasal swab for viral culture\nD. Incentive spirometry", "response": "Above Findings are most likely suggestive of a diagnosis of Idiopathic Pulmonary Hemosiderosis. Clinical feature:- Hemoptysis with wheezing, cough, dyspnea (reflecting bronchospasm) and non-pulmonary symptoms such as failure to thrive or jaundice. During an acute exacerbation, children are frequently febrile. Examination of the chest may reveal retractions and differential or decreased aeration, with crackles or wheezes. Investigation Flexible bronchoscopy - Areas of active bleeding. Bronchoalveolar lavage - pulmonary secretions may be sent for pathologic review (which may show hemosiderin laden macrophages) and culture analysis Chest x-ray- Infiltrates are typically symmetric with apices spared Lung biopsy may be required. Treatment Suppoive therapy, including volume resuscitation, ventilatory suppo, supplemental oxygen, and transfusion of blood products Specific Treatment- Methylprednisolone\n\nSo the answer to this question is B"}
{"instruction": "Classical phenylketonuria is caused by a deficiency of\nA. Phenylalanine transaminase\nB. Phenylalanine hydroxylase\nC. Tyrosine transaminase\nD. Tyrosine hydroxylase", "response": "Classical phenylketonuria (hyperphenylalaninemia type I) → Deficiency of phenylalanine hydroxylase.\nAtypical phenylketonuria (hyperphenylalaninemia type II and III) → Defect in dihydrobiopterin reductase.\nHyperphenylalaninemia type IV and V → Defect in dihydrobiopterin synthesis.\n\nSo the answer to this question is B"}
{"instruction": "In children below 5 years of age, most common cause of gingivitis is\nA. local irritating factors\nB. herpes\nC. vitamin deficiency\nD. malocclusion", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "The cause of homogenous opacity on X-ray is all except –\nA. Pleural effusion\nB. Diaphragmatic Hernia\nC. Massive consolidation\nD. Emphysema", "response": "Emphysema produces blackening (not opacity) due to increased air.\nHomogeneous opacity is produced by consolidation, pleural effusion, hemothorax and diaphragmatic hernia.\n\nSo the answer to this question is D"}
{"instruction": "An 80-year-old man is brought to dermatology OPD by his son for recently noticed skin lesion. A biopsy is carried out with HPE as shown. Which of the following option cannot be used as a management for the above clinical scenario?\nA. Moh's micrographic surgery\nB. Photodynamic therapy\nC. Electrodessication\nD. NONE", "response": "All of the given options are used in the management of the basal cell carcinoma. Skin lesion shows pearly rolled telangiectatic borders with central ulceration suggestive of BCC. HPE: shows lobulated nest of neoplastic cells with retraction and palisaded basal layer. Findings are suggestive of BASAL CELL CARCINOMA. Treatments options for Basal Cell Cancer include electrodesiccation and curettage (ED&C) excision cryosurgery radiation therapy () laser therapy Mohs micrographic surgery (MMS) topical 5-fluorouracil photodynamic therapy (PDT) topical immunomodulators such as imiquimod The choice of therapy depends on tumor characteristics depth location patient age, medical status patient preference.\n\nSo the answer to this question is D"}
{"instruction": "Duputryens contracture commonly affects: September 2005\nA. Little finger\nB. Ring finger\nC. Middle finger\nD. Index finger", "response": "Ans. B: Ring Finger Dupuytren's contracture is more common among people with diabetes, alcoholism, or epilepsy. Dupuytren contracture, a disease of the palmar fascia, results in the thickening and shoening of fibrous bands in the hands and fingers. The ring finger is the one affected most commonly. It is usually limited to the medial three fingers. This disease entity belongs to the group of fibromatoses that include plantar fibromatosis (Ledderhose disease), penile fibromatosis (Peyronie disease), and fibromatosis of the dorsal proximal interphalangeal (PIP) joints (Garrod nodes or knuckle pads).\n\nSo the answer to this question is B"}
{"instruction": "The contraceptive TODAY which has been recently introduced contains :\nA. Prostaglandin F2\nB. Norethisterol\nC. 9 - Nonoxynol\nD. Copper releasing mesh", "response": "9 - Nonoxynol\n\nSo the answer to this question is C"}
{"instruction": "Howel-Jolly bodies may be seen after\nA. Hepatectomy\nB. Splenectomy\nC. Pancreatectomy\nD. Cholecystectomy", "response": "Howell-Jolly bodies are purple nuclear remnants, usually found singly, and are larger than basophilic stippling. They are present in megaloblastic anaemia and after splenectomy TEXTBOOK OF PATHOLOGY 6TH EDITION HARSH MOHAN PAGE NO:293 IMAGE REF:\n\nSo the answer to this question is B"}
{"instruction": "Which of the following organisms is commonly implicated in spontaneous bacterial peritonitis in patients of Nephrotic syndrome?\nA. Staphylococcus\nB. Streptococcus pneumoniae\nC. Hemophilus influenza\nD. Salmonella", "response": "Ans. B. Streptococcus pneumoniaeSpontaneous bacterial peritonitis (SBP), an infection of ascitic fluid without a definitive intra-abdominal source that can be surgically treated. Polymorphonuclear neutrophilic leukocyte (PMN) counts, starting at 250cells/mL are considered valid markers for SBP. Streptococcus pneumoniae as the most common streptococcal organism. Other organisms implicated include Escherichia coli and Klebsiella spp, Enterococcus spp and S. aureus.\n\nSo the answer to this question is B"}
{"instruction": "Malignant tumor associated with Waldenstrom macroglobulinemia includes -\nA. Smoldering myeloma\nB. Primary effusion lymphoma\nC. Mycosis fungoides\nD. Lymphoplasmacytic lymphoma", "response": "Waldenstrom macroglobulinemia is a syndrome in which high levels of IgM lead to symptoms related to hyperviscosity of the blood. It occurs in older adults , most commonly associated with lymphoplasmacytic lymphoma. Smoldering myelomas an uncommon variant of multiple myeloma defined by a lack of symptoms and a high plasma M component. Primary effusion lymphoma presents as a malignant pleural or ascitic effusion in patients with advanced HIV and older adults. Mycosis fungoides is a slowly evolving cutaneous T cell lymphoma occuring in middle aged adult males. Reference; Robbins and Cotran Pathologic basis of disease.South Asia Edition volume 1.page no. 596,598 Harsh Mohan textbook of pathology, 7th edition.Pg no.359\n\nSo the answer to this question is D"}
{"instruction": "'Lucid Interval' may be seen in\nA. Intracerebral haemorrhage\nB. Insanity\nC. Subdural haemorrhage\nD. Alcohol", "response": "Lucid interval- This is a period occurring in insanity during which all the symptoms of insanity disappear completely. Lucid interval refers to a brief period during which an insane person regains sanity that is sufficient to regain the legal capacity to contract and to act on his/her own behalf. Ref ganong's review of medical physiology 25e\n\nSo the answer to this question is B"}
{"instruction": "Prinzmetal angin a is-\nA. Angina after extreme exertion\nB. Caused due to atherosclerotic blockade\nC. Caused due to spasm of artery\nD. Calcium channel blockers not effective", "response": "Ans. is 'c' i.e., Caused due to spasm of artery o Variant angina (VA) which is also referred to as Prinzmetal angina, is a clinical entity characterized by episodes of anein a pectoris, usually at restand often between midnight and early morning, in association with ST-segment elevation on the electrocardiogram (ECG) Episodes are triggered by coronary artery vasospasm, which generally occurs in the absence of high grade coronary artery stenosis.o Variant angina has characteristics that allow it to be distinguished from stable angina pectoris, unstable angina, or microvascular angina.Pathogenesiso Variant angina (VA) is usually caused by focal spasm (of the smooth muscle layer of the arterial wall) of a major coronary artery, resulting in a high-grade obstruction.o Vascular smooth muscle hyper-reactivity is thought to be central to the pathogenesis of variant angina.o Spasm occurs in the absence of any preceding increase in myocardial oxygen demand (eg, exercise) and innormal or diseased vessels.Clinical presentationo Patients with variant angina typically present with a chronic pattern of recurrent episodes of chest pain,o The quality of the chest pain is indistinguishable from classical angina pectoris associated with obstructive coronary artery disease; however, the context in which it occurs differs.o In particular, patients with variant angina report that their episodes are predominantly at rest and that many occur from midnight to early morning.o Each episode of chest pain generally lasts 5 to 15 minutes.Diagnosiso The diagnosis of variant angina is made when a patient with recurrent episodes of anginal type chest pain, which generally occur at rest, is found to have transient ST-segment elevation on an electrocardiogram at the time ofan episode and subsequently found to not have high grade coronary stenoses at coronar\\> arteriography.ManagementSmoking cessationo As smoking cessation removes one of the triggers for variant angina and leads to a significant decrease in the frequency of episodes, at least in the short term, smoking cessation should be encouraged.Nitrates and calcium channel blockerso Calcium channel blockers (nifedipine, diltiazem, and verapamil) and nitrates are effective as chronic therapies for variant angina.o Both present vasoconstriction and promote vasodilation in the coronary vasculature.o For patients who do not have acceptable improvement in symptoms on calcium channel blocker therapy, add a long-acting nitrate.Rho kinase inhibitorso Fasudil is a rho kinase inhibitor that has been shown to inhibit acetylcholine-induced spasm.Statinso Statins have been shown to be effective in preventing coronary# spasm and may exert their benefits via endothelial nitric oxide or direct effects on the vascular smooth muscle.\n\nSo the answer to this question is C"}
{"instruction": "All are features of Wallenberg's syndrome, Except:\nA. Ipsilateral loss of pain and temperature\nB. Ipsilateral loss of taste sensation\nC. Ipsilateral loss of posterior column sensations\nD. Ipsilateral involvement of lower cranial nerves", "response": "Answer is A (Ipsilateral loss of pain and temperature): Pain and temperature sense are lost over opposite side of lesion due to involvement of spinothalamic tract. Symptom Pain numbness, impaired sensation over half the face Nystagmus, diplopia, oscillopsia, veigo, nausea vomiting Dysphagia hoarseness, paralysis of palate, paralysis of vocal cord (lower cranial nerve involvement) Ataxia, fall of side of lesion Loss of taste Homer's syndrome Numbness of ipsilateral arm, trunk & leg\n\nSo the answer to this question is A"}
{"instruction": "True statement about unconjugated hyperbilirubinemia\nA. 85% of the total should be indirect\nB. Seen in hemolytic anemia\nC. Seen in is hemoglobin destruction (T bilirubin production)\nD. All", "response": "Answer is A, B, C (85% of the total should be indirect, Hemolytic anemia, Seen in | hemoglobin destruction (| bilirubin production) Unconjugated Hyperbilirubinemia is associated with > 85% indirect bilrubin or less than 15% of direct bilirubin. Hemolytic disorders and increased hemoglobin destruction cause unconjugated or indirect hyperbilirubinemia. Biliary atresia and neonatal hepatitis lead to conjugated hyperbilirubinemia.\n\nSo the answer to this question is D"}
{"instruction": "The most sensitive and practical technique for detection of myocardial ischemia in die perioperative period is -\nA. Magnetic Resonance Spectroscopy\nB. Radio labeled lactate determination\nC. Direct measurement of end diastolic pressure\nD. Regional wall motion abnormality detected with the help of 2D transoesophagealechocardiography", "response": "Ans. is 'd' i.e., Regional wall motion abnormality detected with the help of 2D transesophageal echocardiography Two dimensional transesophageal echocardiography is the most sensitive method to detect myocardial ischemia in the perioperative period.But there are doubts, if it's a practical procedure too.Morgan states \"Detection of regional wall motion abnormality is a rapid and more sensitive indicator of myocardial ischemia than is the E.C.G. but unfortunately TEE requires expensive equipment and considerable familiarity with the technique in order to make correct and rapid interpretations intraoperatively\".Other methods available for intraoperative monitoring besides transesophageal echocardiography areElectrocardiography (E.C.G.) - The sensitivity of ECG in detecting ischemia is related to the number of leads monitored.Hemodynamic monitoring - It is done byCentral venous or pulmonary artery pressure monitoring.The most sensitive hemodynamic correlates are derived from pulmonary artery pressure monitoring - Ischemia is frequently but not always associated with an abrupt increase in pulmonary capillary wedge pressure.The most common hemodynamic abnormalities observed during ischemic episodes are hypertension and tachycardia.\n\nSo the answer to this question is D"}
{"instruction": "A child was immunized at 6 months of age because of epidemic of measles. Now next step would be -\nA. Administer vaccine as soon as he completes 9 months\nB. Administer vaccine after 4 weeks\nC. Administer along with DPT\nD. Nothing to be done", "response": " MEASLES VACCINE:- Live attenuated vaccine Person to person transmission of measles vaccine strains has never been documented. Freeze dried product. Before use ,the lyophilised vaccine is reconstituted with sterile diluent. Diluent must be cooled before reconstitution but it should not be freezed.After reconstitution , vaccine must be stored in dark at 2-8 degree celcius and used within 4 hrs. Each dose if 0.5 ml contains > 1000 viral infective units of vaccine strain. Measles vaccine may also contain sorbitol and hydrolysed gelatin as stabilizers and neomycin but it doesn&;t have thiomersal. It is thermolabile. Age-before 9 months.The age can be lowered to 6 months if there is measles outbreak in community.For infants immunised between 6 and 9 months,second dose administered as soon as possible after the child reaches 9 months provided that at least 4 weeks have elapsed since the last dose. Route-subcutaneous/intramuscular. Immune response- both humoral and cellular. Contraindications- High fever,pregnancy, history of anaphylactic reaction to vaccine components, immunocompromised individuals, leukemia, lymphoma,severe HIV( early stage of HIV is not a contraindication), treatment with steroids, antimetabolites and serious malignancy. Adverse reactions:- TSS-toxic shock syndrome. Occurs when measles vaccine is contaminated or when the same l is used more than once on same day / next day. The vaccine should not be used after 4 hrs of reconstitution. Symptoms of TSS : severe watery diarrhoea, vomiting, high fever repoed within few hours after vaccination. TSS is totally preventable and reflects poor quality of immunisation. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.149} Hypercalcemia can be a manifestation of a serious illness such as malignancy or can be detected coincidentally by laboratory testing in a patient with no obvious illness. The number between detection of hypercalcemia and death, especially without vigorous treatment, is often <6 months. Accordingly, if an asymptomatic individual has had hypercalcemia or some manifestation of hypercalcemia such as kidney stones for >1 or 2 years, it is unlikely that malignancy is the cause.Hypercalcemia from any cause can result in fatigue, depression, mental confusion, anorexia, nausea, vomiting, constipation, reversible renal tubular defects, increased urination, a sho QT interval in the electrocardiogram, and, in some patients, cardiac arrhythmias. There is a variable relation from one patient to the next between the severity of hypercalcemia and the symptoms. Generally, symptoms are more common at calcium levels >2.9-3 mmol/L (11.5-12 mg/dL), but some patients, even at this level, are asymptomatic. When the calcium level is >3.2 mmol/L (13 mg/dL), calcification in kidneys, skin, vessels, lungs, hea, and stomach occurs and renal insufficiency may develop, paicularly if blood phosphate levels are normal or elevated due to impaired renal function. Severe hypercalcemia, usually defined as >=3.7-4.5 mmol/L (15-18 mg/dL), can be a medical emergency; coma and cardiac arrest can occur.(harrison 18 pg 3100) Davidson&;s principles and practice of medicine 22nd edition. *In crohn&;s disease there the entire wall of bowel is oedematous and thickened involving terminal ileum ,right side colon,jejunum. Sick neonates are preferred over sick older children . Reference:Park&;s textbook of preventive and social medicine,K.Park,21st edition ,of no:414,23rd edition,page no:459. <\\p>\n\nSo the answer to this question is C"}
{"instruction": "Initial drug of choice in a child with status epilepticus -\nA. Lorazepam\nB. Phenobarbitone\nC. Valproate\nD. Phenytoin", "response": "Ans. is 'a' i.e., Lorazepam o Drug used are Lorazepam, Clonazepam, Diazepam, Phenytoin, Phenobarbitone, Thiopentol, Propofol, Midazolam. 0 Lorazepam i.v. is now the preferred initial choice.\n\nSo the answer to this question is A"}
{"instruction": "Which vitamin required for hydroxylation of proline?\nA. A\nB. D\nC. C\nD. K", "response": "Vitamin-c is required for hydroxylation of proline and lysine They form cross links and maintain stability of collagen Ref:Guyton and Hall textbook of medical physiology 12th edition,page number:229\n\nSo the answer to this question is C"}
{"instruction": "Type I hypersensitivity is mediated by which of the following immunoglobulins ?\nA. Ig A\nB. Ig G\nC. Ig M\nD. Ig E", "response": "Harshmohan textbook of pathology 7th edition. *type 1 or anaphylactic or atopic reaction mediated by humoral antibodies of IgE type or reagin antibodies in response to antigen.\n\nSo the answer to this question is D"}
{"instruction": "The internal pudendal artery supplies which of the following\nA. Proximal vagina\nB. Distal vaginal walls\nC. Posterior vaginal wall\nD. Bladder trigone", "response": "Proximal vagina → \n\nCervical branch of uterine artery\nVaginal artery\n\nPosterior vaginal wall → Middle rectal artery\nDistal vaginal wall → Internal pudendal artery.\n\nSo the answer to this question is B"}
{"instruction": "A woman complains of right-sided lower abdominal pain and mild bleeding per vagina for one day after a period of amenorrhoea of 6 weeks. Her general condition is satisfactory. There is tenderness in the right iliac fossa. The urine hCG test is positive. Transvaginal ultrasound scan does not reveal an adnexal mass or an intrauterine pregnancy.What is the next step in the management?\nA. Commence treatment with methotrexate\nB. Perform a laparoscopic examination\nC. Perform two serum beta hCG tests 48 hours apart\nD. Repeat the ultrasound scan after 7 days", "response": "Ans. is c, i.e. Perform two serum bhCG tests 48 hours apartNow in this question:Patient has Rt sided abdominal pain + tenderness + Amenorrhea of 6 weeks + Bleeding + UPT is positive + TVS is unconfirmatorySo most probably diagnosis is ectopic but D/D can be:(i) Abortion(ii) Early intrauterine pregnancy.\n\nSo the answer to this question is C"}
{"instruction": "Atrial myxoma is associated with the following except -\nA. Fever\nB. Weight loss\nC. Systolic murmur at apex\nD. Subungual splinter haemorrhage", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Hedstroem file is an instrument used for\nA. Canal enlargement\nB. Length determination\nC. Obturating with gutta percha in McSpadden technique\nD. Endodontic implants", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Prophylaxis for anthrax\nA. Erythromycin\nB. Doxycycline\nC. Penicillin\nD. Vancomycin", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is the commonest organism responsible for angular conjunctivitis?\nA. Moraxella lacunata\nB. Staphylococcus pyogenes\nC. Herpes simplex\nD. Haemophilus influenzae", "response": "Angular conjunctivitis is characterised by a mild inflammation confined to the conjunctiva and lid margins near the angle. The commonest causative organism is Moraxella lacunata. Ref: A K Khurana, 2nd Edition, Page 88.\n\nSo the answer to this question is A"}
{"instruction": "Cock's peculiar tumour is: September 2007\nA. Infected sebaceous cyst\nB. Osteomyelitis of skull\nC. Cyst in the skull\nD. Tumour of the skull", "response": "Ans. A: Infected sebaceous cyst Cock's peculiar tumour is a sebaceous cyst linked growth. One form of sebaceous cyst is the trichilemmal cyst; these are thought to arise from the hair follicle epithelium and are most commonly found on the scalp. Usually they are multiple but occasionally there can be a proliferating trichilemmal cyst which grows to a large size and ulcerates. These can resemble a squamous cell carcinoma (both clinically and histologically) and these ulcerating solitary cysts are called Cock's peculiar tumour.\n\nSo the answer to this question is A"}
{"instruction": "HCG is secreted by:\nA. Cytotrophoblasts\nB. Syncytiotrophoblasts\nC. Both\nD. Habfaur cells", "response": "Ans. b (Syncytiotrophoblasts). (Ref. Ganong Physiology 21st ed. -453)HUMAN CHORIONIC GONADOTROPIN (hCG)# It is a glycoprotein (molecular wt 36,000 to 40,000 d) with highest carbohydrate (30%) content of any human hormone. It is structurally related to three other glycoprotein hormones--LH, FSH, and TSH.# The 36-hour plasma half-life of intact hCG is much longer than the 2 hours for LH.# Biosynthesis:- Source: Syncytiotrophoblasts of placenta- A single gene located on chromosome 6 encodes the -subunit of all four glycoprotein hormones--hCG, LH, FSH, and TSH.- The secretion of b-hCG roughly corresponds to placental mass, whereas the rate of secretion of the complete hCG molecule is maximal at 8 to 10 weeks' gestation. Plasma cone of beta-hCG, although a minor portion of intact hCG at 10 weeks, can represent 30 to 50 percent during the last trimester.# Concentrations of hCG in Serum and Urine:- The intact hCG molecule is detectable in plasma of pregnant women about 7 to 9 days after the midcycle surge of LH that precedes ovulation. Thus, it is likely that hCG enters maternal blood at the time of blastocyst implantation. Blood levels increase rapidly, doubling every 2 days, with maximal levels being attained at about 8 to 10 weeks' gestation.- Because hCG circulates as multiple highly related isoforms with variable cross-reactivity between commercial assays, there is considerable variation in calculated serum hCG levels among the more than 100 assays. Peak levels reach about 100,000 mlU/mL between the 60th and 80th days after the last menses. Beginning at about 10 to 12 weeks' gestation, maternal plasma levels of hCG begin to decline, and a nadir is reached by about 20 weeks. Plasma levels are maintained at this lower level for the remainder of pregnancy.- The pattern of appearance of hCG in fetal blood is similar to that in the mother, however, fetal plasma levels are only about 3 percent of those in maternal plasma.# Elevated or Depressed hCG Levels in Maternal Plasma or Urine:- Significantly higher plasma levels of hCG are sometimes found in:- Women pregnant with multiple fetuses or with a single erythroblastotic fetus resulting from maternal D-antigen isoimmunization.- Hydatidiform mole or choriocarcinoma.- Women carrying a fetus with Down's syndrome, and this finding can be used in biochemical screening tests# Relatively lower levels of hCG in plasma are found with:- Ectopic pregnancies and impending spontaneous abortion.# Biological Functions of hCG- The best-known biological function of hCG is the so-called rescue and maintenance of function of the corpus luteum--that is, continued progesterone production.- Used to detect pregnancy because it appears in the urine 8 days after successful fertilization (blood and urine tests available).- Elevated hCG in women with hydatidiform moles or choriocarcinoma.- It stimulates fetal testicular testosterone secretion that is maximum at approximately the same time that maximal levels of hCG are attained. hCG enters fetal plasma from the syncytiotrophoblast, acts as an LH surrogate, and stimulates replication of testicular Leydig cells and testosterone synthesis to promote male sexual differentiation.- There is hCG stimulation of the maternal thyroid gland.- Other functions include:* Promotion of relaxin secretion by the corpus luteum.* LH-hCG receptors are found in myometrium and in uterine vascular tissue, and it has been hypothesized that hCG may act to promote uterine vascular vasodilatation and myometrial smooth muscle relaxation.Note: Peak levels reached on 72nd day or 12th week of pregnancy.\n\nSo the answer to this question is B"}
{"instruction": "True about National population policy (2000)-\nA. Reduce IMR< 20\nB. Reduce MMR < 50\nC. 100% immunization\nD. 100% institutional deliveries", "response": "Ans. is 'c' i.e., 100% immunization National population policy (2000)o Objectives of National Population Policy 2000# Immediate objectives: To meet unmet need of contraception; to strengthen health infrastructure; to strengthen health personnel and to promote integrated service delivery for basic RCH care# Mid term objective: 'To bring the total fertility rate (TFR) to Replacement Level; Le, TFR to 2.1'.# Long term objective: To stabilize population by 2045o National Socio-demographic Goals of NPP 2000 (achieve by 2010)# Address the unmet needs for basic reproductive and child health services, supplies and infrastructure# Make school education up to age 14 free and compulsory, and reduce drop outs at primary and secondary school levels to below 20 percent for both boys and girls# Reduce infant mortality rate to below 30 per 1000 live births'# Reduce maternal mortality ratio to below 100 per 100,000 live births# Achieve universal (100%) immunization of children against all vaccine preventable diseases# Promote delayed marriage for girls, not earlier than age 18 and preferably after 20 years of age# Achieve 80 percent institutional deliveries and 100 percent deliveries by trained persons# Achieve universal access to information/counseling, and services for fertility regulation and contraception with a wide basket of choices.# Achieve 100 per cent registration of births, deaths, marriage and pregnancy# Contain the spread of Acquired Immunodeficiency Syndrome (AIDS), and promote greater integration between the management of reproductive tract infections (RTI) and sexually transmitted infections (STI) and the National AIDS Control Organisation# Prevent and control communicable diseases# Integrate Indian Systems of Medicine (ISM) in the provision of reproductive and child health services, and in reaching out to households# Promote vigorously the small family norm to achieve replacement levels of TFR# Bring about convergence in implementation of related social sector programs so that family welfare becomes a people centred programme\n\nSo the answer to this question is C"}
{"instruction": "Scopolamine is used mostly in:\nA. Hyperemesis gravidarum\nB. Vomiting\nC. Constipation\nD. Motion sickness", "response": "(Ref: Katzung's Pharma, 14th ed. pg. 135)* Scopolamine (hyoscine) is a prototypic muscarinic receptor antagonist and is one of the best agents for the prevention of motion sickness.* Scopolamine has many effects in the body including decreasing the secretion of fluids, slowing the stomach and intestines, and dilation of the pupils.* Scopolamine is also used to relieve nausea, vomiting, and dizziness associated with motion sickness and recovery 3 from anesthesia and surgery.\n\nSo the answer to this question is D"}
{"instruction": "A patient at 22 weeks gestation is diagnosed as having IUD which occurred at 17 weeks but did not have a miscarriage. This patient is at increased risk for:\nA. Septic abortion\nB. Recurrent abortion\nC. Consumptive coagulopathy with hypofibrinogenemia\nD. Future infertility", "response": "Ans. is c, i.e Consumptive coagulopathy with hypofibrinogenemiaRef. Dutta Obs. 9/e, p 304, p 304Dead fetus, if retained for more than 4 to 5 weeks, release thromboplastin which leads to DIC (consumptive coagulopathy).In the question, the fetus has been dead and has been retained for five weeks so there are increased chances of DIC.Obstetrical conditions leading to DICa. Septic abortionb. IUDc. Abruptio placentaed. Amniotic fluid embolisme. Severe preeclampsia, eclampsia. HELLP syndrome.\n\nSo the answer to this question is C"}
{"instruction": "70 year old male presented with 3-months history of generalised weakness. On examination, bilateral axillary lymphadenopathy was noted. Histopathological examination of enlarged lymph node showed effacement of lymph node architecture by diffuse proliferation of small-sized, mature-appearing lymphoid cells. Peripheral blood showed lymphocytosis with presence of CD5-positive and CD23-positive B-cells. Which of the following is the most likely diagnosis of this patient?\nA. Burkitt leukemia\nB. Hodgkin lymphoma\nC. Chronic lymphocytic leukemia (CLL)\nD. Diffuse large B-cell lymphoma (DLBCL)", "response": "Chronic lymphocytic leukemia (CLL) CLL is the most common leukemia of adults in the Western world. Median age at diagnosis is 60 years. In CLL, absolute lymphocyte count is more than 5000/cumm. Lymph nodes are diffusely effaced by predominantly small lymphocytes. When present, proliferation centers are pathognomonic for CLL/SLL. The tumor cells express the pan B-cell markers CD19 and CD20, as well as CD23 and CD5. Burkitt lymphoma/leukemia - Adolescents or young adults with extranodal masses; uncommonly presents as \"leukemia\"; aggressive DLBCL - relatively large cell size (usually four to five times the diameter of a small lymphocyte) and a diffuse pattern of growth. CD5 and CD23 negative. Hodgkin lymphoma - arises in a single node or chain of nodes and spreads first to anatomically contiguous lymphoid tissues. Morphologically, the distinctive feature of Hodgkin lymphoma is the presence of neoplastic giant cells called Reed-Sternberg cells.\n\nSo the answer to this question is C"}
{"instruction": "Mallory Hyaline is characteristically seen with -\nA. Yellow fever\nB. Hepatitis B infection\nC. Alcoholic hepatitis\nD. Primary sclerosing cholangitis", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "None of the following are true about N95 masks except\nA. They were designed for influenza viruses during the H1N1 outbreak\nB. N- stands for National Institute of Occupational safety and Health\nC. It filters 95% of all paritcles smaller than 3nm\nD. A beard doesn't allow for a proper seal and makes the N95 ineffective", "response": "N 95 masks N 95 masks were designed by NIOSH for occupational safety of industrial workers. The masks come in different series N for Not resistant to oil. Used when oil paiculates are not present. R for Resistant to oil. Used when oil paiculates are present and the filter is disposed of after one shift. P for oil Proof. Used when oil paiculates are present and the filter is re-used for more than one shift. All 3 series come in variations of 95,99,100 which basically implies their percentage of filtration efficiency againt paicles bigger than 0.3 micron being 95%, 99% and 99.97% respectively. Facial hair can prevent the mask from forming a tight seal thus CDC has listed facial hairstyles which do not hamper the effectiveness of N95 These masks have been found to be effective against influenza viruses and are now currently being used for COVID-19\n\nSo the answer to this question is D"}
{"instruction": "Most common cause of Cushing syndrome is\nA. Pituitary tumor\nB. Ectopic ACTH producing tumor\nC. Steroid supplementation\nD. Adrenal tumor", "response": "Steroid supplementation is the most common cause of question syndrome.\n\nSo the answer to this question is C"}
{"instruction": "All are seen in congestive cardiac failure except –\nA. Kerley B lines\nB. Prominent lower lobe vessel\nC. Pleural effusions\nD. Cardiomegaly", "response": "There are prominent upper lobe vessels (not lower lobe) due to PVH.\nCHF (LVF) presents radiologically with cardiomegaly and signs of pulmonary venous hypertension (see above explanation for signs of PVH).\n\nSo the answer to this question is B"}
{"instruction": "Snyder's test tell us the:\nA. Exact nature of microorganisms\nB. Combined acidogenic nature of microorganisms\nC. Enamel dissolving capacity of saliva\nD. All of the above", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Most common location of extradural hematoma is\nA. Frontal area\nB. Temporal area\nC. Mastoid area\nD. Posterior fossa", "response": "The most common site is temporal, as the pterion is not only the thinnest part of the skull but also overlies the largest meningeal artery –the middle meningeal. An EDH may also occur in other regions such as frontal as well as in the posterior fossa.\n\nSo the answer to this question is B"}
{"instruction": "Cardiac output is a measure of:\nA. Peripheral resistance X tissue fluid\nB. Peripheral resistance X cardiac rate\nC. Blood pressure X cardiac rate\nD. Heart rate X blood volume", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Intercourse in closely related individual in relation -\nA. Incest\nB. Adultery\nC. Bestiality\nD. Tribadism", "response": "Ref:Textbook of forensic medicine and toxicology (V.V.Pillay) 17th edition, page no. 404 Incest is defined as natural sexual intercourse between two persons so closely related that they are forbidden by law to marry. Incest most frequently occurs between members of nuclear family, and the victim s are most often children.\n\nSo the answer to this question is A"}
{"instruction": "Withdrawal of heroin produces all the following symptoms except\nA. Insomnia\nB. Piloerection\nC. Mydriasis\nD. Miosis", "response": "Opioids cause miosis, withdrawal-opp. effects so not miosis Other withdrawal symptoms: yawning, insomnia, mydriasis, lacrimation, nausea, vomiting etc. opiod withdrawl is a distressing experience for the patient that makes the patient to take the sunstance again the main clue for opiod withdrawl isALL ORIFICES BLEED there is lacrimation, sweating, vomiting, rhinorrhea, diarrhoea, muscle cramps and stomach ache the piloerection that occurs in opiod withdrawl is called as COLD TURKEY the tratment of opiod withdrawl can be doneby several means SUPPOIVE CARE: clonidine+benzodiazepines+dicyclomine+anti emetic+anti diarrhoeal AGONIST ASSOSIATED DETOXIFICATION: methadone and bupenorphine ANTAGONIST ASSOSIATED DETOXIFICATION: naltrexone Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 338-340\n\nSo the answer to this question is D"}
{"instruction": "Most potent stimulator of NaiveT-cells -\nA. Mature dentritic cells\nB. Follicular dentritic cells\nC. Macrophages\nD. B-cell", "response": "Question repeated\n\nSo the answer to this question is A"}
{"instruction": "Least common quadrant in cancer breast is\nA. Upper outer\nB. Lower outer\nC. Sub areolar\nD. Lower inner", "response": "Most malignant type of CA breast : Inflammatory breast cancer Best prognosis is seen in : Tubular MC site of CA breast : Upper outer quadrant (left breast >right) Least common site of CA breast lower inner quadrant MC site of metastasis is Bone (osteolytic deposits in lumbar veebrae >Femur >Thoracic veebrae >Rib > Skull Ref: Sabiston 20th edition Pgno :837\n\nSo the answer to this question is D"}
{"instruction": "All of the following are true about Brugia malayi except-\nA. The intermediate hosts in India are Mansoni\nB. The tail tip is free from nuclei\nC. Nuclei are blurred, so counting is difficult\nD. Adult worm is found in the lymphatic system", "response": "Ans. is 'b' i.e., Tail tip is from nuclei Microfilariae of B malayi . Smaller than W. bancrofti . The nuclei are blurred, hence counting is difficult. . Tail-tip is not free from nuclei. There are two discrete nuclei. . The cephalic space is longer. . The intermediate hosts for B. malayi are various species of mansonia.\n\nSo the answer to this question is B"}
{"instruction": "Vidian neurectomy done in:\nA. Allergic rhinitis\nB. Vasomotor rhinitis\nC. Atrophic rhinitis\nD. Drug-induced rhinitis", "response": "ANSWER: (B) Vasomotor rhinitisREF: P L Dhingra 4th edition page 160, 1810%2806%2900013-3/abstractVidian neurectomy was first described for the treatment of intractable vasomotor rhinitisin the 1960s but fell into disrepute because of the recurrence of symptoms and significant complications. With subsequent improvements in the understanding of the nasal and sinus anatomy, endoscopic vidian neurectomy can now? be performed with minimal dissection and morbidityThe principle underlying vidian neurectomy is to sever the preganglionic fibers that reach the sphenopalatine ganglion through the vidian nerve. Several routes have been described to approach the deep seated vidian nerve:Trans antral Trans eptalTranspalatalTransethmoidal andTrans nasalThe most popular approach to the vidian nerve is the Transantral route.\n\nSo the answer to this question is B"}
{"instruction": "Pathognomic of measls ?\nA. Koplik spot\nB. Rash\nC. Fever\nD. Conjuctivitis", "response": "Ans. is 'a' i.e., Koplik spot Measle Caused by RNA virus. Highly contagious droplet spread from secretion of nose and throat 4 day before and 5 days after rash. Secondary attack rate >90% in contact. Prodromal phase - characterized by fever, rhinorrhea, conjuctival congestion and dry hackig cough. Koplik spots bluish-gray specks or \"grains of sand\" on a red base-develop on the buccal mucosa opposite the second molars Generally appear 1-2 days before the rash and last 3-5 days Pathognomonic for measles, but not always present Rash appears on D4 first behind pinna on neck the spread of face, thrunk and abdomen. SSPE is long term complication seen in measls.\n\nSo the answer to this question is A"}
{"instruction": "Abnormalities of bone metabolism is associated with excess of which vitamins -a) Vitamin Ab) Thiaminec) Vitamin Dd) Tocoferol\nA. ad\nB. c\nC. ac\nD. ab", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Allosteric inhibition of an enzyme is -\nA. Binding of inhibitor to catalytic site and inhibition of enzyme\nB. Binding of inhibitor to other site and inhibition of enzyme\nC. Inhibition of enzyme by inhibitors without binding to enzyme\nD. Inactivation by phosphorylation or dephosphorylation", "response": "Ans. is 'b' i.e., Binding of inhibitor to other site and inhibition of enzyme o Some enzymes, called allosteric enzymes, posses a site, in addition to substrate binding (catalytic) site, known as the allosteric site.o Binding of allosteric modulator at the allosteric site affects the conformation of catalytic site,o Such enzymes are called allosteric enzymes.o The allosteric modulator (regulator) may facilitate the conformational change of catalytic site, required for substrate binding.o Such regulators are called allosteric activators (positive allosteric modifier); for example, fructose-2,6-bisphosphate is an allosteric activator of Phosphoffuctokinase-I.o Some allosteric regulators prevent the conformational change required for binding of the substrate,o Such regulators are called allosteric inhibitors (negative allosteric modifier); for example, citrate is an allosteric inhibitor of phosphoructokinase-I.\n\nSo the answer to this question is B"}
{"instruction": "Commonest presentation of sickle cell anemia is -\nA. Priapism\nB. Bone pain\nC. Fever\nD. Splenomegaly", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "A newborn has a fever of 103degF. Blood culture grows gram-positive cocci in chains. This is most likely to be which of the following?\nA. Group A Streptococci (Streptococcus pyogenes)\nB. Group B Streptococci (Streptococcus agalactiae)\nC. Salmonella species\nD. Streptococcus pneumoniae", "response": "Most human infections caused by Streptococci involve the group A organisms (Streptococcus pyogenes). The group B Streptococci are members of the female genital tract and are impoant causes of neonatal sepsis and meningitis. Here we have newborn in the question given, so the most likely organism would be Gr B strep.\n\nSo the answer to this question is B"}
{"instruction": "Herpetic keratitis is treated by\nA. Analgesics\nB. Atropine\nC. Steroids\nD. Idoxuridine", "response": "D i.e. Idoxuridine Drug of choice for herpetic keratitis is Acyclovir Q (topical) Other antiviral drugs used are - Idoxuridine - Trifluorothyrnidine - Vidarabine\n\nSo the answer to this question is D"}
{"instruction": "True regarding estimation of Prothrombin time is:\nA. Immediately refrigerate to preserve factor bility\nB. Platelet rich plasma is essential\nC. Run the test within 2 hours\nD. Activated with Kaolin", "response": ". Run the test within 2 hours\n\nSo the answer to this question is C"}
{"instruction": "The maximum effect of a drug is defined by-\nA. Therapeutic index\nB. Potency\nC. Efficacy\nD. Adversity", "response": "Ans. is 'c' i.e., Efficacy - Refers to maximal response that can be produced by a drug. Potency - Amount of drug needed to produce a given response.\n\nSo the answer to this question is C"}
{"instruction": "The most common neurologic abnormality that occurs with head injury is-\nA. Hemiplegia\nB. Ocular nerve palsy\nC. Altered consciousness\nD. Convulsion", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is false about monoclonal gammopathy of unknown significance (MGUS)?\nA. Less than 3g/dL of monoclonal protein\nB. No evidence of Bence-Jones proteinuria\nC. Bone marrow plasma cells less than 10%\nD. Does not progress to multiple myeloma", "response": "MGUS: MGUS is the most common plasma cell disorder Asymptomatic BM Plasma Cells < 10% S. Para Protiens < 3g/dl 3% of MGUS ( aged > 50yr) can develop Multiple myeloma. 5% Of MGUS (aged >70yr) can develop multiple myeloma. Approximately 1% of patients with MGUS develop a symptomatic plasma cell neoplasm, usually multiple myeloma, per year.\n\nSo the answer to this question is D"}
{"instruction": "Type of human papilloma virus associated with cacinoma cervix\nA. Types 6, 12, 18\nB. Types 16, 18, 31\nC. Types 6, 8, 11\nD. Types 3, 10, 19", "response": "Explanation:\nJuvenile Papillomatosis of the breast\n● It is a relatively common benign localised proliferative lesion in the breast.\n● It is mainly seen in young women (mean age: 19-23 years)\n● Caused by HPV 6 and 11.\nClinical presentation\n● Patients present with a firmt well-defined, mobile mass often in the periphery of the breast.\n● There is usually no nipple discharge.\nPathology\n● Papillary proliferation of the ductal epithelium which partly fills up smaller ducts causing distension.\n● Grossly, well-circumscribed mass containing multiple small cysts (<2 cm) within a dense fibrous stroma\n(therefore sometimes termed swiss cheese disease by pathologists).\n● Lesions can vary in size, usually ranging from 1 to 8 cm.\nRadiographic features\nBreast ultrasound\n● They can appear as an ill-defined, inhomogenous hypoechoic mass with multiple small (up to 4mm) predominantly peripheral cysts.\n● Microcalcifications may be seen at sonography.\nMammography\n● These lesions are usually negative on mammography.\n● Occasionally may show microcalcifications, an asymmetric density or a prominant intraductal pattern. \nGalactography\n● May show a multiple irregular filling defects within the breasts. Breast MRI\nSignal characteristics according to one report include\n● T1 : hypo-intense lobulated mass\n● T2 : may show- presence of multiple small internal cysts, best shown on this sequence and is considered the most specific feature\n● T1 C+ (Gd) : may or may not show marked rapid enhancement\n● Dynamic sequence: shows a benign enhancement profile.\nComplications\n● Despite being a benign entity, it is considered by some to be a marker for familial breast cancer.\n● Approximately /0% develop breast cancer later in life.\n\nSo the answer to this question is B"}
{"instruction": "The tertiary structure of protein is detected by\nA. X-ray diffraction/crystallographs.\nB. Spectrophotometry\nC. Electrophoresis\nD. Chromatography", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "True about ALL –\nA. Anemia\nB. Leukopenia\nC. Hepatomegaly\nD. All of the above", "response": "Clinical manifestations of ALL \n\nSymptoms related to depression of normal marrow function.\nAn accumulation of neoplastic blast cells in the bone marrow suppresses normal hematopoiesis by physical crowding and competition for growth factors.\nThis results in : -\n\nAnemia → Fatigue, pallor\nNeutropenia→Infection, fever\nThrotnbocytopenia → Bleeding, petechiae, ecchymoses, epistaxis.\n\nThese are the most common sign & symptoms.\n\nBone pain and tenderness\n\nResulting from marrow expansion and infiltration of the subperiosteum.\n\nGeneralized lymphadenopathy, splenomegaly and hepatomegaly\n\nCaused by neoplastic infiltration of these tissues.\nMore common in ALL than AML.\n\nSymptoms related to compression of large mediastinal vessels or airway\n\nIn Pre-T ALL of thymus.\n\nCNS manifestation\n\nDue to meningeal involvement.\nA headache, vomiting, nerve palsies.\nMore common in ALL than in AML.\n\nTesticular involvement is also more common in ALL than in AML\n\nSo the answer to this question is D"}
{"instruction": "All are principles of primary health care except?\nA. Intersectoral coordination\nB. Community paicipation\nC. Appropriate technology\nD. Decentralised approach", "response": "o There are 4 main principles of primary health care : 1) Equitable distribution 2)Community paicipation 3)Intersectorial coordination 4) A ppro priate technology Ref: Park 24th edition\n\nSo the answer to this question is D"}
{"instruction": "Which of the following agent is not used in erectile dysfunction?\nA. PGE2\nB. Vardenafil\nC. Phenylephrine\nD. Alprostadil", "response": "Ans. c. Phenylephrine (Ref: KDT 7/e p303-304, 6/e p295-296; Harrison 19/e p326, 18/e p377)PGE2, Vardenafil (phosphodiesterase-V inhibitor) and Alprostadil (PGE1) are used in erectile dysfunction.Phenylephrine is not used in erectile dysfunction.L-arginine - increased NO - Increases c-GMP - Decreased Ca2+ - Smooth muscle relaxation - ErectionTreatment of Erectile DysfunctionSildenafilOnly approved and effective oral agents for erectile dysfunctionQUseful in wide range like in psychogenic, diabetogenic, vasculogenic, post radical prostatectomy (nerve sparing procedure) and spinal cord injury.Acts by inhibiting phosphodiesterase V (PDE -V)Q and releasing NOQ from nerve endings and endothelium.C-GMP is metabolized by PDE-V which is inhibited by sildenafil.Other phosphodiesterase-V inhibitors: TadalafliQ and vardenafilQPIPE therapy: (PapaverineQ/Phentolamme induced penile erection)AndrogenQIntra-urethral alprostodil (PGE1)QPenile prosthesis, vacuum constriction deviceRemember:Master Johnson technique is for premature ejaculationQ.Beta blockers can cause erectile dysfunctionQ.Drugs causing Erectile DysfunctionEnzyme Inhibitors: Ketoconazole, cimetidineAll Anti-hypertensives: Minimum with ACE inhibitors, maximum with beta-blockersAll abusive drugs at high doseFemale hormonal drug given to male, e.g., SERM, estrogen, exmestaneAll psychotic drugsAnti-depressants and anti-psychotic drugs\n\nSo the answer to this question is C"}
{"instruction": "Nuclear cytoplasmic ratio in malignant cells is\nA. 1:06\nB. 1:05\nC. 1:01\nD. 6:04", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "All of the following lesions may be classified as\nodontogenic tumours EXCEPT\nA. Acanthomatous ameloblastoma\nB. Branchial cleft cyst\nC. Myxoma\nD. Simple ameloblastoma", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is not a cause for interstitial keratitis\nA. Syphillis\nB. Leprosy\nC. Tuberculosis\nD. Pneumococcus", "response": "Pneumococcus Interstitial keratitis Corneal stromal inflammation without epithelial involvement. Infective causes are: *Syphillis * TB * Leprosy *Acanthamoeba\n\nSo the answer to this question is D"}
{"instruction": "In human corneal transplantation, the donor tissue is\nA. Synthetic polymer\nB. Donated human cadaver eyes\nC. Donated eyes from live human beings\nD. Monkey eyes", "response": "B i.e. Donated human cadaver eyes Donor corneas are harvested from cadaveric donors within 6 hours after death Q (upto 12 hours after death in cold countries.) Corneal Transplantation (Grafting) /Keratoplasty General Indications To provide a clear visual axis and restore good vision (Optical Keratoplasty) To restore the integrity of the globe in corneal diseases (Tectonic Graft) To remove infective tissue unresponsive to conservative treatment (Therapeutic Graft) To improve the appearance of the eye (Cosmetic Graft) Contraindications Death of unknown cause CNS disease such as Creutzfeldt-Jacob disease, subacute sclerosing panencephalitis, rubella, Reye's syndrome, rabies & infectious encephalitis. Infections such as HIV, Hepatitis, septicemia, syphilis, & endocarditis. Eye disease as retinoblastoma, malignant tumor of anterior segment & active ocular inflammation (uveitis, scleritis, retinitis & choroiditis) Prior ocular surgery (although pseudophakic eyes may be used with good cell density) Congenital or acquired anterior segment abnormalities such as Keratoconus & Fuch's endothelial dystrophy. * Corneas from infants (53 year) are used only very occasionally, even for pediatiric transplants as they are a/w surgical, refractive and rejection problems Graft-Harvesting Donor corneas are harvested from cadaveric donors within 6 hours after death Q (upto 12 hours after death in cold countries.) Graft-Preservation Sho term (upto 96 hours) - Moist chamber (at +40C) method for 24 hours. - M-K (Mc Carey-Kaufman) medium upto 96 hours. Intermediate-term (upto 2 weeks) - K-SOL / DEXOL / OPTISOL-medium Long term (months - years) - Viable: Organ culture & cryopreservation - Nonble: Glycerine Types Full Thickness or Penetrating keratoplasty Paial Thickness or Lamellar Keratoplasty - Superficial LK (replacement of corneal epithelium & superficial stroma) Deep anterior LK (DALK). all opaque tissue almost upto the level of Descemet membrane is removed Descemet stripping endothelial Keratoplasty (DSEK)/DS automated EK (DSAEK; when a microkeratome is used to perform donor lamellar dissection)/ Posterior LK (PLK) Small Patch grafts which can again be full or paial thickness Full Thickness/ Penetrating Keratoplasty (PKP) It is full thickness replacement of diseased corneal tissue with a healthy donor. It can be done in disease involving all or few layers of cornea eg keratoconus, pseudophakic bullous keratopathy, Fuchs endothelial & other dystrophies. An ideal graft size is 7.5 mm; grafts smaller than this may 1/t high astigmatism. Grafts 8.5 mm are prone to postoperative anterior synechiae formation, vascularization and increased intraocular pressure. - PKP has long been the gold standard for treatment of endothelial dysfunction. The limitations of PK include However, because of recent advances & lack of these limitations, endothelial keratoplasty is rapidly gaining popularity. It takes 6 months to many years for the refraction to stabilize 10-15% of patients typically require a hard contact lens for best vision and final mean refractive cylinder of 45D is common PKP incision cuts all corneal nerves, so the inclination to blink and produce tears is reduced postoperatively. This, together with prolonged presence of corneal sutures, increases the risk that ocular surface complications will interfere with recovery. PKP wound never heals back to the full strength of a virgin cornea, so a PKP eye is forever at increased risk of loss from a traumatic injury. Paial Thickness /Lamellar Keratoplasty (LKP) - It is a procedure in which a paial thickess graft of donor tissue is used to provide tectonic stability and /or optical improvement. - It may be of 2 types: anterior LKP and posterior LKP. - In anterior LKP, the transplanted tissue does not include corneal endothelium. This procedure avoids endothelial rejection and thus donor tissue may be obtained from older eyes. Indications for anterior LKP mainly include anterior corneal pathology in which the posterior cornea is unaffected - In deep LKP and posterior LKP, the diseased corneal endothelium is replaced while keeping the anterior corneal surface intact. - Because the donor endothelium is not used, the criteria for anterior LKP are less stringent than those used in PKP; the tissue does not need to be as fresh as that used in PKP. Corneal stroma may be used upto 7 days postmoem (whereas, Posterior LKP has same criteria as PKP) . Endothelial Keratoplasty (EK) i.e. posterior lamellar keratoplasty/ Descemet's Stripping endothelial Keratoplasty involves selective removal of dysfunctional recipient corneal endothelium and replacement with donor tissue consisting of posterior stroma and healthy endothelium. EK is performed through a small incision and spares the majority of host cornea so corneal strength and surface topography are minimally altered & technique is essentially refractive neutral. Fuhermore, corneal innervaton is retained and corneal sutures are not required. So corneal surface complications are minimal. The small incison allows rapid healing and rapid visual recovery after surgery. While fewer patients may achieve 20/20 vision after EK compared with PKP, overall the visual results are more predectible. - DSEK increases corneal thickness because posterior donor stroma is implanted without removal of any recipient stoma. In general, younger patients are likely to achieve better visual acuity after DSEK than older patients (even when have no retinal problems). Whereas PKP was often post phoned until after retirement or at least until visual problems were quite disturbing, EK is now being performed earlier, when visual problems begin to interfere with daily activities, such as reading or driving Infact, it is preferable to perform EK before long standing corneal edema 1/ anterior stromal scarring, because the anterior stroma is not replaced in EK.\n\nSo the answer to this question is B"}
{"instruction": "Most common form of glomerulonephritis worldwide is?\nA. IgA nephropathy\nB. Post streptococcal glomerulonephritis\nC. Rapidly progressive glomerulonephritis\nD. Acute glomerulonephritis", "response": "Most Common GN - IgA nephropathy / Berger disease (MC C/F - gross Microscope Hematuria) Most Common Nephrotic overall - FSGS Most Common Nephrotic in adult - FSGS Most Common Nephrotic in Children - Minimal Changes disease Most Common Nephrotic in elderly - MGN\n\nSo the answer to this question is A"}
{"instruction": "The following vitamin acts as a cofactor for glycogen phosphorylase:\nA. Thiamine pyrophosphate (B1)\nB. Riboflavin (B2)\nC. Pyridoxal phosphate (B6)\nD. Methyl cobalamin (B12)", "response": "Rate limiting enzyme of glycogenolysis is glycogen Phosphorylase which requires PLP i.e. vitamin B6. This vitamin is required as donor of phosphate as Glycogen phosphorylase transfers phosphate to glucose, releasing glucose-1-phosphate. Pyridoxal phosphate is also cofactor for transamination and decarboxylation reaction. Here is a difference to be kept in mind. Transamination Decarboxylation Aldehyde group of pyridoxal phosphate (PLP) plays a role Phosphate group of PLP plays a role\n\nSo the answer to this question is C"}
{"instruction": "Which of the following agents do not act GABAA Cl- channel complex receptors?\nA. Zopiclone\nB. Benzodiazepines\nC. Thiopentone\nD. Promethazine", "response": "Zopiclone (non benzodiazepine hypnotics ),benzodiazepine ,thiopentone(barbiturates) all act on GABA-Cl channel ,whereas promethazin is a antihistamine drug that acts on histaminergic receptors which causes high sedation. Ref: KD Tripathio 8th ed.\n\nSo the answer to this question is D"}
{"instruction": "Which complement component is anaphylotoxin -\nA. C3b\nB. C5.-9\nC. C5a\nD. Cl-3", "response": "Ans. is 'c' i.e., C5a\n\nSo the answer to this question is C"}
{"instruction": "Which of the following screening methods is used under RNTCP?\nA. Active\nB. Passive\nC. Mass\nD. All of the above", "response": "Under RNTCP, active case finding is not pursued. Case finding is passive. Patients presenting themselves with symptoms suggesting tuberculosis are screened with two sputum smear examinations. Ref: Park 21st edition, page 381.\n\nSo the answer to this question is B"}
{"instruction": "Down syndrome most commonly occurs due to ____\nA. Reciprocal translocation\nB. Non-disjunction in maternal meiosis\nC. Mosaicism\nD. Non-disjunction in paternal meiosis", "response": "Down&;s syndrome occurs due to nondisjunction in maternal meiosis. Down&;s syndrome: Most common chromosomal disorder Incidence: 1/800 live bihs Mechanism: Trisomy 21 (meiotic maternal nondisjunction) (95%) Robesonian translocation: 4% Mosaic pattern: 1% Non-disjunction points to the failure of the homologous chromosome to seperate during the meiotic division. Ref: Nelson textbook of pediatrics 21st edition Pgno: 658\n\nSo the answer to this question is B"}
{"instruction": "Masculine voice in females is treated by\nA. Thyroplasty type 1\nB. Thyroplasty type 2\nC. Thyroplasty type 3\nD. Thyroplasty type 4", "response": "The masculine voice in females is treated by Thyroplasty type 3. It is used to shoen (relax) the vocal cord. Relaxation of vocal cord lowers the pitch. This procedure is done in mutational falsetto or in those who have undergone gender transformation from female to male. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 6, page - 302\n\nSo the answer to this question is C"}
{"instruction": "Cerebellar hemangioblastoma and retinal tumors are seen in:\nA. Von Hippel Lindau syndrome\nB. Neurofibromatosis type 1\nC. Tuberous sclerosis\nD. Neurofibromatosis type 2", "response": "Ref: Chapter 28. CNS. page - 1343: Robbins and Cot ran Pathologic Basis of Disease: 8th editionExplanation:The Von Hippel Lindau gene (VHL) is tumor suppressor gene located on Chromosome 3p25-p26 and down-regulates expression of vascular endothelial growth factor; hence its dysregulation is associated with hemangioblastomas and retinal tumors.The neurofibromatosis type 1 (Chr. 17) is associated with:Optic nerve gliomasLisch nodules (pigmented nodules of the iris)Cafe au lait spots (cutaneous hyperpig- mented macules)Neurofibromatosis type 2 (Chr. 22) is associated with:8th nerve schwannomasMultiple meningiomasGliomasEpendymoma of spinal cordTuberous sclerosis complex: It is associated with:Cortical tubersSubependymal nodulesSubependymal giant cell astrocytomasRenal angiomyolipomasRetinal glial hamartomasPulmonary lymphangioleiomyomatosisCardiac rhabdomyomasShagreen patches (cutaneous leathery thickenings)Ash-leaf patches (hypopigmented areas)Subungual fibromas\n\nSo the answer to this question is A"}
{"instruction": "Double bleb sign in USg are depictive of:\nA. Intrauterine two gestations sac\nB. Amniotic sac and yolk sac\nC. Ectopic pregnancy\nD. Heterotopic pregnancy", "response": "Double bleb sign : Visualization of gestational sac containing a yolk sac and amniotic sac giving an appearance of two small bubbles . Feature of an intrauterine pregnancy. Distinguishes a pregnancy from a pseudogestational sac or decidual cast cyst. Ref:Williams 24e pg 170.\n\nSo the answer to this question is B"}
{"instruction": "Tolvaptan is used for:-\nA. SIADH\nB. Central DI\nC. Von Wilebrand disease\nD. Catecholamine resistant Shock", "response": "In SIADH, ADH increases so more activation of V2 receptor, so more water absorption. The patients suffer from dilutional hyponatremia. Option B: Managed by Desmopressin / Nasal spray Option C: Managed by Cryoprecipitate / VW Factor Option D: No definitive treatment, patient dies more often\n\nSo the answer to this question is A"}
{"instruction": "Which of the following drugs should not be given in renal failure ?\nA. Clindamycin\nB. Methicillin\nC. Amoxicillin\nD. Rifampicin", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which one of the following modes of intervention covers the process of advising a patient to change his lifestyle in order to prevent any risk factor for a disease\nA. Health promotion\nB. Specific protection\nC. Disability limitation\nD. Rehabilitation", "response": "Lifestyle modification (modification of risk factors) comes under health promotion which in turn is a pa of primary prevention Primary prevention includes both health promotion and specific protection Ref : Park&;s Textbook of Preventive and Social Medicine; 23rd edition - Pgno. 42\n\nSo the answer to this question is A"}
{"instruction": "A-7 year child presenting with acute otitis media, does not respond to ampicillin. Examination reveals full and bulging tympanic membrane, the treatment of choice is -\nA. Systemic steroid\nB. Ciprofloxacin\nC. Myringotomy\nD. Cortical mastiodectomy", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which of the following compound antagonizes the actions of insulin\nA. Neuropeptide Y\nB. Growth hormone\nC. Substance P\nD. Vasoactive intestinal peptide", "response": "Ans. (b) Growth hormone(Ref: Ganong, 25th ed/p.434)Growth hormone is a diabetogenic hormone. It causes hyperglycemia. It antagonizes the action of insulin\n\nSo the answer to this question is B"}
{"instruction": "A wound specimen obtained from a person working with wool from a Caribbean island demonstrated a large gram-positive rod from a non- hemolytic colony with swirling projections on blood agar. The most likely method to demonstrate spores would be which of the following\nA. Gram stain\nB. Acid-fast stain\nC. India ink stain\nD. Malachite green stain", "response": "Spores can be observed as intracellular refractile bodies in unstained cell suspensions. Also, they are commonly observed by staining with malachite green or carbolfuchsin. The spore wall is relatively impermeable, but heating of the preparation allows dyes to penetrate. Alcohol treatment then serves to prevent spore decolorization. Finally, the spores are counterstained.\n\nSo the answer to this question is D"}
{"instruction": "lining mucosa is found over all of the following surface except:\nA. Cheeks.\nB. Floor of the mouth.\nC. Ventral surface of tongue.\nD. Dorsum of tongue.", "response": "Dorsum of the tongue is specialized mucosa\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is feature of Alzheimer's disease\nA. Early memory loss\nB. Recent memory loss\nC. Recent and past memory loss\nD. Global memory loss", "response": "Recent memory loss\n\nSo the answer to this question is B"}
{"instruction": "About CSF following statement (s) is/are true\nA. The dura is attached firmly to bone\nB. CSF has a net weight of 1400g\nC. Total volume of CSF is 150 ml\nD. Daily production is 550 ml/day", "response": "CSF has a net weight of only 50 g In humans, the volume of CSF is about 150 mLThe rate of CSF production is about 550 mL/day. The dura is attached firmly to boneRef: Ganong's Review of Medical Physiology Twenty-Third Edition Page No: 572\n\nSo the answer to this question is B"}
{"instruction": "Which is elaborated by small cell carcinoma lung?\nA. PTH\nB. ACTH\nC. Erythropoesitn\nD. Noradrenaline", "response": "Ans. is 'b' i.e., ACTH o The ectopic hormones produced by lung carcinoma are:# ACTH} # AAVP(ADH)- Produced by Small cell Ca# ANF# Calcitonin # PTH- Produced by Non-small cell Ca\n\nSo the answer to this question is B"}
{"instruction": "Punishment for a person seeking prenatal diagnostic facilities for purpose of sex selection is\nA. 1 year imprisonment and fine Rs.10000\nB. 3 - 5 years imprisonment and fine Rs.50000 - 1 lakh\nC. 1 year imprisonment and fine Rs.50000 - 1 lakh\nD. 3 year imprisonment and fine Rs.10000", "response": "Section 23(3) PCPNDT ACT (Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT)Act, 1994) Punishment for a person seeking prenatal diagnostic facilities for purpose of sex selection is 3 - 5 years imprisonment and fine Rs.50000 - 1 lakh\n\nSo the answer to this question is B"}
{"instruction": "Proteins are soed by:\nA. Golgi Bodies\nB. Mitochondria\nC. Ribosomes\nD. Nuclear Membrane", "response": "The Golgi apparatus is involved in the glycosylation and soing of proteins. Ref: Biochemistry By Mary K. Campbell, Shawn O. Farrell, 7th Edition, Page 21; Harper's Textbook of Biochemistry, 27th Edition, Pages 506, 518\n\nSo the answer to this question is A"}
{"instruction": "The virus with smallest genome is ?\nA. Reovirus\nB. Parvovirus\nC. Picornavirus\nD. HIV", "response": "Ans. is 'b' i.e., Parvovirus . Smallest genome ----> Parvovirus . Largest genome --> Poxvirus\n\nSo the answer to this question is B"}
{"instruction": "A child presents with recurrent chest infections and recurrent sinusitis. Chest X-ray reveals dextrocardia and situs inversus. The most likely diagnosis is:\nA. Kartagener's syndrome\nB. Ehler-Danlos syndrome\nC. Marfan's symdrome\nD. William Campbell syndrome", "response": "Ans, a. Kartagener's syndrome (Ref: Robbins 9/e p683; Nelson 19/e pi 49?)The most likely diagnosis in a child with history of recurrent chest infections and recurrent sinusitis with dextrocardia and situs inversus on chest X-ray is Kartagener's syndrome.Kartagener's Syndrome (Immotile cilia syndrome/Primary ciliary dyskinesia)* Primary ciliary dyskinesia (PCD) comprises those respiratory disorders having in common the malfunction of airway cilia.* The abnormality results from various inherited primary structural defects in the cilia that lead to repeated and chronic lung and sinus infections.* About 50% of patients with PCD have Kartagener's syndrome: Situs inversus, chronic sinusitis and otitis, and airway disease leading to bronchiectasis.* Recurrent sinopulmonary infections are seenKartagener's Syndrome (Immotile cilia syndrome/Primary ciliary dyskinesia)Ultrastructural changes causing immotility of ciliaImmotility during embryogenesisImmotility in respiratory EpitheliumImmotility of cilia in sperms* Situs inversus* Dextrocardia* Bronchiectasis* Sinusitis* Infertility (male) Major cardiac AnomalyMajor non cardiac anomalyKartagener's syndrome (Immotile cilia syndrome) (Primary ciliary dyskinesia)* Dextrocardia0* Situs inversus* Sinusitis* Bronchiectasis* Infertility\n\nSo the answer to this question is A"}
{"instruction": "Which is not visualized on posterior rhinoscopy:\nA. Eustachian tube\nB. Inferior meatus\nC. Middle meatus\nD. Superior concha", "response": "Posterior rhinoscopy: It is method of examination of the posterior aspect of nose and pharynx. Structures seen on posterior rhinoscopy: - Both choanae - Posterior end of nasal septum - Opening of Eustachian - Posterior end of superior/tube middle and inferior turbinates - Fossa of Rosenmuller - Torus Tubarius - Adenoids - Roof and posterior wall and nasopharynx.\n\nSo the answer to this question is B"}
{"instruction": "Immune complex deposition is the basic underlying pathology in which type of hypersensitivity reaction?\nA. Type I\nB. Type 2\nC. Type 3\nD. Type 4", "response": "Ref: Robbins Pathologic Basis of Disease. 8flt editionExplanation:(See the following table)\n\nSo the answer to this question is C"}
{"instruction": "According to Naegele's rule, calculate EDD of a patient with LMP 9/1/2017:\nA. 16/10/2017\nB. 16/09/2017\nC. 16/11/2017\nD. 9/10/2017", "response": "ANS. A* Adding 7 days + 9 months to LMP gives EDD* Naegele's rule is based on 28 days regular cycle* If the cycle is shorter or longer than 28 days, EDD will be corrected and written as corrected EDD.For irregular cycles:1. If she is having 40 days cycle regularly, to get corrected EDD, add (40-28) with the EDD calculated from LMP.2. If she is having 21 days cycle regularly, to get corrected EDD, substract (28-21) 7 with the EDD calculated from LMP.\n\nSo the answer to this question is A"}
{"instruction": "To avoid pocket formation distance between the finish line and alveolar crest should be:\nA. 0.5 mm\nB. 1 mm\nC. 1.5 mm\nD. 2.5 mm", "response": "If the distance between finish line and the alveolar crest is less than 2mm, the restoration may lead to gingival. inflammation, loss of alveolar crest and pocket formation.\n\nSo the answer to this question is D"}
{"instruction": "Subodontoblastic plexus of Raschkow occupies\nA. Cell rich zone\nB. Cell free zone\nC. Odontoblastic zone\nD. All of the above", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Low risk type of HPV -\nA. Type -16\nB. Type - 6\nC. Type-18\nD. Type-31", "response": "Ans. is 'b' i.e., type 6 o High risk HPV: HPV-16,18,31,33 & 45 - associated with cervical cancero Low risk HPV: HPV- 6 & 11 - associated with precursor lesions CINo HPV-5 & 8 - associated with squamous cell cancer in patients with epidermodysplasia verruciformis.\n\nSo the answer to this question is B"}
{"instruction": "The total number of germ tooth present in a full form foetus is\nA. 20\nB. 28\nC. 44\nD. 48", "response": "Total number of tooth germs formed in human fetus is 52 (20 primary + 32 permanent). Third molar tooth germ initiated at 4 or 5 years. If you exclude the third molar tooth germs, the answer will be 48.\n\nSo the answer to this question is D"}
{"instruction": "Cardiomyopathy may be seen in all of the following except :\nA. Duchene muscular dystrophy\nB. Friedrich's ataxia\nC. Type II glycogen storage disease\nD. Alkaptonuria", "response": "Answer is D (Alkaptonuria) Friedreich's ataxia, Glycogen storage diseases and Muscular dystrophies are known to cause of cardiomyopathy. 11kantonuria hay not been mentioned to cause cardiomi'opathv. Primary myocardial involvement Idiopathic (D,R,H) Failmilial (D,R,H) Eosinophilic endomyocardial disease (R) Endomyocardial fibrosis (R) Secondary Myocardial involvement Infective (D) Connective tissue disorder (D) * Viral myocarditis * Systemic lupus erythematosus * Bacterial myocarditis * Polyaeritis nodosa * Fungal myocarditis * Rheumatoid ahritis * PRotozoal myocarditis * Progressive systemic sclerosis * Metazoal myocarditis * Dermatomyositis * Spirochetal Infiltratiions and granulomas (R,D) * Rickettsial * Amyloidosis Metabolic (D) * Sarcoidosis Familial storage disease (D,R) * Malignancy * Glycogen storage disease Neuromuscular (D) * Mucopolysaccharidoses * Muscular dystrophy * Hemochromatosis * Myotonic dystrophy * Fabry's disease * Friedreich's ataxia (H,D) Deficiency (D) Sensitivity and toxic reactions (D) * Electrolytes * Alcohol * Nutritional * Radiation * Drugs Peripaum hea disease (D)\n\nSo the answer to this question is D"}
{"instruction": "A 27 yr old worker fall from a roof and is brought to the emergency depament. His physical examination and computed tomography (CT) scan reveal dislocation fracture of the thoracic veebrae. The fractured body of the T7 veebra aiculates with which of the following pas of the ribs?\nA. Head of the sixth rib\nB. Neck of the seventh rib\nC. Tubercle of the seventh rib\nD. Head of the eighth rib", "response": "The body of veebra T7 aiculates with the head of the seventh and eighth ribs. The neck of a rib does not aiculate with any pas of the veebra. The transverse process of the veebra aiculates with the tubercle of the corresponding rib.\n\nSo the answer to this question is D"}
{"instruction": "Mechanism of action of d-tubocurarine is\nA. Competitive, nondepolarizing block at the Nm cholinergic receptor\nB. Non - competitive, nondepolarizing block at the Nm cholinergic receptor\nC. Competitive, depolarizing block at the Nm cholinergic receptor\nD. Noncompetitive, depolarizing block at the Nm cholinergic receptor", "response": "Depolarizing MR - Succinylcholine | - Shoest acting MR - C/I in nerve and muscle injury because it can cause | K+ - Hypehermia can occur. - It causes fasciculations responsible for post-operative muscle pain. Non - Depolarizing or competitive MR d- Tubocurarine - It releases lot of histamine that leads to vasodilation and bronchoconstriction. It competitively inhibit the Nm receptor.\n\nSo the answer to this question is A"}
{"instruction": "Dental caries is associated with flouride levels in water below:\nA. 0.1 mg\nB. 0.5 mg /L.\nC. 1.0 mg /L\nD. 2.0 mg /L", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Treatment of severe ulnar neuritis in borderline tuberculoid leprosy is which of the following?\nA. MDT only\nB. MDT +steroid\nC. Wait and watch\nD. MDT + thalidomide", "response": "Borderline tuberculoid leprosy patients may experience both type 1 ant type 2 lepra reactions. If there is nerve involvement in type 1 lepra reaction, coicosteroids are added to the Multi drug treatment regimen. Ref: Textbook of Dermatology, Venereology and Leprology, Devinder Mohan Thappa, 2nd Edition, Page 326 & 332; Handbook of leprosy by Jopling & Mc Dougall 5,th /127, 123; Current treatment options in Neurology 2002, / 189- 196.\n\nSo the answer to this question is B"}
{"instruction": "What is the gold standard investigation of choice for deep vein thrombosis?\nA. Double contrast duplex\nB. Venography\nC. CT scan\nD. MRI", "response": "Ans. B. Venography* Duplex ultrasound is the initial investigation of choice in nearly all patients with suspected DVT.* Its reliability is dependent upon the skill of the user.* Major axial veins of the lower limb are well displayed.* It has a sensitivity of 98.7% and specificity of 100% for above-knee DVT and a sensitivity of 85.2% and specificity of 98.2% for below-knee DVT.* Gold standard/Best test for venous occlusion is invasive venography.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is the most common cause of Meningoencephalitis in children\nA. Mumps\nB. Arbovirus\nC. HSV\nD. Enterovirus", "response": "Most common cause of meningoencephalitis in children is enterovirus. Meningoencephalitis is mainly caused by enteroviruses, varicella-zoster viruses, herpes simplex viruses, or measles viruses. Reference: GHAI Essential pediatrics, 8th edition\n\nSo the answer to this question is D"}
{"instruction": "Embryo is termed till:\nA. 12 weeks after LMP\nB. 10 weeks after fertilization\nC. 10 weeks after LMP\nD. 8 weeks of fertilization", "response": "Ans. (d) 8 weeks of fertilizationRef. Dutta's Obstetrics 7th ed./ 41The prenatal period can be divided intoPeriodProduct (k/a)Extends* Ovular/GerminalOvum1st 2 weeks after ovulation* EmbryonicEmbryoFrom fertilization (2nd week of gestation) to 8th week of development of fertilization (10th week AOG)* FetalFetusFrom 8th week of fertilization or development (10th week AOG to delivery)\n\nSo the answer to this question is D"}
{"instruction": "Skin over hypothenar eminence is supplied by?\nA. Radial nerve\nB. Median nerve\nC. Anterior interosseous nerve\nD. Ulnar nerve", "response": "Ulnar nerve\n\nSo the answer to this question is D"}
{"instruction": "Projections from substantia nigra pars compacta to striatum releases\nA. GABA\nB. Dopamine\nC. Glutamate\nD. Aspartate", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Rhinitis most common bacterial cause -\nA. Haemophilus influenza\nB. Streptococcus haemolyticus\nC. Pasturellamultocida\nD. Comybacterium diphtheria", "response": "Ans. is 'a' i.e., Haemophilus influenza o Acute bacterial rhinitis is most commonly seen among children, but adult may develop the condition after nasal trauma, viral upper respiratory tract infection, or surgery,o The clinical presentation of acute bacterial rhinitis may be identical to that of common cold,o Most common causative organisms include S. pneumoniae, H. influenzae and Moraxella Catarrhalis.o Note: Overall, most common cause of infective rhinitis is viral infection (viral rhinitis).\n\nSo the answer to this question is A"}
{"instruction": "PDL is thinnest at:\nA. CEJ\nB. Apex\nC. Middle\nD. None of the above", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "A child presents with hypochromic microcytic anemia, with normal levels of free Erythrocyte Protoporphyrin The most likely diagnosis is:\nA. Iron deficiency anemia\nB. Lead toxicity\nC. Thalassemia\nD. Anemia of chronic disease", "response": "Answer is C (Thalassemia) Erythrocyte protoporphyrin levels are characteristically normal in Thalassemia Free Erythrocyte Protoporphyrin is a useful screening test for microcytic hypochromic anemias. Free Erythrocyte protoporphyrin levels are increased in iron deficiency anemias, lead poisoning many cases of sideroblastic anemia and anemias of chronic disease. Erythrocyte protoporphyrin levels are normal in Thalassemias. Parameter Iron Deficiency Lead Poisoning Thalassemia trait Chronic disease Free Erythrocyte Ted Ted Normal Ted Protoporphyrin (FEP)\n\nSo the answer to this question is C"}
{"instruction": "Anaesthetic that has a smooth induction is –\nA. Diethyl ether\nB. Thiopental\nC. N2O\nD. Halothane", "response": "This question is straight forward as amongst the given options only thiopental is used as inducing agent.\nIv. inducing agents are used for induction because of rapid and smooth induction and drugs used for this purpose are:\n\nThiopentone\nMethohexitone sod\nPropofol\nEtomidate\n\nTill now we were discussing about inducing property of iv inducing agents. Some of the inhalation anaesthetic agents also have smooth induction.\nInduction by inhalation agents \nUnpleasant\n\nEther\n\nIntermediate\n\nHalothane\nEnflurane\n\nSmooth\n\nIsoflurane\nDesflurane\nSevoflurane\nNitrous oxide\n\nBut, you should keep in mind that smoothest induction is produced by iv inducing agents and therefore they are used as inducing agent.\n\nSo the answer to this question is B"}
{"instruction": "A 64-year-old man developed persistent back pain. On examination, his BP is 120/80, pulse 70, respiratory rate is 15, and temp is 98.6degF. Physical findings include severe pallor & evidence of muscle wasting. On urinalysis, 4 + protein. M/E of urine reveals occasional broad and occasional granular cast. Lab studies: Serum creatinine = 5.1 mg/dl, serum Na = 141, K = 5.6, chloride = 101, CO2 = 14, serum calcium = 11.7, and serum phosphorus = 6.0. Most likely etiology is:\nA. Renovascular disease\nB. Thrombotic renal disease\nC. . Multiple myeloma\nD. SLE", "response": "Multiple myeloma Multiple myeloma is the most likely etiology. The combination of hypercalcemia and acute renal failure raises the possibility of multiple myeloma as the bone breakdown secondary to tumor involvement releases large amounts of calcium to the extracellular fluid and hypercalcemia ensues. The renal failure in myeloma is primarily related to hypercalcemia combined with proteinaceous cast formation within the renal tubules, producing a form of intratubu- lar obstruction as well as a tubular inflammatory lesion. The major diagnostic clue is the finding of dipstick mildly positive urine with a sulfosalicylic acid strongly positive urine. Dipstick testing does not detect the negatively charged light-chain proteins, only the alburnin. Renovascular lesions and thrombotic renal disease could present with this picture, although they should not be asso- ciated with hypercalcemia and severe back pain, and findings upon examination of the urine would not include proteins. Systemic lupus erythematosus (SLE) can, of course, be associated with severe anemia and joint mani- festations, but hypercalcemia is not pa of the picture.\n\nSo the answer to this question is C"}
{"instruction": "Which is most specific for Alcholic liver disease\nA. AST\nB. ALT\nC. GGT\nD. ALP", "response": "AST: ALT ratio of 3:1 is highly specific\nNext is GGT\n\nSo the answer to this question is C"}
{"instruction": "Tetracycline chelates with\nA. Ca salts\nB. Mg salts\nC. Al salts\nD. All of the above", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Which of following pregnancy complications is associated with polycythemia vera\nA. Coagulopathy\nB. Placental abruption\nC. Stillbirth\nD. Placenta previa", "response": "Polycythemia vera → Increased blood viscosity → Thrombotic complications and fetal loss.\n\nSo the answer to this question is C"}
{"instruction": "Most potent stimulus for secretin is -\nA. Dilatation of intestine\nB. Acid chime\nC. Protein\nD. Fat", "response": "B i.e. Acid chyme\n\nSo the answer to this question is B"}
{"instruction": "Acute flaccid complete paralysis with areflexia and loss of perianal reflexes, below the level of spinal cord injury is due to -\nA. Spinal shock\nB. Denervation\nC. Malingering\nD. UMN paralysis", "response": "Ans. is 'a' i.e., Spinal shock Spinal shock* Spinal shock refers to the period after spinal cord injury (usually 24-48 hours) when the reflex activity of the entirespinal cord becomes depressed. Spinal shock' occurs when the spinal cord fails temporarily following injury. During this period the reflex arcs below the level of spinal cord injury are notfunctioning. Spinal shock is basically flaccid paralysis with loss of all spinal reflexes. There is loss ofautonomic, reflex, motor and sensory activity below the level of the cord lesion.* Signs of spinal shock include:i) Flaccid paralysisii) Loss of deep tendon and perianal reflexes* The return of reflex activity below the level of a spinal cord injury signifies the end of spinal shock.* An accurate assessment of neurological status cannot be completed until spinal shock resolves. The earliest indicator of resolution is the return of bulbocavernous reflex. The significance of spinal shock lies in thedetermination of whether a patient has sustained a complete Vs incomplete spinal cord injury. This cannot be* determined until spinal shock has ended. If there is total absence of sensory or motor function below the level ofinjury, after spinal shock has resolved, It indicates complete cord injury. If there is some residual functiondistal to the level of injury after resolution of spinal shock indicates incomplete cord injury.* High thoracic cord has poor prognosis as this area has narrow spinal canal and precarious blood supply, watershadearea of blood supply lies in upper thoracic region.\n\nSo the answer to this question is A"}
{"instruction": "What should be the density of microfilaria in blood to make it infective to the vector\nA. 5 microfilaria / drop of blood\nB. 10 microfilaria / drop of blood\nC. 15 microfilaria / drop of blood\nD. 20 microfilaria / drop of blood", "response": "A density of 15 microfilaria / drop of blood are needed to make it infective.\n\nSo the answer to this question is C"}
{"instruction": "Beta-carbolin at benzodiazepine receptors acts as\nA. Agonist\nB. Antagonist\nC. Inverse agonist\nD. Physiological antagonist", "response": "Ans. c (Inverse agonist) (Ref. KDT 6th/ 395)INVERSE AGONISTS# An inverse agonist is an agent which binds to the same receptor binding-site as an agonist for that receptor but exerts the opposite pharmacological effect.# E.g.:- R015-4513 which is the inverse agonist of the benzodiazepine .- Gabapentin acts by facilitation of GABA-mediated CT channel opening. It does not block GABA receptors. Substances called beta-carboline which also bind this receptor cause stimulation anxiety, increased muscle tone and convulsions. They are inverse agonists of benzodiazepine receptors.Agonistsincrease the inhibitory transmitter GABA potencyInverse agonistsdecrease GABA potencyAntagonistsblock action of agonists. Drugs affecting GABAA-receptor gated chloride channel# GABA: Endogenous agonist at GABAA receptor - promotes Cl- influx# Buscimol: Agonist at GABAA site# Bicuculline: Competitive antagonist at GABAA receptor# Barbiturate: Agonist at an allosteric site (Ppicrotoxin site); prolong GABA action; open CI- channel# Alcohol, inhalational anaesthetics, Propofol: Open CI- channel directly; allosteric facilitation of GABA# Benzodiazepine: Agonist at an allosteric BZD site --^facilitate GABA action# b-Carboline (DMCM): Inverse agonist at BZD site ->>impede GABA action# Flumazenil: Competitive antagonist at BZD site\n\nSo the answer to this question is C"}
{"instruction": "Why cereals and pulses are combined\nA. 10% cereals contain protein and pulses contain 40%\nB. Cereals are deficient in methionine and lysine is deficient in pulses\nC. Cereals are deficient in lysine and methionine is deficient in pulses\nD. Cereals are rich in essential AA", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is not a congenital anomaly?\nA. Amastia\nB. Polymastia\nC. Polythelia\nD. Mastitis", "response": "Mastitis is an inflammation of breast tissue that sometimes involves an infection. The inflammation results in breast pain, swelling, warmth and redness. You might also have fever and chills. Mastitis most commonly affects women who are breast-feeding (lactation mastitis) . Ref - medscape.com\n\nSo the answer to this question is D"}
{"instruction": "Best laboratory test to diagnose HIV infection March 2007\nA. ELISA\nB. Western blot\nC. Complement fixation test\nD. RIA", "response": "Ans. B: Western blot\n\nSo the answer to this question is B"}
{"instruction": "High plasma protein binding of a drug results in\nA. Less drug interaction\nB. High volume of distribution\nC. Decreased glomerular filtration\nD. Lowers duration of action", "response": "* Most drugs bind to plasma proteins in a reversible fashion without translating into a pharmacological response. (Plasma proteins are hence called Silent Receptors) * Acidic drugs bind to Albumin, Basic drugs to alpha1 acid- glycoprotein. * Binding of the drug to plasma protein affects the pharmacokinetic handling of drug by the body. Ref:- HL & KK Sharma's Principles of Pharmacology 3rd Ed; Pg Num:- 48\n\nSo the answer to this question is C"}
{"instruction": "FTU is a measure of:\nA. Area involved in severe drug reactions\nB. Amount of topical drug to be applied\nC. Mucosal involvement in pemphigus\nD. Concentration of drug in topical preparations", "response": "An approximate practical measure of topical medication is the fingeip unit, the quantity of ointment, extruded from a tube with a nozzle of 5 mm diameter extending from the distal crease of the forefinger to ventral aspect of the fingeip. This unit weighs approximately 0.49 g in males and 0.43 g in females and covers, on average, an area of approx 300 cm2.\n\nSo the answer to this question is B"}
{"instruction": "The FNAC of the lesion should reveal:\nA. ‘Orphan-Annie eye’ nucleus cells\nB. Amyloid deposits\nC. Epitheloid cells and giant cells\nD. Follicular cells", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Endoscopic nasal surgery is indicated in-\nA. Chronic sinusitis\nB. Epistaxis\nC. Both\nD. None", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Management of pancreatic abscess is\nA. Needle aspiration\nB. Cystogastrostomy\nC. USG guided drainage\nD. Cystojejunostomy", "response": "Sterile and Infected Pancreatic Fluid Collection (Pancreatic Abscess) The presence of acute abdominal fluid during an episode of AP has been described in 30-57% of patients In contrast to pseudocyst and cystic neoplasia of the pancreas, fluid collections are not surrounded or encased by epithelium or fibrotic capsule Treatment is suppoive because most fluid collections will be Spontaneously reabsorbed by the peritoneum Pancreatic Abscess: The presence of fever, elevated WBC count, and abdominal pain suggest infection of this fluid and percutaneous aspiration is confirmatory Percutaneous drainage and IV administration of antibiotics should be instituted if infection (Pancreatic abscess) is present Ref: Sabiston 20th edition Pgno :1529\n\nSo the answer to this question is A"}
{"instruction": "Target material used for generating X-rays:\nA. Tungsten\nB. Cobalt\nC. Cadmium\nD. Palladium", "response": "Ans. Tungsten\n\nSo the answer to this question is A"}
{"instruction": "Which of the following extrapyramidal effect is seen on chronic use of antipsychotic?\nA. Dystonia\nB. Akathisia\nC. Tardive dyskinesia\nD. Parkinsonism", "response": "Ans.C.Tardive dyskinesia Involuntary frowning, sticking out of the tongue, puckering, pursing, lip-smacking movements are seen in tardive dyskinesia due to chronic antipsychotic usage.Consider drug cessation or switch to an atypical antipsychotic in all patients.\n\nSo the answer to this question is C"}
{"instruction": "Cardiac output peaks during pregnancy at what gestational age?\nA. 20 weeks\nB. 28 weeks\nC. 32 weeks\nD. 36 weeks", "response": "Ans. c (32 weeks). (Ref. Textbook of Obstetrics by Dutta, 4th ed., 53)Cardiac output starts to increase from 10th week of pregnancy, reaches its peak of 40% at about 24-30 weeks.PHYSIOLOGICAL CHANGES ASSOCIATED WITH PREGNANCYCardiovascular System1Blood Volume# Increases progressively from 6-8 weeks gestation (pregnancy)# Reaches a maximum at approximately 32-34 weeks.The increase in plasma volume (40-50%) is relatively greater than that of red cell mass (20-30%) resulting in hemodilution and a decrease in haemoglobin concentration.Intake of supplemental iron and folic acid is necessary to restore hemoglobin levels to normal (12 g/dl).The increased blood volume serves two purposes.First, it facilitates maternal and fetal exchanges of respiratory gases, nutrients and metabolites.Second, it reduces the impact of maternal blood loss at delivery.Typical losses of 300-500 ml for vaginal births and 750-1000 ml for Caesarean sections are thus compensated with the so-called \"autotransfusion\" of blood from the contracting uterus.2Blood ConstituentsAs mentioned above, red cell mass is increased by 20-30%. Leukocyte counts are variable during gestation, but usually remain within the upper limits of normal.Marked elevations, however, develop during and after parturition (delivery).3Fibrinogenas well as total body and plasma levels of factors VII, X and XII increase markedly.The number of platelets also rises, yet not above the upper limits of normal.Combined with a decrease in fibrinolytic activity, these changes tend to prevent excessive bleeding at delivery. Thus, pregnancy is a relatively hypercoagulable state, but during pregnancy neither clotting or bleeding times are abnormal.4Cardiac OutputIncreases to a similar degree as the blood volume.During the first trimester cardiac output is 30-40% higher than in the non-pregnant state.Steady rises are shown on Doppler echocardiography, from an average of 6.7 litres/ minute at 8-11 weeks to about 8.7 litres/minute flow at 36-39 weeks. They are due, primarily, to an increase in stroke volume (35%) and, to lesser extent, to a more rapid heart rate (15%).There is a steady reduction in systemic vascular resistance (SVR) which contributes towards the hyperdynamic circulation observed in pregnancy.5Cardiac Size/ Position/ECGThere are both size and position changes which can lead to changes in ECG appearance. The heart is enlarged by both chamber dilation and hypertrophy.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following causes of Anemia is associated with a Hypoplastic marrow -\nA. Fanconi's Anemia\nB. Paroxysmal Nocturanl Hemoglobinuria (PNH)\nC. Hypersplenism\nD. Myelofibrosis", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "The most accepted theory for dentin sensitivity is\nor\nWhich of the following is the most accepted thoery\nof transmission of dental sensation\nA. Transduction theory\nB. Direct neural stimulation\nC. Hydrodynamic theory\nD. Hydrostatic theory", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which of the following antibiotics acts by inhibiting cell wall synthesis?\nA. Cefepime\nB. Aminoglycosides\nC. Erythromycin\nD. Doxycycline", "response": "Ans. is 'a' i.e. Cefepime\n\nSo the answer to this question is A"}
{"instruction": "Pseudo-Meigs syndrome syndrome seen with-\nA. Fibroids\nB. Adenomyosis\nC. Endometriosis\nD. Ovarian fibroma", "response": "Ans- A . Fibroids Meig's-ovarian fibromas Pseudomeig's-subserous Fibroid Pseudo-Meigs syndrome consists of pleural effusion (an example of which can be seen in the image below), ascites, and benign tumors of the ovary other than fibromas. These benign tumors include those of the fallopian tube or uterus and mature teratomas, struma ovarii, and ovarian leiomyomas.\n\nSo the answer to this question is A"}
{"instruction": "All are true about short bowel syndrome except -\nA. Intestinal transmit time is increased\nB. Nutritional deficiency present\nC. Site atorrhea present\nD. None", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Which of these antihypeensives do not have any central action?\nA. Propranolol\nB. Methyl dopa\nC. Minoxidil\nD. Nitroprusside", "response": "prpranolol is a beta blocker,methyldopa is a alpha agonist, minocidil is a potassium channel blocker and notroprusside is a nitrate all are used in treatment of hypeension. REF KD Tripathi 8th ed.\n\nSo the answer to this question is D"}
{"instruction": "A woman presents to a dermatologist because she has lost almost all the hair on her body, including scalp hair, eyebrows, eyelashes, armpit and groin hair, and the fine hairs on her body and extremities. She most likely has a variant of which of the following?\nA. Alopecia areata\nB. Androgenic alopecia\nC. Chronic cutaneous lupus erythematosus\nD. Lichen planopilaris", "response": "Alopecia areata is caused by an autoimmune attack on hair follicles. It has a wide range of clinical severity, with most cases involving a localized patch of hair (which regrows within 1 year in half of the patients). The hair that does regrow may be gray or depigmented. More severe cases can involve the entire scalp (alopecia totalis) or, as in this patient, the entire body surface (alopecia universalis). These more severe cases are less likely to resolve adequately. Treatment of alopecia areata is often unsuccessful, but topical steroids are typically tried. Androgenic alopecia is common male pattern baldness. Chronic cutaneous lupus erythematosus can produce localized baldness. Lichen planopilaris can produce localized baldness. Ref: Landthaler M., Baumler W., Hohenleutner U. (2012). Chapter 239. Lasers and Flashlamps in Dermatology. In K. Wolff (Ed), Fitzpatrick's Dermatology in General Medicine, 8e.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following mullerian anomaly is least likely to develop endometriosis\nA. Transverse vaginal septum\nB. Bicornuate Uterus\nC. Imperforate Hymen\nD. Unicornuate uterus.", "response": "Bicornuate Uterus is least likely to develop endometriosis.\n\nSo the answer to this question is B"}
{"instruction": "pANCA is sensitive and specified for-\nA. Post streptococcal glomerulonephritis\nB. Idiopathic cresentic glomerulonephritis\nC. Diffuse glomerulosclerosis\nD. None", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A 39-year-old male presents with severe neck pain after a whiplash injury, sustained when his car was struck from behind. Radiographic studies reveal trauma to the ligament lying on the anterior surface of the cervical vertebral bodies. Which ligament is this?\nA. Anterior longitudinal ligament\nB. Ligamentum flavum\nC. Nuchal ligament\nD. Posterior longitudinal ligament", "response": "The anterior longitudinal ligament lies anterior to the vertebral bodies along the vertebral column. The ligamentum flavum connects the lamina of two adjacent vertebrae. The nuchal ligament is a continuation of the supraspinous ligament above C7, which connects spinous processes. The posterior longitudinal ligament lies on the posterior edge of the vertebral bodies. The transverse cervical (cardinal) ligament is associated with the pelvic region of the body and not the spinal column.\n\nSo the answer to this question is A"}
{"instruction": "Impoant intermediate product of biosynthesis of fatty acid is\nA. Cholesterol\nB. Malonyl CoA\nC. Acetyl CoA\nD. Thioesterases", "response": "Carboxylation of Acetyl CoA The first step in the fatty acid synthesis is the carboxylation of acetyl CoA to form malonyl CoA. The acetyl CoA carboxylase is not a pa of the multienzyme complex. But it is the rate-limiting enzyme. Biotin, a member of B complex vitamins, is necessary for this reaction. The enzyme is allosterically regulated, the major effectors being citrate (positive) and palmitoyl CoA (negative). The reaction is similar to carboxylation of pyruvate to form oxaloacetate. The elongation of the fatty acid occurs by addition of 2 carbon atoms at a time. But the 2-carbon units are added as 3-carbon, malonyl units. The whole reaction sequence occurs while the intermediates are bound to ACP (acyl carrier protein).Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 137\n\nSo the answer to this question is B"}
{"instruction": "Patient pays a stipulated amount of money towards the treatment is termed\nA. Deductible\nB. Coinsurance\nC. Fee for service\nD. Third party payment", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Russel bodies are -\nA. Intracellular accumulation of protein\nB. Homogenous eosinophilic deposits\nC. Seen in multiple myeloma\nD. All of the above", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Hepcidin associated with which molecule?\nA. Iron\nB. Copper\nC. Selenium\nD. Flurine", "response": "Ans. is 'a' i.e., Iron Hepcidin is a positive acute phase reactant. Hence during inflammation, liver releases more hepcidin. This inhibits basolateral side transpo of iron along intestine. This results in a hematological picture which mimics iron deficiency anemia. This is the basis of Anemia of Chronic Disease\n\nSo the answer to this question is A"}
{"instruction": "A 19-year-old man with a history of recent-onset asthma presents with chest pain, intermittent claudication and respiratory distress that is unresponsive to bronchodilators and antibiotics. Physical examination reveals mild hypeension (blood pressure = 150/100 mm Hg), bilateral wheezing and numerous purpuric skin lesions on the feet. Laboratory studies demonstrate that leukocytes are increased to 14,000/mL with increased eosinophils and platelets are increased to 450,000/mL. BUN is elevated to 30 mg/dL, and serum creatinine is elevated to 3.5 mg/dL. The serum antineutrophil cytoplasmic antibody test is positive. Urinalysis discloses 3+ proteinuria and RBCs. A renal biopsy demonstrates vasculitis of medium-sized aeries, accompanied by eosinophilia. Which of the following is the most likely diagnosis?\nA. Churg-Strauss disease\nB. Henoch-Schonlein purpura\nC. Loeffler syndrome\nD. Wegener granulomatosis", "response": "Churg-Strauss disease is an idiopathic, systemic, granulomatous disease of small- and medium-size aeries characterized by vasculitis of many organs, fluctuating eosinophilia and late-onset asthma. The majority of patients display antineutrophil cytoplasmic antibodies. The disease is also known as allergic granulomatosis and angiitis. Transbronchial lung biopsy shows granulomatous lesions in vascular and extravascular sites, accompanied by intense eosinophilia. The vasculitis histologically resembles the lesions of polyaeritis nodosa and Wegener granulomatosis, but these diseases do not typically present with an asthmatic syndrome.\n\nSo the answer to this question is A"}
{"instruction": "Rytand's murmur is heard in\nA. Mitral Stenosis\nB. PDA\nC. Complete AV block\nD. Acute rheumatic fever", "response": "Rytand's murmur is mid diastolic murmur in complete heart block.\n\nSo the answer to this question is C"}
{"instruction": "Necrosis of cells is due to :\nA. Ca2+ efflux cell\nB. Fat deposition in cells.\nC. Water imbibition in cells.\nD. Enzymatic digestion.", "response": "• Necrosis: It refers to morphological changes that follow cell death in living tissues.\n• These morphological changes are the result of 2 concurrent processes.\n1. Enzymatic digestion.\n2. Denaturation of proteins.\n• The enzymes used in the process are derived from 2 sources:\n1. From the lysosomes of the dead cells themselves (Autolysis).\n2. From the lysosomes of immigrant leucocytes (Heterolysis).\n\nSo the answer to this question is D"}
{"instruction": "Foot drop due to injury of which nerve\nA. Tibial nerve\nB. Deep peroneal nerve\nC. Superficial peroneal nerve\nD. Sural nerve", "response": "FOOT DROP:- Paralysis of muscles of anterior compament of the leg due to injury to deep peroneal nerve results in loss of power of dorsiflexion of foot and eversion. As a result foot us plantar flexed. Ankle reflex is intact.This is usually caused by injury or disease of the common peroneal nerve due to trauma, leprosy or peripheral neuritis.Sensory loss- first interdigital cleft. {Reference: BDC 6E pg no.97}\n\nSo the answer to this question is B"}
{"instruction": "Myocardial contractility is increased by:\nA. Atropine\nB. Decreased end diastolic volume\nC. Increased heart rate from 70 to 150 beats/min\nD. Reduced arterial pH to 7.3", "response": "Option A: Atropine is a muscarinic receptor antagonist that is used to inhibit the effects of excessive vagal activation on the heart, which is manifested as sinus bradycardia and AV nodal block. Effect on contractility is negligible. \nOption B: Decrease EDV decreases contractility by Frank Starling law.\nOption D: Acidosis, hypercapnoea and hypoxia inhibit myocardium contractility.\nOption C: This effect is known as Bowditch Effect (Myocardial tension increases with an increase in heart rate).\n\nSo the answer to this question is C"}
{"instruction": "Premalignant conditions of stomach include all, Except:\nA. Gastric ulcer\nB. Pernicious anemia and achlorhydria\nC. Hiatus Hernia\nD. Atrophic gastritis", "response": "Answer is C (Hiatus Hernia): Hiatus Hernia is not considered a premalignant lesion for gastric carcinoma. Premalignant lesions for Gastric Adenocarcinoma Chronic Atrophic Gastritis (H. pylori > Pernicious Anemia) Intestinal Metaplasia Type II and Type III (Intestinal Metaplasia type 1 is not associated with increased risk) Gastric Dysplasia Gastric polyps (Adenomatous polyps) (Hyperplastic polyps are generally not considered premalignant as the rate of malignant transformation in these polyps is <1% and confined to polyps > lcm) Previous Gastrectomy Menetrier's Disease Gastric ulcers (long standing gastric ulcers : Low risk)\n\nSo the answer to this question is C"}
{"instruction": "Genetic disorders are diagnosed at 11 weeks of pregnancy by :\nA. Chorionic villous biopsy\nB. Amniocentesis\nC. Endometrial biopsy\nD. Placentography", "response": "Chorionic villous biopsy\n\nSo the answer to this question is A"}
{"instruction": "All of the following are immune complex diseases except-\nA. Serum sickness\nB. Farmer's lungs\nC. SLE\nD. Graft rejection", "response": "Ans. is 'd' i.e., Graft rejectionGraft rejection is Type IV hypersensitivity\n\nSo the answer to this question is D"}
{"instruction": "Most important layer of a slow sand filter is -\nA. Vital layer\nB. Sand bed\nC. Filter system\nD. Raw water", "response": "This is confusing one because of the following statements of Park.\n\t\"The most important part of the filter is the sand bed\" - Park\n\t\"The vital layer is the heart of the slow sand filter\" - Park\nFollowing statement may help in choosing the answer : -\n\n\"Vital layer is the layer that provides the effective purification in potable water treatment, the underlying sand layer providing the support medium for this biological treatment layer\" - Water & Health 3rd/e 733.\n\nRead the mechanism of action of slow sand filter and there will be no confusion.\nMechanism of action of slow sand filter\nSlow sand filter work through the, formation of a gelatinous layer called vital layer or hypogeal layer or Schmutzdecke in the top few cm of sand layer.\nThis layer is formed in the first 10-20 days of operation.\nThe formation of vital layer is known as \"Ripening of the filter\".\nThis vital layer consists of bacteria, fungi, Protozoa, and a range of aquatic insect larvae.\nAs waste passes through vital layer, particles of foreign matter are trapped in the mucilaginous matrix and dissolved organic material is absorbed and metabolized by bacterial, fungi and protozoa → Vital layer has mechanical (physical) as well as biological action.\nSo, the vital layer acts as the heart of slow sand filter.\n\nSo the answer to this question is A"}
{"instruction": "ETDRS vision chart study is done in patients with diabetic retinopathy. ETDRS stands for –\nA. Extended therapy for diabetic retinopathy & its sutdy\nB. Emergency treatment for diabetic retinopathy and study\nC. Eye testing or rotatory drum & its study\nD. Early treatment for diabetic retinopathy study", "response": "Early treatment diabetic retinopathy study (ETDRS) was a multicenter, randomized clinical trial involving 3711 participants designed to evaluate the effectiveness of both organ laser photocoagulation and aspirin therapy in the management of patients with non-proliferative diabetic retinopathy and early proliferative diabetic retinopathy.\nIn addition, it was designed to determine the best time to initiate photocoagulation treatment in diabetic retinopathy.\n\nSo the answer to this question is D"}
{"instruction": "Sunflower type cataract is characteristically seen in-\nA. Chalcosis\nB. Diabetes\nC. Stragardt's disease\nD. Congenital syphilis", "response": "Ans. is 'a' i.e., Chalcosis o Sunflower cataract is seen in Wilson's disease, chalcosis (copper deposition), penetrating trauma with retention of copper or its alloy.DiseaseType of cataracto Myotonic dystrophyChristmas tree cataract, Blue dot cortical cataract, posterior subcapsular cataract.o Wilson's diseaseo Copper deposition (Chalcosis)o Penetrating traumaSunflower cataract (Petals of flower cataract)o Diabetes mellitusSnowflake cataract or Snowstrom cataracto Down's syndromeSnowflake cataracto Hypoparathyroidism (Hypocalcemia) Hypovitaminosis DDiscrete white cortical opacities, Congenital lamellar (zonular) cataracto Atopic dermatitisBlue dot cortical cataract, posterior subcapsular cataracto Congenital rubellaNuclear cataract, Total congenital cataracto GalactosemiaOil drop cataract, Dust like lenticular opacitieso Complicated cataract (Iridocyclitis, High myopia)Posterior cortical breads's crumb appearance. Polychromatic lusture.Rainbow cataracto Blunt traumaVossius ring on anterior surface of lens. Rosette shaped cataract\n\nSo the answer to this question is A"}
{"instruction": "In PCR Acquaticus thermophilus is preferred over E.coli. because -\nA. Thermostable at temperature at which DNA liquefies\nB. Proofreading done\nC. Done in more precisely\nD. Does not require primer", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Ketone body formation without glycosuria is seen in ?\nA. Diabetes mellitus\nB. Diabetes insipidus\nC. Starvation\nD. Obesity", "response": "Ans. is 'c' i.e., StarvationAmongst the given options, DM and starvation are the causes of ketosisDiabetes :- Ketosis with hyperglycemia and glycosuriaProlonged starvation :- Ketosis with low or normal glucose and without glycosuria.In diabetic Ketoacidosis:- (i) Positive Rothera's test (due to ketone bodies) (ii) Positive Benedict's test (due to presence of reducing sugar in urine)In Starvation ketosis:- (i) Postive Rothera's test (due to ketone bodies), (ii) Negative Benedict's test (no sugar in urine)\n\nSo the answer to this question is C"}
{"instruction": "Paraneoplastic opsoclonus myoclonus syndrome is most commonly associated with which malignancy in children?\nA. Hepatoblastoma\nB. Hepatocellular carcinoma\nC. Lymphoma\nD. Neuroblastoma", "response": "Opsoclonus is a disorder of eye movement characterized by involuntary, chaotic saccades that occur in all directions of gaze; it is frequently associated with myoclonus and ataxia. Opsoclonus-myoclonus may be cancer-related or idiopathic. When the cause is paraneoplastic, the tumors involved are usually cancer of the lung and breast in adults and neuroblastoma in children. Ref: Harrison's principle of internal medicine 17th edition, chapter 97.\n\nSo the answer to this question is D"}
{"instruction": "The paradoxical response of GH release to TRH is seen in -\nA. Prolactinoma\nB. Acromegaly\nC. Malnutrition\nD. Pitutary adenoma", "response": "TRH stimulates the secretion of prolactin as well as TSH,\nNormally it does not affect growth hormone secretion but in acromegaly TRH induced growth hormonal stimulation Occurs. \n\nNote:\n\"In prolactinomas paradoxical response of TRH to prolactin occurs\".\nIn normal individuals,\nTRH stimulates prolactin release\nWhere as in prolactinomas\nThere is little or no rise in prolactin in response to TRH.\n\nSo the answer to this question is B"}
{"instruction": "Ptosis results from trauma to which nerve\nA. VII\nB. VIII\nC. III\nD. VI", "response": "Ans. is 'c' i.e. III C.N. Palsy of Levator palpebrae superioris supplied by III C.N. results in ptosis.\n\nSo the answer to this question is C"}
{"instruction": "Filters of which metal that is used to remove long wave\nlength X-rays from the primary beam is:\nA. Platinum\nB. Aluminium\nC. Copper\nD. Lead", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Mechanism of direct transfer of free DNA-\nA. Transformation\nB. Conjugation\nC. Transduction\nD. None", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is primarily a venodilator ?\nA. Hydralazine\nB. Minoxidil\nC. Nitroprusside\nD. Nifedipine", "response": "Ans. is 'c' i.e., Nitroprusside o Hydralazine, minoxidil and nifedipine are primarily aeriolar dilators whereas nitroprusside is a mixed aeriolar and venous dilator, therefore best answer here seems to be nitroprusside.\n\nSo the answer to this question is C"}
{"instruction": "A 25-year-old female presented in the month of December with chronic fatigue, cyanosis with bluish lips and ahralgia. Peripheral blood film is shown below. What is the likely cause?\nA. Cold AIHA\nB. Warm AIHA\nC. Hemoglobinopathy\nD. G6PD Deficiency", "response": "The given figure is of RBC agglutination. The history is suggestive of agglutination occurring in the month of December that is cold induced. Cold Agglutinin AIHA immune hemolytic anemia caused by IgM antibodies that bind red cells avidly at low temperatures (0deg-4degC). antibodies appear transiently following ceain infections, such as with Mycoplasma pneumoniae, EBV, CMV, influenza virus, and HIV. Clinical symptoms result from binding of IgM to red cells in vascular beds where the temperature may fall below 30degC, such as in exposed fingers, toes, and ears.\n\nSo the answer to this question is A"}
{"instruction": "Dental papilla gives rise to\nA. Pulp only\nB. Pulp & Dentin\nC. Pulp & periodontal ligament\nD. All of the above", "response": "The cells of dental papilla will form pulp and dentin and the cells of dental sac will form cementum and periodontal ligament.\n\nSo the answer to this question is B"}
{"instruction": "Autonomic nervous system the cholinergic nerve fibres\nA. All preganglionic fibres, releases acetycholine\nB. Post ganglionic cholinergic fibres secretes acetyl choline\nC. The post ganglionic sympathetic cholinergic nerve fibres supplies sweat glands and blood vessels inheart and skeletal muscles\nD. All of the above", "response": "(All of the above) (223 - 24-G 22nd) (266-68- Ganong 23rd)Neurotransmitters of ANSSympathetic fibres1. Preganglionic fibres - Acetylcholine2. Post ganglionic nor adrenergic fibres - Acetylcholine3. Post ganglionic cholinergic nerve fibres - AcetylcholineThe post ganglionic sympathetic cholinergic nerve fibres supply sweat glands blood vessels in heart and in skeletal musclesParasympathetic fibres1. Preganglionic fibres - Acetylcholine2. Post ganglionic fibres - Acetyl choline\n\nSo the answer to this question is D"}
{"instruction": "Most common neonatal disorder screened is:\nA. Neonatal hypothyroidism\nB. Neonatal hypehyroidism\nC. Hemoglobinopathies\nD. Congenital Dislocation of Hip", "response": "Most common neonatal disorder to be screened is Neonatal hypothyroidism (NNH) Blood sample is collected from Cord's Blood /fromheel prick after 24hrs of bih Test- measurement of T4 or TSH /both simultaneously. As a single method, T4 is more useful (greater precision and reproducibility) Congenital Hypothyroidism is one of the most common preventable cause of mental retardation. Hence, neonatal screening & early supplementation of thyroid hormones can prevent this mental retardation.\n\nSo the answer to this question is A"}
{"instruction": "Suburethral metastasis is seen in :\nA. Carcinoma cervix\nB. Carcinoma endometrium\nC. Choriocarcinoma\nD. Vaginal carcinoma", "response": "Carcinoma endometrium\n\nSo the answer to this question is B"}
{"instruction": "Nihilistic ideas are seen in -a) Simple schizophreniab) Paranoid schizophreniac) Cotard's syndromed) Depressione) Body dysmorphic disorder\nA. cd\nB. bc\nC. bd\nD. ac", "response": "Nihilistic delusion is false belief that oneself, other or the world is non-existent or about to end. It is seen in severe depression.\nIf nihilistic delusions are accompanied by ideas concerning bodily function failure, the syndrome is called Cotard's syndrome.\n\nSo the answer to this question is A"}
{"instruction": "A new test- test B for Diabetes mellitus is performed in a group containing diabetics and non-diabetics.A standard test A has been used as reference to classify them as diabetics and non diabetics. If 120 mg/dl of blood sugar is taken as the cut-off for test B, the area shaded in the graph below represents -\nA. True Positives\nB. False Positives\nC. True Negatives\nD. False Negatives", "response": "Ans- The shaded area indicated has Diabetics proved by a standard test A with blood sugar levels less than 120 mg/dl. Which is less than the cut-off as per the test B criteria required to label them as Diabetic . Hence, even though the shaded area has diabetics - but not picked up by this particular test B- known as False Negative.\n\nSo the answer to this question is D"}
{"instruction": "Beer - claw appearance on CECT abdomen is seen in\nA. Hepatic laceration\nB. Pancreatic laceration\nC. HCC\nD. RCC", "response": "Beer-claw laceration : Multiple linear laceration of liver on CECT abdomen Ref: Sabiston 20th edition Pgno : 437-439\n\nSo the answer to this question is A"}
{"instruction": "Increased airway resistance is/are caused by\nA. Forced expiration\nB. Dense air\nC. Low lung volume\nD. All", "response": "A, B, C i.e. Forced expiration, Dense air, Low lung volume\n\nSo the answer to this question is D"}
{"instruction": "Periodic acid schiff stain shows Block positivity\nA. Myeloblasts\nB. Lymphoblasts\nC. Monoblasts\nD. Megakaryoblasts", "response": "Lymphoblast contain cytoplasmic aggregates of periodic acid-schiff (PAS)-positive material.\n\nSo the answer to this question is B"}
{"instruction": "In the given condition, cause of defective vision is\nA. Astigmatism\nB. Hypermetropia\nC. Visual axis is obscured\nD. Diplopia", "response": "Pterygium: - Definition:- A degenerative condition of the subconjunctival tissue which proliferates as vascularised granulation tissue to invade the cornea . Pathogenesis:- * Elastotic degeneration of the subconjunctival tissue with Fibrovascular proliferation . * Destruction of epithelium & Bowman's layer by advancing fibrovascular tissue resulting in corneal scarring. Cause Of Defective Vision In Pterygium:- * Fibrovascular tissue contracts --> flattening of the cornea in the horizontal axis --> ASTIGMATISM {WITH THE RULE ASTIGMATISM } * Obscuring the pupillary region or the Visual axis. Types Of Pterygium:- Depending upon the growth * STOCKER'S LINE:- seen in atrophic pterygium. Iron deposition in front of the head in the corneal epithelium. Ref:- Parson's Diseases of the eye 22nd edition; pg num:- 184\n\nSo the answer to this question is C"}
{"instruction": "Patients with mutations leading to defective beta-oxidation of fatty acid usually have hypoglycemia because of\nA. Less ATP for gluconeogenesis\nB. Less acetyl CoA for glucose formation\nC. Increased fatty acids decrease glucose utilization\nD. Fatty acids inhibit transpo of glucose for metabolism", "response": "Acetyl-coenzyme A or acetyl-CoA is an impoant molecule that paicipates in many biochemical reactions in protein, carbohydrate, and lipid metabolism. Its main function is to deliver the acetyl group to the citric acid cycle (Krebs cycle) to be oxidized for energy production. Ref-Sathyanarayana 4/e p399\n\nSo the answer to this question is B"}
{"instruction": "Life style modification (discouraging children from adopting harmful lifestyles) is: March 2013 (b)\nA. Primary level of prevention\nB. Secondary level of prevention\nC. Teiary level of prevention\nD. Primordial prevention", "response": "Ans. D i.e. Primordial prevention Primordial prevention is defined as prevention of the development of risk factors before they happen.\n\nSo the answer to this question is D"}
{"instruction": "All of the following may lead to plaque formation except\nA. Pityriasis rosea\nB. Psoriasis\nC. Pemphigus\nD. Lichen planus", "response": "Pemphigus vulgaris is a immunobullous disorder characterised by formation of flaccid blisters in skin and mucous membranes. other options lesions are characterised by papules and plaques. iadvl textbook of dermatology page 1088\n\nSo the answer to this question is C"}
{"instruction": "Birbeck granules in the cytoplasm are seen in-\nA. Mast cells\nB. Langerhan's cells\nC. Thrombocytes\nD. Myelocytes", "response": "Birbeck granules, also known as Birbeck bodies, are rod shaped or \"tennis-racket\" cytoplasmic organelles with a central linear density and a striated appearance. First described in 1961 (where they were simply termed \"characteristic granules\"), they are solely found in Langerhans cells. Although pa of normal Langerhans cell histology, they also provide a mechanism to differentiate Langerhans cell histiocytoses (which are a group of rare conditions collectively known as histiocytoses) from proliferative disorders caused by other cell lines. Formation is induced by langerin.\n\nSo the answer to this question is B"}
{"instruction": "In DIC, which is/are seen -\nA. Normal APTT\nB. Increased PT\nC. Increased factor VIII\nD. None", "response": "Ans. is 'b' i.e., Increased PT; Laboratory findings in DIC o Low platelet count. o Blood film shows microangiopathic haemolytic anaemia. There is presence of fragmented R.B.C. due to damage caused by trapping and passage through fibrin thrombi. o PT, thrombin time, and Activated Paial thromboplastin time all are prolonged. o Plasma fibrinogen level decreased. o Fibrin degradation product (FDPS) are raised. o Factor V and factor VIII decreased in concentration.\n\nSo the answer to this question is B"}
{"instruction": "Gestational sac is seen by TVS at-\nA. 5 weeks\nB. 6 weeks\nC. 7 weeks\nD. 8 weeks", "response": "Ans. is 'a' i.e., 5 weeks [Ref: Dutta's Obs 7th/ep. 68}TVS showso Gestational sac & yolk sac - 5th weeko Fetal pole & cardiac activity - 6th weeko Embryonic movements - 7th weeko Fetal gestational age is best determined by CRL between 7th to 12th weeks (variation +/- 5 days)o Doppler effect of ultrasound can pick up heart rate by 10lh week.\n\nSo the answer to this question is A"}
{"instruction": "Which tumour is not seen in the anterior mediastinum -\nA. Teratoma\nB. Thymic tumours\nC. Thyroid tumours\nD. Neurofibroma", "response": "Ans. is `d' i.e., Neurofibroma Mediastinal Tumors and Other Masses Superior Mediastinum Anterior Mediastinum Posterior Mediastinum Middle Mediastinum Lymphoma Thymoma Neurogenic tumors Bronchogenic cyst Thymoma Teratoma Lymphoma Pericardial cyst Thyroid lesions Lymphoma Gastroenteric hernia Lymphoma Metastatic carcinoma Thyroid lesions Parathyroid tumors Parathyroid tumors\n\nSo the answer to this question is D"}
{"instruction": "A patient with a previous history of tuberculosis now complains of hemoptysis. Chest x-ray reveals an upper lobe mass with a cavity and a crescent-shaped air-fluid level. Select the most likely etiologic agent.\nA. Aspergillus flavus\nB. Coccidioides immitis\nC. Herpes simplex virus type 1\nD. Herpes simplex virus type 2", "response": "The patient who has a history of tuberculosis and now complains of haemoptysis would be revaluated for active tuberculosis. However, the chest x-ray described is characteristic of a fungus ball--almost always the result of an aspergilloma growing in a previous cavitary lesion.\n\nSo the answer to this question is A"}
{"instruction": "Rao and Singh's index is?\nA. Age-dependent index\nB. Age-independent index\nC. Age and sex-dependent index\nD. Independent of wt and ht", "response": "RAO & SINGH'S INDEX: - It is calculated as Weight (in kg) x 100/height2 (in cm) - Normal value: 0.14 - In children with malnutrition: 0.12 - 0.14\n\nSo the answer to this question is B"}
{"instruction": "Major source of estrogen in postmenopausal women is\nA. Peripheral conversion of androstenedione\nB. Secretion from adrenals\nC. Testosterone from the ovary\nD. H", "response": "All postmenopausal and symptomatic per menopausal women who do not have contraindication paicularlyThose with high-risk factors osteoporosis.Those with premature menopauseEvaluation before staing H:History-personal, medical, gynecological, familyExamination -HT, wt., BMI, BP, breast, vaginal examinationPap smearMammographyLipid profileTransvaginal sonography-endometrial thicknessWork up relevant to symptoms, e.g. urinary continence, carbohydrate intolerance, psychoemotional states.Contraindications of H:PregnancyCA breastCA endometriumUndiagnosed abnormal vaginal bleedingActive liver diseasePresent deep vein thrombosis, thromboembolic disorderInvestigation not routinely needed before staing HEndometrial sampling-Only did if the history of abnormal vaginal bleeding, TVS shows endometrial thickness> 5 mm.Serum FSH-Only did if the diagnosis of menopause is not clear, e.g. vasomotor symptoms in absence of amenorrhoea Bone densitometry-Using DEXA (dual energy X-ray absorptiometry) of lumber veebrae, hip bone for women with risk factors for osteoporosis, persistent backache, bone aches, history of recent fracture, for research purpose\n\nSo the answer to this question is A"}
{"instruction": "Obturation may be done in the initial visit if\nA. There is necrotic pulp\nB. There is a swelling\nC. The tooth is vital\nD. The tooth is nonvital", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Stress-induced hyperglycemia is due to:\nA. Glucocoicoids\nB. GH\nC. Epinephrine\nD. All", "response": "A i.e. Glucocoicoids; B i.e. GH; C i.e. Epinephrine\n\nSo the answer to this question is D"}
{"instruction": "Heavy pressure application during mask ventilation may compress:\nA. Marginal mandibular nerve.\nB. Laryngeal nerve.\nC. Arytenoid cartilage.\nD. All of the above.", "response": "Heavy pressure application doing mask ventilation may compress the marginal – mandibular branch of facial N in angle of mandible Region.\n\nSo the answer to this question is A"}
{"instruction": "Gluten sensitive enteropathy is most strongly associated with which of the following?\nA. HLA DQ2\nB. HLA DR4\nC. HLA DQ3\nD. Blood group 'B'", "response": "95% of patients with gluten sensitive enteropathy express HLA DQ2 histocompatibility antigen on chromosome 6. In celiac sprue, the fundamental disorder is a sensitivity to gluten. When small intestinal mucosa is exposed to gluten, there is intraepithelial accumulation of cytotoxic T cells and helper T cell in the lamina propria. Cytokines released by the T cells in turn damage intestinal enterocytes.Ref: Robbins Pathologic Basis of Disease, 6th Edition, Page 813.\n\nSo the answer to this question is A"}
{"instruction": "Prophylaxis of is essential to prevent which vitamin deficiency in patients taking isoniazid?\nA. B1\nB. B2\nC. B3\nD. B6", "response": "Ans. is 'd' i.e., B6 * Isoniazid reacts with pyridoxal to form a hydrazone, and thus inhibits gneration of pyridoxal phosphate.* Isoniazid also combines with pyridoxal phosphate to interfere with its coenzyme function. Due to formation of hydrazones, the renal excretion of pyridoxine compounds is increased.* Thus, isoniazid therapy produces a pyridoxine deficiency state.\n\nSo the answer to this question is D"}
{"instruction": "Huhle cell carcinoma is a variant of ?\nA. Medullary carcinoma\nB. Papillary carcinoma\nC. Follicular carcinoma\nD. Anaplastic carcinoma", "response": "Ans. is 'c' i.e., Follicular carcinoma Follicular carcinoma Second most common type of thyroid cancer. o Huhle cells are seen. o Differentiated from follicular adenoma by capsular and/or vascular invasion. o Unlike in papillary carcinoma, lymphatic spread is rare, and vascular invasion is common in follicular cancers. o Huhle cell or oncocytic carcinoma is a varriant of follicular carcinoma.\n\nSo the answer to this question is C"}
{"instruction": "Retentive grooves in the proximal box of a class II amalgam cavity should be\nA. Sharp and elongated at the dentinoenamel junction\nB. Round and elongated in the dentin\nC. Round and short in the dentin\nD. Sharp and elongated in the dentin", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A 30-year-old lady presents with features of malabsorption and iron deficiency anemia. Duodenal biopsy shows complete villous atrophy. Which of the following antibody is likely to be present?\nA. Antiendomysial antibodies\nB. Anti-goblet cell antibodies\nC. Anti-Saccharomyces cerevisiae antibodies\nD. Antineutrophil cytoplasmic antibodies", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Drug of choice in methicillin-resistant Staphylococcus aureus -\nA. Ceftriaxone\nB. Ceftazidime\nC. Ampicillin\nD. Vancomycin", "response": "Methicillin resistance in S. aureus is determined by the mecA gene, which encodes for resistance to all b-lactam drugs. If CA-MRSA infection is suspected, either linezolid or vancomycin should be added to the initial empirical regimen. (Harrison's Principles of internal medicine, 20th edition)\n\nSo the answer to this question is D"}
{"instruction": "Most common site of subphrenic abscess is\nA. Right anterior intraperitoneal space\nB. Right posterior intraperitoneal space\nC. Left anterior intraperitoneal space\nD. Left posterior intraperitoneal space", "response": "Right posterior intra-peritoneal space(Right subhepatic space/Rutherford Morison's kidney pouch) is bounded in front by the liver & gallbladder,above by the liver,behind by the right kidney & diaphragm,below by the transverse colon & hepatic flexure,to the left by foramen of Winslow & duodenum.It is the largest and deepest space of all.It is the most common site of subphrenic abscess.Causes include appendicitis,cholecystitis,post operative,perforated duodenal ulcer,intestinal obstruction. Reference:SRB' s manual of surgery,5th edition,page no:575.\n\nSo the answer to this question is B"}
{"instruction": "Inveed fir tree appearance is characteristic of\nA. Bacillus anthrax\nB. Hemophilus influenzae\nC. Yersinia pestis\nD. Brucella", "response": "Anthrax bacilli is gram-positive and is found singly, in pairs or in sho chains. On gelatin stab culture, a characteristic inveed fir tree appearance is seen in the case of anthrax bacilli, with slow liquefaction commencing from the top. On blood agar, the colonies are non-hemolytic, though occasional strains produce a narrow range of hemolysis. In broth, growth occurs as floccular deposits, with little or no turbidity. Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 251\n\nSo the answer to this question is A"}
{"instruction": "What is the inheritance pattern of friedreich ataxia?\nA. Autosomal dominant\nB. Autosomal recessive\nC. x linked dominant\nD. x linked recessive", "response": "Friedreich Ataxia and Ataxia Telanjectasis both are autosomal recessive disorder.\n\nSo the answer to this question is B"}
{"instruction": "Glucogenic amino acid is-\nA. Leucine\nB. Lysine\nC. Glutamine\nD. None", "response": "Ans. is 'c' i.e.. Glutamine GlucogenicKetogenicBoth glucogenic & ketogenico Alanineo Arginineo Aspargineo Aspartic acido Cysteineo Glutamineo Glutamic acido Glycineo Histidineo Methionineo Prolineo Serineo Threonineo Valineo Leucineo Lysineo Isoleucineo Phenylalaineo Tyrosineo TryptophanNote : According to Harper 29PSh/'e (P-282), lysine is both ketogenic and glucogenic. But all other textbooks have mentioned it as ketogenic.\n\nSo the answer to this question is C"}
{"instruction": "A 34-year-old power lifter visits the outpatient clinic because he has difficulty walking. During physical examination it is observed that the patient has a problem unlocking the knee joint to permit flexion of the leg. Which of the following muscles is most likely damaged?\nA. Biceps femoris\nB. Gastrocnemius\nC. Popliteus\nD. Semimembranosus", "response": "When the popliteus contracts, it rotates the distal portion of the femur in a lateral direction. It also draws the lateral meniscus posteriorly, thereby protecting this cartilage as the distal femoral condyle glides and rolls backward, as the knee is flexed. This allows the knee to flex and therefore serves in unlocking the knee. The biceps femoris is a strong flexor of the leg and laterally rotates the knee when it is in a position of flexion. The gastrocnemius is a powerful plantar flexor of the foot. The semimembranous, similar to the biceps femoris, is a component of the hamstring muscles and is involved in extending the thigh and flexing the leg at the knee joint. The rectus femoris is the strongest quadriceps muscle in extending the leg at the knee.\n\nSo the answer to this question is C"}
{"instruction": "40 year old lady presented with sudden onset of breathing difficulty. Clinical examination was essentially normal except for tachycardia and tachypnea. She gives history of two episodes of lower limb pain and swelling, first episode was 15 years back during her first pregnancy and second episode 3 months back. What would be the hematological abnormality respoinsible for her condition:\nA. Protein C excess\nB. Resistance to activated protein C\nC. Antithrombin mutation causing accelerated effect\nD. Polycythemia vera", "response": "Here the patient is probably suffering from pulmonary embolism as the major symptom of pulmonary embolism is sudden onset of breathlessness. Chest examination will be normal. As the patient gives history of recurrent episodes of lower limb swelling, she must be suffering from reccurrent deep vein thombosis as a result of some thrombophilic condition. FACTS: Heritable causes of venous thrombosis 1. Antithrombin deficiency and factor V leiden mutation 2. Protein C and S deficiency 3. Activated protein C resistance 4. Polycythemia can cause venous thrombosis but in this patient there are no features to suggest polycythema Ref: Harrison, Edition - 18, Page - 987\n\nSo the answer to this question is B"}
{"instruction": "A 20 years old female has thoughts of cutting her fingers, she plans and imagines doing it but never actually does it. She says that she is not having any guilt of having such thought. And also says the thoughts are distressing her and she is unable to control them. The thoughts vanish either by ending with a seizure or automatically subsides on its own. Which of the following is the cause?\nA. Thought inseion\nB. Obsession\nC. Forced thinking\nD. Thought crowding", "response": "Answer- C. Forced thinkingForced thinking is a rare epileptic phenomenon, usually seen in patients with frontal lobe epilepsy. It is a rare type of aura that refers to recurrent intrusive thoughts, ideas, or crowding of thoughts. The above profile fits into the criteria for epileptic forced thinking, which is a rare phenomenon seen in patients with frontal lobe epilepsy.\n\nSo the answer to this question is C"}
{"instruction": "Slow waves in EEG activity seen in -\nA. Depression\nB. Delirium\nC. Schizophrenia\nD. Mania", "response": "A diagnosis of delirium can be made if the patients EEG finding show a slowing of activity in brain.\n\nSo the answer to this question is B"}
{"instruction": "Prognosis of breast cancer is best determined by: March 2011\nA. Axillary node involvement\nB. Skin infiltration\nC. Size of the tumour\nD. Estrogen receptor status", "response": "Ans. A: Axillary node involvement The best indicators of likely prognosis in breast cancer remain tumour size and lymph node status; however, it is realized that some large size tumours will remain confined to the breast for decades whereas some very small tumours are inoperable at diagnosis. Hence, the prognosis of a cancer depends not on its chronological age but on its invasive and metastatic potential\n\nSo the answer to this question is A"}
{"instruction": "In a female child at bih, oocyte is in a stage of\nA. Anaphase of the first meiotic division\nB. Prophase of the first meiotic division\nC. Anaphase of the second meiotic division\nD. Prophase of the second meiotic division", "response": "Inderbir Singh&;s Human embryology; Tenth edition; Pg 24At the time of bih, all primary oocytes are in the prophase of the first meiotic division.\n\nSo the answer to this question is B"}
{"instruction": "Fascia around nerve bundle of brachial plexus is derived from:\nA. Preveebral fascia\nB. Clavipectoral fascia\nC. Deep cervical fascia\nD. Pectoral fascia", "response": "The preveebral fascia forms a tubular sheath around the veebral column and the preveebral muscles, which are attached to the veebral column. It,Attaches superiorly from the base of the skull and inferiorly to the endothoracic fascia in the thorax.Extends laterally as the axillary sheath, which surrounds the axillary vessels and brachial plexus of nerves to the upper limb.Contains, within its connective tissue fibers, the cervical sympathetic trunk and ganglia.Ref: Moon D.A., Foreman K.B., Albeine K.H. (2011). Chapter 25. Overview of the Neck. In D.A. Moon, K.B. Foreman, K.H. Albeine (Eds), The Big Picture: Gross Anatomy.\n\nSo the answer to this question is A"}
{"instruction": "For salpingitis true is\nA. Always bilateral\nB. Associated with ove injury\nC. Not associated with future infeility\nD. Bacterial vaginosis is not a risk factor for pelvic inflammatory disease development", "response": "Ans. is 'd' i.e., Bacterial vaginosis is not a risk factor for pelvic inflammatory disease developmentPelvic inflammatory disease (PlD)It is the infection of upper female reproductive tract organs.As fallopian tube are involved most commonly, it is also called as acute salpingitis.It is associated most commonly with N gonorrhoea and chlamydial infection.Bacterial vaginosis is not a risk factor for PID.PID / acute salpingitis may be unilateral or bilateral.SequelaeofPlDare:-Tubal factor infeilityEctopic pregnancyChronic Pelvic Pain\n\nSo the answer to this question is D"}
{"instruction": "At pH 7 the binding of 2,3-BPG to hemoglobin occurs at which site?\nA. Sulphydryl group\nB. Carboxy terminal\nC. Amino terminal\nD. Histidine", "response": "2,3-BPG Stabilizes the T Structure of HemoglobinA low Po2 in peripheral tissues promotes the synthesis of 2,3-bisphosphoglycerate (BPG) in erythrocytes. The hemoglobin tetramer binds one molecule of BPG in the central cavity formed by its four subunits (Figure 6-6). However, the space between the H helices of the b chains lining the cavity is sufficiently wide to accommodate BPG only when hemoglobin is in the T state. BPG forms salt bridges with the terminal amino groups of both b chains Val NA1 and with Lys EF6 and His H21.Ref: Harper&;s Biochemistry; 30th edition; Chapter 6 Proteins: Myoglobin & Hemoglobin\n\nSo the answer to this question is C"}
{"instruction": "Normal gastric juice contains all except\nA. Na+\nB. K+\nC. Ca++\nD. Mg++", "response": "Contents of gastric juice\n- Cations\n\nNa+\nK+\nMg+2\nH+\n\n- Anions\n\nCl-\nPO4-2\nSO4-2\n\n- Pepsin\n- Gastric lipase\n- Mucus\n- Intrinsic factor of Castle\n\nSo the answer to this question is C"}
{"instruction": "Following surgical opening of the adductor canal, a patient experienced a loss of cutaneous sensation of the medial side of the leg. Which nerve was cut in the procedure?\nA. Ilioinguinal\nB. Femoral\nC. Obturator\nD. Saphenous", "response": "The saphenous nerve is a branch of the femoral nerve. This nerve, and the nerve to vastus medialis, are the only nerves found in the adductor canal. So, it makes sense that one of these structures was injured. The saphenous nerve is a sensory nerve only; it supplies the skin on the medial side of the leg. The patient's symptoms, as well as the type of procedure done, both point toward an injury to the saphenous nerve. The femoral nerve does not travel in the adductor canal -- it ends by branching superior to the adductor canal, in the femoral triangle. If this nerve was injured, the quadriceps would be impaired, and the patient would have difficulty extending at the knee. The ilioinguinal nerve is a branch of the lumbar plexus which innervates muscles of the lower abdominal wall. The obturator nerve innervates the medial, adductor compament of the thigh. Neither the symptoms nor the location of injury suggest that any of these other nerves were damaged.\n\nSo the answer to this question is D"}
{"instruction": "Drugs used in ADHD are\nA. Atomoxetine\nB. Methylphenidate\nC. Dextro-amphetamine\nD. All the above", "response": "ADHD: Attention Deficit Hyperactivity disorder. Difficulty in paying attention, difficulty in controlling behaviour and hyperactivity. Etiology- both genetic and environmental factors. Abnormality in dopamine transpoer and thyroid receptor beta genes in some patients. Inattention behaviour:- 1. Early distraction by extraneous stimuli 2. Careless mistakes in school 3. Difficulty sustaining attention in tasks or play 4. Forgetful in daily activities. 5. Does not seem to listen to what is being said 6. Daydreams, easily confused, move slowly. 7. Fails to finish schoolwork 8. Difficulty in processing information as quickly and accurately as others. Hyperactive behavior:- 1. Runs about or climbs excessively inappropriately 2. Fidgets with hands and feet 3. Trouble sitting still during dinner, school 4. Difficulty doing quiet tasks or activities Impulsive behavior:- 1. Difficulty awaiting turns in games 2. Blus out answers to question 3. Interrupts conversations Three subtypes are known: 1. Predominantly hyperactive impulsive 2. Predominantly inattendive 3. Combined hyperactive impulsive and inattentive. Diagnosis is primarily clinical, using thorough clinical interview of parents and use of behaviour rating scales. Physical examination includes direct observation of child and ruling out chronic systemic illnesses that affect child&;s attention span. Management: Educating the parents Treatment involves combination of behavior therapy and medications. Drugs :- Stimulants ( methylphenidate, anphetamine and their derivatives) are effective in ameliorating inattention, hyperactivity and impulsivity. Atomoxetine, a selective norepinephrine reuptake inhibitor and extended release preparations of selective alpha adrenergic agonists( guanfacine, clonidine) has proved to be effective. Reference: GHAI Essential pediatrics, 8th edition\n\nSo the answer to this question is D"}
{"instruction": "Personal history includes all except:\nA. Occupational details\nB. Sexual history\nC. Academic details\nD. Food preferences", "response": "Ans. D. Food preferencesPersonal history includes:* Birth and early development* Education* Occupational history* Substance use* Marital & sexual history (including menstrual history)\n\nSo the answer to this question is D"}
{"instruction": "False statement about fetal development-a) Fetal legs develop before upper limbb) Growth in length is very fast in 3-5th monthc) Thumbs are formed in preaxial borderd) Fetus gains maximum weight in 1st trimestere) Upper limb develops before legs\nA. b\nB. c\nC. ad\nD. ab", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Ca Breast stage I and II managed by -a) Total mastectomyb) Modified radical mastectomyc) Lumpectomy and axillary clearanced) Lumpectomy, axillary clearance and radiotherapy\nA. c\nB. d\nC. bd\nD. ac", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Bronchial asthma is characterized by -a) Inflammatory disease of airwayb) Allergic disease of air wayc) Hyporesponsiveness of airwayd) Hyperresponsiveness of airwaye) Treatment is mostly inhaled steroid\nA. abcd\nB. bcde\nC. acde\nD. abde", "response": "Asthma -\n\"Asthma is a chronic inflammatory disorder of the airway that causes recurrent episodes of wheezing, breathlessness, chest tightness and cough particularly at night or in the early morning. These symptoms are usually associated with wide spread but variable bronchoconstriction and airflow limitation that is at least partly reversible, either spontaneously or with treatment. It is thought that inflammation causes an increase in airway responsiveness (bronchospasm) to a variety of stimuli\".\n- Inhaled steroid has an important role in the t/t of Asthma.\n\nSo the answer to this question is D"}
{"instruction": "In females, which of the following is the last visceral organ to putrefy after death?\nA. Prostate\nB. Uterus\nC. Brain\nD. Liver", "response": "Virgin uterus is one of the last visceral organs to putrefy. Gravid uterus or uterus soon after delivery putrefies rapidly. In males prostate resist putrefaction for a very long time. The last organ to putrify is bone.\n\nSo the answer to this question is B"}
{"instruction": "In pregnancy peak level of HCG occurs at :\nA. Early gestation\nB. Mid gestation\nC. Late gestation\nD. Prelabour", "response": "Early gestation\n\nSo the answer to this question is A"}
{"instruction": "Keratic precipitates are on which layer of cornea -\nA. Epithelium\nB. Endothelium\nC. Stroma\nD. Bowman's membrane", "response": "KPs are proteinaceous cellular deposits occuring at the back of cornea (corneal endothelial deposits).\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is not usually involved in ankylosing spondylitis?\nA. Sacroiliac joint\nB. Spine\nC. Ankle\nD. Elbow", "response": "Usually axial skeleton is severely involved. Elbow joint is not involved. Commonest joint involved is Sacroiliac joint.\n\nSo the answer to this question is D"}
{"instruction": "\"Mad cow\" disease is caused by?\nA. HIV virus\nB. Mycoplasma\nC. Chlamydia\nD. Prions", "response": "Ans. D. Prions. (Ref. Robbin's pathology 8th/pg. 880)Prion Diseases# This includes sporadic, familial, iatrogenic and variant forms of Creutzfeldt-Jakob disease (CJD).# Several animal diseases from this group are also known, including scrapie in sheep and goats and bovine spongiform encephalopathy in cattle (\"mad cow\" disease).6# All these disorders are associated with abnormal forms of a normal cellular protein, termed prion protein (PrPc).# The unique pathogenesis of prion diseases is related to changes in the conformation of PrP from its native PrPc form to an abnormal configuration called either PrPsc (for scrapie) or PrPres (for protease resistant).Creutzfeldt-Jakob Disease# CJD is a rare but well-characterized prion disease that manifests clinically as a rapidly progressive dementia.# It is sporadic in about 85% of cases, with a worldwide annual incidence of about 1 per million; familial forms also exist.# The disease has a peak incidence in the seventh decade.# There are well-established cases of iatrogenic transmission by deep implantation electrodes and contaminated preparations of human growth hormone.# The clinical presentation begins with subtle changes in memory and behavior that rapidly progress to dementia. The disease is uniformly fatal, with an average duration of only 7 months.# Morphology:- On microscopic examination, the pathognomonic finding is a spongiform transformation of the cerebral cortex and deep gray matter structures (caudate, putamen); this consists of a multifocal process that results in* the uneven formation of small, apparently empty, microscopic vacuoles of varying sizes within the neuropil and sometimes in the perikaryon of neurons.* In advanced cases, there is severe neuronal loss, reactive gliosis, and sometimes expansion of the vacuolated areas into cystlike spaces (\"status spongiosus\").* No inflammatory infiltrate is present.- In all forms of prion disease, immunohistochemical staining demonstrates the presence of proteinase K-resistant PrPsc in tissue.- Western blotting of tissue extracts after partial protease digestion allows detection of diagnostic PrPsc.\n\nSo the answer to this question is D"}
{"instruction": "The anti-malarial drug belonging to 8-aminoquinoline derivatives?\nA. Doxycycline\nB. Quinidine\nC. Primaquine\nD. Chloroquine", "response": "8-aminoquinoline derivatives are primaquine, bulaquine, and tafenoquine.4 Aminoquinoline is Chloroquine.Ref: Sharma and Sharma 2nd edition; pg 809.\n\nSo the answer to this question is C"}
{"instruction": "Which one of the following activities cannot be formed by a 7 month old infant-\nA. Pivot\nB. Cruise\nC. Transfer objects\nD. Enjoy mirror", "response": "Ans. is 'b' i.e., Cruise\n\nSo the answer to this question is B"}
{"instruction": "Etiology of Pityriasis rosea is: March 2012\nA. M. furfur\nB. Herpes virus\nC. Autoimmune\nD. Staphylococcus", "response": "Ans: B i.e. Herpes virus Skin conditions and causative agent Etiological factor for pityriasis versicolor is Malassezia furfur (earlier classified as pityrosporum ovale), a commonest yeast Etiology of pityriasis rosea is unkown. A virus (Human herpes Virus-7 more frequently, HHV-6 less frequently) has often been incriminated Pemphigus vulgaris is an autoimmune disease, characterized by acantholysis, induced by deposition of IgG autoantibodies in an intercellular area of epidermis Staphylococcus aureus, present in either a distant cutaneous focus or in an extracutaneous focus releases an exfoliative toxin that results in peeling of skin (staphylococcal scalded skin syndrome).\n\nSo the answer to this question is B"}
{"instruction": "Mechanism of action of thalidomide is: March 2013\nA. Antimicrobial\nB. Antiemetic\nC. Anti-allergic\nD. Immunomodulation", "response": "Ans. D i.e. Immunomodulation Thalidomide It is a synthetic derivative of glutamic acid (alpha-phthalimido-glutarimide) with teratogenic, immunomodulatory, anti-inflammatory and anti-angiogenic propeies. Thalidomide acts primarily by inhibiting both the production of tumor necrosis factor alpha (TNF-alpha) in stimulated peripheral monocytes and the activities of interleukins and interferons. This agent also inhibits polymorphonuclear chemotaxis and monocyte phagocytosis. In addition, thalidomide inhibits pro-angiogenic factors such as vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), thereby inhibiting angiogenesis.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following topics is principally focused on in cognitive therapy?\nA. Unconscious and repressed memories\nB. Faulty ideas and beliefs\nC. Transference manifestations\nD. Dream interpretation", "response": "Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders, including phobias, addictions, depression, and anxiety Ref ganong's review of medical physiology 25e p761\n\nSo the answer to this question is B"}
{"instruction": "Dribbling of saliva is feature of:\nA. Antemoem hanging\nB. Strangulation\nC. Postmoem hanging\nD. Drowning", "response": "Signs of antemoem hanging: Salivary dribbling is seen on the opposite side of the knot. Le facie sympathique : is ipsilateral dilatation of the pupil and paial opening of the eyelids.\n\nSo the answer to this question is A"}
{"instruction": "The longest acting, most potent and most toxic LA is:\nA. Lidocaine\nB. Dibucaine\nC. Bupivacaine\nD. Tetracaine", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is not a feature of Crohn’s disease?\nA. Continous lesions\nB. Non-caseating granulomas are present\nC. Backwash ileitis may be associated with Crohn’s disease\nD. Cobblestone appearance", "response": "Ref. Robbins Pathology. 9th edition. Page. 798\n \nCrohns Disease\n\nPresent with skip lesions\nEarliest lesion – Aphthous ulcers\nCan involve whole of GIT – Form oral cavity to amus\nSmoking is a risk factor\nFissure, fistula seen\nStricture seen\nGross features – Creeping pad of fat, Cobblestone appearance\nMicroscopy - Non caseating granuloma under microscopy, Transmural inflammation\n\nSo the answer to this question is A"}
{"instruction": "Which is a normal finding in cystometry\nA. Absence of systolic detrussor contraction\nB. Residual volume of 75 ml\nC. Leakage on coughing\nD. First sensation of urination at 300 ml", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "The most reliable criteria in G uastaf son method of age estimation is:\nA. Attrition\nB. Secondary dentin deposition\nC. Transparency of root\nD. Cementum apposition", "response": "C i.e. Transparency of root\n\nSo the answer to this question is C"}
{"instruction": "A 55-year-old man complains of severe muscle weakness and drooping eyelids. He states that his symptoms worsen with repetitive movements but then resolve after a sho rest. A chest X-ray reveals an anterior mediastinal mass. A biopsy of this mass would most likely reveal which of the following pathologic changes?\nA. B-cell lymphoma\nB. Hodgkin lymphoma\nC. Metastatic carcinoma\nD. Thymic hyperplasia", "response": "- Given clinical features suggests the diagnosis of Myasthenia gravis. Myasthenia gravis -Acquired autoimmune disease characterized by abnormal muscular fatigability, caused by circulating antibodies to acetylcholine receptor at myoneural junction . -Manifests with ptosis (drooping eyelids) or diplopia (double vision) because of weakness in extraocular muscles. -Pattern of weakness is distinctly different from most primary myopathic diseases, in which there is relative sparing of facial & extraocular muscles. -Repetitive firing of muscles makes weakness more severe, whereas cholinesterase inhibitors improve strength markedly - diagnostically useful. - In 2/3rd of patients, thymic hyperplasia is closely associated with myasthenia gravis & 15% have thymoma. - Conversely, 1/3rd to 1/2 of patients with thymoma develop myasthenia gravis. - Thymectomy is often an effective treatment for these patients. - Cholinesterase inhibitors, immunosuppression, plasmapheresis can also be used in treatment.\n\nSo the answer to this question is D"}
{"instruction": "Secondary syphilis is manifested by – a) Painless lymphadenopathyb) Pruritic rashc) Mucosal erosiond) Asymptomatic rashe) Mostly asymptomatic\nA. bce\nB. bde\nC. acde\nD. abde", "response": "Most common manifestation of syphilis is rash. Rash is usually bilaterally symmetrical macule which is non-pruritic and asymptomatic. The rash may also be papule, papulosquamous or papulopustular.\nThere may be associated non-tender (non-painful) lymphadenopathy.\nMucous patches (superficial mucosal erosions) may be seen on oral or genital mucosa.\nthe important feature is condyloma lata.\n\nSo the answer to this question is C"}
{"instruction": "Most common cause of aificial hea valve infection?\nA. Staphylococcus aureus\nB. Streptococcus mutans\nC. Staph epidermidis\nD. Pneumococcus", "response": "Ans. is 'c' i.e., Staph epidermidis Most common cause of prosthetic valve endocarditis upto 12 months is coagulase - negative staphylococci (staph. epidermidis). Most common causes of infective endocarditis In native wall - Staphylococcus aureus. In early prosthetic valve (up to 12 months after valve surgery) - Staphylococcus epidermidis (coagulase negative staphylococcus). In late prosthetic valve (more than 12 months after valve surgery) - streptococcus viridans. In IV drug abusers - Staphylococcus aureus. In patients with intravenous catheter - coagulase negative staphylococci. After dental procedure (tooth extraction) - streptococcus mutans.\n\nSo the answer to this question is C"}
{"instruction": "Methanol attacks ?\nA. Cones\nB. Rods\nC. Ganglion cells of retina\nD. Germinal cell layer", "response": "Ans. is 'c' i.e., Ganglion cells of retina Methyl alcohol is metabolised very slowly and thus stays for a longer period in the body. It is oxidised into formic acid and formaldehyde in the tissues. These toxic agents cause oedema followed by degeneration of the ganglion cells of the retina, resulting in complete blindness due to optic atrophy.\n\nSo the answer to this question is C"}
{"instruction": "Which of these statements is false for lesions of Erythema nodosum –\nA. They are considered as hypersensitivity reaction\nB. The skin overlying the lesions is red, smooth and shiny\nC. They are usually non tender\nD. They can be associated with tuberculosis", "response": "Lesions of erythema nodosum are very tender, and overlying skin is red & shiny.\nErythema nodosum is presumed to be a hypersensitivity reaction, and may occur in association with several systemic diseases, infections (e.g. TB), drugs or it may be idiopathic\n\nSo the answer to this question is C"}
{"instruction": "A patient had the following blood biochemical values. Calcium 6; uric acid 13; Phosphorus 12; Creatinine 6. Which could be the possible diagnosis -\nA. Krait bite\nB. Uric acid nephropathy\nC. Hypercalcemic nephropathy\nD. Rickets", "response": "Acute uric acid nephropathy (AUAN, also acute urate nephropathy) is a rapidly worsening (decreasing) kidney function (acute kidney injury) that is caused by high levels of uric acid in the urine (hyperuricosuria) . Ref Harrison20th edition pg 267\n\nSo the answer to this question is B"}
{"instruction": "Episodic generalized weakness can occur due to all of the following acute electrolyte disturbances, EXCEPT\nA. Hypokalemia\nB. Hypocalcemia\nC. Hyponatremia\nD. Hypophosphatemia", "response": "Hypocalcaemia is low calcium levels in the blood serum.The normal range is 2.1-2.6 mmol/L (8.8-10.7 mg/dl, 4.3-5.2 mEq/L) with levels less than 2.1 mmol/l defined as hypocalcemia. Mildly low levels that develop slowly often have no symptoms.Otherwise symptoms may include numbness, muscle spasms, seizures, confusion, or cardiac arrest. Initial treatment for severe disease is with intravenous calcium chloride and possibly magnesium sulfate.Other treatments may include vitamin D, magnesium, and calcium supplements If due to hypoparathyroidism, hydrochlorothiazide, phosphate binders, and a low salt diet may also be recommended. About 18% of people who are being treated in hospital have hypocalcemia. Ref Harrison20th edition pg 2569\n\nSo the answer to this question is B"}
{"instruction": "which of the following is a SNRI\nA. duloxetine\nB. seraline\nC. citalopram\nD. ironiazid", "response": "SNRI * IMPOANCE Dual antidepressant like TCA but better than TCA has it has no dryness of mouth, hypotension, sedation * MECHANISM Inhibits the reuptake of both serotonin and dopamine * DRUGS VENLEFEXINE DESVENLEFEXINE DULOXETINE * USE Duloxetine===PAIN ASSOSIATED WITH DIABTIC NEUROPATHY and STRESS URINARY INCONTINENCE Milnacipran===Fibromyalgia * SIDE EFFECTS DIASTOLIC HYPEENSION DELAYED ORGASM WITHDRAWL SYNDROME ON DISCONTINUATION, hence should not be abruptly stopped. To try slow tapering Ref. kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 955\n\nSo the answer to this question is A"}
{"instruction": "The follwing are opioid withdrawl symptoms except:\nA. Insomnia\nB. Piloerection\nC. Rhinorrhea\nD. Constipation", "response": "D i.e. Constipation\n\nSo the answer to this question is D"}
{"instruction": "Fetal hydrops is most commonly associated with:\nA. Cardiac anomalies.\nB. Renal anomalies.\nC. GI anomalies.\nD. Skeletal anomalies.", "response": "Ans. A. Cardiac anomaliesCardiac anomaly is the most common anatomical abnormality associated with fetal hydrops. In general hydrops associated with a structurally abnormal heart carries a poor prognosis, as the anomaly is usually severe. Those hydropic fetuses with arrhythmia but with structurally normal heart usually respond to either transplacental or direct fetal therapy. In these cases, the prognosis is good.\n\nSo the answer to this question is A"}
{"instruction": "Epigenetic deals with genetic modifications that do not alter the sequence of DNA. All of the following can detect epigenetic modification except:\nA. HPLC\nB. Methylation specific PCR\nC. Bisulphite method\nD. ChIP on Chip", "response": "Ans. a. HPLC (Ref: Robbins 9/e p180, 319-320 8/e p180-181)Methylation specific PCR, Bisulphite method and ChlP on Chip can detect epigenetic modification but not the HPLC.'Epigenetics is defined as the study of heritable chemical modification of DNA or chromatin that does not alter the DNA sequence itself Examples of such modification include the methylation of DNA, and the methylation and acetylation of histones. Since traditional Sanger sequencing alone cannot detect DNA methylation; other techniques have been developed to uncover these chemical modifications. One common approach is to treat genomic DNA with sodium bisulfite, a chemical that converts unmethylated cytosines to uracil, white methylated cytosines are protected from modification. An assay termed methylation-specific PCR uses two PCR primer sets to analyze single DNA loci: one to detect a DNA sequence with unmethylated cytosines (which are converted to uracils after bisulfite treatment) and the other to detect DNA sequences with methylated cytosines (which remain cytosines after bisulfite treatment).Additional techniques are evolving that provide a genome-wide snapshot of epigenetically altered DNA. These techniques are based on the ability to detect histone modifications such as methylation and acetylation (which, like DNA methylation, are important regulators of gene expression) by using antibodies against specifically modified histones. Such antibodies can be used to pull down bound DNA sequences, a method termed chromatin immunoprecipitation (ChIP). These pulled- down sequences can be amplified and analyzed by hybridizing to microarrays ('ChIP on Chip') or sequencing ('ChIP- Seq') to map epigenetically modified genes throughout the genome. - Robbins 8/e p180 Isolation of cells of the immune response* Use the correct number of cells: 1 x 106 x to 10 x 106* Collect biological replicates of cells* Choose an appropriate control for antibody specificity (knockout or RNAi knockdown)Fragmentation by sonication or MNase treatment* Shear chromatin to a size range of ~ 150-300 bp* Sonicate chromatin extracts for non-histone proteinsSonication conditions should be determined empirically for each cell typeTreat chromatin extracts with MNase for analysis of histone modificationsDo not overdigest chromatinChIP analysis of histone modifications, transcription factors or epigenetic regulators* Select antibody: monoclonal versus polyclonal* Choose reference control (Input or IgG)* Perform ChIP with established protocols* Purify DNALibrary construction* Do end repair and adapter ligation* Perform PCR using primers compatible with sequencing platformAvoid overamplifying DNA Sequencing* Determine sequencing depth on the basis of the prevalence of binding throughout the genome: more sequencing tags may be needed for diffuse signals (such as H3K27me3)* Perform single-end or paired-end sequencingEpigenetic AlterationsEpigenetics is defined as the study of heritable chemical modification of DNA or chromatin that does not alter the DNA sequence itself.Examples of such modification include the methylation of DNA. and the methylation and acetylation of histonesQ.Since traditional Sanger sequencing alone cannot detect DNA methylation, other techniques have been developed to uncover these chemical modifications.One common approach is to treat genomic DNA with sodium bisulfite, a chemical that converts unmethylated cytosines to uracil, while methylated cytosines are protected from modificationQ.An assay termed methylation-specific PCR uses two PCR primer sets to analyze single DNA loci: one to detect a DNA sequence with unmethylated cytosines (which are converted to uracils after bisulfite treatment) and the other to detect DNA sequences with methylated cytosinesQ (which remain cytosines after bisulfite treatment).Additional techniques are evolving that provide a genome-wide snapshot of epigenetically altered DNA.These techniques are based on the ability to detect histone modifications such as methylation and acetylation (which, like DNA methylation, are important regulators of gene expression) by using antibodies against specifically modified histones. Such antibodies can be used to pull down bound DNA sequences, a method termed chromatin immunoprecipitation (ChlP).These pulled-down sequences can be amplified and analyzed by hybridizing to microarrays ('ChlP on Chip') or sequencing ('ChIP-Seq') to map epigenetically modified genes throughout the genome.\n\nSo the answer to this question is A"}
{"instruction": "Symptomatic treatment is not required in withdrawal of\nA. Cannabis\nB. Morphine\nC. Alcohol\nD. Cocaine", "response": "A i.e. Cannabis\n\nSo the answer to this question is A"}
{"instruction": "Patient with BP 90/60 mmHg, lips and peripheries are cyanosed; blood drawn was chocolate color. Diagnosis is: DNB 10\nA. Methemoglobinemia\nB. Hypovolumic shock\nC. Metal fume fever\nD. Alphos poisoning", "response": "Ans. Methemoglobinemia\n\nSo the answer to this question is A"}
{"instruction": "Rapid infusion of blood causes\nA. Acute Left heart failure\nB. Ankle edema\nC. Pulmonary edema\nD. Respiratory Distress", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Painful arc syndrome is caused by impingement of ?\nA. Sub acromial bursa\nB. Sub deltoid bursa\nC. Rotator cuff tendon\nD. Biceps tendon", "response": "Ans. is 'c' i.e., Rotator cuff tendon Painful arc syndrome Pain in the shoulder and upper arm during mid range of glenohumeral abduction. Causes - supraspinatus tendon tear or tendinitis, subacromial bursitis, fracture of greater tuberosity. The space between the upper end of humerus and the acromion gets compromised so that during mid abduction the tendon of rotator cuff gets nipped between the greater tuberosity and acromion.\n\nSo the answer to this question is C"}
{"instruction": "Pure aryans have which type of skull :\nA. Mesaticephalic\nB. Brachycephalic\nC. Dolicocephalic\nD. None of the above", "response": "C i.e. Dolicocephalic\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is the derivative of tumor from Rathke's pouch?\nA. Meningioma\nB. Craniopharyngioma\nC. Ependymoma\nD. Low grade glioma", "response": "Ans. B CraniopharyngiomaRef: Grays Anatomy E-Book 2015 ed. P 431* In embryogenesis Rathke's pouch is an evagination at the roof of the developing mouth in front of buccopharyngeal membrane. It gives rise to anterior pituitary (adenohypophysis).* Craniopharyngioma are benign cystic lesions derived from Rathke's pouch, most frequently in children. It is associated with hypopituitarism, growth retardation and diabetes insipidus.* Clinical features:# Raised ICT# Presents before 20 years of age# Visual field abnormalities# Weight gain# Cranial nerve damage* Investigation: MRI is superior to CT.\n\nSo the answer to this question is B"}
{"instruction": "Clinical feature of minimal change glomerulonephritis are all except -\nA. Hypeension\nB. Edema\nC. Non Selective proteinuria\nD. Fever", "response": "Minimal change disease -clinical features are Abrupt onset of edema Severe Hypoalbuminemia selective proteinuria -urine predominantly contains albumin with minimal amounts of higher molecular weight protiens. Less common clinical features include-hypeension ,microscopic hematuria ,atopic or allergic symptoms and decreased renal function. Ref:Harrison 20th edition pg no. 2142\n\nSo the answer to this question is C"}
{"instruction": "Recurrent corneal erosion seen in-\nA. Corneal dystrophy\nB. Keratoglobus\nC. Keratoconus\nD. Peutz- anomalies", "response": "Corneal dystrophies are inherited disorders in which the cells have some inborn defects due to which pathological changes may occur with passage of time leading to development of corneal haze in otherwise normal eyes that are free from inflammation or vascularization. There is no associated systemic disease. Dystrophies occur bilaterally, manifesting occasionally at bih, but more usually during first or second decade and sometimes even later in life.Reference:Comprehensive ophthalmology,AK Khurana,4th edition,page no.117\n\nSo the answer to this question is A"}
{"instruction": "Embryo reduction of multiple pregnancy is done at:\nA. 8-10 weeks\nB. 11-13 weeks\nC. 13-15 weeks\nD. 16-18 weeks", "response": "Embryo reduction in multifetal pregnancy us done usually at 11-13 weeks of gestation.For more information,refer page no 241 of dutta's text book of obsteics,8 th edition.\n\nSo the answer to this question is B"}
{"instruction": "Which is the most common clinical feature of Ewing's sarcoma?\nA. Fever\nB. Limp\nC. Pain\nD. Palpable mass", "response": "Ans. C. Pain. (Ref. Practical Orthopedics by Ebnezar/pg.92).Ewing's sarcoma: Clinical history# patient is usually male.# Age grp 4-25 yrs# Long bones most commonly affected# Pain is the presenting feature. Pain may be intermittent and worse at night.# Swelling locally and limp may be present.# PatientCLINICAL FINDINGS of Osteosarcoma and Ewing Sarcoma OsteosarcomaEwing SarcomaLocal tenderness94 (92%)33 (70%)Palpable mass40 (39%)16 (34%)Painful movement of joint40 (39%)16 (34%)Restricted movement of joint23 (23%)8 (17%)Fever (reported or measured)3 (3%)14 (30%)Atrophy of muscle5 (5%)0 (0%)Limpt (noted or reported)28 (31%)19 (40%)\n\nSo the answer to this question is C"}
{"instruction": "A hospital has always some beds vacant for emergency, isolation, emergency etc. These vacant beds are known as:\nA. Essential bed space\nB. Mandatory bed space\nC. Dead bed space\nD. None of the above", "response": "A hospital has always some beds vacant for emergency, isolation, emergency etc. These vacant beds are known as dead bed space. This accounts for around 15 to 20%. Ref: Textbook of community medicine, S. Lal, 3rd edition pg: 686.\n\nSo the answer to this question is C"}
{"instruction": "Nicoladoni branham sign is -\nA. Compression cause bradycardia\nB. Compression cause tachycardia\nC. Hypotension\nD. Systolic filling", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "An individual has been on a fad diet for 6 weeks and has begun to develop a number of skin rashes, diarrhea, and forgetfulness. These symptoms could have been less severe if the diet contained a high content of which one of the following?\nA. Tyrosine\nB. Tryptophan\nC. Thiamine\nD. Thymine", "response": "At least eight different carrier proteins transport different groups of amino acids.a. Sodium-amino acid carrier system(1). A number of transport systems involve the uptake by the cell of a sodium ion and an amino acid by the same carrier protein on the luminal surface (examples are systems A, ASC, N, and B).(2). The sodium ion is pumped from the cell into the blood by the Na+-K+ ATPase, whereas the amino acid travels down its concentration gradient into the blood.(a). Thus, the transport of amino acids from the intestinal lumen to the blood is driven by the hydrolysis of adenosine triphosphate (ATP) (secondary active transport).b. The L-system of amino acid transport is not dependent on sodium for cotransport. The L-system transports branched-chain and aromatic amino acids and will be exploited in a treatment for phenylketonuria (PKU).The individual has developed pellagra caused by a lack of dietary niacin. Although dietary niacin is the major source of the nicotinamide ring of NAD, it may also be produced from excess tryptophan. Tyrosine, thiamine, thymine, and riboflavin cannot contribute to the synthesis of the nicotinamide ring of NAD.\n\nSo the answer to this question is B"}
{"instruction": "The sixth complication of diabetes mellitus is\nA. Retinopathy\nB. Rental failure\nC. Ischemic heart diseases\nD. Periodontitis", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "ST segment elevation is seen in: September 2005\nA. Prinzmetal's angina\nB. Acute pericarditis\nC. Acute MI\nD. All of the above", "response": "Ans. D: All of the above Differential Diagnosis of ST Segment Elevation: Ischemic Hea Disease (usually convex upwards, or straightened) - Acute transmural injury (acute anterior MI) Persistent ST elevation after acute MI suggests ventricular aneurysm - ST elevation may also be seen as a manifestation of Prinzmetal's (variant) angina (coronary aery spasm) Acute Pericarditis - Concave upwards ST elevation in most leads except aVR - No reciprocal ST segment depression (except in aVR) - May see PR segment depression, a manifestation of atrial injury Other Causes: - Left ventricular hyperophy (in right precordial leads with large S-waves) - Left bundle branch block (in right precordial leads with large S-waves) - Advanced hyperkalemia - Hypothermia (prominent J-waves or Osborne waves)\n\nSo the answer to this question is D"}
{"instruction": "Which of the following structures is most significant in resisting hyperextension of the hip joint?,\nA. Pubofemoral ligament\nB. Ischiofemoral ligament\nC. Iliofemoral ligament\nD. Gluteus maximus muscle", "response": "The Iliofemoral Ligament resist both hyperextension and lateral rotation at the hip joint. The Pubofemoral ligament reinforces the joint inferiorly and limits extension and abduction. The Ischiofemoral ligament reinforces the joint posteriorly and limits extension and medial rotation. The Gluteus Maximus muscle extends and laterally rotates the thigh and does not paicularly resist hyperextension\n\nSo the answer to this question is C"}
{"instruction": "Which of the following statements are TRUE/FALSE among the statements given below, in relation to surgical wounds? 1. No antibiotics required in clean surgery 2. Incision of abscess is done in contaminated wounds 3. Spillage of stomach content conves a clean/contaminated wound case to a contaminated case 4. In clean/contaminated wounds infection rate is 10% 5. Hernial repair is contaminated wound\nA. 1,2,3 true & 4,5 false\nB. 3,4,5 true & 1,2 false\nC. 1,3,4 true & 2,5 false\nD. All are true", "response": "\"Prophylactic systemic antibiotics are not indicated for patients undergoing low -risk, straightforward clean surgical operations in which no obvious bacterial contamination or inseion of a foreign body has occured. SSi risk has traditionally been correlated to wound class. The accepted range of infection rate has been 1% to 5% for clean, 3% to 11% for clean/contaminated, 10% to 17% for contaminated, and greater than 27% for diy wounds\"- sabiston 18/e page 301-03\n\nSo the answer to this question is C"}
{"instruction": "Torsional force is:\nA. Compression\nB. Tensile force\nC. Shear\nD. Transverse bending force", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which of the following nasal spray is very effective in control of enuresis –\nA. Pitressin\nB. Desmopressin\nC. Lipressin\nD. None of the above", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "What is the single most effective step in resuscitation of babies who fail to breathe at bih?\nA. Suction of airways\nB. Tactile stimulation\nC. Positive pressure ventilation\nD. Chest compressions", "response": "Positive pressure ventilation is the single most effective step in the resuscitation of neonates who fail to breathe at bih. Device used for PPV- 'Ambu bag'\n\nSo the answer to this question is C"}
{"instruction": "Which of the following are true concerning a young epileptic, who has a grand mal seizure in the dental office?\nA. It is generally fatal\nB. It is best treated by injecting phenytoin\nC. They generally recover if restrained from self injury and oxygen is maintained\nD. Use physical restraints judiciously", "response": "DENTAL MANAGEMENT OF EPILEPTIC PATIENTS\nPrevention of seizures can be best managed by:\n\nType and frequency of seizures prior to treatment.\nReduce stress. Diazepam is drug of choice.\nUse of dental chair light avoided.\nAppropriate drug therapy for seizures.\nDue to the use of antiepileptic medication, typical fibrous gingival hyperplasia. Surgical removal necessary.\nIf seizure occurs in the dental chair, lower the chair to supine position.\nProtect the patient from injuring himself.\nMaintain a patent airway.\nGive Diazepam 1mg/kg IV slowly up to 10mg.\nGive oxygen.\nIf condition does not improve admit to hospital.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is the most common renal cystic disease in infants is?\nA. Polycystic kidney\nB. Simple renal cyst\nC. Unilateral renal dysplasia\nD. Calyceal cyst", "response": "The multicystic dysplastic kidney is the commonest form of congenital cystic renal dysplasia and is due to complete ureteric obstruction in fetal life. The condition is usually unilateral; the bilateral disease is lethal.\nMulticystic dysplastic kidney\n\nThe multicystic dysplastic kidney is a congenital condition in which the entire kidney is dysplastic with a preponderance of cysts.\nThe kidney is replaced by multiple cysts of varying sizes that do not communicate and no identifiable parenchyma is present.\nContralateral vesicouretral reflux is present in 15% cases.\nContralateral hydronephrosis is present in 5 - 10% cases.\nIt is the most common cause of an abdominal mass in a neonate. - Nelson\n\nSo the answer to this question is C"}
{"instruction": "Krukenberg adenocarcinoma of ovary can occur as result of metastases from all except?\nA. Stomach\nB. Breast\nC. Liver\nD. Pancreas", "response": "Ans. is 'c' i.e., Livero Metastatic gastrointestinal & breast neoplasm to ovary are referred to as krukenberg tumors and are characterized by bilateral metastasis composed of mucin-producing signet-ring cells.o The primary sites are --> Stomach (most common), Pancreas, Colon, Gall bladder, Breast.\n\nSo the answer to this question is C"}
{"instruction": "All of the following statements regarding 'Menisci' is true except:\nA. Medial meniscus is more mobile than lateral\nB. Lateral meniscus covers more tibial aicular surface than lateral\nC. Medial meniscus is more commonly injured than lateral\nD. Menisci are predominantly made up of Type I Collagen", "response": "The medial meniscus is more stable than the lateral one. All the other options are true. Ref: Ohopedic Spo Medicine : Principles and Practice, Fabrizio Margheritini, 2011, Page 398-406; Gray's, 39 Edition, Page 1477.\n\nSo the answer to this question is A"}
{"instruction": "How is the Human povey index - 2 (HPI -2) different from Human povey Index - 1 (HPI - 1, as described in UNDP?\nA. It also captures the financial inclusion\nB. It also captures the social exclusive\nC. It also captures the geriatric empowerment\nD. It also captures the occupational health", "response": "Human povey index for developing countries (HPI-1) The following three dimensions are taken into account: Deprivation of longevity, measured as a percentage of the individuals with a life expectancy lower than 40 years (P1). Deprivation of knowledge, expressed as a percentage of illiterate adults (P2). Deprivation of decent living standards (P3) HPI-2 also considers a fouh dimension, social exclusion, measured with the long-term unemployment rate (P4), that is the percentage of those unemployed for 12 months or over compared to the total work force (the sum of those working and those seeking a job). Ref : Park&;s textbook of preventive and social medicine; 23rd edition\n\nSo the answer to this question is B"}
{"instruction": "Asbestosis is associated with all except-\nA. Pleural fibroma\nB. Bronchogenic cancer\nC. Gastric cancer\nD. Mesothelioma", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "A urinary tract infection as a result of Proteus mirabilis facilitates the formation of kidney stones because the organism:\nA. Destroys blood vessels in the kidney\nB. Exhibits \"swarming\" motility\nC. Ferments many sugars\nD. Produces a potent urease", "response": "Proteus mirabilis facilitates the formation of kidney stones because the organism produces a potent urease. Proteus: Causes 1-2% of cases of UTI in healthy women. 5% of cases of hospital-acquired UTI. High prevalence of stones is due to bacterial production of urease (Hydrolyzes urea -ammonia - alkalization of the urine-precipitation of struvite and carbonate-apatite crystals- development of calculi). Option 1: Destruction of blood vessels in the kidney is seen in HUS (Haemolytic uremic syndrome) caused by Enteroheamorrhagic Escherichia coli (EHEC). Option 2: Swarming is the propey of Proteus but not associated with stone formation. Option 3: Proteus is lactose non fermenter ie. does not ferment lactose (sugar).\n\nSo the answer to this question is D"}
{"instruction": "Radiological findings of scurvy are AJE –\nA. Epiphyseal widening\nB. Metaphyseal porosis\nC. White line\nD. Pelkan spur", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "In case of cyanide poisoning, antidote of amyl nitrite is given. This is an example of:\nA. Receptor antagonism\nB. Chemical antagonism\nC. Physical antagonism\nD. Physiological antagonism", "response": "Cyanide inhibits ETC complex 4 and hence a powerful toxin. In Acute cyanide poisoning Amyl nitrite is given followed by sodium thiosulphate. This is an example of Chemical antagonism i.e. one drug binding to other making it unavailable in body. Mechanism of action of amyl nitrite: Amyl nitrite conves Hb - Met Hb - sequester CN by making complex - complex can be thrown out of body. Hence, Amyl nitrite makes CN unavailable in the body. Other Options:- Receptor antagonism:- In this, a type of receptor ligand/drug = blocks a biological response by binding to and blocking a receptor. Physical antagonist:-It is a type of antagonist that is based on the physical propey of the drug, It can bind to the agonist and prevent its action. Physiological antagonism describes the behavior of a substance that produces effects counteracting those of another substance using a mechanism that does not involve binding to the same receptor.\n\nSo the answer to this question is B"}
{"instruction": "Long term tamoxifen therapy may cause :\nA. Endometrium Ca\nB. Ovary Ca\nC. Cervix Ca\nD. Vagina Ca", "response": "Ans. is a i.e. Endometrium cancer Long term Tamoxifen therapy is a predisposing factor for Endometrial hyperplasia and cancers. For more details, refer answer 6 Also know : Malignancies caused by Long Term Tamoxifen therapy : Carcinoma endometrium - it is the most common carcinoma associated with it. Uterine sarcoma. Rarely liver cancer with long term high dose. Non Malignant effects of Tamoxifen on uterus : Endometrial hyperplasia Endometriosis Fibroid uterus Ovarian cysts Menstrual irregularities or Amenorrhea.\n\nSo the answer to this question is A"}
{"instruction": "Anakinra, used in the treatment of rheumatoid arthritis is\nA. IL-1\nB. TNF ALPHA\nC. TNF BETA\nD. IL-7", "response": "(A) IL-1 # Recombinant IL-1 receptor antagonist (IL-1Ra) (anakinra): Inhibit IL-1 and is FDA approved for rheumatoid arthritis. Recombinant TNF-receptor-Ig fusion protein (etanercept): Inhibit TNF-alfa and is FDA approved for rheumatoid arthritis, juvenile rheumatoid arthritis, psoriasis Anti-TNF-alfa monoclonal antibody: Humanized mouse chimeric MAb, infliximab Fully humanized MAb, adalimumab inhibit TNF- alfa FDA approved for rheumatoid arthritis, Crohn's colitis (infliximab); FDA approved for rheumatoid arthritis (adalimumab). No TNF BETA inhibitors used. No IL-7 inhibitors used Anakinra is also useful in: Neonatal onset inflammatory disease, Muckle-Wells syndrome, and familial cold urticaria, Systemic juvenile onset inflammatory arthritis and adult onset Still's disease. Remember: Anakinra should not be combined with an anti-TNF drug (causes high rate of serious infections).\n\nSo the answer to this question is A"}
{"instruction": "Patient presenting with abdominal pain, diarrhea taking clindamycin for 5 days. Treated with metronidazole symptoms subsided. What is the causative agent -\nA. Clostridium difficile\nB. Clostridium perfringens\nC. Clostridium welchi\nD. Clostridium marneffi", "response": "Ans. is 'a' i.e., Clostridium difficile\n\nSo the answer to this question is A"}
{"instruction": "Acute onset of blurred vision and absent pupillary response with rapidly progressive descending muscular weakness manifesting as quadriparesis in an afebrile 20 year old male with preserved sensorium is -\nA. Porphyria\nB. Botulism\nC. Polio\nD. Diphtheria", "response": "Ans. is tb' i.e., Botulism Remember these important points about Botulismo Acute onset of weakness in muscles innervated by cranial nerve with prominent bulbar palsy (4D's) i.e. -# Diplopia# Dysphonia# Dysphagia# Dysarthriao Descending symmetrical weakness occurs often leading to weakness,o Sensory' abnormalities are absent because only motor and autonomic nerves affected.o Mental function not affected o Afebrileo Absent pupillaty reflexes\n\nSo the answer to this question is B"}
{"instruction": "All of the following are features of hemolytic anemia Except:\nA. Decreased RBC life span\nB. Decreased Haptoglobin\nC. Unconjugated hyperbilirubinemia\nD. Bilirubin in urine", "response": "Answer is D (Bilirubin in urine) Presence of bilirubin in urine is not a feature of Hemolytic Anemias. Presence of bilirubin in urine indicates the presence of conjugated bilirubin in the plasma. Hemolytic anemias are associated with unconjugated hvperbiliruhinemia not conjugated hyperbilirubinemia.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is not true about facial nerve & its relations\nA. Processus cochleariformis acts as a landmark for geniculate ganglion of facial nerve\nB. Tympanic segment of facial nerve lies below round window & above horizontal semi circular canal\nC. Mastoid segment of facial nerve lies always behind tympanomastoid suture\nD. A patient with lesion between geniculate ganglion & nerve to stapedius will have phonophobia & loss of stapedial reflex & taste sensation", "response": "Tympanic segment of facial nerve lies Above oval window & Below Horizontal SCC FOR MIDDLE EAR AND MASTOID SURGERY Processus cochleariformis- It demarcates geniculate ganglion which lies just anterior to it. Tympanic segment of the nerve stas at this level. Oval window and horizontal canal- Facial nerve runs above oval window (stapes) and below the horizontal canal. Sho process of incus- Nerve lies medial to sho process of incus at level of aditus. Pyramid-Nerve runs behind the pyramid and the posterior tympanic sulcus. Tympanomastoid suture- In veical/mastoid segment, nerve runs behind this suture. Digastric ridge- Nerve leaves the mastoid at the anterior end of digastric ridge.\n\nSo the answer to this question is B"}
{"instruction": "Prognosis of lymphoma depends on all of the following except: March 2011\nA. Number of lymph node sites\nB. Tumour size\nC. Tumour stage\nD. Associated symptoms", "response": "Ans. D: Associated symptoms\n\nSo the answer to this question is D"}
{"instruction": "Recurrent polyps are seen in:\nA. Antrochoanal polyp\nB. Ethmoidal polyp\nC. Nasal polyp\nD. Hyperophic turbinate", "response": "Ethmoidal Polyps They are mostly seen in adults. Etiology--usual cause of ethmoidal polyps is allergy Allergic nasal polyps are rarely, if ever seen in childhood. They are only seen in childhood in association with mucoviscoidosis. Ethmoidal polyps are also associated with: Bronchial asthma Aspirin intolerance Cystic fibrosis Nasal mastocystosis - Syndromes like: Kaageners/Young syndrome/Churg-Strauss syndrome It is generally bilateral Appear as multiple, sessile or pedunculated masses like a bunch of grapes Insensitive to touch and do not bleed on probing. Recurrence is common after removal.\n\nSo the answer to this question is B"}
{"instruction": "A 40-year-old otherwise healthy gardener presents with several subcutaneous nodules on his right hand, where he had cut himself on rose thorns. Physical exam reveals several erythematous fluctuant lesions. Which of the following organisms is most likely responsible for his condition?\nA. Aspergillus\nB. Malassezia\nC. Onchocerca\nD. Sporothrix", "response": "Whenever you see a question on a gardener who works with roses, think \"Sporothrix schenckii.\" This organism is responsible for \"rose gardener's disease,\" known technically as sporotrichosis. The organism enters through skin breaks in the fingers or hands, causing a chancre, papule, or subcutaneous nodule with erythema and fluctuance. Ulcerating lesions appear along lymphatic channels, but the lymph nodes are not commonly infected. Potassium iodide is the treatment of choice for the sub cutaneous manifestations. Aspergillus causes pulmonary aspergillosis ; a systemic mycotic infection. There is an allergic type that is caused by a hypersensitivity reaction to the organism and an infectious type that occurs more commonly in the immunocompromised. Hemoptysis is a common symptom. Malassezia, specifically M. furfur, causes tinea versicolor, a superficial mycotic infection. Onchocerca, specifically O. volvulus, causes river blindness. Ref: Ray C.G., Ryan K.J. (2010). Chapter 44. Dermatophytes, Sporothrix, and Other Superficial and Subcutaneous Fungi. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.\n\nSo the answer to this question is D"}
{"instruction": "Catecholamine action on α–receptors causes:\nA. Increased atrial contraction\nB. Increased heart rate\nC. Detrusor relaxation\nD. Gastrointestinal sphincter contraction", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Sturm's conoid refers to configuration of the rays refracted through:\nA. Concave spherical surface\nB. Convex spherical surface\nC. Toric surface\nD. Irregular surface", "response": "Ans. Toric surface\n\nSo the answer to this question is C"}
{"instruction": "Commonest cause of brain abscess -\nA. CSOM\nB. Pyogenic meningitis\nC. Trauma\nD. Chr. sinusitis", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "The genetic ability of a bacterium to grow in the presence of several antibiotics is passed in vivo from one bacterium to another by:\nA. Conjugation\nB. Rarefaction\nC. Transduction\nD. Transformation", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Aeriovenous fistula can safely be ligated if the following is positive:\nA. Allen's Test\nB. Henle-Coenen sign\nC. Tredelenberg test\nD. Schwaz Test", "response": "Allen&;s Test: Tests the adequacy of the blood supply to the hand from the radial and ulnar aeries and the arcade between them. Allen&;s test is used to know the integrity of palmar arch (Patency of radial and ulnar aeries). If these are patent, AVF can be safely ligated. Method of Allen&;s Test Elevate the hand and apply digital pressure on the radial and ulnar aeries occlude them. Ask the patient to make a fist several times. The tips of the finger should go pale. Release each aery in turn and observe the return of colour. Ref: Sabiston 20th edition Pgno: 1979\n\nSo the answer to this question is A"}
{"instruction": "Essential amino acids are named so:\nA. Because they are produced in the body\nB. Because they are not produced in the body\nC. They are not impoant for life\nD. Every food stuff essentially contains them", "response": "Essential amino acids are so called not because they are more impoant to life than the others, but because the body does not synthesize them, making it essential to include them in one's diet in order to obtain them. They are Leucine, Arginine, Histidine, Isoleucine, Meyhionine, Phenylalanine, Threonine, Tryptophan, Valine and lysine. Additionally, cysteine (or sulphur-containing amino acids), tyrosine (or aromatic amino acids), histidine and arginine are required by infants and growing children.\n\nSo the answer to this question is B"}
{"instruction": "Percentage of pheochromocytoma that are bilateral is:\nA. <1%\nB. 1-5%\nC. 10%\nD. 25%", "response": "Pheochromocytomas often are called the 10 percent tumor because 10% are bilateral, 10% are malignant, 10% occur in pediatric patients, 10% are extra-adrenal, and 10% are familial. Ref: Schwaz's principle of surgery 9th edition, chapter 38.\n\nSo the answer to this question is C"}
{"instruction": "A 70 year old male, known case of chronic renal failure suffers from a pathological fracture of Rt femur, the diagnosis is -\nA. Primary Hrperparathyroidism\nB. Secondary Hyperparathyroidism\nC. Scurvy\nD. Vitamin D Resistant rickets", "response": "Ans. is 'b' i.e., Secondary Hyperparathyroidism Secondary hyperparathyroidism (Renal osteodystrophy)o Bone and joint pain are common, as are limb deformities.o Pathological fractures are common.Diagnosiso The PTH is elevated due to decreased levels of calcium or 1,25-dihydroxy-vitamin D3. It is usually seen in cases of chronic renal disease.o Elavated creatinine and BUNCauseo Chronic kidney failure is the most common cause of secondary hyperparathyroidism. Failing kidneys do not convert enough vitamin D to its active form, and they do not adequately excrete phosphate. When this happens, insoluble calcium phosphate forms in the body and removes calcium from the circulation. Both processes lead to hypocalcemia and hence secondary hyperparathyroidism.Treatmento If the underlying cause of the hypocalcemia can be addressed, the hyperparathyroidism will resolve. In people with chronic renal failure, treatment consists of dietary restriction of phosphorus, supplements with an active form of vitamin D such as calcitriol, doxercalciferol, paricalcitol, etc. and phosphate binders which can be divided into calcium-based and non-calcium based.o In the treatment of secondary hyperparathyroidism due to chronic kidney disease on dialysis calcimimetics does not appear to affect the risk of early death It does decrease the need for a parathyroidectomy but caused more issues with low blood calcium levels and vomiting.o Most people with hyperparathyroidism secondary to chronic kidney disease will improve after renal transplantation, but many will continue to have a degree of residual hyperparathyroidism (tertiary hyperparathyroidism) posttransplant with associated risk of bone loss, etc.\n\nSo the answer to this question is B"}
{"instruction": "Flat capnogram found in A/E\nA. Disconnection of anesthetic tubing\nB. Accidental extubation\nC. Mechanjca1 ventilation failure\nD. Bronchospasm", "response": "in bronchospasm,there is prolonged expiratory upstroke(abscence of phase 3 plateau). in tube displacement,disconnection,accidental extubation,ventilation failure,it is flat.\n\nSo the answer to this question is D"}
{"instruction": "Complications of chronic duodenal ulcer are all except -\nA. Bleeding\nB. Stricture\nC. Malignancy\nD. Perforation", "response": "Ans. is 'c' i.e., Malignancy o Most common complication of peptic ulcer is gastro intestinal bleeding.o It is seen with both chronic and acute type of ulcers. Infact, chronic peptic ulcers are the most common cause of haematemesis and malaena.Complications of peptic ulcer -1) Gastrointestinal bleedingMost common complication of peptic ulcerBleeding is more common in duodenal ulcersIt is commonly seen in posterior duodenal ulcers because of erosion of gastroduodenal artery:2) PerforationIt is the second most common complication of peptic ulcer disease.Perforation occurs commonly in the ulcers located in the anterior part of duodenum.Duodenal ulcers tend to penetrate into pancreas causing pancreatitis.Gastric ulcers tend to penetrate into left hepatic lobe.3) Gastric outlet obstructionIt is the least common ulcer related complication.It is commonly associated with duodenal ulcers.o Tea pot stomach is caused due to longitudinal shortening of the gastric ulcer at the lesser curvature of the stomach (It causes the stomach to look like tea pot).o Hour glass stomach is caused due to cicatricial contraction of a saddle shaped ulcer at the lesser curvature.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is a nonmolar trophoblastic neoplasm?\nA. Complete hydatidiform mole\nB. Paial hydatidiform mole\nC. Invasive mole\nD. Choriocarcinoma", "response": "GTD histologically is divided into hydatidiform moles, which are characterized by the presence of villi, and nonmolar trophoblastic neoplasms, which lack villi.Nonmolar trophoblastic neoplasms include choriocarcinoma, placental site trophoblastic tumor,and epithelioid trophoblastic tumor.Reference: William&;s Obstetrics; 25th edition; Chapter 20; Gestational trophoblastic diseases\n\nSo the answer to this question is D"}
{"instruction": "Stereotypic moments are\nA. Sustained posture against gravity\nB. Passive inducible movements\nC. Repetitive, spontaneous, nonfunctional movements\nD. Resistance to passive movements", "response": "Stereotypic movements are seen in catatonic type of schizophrenia.\n\nSo the answer to this question is C"}
{"instruction": "String sign is seen in:\nA. Crohn's disease\nB. TB of the ileocaecal region\nC. Idiopathic hyperophic pyloric stenosis\nD. All of the above", "response": "Ans. All of the above\n\nSo the answer to this question is D"}
{"instruction": "Most common cause of acute intestinal obstruction in children is\nA. Volvulus\nB. Inguinal hernia\nC. Intussusception\nD. None", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Haplike's test is done for\nA. Cochleas function\nB. Vestibular function\nC. Middle Ear function\nD. Not related to the Ear", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is an autosomal recessive condition\nA. A. Ataxia telangectasia\nB. B. Peutz jiggers syndrome\nC. C. Neurofibromatosis\nD. D. Tuberous sclerosis", "response": "Ataxia telangectasia is an autosomal recessive condition Patients have increased sensitivity to x rays induced chromosome abnormalities Characterized by an ataxic dyskinetic syndrome beginning in early childhood ,caused by neural degeneration predominantly in the cerebellum, the subsequent development of telangectasia in the conjunctiva and skin and immunodeficiency The lymph nodes ,thymus, and gonads are hypopladtic Clinical features recurrent spinopulmonary infection and unsteadiness in walking Incteased risk development of lymphoid development of lymphoid malignant disrase. Refer ribbons 8/e p302\n\nSo the answer to this question is A"}
{"instruction": "Motility in the upper third of the esophagus is decreased in all except:\nA. Pseudo-bulbar palsy\nB. Chagas disease\nC. Myasthenia gravis\nD. Scleroderma", "response": "Classification of Esophageal Motility Disorders Disorders of the Pharyngo-esophageal junction Neurological: Stroke, motor neurone disease, multiple sclerosis, Parkinson&;s disease Myogenic: Myasthenia, muscular dystrophy Pharyngo-esophageal (Zenker&;s diveiculum) Disorders of the body of the esophagus Diffuse esophageal spasm Nutcracker esophagus Autoimmune disorders- Systemic Sclerosis (CREST) Reflux associated idiopathic Allergic Eosinophilic esophagitis Non-specific esophageal dysmotility Disorders of the lower esophageal sphincter Achalasia Incompetent lower sphincter (i.e., GERD) Ref: Bailey and Love 27th edition Pgno: 1096\n\nSo the answer to this question is D"}
{"instruction": "A 4-year-old child presented to the OPD with a palpable abdominal mass in the right flank region which was painless and slowly increasing in size along with some episodes of fever and hematuria. On examination, hypeension was noted. CT scan of the abdomen was done. The patient was operated and the mass was resected. The gross specimen and the HPE examination are given below. All of the following genes can be mutated in the above disease except: -\nA. WT1\nB. CTNNB1\nC. AMER1\nD. RAS", "response": "This is a case of Wilm's tumour. Wilms tumor is often associated with mutations in the WT1 gene, CTNNB1 gene, or AMER1 gene CT image shows a mass in the right kidney. Gross nephrectomy specimen shows a Wilms tumor pushing the normal renal parenchyma to the side. HPE image shows the characteristic three components:* Malignant small round (blue) cells ~ 2x the size of resting lymphocyte (blastema component) Tubular structures/rosettes (epithelial component) Loose paucicellular stroma with spindle cells (stromal component) The median age at diagnosis of this kidney tumor (see the image below) is approximately 3.5 years. Clinical findings include the following: Asymptomatic abdominal mass (in 80% of children at presentation) Abdominal pain or hematuria (25%) Urinary tract infection and varicocele (less common) Hypeension, gross hematuria, and fever (5-30%) Hypotension, anemia, and fever (from hemorrhage into the tumor; uncommon) Respiratory symptoms related to lung metastases (in patients with advanced disease; rare)\n\nSo the answer to this question is D"}
{"instruction": "Positive adsons test is seen in -\nA. Thoracic outlet syndrome\nB. Burger disease\nC. Varicose veins\nD. Radial nerve injury", "response": "Ans. is 'a' i.e., Thoracic outlet syndrome Thoracic Outlet Syndrome:* Neurological and vascular symptoms and signs in the upper limbs may be produced by compression of thelower trunk of the brachial plexus (C8 and Tl) and subclavian vessels between the clavicle and the first rib.* Symptoms and signs of thoracic outlet syndrome may be reproduced by variousprovocative manoeuvres. In Adson's test the patient'sneck is extended and turned towards the affected sidewhile he or she breathes in deeply; this compresses theinterscalene space and may cause paraesthesia andobliteration of the radial pulse.* In Wright's test thearms are abducted and externally rotated; again thesymptoms recur and the pulse disappears on theabnormal side.* The examination is continued by askingthe patient to hold his or her arms high abovetheir head and then open and close the fingers rapidlyjthis may cause cramping pain on the affected side(Roos's test). Unfortunately these tests are neither sensitivenor specific enough to clinch the diagnosis.\n\nSo the answer to this question is A"}
{"instruction": "Persistent bucconasal membrane result in\nA. Cleft lip\nB. Choanal atresia\nC. Cleft palate\nD. T-O Fistula", "response": "Ans. b (Choanal atresia). (Ref. Diseases of ENT, PL Dhingra, 3rd ed., 78, 210, 510)# Persistant bucconasal membrane leads to choanal atresia.Choanal atresia# Is a autosomal recessive trait in which the posterior choanae unilaterally or bilaterally fail to develop properly.# Persistent bucconasal membrane is the basic etiology.# Occurs in 1 in 5,000 births; more common among girls (2:1)# Unilateral > bilateral atresia.# Because newborns are obligate nose breathers, bilateral atresia is immediately apparent as respiratory distress.# Characteristics is the history or failure to pass a rubber catheter or nasogastric tube into the pharynx.# Symptoms of choanal atresia include failure to thrive due to poor feeding and mucoid nasal discharge.# The presence of choanal atresia can be confirmed with visualization of retention material in the posterior part of the nose on a lateral radiograph with the patient in the supine position.# Anatomic characterization of the deformity with CT can be important for planning surgical procedures.# Surgical treatment methods for membranous atresia include puncture of the choanal membrane and placement of a stent for 6 weeks.# If bony atresia is present, the bony wall can be taken down transnasally with microsurgical techniques followed by placement of a stent.# When suboptimal resection for atresia or choanal stenosis occurs, transpalatal repair at 3-4 years age is advised.# The septum usually deviates to the affected side; however, more posterior examination shows atresia.# Transpalatal repair is being replaced by endoscopic techniques of repair of atresia in children and adults.\n\nSo the answer to this question is B"}
{"instruction": "All of these pulmonary changes are seen in restrictive lung disease except:\nA. |FEV1/FVC\nB. |TLC\nC. |RV\nD. | VC", "response": "Vital capacity is sum of ERV + TV + IRV. All these lung volumes are Reduced in Restrictive lung disease due to pulmonary fibrosis. Do not mix with Timed vital capacity which is a ratio of FEV1/ FVC and is increased in restrictive lung disease.\n\nSo the answer to this question is D"}
{"instruction": "All of the following vascular changes are observed in acute inflammation, except\nA. Vasodilation\nB. Stasis of blood\nC. Increased vascular permeability\nD. Decreased hydrostatic pressure", "response": "The main vascular reactions of acute inflammation are increased blood flow secondary to vasodilation and increased vascular permeability, both designed to bring blood cells and proteins to sites of infection or injury.Changes in Vascular Caliber and FlowAfter transient vasoconstriction (lasting only for seconds), aeriolar vasodilation occursThe microvasculature becomes more permeable, and protein-rich fluid moves into the extravascular tissuesAs stasis develops, leukocytes (principally neutrophils) begin to accumulate along the vascular endothelial surface--a process called marginationIncreased Vascular PermeabilitySeveral mechanisms may contribute to increased vascular permeability in acute inflammatory reactions ( Robbins Basic Pathology, 9 th edition, page 33 )\n\nSo the answer to this question is D"}
{"instruction": "Dose of acyclovir in a patient suffering from herpes genitalis is :\nA. 200 mg, three times a day for 5 days\nB. 200 mg, five times a day for 5-7 days\nC. 600 mg, five times a day for 5 days\nD. 800 mg, five times a day for 7 days", "response": "Herpes labialis by HSV-I - T/t acyclovir 200mg 5 T/D 5-7 days or Herpes genitalis by HSV-II Acyclovir 200 mg, five times a day for 5-7 days OR Acyclovir 400mg TDS 5-7 days Herpes zoster- DOC acyclovir 800mg 5 T/D * 7days Chicken pox(varicella zoster)- DOC-Acyclovir 800mg 4T/D 7 days If patient immunocompromised- IV. Acyclovir Incase of acyclovir resistance- foscainet Recurrent (i.e. >6 episodes 1yr) h.labialis -prophylactic Therapy Acyclovir 400mg BD 6 Months\n\nSo the answer to this question is B"}
{"instruction": "Antibody diversity is due to -a) Gene rearrangementb) Gene translocationc) Antigenic variationd) CD40 moleculese) Mutation\nA. ace\nB. bde\nC. cde\nD. ade", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "A 45 years old male presents with complain of black spots on his tooth surface. He gives a history of multiple gold restorations and insists on getting the same for this tooth.The intraoral examination reveals pit and fissure caries in relation to 16. During the condensation of the restorative material, the compacted surface should be\nA. Saucer shaped, with the compaction on the external walls slightly ahead of the center\nB. Convex in the center with the compaction on the external walls slightly ahead of the center\nC. Flat in the center with the compaction on the external walls slightly ahead of the center\nD. Flat throughout the floor", "response": "Generally the line of force is perpendicular to the pulpal floor in the center of the mass and at a 45-degree angle to the pulpal floor as the external walls are reached. At this stage and during all building of the restoration, the compacted surface should be saucer shaped, with the compaction of gold on the external walls slightly ahead of the center. The surface should never be convex in the center because this may result in voids in the gold and poor adaptation of the gold along the external walls when the condenser nib is “crowded out” along the wall by the center convexity. The operator continues building the restoration until the cavosurface margin is covered with foil. One needs to exercise extreme care that gold is always present between the condenser face and the cavosurface margin; otherwise the condenser may injure (i.e., fracture) the enamel margin. The central area of the restoration’s surface is filled in to the desired level. Tooth surface contour of the gold is created to simulate the final anatomic form, and a slight excess of gold is compacted on the surface to allow for the finishing and polishing procedures.\nSturdevant operative dentistry 7th EDITION, Page No:131\n\nSo the answer to this question is A"}
{"instruction": "True statement regarding 'at risk baby': September 2009\nA. Bih weight less than 2.75 kg\nB. Weight less than 70% of the expected weight\nC. Bih order more than 3\nD. Ist degree malnutrition", "response": "Ans. B: Weight less than 70% of the expected weight The basic criteria for identifying 'at risk' babies include: Bih weight less than 2.5 kg. Twins Bih order 5 and more Aificial feeding Weight below 70% of the expected weight (II and III degrees of malnutrition) Failure to gain weight during three successive months Children with diarrhea, PEM Working mother/ one parent\n\nSo the answer to this question is B"}
{"instruction": "A newborn with eyes closed 6 hrs after birth is lustily crying; There are no chest retraction & movements of all four limbs are present. Neonatal behavioral response grading.\nA. State 1\nB. State 3\nC. State 5\nD. State 6", "response": "d. State 6(Ref: Nelson's 20/e p 63)As the neonate is lustily, (i.e. strongly) crying, his behavioral response grading is state 6 (prechtl's system)Behavioral StateDescription1Eyes closed, regular respiration, no movements (may have startle) (Quiet sleep)2Eyes closed, irregular respiration, may have small isolated/ gross movements (Active sleep)3Eyes open, regular respiration, no movement (may have small isolated movements) (Drowsy)4Eyes open, gross movements, no cry (Alert)5Fussy6Strong cry\n\nSo the answer to this question is D"}
{"instruction": "False about C. diphtheriae\nA. Toxin production is chromosome mediated\nB. Toxic production is phage mediated\nC. Toxic to hea and neuron\nD. Toxin inhibitis protein synthesis", "response": "Ans. (a) Toxin production chromosome mediated Already explained Note: Toxicity of corynebacterium is under control of phage gene, but the invasiveness is under control of bacterial gene.\n\nSo the answer to this question is A"}
{"instruction": "A 22-year-old man develops the insidious onset of low back pain improved with exercise and worsened by rest. There is no history of diarrhea, conjunctivitis, urethritis, rash, or nail changes. On examination, the patient has loss of mobility with respect to lumbar flexion and extension. He has a kyphotic posture. Which test or group of tests would be most supportive of your suspected diagnosis?\nA. MRI of the lumbosacral spine showing spinal compression fractures associated with bony destruction.\nB. An elevated sedimentation rate, a mild anemia on CBC, positive HLA-B27 in blood and sclerosis of the sacroiliac joints on plain films of the back.\nC. A positive rheumatoid factor, anti-CCP, and an elevated C-reactive protein level.\nD. Lumbosacral x-rays showing vertebral joint space narrowing and osteophyte formation at various levels.", "response": "As indicated in the question, insidious back pain occurring in a young male and improving with exercise suggests one of the spondyloarthropathies-ankylosing spondylitis, reactive arthritis (formerly termed Reiter syndrome), psoriatic arthritis, or enteropathic arthritis. In the absence of symptoms or findings to suggest one of the other conditions, laboratory tests that show a mild anemia, a positive HLA-B27 (present in 90% of patients with ankylosing spondylitis), an elevated sedimentation rate, and symmetrical sacroiliitis on x-ray would all be very supportive of the diagnosis of ankylosing spondylitis. The prognosis in ankylosing spondylitis is generally good, with only 6% dying of the disease itself. While pulmonary fibrosis and restrictive lung disease can occur, they are rarely a cause of death (cervical fracture, heart block, and amyloidosis are leading causes of death as a result of ankylosing spondylitis). The MRI described in answer a would be more suggestive of spinal tuberculosis (Pott disease) or metastatic cancer. Rheumatoid factor is negative in all the spondyloarthropathies as would be the anti-CCP test, although the C-reactive protein level could be elevated in any inflammatory condition. Joint space narrowing and osteophytes are the hallmarks of osteoarthritis which would be unusual in a young man. While Crohn disease can cause an enteropathic arthritis, which may precede the GI manifestations, this diagnosis is far less likely in this case than ankylosing spondylitis.\n\nSo the answer to this question is B"}
{"instruction": "STYLOHYOID muscle is supplied by ?\nA. Facial\nB. Glossopharyngeal\nC. Ansa cervical\nD. Vagus", "response": "Ans. is 'a' i.e., Facial\n\nSo the answer to this question is A"}
{"instruction": "Calcium requirement in an infant (mg/day) -\nA. 100\nB. 200\nC. 300\nD. 500", "response": "Ans. is 'd' i.e., 500 Calcium requirementsAgeRDA - mg/dayAdult600Pregnant1200 (+600)Lactation1200 (+600)Infant500Children 1 - 9 years60010-16 years80016-18 years800\n\nSo the answer to this question is D"}
{"instruction": "Gallows traction is used in management of fracture shaft -\nA. Femur\nB. Tibia\nC. Humerus\nD. Ulna", "response": "Ans. is 'a' i.e., Femur o Gallow s traction is used for treatment of fracture shaft femur, in infants and children < 2 vrs of age.Fracture shaft femur in infant and young childreno It is published that upto one half of infants and young children who sustain femur fractures are victims of child abuse and child abuse occurs in 50 - 80% of children (< 2 years of age) with femoral fracture.o Other causes of fracture are osteogenesis imperfecta (blue sclera, hearing loss, multiple fracture), bone tumors (eosinophilic granuloma, aneurysmal bone cyst),o Fracture heals within 2 weeks in infant and children upto 2 years of age.o Treatment depends upon the age of the patient : -Conservative : - It is the treatment of choice in children.0-2 yeas Plaster spica or modified Bryant or Gallow^s traction or pavilic harness (< 6 month of age).2-10 years : - Split Russel traction10-15 years : - 90-90deg femoral skeletal traction.SurgicalSurgery is done less commonly in children.It is indicated in older children when closed reduction by conservative treatment is not possible.Intramedullar titanium elastic nailing is the surgery of choice.\n\nSo the answer to this question is A"}
{"instruction": "True about Octreotide\nA. Is active orally\nB. Is not a somatostatin analogue\nC. Used in secretory diarrhea\nD. Is a growth hormone agonist", "response": "Octreotide is a synthetic octapeptide with actions similar to somatostatin. Routes of administration: - Intravenous (v. sho duration of action) - Subcutaneous - Intramuscular (depot preparation) It is 40 times more potent than somatostatin in suppressing GH secretion. It is being preferred over somatostatin for acromegaly and secretory diarrheas associated with carcinoid, AIDS, cancer chemotherapy or diabetes. Uses Based on propeies of inhibiting secretion of various hormones (GH, TSH, PL, insulin, glucagon), all gi secretions (including gastrin & HCI) and constriction of splanchnic, hepatic and renal blood vessels. Carcinoid and Vipoma induced secretory diarrhea and systemic symptoms such as flushing and wheezing. Diarrhea due to vagotomy and dumping syndrome, sho bowel syndrome or AIDS. GI bleeding Pancreatic fistula, insulinoma, glucagonoma, pancreatic ascites Oncogenic osteomalacia Acromegaly Adverse effects: Abdominal pain, nausea, steatorrhoea, diarrhea, gall stones.\n\nSo the answer to this question is C"}
{"instruction": "Stress concentration in Root dentin is least with:\nA. Smooth tapered post.\nB. Serrated tapered post\nC. Smooth parallel post.\nD. Serrated parallel post", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which of the following statement(s) is/are true about phrenic nerve except -\nA. It is primary motor supply to diaphragm\nB. Accessory phrenic nerve joins the phrenic nerve near the first rib\nC. Formed in front of scalenus medius muscle\nD. It descends posterior to sternocleidomastoid", "response": "Ans is. 'C i.e., Formed in front of scalenus medius muscle Lies anterior to anterior scalenus muscle Phrenic nerve is a mixed nerve & carries motor fibres to the diaphragm & sensory fibres from the diaphragm, pleura, pericardium & pa of the peritoneum.Origin:It arise in the neck from the ant. rami of the 3rd, 4th & 5th cervical nervesIt is formed at the lateral border of the scalenus anterior, opposite the middle of the sternocleidomastoid at the level of the upper border of the thyroid cailage.Relations:It runs veically downwards on the ant. surface of the scalenus ant. & in this pa it is related anteriorly toPreveebral fasciaInf. belly of omohyoidTransverse cervical aerySuprascapular aeryInternal jugular veinSternocleidomastoid mus.Thoracic duct on left side.After leaving the ant. surface of the scalenus ant. the nerve runs downwards on the cervical pleura behind the commencement of the brachiocephalic vein. (on left side nerve leaves the scalenus ant. at a higher level & crosses in front of the .first pa of the subclan a.). Here it crosses the internal thoracic aery (either anteriorly or posteriorly) & enters the thorax behind the 1st costal cailage.\n\nSo the answer to this question is C"}
{"instruction": "Treatment of campyiobacter-\nA. Tetracycline\nB. Ampicillin\nC. Erythromycin\nD. Ciprofloxacin", "response": "Ans. is 'd' Le., Ciprofloxacin o Campylobacter infection in usually a mild self limited infection# Given the self limited nature of most Campylobacter infections and the limited efficacy of routine antimicrobial therapy treatment is required only for severe disease or risk for se\\rere disease.Treatment of Campylobactor ieiunaeo First line agents for treatment of Campylobacter gastroenteritis include :Fluoroquinolone (if sensitive)Azithromycin Erythromycin was previously favoured although it is no longer favoured as first line agent given its toxicity and potential drug interactionso Azithromycin is particularly favoured over the erythromycin for patients on medications that inhibit CYP3A4.Since concurrent use of erythromycin and such drugs can increase risk of sudden cardiac death.o In patients with uncomplicated Campylobacter infection at risk for severe disease the drugs typically used are:LevofloxacinCiprofloxacin or azithromycinFor systemic infections treatment is empirically started witho Gentamycino Imipenemo Chloramphenicol\n\nSo the answer to this question is D"}
{"instruction": "When noting condylar guidance , the incisal pin should be:\nA. In contact with guidance table.\nB. Out of contact.\nC. The cuspal inclines.\nD. None of the above.", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Lancefield group of streptococci is based on\nA. M proteins\nB. Carbohydrate ( C ) antigen on the cell wall\nC. Bile solubility\nD. Sugar fermentation", "response": "Carbohydrate contained in the cell wall of many streptococci forms the basis of serologic grouping into Lancefield groups A-H and K-U. The serologic specificity of the group-specific carbohydrate is determined by an amino sugar.Jawetz 23e pg: 213\n\nSo the answer to this question is B"}
{"instruction": "Most common organism causing ventilator associated pneumonia -\nA. Legionella\nB. Pneumococcus\nC. Pseudomonas\nD. Coagulase negative staphylococcus", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "\"Elschnig Pearl\" in papillary aperture is a sign of\nA. Acute iridocylitis\nB. Pseudoexfoliation syndrome\nC. After-cataract\nD. Secondary cataract", "response": "Ans. c (After cataract) (Ref. Basak, Ophthalmology, 2nd ed., 182)AFTER CATARACT# Posterior capsular opacification following ECCE & discission of congenital/traumats cataract.# More common in children# Elschning's pearl (Balloon lens-cell)# Soemerring's ring (Ring behind iris formed by lens fibers)# Treatment:- Discission or needling- Capsulotomy/membranectomy Nd-YAG Laser capsulotomy (safe, noninvasive & quick OPD procedure)\n\nSo the answer to this question is C"}
{"instruction": "Long QT syndrome- All of the following may be a cause in children except -\nA. Romano Ward syndrome\nB. Jarvell and Lange Nielson Syndrome\nC. Macrolide antibiotics\nD. Holt Oram Syndrome", "response": "Ans. is 'd' i.e., Holt Oram Syndrome Long OT syndrome in children Congenitalo Jarvell and Lange Nielson Syndromeo Romano Ward syndromeAcquiredo The acquired causes of long QT syndrome include drugs, electrolyte imbalance, marked bradycardia, cocaine, organophosphorus compounds, subarachnoid hemorrhage, myocardial ischemia, protein-sparing fasting, autonomic neuropathy, and human immunodeficiency virus (HIV) diseaseo Implicated drugs include the followingo Class IA and III antiarrhythmicso Macrolide antibioticso Pentamidineo Antimalarialso Antipsychoticso Arsenic trioxideo Methadone\n\nSo the answer to this question is D"}
{"instruction": "Transection at mid pons level results in?\nA. Hyperventlation\nB. Apneusis\nC. Rapid and shallow breathing\nD. Hypoxia", "response": "B i.e. Apneusis\n\nSo the answer to this question is B"}
{"instruction": "In a foetus, the insulin secretion begins by\nA. 3rd month\nB. 5th month\nC. 7th month\nD. 9th month", "response": "Insulin is a peptide hormone, produced by beta cells of the pancreas, and is central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, skeletal muscles, and fat tissue to absorb glucose from the blood. In the liver and skeletal muscles, glucose is stored as glycogen, and in fat cells (adipocytes) it is stored as triglycerides. In mammals, insulin is synthesized in the pancreas within the b-cells of the islets of Langerhans. One million to three million islets of Langerhans (pancreatic islets) form the endocrine pa of the pancreas, which is primarily an exocrine gland. The endocrine poion accounts for only 2% of the total mass of the pancreas. Within the islets of Langerhans, beta cells constitute 65-80% of all the cellsRef: Ganong&;s review of medical physiology; 24th edition; page no-432\n\nSo the answer to this question is A"}
{"instruction": "All are true regarding Seminoma EXCEPT\nA. Common in age between 35 and 45 years\nB. Metastasis to lymphatics\nC. Radio resistant\nD. Not seen before puberty", "response": "C. i.e. (Radio resistant) (1312 - 13. S. Das 5th) (1385-B & L 25th)* Testicular seminoma is remarkably radiosensitive tumour and vigorous attempt should be made to irradicate the tumour even in patients with advanced diseaseSEMINOMA - is the most common form of testicular tumour in the adult (Between 35 and 45 years). They almost never occur in infancy* Painless swelling is commonest presentation* A seminoma metastasizes almost exclusively by the lymph vessels* Active lymphocytic infiltration of the tumour suggests a good host response and a better prognosisTERATOMA - age between 20 and 35. years* Pulmonary metastasis suggests that the tumour is a teratoma*** Teratoma is less sensitive to radiation* Jaundice and palpable liver may be the only presenting features of a case of teratoma* Most common testicular tumor in prepubertal adults is Yolk sac tumour**\n\nSo the answer to this question is C"}
{"instruction": "Cells associated with humoral immunity is: September 2005\nA. NK cells\nB. B cells\nC. T cells\nD. Null cells", "response": "Ans. B: B cells Humoral immunity is that aspect of specific immunity which is mediated by B lymphocytes and involves the binding of antibodies to antigens Characteristics: Acquired humoral immunity is the recognition of antigens associated with microorganisms or foreign substances. This recognition is coupled with the ability to initiate appropriate actions (e.g., antibody production) against these microorganisms or foreign substances. Acquired humoral immunity may be subdivided into: - that acquired actively - that acquired passively Cellular immunity: * For immunity mediated by cytoxic T cells, an antigen is always a protein or a poion of a protein. * This is because only peptides (protein fragments) interact with MHC (major histocompatibility complex) and cell mediated immunity requires interaction with these MHC-associated peptides.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is the most common location of hypeensive hemorrhage?\nA. Pons\nB. Thalamus\nC. Putamen/external capsule\nD. Subcoical white matter", "response": "Answer is C (Putamen): 'The putamen is the most common site fir hypeensive haemorrhage' - Harrison's\n\nSo the answer to this question is C"}
{"instruction": "The most likely complication of prolonged use of nasal decongestant drops is\nA. Atrophic rhinitis\nB. Naso-pharyngeal moniliasis\nC. Hyperophy of nasal mucosa\nD. Blockage of eustachian tubes", "response": "NASAL DECONGESTANTS These are a agonists which on topical application as dilute solution (0.05-0.1%) produce local vasoconstriction. The imidazoline compounds-- naphazoline, xylometazoline and oxymetazoline are relatively selective a2 agonist (like clonidine). They have a longer duration of action (12 hours) than ephedrine. side effects:- They may cause initial stinging sensation (Especially naphazoline). Regular use of these agents for long periods should be avoided because mucosal ciliary function is impaired: atrophic rhinitis and anosmia can occur due to persistent vasoconstriction. They can be absorbed from the nose and produce systemic effects, mainly CNS depression and rise in BP. cautious use:- These drugs should be used cautiously in hypeensives and in those receiving MAO inhibitors. Ref:- kd tripathi; pg num:-136\n\nSo the answer to this question is A"}
{"instruction": "Cerebellar connection to other parts of the brain is projected through which cell?\nA. Golgi cells\nB. Basket cells\nC. Purkinje cells\nD. Oligodendrocytes", "response": "Ans. C Purkinje cellsRef Gray's, 41sted. pg. 335-336* The axons of purkinje cells are the only output through cerebellar cortex.* However, it should be kept in mind that the output from the cerebellum is through deep nuclei, and purkinje cells axons generally pass to deep nuclei.\n\nSo the answer to this question is C"}
{"instruction": "A child during anesthesia with Halothane and succincyl coA develops severe stiffness of masseters. What is the most probable diagnosis?\nA. Neuroleptic malignant syndrome\nB. Malignant hypehermia\nC. Anaphylaxis\nD. Halothane hepatitis", "response": "Malignant hypehermia is a condition that triggers a severe reaction to ceain drugs used as pa of anesthesia for surgery. Without prompt treatment, the disease can be fatal. The genes that cause malignant hypehermia are inherited. In most cases, no signs or symptoms of the condition exist until you are exposed to anesthesia. Malignant hypehermia is a genetic(autosomal dominant) hypermetabolic muscle disease. Triggering agents include Inhaled general anesthetics Ether Halothane Methoxyflurane Enflurane Isoflurane Desflurane Sevoflurane Depolarizing muscle relaxants Succinylcholine\n\nSo the answer to this question is B"}
{"instruction": "Fordyce granules mostly occurs in all of the following areas EXCEPT\nA. Vermillion of the lip\nB. Posterior tonsillar pillar\nC. Alveolar ridge\nD. Palate", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "A 29-day old child presents with features of congestive cardiac failure and left ventricular hyperophy. Auscultation shows a sho systolic murmur. Most likely diagnosis is:\nA. Rheumatic fever\nB. Tetralogy of Fallot\nC. Transposition of great aeries\nD. Ventricular septal defect", "response": "Tetralogy of Fallot and transposition of great aeries are cyanotic hea diseases and rheumatic fever will not occur in this age group. So the answer is ventricular septal defect. When the effective area of the defect is large, there is viually no resistance to flow, and systemic systolic pressure is present in the right ventricle and the pulmonary aery. At bih, pulmonary vascular resistance is high, with little if any left-to-right shunt, despite the presence of a large defect. This resistance gradually falls over the first few weeks of life, permitting a progressively greater amount of blood to flow through the defect, to the pulmonary aeries and back to the left atrium and left ventricle. In many infants, the left ventricular volume overload eventually leads to left ventricular \"failure,\" with elevated left ventricular end-diastolic and left atrial pressures and pulmonary congestion. With a large VSD and a high pulmonary vascular resistance, the systolic murmur becomes soft and sho because there is little left-to-right shunt across a large defect, and a right-to-left shunt across the VSD causes little or no murmur. Ref: Brown D.W., Fulton D.R. (2011). Chapter 83. Congenital Hea Disease in Children and Adolescents. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e.\n\nSo the answer to this question is D"}
{"instruction": "In an ablated animal, myeloid series cells are injected. Which of following is seen after incubation period?\nA. RBCs\nB. Fibroblasts\nC. T lymphocytes\nD. Hematopoetic stem cells", "response": "Ans. a. RBCs (Ref: Robbins 9/e p580, 8/e p590-593; Harrison 19/e 89e-1, 18/e p539-542)As ablated animal is injected with myeloid series cell, it will show RBC's after incubation period.Hematopoietic Stem CellsHematopoietic stem cells are able to generate every lineage found in the hematopoietic system including RBCs, platelets and a variety of lymphoid cells.Hematopoietic Stem Cells differentiates into Two ProgenitorsCommon Lymphoid Progenitors (CLP)Common Myeloid Progenitors* Generate cells of the lymphoid cells; B and T lymphocytes, Natural killer cellsQ* Generate RBCs, platelets, granulocytes and monocytes, dendritic cells, macrophage progenitorQHematopoiesisStem - Progenitor - Precursor - Adult - MatureCommitted Progenitor Stage to Mature Cell (Erythropoiesis)Common myeloid progenitor - Proerythroblast - Basophilic erythroblasl - Polychromatic erythroblast - Polychromatic erythrocyte (reticulocyte) -Erythrocyte (RBC)(CFV - colony firming unit; SCF Stem cells factor; FIt3L, Flt3 lipand; LIN - Nepatine for lineage specific markers)\n\nSo the answer to this question is A"}
{"instruction": "True about C. jejuni (NOT RELATED -MICROBIOLOGY)\nA. Gram-positive bacillus\nB. Symptoms may initially mimic cholecystitis\nC. Most often occurs several days after consumption of undercooked chicken.\nD. Penicillin in drug of choice", "response": "Campylobacter species are small motile, non-spore-forming, comma-shaped, gramnegative bacilli, best grown in a microaerophilic environment at 42degC (107.6degF).C. jejuni gastroenteritis is usually self-limited; however, if necessary, erythromycin is the drug of choice.Campylobacter infection most often occurs several days (upto 7 d) after consumption of undercooked chicken.Symptom of fever and abdominal pain may initially mimic appendicitis/ pseudoappendicitis.Guillain-Barre is a rare neurological complication of C. jejuni gastroenteritis.\n\nSo the answer to this question is C"}
{"instruction": "HLA - B47 is associated with\nA. Myasthenia gravis\nB. Behcet's disease\nC. Congenital adrenal hyperplasia\nD. Abacavir hypersensitivity", "response": "HLA - B8 - Myasthenia gravis\nHLA-B51 - Behcet's disease\nHLA - B47 - CAH\nHLA- B57 - Abacavir hypersensitivity.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is not a feature of APLA?\nA. Haemolytic anemia\nB. False positive VDRL\nC. Thrombocytopenia\nD. Decreased PT with increased APTT", "response": "Antiphospholipid syndrome (APS) It is an autoantibody-mediated acquired thrombophilia characterized by recurrent aerial or venous thrombosis and/or pregnancy morbidity. Catastrophic APS (CAPS) is defined as a rapidly progressive thromboembolic disease involving simultaneously three or more organs, organ systems, or tissues leading to the corresponding functional defects. Patients with APS often possess antibodies recognizing Treponema pallidum PL/cholesterol complexes, which are detected as biologic false-positive serologic tests for syphilis (BFP-STS) and Venereal Disease Research Laboratory (VDRL) tests. Lupus anticoagulant (LA) Antibodies recognize b2GPI or prothrombin (PT) and elongate aPTT, implying that they interfere with the generation of thrombin by prothrombin . Prolongation of the clotting times is an in vitro phenomenon, and LA induces thromboses in vivo. Other two antibodies are Antibodies against cardiolipin (aCL) and Antibodies against b2GPI (anti-b2GPI). Clinical Features of Antiphospholipid Syndrome Venous Thrombosis and Related Consequences Deep vein thrombosis Livedo reticularis Pulmonary embolism Superficial thrombophlebitis Thrombosis in various other sites Aerial Thrombosis and Related Consequences Stroke Cardiac valve thickening/dysfunction and/or Libman-Sacks vegetations Transient ischemic attack Myocardial ischemia (infarction or angina) and coronary bypass thrombosis Leg ulcers and/or digital gangrene Aerial thrombosis in the extremities Retinal aery thrombosis/amaurosis fugax Ischemia of visceral organs or avascular necrosis of bone Multi-infarct dementia Neurologic Manifestations of Unceain Etiology Migraine Epilepsy Chorea Cerebellar ataxia Transverse myelopathy Renal Manifestations Due to Various Reasons Renal Aery/Renal Vein/Glomerular Thrombosis Fibrous Intima Hyperplasia Osteoaicular Manifestations Ahralgia Ahritis Obstetric Manifestations (Referred to the Number of Pregnancies) Preeclampsia Eclampsia Fetal Manifestations (Referred to the Number of Pregnancies) Early fetal loss (<10 weeks) Late fetal loss (>=10 weeks) Premature bih among the live bihs Hematologic Manifestations Thrombocytopenia Autoimmune hemolytic anemia Ref: Harrison&;s Principles of Internal Medicine; 20th edition; Chapter 379 Antiphospholipid Syndrome; Page no: 2135\n\nSo the answer to this question is D"}
{"instruction": "The carbohydrate not associated with dental plaque is:\nA. Dextrose\nB. Levans\nC. Glucose\nD. Rhamnose", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Investigation of choice in appendicitis in adults\nA. CT Scan\nB. USG\nC. Serum ESR\nD. MRI Abdomen", "response": "Answer- A. CT Scan\n\nSo the answer to this question is A"}
{"instruction": "Protein-A of S.Aureus binds to Fc region of\nA. IgD\nB. IgE\nC. IgG\nD. IgA", "response": "Protein-A binds to Fc region of IgG - basis of coagglutination reaction.\n\nSo the answer to this question is C"}
{"instruction": "A 11-year-old boy came with history of cough for 15 days. On examination he was found to have cervical lymphadenopathy. The lymph node biopsy is shown below. Which of the following is the most appropriate diagnosis?\nA. Tuberculosis\nB. Leprosy\nC. Sarcoidosis\nD. Syphilis", "response": "Cavitation occurs only in secondary tuberculosis. Both primary and secondary tuberculosis are characterized bycaseating granulomas, often with Langhans giant cells, which heal by scarring and calcification. The skin test result for tuberculin sensitivity is positive in both forms.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following X-ray should be advised for age determination between 1-13 years of age\nA. Shoulder\nB. Wrist\nC. Elbow\nD. Iliac bones", "response": "A bone age study helps doctors estimate the maturity of a child&;s skeletal system. It&;s usually done by taking a single X-ray of the left wrist, hand, and fingers. It is a safe and painless procedure that uses a small amount of radiation. ... The bone age is measured in years . Reference: GHAI Essential pediatrics, 8th edition\n\nSo the answer to this question is B"}
{"instruction": "Base of the skull fracture presents with involvement of the petrous temporal bone, which of the following important sign:\nA. Subconjunctive haematoma\nB. CSF rhinorrhoea\nC. Raccon eyes\nD. Battle sign", "response": "(Battle sign) (595-Baily & Love 24th) (302-B &L 25th)Base of Skull Fractures* Anterior fossa fracture - May open into the frontal or ethmoid air sinuses or run across the cribriform plate.* Presents with sub conjunctival hematoma, anosmia, epistaxis, nasal tip anaesthesia, CSF-rhinorrhea and occasionally carotico-cavernous fistua.* Periorbital haematoma or \"raccoon eye\" indicate subgaleal haemorrhage.* Middle fossa fracture involving petrous temporal bone presents with CSF otorrhoea, haemotympanum, occicular disruption, Battle sign or VII and VIII cranial nerve palsiesBattle sign - bruising behind the ear appearing 36 hours after a head injury with a petrous temporal base of skull fracture\n\nSo the answer to this question is D"}
{"instruction": "A 23 year old profession footballer suffered a twisting injury to his right ankle. On examination, there is a lot of swelling around the medial malleolus but x-ray doesn't show any fracture. The structure injured could be\nA. Deltoid Ligament\nB. Anterior talofibular ligament\nC. Spring ligament\nD. Tendo Achilles", "response": "(Refer: Manish Kumar Varshney's Essential Ohopedics Principles & Practice, 1st edition, pg no. 1265 - 1267)\n\nSo the answer to this question is A"}
{"instruction": "Not a synthetic pyrethroid insectiside -\nA. Propoxur\nB. Permethrin\nC. Cypermethrin\nD. Etofenoprox", "response": "Ans. is 'a' i.e., Propoxuro Inectisides are divided into:-A) Fumigants : Hydrogen cyanide, SO2, methyl bromide, carbon disulphate.B) Stomach poisons: Paris green, Sodium fluoride.C) Contact (nerve) poisons: These are divided into -1) Natural: Pyrethrum, rotenone, Derris, nicotine, mineral oil.2) Synthetic: These are -i) Organophosphates: Malathion, parathion, fenthion, diazinon, fenitrothion, abate, chlorthion, dioxathion, chlorpyrifos, trichlorfon.ii) Carbamates : Carbaryl, propoxur, dimetilan, pyrolon.iii) Organochlorine: DDT, BHC (HCH), dieldrin, aldrin, chlordane, lindane, heptachlor.iv) Synthetic pyrethroid (pyrethrum derivatives) : Pothrin, resmethrin, permethrin, biopermethrin, cypermethrin, cyphenothrin, cycloprothrin, deltamethrin, cyfluthrin, etofenoprox.\n\nSo the answer to this question is A"}
{"instruction": "Harlequin skin change is seen due to mutation of which gene?\nA. ABC A 12\nB. FAD\nC. Keratin 1\nD. ALOXE 3", "response": "Ans. is 'a' i.e., ABCA 12 Harlequin Ichthyosis* Harlequin ichthyosis (HI) is caused by mutations in the ABCA 12 gene.* Mutation in the gene leads to defective lipid transport and ABCA 12 activity is required for the generation of long- chain ceramides that are essential for the development of the normal skin barrier. It is inherited by autosomal recessive mode of inheritance.Clinical Manifestations* At birth, markedly thickened, ridged, and cracked skin forms horny plates over the entire body, disfiguring the facial features and constricting the digits.Treatment* Initial treatment includes high fluid intake to avoid dehydration from transepidermal water loss and use of a humidified heated incubator, emulsifying ointments, careful attention to hygiene, and oral retinoids (1 mg/kg/ day).* Prenatal diagnosis has been accomplished by fetoscopy, fetal skin biopsy, and microscopic examination of cells from amniotic fluid.Extra edge* N.B. The fetus in ichthyosis appears grostesque and the appearance is called harlequin fetus. But, it is different from Harlequin color change.Harlequin color change* This rare but dramatic vascular event occurs in immediate newborn period and is most common in low birth weight infants.* If reflects an imbalance in the autonomic vascular regulatory mechanism.* When the infant is placed on the side, the body is bisected longitudinally into pale upper half and a deep red dependent half.\n\nSo the answer to this question is A"}
{"instruction": "The mandibular labial frenum is a fibrous band that can be influenced by\nA. Incisivus\nB. Orbicularis oris\nC. Caninus and incisivus\nD. Incisivus and orbicularis oris", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Which antigen is not of prognostic significance in carcinoma breast\nA. Her 2 neu\nB. Epithelial membrane antigen\nC. ER\nD. PR", "response": "The presence of hormone receptors confers a slightly better prognosis.The highest rate of response (approximately 80%) to antiestrogen therapy (oophorectomy or tamoxifen) is seen in women whose tumor cells express both estrogen and progesterone receptors Overexpression of HER2/NEU:Overexpression of this membrane-bound protein is almost always caused by gene amplification ref : Robbins Basic Pathology, 9E,page-713\n\nSo the answer to this question is B"}
{"instruction": "What is the concentration of lignocaine used for topical anaesthesia?\nA. 2%\nB. 2-10%\nC. 7-12 %\nD. 12-15%", "response": "Anesthesia of mucous membranes of the nose, mouth, throat, tracheobronchial tree, esophagus, and genitourinary tract can be produced by direct application of aqueous solutions of salts of many local anesthetics or by suspension of the poorly soluble local anesthetics. Tetracaine (2%), lidocaine (2-10%), and cocaine (1-4%) typically are used. Maximal safe total dosages for topical anesthesia in a healthy 70-kg adult are 300 mg for lidocaine, 150 mg for cocaine, and 50 mg for tetracaine. Ref: Catterall W.A., Mackie K. (2011). Chapter 20. Local Anesthetics. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.\n\nSo the answer to this question is B"}
{"instruction": "Most common histological type of the thyroid carcinoma is\nA. Medullary type\nB. Follicular type\nC. Papillary type\nD. Anaplastic type", "response": "Papillary thyroid cancer is the most common cancer. Occurs in 70-80% of patients diagnosed with thyroid cancer. Common in females and younger age group. According to Woolner's Classification there are 3 types. 1)Occult primary(less than 1.5cm) 2) Intrathyroidal 3) Extrathyroidal Reference: SRB's Manual of Surgery, 6th Edition, page no = 468.\n\nSo the answer to this question is C"}
{"instruction": "During which gestational age is peak serum HCG levels attained ?\nA. 7-9 weeks\nB. 11-13 weeks\nC. 20 weeks\nD. 25 weeks", "response": "Human chorionic gonadotropin Glycoprotein with alpha and beta chains 3 subunit is specific to hCG Secreted by trophoblastic tissue, some amount by fetal tissues, adult ant pituitary Many isoforms of hCG with variable crossreactivity between various assays More than loo commercial assays Sandwich type immunoassay: Sens - 1 IU/ml Immuno radiometric assays: more Sensitive Ref : Dutta book of obstetrics 8th Ed.\n\nSo the answer to this question is A"}
{"instruction": "To prevent the spread of yellow fever across borders, the area surrounding airpos and seapos should be free from breeding of aedes mosquito. What is the area to be kept free of aedes mosquito/insect vector?\nA. At Least 200m around the sea/airpos\nB. At Least 300m around the sea/airpos\nC. At Least 400m around the sea/airpos\nD. At Least 500m around the sea/airpos", "response": "As per the guidelines an area extending at least 400 m around an airpo/sea po must be kept free from the breeding of insect vector. Also know: Aedes aegypti index - is the % of houses and their premises in a well defined area, showing actual breeding of aedes aegypti larvae. It should not be more than 1% in towns and seapos in endemic areas to ensure freedom from yellow fever. Ref: Park, Edition 21, Page - 259.\n\nSo the answer to this question is C"}
{"instruction": "Predisposing factor to carcinoma endometrium is\nA. Multiparity\nB. Early marriage\nC. DM\nD. OCP", "response": "i.e. (D M): (416-18-Shaw's 15th)PREDISPOSING FACTORS IN CARCINOMA ENDOMETRIUM* Un opposed and unsupervised administration of hormone replacement therapy (HRT) after menopause predispose to endometrial hyperplasia and cancer. Fortunately the malignancy is well-differentiated with good prognosis* Chronic non ovulatory cycle as seen in DUB* In some families, a strong familial predispotion is noticed. This may be due to genetic or dietic habits such as animal protein and fat. The oestrone is derived by peripherlal aromatization in the fat tissue from androstenedione and contributes to high level of oestrogen. Women with familial Lynch II syndrome suffering from anorectal and breast cancer are also likely to suffer from endometrial cancer* Tamoxifen given to women with breast cancer increases the risk of endometrial hyperplasia and cancer to 2- 3 folds* Combined oral hormonal pills have protective effect and reduce its risk by 40-50% and also adding progestogens for 12 days each cycle to oestrogen in HRT reduces its risks to 20%**** Obesity, hypertension and diabetes characterize this cancer in 30%* Infertile women and women with PCOS on account of non-ovulation have high oestrogen. They develop endometrial hyperplasia and endometrial cancer more than normal women. The uterine fibroid is associated with endometrial cancer in 3% after the age of 40 years* 15% women with endometrial cancer have feminizing ovarian tumour at the time of diagnosisOCP|| |Tumours associated Provides protection1. Cervical cancer 1. Ovarian tumours2. Hepatic adenoma 2. Uterine tumours3. Pituitary adenoma 3. Benign breast disease\n\nSo the answer to this question is C"}
{"instruction": "Iris pearls are seen in uveiitis due to -\nA. Tuberculosis\nB. Syphilis\nC. Toxoplasma\nD. Leprosy", "response": "Ans. is 'd' i.e., Leprosy * Lepromatous uveitis may occur as acute iritis (non-granulomatous) or chronic iritis (granulomatous).1) Acute iritis : It is caused by antigen-antibody deposition and is characterised by severe exudative reaction.2) Chronic granulomatous iritis : It occurs due to direct organismal invasion and is characterised by presence of small glistening'iris pearls' near the pupillary margin in a necklace form; small pearls enlarge and coalesce to form large pearls. Rarely, a nodular lepromata may be seen.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following effects is unlikely to occur during treatment with imipramine ?\nA. Elevation of seizure threshold\nB. Mydriasis\nC. Sedation\nD. Urinary retention", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Microscopy of corneal ulcer showed branching septate hyphae. The probable diagnosis is:\nA. Candida\nB. Mucormycosis\nC. Aspergillus\nD. Histoplasma", "response": "Ans. Aspergillus\n\nSo the answer to this question is C"}
{"instruction": "A 72-year-old man undergoes a subtotal colectomy for a cecal perforation due to a sigmoid colon obstruction. He has had a prolonged recovery and has been on total parenteral nutrition (TPN) for 2 weeks postoperatively. After regaining bowel function, he experienced significant diarrhea. Examination of his abdominal wound demonstrates minimal granulation tissue. He complains that he has lost his taste for food. He also has increased hair loss and a new perioral pustular rash. Which of the following deficiencies does he most likely have?\nA. Zinc\nB. Selenium\nC. Molybdenum\nD. Chromium", "response": "The patient has a zinc deficiency. Alopecia, poor wound healing, night blindness or photophobia, anosmia, neuritis, and skin rashes are all characteristic of patients with zinc deficiency, which often results in the setting of excessive diarrhea. Selenium deficiency is characterized by the development of a cardiomyopathy. Molybdenum deficiency is manifested by encephalopathy due to toxic accumulation of sulfur-containing amino acids. Chromium deficiency can occur in patients on long-term TPN and is characterized by difficult-to-control hyperglycemia and peripheral neuropathy and encephalopathy. Thiamine deficiency results in beriberi, which includes symptoms of encephalopathy and peripheral neuropathy; patients with beriberi can also develop cardiovascular symptoms and cardiac failure.\n\nSo the answer to this question is A"}
{"instruction": "Amsel criteria does not include:\nA. Thick, curdy white discharge\nB. Clue cells\nC. Whiff test positive\nD. Vaginal pH >4.5", "response": "Amsel criteria include thin, white homogenous discharge not thick discharge.\nOption b,c,d are included in Amsel criteria.\n3 out of 4 should be present to diagnose it as Bacterial vaginosis.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following types of glomerulonephritis is least likely to cause CRF:\nA. Post streptococcal glomerulonephritis\nB. Membranous GN\nC. Membrano proliferative GN\nD. Focal segmental glomerulosclerosis", "response": "Answer is A (Post streptococcal GN): Acute post streptococcal GN is a cause of acute Renal failure and not Chronic Renal Failure. The other types of GN listed in the question are causes of CRF. In Post Streptococcal Gn (Acute GN): 95% of the affected children recover. The remaining of who do not recover, develop a Rapidly Progressive form of Glomerulonephritis and land up in ACUTE RENAL FAILURE.\n\nSo the answer to this question is A"}
{"instruction": "Methylene blue reduction test is done for estimating –\nA. Fat content of milk\nB. Sugar content of milk\nC. Protein content of milk\nD. Bacterial activity in milk", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Drug of choice of paroxysmal supraventricular tachycardia is ?\nA. Adenosine\nB. Digitalis\nC. Procainamide\nD. Mexiletine", "response": "Ans. is 'a' i.e., Adenosine Treatment of paroxysmal supraventricular tachycardia Valsalva maneuver, carotid sinus massage - T vagal discharge - AV node conduction & T refractoriness. Adenosine CCBs b-blockers Adenosine is prefered because of very sho duration of action and lack of negative ionotropic effect. Prevention of PSVT - Drugs that slow conduction in the antegrade slow pathway, e.g. - Digitalis, P-blockers, CCBs.\n\nSo the answer to this question is A"}
{"instruction": "Vitamin A prophylaxis to a child is\nA. Health promotion\nB. Specific protection\nC. Primordial prevention\nD. Secondary prevention", "response": "Ans. is 'b' i.e. Specific protection Vitamin A prophylaxis is a form of specific protection against vitamin A deficiency resulting in xerophthalmiaSpecific protection is an interventional strategy for primary prevention in a disease process.Disease process, prevention & interventions can be summarised as below:* Health education is a part of health promotion Levels of preventionPrimordial prevention - Prevention of the development or emergence of Risk Factors in population groups in which they have not yet appeared Primary prevention - Action taken prior to the onset of disease which removes the possibility that the disease will ever occur. It signifies intervention in the pathogenesis phase of the disease.Secondary prevention - Action which halts the progress of disease at its incipient stage and prevents complications i.e. early diagnosis & treatment.Tertiary treatment - Intervention in the late pathogenic phase all measures to reduce or limit impairments, Disabilities and handicap Specific protection:Specific protection is possible in a limited number of cases.The interventions available areImmunizationUse of specific nutrients (For e.g. Vit. A, Iron & FA)ChemoprophylaxisProtection against occupational hazardsProtection against accidentsProtection from carcinogensAvoidance of allergensControl of environmental hazards e.g. air pollution, noise control etc.\n\nSo the answer to this question is B"}
{"instruction": "An infant presents with history of seizures and skin rashes. Investigations show metabolic acidosis increased blood ketone levels. This child is likely to be suffering from:\nA. Propionic aciduraria\nB. Urea cyclic disorder\nC. Phenylketonuria\nD. Multiple carboxylase deficiency", "response": "Each child with Homo Carboxylase Synthatase Deficiency (HCSD) is likely to experience slightly different effects. Many babies with this condition sta to have symptoms within hours of bih or during the first few days or weeks of life. Other babies have their first symptoms sometime in infancy, usually before two years of age. A small number of people with HCSD never show symptoms and are only found to be affected after a brother or sister is diagnosed. HCSD causes episodes of illness called metabolic crises. Some of the first symptoms of a metabolic crisis are: poor appetite vomiting extreme sleepiness or lack of energy irritability low muscle tone (floppy muscles and joints) severe peeling skin rash Common lab findings are: low blood sugar, called hypoglycemia high levels of acidic substances in the blood, called metabolic acidosis slightly high levels of ammonia in the blood low platelets ketones in the urine high levels of substances called organic acids in the urine If a metabolic crisis is not treated, a child with HCSD can develop: breathing problems seizures swelling of the brain coma, sometimes leading to death Ref: Kliegman, Behrman, Jenson, Stanton, (2007), Chapter 85, \"Defects in Metabolism of Amino Acids\", In the book, \"Nelson's Textbook of Pediatrics\", Volume 1, 18th Edition, New Delhi, Page 543\n\nSo the answer to this question is D"}
{"instruction": "Hyperprolactinoma causes\nA. Inter menstrual bleeding\nB. Prolonged menstruation\nC. Oligomenorrhea\nD. Polymenorrhea", "response": "(Oligomenorhea): (2287-88- H18th edition; 788-Davidson 21st)HYPER PROLACTINEMIA* Hyper prolactinemia is the most common pituitary hormone hyper secretion syndrome in both men and women* PRL- secreting pituitary adenoma (Prolactinomas) are the most common cause of PRL levels > 200 mg/L* Pregnancy and lactation are the important physiologic causes of hyperprolactinemia* Amenorrhea, galactorrhea and infertility are the hall marks of hyperprolactinemia in women* More commonly hyperprolactinemia develops later in life and leads to oligo menorrhea** and ultimately to amenorrhea* Decreased libido, weight gain and mild hirsutism may also complainMen-* Diminished libido , infertility and visual loss, impotence and oligospermia* True galactorrhea is uncommon in men hypogonadism, osteopenia, reduced muscle mass and decreased beard growth\n\nSo the answer to this question is C"}
{"instruction": "Best level of anesthesia for LSCS:\nA. T8\nB. T10\nC. T6\nD. T4", "response": "Ans. is d, i.e. T4Ref Dutta Obs. 7/e, p 519Spinal anesthesia:Spinal anesthesia is done by injection of local anesthetic agent into the subarachnoid space. It has less procedure time and high success rate. Spinal anesthesia can be employed to alleviate the pain of delivery and during the third stage of labor. For normal delivery or for outlet forceps with episiotomy, ventouse delivery, block should extend from T10 (umbilicus) to S1. For cesarean delivery, level of sensory block should be up to T4 dermatome. Hyperbaric bupivacaine (10-12 mg) or lignocaine (50-70 mg) is used.\n\nSo the answer to this question is D"}
{"instruction": "A 12-year-old girl presents for a routine physical examination. The patient has numerous freckles over her upper trunk and face. Which of the following terms best describes the morphologic appearance of her freckles?\nA. Comedo\nB. Macule\nC. Nodule\nD. Papule", "response": "Freckles, or ephelides, are small, brown macules that occur on sun-exposed skin, especially in people with fair skin. Freckles usually appear at about age 5 years. The pigmentation of a freckle deepens with exposure to sunlight and fades when light exposure ceases. Freckles show hyperpigmentation of the basal keratinocytes without a concomitant increase in the number of melanocytes. The other choices represent raised lesions of the skin.Diagnosis: Freckles, ephelides\n\nSo the answer to this question is B"}
{"instruction": "Examination of the fundus shows Cherry red spot in all of the following conditions, EXCEPT:\nA. Gaucher's disease\nB. Tay Sach's disease\nC. Niemann Pick Disease\nD. Central retinal vein occlusion", "response": "Cherry red spot is an ophthalmoscopic finding caused by the abnormal accumulation of products like gangliosides in the ganglion layer of the retina. The absence of ganglion cells in the area gives rise to a cherry-red spot surrounded by white cells filled with storage material. As the cells sta to die, optic atrophy becomes visibly apparent. Cherry red spot is seen in: Berlin's oedema Gaucher's disease Tay sach's disease Neimann pick's disease Central retinal aery occlusion Ref: Ophthalmology By A.K Khurana, 4th Edition, Page 257, 478; Harrison's Principles of Internal Medicine By Robe J. Hopkin, Gregory A. Grabowski, Chapter 355, Page 2452\n\nSo the answer to this question is D"}
{"instruction": "Circumcision cannot be used in management of\nA. Phimosis\nB. Severe balanitis xerotica\nC. Paraphimosis\nD. Penile Cancer", "response": "Answer- D. Penile CancerPhimosisBalanitis PosthitisParaphimosisSevere UTIs\n\nSo the answer to this question is D"}
{"instruction": "Hypersensitivity vasculities seen in -\nA. Capillaries\nB. Arterioles\nC. Post capillary venules\nD. Medium sized vessels", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is Venodilator\nA. Hydralizine\nB. Minoxidil\nC. Nitroprusside\nD. Nifedipine", "response": "Hydralizine, minoxidil and nifedipine are primarily aeriolar dilator whereas nitroprusside is a mixed aerial and venous dilator. Therefore best answer seems to be is a nitroprusside Refer kDT 6/e p540\n\nSo the answer to this question is C"}
{"instruction": "Following admission to the hospital for intestinal obstruction, a 48-year-old woman states that she previously had undergone cholecystectomy and choledochoduodenostomy. The most likely indication for the performance of the choledochoduodenostomy was:\nA. Hepatic metastasis were present.\nB. Multiple stones were present in the gallbladder at the previous operation.\nC. Multiple stones were present in the CBD at the previous operation.\nD. The common hepatic duct had a stricture.", "response": "Multiple stones were present in the CBD at the previous operation. During exploration of the CBD, most stones can be removed by using Desjardin's forceps or under direct vision using a choledochoscope and Dormia basket. However, if there are multiple stones impacted in the lower part of the CBD, a drainage procedure may be indicated. The CBD must be dilated before considering performing a choledochoduodenostomy at the time of gallbladder surgery (Figure below). If a stone is present in a dilated CBD after previous cholecystectomy, a choledochoduodenostomy is performed, because the rate of recurrent jaundice is high (>20%). Alternatively ERCP and sphincterotomy could be considered.Treatment for invasive gallbladder cancer is cholecystectomy and a wedge resection of the liver along with a regional lymphadenectomy. The wedge resection of the liver is illustrated. Segments 4 and 5 together with the lymph node regions should be removed.\n\nSo the answer to this question is C"}
{"instruction": "All muscles are useful in Supination and Pronation of Hand EXCEPT\nA. Anconeus\nB. Brachio-radialis\nC. Supinator\nD. Biceps brachii", "response": "(A) Anconeus # Supination & Pronation are rotatory movements of forearm (and hand) around a vertical axis.> In a semiflexed elbow, the palm is turned upwards in supination, and downwards in pronation Remember: Kings pronate, Beggars supinate> The movements are permitted at the superior and inferior radioulnar joints, there is no middle radioulnar joint, and so no role. The radius is pronated by the pronator teres and pronator quadratus muscles. Pronation is performed by pronator quadratus and pronator teres muscle. Brachioradialis puts the forearm into a midpronated/supinated position from either full pronation or supination. Hand is supinated by the brachioradialis, supinator (brevis), and biceps muscles. The hand is supine in the anatomical position (i.e., palms facing up during autopsy).This action is performed by the Biceps brachii and the Supinator muscle\n\nSo the answer to this question is A"}
{"instruction": "Boundaries of quadrilateral space include all except?\nA. Teres major\nB. Long head of triceps\nC. Neck of humerus\nD. Deltoid", "response": "Deltoid\n\nSo the answer to this question is D"}
{"instruction": "Most common site of endometriosis:\nA. Fallopian tube\nB. Cervix\nC. Ovary\nD. Vagina", "response": "Most common site of endometriosis is ovary other common sites are: fallopian tubes, pelvic peritoneum, uterosacral ligaments Others sites: Bowel Lung (periodic hemoptysis) Nose (periodic epistaxis) Eyes (periodic subconjuctival hemorrhage)\n\nSo the answer to this question is C"}
{"instruction": "Slap cheek appearance is seen in -\nA. Erythema infectiosum\nB. Exanthem subitum\nC. Roseola infantun\nD. None of above", "response": "Ans. is 'a' i.e., Erythema infectiosum o Erythema infectiosum (also known as fifth disease) is usually a benign childhood condition characterized by aclassic slapped-cheek appearance (see the image below) and lacy exanthem. It results from infection with human parvovirus (PV) B19. an erythrovirus.o Human herpesvirus 6 (HHV-6) is a dominant cause of roseola infantum (exanthem subitum or sixth disease).\n\nSo the answer to this question is A"}
{"instruction": "The buffering capacity of a buffer is maximum at pH equal to\nA. 0.5 pKa\nB. pKa\nC. pKa+1\nD. 2pKa", "response": "The pH of a buffer is determined by the Henderson-Hasselbalch equation So, at the max buffering capacity, = . This is because a buffer reacts in the following manner--it is able to buffer against equal amounts of acid (H+) or base (OH-) added. A- + H+ - HA HA + OH- - H2O + A- Finally, we can see from the above Henderson-Hasselbalch equation that when = , pH = pKa.\n\nSo the answer to this question is B"}
{"instruction": "A 10 year old male patient broke his tooth while playing. He gives a history of Endocardial cushion defect. Extra-oral examination reveals an underdeveloped midface, brachycephalic skull, flat nasal bridge and oblique palpebral fissures. What would be the common cardiac finding in patients with this condition?\nA. Atrioventricular septal defects\nB. Ventricular septal defects\nC. Patent ductus arteriosus\nD. All of the above", "response": "Affected individuals are more prone to congenital heart defects (50%) such as atrioventricular septal defects, ventricular septal defects, isolated secundum atrial septal defects, patent ductus arteriosus, and tetralogy of Fallot.\n\nSo the answer to this question is D"}
{"instruction": "A Syndrome is characterized by Pancreaticneoplasm (insulinoma), Pituitary, and Parathyroid involvement. The syndrome is:\nA. Polyglandular Type I\nB. Polyglangular Type 2\nC. Wermer\nD. Sipple", "response": "Wermer\n\nSo the answer to this question is C"}
{"instruction": "The shortest diameter of the pelvic inlet is -\nA. Obstetric conjugate\nB. True conjugate\nC. Diagonal conjugate\nD. Transverse diameter", "response": "Ans-A\n\nSo the answer to this question is A"}
{"instruction": "Ante's law provides an aid for\nA. Selection of pontic\nB. Selection of connector\nC. Selection of retainers\nD. Selection of abutments", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "A 12-year-old boy with a femur fracture after a motor vehicle collision undergoes operative repair. After induction of anesthesia, he develops a fever of 40degC (104degF), shaking rigors, and blood-tinged urine. Which of the following is the best treatment option?\nA. Alkalinization of the urine, administration of mannitol, and continuation with the procedure\nB. Administration of dantrolene sodium and continuation with the procedure\nC. Administration of dantrolene sodium and termination of the procedure\nD. Administration of intravenous steroids and an antihistamine agent with continuation of the procedure", "response": "The patient is manifesting symptoms of malignant hypehermia (fevers, rigors, and myoglobinuria), which is treated by administration of dantrolene, immediate discontinuation of offending medication (which can include succinylcholine or halothanebased inhalational anesthetics), and suppoive cooling measures. While urine alkalinization, loop diuretics, and mannitol are appropriate treatment measures for rhabdomyolysis, the underlying problem in this patient is malignant hypehermia, which, because of its associated moality of 30% in severe cases, should be treated first and foremost. Malignant hypehermia is not a manifestation of anaphylactic shock, and therefore steroids and antihistamines have no role in its treatment.\n\nSo the answer to this question is C"}
{"instruction": "1 and 1/2 year old child with history of chronic diarrhea was brought to the hospital with complaints of perioral and perineal rash. What is your diagnosis?\nA. Epidermolysis bullosa\nB. Staphylococcal scalded skin syndrome\nC. Acrodermatitis enteropathica\nD. Toxic epidermal necrolysis", "response": "Ans. C. Acrodermatitis enteropathicaAcrodermatitis enteropathica:* Autosomal recessive disorder seen in infants due to defect in intestinal zinc specific transporter - Human ZIP4 protein* Genetic locus - Chromosome 8q24.3* Classically presents while weaning from breast milk to formula, which has lower zinc bioavailability than breast milk.* C/F - Perioral and perineal rashes, periungual dermatitis- Beau's lines on nails, chronic diarrhea, alopecia.* Labs - Low serum zinc, ALP* Paneth cell inclusion in intestinal mucosal biopsy* Treatment - Zinc - 50mg/day for infants, upto 150mg/day for children\n\nSo the answer to this question is C"}
{"instruction": "Postmortem rigidity disappears first in:\nA. Upper limbs\nB. Neck\nC. Lower limbs\nD. Eyelids", "response": "Ans. (d) EyelidsRef: The Essentials of FSM by K.S. Narayan Reddy 31st ed. /140-43, 147; Reddy's 2Th/ 142Order of appearance and disappearance (in sequence)* Heart (left chamber in 1 hour)* Eyelids (3-4 hours)* Face muscles* Neck and trunk* Upper extremities* Legs* Small muscle of finger and toes (last to be affected, 11-12 hours)Also Know* Postmortem rigidity lasts for 18-36 hours in summer and 24-48 hours in winter.* Postmortem rigidity disappear in the same order as that of the appearance\n\nSo the answer to this question is D"}
{"instruction": "DOC for Tourette syndrome\nA. Haloperidol\nB. Valproate\nC. B complex\nD. Clonidine", "response": "Ans. is 'd' i.e., Clonidine Earlier Haloperidol was considered as DOC for Tourette syndrome. Clonidine is considered as DOC for Tourette syndrome\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is known as Preisz Nocard bacillus\nA. Corynebacterium diphtheria\nB. Corynebacterium pseudotuberculosis\nC. Influenza bacillus\nD. Salmonella", "response": "Corynebacteria of veterinary impoance are Corynebacterium pseudotuberculosis. Also called as Preisz - Nocard bacilli. Causes pseudotuberculosis in sheeps and suppurative lymphadenitis in horses. Reference: Textbook of Microbiology; Anathanarayan and panicker&;s; 9th edition; Page no: 242\n\nSo the answer to this question is B"}
{"instruction": "Which amongst these is a tuberculid?\nA. Erythema nodosum\nB. Scrofuloderma\nC. Lupus vulgaris\nD. Erythema induratum", "response": "It is a nodular type of hypersensitivity reaction typically presents as red tender nodules.\n\nSo the answer to this question is D"}
{"instruction": "The length of distal convoluted tubule is\nA. 5 mm\nB. 2 mm\nC. 12 mm\nD. 8 mm", "response": "Although the DCT is the shoest segment of the nephron, spanning only about 5 mm in length in humans (1), it plays a critical role in a variety of homeostatic processes, including sodium chloride reabsorption, potassium secretion, and calcium and magnesium handling Ref: guyton and hall textbook of medical physiology 12 edition page number:460,461,462\n\nSo the answer to this question is A"}
{"instruction": "Which is the prognostic scoring system for head injury in children?\nA. CCS\nB. AUDIT\nC. Injury severity score\nD. Pediatric Trauma Score", "response": "Ans. is 'a' i.e., CCS * Scoring scales such as the Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Pediatric Trauma Score and Revised Trauma Score are used to predict mortality as well as morbidity in patients sustaining trauma in general.* They use physiological parameters to predict patient outcome.* CCS (Children Coma Score) is the paediatric counterpart of Glasgow Coma Score for patient with head injury.Children Coma Score:Eye Opening (Total Possible Points 4)Spontaneous4 To voice3 To pain2 None1 Verbal Response (Total Possible Points 5)Older Children Anfants and Young Children Oriented5Appropriate words, smiles, fixes, and follows5Confused4Consolable crying4Inappropriate3Persistently imitable3Incomprehensible2Restiess, agitated2None1None1Motor Response (Total Possible Points 6)Obeys6 Localized pain5 Withdraws4 Flexion3 Extension2 None1\n\nSo the answer to this question is A"}
{"instruction": "Single file pattern is seen in breast cancer type-\nA. Intraductal\nB. Infiltrating lobular\nC. Infiltrating ductular\nD. All of the above", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following carriers recieved source of infection from other carrier is called-\nA. Incubatory carrier\nB. Convulescent carrier\nC. Healthy carrier\nD. Chronic carrier", "response": ".\n\nSo the answer to this question is C"}
{"instruction": "A 35-year-old man is admitted after severing his arm on industrial machinery. His airway is patent and there is no identifiable hindrance to breathing. Hispulse is 110 beats/min, blood pressure is 130/105 mmHg, and respiratory rate is 25 breaths/min. Which stage of shock is this patient in?\nA. Class I\nB. Class II\nC. Class III\nD. Class IV", "response": "The following table illustrates the clinical signs of the different stages of hypovolaemic shock. Class I Class II Class III Class IV Percent blood loss Up to 15 15-30 30-40 >40 Pulse rate <100 >100 >120 >140 Blood pressure Normal Normal | | Pulse pressure Normal | | | Respiratory rate 14-20 20-30 30-40 >35 Urine output (mL/h) >30 20-30 5-15 <5 Mental status Slight anxiety Mild anxiety Anxious, confused Confused\n\nSo the answer to this question is B"}
{"instruction": "Blood is stored at what temperature in blood bank?\nA. -2 to -4 degrees Celsius\nB. -2 to 0 degrees Celsius\nC. 1 to 6 degrees Celsius\nD. 6 to 12 degrees Celsius", "response": "Ans. is 'c' i.e., 1 to 6 degrees Celsius\n\nSo the answer to this question is C"}
{"instruction": "The superficial external pudendal artery is a branch of -\nA. Femoral artery\nB. External iliac artery\nC. Internal iliac artery\nD. Aorta", "response": "Femoral artery branches\n- Superficial\n\nSuperficial external pudendal\nSuperficial epigastric\nSuperficial circumflex iliac\n\n- Deep\n\nProfunda femoris\nDeep external pudendal\nMuscular branches\nDescending genicular branch\n\nSo the answer to this question is A"}
{"instruction": "The most useful incision in the operating room for patients with penetrating pericardium injury is\nA. Left anterior thoracotomy\nB. Right anterior thoracotomy\nC. Subxyphoid\nD. Median sternotomy", "response": "The subxiphoid incision is useful for determining if there is blood in the pericardium and if there is an intracardiac injury; however, exposure is extremely limited, and definitive repair can rarely be performed through the incision. Left (or right) anterior thoracotomy is easily performed, especially in the emergency room, and gives adequate exposure to ceain areas of the hea. However, each has significant limitations in exposure. Either may be extended across the thoracotomy into the other side of the chest, thus producing a bilateral anterior thoracotomy. Exposure is excellent through this incision, and most injuries can be satisfactorily repaired through this approach. Most cardiac operations today are performed through median sternotomy incisions. If the patient is in the operating room, this incision is easily performed and always provides excellent exposure for all areas of the hea.\n\nSo the answer to this question is D"}
{"instruction": "Reverse 3 sign in barium swallow is seen in:\nA. Coarctation of aorta\nB. Aberrant right subclavian artery\nC. Patent ductus arteriosus\nD. Double aortic arch", "response": "Ans-A Ref: OP Ghai, Textbook of Pediatrics: 7th edition, page: 421 Nelson's Textbook of Pediatrics 18th edition: page no 1901Explanation:Radiological signs of coarctation of aorta:Rip notching or dock sign is the notching of the under surfaces of posterior ribs extending from third to ninth ribs. It may be unilateral or bilateral and is seen only after the age of 6 yearsPost stenotic dilatation is the dilation of the aorta distal to coarctation3-sign is a combination of dilated left subclav ian artery above.stenosed coarcted segment in the middle and dilated post-stenotic aorta belowE-sign is seen on the lateral view on a barium swallow. This results from the dilated left subclavian artery and dilated post stenotic aorta indenting the barium filled oesophagus.Coarctation of the aortais produced by a deformity of the aortic media and intima. which causes a prominent posterior infolding of the aortic lumen.This deformity characteristically occurs at or near the junction of the aortic arch and the descending thoracic aorta.Cystic medial necrosis is a common occurrence at the level of coarctation and may predispose the aorta to infective endarteritis, intimal dissection, and aneurysm.Coarctation of the aorta accounts for 5% -10% of congenital cardiac lesions.It occurs with increased frequency among patients with Turner syndrome. 20%-36% of whom are affected.Clinical manifestations vary from congestive heart failure in infancy to hypertension with differential pressures between the upper and lower extremities in adulthood.Two classic radiologic signs associated with aortic coarctation are the figure-of-three sign and the reverse figure-of-three sign.The aortic segment affected by coarctation has a shape that resembles the number 3 on frontal chest radiographs.The number 3 is formed by dilatation of the left subclavian artery and aorta proximal to the site of coarctation, indentation of the site, and dilatation of the aorta distal to the site.This sign is seen in 50%-66% of adults with aortic coarctation.The reverse figure-of-threesign. a mirror image of the number 3, is observedon the left anterior oblique view during bariumesophagography in patients with aortic coarctation.Common radiologic signs in Congenital Heart DiseaseTransposition of Great arteriesEgg on side or Apple on a string apoearanceTotal anomalous pulmonary venous return5nowman or Figure of esght appearancePartial anomalous pulmonary venous returnScimitar signTetralogy of FallotBoot shaped HeartEbstein's anomalyBox shaped heartEndocardial Cushion defectGoose neck sign\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not a feature of Alcoholic liver disease?\nA. Macrovesicular fat within hepatocytes\nB. Lipogranuloma\nC. Lymphocytic infiltration of portal tracts\nD. Portal & sinusoidal collagen deposits", "response": "Ans. (c) Lymphocytic infiltration of portal tracts(Ref: Robbins 9th/pg 837; 8th/pg 850; Rosai and Ackerman's Surgical Pathology, Volume 1, chapter 13)Lipogranuloma (or fat granuloma) represents a focal response to rupture of lipid-laden hepatocytes. It contains macrophages, occasional lymphocytes, eosinophils, and sometimes giant cells; It may be seen in Alcoholic liver disease; Neutrophil rather than lymphocytic infiltration is seen in alcoholic liver disease\n\nSo the answer to this question is C"}
{"instruction": "In ductus venous, the fetal blood from the placenta reaches to the liver through\nA. Poal vein\nB. Right umbilical vein\nC. Inferior vena cava\nD. Left umbilical vein", "response": "when there is an increase in placental circulation, to facilitate the rapid transpo of blood through the liver ,a large passage is formed between left umbilical vein and right hepato cardiac channel.This passage is called ductus venosus REFERENCE: TEXTBOOK OF CLINICAL EMBRYOLOGY... VISHRAM SINGH SECOND EDITION....PAGE NO:241\n\nSo the answer to this question is D"}
{"instruction": "True regarding Sjogren's syndrome are all of the following except: September 2009\nA. Autoimmune condition\nB. Males are commonly affected\nC. Progressive destruction of lacrimal and salivary gland\nD. No single laboratory investigation is pathognomic", "response": "Ans. B: Males are commonly affected SjOgren's Syndrome (SS) is a systemic autoimmune disease characterised by lymphocytic infiltration, acinar cell destruction and proliferation of duct epithelium in all salivary and larimal gland tissue. Extra glandular involvement of muscles, blood vessels, lungs, kidneys may also occur. Females are affected more than the males It may be primary and secondary (when associated with other connective tissue diseases). There is a risk of progression to lymphoid malignancy. Dry mouth, dry eyes and ahritis/ahralgia are the 3 common presenting features. Of the extraaicular manifestations, Raynaud's phenomena is the most common skin manifestation seen in 35% of patients. Vasculitis has been repoed in 5% of patients with Sjogren's syndrome. This includes small vessel leucocytoclastic vasculitis and medium vessel necrotising vasculitis. Distal A may be silent or lead to renal stones, nephrocalcinosis and compromised renal function. Hypergammaglobulinemia may be due to polyclonal activation of B cells. The diagnosis is base on the history as no single laboratory investigation is pathognomic of either primary or secondary Sjogren's syndrome\n\nSo the answer to this question is B"}
{"instruction": "Not a family of selectin\nA. P selectin\nB. L selectin\nC. A selectin\nD. E selectin", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Penile ulcer is painful in:\nA. Syphilis\nB. LGV\nC. Donovanosis\nD. Chancroid", "response": "Ans. is. 'd' i. e., Chancroid\n\nSo the answer to this question is D"}
{"instruction": "Slope of pressure volume curve of lung represents:\nA. Compliance of lung\nB. Conductance\nC. Surface tension\nD. Transpulmonary pressure", "response": "Ans. a (Compliance of lung). (Ref. Ganong Physiology 23rd/ pg. 654-657; Figure 35-10)Lung compliance is an index of lung distensibility or the ease with which the lungs are expanded; thus, compliance is the inverse of elastic recoil. Compliance is defined as the ratio of change of lung volume to the change in pressure required to inflate the lung (dV/dP). Compliance decreases in patients with pulmonary edema or surfactant deficiency and increases when there is a loss of elastic fibers in the lungs, such as occurs in patients with emphysema and with aging.MECHANICS OF BREATHING - Compliance of the lungs & chest wall# Curve of airway pressure plotted against volume, is relaxation pressure curve of the total respiratory system.# The pressure is zero at a lung volume that corresponds to the volume of gas in the lungs at the end of quiet expiration (relaxation volume, which equals the functional residual capacity).# It is positive at greater volumes and negative at smaller volumes. The change in lung volume per unit change in the airway pressure (DV/DP) is the stretchability (compliance) of the lungs and chest wall.Q# It is normally measured in the pressure range where the relaxation pressure curve is steepest, and the normal value is approximately 0.2 L/cm H2O.# The curve is shifted downward and to the right (compliance is decreased) by pulmonary congestion and interstitial pulmonary fibrosis; pulmonary fibrosis is a progressive disease of unknown cause in which there is stiffening and scarring of the lung.# The curve is shifted upward and to the left (compliance is increased) in emphysema.# It should be noted that compliance is a static measure of lung and chest recoil.# Two major forces contribute to lung compliance:o tissue elastic forces ando surface tension forces.Q\n\nSo the answer to this question is A"}
{"instruction": "All are risk factors for ca endometrium except -\nA. Tamoxifen\nB. Multiparity\nC. Obesity 8c hypertension\nD. Late menopause", "response": "Ans. is 'b' i.e., Multiparity Rick Factors for Endometrial CA (Estrogen-dependent tumor):* Nulliparity* Early menarche, Late menopause* Obesity* Diabetes mellitus and hypertension* Unopposed estrogen therapy/Anovulation* Tamoxifen therapy* Atypical endometrial hyperplasia* Obesity, hypertension, and diabetes mellitus associated with CA endometrium = corpus CA syndrome* OC PILLS, POP, DMPA, MIRENA, Multiparity are all protective for CA endometrium\n\nSo the answer to this question is B"}
{"instruction": "The largest organ of the body is\nA. Liver\nB. skin\nC. Gluteus maximus\nD. Femur", "response": "The liver is the largest gland in the body and has a wide variety of functions (265-Snell 7th )\nThe liver is the largest gland in the body. (283-BDC-2)\nFemer is the longest and the strongest bone of the body (16-B DC-2)\nSkin is the largest organ of the body (278-K- Sembulingam physiology)\nSkin is considered as the largest sense organ in the body it has many nerve endings, which are specialized to form cutaneous receptors (281-K. Sembulingam physiology 3rd )\n\nSo the answer to this question is B"}
{"instruction": "Patients with C5 through C9 complement deficiencies would be most likely to have which of the following infections?\nA. AIDS\nB. Meningococcal infection\nC. Pneumococcal infection\nD. Giardiasis", "response": "Patients with complement deficiencies such as C5 through C9, which form the membrane attack complex (MAC), are predisposed to disseminated meningococcal disease. These patients may also be susceptible to gonococcal infection. There appears to be no disposition to AIDS or to fungal, parasitic, or pneumococcal infections.\n\nSo the answer to this question is B"}
{"instruction": "Horner's syndrome is seen in all except -\nA. Carotid artery aneurysm\nB. Medial medullary syndrome\nC. Can occur following surgery for raynaud's syndrome\nD. Multiple sclerosis", "response": "Ans. is 'b' i.e., Medial medullary syndrome Horner*s syndrome is a classic neurologic syndrome whose signs include : -Miosis,Ptosis, andAnhidrosisAlso called ocul sympathetic paresis, a Horner's syndrome can be produced by a lesion anywhere along the sympathetic pathway that supplies the head, eye, and neck.NeuroanatomyHorner's syndrome can result from a lesion anywhere along a three-neuron sympathetic (adrenergic) pathway that originates in the hypothalamusThe first-order neuronDescends caudally from the hypothalamus to the first synapse, which is located in the cervical spinal cord (levels C8-T2, also called ciliospinal center of Budge).The second-order neuronTravels from the sympathetic trunk, through the brachial plexus, over the lung apex. It then ascends to the superior cervical ganglion, located near the angle of the mandible and the bifurcation of the common carotid artery.The third-order neuronThen ascends within the adventitia of the internal carotid artery, through the cavernous sinus, where it is in close relation to the sixth cranial nerve.The ocul sympathetic pathway then joins the ophthalmic (VI) division of the fifth cranial nerve (trigeminal nerve).In the orbit and the eye, the ocul sympathetic fibers innervate the iris dilator muscle as well as Muller's muscle, a small smooth muscle in the eyelids responsible for a minor portion of the upper lid elevation and lower lid retraction.EtiologyThe etiology of Horner's syndrome in adults relates to the lesion location.First-order syndrome (central)* Lesions of the sympathetic tracts in the brainstem or cervicothoracic spinal cord can produce a first-order Horner's syndromeLateral medullary syndromeQ (M.C.)Brainstem disease (stroke, tumour, demyelinating disorder)SyringomyeliaCervical cord trauma (including surgery)Spinal cord tumourDiabetic autonomic neuropathyMultiple sclerosisSecond-order syndromeTrauma or surgery involving spinal cord, thoracic outlet lung apex.Pancoast tumourCarotid and Aortic aneurysm and dissectionLumbar epidural anaesthesia.Third-order syndrome (Postganglionic)Lesions of internal carotid artery such asDissection, thrombosisOtitis mediaCavernous sinus mass Surgery for Raynaud's syndrome (cervical sympathectomy) may cause trauma to cervical spinal cord.\n\nSo the answer to this question is B"}
{"instruction": "Hypocretin system plays a critical role in which of the following disorders?\nA. Insomnia\nB. Depression\nC. OCD\nD. Narcolepsy", "response": "Ans. D. NarcolepsyIt has become apparent that the hypo cretin system plays a critical role in narcolepsy. Narcolepsy is the prototypical example of sleepiness produced by a basic central nervous system dysfunction of sleep mechanisms. The etiology stems from a genetically triggered hypo cretin dysfunction and deficit. Insomnia is defined as difficulty initiating sleep or maintaining sleep or having nonrestorative sleep for 1 month or more. The insomnia or resulting sleepiness must cause clinically significant impairment or distress. To qualify as primary insomnia, the etiology must not be rooted in psychiatric conditions, parasomnias, substance use or abuse, sleep-disordered breathing, or circadian rhythm disorders.\n\nSo the answer to this question is D"}
{"instruction": "Parasympathetic postganglionic fibres are carried by the\nA. Long ciliary nerves\nB. Greater petrosal nerves\nC. Auriculotemporal nerve\nD. Deep petrosal nerve", "response": "Long ciliary nerves are mixed sensory and sympathetic. Greater petrosal nerves carries preganglionic parasympathetic fibers from the facial nerve to the pterygopalatine ganglion. The deep petrosal nerve carries mainly sympathetic fibres from the superior cervical ganglion and internal carotid plexus.\n\nSo the answer to this question is C"}
{"instruction": "What is the use of Ballard's scoring system in newborn babies?\nA. Assessment of gestational age\nB. Assessment of bih weight\nC. Prediction of neonatal death\nD. Screening for sepsis", "response": "Ballard's scoring system in newborn babies is used for assessment of gestational age It is based on neuromuscular criteria and physical criteria for maturity It is accurate to +-2 weeks\n\nSo the answer to this question is A"}
{"instruction": "A 35-year-old smoker is involved in a house fire and receives a 45% total surface area burn. One half of the burned surface appears to be third degree. On the third post-burn day, the patient is noted to have bloody drainage from a nasogastric tube and a decrease of 5% in his hematocrit. Appropriate management should include which of the following?\nA. Urgent upper gastrointestinal contrast study to delineate site of bleeding\nB. Immediate selective aeriography the left gastric aery to diagnose and treat presumed stress ulceration\nC. Urgent esophagogastroduodenoscopy to diagnosis the cause of bleeding\nD. Urgent intravenous infusion of vasopressin at 0.2-0.4 IU/min", "response": "Patients who have sustained a major thermal burn of 35% or more of their body surface area are at a predictably high risk for the development of gastric erosions and hemorrhage. Endoscopy has demonstrated that gastric erosions are present in 93% of these patients, whereas the occurrence of severe acute upper gastrointestinal hemorrhage in severely burned patients ranges between 25% to 50%. At least 60% of patients at risk develop stress erosions within 1 to 2 days after the precipitating event. Painless upper gastrointestinal bleeding may be the only clinical sign. The onset of hemorrhage is often delayed, usually occurring 3 to 10 days after the onset of the primary disease. Esophagogastroduodenoscopy is the diagnostic modality of choice to confirm the diagnosis and to differentiate stress erosion from other sources of upper gastrointestinal hemorrhage. Correct identification of the bleeding source is made in greater than 90% of instances. If endoscopy is not diagnostic, visceral angiography through selective catheterization of the left gastric or splenic vessels may provide information regarding the primary vessel supplying the bleeding site. In contrast, barium examinations are usually of little value, due to the superficial nature of stress erosions, and in fact may be detrimental by interfering with the interpretation of subsequent aeriography.\n\nSo the answer to this question is C"}
{"instruction": "Fixation reflex develops at the age of\nA. 2-4 months\nB. 4-6 months\nC. 6-8 months\nD. 5-7 years", "response": "Fixation reflex 2-4 months.\nMacular differentiation 4-6 months.\nStereopsis 5-7 years.\n\nSo the answer to this question is A"}
{"instruction": "All are true about Peyronie's disease EXCEPT:\nA. Self limiting\nB. Medial treatment is effective\nC. Association with Dupvytren's contracture\nD. Calcified plaques", "response": "(Medical treatment is effective) (1399-1400-Baily & 24th) (1373-B &L 25th)PEYRONIE'S DISEASE - Common cause of erect penis.* Hard plaques of fibrosis can usually be palpated in the tunica of one or both corpora covemosa. The plaque may be calcified.* May result of past trauma, there is association with dupuytren *s contracture.Treatment - continue to progress or remit after 3-5 years* When the deformity of the penis is causing distress, it may be possible to straighten it by placing non absorbable sutures in corpus cavernous opposite the plaque. This reduces the elasticity in the region to balance that caused by the plaque (NES BITT'S OPERATION)Peyronie's disease* Medical treatment are often ineffective* The disease is typically self-limiting* Surgery may be indicated to correct deformity with sexual function.\n\nSo the answer to this question is B"}
{"instruction": "The apparent volume of distribution (Vd) of a drug exceeds total body fluid volume, if a drug is:\nA. Sequestrated in body tissues\nB. Slowly eliminated from body\nC. Poorly soluble in plasma\nD. Highly bound to plasma proteins", "response": "- The apparent volume of Distribution (Vd) = Dose administered by IV route/Plasma concentration.\n- Consider the body as a single compartment in which the drug gets homogenously distributed. So it can be defined as, “The volume that would accommodate all the drug in the body if the concentration throughout was the same as in plasma.”\n- In the case of lipid insoluble drugs, drugs do not enter the cells. So their V will be similar to ECF volume. \n- Drugs sequestrated in other tissues may have V much more than total body water or even body mass.\n\nSo the answer to this question is A"}
{"instruction": "Chronic active hepatitis is distinguished from chronic persistent hepatitis by -\nA. Characteristic liver pathology\nB. HBS Ag in serum\nC. Extrahepatic manifestations\nD. Presence of anti smooth muscle antibody", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Fibrosis is due to-\nA. TGF-b\nB. TNF-a\nC. IL - 7\nD. IL -10", "response": "Robbins and Cotran pathologic basis of disease South Asia edition. Robbins 9/e p46 *activated macrophages secrete 1 growth factors ,TGF Beta:tissue repair and fibrosis. 2 IL 10 ,TGF Beta: anti inflammatory effect.\n\nSo the answer to this question is A"}
{"instruction": "Retained mandibular deciduous central incisors will 10\nresult in\nA. Lingual eruption of mandibular permanent incisors\nB. Labial eruption of mandibular permanent incisors\nC. Impaction of mandibular permanent incisors\nD. Ankylosis of mandibular permanent incisors", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "ANA (antinuclear antibody) is seen in all except:\nA. SLE\nB. RA\nC. Sjogren's syndrome\nD. Systemic sclerosis", "response": "Ans. (b) RA(Ref: Harrison 18th/chapter 321, 323)Antibodies seen in RA are rheumatoid factors (RFs) and anti-cyclic citrullinated peptides (CCP) antibodies ANA is seen in:Almost all (>95%) cases of SLEIn virtually all patients with SSc (Systemic sclerosis)50% to 80% cases of Sjogren syndrome\n\nSo the answer to this question is B"}
{"instruction": "Pharmacodynamics deals with -\nA. Effect of drugs on body\nB. Effect of body on drugs\nC. Absorption of drugs\nD. Metabolism of drugs", "response": "Ans. is 'a' i.e., Effect of drugs on body o Pharmacodynamics is the study dealing with effect of drugs on body. It includes action of drugs as well as their mechanism.o Pharmakokinetics is the quantitative study of drug movement, in through and out of the body. That means, it is the study of the effect of body on the drug. So, it is also known as ADME study as it deals with Absorption, Distribution, Metabolism and Excretion of a drug.RememberPharmacodynamics (D) - Drug does to bodyPharmacokinetics -Body does to drug\n\nSo the answer to this question is A"}
{"instruction": "Transoesophageal Echocardiography is useful in -\nA. Sinus venosus type of ASD\nB. Dissection of arch of aoa\nC. Prosthetic valve Thrombosis\nD. Vascular ring", "response": "Transoesophageal echocardiography (TOE) involves passing an endoscope-like ultrasound probe into the oesophagus and upper stomach under light sedation and positioning it behind the LA. It is paicularly useful for imaging structures such as the left atrial appendage, pulmonary veins, thoracic aoa and interatrial septum, which may be poorly visualised by transthoracic echocardiography, especially if the patient is overweight or has obstructive airway disease. The high-resolution images that can be obtained makes TOE paicularly valuable for investigating patients with prosthetic (especially mitral) valve dysfunction, congenital abnormalities such as atrial septal defects, aoic dissection, infective endocarditis (vegetations that are too small to be detected by transthoracic echocardiography) and systemic embolism (intracardiac thrombus or masses) A vascular ring is a congenital defect in which there is an abnormal formation of the aoa and/or its surrounding blood vessels. The trachea and esophagus are completely encircled and sometimes compressed by a \"ring\" formed by these vessels, which can lead to breathing and digestive difficulties Ref Harrison 20edition pg 1441\n\nSo the answer to this question is D"}
{"instruction": "All are hepatotoxic except\nA. Halothane\nB. Chlorform\nC. Methoxyflurane\nD. Isoflurane", "response": "Isoflurane is metabolized to trifluoroacetic acid. Although serum fluoride fluid levels may rise, nephrotoxicity is extremely unlikely, even in the presence of enzyme inducers. Prolonged sedation (>24 h at 0.1-0.6% isoflurane) of critically ill patients has resulted in elevated plasma fluoride levels (15-50 mmol/L) without evidence of kidney impairment. Similarly, up to 20 MAC-hours of isoflurane may lead to fluoride levels exceeding 50 mmol/L without detectable postoperative kidney dysfunction. Its limited oxidative metabolism also minimizes any possible risk of significant hepatic dysfunction. Total hepatic blood flow (hepatic aery and poal vein flow) may be reduced during isoflurane anesthesia. Hepatic oxygen supply is better-maintained with isoflurane than with halothane, however, because hepatic aery perfusion is preserved. Liver function tests are usually not affected. The major effect of acute inhalation of chloroform is central nervous system depression. At concentrations from 1,500-30,000 ppm, chloroform exposure can induce anesthesia; at concentrations exceeding 40,000 ppm, it can be fatal. Chronic inhalation of chloroform in humans results in hepatotoxicity and central nervous symptoms such as depression and irritability. Meanwhile, chronic oral exposure to chloroform in humans results in effects on the blood, livers, and kidneys. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e\n\nSo the answer to this question is D"}
{"instruction": "Which of the following drug is most effective in preventing emergence delirium with ketamine:\nA. Atropine\nB. Droperidol\nC. Thiopentone\nD. Midazolam", "response": "Benzodiazepine have proved the most effective in preventing emergence delirium with ketamine midazolam is drug of choice. Concomitant intravenous propofol and thiopentone decreases incidence of emergence delirium seen with propofol. Previous intravenous glycopyrolate increases the incidence of emergence delerium.\n\nSo the answer to this question is D"}
{"instruction": "True about psoriatic ahritis are all expect ?\nA. HLA-Cw6 association\nB. Involvement of DIP joint\nC. More common in males\nD. DOC is methotrexate", "response": "Ans. is 'c' i.e., More common in males Psoriatic ahritis does not have sex predilection. The largest and most consistent repoed relative risk has been with HLA-Cw6. Psoriatic ahritis involves DIP joints and the DOC for psoriatic ahritis is methotrexate. Psoriatic ahritis Psoriatic ahritis refers to an inflammatory ahritis that characteristically occurs in individuals with psoriasis. Only 5% of patients with psoriasis develop ahritis. In 60-70% of cases, psoriasis precedes joint disease. In 15-20%, the two manifestations appear within 1 year of each other. In about 15-20% of cases, the ahritis precedes the onset of psoriasis and can present a diagnostic challange. Clinical features The usual age at onset is 30-50 years. The patient may present with one of several patterns of joint involvement. These include : Ahritis of distal interphalangeal (DIP) joints Assymetrical oligoahritis : Most common pattern Symmetrical polyahritis similar to RA Axial involvement (sacroiliac and spine) similar to ankylosing spondylitis Ahritis multilans So, Psoriatic ahritis can present with symptoms similar to any other inflammatory ahritis (RA, AS) or with any other different pattern. Shoening of digitis, called telescoping, because of underlying osteolysis is paicularly characteristic of Psoriatic ahritis and there is much greater tendency than in RA for both fibrous and bony ankylosis. Other findings are enthesitis, nail changes, and tenosynovitis. Treatment of Psoriatic ahritis Anti TNF - a agents eg etanercept and infliximab are newer drugs and are effective even in longstanding restistent PsA cases to previous therapy and extensive skin lesion. Methotrexate is drug of choice. Other effective agents are sulfasalazine, cyclosporine, retinoic acid & psoralen & UV-A (PUV A). Use of immunosuppressive therapy including anti TNF a agents, methotrexate and cycloserine are contraindi cated in HIV associated PsA.\n\nSo the answer to this question is C"}
{"instruction": "All of the following statements about Neurofibromatosis are true, except?\nA. Cataract\nB. Scoliosis\nC. Cutaneous neurofibromas\nD. Autosomal Recessive Inheritance", "response": "Neurofibromatoses are a group of clinically and genetically different autosomal dominant hereditary diseases that predispose to benign and malignant tumors of the nervous system. It is of two types NF 1 and NF2. Cutaneous neurofibromas occur in NF1, and NF 2 is associated with posterior subcapsular cataract. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 379; Color Atlas of Genetics By Eberhard Passarge, 3rd Edition, Page 338\n\nSo the answer to this question is D"}
{"instruction": "Rhomboids major is inseed on ?\nA. Medial border of scapula\nB. Lateral border of scapula\nC. Inferior angle of scapula\nD. Inteubercular groove of humerus", "response": "Ans. is 'a' i.e., Medial border of scapula(Ref: Garg 4Uh/e p. 803, 810-812))Origin:Spinous processes of T2 to T5 veebraeInseionMedial border of the scapula, inferior to the inseion of rhomboid minor muscle.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is the most common location of hypeensive intracranial hemorrhage?\nA. Pons\nB. Thalamus\nC. Putamen\nD. Subcoical white matter", "response": "In order of frequency, the most common sites of hypeensive intracerebral bleed are the lentiform nucleus, especially the putamen, supplied by the lenticulostriate aeries, the thalamus, supplied by posterior perforating aeries off the posterior cerebrobasilar aery bifurcation, the white matter of the cerebral hemispheres (lobar hemorrhages), the pons, supplied by small perforating aeries from the basilar aery; and the cerebellum, supplied by branches of the cerebellar aeries. Ref: Clinical Neuroanatomy, 26th Edition By Stephen G. Waxman, Chapter 12\n\nSo the answer to this question is C"}
{"instruction": "Which of the following type of cells are NOT found in stomach?\nA. Chief cells\nB. Parietal cells\nC. Argentaffin cells\nD. Goblet cells", "response": "Cardia and pyloric region of the stomach consist of glands which secretes mucus and body of the stomach including the fundus consist of parietal cells and chief cells. Goblet cells are found in the epithelium lining the small intestine.The parietal cell secretes hydrochloric acid and are located the middle and basilar poion of the gastric glands.Chief cells or zymogen cells are found near the base of the gastric glands. They synthesize and secrete pepsinogen.Enteroendocrine (argentaffin) cells secrete different neuropeptides and regulatory molecules. Gastrin producing G cells are found in the antrum, enterochromaffin cells secreting serotonin, substance P or motilin are found throughout the gastric mucosa, glucagon secreting A cells are found in the proximal third of the stomach and somatostatin secreting D cells are found in the upper third of stomach and antrum.\n\nSo the answer to this question is D"}
{"instruction": "Acute onset areflexic quadriparesis with blurred vision and absent pupillary response in a 20 years old male, the most probable diagnosis is?\nA. Porphyria\nB. Botulism\nC. Polio\nD. Diphtheria", "response": "ANSWER: (B) BotulismREF: Harrison s 17th ed p. 901, CMDT - 2006/1410The clinical picture is most consistent with diagnosis of botulismBotulismh/o recent injection of canned or smoked foods or injection of drugSymmetric descending paralysis with prominent bulbar palsyDiplopia , dysarthria , dysphonia , dysphagiaPupils are fixed and dilatedPtosis and cranial nerve palsy with impairment of extra ocular muscles and fixed dilated pupils are characteristic signsSensory examination is normalNormal sensoriumAfebrile\n\nSo the answer to this question is B"}
{"instruction": "The foetal circulation is first intact and functional, separated from maternal circulation at the age of:\nA. 8 days\nB. 12 days\nC. 17 days\nD. 21 days", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Refeeding syndrome is due to increased release of the following hormone:\nA. Growth hormone\nB. Glucocoicoids\nC. Insulin\nD. Thyroxine", "response": "Refeeding syndrome occur with rapid and excessive feeding of patients with severe underlying malnutrition due to starvation, alcoholism, delayed nutritional suppo, anorexia nervosa, or massive weight loss in obese patients. With refeeding, a shift in metabolism from fat to carbohydrate substrate stimulates insulin release, which results in the cellular uptake of electrolytes, paicularly phosphate, magnesium, potassium, and calcium. However, severe hyperglycemia may result from blunted basal insulin secretion. The refeeding syndrome can be associated with enteral or parenteral refeeding, and symptoms from electrolyte abnormalities include cardiac arrhythmias, confusion, respiratory failure, and even death. Ref: Shires G. (2010). Chapter 3. Fluid and Electrolyte Management of the Surgical Patient. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwaz's Principles of Surgery, 9e.\n\nSo the answer to this question is C"}
{"instruction": "All of the following are major complications of massive transfusion, except -\nA. Hypokalemia\nB. Hypothermia\nC. Hypomagnesemia\nD. Hypocalcemia", "response": "Major complications in blood transfusion are fever,chills,tachycardia ,flushing ,rigor,uicaria,abdominal pain,shoeness of breath,anaphylactic shock,transmission of infection,air embolism ,thrombophlebitis,circulatory overload. Since very rapid hemolysis is a compliacation of transfusion ,hyperkalemia occurs.Reference:Davidson's principles & practice of medicine 22nd edition pg no 1016.\n\nSo the answer to this question is A"}
{"instruction": "Pancytopenia with a cellular marrow is seen in all except -\nA. PNH\nB. Megaloblastic anemia\nC. Myelodysplastic syndrome\nD. Congenital dyserythropoietic anemia", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Spermatogenesis occurs at:\nA. Body temperature\nB. Temperature lower than core body temperature\nC. Temperature higher than core body temperature\nD. Temperature does not play a role", "response": "Spermatogenesis requires a temperature considerably lower than that of the interior of the body. Ref: Ganong's Review of Medical Physiology, 22nd Edition, Page 427; Guyton and Hall - Textbook of Medical Physiology, 10th Edition, Page 920\n\nSo the answer to this question is B"}
{"instruction": "Brill Zinsser disease is caused by\nA. C. burnetti\nB. R. typhi\nC. R. slovaca\nD. R. prowazekii", "response": "DiseaseEtiologyDescriptionGroup Affected/Epidemiologic FactorsClinical SyndromeEpidemic typhusRickettsia prowazekiiMaculopapular eruption appearing inaxillae, spreading to trunk and later toextremities; usually spares face, palms, soles;evolves from blanchable macules to confluent eruption with petechiae; rash evanescentin recrudescent typhus (Brill-Zinsserdisease)Exposure to body lice;occurrence of recrudescenttyphus as relapseafter 30-50 yearsHeadache, myalgias;moality rates 10-40% ifuntreated; milder clinicalpresentation in recrudescentformRef: Harrison; 19th edition; Page no: 128\n\nSo the answer to this question is D"}
{"instruction": "Attitude of lower limb seen in posterior dislocation of hip is?\nA. Flexion, Abduction, Internal rotation\nB. Flexion, Adduction, Internal rotation\nC. Flexion, Abduction, External rotation\nD. Flexion, Adduction, External rotation", "response": "ANSWER: (B) Flexion, Adduction, Internal rotationREF: Apley's 8th ed p. 681Flexion , adduction , internal rotationPosterior dislocation of hipFlexion , adduction , lateral rotation with shorteningIntracapsular fracture of hipFlexion , abduction and lateral rotationAnterior dislocation of hip\n\nSo the answer to this question is B"}
{"instruction": "80 years old female after fall developed inability to walk with external rotation deformity on examination SLR is not possible and broadening of trochenter is present. The possible diagnosis is:\nA. Neck femur\nB. Inter trochanteric femur\nC. Subtrochanteric femur\nD. Greater trochanter", "response": "B i.e. Inter trochanteric femur\n\nSo the answer to this question is B"}
{"instruction": "Regarding HIV which of the following statement is not TRUE?\nA. It is a DNA retrovirus\nB. Contains Reverse Transcriptase\nC. May infect host CD4 cells other than T-lymphocytes\nD. Causes a reduction in host CD4 cells at late stage of disease", "response": "The genome of HIV is diploid, composed of 2 identical single stranded positive sense RNA copies. In association with viral RNA is the reverse transcriptase enzyme which is the characteristic feature of retroviruses. Pathogenesis: When virus infects a cell RNA, viral RNA is transcribed by the enzyme, first to single stranded DNA and then to double stranded DNA which is integrated into the host cell chromosome. The provirus initiate viral replication by directing synthesis of viral RNA and other components. When naked virus buds outs through host cell surface membrane, it acquires a lipoprotein envelope which consist of lipid derived from the host cell membrane and glycoprotein which are virus coded. The spikes which constitute the major surface component of the virus, binds to CD4 receptors on susceptible host cells. The transmembrane pedicle cause cell fusion. Ref: Ananthanarayan and Panicker's Textbook of Microbiology, 8th Edition, Page 395\n\nSo the answer to this question is A"}
{"instruction": "A 40 year old female presents with swelling in the neck. O/E it is a 2x2 cm nodule on the right lobe of thyroid. No palpable cervical nodes. FNAC shows features of papillary carcinoma. Treatment of choice\nA. Total thyroidectomy\nB. Right hemithyroidectomy\nC. Hartley-Dunhill operation\nD. Subtotal thyroidectomy", "response": "Answer: a) Total thyroidectomy (SABISTON 19TH ED, P-908)PAPILLARY CARCINOMA (80%)Most common type of thyroid carcinomaMore common in womenMostly in the age group 25 - 50Mutations in RET or BRAF geneAssociated with previous exposure to ionizing radiationHistologyNuclei: optically clear or empty appearance - groundglass or Orphan Annie eye nucleiCrowded nuclei may demonstrate groovingPsammoma bodiesSeldom encapsulatedMultiple foci seenHistologic variants - follicular (mc), tall cell, diffuse sclerosing, insular, columnarSlowly progressive and less aggressive tumorThyroglobulin is used as tumor markerSpread to lymph nodes is common, blood borne metastasis is unusualLymph node status does not alter the prognosisSeen as cold masses on scintiscansClassic papillary carcinoma and follicular variant - Excellent prognosisAll other subtypes - aggressiveDiffuse sclerosing variantOccurs in younger individuals, including childrenExtensive, diffuse fibrosis throughout the thyroid glandOften associated with a prominent lymphocytic infiltrate, simulating Hashimoto thyroiditisLack BRAF mutations, but RET/PTC translocations are found in 50% casesMicrocarcinoma (Occult carcinoma)Papillary cancers less than 1 cmMost commonly come to attention as an incidental finding in patients undergoing surgeryMajority of such tumours never progress to become a clinically significant entityHave a uniformly excellent prognosisFactors associated with worse prognosisMale genderAge > 40 yarsSize > 3 cmTall cell variantAge at diagnosis - most important prognostic factor in well-differentiated thyroid cancer Treatment of differentiated thyroid cancerSolitary intrathyroidal papillary microcarcinoma: no clinically involved cervical lymph nodes, no history of head and neck radiation - unilateral thyroid lobectomy and isthmusectomyTumors > 1 cm with no palpable nodes: Total thyroidectomyTumors > 2 cm with nodal involvement and/or metastases: Total thyroidectomy + node dissection + radioiodine ablation + long term TSH suppressionThyroid cancer > 1 cm or papillary cancer < 1 cm: clinically positive nodal disease, multicentricity, or a history of head and neck radiation - total or near-total thyroidectomy, followed by radioablationTSH suppression: thyroxine 0.1- 0.2 mg daily for all patients after operation for differentiated thyroid carcinoma on the basis that most tumours are TSH dependent.\n\nSo the answer to this question is A"}
{"instruction": "Laryngeal cartilage forming complete circle -\nA. Arytenoid\nB. Cricoid\nC. Thyroid\nD. Hyoid", "response": "Ans. is 'b' i.e., Cricoid [Ref: Dhingra 5th/ep. 299\\Lvrangeal cartilagesThyroid (unpaired)o It is the largest of all laryngeal cartilages. It is 'V* shaped with right and left lamina. Both laminae (alae) meet anteriorly forming an angle of 90deg in males and 120deg in females. Vocal cords are attached to the middle of thyroid angle.Cricoid (unpaired)o It is the only cartilage forming a complete ring, therefore is shaped like a ring. It articulates with arytenoid cartilage to form cricoarytenoid joint, a type of synovial joint.Epiglottis (unpaired)o It is leaf-shaped elastic cartilage (in adults). It is omega shaped in children. It forms the anterior wall of laryngeal inlet.Arytenoid cartilage (paired)o Each Arytenoid cartilage is pyramidal in shape. Base articulates with cricoid cartilage, and apex supports the comiculate cartilage. A vocal process directed anteriorly and gives attachement to vocal cord. A muscular process directed laterally and gives attachment to intrinsic laryngeal muscles.Corniculate cartilage (of Santorini): Pairedo Articulates with apex of Arytenoid cartilageCuneiform cartilage (of Wrisberg): Pairedo Situated in aryepiglottic fold in front of comiculate cartilage.\n\nSo the answer to this question is B"}
{"instruction": "False about Randomised Control Trials is\nA. Randomisation is done while selecting subjects for the study\nB. Results of attrition are included in the analysis\nC. Double blinding is the most common form of blinding observed\nD. Cross-over design helps removing ethical concerns", "response": "The essential purposes of randomization in a randomized controlled trial are:\n- Participants have ‘Equal and Known Chance’ of falling into either ‘Experimental Group’ or ‘Reference Group’\n- To eliminate Selection Bias (Selection Bias or ‘Susceptibility Bias’ is the bias due to differential susceptibility of two groups to outcome, even before intervention/experiment is performed; Thus two groups are not comparable)\n- To ensure comparability among two groups\n- To have ‘similar prognostic factors’ among two groups\n- ‘Randomisation is done while dividing patients into the Experimental (Intervention) Group and the Reference Group’ AND not while selecting patients for RCT\n- Randomisation is known as ‘Heart of a trial’\n- Randomisation is superior to Matching.\n\nSo the answer to this question is A"}
{"instruction": "Daisy head colonies are seen with -\nA. Staph. Aureus\nB. Corynebacterium diphtheriae\nC. Staph. Pyogenes\nD. Anthrax", "response": "Ans. is 'b' i.e., Corynebacterium Diphtheriae\n\nSo the answer to this question is B"}
{"instruction": "TMJ development starts at:\nA. 2 weeks\nB. 10 weeks\nC. 29 weeks\nD. 25 weeks", "response": "Three phases in the development of the TMJ were identified:\n\nThe first is the blastematic stage (weeks 7-8 of development), which corresponds with the onset of the organization of the condyle and the articular disc and capsule. During week 8, intramembranous ossification of the temporal squamous bone begins. \nThe second stage is the cavitation stage (weeks 9-11 of development), corresponding to the initial formation of the inferior joint cavity (week 9) and the start condylar chondrogenesis. Week 11 marks the initiation of organization of the superior joint cavity. \nAnd the third stage is the maturation stage (after week 12 of development).\n\nSo the answer to this question is B"}
{"instruction": "A group of 8 expes discussing and interacting about a topic in front of large audience is?\nA. Workshop\nB. Symposium\nC. Semin ar\nD. Panel discussion", "response": "- panel discussion is a group approach in health communication. - in a panel discussion, 4-8 people who are qualified to talk about a topic sit and discuss a given problem or topic in front of a large group or audience. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:865 <\\p>\n\nSo the answer to this question is D"}
{"instruction": "Reverse cold chain is used for\nA. Carrying stool samples of polio patients from a PHC to the lab\nB. Transpoing outdated vaccines from PHC to district hospital\nC. Transpoing vaccine to lab, to check its potency\nD. Transpoing vaccine from camps to sub - centre", "response": "The cold chain is a system of storage and transpo of vaccines at low temperatures from the manufacturer to the actual vaccination site. The cold chain system is necessary because vaccine failure may occur due to failure to store and transpo under strict temperature control (refer pgno:109 park 23 rd edition)\n\nSo the answer to this question is A"}
{"instruction": "Metformin is used as a antihyperglycemic agent in DM, but there are some other uses for this drug. All the following are such uses of the drug, except:\nA. PCOD\nB. Non-alcoholic fatty liver disease\nC. Alcoholic fatty liver disease\nD. Metabolic abnormalities associated with HIV disease", "response": "Other uses of metformin: PCOD Impaired glucose tolerance Obesity Metabolic abnormalities associated with HIV disease Non alcoholic fatty liver disease Ref: Harrison, 18th Edition, Page 2995\n\nSo the answer to this question is C"}
{"instruction": "The pathways followed by corrosive acids in stomach is called -\nA. Curling ulcer\nB. Cushing ulcer\nC. Magenstrasse\nD. None", "response": "Ans. is 'c' i.e., Magenstrasse o Magenstrasse is the term applied to the pathway acidic agents follow in stomach.o The pathway of acids and alkalis in food filled stomach starts along the lesser curvature of the stomach and leads to the pylorus, which explains the location of greatest damage in food filled stomach,o Stomach without food have significant injury in the lower half of two thirds and may have sparing of fundus.Magenstrasse is the term applied to the pathway acidic agents followShaded region indicates the area of greatest injury caused by acid ingestion irt a food-frlled stomachShaded region indicates the area of greatest injury caused by acid ingestion in an empty stomach\n\nSo the answer to this question is C"}
{"instruction": "Lung injury with bad prognosis is?\nA. Open pneumothorax\nB. Closed pneumothorax\nC. Tension pneumothorax\nD. All have same prognosis", "response": "ANSWER: (C) Tention pneumothoraxREF: Handbook of practical medicine: Volume 1 by Hermann Eichhorst page 29As a general thing, the prognosis of open and dosed pneumothorax is more favorable than that of tention pneumothorax, because the latter is apt to be attended with great tension of the gases, and marked displacement of the adjacent structures\n\nSo the answer to this question is C"}
{"instruction": "A 15 year old boy presents was brought to OPD with a history of pain and swelling in the right thigh. Biopsy of the mass demonstrates Osteosarcoma. His mother was diagnosed with breast cancer 1 year ago and his maternal grandmother died of the breast cancer 10 years ago. The child has 3 younger siblings. Siblings are at an increased risk of developing which of the following cancer ?\nA. Wilms\nB. Neuroblastoma\nC. Hepatoblastoma\nD. Glioma", "response": "This is a likely the case of Li Fraumeni syndrome. Li Fraumeni syndrome Cancer predisposition syndrome before the age of 45 years Associated with high risks for a diverse spectrum of childhood- and adult-onset malignancies due to germline p53 gene mutation as per Chompret criteria. 5 cancer types are : Adrenocoical carcinomas, Breast cancer, Central nervous system tumors, Osteosarcomas, Soft-tissue sarcomas. Out of the given options central nervous system tumor is glioma\n\nSo the answer to this question is D"}
{"instruction": "The water channel presented in proximal convoluted tubule is:\nA. Aquaporin 1\nB. Aquaporin 2\nC. Aquaporin 5\nD. Aquaporin 9", "response": "Rapid diffusion of water across cell membranes depends on the presence of water channels, integral membrane proteins called aquaporins. Aquaporin-1 is localized to both the basolateral and apical membrane of the proximal tubules and its presence allows water to move rapidly out of the tubule along the osmotic gradients set up by active transpo of solutes, and isotonicity is maintained. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 37. Renal Function & Micturition. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.\n\nSo the answer to this question is A"}
{"instruction": "Patent foramen ovale is due to\nA. Failure of closure of sinoatrial orifice\nB. Failure of fusion of septum primum and endocardial cushion\nC. Failure of fusion of septum primum and septum intermedium\nD. Failure of fusion of septum primum and septum secondum", "response": "The primitive atrium is divided into left and right atria by an interatrial septum which is formed by fusion of septum primum and septum secundum. The sequence of events are as follows\n\nSeptum primum arises from the roof of the common atrium (primitive atrium) and grows caudally towards septum intermedium (fused AV cushions).\nForamen primum is formed between the free border of growing septum primum and fused AV cushions (septum intermedium).\nShortly afterwards the septum primum fuses with septum intermedium (fused AV cushions), obliterating foramen primum\nForamen secundum is formed by degeneration of cranial part of septum primum.\nSeptum secundum grows caudally to the right of septum primum and overlaps the foramen secundum. The passage between septum primum and septum secundum is called foramen ovale. After birth, foramen ovale closes by fusion of septum primum with septum secundum. Failure of fusion of these two septa results in patent foramen ovale.\n\nSo the answer to this question is D"}
{"instruction": "All findings are seen in a patient with isolated aoic stenosis except?\nA. Left ventricular impulse is displaced laterally\nB. Pulsus bisferiens is hallmark finding\nC. Systemic BP is normal in early stages of disease\nD. Carotid thrill", "response": "Aoic stenosis(AS) Results in LVH -Double apical impulse and shift of apex beat laterally. Characteristic pulse -Pulsus parvus et tardus. Early stages -BP -Normal. Later stages -Low SBP , | Pulse pressure. Murmur - Ejection systolic murmur with carotid thrill. Pulsus bisferiens is seen in HOCM & severe AR.\n\nSo the answer to this question is B"}
{"instruction": "After which of the following gestational age is a dead baby said to be a still born ?\nA. 20 days\nB. 28 days\nC. 20 weeks\nD. 28 weeks", "response": "The term stillborn refers to the death of a fetus after 28 weeks of gestation or death of a fetus weighing 1000gms.\n\nSo the answer to this question is D"}
{"instruction": "Sternocleidomastoid is supplied by all of the following aeries except\nA. Occipital\nB. Posterior auricular\nC. Thyrocervical trunk\nD. Superior thyroid", "response": "Superior thyroid aery is a branch of ECA, inferior thyroid aery is a branch of thyrocervical trunk of subclan aery Ref: Gray's40e/262\n\nSo the answer to this question is C"}
{"instruction": "The following tests are used to check the efficiency of pasteurization of milk except :\nA. Phosphatase test\nB. Standard plate count\nC. Coliform count\nD. Methylene blue reduction test", "response": "Methylene blue Reduction test is a indirect test for detection of microorganism in milk. It is carried out on milk prior to the process of pasteurization and is not used to check the efficiency of pasteurization. Ref: Alcamo's Laboratory Fundamentals of Microbiology By Jeffrey Pommerville, 2010, Page 297\n\nSo the answer to this question is D"}
{"instruction": "Group B fibers are present in:\nA. Intrafusal fibers of the muscle spindle\nB. Golgi tendon apparatus\nC. Autonomic preganglionic fibers\nD. Spinothalamic tracts", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "This virus is the leading cause of bronchiolitis and community-acquired pneumonia in infants.\nA. Measles virus\nB. Influenza virus\nC. Respiratory syncytial virus\nD. Parainfluenza virus", "response": "Orthomyxoviruses and paramyxoviruses are RNA viruses that contain a single-stranded RNA genome. The influenza viruses belong to the orthomyxoviruses. They cause acute respiratory tract infections that usually occur in epidemics. Isolated strains of influenza virus are named after the virus type (influenza A, B, or C) as well as the host and location of initial isolation, the year of isolation, and the antigenic designation of the hemagglutinin and neuraminidase. Both the hemagglutinin and neuraminidase are glycoproteins under separate genetic control, and because of this they can and do vary independently. The changes in these antigens are responsible for the antigenic drift characteristic of these viruses. The paramyxoviruses include several important human pathogens (mumps virus, measles virus, respiratory syncytial virus, and parainfluenza virus). Both paramyxoviruses and orthomyxoviruses possess an RNA-dependent RNA polymerase that is a structural component of the virion and produces the initial RNA. Respiratory syncytial viruses (RSV) are not related to the paramyxoviruses. They are 150-nm single-stranded RNA viruses. There are 2 antigen groups, A and B, which play no role in diagnosis and treatment. While the overall mortality is 0.5%, at-risk groups may be 25 to 35% mortality if untreated. Some parainfluenza virus infections (type 3) may be indistinguishable from RSV, but most parainfluenza infections produce a laryngotracheobronchitis known as croup.\n\nSo the answer to this question is C"}
{"instruction": "Prostatic calculi is made up of ?\nA. Calcium carbonate\nB. Calcium oxalate\nC. Calcium phosphate\nD. Triple phosphate", "response": "Prostatic calculi are of two varieties: endogenous, which are common, and exogenous, which are comparatively rare. An exogenous prostatic calculus is a urinary (commonly ureteric) calculus that becomes arrested in the prostatic urethra. Endogenous prostatic calculi are usually composed of calcium phosphate combined with about 20% organic material.Reference : page 1353 Bailey and Love's sho practice of surgery 25th edition\n\nSo the answer to this question is C"}
{"instruction": "Insulin acts on glucose metabolism by:\nA. T permeability of glucose across cell membrane\nB. permeability across cell membrane against glucose gradient\nC. T permeability of renal cells\nD. T glucose transpo to brain", "response": "B i.e. T permeability across cell membrane against glucose gradient Insulin increases glucose uptake by increasing the number of glucose transpoer in cell membrane. Direct insulin stimulated glucose uptake is mediated by Glut 4 and is seen only in: Muscle: Skeletal muscleQ and cardiac muscleQ Adipose tissueQ Glucose Transpoers In Mammals Facilitated Bidirection Diffusion Function Major Sites of Expression Km GLUT 1 Basal glucose uptake - Placenta, blood - brain barrier, Red cells, kidneys 1-2 GLUT 2 B cell glucose sensor; transpo out of intestinal & renal epithelial cells. - B cells of islets, Liver, Small intestine, Kidney 12-20 GLUT 3 Basal glucose uptake - Brain, placenta, kidney <1 GLUT 4 Insulin stimulated glucose uptakeQ - Skeletal & cardiac muscleQ - Adipose tissueQ 5 GLUT 5 Fructose transpo - Jejunum, Sperm 1-2 GLUT 6 None - Pseudogene ? GLUT 7 Glucose 6-PO4 transpoer in endoplasmic reticulum - Liver ? Secondary Active Transpo Na+ glucose cotranspo (unidirectional -transpoer) SGLT-1 Active uptake of glucose against Small intestine, renal tubule 0.1 - 1.0 SGLT-2 concentration gradient Renal tubule 1.6\n\nSo the answer to this question is B"}
{"instruction": "Fetal growth is maximally affected by –\nA. Insulin\nB. Growth hormone\nC. Cortisol\nD. Thyroxine", "response": "Insulin and insulin like growth factor stimulate fetal growth.\nThyroxine has no effect on linear growth but it has effect on skeletal maturation.\nFetal or maternal GH is not essential for fetal growth in utero.\n\nSo the answer to this question is A"}
{"instruction": "Active tension in a muscle depends upon which of the following\nA. Number of muscle fibres\nB. Number of motor units recruited\nC. Aerobic capacity of muscle\nD. Action potential amplitude", "response": "Active Tension in a muscle depends upon the number of motor units recruited. The greater the number of motor units recruited, the greater will be the active tension. Factors Determining Muscle Tension (Active Tension) Tension developed by each fiber Action potential frequency Fibre length (Length-tension relationship) Fibre length Fatigue Number of active fibers Number of fibers per motor unit Number of active motor units (recruitment) Ref: Vander's Human physiology: The Mechanisms of Body function 11th edition Pgno: 276\n\nSo the answer to this question is B"}
{"instruction": "Standard views for mammography are:\nA. AP and Lateral\nB. AP and Medio-lateral oblique\nC. Cranio-caudal and Medio-lateral view\nD. Cranio-caudal and Medio-lateral oblique", "response": "The two standard mammographic projections are:\nA mediolateral oblique (MLO) view and a craniocaudal (CC) view.\nThe MLO is taken with the X-ray beam directed from superomedial to inferolateral, usually at an angle of 30°-60°.\nThe MLO projection is the only projection in which all the breast tissue can be demonstrated in a single image.\nIn CC view, the X-ray beam travels from superior to inferior. Positioning is achieved by pulling the breast up and forward away from the chest wall, with compression applied from above.\n\nSo the answer to this question is D"}
{"instruction": "Homer wright rossette are seen in-a) Neuroblastomab) Astrocytomac) Meningiomad) Pinealoma\nA. ad\nB. c\nC. ac\nD. ab", "response": "Rosettes\n\nRosettes are pathological findings characterized by a halo or spoke wheel arrangement of cells surrounding a central core or hub.\n\nType of Rosette\n1. Flexner - Wintersteiner Rosettes\n\nA halo of cells surrounds a largely empty central hub but small cytoplasmic extension from cells project into the lumen.\nIt is characteristic of retinoblastoma.\nMay also be seen in → Medulloblastoma, Primitive neuroectodermal tumor, Pineoblastoma.\n\n2. Homer Wright rosettes\n\nA halo of cells surrounds a central hub that contains a meshwork of fibres (neutrophil rich centre).\nHomer-Wright rosettes are characteristic of neuroblastomas and medulloblastomas.\nMay also be seen in → Primitive neuroectodermal tumors (PNET), Pineoblastomas, Retinoblastomas.\n\n3. True ependymal Rosette\n\nA halo of cells surrounds an empty lumen.\nIt is characteristic of ependymomas.\n\n4. Perivascular pseudorosettes\n\nA halo of cells surrounds a blood vessel.\nThe term pseudo is used because the central structure is not formed from the tumor itself, and represents a nonneoplastic element.\nMay be seen in\n\tEpendymonas\n\tGlioblastomas\n\tMedulloblastomas\n\tRetinoblastoma\n\tPrimitive neuroectodermal tumors \n\tMonimorphous pilimyxoid astrocytoma\n\tCentral neurocytoma\n\nSo the answer to this question is A"}
{"instruction": "Midyear population calculated on?\nA. 1st june\nB. 30th june\nC. 1st july\nD. 31st june", "response": "ANSWER: (C) 1st JulyREF: Park 18th ed p.639Mid year population is estimated population on 1st of julyCensus estimation is done at end of first quarter in the first year after a decade (end of march)\n\nSo the answer to this question is C"}
{"instruction": "Mulberry molar is associated with:\nA. Initiation.\nB. Histodifferentiation.\nC. Morpho differentiation.\nD. Apposition.", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Sacrotuberous ligament is pierced by ?\nA. SI nerve\nB. L5 nerve\nC. Coccygeal nerve\nD. None", "response": "Ans. is 'c' i.e., Coccygeal nerve Sacrotuberous ligament is pierced by :-Perforating cutaneous nerveFifth sacral (S5) and cocygeal nervesBranches of coccygeal plexusCoccygeal branch of inferior gluteal aery\n\nSo the answer to this question is C"}
{"instruction": "Following is not true regarding summons -\nA. It is a legal document\nB. No conduct money is paid to the doctor in criminal cases\nC. Section 61-69 CrPC deal with summons\nD. None of the above", "response": "It is a legal document.sections. 61 to 69 of Cr.P.C.del with the summons. Conduct is paid to doctor in criminal cases. Ref:The synopsis of Forensic Medicine (Dr.K.S.Narayan Reddy), pg no-5,29th edition.\n\nSo the answer to this question is B"}
{"instruction": "A 25 years old female develops serous otitis media of left ear with cough and occasional hemoptysis and hematuria and epistaxis for one and half months her hemoglobin is 7 gm. B.P is > 170/100, proteinuria +++, RA - ve and ANCA - ve, the likely cause is?\nA. Wegener's granulomatosis\nB. Rheumiatoid ahritis\nC. Rapidly proliferative glomerulonephritis\nD. Goodpasteur's syndrome", "response": "Answer is A>D (Wegener's granulumatosis > Goodpasture's Syndrome); The patient in question is presenting with characteristic clinical triad of Wegener's granulomatosis, namely, Vasculitis of upper respiratory tract (serous otitis media, epistaxis), Vasculitis of lower respiratory tract (cough and hemoptysis) and vasculitis of the kidney (proteinuria)Although positive ANCA assays are often instrumental in suggesting the diagnosis of WG, Negative ANCA assays do not preclude the diagnosis, 10% of patients with disseminated WG and upto 30% of patients with limited WG may be negative for ANCAThe clinical picture is classical of Wegner's Granulomatosis. However, the absence of ANCA confuses the diagnosis. Neveheless the presence or absence of ANCA should be adjunctive and in the presence of a classical clinical picture of WG, tissue diagnosis (biopsy) should be performed to confirm the diagnosis.Definitive diagnosis of WG is established by tissue biopsy and not by presence or absence of ANCAPulmonary + Renal Syndrome Pulmonary (Hemoptysis) + Renal (Proteinuria) manifestationsWegener's granulomatosisClassical Clinical presentation is one of a young Male/Female (male: female=1:1) presenting with upper respiratory tract features (Otitis media, Epistaxis) along with hemoptysis and acute glomerulonephritis+ANCA is usually positive and suggests the diagnosisNegative ANCA does not preclude the diagnosis. In the presence of classical clinical picture a provisional diagnosis of WG should be made on clinical ground and confirmed/ excluded by tissue biopsyThe patient in question is presenting with classical clinical triad of Wegener's granulomatosis. Although ANCA is negative a negative ANCA does not preclude the diagnosis of WG. Based on the strong clinical suspicion, WG should the single best initial provisional diagnosis and tissue biopsy should be performed.Goodpasture's syndrome Classical clinical presentation is one of a young male smoker (male female=3-4:1) presenting with hemoptysis and signs of acute glomerulonephritis Although disease may be preceeded by an upper respiratory tract infection, upper respiratory tract involvement features like otitis media and epistaxis are not characterstic of good pasture's syndrome ANCA is usually negative Diagnosis is made by detecting serum levels of Anti GBM antibodies The patient in question is not presenting with classical clinical features of good pasture's syndrome and serum levels of Anti GBM antibodies have not been provided in the question. These make a diagnosis of Good pasture's syndrome less likely.\n\nSo the answer to this question is A"}
{"instruction": "All are cluster C disorders of personality except\nA. anxious\nB. avoidant\nC. scchizoid\nD. dependent", "response": "personality disorders are of several types they can be named mainly as 3 clusters knowledgeof this is necessary for answering a lot of questions CLUSTER A=== paranoid, schizoid, schizotypal CLUSTERB===histironic, borederline, narcisstic, antisocial CLUSTERC====anxious, dependent, anakastic Ref.kaplon and sadock, synopsis of psychiatry,11 th edition, pg no.742\n\nSo the answer to this question is C"}
{"instruction": "Tectal breaking is seen in:\nA. Dandy-walker malformation\nB. Amold-chiari malformation\nC. Aqueductal stenosis\nD. Third ventricular tumor", "response": ". Amold-chiari malformation\n\nSo the answer to this question is B"}
{"instruction": "Which of the following can be seen in SCID?\nA. Autoimmune ds\nB. Granuloma formation\nC. GVHD\nD. Graft rejection", "response": "SCID (Severe Combined Immunodeficiency) Combined deficiency of B & T cells seen; so autoimmune ds, granuloma formation & graft rejection are absent GVHD which is due to immune-competent cells attacking an immunosuppressed host can still be seen\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is not transmitted by Arthropod-\nA. Q fever\nB. Rickettsial pox\nC. Rocky mountain spotted fever\nD. Relapsing feve", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Drug of choice for anaphylactic shock is:\nA. Adrenaline.\nB. Dopamine.\nC. Non-adrenaline.\nD. All of the above.", "response": "Dopamine is the drug of choice for cardiogenic shock with oliguric renal failue.\n\nSo the answer to this question is A"}
{"instruction": "Elimination after 3 half lives in first order kinetics is\nA. 12.50%\nB. 75%\nC. 87.50%\nD. 94%", "response": "Cp - > Cp/2 in 1 half-life i.e. 50.0 % lost 50.0 % Cp - > Cp/4 in 2 half-lives i.e. 25.0 % lost 75.0 % Cp - > Cp/8 in 3 half-lives i.e. 12.5 % lost 87.5 % Cp - > Cp/16 in 4 half-lives i.e. 6.25 % lost 93.75 % Cp - > Cp/32 in 5 half-lives i.e. 3.125 % lost 96.875 % Cp - > Cp/64 in 6 half-lives i.e. 1.563 % lost 98.438 % Cp - > Cp/128 in 7 half-lives i.e. 0.781 % lost 99.219 % Ref-KDT 7/e p30\n\nSo the answer to this question is C"}
{"instruction": "Which among the following is not formed by kidney?\nA. Erythropoietin\nB. Renin\nC. Vitamin D\nD. Aldosterone", "response": "Ans: d (Aldosterone) Ref: Ganong 22nd ed/ p.454)Kidney produces 3 hormones1) 1,25(OH) cholecalciferol (vitamin D)2) Renin3) ErythropoietinAldosterone: is produced by Zona Glomerulosa of adrenal cortex.Erythropoietin: by the interstitial cells in the peritubular capillaries in kidneys (85%) and perivenous hepatocytes of liver (15%).Renin: by the juxta glomerular cells of the kidney.Renin Angiotensin SystemAngiotensinogen (from liver) - found in alpha 2 globulin fraction of plasma Renin (from JG cells)Angiotensin I ACE (Angiotensin converting enz. from Pulm. endothelium)Angiotensin IIMetabolism of vitamin D\n\nSo the answer to this question is D"}
{"instruction": "Focal length of lens is 0.75 m, what will be its refreactive power -\nA. 0.75D\nB. 1.5D\nC. 1.25 D\nD. 1.33 D", "response": "The most convenient system for ophthalmic purpose is the one which takes a lens with focal distance of 1 meter as standard. Such a lens has a power of 1 dioptre (D). Thus , simple formula to calculate the refreactive power of a lens is - 1 Refractive power (D)= -------------------------------- Focal length (meter) 1 In this question refractive power =---------------------=1.33D 0.75 Reference : Parson&;s 22nd edition page 47\n\nSo the answer to this question is D"}
{"instruction": "The renal biopsy of a 6–year–old boy with recurrent gross hematuria shows IgA nephropathy. The urinary protein excretion is 130 mg/day. Which of the following is the most appropriate next step in the management –\nA. Administer corticosteroids\nB. Give Azathiopiine\nC. Start Cyclosporine\nD. Urinary bag sample", "response": "T/T of IgA nephropathy\n\nThere is no proven tit for IgA nephropathy.\nThe primary t/t is proper blood pressure control.\n\nThe drugs which have been proved useful are:-\ni) Fish oil (It contains omega - 3 fatty acids).\n\nIt is an anti-inflammatory agent and it prevents the rate of renal progression.\n\nii) Immunosuppressive therapy -\n\nIt is done with corticosteroids with or without cytotoxic therapy.\n\niii) ACE inhibitors and Angiotensin II receptor antagonists -\n\nTheir role in reducing proteinuria and retarding the rate of renal progression is still to be determined.\n\niv) Prophylactic antibiotics and tonsillectomy -\n\nIt may reduce the frequency of gross hematuria but they have no effect on the progression of renal disease.\n\nSo the answer to this question is A"}
{"instruction": "Quinsy is characterized by all except -\nA. Peritonsillar abscess\nB. Indication for tonsillectomy\nC. Should be drained\nD. Affects nasal mucosa", "response": "Ans-D\n\nSo the answer to this question is D"}
{"instruction": "Most common malignancy in marjolin's ulcer\nA. Adenocarcinoma\nB. Squamous cell carcinoma\nC. Basal cell carcinoma\nD. Malignant fibrous histiocytoma", "response": "(B) Squamous cell carcinoma) (29, 548- Bailey & Love)A squamous cell carcinoma known as Marjolin's ulcer being the most common (Leg ulcers)Most frequently associated with * Chronic venous ulcer* Long standing burn scar* Squamous cell carcinoma developing in long standing scar/ulcers* Adenocarcinomas are the most common histological subtype of stomach cancer * *** Gastric carcinomas are often associated with hypochlorhydria /achlorhydria* Gastric carcinomas are relatively radioresistant* Maleny's ulcer (Burro wing ulcer) is caused by synergistic infection by Microerophilic Nonhaemolytic streptococci and Aerobic, Hemolytic staphylococci\n\nSo the answer to this question is B"}
{"instruction": "The greater omentum is derived from which of the following embryonic structures?\nA. Dorsal mesoduodenum\nB. Dorsal mesogastrium\nC. Pericardioperitoneal canal\nD. Pleuropericardial membranes", "response": "Both the omental bursa and the greater omentum are derived from the dorsal mesogastrium, which is the mesentery of the stomach region.Must know:The dorsal mesoduodenum is the mesentery of the developing duodenum, which later disappears so that the duodenum and pancreas come to lie retroperitoneally.The pericardioperitoneal canal embryologically connects the thoracic and peritoneal canals. The pleuropericardial membranes become the pericardium and contribute to the diaphragm. Ref: Gray's Basic Anatomy: With Student Consult Online Access - Page 151\n\nSo the answer to this question is B"}
{"instruction": "Which of following is not seen in nephritic syndrome -\nA. Edema\nB. Hematuria\nC. HTN\nD. Hypocholestremia", "response": "Ans. is `d' i.e., Hypocholestremia\n\nSo the answer to this question is D"}
{"instruction": "Metachromatic Granules are stained by -\nA. Ponder's stain\nB. Negative stain\nC. Gram's stain\nD. Leishman stain", "response": "The granules are often situated at the poles of the bacilli and are called Polar bodies they are more strongly Gram positive than the rest of the bacterial cell stained with Loefflers methyelene blue the granules take up a bluish purple colur and are hence called Metachromatic Granules . They are also called Volutin or Babes Ernest Granules . These granules composed of polymetaphosphate and serve as storage granules . Special stains such as Albes , Neissers and Ponders have been devised for demonstrating the granules clearly Ref :Ananthanarayan & paniker's Textbook of microbiology 9th edition pg no 237\n\nSo the answer to this question is A"}
{"instruction": "Syringes and glass ware are sterilized by:\nA. Irradiation\nB. Autoclave\nC. Hot air owen\nD. Cidex", "response": "Hot air owen\n\nSo the answer to this question is C"}
{"instruction": "All changes occur in fibroid uterus except :\nA. Atrophy\nB. Squamous metaplasia\nC. Calcification\nD. Hyaline dogeneration", "response": "Ans. is b i.e. Squamous metaplasia Fibromyoma can have following complications and r4----,:ative changes. Complication Changes / Degenerations Torsiondeg Haemorrhagedeg Infectiondeg Ascites; Pseudo-Meig's Syndromedeg (Produced by pedunculated deg subserous fibroid) deg Maliy iant changedeg (rarest) - Avoid = Atrophy - Red = Red degeneration - Hot = Hyaline degeneration (MC) - Fatty = Fatty degeneration or calcification -Meat = Myxomatous degeneration - chicken = Cystic degeneration (Mnemonic : Avoid Red hot fatty meat of chicken) Also know : Most common degeneration : Hyaline degeneration.deg Degeneration stas from the central pa.deg Calcification stas in periphery (Womb stone).deg Most uncommon (Rarest) change in fibroid is malignant change / sarcomatous change.deg It occurs in 0.5%deg cases of fibroid.\n\nSo the answer to this question is B"}
{"instruction": "ABO antigens are not found in:\nA. Semen\nB. Plasma\nC. Sweat\nD. CSF", "response": "Ans: D (CSF) Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy. 29th edition. 2010Explanation:ABO antigensABO antigens are found in high concentration in saliva, semen, vaginal and gastric secretions.They are found in low titres in sweat, tears and urine.Totally absent in nerve tissue, epithelium, skin appendages, bone and cartilage.\n\nSo the answer to this question is D"}
{"instruction": "True about MHCAI-\nA. Present on chromosome 4\nB. Class III has complement\nC. Class II comprises A, B, C loci\nD. Class I is involved in mixed leucocyte reaction", "response": "MHC gene is present on the short arm of chromosome 6.\nClass II comprises DR, DQ, DP regions (A, B, C loci are present on class I).\nClass III consists of complement components,\nMixed leukocyte reaction involves class II MHC.\nThe histocompatibility antigens (human leukocyte antigens - HLA) are cell surface antigens that induce an immune response leading to the rejection of allografts.\nThe principal physiologic function of the cell surface histocompatibility molecules is to bind peptide fragments of foreign proteins for the presentation of antigen-specific T cells.\nThe histocompatibility antigens are encoded by a closely linked multiallelic cluster of genes -» Major histocompatibility complex (MHC) or Human leukocyte antigens complex (HLA complex).\nHLA complex of genes is located on the short arm of chromosome 6.\n\nSo the answer to this question is B"}
{"instruction": "In dacryocystorhinostomy operation the communication of the sac is established with:\nA. Middle meatus\nB. Superior meatus\nC. Inferior meatus\nD. All of the above", "response": "Ans. Middle meatus\n\nSo the answer to this question is A"}
{"instruction": "In a positively shewed curve, true statement is?\nA. Mean = median\nB. Mean < Mode\nC. Mean > Mode\nD. Mean = Mode", "response": ".\n\nSo the answer to this question is C"}
{"instruction": "The drugs used in the treatment of idiopathic hypercalcemia except is -\nA. Allopurinol\nB. Furosemide\nC. Acetazolamide\nD. Thiazide", "response": "Thiazide type diuretics cause Hypercalcemia by retaining calcium from excretion whereas loop diuretic increase calcium excretion . Steroids are also used in treatment of Hypercalcemia Ref - pubmed.com\n\nSo the answer to this question is D"}
{"instruction": "Laparoscopic uterine nerve ablation (LUNA) is used most commonly in the treatment of-\nA. Mild to mod Endometriotic lesions\nB. Severe Vasomotor symptoms of menopause\nC. Conservative management of Fibroids\nD. Pain relief in Ca Ovary", "response": "Ablation of endometriotic lesions along with laparoscopic uterine nerve ablation (LUNA) in minimal to moderate disease reduces pain associated with endometriosis Ablation of endometriotic lesions plus adhesiolysis in minimal to mild endometriosis is more effective than diagnostic laparoscopy alone in improving feility LUNA: involves the destruction of the uterine nerve fibres that exit the uterus through the uterosacral ligament. Impoant complication is devervation of pelvis and uterine prolapse PSN: Pre Sacral Neurectomy: interruption of sympathetic innervation of the uterus at the level of superior hypogastric plexus\n\nSo the answer to this question is A"}
{"instruction": "The protective factors of breast milk are known to be associated with:\nA. IgM antibodies\nB. Lysozyme\nC. IgA antibodies\nD. Mast Cells", "response": "Breastmilk contains mainly secretory IgA, which has a specific antigen-targeted anti-infective action. Other protective factors include macrophages, lymphocytes, lactoferrin, lysozyme, Bifidus factor, and interferon. But, as IgA plays a major role, it is the best answer here. Components Of breast milk and diseases they protect against: Components of breast milk Protection against Lysozyme Escherichia coli, Salmonella Entamoeba histolytica Lactoferrin E.coli, Shigella, Salmonella E.histolytica, Giardia lamblia Plasmodium falciparum Rotavirus Bifidus factor E.coli, Shigella, Salmonella Low levels of para-amino benzoic acid Plasmodium Ref: Ghai Essential Pediatrics 9th edition Pgno: 145\n\nSo the answer to this question is C"}
{"instruction": "A 12 year old, Aswin, presents with a severely damaged nail on his index finger, after accidentally crushing the finger while closing a door. A decision is made to excise the injured nail. In preparation for the procedure, the physician would most likely anesthetize a branch of which of the following nerves?\nA. Anterior interosseous nerve\nB. Median nerve\nC. Musculocutaneous nerve\nD. Radial nerve", "response": "The median nerve supplies the surface of the lateral palm, the palmar surface of the first three digits and the distal dorsal surface of the index and middle fingers (including the nail beds). Therefore, prior to performing surgery in this area, it is essential to anesthetize a branch of this nerve (possibly a proper digital branch) to eliminate pain sensation around the nail bed of the index finger.Neither the anterior interosseous nor the musculocutaneous nerves supplies the hand. The anterior interosseous nerve supplies the flexor pollicis longus, the lateral half of flexor digitorum profundus, and pronator quadratus. The musculocutaneous nerve supplies the coracobrachialis, biceps, and most of the brachialis muscle, then becomes the lateral cutaneous nerve of the forearm. The radial nerve supplies skin on the radial side of the dorsal surface of the hand, but not the fingeips.\n\nSo the answer to this question is B"}
{"instruction": "Antibody dependent killing:\nA. NK cell\nB. NK cell only\nC. Macrophage\nD. NK cells, neutrophils & macrophage", "response": "Antibodies coat the target cell and target cell will be attacked by phagocytic cells such as:- Neutrophils Macrophages The NK cells. It forms the basis for type II Hypersensitivity reaction\n\nSo the answer to this question is D"}
{"instruction": "In which of the following virus is shed in stool:\nA. Herpangina\nB. Influenza\nC. Varicella\nD. Smallpox", "response": "Ans. a. Herpangina\n\nSo the answer to this question is A"}
{"instruction": "Lamina papyracea separates nose from\nA. Sphenoid bone\nB. Orbit\nC. Frontal bone\nD. Maxillary sinus", "response": "Ref: Henry Gray. Anatomy of the Human Body. The lateral surface is formed of a thin, smooth, oblong plate, the lamina papyracea (os planum), which covers in the middle and posterior ethmoidal cells and forms a large pa of the medial wall of the orbit; it aiculates above with the orbital plate of the frontal bone, below with the maxilla and orbital process of the palatine, in front with the lacrimal, and behind with the sphenoid.\n\nSo the answer to this question is B"}
{"instruction": "Nephrotic syndrome may be caused by the following except -\nA. Renal cell carcinoma\nB. Minimal change nephropathy\nC. Diabetes mellitus\nD. Rheumatoid ahritis", "response": "Diabetes, which is the most common secondary cause of nephrotic syndrome in adults. It can cause kidney damage, known as diabetic nephropathy. Lupus (systemic lupus erythematosus), a chronic disease of the immune system, can seriously damage the kidneys. This can damage your kidneys Minimal Change Disease (MCD for sho) is a kidney disease in which large amounts of protein is lost in the urine. It is one of the most common causes of the Nephrotic Syndrome (see below) worldwide. When the kidney filters are damaged, however, protein sometimes \"slips through\" into the urine Renal cell carcinoma presenting as nephrotic syndrome. Nephrotic syndrome is a rare complication of renal cell carcinomas, and it is paicularly uncommon for minimal change nephropathy to be associated with solid tumours Ref Harrison20th edition pg 278\n\nSo the answer to this question is D"}
{"instruction": "A patient present with lower gastrointestinal bleed. Sigmoidoscopy shows ulcers in the sigmoid. Biopsy from this area shows flask-shaped ulcers. Which of the following is the most appropriate treatment -\nA. Intravenous ceftriaxone\nB. Intravenous metronidazole\nC. Intravenous steroids and sulphasalazine\nD. Hydrocoisone enemas", "response": "Typical flask shaped ulcers are seen in amoebiasis. Intestinal & early hepatic amoebiasis responds quickly to oral metronidazole (800mg 3times daily for 5-10 days) or other long acting nitroimidazoles like tinidazole or ornidazole. In severe cases of amoebic dysentery or liver abscess 500mg may be infused i.v. slowly every 6-8 hrs for 7-10 days or till oral therapy is instituted . Reference: Harrison20th edition pg 1207\n\nSo the answer to this question is B"}
{"instruction": "What complication commonly occurs in anterior duodenal ulcer -\nA. Bleeding\nB. Penetration\nC. Perforation\nD. Stricture formation", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Necrosis of cells is due to -\nA. Ca' efflux in cell\nB. Fat deposition in cells\nC. Water imbibition in cells\nD. Enzymatic digestion", "response": "Ans. is 'd i.e., Enzymatic digestion o Cell injury is reversible upto a ceain point, but if the stimulus persists, irreversible injury and ultimate cell death occur. o There are two principal patterns of cell death : ? a Necrosis q Apoptosis Necrosis o Necrosis refers to a spectrum of morphological changes that follow cell death in living tissue. o Remember this fact Cell death is not due to necrosis rather necrosis (i.e., morphological changes) occurs after cell death cells placed immediately in fixative are dead but not necrotic. Necrosis only represents the morphological changes that occur after cell death. o These morphological changes (necrosis) is the result of 2 concurrent processes : ? 1. Enzymatic digestion of the cell q Enzymes used in the process are derived from two sources :? (a) From the lysosomes of the dead cells themselves (Autolysis) (b) From the lysosomes of the immigrant leukocytes (Heterolysis) 2. Denaturation of intracellular proteins o These processes require hours to develop, So immediatly after cell death there are no detectable necrotic changes. o Necrosis usually effects a group of contigous cells (in contrast to apoptosis that involves death of a single cells), but it can effect single cell also. o In necrosis, there is diruption of membrane integrity --3 Intracellular contents leak out and elicit inflammation --> Inflammatory changes in the surrounding tissue (By contrast, in apoptosis there is no inflammatory reaction in the tissue). Morphological changes o As necrosis follows irreversible injury, the morphological changes are same that have been described in irreversible injury. These are ? 1.Membrane damage 2.Large flocculent amorphous densities in mitochondria. 3.Intracytoplasmic myelin figures 4.Decreased basophilia and increased eosinophilia due to decreased RNP. 5.Nuclear changes : Karyolysis --> Basophilia of chromatin Pyknosis --> Nuclear shrinkage Karyorrhexis --> Fragmentation of Pyknotic nucleus.\n\nSo the answer to this question is D"}
{"instruction": "Pupil is small in all of the following except:\nA. During sleep\nB. Adie's pupil\nC. Argyll Robeson pupil\nD. Pontine haemorrhage", "response": "Ans. Adie's pupil\n\nSo the answer to this question is B"}
{"instruction": "The most radio sensitive tumor amongst the following is:\nA. Small cell lung cancer\nB. Seminoma\nC. Soft tissue sarcoma\nD. Osteosarcoma", "response": "Ans. (b) SeminomaRef: Devita Th/1907* Most radiosensitive tumor: HL > Ewings* Most radiosensitive tumor of head and Neck: Nasopharyngeal CA > Glottic CARadiosensitivity of tumorsHighly sensitiveModerate sensitiveRelatively ResistantHighly Resistant# Ewing's sarcoma# Lymphoma# Wilms tumor# Multiple Myeloma# Seminoma# Nasopharyngeal CA# Dysgerminoma# Medulloblastoma# Small Cell Cancer lung# Breast Cancer# Ovarian Cancer# Basal cell cancer# Nasopharyngeal Cancer# Dysgerminoma# Small Cell Cancer lung# Breast Cancer# Ovarian Cancer# Basal cell cancer# Renal cell CA# Rectal/ colon cancer# Bladder Carcinoma# Soft tissue sarcoma Squamous cell carcinoma of lung# Cervix cancer# Hepatoma# Melanoma# Pancreatic cancer# Osteosarcoma\n\nSo the answer to this question is B"}
{"instruction": "Which is not seen in Polycythemia Vera?\nA. Ocular congestion\nB. Increase RBC count\nC. Increase erythropoietin level\nD. Increased Vit B12 binding capacity", "response": "Polycythemia vera is characterized by an increase in red cell mass without any increase in level of erythropoietin. In fact erythropoietin level is decreased due to feedback by increased erythrocytes. The plasma erythropoetin level is a useful diagnostic test in patients with isolated erythrocytosis, because an elevated level excludes polycythemia vera as the cause for erythrocytosis.\n\nSo the answer to this question is C"}
{"instruction": "Which one of the following is not a characteristic feature of rheumatoid ahritis ?\nA. Sacroiliitis\nB. Metacarpophalangeal joint involvement\nC. Symmetrical ahritis\nD. Positive rheumatoid factor", "response": "Ans. is 'a' i.e., Sacroiliitis\n\nSo the answer to this question is A"}
{"instruction": "Which of the following evaluation methods is most sensitive in diagnosing pregnancy early?\nA. Serum pregnancy test\nB. Detection of fetal heart tones by Doppler equipment\nC. Abdominal ultrasound\nD. Bimanual exam to assess uterine size", "response": "A Doppler instrument will detect fetal cardiac action usually no sooner than 10 weeks.\nA sensitive serum pregnancy test can detect placental HCG levels by 8 to 9 days post-ovulation, and it is therefore the most sensitive modality for detecting and diagnosing pregnancy.\n\nSo the answer to this question is A"}
{"instruction": "Sequestrated lung is most commonly supplied by:\nA. Bronchial artery\nB. Subclavian artery\nC. Pulmonary artery\nD. Ascending aorta", "response": "Ans. d (Ascending aorta). (Ref. Sutton Radiology 7th ed. 253)Pulmonary sequestration# Sequestrated lung is \"a congenital mass of aberrant pulmonary tissue that has no normal connection with the bronchial tree or with the pulmonary arteries, and usually supplied separately by a anomalous branch from ascending aorta directly.# It is usually located in one of the basal segments of lower lobe. In 98% cases intralobar sequestration involves medial parts of left lower lobe. 98% of extralobar sequestrations are left sided.# Two varieties of pulmonary sequestration are known:A. Extralobar: it is most common variety in neonates and infants, is located between the lower lobe and diaphragm, has its own pleural covering, and other anomalies are common (65%), (like pulmonary hypoplasia, horseshoe lung, CCAM, bronchogenic cysts, diaphragmatic hernia and cardiac anomalies).B. Intralobar sequestration: diagnosed after adolescence, contained within lung with no separate pleural covering, and is intimately connected to adjacent lung.\n\nSo the answer to this question is D"}
{"instruction": "Most probable diagnosis in a newborn baby with regurgitation of feeds and continuous drooling of saliva is:\nA. Esophageal atresia\nB. Diffuse esophageal spasm\nC. Achalasia cardia\nD. Zenker's diveiculum", "response": "Continuous drooling of saliva indicates no communication of Esophagus distally - esophageal atresia. Type E is also known as H shaped Fistula Least Common- Type D Classification of TEF Type A: Atresia only (6%) Type B: Atresia with proximal TEF (2%) Type C: Atresia with distal TEF (85%): Most common Type D: Atresia with both proximal and distal TEF (rare) Type E: TEF only (1%) Clinical Features The diagnosis of EA is enteained in an infant with excessive salivation along with coughing or choking during the first oral feeding. A maternal history of polyhydramnios is often present. The newborn baby with atresia regurgitates all of its first and subsequent feeds0. Saliva pours continuously from its mouth . Repeated episodes of coughing, choking and cyanosis occur on feeding in TEF. Associated Anomalies MC anomaly associated with TEF is CVS (VSD). Esophageal atresia may occur as pa of VACTERL group of anomalies: -V: Veebral body segmentation defects0 -A: Anal atresia0 -C: Cardiovascular (PDA, VSD) -TE: Tracheoesophageal fistula -R: Renal (unilateral renal agenesis) -L: Limb anomalies (radial ray hyplasia)\n\nSo the answer to this question is A"}
{"instruction": "In a case of chest pain with pericarditis and pericardial effusion, pain is referred by?\nA. Superficial cardiac plexus\nB. Phrenic nerve\nC. Deep cardiac plexus\nD. Vagus nerve", "response": "The phrenic nerve arises from the ventral rami of cervical spinal nerves C3-5 and courses down in the preveebral fascia, in front of the anterior scalene muscle, into the thorax between the subclan aery and vein. It provides motor innervation to the diaphragm. The fibrous and parietal pericardial are supplied by the phrenic nerve (C3-C5). They are sensitive to pain. The visceral pericardium or epicardium is supplied by autonomic nerves, not sensitive to pain.\n\nSo the answer to this question is B"}
{"instruction": "True about cholera -\nA. Gram negative rod\nB. Associated with fever\nC. Causes painful watery diarrhea\nD. All", "response": "Ans. is `a' i.e., Gram negative rod Vibrio cholerae is a gram negative rod (bacillus). It causes painless watery diarrhea, without associated fever. Vibrios are highly susceptible to acids and gastric acidity provides an effective barrier against small dose of V. cholerae. Therefore, achlorhydria predisposes for infection by V cholerae.\n\nSo the answer to this question is A"}
{"instruction": "Cold caloric test stimulates -\nA. Cochlea\nB. Lateral semi circular canal\nC. Posterior semicircular canal\nD. All", "response": "Caloric Tests: Important points\n\nPrinciple: to induce nystagmus by thermal stimulation of vestibular system.\nLateral semicircular canalQ is commonly tested by all these tests\nThere are 3 methods of performing these tests:\n\nSo the answer to this question is B"}
{"instruction": "A 25-year-old woman presents to the emergency room with new symptoms of decreased urine output, leg edema, and facial swelling. She was previously well and has no significant past medical history. Laboratory investigations reveal acute kidney injury and a renal biopsy is performed. Immunofluorescence of the biopsy specimen reveals a granular pattern of immune complex-mediated glomerulonephritis. (See Figure below) Which of the following conditions is most likely to cause this pattern of renal injury?\nA. acute tubular necrosis (ATN)\nB. Wegener granulomatosis\nC. postinfectious glomerulonephritis\nD. hemolytic uremic syndrome (HUS)", "response": "Immune complexes with low complement levels can be seen in idiopathic and postinfectious glomerulonephritis, lupus, cryoglobulinemia, shunt nephritis, and bacterial endocarditis. Immune complexes are not detected in ATN, Wegener's, HUS, or Goodpasture syndrome. Immune complexes with normal complement levels are found in IgA nephropathy and Henoch-Schonlein purpura.\n\nSo the answer to this question is C"}
{"instruction": "Novy-McNeal-Nicolle INNN] medium is used for:\nA. Giardia lamblia\nB. Leishmania donovani\nC. Echinococus\nD. Toxoplasma gondii", "response": "Ans. B: Leishmania donovani A variety of media have been used for the culture of leishmanias. These can be divided into three main categories: semisolid, biphasic, and liquid. While biphasic and semisolid culture media need blood, an impoant factor for the reproduction of parasites, most liquid media require fetal calf serum (FCS) or erythrocyte lysate. NNN medium is a solid medium with a little water of condensation on the top of the slant. The organisms crowd together in this water of condensation. Biphasic Novy-MacNeal-Nicolle (NNN) culture medium, which has been used for a long time, is preferred because it is far cheaper than commercial media. Although it is quite suitable for the isolation of parasites, in this medium samples taken from leishmaniosis patients fail to produce a great number of promastigotes in a sho time.\n\nSo the answer to this question is B"}
{"instruction": "Infection by which of the following agents leads to wart formation-\nA. Herpes simplex virus\nB. HPV\nC. Molluscum contagiousum virus\nD. Varicella zoster virus", "response": "Ans. is 'b' i.e., HPV o Human papilloma virus (HPV) is the causative agent of all type of warts.Type of wartSite of involvementHPV types1. Verruca vulgaris (common wart)Most common type wart On Hands and fingers2 (most common), 4, 272. Verruca Plana (Flat wart)Face, hands3, 103. Verruca plantaris (Palmoplantar warts)Palms & soles1,2,4, 57i) Superficial palmoplantar wart (Mosaic wart) 2 (most common)ii) Deep palmoplantar wart (Myrmecia wart) 1 (most common)4. Condyloma acuminata (anogenital wart)Genital, perianal, perineum,Most common - 6,11, (low risk)Other - 16, 18, 31, 33, 45 (High risk)5. Laryngeal papillomatosisLarynx, respiratory tract6, 116. Bowenoid papulosisGenitalia167. Epidermodysplasia verruciformisExtensive5, 8\n\nSo the answer to this question is B"}
{"instruction": "Dwarf tapeworm is the common name of which of the following\nA. Echinococcus multilocularis\nB. Hymenolepis nana\nC. Taenia saginata\nD. Taenia solium", "response": "Hymenolepis nana is commonly known as dwarf tapeworm The name hymenolepis refers to the thin membrane covering the egg(greek: hymen -membrane,lepis-covering,nana (nanus) -dwarf) Ref: panikers textbook of Medical parasitology 8th edition page :136\n\nSo the answer to this question is B"}
{"instruction": "Dryness of eye is caused by injury to the facial nerve at-\nA. Chorda tympani\nB. Cerebellopontine angle\nC. Tympanic canal\nD. Geniculate ganglion", "response": "Dryness in the eye (loss of lacrimation) occurs if the injury is at or proximal to geniculate ganglion.\nFirst, see the major symptoms of facial nerve palsy : -\nLoss of lacrimation: - Due to the involvement of greater superficial petrosal nerve.\nLoss of stapedial reflex: - Due to the involvement of nerve to stapedius.\nLack of salivation: - Due to chorda tympani.\nLoss of taste sensation from Anterior 2/3 of the tongue: - due to chorda tympani.\nParalysis of the muscle of facial expression: - Due to terminal (peripheral) branches.\nNow you can make out the site of injury : -\nAll the 5 symptoms (i to v) are present → Injury is at or proximal to geniculate ganglion (as all the branches of the facial nerve are involved).\nThere is no loss of lacrimation (greater superficial petrosal nerve is spared) but symptoms (ii) to (v) occur → Injury is distal to geniculate ganglion but proximal to or at the level of the second genu from where the nerve to stapedius arises.\nOnly symptoms (iii) to (v) are present (greater petrosal and nerve to stapedius are spared) → Injury is distal to the second genu but proximal to the origin of chorda tympani, i.e., Injury is between Second genu and mid portion of verticle segment.\nOnly (Vth) symptom is present → Injury is distal to the origin of chorda tympani, which may be at the level of the stylomastoid foramen.\n\nSo the answer to this question is D"}
{"instruction": "A fifty-year-old man presents to his practitioner complaining that he often feels as if the room is spinning when he gets up from a recumbent position or turns his head. He has not lost consciousness and has had no chest pain. He has no cardiac history and a recent treadmill test showed no abnormalities. On examination, the sensation can be produced by rapidly turning the head. It can be reproduced many times, but it eventually ceases. Nystagmus is elicited. Hearing is normal. Which of the following is the most likely diagnosis?\nA. Benign paroxysmal positional veigo\nB. Brain stem tumor\nC. Meniere's disease\nD. Syncope", "response": "Benign paroxysmal positional veigo (BPPV) is veigo that is precipitated by head position. It can be precipitated by trauma, but often no precipitating factor is identified. It generally abates after weeks to months. On exam, patients display nystagmus and the symptoms can be reproduced by head movement. In addition, the symptoms show latency, fatigability and habituation. Brain stem tumor and veebrobasilar TIA are causes of central causes of veigo, but would often be associated with other neurologic findings. Meniere disease displays the classic triad of unilateral tinnitus, unilateral deafness, and paroxysmal veigo. Since the patient has normal hearing, this is unlikely to be Meniere syndrome, although hearing loss may not manifest until later stages of the disease. Syncope is defined as transient loss of consciousness of cardiovascular origin. Thus since the patient has a lack of other cardiovascular symptoms and has not lost consciousness, this is not syncope.\n\nSo the answer to this question is A"}
{"instruction": "All are true about Pthisis bulbi except\nA. Size of eye decreases\nB. Calcification occurs in Bowman's layer of cornea\nC. IOP increases in later stages\nD. Treatment is enucleation operation", "response": "IOP will not increase in Pthisis bulbi.\n\nSo the answer to this question is C"}
{"instruction": "Hysterosalphingography is clone during?\nA. During menstruation\nB. Luteal phase\nC. Follicular phase\nD. Secretory phase", "response": "Follicular phase REF: Shaw's Gynecology 13th ed p.- 210 \"Hysterosalphingography is performed between the end of the menstrual period and ovulation at around 10th day. This is the phase of follicular development\"\n\nSo the answer to this question is C"}
{"instruction": "Which of the following drugs is not recommended in septic shock:\nA. Normal saline\nB. Activated protein C\nC. Steroids\nD. Rituximab", "response": "Essentials of medical pharmacology, seventh edition, page no 872 Answer is option 4, rituximab It is not recommended in septic shock since it will adverse the condition. The major adverse effects are chills, fever, uicarial rashes, pruritus, dyspnoea, and hypotension. Pretreatment with antihistamines dampens the reaction.\n\nSo the answer to this question is D"}
{"instruction": "False about p53 is-\nA. It is present on chromosomes 17\nB. It causes cell cylce arrest in G1\nC. 53 KDa\nD. Non mutated wild p53 is associated with neoplasm in childhood", "response": "p53 is the protein produced by TP53, guardian of human genome. It stimulates cells for DNA repair and in anti onco genic.Basic Pathology, Robbins. Page no.:185\n\nSo the answer to this question is D"}
{"instruction": "Infraorbital anesthesia involves which nerve:\nA. Anterior superior alveolar nerve\nB. Posterior superior alveolar nerve\nC. Facial nerve\nD. Mandibular nerve", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Long and peaked a waves are seen in all except-\nA. Tricuspid atresia\nB. Ebsteins anomaly\nC. Hyperkelamia\nD. Right atrial enlargement", "response": "ECG : left axis detion in tricuspid atresia The common ECG findings in Ebstein anomaly include tall and broad P waves, prolonged PR interval, right bundle branch block pattern, fragmented QRS complex, and tachyarrhythmias due to accessory pathways usually present around the malformed TV. ECG Criteria of Right Atrial Enlargement Right atrial enlargement produces a peaked P wave (P pulmonale) with amplitude: > 2.5 mm in the inferior leads (II, III and AVF) > 1.5 mm in V1 and V2 Ref Harrison 20th edition pg 1476\n\nSo the answer to this question is C"}
{"instruction": "CRF shows all except\nA. Hyperphosphatemia\nB. Hyperuricaemia\nC. Decreased 11/2 of insulin\nD. Decreased serum vitamin D3", "response": "Ans. is 'c' i.e., Decreased of insulin\n\nSo the answer to this question is C"}
{"instruction": "Viability of fetus is beyond ?\nA. 25 weeks\nB. 28 weeks\nC. 30 weeks\nD. 32 weeks", "response": "Ans. is 'b' i.e.,28 weeksViability means the physical ability of a fetus to lead a separate existence after bih apa from its mother, by viue of a ceain degree of development. A child is ble after 210 days (7 months) of intrauterine life, and in some cases after 180 days (6 months) but in most of these cases fetus is immature.\n\nSo the answer to this question is B"}
{"instruction": "Typical feature of thoracic veebrae ?\nA. Hea shaped\nB. Large body\nC. Triangular veebral foramen\nD. None", "response": "Ans. is 'a' i.e., Hea shaped Thoracic veebrae There are 12 thoracic veebrae. T2-T9 are typical thoracic veebrae and Tl, TIO, Tl 1, T12 are atypical thoracic veebrae. Characteristic features of typical thoracic veebra : -Body is medium sized and hea shaped.Spinous process is long and inclined downward.Veebral foramen is small and circular.Transverse process possess costal facets for rib aiculation (last two veebrae lack these facets). Costal facets are also present on the sides of body for aiculation of heads of ribs.Superior aicular facet is directed backwards and laterally, and inferior aicular facet faces forward and medially. Aicular procesess are veically placed and interlocked; So dislocation can only occur if they are fractured.\n\nSo the answer to this question is A"}
{"instruction": "Inspissation is ?\nA. Heating at 160degC for 15 minutes\nB. Heating at 160degC for 30 seconds\nC. Heating at 80degC for 30 minutes\nD. Heating at 120degC for 15 seconds", "response": "Ans. is 'c' i.e., Heating at 80degC for 30 minutes Inspissation: It is heat exposure method that is employed with high protein material, like egg containing media, that cannot withstand the high temperature used in autoclaving. The medium is exposed to 80degC for 30 minutes for three successive days in inspissator. It can be used for LI medium and loeffler serum slop.\n\nSo the answer to this question is C"}
{"instruction": "Antisperm antibody testing is not needed if the sperm are to be used for-\nA. ICSI\nB. GIFT\nC. ZIFT\nD. IVF", "response": "Antisperm antibody testing is not needed if the sperm are to be used for Intracytoplasmic sperm injection (ICSI). Antisperm antibody testing Using the immunobead test, washed spermatozoa are exposed and assessed for binding to labeled beads. In the mixed agglutination reaction, human red blood cells sensitized with human immunoglobulin G (IgG) are mixed with the paner's semen. Spermatozoa that are coated with antibodies form mixed agglutinates with the red blood cells Anti sperm antibodies cause agglutination of sperms and hence the sperms are'nt free to move and feilise the oocyte. This test is therfore impoant before A procedures except ICSI because here the sperm is directly injected into the oocyte cytoplasm.\n\nSo the answer to this question is A"}
{"instruction": "Prolonged treatment with INH leads to deficiency of?\nA. Pyridoxine\nB. Thiamine\nC. Pantothenic acid\nD. Niacin", "response": "Pyridoxine: Chemistry and source: Pyridoxine, Pyriodoxal and Pyridoxamine are related naturally occurring pyridine compounds that have vit B6 activity. Dietary sources are-liver, meat, egg, soybean, vegetables and whole grain . Absorption and fate: All three forms of the vitamin are well absorbed from the intestine. They are oxidized in the body and excreted as pyridoxic acid. little is stored. Physiological role and actions: Pyridoxine and pyridoxamine are readily oxidized to pyridoxal, which is then phosphorylated to pyridoxal phosphate. Isoniazid reacts with pyridoxal to form a hydrazone, and thus inhibits generation of pyridoxal phosphate. Isoniazid also combines with pyridoxal phosphate to interfere with its coenzyme function. Due to formation of hydrazones, the renal excretion of pyridoxine compounds is increased. Thus, isoniazid therapy produces a pyridoxine deficiency state.\n\nSo the answer to this question is A"}
{"instruction": "In leprosy nerves commonly involved?\nA. High ulnar, low median\nB. High median, low ulnar\nC. Triple nerve palsy\nD. High radial, low median", "response": "Involvement is high ulnar (at or above elbow) and low median (at wrist). The sensory component is commonly the first and most severely affected, but occasionally there is a pure motor lesion. Autonomic dysfunction is always present in severe nerve damage. MC cranial nerve involved: Facial MC peripheral nerve involved: Ulnar>Posterior Tibial\n\nSo the answer to this question is A"}
{"instruction": "Blunt injury abdomen, patient was hemodynamically stable, next investigation:\nA. X-ray abdomen\nB. Barium swallow\nC. FAST\nD. DPL", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Paneth cells contain -\nA. Zinc\nB. Copper\nC. Molybdenum\nD. Selenium", "response": "Paneth cells are zinc-containing cells widely distributed in Lieberkuhn's crypts of the intestine in a variety of species.\nThese cells have atypically oriented bright eosinophilic granules containing a variety of antimicrobial proteins and play a role in mucosal immunity (and not mucin secretion).\nThe principal defence molecule secreted by Paneth cells are alpha-defensins.\nIn addition to defensins, Paneth cells secrete lysozyme, TNF- α, and phospholipase-A2.\n\nSo the answer to this question is A"}
{"instruction": "Effects of estrogen are all of the following except ?\nA. Reduces HDL\nB. Reduces LDL\nC. Increases triglyceride\nD. Reduces bone resorption", "response": "Ans. is 'a' i.e., Reduces HDL o Estrogens decrease LDL while increase HDL and triglyceride -4 atherosclerosis is rare before menopause.\n\nSo the answer to this question is A"}
{"instruction": "True about conversion of 20C fatty acid conversion to prostaglandin synthase\nA. First PG synthesized is PGI I2\nB. It is rate limiting enzyme\nC. It convees PGI H2 to PGI E2\nD. The primary prostaglandin is PG H2", "response": "Biosynthesis of Prostaglandins Prostaglandins are derived from the PUFA, the three series being derived from the following fatty acids. 1 series (1 double bond) -from Linoleic acid 2 series (2 double bonds)-from Arachidonic acid 3 series (3 double bonds)-Eicosa Penta-enoic Naturally occurring PGs belong to the 2 series. i. PGs are not stored as such; the precursor fatty acids are stored in membrane as phospholipids. The arachidonic acid is released by the action of phospholipase A2 on phospholipids (Fig. 13.3). ii. Synthesis is catalyzed by Prostaglandin H synthase (PGHS). It contains two separate enzyme activities, cyclo-oxygenase, and peroxidase. iii. PGG2 and PGH2 are formed as intermediates during the synthesis of other PGs. Specific enzymes conve PGH2 to other prostaglandinsRef: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 164\n\nSo the answer to this question is D"}
{"instruction": "A 22-year-old man is admitted to the hospital after a car collision. Radiographic examination reveals an oblique fracture of his humerus. Upon physical examination the patient is unable to extend his forearm. The damaged nerve was most likely composed of fibers from which of the following spinal levels?\nA. C5, C6\nB. C5, C6, C7\nC. C5, C6, C7, C8, T1\nD. C6, C7, C8, T1", "response": "The radial nerve acts to extend the forearm at the elbow. This nerve is derived from all the roots of the brachial plexus C5 to T1. None of the other answers include all the roots and are therefore incorrect.\n\nSo the answer to this question is C"}
{"instruction": "The frequent mechanism in perforation of appendix is?\nA. Impacted faecolith\nB. Tension gangrene due to the accumulating secretions\nC. Necrosis of lymphoid patch\nD. Retrocaecal function", "response": "Ans. is 'b' i.e., Tension gangrene due to the accumulating secretions\n\nSo the answer to this question is B"}
{"instruction": "A 36-year-old G2P1 woman at 24 weeks gestation is noted to have fatigue of 4 weeks duration. Her hemoglobin level is 8.0 g/ dL, leukocyte count is 2.0 cells/ uL, and platelet count is 20,000/ uL. Which of the following is the most likely diagnosis\nA. H ELLP syndrome\nB. Preeclampsia with severe features\nC. Acute leukemia\nD. Iron deficiency anemia", "response": "Pancytopenia, a reduction in the number of RBCs, WBCs, and platelets circulating throughout the body, suggests a bone marrow process. None of the other answer choices involve low leukocyte counts (leucopenia). Low platelets (thrombocytopenia) may also be a manifestation of severe preeclampsia, and is pa of the criteria for HELLP syndrome as well. Iron deficiency anemia involves low hemoglobin levels and is common in pregnancy due to decreased iron stored prior to pregnancy, and increased demands for iron during pregnancy. Since this patient's blood work showed low WBCs, a bone marrow biopsy should be done. A pregnant woman with leukemia may require chemotherapy, which poses a risk of intrauterine growth retardation to the developing fetus. Acute leukemia itself carries a risk for preterm labor, spontaneous aboion, and stillbih.\n\nSo the answer to this question is C"}
{"instruction": "Onion skin spleen is seen in -\nA. ITP\nB. Thalassemia\nC. SLE\nD. Scleroderma", "response": "In spleen the central peniciliary arteries show thickening and perivascular fibrosis, producing so called Onion Skin lesions.\n\nSo the answer to this question is C"}
{"instruction": "Lyedig cells secrete ?\nA. Testosterone\nB. Inhibin\nC. Mullerian inhibiting substance (MIS)\nD. ABP", "response": "Ans. is 'a' i.e., TestosteroneThe hormone-secreting cells in the testes are the leydig cells and seoli cells. Leydig cells have receptors for LH and secrete all the androgens, i.e., testosterone (major androgen), dihydrotestosterone (DHT), androstendione and dehydroepiandrosterone (DHEA). All of theme have 19 carbon atoms.Seoli cells are under the control of FSH, i.e., have receptors for FSH. When stimulated by FSH, these cells secrete androgen binding protein (ABP), in hibin and MIS (mullerian inhibiting substance). Seoli cells also contain aromatase; the enzyme that conves androgens to estrogens. Beside these hormonal function, junction between adjacent seoli cells forms blood-testis barrier which does not allow harmful substances to enter the area where spermatogenesis is going on. Seoli cells also have receptors for androgens (testosterone) which stimulates spermatogenesis.\n\nSo the answer to this question is A"}
{"instruction": "Triple deformity of the knee is a complication of: September 2012\nA. Tuberculosis\nB. Osteoahritis\nC. Septic ahritis\nD. All of the above", "response": "Ans. A i.e. Tuberculosis Skeletal TB MC site of skeletal TB: Veebrae In Spine, TB stas in: Veebral body MC region involved in spinal TB: T9-L1 Earliest symptom of spinal TB: Pain Earliest X-ray sign in Pott's disease: Narrowing of disc space\n\nSo the answer to this question is A"}
{"instruction": "A patient who is on LMWH, suddenly develops hemorrhage, next step is\nA. Level of factor X\nB. APTT\nC. Platelet count\nD. PT", "response": "LMWH is monitored by factor Xa assay.(Refer: Harrison's Principles of Internal Medicine, 18th edition, pg no: 996)\n\nSo the answer to this question is A"}
{"instruction": "Parathyroid autotransplantation is done in which of the following muscle?\nA. Brachioradials\nB. Biceps\nC. Triceps\nD. Saorius", "response": "Parathyroid auto transplantation is done in 2 muscles Sternocleidomastoid muscle Brachioradialis of non-dominant hand SCM Brachioradialis Indication: Accidental removal of PT gland while performing a thyroidectomy. | A small amount of the PT gland is auto-transplanted into SCM muscle. Indication: Hyperparathyroidism due to parathyroid adenoma (or) Parathyroid hyperplasia. | A sub-total parathyroidectomy is performed and a small amount of PT gland is implanted into brachioradialis muscle of non-dominated hand. Transplanted site is marked with silk suture or clip for easy identification\n\nSo the answer to this question is A"}
{"instruction": "Hypercalcemia is seen in all EXCEPT:\nA. Bone metastasis\nB. Sarcoidosis\nC. Pseudohypoparathyroidism\nD. Hyperparathyroidism", "response": "Ans. C i.e. Pseudohypoparathyroidism Pseudohypoparathyroidism presents with hypocalcemia, normal to raised PTH, normal 25-(OH)D, and decreased 1,25-(OH),D\n\nSo the answer to this question is C"}
{"instruction": "A 35 year old female with a previous history of bih of a child with Down's syndrome, presents with 18 weeks Amenorrhoea. The Investigation of choice rule out Down's syndrome in the present pregnancy is:\nA. Triple test\nB. Amniocentesis\nC. Cordocentesis\nD. Chorionic villous biopsy", "response": "The Answer is B (Amniocentesis) : At 18 weeks of pregnancy the best confirmatory test available is amniocentesis 'Triple test only gives a risk ratio. For confirmation of diagnosis, amniocentesis has to be done' - Dutta\n\nSo the answer to this question is B"}
{"instruction": "Production of fructose in seminal fluid is by following steps\nA. Glucose-6-phosphate > fructose-6-phosphate > fructose\nB. Glucose-6-phosphate > sorbitol phosphate > fructose phosphate > fructose\nC. Glucose-6-phosphate > glucose > sorbitol > fructose\nD. Glucose-6-phosphate > fructose- 1 -phosphate > fructose", "response": "Glucose-6-phosphate>glucose>Sorbitol>Fructose \n\nFructose can be synthesis from glucose or glycogen. The pathway is :-\n\nSo the answer to this question is C"}
{"instruction": "Oral vancomycin is indicated in the following condition\nA. Bacillary dysentery\nB. Campylobacter diarrhoea\nC. Appendicitis\nD. Antibiotic associated pseudomembranous enterocolitis", "response": "GLYCOPEPTIDE ANTIBIOTICS Vancomycin Mech of action:- Vancomycin acts by inhibiting bacterial cell wall synthesis. It binds to the terminal dipeptide 'D-ala-D-ala' sequence of peptidoglycan units-- prevents its release from the bactoprenol lipid carrier so that assembly of the units at the cell membrane and their cross linking to form the cell wall cannot take place. pharmacokinetics:- Vancomycin is not absorbed orally. After i.v. administration, it is widely distributed, penetrates serous cavities, inflamed meninges and is excreted mainly unchanged by glomerular filtration with a t 1/2 of 6 hours. Dose reduction is needed in renal insufficiency. Toxicity:- Systemic toxicity of vancomycin is high. It can cause plasma concentration dependent nerve deafness which may be permanent. Kidney damage is also dose-related. Other oto- and nephrotoxic drugs like aminoglycosides must be very carefully administered when vancomycin is being used. Skin allergy and fall in BP during i.v. injection can occur. Vancomycin has the potential to release histamine by direct action on mast cells. Rapid i.v. injection has caused chills, fever, uicaria and intense flushing-- called 'Red man syndrome'. Uses:- Given orally (125-500 mg 6 hourly), it is the second choice drug to metronidazole for antibiotic associated pseudomembranous enterocolitis caused by C. difficile. Staphylococcal enterocolitis is another indication of oral vancomycin. Ref:- kd tripathi; pg num:-757\n\nSo the answer to this question is D"}
{"instruction": "A pt present with clinical features of veigo nystagmus the following condition is dft to thrombosis in which aery?\nA. Posterior cerebral Aery\nB. middle cerebral Aery\nC. Superior cerebellar aery\nD. Internal candid Aery", "response": "ref : BD CHAURASIA\n\nSo the answer to this question is C"}
{"instruction": "All are true about staing of b-Blocker therapy in a case of CHF except aEUR'\nA. They should be staed with optimal doses\nB. They should be gradually increased over weeks\nC. Special precautions should be taken in cases of NYHA class III and IV\nD. Carvedilol and Metoprolol are the preferred drugs", "response": "They should be staed with optimal dose Beta blocker therapy represents a major advance in the treatment of patients with depressed ejection fraction. - Although the negative inotropic effect of beta blocker resulted in their contraindication in left ventricular dysfunction until very recently, there is now evidence that, not only are they tolerated, but they greatly improves prognosis. How does blockade of fi receptors help in hea failure?? Left ventricular dysfunction results in neurohormonal activation (renin angiotensin aldosterone system, sympathetic system, cytokine release) which, although beneficial in acute cases is reponsible for gradual deterioration in myocardial function. For instance , in response to decrease in cardiac output, an increase in circulating norepinephrine (NE) can be seen which acts on the sympathetic myocardial receptors paicularly beta-1 thus increasing tnyocardial contractility. In addition, by stimulating peripheral alpha receptor, NE induces peripheral vasoconstriction, which helps to maintain blood pressure - This effect is counter balanced by peripheral *to-2 stimulation and consequent vasodilation. Prolonged exposure of hea to alpha and beta receptor stimulation unfounately, promotes left ventricular modelling, cell death due to necrosis or apoptosis and water/ salt retention. 8 blockers interfere with the harmful effect of sustained activation of the adrenergic nervous system by competitively antagonizing one or more adrenergic receptors. When given along with ACE inhibitors beta blockers reverse the process of RV remodelling, improve patient symptoms, prevents hospitalisation and prolongs life. Therefore II blockers are indicated for patients with symptomatic or asymptomatic HF and depressed Ejection Fraction < 40%. There are three beta blockers that have been shown to be effective in reducing the risk of death in patients with chronic HE : - Bisoprolol - Metoprolol - Carvedilol Current recommendation are to consider the addition of fl blockers in the case of patients presenting with functional class II or Ill congestive hea failure if caused by systolic function. Dose of 13eta blockers First of all, treatment should be staed at extremely low doses:? - This dosage should be maintained for at least two to .four weeks and is increased only if the patient has tolerated it well. - if the patient does not tolerate the increased dosage the medication should not be considered a failure and treatment should be maintained at the tolerated dose. - The dose of beta blocker should he increased, until, the dose, used are similar to those that have been repoed to be effective in clinical trials. Administering ,8 blockers may lead to worsening fluid retention consequent to the withdrawl of adrenergic suppo to the hea and the circulation. - Thus it is impoant to optimize the dose of diuretic before staing therapy with beta blockers. - The increased, fluid retention can usually be managed by increasing the dose of diuretics. Beta blockers in NYHA class IV :? Since most of the clinical trials of Beta blocking agents have been conducted in patients with hea failure NYHA .functional class 11/ HI, until recently, there was limited information regarding safety and efficacy of Beta blockers in patients with hea failure NYHA functional class IV. Carvedilol prospective Randomized cumulative survival (COPER- NICUS) - The COPERNICUS TRIAL was designed as multicentric multinational trial in patients with severe hea failure randomized to Carvedilol vs Placebo. -The result of COPERNICUS demonstrates that even in patients with advanced hea .failure, Carvedilol exes a beneficial effect.\n\nSo the answer to this question is A"}
{"instruction": "A 45-year-old woman presents with a 4-month history of severe headaches and pain, and blanching of the hands upon exposure to cold. She is a nonsmoker. Over the past 6 months, she has noticed progressive difficulty in swallowing solid food. Physical examination reveals smooth and tight skin over the face and fingers. The serologic test for anti-Scl-70 (antitopoi-somerase) is positive. Painful hands in this patient are best described using which of the following terms?\nA. Chilblains\nB. Homans' sign\nC. Intermittent claudication\nD. Raynaud phenomenon", "response": "This patient suffers from scleroderma complicated by Raynaud phenomenon. The latter refers to intermittent, bilateral attacks of vasospasm of the fingers or toes (sometimes affecting the ears or nose), resulting in pallor, paresthesias, and pain from ischemia. The symptoms are precipitated by cold or emotional stimuli and relieved by heat. Raynaud phenomenon may occur as an isolated disorder or as a feature of a number of systemic diseases, including systemic lupus erythematosus and scleroderma. Intermittent claudication (choice C) is associated with peripheral vascular disease (atherosclerosis). Chilblains (choice A) represent itchy or tender red or purple bumps that occur as a reaction to cold.Diagnosis: Scleroderma\n\nSo the answer to this question is D"}
{"instruction": "Major end product of beta oxidation of odd chain fatty acids:\nA. Propionyl CoA\nB. Succinyl CoA\nC. Acetyl CoA\nD. Malonyl CoA", "response": "Odd chain fatty acid on beta-oxidation Give many Acetyl CoA (released at every step) and only 1 Propionyl CoA. In 17 C fatty acid ( odd chain ) , when it's broken down , 7 molecules of acetyl CoA ( 14 C)and 1 molecule of propionyl CoA (3C) are obtained So, major end product is Acetyl CoA whereas Propionyl CoA is a minor end product.\n\nSo the answer to this question is C"}
{"instruction": "Most important component of level of living-\nA. Health\nB. Education\nC. Food\nD. Clothes", "response": "Health is the most important component because its impairment always means impairment of level of living.\n\nSo the answer to this question is A"}
{"instruction": "An OPV vial shows this symbol on it. What does it indicate?\nA. The vaccine has reached its expiry date\nB. The vaccine has not been stored properly\nC. The vaccine vial is empty\nD. Use the vaccine if expiry date not reached", "response": "d. Use the vaccine if expiry date not reachedThis is a vaccine vial monitor (VVM) showing white inner square & blue outer circle; VVM provides an indication of the cumulative heat to which the vial has been exposed\n\nSo the answer to this question is D"}
{"instruction": "As per POCSO act, child was brought for age estimation. Xray wrist taken. The maximum age of the wrist joint is:\nA. 4 years\nB. 7 years\nC. 10 years\nD. 13 years", "response": "The POCSO Act defines a child as any person below the age of 18 years and provides protection to all children (both males and females) under the age of 18 years from sexual abuse. Ossification Centres of Carpal Bones: Capitate: 1-3 months Hamate: 2-4 months Triquetrum: 2-3 years Lunate: 2-4 years Scaphoid: 4-6 years Trapezium: 4-6 years Trapezoid: 4-6 years Pisiform: 8-12 years Capitate is the first one andPisiformis the last one to ossify. Base of 1stmetacarpel is not fused with the shaft which means age is <15 years. Pisiform has not apppeared so the age is less than 12 years.\n\nSo the answer to this question is C"}
{"instruction": "Sperm acquires motility in\nA. Seminal vesicle\nB. Testes\nC. Epididymis\nD. Ejaculatory duct", "response": "The seminiferous tubules of the testes are the staing point for the process, where spermatogonial stem cells adjacent to the inner tubule wall divide in a centripetal direction--beginning at the walls and proceeding into the innermost pa, or lumen--to produce immature sperm. Maturation occurs in the epididymis Ref: guyton and hall textbook of medical physiology 12 edition page number:625,626,627\n\nSo the answer to this question is C"}
{"instruction": "Pernicious anaemia is associated with the deficiency of:\nA. Folic acid\nB. Vitamin B1\nC. Vitamin B6\nD. Vitamin B12", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is the inheritance pattern of Familial Hypercholesterolemia?\nA. Autosomal dominant\nB. Autosomal recessive\nC. X Linked dominant\nD. X Linked recessive", "response": "Familial hypercholesterolemia (FH) is an autosomal dominant disorder that causes severe elevations in total cholesterol and low-density lipoprotein cholesterol (LDLc). The LDL receptor gene is located on the sho arm of chromosome 19. It is the primary determinant of hepatic LDL uptake, which normally processes approximately 70% of circulating LDL.\n\nSo the answer to this question is A"}
{"instruction": "A patient with diarrhea has a fecal smear that is negative for leukocytes. The patient's diarrhea is most likely caused by\nA. Campylobacter enteritis\nB. Shigellosis\nC. Typhoid fever\nD. Enterotoxigenic Escherichia coli", "response": "The enterotoxigenic strain of Escherichia coli secretes a heat-labile toxin that stimulates adenylate cyclase, producing a cholera-like syndrome that is responsible for the majority of cases of traveler's diarrhea. Because the bowel mucosa is not invaded and there is no toxin-induced damage, the fecal smear is negative for leukocytes. Campylobacter enteritis, shigellosis, typhoid fever, and amebiasis are all invasive, and infected individuals have stools with inflammatory cells. Typhoid fever is unique because the inflammatory cells are not neutrophils, but mononuclear cells.\n\nSo the answer to this question is D"}
{"instruction": "Neurofibromatosis true all, except aEUR'\nA. Autosomal recessive\nB. Associated with cataract\nC. Scoliosis\nD. Multiple fibroma", "response": "Autosomal recessive Neurofibromatosis is an inherited disorder It is of two types: ? Neurofibromatosis - Neurofibromatois II Genetics of Neurofibromatosis Both the neurofibromas are inherited in an autosomal dominant pattern. The genes for them are located on different chromosome - NF-1--) Neurofibrin gene on chromosome 17 - NF-2 --) Merlin gene on chromosome 22 NEUROFIBROMATOSIS TYPE I ? Neurofibromatosis is a comparatively common hereditary disorder in which the skin, nevous system, bone, endocrine glands and sometimes other organs are at the sites of a variety of congenital abnormalities often taking the fonn of benign tumours. . The main feature of neurofibromatosis I is - (i) Spots of hyperpigmentation and (ii) Cutaneous and subcutaneous neurofibromatous tumours'. Hyperpigmentation in Neurofibromatosis I takes two forms :? a) Cafe - au - lait spots' . These are patches of pigmentation and they appear sholy after bih' and occur anywhere on the body. . They are light brown in colour (cafe - au - lait) and do not change in number as the patient ages but they increase in size during pubey. . Presence of more than six cafe - au - lait spots > 1.5 cm in size is considered diagnostic of Neurofibromatosis. b) Freckles' . Neurofibromatosis I is also characterized by the presence of Freckles like or diffuse pigmentation of the axillae and other interiginous areas (groin, under breast) and small round whitish spots. When coupled with cafe au lait patches they are viually pathogtzomonice of the disease. ii) Neurofibromas a) Cutaneous tumours . They are situated in the dermis and form discrete soft or, firm papules. . They are ,flesh coloured or violaceous and often topped with comedo. When pressed, the soft tumours tend to invaginate through a small opening in the skin giving the feeling of a seedless raisin or a scrotum without a testicle. This phenomenon is spoken of as \"button holding\". b) Subcutaneous tumours . They take two forms ? a) Firm discrete nodules attached to a nerve. b) Plexiform neuromase (overgrowth of subcutaneous tissue sometimes reaching enormous size and occur most often in the face, scalp, neck and chest and may cause hideous disfigurement). Lisch Nodule'? This is another unique .finding of neurofibromatosiso. . It is a small whitish spote present in the iris. Tumours associated with Neurofibromatosis I are 1) Tumours of the CNS a) Optic Nerve Gliomao b) Non-optic Gliomas (usually low grade astrocytomas) c) Nonneoplastic ' hamaomatous\" lesion Osborn writes - \"The common CNS tumor in NF-1 is optic nerve glioma occuring in 5 to 15% of casese\" 2) Other tumours associated with NF-1 a) Pheochromocytoma b) Rhabdomyosarcoma c) leukemia (myeloid leukemia) d) Wilms tumour e) Juvenile Xanthogranuloma\n\nSo the answer to this question is A"}
{"instruction": "Population covered by a community health centre?\nA. 5000\nB. 30,000\nC. 100,000\nD. None", "response": "Ans. is 'c' i.e., 100,000\n\nSo the answer to this question is C"}
{"instruction": "Which of the following interactions does not cause film fog?\nA. Coherent scattering\nB. Transient scattering\nC. Photoelectric absorption\nD. Compton scattering", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "2, 3 DPG binds to __________ site of Hb and __________ release of O2\nA. One, increase\nB. Four, increase\nC. One, decrease\nD. Four, decrease", "response": "Fate of 2,3 - DPG2, 3-DPG is synthesized within RBCs from 3 phospho glyceraldehyde, which is a product of glycolysis the Embden-Meyerhof pathway.It is a highly charged anion that binds to the P chains of deoxy-hemoglobin. One mole of deoxyhemoglobin binds 1 mol of 2,3-DPG.HbO2 + 2,3-DPG = Hb - 2,3-DPG + O2In this equilibrium, an increase in the concentration of 2,3-DPGshifts the reaction to the right, causing more 02 to be liberated.Factors affecting 2,3-DPG concentration and affinity for hemoglobinIncreasing 2,3-DPGDecreasing 2,3-DPGChronic hypoxia egObstructive pulmonary emphysemaHigh altitudeCyanotic congenital hea diseaseAnaemiaeg.sickle cell HbAcidosisExerciseHormonesThyroid hormoneGrowth hormoneAndrogensPregnancyInosineDihydroxyacetonePyruvatePhosphateStored bloodFetal hemoglobinAlkalosis\n\nSo the answer to this question is A"}
{"instruction": "A 43-year-old man presents with signs and symptoms of peritonitis in the right lower quadrant. The clinical impression and supportive data suggest acute appendicitis. At exploration, however, a tumor is found; frozen section suggests carcinoid features. For each tumor described, choose the most appropriate surgical procedure. A 2. 5-cm tumor at the base of the appendix (SELECT 1 PROCEDURE)\nA. Appendectomy\nB. Segmental ileal resection\nC. Cecectomy\nD. Right hemicolectomy", "response": "Carcinoid tumors are most commonly found in the appendix and small bowel, where they may be multiple. They have a tendency to metastasize, which varies with the size of the tumor. Tumors <1 cm uncommonly metastasize. Tumors >2.0 cm are more often found to be metastatic. Metastasis to the liver and beyond may give rise to the carcinoid syndrome. The tumors cause an intense desmoplastic reaction. Spread into the serosal lymphatics does not imply metastatic disease; local resection is potentially curative. When metastatic lesions are found in the liver, they should be resected when technically feasible to limit the symptoms of the carcinoid syndrome. When extensive hepatic metastases are found, the disease is not curable. Resection of the appendix and cecum may be performed to prevent an early intestinal obstruction by locally encroaching tumor.\n\nSo the answer to this question is D"}
{"instruction": "A patient presents with the clinical features of interstitial lung disease. How will you confirm the diagnosis: September 2007, 2010\nA. CT scan\nB. X - Ray\nC. Bronchoscopy\nD. MRI", "response": "Ans. A: CT Scan CT scans are often the first diagnostic step for interstitial lung disease and may also help rule out other conditions that may cause similar symptoms. Pulmonary function tests (PFTs) are noninvasive tests that measure the function of the lungs. Spirometer can measure the volume of the lungs as well as the air flow into and out of the lungs. Biopsies or washings may be taken of the lungs and airways during bronchoscopy.\n\nSo the answer to this question is A"}
{"instruction": "Which is not a feature of pilonidal sinus:\nA. Branching tracts are common\nB. Recurrence is uncommon\nC. Bony involvement is uncommon\nD. Seen in Drivers", "response": "\"Recurrence is common, even though adequate excision of the track is carried out.\" - Bailey & Love \"Once an acute episode has resolved, recurrence is common\"- Schwartz 9/e p1067\nPilonidal disease\nPilonidal disease consists of a hair-containing abscess or chronic sinus, occurring in the intergluteal cleft.\nIt is an acquired disease\nAlthough earlier it was thought to be a congenital disease, it is now considered to be an acquired infection of natal cleft hair follicles. The hair follicles become infected and rupture into the subcutaneous tissues to form a pilonidal abscess. Hair from surrounding skin is pulled into the abscess cavity by the friction generated by the gluteal muscles during walking.\nMore common in males\nThe incidence of pilonidal disease is more common in males (3:1 male: female ratio) between ages 15 & 40 with peak incidence between 16 & 20 yrs.\nPilonidal ds is more common in people with more body hair (hirsute). The ds. is almost rare in persons with less body hair.\nTreatment of choice is surgery\nPilonidal sinus should be excised along with the secondary openings. (But only after controlling acute infection).\nAcute pilonidal abscesses and sinus ds can be managed by simple incision and drainage (under local anesthesia).\n\nSo the answer to this question is B"}
{"instruction": "Breast conservation surgery is contraindicated in-\nA. Pregnancy\nB. Axillary node involvement\nC. Subareolar lump tnt\nD. Large pendulous breast", "response": "Ans. is 'a' i.e., Pregnancy Conservative breast cancer managementAbsolute ContraindicationsPregnancy is an absolute contraindication to the use of breast irradiation. However, in many cases, it may be possible to perform breast-conserving surgery in the third trimester and treat the patient with irradiation after delivery.Women with tw o or more primary tumors in separate quadrants of the breast or with diffuse malignant- appearing microcalcifications are not considered candidate for breast conservation treatment.A history of prior therapeutic irradiation to the breast region that would require retreatment to an excessively high total-radiation dose to a significant volume is another absolute contraindication.Persistent positive margins after reasonable surgical attempts.Relative ContraindicationsA history of collagen vascular disease is a relative contraindication to breast conservation treatment because published reports indicate that such patients tolerate irradiation poorly. Most radiation oncologists will not treat patients with scleroderma or active lupus erythematosus, considering it an absolute contraindication. In contrast, rheumatoid arthritis is not a relative or an absolute contraindication.The presence of multiple gross tumors in the same quadrant and indeterminate calcifications must be carefully assessed for suitability because studies in this area are not definitive.Tumor size is not an absolute contraindication to breast conservation treatment, although there is little published experience in treating patients with tumor sizes greater than four to five cm. However, a relative contraindication is the presence of a large tumor in a small breast in which an adequate resection would result in significant cosmetic alteration. In this circumstance, preoperative chemotherapy should be considered.Breast size can be a relative contraindication. Large pendulous breast is a relative contraindication, as it presents difficulty in delivering a uniform radiation dose.Centrally located tumor for which removal of the nipple areola complex is required to obtain a tumor free margin is a relative contraindication. It depends on patient acceptability. The nipple and areola can now be reconstructed.\n\nSo the answer to this question is A"}
{"instruction": "A 3 year old boy with normal developmental milestones with delayed speech and difficulty in communication and concentration is not making friends. Most probable diagnosis is:\nA. Autism\nB. ADHD\nC. Mental retardation\nD. Specific learning disability", "response": "Autism is a neurologic disorder characterized by, Qualitative impairments in social interaction Qualitative impairments in communication Restricted repetitive and stereotyped patterns of behavior, interests, and activities Ref: Goldson E., Reynolds A. (2012). Chapter 3. Child Development & Behavior. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.\n\nSo the answer to this question is A"}
{"instruction": "A patient presents with a severe form of atopic asthma. Which of the following changes would most likely be found in this patient's blood?\nA. Basophilic leukocytosis\nB. Eosinophilic leukocytosis\nC. Lymphocytosis\nD. Monocytosis", "response": "An increased number of eosinophils (AKA eosinophilia) occurs in association with several conditions, the most frequent of which are immune-mediated diseases (e.g., asthma, hay fever, and pemphigus vulgaris) and parasitic infestations. This is due to an absolute increase in the number of circulating eosinophils, brought about by IL-5, which stimulates differentiation of eosinophilic precursor cells in the bone marrow.Basophilic leukocytosis is a rare event that is sometimes observed in association with chronic myelogenous leukemia. It is not seen in patients with asthma. Lymphocytosis may result from a vast array of conditions, but it is not typical of asthma or other allergic diseases. Lymphocytosis may develop in response to a number of infections (e.g., brucellosis, whooping cough, hepatitis, infectious mononucleosis, and tuberculosis) or manifest as pa of chronic lymphocytic leukemia. Monocytosis refers to an increase in number of monocytes, which are circulating macrophages. Chronic infections (e.g., tuberculosis, rickettsiosis, and malaria) and chronic inflammatory conditions (e.g., collagen vascular diseases and inflammatory bowel disease) are the most common underlying causes.\n\nSo the answer to this question is B"}
{"instruction": "Cause of bladder cancer are all except: March 2011\nA. Alcohol\nB. Naphthylamine exposure\nC. Cigarette smoking\nD. Schistosoma hematobium", "response": "Ans. A: Alcohol Cigarette smoking is the main aetiological factor for bladder carcinoma 2-naphthylamine may be carcinogenic Urothelial cell carcinoma may be strongly associated with Schistosoma haematobium infection (bilharzial bladder cancer) Carcinoma urinary bladder: Over 90% are transitional cell Ca Carcinogenic compounds: - 2 - Naphthylamine - Methylene dianiline - Benzidine - 0-toluidine Occupations at risk of bladder Ca: - Textile workers - Dye workers - Tyre workers Squamous cell Ca may be seen with: - Schistosomiasis - Stones - Irradiation - Smoking Primary adenoCa may be seen with: - From urachal remnants - From area of glandular metaplasia MC site: Trigone and posterior wall MC symptom: Painless hematuria Cystoscopy is main stay of evaluation Filling defect on IVU is the MC sign Intravesical BCG vaccine may be used in initial stages Other terms: Kiss cancer: Benign bladder tumour Tear drop bladder: Pelvic hematoma\n\nSo the answer to this question is A"}
{"instruction": "Marker for pancreatic non-functional neuro-endocrine tumor is\nA. Chromogranin-A\nB. CD100\nC. CEA\nD. PSA", "response": "Ans is 'a' i.e. Chromogranin-A Chromogranin-A (CgA) is a glycoprotein used commonly as a tumor marker in histopathology but also has elevated circulating levels in patients with both functional and non-functional PNETs.Other markers for PNETs - pancreatic polypeptide (PPP), pancreastatin, and neuron-specific enolase (NSE).\n\nSo the answer to this question is A"}
{"instruction": "Mission Indradhanush is for\nA. non communicable disease\nB. universal immunization\nC. Family planning\nD. safe water and sanitization", "response": "ref : park 21st ed\n\nSo the answer to this question is B"}
{"instruction": "Efficacy of Measles vaccine after second dose:-\nA. 90%\nB. 95%\nC. 99%\nD. 100%", "response": "Efficacy of Measles Vaccine:- >90% with 1 dose. >99% with 2 doses. (AMMRS Strategy)\n\nSo the answer to this question is C"}
{"instruction": "Most effective HDL raising drug is:\nA. Omega three fatty acids\nB. Niacin\nC. Fenofibrate\nD. Rosuvastatin", "response": "Niacin is the most effective HDL raising drug currently available. Niacin is the only drug currently available that lowers Lipoproteinp(a), and can be considered as an addition to a statin in patient with elevated Lp(a). Statins have a modest HDL-raising effect (5-10%). Fibrates are the most effective drugs available for reducing triglyceride levels and also raise HDL-C levels modestly. Omega three fatty acids are also effective in raise HDL level. Ref: Harrisons principles of internal medicine, 18th edition, Page: 3161\n\nSo the answer to this question is B"}
{"instruction": "GnRH agonist is used in all EXCEPT\nA. Delaying puberty in individuals with precocious puberty\nB. Endometriosis\nC. Hypoestrogenism\nD. Congenital adrenal hyperplasia", "response": "(C) Hypoestrogenism# Gonadotropin-Releasing Hormone Agonist (GnRH agonist, GnRH-A) is a synthetic peptide modeled after the hypothalamic neurohormone GnRH that interacts with the gonadotropin-releasing hormone receptor to elicit its biologic response, the release of the pituitary hormones FSH and LH.# H agonists are useful in:> Suppression of spontaneous ovulation as part of controlled ovarian hyperstimulation, which is an essential component in in vitro fertilisation (IVF).> Typically, after GnRH agonists have induced a state of hypoestrogenism, exogenous FSH is given to stimulate ovarian follicle, followed by human chorionic gonadotropins (hCG) to trigger oocyte release.> GnRH agonists routinely used for this purpose are: buserelin, leuprorelin, nafarelin, and triptorelin.> Final maturation induction after having performed controlled ovarian hyperstimulation.> Usage of GnRH agonist for this purpose necessitates using a GnRH antagonist instead of a GnRH agonist for suppression of spontaneous ovulation, because using GnRH agonist for that purpose as well inactivates the axis for which it is intended to work for final maturation induction.> Treatment of cancers that are hormonally sensitive and where a hypogonadal state decreases the chances of a recurrence. Thus they are commonly employed in the medical management of prostate cancer and have been used in patients with breast cancer.> Treatment of delaying puberty in individuals with precocious puberty.> Delaying puberty pending treatment decisions in children with gender incongruency> Management of female disorders that are dependent on estrogen productions.> Women with menorrhagia, endometriosis, adenomyosis, or uterine fibroids may receive GnRH agonists to suppress ovarian activity and induce a hypoestrogenic state.> Suppressing hormone levels in transsexual people, especially trans women.> Severe cases of congenital adrenal hyperplasia> Side effects of the GnRH agonists are signs and symptoms of Hypoestrogenism, including hot flushes, headaches, and osteoporosis.\n\nSo the answer to this question is C"}
{"instruction": "The following are true of vibrio cholerae excepta) Produces indole and reduces nitratesb) Synthesises neuraminidasec) Dies rapidly at low temperatured) Vaccine confers long immunity\nA. ab\nB. bc\nC. cd\nD. ac", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Warm autoinumne hemolytic anaemia may be seen in all of the following conditions except :\nA. Systemic lupus erythematous\nB. a-Methyl dopa therapy\nC. Non hodgkin's lymphoma\nD. Mycoplasma pneumonia", "response": "Answer is D (Mycoplasma Pneumonia) Mycoplasma pneumoniae infections are associated with a cold antibody haemolytic anemia Autoimmune hemolytic anemias are characterized by formation of autoantibodies against patient's own red cells. Depending upon reactivity of autoantibodies these are fuher divided into two types. Warm Antibody Hemolytic Anemia Cold Antibody Hemolytic Anemia * Antibodies here bind with antigens (on RBC) at * Antibodies here bind with antiens (on RBC) better at body temperature (37degC) temperatures lower than 37degC * These antibodies are called warm antibodies and are * These antibodies are called cold reactive antibodies and are nearly IgG (Rarely IgM or IgA) usually IgM Q Causes Causes 1. Idiopathic 1. Acute: Mycoplasma infection Q Infectious mononucleosis e 2. Lymphomas: CLL Q,Non-Hodgkins, etc 2. Chronic : IdiopathicQ 3. SLE deg and other Collagen Vascular Diseases 3. Paroxysmal cold hemoglobinuria e 4. Drugs: eg. a MethyldopaQ Mechanism of Hemolysis Mechanism of Hemolysis Human red cells cooled with IgG are trapped by splenic Antibodies of IgM type bind on Red cell surface and cause macrophages - red cell destruction agglutination. Hemolytic effect is mediated through fixation of C3 to RBC surface.Q Diagnosis Diagnosis Positive direct Coomb's test, at 37degC for presence of Positive direct Coomb's test for detection of C3 on the red cell warm antibodies on surface of Red cellQ surface but 1gM responsible for coating on red cells is not Positive Indirect Coomb's test at 37degC for presence of large quantities of warm antibodies in serum. Q found. Q\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is used to compare two data sets taken on two different scales of measurement?\nA. Variance\nB. Coefficient of variation\nC. Standard error of mean\nD. Standard deviation", "response": "Ans. b. Coefficient of variation (Ref: http://en.wikipedia.org/wiki/Coefficient_of_yariation)Coefficient of variation is used to compare two data sets taken on two different scales of measurement.'For comparison between data sets with different units or widely different means, one should use the coefficient of variation instead of the standard deviation. - http://en.wikipedia.org/wiki/Coefficient_of_variationCoefficient of variation (CV)Coefficient of variation (CV) is a normalized measure of dispersion of a probability distribution or frequency distribution.It is defined as the ratio of the standard deviation to the mean.The absolute value of the CV is sometimes known as relative standard deviation (RSD). which is expressed as a percentage.AdvantagesDisadvantages* The coefficient of variation is useful because the standard deviation of data must always be understood in the context of the mean of the data.* In contrast, the actual value of the CV is independent of the unit in which the measurement has been taken, so it is a dimensionless number.* For comparison between data sets with different units or widely different means, one should use the coefficient of variation instead of the standard deviationQ.* When the mean value is close to zero, the coefficient of variation will approach infinity and is therefore sensitive to small changes in the mean. This is often the case if the values do not originate from a ratio scale.* Unlike the standard deviation, it cannot be used directly to construct confidence intervals for the mean.\n\nSo the answer to this question is B"}
{"instruction": "The best indicator for the measurement of \"completed family size\", that is, the number of children a woman would have through her reproductive years is -\nA. General feility rate\nB. Total feility rate\nC. Gross reproduction rate\nD. Net reproduction rate", "response": "Total feility Rate Is standardised Index for feility level Average no of children a woman would bear in her reproductive life span ; Also known as 'Period Total Feility Rate' Gives magnitude of approximately 'Completed family size' - No of alive children in a family Obtained by summing single year age-specific rates at a given time TFR is a synthetic rate : Is not actually counted, as thus would involve waiting until women compelete child bearing TFR (India) : 2.2 (2017) Replacement level of feility : (TFR=2.1): TFR at which new born girls would have an average of exactly 1 daughter over their lifetimes (women have just enough babies to replace themselves) Replacement TFR (industrialised countries) =2.1 Replacement TFR (developing countries) =2.5-3.3 Reolacemnet TFR (globally) = 2.33 Ref: Park 25th edition Pgno : 540\n\nSo the answer to this question is B"}
{"instruction": "What is/are effect on the membrane when extracellular concentration of K+ decreased?\nA. | magnitude of RMP\nB. | negativity of the membrane\nC. | magnitude of RMP\nD. | negativity of membrane", "response": "While K+ is positively charged and more abundant on the inside, there exists a great amount of negatively charged paicles (the anions), accounting for the negative charge inside the membrane. The cell membraneforms the border of a neuron and acts to control the movement of substances into and out of the cell. Ref guyton and hall textbook of medical physiology 12/e pg 58\n\nSo the answer to this question is B"}
{"instruction": "Following statements are true about Afrezza except\nA. Used for both Type I and Type II diabetes\nB. Substitute for long acting insulin\nC. It is a rapid acting insulin\nD. Used as inhaled insulin formulation and techno-sphere technology", "response": "Afrezza Approved in 2014 For both Type I and Type II diabetes Available as single-use caridges of 4 and 8 units Is rapid acting inhaled insulin, administered at the beginning of each meal * Inhaled insulin formulation (2.5mm) and technosphere technology Remember: Afrezza Not a substitute for long acting insulin Must be used in combination with long acting insulin in Type I diabetes Not recommended for treatment of Diabetic Ketoacidosis or in patient who smoke. Use restricted in Asthma Active lung cancer Chronic Obstructive Pulmonary Disease\n\nSo the answer to this question is B"}
{"instruction": "Which of the following drugs have narrow therapeutic index\nA. Phenytoin\nB. Lithium\nC. Digoxin\nD. All of the above", "response": "Therapeutic index measures the safety of the drug. Wider therapeutic index safer is the drug. Hence, drugs like lithium, Phenytoin, Digoxin which have narrow therapeutic index can become either ineffective or toxic with small variations in the dosage.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is most useful for sex determination?\nA. Skull\nB. Femur\nC. Pelvis\nD. Tibia", "response": "Ans: C (Pelvis) Ref: The Essentials of Forensic Medicine and Toxicology by KS Moray an Reddy. 29th edition. 2010. Pg. 57-6/Explanation:According to Krogman theory, the degree of accuracy in sexing adult skeletal remains is:Entire Skeleton100 %Pelvis alone95 %Skull alone90 %Pelvis + Skull98 %Long bones alone80 %Some Important Difference Between Male and FemalePelvis (See Table-5)\n\nSo the answer to this question is C"}
{"instruction": "All of these are the adverse effects of naloxone in the treatment of opioid poisoning except.\nA. Hypeension\nB. Pulmonary edema\nC. Seizures\nD. Ventricular dysrrythmia", "response": "Adverse effects of naloxone are uncommon, may include rise in BP , pulmonary edema,ventricular dysrrythmia. Ref: KD Tripati 8th ed.\n\nSo the answer to this question is C"}
{"instruction": "What is TRUE about antinuclear antibody (ANA) -\nA. Anti-RNA antibody is specific for SLE\nB. Double stranded Anti-DNA is specific for SLE\nC. ANA normally present in 80%\nD. None of the above", "response": "Ans. is 'b i.e., Double stranded Anti-DNA is specific for SLE \"Antibodies to double - stranded DNA and the Smith (Sm) antigen are viually diagnostic of SLE\". -- Robbins Antibodies in SLE SLE is an autoimmune disease and the fundamental defect is a failure of mechanism that mantain self tolerance. o Failure of tolerance results in formation of autoantibodies and autoimmunity. o Amongst these antibodies, most impoant are antinuclear antibodies (ANA). ANAs are directed against several nuclear antigens and can be of following types. 1. Generic antinuclear antibody o Most common (between 95 to 100% of the patients). o Against DNA, RNA and proteins. o Most sensitive antibodies for SLE --> best screening test. o But, not specific because patients with other autoimmune diseases also show positive test. 2. Anti ds DNA antibody o Most specific for SLE o Not sensitive 3. Anti Smith (Sm) antibody o Along with anti ds DNA antibody, most specific for SLE. o Not sensitive 4. Antihistone antibody Paicularly seen in drug induced SLE. 5. Anti RNP- SS - A (Ro), SS-B (La) Seen in neonatal lupus with congenital hea block and in subacute cutaneous lupus. o Associated with decreased risk of lupus nephritis. o More common in sjogren syndrome (Sicca syndrome). 6. Anti Ui RNP Seen in patients that have overlap feature of several rheumatic syndromes including SLE Mixed connective tissue disease. 7. Anti DNA topoisonerase (Scl - 70) o In less than 5% of patients of SLE. o More common in patients with systemic sclerosis. 8. Anticentromere In less than 5% of patients of SLE. More common in patiens with localized form of systemic sclerosis, i.e. scleroderma. 9. Anti-histidyl t-RNA systhatase In less than 5% of SLE patiens. o More common in patiens with inflammatory myopathies. Besides antinuclear antibodies following antibodies are also seen in SLE ? 1. Antiphospholipid (lupus anticoagulant) 2. Antierythrocyte ---> causes hemolytic anemia 3. Antiplatelet --> Causes thrombocytopenia 4. Antiribosomal P 5. Antineuronal\n\nSo the answer to this question is B"}
{"instruction": "Not true about Glossopharyngeal neuralgia\nA. Eagle's syndrome\nB. Reichert syndrome\nC. Syncope is not seen\nD. Tonsillectomy has to be done to approach and treat glossoharyngeal neuralgia", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which is not a complication of PUVA therapy:\nA. Premature aging of skin\nB. Cataracts\nC. Skin cancers\nD. Exfoliative", "response": "D. i.e. Exfoliation\n\nSo the answer to this question is D"}
{"instruction": "Diencephalon represents\nA. Lateral ventricle\nB. 3rd ventricle\nC. 4th ventricle\nD. Aquedct", "response": "The diencephalon is the pa of brain between the cerebrum and brainstem.The cavity within it is called third ventricleThe pas of diencephalon are:ThalamusMetathalamusEpithalamusSubthalamusHypothalamus(Ref: Vishram Singh textbook of clinical neuroanatomy Second Edition pg -123)\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is not targeted in Millenium Development Goals (MDGs)?\nA. Eradicating extreme povey\nB. Fostering global panership for development\nC. Reducing child moality\nD. Improving health care delivery", "response": "Governments have set a date of 2015 by which they would meet the MDGs I.e, eradicate extreme povey and hunger;achieve universal primary education;promotes gender equality;improve maternal health,ensure environmental sustainability and develop a global panership for development (refer pgno:893 park 23rd edition)\n\nSo the answer to this question is D"}
{"instruction": "All of the following are causes of primary amenorrhea, EXCEPT:\nA. Rokitansky syndrome\nB. Sheehan syndrome\nC. Kollman syndrome\nD. Turner syndrome", "response": "Sheehan's syndrome, characterized by postpaum amenorrhea, results from postpaum pituitary necrosis secondary to severe hemorrhage and hypotension and is a rare cause of secondary amenorrhea. Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome) is the second most common cause of primary amenorrhea. Kallmann syndrome results from defective hypothalamic gonadotropin-releasing hormone (GnRH) synthesis and is associated with anosmia or hyposmia due to olfactory bulb agenesis or hypoplasia. It is a cause of primary amenorrhea. Patients with Turner's syndrome usually present with primary amenorrhea. Must know: Causes of Secondary Amenorrhea: Common: Pregnancy Hypothalamic amenorrhea Pituitary amenorrhea Androgen disorders: polycystic ovarian syndrome, adult-onset adrenal hyperplasia Galactorrhea-amenorrhea syndrome Less Common: Premature ovarian failure Asherman's syndrome Sheehan's syndrome Drug-induced amenorrhea Rare: Diabetes Hypehyroidism or hypothyroidism Cushing's syndrome or Addison's disease Cirrhosis Infection Malnutrition Irradiation or chemotherapy Hemosiderosis Ref: Simon A., Chang W.Y., DeCherney A.H. (2013). Chapter 54. Amenorrhea. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.\n\nSo the answer to this question is B"}
{"instruction": "Fournier's gangrene is seen in: September 2008\nA. Scrotum\nB. Shaft of penis\nC. Base of penis\nD. Glans penis", "response": "Ans. A: Scrotum Idiopathic scrotal gangrene/Fournier's gangrene is an uncommon condition of the scrotum. Hemolytic streptococci are associated with other organisms (Staph., E.coli etc.) in a fulminating inflammation of the subcutaneous tissues, which results in obliterative aeritis of the aerioles to the scrotal skin.\n\nSo the answer to this question is A"}
{"instruction": "Caustic poison erodes mucosa because\nA. Glue like action\nB. Hygroscopic in nature\nC. High affinity for mucosa\nD. Being programmed to stick", "response": "B i.e. Hygroscopic in nature Caustic alkalis are the commonest cause of chemical burns. The hydroxyl ion produces a saponification of fat, soluble alkaline proteinases, cellular dehydration hygroscopic excrating water from tissues)Q, exothermic reaction, coagulation of cellular proteins and conversion of hemoglobin into haematin. Mainly in the local tissues of alimentary tract (or rarely respiratory) mucosa.\n\nSo the answer to this question is B"}
{"instruction": "Smallest unit of antigenicity\nA. Epitope\nB. Paratope\nC. Idiotype\nD. Hapten", "response": "Epitope of antigenic determinant is the smallest unit of antigenicity.\n\nSo the answer to this question is A"}
{"instruction": "\"Guidance to eruption\" is another term for\nA. Frankel's appliance\nB. Activator\nC. Serial extraction\nD. Bionator", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "alder-Reilley bodies are seen in -\nA. Mucopolysacharidosis\nB. Langerhans Histiocytosis\nC. Alport's syndrome\nD. Chediak-Higashi syndrome", "response": "Ans. is 'a' i.e., Mucopolysacharidosis Hypersegmentationo The presence of abnormally increased nuclear lobulation, is one of the first hematologic abnormalities seen in megaloblastic anemia.o Normal mature circulating neutrophils have an average of 3 lobes and always fewer than 5 lobes. Eosinophils have fewer than 4 lobes and basophils have fewer than 3 lobes.o More than 3 cells having 5 lobes or a single cell with 6 lobes found in the course of a 100 cell differential is evidence of hypersegementation.o Hypersegmentation is sometimes referred to as a myeloid \"right shift\". Hypersegmentation may accompany other disorders in which there is a disturbance of maturation, such as iron defiency.Pelger-Huet anomalyo A congenital autosomal dominant disorder in which granulocyte nuclei fail to segment normally, o In the homozygote state the nucleus is round. In heterozygotes most granulocytes have bilobed nuclei (\"pince- nez\" cells) resembling bands.o The trait is benign and occurs in 1 in 6,000 people. Cell function is normal.o An acquired or pseudo-Pelger-Huet anomaly is seen in myelodysplastic disorders and following drug therapy and may accompany leukemia and certain infections.Toxic granulationo Toxic granulation is found severe inflammatory states.o The toxic granules are azurophilic, usually found in the promyelocyte, metamyelocyte, band and segmented stages.o The toxic granulation is thought to be due to impaired cytoplasmic maturation, in the effort to rapidly generate large numbers of granulocytes.L Dohie bodieso L Dohie bodies are single or multiple blue cytoplasmic inclusions.o They represent remnants of rough endoplasmic reticulum from earlier maturational stages.o They are associated with myeloid \"left shifts\" and are seen in conjuction with toxic granulation.May-Hegglin anomalyo May-Hegglin anomaly is a rare autosomal dominant abnormality characterized by large pale basophilic inclusions resembling Dohie bodies and appear to be altered RNA.o Giant platelets and sometimes thrombocytopenia are associated with this. The anomaly is usually but may be associated with bleeding.The chedlak-Hagashi syndromeo The chedlak-Hagashi syndrome is a rare autosomal recessive condition associated with abnormally large leukocyte granules resulting from fusion of lysozymes.o This disorder may affect granulocytes, leukocytes and monocytes. Chemotaxis and phagocytosis is defective.o Platelets lack dense granules and platelet function is abnormal.o Giant melanosomes in occular and skin tissues result in hypopigmentation.The alder-reillv anomalyo The alder-reilly anomaly is associated with the genetic mucopoly-saccharidoses.o Patients with mucopolysaccharidoses lack the lysozymal enzymes necessary to break down mucopolysaccharides.o Dense azurophilic granules, resembling toxic granulation in neutrophils, are seen in all leukocytes.o Most characteristic of these disorders are the metachromatic granules surrounded by a clear zone seen in lymphocytes.Alder Reiilv granuleso Alder Reilly granules are larger than normal azurophilic and basophilic granules (Alder-Reilley bodies) in the cytoplasm of granulocytes, monocytes and lymphocytes seen in patients with mucopolysaccharodosis, mucopolysulfatidosis and lipofuscinosis.o Alder reilley granules stain iliac with wright giemsa and are metachromatic with toluidene blue. They are evenly distributed throughout the cytoplasm and at times may be so dense as to partially obscure the nuclear.\n\nSo the answer to this question is A"}
{"instruction": "Actinomycosis is commonly seen in -\nA. Tibia\nB. Mandible\nC. Scapula\nD. Femur", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Glycosylated hemoglobin in a normal pregnant lady should be less than:\nA. 4.50%\nB. 5.50%\nC. 6.50%\nD. 7.50%", "response": "The cut off for glycosylated hemoglobin in a pregnant lady is less than 6.5 %.\n\nSo the answer to this question is C"}
{"instruction": "The substrate depleted earliest in the postoperative period is\nA. Branched-chain amino acids\nB. Non-branched-chain amino acids\nC. Glycogen\nD. Glucose", "response": "The metabolic response to surgery (and other trauma) is a result of neuroendocrine stimulation that sharply accelerates protein breakdown, stimulates gluconeogenesis, and produces glucose intolerance. The glycogen stores are rapidly depleted because of a fall in insulin and a rise in glucagon levels in the plasma. The peripheral effects of the neuroendocrine secretion result in an increase in plasma levels of amino acids, free fatty acids, lactate, glucose, and glycerol. In the liver, the coisol and glucagon stimulate glycogenolysis, gluconeogenesis, and increased substrate uptake.\n\nSo the answer to this question is D"}
{"instruction": "Radiation dose monitoring in occupational personal is done by\nA. TLD Badge\nB. Linear accelerator\nC. Collimators\nD. Grid", "response": "ref : david sutton\n\nSo the answer to this question is A"}
{"instruction": "All of the following are suggestive of low lesion in Anorectal malformation except ?\nA. Bucket handle deformity\nB. Midline raphe fistula\nC. Meconuria\nD. Perineal fistula", "response": "Clinical clues suggestive of low lesion 1. Bucket handle deformity - Prominent midline skin tag stem tag below which one can pass an instrument 2. Midline Raphe fistula 3. Perineal fistula - Presence of meconium coming out through a small opening anterior to anal dimple 4. Anal stenosis - Narrow anal canal 5. Anal membrane - Very thin epithelial membrane through which one can see meconium Meconuria and Flat bottom are signs suggestive of High lesion .\n\nSo the answer to this question is C"}
{"instruction": "Sho structured primi gravida has height less then\nA. 140 cm\nB. 145 cm\nC. 150 cm\nD. 135 cm", "response": "140 cm\n\nSo the answer to this question is A"}
{"instruction": "Delivery of stimulus above threshold intensity leads to a constant amplitude of AP and is known as:\nA. All or none law\nB. Electronic potential\nC. Absolute refractory period\nD. Relative refractory period", "response": "All or none principle - - Once AP, is elicited at any point on membrane of normal fiber, depolarization process travels over entire membrane if conditions are right, but it doesn't travel at all if conditions are not right. This is all or none principle. Relative refractory period: - It is the time, at which muscle is difficult to excite than normal but can be excited by very strong excitatory signal. Absolute refractory period: - Period during which 2nd action potential cannot be elicited, even with strong stimulus . Electronic potential: - Work per unit of charge required to move a charge from reference point to specified point is called electric potential.\n\nSo the answer to this question is A"}
{"instruction": "Peribulbar injection is given in:\nA. Subtenon space\nB. Muscle case\nC. Periorbital space\nD. Subperiorbital space", "response": "C i.e. Periorbital space Peribulbar injection is given in peripheral orbital space Q\n\nSo the answer to this question is C"}
{"instruction": "Following is not true about adipocere formation\nA. It's a modification of putrefaction\nB. Its developed in the presence of moist air\nC. It occurs in dead bodies lying in water\nD. Body has rotten & foul smell", "response": "Adipocere has rancid butter/ ammonical smell Mummification is odourless Decomposition is foul smelling Factors Influencing Adipocere Formation : A warm, moist and anaerobic environment ors adipocere formation. i. Environmental temperature: Heat accelerates, and cold retards adipocere formation in a body. ii. Moisture: Moisture is essential for chemical reactions to occur. It occurs rapidly in bodies submerged in water than in damp soil. iii. Bacterial infection: Early activity by anerobes such as Clostridium perfringens assist in the reaction, as the bacteria produce lecithinase which facilitates hydrolysis and hydrogenation. iv. Built: In obese people and mature newborn, it is formed quickly. v. Age: Fetuses < 7 months do not show adipocere formation. vi. Air current: It retards adipocere formation by evaporation of the body fluid, and by reducing the body temperature. vii.Running water: Adipocere formation is retarded as the electrolytes are washed away from the surface of the body which is necessary for the change.\n\nSo the answer to this question is D"}
{"instruction": "All statements are true about Paget-Schroetter syndrome except\nA. Also known as Venous thoracic outlet syndrome\nB. Associated with Jugular-subclan venous thrombosis(JSVT)\nC. H/O performing prolonged activities\nD. Results in damage to the subclan vein", "response": "Paget-Schroetter syndrome Also k/a Venous thoracic outlet syndrome or Effo thrombosis Associated with Axillary-subclan venous thrombosis (ASVT) C/F : H/O performing prolonged activities ,Repetitive motion activities, Results in damage to the subclan vein, where it passes between head of clavicle and first rib in association with the subclavius muscle.\n\nSo the answer to this question is B"}
{"instruction": "Bankart's lesion is seen at\nA. Post surface of glenoid labrum\nB. Ant surface of glenoid labrum\nC. Ant part of head of humerus\nD. Post part of head of humerus", "response": "Ans. is 'b' i.e Ant. Surface of glenoid labrum In anterior dislocation of shoulder following pathological changes are seen*.Bankart's lesion :Ant. Dislocation causes stripping of the glenoid labrum along with the periosteum from the anterior surface of the glenoid and scapular neck.The head thus comes to lie in front of the scapular neck, in the pouch thereby created.Hill Sach's lesion :This is a depression on the humeral head in its postero-lateral quadrant*. Caused by impingement by the interior edge of the glenoid on the head as it dislocates.Roundening of the anterior glenoid rim occurs as the head dislocated over it.There may be associated fractures of the greater tuberosity of the humerus or of the rim of the glenoid.\n\nSo the answer to this question is B"}
{"instruction": "Maximal deaths in MI occurs within\nA. 0-24 hrs\nB. 24-48 hrs\nC. 48-72 hrs\nD. > 72 hrs", "response": "(A) 0-24 hrs > The vast majority of deaths due to ventricular fibrillation occur within the first 24 h of the onset of symptoms, and of these, over half occur in the first hour.> Therefore, the major elements of prehospital care of patients with suspected STEM I include Recognition of symptoms by the patient and prompt seeking of medical attention Rapid deployment of an emergency medical team capable of performing resuscitative maneuvers, including defibrillation Expeditious transportation of the patient to a hospital facility that is continuously staffed by physicians and nurses skilled in managing arrhythmias and providing advanced cardiac life support Expeditious implementation of reperfusion therapy\n\nSo the answer to this question is A"}
{"instruction": "Delayed hypersensitivity in skin tests, is assessed by\nA. Erythema\nB. Bulla\nC. Necrosis\nD. Induration", "response": "Intradermal test for delayed hypersensitivity - Usually employed for infectious diseases. - Antigen is prepared from the respective infective agents and injected intradermally. - Significantly indurated nodule after 48 hrs is considered to indicate delayed hypersensitivity to the antigen. - Test continues to remain positive even after the infection has subsided, though active infections usually produce more severe reactions. -In overwhelming infections the test can completely become negative because of the suppression of delayed hypersensitivity. Erythema- redness of the skin or mucous membranes due to increased flow in superfiial cappillaries Bulla- clear fluid filled lession with size mor tha 0.5 cm Necrosis-irreversibe cell injury leading to cell death due to denaturation of proteins / enzymatic digestion of cells. it is always pathological and associated with inflamation\n\nSo the answer to this question is D"}
{"instruction": "A 29-years-old male taking oral hypoglycemic drug never had ketonuria in his life. His BMI is 20.5. His grandfather had diabetes and his father who is the only son of his grandfather too had the disease. Which type of DM this person will be most likely -\nA. Pancreatic\nB. MODY\nC. Type I\nD. Type II", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "T helper cells recognizes -\nA. MHC class I\nB. MHC class II\nC. Processed peptides\nD. Surface Ig", "response": "MHC restriction\n\nT cells (in contrast to B cells) cannot be activated by soluble antigens.\nTherefore, presentation of processed antigen by antigen presenting cells is required for induction of cell mediated immunity.\nT cell receptors recognizes peptide antigens that are displayed by major histo compatibility complex (MHC) molecules on the surface of antigen presenting cells.\nT cells develop MHC restriction so that :-\n\n\nHelper (CD4) T cells respond only to foreign antigens presented along with HLA class II (MHC class II).\nCD8 T cells respond to antigens presented along with HLA class I (MHC class I).\nMHC restriction refers to the fact that a given T cell will recognize a peptide antigen only when it is bound to a particular MHC molecule.\n\nSo the answer to this question is B"}
{"instruction": "All the following are true regarding Dracunculiasis, EXCEPT:\nA. The parasites reach adulthood by 6 months\nB. Control of cyclops help in the spread of the disease\nC. Mebendazole and niridazole are effective in preventing the transmission of the disease\nD. No effective vaccines are available to prevent the disease", "response": "Dracunculiasis has no diagnostic test for preclinical detection, no vaccine to immune at risk community and no drug to kill any stage of the parasite. The parasites reach adulthood by about 9 - 12 months. Ref: Park, Edition 21, Page - 223\n\nSo the answer to this question is C"}
{"instruction": "Which of the following diuretics will continue to induce significant diuresis after return of blood volume to normal levels?\nA. hydrochlorothiazide\nB. spironolactone\nC. triamterene\nD. furosemide", "response": "The loop diuretics inhibit tubular reabsorption of sodium, potassium, and chloride in the loop of Henle and can continue to cause diuresis even during volume contraction. The likely site of action of furosemide is in the thick ascending limb of the loop of Henle.\n\nSo the answer to this question is D"}
{"instruction": "NOT a content of carpal tunnel\nA. Flexor pollicis longus\nB. Flexor digitorum profundus\nC. Ulnar nerve\nD. Median nerve", "response": "Carpal tunnel Contents - 1. 4 tendons of Flexor Digitorum Profundus (FDP) 2. 4 tendons of Flexor Digitorum Superficialis (FDS) 3. 4 tendons of Flexor Pollicis Longus (FPL) 4. Median nerve Structure passing anterior to carpal tunnel: 1. Ulnar nerve 2. Ulnar aery 3. Palmaris longus tendon. Structure embedded into flexor retinaculum Flexor carpi radialis tendon.\n\nSo the answer to this question is C"}
{"instruction": "Anterior end of the spleen is held up by -\nA. Lienorenal ligament\nB. Phrenicocolic ligament\nC. Gastrosplenic ligament\nD. Gastrocolic ligament", "response": "Phrenicocolic ligament is not attached to the spleen but supports its anterior end.\n\nSo the answer to this question is B"}
{"instruction": "Left border of heart on chest X–ray is formed by -a) Aortic archb) Left Pulmonary arteryc) Right atriumd) Left ventriclee) Right ventricle\nA. b\nB. c\nC. ac\nD. ad", "response": "Amongst the given options, left heart border is formed by Aortic knuckle (formed by aortic arch) and left ventricle.\nSome guides have included left pulmonary artery in the answer. But, it is pulmonary trunk which forms left heart border (not left pulmonary artery).\n\nSo the answer to this question is D"}
{"instruction": "Light radiographic film is due to:\nA. Overdeveloping\nB. Overfixing\nC. Directly putting in fixer\nD. Exposure to sunlight", "response": "LIGHT RADIOGRAPHS \nProcessing Errors \nUnderdevelopment (temperature too low; time too short; thermometer inaccurate) Depleted developer solution \nDiluted or contaminated developer \nExcessive fixation \nUnderexposure \nInsufficient mA \nInsufficient kVp \nInsufficient time \nFilm-source distance too great \nFilm packet reversed in mouth \nDARK RADIOGRAPHS\nProcessing Errors \nOverdevelopment (temperature too high; time too long) \nDeveloper concentration too high \nInadequate time in fixer\nAccidental exposure to light \nImproper safelighting \nStorage of films without shielding, at too high a temperature, or past expiration date\nReference: White and Pharoah's Oral Radiology Principles and Interpretation 7th edition page no 80\n\nSo the answer to this question is B"}
{"instruction": "Most common cause of aortic dissection:\nA. Syphilis\nB. Hypertension\nC. Marfan syndrome\nD. Cystic medial necrosis", "response": "Ans. (b) HypertensionRef: Harrison 19th ed. /1640* 70% cases of aortic dissection occur due to hypertension. The tear occurs in tunica media and causes a tearing pain in the chest with maximum intensity in inter-scapular area. The IOC for aortic dissection is trans-esophageal echocardiography.* Marfan syndrome also can present with aortic dissection, which in fact is the leading cause of death in these patients. Syphilis involves the arch of aorta and causes an aneurysm that can rupture anyday.\n\nSo the answer to this question is B"}
{"instruction": "Blastomycosis may involve any of the following organs except(NOT RELATED)\nA. Skin\nB. Lungs\nC. Lymphatics\nD. Intestinal tract", "response": "Blastomycosis does not involve intestinal tract\n\nSo the answer to this question is D"}
{"instruction": "Immunity by vaccination is\nA. Active natural\nB. Passive natural\nC. Active acquired\nD. Passive acquired", "response": "Active immunity occurs as a result of infection or by specific immunization and is usually associated with the presence of antibodies or cells having a specific action on the microorganism or on its toxin. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 109\n\nSo the answer to this question is C"}
{"instruction": "In the human body, which of the following trace elements is next to iron:\nA. Ca2+\nB. Zn2+\nC. Cu2+\nD. Selenium", "response": "After Iron (18mg/day), zinc (11mg/day) comes next in total requirement among trace elements.Followed by manganese and copper.** NA, K, Ca, Cl, Ph, Mg are not trace elements.(ref: OP Ghai 8/e p123)\n\nSo the answer to this question is B"}
{"instruction": "WEBER'S test in otitis media will be\nA. Not lateralized\nB. Lateralised to poorer ear\nC. Lateralised to better ear\nD. Inconclusive", "response": "Otitis media causes conductive hearing lossWeber's testLateralized to poorer ear-conductive hearing lossLateralized to better ear-SNHLNo lateralization - NormalRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 24\n\nSo the answer to this question is B"}
{"instruction": "Watery diarrhea in children is caused by\nA. ETEC\nB. EPEC\nC. EIEC\nD. EAEC", "response": "Enteropathogenic E.coli: associated mainly with diarrhea in children and infants usually occurring as an institutional outbreak. The pathogenesis of EPEC diarrhea is not fully understood. EPEC is non-invasive and does not produce enterotoxin. Another mechanism is by adherence to the enterocyte membrane. This activity is regulated by the chromosomally coded locus of enterocyte effacement (LEE). This is a pathogenicity island by an intimin protein coded for by the eae gene. This results in the disruption of the brush border microvilli. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 285\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is a feature of marasmus and not kwarshiorkor?\nA. Vorac ious appe ti te\nB. Fatty change in liver\nC. Hypoalbuminemia\nD. Edema", "response": "Ref: Nelson's Textbook of Pediatrics. 19th Edition. Robbins Pathologic basis of disease, 8th edition. Page: & Vishnu Shot's Protein Energy Malnutrition. 1st ed.Peepee. Page: 121 135.Explanation:MARASMUS (Xonedeniatous malnutrition)It is characterized by failure to gain weight and irritability. followed by weight loss and listlessness until emaciation results.The skin loses turgor and becomes wrinkled and loose as subcutaneous fat disappears.Loss of fat from the sucking pads of the cheeks often occurs lateInfants are often constipated, but they can have starvation diarrhea, with frequent small stools containing mucus.The abdomen may be distended or flat. with the intestinal pattern readily visible.There is muscle atrophy and re su Itant hypotonia.Children often have Voracious appetiteAs the condition progresses, the temperature usually becomes subnormal (Hypothermia) and the pulse slowsKWASHIORKOR (Edematous malnutrition)It can occur initially as vague manifestations that include lethargy, apathy, and irritability.When kwashiorkor Is advanced, there is lack of growth. lack of stamina, loss of muscle tissue, increased susceptibility to infections, vomiting, diarrhea, anorexia, flabby subcutaneous tissues, and edema.Psychological changesThe edema usually develops early secondary to hypoalbum in emia.It is often present in internal organs before it is recognized in the face and limbs.Liver enlargement due to fatty liver can occur early or late in the course of disease.Dermatitis is common, with darkening of the skin in irritated areas, but in contrast to pellagra not in areas exposed to sunlight.Depigmentation can occur after desquamation in these areas, or it may be generalizedThe hair is sparse and thin, and in dark-haired children, it can become streaky red or gray.Eventually, there is stupor, coma and death\n\nSo the answer to this question is A"}
{"instruction": "All are true about extra lobar pulmonary sequestration except:\nA. More common in males\nB. Surrounded by seperate pleural covering\nC. Associated with multiple other anomalies\nD. Removed by either segmentectomy or lobectomy", "response": "There is less risk of infection in extralobar pulmonary sequestration as there is no bronchial communication in most of the cases.\n\nSo the answer to this question is D"}
{"instruction": "The infectious disease among following which closely resemble vasculitis is:\nA. Lyme disease\nB. Rubella\nC. Tuberculosis\nD. Leprosy", "response": "Infectious diseases that mimic vasculitis are: Bacterial endocarditis Disseminated gonococcal infection Pulmonary histoplasmosis Coccidioidomycosis Syphilis Lyme disease Rocky Mountain spotted fever Whipple's disease Ref: Harrison, E-18, P-2787.\n\nSo the answer to this question is A"}
{"instruction": "What is deficient in exclusively breast fed baby ?\nA. Vitamin B\nB. Vitamin A\nC. Vitamin C\nD. Proteins", "response": "Ans. is 'a' i.e., Vitamin B o Deficiency of Vitamin B12 may occur in exclusive breastfed infants of mother who is on strict vegetarian diet. Remember following impoant facts ? o Milks from the mother whose diet is sufficient and properly balanced will supply all the necessary nutrients except fluoride and Vitamin D. o The iron content of human milk is low, but most normal term infants have sufficient iron stores for the first 4-6 months. Human milk iron is well absorbed. Nonetheless, by 6 months the breast-fed infant's diet should be supplemented with iron foified complementary foods. o The Vitamin K content of human milk is low and may cause hemorrhagic disease of newborn.\n\nSo the answer to this question is A"}
{"instruction": "Adrenal medulla secretes all EXCEPT:\nA. Epinephrine\nB. Nor epinephrine\nC. Dopamine\nD. Coisol", "response": "Coisol REF: Ganong 22ed chapter20 \"Coisol is secreted by adrenal coex not medulla\" \"Norepinephrine, epinephrine, and dopamine are secreted by the adrenal medulla\"\n\nSo the answer to this question is D"}
{"instruction": "A middle aged female repoed with dull diffuse progressive headache of 2 months duration associated with episodes of vomiting and blurred vision at times. Cough increases the headache.Likely patient has\nA. Vascular headache\nB. Intracranial space occupying lesion\nC. Intracerebral hemorrhage\nD. Acute pyogenic meningitis", "response": "A space-occupying lesion of the brain is usually due to malignancy but it can be caused by other pathology such as an abscess or a haematoma. Almost half of intracerebral tumours are primary but the rest have originated outside the CNS and are metastases Features of a headache indicating a high risk of a space-occupying lesion of the brain or idiopathic intracranial hypeension include: A new headache with features suggestive of raised intracranial pressure, including papilloedema, vomiting, posture-related headache, or headache waking the patient from sleep Ref Harrison20th edition pg 2456\n\nSo the answer to this question is B"}
{"instruction": "The following is not a feature of Alzeimer's disease?\nA. Neurofibrillary tangles\nB. Senile (neuritic) plaques\nC. Amyloid angiopathy\nD. Lewy bodies", "response": "Ans. is d ' i.e.;Lewy bodies Impoant pathological findings in Alzheimer's disease. i) Coical atrophy with sidening of the cerebral sulci. ii) Compensatory ventricular enlargement Hydrocephalus exvacuo. iii) Neuritic (senile) plaques Made up of A f3,0 & A1342. iv) Diffuse plaques --> Contain Ab42. v) Neurofibrillary tangles --> Contain tau protein vi) Cerebral amyloid angiopathy. vii) Granulovascular degeneration Hirano bodies\n\nSo the answer to this question is D"}
{"instruction": "The amino acid which is associated with atherosclerosis is\nA. Lysine\nB. Homocysteine\nC. Cysteine\nD. Alanine", "response": "Ref Harrison 19 th ed pg 1579 There is a strong positive correlation between atherosclerosis and circulating levels of homocysteine.\n\nSo the answer to this question is B"}
{"instruction": "Splanchnic vessels and venules contain- % of blood volume:\nA. 20-Oct\nB. 20-30\nC. 40-50\nD. 60-70", "response": "Under normal resting conditions splanchnic circulation receives 25-28% of the cardiac output. It is also a large reservoir of blood containing about 20-25% of total blood volume. The splanchnic circulation consists of the vascular beds of spleen, GIT and liver. Splanchnic blood flow curses through Control over the splanchnic bed in response to stress is central. Stimulation of carotid and aoic baroreceptors cause causes sympathetic neural stimulation of splanchnic resistance and capacitance vessels and a large decrease in venous capacitance size. Ref: Moss and Adams' Hea Disease in Infants, Children, and Adolescents page 62.\n\nSo the answer to this question is B"}
{"instruction": "This radiological appearance is seen with which medical disorder?\nA. Rickets\nB. Thalassemia\nC. Osteopetrosis\nD. Acromegaly", "response": "The image shows X ray of hand showing SPADE LIKE PHALANX. This is seen in Acromegaly. Signs Visual field defects Broad nose Large tongue Goiter Prominent supraorbital Ridge Prognathism Interdental separation Galactorrhoea Hirsutism Thick greasy skin Carpal tunnel syndrome Spade like hands Large feet Tight rings Proximal myopathy Ahopathy Hea failure Hypeension Oedema Glycosuria\n\nSo the answer to this question is D"}
{"instruction": "Most common extra skin manifestation of varicella is involvement of ?\nA. CNS\nB. Lungs\nC. Kidneys\nD. CVS", "response": "Ans. is 'a' i.e., CNS The most common extracutaneous site of involvement in children is the CNS - Harrison Complications - The most common infectious complication of varicella is secondary bacterial superinfection of the skin, which is usually caused by streptococcus pyogenes or Staphylococcus aureus. - The most common extracutaneous site of involvement in children is CNS. - Varicella pneumonia is the most serious complication following chickenpox in adults. Complications CNS Pulmonary Others . Cerebellar ataxia . Pneumonia . Myocarditis . Meningitis . Nephritis . Encephalitis . Ahritis . G.B Syndrome . Hepatitis . Transverse Myelitis . Corneal lesions . Reye's Syndrome (with H/O salicylates) . Bleeding diasthesis\n\nSo the answer to this question is A"}
{"instruction": "Intervertebral disc is which type of joint -\nA. Primary cartilaginous\nB. Secondary cartilaginous\nC. Pivot\nD. Ellipsoid", "response": "Ans. is 'b' i.e., Secondary cartilaginous Cartilaginous joints1) Primary cartilaginous joints (synchondrosis, or hyaline cartilage joint) : These are :-i) Joint between epiphysis and diaphysis of a growing long bone, i.e. physis.ii) Spheno-occipital jointiii) 1st costostemal joint (1st chondrosternal joint)iv) Costochondral joints2) Secondary cartilaginous joints (Symphyses or fibrocartilaginous joints) : These are:-i) Symphysis pubisii) Sacroccygeal jointiii) Manubriostemal jointiv) Intervertebral discv) Symphysis menti\n\nSo the answer to this question is B"}
{"instruction": "Features of rheumatic carditis are all except ?\nA. Aschoff nodule\nB. Lymphatic infiltration\nC. Myocardial fibrosis\nD. Intramyocardial microemboli", "response": "Ans. is 'd' i.e., Intramyocardial microemboli\n\nSo the answer to this question is D"}
{"instruction": "Pseudopolyps are typically seen in\nA. Crohn's disease\nB. Ulcerative colitis\nC. Celiac disease\nD. Tropical sprue", "response": "Ans. is 'b' i.e., Ulcerative colitis Pseudopolyps are typically seen in Ulcerative colitis. The involved mucosa in ulcerative colitis shows broad based ulcers are aligned along the long axis of the colon. Isolated\n\nSo the answer to this question is B"}
{"instruction": "Secondary syphilis is characterized by the following except -\nA. Occurs 6-8 weeks after development of chancre\nB. Painful and itchy maculopapular lesions\nC. Constitutional features are present\nD. Meningitis, hepatitis, glomerulonephritis and uveitis may occur", "response": "The protean manifestations of the secondary stage usually include mucocutaneous lesions and generalized nontender lymphadenopathy. The skin rash consists of macular, papular, papulosquamous, and occasionally pustular syphilides; often more than one form is present simultaneously. The eruption may be very subtle, and 25% of patients with a discernible rash may be unaware that they have dermatologic manifestations. Involvement of the hair follicles may result in patchy alopecia of the scalp hair, eyebrows, or beard in up to 5% of cases. Constitutional symptoms that may accompany or precede secondary syphilis include sore throat (15-30%), fever (5-8%), weight loss (2-20%), malaise (25%), anorexia (2-10%), headache (10%), and meningismus (5%). Acute meningitis occurs in only 1-2% of cases. Less common complications of secondary syphilis include hepatitis, nephropathy, gastrointestinal involvement (hyperophic gastritis, patchy proctitis, or a rectosigmoid mass), ahritis, and periostitis. (Harrison's Principles of internal medicine, 20th edition, page 1382)\n\nSo the answer to this question is B"}
{"instruction": "All are seen in primary extraglandular Sjogren syndrome except -\nA. Rheumatoid ahritis\nB. Raynaud's phenomena\nC. Lymphoma\nD. Splenomegaly", "response": "Ans. is 'a' i.e., Rheumatoid ahritiso Primary Sjogren syndrome is not associated with other autoimmune disorders, e.g. Rheumatoid ahritis. o Sjogren syndrome occurs in elderly (50-60 yrs)female.\n\nSo the answer to this question is A"}
{"instruction": "Foot eversion is caused by\nA. Extensor digitorum\nB. Peroneus longus\nC. Tibialis anterior\nD. Tibialis posterior", "response": "Foot eversion occurs at subtalar joint by Peroneus longus, Peroneus brevis and Peronius Teius. Inversion of foot done by Tibialis anterior and Tibialis posterior.\n\nSo the answer to this question is B"}
{"instruction": "Choristoma is\nA. Dilated vascular malformation\nB. Malignant stroma of stem cells\nC. Normal tissue at abnormal site\nD. Benign tumour in which normal elements become abnormally overgrown", "response": "Choristoma Ectopic rest of normal tissue Eg: pancreatic tissue in submucosa of stomach\n\nSo the answer to this question is C"}
{"instruction": "All of following statements are true regarding Q fever except.\nA. It is a zoonotic infection.\nB. Human disease is characterized by an interstitial pneumonia\nC. No rash is seen\nD. Weil Felix reaction is very useful for diagnosis.", "response": "Ans. is 'd' i.e. Weil Felix reaction is very useful for diagnosis Q. Fever is caused by a Rickettsia, Coxiella BurnettiCoxiella burnetti is unique to Rickettsia because it has an endospore form. This endospore form confers properties to the bacteria that differ from other Rickettsiae :Resistance to heat and dryingExtracellular existence :- The spores resistance allows extended survival outside a host cell. However like chlamydiae and other Rickettsiae growth and division must occur intracellularly using the host's ATP.Non arthropod transmission: Coxiella burnetti grows in tick and cattles. The spores remains viable in dried tick faeces deposited on cattle hides and in dried cow placentas. These spores are aerosolized and when inhaled cause human disease. So spore inhalation rather than an arthropod bite causes Q fever.Pneumonia: Because the spores are inhaled into the lungs, a mild pneumonia similar to that of a mycoplasma pneumonia (interstitial pneumonia) often develops. Clinical features are :Abrupt onset of fever and soaking sweatsThis is the only rickettsial disease that causes pneumonia and in which there is no rash.Weil Felix is a simple and useful test for the diagnosis of some Rickettsial disease.It is positive in -Epidemic typhus*Endemic typhus*Brill Zinsser disease * (weekly positive)It is negative in -Rickettsial pox*Q. Fever*Trench feverPrinciple of Weil Felix test :Some Rickettsia share antigenic characteristics with certain strains of Proteus Vulgaris (0X19 and 0X2) and proteus mirabilis (OXK). It is purely coincidental that they have the same antigens. Proteus is not involved at all in rickettsial diseases.The Weil Felix reaction is a classic test that uses these cross reacting proteus antigens to help confirm diagnosis of a rickettsial infection.This test is done by mixing the serum of a patient suspected of having a rickettsial disease, with antigens from specific strains of proteus. If the serum has antirickettsial antibodies, latex beads coated with proteus antigens will agglutinate.\n\nSo the answer to this question is D"}
{"instruction": "Which is NOT a function of gastrin?\nA. Stimulation of gastric acid\nB. Stimulation of pepsin\nC. Stimulation of growth of the gastric mucosa\nD. Stimulation of direct cholesterol absorption", "response": "Stimulation of cholesterol absorption is not a function of gastrin. Gastrin has been shown to have effects on gut motility (increase). Pepsin release by gastrin is for breakdown of food into smaller paicles for fuher digestion. Growth of the gastric mucosa is also dependent upon gastrin. Gastrin also causes concentration of the musculature that closes the gastroesophageal junction. It stimulates insulin and glucagon secretion, but only after a protein meal and not a carbohydrate meal. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 25. Overview of Gastrointestinal Function & Regulation. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.\n\nSo the answer to this question is D"}
{"instruction": "Most common cause of empyema is\nA. Bronchopleural fistula\nB. Tubercular pneumonia\nC. Bacterial pneumonia\nD. Pleurisy", "response": "Empyema thoracic is collection of pus in pleural space and is synonymous with grossly purulent exudative parapneumonic effusions. Ref Harrison 19th edition pg 951\n\nSo the answer to this question is C"}
{"instruction": "Ramesh 40 yrs male patient presenting with polyuria, pain abdomen, nausea, vomiting, altered sensorium was found to have bronchogenic carcinoma. The electrolyte abnormality seen in him would be:\nA. Hypokalemia\nB. Hyperkalemia\nC. Hypocalcaemia\nD. Hypercalcemia", "response": "Answer is D (Hypercalcemia): Presence of polyuria, abdominal pain, and general symptoms such as nausea, vomiting and altered sensorium in a patient with bronchogenic carcinoma suggest a diagnosis of hypercalcemia secondary to paraneoplastic syndrome from PTII related peptide production.\n\nSo the answer to this question is D"}
{"instruction": "Cancer management in which of the following malignancies has dramatically increase the survival:\nA. Glioblastoma multiforme\nB. Esophageal carcinoma\nC. ALL in children\nD. Cholangiocarcinoma", "response": "Ans. c. ALL in children (Ref: of the outcome of acute lymphoblastic leukemia in children Terzah M Horton, MD, PhD: http:// en. wikipedia. org/ wiki/ Acute_lymphoblastic_leukemia)\"Acute leukemia is the most common form of cancer in children, comprising approximately 30 percent of all childhood malignancies. Of the acute leukemias, acute lymphoblastic leukemia (ALL) occurs five times more commonly than does acute myeloid leukemia (AML). Survival rates for ALL have improved dramatically since the 1980s, with a current five- year overall survival rates estimated at greater than 85 percent. This improvement in survival is due to treatment of a large number of children on sequential standardized research protocols.\"- style=\"font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif\"> of the outcome of acute lymphoblastic leukemia in children Terzah M Horton. MD, PhD\"Prognosis of ALL: The survival rate has improved from zero, four decades ago to 20-75 percent currently, largely due to clinical trials on new chemotherapeutic agents and improvements in stem cell transplantation (SCT) technology. New drugs, and matching treatment to the genetic characteristics of the blast cells, may improve those rates.\"- http:// en.wikipedia.org/wiki/Acute_lymphohlastic_leukemia;\n\nSo the answer to this question is C"}
{"instruction": "A 63-year-old man presents to the emergency department because of transient symptoms of vertigo, slurred speech, diplopia, and paresthesia. He is symptom-free now, and clinical examination is entirely normal. His past medical history is significant for osteoarthritis, hypertension, and dyslipidemia. Which of the following is the most likely cause for symptoms?\nA. posterior circulation transient ischemic attack (TIA)\nB. anterior communicating artery aneurysm\nC. hypertensive encephalopathy\nD. pseudobulbar palsy", "response": "Posterior circulation TIA is suggested by the constellation of symptoms (vertigo, dysarthria, and diplopia and the transient episode of his symptoms. The basilar artery is formed by the two vertebral arteries and supplies the pons, the midbrain, and the cerebellum with vertebrobasilar TIAs, tinnitus, vertigo, diplopia, ataxia, hemiparesis, and bilateral visual impairment are common findings. This patient does not have occlusion of the middle cerebral artery since it results in cortical symptoms of motor and sensory loss on the contralateral side. This is also not hypertensive encephalopathy since it causes confusion, headache, nausea, vomiting, and focal neurologic signs.\n\nSo the answer to this question is A"}
{"instruction": "Inheritance of Gardner syndrome is\nA. Autosomal recessive\nB. Autosomal dominant\nC. X linked\nD. None of the above", "response": "Gard*ner syn*drome Multiple polyposes predisposing to carcinoma of the colon; also multiple tumors, osteomas of the skull, epidermoid cysts, and fibromas; autosomal dominant inheritance, caused by mutation in the adenomatous polyposis coli gene (APC) on chromosome 5q. This disorder is allelic to familial adenomatous polyposisRef: Harrison &;so manual of Medicine 19th edition Page no: 325\n\nSo the answer to this question is B"}
{"instruction": "Fracture of hyoid bone is indicative of: FMGE 09, 11; Maharashtra 09; AP 11; NEET 13\nA. Manual strangulation\nB. Ligature strangulation\nC. Bansdola\nD. Hanging", "response": "Ans. Manual strangulation\n\nSo the answer to this question is A"}
{"instruction": "Disulfiram mechanism of action ?\nA. Stimulates alcohol dehydrogenase\nB. Stimulates aldehyde dehydrogenase\nC. Inhibits aldehyde dehydrogenase\nD. Inhibits dopamine oxidase", "response": "Ans. is 'c' i.e., Inhibits aldehyde dehydrogenase\n\nSo the answer to this question is C"}
{"instruction": "1 part per million fluoride is:\nA. 1 mg in 10 L of water\nB. 1 mg in 1 L of water\nC. 10 mg in 1 L of water\nD. 100 mg in 10 L of water", "response": "ppm (or ppmm) is used to measure the concentration of a contaminant in soils and sediments. In that case, 1 ppm equals 1 mg of substance per liter of solid (mg/liter).\n\nSo the answer to this question is B"}
{"instruction": "Flower 'Vase' pattern of the pelvis in an intravenous urogram is seen in -\nA. Polycystic kidney\nB. Renal carcinoma\nC. Horse shoe kidney\nD. Ectopic kidney", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "All of the following are associated with polycystic ovarian syndrome except:\nA. Ovarian carcinoma\nB. Endometrial carcinoma\nC. Insulin resistance\nD. Osteoporosis", "response": "Ans. is d, i.e. OsteoporosisRef: Leon Speroff 7th/ed, p470-480, 8th/ed, p500-518; Novak 14th/ed, p1082, 15th/ed, p1085Relationship between bone mineral density and Insulin resistance in PCOS Journal of Bone mineral metabolism vol 19, Number 4, July 2001, p 257-262This was definitely one of the most controversial questions in AIPG 2010. Endometrial cancer and insulin resistance are seen in PCOD. Osteoporosis is never seen in PCOD patients.What about ovarian cancer?The main theory for development of epithelial ovarian cancer (which accounts for 85-90% of all ovarian CA) is the \"Theory of incessant ovulation\" which means \"more the ovulation, more the risk\".But in PCOS there is anovulation and hence per say it is protective for CA ovary.But, PCOS patients are infertile and ovulation induction is required for treatment of infertility. Use of ovulation inducing agents like gonadotrophins, clomiphene letrozole, etc. is one of the risk factors for development of ovarian cancer. This is how PCOS can be associated CA ovary. So the studies are still going on whether ovarian cancer leads to PCOS or not:\"The risk of ovarian cancer is increased two to threefold in woman with PCOS.\" - Ref: Novak 15th/ed, p1085\n\nSo the answer to this question is D"}
{"instruction": "True about Apoptosis are all except\nA. Inflammation is present\nB. Chromosomal brekage\nC. Clumping of chromatin\nD. Cell shrinkage", "response": "Fragments of the apoptotic cells then break off, giving the appearance that is responsible for the name (apoptosis, \"falling off\"). The plasma membrane of the apoptotic cell remains intact, but the membrane is altered in such a way that the cell and its fragments become avid targets for phagocytes. The dead cell and its fragments are rapidly cleared before cellular contents have leaked out, so apoptotic cell death does not elicit an inflammatory reaction in the host. Apoptosis differs in this respect from necrosis, which is characterized by loss of membrane integrity, enzymatic digestion of cells, leakage of cellular contents, and frequently a host reaction.( Robbins Basic Pathology, 9 th edition, page 18 )\n\nSo the answer to this question is A"}
{"instruction": "Vimal, a 70 years old male presents with a h/o lower GI bleed for last 6 months. Sigmoidoscopic examination shows a mass, of 4 cms about 3.5 cms above the anal verge. The treatment of choice is ?\nA. Colostomy\nB. Anterior resection\nC. Abdominoperineal resection\nD. Defunctioning anastomosis", "response": "Ans. is 'c' ie. Abdominoperineal resection Treatment of rectal cancer Surgical and oncologic management varies greatly depending on the stage and location of the tumor within the rectum. Superficially invasive, small cancers may be managed effectively with local excision. However, most patients have more deeply invasive tumors that require major surgery, such as Low anterior resection (LAR) or APR. a) Low anterior resection: This is sphincter saving procedure. In this procedure the sigmoid colon and proximal rectum are removed The descending colon is anastomosed to the distal rectum. Previously this sphincter saving LAR procedure was possible for lesions confined in upper 2/3'd of rectum. Lesions in lower third were treated with APR with permanent colostomy. With the introduction of stapling gun, the sphincter saving LAR operation can now be done even in lesions of lower 1/3 rectum, provided a margin of 2 cm or more of normal bowel can be resected below the lesion but above the dentate line. (some books write that even 1cm margin can be adequate, but provided the carcinoma is well differentiated) Devito Oncology writes- \"Tumors within 1 to 2 cm of the dentate line, that is those that can be removed with at least a 1-cm distal margin, can be resected and intestinal continuity restored with a coloanal azzastomosis.\" b) Abdominoperineal resection (also k/a Miles procedure) : There is complete excision of the distal sigmoid colon, rectum and anus, by concomitant dissection through the abdomen and perineum with creation of a permanent colostomy. APR is performed when adequate distal margins for low anterior resection cannot be obtained i.e. for carcinomas in lower rectum. c) Local excision: In carefully selected patients with small, well differentiated, superficial, mobile polypoid lesions, a full thickness excision can be performed through the transanal route as the definitive therapy. Local excision can be done for selected T1 and T2 lesions without evidence of nodal disease. Transanal excision can spare the patient the morbidity of a more extensive rectal resection. However, it does not stage the nodal drainage areas and therefore cannot provide as complete staging and management of the tumor as a definitive resection. Tumors considered for local excision must meet a number of criteria to minimize the risk of local regional recurrence. Devita's Oncology writes- \"Generally, local excision is limited to tumors within 8 to 10 cm of the anal verge, encompass less than 40% of circumference of the bowel wall, are of well or moderately well differentiated histology, and have no pathological evidence of venous or lymphatic vessel invasion on biopsy.\" Various technical approaches have been described to achieve transanal local excision, including use of a special proctoscope equipped with a magnifying camera (transanal endoscopic microsurgery). Transanal endoscopic microsurgery makes use of a specially designed proctoscope, magnifying system, and instruments similar to those used in laparoscopy to allow local excision of lesions higher in the proximal rectum. d) Palliative procedures: Unresectable rectal cancers can be palliated by fulgration (electrocoagulation) or laser photocoagulation. e) Chemoradiation: Chemoradiation can be given as adjuvant or neoadjuvant therapy. Also know: Haman's procedure This is a compromise type of resection in which the rectum and/or sigmoid colon are resected and an end colostomy done. Anastomosis and perineal dissection of the distal rectum and perineum are not done. This procedure is used - if there is too much obstruction or sepsis to allow a safe anastomosis. - for elderly or severly unstable pts. who would not stand a lengthy ant resesction or an APR procedure. In this pt. the tumor lies 3.5 cms above the anal verge (the lower limit is taken into consideration). Dentate line is 2 cm from the anal verge (Ref: Devito Oncology 8/e), so this lesion is just about 1.5 cm above the dentate line. A minimum margin of 2 cm is required below the tumor for sphincter saving LAR, so this patient will have to go an APR procedure to remove the tumor.\n\nSo the answer to this question is C"}
{"instruction": "Tinea ungium affects:\nA. Nail fold\nB. Nail plate\nC. Joints\nD. Interdigital space", "response": "Tinea unguium is clinically defined as dermatophytic infection of the nail plate. Dermatophytic Skin Disease Location Of Lesions Tinea corporis Nonhairy, smooth skin. Tinea pedis (athlete's foot) Interdigital spaces on feet of persons wearing shoes. Tinea cruris (jock itch) Groin. Tinea capitis Scalp hair. Tinea barbae Beard hair (Note -Sycosis barbae is folliculitis of beard hair caused by Staphylococcus) Tinea unguium Nail Tinea Manuum Hand\n\nSo the answer to this question is B"}
{"instruction": "Increased ICT is associated with all except:\nA. Paraparesis\nB. Abducent paralysis\nC. Headache\nD. Visual blurring", "response": "Increased intra cranial tension (ICT) is associated with headache, vomiting, visual blurring and diplopia (abducent paralysis). Paraparesis maybe a localizing sign but rarely associated with increased intracranial tension. Ref: API 6th Edition, Page 707, 708; Davidson's principles and practice of Medicine, 20th Edition, Chapter 26, Page 1235.\n\nSo the answer to this question is A"}
{"instruction": "Cowden syndrome is commonly associated with\nA. Renal cell carcinoma\nB. Thymic Carcinoid\nC. Cerebellar haemangioblastoma\nD. Hamartoma", "response": "(D) Hamartoma # Cowden syndrome (also known as \"Cowden's disease,\" and \"Multiple hamartoma syndrome\") is a rare autosomal dominant inherited disorder characterized by multiple tumor-like growths called hamartomas and an increased risk of certain forms of cancer.> Stauffer syndrome - paraneoplastic, non-metastatic liver disease is a sign of Renal cell carcinoma.> Thymic carcinomas are, for the most part, of epithelial origin, although a few other unusual cell types can be found. All these lesions are very uncommon, and several are rare. They include some with low malignant potential (eg, well-differentiated squamous cell carcinoma, basaloid carcinoma, mucoepidermoid carcinoma) and those with features of a more aggressive malignancy (E.g., Sarcomatoid carcinoma, clear cell carcinoma, neuroendocrine carcinoma, lymphoepitheliomalike tumors, anaplastic undifferentiated tumors).\n\nSo the answer to this question is D"}
{"instruction": "A 10 years old female presented with recurrent attacks of cholangitis. CECT was done, the diagnosis on the basis of CECT is:\nA. Type 1 choledochal cyst\nB. Type 3 choledochal cyst\nC. Type 4 choledochal cyst\nD. Type 5 choledochal cyst", "response": "The CECT shows central dot; which is seen in type 5 choledochal cyst/ Caroli's disease Choledochal cyst.- Characterized by dilatation of bile duct. TODANI modification of ALONSO LEJ classification: -- Type I - dilatation of extra hepatic bile duct (MC)- Type II - diveicular dilatation of extra hepatic bile duct- Type III - dilatation of intraduodenal pa of bile duct (choledochocele)- Type IV (A) - dilatation of both intra and extra hepatic bile duct- Type IV (B) - multiple cyst involving only extra hepatic bile duct - Type V - multiple cyst involving only intra hepatic bile duct (Caroli's disease)\n\nSo the answer to this question is D"}
{"instruction": "All of the following facts related to chronic inflammation are true, except:\nA. It can be severe and progressive.\nB. Granulomas are an example of chronic inflammation.\nC. Dominant cells in chronic inflammation are neutrophils.\nD. Chronic inflammation is involved in pathogenesis of metabolic syndrome and ceain cancers.", "response": "Chronic inflammation is of longer duration and is associated with:- Granulomatous reaction is a pattern of chronic inflammatory response. Presence of macrophages (dominant cells), lymphocytes and plasma cells. The proliferation of blood vessels, deposition of connective tissue. It is severe and progressive. Chronic inflammation is implicated in pathogenesis of neurodegenerative diseases, metabolic syndrome, type 2 diabetes and ceain cancers.\n\nSo the answer to this question is C"}
{"instruction": "All are side effects of OC pills except -\nA. Weight gain\nB. Breast discomfo\nC. Ovarian malignancy\nD. DVT", "response": "park's textbook of preventive and social medicine 23rd edition. *cardiovascular effects:myocardial infarction, cerebral thrombosis,and venous thrombosis. *carcinogenesis:increased risk of cervical cancer with increased duration of use. *metabolic effects:elevation of blood pressure, alteration in serum lipid,increased blood glucose level ,breast tenderness,weight gain,head ache and migraine, liver disorder,premature cessation of lactation,ectopic pregnancy, delayed subsequent pregnancy, foetal developmental defect\n\nSo the answer to this question is C"}
{"instruction": "Von-Meyenburg's complexes are seen in -\nA. Brain\nB. Liver\nC. Kidney\nD. Spleen", "response": "Von Meyenburg Complexes\n\nClose to or within the portal tract, these are small clusters of modestly dilated bile ducts embedded in a fibrous, sometimes hyalinised stroma.\nAlthough these \"bile duct microhamartomas\" may communicate with the biliary tree, they generally are free of the pigmented material tree.\nThey presumably arise from residual embryonic bile duct remnants. Occasionally, a triangular bile duct hamartoma may lie just under Glisson's capsule.\n\nPolycystic liver disease\n\nThere are multiple diffuse cystic lesions in the liver.\n\nCongenital hepatic fibrosis\n\nPortal tracts are enlarged by irregular, broad bands of collagenous tissue, forming septa that divide the liver into irregular islands.\nVariable numbers of abnormally shaped bile ducts are embedded in the fibrous tissue and are in continuity with the biliary tree.\n\nCaroli disease\n\nThe larger ducts of the intrahepatic biliary tree are segmentally dilated and contain inspissated bile.\n\nSo the answer to this question is B"}
{"instruction": "All are features off haemolytic uremic syndrome,EXCEPT-\nA. Hyperkalemia\nB. Anaemia\nC. Renal microthrombi\nD. Neuro psychiatric disturbances", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "A 45-year-old man presented with regurgitated food paicles eaten several days earlier. He has foul smelling breath and occasional dysphagia for solid food. What is the probable diagnosis\nA. Gastric outlet obstruction\nB. Zenker's diveiculum\nC. Scleroderma\nD. Diabetic gastroparesis", "response": ".OESOPHAGEAL DIVEICULUM can be of two types mainly, *Pulsion diveiculum: a. Pharyngeal pouch through Zenker's or Killian's dehiscence. b. Epiphrenic pulsion diveiculum occurs in the lower oesophagus, usually towards the right side, due to obstruction in the distal oesophagus or due to uncoordinated LOS relaxation. 2. Traction diveiculum: Occurs in mid-oesophagus or in the parabronchial region, is due to mediastinal granulomatous disease like tuberculosis. Investigations * A barium swallow is typical. * Oesophagoscopy and endosonography. * CT Chest as the final evaluation. Treatment * Treat the cause. * Excision of the diveiculum - epiphrenic diveiculectomy. * Cricopharyngeal myotomy or lower oesophageal myotomy with the antireflux procedure is usually required. Ref: SRB&;s manual of surgery,3 rd ed, pg no 751\n\nSo the answer to this question is B"}
{"instruction": "Which structure resembles radiographically with PDL of maxillary 2nd molar?\nA. Greater palatine foramen\nB. Median palatine foramen\nC. Zygomatic process\nD. Angle of maxilla", "response": "Greater palatine foramen is seen as a radiolucent area (oval or round). Rarely, it is seen in the periapical film over the roots of first molar and sometimes at the apices of second premolar and second molar. This should not be confused with periapical pathologies.\n\nSo the answer to this question is A"}
{"instruction": "Gettlers test is for\nA. Hanging\nB. Strangulation\nC. Burns\nD. Drowning", "response": "Ans. is 'd' i.e., Drowning Gettler test Gettler test is done for drowning. It estimates chloride content of blood from both sides of hea. Normally the chloride content is equal in the right and left chambers of the hea (600 mg/100 ml). In fresh water drowning due to hemodilution the chloride content is decreased and in salt water drowning due to hemoconcentration the chloride content is increased in left side of hea. A 25% difference in chloride is significant but the test is of doubtful value. Limitations of gettler test:? 1. No value in atypical drowning; congenital cardiac defects as shunts and patent foramen ovale; and if drowning medium contains same amount of chloride. 2. There is progressive loss of Cl- from blood after death. Therefore the test has to be made within a reasonably sho time after death\n\nSo the answer to this question is D"}
{"instruction": "In osteomalacia which of the following biochemical feature is true?\nA. Elevated serum calcium level\nB. Elevated serum phosphate level\nC. Elevated serum alkaline phosphatase\nD. Elevated 25-hydroxyvitamin D3", "response": "In osteomalacia, serum ALP (alkaline phosphatase) levels are raised, 25(OH)D levels are low or undetectable, PTH is elevated, serum calcium and phosphate levels may also be low but normal values do not exclude the diagnosis. Reference : page 1127 Davidson's Principles and practice of Medicine 22nd edition\n\nSo the answer to this question is C"}
{"instruction": "Treatment for motion sickness for a trip next morning?\nA. Scopalamine patch a night before\nB. Tab. Ranitidine one night before and then before the trip\nC. Dimenhydrinate 1 hour before\nD. Omeprazole", "response": "ANS. AFor the prophylaxis of motion sickness, apply scopalamine one patch behind ear at least 4-12 hours (preferably 12 hour) before anticipated exposure to motion.\n\nSo the answer to this question is A"}
{"instruction": "A patient presents with unconjugated hyperbilirubinemia and elevated urobilinogen levels in urine. The most likely diagnosis is -\nA. Hemolytic Jaundice\nB. Crigler Najjar syndrome\nC. Gilbert's syndrome\nD. Dubin Johnson syndrome", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Necrobiosis Lipoidica Diabeticorum is most marked on:\nA. Forearms\nB. Face\nC. Front of legs\nD. Back of legs", "response": "Necrobiosis Lipoidica Diabeticorum is an uncommon disorder, accompanying diabetes in predominantly young women. This usually begins in the Pretibial region as an erythematous plaque or papules that gradually enlarge, darken, and develop irregular margins, with atrophic centers and central ulceration. They are often painful. The etiology is microangiopathy.\n\nSo the answer to this question is C"}
{"instruction": "The common cause of subarachnoid hemorrhage is-\nA. Arterio-venous malformation\nB. Cavernous angioma\nC. Aneurysm\nD. Hypertension", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which of laryngeal cailage is elastic?\nA. Epiglottis\nB. Corniculate\nC. Cuneiform\nD. Thyroid", "response": "The other cailages of the larynx, e.g. epiglottis corniculate, cuneiform and processes of the arytenoid are made of elastic cailage and do not ossify. Epiglottic Cailage/Epiglottis is a leaf-shaped cailage placed in the anterior wall of the upper pa of the larynx. Its upper end is broad and free and projects upwards behind the hyoid bone and the tongue. The lower end is pointed and is attached to the upper pa of the angle between the two laminae of the thyroid cailage. Ref: BD Chaurasia's HUMAN ANATOMY, Volume 3, 4th edition.\n\nSo the answer to this question is A"}
{"instruction": "Enzyme alglucerase is used in the treatment of ?\nA. Gaucher's disease\nB. Galactosemia\nC. Niemann Pick disease\nD. Pompe's disease", "response": "Ans. is 'a' i.e., Gaucher's diseaseAlglucerase (ceredase) is used in the treatment of Gaucher's disease.\n\nSo the answer to this question is A"}
{"instruction": "Masculinising tumours of the ovary :\nA. Dysgerminoma\nB. Embryonal cell carcinoma\nC. Arrhenoblastoma\nD. None", "response": "Arrhenoblastoma\n\nSo the answer to this question is C"}
{"instruction": "All of the following is true about hydroxyurea except:\nA. Cause myelosuppression\nB. Oral bioavailability is very less\nC. Used in CM L\nD. Act as radiosensitizer", "response": "Ans: B (Oral...) HYDROXYUREA# Hydroxyurea is an analog of urea whose mechanism of action involves the inhibition of DAM synthesis by inhibiting the enzyme ribonucleotide reductase, resulting in depletion of deoxynucleoside triphosphate pools. This agent exerts its effects in the 5 phase of the cell cycle.The drug is administered orally and has nearly 100% oral bioavailability.It is mainly used in chronic myelogenous leukemia, blast crisis of acute myeloid leukemia , psoriasis & sickle cell anaemiaHowever, it is also effective as an adjunct with radiation therapy(as radiosensitizer) for head and neck cancer and in treating essential thrombocytosis and polycythemia vera.Myelosuppression is the dose-limiting toxicity, but nausea and vomiting, mucositis and diarrhea, headache and increased lethargy, and a maculopapular skin rash with pruritus are also observed.\n\nSo the answer to this question is B"}
{"instruction": "Internal laryngeal nerve runs along which border of Pharyngeal muscle\nA. Medial\nB. Lateral\nC. Superior\nD. Inferior", "response": "Ref: BD Chaurasia&;s HUMAN ANATOMY, Volume 3, 4th edition. The superior laryngeal nerve arises from the inferior ganglion of the vagus, runs downwards and forwards on the superior constrictor deep to the internal carotid aery, and reaches the middle constrictor where it divides into the external and internal laryngeal nerves. The internal laryngeal nerve is thick. It passes downwards and forwards, pierces the thyrohyoid membrane above the superior laryngeal vessels. It supplies the mucous membrane of the larynx upto the level of the vocal folds.\n\nSo the answer to this question is C"}
{"instruction": "A patient presented with 2 months history of increased ICP, with massive parietal edema, CT/MRI shows single and were circumscribed region lesion\nA. Granuloma\nB. Metastases\nC. Glioblastoma\nD. All of the above", "response": "(A) Granuloma > Granuloma usually presents with increased ICP, with massive parietal edema. CT/MRI shows single circumscribed region lesion. Gliomas include astrocytomas, oligodendrogliomas and mixed tumours. Common sites include the cerebellum, optic nerve and chiasma, hypothalamus and brainstem. Diffuse astrocytomas (WHO grade II) are most common in the fourth decade of life and often present with seizures or are incidental findings. CT scan shows enhancement which is often irregular around a centre of low density which may represent necrosis calcification may be present. Cerebral metastases are by far the most common intracranial tumours and will affect approximately one in every four cancer sufferers. They tend to occur in the fifth to seventh decades. The majority of patients with cerebral metastases have multiple lesions. Metastatic tumours show isodense on unenhanced CT and enhance vividly on intravenous contrast.\n\nSo the answer to this question is A"}
{"instruction": "All are true about cancrum oris except -\nA. Associated with malnutrition and vitamin deficiency\nB. Follows chronic infection\nC. Involves jaw\nD. Treatment is excision and skin grafting with tubed pedicle graft", "response": "Answer is 'b' i.e. Follows chronic infection Cancrum oris (also k/a Noma and Gangrenous stomatitis) Cancrum oris is now rarely seen in developed countries, but is still not uncommon in many developing countries. It is a gangrenous process of the mouth, which stas suddenly, rapidly involve the adjacent tissues of the face, quickly becomes well demarcated, and then spreads no fuher. It most often affects one or both sides of the jaw, and occasionally the front of the face (mouth, lips, nose & chin). The gangrenous process may spread to destroy the bones of the face. This disease occurs primarily in severely malnourished child less than 5 yrs of age. Often they have had a preceeding illness such as measels, malaria, scarlet fever, tuberculosis, malignancy or immunodeficiency, which has weakened the general health of the child. The exact cause is not known, but may be bacterial. Fusiformis & Borrelia are largely responsible, but the ds. is not contigious. Untreated cancrum oris is almost always quickly fatal, due to associated illness or a complication, such as septicemia or aspiration pneumonia. Management involves a) correction of general condition b) antibiotics (Penicillin + Metronidazole) c) Excision of the dead tissue d) Plastic surgery Coming to the question, the best choice is option 'b' i.e. follows chronic infection, as the ds. not always follows an infection. The infectious ds deteriorates the general health of the child who becomes susceptible to cancrum oris because of his poor health.\n\nSo the answer to this question is B"}
{"instruction": "Treatment of choice for prophylaxis in patients with repeated episodes of bipolar illness: March 2004\nA. Lithium\nB. Valproate\nC. A + B\nD. None of the above", "response": "Ans. C i.e. A + B Ref: Kumar and Clark's\n\nSo the answer to this question is C"}
{"instruction": "Punishment for perjury is covered under section -\nA. 191 IPC\nB. 193 IPC\nC. 195 IPC\nD. 197 IPC", "response": "Ans. is 'b' i.e., 193 IPC Perjury, Hostile witness and false certificateo 191 IPC: (i) Giving false evidence (perjury) under oath and (ii) hostile witness.o 192 IPC : Fabricating false evidence (perjury).o 193 IPC : Punishment for false evidence (punishment for perjury) : imprisonment upto 7 years + fine,o 194 IPC: Giving or fabricating false evidence to procure conviction of capital offence.o 195 IPC: Giving or fabricating false evidence to procure conviction of offence punishable with imprisonment for life.o 197IPC: Issuing or signing (attesting) false certificate by a doctor is a criminal offence.o 201 IPC : Causing disappearance of evidence.\n\nSo the answer to this question is B"}
{"instruction": "Cholera toxin:\nA. Increases the levels of intracellular cylic GMP\nB. Acts through the receptor the opiates\nC. Causes continued activation of adenylate cyclase\nD. Inhibits the enzyme phosphodiesterase", "response": "Ans. is 'c' i.e. Causes continued activation of adenylate cyclase Cholera toxin (CT) is a potent protein enterotoxin, chiefly responsible for the virulence of V. cholera.It is elaborated by the organism following its colonization of the small intestine .Effect of cholera toxin leads to watery diarrhoea, the characteristic feature of cholera.Mechanism of Cholera Toxin ActionCholera toxin consists of 2 subunits a monomeric enzymatic moiety (A subunit) a pentameric binding moiety (B subunit)The B-subunit, serves as a 'landing pad' and binds to GM1 ganglioside, a glycolipid on the surface of epithelial cells of the small intestine. This facilitates the entry of A-subunit into the epithelial cells.The entry of A-subunit into the cells leads to activation of its A1 fragment.Activated A1 interacts with cytosolic proteins called ADP-ribosylation factors (ARF)The ARF-A1 complexes catalyze ADP-ribosylation of a G-protein called GSa.The ADP-ribosylated Gsa in turn binds to and stimulates adenylate cyclase. Activated adenylate cyclase generates high levels of intracellular cyclic AMP (cAMP) from ATP.cAMP inhibits the absorptive sodium transport system (decreases sodium & chloride reabsorption) and activates the secretory chloride transport system (increases chloride and bicarbonate secretion)This leads to accumulation of sodium chloride in the intestinal lumen.Accumulated sodium chloride draws water into the lumen due to increased osmolality leading to watery diarrhoea.Cholera |Na+ &Cl- | Cl- & HC03-\n\nSo the answer to this question is C"}
{"instruction": "A 58 year old lady is diagnosed to have carcinoma stomach. CT scan of abdomen showed a mass measuring 4 cm mass in the antrum with involvement of serosa. What is the treatment?\nA. Total gastrectomy\nB. Subtotal gastrectomy\nC. Palliative\nD. Chemotherapy", "response": "For tumours distally placed in the stomach, it appears unnecessary to remove the whole stomach. Distal gastrectomy is choiceFor proximal tumours total gastrectomy is done.Palliative, chemotherapy are choice in non operable cancers.Non operabilityHaematogenous metastases,Involvement of the distant peritoneum, N4 nodal disease and disease beyond the N4 nodes, and Fixation to structures that cannot be removed.Bailey and Love 27e pg: 1132\n\nSo the answer to this question is B"}
{"instruction": "Most severely affected child in Rh-isoimmunization patients if:\nA. Rh negative mother with Rh positive in 2nd child\nB. Rh positive mother with Rh negative in 2nd child\nC. Rh positive mother with Rh negative in 1st child\nD. Rh negative mother with Rh negative in 2nd child", "response": "Rh negative mother delivering Rh positive child for the first time gets sensitized to the D antigen of the fetus and stas developing D antibody which is fully loaded in maternal circulation. When Rh negative mother delivers her Rh positive 2nd child the antibody in the fetal circulation causes hemolysis in fetal circulation and the child is most severely affected.\n\nSo the answer to this question is A"}
{"instruction": "Automatization is:\nA. Shift of hydrogen\nB. Shift of carbon\nC. Shift of both\nD. None of these", "response": "The process of shifting a hydrogen atom from one carbon to another to produce enediols is referred to as automatization.\n\nSo the answer to this question is A"}
{"instruction": "IQ of 98 is classed at which level of intelligence?\nA. Idiot\nB. Normal\nC. Superior\nD. Near genius", "response": "Explanation: Level of intelligence IQ range Idiot 0-24 Imbecile 25-49 Moron 50-69 Borderline 70-79 Low normal 80-89 Normal 90-109 Superior 110-119 Very superior 120-139 Near genius 140 and above Ref: Park's textbook of Preventive and Social Medicine, 21stedition, page-629.\n\nSo the answer to this question is B"}
{"instruction": "Scrub typhus vector\nA. Tromboculid mite\nB. Louse\nC. Tick\nD. Reduvid bug", "response": "Tromboculid mite 8\"/e, p. 574 (17th /e page 543)] Mites are vectors for the following diseases: Diseases Vector Scabies Itch mite Scrub Typhus Trombiculid mite Rickettsial pox Trombiculid mite This topic has been discussed in detail earlier. Mostly they keep on asking about Ticks and mites so remember the diseases caused by Ticks too. Vector Disease Vector (a) Soft tick * Q fever, Relapsing fever (b) Hard tick * Tick typhus * Viral encephalitis * Viral fevers * Viral hemorrhagic fever (KFD) * Tuleremia * Human babesiosis, Tick paralysis\n\nSo the answer to this question is A"}
{"instruction": "The period of mixed dentition is between the ages of :\nA. 2-5 years\nB. 6-11 years\nC. 12-14 years\nD. 15-17 years", "response": "B i.e. 6-11\n\nSo the answer to this question is B"}
{"instruction": "An 11 year old male patient complains that his upper front teeth appear to be sticking out. Intra-oral examination reveals a Class II incisor and molar relation. Fixed orthodontic therapy along with a high pull headgear was initiated. What type of anchorage does this appliance provide?\nA. Cortical\nB. Simple\nC. Compound\nD. Reinforced", "response": "Anchorage can be reinforced by having the patient wear an extraoral appliance (headgear) placing backward force against the upper arch. The reaction force from the headgear is dissipated against the bones of the cranial vault, thus adding the resistance of these structures to the anchorage unit. \nCortical anchorage: Rickets introduced the concept of cortical anchorage, which uses the denser alveolar cortical bone for anchorage. \nSimple anchorage: Resistance of the anchorage unit to tipping. \nCompound anchorage: Resistance provided by more than one tooth with greater support to move teeth with less support.\nContemporary orthodontics, William Proffit, 4th edition page 346, 380\n\nSo the answer to this question is D"}
{"instruction": "Early strict toilet training can result in-\nA. Nocturnal enuresis\nB. Encopresis\nC. Night terror\nD. Temper tantrums", "response": "Ans. is 'b' i.e., Encopresis\n\nSo the answer to this question is B"}
{"instruction": "A 25 yr. old comes in emergency with 2 1/2 months amenorrhea and abdominal pain and bleeding from vagina for 1 day. Her vitals are stable. On per speculum examination, mild bleeding is seen coming from the os. On per vaginal examination, the uterus is 10-week size, os is open and admits one finger. The most likely diagnosis is?\nA. Threatened abortion\nB. Missed abortion\nC. Inevitable abortion\nD. Incomplete abortion", "response": "Ans. C. Inevitable abortionThe size of the uterus corresponds to the period of gestation, bleeding is mild, os is open, thus inevitable abortion.\n\nSo the answer to this question is C"}
{"instruction": "A Person hearing two different tones in left and right ear when presented with a single tone. This condition is called\nA. Monoaural diplacusis\nB. Binaural diplacusis\nC. Tinnitus\nD. Increased sensitivity to sound", "response": "Ans. 'b' i.e., Binaural diplacusis Monaural diplacusis:- Inmonauraldiplacusis,alistenerhearstwotoneswhenasingletoneispresentedtoasingle ear, i.e. one ear hears two different tones when presented one.Binaural diplacusis :- In binaural diplacusis, a listener hears two different tones in right & left ear when a single tone is presented to both ears.Both monoaural and binaural diplacusis are caused by inhomogeneities in the cochlea that also give rise to spontaneous otoacoustic emissions.\n\nSo the answer to this question is B"}
{"instruction": "Duration of treatment in multibacillary leprosy according to WHO is –\nA. 6 months\nB. 1 year\nC. 2 years\nD. 5 years", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A reactant generated by neutrophils that plays an impoant role in bacterial killing is\nA. NADPH oxidase\nB. Hexose monophosphate shunt\nC. G proteins\nD. Superoxide anion", "response": "Superoxide anion is generated when oxygen is reduced by cytoplasmic NADPH. The reduction is carried out by the enzyme NADPH oxidase, which is not a reactant but a catalyst activated in cells responding to bacteria.\n\nSo the answer to this question is D"}
{"instruction": "The reference protein is\nA. Cow's milk\nB. Hen's Egg\nC. Meat\nD. Fish", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Half-life of carbimazole is\nA. 4 hours\nB. 8 hours\nC. 16 hours\nD. 24 hours", "response": "Carbimazole has a half-life of 5.3 to 5.4 hours. It is possible that the plasma half-life may also be prolonged by renal or hepatic disease. See section 4.2. Thiamazole crosses the placenta and appears in breast milk. Ref: kd tRIPATHI 8TH ED.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is/are used as die material:\nA. Gypsum\nB. Epoxy resin\nC. Electroplated silver\nD. All of the above.", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Best agent for premenstrual syndrome management is?\nA. gesterone\nB. Anxiolytic\nC. SSRI\nD. Vitamin E", "response": "SSRI are the first choice of drug for premenstrual dysphoric syndrome. REF KD Tripati 8TH ED\n\nSo the answer to this question is C"}
{"instruction": "Which of the following conditions is diagnosed using Cozen's test?\nA. Little leaguer's elbow\nB. Tennis elbow\nC. Golfer's elbow\nD. Frozen shoulder", "response": "Cozen's test - In this test active extension of wrist against resistance produces pain at the point of common extensor origin. It is considered a positive finding for lateral epicondylitis or Tennis elbow.\n\nSo the answer to this question is B"}
{"instruction": "BCG is-\nA. Live vaccine\nB. Kileld vaccine\nC. Toxoid\nD. None", "response": " BCG Live vaccine Aim- To induce a benign,aificial primary infection which will stimulate an acquired resistance to possible subsequent infection with virulent tubercle bacilli, and thus reduce the morbidity and moality from primary tuberculosis among those most at risk. WHO recommends the &;Danish 1331&; strain for vaccine production. Stable for several weeks at ambient temperature in a tropical climate and for upto 1 year if kept away from direct light and stored in a cool environment below 10 deg celcius. Vaccine must be protected from light ( wrapped up in a double layer of red/ black cloth). Normal saline is recommended as diluent for reconstituting the vaccine as distilled water may cause irritation. Reconstituted vaccine may be used within 3 hours. Dosage-0.1 mg in 0.1 ml volume. The dose of newborn below 4 weeks is 0.05 ml. Afministered intradermally using tuberculin syringe. Injected slightly above the inseion of left deltoid. If injected too high / too low adjacent lymph nodes may become involved and tender. The vaccine must not be contaminated with an antiseptic/detergent. If alcohol is used to swab the skin , it must be allowed to evaporate before the vaccine is given. Phenomenon after vaccination:/ 2-3 weeks after a correct intradermal injection of a potent vaccine, a papule develops at the site of vaccination. It increases slowly in size and reaches a a diameter of about 4-8 mm in 5 weeks. It then subsides or breaks into a shallow ulcer but usually seen covered by a crust. Healing occurs within 6-12weeks leaving a permanent,tiny, round scar (4-8 mm in diameter).This is a normal reaction. Normally the individual become mantoux postive after 8 weeks has elapsed. Adverse reactions: prolonged severe ulceration at the site of vaccination, suppurative lymphadenitis, osteomyelitis and disseminated BCG infection. Contraindications: BCG should not be given to patients with generalised eczema, infective dermatosis, hypogammaglobulinemia , those with history of deficient immunity, patients under immunosuppressive treatment and in pregnancy. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.196} Abdominal aoic aneurysm: Most commonest type of large vessel aneurysm. 95% have associated atheromatous change. 95% occur below renal aeries. Symptomatic aneurysms may cause minor symptoms such as back and abdominal discomfos, before severe sudden abdominal pain due to rupture develops. Asymptomatic aneurysms are found accidentally on physical examination. Abdominal aoic aneurysms csn rupture into anteriorly into peritoneal cavity (20%) or posterolaterally to retroperitoneal space (80%). Anterior rupture leads to free bleeding into peritoneum whereas posterior rupture leads to retroperitoneal haematoma. The patient remain conscious but in severe pain. If no operation is performed , death is inevitable. Indications for surgery:- 1. Asymptomatic aneurysm more than 5.5 cm 2. Growth rate more than 0.5 cm per year. 3. Painful tender aneurysm 4. Thrombosed aneurysm, aneurysm with distal emboli. {Reference: SRB&;s manual of surgery, 5th edition , page no. 198}\n\nSo the answer to this question is B"}
{"instruction": "Following are the causes of painless sudden onset of loss of vision except ?\nA. Acute congestive glaucoma\nB. Vitreous hemorrhage\nC. CRAO\nD. Central serous retinopathy", "response": "Ans. is 'a' i.e., Acute congestive glaucoma Acute congestive glaucoma causes sudden painful loss of vision.\n\nSo the answer to this question is A"}
{"instruction": "Lord's and Jaboulay's operation is done for:March 2011\nA. Rectal prolapse\nB. Fistula in Ano\nC. Inguinal hernia\nD. Hydrocele", "response": "Ans. D: HydroceleProcedures for acquired hydroceles:Lord's operation is suitable when the sac is reasonably thin walledEversion of the sac with placement of the testis in a pouch prepared by dissection in the fascial planes of the scrotum is an alternative (Jaboulay's procedure)\n\nSo the answer to this question is D"}
{"instruction": "“Acrodermatitis enteropathica” is seen in a deficiency of\nA. Molybdenum\nB. Selenium\nC. Chromium\nD. Zinc", "response": "Essential features of zinc deficiency are:\n\nDistinctive rash, often around the eyes, nose, mouth, anus and distal parts.\nAnorexia, often accompanied by diarrhoea\nGrowth retardation in children\nImpaired wound healing\nHypogonadism with I reproductive capacity.\nAltered immune function\nImpaired night vision related to altered vitamin A metabolism\nDepressed mental function\nIncreased incidence of congenital malformation in infants of Zn-deficient mothers. Micro and macroelements\n\nSo the answer to this question is D"}
{"instruction": "Abtacept is used in treatment of which of the following conditions?\nA. Rheumatoid ahritis\nB. Asthma\nC. Paroxysmal nocturnal hemoglobinuria\nD. Autoimmune haemolytic anemia", "response": "Abatacept is a recombinant fusion protein composed of the extracellular domain of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) fused to human IgG Fc. CTLA-4 is a costimulatory molecule found on T cells that binds to CD80 and CD86 on antigen presenting cells. This fusion protein blocks activation of T cells by binding to CD80 or CD86 so that CD28 on T cells cannot bind and stimulate the T cell and lead to cytokine release. Abatacept is approved for patients with severe rheumatoid ahritis who have failed other disease-modifying antirheumatic drugs Ref: Katzung 11th edition Chapter 61.\n\nSo the answer to this question is A"}
{"instruction": "Substance present in both serum and plasma:September 2007\nA. Fibrinogen\nB. Factor II\nC. Factor VII\nD. Factor V", "response": "Ans. C: Factor VIISerum has essentially the same composition as that of plasma except that its fibrinogen and clotting factors II,V and VIII has been removed and it has a higher seroton in content.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is not used as vector in genetics?\nA. Adeno virus\nB. Proteosome\nC. Liposome\nD. Retrovirus", "response": "VECTORS : The gene is trasferred to acarrier ,known as a vector.Most commonly used vectors are plasmids.Plasmids are circular double -stranded DNA molecuels seen inside bacteria. Different vector systems used for gene delivery are : Retro viruses , Adenoviruses , Adeno associated viralvectors and Herpes simplex virruses.Non -virus systems include Liposomes , Plasmids and physical methods. Proteosomes are protein complexes which degrade unneeded or damaged proteins by proteolysis , a chemical reaction that breaks petide bonds.Enzymes that help such reactions are called proteolysis. REF :DM VASUDEVAN TEXTBOOK ,7th EDITION , Page no :629.\n\nSo the answer to this question is B"}
{"instruction": "Normal platelet count is/are seen in: (PGI Nov 2010)\nA. D1C\nB. Shaken baby syndrome\nC. Microangiopathic hemolytic anaemia\nD. Splenomegaly", "response": "Ans B \"Non-immunological dysfunction casuingThrombocytopenia: Microangiopathic hemolytic anaemia - Robbins 7th/651 (table)\"Kasabach-Merritt syndrome (KMS) is defined as profound thrombocytopenia Q related to platelet trapping within a vascular tumor\"- Wiliam's Haematology 7th/\"Shaken baby syndrome (SBS) is a form of physical child abuse that occurs when an abuser violently shakes an infant or small child,creating a whiplash-type motion that causes acceleration- deceleration injuries. It is common for there to be no external evidence of trauma\"-en.wiki_wikipedia.arg_sbsShaken baby syndrome (SBS) is notgiven in list of thrombocytopenia in any' above referencesTable (Wiliam'sHaematology 7th/818)Classification of ThrombocytopeniaPseudo-thrombocytopeniaPlatelet agglutinationPlatelet satellitismAntiphospholipid antibodiesGplla-Illa antagonistsGiant plateletsMiscellaneous associationsimpaired platelet productionCongenita] Sebastian syndrome Epstein syndrome May- Hegglin anomalyM editerranean macrothrombocytopeniaFamilial platelet syndrome with predisposition to acute myelogenous leukemiaThrombocytopenia with linkage to chromosome 10Paris-Trousseau syndromeThrombocytopenia with radial synostosisAutosomal recessiveCongenital amegakaryocytic thrombocytopeniaThrombocytopenia with absent radius (TAR) syndromeBernard-Soufier syndromeGray platelet syndromeX-linked thrombocytopeniasWiskott-Aldrich syndromeX-linked thrombocytopeniaX-linked thrombocytopenia with dyserythrocytosisAcquiredMarrow infiltrationinfectious disease : Cytomegalovirus, HIV& ParvovirusRadiotherapy and chemotherapyFolic acid and vitamin deficiencyParoxysmal nocturnal hemoglobinuriaAcquired aplastic anemiaMyelodysplastic syndromesAcquired pure megakaryocytic thrombocytopeniaAccelerated platelet destructionImmune-mediated thrombocytopeniaAutoimmune thrombocytopenic purpuraIdiopathicSecondary (infections, pregnancy-related, lymphoprolifera- tive disorders, collagen vascular diseases)Alloimmune thrombocytopenia: Neonatal thrombocytopenia Posttransfusion purpuraNon immune thrombocytopeniaThrombotic microangiopathiesThrombotic thrombocytopenic purpura and hemolytic uremic syndromeDisseminated intravascular coagulopathyKasabach-Merritt syndromePlatelet destruction by artificial surfacesHemopbagocytosisAbnormal platelet distribution or poolingSplenomegalyHypersplenismHypothermiaMassive transfusionDrug-induced thrombocytopeniaHeparin-induced thrombocytopenia (HIT)Other drug-induced thrombocytopenias\n\nSo the answer to this question is B"}
{"instruction": "Vasponstricator L.A. is\nA. Cocaine\nB. Procaine\nC. Lidocaine\nD. Chlorprocain", "response": "All local anaesthetics are vasodilators except cociane which is a vasoconstrictor\n\nSo the answer to this question is A"}
{"instruction": "All are seen in the floor of third ventricle except?\nA. Mammillary body\nB. Oculomotor nerve\nC. Optic chiasma\nD. Tuber cinereum", "response": "Boundaries of 3rd ventricle: LATERAL WALL - Thalamus, Hypothalamus FLOOR - Mammillary body , tegmentum pa of mid brain , tuber cinereum ,infundibular stalk , optic chiasma. ROOF - Fornix ANTERIOR - lamina terminalis , anterior commissure POSTERIOR - pineal body , posterior commissure Extra edge Septum pellucidum Thin ,triangular,veical double membrane separating the anterior horns of the left and right lateral ventricles of the brain. Extends between corpus callosum and the fornix.\n\nSo the answer to this question is B"}
{"instruction": "Koplik spots on the buccal mucosa are seen in relation to which of the following teeth?\nA. Incisors and canine\nB. Canine and premolar\nC. Only premolars\nD. Premolar and molars", "response": "Koplik spots: pathognomonic of measles \nThe Koplik’s spots are white papules resembling table salt like crystals with a red base, which appear usually on the buccal mucosa opposite to first and second molar teeth. \nRef: Shafer's textbook of oral pathology 7th edition page 348\n\nSo the answer to this question is D"}
{"instruction": "Source of energy for a running race athlete for the initial 3 minutes of running\nA. Free fatty acid\nB. Creatine phosphate\nC. Muscle glycogen\nD. Blood Glucose", "response": "Systems for energy during strenuous exercise or running 1. First System-Phosphagen system (8-10 seconds) - Immediate source of energy for Muscles is Creatine Phosphate. - But this is of limited supply in muscles, so depleted quickly 2. Second system -Anaerobic Glycolysis or Lactate system. (for 1-3 minutes ) - This system derives ATPs using Glucose derived from Muscle Glycogen 3.Third system -Aerobic System (or Mitochondrial Respiration) - can use carbohydrates, Fats, or Proteins to produce energy. - Slowest in providing energy, but more efficient than the other two systems - This system uses mainly TCA & ETC. Reasons for use of Phosphocreatine:- - Does not uses O2 - Does not produce lactate - Quickest source of energy - Most direct form of energy production\n\nSo the answer to this question is C"}
{"instruction": "Fecal leucocytes are absent in all of the following, except:\nA. Giardiasis\nB. Cryptosporidiosis\nC. Campylobacter infection\nD. Clostridium perfringes infection", "response": "Campylobacter infection\n\nSo the answer to this question is C"}
{"instruction": "Which of the following drugs is contraindicated in a patient with raised intracranial pressure?\nA. Thiopentone\nB. Propofol\nC. Midazolam\nD. Ketamine", "response": "Cerebral blood flow, metabolism, oxygen consumption and ICT all are increased by ketamine - ketamine is contraindicated in raised ICT.(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.186-193)\n\nSo the answer to this question is D"}
{"instruction": "Most common cause of acute mesenteric ischemia is:\nA. Arterial thrombosis\nB. Venous thrombosis\nC. Embolism\nD. Non occlusive disease", "response": "Acute Mesenteric Ischemia :\n• Emboli (50%) :\n−− Arrhythmia, Valvular disease, Myocardial infarction\n−− Hypokinetic ventricular wall\n−− Cardiac aneurysm, Aortic atherosclerotic disease\n• Thrombosis (25%) : Atherosclerotic disease\n• Nonocclusive (5–15%) :\n−− Pancreatitis, Heart failure, Sepsis.\n−− Cardiac bypass, Burns, Renal failure.\n• Venous occlusion:\n−− Hypercoagulable state.\n−− Sepsis Compression, Pregnancy, Portal hypertension.\n\nSo the answer to this question is C"}
{"instruction": "Glioma of optic nerve is usually -\nA. Gemistocytic\nB. Pilocytic\nC. Fibrillary\nD. Lamellar", "response": "Ans. is 'b' i.e., Pilocytic Optic nerve glioma o Optic nerve glioma, also referred to as juvenile pilocytic astrocytoma, is the most frequent tumor of the optic nerve in childhood. o It is a developmental hamaoma. o It is either stationary or only slowly progressive. o Tumor may arise in any poion of nerve --> i) Intraorbital, ii) Intracanalicular iii) Intracranial\n\nSo the answer to this question is B"}
{"instruction": "Minimal change glomerulopathy may be seen ' association with all of the following except,\nA. Hepatitis B\nB. HIV\nC. Drug-induced interstitial nephritis\nD. Hodgkin's disease", "response": "Secondary MCD wherein the extraglomerular disease process evokes, directly or indirectly, the characteristic changes in permselectivity and morphology. In this circumstance the morphology is similar, if not identical, to primary or 'idiopathic' MCD. Moreover, it is possible, even likely, that similar or identical pathogenetic mechanisms are operative. In this scenario, a distinct etiologic link is presumed to exist between the extraglomerular disease process and the occurrence of MCD. Such a linkage would be strongly suppoed if cure of the extraglomerular disease lead to the eradication of MCD and if recurrence of the extraglomerular disorder was associated with relapse. While an attempt has been made to be comprehensive, it is possible that individual repos describing an association between the specific extra-glomerular disease and MCD may have been overlooked. The majority of the instances in which MCD has been associated with an extraglomerular disease involve neoplastic processes and idiosyncratic, hyper-sensitivity or toxic reactions to drugs. Neoplasia A variety of neoplastic processes have been repoed in association with MCD (Table 2) . In some, the association is rare enough to suspect that chance alone may have been the operational mechanism underlying the association. In others, the association is clearly contemporaneous and likely causal. Among patients with glomerular disease associated with neoplasia, 40% have MCD on renal biopsy. As mentioned previously it is possible that some of the described associations between neoplasia and MCD may be the consequence of treatment of MCD (especially cytotoxic drug therapy) predisposing to the emergence of a malignancy. Hodgkin's disease and non-Hodgkin's lymphoma are among the most frequently repoed neoplastic processes associated with MCD . Interestingly, repos describing the concurrence of MCD and Hodgkin's disease have decreased in recent years, perhaps due to the more effective diagnostic and therapeutic strategies available for this and related diseases. MCD is a rare complication of Hodgkin's ppdisease occurring in from 1:2000 to 1:10 000 cases. MCD has been associated with both limited (Stage 1) and disseminated (Stage 4) forms of Hodgkin's disease.Therapy of Hodgkin's disease, either by local radio- therapy to regional lymph nodes or by systemic chemotherapy, has often resulted in remission of MCD and recurrences of Hodgkin's disease have been associated with recurrence of MCD. These observations strongly imply a causal relationship between the tumour (or a product of the abnormal neoplastic cells) and the pathophysiological abnormalities involved in MCD. Indeed, it is quite possible that the same clone of cells which are involved in the development of Hodgkin's disease are also involved in the pathogenesis of MCD in both the primary and secondary forms. Such an explanation is more difficult to conjecture for the association of MCD with theother tumours listed in Table 2, except for mycosis fungoides, angiofollicular lymph node hyperplasia, non-Hodgkin's lymphoma and chronic lymphatic leukaemia . Perhaps, in these instances, the peurbations for MCD have also triggered the oncogenic potential of cells predisposed to neoplastic transformation (e.g. lack of a wild type tumour suppressor gene). Alternatively, lymphocytes infiltrating neoplastic growths could be induced to elaborate factors responsible for abnormal permeability. Whatever the case may be, it is wohwhile to consider potential underlying neoplasia in patients with MCD when atypical features are present such as weight loss, anorexia, lymphadenopathy, haematuria, fever, pleural effusions or skin lesions. Overall, the occurrence of MCD as a complication of neoplastic disorders is quite uncommon. MCD may precede the diagnosis of neoplasia by months or years or may follow the diagnosis of neoplasia by months or years. Some repos have suggested that NK-cell deficiency is associated with the development of MCD in patients with Hodgkin's disease Ref Harrison20th edition pg 299\n\nSo the answer to this question is A"}
{"instruction": "AV node is situated in ?\nA. Opening of SVC\nB. Interventricular septum\nC. Koch's triangle\nD. None", "response": "Ans. is 'c' i.e., Koch's triangle AV node is situated in triangular pa (triangle of Koch) in the lower pa of interatrial septum. Triangle of Koch is landmark for AV node with its transition zone. It is bounded by tendon of todaro (superiorly), tricuspid valve septal leaflet (inferiorly) and coronary sinus orifice (basally). Conducting system Location in hea SA node Upper end of crista terminalis, near opening of SVC AV node Triangle of Koch's (near interatrial septum) Bundle of his Membranous pa of interventricular septum RBB Right surface of interventricular septum LBB Left surface of interventricular septum\n\nSo the answer to this question is C"}
{"instruction": "Barr body is seen in :\nA. Turners syndrome\nB. Klinefelters syndromeTesticular feminisation\nC. Tesiicular leminisation syndrome\nD. 46 XY", "response": "Klinefelters syndrome\n\nSo the answer to this question is B"}
{"instruction": "False about sympathetic ophthalmitis\nA. Injured eye is called exciting eye\nB. Common in children\nC. It follows a blunt trauma\nD. It is a serious bilateral granulomatous panuveitis", "response": "It follows a penetrating ocular trauma.\n\nSo the answer to this question is C"}
{"instruction": "Amoebae not found in human intestine:\nA. E. histolytica\nB. E. colt\nC. E. nana\nD. E. gingivalis", "response": "Ans. d. E. gingivalis\n\nSo the answer to this question is D"}
{"instruction": "Griseofulvin isnot useful in one of the following:\nA. Tinea capitis\nB. Tinea cruris\nC. Tinea versicolor\nD. Tinea pedis", "response": "HETEROCYCLIC BENZOFURAN Griseofulvin It was one of the early antibiotics extracted from Penicillium griseofulvum. However, because of lack of antibacterial activity, little attention was paid to it: clinical utility in dermatophytosis was demonstrated only around 1960. Griseofulvin is active against most dermatophytes, including Epidermophyton, Trichophyton, Microsporum, etc., but not against Candida and other fungi causing deep mycosis. Bacteria are also insensitive. Dermatophytes actively concentrate it: this feature probably accounts for its selective toxicity. Resistance can be induced in vitro and this is associated with loss of concentrating ability. However, emergence of resistance during clinical use is rare. Griseofulvin interferes with mitosis-multinucleated and stunted fungal hyphae result from its action. It also causes abnormal metaphase configurations. However, unlike the typical mitotic inhibitors (colchicine, vinca alkaloids), it does not cause metaphase arrest; rather the daughter nuclei fail to move apa or move only a sho distance. It does not inhibit polymerization of tubulin (microtubular protein which pulls the chromosomes apa), but binds to polymerized microtubules and somehow disorients them. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:760\n\nSo the answer to this question is C"}
{"instruction": "Opening of esophagus into diaphragm is at the level of -\nA. T6\nB. T10\nC. T12\nD. T8", "response": "Ans. is 'b' i.e., T10 OpeningVertebral levelIn which part of diaphragmPassing structureVena CavaiT8Central tendony Inferior vena cavay Right phrenic nerveOseophageaiT10Muscular portion derived from right crusy Oesophagusy Oesophageal br. of left gastric arteryy Gastric or vagus nerveAorticT12Osseoaponeurotic betweenright and lateral crusy Aortay Thoracic ducty Azygous vein\n\nSo the answer to this question is B"}
{"instruction": "Most common cause of Budd Chiari syndrome is:\nA. Idiopathic\nB. Valves in hepatic veins\nC. Hepatocellular carcinoma\nD. Thrombosis of hepatic veins", "response": "Answer is D (Thrombosis of hepatic veins) Most common cause of Budd Chiari Syndrome is hepatic vein obstruction Its the common cause of hepatic vein obstruction causing Budd Chiari Syndrome is 'thrombosis of hepatic veins'.\n\nSo the answer to this question is D"}
{"instruction": "The narrowest pa of ureter is?\nA. At pelvic brim\nB. At ischial spine\nC. Pelvic ureteric junction\nD. At the entry of bladder", "response": "The constrictions of the ureter are three in number as follows : (i) At the junction of pelvis of the ureter with abdominal pa of the ureter. (ii) At the pelvic brim. (iii) Where it pierces the bladder. It is narrowest here. Ureter: The ureter is a retroperitoneal, distensible muscular tube that connects the kidney with the bladder. It runs downward and medialward in front of the Psoas major and, entering the pelvic cavity, finally opens into the fundus of the bladder. The slit like lumen of the ureter has a stellate appearance because its mucosa is folded longitudinally. Aeries and veins: The aeries supplying the ureter are branches from the renal, internal spermatic, hypogastric, and inferior vesical. Nerves: The nerves are derived from the inferior mesenteric, spermatic, and pelvic plexuses. Constrictions - There are three normal anatomical constrictions where a stone from the renal pelvis can become lodged. The sites are; 1) The ureteropelvic junction 2) Site where it crosses the iliac vessels 3) Ureterovesicular junction: Passage of ureter through the bladder wall.\n\nSo the answer to this question is D"}
{"instruction": "Best investigation for Bronchiectasis is?\nA. Chest X Ray\nB. MRI\nC. Pulmonary Function Tests\nD. HRCT", "response": "ANSWER: (D) HRCTREF: Harrison's Internal Medicine 17th edition chapter 252Though the chest radiograph is important in the evaluation of suspected bronchiectasis, the findings are often nonspecific. CT, especially with high-resolution images 1.0-1.5 mm thick, provides an excellent view of dilated airways. Consequently, it is now the standard technique for detecting or confirming the diagnosis of bronchiectasis.\n\nSo the answer to this question is D"}
{"instruction": "A bony hard asymptomatic swelling found on the midline of the hard palate, that appears radiopaque on a radiograph is most likely a -\nA. Odontoma\nB. Myxoma\nC. Bony cyst\nD. Torus palatinus", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Ascending aoa Involvement is the commonest site of which aneuryam\nA. Syphilitic\nB. Atherosclerotic\nC. Mycotic\nD. None of the above", "response": "Syphilitic aneurysm Teiary sypilis... Trepenomonas has affinity for vaso vasorum of mainly thoracic aoa leads to obliterative endaeritis leads to ischemic damage to the aoic media and aneurysm Ramdas Nayak page no. 379\n\nSo the answer to this question is A"}
{"instruction": "How does staphylococcus aureus differ from staphylococcus epidermidis?\nA. It is coagulase positive\nB. It is a common cause of UTI\nC. It forms white colonies on blood agar\nD. It causes endocarditis in drug addicts", "response": "Staphylococcus aureus is coagulase positive whereas staphylococcus epidermidis is coagulase negative. Other coagulase negative staphylococci are S haemolyticus, S saccharolyticus, S hominis, S schleiferi, S lugdunensis and S simulans. Test Staphylococcus aureus Staphylococcus epidermidis Coagulase Positive Negative Clumping factor Positive Negative Heat stable nuclease Positive Negative Urease Variable Negative Acid from mannitol Positive Negative Acid from trehalose Positive Negative Ref: Textbook of Microbiology and Immunology By Parija, Pages 188-190\n\nSo the answer to this question is A"}
{"instruction": "Which of the following are situated away from the coding region\nA. Promoter\nB. Enhancer\nC. Operator\nD. All of these", "response": "Structural genes are present in coding region. Rest all genes, like promoter gene, operator gene, regulatory gene (enhancer/repressor), are present away from coding region.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following drugs should not be used in a setting of severe hypeension in elderly on empirical basis\nA. Enalapril\nB. Amlodipine\nC. Chlohiazide\nD. Prazosin", "response": "Postsynaptic, selective a-adrenoreceptor antagonists lower blood pressure by decreasing peripheral vascular resistance. They are effective antihypeensive agents used either as monotherapy or in combination with other agents. However, in clinical trials of hypeensive patients, alpha blockade has not been shown to reduce cardiovascular morbidity and moality or to provide as much protection against CHF as other classes of antihypeensive agents. These agents are also effectivein treating lower urinary tract symptoms in men with prostatic hyperophy. Nonselective a-adrenoreceptor antagonists bind to postsynaptic and presynaptic receptors and are used primarily for the management of patients with pheochromocytoma. ref:harrison&;s principles of internal medicine,ed 18,pg no 4279\n\nSo the answer to this question is D"}
{"instruction": "Alveolar hypoventilation is observed in:\nA. Guillain -Barre syndrome\nB. Acute asthma\nC. Bronchiectasis\nD. CREST syndrome", "response": "Neuromuscular diseases that can cause alveolar hypoventilation include myasthenia gravis, amyotrophic lateral sclerosis, Guillain-Barre syndrome and muscular dystrophy. Patients with neuromuscular disorders have rapid, shallow breathing secondary to severe muscle weakness or abnormal motor neuron function.\n\nSo the answer to this question is A"}
{"instruction": "For vascular anastomosis sutures of choice -\nA. Polypropylene\nB. Chromic catgut\nC. Silk\nD. Nylon", "response": "Ans. is 'a' i.e., Polypropylene Vascular anastomoses:* Vascular anastomoses require an extremely accurate closure as they must be immediately watertight at the end of the operation when the vascular clamps are removed.* In many cases, some form of prosthetic material or graft may be used which will never be integrated into the body tissues and so the integrity of the suture line needs to be permanent.* For this reason, polypropylene is one of the best sutures as it is not biodegradable. It is used in its monofilament form, mounted on an atraumatic, curved, roundbodied needle.* Knot security is important, and as polypropylene is monofilament and the anastomosis often depends on one final knot, several throws (between six and eight) of a well-laid reef knot are required.* The suture line must be regular and watertight with a smooth intimal surface to minimise the risk of thrombosis and embolus, as well as to avoid any leakage.* Suture size depends on vessel calibre: 2/0 is suitable for the aorta, 4/0 for the femoral artery and 6/0 for the popliteal to distal arteries.* Micro vascular anastomoses are made using a loupe and an interrupted suture down to 10/0 size.\n\nSo the answer to this question is A"}
{"instruction": "Splaying and cupping of the'metaphysis is seen in :\nA. Rickets\nB. Scurvy\nC. Paget's disease\nD. Lead poisoning", "response": "A i.e. Rickets\n\nSo the answer to this question is A"}
{"instruction": "Most common Morphological difference between Ulcerative Colitis and Crohn's disease\nA. Mucosal edema\nB. Crypt abscess\nC. Diffuse polyps\nD. Lymphoid aggregates", "response": "Ref:- Bailey and Love 27th Edition; Pg num:- 1268\n\nSo the answer to this question is B"}
{"instruction": "Benedict test is for\nA. Bile salts in urine\nB. Bile pigment in urine\nC. Reducing sugar in urine\nD. Ketone bodies in urine", "response": "It is commonly employed to detect the presence of glucose in urine. Benedict&;s reagent contains sodium carbonate, copper sulfate, and sodium citrate. In alkalain medium, sugars form enediol, cupric ions are reduced, correspondingly sugar is oxidized. Glucose is a reducing sugar. Any sugar with free aldehyde/keto group will reduce Benedict&;s reagent.Ref: DM Vasudevan, 7th edition, page no: 73\n\nSo the answer to this question is C"}
{"instruction": "Structure lying at marker C ?\nA. Subclan vein\nB. Subclan aery\nC. Scalenus anterior\nD. Scalenus medius", "response": "Scalenus anterior muscle Attaches to the scalene tubercle on the inner(medial) border of 1st rib. * It's tendon is sandwiched between subclan vein (passing anterior) and subclan aery (passing posterior). Both vessels cross over the superior surface of 1st rib. Key: A - Area for attachment of scalenus medius B - Groove for subclan aeryC - Scalene tubercle (attachment of anterior scalene) D - Groove for subclan vein\n\nSo the answer to this question is C"}
{"instruction": "When can one diagnose acute respiratory distress in a newborn?\nA. Within 7 days of known clinical insult\nB. Respiratory failure not fully explained by cardiac failure or fluid overload\nC. Left ventricular dysfunction\nD. All of the above", "response": "(D) All of the abovePEDIATRIC CRITICAL CARE MEDICINE -2015 AgeExclude patients with peri-natal related lung diseaseTimingWithin 7 days of known clinical insultOrigin of EdemaRespiratory failure not fully explained by cardiac failure or fluid overloadChest ImagingChest imaging findings of new infiltrate(s) consistent with acute pulmonary parenchymal diseaseOxygenationNon-Invasive mechanical ventilationInvasive mechanical ventilationPARDS (No severity stratification)MildModerateSevereFull face-mask bi-level ventilation or CPAP >=5cmH2 O4<=OI<16OI>=16 PF ratio <3005<=OSI<7.57.5<=OSI<12.3OSI>=12.3Special PopulationsCyanotic Heart DiseaseStandard Criteria above for age, timing, origin of edema & chest imaging with an acute deterioration in oxygenatioin not explained by underlying cardiac disease.Chronic Lung DiseaseStandard Criteria above for age, timing and origin of edema with chest imaging consistent with new infiltrate and acute deterioration in oxygenation from baseline which meet oxygenation criteria above.Left Ventricular DysfunctionStandard Criteria for age, timing and origin of edema with chest imaging changes consistent with new infiltrate and acute deterioration in oxygenation which meet criteria above not explained by left ventricular dysfunction. PATHOPHYSIOLOGIC APPROACH TO CLINICAL CONDITIONS CAUSING RESPIRATORY DI$TRESSEtiologyPathophysiologyClinical conditionsInterference with air flow (entry or exit)*. Upper airway obstruction*. Acute laryngitis, laryngotracheitis, foreign body*. Lower airway obstruction*. Bronchiolitis, asthma*. Mechanical compression*. Large pleural effusion, pneumothorax*. Thoracic wall injuries*. Flail chestInterference with alveolar*. Failure of alveolar ventilation*. Pneumonia, pulmonary edemagas exchange*. Failure of diffusion*. Pneumonia, pulmonary edemaCardiovascular problems*. Mechanical or inadequate function*. Congestive cardiac failure, arrhythmias, myocarditis, pericarditis, Right-to-left shuntsCNS*. Depression of respiratory center*. Raised ICT*. Stimulation of respiratory center*. Acidosis, salicylate intoxication*. Neuromuscular impairment of respiration*. Acute paralytic poliomyelitis, Guillain-Barre Syndrome, organophosphate poisoning, snake bite, diaphragmatic paralysisOther*. Insufficient oxygen supply to tissues and/ or increased oxygen demands*. Sepsis, severe anemia, high altitude, carbon monoxide exposure, smoke inhalation, met-hemoglobinemia*. Compensation for metabolic acidosis*. Diabetic ketoacisosis, acute renal failure\n\nSo the answer to this question is D"}
{"instruction": "The ion that contributes maximally to the development of RMP is:\nA. Na+\nB. K+\nC. Cl-\nD. Ca++", "response": "A resting cell is much more permeable to K+ as compared to Na+ or other ions. During resting conditions, if all the ions are moving down their concentration gradients to finally reach equilibrium, the movement of K+ will be much greater. Thus, K+ diffusing out, down its concentration gradient will be the greatest contributor to the RMP. As K+ diffuses outward to reach equilibrium, it drags the membrane potential to its own equilibrium potential. (Equilibrium potential for K+ = - 90 mV)\n\nSo the answer to this question is B"}
{"instruction": "Adson's test is positive in\nA. Cervical rib\nB. Cervical fracture\nC. Cervical spondylosis\nD. Cervical dislocation", "response": "Adson's sign is the loss of the radial pulse in the arm by rotating head to the ipsilateral side with extended neck following deep inspiration . Ref : S. Das surgery 3/e p641\n\nSo the answer to this question is A"}
{"instruction": "65 year old patient comes with dysphagia and regurgitation. Barium swallow shows diverticula at lower oesophagus. Which of the following is false about this condition\nA. Endoscopy is used to rule out malignancy\nB. Chest x ray shows air fluid level in posterior mediastinum\nC. It arises from killians triangle\nD. Treatment is resection Plus myotomy", "response": "This is the case of epiphanic diverticulum. It is usually seen in lower oesophagus. It is confused with para esophageal hernia.\n\nSo the answer to this question is C"}
{"instruction": "'Learned behaviour which is socially acquired' is known as:-\nA. Customs\nB. Acculturation\nC. Standard of living\nD. Culture", "response": "Culture : is the learned behavior which is socially acquired. Acculturation : Is 'culture contact' or mixing of two cultures. It can occur through; Trades & commerce Industrialization Propagation of religion Education Conquest Custom : the established pattern of behavior that can be objectively verified within a paicular social setting Folkwares : Right ways doing thing in less vital areas of human conduct. Mores: More stringent customs. Attitude : A relatively enduring organization of beliefs around an object or concept, which predisposes one to respond in a ceain manner Attitude are acquired characteristics which are more or less permanent ways of behaving.\n\nSo the answer to this question is D"}
{"instruction": "Superolateral boundary of axillary dissection is\nA. Clavipectoral fascia\nB. Branchial plexus\nC. Axillary aery\nD. Axillary vein", "response": "Lateral group of axillary nodes are present along axillary vein. Axillary dissection is the removal of fat, fascia, nodes in the axilla. Usually level 1 and level 2 nodes are removed. Nodes below the axillary vein are usually removed. so the superolateral boundary of axillary dissection is axillary vein. Dissection is done through an individual crease transverse inciaion in the axilla. Reference :SRB's Manual of Surgery, 6th Edition, page no = 543, 529.\n\nSo the answer to this question is D"}
{"instruction": "Worm like filling defect is seen In\nA. Erosive gastritis\nB. Esophageal varices\nC. CA esophagus\nD. Schatzki's ring", "response": "On USG Thickened sinus, interrupted mucosal folds (earliest sign) Toous radiolucencies of variable size The \"worm-eaten\" smooth lobulated filling defects Ref: Wolfgang Radiology 2nd edition Pg no : 509\n\nSo the answer to this question is B"}
{"instruction": "Calcium does not bind to\nA. Tropomyosin\nB. Calmodulin\nC. Troponin\nD. None", "response": "Tropomyosin-A protein that binds to and stabilizes actin filaments in cells. In skeletal and cardiac muscle cells, tropomyosin is released after interacting with troponin and calcium, facilitating the binding of actin to myosin that causes muscle contraction.Calmodulin- a calcium-binding protein present in all nucleated cells, thought to be an essential mediator of most calcium-sensitive cellular processes.Troponin- a complex of muscle proteins which, when combined with Ca++, influence tropomyosin to initiate contraction.Ref: Ganong&;s review of medical physiology; 24th edition; page no:-378\n\nSo the answer to this question is A"}
{"instruction": "Procedure to be performed in case of arrest of after coming head due to contracted pelvis in breech:\nA. Craniotomy\nB. Decapitation\nC. Zavanelli maneuver\nD. Cleidotomy", "response": "Entrapment of aftercoming head This complication is usually seen with preterm delivery as the incompletely dilated cervix constricts aruond the neck .Duhurssen&;s incisions can be placed over the cervix avoiding the 3 and 9 o&;clock positions .other alternatives are intravenous nitroglycerin for cervical dilatation.General an anaesthesia followed by breech extraction is another option.As a last reso replacement of fetus high into the vagina and uterus followed by Caesarean section can be attended (Zavanelli manoeuvre).Another option with those who have experience of the same is symphysiotomy to widen the anterior pelvis (refer sheila textbook of obstetrics pgno:381 2 nd edition)\n\nSo the answer to this question is C"}
{"instruction": "Which of the following local anaesthetic is active topically?\nA. Lidocaine and Benzocaine\nB. Lidocaine and mepivacaine\nC. Mepivacaine and benzocaine\nD. Prilocaine and mepivacaine", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is given at intervals as a pulsatile therapy?\nA. GnRH agonist\nB. Insulin\nC. FSH\nD. Estrogen", "response": "Only pulsatile exposure to GnRH induces FSH/LH secretion while continuous exposure desensatizes pituitary gonadotropes resulting in loss of Gn release GNRH agonists are usually given in pulsatile manner while antagonists are given in continous manner (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 239)\n\nSo the answer to this question is A"}
{"instruction": "Percentage of drug existing as enantiomer is:\nA. <1%\nB. 10%\nC. >50%\nD. 100%", "response": "Ans: c (>50%) Ref: Katzung, 10 ed, p. 4Due to chirality (stereoisomerism) more than half of all useful drugs exists as enantiomers.Other important properties:One of the enantiomers will be more potent than its mirror image. The potent enantiomer which is active at one type of receptor may not be active at another type.One of the enantiomers will be more susceptible to drug metabolizing enzymes than the other.\n\nSo the answer to this question is C"}
{"instruction": "Muscle shown in the illustration predominantly uses:\nA. GLUT 1\nB. GLUT 2\nC. GLUT 3\nD. GLUT 4", "response": "Ans. D. GLUT 4a. Muscle shown is the skeletal muscle.b. Glucose transporter type 4, also known as GLUT 4, is a protein encoded in humans, by the GLUT4 gene. GLUT4 is the insulin-regulated glucose transporter found primarily in adipose tissues and striated muscle (skeletal and cardiac). The first evidence for this distinct glucose transport protein was provided by David James in 1988. The gene that encodes GLUT4 was clone and mapped in 1989.c. Recent reports demonstrated the presence of GLUT4 gene in central nervous system such as the hippocampus. Moreover, impairment in insulin-stimulated trafficking of GLUT4 in the hippocampus result in decreased metabolic activities and plasticity of hippocampal neurons, which leads to depressive like behaviour and cognitive dysfunction.GLUT4 is primarily found in: -a. Skeletal muscleb. Cardiac musclec. Adipose tissue\n\nSo the answer to this question is D"}
{"instruction": "A woman presents to the Gynecology outpatient department with a history suggestive of stress incontinence. Which of the following is the treatment of choice for genuine stress incontinence -\nA. Burch Colposuspension\nB. Kelly's Procedure\nC. Sling Suspension Procedure\nD. Tension Free Vaginal Taping", "response": "Ans-D Tension Free Vaginal Taping (Ref. Shaw Gynecology 14th/pg. 175; TeLinde 9th/pg. 1052-1056; Novak's Gynecology 13th/pg. Chapter 20) Treatment of choice for genuine stress incontinence -Tension Free Vaginal Taping Gold standard treatment /Treatment with highest success rate is of Burch Colposuspension Operations for stress incontinence can be classified into four broad categories a. Traditional anterior vaginal colporrhaphy. b. Operations to correct stress incontinence resulting from anatomic hypermobility (retropubic bladder neck suspension operations, needle suspension procedures, tension-free vaginal tape, and some sling procedures). c. Operations for stress incontinence resulting from intrinsic sphincteric weakness or dysfunction (sling operations and periurethral injections). d. Salvage operations (intentionally obstructive sling operations, implantation of an artificial urinary sphincter, urinary diversion). Cure rates of different surical procedures for stress incontinence Operation Longterm cure (%) Kelly's repair Bladder buttress operation 67.8 MMK (Marshall-Marchetti-Krantz) operation 89.5 Burch colposuspension 89.8 Endoscopic suspension 86.7 Tension-free vaginal T-tape (TVT) 88-90 Vaginal sling operations 93.9 I. Sling Operations: a. After reviewing reports that included patient follow-up for more than 48 months, the American Urological Association and the Female Stress Urinary Incontinence Guidelines Panel concluded that the two most effective surgical treatments for stress incontinence are retropubic bladder neck suspensions and sling procedures. b. This panel confirmed that the use of sling operations in women with complex or recurrent stress urinary incontinence is a safe and effective treatment. II. Anterior Colporrhaphy Anterior vaginal repair is the oldest operation for stress incontinence in gynecology. It was described by Howard Kelly in 1914. He believed that stress incontinence was caused by an open vesical neck rather than from loss of urethral support, and he designed an operation to cure this condition by pulling the bladder neck closed using periurethral Kelly plication sutures. The problem with most techniques of anterior colporrhaphy is that they do not hold up well over time. Most surgical series that have evaluated techniques of anterior colporrhaphy for stress incontinence show long-term success rates of only 35% to 65%, a figure that most would regard as unacceptably low. Anterior colporrhaphy should be reserved primarily for patients requiring cystocele repair who do not have significant stress incontinence.\n\nSo the answer to this question is D"}
{"instruction": "An ideal root-canal filling material should satisfy all of the following except which one?\nA. The material should be well tolerated by periradicular tissues\nB. The material should be easily placed\nC. The material should be absorbable\nD. The material should be visible radiographically", "response": "Grossman's Requirements for an Ideal Root Canal Filling Material \n\nThe material should be easily introduced into the root canal.\nIt should seal the canal laterally as well as apically.\nIt should not shrink after being inserted.\nIt should set slowly.\nIt should be impervious to moisture.\nIt should be bactericidal or, at least, should discourage the growth of bacteria.\nIt should be radiopaque.\nIt should not stain the tooth structure.\nIt should not irritate periradicular tissues or affect the tooth structure.\nIt should be sterile, or easily and quickly sterilized immediately before insertion.\nIt should be easily removable from the root canal if necessary. \n\nRef: Grossman endodontics 13th ed page no 343\n\nSo the answer to this question is C"}
{"instruction": "Gold criteria for very severe airflow obstruction in COPD is\nA. FEV1/FVC<0.7 & FEV1>=80% predicted\nB. FEV1/FVC<0.7 & >=50% FEV1 but <80% predicted\nC. FEV1/FVC<0.7 & FEV1>=30% but <50% predicted\nD. FEV1/FVC<0.7 and FEV1<30% predicted", "response": "(D) FEV1/FVC<0.7 and FEV1<30% predicted [?]Hallmark of COPD is airflow obstruction.oPulmonary function test shows airflow obstruction with a reduction in FEV1 and FEV/FVC.oWith worsening disease severity, lung volumes may increase, resulting in an increase in total lung capacity, functional residual capacity, and residual volume.oIn patients with emphysema, the diffusing capacity may be reduced, reflecting the lung parenchymal destruction characteristic of the disease.oDegree of airflow obstruction is an important prognostic factor in COPDoIt is the basis for the Global Initiative for Lung Disease (GOLD) severity classificationGOLD CRITERIA FOR COPD SEVERITYGold StageSeveritySymptomsSpirometry0At riskChronic cough, sputum, productionNormalIMildWith or without chronic cough or sputum productionFEV1 /FVC<0.7 & FEV1 >80% predictedIIAModerateWith or without chronic cough or sputum productionFEV1 /FVC<0.7 & >=50%FEV1 but <80% predictedIIISevereWith or without chronic cough or sputum productionFEV1 /FVC<0.7SFEV1 >=30% but <50% predictedIVVery SevereWith or without chronic cough or sputum productionFEV1 /FVC<0.7 & FEV1 <30% predicted or FEV1 <50% predicted with respiratory failure or signs of right heart failure[?]Stage IV: Very Severe COPD:oSevere airflow limitation (FEV1/FVC<70%;FEV1<.30% predicted) or FEV1<50% predicted plus chronic respiratory failure.-Quality of life is appreciably impaired.-Exacerbations may be life-threatening.oAvoid risk factorsoOffer influenza vaccinationoAdd short-acting bronchodilators as neededoAdd rehabilitationoAdd inhaled glucocorticoids if repeated exacerbationsoAdd long-term oxygen if chronic respiratory failureoConsider surgical treatments-Arterial blood gases & Oximetry may demonstrate resting or exertional hypoxemia.-Radiographic studies may assist in the classification of the type of COPD.-CT scan is the current definitive test for establishing the presence or absence of emphysema in living subjects.-Recent guidelines have suggested testing for a, AT deficiency in all subjects with COPD or asthma with chronic airflow obstruction.-Only three interventions-smoking cessation, oxygen therapy in chronically hypoxemic patients & lung volume reduction surgery in selected patients with emphysema have been demonstrated to i influence the natural history of patients with COPD.\n\nSo the answer to this question is D"}
{"instruction": "Coloured halo is seen in all except:\nA. Open angle glaucoma\nB. Closed angle glaucoma\nC. Cataract\nD. Any of the above", "response": "A i.e. Open angle glaucoma\n\nSo the answer to this question is A"}
{"instruction": "Which of the following statements about confidence limits/ interval is TRUE?\nA. Smaller the confidence level larger will be the confidence interval\nB. Less variable the data, wider will be the confidence interval\nC. Sample size does not affect the confidence interval\nD. 95% confidence interval will cover 2 standard errors around the mean", "response": "The confidence interval is derived from the standard error of the mean. It is used to measure the dispersion of distribution. The confidence interval is often called as percentage confidence. The 95% critical value of confidence limit/interval covers +/- 1.96 (approx 2 S.E.) around the mean. Ref: Choosing and Using Statistics : A Biologist's Guide By Calvin Dytham, Pages 56-57; Introductory Econometrics : A Modern Approach By Jeffrey M. Wooldridge, Pages 138-140; Schaum's Outline of Theory and Problems of Probability and Statistics By Murray R. Spiegel, John J. Schiller, R. Alu Srinivasan, Pages 205-208.\n\nSo the answer to this question is D"}
{"instruction": "All of the following drug is CYP3A inhibitor except-\nA. Erythromycin\nB. Itraconazole\nC. Ritonavir\nD. Saquinavir", "response": "Ans. is 'd' i.e., Saquinavir\n\nSo the answer to this question is D"}
{"instruction": "Most common cause of small intestine obstruction is?\nA. Intussception\nB. Idiopathic adhesions\nC. Tumors\nD. Postoperative adhesions", "response": "ANSWER: (D) Postoperative adhesionsREF: Bailey & Love 25th edition page 1188, overview\"The most common cause of small-bowel obstruction (SBO) is postsurgical adhesions\"\n\nSo the answer to this question is D"}
{"instruction": "Highest mortality in pregnancy\nA. Fallot's tetrologv\nB. Coarctation of aorta\nC. Marfan’s syndrome\nD. Eisenmenger syndrome", "response": "Eisenmenger syndrome\n\nThese patients have pulmonary hypertension with shunt (right to left) through an open ductus or ASD or VSD.\nMaternal mortality is high i.e. 50% & so is a perinatal loss (50%).\nFallot’s tetralogy, coarctaion of aorta & Marfan's syndrome hav mortality’ rate of 5-10%, 3-9% & 25% respectively\n\nSo the answer to this question is D"}
{"instruction": "In which of the following chronic Conditions, degenerative changes in the brain are Seen which are not a pa of normal ageing?\nA. Dementia\nB. Pseudodementia\nC. Amnestic synrome\nD. Delirium", "response": "Amnesia is a deficit in memory caused by brain damage or disease, but it can also be caused temporarily by the use of various sedatives and hypnotic drugs. The memory can be either wholly or paially lost due to the extent of damage that was caused.There are two main types of amnesia: retrograde amnesia and anterograde amnesia. Retrograde amnesia is the inability to retrieve information that was acquired before a paicular date, usually the date of an accident or operation.In some cases the memory loss can extend back decades, while in others the person may lose only a few months of memory. Anterograde amnesia is the inability to transfer new information from the sho-term store into the long-term store. People with this type of amnesia cannot remember things for long periods of time. These two types are not mutually exclusive; both can occur simultaneously People with amnesia can learn new information, paicularly non-declarative knowledge. However, some people with dense anterograde amnesia do not remember the episodes during which they previously learned or observed the information. Declarative information Some patients with anterograde amnesia can still acquire some semantic information, even though it might be more difficult and might remain rather unrelated to more general knowledge. H.M. could accurately draw a floor plan of the home in which he lived after surgery, even though he had not lived there in years. The reason patients could not form new episodic memories is likely because the CA1 region of the hippocampus was a lesion, and thus the hippocampus could not make connections to the coex. After an ischemic episode following surgery, an MRI of patient R.B. showed his hippocampus to be intact except for a specific lesion restricted to the CA1 pyramidal cells. Non-declarative information Some retrograde and anterograde amnesics are capable of non-declarative memory, including implicit learning and procedural learning. For example, some patients show improvement on the pseudorandom sequences experiment as healthy people do. Therefore, procedural learning can proceed independently of the brain system required for declarative memory. According to fMRI studies, the acquisition of procedural memories activates the basal ganglia, the premotor coex and the supplementary motor area, regions which are not normally associated with the formation of declarative memories. This type of dissociation between declarative and procedural memory can also be found in patients with diencephalic amnesia such as Korsakoff's syndrome. Another example demonstrated by some patients, such as K.C. and H.M, who have medial temporal damage and anterograde amnesia, still have perceptual priming. Those patients did well in the word fragment completion test. Ref Harrison20th edition pg 2134\n\nSo the answer to this question is C"}
{"instruction": "Retinopathy of prematurity is commonly predisposed by-\nA. Less gestation age\nB. Low birth weight\nC. O2 toxicity\nD. Carbohydrate excess", "response": "Ans. is less gestation age (Ref Nelson, 17/e, p 2113, 2114 (16/e, p. 1925); O.P. Ghai, 6/e, p 629 (5/e, p. 504)).There is always the confusion between pre-maturity (less gestation age) and O2 toxicity, as the predisposing factor (Some are also confused with low birth weight).Read these lines from Nelson. They will clear away most of your doubts.\"Retinopathy of prematurity occurs almost exclusively in pre-term infants.\"The risk factor's associated with ROP are not fully known, but prematurity and the associated retinal immaturity at birth represents the major factors.Hyperoxia is also a major factor but other problems, such as respiratory distress, apnea, bradycardia, heart disease, infection, hypoxia, hypercarbia, acidosis, anemia and the need for transfusion are thought by some to be contributory factors\".Crux is Predisposing factor for ROP -Prematurity (les gestation age)* Precipitating factor -Hyperoxia*\n\nSo the answer to this question is A"}
{"instruction": "Nerve to which of the following extraocular muscle gives rise to a branch of ciliary ganglion:\nA. Superior rectus\nB. Inferior oblique\nC. Rectus medialis\nD. Rectus lateralis", "response": "Ciliary ganglion is a parasympathetic ganglion located near the apex of the orbit between the optic nerve and lateral rectus. It has three roots parasympathetic or motor, sympathetic and sensory roots. The motor root arises from the nerve to inferior oblique, sympathetic root arises from the nasociliary nerve and sympathetic root is a branch from the internal carotid plexus. Ref: Human Anatomy by B.D Chaurasia, 4th Edition, Vol 3, Page 114.\n\nSo the answer to this question is B"}
{"instruction": "All of the following are true about Primary CNS Lymphoma except:\nA. Most common type in immunocompetent patients is DLBCL\nB. Glucocoicoids should be given before biopsy to reduce the risk of edema\nC. Stereotactic biopsy is necessary for histologic diagnosis\nD. High-dose methotrexate is used for the treatment", "response": "PCNSL: Has increased incidence in immunocompromised patients Most common type in immunocompetent patients is DLBCL Lymphoma anywhere in the body- Biopsy is needed for diagnosis In PCNL - Stereotactic biopsy is necessary for histologic diagnosis Steroids are C/I as they have cytolytic effect on tumor PCNL is also known as Ghost tumor - tumor disappear if given steroids Treatment: Chemotherapy - high dose Methotrexate\n\nSo the answer to this question is B"}
{"instruction": "True about nocardia are all EXCEPT:\nA. Penicillin is drug of choice\nB. Most common disease caused is pneumonia\nC. Aerobic\nD. Acid fast", "response": "Penicillin is drug of choice REF: Harrsion's 18th ed chapter 162 NOCARDIA: Aerobic, gram positive, urease, catalase positive, paially acid fast. Most common species: N. ASTEROIDES Most common risk factor: contact with soil or vegetable Most common manifestation: pneumonia Most common site of extra pulmonary dissemination: brain DOC: Trimethoprim - sulphamethoxazole\n\nSo the answer to this question is A"}
{"instruction": "Propylthiouracil is preferred over Methimazole in treatment of Thyroid storm because\nA. It is more potent antithyroid drug.\nB. It is less plasma protein bound\nC. It decreases peripheral conversion of T4 to T3\nD. All of the above", "response": "Propylthiouracil is preferred over Methimazole in treatment of Thyroid storm because: Propylthiouracil impairs peripheral conversion of T4 - T3 However, PTU is less potent and has higher plasma protein binding as compared to methimazole.\n\nSo the answer to this question is C"}
{"instruction": "Bilious vomiting is seen in all except:\nA. Jejunal atresia\nB. Volvulus of small intestine\nC. Duodenal atresia\nD. Pyloric stenosis", "response": "Ans: d (Pyloric stenosis)Ref: Bailey & Love, 24th ed, p. 1033 & 23rd ed, p. 899\n\nSo the answer to this question is D"}
{"instruction": "True statement regarding Pulmonary ventilation is\nA. PaO2 is maximum at the apex.\nB. V/Q is maximum at the base.\nC. Ventilation per unit lung volume is maximum at the apex\nD. Blood circulation is minimum at the base", "response": "A i.e. PaO2 is maximum at apexVentilation perfusion ratio is maximum at the Apex of lungQ and minimum at base.In an upright positionVentilation per unit lung volume is greatest at basePerfusion per unit lung volume is greatest at base- a 2 is maximum at apex.High V- p ratio at the apex accounts for predilection of the tuberculosis for this area.In patient with unilateral lung disease the patient is positioned such that the good lung is in dependent position. Aerial oxygenation is improved in this position due to effect of gravity on ventilation.(The situation in infants is opposite. i.e. infants do better with the diseased lung in the dependent position)\n\nSo the answer to this question is A"}
{"instruction": "All of the following decrease with age except:-\nA. Total lung capacity\nB. PaO2\nC. FRC\nD. FEV1", "response": "With increasing age, total lung capacity decreases : decrease in lung volumes d/o* Decrease strength of respiratory muscles : decrease TV, decrease TLC* Decrease elasticity of lung : decrease IRC, decrease TLC* Decrease inspiratory capacity : decrease PaO2* Airway remodeling : decrease FEV1 * Increase FRC k/o airway remodeling, more air tends to Increase RV stay trapped in the alveoli. FRC will increase with age, because of loss of elastic tissue and airway remodelling, more amount of air is trapped in alveoli.\n\nSo the answer to this question is C"}
{"instruction": "An asymptomatic male came for USG abdomen for medical fitness. A focal lesion was found in his liver on ultrasound as shown here. The patient was told that this is the most common benign hepatic tumor. Which of the following is a false statement about this lesion?\nA. The most sensitive and specific investigation CT Triphasic Contrast\nB. Most of these lesions are asymptomatic\nC. Characteristic Centripetal fill-in appearance is seen on postcontrast study.\nD. Angiography shows characteristic \"cotton-wool\" appearance.", "response": "Ans. A. The most sensitive and specific investigation CT Triphasic ContrastHemangiomas are the commonest benign hepatic tumors with a prevalence at postmortem of between 4 per cent and 20 per cent. Multiple hemangiomas occur in up to 10 per cent of cases. They are composed of vascular channels of varying size (cavernous to capillary), lined with endothelium, often with intervening fibrous tissue of varying amounts. Most hemangiomas are asymptomatic, incidental findings on imaging. Those between approximately 2 and 4 cm in diameter are most likely to possess characteristic features allowing a confident diagnosis by imaging alone.\n\nSo the answer to this question is A"}
{"instruction": "A child presents with antimongoloid slant, pulmonary stenosis, sho stature and undescended testis. The likely diagnosis is-\nA. Hypoparathyroidism\nB. Noonan syndrome\nC. Klinefelter syndrome\nD. XYY sex chromosomes", "response": "Ans. is 'b i.e., Noonan Syndrome\n\nSo the answer to this question is B"}
{"instruction": "A woman at 8 months of pregnancy complains of abdominal pain and slight vaginal bleed. On examination the uterine size is above the expected date with absent fetal heart sounds. The diagnosis:\nA. Hydramnios\nB. Concealed hemorrhage\nC. Active labor\nD. Uterine rupture", "response": "Ans. is b, i.e. Concealed hemorrhageRef Dutta Obs. 7/e, p 255, 212, 429Let's analyse all options separately to see which suits the best.OptionsPoints in favourPoints against* Option \"a\" Hydramnios* Size of uterus > gestational age.* Absent fetal heart sounds (in polyhydramnios fetal heard sound is not distinctly heard) 05* Abdominal pain and vaginal bleeding (Main complain of patient with hydramnios is difficulty in breathing and swelling over legs Option \"a\" ruled out* Option \"c\" Active labor* Complain of abdominal pain and slight vaginal bleed (Which can be show of active labor)* Height of uterus > than the period of gestation (Height of uterus = period gestation in normal labor)* Absent fetal heart sound (FHS is present in normal laborOption \"d\"Rupture uterus Since period of gestation is 8 month i.e. rupture is occurring during pregnancy and since no H/o scared uterus is given we are taking it as spontaneous rupture during pregnancy* Height of uterus more than period of gestation* Absent fetal heart sounds* In rupture patient complains of acute pain in abdomen accompanied by fainting attack/collapse* Acute tenderness on abdominal examination* Palpation of superficial fetal parts Spontaneous rupture during pregnancy of un-scarred uterus occurs in high parous women and is not commonOption \"b\" Concealed hemorrhage* Abdominal pain and vaginal bleeding* Height of uterus more than period of gestation* Absent fetal heart sound So, concealed hemorrhage is the diagnosis.\n\nSo the answer to this question is B"}
{"instruction": "Marcus Gunn pupil is due to ?\nA. Total afferent pupillary defect\nB. Relative afferent pupillary defect\nC. Efferent pathway defect\nD. Cerebral lesion", "response": "Ans. is 'b' i.e., Relative afferent papillary defect Marcus Gunn pupil Marcus Gunn pupil is seen in relative afferent pathway defect (RAPD) An incomplete optic nerve lesion or retinal disease cause it (in contrast to amaurotic light reflex, where there is total afferent pathway defect). It is best tested by swinging flash light test. To perform this test, a bright flash light is shone to one pupil and constriction of that pupil is noted. Then the flashlight is quickly moved to the contralateral pupil and the response in that pupil is noted. This swinging to and fro of the flashlight is repeated several times while the pupillary response is observed. Normally, both pupils constrict equally and the pupil to whom light is transferred remains tightly constricted. In the presence of relative afferent pupillary defect in one eye, both the pupil will dilate when the flash light is moved from the normal to the abnormal eye. This is a paradoxical resposne. This is called Marcus Gunn pupil and is the earliest indicator of optic nerve disease even in the presence of a normal visual acuity. Relative afferent papillary defect (RAPD) or Marcus Gunn pupil is a reliable and objectve sign of unilateral or assymmetric disease or any lesion in afferent papillary pathway, i.e., retina, optic nerve, optic chiasma, optic tract or midbrain (pretectal nucleus). However, RAPD is most characteristic of lesions in the optic nerve.\n\nSo the answer to this question is B"}
{"instruction": "Treatment of pouch of Douglas abscess is -\nA. Laparotomy\nB. Posterior colpotomy\nC. Antibiotics\nD. Extraperitoneal drainage", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "M in 99Tc\"' stands for?\nA. Micro\nB. Mega\nC. Metastable\nD. Metastatic", "response": "Metastable REF: Nuclear Physics: Principles And Applications by Lilley Page 20 \"In 99Tcm the superscript M denotes that the technetium 99 is not in its ground state but a long lived metastable excited state\"\n\nSo the answer to this question is C"}
{"instruction": "A 35-year-old alcoholic presents with diarrhoea and scaly rash on his neck, hands and feet. He will improve if he is treated with which one of the following?\nA. Vitamin A\nB. Thiamine\nC. Folic acid\nD. Nicotinic acid", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Which of the following minerals potentiates the action of insulin?\nA. Molybdenum\nB. Chromium\nC. Manganese\nD. Selenium", "response": "The total human body contains about 6 mg chromium. The Chromium content of blood is about 20 Mg/dl. Cr performs several biochemical functions such as \nIn association with insulin, Cr promotes the utilization of glucose. \nCr is a component of a protein namely chromodulin which facilitates the binding of insulin to cell receptor sites.\nCr lowers the total serum cholesterol level.\nlt is involved in lipoprotein metabolism.\nCr decreases serum low density lipoproteins (LDL) and increases high density lipoproteins (HDL) and, thus, promotes health.\nlt is believed that Cr participates in the transport of amino acids into the cells (heart and liver).\nIt is estimated that an adult man consumes about 10 to 100 mg/day. \nThe good sources of Cr include brewer's yeast, grains/ cereals/ cheese and meat.\nChromium deficiency causes disturbances in carbohydrate, lipid and protein metabolisms.\nExcessive intake of Cr results in toxicity, leading to liver and kidney damage.\n\nKey Concept:\nChromium in the form of chromodulin facilitates the binding of insulin to cell receptor sites.\nRef : Textbook of Biochemistry, Satyanarayana\n\nSo the answer to this question is B"}
{"instruction": "All are associated with MEN 2 except:\nA. Pheochromocytoma\nB. Islet cell hyperplasia\nC. Medullary carcinoma thyroid\nD. Parathyroid adenoma", "response": "Answer is B (Islet cell hyperplasia): Pituitary islet cell tumors/hyperplasia are associated with MEN- I syndromes and not with MEN II syndromes.\n\nSo the answer to this question is B"}
{"instruction": "Most common nosocomial infection is\nA. Respiratory tract infection\nB. Gastrointestinal tract infection\nC. Urinary tract infection\nD. Throat infection", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "\"Bracket Calcification\" on Skull X-Ray is seen in –\nA. Tuberous Sclerosis\nB. SturgeWebeSyndrome\nC. Lipoma of corpus callosum\nD. Meningioma", "response": "Bracket calcification is seen in lipoma of the corpus callosum.\n\nSo the answer to this question is C"}
{"instruction": "A 7 yrs old child has conservative behavior, not playing quitely with peers, and difficulty in organization. He also interrupts others in school and easily gets distracted. Which of the foiling is likely diagnosis?\nA. Learning disorder\nB. Autistic disorder\nC. Attention deficit hyperactivity disorder\nD. Conduct disorder", "response": "Ans. C. ADHD. (Ref: Kaplan & Sadock's Synopsis of Psychiatry, Xth/Ch.43, Page no, 1208.)A 7-year-old child has conservative behavior, not playing quietly with peers, and difficulty in organization. He also interrupts others in school and easily gets distracted. The most likely diagnosis is ADHD (Attention deficit hyperactivity disorder).Kaplan, pg. 576............\"Excessive motor activity, usually with intrusive and annoying qualities, poor sustained attention, difficulties inhibiting impulsive behaviors in social situations and on cognitive tasks, and difficulties with peers are the main characteristics of ADHD, combined type. Symptoms must be present in two or more settings (in this case, home and school) and must cause significant impairment. The Rx of choice for ADHD is CNS stimulants, primarily detroamphetamine, methylphenidate, and pemoline.**.Discussion:Conduct disorder# Children with conduct disorder display a persistent disregard for rules and other people's rights that lasts at least one year.# Aggression toward people and animals, destruction of property, deceit and illegal activities, and frequent truancy from school are the main characteristics of the disorder.# Patients with antisocial personality disorder display a pervasive pattern of disregard for and violation of the rights of others since the age of 15 years, with evidence of a conduct disorder before age 15. Substance abuse is just one facet of conduct disorder.# Children with oppositional defiant disorder are problematic and rebellious but do not routinely engage in aggressive, destructive, or illegal activities.Autistic disorder# Autistic disorder is characterized by lack of interest in social interactions, severely impaired verbal and nonverbal communication, stereotyped behaviors, and a very restricted range of interests.# Children with autism do not involve themselves in imaginative and imitative play and can spend hours lining and spinning things or dismantling toys and putting them together.# Patients with obsessive-compulsive disorder may spend hours on repetitive tasks (such as lining up toys) but do not show the difficulties with language and social interaction that this patient displays.# Patients with Asperger's syndrome show no clinically significant delay in spoken or receptive language development, making this diagnosis unlikely.# Patients with Rett's disorder by the age of 5 would be expected to have microcephaly and a disordered gait (unsteady and stiff).Attention-deficit hyperactivity disorderOnset before age 12. Limited attention span and poor impulse control. Characterized by hyperactivity, impulsivity, and/or inattention in multiple settings (school, home, places of worship, etc.). Normal intelligence, but commonly coexists with difficulties in school. Continues into adulthood in as many as 50% of individuals. Associated with*frontal lobe volume/ metabolism. Treatment: methylphenidate, amphetamines, atomoxetine, behavioral interventions (reinforcement, reward).Conduct disorderRepetitive and pervasive behavior violating the basic rights of others (e.g,, physical aggression, destruction of property, theft). After age 18, many of these patients will meet criteria for diagnosis of antisocial personality disorder.Oppositional defiant disorderEnduring pattern of hostile, defiant behavior toward authority figures in the absence of serious violations of social norms.Tourette syndromeOnset before age 18. Characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for > 1 year. Lifetime prevalence of 0.1-1.0% in the general population. Coprolalia (involuntary obscene speech) found in only 10-20% of patients. Associated with OCD and ADHD. Treatment: antipsychotics and behavioral therapy.Separation anxiety disorderCommon onset at 7-9 years. Overwhelming fear of separation from home or loss of attachment figure. May lead to factitious physical complaints to avoid going to or staying at school. Treatment: SSRIs and relaxation techniques/behavioral interventions.\n\nSo the answer to this question is C"}
{"instruction": "In multibacillary leprosy, the follow-up examination after adquate Rx should be done early for -\nA. 3 years\nB. 5 years\nC. 10 years\nD. 2 years", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "All are true about humerus attachment except?\nA. Supraspinatus at LT\nB. Subscapularis at LT\nC. Teres minor at GT\nD. Infraspinatus at GT", "response": "Supraspinatus is inseed into the uppermost impression on the greater tubercle. The subscapularis is multipennate and is inseed into the lesser tubercle. Teres major is inseed into the lower impression on the greater tubercle. The infraspinatus is inseed into the middle impression on the greater tubercle. Reference:page no: 16 ,BD Chaurasia- upper limb& thorax, 6th edition Figure :2.15,2.16 , page no:16 - BD Chaurasia - upper limb & thorax , 6 the edition\n\nSo the answer to this question is A"}
{"instruction": "\"Bad-trip\" is associated with:\nA. Bhang\nB. Ganja\nC. Cocaine\nD. LSD", "response": "Ans. (d) LSDRef.: Harrison 19th ed. / 469e-4* LSD intoxication causes bad trips, which is acute panic reaction in which the individual experience a loss of control over his self.* Spontaneous recurrence of LSD, or sometimes cannabis use experience even during a withdrawal state is known as Flash back.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following disease is NOT caused by exposure to cold?\nA. Trench fever\nB. Trench feet\nC. Chilblains\nD. Frost bite", "response": "Exposure to cold causes frost bite, chilblains and trench feet. Trench fever (also known as \"Five day fever\", \"Quintan fever\") is a disease transmitted by body lice. Ref: Park 21st edition, page: 746.\n\nSo the answer to this question is A"}
{"instruction": "On barium swallow Leiomyoma shows following characteristic appearance-\nA. Rat tail appearance\nB. Cork screw appearance\nC. Oval mass lined by barium\nD. String sign", "response": "Ans. is 'c' i.e., Oval mass lined by barium * On barium swallow, leiomyoma may be seen as a discrete round or ovoid submucosal mass that is well outlined by barium. Its borders form slightly obtuse angles with the oesophageal wall.* Oesophageal leiomyoma is a benign smooth-muscle neoplasm of the oesophagus. It is the most common benign tumor of the oesophagus.* They typically involve the mid-to-distal oesophagus.\n\nSo the answer to this question is C"}
{"instruction": "Common source of staph in hospital -a) IV fluidsb) Infective woundsc) Hands of hospital personneld) Bed linene) Instruments\nA. a\nB. c\nC. bc\nD. ad", "response": "Hospital infection \n\nFor staphylococci most common source of infection are human and carriers, animal and inanimate objects being less common. Patients with superficial infections (i.e., infective wounds) and respiratory infections disseminate large numbers of staphylococci into the environment.\n\n\nTransmission of staphylococci results most frequently from transient colonization of hands of hospital personnel, who then transfer strains from one patient to another. (Harrison 17th/e p. 873)\nThe cocci shed by patients and carriers contaminate fomites such as handkerchiefs, bed linen and blankets and may persists on them for day and week.\n\nDon't get confused by option 'd', bed linen is a source of infection but it is not a common source - \"inanimate objects are less common source of infection.\"\n\nSo the answer to this question is C"}
{"instruction": "Management of carcinoma breast in 2nd trimester are all except\nA. Chemotherapy Doxirubicin+cyclophosphamide+5FU\nB. Mastectomy\nC. Focal 3D\nD. Breast Conservative surgery is a valid option", "response": "If the diagnosis of breast cancer is made in the first or early second trimester of pregnancy, lumpectomy and axillary dissection can be followed by chemotherapy after the first trimester and radiation after delivery. Chemotherapy is indicated for node-positive cancers or node-negative tumors greater than 1 cm. Current chemotherapeutic regimens are relatively safe after the first trimester, when the teratogenic risk is greatest. Generally, treatment regimens are the same as for non- pregnant patients with dose alterations because the increased plasma volume, the hypoalbuminemia, and the fact that almost all chemotherapeutic agents cross the placenta change the pharmacokinetics of the drugs. Ref: Sabiston 20th edition Pgno: 2060\n\nSo the answer to this question is C"}
{"instruction": "IgG4-related disease is a newly recognized entity. Which of the following thyroid abnormality is associated with this condition?\nA. De quervain thyroiditis\nB. Postpaum thyroiditis\nC. Reidel thyroiditis\nD. Hashimoto thyroiditis", "response": "- Riedel thyroiditis, a rare disorder associated with IgG4 characterized by extensive fibrosis involving thyroid & contiguous neck structures. - The presence of a hard & fixed thyroid mass clinically simulates a thyroid carcinoma; but unlike thyroid carcinoma it is seen in young pts. - It may be associated with fibrosis in other sites like trachea, esophagus etc resulting in stridor, dysphagia etc. - Treated by rituximab/ tomoxifen/ steroids. EXTRA EDGE: - IgG4-Related diseases are: Mikulicz syndrome (enlargement and fibrosis of salivary & lacrimal glands) Riedel thyroiditis idiopathic retroperitoneal fibrosis autoimmune pancreatitis, and inflammatory pseudotumors of orbit, lungs & kidneys.\n\nSo the answer to this question is C"}
{"instruction": "Not true about Medullary breast CA: -\nA. Good prognosis\nB. Around 3rd-4th decade\nC. BRCA 1\nD. Desmoplasia less than typical breast Cancer", "response": "Ans. (d) Desmoplasia less than typical breast Cancer(Ref. Bailey 27th Page 872)* Medullary cancer is comparatively common in young females* Soft in consistency* Poor prognosis* Triple negative ER, PR and HER 2 Negative tumor* Associated with BRCA 1 commonly* Desmoplasia is more than typical ductal adeno carcinoma breast\n\nSo the answer to this question is D"}
{"instruction": "Which of the following drugs is most effective against an organism producing aminoglycoside inactivating enzymes?\nA. Amikacin\nB. Streptomycin\nC. Gentamicin\nD. Tobramycin", "response": "(Ref: KDT 6/e p724) Amikacin is most resistant to aminoglycoside inactivating enzymes. Aminoglycosides are not effective against anaerobes.\n\nSo the answer to this question is A"}
{"instruction": "complication of acute sinusitis:\nA. orbital cellulitis\nB. Potts puffy tumor\nC. Conjunctival chemosis\nD. Subduram abscess", "response": "A,B,C and D mucocele and pyocele and pnuematocele are complications of chronic sinusitis. local complications of acute sinusitis: subperiosteal abscess osteomyelitis orbital cellulitis preseptal cellulitis post septal cellulitis orbital abscess cavernous sinus thrombosis maxillary sinusitis sphenoid sinusitis Systemic complications: Brain abscess meningitis toxic shock syndrome Ref Scott Brown 7/e,Vol 2,p 1539,1540.\n\nSo the answer to this question is B"}
{"instruction": "A 75 year old man with no past medical history presents with increasing shortness of breath over 6 months. He previously worked at a shipyard where he had significant exposure to asbestos. He has a large right-sided pleural effusion. Pleural aspiration is performed and reveals an exudate but cytopathological examination identifies no malignant cells. CT scanning reveals circumferential pleural thickening but no other abnormalities.\nWhich test is most likely to give a diagnosis?\nA. Thoracoscopy\nB. Bronchoscopy\nC. Echocardiogram\nD. Repeat pleural aspiration", "response": "Direct visualisation and targeted biopsy of any pleural lesion provides the best chance of a tissue diagnosis. Mesothelioma cannot b~ diagnosed on cytopathological examinatipn of pleural fluid. Bronchoscopy would not help with pleural disease but may be helpful if there were an endobronchial lesion with pleural metastases. Echocardiogram is not c6nsidered helpful because there is pleural thickening as well as a right-sided pleural effusion, so heart failure is an unlikely cause.\n\nSo the answer to this question is A"}
{"instruction": "What is the effect of calcitonin on bone resorption\nA. Inhibits resorption\nB. Promotes resorption\nC. Both propeies\nD. Enhances mineralisation", "response": "Physiologic Effects of Calcitonin Bone: Calcitonin suppresses resorption of bone by inhibiting the activity of osteoclasts, a cell type that \"digests\" bone matrix, releasing calcium and phosphorus into blood. Kidney: Calcium and phosphorus are prevented from being lost in urine by reabsorption in the kidney tubules. Calcitonin inhibits tubular reabsorption of these two ions, leading to increased rates of their loss in urine .R Ref - Harrisons internal medicine 20e p2923\n\nSo the answer to this question is A"}
{"instruction": "All of the following structures come in relation with the urethral crest which is situated in the prostatic pa of the urethra, EXCEPT?\nA. Ejaculatory ducts\nB. Prostatic utricle\nC. Prostatic sinus\nD. Colliculus seminalis", "response": "Urethral crest is a midline longitudinal ridge on the posterior wall of the prostatic urethra. Prostatic sinus is a groove on each side of urethral crest. About 15-20 prostatic ducts open into the prostatic sinus to pour secretion of prostate into the urethra.Colliculus seminalis is an elevation at the middle of urethral crest. It has three openings on it, a median for prostatic utricle and lateral for ejaculatory duct of each side.Prostatic urethra is the proximal 3cm of the male urethra lying inside of the prostate gland. It pierces the base of prostate and leaves it at the apex. It lies near the anterior surface. It is the most dilatable and wide pa of the male urethra.\n\nSo the answer to this question is C"}
{"instruction": "Muscle relaxant with ganglion blocker action is\nA. Pancuronium\nB. Trimethoprim\nC. Curare\nD. Halothane", "response": "Curare is an example of a non-depolarizing muscle relaxant that blocks the nicotinic acetylcholine receptor (nAChR), one of the two types of acetylcholine (ACh) receptors, at the neuromuscular junction\n\nSo the answer to this question is C"}
{"instruction": "World Health Organization 2010 criteria for morphology (strict criteria) for semen analysis includes -\nA. >15% normal forms\nB. >=4% normal forms\nC. >=25% normal forms\nD. >=32% normal forms", "response": "Normal Semen Analysis: World Health Organization 2010 Guideline Volume >=1.5 mL Sperm concentration >=15 million/mL Total sperm number >= 39 million/ ejaculate Sperm motility >40%motile, >32%progressive Morphology >=4% normal forms (kruger's strict criteria) Vitality 58 % White blood cells <1 million/mL Immunobead/Mixed antiglobulin Reaction <50% coated with antibodies reaction\n\nSo the answer to this question is B"}
{"instruction": "Radiographically, the normal horizontal plane of alveolar bone interdentally is related to\nA. Cemento enamel junction of adjacent teeth\nB. Epithelial attachment of adjacent teeth\nC. Trabecular pattern of bone\nD. All of the above", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Neurons of first order for visual sensations are:\nA. Rods and cones\nB. Bipolar cells\nC. Ganglion cells\nD. None of the above", "response": "Ans. Bipolar cells\n\nSo the answer to this question is B"}
{"instruction": "True about solitary rectal ulcer syndrome is all/except\nA. Increased muscle layer proliferation\nB. Crypt distortion\nC. Lamina propria infiltration with lymphocyte\nD. Subepithelial fibrosis", "response": "Histopathology of solitary rectal ulcer syndrome shows hypocellular lamina propria. There is relative absence of inflammatory cells. Surgical Pathology & Cytopathology writes - \"There may be crypt architectural distortion and branching similar to that evident in idiopathic irritable bowel syndrome (IBD), but without the dense lamina propria inflammation\".\nSolitary Rectal Ulcer Syndrome\n\nThe pathogenesis of mucosal prolapse syndrome or solitary rectal ulcer syndrome is unclear. It has been postulated that there is a dysfunction of the neuromuscular control of defecation. This necessitates an increase in intraabdominal pressure to achieve expulsion of the stool. The pressure then forces a rectal mucosal fold to prolapse into the anal canal. Localized ischemia of the prolapsed mucosa as a result of local vascular compromise then produces the characteristic histological change of SRUS.\nSRUS affects both sexes, over a wide range, but is most common in women 20-40 years of age.\nMost lesions occur on the anterior or anterolateral rectal wall, but SRUS may involve the bowel anywhere from the sigmoid to the anorectal junction.\nDespite the designation solitary rectal ulcer, in 10 to 15% of cases multiple ulcers may be present within a single patch of diseased mucosa.\nEndoscopically only about half of the patients with SRUS have an actual ulcer. The remaining patients have an area of mucosal erythema, mucosal nodules, or frank polyps, which may or may not have surface ulceration.\nThe histological features can be correlated to the underlying pathogenesis of the disorder. Prolapsed mucosa becomes ischemic due to compression of the vascular supply, particularly the small veins. This leads to detachment of the surface epithelium and withering of the superficial portion of the crypts, similar to ischemia from any cause. Since the prolapse is typically intermittent, during intervals of normal blood flow regrowth of the mucosa is stimulated, resulting in mucosal hyperplasia due to elongation of the crypts. As an additional response to the ischemic injury, fibrosis of the lamina propria occurs. There may be crypt architectural distortion and branching similar to that evident in idiopathic irritable bowel syndrome, but without the dense lamina propria inflammation. The muscularis mucosa also becomes thickened and disorganized and tongues of muscle extend upwards from the muscularis mucosa to the surface epithelium.\nIn some cases the ischemia is severe enough to lead to erosion or ulceration, often with a scanty overlying pseudo membrane. The cells show enlarged, hyper chromatic nuclei, excess mitotic activity, and mucin-depleted goblet cells.\n\nSo the answer to this question is C"}
{"instruction": "By spirometry, one can measure -\nA. Residual volume\nB. FRC\nC. TLC\nD. Tidal volume", "response": "Ans. is 'd' i.e., Tidal volume o Pulmonary ventilation can be studied by recording the volume movement of air into and out of the lungs, a method called spirometry.o A spirometer is a device in which, one breathes into and out of the device.o The volume of air breathed in or out are measured.o Spirometry can measure (spirometric measurement are) : - Tidal volume (TV), inspiratory reserve volume (IRV), expiratory reserve volume (ERV), and vital capacity (VC)r /FEV1.o As residual air (residual volme) can not be expired (residual volume is the amount of air remaining in the lung after maximum possible expiration), residual volume cannot be measured by spirometry ,o Therefore, the capacities which have residual volume as one of their components, cannot be measured by spirometry.o These capacities are functional residual capacity (ERV + RV) and total lung capacity (VC + RC).o The commonly employed methods for functional residual capacity (FRC) estimation are: -i) Gas-dilution methods : - Helium dilution technique, nitrogen washout technique.ii) Plethysmography\n\nSo the answer to this question is D"}
{"instruction": "A patient presents with polyuria and elevated prolactin levels. There is family history of father died due to renal stones. He has Ca2+of 12 g% and PTH levels of 260 IU/L. Most likely diagnosis is:\nA. MEN 1\nB. PGA 1\nC. MEN 2\nD. Autoimmune polyendocrinopathy", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Which of the following disorders has the potential to develop myeloid leukemia\nA. Micro angiopathic hemolytic anemia\nB. Sideroblastic anemia\nC. Paroxysmal nocturnal Hemoglobinuria\nD. Megaloblastic anemia", "response": "PNH can transform into AML or Myelodysplastic syndrome.\n\nSo the answer to this question is C"}
{"instruction": "True about benzodiazepines ?\nA. Increased release of GABA\nB. Antagonzing release of GABA\nC. Lorazepam is shoer acting than temazepam\nD. Atropine is its antagonist", "response": "Ans. is 'c' i.e., Lorazepam is shoer acting than temazepam Lorazepam has VA 10-20 hours, while Temazepam has VA 10-40 hours. About other options BZDs do not increase or decrease the release of GABA, they bind on GABAA receptors and increase Cl- conductance - GABA facilitatory action. Flumazenil (not atropine) is the antagonist of BZDs.\n\nSo the answer to this question is C"}
{"instruction": "C.P.I.T.N is used in\nA. Biggest population\nB. Smallest population\nC. Diagnostic tool\nD. Screening purposes", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Which is the principal virulence factor in Clostridium tetani\nA. Tetanolysin\nB. Tetanospasmin\nC. Tetanotactin\nD. Immobility factor", "response": "C.tetani produces two distinct toxins- a hemolysin(tetanolysin), and neurotoxin(tetanospasmin). Tetanospasmin: This is the toxin responsible for tetanus. This toxin acts pre-synaptically. The abolition of spinal inhibition causes an uncontrolled spread of impulses initiated anywhere in the central nervous system. This results in muscle rigidity and spasms. Tetanolysin: it is not relevant in the pathogenesis of tetanus. Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th Edition; Pg: 265\n\nSo the answer to this question is B"}
{"instruction": "Suture least adherent to tissue and have a property of\nplasticity\nA. Nylon\nB. Prolene\nC. PDS\nD. Silk", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A patient with clustered, white lesions on the buccal mucosa (opposite the upper 1st & 2nd molars) pathognomonic for measles. These are:-\nA. Leukoplakia\nB. Koplik spots\nC. Kaposi spots\nD. None", "response": "Koplik spots - These are white lesions on buccal mucosa opposite the first and second lower molars. They are small, bluish-white spots on a red base, smaller than the head of a pin It is pathognomonic of measles. Measles- Causative organism - RNA paramyxovirus Incubation period - 10-14 days Pathognomic c/f - Koplik spots Clinical feature- retroauricular origin of rash M/c complication- serous otitis media\n\nSo the answer to this question is B"}
{"instruction": "Most common type of gastric polyp is -\nA. Hyperplastic polyp\nB. Hamaomatous polyp\nC. Malignant polyp\nD. Familial polyosis", "response": "Hyperplastic or inflammatory polyps are regenerative, nonneoplastic lesions which are the most common type (90%).. Hamaomatous polyp are not true neoplasms but are malformations. Eg: Peutz-Jeghers syndrome, juvenile polyp, pancreatic heterotopia, heterotopia of Brunner's glands and inflammatory fibroid polyps. TEXTBOOK OF PATHOLOGY HARSH MOHAN 6TH EDITION PAGE.554 IMAGE Ref : TEXT BOOK OF PATHOLOGY HARSH MOHAN 6TH EDITION Table 20.4 PAGE :554\n\nSo the answer to this question is A"}
{"instruction": "Which of the following statements regarding liver enzymes is true\nA. ALT is less specific indicator of liver injury than AST\nB. Absolute levels of aminotransferase correlate with outcome\nC. Glutathione-S- Transferase is used as a hepatic prognostic marker after surgery\nD. None of the above", "response": "Answer is C (Glutathione-S- Transferase is used as a hepatic prognostic marker after surgery) Glutathione - S - Transferase is an emerging enzyme marker for post-transplant monitoring (surgery) as an aid to the diagnosis of acute allagraft rejection ALT is a more specific indicator of liver injury than AST and absolute levels of aminotransferase do not correlate with outcome. ALT is a more specific indicator of Liver injury than AST AST (Aspaate Aminotransferase) is found in the liver, cardiac muscle, skeletal muscle, kidneys, brain, pancreas, lung, leukocytes and erythrocytes in decreasing order of concentration. ALT is found primarily in the liver and is therefore a more specific indicator of Liver injury - Harrison's 186/2528 Absolute level of Aminotransferase elevation do not correlate with outcome `There is poor correlatation between extent of Liver cell Necrosis and the elevation of serum aminotransferase levels in chronic liver diseases. Similarly, absolute elevation of aminotransferase levels is of little value in predicting the outcome of acute hepatocellular disorders' - Schiff's Deseases of the Liver Serum Glutathione - S- Transferase may be used as a prognostic marker after transplant surgery 'Serum Alpha - Glutathione - S - Transferase is an emerging static test indicating hepatocellular damage. As in vivo plasma half life of this enzyme is less than 60-90 minutes, this enzyme offer advantages in post-transplant monitoring as an aid to the diagnosis of acute allagraft rejection. Recent investigations have indicated that monitoring of GST reduced both moality and morbidity in liver transplant recipients. GST showed a distinct higher sensitivity (81%) for acute rejection than conventional liver function tests (the specificity however was relatively low (45%). Glutathione - S-Transferase (GST) - Miller's Anesthesia (Elsevier) 2010/426 Glittathione-S-Transferase is a sensitive and specific test for some patterns of Liver injury. The enzyme has a brief plasma half life (90 minutes) and is released rapidly into circulation following hpatocellular injury. Thus serial GST measurements can reveal time course of hepatic injury from its onset to its resolution. In contrast to AST and ALT which reside in Acinar Zone I, GST localizes in Acinar Zone III (centrilobular region). This zone contains the hepatacyte population with highest susceptibility to injury from hypoxia or reactive drug metabolites. Accordingly GST would be more sensitive than AST or ALT as a marker of contrilobular necrosis in its incipient stage.\n\nSo the answer to this question is C"}
{"instruction": "In a pregnant woman with heart disease, all of the following are to be done except:\nA. IV methergin after delivery\nB. Prophylactic antibiotic\nC. IV frusemide postpartum\nD. Cut short 2nd stage of labor", "response": "Ans. is a, i.e. IV methergine after deliveryRef. Dutta Obs. 7/e, p 278As discussed in the chapter overview all the options given in the question are correct except for 'c' i.e. methergine after delivery. Methylergometine is contraindicated in patient of heart desease.\n\nSo the answer to this question is A"}
{"instruction": "Not a feature of Stein Leventhal syndrome is\nA. Increased androgens\nB. Increased or normal oestrogens\nC. Galactorrhoea\nD. Increased LH", "response": "Stein-Leventhal syndrome is another term for polycystic ovarian disease (PCOD). In this condition, androgens are raised due to hypehecosis leading to hirsutism. Oestrogen level is normal but LH level and LH / FSH ratio is raised. It is an impoant cause of secondary amenorrhoea and infeility in young women. Clomiphene is the drug of choice for infeility in PCOD and cyproterone acetate is the drug of choice for hirsutism. ref Katzung 12th ed.\n\nSo the answer to this question is C"}
{"instruction": "In case of chronic lead poisoning, the levels of which of the following is elevated: NIMHANS 11\nA. Porphobilinogen\nB. 6-amino levulinic acid\nC. Bilirubin\nD. Urobilinogen", "response": "Ans. 6-amino levulinic acid\n\nSo the answer to this question is B"}
{"instruction": "Which of the following drugs is not used for H.pylori treatment?\nA. Oxytetracycline\nB. Bismuth compounds\nC. Amoxicillin\nD. Omeprazole", "response": "(ref :KDT 6/e p637)\n\nSo the answer to this question is A"}
{"instruction": "The difference in molecular weight between Phenylalanine & Tyrosine is by :\nA. 17\nB. 16\nC. 64\nD. 32", "response": "Usually students tend to mark 17 as the answer. Phenylalanine gets conveed to Tyrosine by enzyme Phenylalanine Hydroxylase. Most Hydroxylases are Mono-oxygenases i.e. EC No. 1. In hydroxylation reactions, only one oxygen atom from the molecular oxygen is added because H was already present in the phenylalanine. So, change in molecular weight is by 16 and NOT 17. Extra Information: Phenylalanine is an essential amino acid and its only role in the body is to give rise to tyrosine.\n\nSo the answer to this question is B"}
{"instruction": "Geographic tongue is of red colour because of\nA. Infiltration of eosinophils\nB. Infiltration of neutrophils\nC. Both of the above\nD. None of the above", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "The impression material with lowest viscosity is\nA. Plaster of paris\nB. Agar-agar\nC. Zinc oxide eugenol\nD. Elastomers", "response": "Impression plaster is a β-calcium sulfate hemihydrate used at a water/powder ratio of approximately 0.5 to 0.6. Its fluidity makes it suitable for making impressions of soft tissues in the uncompressed state, a characteristic of mucostatic impression material.\nRef: Phillips 12 ed page no 177\n\nSo the answer to this question is A"}
{"instruction": "Sentinel surveillance; TRUE is:\nA. Data is itself reported to the health system\nB. Active collection of data\nC. Employed to identify the missing case\nD. All of the above", "response": "Surveillance: \n\nOngoing systematic collection, analysis & interpretation of data and use of this information to take action for prevention and control of disease. \nUsed for purpose of 'health planning'. \n\nTypes of Surveillance:\n\nSo the answer to this question is C"}
{"instruction": "In Alzheimer's disease (AD) which of the following is not seen:\nA. Aphasia\nB. Acalculia\nC. Agnosia\nD. Apraxia", "response": "B i.e. Acalculia\n\nSo the answer to this question is B"}
{"instruction": "A 30 year old male patient presents with bleeding per rectum.\nHe complains of Hemorrhoids which are reduced spontaneously.\nTreatment of choice Is\nA. Open hemorroidectomy\nB. Sitz bath\nC. Sclerotherapy\nD. Stapled hemorroidopexy", "response": "2nd degree hemorrhoids are treated by sclerotherapy which is done without anesthesia.\n\nSo the answer to this question is C"}
{"instruction": "Epidermal growth factor is required for:\nA. Epithelium proliferation and tooth eruption\nB. Angiogenesis\nC. Collagen formation\nD. Fibroblast formation", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Urate crystals are deposited in small joints of the hands & feets in: September 2003\nA. Gout\nB. Still's disease\nC. Retropharyngeal abscess\nD. Ankylosing spondylitis", "response": "Ans. A i.e. Gout\n\nSo the answer to this question is A"}
{"instruction": "Substance commonly used for organ/tissue preservation for histopathological examination is?\nA. Ethyl alcohol\nB. Formalin\nC. Saturated salt solution\nD. Normal saline", "response": "ANSWER: (B) FormalinREF: Parikh 6th edition page 2.62Repeat in December 2009\"10% formalin is used as a preservative for tissue meant for histopathological examination\"\n\nSo the answer to this question is B"}
{"instruction": "Prophylactic intracranial radiation is given in\nA. Small cell carcinoma\nB. Testicular carcinoma\nC. Breast carcinoma\nD. Gastric carcinoma", "response": "This aggressive form of lung cancer most commonly occurs in smokers. It usually starts in the breathing tubes (bronchi) and grows very quickly, creating large tumours and spreading (metastasising) throughout the body.\nSymptoms include bloody phlegm, cough, chest pain and shortness of breath.\nTreatment includes surgery (for small tumours) as well as chemotherapy, sometimes in combination with radiation therapy.\n\nSo the answer to this question is A"}
{"instruction": "L-aspraginase is used in which type of Leukemia -\nA. AML\nB. CML\nC. ALL\nD. CLL", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Haemobilia is charactericed by all except\nA. Jaundice\nB. Biliary colic\nC. Melaena\nD. Fever", "response": "Hemobilia,i,.e.,bleeding from the liver or occasionally from the gallbladder into the biliary tract. Hemobilia is characterised by Triad of Sandloom/Quincke's which includes Jaundice(60%);Colicky pain (70%) and Upper GI bleed with melaena(90%),haematemesis(60%).All three features of triad are seen only in 20% cases. Reference :SRB's manual of surgery,5th edition,page no:663.\n\nSo the answer to this question is D"}
{"instruction": "First ocular sign of Vitamin A deficiency ?\nA. Bitot's spot\nB. Conjunctival xerosis\nC. Night blindness\nD. Keratomalacia", "response": "Ans. is 'b' i.e., Conjunctival xerosis\n\nSo the answer to this question is B"}
{"instruction": "Which of the following would be associated with parallel changes in aldosterone and coisol secretion?\nA. Addison's disease\nB. Cushing's disease\nC. Cushing's syndrome\nD. Conn's syndrome", "response": "Addison's disease results from an inability of the adrenal coices to produce sufficient adrenocoical hormones. Persons with Addison's disease have diminished secretion of both glucocoicoids (coisol) and mineralocoicoids (aldosterone). Hypersecretion by the adrenal coex causes a complex cascade of hormone effects called Cushing's syndrome. When Cushing's syndrome is secondary to excess secretion of ACTH by the anterior pituitary, this condition is referred to as Cushing's disease. In persons with Cushing's disease or Cushing's syndrome, coisol secretion is elevated but aldosterone secretion is normal. Occasionally a small tumor of the zona glomerulosa cells occurs and secretes large amounts of aldosterone; the resulting condition is called primary aldosteronism or Conn's syndrome.\n\nSo the answer to this question is A"}
{"instruction": "A 43-year-old woman has had a 10-year history of severe and recurrent peptic ulcer disease (PUD) that is refractory to medical therapy. She has had ulcers at multiple sites of the small bowel including the distal duodenum and jejunum. She also has chronic diarrhea, but not enough fat to make the diagnosis of steatorrhea. Evaluation for Helicobacter pylori infection is negative.For the above patient with GI symptoms, select the possible diagnoses and associated findings.\nA. celiac sprue\nB. gastrinoma\nC. associated with decrease in pancreatic enzymes\nD. hypersensitivity reaction", "response": "Zollinger-Ellison syndrome is caused by a non-beta islet cell tumor of the pancreas. It may be associated with the syndrome of multiple endocrine neoplasia, type I (MEN I). The syndrome should be suspected in patients with multiple ulcers, ulcers resistant to therapy, ulcers in unusual locations, strong family history of ulcers, unexplained diarrhea, or evidence of MEN I.\n\nSo the answer to this question is B"}
{"instruction": "All are true about Madura mycetoma except\nA. Fungal infection\nB. Presented as painful nodular lesion for many months\nC. Discharging sinuses\nD. Bone involvement seen", "response": "Clinical features of mycetoma include - painless multiple nodular swellings which may be suppurative and drain through sinuses, feet and lower legs are commonly affected. Bone involvement may lead to osteomyelitis and deformities. Ref: Textbook of Microbiology, Ananthanarayan and Paniker; 9th edition\n\nSo the answer to this question is B"}
{"instruction": "Which of the following the characteristic feature of subdural hematoma -\nA. Convex hyper density\nB. Biconvex hypo density\nC. Convexo-concave hypo density\nD. Concavo-convex hyper density", "response": "Ans. is 'd' i.e. Concavo-convex hyperdensity .On CT Scan Subdural hematoma - Concavo convex* hyperdensity Epidural hematoma - Biconvex hyperdensity *\n\nSo the answer to this question is D"}
{"instruction": "Anterior compament of leg contains all except\nA. Peroneus brevis\nB. Tibialis anterior\nC. External hallucis longus\nD. External digitorum longus", "response": "ANTERIOR COMPAMENT:- Muscles:-1. Tibialis anterior 2. Extensor hallucis longus3. Extensor digitorum longus 4. Peroneus teius. Aery: anterior tibial aery. The blood supply of anterior compament is reinforced by the perforating branch of peroneal aery. Nerve:-Deep peroneal nerve. {Reference: BDC 6E vol2 pg 93}\n\nSo the answer to this question is A"}
{"instruction": "In osteomyelitis, solid periosteal reaction seen in the X-ray at\nA. 1st week\nB. < 2 + hours\nC. 2nd week\nD. 3rd week", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Insulin dependent glucose uptake is not seen in ?\nA. Skeletal muscles\nB. Hea\nC. Adipose tissue\nD. Kidney", "response": "Insulin dependent glucose uptake is through GLUT-4 and is seen in :? 1) Skeletal muscles 2) Cardiac muscles (hea) 3) Adipose tissue\n\nSo the answer to this question is D"}
{"instruction": "All the following effects are produced by inhibitors of prostaglandin synthesis except\nA. Prolongation of bleeding time\nB. Prolongation of prothrombin time\nC. Prolongation of labour\nD. Gastric mucosal damage", "response": "(Ref:. KDT 6/e p186) Prothrombin time is increased by the drugs interfering with the coagulation pathway (e.g. warfarin). As cox has no role in coagulation, inhibitors,of PG svnthesis do not prolong PI. However, bleeding time (BT) is prolonged by the drugs interfering with platelet function. Aspirin increases,.BT by acting as an antiplatelet agent.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following coding system used in ICD-10 is used for “Schizophrenia, schizotypal and delusional disorders”?\nA. F10-F19\nB. F20-F29\nC. F30-F39\nD. F40-F48", "response": "F20-F29\n(Ref : ICD-10 WHO)\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is most commonly involved in Hypersensitivity vasculitis:\nA. Capillaries\nB. Aerioles\nC. Post-capillary venules\nD. Medium sized aeries", "response": "Answer is C (Post-capillary venules): Post-capillary venules are most commonly involved in Hypersensitivity vasculitis Hypersensitivity vasculitis Hypersensitivity vasculitis refers to small vessel vasculitis that is restricted to the skin and not associated with any other form of primary or secondary vasculitis. Implicit in the definition is that this condition is not associated with medium or large vessel disease at other sites, nor with small vessel disease in other organs (only skin) Microscopic polyangitis affects the skin and also internal organs and hence is not considered pa of hypersensitivity vasculitis The typical histopathological feature of cutaneous vasculitis is the presence of leukocytoclastic vasculitis of small vessels. Vasculitis is charachterized by Leukocytoclasis -- Harrison's Synonyms for Hypersensitivity vasculitis include: cutaneous small vessels vasculitis, leucocytoclastic vasculitis, cutaneous leucocytoclastic angitis etc. 'Post-capillary venules are the most commonly involved vessels. Capillaries and aerioles may be involved less frequently' -- Harrison American College of Rheumatology 1990 Criteria for the Classification of Hypersensitivity Vasculitis Laboratory and Radiographic Work-up of Patients with Possible Hypersensitivity Vasculitis Age at disease onset > 16 years Medication at disease onset Palpable purpura Maculopapular rash Biopsy including aeriole and venule, showing granulocytes in a perivascular or extravascular location For purposes of classification, hypersensitivity vasculitis may be diagnosed if the patient meets at least three of these five criteria.\n\nSo the answer to this question is C"}
{"instruction": "Pyruvate dehydrogenase is inhibited allosterically by ?\nA. AMP\nB. Pyruvate\nC. NADH\nD. `Insulin", "response": "Ans. is 'c' i.e., NADH\n\nSo the answer to this question is C"}
{"instruction": "Characteristic feature of Otosclerosis are all except:\nA. Conductive deafness\nB. Positive Rinne's test\nC. Paracusis willisii\nD. Mobile ear drum", "response": "Tuning Fork Tests in OtosclerosisRinnes test-negativeWebers test-lateralised to ear with greater conductive lossAbsolute bone conduction-normal (It is decreased in cochlear otosclerosis)Pure tone audiometry-shows loss of air conduction more for lower frequency. * Tympanic membrane is normal and mobile in 90% cases. Schwaz sign--Flammingo cases pink colour of tympanic membrane is seen in 10% cases. It indicates active focus with increased vascularity.Stapes footplate--Shows a rice grain / biscuit type appearanceBlue mantles are seen histopathologically.\n\nSo the answer to this question is B"}
{"instruction": "AU ER rods seen in -\nA. Ml AML\nB. M3 AML\nC. M6AML\nD. ALL", "response": "Ans. is 'b' i.e., M3 AMLAcute myelogenous leukemia (AML)o AML is a cancer of myeloid line of WBCs, characterized by the rapid proliferation of abnormal cells which accumulate in the bone marrow and interfere with the production of normal blood cells,o AML is the most common acute leukemia affecting adults.o The diagnosis of AML is based on finding that myeloid blasts make up more than 20% of the cells in the marrow,o Myeloblasts are myeloperoxidase (peroxidase positive)o Auer rods (represent abnormal azurophilic granule) are also present in myeloblasts and their presence is taken to be definitive evidence of myeloid differentiation.o In some AMLs, blast cells exhibit differentiation of other myeloid stem cell line (other than myeloblast), e.g.,Monoblast - Lack auerrods, peroxidase negative, but nonspecific esterase positive.Megakaryocytic differentiationErythroblast\n\nSo the answer to this question is B"}
{"instruction": "All of the following are true regarding enoxaparin EXCEPT:\nA. It has higher and predictable bioavailability\nB. It act by inhibiting both factor Ila and factor Xa\nC. Monitoring is not required\nD. It has more favorable pharmacokinetics", "response": "Ref KDT, 6th ed. pg. 599-600* Low molecular weight heparin, Enoxaparin, inhibits only factor Xa whereas unfractionated heparin inhibits both factor IIa and factor Xa.\n\nSo the answer to this question is B"}
{"instruction": "What will be the line of treatment, if coronal pulp dies?\nA. Extraction\nB. Surgical removal of apical fragment\nC. RCT of coronal fragment and treat the apical fragment with apexification\nD. All of the above", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Both Vitamin K and C are involved in\nA. The synthesis of clotting factors\nB. Post translational modifications\nC. Antioxidant mechanisms\nD. The microsomal hydroxylation reactions", "response": "Vitamin C plays the role of a coenzyme in the hydroxylation of proline and lysine while procollagen is conveed to collagen (i.e. post-translational modification). The functions of vitamin K are concerned with the blood clotting process. It brings about the posttranslational (after protein biosynthesis in the cell) modification of ceain blood clotting factors ii, vii, ix, x ref Satyanarayana 4th ed page 130, 132\n\nSo the answer to this question is B"}
{"instruction": "All of the following measure the plaque index except:\nA. Ramjford index\nB. Moller's index\nC. OHI-S index\nD. Loe and Silness", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Level of iodisation in salt according to PFA at Consumer level :\nA. 10 ppm\nB. 15 ppm\nC. 30 ppm\nD. 45 ppm", "response": "Production level - 30 ppm.\nConsumer level - 15 ppm.\n\nSo the answer to this question is B"}
{"instruction": "Roll back malaria included all except -\nA. Insecticides nets\nB. Strengthening health system\nC. Develop new insecticide\nD. Training health workers", "response": "Insecticides nets, Strengthening health system, Develop new insecticide,. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE 21ST EDITION. PAGE NO - 243\n\nSo the answer to this question is D"}
{"instruction": "A child aged 3 yrs, presented with severe sensorineural deafness was prescribed hearing aids, but showed no improvement. What is the next line of management:\nA. Fenestration surgery\nB. Stapes mobilisation\nC. Choclear implant\nD. Conservative", "response": "Ans. is 'c' Cochlear implant Any person who fails to benefit from hearing aids in given , cochlear implant. Here the child does not benefit from hearing aid so he should be given cochlear implant.Note : Make sure that the patient is not prelingually deaf because Cochlear implants are not useful in prelingually deaf patient.\n\nSo the answer to this question is C"}
{"instruction": "All of the following disease may be acquired by ingestion except -\nA. Taeniasis\nB. Guinea worm\nC. Toxoplasmosis\nD. Leishmaniasis", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "A 12 year old boy rapidly develops hypoglycemia after moderate activity. On physical examination, kidney and liver are found to be enlarged. Histopathology of liver shows deposits of glycogen in an excess amount. Blood examination reveals raised ketone bodies, lactic acid and triglycerides. What is the diagnosis?\nA. Von Gierke's disease\nB. Pompe's disease\nC. McArdle's disease\nD. Cori's disease", "response": "Type Ia Glycogen Storage Disease-Von Gierke’s Disease\n\nMost common Glycogen Storage Disorder in childhood.\nAutosomal recessive.\n\nThe biochemical hallmarks are:\n\nHypoglycemia\nLactic acidosis\nHyperlipidemia\nHyperuricemia\n\nClinical Presentation\nMost commonly present at 3–4 months of age with:\n\nDoll like facies with fat cheeks\nRelatively thin extremities\nShort stature, protuberant abdomen\nMassive hepatomegaly\nKidneys are also enlarged\nNo splenomegaly\nPlasma may be milky due to associated hypertriglyceridemia\n\nReference- Harper’s illustrated biochemistry. 30th edition page no: 179\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is the most cranial structure in the root of left lung?\nA. Bronchus\nB. Pulmonary artery\nC. Pulmonary vein\nD. Bronchial artery", "response": "Ans. is 'b'i.e. Pulmonary artery Root of the lung is a short broad pedicle which connects the medial surface of the lung to the mediastinum.Contents of RootPrincipal bronchus on the left side, and eparterial and hyparterial bronchi on right side.One pulmonary artery.Two pulmonary veins, superior and inferior.Bronchial arteries, one on the right side and two on the left side.Bronchial veins.Anterior and posterior pulmonary plexuses of nerves.Lymphatics of the lung.Bronchopulmonary lymph nodes.Areolar tissue.Arrangement of Structures in the RootFrom before backwards. It is similar on the two sides.Superior pulmonary veinPulmonary arteryBronchusFrom above downwards. It is different on the two sides. Right side Left side Eparterial bronchus 1 .Pulmonary artery Pulmonary artery 2.Bronchus Hyparterial bronchus 3 .Inferior pulmonary vein Inferior pulmonary vein Relations of the Root Anterior Posterior Common on the two sides a. Common on the two sides 1 . Phrenic nerve 1 .Vagus nerve2. Pericardiophrenic vessels 2.Posterior pulmonary plexus 3 . Anterior pulmonary plexus b. On left side On the right side 1 .Descending thoracic aortaSuperior vena cavaA part of the right atrium. Superior Inferior On right side Pulmonary ligament Terminal part of azygos vein On left side Arch of the aorta\n\nSo the answer to this question is B"}
{"instruction": "The following are live attenuated vaccine, except-\nA. Oral poilio\nB. Yellow fever\nC. Measles\nD. Influenza", "response": "oral polio vaccines were first introduced by Sabin in 1957.it contains live attenuated strains of virus type 1,2, and 3.grown in primary monkey kidney or h7man diploid cell cultureref;parks tectbook,ed22,pg 187\n\nSo the answer to this question is A"}
{"instruction": "Macular edema is caused by all except –\nA. Micro aneurysm\nB. Capillary dilatation\nC. Neovascularization\nD. None", "response": "Causes of macular edema :-\n\nMetabolic alteration :- Diabetes, retinitis pigmentosa, inherited cystoid macular edema (CME).\nIschemia CRVO, Diabetic retinopathy, severe hypertensive retinopathy, HELLP syndrome, vasculitis.\nMechanical force :- Vitreous traction on the macula.\nInflammation :- Intermediate uveitis, post-operative CME, choroidal inflammatory diseases.\nPharmacotoxicity :- Epinephrine (in Aphakia), Betaxolol, latanoprost..\n\nSo the answer to this question is D"}
{"instruction": "You decide not to give sildenafil to patient who is on antianginal drug, which of the following drug it can be?\nA. Calcium channel blockers\nB. Beta blockers\nC. Nitrates\nD. ACE inhibitors", "response": "Ans. C. NitratesNitrates act by increase CGMP and sildenafil decrease the breakdown of this compound. Marked increase in CGMP results in profound hypotension and reflex tachycardia.\n\nSo the answer to this question is C"}
{"instruction": "Ramu presents with recurrent attacks of cholelithiasis, USG examination shows dilated CBD of 1 cm. The next line of management is\nA. ERCP\nB. PTC\nC. Cholecystostomy\nD. Intravenous cholangiogram", "response": "ERCP Endoscopic clearance of CBD stones can avoid the need for an open operation if expeise in laparoscopic common bile duct exploration is not available Indications of preoperative ERCP Patients with worsening cholangitis Ampullaru stone impaction Biliary pancreatitis Cirrhosis Contraindications of endoscopic sphincterectomy CBD diameter >2cm Long suprasphincteric stricture >15mm Peri-Vaterian Diveiculum Duodenal Wall and head of the pancreas severely inflamed Ref: Sabiston 20th edition Pgno : 1511\n\nSo the answer to this question is A"}
{"instruction": "Burking includes: NEET 13\nA. Choking\nB. Ligature\nC. Overlaying\nD. Traumatic asphyxia", "response": "Ans. Traumatic asphyxia\n\nSo the answer to this question is D"}
{"instruction": "Na+ uptake at basolateral surface of apical cells is by\nA. Active transpo\nB. Passive transpo\nC. Diffusion\nD. Osmosis", "response": "Ans. is 'a' i.e., Active transpo\n\nSo the answer to this question is A"}
{"instruction": "Which of the following configuration is used in designing an RPD with Kennedy — Class II edentulous arch?\nA. Bilateral\nB. Tripod\nC. Quadrilateral\nD. Unilateral", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which is a most likely complication of lUD?\nA. Hypofibrinogenemia\nB. Sterility\nC. Cervical tear\nD. None of the above", "response": "The most common complication seen in intrauterine fetal death is hypo fibro gene mia due to consumption coagulopathy. \nIt occurs due to the release of thromboplastin from dead fetus and placenta into the maternal circulation.\n\nSo the answer to this question is D"}
{"instruction": "Botox Is used in treatment of:\nA. Achalasia cardia\nB. Toicollid\nC. Both\nD. None", "response": "Botox is derived from botulinum toxin It decreases acetyl choline release by degrading synaptobrevin\n\nSo the answer to this question is C"}
{"instruction": "A 70-year-old male patient with intentional tremor, drunken gait, and past pointing is having a lesion in which of the following structures\nA. Basal ganglia\nB. Pyramidal tract\nC. Cerebellum\nD. Thalamus", "response": "\"Most abnormalities associated with damage to the cerebellum are apparent during movement Ataxia is manifest not only in the wide-based, unsteady, \"drunken\" gait of patients but also in defects of the skilled movements involved in the production of speech, so that slurred, scanning speech results. Voluntary movements are also highly abnormal when the cerebellum is damaged. For example, attempting to touch an object with a finger results in overshooting. This dysmetria or past-pointing promptly initiates a gross corrective action, but the correction overshoots to the other side, and the finger oscillates back and foh. This oscillation is called an intention tremor.\"\n\nSo the answer to this question is C"}
{"instruction": "Antibiotic that can be used as antiplaque agent is/are:\nA. Penicillin.\nB. Vancomycin.\nC. Kanamycin.\nD. All of the above.", "response": "Penicillin, vanomycin, kanamycin have been used as antiplaue agents but their use has been considerably reduced due to bacterial resistance and hypersensitivity reactions.\n\nSo the answer to this question is D"}
{"instruction": "On X-ray of the abdomen, soap bubble appearance is seen in:\nA. Multiple cystic kidney\nB. Meconium ileus\nC. Cystic lymphangiectasis\nD. Volvulus", "response": "Ans. Meconium ileus\n\nSo the answer to this question is B"}
{"instruction": "Which is the most common functioning tumour of pituitary?\nA. GH secreting tumor\nB. Prolactinoma\nC. ACTH producing adenoma\nD. Oncocytoma", "response": "MC Functioning tumour of pituitary: Prolactinoma MC tumor of pituitary: Non- functioning adenoma\n\nSo the answer to this question is B"}
{"instruction": "This type of psoriasis is commonly seen in children and may follow a streptococcal sore throat –\nA. Guttate\nB. Stable plaque\nC. Pustular\nD. Arthropathic", "response": "Guttate psoriasis occurs in children and adults. It is precipitated by URTI (e.g. streptococcal tonsilitis)\n\nSo the answer to this question is A"}
{"instruction": "Which one of the following is true regarding HIV infection -\nA. Following needle stick injury infectivity is reduced by adminsitration of nucleoside analogues\nB. CD4 counts are the best predictors of disease progression\nC. Infected T cells survive for a month in infected patients\nD. In latent phase HIV has minimal replication", "response": "Pathogenesis of HIV infection and AIDS\nPrimary infection of cells through the blood and mucosa. \n\nThe initial entry of the virus may be through a mucosal surface, as in sexual intercourse (via rectal or cervical mucosa) or via blood exposure e.g. (after intravenous drug abuse).\nFrom the mucosa the virus is carried to the regional lymph nodes by dendritic cells while the virus initially inoculated into the blood is rapidly cleared by the spleen and lymph nodes.\nThus, with either mode of entry, the virus initially replicates in the lymphoid organs and then spills over into the blood.\n\nInfection established in lymphoid tissue e.g, lymph node\n\nAfter the infection is established in the lymph node the virus spills into the blood the patient will now experience the acute HIV syndrome.\n\nAcute HIV syndrome, the spread of infection throughout the body\n\nThis phase is characterized initially by high levels of virus in plasma and widespread seeding of the virus in lymphoid tissues.\nSometimes there is an abrupt reduction in CD4+ T cells.\nDuring this period, the HIV virus can be readily isolated from the blood, and there are high levels of HIV p24 antigen in serum.\nSoon, however virus specific immune response develops\n\nImmune response\n\nThe viremia is readily controlled by the development of an antiviral immune response.\nIt is estimated that 40% to 90% of individuals who acquire a primary infection develop the viral syndrome 3-6 weeks after infection and this resolves spontaneously in 2 to 4 weeks.\nThe resolution of viremia occurs due to the immune response.\nVirus-specific antibodies develop evidenced by seroconversion (usually within 3-7 weeks of presumed exposure) and more importantly virus-specific CD8+ cytotoxic T cells also develop.\nHIV specific CD8+ T cells are detected in the blood, at this time, viral titres begin to fall and are most likely responsible for containment of HIV infection.\nAs viral replication stops CD4+ T cells return to near normal numbers, signalling the end of the acute phase.\n\nClinical Latency\n\nThe clinical latency or the middle chronic phase represents a stage of relative containment of the virus.\nAlthough the plasma viremia declines, there is widespread dissemination and seeding of the virus, especially in the lymphoid organs.\nThe viral load at the end of the acute phase reflects the equilibrium reached between the virus and the host after the inital battle and in a given patient may remain fairly stable for several years.\nThis level of steady state viremia, or the viral \"set point\" is a predictor of the rate of decline of CD4+ T cells and therefore progression of HIV disease.\nIn one study, only 8% of patient with a viral load of less than 4350 copies of viral mRNA/ 1 progressed to full blown AIDS in 5 years, where as 62% of those with a viral load of greater than 36, 270 copies had developed AIDS in the same period.\nFrom a practical standpoint, therefore the extent of viremia, measured as IIIV-tRNA is a useful surrogate marker of HIV disease progression and is of clinical value in the management of people with HIV infection.\nHowever, in patients treated with highly active antiretroviral therapy (HAART), clinical improvement is often greater than the decrease in plasma viremia and it is generally accepted that virenzia as well as the blood CD4+ T cell counts should be considered in the management.\nRegardless of the viral burden, during the middle or chronic phase, there is continuing battle between HIV and the host immune system.\nThe CD8+ cytotoxic T cell response remains activated and extensive viral and CD4+ cell turnover continues.\nHowever, because of immune regenerative capacity of the immune system a large proportion of the lost CD4+ cells is replenished.\nThus the decline in CD4+ cell count in blood is modest.\nAfter an extended variable period, there begins a gradual erosion of CD4+ T cell and full blown AIDS ensues AIDS\nIn this phase the host defence begins to wane.\nThere is loss of CD4+ T cells.\nConcomitant with this loss, the proportion of the HIV virus in the blood increases.\nIt is characterized by a breakdown of the host defence, a dramatic increase in plasma virus and clinical disease.\nTypically the patient presents with long lasting fever (> 1 months), fatigue, weight loss and diarrhoea.\nAfter a variable period, serious opportunistic infections, secondary neoplasms or clinical neurological disease (grouped under the rubric AIDS indicator disease, discussed below), supervene and the patient is said to have developed AIDS.\nIt should be evident from our discussion that in each of the three phases of HIV infection, viral replication continues to occur .\nEven in the chronic phase, before the severe decline in CD4+ cell count and the development of AIDS, there is extensive turnover of the virus.\nIn other words HIV infection lacks a phase of true microbiologic latency, thus it is a phase during which all the HIV is in the form of proviral DNA and no cell is productively infected.\n\nSo the answer to this question is A"}
{"instruction": "Unwinding Enzyme in DNA synthesis:\nA. Helicase\nB. Primase\nC. DNA Polymerase\nD. Transcriptase", "response": "Ans. A. Helicase(Ref: Harper 31/e page 364)Classes of proteins involved in DNA replicationProteinFunctionDNA polymerasesDeoxynucleotide polymerizationHelicasesProcessive unwinding of DNATopoisomerasesRelieve torsional strain that results from helicase-induced unwindingProteinFunctionDNA primaseInitiates synthesis of RNA primersSingle-strand binding proteinsPrevent premature reannealing of dsDNADNA ligaseSeals the single strand nick between the Nascent chain and Okazaki fragments on lagging strand\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is the optimal position for inseing an IOL during a cataract surgery?\nA. Anterior chamber\nB. Posterior chamber\nC. Iris clip\nD. Any of the above", "response": "The lens should be placed in the capsular bag of the posterior chamber. Intraocular lens implants can easily be inseed behind the iris and in front of the posterior lens capsule. This is safest and most secure place for intraocular lens implants to rest within the eye.\n\nSo the answer to this question is B"}
{"instruction": "Nasal perforation in bony part seen in\nA. Syphilis\nB. Tuberculosis\nC. Wegner's granuloma\nD. Allergic rhinitis", "response": "A. (Syphilis) (144 - Dhingra 4th) (189 - Maqbool 11th)Lupus, tuberculosis and leprosy - causes perforation in the cartilaginous part while syphilis involves the bony part**PERFORATION OF NASAL SEPTUM1. Traumatic perforations - Trauma is the most common cause*a. Surgical (during and after SMR) or accidentalb. Constant habit of nose pickingc. Tight nasal packingd. Repeated cauterization with chemicals or galvanocautrye. Haematoma and abscess formation due to necrosis of the septal cartilage2. Pathologic perforationsa. Septal abscessb. Nasal myiasis, allergic rhinitisc. Rhinolith or neglected foreign body causing pressure necrosisd. Chronic granulomatous conditions like lupus, tuberculosis and leprosy, syphilise. Wegener's granuloma is a midline destructive lesion which may cause total septal destruction**f. Irritants like tobacco or cocaine snuff and fumes such as those of chronic acid and mercuryg. Tumours of the septum eg chondrosarcoma, granuloma.* Perforation of posterior septum is commonly seen in syphilis**Treatment - Inactive small peforation can be surgically closed by plastic flaps - larger perforations are difficult to close.\n\nSo the answer to this question is A"}
{"instruction": "Most common site of occurrence of Craniopharyngioma is?\nA. Infrasellar\nB. Suprasellar\nC. Posterior fossa\nD. Nasopharyx", "response": "Ans. is 'b' i.e., Suprasellar* Location of craniopharyngiomas can bei) Sellar - suprasellar (most cases) - most commonly arising on the pituitary stalk and projecting into the hypothalamus.ii) Infrasellar or intrasellar.iii) Prechiasmic.iv) Retrochiasmic.* Rare locations include extradural and extracranial-nasopharyngeal, posterior fossa or extending down the cervical spine.\n\nSo the answer to this question is B"}
{"instruction": "A 28 year old female presents with acute abdominal pain,vaginal bleeding,severe pallor, hypotension after having induction of ovulation 2 months back for infeility. The provisional diagnosis is:\nA. Uterine fibroid\nB. Ovarian cyst\nC. Ruptured ectopic pregnancy\nD. inevitable aboion", "response": "fig-Ruptured ectopic pregnancy in the right Fallopian tube with surrounding blood clots Infeility, per se, as well as the use of Assisted reproductive technology ,is linked to substantively increased risks for ectopic pregnancy After one ectopic the chance of a second ectopic is 10% A \"classic\" presentation is characterized by the triad of delayed menstruation, pain, and vaginal bleeding or spotting.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following swelling moves on protrusion of tongue -\nA. Thyroglossal cyst\nB. Branchial cyst\nC. Ranula\nD. Cyst in hyoid bone", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "In PCOD, which is true\nA. Increase FSH, decrease LH\nB. Increase LH, decrease estrogen\nC. Increase FSH/LH ratio, decrease estrogen\nD. Increase LH, increase estrogen", "response": "(D) Increase LH, increase estrogen > The ratio of LH (Luteinizing hormone) to FSH (Follicle stimulating hormone) is greater than 1:1, as tested on Day 3 of the menstrual cycle due to increase in LH.Oestrogen levels are incresed.\n\nSo the answer to this question is D"}
{"instruction": "True statement about fibrous cartilage is\nA. This is the strongest kind of cartilage.\nB. It is made of alternating layers of hyaline cartilage matrix and thick layers of dense collagen fibers oriented in the direction of functional stresses\nC. It does not have perichondrium as it is usually a transitional layer between hyaline cartilage and tendon or ligament\nD. All of the above", "response": "all these statements are true for fibrous cartilage.\n\nSo the answer to this question is D"}
{"instruction": "Triage means -\nA. Soing out of cases on availability of medical resources and seventy of patients condition\nB. Patients are divided into 3 groups\nC. Severely injured patients are attended first in military camps\nD. None of the above", "response": "Triage is the name of the system that is used to so when and where patients will be seen in an emergency depament. The triage system exists because, while all patients at emergency depaments may be experiencing serious illness or injury, those with life-threatening and severe conditions must be treated first. Ref Davidson 23rd edition pg 1337\n\nSo the answer to this question is A"}
{"instruction": "Malignancy is typically associated with disordered differentiation and maturation. Which of the following mentioned option best describe anaplasia?\nA. Hepatic tumors synthesizing bile\nB. Skin tumor producing keratin pearl\nC. Bronchial epithelium cell producing keratin pearl\nD. Colonic tumor cell producing mucin", "response": "Lack of Differentiation is called Anaplasia. Hepatic tumors synthesizing bile - The actual function of the hepatocytes is to produce bile.(Normal state) Skin tumor producing keratin pearl - Skin has the presence of Squamous epithelium and that is going to have the presence of keratin pearl (Again normal) Bronchial epithelium cell producing keratin pearl- The ciliated columnar epithelium of the bronchi is producing something which is the function of squamous epithelium, this is referred as disordered function which signifies anaplasia. Colonic tumor cell producing mucin- colonic epithelium is columnar epithelium and it is its normal function to produce mucin.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is a mineralocoicoid antagonist -\nA. Spironolactone\nB. Inamrinone\nC. Nicorandil\nD. Ketorolac", "response": "Ans. is 'a' i.e., Spironolactone\n\nSo the answer to this question is A"}
{"instruction": "\"Risk ratio\" is utilized to calculate :-\nA. Relative risk\nB. Attributable risk\nC. Population attributable risk\nD. Odds ratio", "response": "- Risk ratio is the ratio of incidence of disease in exposed to incidence of disease in non-exposed. - It is utilized to calculate relative risk. EXTRA EDGE: - R.R. = Ie / Ine - A.R. = x 100 - P.A.R. = x 100\n\nSo the answer to this question is A"}
{"instruction": "In normal immune system, the epithelioid cells are derived from:\nA. TH1\nB. TH2\nC. Macrophages\nD. TH19", "response": "Ref: Robbins Basic Pathology, E-book, P 85* Epithelioid cells are defined as cells that resemble epithelial cells (keratinocytes). They have large oval, pale, vesicular nuclei and abundant eosinophilic cytoplasm.* The best-known epithelioid cells are those derived from macrophages within granulomas, but tumor cells can also be described as epithelioid. Immunostaining may be needed to identify the type of epithelioid cell.MOST COMMON LESIONS WITH EPITHELIOID CELLS* Granulomas* Squamous cell carcinoma* Spitz nevus (spindle and epithelioid cell nevus)* Melanoma\n\nSo the answer to this question is C"}
{"instruction": "Wheal and flare reaction is: September 2005\nA. Type I hypersensitivity\nB. Type II hypersensitivity\nC. Type III hypersensitivity\nD. Type IV hypersensitivity", "response": "Ans. A: Type I hypersensitivity\n\nSo the answer to this question is A"}
{"instruction": "Antiperistalsis is more commonly seen in\nA. Colon\nB. Jejunum\nC. Ileum\nD. Duodenum", "response": "Excessive distention or irritation of the duodenum provides an especially strong stimulus for vomiting. In the early stages of excessive gastrointestinal irritation or overdistention, antiperistalsis begins to occur, often many minutes before vomiting appears.\n\nSo the answer to this question is D"}
{"instruction": "Sperm get nutrition from:\nA. Fructose\nB. Glucose\nC. Sucrose\nD. Amylase", "response": "Seminal vessels secrete a mucoid material containing abundance of fructose, citric acid and other nutrient substance. This adds to the bulk of semen & fructose in the seminal fluid is of nutrient value to the sperm GLUT- 5: fructose transpo.\n\nSo the answer to this question is A"}
{"instruction": "A 3-month-old child has moderate fever and non productive cough and mild dyspnea. After a course of antibiotic, the condition of the child improved transiently but he again develops high fever, productive cough and increased respiratory distress. CXR shows hyperlucency and PFT shows obstructive pattern. Most probable diagnosis is:\nA. Alveolar microlithiasis\nB. Postviral syndrome\nC. Follicular bronchitis\nD. Bronchiolitis obliterans", "response": "d. Bronchiolitis obliterans(Ref: Nelson's 20/e p 2044-2047, Ghai 8/e p 381-382)Bronchiolitis obliterans (BO)What is it?A chronic obstructive lung disease of bronchioles and smaller airways, that results from an insult to the lower respiratory tract leading to fibrosis of small airwaysPathogenesis* After the initial insult, inflammation affecting terminal bronchioles, respiratory bronchioles and alveolar ducts can result in the obliteration of the airway lumen* Epithelial damage resulting in abnormal repair is characteristic of BO* Complete or partial obstruction of the airway lumen can result in air trapping or atelectasisClinical features* Cough, fever, cyanosis, dyspnea, chest pain and respiratory distress followed by initial improvement* It is easily confused with pneumonia, bronchitis, or bronchiolitis* Progression of disease with increasing dyspnea, chronic cough, sputum production and wheezing seenDiagnosis* Chest X-ray may be normal or can demonstrate hyperlucency and patchy infiltrates* Occasionally, a Swyer-James syndrome (unilateral hyperlucent lung) develops* PFT shows obstructive pattern\n\nSo the answer to this question is D"}
{"instruction": "Unpaired laryngeal cartilage-\nA. Arytenoid\nB. Corniculate\nC. Cuneiform\nD. Epiglottis", "response": "Ans. is 'd' i.e., Epiglottis o The skeletal supports of larynx is provided by Six cartilages, 3 out of which are paired (so there are total 9 cartilages). i) Unpaired Thyroid, cricoid, epiglottis. ii) PairedArytenoid, Corniculate, cuneiform.\n\nSo the answer to this question is D"}
{"instruction": "Mottled enamel is due to:\nA. Vitamin A deficiency\nB. Excess of fluoride\nC. Vitamin D deficiency\nD. Teratogens", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A woman presents with a thick curdy-white vaginal discharge. The best treatment for her is:\nA. Miconazole\nB. Metronidazole\nC. Nystatin\nD. Doxycycline", "response": "Candidiasis Its seen in Immuno-compromised women, Pregnancy, Chemotherapy, T.B, etc Is a Yeast like fungi Has Thick curdy discharge Petichiae hemorrhages when white are removed Treatment Clotrimazole cream/ pessary Miconazole cream/ pessary Oral: fluconazole, itraconazole, ketoconazole\n\nSo the answer to this question is A"}
{"instruction": "Virulence factors for meningococci\nA. Capsule\nB. Pili\nC. Endotoxin\nD. Coagulase", "response": "Meningococci are capsulated, unlike Neisseria. Based on their capsular polysaccharide antigens, they are classified into 13 subgroups, of which groups A, B, C, X, Y and W-135 are the most impoant Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 231\n\nSo the answer to this question is A"}
{"instruction": "Advantages of median episiotomy over mediolateral episiotomy are all except: March 2005\nA. Less blood loss\nB. Easy repair\nC. Extension of the incision is easy\nD. Muscles are not cut", "response": "Ans. C: Extension of the Incision is Easy Mediolateral episiotomy is performed by making a diagonal incision across the midline between the vagina and anus This method is used much less often. The disadvantages are: Apposition of the tissues is not so good. May require more healing time than the midline incision. Blood loss is little more Postoperative discomfo is more Relative increased incidence of wound disruption Dyspareunia is comparatively more The advantages are: If necessary the incision can be extended. Relative safety from rectal involvement from extension.\n\nSo the answer to this question is C"}
{"instruction": "In which stage of the syphilis, nose is involved commonly ?\nA. Primary\nB. Secondary\nC. Teiary\nD. Equally involved in all stages", "response": "Ans. is 'c' i.e., Teiary Nasal syphilis Nasal syphilis may be : i) Acquired or ii) Congenital. Teiary stage in which nose is involved most commonly. There is formation of gumma followed by bony perforation of nasal septum. Bridge of the nose collapses causing a saddle deformity. Atrophic rhinitis may occur as a complication.\n\nSo the answer to this question is C"}
{"instruction": "Vitamin E prevents rancidity by virtue of its---------property:\nA. Antioxidant\nB. Oxidant\nC. Sulfuration\nD. Hydrogenation", "response": "A Harper, 26th ed, p. 486 & 25th ed. p. 647\n\nSo the answer to this question is A"}
{"instruction": "A lady on long term hemodialysis developed carpel tunnel syndrome. The cause was diagnosed to be amyloidosis by using a biopsy. What is the type of amyloid that is seen?\nA. Beta 2 microglobulin\nB. Amyloid light chain\nC. ATTR\nD. Serum amyloid associated protein", "response": "Ans. is 'a' i.e. Beta 2 microglobulin Dialysis-related amyloidosis (DRA) is a disorder caused by tissue deposition of beta2 microglobulin as amyloid fibrils.The clearance of beta2 microglobulin, a component of the major histocompatibility complex that is present on cell surfaces, normally occurs by glomerular filtration with subsequent reabsorption and catabolism in proximal tubules. Clearance therefore declines in patients with reduced kidney function, leading to plasma accumulation and slow tissue deposition.The tissue deposition of amyloid detected histologically occurs much earlier than any clinical or radiographic manifestations of the illness.In contrast to fragments of immunoglobulin light chains in primary amyloidosis and serum amyloid A in secondary amyloidosis, the amyloid protein in DRA is composed primarily of beta2- microglobulin.The amyloid found in the bone cysts and synovial tissue in patients with DRA is similar to other forms of amyloid in its staining properties with Congo red and in exhibiting apple-green birefringence under polarized light. It has been proposed that beta2- microglobulin has a high affinity for collagen, an effect that could explain the predominance of joint and bone diseaseClearance of beta2-microslobulinUnderlying the tissue deposition of beta2-microglobulin among patients with end-stage renal disease is the inability to adequately clear this substance, even with modem high flux hemodialysis and/or convective therapies. Bones and diseasesLess tendency to deposit in gastrointestinal organsRarely involvesp2 amyloid has preference for deposition in bones joints and synoviump2 amyloid has affinity for collagenCarpal tunnel syndromeScapulohumeral periarthritisEffusive arthropathySpondyloarthropathyBone diseasesColonStomachEsophagusSmall intestineCardiacPulmonarycutaneousTissue histologyIn contrast to fragments of immunoglobulin light chains in primary amyloidosis and serum amyloid A in secondary amyloidosis, the amyloid protein in DRA is composed primary of beta2-microglobulinThe amyloid found in the bone cysts and synovial tissue is similar to other forms of amyloid in its staining properties with Congo red and in exhibiting apple-green birefringence under polarized light - Biopsy remains the \"gold standard\" for the diagnosis of beta2- microglobulin amyloidosis. Despite this, the diagnosis of DRA is usually clinical and relies upon the combination of typical clinical features plus characteristic radiographic findings. Abdominal fat pad aspirates are not useful for the diagnosis of DRA.Type of AmyloidosisMajor Fibril proteinPrecursor proteinSystemic Amyloidosis Primary amyloidosisSecondary amyloidosisHemodialysis associated amyloidosisALAAAb2 microglobulinImmunoglobulin light chainSSAb2 microglobulinHereditary amyloidosis Familial Mediterranean feverFamilial amyloidotic neuropathiesSystemic senile amyloidosisAAATTRATTRSAATransthyretinTransthyretinLocalized amyloidosis Senile cerebral(Alzheimer's)Medullary ca thyroidIslet of LangerhansIsolated atrial amyloidosisAbAcalAIAPPAANIAPPCalcitoninIslet amyloid peptideAtrial natriuretic factor\n\nSo the answer to this question is A"}
{"instruction": "Greenish discolouration at putrefaction is due to-\nA. MetHb\nB. Sulph-meth Hb\nC. Deoxy Hb\nD. Carboxy Hb", "response": "Ans. is 'b' i.e., Sulph-meth Hb Signs of putrefactiono The signs and effects of putrefaction are as followsColour changesThe earliest sign of decomposition is greenish discoloration of body, seen in right iliac fossa externally and under liver internally. This is due to involvement of caecum. Which contains more liquid and is full of bacteria. In these areas, it appears in 12-18 hours and slowly spreads to whole body in 24-48 hours. Greenish discoloration is due to formation of sulph-meth-haemoglobin,Morbling occurs when Hb dissociates from RBCs and the colour of Hb is taken up by vessels, which are seen as prominent lines having purple or green or brown colour. Marbling occurs in 24-48 hours.Formation of foul smelling gasesDue to action of bacteria, foul smelling gases are formed, e.g. SO., H^S, ammonia, methane and CO,.Effects of gasesBloating up of body occurs in 34-48 hours. At the same time following changes occurs :i) Appearance of stomach contents and froth on nose and mouth.ii) Degloving and destocking with appearance of putrifactive blisters,iii) Emptying of heart due to pressure of gas.In 48-72 hours prolapse of rectum and uterus occur and postmortem delivery may occur if the dead woman is pregnant. Color of postmortem staining also changes to brown and finally to black. False rigidity (putrefactive rigidity ) may occur at this time.Appearance of maggotsFlies lay their eggs in wrounds, exposed natural orifices and exposed moist parts of the body and folds of skin, e.g. neck, axilla, nostrils, mouth etc. Flies lay eggs in 6-12 hours after death and these eggs change in larva (maggot) in 1 -2 days. Thus maggots appear in 2-3 days after the death. After further 4-5 days, the maggots change into pupa, which convert into adult flies in next 3-5 days. Thus adult flies will be coming out of the body after total 8-12 days of death. Thus appearance of maggot determine the time since death.Other late changesIn 3-5 days : Nails and teeth become loose and can be pulled out, sutures of skull may separate.In 7-12 days: Liquefaction of body (colliquative putrefaction) occurs.In 1-3 months : Skeletonization of dead body occurs.Finally: Bones also decompose : Exposed bones in 1-5 years and deep burried bone (> 2 meters) in 25-100 years.Internal changesLiver becomes spongy and is called as foamy or Swiss cheese or honeycombed liver.In 7-12 days lequefaction of internal organs occur.Floatation of body (if body is in water)Floatation of body occurs due to accumulation of sufficient putrefactive gases. Abdomen is above (due to gases) and spine is below during floatation. Time required for floatation is ordinarily 24 hours after death in summers and 2-3 days in winter. Factors affecting floatation are :-i) Causing early floatation : Newborn mature infant, females, in summer, clothed body, obese, in sea water and in still pond wrater.ii) Causing delayed floatation : Still birth/i immature newrbom, male, in winter, naked body, thin built, in fresh water and in running stream water.o inspiration and expiration before death has no effect on floatation as floatation is due to putrefactive gases (not due to respiratory air).\n\nSo the answer to this question is B"}
{"instruction": "On giving a patient insulin, which of the following is expected to occur first?\nA. Increased transpo of K+ into adipocytes\nB. Stimulation of protein synthesis\nC. Activation of glycolysis\nD. Increase in mRNA for lipolysis", "response": "Increased transpo of K+ into adipocytes will occur first onn giving an injection of insulin. Based onn time on onset, actions of insulin are classified as: Rapid(seconds): Increased permeability, leading to : Increased transpo of glucose, aminoacids, and K+ into insulin sensitive cells. Intermediate(minutes): Changes in activity levels of intracellular enzymes, leading to: Stimulation of protein synthesis Inhibition of proteinn degradation Activation of glycolytic enzymes and glycogen synthase Innhibition of phophorylase and glucogenic enzymes. Delayed (Hours to days): Changed rates of transcription for DNA, leading to: Increased in mRNAs for lipogenic and other enzymes. Ref: Guyton and Hall 13th edition Pgno: 985\n\nSo the answer to this question is A"}
{"instruction": "Rupture of extensor pollicis longus occurs four weeks after:\nA. Colles' fracture\nB. Radial styloid fracture\nC. Smith's fracture\nD. Scaphoid fracture", "response": "A i.e. Colle's fracture\n\nSo the answer to this question is A"}
{"instruction": "Fluconazole is more effective than itraconazole in the following systemic fungal disease\nA. Pulmonary histoplasmosis\nB. Cryptococcal meningitis\nC. Non-meningeal blastomycosis\nD. Disseminated sporotrichosis", "response": "Ref-KDT 6/e p763,764 Fluconazole has maximum CNS penetration whereas itraconazole has limited entry in the brain. Therefore fluconazole is preferred over itraconazole for the treatment of cryptococcal meningitis. For all other conditions listed in the question, itraconazole is first choice drug.\n\nSo the answer to this question is B"}
{"instruction": "ICD 10\nA. Revised every 5 years\nB. Consists of 10 chaptors\nC. Arranged in 3 volumes\nD. Produced by UNICEF", "response": "ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD) Medical classification list by the World Health Organization (WHO); Revised every 10years Consists of 21chapters The ICD-10 consists of: Tabular lists containing cause-of-death titles and codes (Volume 1) Inclusion and exclusion terms for cause-of-death titles (Volume 1) Description, guidelines, and coding rules (Volume 2) and An alphabetical index to diseases and nature of injury, external causes of injury, table of drugs and chemicals (Volume 3) Ref : Park's textbook of preventive and social medicine; 23rd edition\n\nSo the answer to this question is C"}
{"instruction": "What is glomerular filtration rate?\nA. 100 ml/min\nB. 125 ml/min\nC. 150 ml/min\nD. 175 ml/min", "response": "(B) 125 ml/min # GFR in a healthy person of average size is approximately 125 mL/min. Its magnitude correlates fairly well with surface area, but values in women are 10% lower than those in men even after correction for surface area.> A rate of 125 mL/min is 7.5 L/h, or 180 L/d, whereas the normal urine volume is about 1 L/d. Thus, 99% or more of the filtrate is normally reabsorbed.> At the rate of 125 mL/min, in 1 day the kidneys filter an amount of fluid equal to 4 times the total body water, 15 times the ECF volume, and 60 times the plasma volume.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is not gram-positive?\nA. Listeria\nB. Moraxella\nC. Nocardia\nD. Actinomycetes", "response": "Cocci are mostly gram positive except Bacilli are mostly gram negative except -meningococci -gonococci -veilonella -MORAXELLA M- Mycobacrerium A-Anthracis bacillus C-Clostridium species D-Diptheriae cornybacterium o N Nocardia A Actinomycetes L -Listeria D -Diptherioids s\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is aldosterone antagonist?\nA. Eplerenone\nB. Deoxicorticosterone\nC. Fenoldopam\nD. Frusemide", "response": "Ans. a (Eplerenone) (Ref. KDT 5th/pg. 534; Katzung 9th/pg. Chapter 11)Eplerenone is a new, selective mineralocorticoid receptor antagonist without clinically significant androgen receptorblocking or progesterone receptor stimulating activities, which translates into absence of gynecomastia and impotence inmen and of menstrual irregularity in women. It is approved in treatment of hypertension.Mineralocorticoid receptors are expressed in many tissues, including:# Kidney,# Colon,# Heart,# Central nervous system (hippocampus),# Brown adipose tissue and# Sweat glands (not in liver).Educational points:# Lithium & demeclocyline are ADH antagonists.\n\nSo the answer to this question is A"}
{"instruction": "Serum ACE may be raised in all of the following except;\nA. Sarcoidosis\nB. Silicosis\nC. Berylliosis\nD. Bronchogenic carcinoma", "response": "Answer is D (Bronchogenic carcinoma) : CE levels are not elevated in Bronchogenh. carcinoma.\n\nSo the answer to this question is D"}
{"instruction": "Bicarbonate is absorbed -\nA. Activity in PCT\nB. Actively in DCT\nC. Indirectly in PCT\nD. Actively in DCT", "response": "Ans. is 'c' i.e., Indrectly in PCT o About 80-90 of filtered HCO2, is absorbed in PCT.o Absorption of HCO,' is indirect, which is due to secretion H+, i.e., secretion of H+ is coupled with absorption of HCO3-o Filtered HCO3' reacts with H+ to form H2CO, which then is dissociated into H2Oand CO2,.o CO. diffuses into epithelial cell and generate HCO2 which is then reabsorbed. In early tubular segmentso In proximal tubule, thick ascending limb of loop of Henle and early distal tubule, the H+ is secreted into tubular fluid by \"Na+ - H+ exchanger\", i.e., by 'sodium and hydrogen countertransport'o The energy is derived from Na+ Kf ATPase locate on the basolateral membrane. Therefore, it is a secondary active transport.o Filtered HCO3 is reabsorbed by interaction with these secreted H+ . Filtered HCO3- react with H' to form H2CO3o This H,CO. dissociates into CO. and H,0 by carbonic anhydrase, which is present in the brush border of proximal tubules, thick ascending limb and early distal tubules.o The CO, rapidly diffuses into the tubular cell where it reacts with water to form H2C03 under the influence of intracellular carbonic anhydrase.o This H,CO. in turn dissociates to form HCO. and H+; the HCO. then diffuses across the basolateral membrane into the interstitial fluid and is taken up by peritubular capillaries.Distal nephrono In the late distal tubule and collecting ducts, H+ ions are secreted by primary active transport, i.e., H+ ions are directly transported by hydrogen - transporting ATPase.o Primary active secretion of H+ occurs in special type of cell called the intercalated (I) cellsQ.o Hydrogen ion secretion in these cells is accomplished in two steps : (1) The dissolved CO2 in the cells combine withH2O to form H2CO3, and (2) The H2CO3. then dissociates into HCO3' which is reabsorbed into the blood, plus H-, which is secreted into the tubule.o For each H+ secreted, an HCO3 is reabsorbed similar to the process in the early segments.o The main difference is that H+ moves across the luminal membrane by primary active transport instead of by counter-transport as occurs in the early parts of the nephron.\n\nSo the answer to this question is C"}
{"instruction": "DIENES phenomenon s used for\nA. Mycoplasma\nB. Chlamydiae\nC. Plague\nD. Diptheria", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Dimension of HDI which is measured to check good standard of living ?\nA. Income\nB. Knowledge\nC. Lingevity\nD. Housing", "response": "Ans. is 'a' i.e., Income HDI is a composite index combining indicators representing three dimensions ? Longevity (life expectancy at bih) Knowledge (Adult literacy rate and mean years of schooling, i.e. Gross enrolement ratio) Income (real GDP per capita in purchasing power parity in US dollars) Among these three, income is included in standard of living. Standard of living It refers to the usual scale of our expenditure, goods we consume and services we enjoy. It includes :? Income & occupation Standards of housing, sanitation & nutrition Level of provision of health, educational, recreational and other services. Standard of living depends on per capita GNP\n\nSo the answer to this question is A"}
{"instruction": "Shape of the arterial pulse is influenced by:\nA. Viscosity of blood\nB. Velocity of blood\nC. Cross sectional area of artery\nD. Arterial wall expansion", "response": "The blood forced into the aorta during systole not only moves the blood in the vessels forward but also sets up a pressure wave that travels along the arteries. The pressure wave expands the arterial walls as it travels, and the expansion is palpable as the pulse. The rate at which the wave travels, which is independent of and much higher than the velocity of blood flow, is about 4 m/s in the aorta, 8 m/s in the large arteries, and 16 m/s in the small arteries of young adults. Consequently, the pulse is felt in the radial artery at the wrist about 0.1 s after the peak of systolic ejection into the aorta. With advancing age, the arteries become more rigid, and the pulse wave moves faster.\nReference: Ganong’s Review of Medical Physiology T W E N T Y - F I F T H E D I T I O N page no 540\n\nSo the answer to this question is D"}
{"instruction": "Cornea drives its nutrition chiefly from:\nA. Aqueous humour\nB. Mucous layer\nC. Corneal vessels\nD. Perilimbal vessels", "response": "Cornea is avascular and dehydrated structure Gets glucose from aqueous humour Gets oxygen from 3 different source. Air Tear film Aqueous The innermost layer of the tear film is the mucous layer, which consists of secreted mucins, electrolytes and water produced by conjunctival goblet cells Mucin stabilizes the tear film\n\nSo the answer to this question is A"}
{"instruction": "All are true about Typhoid except -\nA. Incubation period 10-14 years\nB. Most common among males\nC. Carrier are treated by ampicillin\nD. Highest incidence occur in 30-40 years age group", "response": " Typhoid fever:- Typical continuous fever for 3-4 weeks,relative bradycardia with involvement of lymphoid tissue. Without effective treatment, typhoid kills over 10% of those infected. Causative agent- Salmonella typhi. S.paraA and S.paraB are infrequent. Reservoir- man Case - a case is infectious as long as bacilli appear in stools /urine. Carriers:- 1. Convalescent carriers-excrete bacilli for 6-8 weeks,after which their number dimnishes rapidly. 2. Chronic carriers- persons who excrete bacilli for more than a year after a clinical attack. In most chronic carriers,the organism persists in gall bladder and in biliary tract. Source of infection- faeces and urine of cases/carriers. Age group involved mostly is 5-19 yrs old. Males affected more than females. Incubation period- 10-14 days. Mode of transmission: faecal oral route/ urine oral routes. Treatment of carriers:- Intensive course of ampicillin/ amoxycillin (4-6g/day) together with probenecid for 6 weeks. {Reference: park&;s textbook of preventive and social medicine, 23rd edition, pg no.235} DAVIDSON&;S principles and practice of medicine 22nd edition. #around 60% of tumours arising from head of pancreas and involvement of common bile duct result in the development of obstructive jaundice, often with severe pruritis.Advanced stage present with central abdominal pain ,weight loss,pain radiates from upper abdomen from back. Davidson&;s principles and practice of medicine 22nd edition. *Manometry confirms the high pressure non relaxing oesophageal sphincter with poor contractility of the oesophageal body. Not all individuals bitten by infected mosquitoes develop disease. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:286. <\\p>\n\nSo the answer to this question is D"}
{"instruction": "SPECT Stands for\nA. Single Proton Emission Computed Tomography\nB. Single Positron Emission Computed Tomography\nC. Single Photon Emission Computed Tomography\nD. Single Positive Emission Computed Tomography", "response": "SPECT stands for Single Photon Emission Computed Tomography, It uses a 360 degree revolving Gamma Camera and Acquires 3D images using Tc99m labelled radioisotopes like HMPAO (Hexamethylpropyleneamine oxime).\n\nSo the answer to this question is C"}
{"instruction": "A pt. operated for direct inguinal hernia developed anethesia at the root of the penis and adjacent pa of the scrotum the nerve likely to be injured is ?\nA. Genital br. of genitofemoral nerve (supply daos muscle)\nB. Femoral br. of genitofemoral nerve\nC. Iliohypogastric nerve\nD. Ilioinguinal nerve", "response": "Ans. is 'd' i.e. ilioinguinal nerve All the three nerves ie genifotemoral, ilioinguinal & iliohypogastric are branches of the lumbar plexus and all may be injured in op. for hernia.llioinguinal-Nerveenters the inguinal canal by piercing the internal oblique muscle (not through the deep ring)*it then emerges from the superficial inguinal ring to supply skin ofproximomedial skin of the thighskin over the penile root.upper pa of the scrotumIliohypogastric nervesdivides into two branches - lateral cutaneous and anterior cutaneous.lateral cutaneous supplies - posterolateral gluteal skinAnterior cutaneous supplies - suprapubic skinGenitofemoral nerve divides into two branchesGenital andFemoralGenital br of Genitofemoral nerve - enters the inguinal canal at its deep ring and supplies- the Cremaster*- the scrotal skin*Femoral br of genitofemoral nerve- passes behind the inguinal ligament, enters the femoral sheath lateral to femoral aery*, pierces the ant layer of the femoral sheath and fascia lata and supplies the skin anterior to the upper pa of femoral triangle.From these descriptions it is obvious that the nerve likely to be injured is ilioinguinal nerve.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following cardiac valves is not commonly involved in rheumatic fever?\nA. Mitral\nB. Aoic\nC. Pulmonary\nD. Tricuspid", "response": "In chronic disease the mitral valve is viually always involved. The mitral valve is affected in isolation in roughly two thirds of RHD, and along with the aoic valve in another 25% of cases. Tricuspid valve involvement is infrequent, and the pulmonary valve is only rarely affected.\n\nSo the answer to this question is C"}
{"instruction": "In which of the following are linear IgA deposits in mesangium noted?\nA. Henoch Schoenlein Purpura\nB. Malaria\nC. Good Pasture's Syndrome\nD. Wegener's Granulomatosis", "response": "Ans. A. Henoch Schoenlein Purpura. (Ref. Harrison's 17th/pg. 1813, 1789)Ref. Harrison's 17th/pg. 1789.........\"Henoch-Schonlein purpura is distinguished clinically from IgA nephropathy by prominent systemic symptoms, a younger age (<20 years old), preceding infection, and abdominal complaints. Deposits of IgA are also found in the glomerular mesangium in a variety of systemic diseases, including chronic liver disease, Crohn's disease, gastrointestinal adenocarcinoma, chronic obstructive bronchiectasis, idiopathic interstitial pneumonia, dermatitis herpetiformis, mycosis fungoides, leprosy, ankylosing spondylitis, relapsing polychondritis, and Sjogren's syndrome. IgA deposition in these entities is not usually associated with clinically significant glomerular inflammation or renal dysfunction and thus is not called IgA nephropathy\"Discussion:IgA nephropathy:# Berger first described it. It is classically characterized by episodic hematuria with the deposition of IgA in the mesangium. IgA nephropathy is one of the most common forms of glomerulonephritis worldwide. There is a male preponderance, a peak incidence in the second and third decades, and rare familial clustering.# The two most common presentations of IgA nephropathy are recurrent episodes of macroscopic hematuria during or immediately following an upper respiratory infection in children (Henoch-Schonlein purpura) or asymptomatic microscopic hematuria most often seen in adults.# Rx: - ACE inhibitors in patients with proteinuria or declining renal function.- Tonsillectomy, steroid therapy, and fish oil have all been suggested to benefit some patients.- When presenting as RPGN, patients need steroids, cytotoxic agents, and plasmapheresis.RENAL INVOLVEMENT in Hemolytic Uremic Syndrome (HUS) and Thrombotic Thrombocytopenic Purpura (TTP)# Microscopic hematuria (78%) and subnephrotic proteinuria (75%) are the most consistent findings.# The characteristic lesion in HUS/TTP is thrombotic microangiopathy.# Microthrombi are demonstrated in renal arterioles and capillaries.# In TTP, microthrombi are composed mainly of platelet aggregates and thin layer of fibrin and stain strongly for vWF, implicated in its pathogenesis. In contrast, microthrombi in HUS contain predominantly fibrin.# Subendothelial hyaline deposits and endothelial cell swelling also contribute to vascular occlusion. Glomerular lesions are ischemic. The glomerular capillary walls are wrinkled, the glomerular tuft may be atrophied, and the Bowman capsule is thickened. Acute cortical or tubular necrosis may occur.# Immunofluorescence studies invariably demonstrate fibrinogen along the glomerular capillary walls and in arterial thrombi. Granular deposits of C3 and IgM may be observed in vessel walls and glomeruli.# Electron-microscopic studies demonstrate swelling of the glomerular endothelial cells and detachment from the glomerular basement membrane.\n\nSo the answer to this question is A"}
{"instruction": "A young female presented with consumption of some substance in the emergency department. Greenish blue froth was seen coming out of her nostrils and oral cavity. The poisoning is most likely due to which of the following?\nA. Arsenic poisoning\nB. Copper poisoning\nC. Mercury poisoning\nD. Lead poisoning", "response": "Ans. b. Copper poisoning (Ref: Reddy 33/e p547, 29/e p490)Greenish blue froth from nostrils and oral cavity is seen in copper poisoning.PoisoningColour of Hair and SkinArsenic (As)* Yellow colour of skin, hair and mucous membraneQ* Milk rose (Brownish pigmentation)QCopper (Cu)* Jaundiced skin* Green-Blue skin, hair and perspirationQ* Green-Purple line of gumsQMercury (Hg)* Brown/Black-Blue line on gumsQ with loosening of tooth and necrosis of jaw* Brown deposits on anterior tens capsuleQ (Mercuria lends)* Acrodynia (Pink disease)QLead (Pb)* Blue stippled burtonian line on gumsQ, especially on upper jaw near dirty and infected teethCopper PoisoningCopper (Cu) as a metal is not poisonous. Poisonous salts include:SubstanceColorFatal DoseFatal periodCopper subacetate (Verdigris, zangal)Blue green15 gm1-3 daysQ(Usually 12-24 hours or may be up to 3-5 days or even a week)Copper sulphate (blue vitriol, nila tutia)Blue30 gmVerdigris is formed by the action of vegetable acids while cooking in copper cooking utensils, which have been not properly tin lined.Acute PoisoningChronic Poisoning* Symptoms start in 15-30 minutes of ingestion/inhalation and include metallic taste, increased salivation, thirst, burning/colic abdomen pain, nausea, eructations and blue-green vomiting* Diarrhea with liquid and brown but not bloody motions* Renal failure may lead to oliguria, albuminuria, hematuria, acidosis and uremia. Hemolysis, hemoglobinuria, methhemoglobinuria, jaundice, pancreatitis, leg cramps, spasms and convulsions may occur in severe cases.* Common among industrial workers e.g. metal fume fever in copper welders, histiocytic granulomatous lung and liver due to chronic inhalation of CuSO4 spray (vineyard' sprayer's lung disease)* Symptom complex is called Wilson's disease, hemochromatosis, bronzed diabetes and pigment cirrhosis. Presence of copper deposits in tissues is called chalcosis.* Symptoms consist of gradual anemia, purple (blue-green) line on gumsQ, nausea, vomiting with blue/green vomitusQ, colic, diarrhea, malaise, peripheral neuritis, muscle degeneration and atrophy.* Skin is jaundiced; urine, hair, froth, mucosa, and perspiration become green (blue-greenQ.\n\nSo the answer to this question is B"}
{"instruction": "Police inquest is done in all except -\nA. Suicidal death\nB. Homicidal death\nC. Dowry death\nD. Accidental death", "response": "Ans. is 'c' i.e., Dowry deatho In dowry death, magistrate inquest is carried out.Police inquest (See 174 CrPC)o It is the commonest type of inquest in India. It is inferior to other types inquest. Police inquest is carried out by a police officer, not below the rank of head constable (usually a sub-inspector). Such police officer (PO) is known as investigating officer (IO). After informing the nearest executive magistrate, he goes to the place of offence and conducts the inquest. In presence of two or more respectable inhabitants (panchas), then prepare the report of the apparent cause of death (Panchnama) signed by IOand witnesses. If no foul play is suspected, the body is handed over to the relatives, otherwise body is sent for postmortem examination to find out the cause of death. IO (police) may summon the person, the summoned person is bounded to attend and answer questions. Refusal to answer questions by the police is punishable under section 179 IPC. Police inquest is done inDeath by sucideDeath by killing by another person (murder) or an animal or machineryDeath by accidentDeath under circumstances raising a reasonable suscpicion that some other person has commited an offence.Magistrate inquest (Sec 176, CrPC)o Magistrate's inquest is carried out by an executive magistrate, district magistrate (DM) or sub-divisional magistrate (SDM). It is done in cases ofDeath in prison, reformatories, Brostal school.Death in police custody, while under police interrogation.Death due to police firing.Dowry death, i.e. death of a married female less than 30 years of age or death within 7 years of marriage.Exhumation.Death in pscychiatry hospital.Any person dies or disappears, or rape is alleged to have been committed on any woman, while such person or woman is the custody of police or any other custody authorized by court (Sections 174(4), 176 and 176, 1-A CrPC).\n\nSo the answer to this question is C"}
{"instruction": "Vidian neurectomy is used for the treatment of-\nA. Chronic vasomotor rhinitis\nB. Benign positional paroxysmal vertigo\nC. Meniere's disease\nD. Otosclerosis", "response": "Ans. is 'a' i.e., Vasomotor rhinitis Vasomotor rhinitiso Vasomotor is a nonallergic condition that involves a constant runny nose, sneezing and nasal congestion, i.e., the nose is stuffy or runny for reasons other than allergies and infections. The exact etiology is unknown, but triggers include emotions, odors, poor air quality, spicy foods, and medication side effects. Pathogenesis include:-Parasympathetic overactivityHyperactive nasal mucosa to several non-specific stimuli especially in women of 20-40 years.o Symptoms of vasomotor rhinitis include excessive clear rhinorrhoea, nasal obstruction/congestion, irritation, paroxysmal sneezing and post-nasal drip. Nasal mucosa is hypertrophied & congested: and mucosa of turbinates may give mulberry like appearance and is pale to dusky red in colour.o Complications of vasomotor rhinitis include hypertrophic rhinitis & sinusitis, and nasal polyp.Treatmento Treatment of vasomotor rhinitis includes : -Conservative treatmentAvoidance of physical factors which provoke symptoms.Antihistaminics and oral or nasal decongestants.Topical or systemic steroidsSurgical treatmentNasal obstruction can be relieved by measures which reduce the size of hypertrophied nasal turbinate : - Cryosurgery, submucosal diathermy, Linear cauterization, partial or total turbinectomy, submucosal resection of turbinate.Excessive rhinorrhoea in vasomotor Rhinitis not corrected by medical therapy and bothersome to the patient, is relieved by sectioning the parasympathetic secretomotorfibres to nose i.e., vidian neurectomy.\n\nSo the answer to this question is A"}
{"instruction": "Acidic drug is more ionized at-\nA. Alkaline\nB. Acidic pH\nC. Neutral pH\nD. None", "response": "Ans. is 'a' i.e., Alkaline pH Implication of ionization Acidic drugs ionize more at alkaline pH. o Basic drugs ionize more at acidic pH. o Unionized drug is lipid-soluble and diffusible. o Ionised drug is lipid-insoluble and nondiffusible. o Acidic drugs (salicylates, barbiturates) are predominently unionized in acid gastric juice and are absorbed from stomach. Basic drugs (morphine, quinine) are predominently unionized in intestinal alkaline pH and are absorbed from intestine. o In the stomach acidic drug (aspirin, pKa - 3.5) arc unionised (lipid soluble & diffusable) and so diffuses into gastric epithelial cells. In gastric epithelial cell, it will ionize (pH-7.4) becomes less diffusable and so will localize there. This ion trapping is one mechanism where by aspirin is concentrated in, and so harms, gastric mucosa. o Basic drugs attain higher concentration intracellularly (pH 7.0 Vs 7.4 of plasma). o Acidic drugs are ionized more in alkaline urine - do not back diffuse in the kidney tubules and arc excreted faster. o Similarly basic drugs are excreted faster in acidic urine.\n\nSo the answer to this question is A"}
{"instruction": "Scales used for assessing soeio-economie status of populations are the following except?\nA. Modified udai Pareek scale\nB. Modiefied Kuppuswamy scale\nC. Like scale\nD. BG Prasad scale", "response": "Ans. is 'c' i.e., Like scale\n\nSo the answer to this question is C"}
{"instruction": "What term is used to describe this finding?\nA. Arc eye\nB. Asthenopia\nC. Choroideremia\nD. Coloboma", "response": "Answer D. ColobomaColobomas are the result of abnormal closure of the optic fissure. They may occur anywhere along the optic fissure and can affect the iris, choroid, or macula. Isolated iris colobomas are asymptomatic, but those involving the macula or the optic disk can result in severe visual impairment. Typical iris colobomas occur in the inferonasal quadrant.\n\nSo the answer to this question is D"}
{"instruction": "Calcific hepatic metastases are seen in –\nA. Adenocarcinoma of the colon\nB. Carcinoid tumours\nC. Renal cell carcinoma\nD. Lymphoma", "response": "A calcified pattern in hepatic metastasis is commonly due to mutinous adenocarcinoina of colon or ovary.\n\nSo the answer to this question is A"}
{"instruction": "CT skull giving tram track appearance is diagnostic of-\nA. Neurofibroma\nB. Tuberous sclerosis\nC. Von Hippel Lindau disease\nD. Sturge Weber syndrome", "response": "Ans is 'd' i.e. Sturge Weber syndrome * CT scans in Sturge Weber syndrome show the tramline gyriform calcification of apposing gyri that underlies the contrast-enhancing leptomeningeal vascular malformation.Other CT scan findings Sturge Weber syndrome* Cortical atrophy* Abnormal draining veins* Enlarged choroid plexus* Blood-brain barrier breakdown (during seizures)* Contrast enhancement\n\nSo the answer to this question is D"}
{"instruction": "The length of tongue spike in tongue thrusting habit breaking appliance should be upto the\nA. Incisal edges of maxillary incisors\nB. Incisal edges of mandibular incisors\nC. Cingulum of mandibular incisors\nD. Cervical margin of mandibular incisors", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which among the following is used as yardstick for the assessment of standards of therapy\nA. Proportional mortality rate\nB. Survival rate\nC. Case fatality rate\nD. Crude death rate", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Tertiary syphilis most frequently involves the\nA. CNS\nB. Liver\nC. Testes\nD. Aorta", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Cause of False positive D-xylose test include all of the following, Except\nA. Bacterial overgrowth\nB. Renal failure\nC. Ascitis\nD. Celiac sprue", "response": "Answer is D (Celiac sprue) Celiac sprue is associated with a positive D- xylose and not a False positive Dxylose test. D-xylose Test Positive test ecreased (4) D- Xylose excretion in urine due to malabsorption from gastrointestinal mucosal disease Causes Include Celiac disease Tropical sprue Whipple's disease Other mucosal diseases\n\nSo the answer to this question is D"}
{"instruction": "Nitrates in excess of ----mg/L may cause infantile methaemoglobinemia\nA. 15\nB. 25\nC. 35\nD. 45", "response": "Nitrates level >50 increases the risk of infantile methaemoglobinaemia. Ref: Park's textbook of PSM 25th edition, pg 783\n\nSo the answer to this question is D"}
{"instruction": "Tension band wiring is done in following except?\nA. Fracture patella\nB. Fracture olecranon\nC. Colie's Fracture\nD. Fracture medial malleolus", "response": "Ans. C. Colle's Fracture. (Ref Maheshwari orthopaedics 3rd/pg. 24 & 139)Maheshwari orthopaedics 3rd/pg. 24 mentions........................|||Tension-band wiringTension-band plateTension-band fixation|||iUsed for producing dynamic compression in Patella, Olecranon & transverse malleolus .Used for Humerus & Tibia .Used for Tibia .RECENT ADVANCES IN Rx OF FRACTURES:# A.O. method# Cast (functional) bracing# Ilizarov's techniqueA.O. method:In this method the following principles are used to achieve stable fixation:# A. Inter-fragmentary compression i.e., achieving compression between different fragments.# B. Splinting (splinting fracture fragments internally or extrenally)# C. Combination of A and B.A. Inter-fragmentary compression i.e., achieving compression between different fragments.a. Static compressionb. Dynamic compression# Methods of producing static compression:- a). Lag screw- b). Compression plating- c). External fixator# Methods of producing dynamic compression:- a). Tension-band wiring e.g. Patella & Olecranon - b). Tension-band plate e.g. Humerus & Tibia - c). Tension-band fixation e.g. Tibia .B. Splinting.a. IM splinting: e.g. Kuntscher's nailing for+shaft of femur.b. EM splinting: e.g. plating without compression (neutralising plate), or plate supporting the without fixing it (buttress plate) sometimes used for tibial condyle .c. Outside the body e.g. external fixators used merely to hold the fragments.C. Combination of A and B.e.g. for Spiral of shaft of femur.Cast (functional) bracing# Popularized by Sarmiento (1973)# Done if fracture reduction is satisfactory, and once the swelling subsides - usually 2-3 weeks after injury.# Most commonly used for of the shaft tibia. It is also used for femoral/humerus shaft, and other fractures.Ilizarov's technique# * Infected non-union of long bones is a problem in the developing countries.# * Persistent infection, deformity, shortening, bone loss, joint stiffness and disability complicate the non-union.# * Secondary procedures are often required for correction of bone defects and deformity.# * Ilizarov method deals with all the above problems simultaneously and offers a kind of universal remedy for infected non-unions.# *The stability of the fixation and provision for bone transport allows bridging of bone defects, limb lengthening, early weight bearing ambulation and joint mobilization.# The basic principle of Ilizarov's technique is that Osteogenesis requires dynamic state, which causes dormant mesenchymal cells at the non-union gap to differentiate into functioning osteoblasts.# Distraction or compression is carried out at lmm/day.# This is done is four settings i.e. l/4th mm four times a day.# It is useful in management of:- Limb lengthening- Non-union especially resistant to conventional methods of Rx or those associated with deformity or shortening.- Deformity correction, which may be congenital or acquired.- Osteomyelitis can be treated as this technique offers possibility of excision of necrotic bone - creating a gap, which can be made up by transporting a segment of bone from either end.- Arthrodesis can be performed by crushing articular surfaces against each other, and thus stimulating union between opposite bones.# Advantages:- Immediate load bearing- Healthy viable bone in place of de-vascularized bone- Correction of more than one problems by one-stage operation.# Disadvantages:- Inconvenience- Long duration Rx- Pin-tract infection- Nerve palsy by pin insertion or traction- Joint stiffness of the soft tissues by external fixator.\n\nSo the answer to this question is C"}
{"instruction": "Uterus reaches up to umbilical level at: September 2009\nA. 16 weeks\nB. 20 weeks\nC. 24 weeks\nD. 28 weeks", "response": "Ans. C: 24 weeks The height of the uterus is midway between symphysis pubis and umbilicus at 16th week; at the level of umbilicus at 24th week and at the junction of the lower third and upper two-third of the distance between the umbilicus and ensiform cailage at 28th week.\n\nSo the answer to this question is C"}
{"instruction": "Most permissible capillaries are seen in\nA. Kidney\nB. Liver\nC. Brain\nD. Skin", "response": "Capillaries are classified in toContinuous or non fenestrated capillaries - Endothelial cells are arranged without any gap in between them. Eg. Skin, BBB. Allows only very small molecules to pass through. Fenestrated capillaries - Gaps in between endothelial cells ranging from 70-100nm in diameter which are lined by basement membrane. Eg. Capillaries of intestinal villi, renal glomeruli, choroid plexus of the ventricles of the brain, ciliary process of eyes and endocrine glandsDiscontinuous type- Very wide cleft are present in between endothelial cells. The basement membrane is incomplete or absent. Almost all substance in plasma can cross this gap. Seen in liver sinusoids, sinusoids of spleen, anterior pituitary and parathyroid gland Ref: Textbook of medical physiology by N Geetha, 2nd edition, page no. 194\n\nSo the answer to this question is B"}
{"instruction": "Precocious pubey is seen in -\nA. Hypothyroidism\nB. CNS irridation\nC. Mc cune-Albright syndrome\nD. All", "response": "Ans. is 'a' i.e., Hypothyroidism; 'b' i.e., CNS irradiation; 'c' i.e., Mc Cune Albright syndrome Precocious pubey o Pubey before the age of 8 years in girls or 9 years in boys is considered precocious pubey. o Menarche before the age of 10 years in girls is also considered as precocious. o Precocious pubey is of two types 1. Central or true precocious pubey Results from excessive GnRH, gonadotropins and target sex hormone elaborated by premature activation of hypothlamic pituitary-gonadal (HPG) axis. 2. Peripheral or pseudo-precocious pubey Due to increased sex steroid secretion from either the adrenal gland or the gonads. It is independent of HPG axis activation Causes of Precocious pubey A. Central precocious pubey 1. Idiopathic : Sporadic or familial. 2. Central nervous system abnormalities i) Congenital anomalies of CNS: Hypothalamic hamaoma, hydrocephalus, porencephaly, arachnoid cysts. ii) Acquired lesions of CNS : Inflammation, granuloma, trauma, surgery, radiation, chemotherapy. iii) Tumors of CNS : Pineal tumors, optic glioma, ependymoma, camiopharyngioma. iv) Hypothyroidism B. Peripheral precocious pubey : Isosexual Girls 1. Ovarian causes : McCune-Albright syndrome, benign follicular cysts, granulosa-theca cell tumors; Gonadoblastoma 2. Adrenal causes : Feminizing adrenal neoplasia 3. Exogenous estrogen administration Boys 1. Testis : Leydig cell tumor, adrenal rest tumor, testotoxicosis. 2. Adrenal: CAH (21 or 11-(3 hydroxylase deficiency), virilizing tumors. 3. hCG secreting tumors : Hepatoma, hepatoblastoma, choriocarcinoma, chorionepithelioma, teratoma, dysgerminoma. Exogenous testosterone C. Heterosexual precocity 1. Girls : Virilization in girls due to virilizing CAH, ovarian or adrenal neoplasia, polycystic ovarian disease. 2. Boys : Feminization due to estogen producing adrenal tumors, exogenous estrogen, marijuana smoking. Note - Hypothyroidism usually causes delayed pubey, but juvenile hypothyroidism some times can cause precocious pubey.\n\nSo the answer to this question is D"}
{"instruction": "Most common metabolic complication of gastrectomy is\nA. Iron deficiency anemia\nB. Megaloblastic anemia\nC. Hypocalcemia\nD. Osteoporosis", "response": "Nutritional disorders are common after gastrectomy. Weight loss is common after gastrectomyAnaemia may be due toeither iron or vitamin B12 deficiency.Iron-deficiency anaemia occurs after both gastrectomy and vagotomy and drainage. Reduced iron absorption is probably the most impoant factor, although the loss of blood from the gastric mucosa may also be impoant. Vitamin B12 deficiency is prone to occur after total gastrectomy. However, because of the very large vitamin B12 stores that most patients have, this maybe very late in occurring.Bone disease is seen principally after gastrectomy and mainly in women. The condition is essentially indistinguishable from the osteoporosis commonly seen in post-menopausal women.Bailey and love pg: 1127\n\nSo the answer to this question is A"}
{"instruction": "Cavernous sinus thrombosis can occur due to spread of odontogenic infection via:\nA. Tissue spaces\nB. Lymphatic route\nC. Hematogenous route\nD. All of the above", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which one of the following statements is false regarding vincristine -\nA. It is an alkaloid\nB. Its use is associated with neurotoxicity\nC. It does not cause alopecia\nD. It is a useful drug for induction of remission in acute lymphoblastic leukaemia", "response": "Ans. is 'c' i.e., It does not cause alopecia o Vincristine belongs to the plant alkaloid group of anticancer. o Useful for inducing remission in childhood ALL (not useful in maintenance therapy) o It can also be used for pediatric solid tumors (Wilm's tumor, neuroblastoma, rhabdomyosarcoma) and lymphomas. o Prominent adverse effects? o Peripheral neuropathy Alopecia SIADH\n\nSo the answer to this question is C"}
{"instruction": "Angiotensin II causes all of the following except:\nA. Stimulation of thirst\nB. Aldosterone secretion\nC. Increased ADH secretion\nD. Vasodilation", "response": ". Ans. d. VasodilationAngiotensin II causes vasoconstriction (most potent or - 4-S times more than noradrenaline on weight basis).\"Cotonic motility is minimal in fasting period. Eating stimulates colonic contractions. Fat component of meal is major stimulus to colonic contractions. Protein ingestion inhibits colonic contraction. Maximum postprandial increase in motility is seen in sigmoid colon > descending colon > transverse colon\"Actions of Angiotensin IIBlood Vessels(AT1A receptors)Brain(AT1a receptors)Adrenal Cortex(AT1B receptors)Others* Potent arteriolar (Vaso) constrictor causing:-Rise in systolic and diastolic BP-Rise in total peripheral resistance* Its pressor activity is decreased in cirrhosis and in Na* depleted individuals. Because circulating angiotensin II is increased in those conditions, which down regulates angiotensin receptors in vascular smooth muscle* It does not penetrate blood brain barrier, but triggers responses by acting on circum ventricular organs (out side BBB)* Area postrema is primarily responsible for pressure potentiation. Angiotensin II acts here to decrease the sensitivity of baroreflex* Dipsogenic effect (i.e. Increase thirst or water intake) is due to action of subfornical organ and organum vasculosum of lamina terminalis.* | Antidiuretic hormone(ADH) or vasopressin) from posterior pituitary* | ACTH* Increase secretion of aldosterone which:- Promotes Na and water reabsorption0- Expands ECF (leading to CO)- Facilitates K+ excretion* Direct effect on PCT to increase Na+ reabsorption by increasing Na+ - H+ exchange* Contraction of mesangial cells with resultant decrease in GFR* Direct action on post ganglionic sympathetic neurons facilitates release of norepinephrine\n\nSo the answer to this question is D"}
{"instruction": "A child with congenital hearing loss is brought for cochlear implantation. For the implantation, the following structure should be intact:\nA. Outer hair cell\nB. Inner hair cell\nC. Spiral ganglion cell\nD. Auditory nerve", "response": "Cochlear implants are neural prostheses that conve sound energy to electrical signals and can be used to stimulate the auditory division of the eighth nerve directly. Successful cochlear implantation requires an intact and functional auditory processing pathway, from spiral ganglion cells to the auditory coex.\n\nSo the answer to this question is D"}
{"instruction": "A 40 year old man was admitted to the hospital emergency with sudden onset of the symptoms and signs of severe left ventricular failure. Calculate the atrial rate of the patient.\nA. 100/min\nB. 150/min\nC. 200/min\nD. 300/min", "response": "Ventricular rate : 1500/10 = 150 ECG shows HR of 150/min with normal axis. Saw tooth waves are noted with 2:1 AV block. Ventricular rate is 150/min therefore the atrial rate would be 300/min.\n\nSo the answer to this question is D"}
{"instruction": "Kala-azar is not responding to primary treatment. The treatment should now consist of-\nA. Double dose of antimony\nB. Amphotericin - B\nC. Ketoconazole\nD. Splenectorny", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A 4-year child presents with a history of hoarseness, croupy cough and aphonia, the child has dyspnoea with wheezing. The most probable diagnosis is ?\nA. Asthmatic bronchitis\nB. Laryngeal foreign body\nC. Bronchopneumonia\nD. Retropharyngeal abscess", "response": "Ans. is 'b' i.e., Laryngeal foreign body\n\nSo the answer to this question is B"}
{"instruction": "Which is not a 2nd generation antihistaminic ?\nA. Loraudine\nB. Acrivastatine\nC. Cyclizine\nD. None of the above", "response": "Cyclizine Histamine is a naturally occuring amine. It is found in most body tissues but is predominantly secreted by mast cells. Histamine acts as a local hormone (autacoid) i.e. it acts within the immediate vicinity of its release. It main physiological effects are on: Blood vessels ? - Aerioles are dilated - Capillary permeability is increased Smooth muscles -- Cause contraction of the smooth muscles G.I.T. -- Increase gastric acid secretion Histamine acts through two receptors - H1 --> mediates edema and vascular effects of Histamine - H2 --> mediates effect on gastic secretion. Hi receptor antagonists : T- hey are classified in two types (i) First generation antihistamines (ii) Second generation antihistamines The term antihistamine is unsatisfactory for the first generation or older generation antihistamine because besides blocking histamine receptors, they also show considerable blocking activity against - muscarinins receptors - serotonin receptors - a adrenergic receptors They also enter the brain readily and cause sedation. Because of their non-specificity and their highly sedative action, they have a great tendency to cause serious adverse effect. Because of these disadvantages, second generation antihistamines were developed which are more selective for H1 receptor and largely free of antimuscarinic and antiadrenergic activity. The newer second generation antihistamines penetrate the blood-brain barrier poorly and are largely devoid of sedative effects.\n\nSo the answer to this question is C"}
{"instruction": "Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the\nA. Contralateral side in a simple pneumothorax\nB. Affected side in a hemothorax\nC. Affected side in a tension pneumothorax\nD. Contralateral side in hemothorax", "response": "The trachea will shift according to the pressure gradients within the thoracic cavity. \nIn tension pneumothorax and hemothorax, accumulation of air or fluid causes a shift away from the injured side. \nIf there is no significant air or fluid accumulation, the trachea will not shift.\nTracheal deviation toward the contralateral side in simple pneumothorax is seen when the thoracic contents shift in response to the \nrelease of normal thoracic pressure gradients on the injured side.\n\nSo the answer to this question is D"}
{"instruction": "Sub acute - Sclerosing pan - encephalitis (SSPE) is caused by\nA. Measles\nB. Mumps\nC. Rubella\nD. Small pox", "response": "(Measles) (137-Park 20th)* Subacute sclerosing pan-encephalitis (SSPE) is a rare complication which develops many years after the initial measles infections. It is characterized by progessive mental deterioration leading to paralysis, probably due to persistence of the virus in the brain.* Measles vaccination definitely constitutes a protection against the neurological and other complications by preventing natural measles from occurring* **A11 cases of severe measles and all cases of measles in areas with high case fatality rates should be treated with vitamin A\n\nSo the answer to this question is A"}
{"instruction": "A 34 weeks pregnant female presented with intense itching over vulvar area and a white, cheesy vaginal discharge. On examination, vulvar erythema is noted. Which among the following is the causative organism in this patient?\nA. Epidermophyton\nB. Aspergillus\nC. Candida albicans\nD. Tinea", "response": "Candida albicans, the most common Candida species, causes symptomatic vulvovaginitis in approximately 90% of the cases. Clinical infection is associated with a systemic disorder (diabetes mellitus, HIV, obesity), pregnancy, medication (antibiotics, coicosteroids, oral contraceptives), and chronic debilitation. Vulvovaginal candidiasis presents with intense vulvar pruritus; a white, cheesy vaginal discharge; and vulvar erythema. A burning sensation may follow urination, paicularly if there is excoriation of the skin from scratching. The current medical treatment of candidal infection is by imidazoles. Ref: Bornstein J. (2013). Chapter 39. Benign Disorders of the Vulva & Vagina. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.\n\nSo the answer to this question is C"}
{"instruction": "Which is not the action of TGF?\nA. Anti-inflammatory\nB. Proliferation of fibrous tissue\nC. Inhibition of metalloproteinases\nD. Anaphylaxis", "response": ".\n\nSo the answer to this question is D"}
{"instruction": "Following age pyramid denotes\nA. Developing country\nB. Developed country\nC. Underdeveloped country\nD. Poor country", "response": "The pyramid of developing country (e.g. India) has a broad base and a tapering top.\nIn developed countries, the pyramid generally shows a bulge in the middle and has a narrower base (as in figure given in the question).\n\nSo the answer to this question is B"}
{"instruction": "Drug of choice for Neutropenia due to cancer chemotherapy is\nA. Vitamin B-12\nB. IL 11\nC. Filgrastim\nD. Erythropoietin", "response": "ANSWER: (C) FilgrastimREF: KDT 6TH edition, page 833, internet resourcesSee APPENDIX-37 below \"ANTICANCER DRUGS TOXIC AMELIORATION\" APPENDIX - 37Classification of Cancer Chemotherapy Agents:GroupSubgroups & AgentsAcute ToxicityDelayed ToxicityUsesAlkylatingAgentsNitrogen Mustard Alkylation of DNA at N7 &06 position of Guanine -DNA crosslinking I; b/n 2 strands - prevents duplication(1) Mechiorethamine(First anticancer drug)CINV-chemo induced nausea vomiting (4hr- 48hrs)MyelosuppressionMyelosuppression (delayed type-onset = 7d, Nadir = 10-14d, reco%rerv = 21-28d)AlopeciaMOPP-HodgkinslymphomaAA are commonly used in chronic leukemia(2) Cyclophosphamide1CP - 4hydroxyCP -aldophosphamide- Acrolein (toxic) & phosphamide mustard (active)]CINVMyelosuppression(CP>Ifo)Myelosuppression (CP>Ifo) Alopecia, SIADHHemorrhagic cystitis (Ifo>CP)Sec cancer-transitional cell cancer of bladderWagner'sgranulomatosis DOC CMF-Breast, small cell lung ca Broad spectrumAA are nonphase specific(3) Ifosfamide 4hydroxy ifosfamide (active)CINVMyelosuppression(CP>Ifo)Myelosuppression(CP>Ifo)AlopeciaHemorrhagic cystitis (Ifo>CP)Broad spectrum Lung, breast, ovary, sarcoma, testis, germ cell tumorAA causes secondary leukemia in 4-5 years(4) Melphanamino acid derivative ofmechloretamineCINVMyelosuppressionMyelosuppression No alopeciaMultiple myeloma DOCCan replace C in CMF (5) ChlorambucilMyelosuppression CINV is rareMyelosuppression No alopeciaCLL, Hodgkin's Nitrosoureas(lipophilic-crosses BBB) Nitrosoureas causes delayedMyelosuppression (onset-15d, Nadir-4wks, recovery-6wks) (1) Carmustine (BCNU- bis chloro nitroso urea)CINV (severe-2hrs)Myelosuppression, male infertility,Pulmonary fibrosisBrain tumors DOC(Glioblastomamultiforme.Astrocytoma,Medulloblastoma) (2) Lomustine (CCNU)CINV (severe-2hrs)Myelosuppression Interstitial lung diseasedo (3) Semustine (methyl CCNU)CINV (severe-2hrs)Myelosuppressiondo (4) Streptozocin (methylation of protein & nucleic acid)CINV (severe-2 hrs)No MyelosuppressionPancreatic islet cell tumorCarcinoid tumor Alkyl Sulfonates(Intra strand cross linking of DNA by 2 N7 Guanine) BUSULFAN {Dealkylating agent)Hyperuricemia(MC)Sterility, gynecomastia, seizures, Skin pigmentation, Adrenal insufficiency Pulmonary fibrosis (specific)CM L-DOC until imatinibConditioning of BM transplant Ethyl Enimines Thiotepa(Organophosphorous)CINVMyelosuppressionSeldom used nowNon ClassicalAlkylatingAgentsTriazenes Acts on RNA &Protein synthesis not/ mild DNADacarbazine (Active- methyl carbonium ion)CINV-severePermanent sterility Myelos uppre ssion (early/classical)MAID-sarcoma, ABVD-Hodgkins Malignant melanoma (most active agent) Procarbazine (autoxidize spontaneously, Active- Azoprocarbazine, crosses BBB)CINV, MAO inhibitor Disulfiram like reactionMyelosuppression,DermatitisLeukenogenic,teratogenicMOPP-Hodgkin'sPCV-Glioblastoma AltretamineCINV-severe HypotensionNeuro toxic NephrotoxicRefractory ovarian cancerAlkylating Like AgentsPlatinum Compounds 1st gen platinum Inactivated by aluminumCisplatinCINV (most emitogenic)Hypo Mg, K, Ca sec to hypo Mg)Myelosuppression N ephrotoxicity, Ototoxicity Secondary leukemiaCMF-Solidmalignancies2nc generation platinum, Cross resistance- cisplatinCarboplatinCINV (cis>carbo)Myelosuppression(carbo>ds)No nephrotoxicityLess potent than cisplatin (1:4) GemCarco-Iung cancer3rd generation platinum No cross resistanceOxaliplatinPSN pathy (reversible hand & foot, temp loss)Neurotoxicity (dose limiting)No nephrotoxicity PSN pathyflrreversible, hand, foot, leg, arm, temp loss, propio loss)FOLFOX- colon cancerCis/carboplatin resistance AntimetabolitesFolate Antagonists S phase specificMethotrexate HepatotoxicityMyelosuppressionMucositisChoriocarcinoma DOC, ALL, Osteosarcoma. RA, ectopic Myasthenia, psoriasis, meningeal leukemia (intrathecal route)Inhibits DMA syn thesisPemetrexed : Mesothelioma, nonsmall cell lungNo acute toxicidesPurine Analogue Commonly used in acute leukemias6 THIO Guanine MyelosuppressionHepatotoxicityAdult acute leukemia 6 Mercapto Purine Myelosupp ression, hepatotoxicityChildhood acute leukemia Fludrabine Myelosuppression, Flu like symptom (fever, myalgia, arthralgia) Cladribine Myelosuppression, Nephrotoxic, ClXVHairy cell leukemia Pentostatin NephrotoxicHairy cell leukemia Pyrimidine Analogue 5 Fluorouracil (5-FU) GI upset-diarrhea (MC) Hand foot syndrome, CINVMyelosuppression, neurotoxicity Cerebellar ataxia Cytrabine Stomatitis, CINV, Cerebellar ataxia MyelosuppressionAML Capecitabine CINV, Diarrhea, Hand foot syndrome Myelosupp ression (<5FU)Metastatic breast cancer, Metastatic colorectal cancer Gamecitabine CINV, Myelosuppression (dose limiting)Pancreatic cancer DOC Bladder & Nonsmall cell lung CaAntibioticsAnthracyclinsTopoisomerase 2 inhibitor (me)Quinone Free radical injury & intercalation b/n DNA strandsMembrane binding (responsible for cardiotoxicity) Doxorubicin (Adriamycin)CINV, AlopeciaMyelosuppression (dose limiting, neutropenia >th rombocytopenia) Cardiotoxicity(cardiomy opathy, CHF)Radiation recall Hand foot syndromeBroad spectrum Solid tumors & sarcomas (rhabdo/ leiomyosarcoma, Kaposi sarcoma) DaunorubcinCl MV, AlopeciaMyelosuppression, cardiotoxicity, radiation recallNarrow spectrum AML Idarubcin (synthetic Daunorubicin analogue)CINV, Alopecia, Red urine (not hematuria)Myelosuppression, cardiotoxicity, radiation recallAML (more efficacious than daunorubicin) MitoxantroneCINV, Bluish discoloration of nailsMyelosuppression (dose limiting)Lower cardiotoxicity? Other Antibiotics Bleomycin(Glyco peptide Antibiotic) Free radical injury - ds- ss DMA breaks, have both DNA & Fe binding domainAllergic reaction HypotensionPulmonary fibrosis (dose limiting)Mucocutaneous toxicity? Marrow sparingHL, NHL, SCC Malignant pleural effusionAscitis (sclerosing agent) Mitomycin- CActs as alkylating agentCINVHemolytic uremic syndrome. Pulmonary- fibrosis, 8th nerve damageRadiosensitizer- DOC, SCC Dactinomycin Inhibits all forms of DMA dependent RMA synthesis, r-RNA most sensitiveCINVMyelosupp ression Alopecia Radiation recallPediatric tumors (Ewing's, witm's, Rhabdomyosarcoma) Radiosensitizer ActinomycinCINVDesquamationMyelosuppressionAlopeciaPediatric tumors (Ewing's, wilm's, Rhab domyosarcoma) Radiosensitizer PlicamycinCINV EnzymeL-ASPARGINASE (inhibits protein synthesis of tumor cell by depletion of L-Aspargine)Anaphylaxis/ hyper sensitivity- fever, chills, rash, urticaria (brochospasm, hypotension if severe)Hypercoagulable state Pancreatitis, Hepatotoxicity Marrow sparing, no alopeciaALLIneffective in solid tumors(normal cells spared)Plant DerivedVinca AlkaloidsM phase specificInhibits tubulin polymerizationMitotic inhibitors VincristineAlopeciaPSNpathySIADH, Marrow sparingLymphosarcoma, wilm's, Ewing's Remission of childhood acute leukemia. VinblastineAlopecia (Vc >Vb)PSNpathy (Vc >Vb) MyelosuppressionHodgkin s, testicular carcinoma EpipodophylotoxinsTopoisomerase 2 inhibitor Etopside (VP-16)CINV, HypotensionMyelosuppression, early onset secondary leukemia (1-3 years) alopecia Teniposide (VP-26) TaxansM phase specificEnhance tubulin polymerizationSpindle poison PaclitaxelHypersensitivityPSNpathy (stocking glove type) Myelosuppression,Cisplatin resistance Relapse &resistant breast/ovary ca Docetaxel (more potent)HypersensitivityMyelosuppression, PSNpathy (is less frequent)Cisplatin resistance, Relapse-resistant br/ovary ca CamptothecinTopoisomerase 1 inhibitorss DNA breaks TopothecanCINVMyelosuppression (dose limiting) Irinothecan (active = SN-38)CINV, Cholinergic syndrome (SLUDGE) including early diarrhea-24hrsMyelosuppression, cholinergic syndrome (SLUDGE) including late diarrhea 3-10d (dose limiting)Advanced colorectal ca- DOCMiscellaneousArsenic Trioxide (degradation of PM LI & RARa protein)Headache, lightheadednessCINVCardiotoxicity (QT prolongation, arrhythmias), Myelosuppression Syndrome-fever, fluid retention, wt gain, rashAPL-induction in tretinoin relapse and refractoryHydroxyurea has 100% oral bioavailabilityHydroxyurea (inhibits ribonucleotide reductase - inhibits DMA synthesis)CINVMyelosuppression (dose limiting)HyperpigmentationCMLAML-blast crisis Imatinib (Bcr-Abl Tyrosine kinase inhibitor)CINVFluid retention, Ankle & perioral edemaCML-chronic phase GIST with Ckit tyrosine kinase Dasatinib & Nilotinib (novel agents- TK inhibitors) CML- imatinibresistance/intoleranceAnticancer Drug Toxicities:MYELOSUPPRESSIONAll except Asparginase, Vincristine, BleomycinCARDIOTONICAnthracyclins, arsenic trioxideNEPHROTOXICPlatinum compounds (cisplatin>carboplatin>oxaliplatin)PULMONARY FIBROSISBleomycin. Busulfan, CarmustinePERIPHERAL NEUROPATHYGxaliplatin, vincristine Taxans (stoking & glove type)HAEMORRHAGIC CYSTITISCyclophosphamide, IfosfamideHAND FOOT SYNDROME5FU, Capecitabine, DoxorubicinCEREBELLAR ATAXIAPyrimidine analogs like Cytrabine & 5FUSIADHCyclophosphamide, VincristineSECONDARY LEUKEMIAAll alkylating agents & alkylating like agents (in 4-5 years) E topside (in 1-3 years)STERLITYAlkylating agentsDISULFIRAM LIKE REACTIONProcarbazineCHOLINERGIC SYNDROMEIrinitecanRADIATION RECALL SYNDROMEAnthracydinsAnticancer Drugs Toxic Amelioration:ToxicityMeasuresMethotrexateFolinic acidAlkalization of urine (Mtz is weak acid & reabsorbed in acidic urine)Hemorrhagic cystitis (cyclophosphamide, ifosfamide)ME SNA (2 mercapto ethyl sulfonyl sodium) systemic ACETYLCYSTEINE irrigation of bladderHigh fluid intakeFrequent voidingCINV (Cytotoxic drug induced nausea Stvomiting )Ondansetron (5HT3 Antagonist)Cytotoxic drug induced MucositisPabfermin (human recombinant keratinocyte growth factor)TUMOR LYSIS SYNDROME (hyperkalemia, hypophosphatemia, hyperuricemia, hypemricosuria, hypocalcaemia, acute renal failure)prophylactic ALLOPURINOL (xanthine oxidase inhibitor)alternatively RASBURICASE (urkase)Aggressive hydrationHigh urine outputAlkalization of urine not recommended/controversialDiuresis is reserved for well hydrated patientsHEMODIALYSIS (if above fails) MYE LOS OPPRESSIONFor AnemiaERYTHROPOIETIN (recombinant)For NeutropeniaFILGRASTIM- Granulocyte colony-stimulating factor (G-CSF) analogSARGRAMOSTTM - Recombinant granulocyte macrophage colony stimulating factor (GM-CSF)For ThrombocytopeniaOPRELVEKIN (IL-11)BONE MARROW TRANSPLANT (for extreme suppression)CANCER CACHEXIATHALIDOMIDECYTOPROTECTION of normal tissueAMIFOSTINE= WTR-2721=prodrug(active = free thiol=WR-1065. activation normal tissue)USES=cispIatin based chemotherapy & radiation therapyAnthracyclins induced CARDIOTOXICITYDEXRAZOXAXE (ICRF-187) Iron chelating agent Cardio protective agent, derivative of EDTA\n\nSo the answer to this question is C"}
{"instruction": "Antihypertensive drug of choice in a diabetic patient is:\nA. Methyldopa\nB. Beta blocker\nC. ACE inhibitor\nD. Thiazides", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Fructose is not used in IV infusion as it cause -\nA. Irritability\nB. Mental retardation\nC. Increased erythrocyte protoporphyrin\nD. None", "response": "Ans. is 'None' Fructose causes lactic acidosis & hepatocellular dysfunction.\n\nSo the answer to this question is D"}
{"instruction": "Which is not transmitted by arthropod :\nA. Rickettsia prowazaki\nB. Coxiella burneti\nC. Rickettsia akasi\nD. Rickettsia rickettsi", "response": "Ans. is 'b' i.e. Coxiella Burnetti \"Rickettsia is a small obligate intracellular parasite and except for Q fever (caused by Coxiella burnetti) are transmitted to human by Arthropod\"Human Diseases Caused By RickettsiaOrganism Disease Vector* Rickettsia prowazekii Epidemic Typhus* louse** Rickettsia typhi Endemic Typhus* Flea** Orientia Tsutsugamushi Scrub Typhus* Mite** Rickettsia Ricketsei Rocky mountain* spotted fever* Tick** Rickettsia Akari Rickettsialpox* Mite** Coxiella Burnetti Q fever * Airborne fomites*\n\nSo the answer to this question is B"}
{"instruction": "All are elevators of mandible except -\nA. Temporalis\nB. Medial pterygoid\nC. Masseter\nD. Digastric", "response": "Depressors of mandible are :-\n\n\nMuscle of mastication : Lateral pterygoid (major depressor).\nSuprahyoid muscles : Digastric, mylohyoid, geniohyoid.\n\n\nElevators of mandible are :-\n\n\nMuscles of mastication : Masseter, temporalis, medial pterygoid.\n\nSo the answer to this question is D"}
{"instruction": "Postmoem blood is collected from which vessel ?\nA. Femoral aery\nB. Femoral vein\nC. Cephalic vein\nD. Brachial aery", "response": "Ans. is 'b' i.e., Femoral vein Before autopsy 10 - 20 ml of blood is collected from the femoral vein in groin. Jugular/ subclan vein can also be used.\n\nSo the answer to this question is B"}
{"instruction": "&;Take in&; of split skin graft occurs when\nA. Tight dressing is applied\nB. Excessive discharge from wound\nC. ss hemolytic streptococcus infection is present\nD. Wound bed not vascularised", "response": ".take in occurs if there is close contact of graft with recepient bed and decreased when there is infection or pus draining or wound bed not vascularized\n\nSo the answer to this question is A"}
{"instruction": "All are metabolic causes of liver disease except\nA. Histiocytosis\nB. Hemochromatosis\nC. Gaucher's disease\nD. Wilson disease", "response": "Ans. is 'a' i.e., HistiocytosisMetabolic liver diseases can be classified into 3 categories:Manifestations due to hepatocellular necrosis: Galactosemia, hereditary fructose intolerance, tyrosinemia type I, Wilson disease, Hemochromatosis and al -antitrypsin deficiency.Cholestatic jaundice :Al -antitrypsin deficiency, Byler's disease, cystic fibrosis, Niemann-Pick disease and some disorders of peroxisome biogenesis.Hepatomegaly (disorders with liver damage & storage diseases ): Glycogen storage diseases, cholesteryl ester storage disease and, when associated with splenomegaly, lysosomal storage diseases (eg:- Gaucher disease).\n\nSo the answer to this question is A"}
{"instruction": "Megaloblastic anaemia may be caused by all of the following except\nA. Phenytoin\nB. Methotrexate\nC. Pyrimethamine\nD. Amoxicillin", "response": " Phenytoin decreases folate absorption & increases its excretion causing megaloblastic anaemia. Methotrexate is folate antagonist Pyrimethamine in high doses causes megaloblastic anaemia,especially in those with marginal folate stores. Reference :Tripathi essentials of medical pharmacology 7th edition IP of staphylococcal food poisoning is 1-8 hours. Reference:Park&;s textbook of preventive and social medicine,K.Park,23rd edition,page no:238. <\\p>\n\nSo the answer to this question is B"}
{"instruction": "Munsen sign is seen in: March 2013 (h)\nA. Corneal dystrophy\nB. Perforated corneal ulcer\nC. Keratoconus\nD. Marfan syndrome", "response": "Ans. C i.e. Keratoconus Keratoconus Protrusion of central pa of cornea with thinning, Corneal nerves are visible, Associated features: - Munsen's sign, - Fleischer sign\n\nSo the answer to this question is C"}
{"instruction": "Difference between primary and secondary healing is -\nA. More granulation tissue and fibrosis is seen in secondary healing\nB. Scar is more cosmetic in secondary healing\nC. Secondary healing occurs faster\nD. Surgical wound heal commonly by secondary healing", "response": "Ans. is 'a' i.e., More granulation tissue and fibrosis is seen in secondary healing Primary Healingo Primary wound healing or healing by first intention occurs within hours of repairing a full-thickness surgical incision. This surgical insult results in the mortality of a minimal number of cellular constituents.Delayed Primary Healingo If the wound edges are not reapproximated immediately, delayed primary wound healing transpires. This type of healing may be desired in the case of contaminated woundsSecondary Healingo A third type of healing is known as secondary healing or healing by secondary intention. In this type of healing, a full-thickness wound is allowed to close and heal. Secondary healing results in an inflammatory response that is more intense than with primary wound healing. In addition, a larger quantity of granulomatous tissue is fabricated because of the need for wound closure. Secondary healing results in pronounced contraction of wounds.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following muscle lies between superficial and deep pas of submandibular salivary gland?\nA. Hyoglossus\nB. Styloglossus\nC. Mylohyoid\nD. Geniohyoid", "response": "Submandibular gland is a large salivary gland situated in the anterior pa of the digastric triangle. It is roughly J-shaped,being indented by the posterior border of the mylohyoid which divides into a larger pa superficial to the muscle,and a small pa lying deep to the muscle. Reference: B D Chaurasia's human anatomy; 5th edition, page.166.\n\nSo the answer to this question is C"}
{"instruction": "Streptococcus causing rheumatic hea disease is\nA. Streptococcus milleri\nB. Streptococcus mutans\nC. Streptococcus pyogenes\nD. Streptococcus equisimilis", "response": "Streptococcus pyogenes infection leads to two impoant non-suppurative post-streptococcal sequelae - acute rheumatic fever and acute glomerulonephritis. This complication ensues 1-3 weeks after the acute infection so that the organism may not be detectable when sequelae set in. In rheumatic fever, carditis, including connective tissue degeneration of the hea valves and inflammatory myocardial lesions characterized by Aschoff nodules is seen. Occurs due to an antigenic cross-reaction between group A carbohydrate of Streptococcus pyogenes and cardiac valves Streptococcal antigens cross-reactive with human tissues Streptococcal antigen Human antigen Disease Hyaluronic acid Synol fluid Reactive ahritis Cell Wall M protein Myocardium ARF(Acute rheumatic fever) Cell Wall C carbohydrate Cardiac Valves ARF(Acute rheumatic fever) Peptidoglycan Skin antigens Guttate psoriasis Cytoplasmic membrane Glomerular vascular intima Acute glomerulonephritis (AGN) Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 215\n\nSo the answer to this question is C"}
{"instruction": "Which one of the following is NOT an advantage of immediate dentures:\nA. reduced post operative pain\nB. easy adaptation\nC. less chairside time\nD. none of the above", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "A 60-year-old man with a chronic cough, bloody sputum, and marked weight loss is diagnosed as having tuberculosis. A \"serpentine-like\" colonial morphology is noted on Lowenstein-Jensen agar. This latter finding is caused by which of the following factors?\nA. A large \"slimy\" capsule\nB. Wax D\nC. Coagulase\nD. Cord factor", "response": "Ans. D. Cord factora. Virulent strains of M. tuberculosis grow in a characteristic \"serpentine\" cordlike pattern, whereas avirulent strains do not.b. Virulence of the organism is correlated with cord factor (trehalosedimycolate).\n\nSo the answer to this question is D"}
{"instruction": "Which of the following behavioural problems would suggest an organic brain lesion\nA. Formal thought disorder\nB. Auditory hallucinations\nC. Visual hallucinations\nD. Depression", "response": "Visual hallucinations are more common in acute organic states with clouding of consciousness than in functional psychosis. Visual hallucinations are extremely rare in schizophrenia, so much so that they should raise a doubt about the diagnosis. Fish's Clincal Psychopathology 3rd edition, pages 23,24.\n\nSo the answer to this question is C"}
{"instruction": "A patient with Carcinoma cheek has tumor of 2.5 cms located close to and involving the lower alveolus. A single mobile homotateral node measuring 6 cm is palpable. Based on these clinical findings TNM stage of the tumor is\nA. T1 N1 Mo\nB. T2 N2 Mo\nC. T3 N1 Mo\nD. T4 N2 Mo", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "The most important function of sentinel surveillance is\nA. To determine the trend of disease in a population\nB. To notify disease\nC. To find the total amount of disease in a population\nD. To plan effective control measures", "response": "Sentinel Surveillance\n\nIt estimates disease prevalence in a population.\nIt is a method for identifying the missing cases and thereby supplementing the notified cases.\n\nSo the answer to this question is C"}
{"instruction": "Streak ovaries are seen in: CMC (Vellore) 09\nA. Klinefelter syndrome\nB. Turner syndrome\nC. Down syndrome\nD. Kallamann syndrome", "response": "Ans. Turner syndrome\n\nSo the answer to this question is B"}
{"instruction": "All of the following are peripherally acting muscle relaxants except\nA. Dantrolene\nB. Pancuronium\nC. Succinyl choline\nD. Baclofen", "response": "Baclofen is a GABA - B agonist that acts centrally to produce muscle relaxation.\n\nSo the answer to this question is D"}
{"instruction": "F factor integrates with bacterial chromosome to form -\nA. HFr\nB. F+r\nC. F-\nD. F", "response": "Factor: The F factor is the transfer factor that contains the genetic information necessary for the synthesis of sex pilus and for self-transfer but is devoid of other identifiable genetic markers such as drug resistance. Cells carrying the F factor have no distinguishing feature other than their ability to mate with F - cells and render them F+. he F factor is actually an episode and has the ability to exist in some cells in the integrated data or inseed into the host chromosome. Such cells are able to transfer the chromosomal gene to recipient cells with high frequency and are known as Hfr cells. following conjugation with an Hfr cell an F- only rarely becomes F+ though it receives chromosomal genes from the donors. REF:Ananthanarayan and Panicker's Textbook ofMicrobiology 8thEdition pg no:65\n\nSo the answer to this question is A"}
{"instruction": "Floor space of 2 persons –\nA. 70–90 sq.ft\nB. 90–100 sq.ft\nC. 50–70 sq.ft\nD. 110–120 sq.ft", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "A 37-year-old woman comes to the emergency depament with sudden onset of left leg weakness. There is no history of any prior medical illness. On neurological examination, there is no wasting, muscle tone is normal, deep-tendon reflexes are normal, and plantars show 'flexor' response. The patient cannot raise her left leg off the bed while supine and is very worried that something is wrong. MRI brain does not reveal any abnormality. Which of the following is the most likely diagnosis?\nA. Conversion disorder\nB. Factitious disorder\nC. Illness anxiety disorder\nD. Malingering", "response": "This patient had a sudden onset of neurological symptoms , and the symptoms and clinical examination findings are inconsistent. This is a strong pointer towards conversion disorder. Please note that there is no la belle indifference (lack of concern for the symptoms) in this patient. La belle indifference is not seen in all patients with conversion disorder. In contrast to conversion disorders, patient with factitious disorders voluntarily produce the symptoms and the question gives a hint about it.\n\nSo the answer to this question is A"}
{"instruction": "Most immunogenic in\nA. 0 antigen\nB. H antigen\nC. Vi antigen\nD. Somatic antigen", "response": "Ans. is 'b' i.e., H. antigen\n\nSo the answer to this question is B"}
{"instruction": "Keratoconus is defined as: March 2013 (h)\nA. Degeneration of conjunctiva\nB. Cornea undergoes necrosis due to vitamin A deficiency\nC. Cornea thins near the centre & bulges forwards\nD. Recurrent corneal ulcerations of cornea", "response": "Ans. C i.e. Cornea thins near the centre & bulges forwards\n\nSo the answer to this question is C"}
{"instruction": "Pseudocoma results from infarction or haemorrhage in-\nA. Pons\nB. Mid-brain\nC. Medulla\nD. Hypothalamus", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Wernicke's hemianopic pupil is seen in the lesion of\nA. Optic tract\nB. Optic nerve\nC. Optic chiasma\nD. Occipital lobe (visual coex)", "response": "Wernickes hemianopic pupil is seen in the lesion of optic tracts - characterized by contralateral homonymous hemanopia with a characteristic pupillary response. Narrow beam of light when shown into the non-seeing pa of the retina, pupil fails to react while when shown into the seeing pa of the retina, pupillary constriction occurs. Make your concept - Homonymous means same side (i.e. right or left) - Heteronymous means opposite side (i.e. nasal or temporal) - Congruous means same shape or symmetric on both sides - Incongruous means different shape or asymmetric on both sides - Hemianopia means half side is involved - Generally Anterior lesions cause heteronymous, incongruous defects and posterior lesions cause more homonymous and congruous defects Impoant Points on Visual Pathway Lesions 1. Optic nerve lesion - I/l direct and c/ L consensual gone Causes - optic atrophy/ optic neuritis - avulsion optic nerve 2. Proximal pa of optic nerve - I/L blindness C/L hemianopia 1. Saggital chiasma lesion - Bitemporal hemianopia - Paial descending optic atrophy Causes - suprasellar aneurysm - tumors of pitutory craniopharyngioma - suprasellar meningioma 2. Lateral chiasma - Binasal hemianopia of pupillary reflex Causes - Distention of 3rd ventricle Since some fibres of other side there is crossover Binasal Hemianopia 3. Optic tract Lesion- - Contralateral homonymous hemianopia with incongruity - Bow tie pattern of optic atropy 5.Temporal lobe lesion - contralateral homonymous superior quadrantanopia (pie in the sky defect) 6. Parietal Lobe lesion- Pie in the floor. Contralateral homonymous inferior quadrantanopia Homonymous hemianopsia, also referred to as homonymous hemianopia is the loss of half of the field of view on the same side in both eyes. Left superior homonymous quadrantanopia Left inferior homonymous quadrantanopia 7.Keyhole visual field defects: Vascular lesion of Lateral Geniculate body 8. Occipital lobe lesion Congruous homonymous hemianopia with sparing of macula Cause: Occlusion of posterior cerebral aery Congruous Homonymous macular defect Cause: Bullet injury/ head injury Bilateral homonymous macular defect Cause: Bilateral occipital defect\n\nSo the answer to this question is A"}
{"instruction": "Facial artery arises at the level of:\nA. Below hyoid bone\nB. Above hyoid bone\nC. Hyoid bone\nD. Above Styloid process", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A 19 yrs old male has a small circumscribed sclerotic swelling over diaphysis of femur, likely diagnosis is:\nA. Osteoclastoma\nB. Osteosarcoma\nC. Ewing's sarcoma\nD. Osteoid osteoma", "response": "Sclerotic lesion over diaphysis of a long bone in a young patient indicative of osteoid osteoma. Ref: Essential Ohopedics By Maheshwari 2nd Edition, Page 213\n\nSo the answer to this question is D"}
{"instruction": "After applying a statistical test, an investigator gets the ‘P value’ as 0.01. it means that\nA. The probability of finding a significant difference is 1%\nB. The probability of declaring a significant difference is 1%\nC. The difference is not significant 1% times and significant 99% times\nD. The power of the test used is 99%", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Most common cause of acute tonsilitis ?\nA. Streptococcus pneumoniae\nB. H. Influenza\nC. 13- hemolytic streptococci\nD. Staphylococcus aureus", "response": "Ans. is 'c' i.e., 13- hemolytic streptococci Tonsils frequently serve as the site of acute infection, which causes acute tonsillitis. Tonsillitis is paicularly common in children, especially in school going age group. However, it can occur in adult also. Virus initiates an acute tonsillitis attack and predisposes to bacterial infection. 8-hemolytic streptococcus is the most common organism causing acute tonsillitis. Other bacteria causing acute tonsillitis are staphylococcus, hemophilus and pneumococcus.\n\nSo the answer to this question is C"}
{"instruction": "Consequence of maternal use of cocaine is:\nA. Hydrops\nB. Sacral agenesis\nC. Cerebral infarction\nD. Hypertrichosis", "response": "Cocaine addiction can cause – miscarriage, intrauterine fetal death, PROM, preterm labour and IUGR.\nIt can lead to the following Malformations in the fetus:\n\nMicrocephaly, cutis aplasia, porencephaly, subependymal and periventricular cysts, ileal atresia, cardiac anomalies, visceral infarcts, limb reduction defects and genitourinary malformations.\nIt produces cerebral infarction and periventricular leukomalacia in the fetus.\nThe risk of malformations in the embryo/fetus is highest after the first trimester.\n\nSo the answer to this question is C"}
{"instruction": "If the distance between the tip of tongue and insertion of lingual frenum is 6 mm, then it will be:\nA. Mild ankyloglossia\nB. Moderate ankyloglossia\nC. Severe ankyloglossia\nD. Complete ankyloglossia", "response": "Class 1 - Mild ankyloglossia - 12-15 mm\nClass 2 - Moderate ankyloglossia - 8-11 mm\nClass 3 - Severe ankyloglossia - 4-7 mm\nClass 4 - Complete ankyloglossia - 0-3 mm.\n\nSo the answer to this question is C"}
{"instruction": "Wredin's test is significant in live born fetus related to\nA. Lungs\nB. Stomach\nC. Skull\nD. Middle ear", "response": "Wredin's test After bih, the gelatinous substance in the middle ear is replaced by air through Eustachian tube. This is now considered as not a reliable test. Ref: FORENSIC MEDICINE AND TOXICOLOGY Dr PC IGNATIUS THIRD EDITION PAGE 351\n\nSo the answer to this question is D"}
{"instruction": "Alpha waves are typically seen in which of the following states:\nA. Deep sleep\nB. Relaxed awake\nC. Awake ale\nD. Highly focused", "response": "Alpha waves are typically seen in a relaxed yet awake state. Alpha waves are one type of brain waves detected either by electroencephalography (EEG) that predominantly originate from the occipital lobe during wakeful relaxation with closed eyes. Alpha waves are reduced when eyes are opened (patient becomes ale : transition to Beta waves) or when patient drifts into sleep (Transition to Theta waves) Waves State Associated states Gamma waves Frequency: 32-100 Hz Conscious, Highly focused Heightened perception, Heightened learning & problem-solving tasks Beta waves Frequency: 13-32 Hz (Fast Dyschronous Activity) Conscious ale Active thinking (Active conversation; Making decisions; solving a problem; Focusing on a task; Learning a new concept Alpha Waves Frequency: 8-13 Hz (Synchronous Activity) Conscious Relaxed (Relaxed Awake with eyes closed) Physically and mentally relaxed They become detectable when the eyes are closed and the mind is relaxed They may also often be going during activities such as Yoga; mild meditation and visualisation Theta waves Frequency: 4-8 Hz (Slow rhythmic Activity) Reduced Consciousness Creativity, insight, dreams, reduced consciousness Most frequently, Theta waves are strongly detectable when we&;re dreaming in our sleep Deep Meditation and Dreaming Also in Day-dreaming Seen in Stage-1 NREM sleep Seen in REM sleep (Dreaming) Humans aroused at a time when they show the EEG characteristics of REM sleep generally repo that they were dreaming Delta waves Frequency : 0.5-4 Hz (Large Rhythmic Activity) Unconscious state Deep sleep (Dreamless) These are the slowest of all brain waves, and are strongest when we are enjoying restorative sleep in a dreamless state. Typically seen in NREM Sleep stage III and IV Ref: Guton and Hall 25th edition\n\nSo the answer to this question is B"}
{"instruction": "Tissue bridges are seen in: DNB 10\nA. Abrasion\nB. Contusion\nC. Laceration\nD. Stab wound", "response": "Ans., Laceration\n\nSo the answer to this question is C"}
{"instruction": "Cone biopsy is indicated in all the following conditions except :\nA. Indefinite diagnosis on colposcopy\nB. CIN-III\nC. Cervical metaplasia\nD. Microinvasive carcinoma", "response": "Ans. is c i.e. Cervical metaplasia ications of Cone bi biopsy or conization is both Diagnostic as well as therapeutic procedure. Complications of cone biopsyCone : Diagnostic Therapeutic Limits of the lesion can not be visualised with coloposcopy.deg The squamo-columnar junction is not seen at colposcopydeg In endocervical curettage - histological findings are positive for CIN-II or CIN - IIIdeg Micro invasive carcinoma or adenocarcinoma in situ is suspected based on biopsy, colposcopy or cytology results Lack of correlation between cytology, biopsy & colposcopy results Infectiondeg A Cervical stenosisdeg Incompetent osdeg Conisation for a lesion grossly suggestive of invasive cancer is not indicated, as it predisposes the patient to serious pelvic infections and bleeding. The diagnosis is confirmed by a simple biopsy / colposcopic directed biopsy. Remember : Spread of malignancy is not a complication of cone biopsy. Extra edge : AgNOR : It is a new molecular tumor marker which stands for silver stained nucleolar organizer DNA is present in dysplastic cells. They appear as black dots which increase in number but decrease in sizze with advancing dysplasia. The lesions with low counts often regress, whereas those with high counts progress and need treatment.\n\nSo the answer to this question is C"}
{"instruction": "A 25 year old university student had a fight with the neighboring boy. On the next day, while out, he started feeling that two men in police uniform were observing this movement. When he reached home in the evening he was frightened. He expressed that police was after him and would arrest him. His symptoms represent:\nA. Delusion of persecution\nB. Ideas of reference\nC. Passivity\nD. Thought insertion", "response": "Delusion of Persecution :\n\nThe patient has delusions that he is being persecuted against, e.g. 'people are against me'.\n\nThought Insertion:\n\nSubject experiences thoughts imposed by some external force on his passive mind.\n\nSomatic Passivity :\n\nBodily sensations especially sensory systems, are experienced as imposed on the body by some external force e.g. Robot, X-ray waves\n\nSo the answer to this question is A"}
{"instruction": "Lacunar cells are seen in\nA. Lymphocyte predomninat HL\nB. Lymphcyte depleted HL\nC. Nodular sclerosis\nD. Mixed cellularity", "response": "Hodgkins Lymphoma*Hodgkin lymphoma encompasses a group of lymphoid neoplasms*Arise almost invariably in a single lymph node or chain of lymph nodes and spread characteristically in a stepwise fashion to the anatomically contiguous nodes. Hence staging is impoant.*Its characterized by presence of noeplastic giant cells called as Reed-Sternbergs cell with two nuclear lobes, large inclusion-like nucleoli and abundant cytoplasm.Classification1.Nodular sclerosis2.Mixed cellularity3.Lymphocyte rich4.Lymphocyte depleted5.Lymphocyte predominanceCharacteristics of different subtypes of Hodgkin lymphomaSubtypeMorphology Background infiltrateImmunophenotypeNodular sclerosisLacunar cellsOccasional RS cellsT cells, esinophils, macrophages, plasma cellsCD15+ CD30+ EBV-Mixed cellularityMononuclear cells ( Hodgkin cell) & RS cellT cells, esinophils, macrophages, plasma cellsCD15+ CD30+ EBV+ (70%)Lymphocyte richMononuclear cells ( Hodgkin cell) & RS cellT cells richCD15+ CD30+ EBV+ (40%)Lymphocyte depletedFrequent RS cellsPaucity of background reactive cellsCD15+ CD30+ EBV+ (90%)Lymphocyte predominanceFrequent L&H (popcorn cells)Follicular dentritic cells and reactive B cellsCD15- CD30- EBV- CD20+Note: 1) L&H - lymphocytic and histiocytic variant of Hodgkin lymphoma seen in Lymphocyte predominant subtype. 2) CD 15 and 30 are the classical markers of Hodgkin lymphoma 3) Lymphocyte predominant is different from the other 4 subtypes of Hodgkin lymphoma. Hence called as a NONCLASSICAL variant.4) Prognosis Excellent - Nodular sclerosis, Mixed cellularity, Lymphocyte-rich, Lymphocyte predominant Less orable- Lymphocyte depleted(Ref: Robbins 8/e p618, 7/e p422-423)\n\nSo the answer to this question is C"}
{"instruction": "NSAID used commonly for topical ocular use is-\nA. Ibuprofen\nB. Aceclofenac\nC. Ketorolac\nD. Acetaminophen", "response": "(Refer: AK Khurana Comprehensive Ophthalmology, 6th edition, pg no. 454 – 455)\nCommonly used topicalocular NSAIDS\n\nKetorolac\nFlurbiprofen\nDiclofenac sodium\n\nSo the answer to this question is C"}
{"instruction": "A patient with burns die within 24 hours. What could be the most probable cause:\nA. Circulatory shock\nB. Physical burn injury to the airways above the larynx\nC. Physical burn injury to the airways below the larynx\nD. Circumferential burn", "response": "Ans. B: Physical burn injury to the airways above the larynx Inflammatory and circulatory changes in burn patient produce a net flow of water, solutes and proteins from the intravascular to extravascular space. This flow occurs over the first 36 hours after the injury. As the burn size approaches 10-15% of the total body surface area (TBSA), the loss of intravascular fluid can cause a level of circulatory shock Once burned, the linings of nose, mouth, tongue, palate and larynx will sta to swell. After a few hours, they may sta interfere with the larynx and may completely block the airway, if action is not taken to secure an airway Physical burn injury to the airways below the larynx is a rare injury Circumferential burns may compromise circulation to a limb\n\nSo the answer to this question is B"}
{"instruction": "Peripheral neuritis with characteristic ‘wrist drop’ or 'foot drop' is seen in:\nA. Lead poisoning\nB. Mercury poisoning\nC. Copper poisoning\nD. Bismuth poisoning", "response": "Lead intoxication is manifested by serious gastrointestinal disturbances which include nausea, vomiting, colic, and constipation. A peripheral neuritis also develops which may produce the characteristic wrist-drop or foot-drop. \nRef: Shafer's textbook of oral pathology 7th edition page 558\n\nSo the answer to this question is A"}
{"instruction": "For Karyotype analysis of stillborns, recommended tissue sample is all except\nA. Umbilical cord segment about 1.5 cm long\nB. Fetal patella\nC. Placental block taken below cord insertion\nD. Fetal skin", "response": "Skin of Fetus is not recommended as tissue sample for karyotyping.\n\nSo the answer to this question is D"}
{"instruction": "All of the following are used in the treatment of Thrombotic Thrombocytopenic Purpura, Except.\nA. Plasmapharesis\nB. Coicosteroids\nC. Immunotherapy\nD. Heparin", "response": "Answer is D (Hepari) Heparin and platelet transfusions are not used in the treatment of Thrombotic Thrombocytopenic Purpura Heparin and platelet transfusions are not used in treatment of TTP 'Heparin is not indicated in the treatment of TTP-HUS. Platelet transfusion is also not indicated and may worsen neurological symptoms and renal dysfunction. Platelet transfusion can lead to the geeration of new or expanding thrombi, as the infused platelets are transfused' - Cleveland Clinic. Internal Medicine Case Reviews (2003)/153 Plasmapharesis, Coicosteroids and Immunotheram may he used in treatment of TTP Plasmapharesis forms the mainstay of treatment for TTP. Coicosteroids and lmmunotherapy may be used as adjuncts to plasma exchange in refractory /relapsed cases.\n\nSo the answer to this question is D"}
{"instruction": "Initial treatment of keloid\nA. Topical steroid\nB. Intralesional steroid\nC. Excision\nD. Radiotherapy", "response": "Answer- B. Intralesional steroidIntralesional injection of steroid (Triamcinolone acetate) is now recommended as the first line of t/t for keloid.\n\nSo the answer to this question is B"}
{"instruction": "A person developing hatredness towards his brother starts, overcaring him and brings gifts to him.This is an example of\nA. Sublimation\nB. Passive aggression\nC. Reaction formation\nD. Dissociation", "response": "Reaction formation is a neurotic defense mechanism where an individual transforms his feelings into exact opposite.\n\nSo the answer to this question is C"}
{"instruction": "All are non-proliferative glomerulonephritis, except:\nA. Membranous glomerulonephritis\nB. Mesangiocapillary glomerulonephritis\nC. Diabetic glomerulosclerosis\nD. Amyloidosis", "response": "Conditions with Proliferative Glomerulonephritis : SLE (paicularly class II) HIV Membranoproliferative/Mesangiocapillary glomerulonepritis Neoplasia (CLL and MALT lymphoma) Post streptococcal glomerulonephritis Rest all options are the conditions with non proliferative glomerulonephritis.\n\nSo the answer to this question is B"}
{"instruction": "Leeway space is used during:\nA. Early mesial shift.\nB. Late mesial shift.\nC. Mesial step.\nD. None", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Ether was first used by:\nA. Preistly\nB. Moon\nC. Wells\nD. Simpson", "response": "Moon\n\nSo the answer to this question is B"}
{"instruction": "Serious infections can occur when absolute neutrophil count decreases to?\nA. Less than 500/mL\nB. Less than 800/mL\nC. Less than 1000/mL\nD. Less than 1500/mL", "response": "a. Less than 500/mL(Ref: Nelson's 20/e p 1048, Ghai 8/e p 357)Serious infections are most likely when the neutrophil count falls below 500 per mm3.\n\nSo the answer to this question is A"}
{"instruction": "Toxic shock syndrome is caused by\nA. Streptococcus pyogenes\nB. Staphylococcus aureus\nC. Streptococcus albicans\nD. Enterococcus Durans", "response": "Toxic shock syndrome is a potentially fatal multisystem disease caused by Staphylococcus aureus. Present as fever, hypotension, myalgia, vomiting, diarrhea, mucosal hyperemia and an erythematous rash which desquamates subsequently. This is associated with infection of mucosal or sequestered sites by toxic shock syndrome toxin (TSST)-Producing S.aureus strains usually belonging to bacteriophage group I.TSST type I (formerly known as enterotoxin type F or pyrogenic exotoxin C)is most often responsible, though enterotoxin B or C may also cause the syndrome . Staphylococcal enterotoxins and TSST -1 are superantigens which are a potent activator of T lymphocytes. Being Vbeta-restricted T cell mitogens, such superantigens stimulates large numbers of T cells without relation to their epitope specificity. This leads to excessive and deregulated immune response, with the release of cytokines interleukins 1,2, tumour necrosis factor and interferon gamma. This explains multisystem involvement and florid manifestation in staphylococcal food poisoning and TSS. Soft tissue infections with some M types of S.pyogens (1,3,12,28) may sometimes cause a toxic shock syndrome resembling staphylococcal TSS. Streptococcal TSS and necrotizing fasciitis occur in persons not immune to the infecting M types Ref: Textbook of Microbiology; Ananthanarayanan and Panicker; Tenth Edition; Page No: 204, 215\n\nSo the answer to this question is B"}
{"instruction": "An investigator is studying the impact seatbelts have on the severity of injuries incurred during a motor vehicle accident. \n\nWhich of the following study designs would be most appropriate for answering this question?\nA. Case series\nB. Case-control study\nC. Cohort study\nD. Clinical trial", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Maximum damage to Napoleon’s army during his march to Moscow was done by\nA. Diarrhea\nB. Plague\nC. Typhus\nD. Typhoid", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "All are true for octeride except -\nA. Used in Acromegaly\nB. Used orally\nC. Given in secretory diarrhea\nD. Used in poal hypeension", "response": "Ans. is 'b' i.e., Used orally Octeride o It is synthetic somatostatin analogue. o It is more potent and longer acting than somatostatin --> preferred over somatostatin. o It is used in acromegaly, bleeding esophageal varices (poal hypeension) and secretory diarrhea associated with carcinoid, WDHA syndrome, gastrinoma and glucagonoma.\n\nSo the answer to this question is B"}
{"instruction": "All of the following are known risk factors for the development of ovarian carcinoma except :\nA. Family history of ovarian carcinoma\nB. Use of oral pills\nC. Use of Clomiphene\nD. BRCA - 1 positive individual", "response": "Ans. is b i.e. Use of oral pills Oral pills decrease risk of developing ovarian carcinoma. Risk factor for ovarian cancer : Factors related to ovary Personal Factors Genetic disease PCOD Ovulation inducing drugs Exogenous estrogens Family history High dietry intake of saturated fat Nulliparity Turner syndrome - increases risk of dysgerminoma and gonadoblastoma Breast ovarian cancer syndrome - related to mutation in BRCA-1 & BRCA-2 HNPCC syndrome = Lynch II syndrome - associated with colon cancer, Facto. ....t.;;Aeasing ovarian cancer : Oral contraceptive pills (decrease risk by 50% for user of 5 years or longer) Pregnancy - (Risk reduction of 13 to 19% per pregnancy) Breast feeding - Chronic anovulation - Multiparity Tubal ligation, hysterectomy. Remember :A simple \"Funda\" Repeated ovulation increases the risk of ovarian cancer. So, anovulation, pregnancy, multiparity and breast feeding are protective against ovarian cancer.\n\nSo the answer to this question is B"}
{"instruction": "In tetany hyperexcitability is due to\nA. Low ca ++ causes T permeability to Na+\nB. Prevent K. release\nC. Prevent Na* & IC- release\nD. I.Ca+' produce generation of AP", "response": "A i.e. Low Ca++ CausesT Na+ permeabilityA decrease in extra cellular Ca++ Concentration increases the excitability of nerve and muscle cells by decreasing the amount of depolarization necessary to initiate the change in Na+ & IC' conductance that produce the action potentialQ. In fact Ca++ needs to fall only 50% below the normal before spontaneous discharge occur from peripheral nerves, often causing tetany.The voltage gated calcium channels are slightly permeable to Na+ as well as Ca++;when they are activated both Na+ and Ca++ flow to interior of the fiber. When there is deficit of Ca2+ in ECF, Na+ channels become activated (opened) by very little change of membrane potential (from its very negative resting level to a less negative level). Therefore nerve fibers become highly excitable. Sometime discharging repetitively without provocation rather than remaining in resting stage.Conversely, an increase in ECF Ca++ stabilizes the membrane by decreasing excitability.\n\nSo the answer to this question is A"}
{"instruction": "Which one of the following sites of endometriosis is not treated by medical therapy :\nA. Rectosigmoid\nB. Ovarian\nC. Episiotomy\nD. Pulmonary", "response": "Ovarian\n\nSo the answer to this question is B"}
{"instruction": "Cervical cord injury does not cause:\nA. Homer's syndrome\nB. Loss of sensation over face\nC. Spasticity of foot\nD. None", "response": "Answer is B (Loss of sensation over face) Cervical cord injury is not associated with loss of sensations over face. Cervical cord injury may be associated with wasting and fasciculations over the limbs but not on the lower limbs.\n\nSo the answer to this question is B"}
{"instruction": "Glucose-6 Phosphatase deficiency is seen in\nA. Von Gierke disease\nB. Tay sach disease\nC. Pompe disease\nD. Anderson disease", "response": "NameEnzyme DeficiencyClinical FeaturesVon Gierke diseaseGlucose-6-phosphataseGlycogen accumulation in liver and renal tubule cells;hypoglycemia; lactic acidemia; ketosis; hyperlipemiaRef: Harper&;s Biochemistry; 30th edition; Chapter 18 Metabolism of Glycogen; Page no: 179\n\nSo the answer to this question is A"}
{"instruction": "Which hormone is conveed into active form in liver?\nA. Coicosteroid\nB. ACTH\nC. Thyroid hormone\nD. Estradiol", "response": "Ans. is'c'i.e., Thyroid hormone(Ref Principles of medical physiology lt p.71)Thyroxine (T4) is conveed to T, (active form) in liver (majority) and kidney.\n\nSo the answer to this question is C"}
{"instruction": "Which toxin of streptococcus causes hemolysis -a) Streptolysin Ob) Streptolysin Sc) Streptodornase d) Hyaluronidase\nA. ac\nB. a\nC. ad\nD. ab", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "With regards to hereditary spherocytosis, which of the following is false\nA. Usually has autosomal dominant inheritance\nB. Caused by mutations in genes for proteins such as spectrin, ankrin or band 3\nC. Red blood cells are destroyed in the spleen\nD. Aplastic crises are common", "response": "Ans. is 'd' i.e., Aplastic Crisis are common Aplastic crisis are a rare/uncommon complication of Hereditary Spherocytosis typically caused by virally induced bone marrow suppression. The most common aetiological agent that induces Aplastic Crisis in patients with Hereditary Spherocytosis is Parvovirus B19 Hereditary spherocvtosis usually has autosomal dominant inheritance caused by mutation in genes for proteins such as spectrin. ankrin or band 3. The genes responsible for HS include akyrin, b spectrin, band-3-protein, a-spectrin, and protein 4.2. In approximately two-thirds to three-quaer of HS patients, inheritance is autosomal dominant. In the remaining patients, inheritance is non-dominant due to autosomal recessive inheritance of a de novo mutation. In patients with hereditary spherocvtosis Red blood cells are destroyed in the spleen The spleen plays a critical role in the pathobiology of HS, as destruction of spherocytes in the spleen is the primary cause of hemolysis in HS patients. Aplastic Crisis is an Uncommon Complication Aplastic crisis following virally induced bone marrow suppression are uncommon, but may result in severe anaemia with serious complications including congestive hea failure or even death. The most common aetiological agent in these cases is parvovirus B19. Parvovirus selectively infects erythropoietic progenitor cells and inhibits their growth\n\nSo the answer to this question is D"}
{Reference: BDC 6E pg no.34}\n\nSo the answer to this question is B"}
{"instruction": "The gene for folic acid transpoer is located on which chromosome:\nA. 5\nB. 15\nC. 21\nD. X", "response": "C i.e. 21Folic acid transpoer gene (SLC 19 AI solute carrier family 19) is located on long arm of chromosome 21 (21q) Q at band 22.3. Transpo of folate occurs by potocytosis which functionally couples folate receptor, folate transpoer and V- type h+ pump.\n\nSo the answer to this question is C"}
{"instruction": "Diffusion hypoxia seen during ?\nA. Induction of anesthesia\nB. Reversal of anesthesia\nC. Post operative period\nD. None of the above", "response": "Ans. is 'b' i.e., Reversal of anaesthesia Second gas effect and diffusion hvpoxia In initial pa of induction, diffusion gradient from alveoli to blood is high and larger quantity of anaesthetic is entering blood. If the inhaled Concentration of anaesthetic is high (eg N20), Substantial loss of alveolar gas volume will occur and it creates negative intralveolar pressure that leads to removal of more gas from cylinder to alveoli Concentration effect. If another inhalation agent is (eg Halothane) is being given at the same time, it also will be delivered to lung from the cylinder (due to negative intraalveolar pressure) Second gas effect. During recovery reverse occurs - N20 having low blood solubility, rapidly diffuses into alveoli and dilutes the alveolar air --> paial pressure of oxygen in alveoli is reduced. The resulting hypoxia is known as diffusion hypoxia. Diffusion hypoxia can be prevented by continuing 100% 02 inhalation for a few minutes after discontinuing N20, instead of straight away switching over to air.\n\nSo the answer to this question is B"}
{"instruction": "Naloxone for opioid receptor acts as:\nA. Pure agonist\nB. Pure antagonist\nC. Paial agonist\nD. Agonist antagonist", "response": "Naloxone is a pure antagonist and is preferred over older weak agonist-antagonist agents that had been used primarily as antagonists, eg, nalorphine and levallorphan. Ref: Katzung, 11th edition, Chapter 31.\n\nSo the answer to this question is B"}
{"instruction": "Present \"General fertility rates\"\nA. 84\nB. 118\nC. 128\nD. 138", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Suspended animation:\nA. Is apparent death from which a person can be aroused\nB. Is true death from which person cannot be aroused\nC. May last for days or weeks\nD. Cannot be produced voluntarily", "response": "Ans. (A). Is apparent death from which a person can be arousedSuspended animation lasts for few seconds to 1/2 hoursQIt is apparent death from which person can be arousedYoga practitioners produce suspended animation like state voluntarilyThere is no cell deathQ in suspended animation.\n\nSo the answer to this question is A"}
{"instruction": "All of the following are the criteria for overcrowding except:-\nA. Per capita space if <70-90 ft2/person\nB. If >1 persons/room\nC. If sex separation is absent\nD. 2 people of opposite sex >9 years & not husband and wife are made to sleep in 1 room", "response": "Housing: Overcrowding criteria:- Per capita space if <70-90 ft 2 /person If >2 persons/room If sex separation is absent i.e. when 2 people of opposite sex >9yrs & not husband and wife are made to sleep in 1 room Persons per room 1 room 2 persons 2 rooms 3 Persons 3 rooms 5 Persons 4 rooms 7 Persons 5 or more 10 persons (additional 2 for each fuher room)\n\nSo the answer to this question is B"}
{"instruction": "All of the following are risk factors for carcinoma gall bladder, EXCEPT -\nA. Typhoid carriers\nB. Adenomatous gall bladder polyps\nC. Choledochal cysts\nD. Oral contraceptives", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "In a patient with acute leukemia, immunophenotype pattern is CD 19+ve, CD 10+ve, CD33+ve, CD13+ve.He may probably have-\nA. Biphenotypic leukemia\nB. ALL\nC. AML-M2\nD. AML-M0", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Most significant indicator of fertility is -\nA. Net reproductive rate\nB. Family size\nC. Gross reproduction rate\nD. General fertility rate", "response": "Net reproduction rate \n\nNet reproductive rate is defined as\n\n\"The no. of daughters a new born girl will bear during her lifetime assuming fixed age specific fertility and mortality rates\"\n\nIt is the only fertility related statistics which also takes mortality rates into consideration.\nNRR of one is equivalent to attaining approximately the two child norms.\nGoal of NRR=1 can be achieved only if at least 60%* of the eligible couples are effectively practicing family planning.\n\n\nGross reproduction rate (GRR): \n\nAverage number of girls that would be born to a married woman if she experiences the current fertility pattern throughout her reproductive span (15-44 or 49 year) assuming no mortality.\n\nSo the answer to this question is A"}
{"instruction": "Immune complex mediated reaction\nA. Type I\nB. Type II\nC. Type III\nD. Type IV", "response": "Ans. is 'c' i.e., Type III reactions Type III hypersensitivity o Type III hypersensitivity reaction is antigen-antibody immune complex mediated that are deposited in postcapillary venules of various tissues with subsequent complement fixation. o Immune complexes produce tissue damage mainly be eliciting inflammation. Type III hypersensitivity may be of two types A. Systemic or generalized Immune complex disease (serum sickness) - It occurs in three phases :? Phase I --> Formation of antigen - antibody immune - complex in the blood. Phase II --> Traveling of immune complex through blood and deposition in various tissues. Phase III ---> Induction of inflammation by immune complex. Generally, common sites of deposition of immune complex incude - Skin Joints Lungs Kidney Blood vessels B. Localized immune complex disease (Ahus reaction) Ahus reaction is a localized area of tisue necrosis resulting from acute immune - complex vasculitis, usually elicited in the skin.\n\nSo the answer to this question is C"}
{"instruction": "Most common cause of hirsutism in a teenage girl:\nA. Ovarian disease\nB. Pheochromocytoma\nC. Obesity\nD. Adrenogenital syndrome", "response": "As explained earlier PCOD is the most common cause of hirsutism.\nPCOD most common affects teenage girls (15–25 years). Therefore, In teenage girls most common cause of hirsutism is PCOD.\n\nSo the answer to this question is A"}
{"instruction": "A very preterm baby on 30 mL/kg of enteral feeding developed sudden severe abdominal distension with visible bowel loops on day 6 of life. The baby also showed temperature instability and lethargy. s-ray of the abdomen showed poal venous gas. The staging of NEC is:\nA. lb\nB. 2a\nC. 2b\nD. 3a", "response": "Ans. c. 2b\n\nSo the answer to this question is C"}
{"instruction": "The Lymph node to be involved in Cancer Gall bladder to be called as M1 Stage?\nA. Inter aortocaval node\nB. Superior mesenteric node\nC. Coeliac node\nD. Pancreatico duodenal node", "response": "Ans. (a) interaortocaval NodeRef: Blumgart 6th Edition Page 788, 799* The first Manuever during Extended Cholecystectomy is to do Kocherisation and assess Aortocaval and Retro pancreatic nodes. The coeliac node must also be assessed; and Suspicious nodes sent for Frozen Section and if positive the procedure is terminated.* N1 = Metastases to nodes along cystic duct, common bile duct, hepatic artery, and/or portal vein* N2 = Metastases to periaortic, pericaval, superior mesenteric artery, and/or celiac artery nodes* M1 = Interaortocaval nodes\n\nSo the answer to this question is A"}
{"instruction": "A recurrent Chalazion should be subjected to histopathologic evaluation to exclude the possibility of-\nA. Squamous cell carcinoma\nB. Sebaceous cell carcinoma\nC. Malignant melanoma\nD. Basal cell carcinoma", "response": "*A recurrent Chalazion in old age should arouse suspicion of malignant change into meibomian gland adenocarcinoma (Sebaceous cell carcinoma). Ref: Kanski 5th/e p.13\n\nSo the answer to this question is B"}
{"instruction": "Seen in B/L congenital hip dislocation is/are -a) Short stratureb) Wandering acetabulumc) Waddling gaitd) Lumbar lordosis\nA. acd\nB. ad\nC. bc\nD. bde", "response": "In a bilateral dislocation the gait is described as 'duck like waddle' or 'sailor's gait and consists of an inclination to the side on which the weight is born (lurching gait on both side). In unilateral cases the child lurches towards affected side. This is known as abductor lurch or Trendelenburg gait.\n\n\nLordosis is particularly noticeable in bilateral cases & is often presenting complaint.\n\n\nThere short stature with both lower limbs appear too short for the body.\nThere is compensatory genu valgum. As both hips are adducted patient tries to keep the feet outside, which causes bilateral compensatory genu valgum.\n\n\nShenton's line is broken.\n\nSo the answer to this question is A"}
{"instruction": "Kevorkian sign is seen in\nA. Cornea\nB. Retinal vessels\nC. Pupil\nD. Vitreous humour", "response": "Kevorkian sign is seen as a postmoem change that occurs in the retinal *it is characterized by fragmentation of blood column in the retinal vessels *it appears within minutes after and last for about 1 *it can be visualised by using an opthamalscope Other postmoem changes in eye : Cornea -dull, opaque, hazy, wrinkled Flaccidity of eyeballs occurs due to fall in intraocular pressure Tache :One of the post Moem where a film of cell debris and mucus forms two yellow triangles on sclera on either side of ,with base towards the margin of ,appearing 3-4 hours after death Refer:The essentials of Forensic Medicine and Toxicology ,33rd edition, page 154\n\nSo the answer to this question is B"}
{"instruction": "Disposable syringes are sterilized by\nA. 2% glutaraldelyde\nB. Autoclave\nC. Hot air oven\nD. Ionizing radiation", "response": "Disposable plastics eg : Rubber or plastic syringes infusion sets, catheters are sterilized by Ionizing radiation.\n\nSo the answer to this question is D"}
{"instruction": "A 4-month-old infant with Tetralogy of Fallot presents with fever and loose stools. Which of the following is compatible with the diagnosis of Tetralogy spells?\nA. O2 saturation < 70% in room air\nB. Inability to hear a murmur\nC. Hepatomegaly\nD. S3 gallop rhythm", "response": "Paroxysmal hypercyanotic attacks (hypoxic, \"blue,\" or \"tet\" spells) are a paicular problem during the first 2 years of life. The infant becomes hyperpneic and restless, cyanosis increases, gasping respiration ensue, and syncope may follow. The spells occur most frequently in the morning on initially awakening or after episodes of vigorous crying. Temporary disappearance or a decrease in intensity of the systolic murmur is usual as flow across the right ventricular outflow tract diminishes.\n\nSo the answer to this question is B"}
{"instruction": "As per the latest guidelines which of the following dehydration status requires ORT prescription –\nA. Mild dehydration\nB. Moderate dehydration\nC. Some dehydration\nD. Any dehydration", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "The following immunoglobulin is not known to fix complement\nA. IgE\nB. IgM\nC. IgA\nD. IgG", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Daughter cells formed from the cleavage of zygote are\nA. Morula\nB. Gastrula\nC. Blastula\nD. Blastomere", "response": "Zygote first divide into blastomere, 16 cell stage is known as Morula.\n\nSo the answer to this question is D"}
{"instruction": "C-3 nephritic factor is associated with which of the following conditions?\nA. MPGN Type 1\nB. MPGN Type 2\nC. Membranous nephropathy\nD. Minimal change disease", "response": "Dense-Deposit Disease (type II MPGN) Resulting in excessive activation of the alternative complement pathway. Normally, this C3 convease is labile, but more than 70% of patients with dense-deposit disease have a circulating autoantibody termed C3 nephritic factor (C3NeF) that binds the alternative pathway C3 convease and protects it from inactivation.\n\nSo the answer to this question is B"}
{"instruction": "All of the following muscles are derived from 6th branchial arch EXCEPT:\nA. Lateral cricoarytenoid\nB. Posterior cricoarytenoid\nC. Interarytenoid\nD. Cricothyroid", "response": "Ans. D CricothyroidRef: I.B. Singh, 9th ed. pg. 116* Cricothyroid muscle is derived from fourth branchial arch. It is the only intrinsic laryngeal muscle not derived from 6th branchial arch* Nerve supply: Superior laryngeal nerve\n\nSo the answer to this question is D"}
{"instruction": "All are true about Neuroendocrine tumor of pancreas except:\nA. Insulinoma is MC\nB. VIP cause diarrhea\nC. Diarrhea is MC symptom of gastrinoma\nD. Somatostatinoma cause gall stone formation", "response": "“Insulinomas are the most common pancreatic endocrine neoplasms and present with a typical clinical syndrome known as Whipple’s triad\" - Schwartz\nGastrinoma (Zollinger-Ellison Syndrome); The most common presenting symptoms are an abdominal pain (70-100%), diarrhea (37-73%). and gastroesophageal reflux disease (GERD) (30- 35%); 10-20% have diarrhea only\"-Harrison\nTable: GI Neuroendocrine Tumor Syndrome\n\nSo the answer to this question is C"}
{"instruction": "Benzyl peroxide acts in acne vulgaris by:\nA. Decreased sebum production\nB. Acts as oxidizing agent\nC. Reduces epithelial proliferation\nD. Decreasing bacterial count", "response": "Ans. D. Decreasing bacterial countTopical Therapy for acne:This is designed to produce peeling of the skin, restore normal keratinization and produce a bactericidal action Topical antibiotics include erythromycin (12%) clindamycin (12%) and benzyl peroxide (510%). Benzyl peroxide has bacterio static properties in addition to its action as a peeling agent.\n\nSo the answer to this question is D"}
{"instruction": "Acetyl CoA cannot be conveed to:\nA. Fatty Acids\nB. Glucose\nC. Ketone Bodies\nD. Cholesterol", "response": "Acetyl CoA is a staing material for Fatty Acid Synthesis, Cholesterol Synthesis & Ketone Body Synthesis (option a, c & d). But Acetyl CoA is never a substrate for Gluconeogenesis i.e. it can never form glucose (option b). Because Acetyl CoA can never be conveed back to Pyruvate as Link reaction or Pyruvate Dehydrogenase is irreversible. However, acetyl-CoA can stimulate gluconeogenesis by activating pyruvate carboxylase (see fig) Extra Edge: Acetyl CoA is NOT:- Not The intermediate of TCA. The first substrate of TCA. The carrier of TCA .\n\nSo the answer to this question is B"}
{"instruction": "Hirschsprung's disease is due to:\nA. Loss of ganglion cells in the sympathetic chain\nB. Atrophy of longitudinal muscles\nC. Failure of migration of neural crest cells from cranial to caudal direction\nD. Malformed taenia coli", "response": "The cause of Hirschsprung's disease remains incompletely understood, although current thinking suggests that the disease results from a defect in the migration of neural crest cells, which are the embryonic precursors of the intestinal ganglion cell. Under normal conditions, the neural crest cells migrate into the intestine from cephalad to caudad.\nThe process is completed by the twelfth week of gestation, but the migration from the midtransverse colon to anus takes 4 weeks. During this latter period, the fetus is most vulnerable to defects in the migration of neural crest cells. This may explain why most cases of aganglionosis involve the rectum and rectosigmoid.\nThe length of the aganglionic segment of bowel is therefore determined by the most distal region that the migrating neural crest cells reach. In rare instances, total colonic aganglionosis may occur.\n\nSo the answer to this question is C"}
{"instruction": "Epithelium lining of lingual surface of epiglottis is\nA. Simple Columnar\nB. Pseudostratified ciliated columnar\nC. Simple Cuboidal\nD. Stratified squamous epithelium", "response": "Stratified squamous epithelium is present in pharynx, lingual surface of epiglottis which is non keratinised in nature whereas in laryngeal surface of epiglottis it is lined by pseudostratified ciliated columnar epithelium (respiratory epithelium).\n\nSo the answer to this question is D"}
{"instruction": "30 yr female with depressed mood, decreased appetite & no interest since one year. Diagnosis is?\nA. Dysthymia\nB. Depression\nC. Anxiety\nD. None", "response": "Ans. is 'b' i.e., Depression Depressed mood, decreased appetite and no interest since one year suggest the diagnosis of depression. o For diagnosis of dysthymia, depressive symptoms should be present for at least 2 years. Mood disorders According to ICD-10, mood (affective) disorders are grouped into six main categories. Manic episode: - Single episode of mania (not recurrent). Depressive episode : - Single episode of depression. Bipolar mood (affective) disorders : - Recurrent episodes of mania alone or recurrent episodes of mania & depression in the same patient at different times. Recurrent depressive disorder : - Recurrent (two or more) depressive episodes. Persistent mood disorder : - Persistent mood symptoms which last for more than 2 years (I year in children & adolescents). Example are dysthemia & cyclothymia. Other mood disorders : - Mixed episodes, i.e., picture of depression and mania is present at the same time intermixed (in contrast to bipolar disorders where depression and mania occur at different time). It also includes rapid cycling --> picture of mania and depression alternates rapidly with each other without a normal intervening period (in contrast to bipolar disorder where normal intervening is present between two episodes).\n\nSo the answer to this question is B"}
{"instruction": "Cryoprecipitate contains all except -(\nA. Factor VIII\nB. Factor IX\nC. Fibrinogen\nD. VWF", "response": "Cryoprecipitate contains fibrinogen & coagulation factor concentrated from plasma by controlled thawing.10-20mL pack contains fibrinogen 150-300mg, factor VIII 80-120 U, von Willebrand factor 80-120U. Reference :Davidson's principle & practice of medicine 22nd edition pg no 1012.\n\nSo the answer to this question is B"}
{"instruction": "What will be the effect on spirometry in case of lobectomy done for bronchogenic carcinoma?\nA. Increased residual volume\nB. Increased vital capacity\nC. Increased dead space ventilation\nD. Increased closing volume", "response": "In case of lobectomy, since the remaining lung tissue is lesser, all parameters like vital capacity, residual volume and closing volume will reduce. Hence, due to hypoxic stimulus post-operative patients of lobectomy will take rapid shallow breaths. This will lead to increased Dead space ventilation.\n\nSo the answer to this question is C"}
{"instruction": "Steroid resistant nephritic syndrome is:\nA. Nephrin\nB. Alpha-actinin-4\nC. Podocin\nD. Transient Receptor Potential 6", "response": ". Podocin\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is true about direct filling gold?\nA. Properly condensed mat gold has no voids\nB. Whatever may be the type, voids are inherent\nC. Voids can be avoided with manual condensation\nD. None of the above", "response": "Porosity is likely to occur in all direct gold restorations. Each type of gold requires a slight variation in technique to avoid either closed pores or open pores that intersect the surface.\nRef: Phillips 12 ed page no 414,415\n\nSo the answer to this question is B"}
{"instruction": "A quack gives a penicillin injection to a patient who dies due to it. Will the quack be relieved for his criminal responsibility by raising a plea of accident\nA. Definitely\nB. Likely to\nC. Never\nD. Deserves to be acquitted on the Strength of evidence", "response": "C i.e. Never\n\nSo the answer to this question is C"}
{"instruction": "A cast is poured with polysulphide impression material, but details are not achieved in cast. For achieving that what should be done?\nA. Adding surfactant to gypsum\nB. Mixing surfactant to impression material\nC. Spraying water to gypsum\nD. Spraying water + mixing surfactant to gypsum", "response": "Absence of fine details in cast poured with polysulfide impression materials indicates its hydrophobic property.\nA nonionic surfactant can be added to the impression materials in the manufacturing process to produce a degree of hydrophilicity to the surface of the material.\nThe beneficial effect of optimal surfactant mixing at the time of manufacturing is not reduced by rinsing the impression prior to pouring, so fine details can be achieved on cast too.\n\nSo the answer to this question is B"}
{"instruction": "Sexual ambiguity may be seen in which of the following condition -\nA. Androgen insenstivity\nB. Pure gonadal dysgenesis\nC. Swyer syndrome\nD. Mixed gonadal dysgenesis", "response": "Ref - semantischolar.org\n\nSo the answer to this question is D"}
{"instruction": "Graft from homozygotic twin is known as -\nA. Autograft\nB. Isograft\nC. Allograft\nD. Xenograft", "response": "Ans. is 'b' i.e., Isograft o Graft from homozygotic (identical) twin is called as isograft.Grafto A tissue graft is a medical procedure in which tissue from a donor is used to replace missing or damaged tissue on a patient ( recipient).Terminology of grafts :DonorNameSynonymsSelfDifferent individual, genetically identical with recipient (Identical twin or member of same inbred strain)Genetically unrelated member of same speciesDifferent speciesAutograftIsograftAutogenous or autogenic graft.Isologous or syngeneric graft or syngraftAllograftXenograftAllogenic graft. Formerly called homograftXenograft, Formerly called heterografto Orthoptic graft - Graft applied in anatomically normal site eg. skin graft,o Heterotopic graft - Graft applied in anatomically abnormal site.\n\nSo the answer to this question is B"}
{"instruction": "Hanging cuain sign seen in?\nA. Pityriasis rosea\nB. Pityriasis Versicolor\nC. Pityriasis rubra pilaris\nD. Pityriasis lichenoides chronica", "response": "Pityriasis rosea REF: Dermatology. 1995; 190(3): 252. PubMed PMID: 7599393, Clinical Pediatric Dermatology - By Thappa page 104 PITYRIASIS ROSEA The primary eruption, herald patch (Mother spot) is a single oval or round patch with a central wrinkled salmon colored area and a darker peripheral zone separated by a \"collarette of scales\" (when stretched across the long axis, the scales tends to fold across the line of stretch, the so called Hanging cuain sign).\n\nSo the answer to this question is A"}
{"instruction": "Energy producing enzymes are located in\nA. Rough endoplasmic reticulum\nB. Ribosomes\nC. Golgi apparatus\nD. Mitochondria", "response": "In mitochondria, enzymes for energy metabolism and protein synthesis can be found.\n\nSo the answer to this question is D"}
{"instruction": "A congenital hydrocele is best t/t by -\nA. Eversion of sac\nB. Excision of sac\nC. Lords procedure\nD. Herniotomy", "response": "Congenital hydrocele are a special form of indirect inguinal hernia and are treated by herniotomy.\" Congenital hvdrocele In this condition, the process us vaginalis remain patent so there is direct communication of the tunica vaginalis with the peritoneal cavity. The communicating orifice at the deep inguinal ring is too small for the development of a hernia. It is present since bih*. In contradiction to assumption. a congenital hydrocele is not easily reducible* due to the narrowness of the deep inguinal ring but when the child lies supine, it disappears. Treatment methods of hydrocele For Congenital hydrocele - Herniotomy* For other types : Jaboulays method - for small & medium sized hydrocele * Lords procedure - for big size hydrocele * Excision of sac - for hematocele, infected sac. Also, Remember MC type of Primary hydrocele is - Vaginal type'''. Hydrocele en Basic* - this type of hydrocele has two intercommunicating sac, one above and one below the neck of the scrotum.\n\nSo the answer to this question is D"}
{"instruction": "Vitamin D analogue calcitriol is useful in the treatment of –\nA. Lichen planus\nB. Psoriasis\nC. Phemphigus\nD. Leprosy", "response": "Drugs for psoriasis\nTopical medications\n\nVitamin D (calcipotriene)\nCool tar\nCorticosteroids\nTree bark extract (dithranol)\nTopical retinoids\n\nSystemic \n\nPsoralens (Methoxsalen, trioxsalen) \nMethotrexate \nAcitretin \nEtanercept \nCyclosporine \nAlefacept\nTacrolimus\n6-Thioguanine\nHydroxyurea\nTacrolimus\nAdalimumab\n\nPhoto therapy\n\nPUVA (oral psoralen plus UV-A)\nNarrow - band UV-B (NB-UVB)\n\nSo the answer to this question is B"}
{"instruction": "Common stain for fungal hyphae:\nA. Methylene blue\nB. Gomori Methanamine silver\nC. Congo red\nD. Oil red 0", "response": "Ans is b i.e Gomori Methanamine silver Ref. Chakraboy 2/e 617 \"Gomori Methenamine Silver (GMS) and Periodic acid-Schiff (PAS) are the two most common stains used to look for fungi in tissues and in cytology specimens.\" The GMS stain is more sensitive than the PAS stain as it stains both ble and non-ble fungal elements (which are refractory to other stains) but it stains inflammatory cells (lysosomes) and tissue reticulin too (in addition to fungi.) PAS staining has the slight advantage that the morphology of the tissue adjacent to the fungi can be better visualized, but this can be addressed using a GMS stain and H and E counterstain (which stains only tissue).\n\nSo the answer to this question is B"}
{"instruction": "A patient with alkaline urine which is cloudy with plenty of pus cells is suffering from infection with -\nA. E. coli\nB. Proteus\nC. T.B.\nD. None", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "High sensitive -\nA. Low false positive\nB. Low false negative\nC. Low true negative\nD. Low true positive", "response": "True positive is directly related to sensitivity\nFalse negative is inversely related to sensitivity\nTrue negative is directly related to specificity\nFalse positive is inversely related to specificity\n\nSo the answer to this question is B"}
{"instruction": "All of the following are true regarding Down's Syndrome EXCEPT;\nA. Only found in female\nB. Simian crease\nC. Growth retardation\nD. Epicanthus with oblique palpebral fissure", "response": "Down's syndrome (Trisomy 21): Mental retardation Epicanthic folds and flat facial profile Simian's crease Umblical hernia Hypotonia Gap between first and second toe Congenital hea defects\n\nSo the answer to this question is A"}
{"instruction": "All are true regarding lupus anticoagulant except\nA. Increased PT\nB. Increased aboion\nC. Rashes\nD. None", "response": "Ans. is 'None'\n\nSo the answer to this question is D"}
{"instruction": "Test for colour vision\nA. Ishihara plates\nB. Holmgren's wool test\nC. City university test\nD. All the above", "response": "Others\nEdridge - Green lantern test.\nFans worth D 15 hue discrimination test.\nNagel's anomaloscope.\nHardy - Rand - Rittler plates.\n\nSo the answer to this question is D"}
{"instruction": "Disinfection of water is not requihred if the source is from-\nA. Tube well\nB. Step well\nC. Draw well\nD. River", "response": "Park's textbook of preventive and social medicine 23rd edition. *Tube wells are usually machine dug and may be several hundred metres deep. Deep wells furnish the safest water and are often the most satisfactory sources of water supply\n\nSo the answer to this question is A"}
{"instruction": "Which among the following drug is contra–indicated in renal failure ?\nA. Pethidine\nB. Morphine\nC. Fentanyl\nD. Atracurium", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Jumping genes are also known as\nA. Plasmids\nB. Oncogenes\nC. Transposons\nD. Introns", "response": "Transposons are called as Jumping genes as they can jump from one chromosome locus to another.\n\nSo the answer to this question is C"}
{"instruction": "Gleason Score is used to grade which cancer -\nA. Prostate Cancer\nB. Transitional Cell CA\nC. Penile Cancer\nD. Anal Cancer", "response": "Ans. is 'a' i.e., Prostate Cancer Gleason score and grading systemo Gleason score is the most commonly used histological grading system for prostate cancero The two most predominant histological patterns of the prostate cancer are assigned a Gleason grade ranging from 1-5.o Primary grade is assigned to the pattern of cancer that is most commonly observed in the histological slides of the specimen.o Secondary grade is assigned to the second most commonly observed pattern in the specimeno Gleason score is the sum of the two grades. Thus it is also known as Gleason sum.o If the entire specimen has only one pattern present, then both the primary and sencondary grades are reported as the same grade.o As Gleason grades range from 1 to 5, Gleason score thus range from 2 to 10. o The Gleason score is used to help evaluate the prognosis of men with prostate cancer. Together with other parameters, the Gleason score is incorporated into a strategy of prostate cancer staging which predicts prognosis and helps guide therapy.o A point of importance is that the primary Gleason grade is most important with respect to placing patients in prognostic groups. For example in patients with a Gleason score 7, a Gleason 4+3 is a more aggressive cancer than a Gleason 3+4.\n\nSo the answer to this question is A"}
{"instruction": "509-IPC deals with -\nA. Masturbation in public place\nB. Inquest\nC. Dowry death\nD. Act intended to insult the modesty", "response": "Dowry death-S.304-B I.P.C. Inquest -S.174, Cr.P.C. is police inquest. S.176,Cr.P.C. is magistrate inquest. S.509, I.P.C.: Whoever intending to insult the modesty of any women. Ref: The synopsis of forensic medicine(Dr.K.S.Narayan Reddy), edition 28th page no: 149, 215.\n\nSo the answer to this question is D"}
{"instruction": "Pale infarcts are seen at all of the following sites except-\nA. Hea\nB. Spleen\nC. Kidney\nD. Lung", "response": "Ans is 'd' i.e., Lung INFARCTION o An infarct is an area of ischemic necrosis by occlusion of either the aerial supply or venous drainage in a paicular tissue. Pathogenesis o Mostly it is caused by interrupted blood supply. o \"Nearly 99% of all infarcts results from thrombotic or embolic events and almost all result. from aerial occlusion\". o Other causes of interrupted aerial supply are local vasospasm, extrinsic compression of a vessel by tumor, twisting of vessel e.g., in testicular torsion, expansion of atheroma due to hemorrhage within the plaque. o Venous obstruction usually cause congesion, edema, infarction does not occur because bypass channels rapidly open after the thrombus, providing some outflow from the area, which inturn improves aerial inflow. Infarct cause by venous thrombosis is more likely in organs with a single venous outflow channel, such as in testis and ovary. Types of infarct o Infarcts are classified on the basis of their color. o Infarcts are classified into either Red (Haemorrhagic) or White or Pale (anaemic) infarcts, reflecting the amount of haemorrhage. Red infarcts (Haemorrhagic) : occur with : Venous occlusions (eg ovarian torsion); In loose tissues (such as lungs); In tissues with dual circulation (e.g. Lung & S. intestine) In tissues that were previously congested because of sluggish venous out flow. When flow is reestablilshed to a site of previous aerial occulusion and necrosis. White or Pale infarcts : occur with : Aerial occlusions, or In solid organs e.g. Hea, spleen, Liver, kidney and brain where the solidity of tissue limits the amount of haemorrhage that can seep into the area of ischaemic necrosis.\n\nSo the answer to this question is D"}
{"instruction": "Painless effusions in joints in congenital syphilis is called -\nA. Clutton' s joints\nB. Banton's joints\nC. Charcot's joints\nD. Synovitis", "response": "Ans. is 'a' i.e., Clutton's joints\n\nSo the answer to this question is A"}
{"instruction": "A 47-year-old female patient's right breast exhibited characteristics of peau d'orange; that is, the skin resembled orange peel. This condition is primarily a result of which of the following?\nA. Shortening of the suspensory ligaments by cancer in the axillary tail\nB. Blockage of cutaneous lymphatic vessels\nC. Contraction of the retinacula cutis of the are ola and nipple\nD. Invasion of the pectoralis major by the cancer", "response": "When cutaneous lymphatics of the breast are blocked by cancer, the skin becomes edematous, except where hair follicles cause small indentations of the skin, giving an overall resemblance to orange peel. Shortening of the suspensory ligaments or retinacula cutis leads to pitting of the overlying skin, pitting that is intensified if the patient raises her arm above her head. Invasion of the pectoralis major by cancer can result in fixation of the breast, seen upon elevation of the ipsilateral limb. Inversion of areolar skin with involvement of the ducts would also be due to involvement of the retinacula cutis.\n\nSo the answer to this question is B"}
{"instruction": "For which one of the following tumours Gastrin is a biochemical marker:\nA. Medullary carcinoma of thyroid\nB. Pancreatic neuroendocrine tumour\nC. Pheochromocytoma\nD. Gastrointestinal stromal tumor", "response": ". Pancreatic neuroendocrine tumour\n\nSo the answer to this question is B"}
{"instruction": "Forensic entomology:\nA. Study of insects\nB. Study of poisons\nC. Study of death\nD. Study of snakes", "response": "Ans. (A). Study of insectsThanatologyQDeath & its aspectsTaphonomyDecomposition of human remainsAnthropometrystudy of the measurements and proportions of the human bodyDactylographyQFinger printsCheiloscopyQLip printsPoroscopyQSweat poresQ in between fingerprintridgesRugoscopyQPalatal rugaeQ of hard palateQOdontologyQDentition pattern & bite marksPodographyQFoot printsCalligraphyHand writingMedical etiquetteLevel of courtesy between medical colleaguesMedical ethicsMoral principles guiding the doctorsEcotoxicologyPoisons in relation to environmentToxicologyPoisons & its effectsToxicologyToxins & its effectsHerpetologyReptilesOphiologyQSnakesEntomologyQInsects\n\nSo the answer to this question is A"}
{"instruction": "Development examination should be fuher evaluated in child of 12 weeks if he ?\nA. Does not vocalize\nB. Does not babble\nC. Does not change bright red ring from one hand to other even if given in hand\nD. Does not hold head at 90deg", "response": "Ans. is 'a' i.e., Does not vocalize o Vocalization develops by 4 weeks. o Babbling develops by 7 months o A child transfer the objects from one hand to another by 5-7 months. o A child can hold head at 90deg (above horizontal plane in ventral suspension) by 3 months --> Neck holding develops by 3 months.\n\nSo the answer to this question is A"}
{"instruction": "First line drug used for painful diabetic neuropathy is ?\nA. Carbamazepine\nB. Duloxetine\nC. Venlafaxine\nD. EMLA", "response": "Chronic, painful diabetic neuropathy is difficult to treat but may respond to duloxetine, amitriptyline, gabapentin, valproate, pre- gabalin, or opioids. Two agents, duloxetine and pregabalin, have been approved by the U.S. Food and Drug Administration (FDA) for pain associated with diabetic neuropathy, but no treatments are satisfactory. Reference : page 2427 Harrison's Principles of Internal Medicine 19th edition\n\nSo the answer to this question is B"}
{"instruction": "Bowel can get strangulated in all of the following space, EXCEPT:\nA. Rectouterine pouch\nB. Ileocolic recess\nC. Paraduodenal recess\nD. Omental bursa", "response": "Omental bursa, paraduodenal recess and ileocolic recess are peritoneal recesses. Peritoneal recesses These are small pockets of the peritoneal cavity enclosed by small, inconstant folds of peritoneum. These are best observed in fetuses and are mostly obliterated in adults. Sometimes they persists to form potential sites for internal hernias and strangulation. These are: Lesser or omental bursa Duodenal recesses: includes superior duodenal recess, inferior duodenal recess, paraduodenal recess, retroduodenal recess, Duodenojejunal recess and mesenterico-parietal fossa (of waldeyer) Caecal fossa: Superior ileocaecal (or ileocolic) recess, Inferior ileocaecal (or ileocolic) recess and retrocaecal recess. Intersigmoid recess Ref: BDC Vol II, 3/e, Page 204.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following topical steroids is the most potent?\nA. Halobetasol propionate\nB. Fluticasone\nC. Hydrocortisone\nD. Triamcinolone acetonide", "response": "Ans. is 'a' i.e., Halobetasol propionate Classification of topical steroids based on potencyClass 1(Super potent)Clobetasol propionate ointment and cream 0.5%Betamethasone dipropionate ointment 0.05%Halobetasol propionate ointment and cream 0.05%Class 2(Highly potent)Mometasone furoate ointment 0.1%Class 3(Potent)Betamethasone dipropionate cream 0.05%Fluticasone propionate ointment 0.05%Class 4(Moderately potent)Fluocinolone acetonide ointment 0.025%Fluticasone propionate cream 0.05%Mometasone furoate cream 0.1%Class 5(Moderately potent)Betamethasone valerate cream 0.1%Hydrocortisone butyrate cream 0.1%Class 6(Mildly potent)Desonide cream 0.05%Fluocinolone acetonide solution 0.05%Class 7(Least potent)Dexamethasone cream 0.1%Hydrocortisone 1%\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is the most common origin of cerebral metastasis?\nA. Lung cancer\nB. Breast cancer\nC. Melanoma\nD. Colon cancer", "response": "Lung: 40%\nBreast : 10 - 30%\nMelanoma : 5 - 15%\nUnknown : 15%\n\nSo the answer to this question is A"}
{"instruction": "Which of the following drug is not used for Methicillin Resistant Staph. Aureus (MRSA).?\nA. Cefaclor\nB. Cotrimoxazole\nC. Ciprofloxacin\nD. Vancomycin", "response": "Ans- A Cefaclor Drugs used for MRSA Vancomycin Chloramphenicol Linezolid Minocycline Quinupristin/ dalfopristin Trimethoprim - sulfamethoxazole Fluoroquinolones\n\nSo the answer to this question is A"}
{"instruction": "A patient experiences paralysis of the muscle that originates from the femur and contributes directly to the stability of the knee joint.Which of the following muscles is involved?\nA. Vastus lateralis\nB. Semimembranosus\nC. Saorius\nD. Biceps femoris (long head)", "response": "All of them contribute to the stability of the knee joint but The vastus lateralis muscles arise from the femur and all the other muscles originate from the hip (coxal) bone.\n\nSo the answer to this question is A"}
{"instruction": "Toxigenicity of Corynebacterium diphtheria is determined by\nA. Elek's gel precipitation test\nB. Aselole reaction\nC. Nagler's reaction\nD. All", "response": "Elek's gel precipitation test: a rectangular strip of filter paper impregnated with diphtheria antitoxin is placed on the surface of a 20% normal horse serum agar in a Petri dish while the medium is still fluid. -when agar has set, the surface is dried and narrow streaks of strains are made at right angles to the filter paper strip. A positive and negative control should be put up. The plate is incubated at 37degC for 24-48 hours. The toxin produced by the bacterial growth will diffuse in agar and where it meets the antitoxin at optimum concentration, will produce a line of precipitation. The presence of such arrow headlines of a precipitate indicates the strain is toxigenic. No precipitate is formed in the case of non-toxigenic strains. Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 243\n\nSo the answer to this question is A"}
{"instruction": "Which events occured before 1900 AD\nA. Establishment of seat of social medicine at Oxford\nB. Work on scurvy by james Lind\nC. Epidemiological work on cholera by John Snow\nD. Use of BCG vaccine", "response": "An english epidemiologist John Snow studied the epidemiology of cholera in London from 1848-1854 and established the role of polluted drinking water in spread of cholera.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following increases turbulence in blood flow?\nA. Reynolds number< 2000\nB. Decrease in velocity of blood\nC. Decrease in density of blood\nD. Increase in diameter of blood vessel", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Most common site of lentigo maligna melanoma is:\nA. Face\nB. Legs\nC. Trunks\nD. Soles", "response": "\"Lentigo maligna melanoma is usually confined to chronically sun-damaged, sun-exposed sites (face, neck, back of hands) in older individuals.\" Harrison\nMost common site of melanoma\n\nof melanoma in females → lower extremity (knee to ankle) \nof melanoma in males → Trunk & back\nof lentigo maligna melanoma → Face, neck\nof acral lentiginous melanoma → Palms, soles, subungual region\n\nSo the answer to this question is A"}
{"instruction": "CSF in meningococcal meningitis shows -\nA. Gm '+ve' Diplococci, in pus cells\nB. Gm '-ve' Diplococci in pus cells\nC. Gm '-ve' bacilli\nD. Gram '+ve' bacilli", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Orchidopexy for undescended testis is recommended at which age ?\nA. 3 months\nB. 6 months\nC. 2 year\nD. 5 year", "response": "Orchidopexy is usually performed after the age of 1 year to avoid the risks of operating on a tiny patient. Testes should be brought down into the scrotum before the boy stas school.Orchidopexy during the second year of life is currently recommended by paediatric surgeons. Orchidopexy before 2 years of age improves feility, may reduce the risk of malignancy and has psychological benefits Reference : page1378 and 77 Bailey and Love's sho practice of surgery 25th edition\n\nSo the answer to this question is C"}
{"instruction": "A 65 year old female presents with recurrent episodes of gross painless hematuria. What is the most common cause of gross painless hematuria?\nA. Renal tuberculosis\nB. Ca bladder\nC. Urethral stricture\nD. Intestinal nephritis", "response": "Gross painless hematuria is the most common presenting sign of bladder cancer. Other symptoms includes irritative voiding symptoms such as frequency, urgency and dysuria. Microscopic hematuria is mainly nephrologic in origin whereas gross hematuria is commonly urologic in origin. Reference: Conn's Current Therapy 2012, page 894.\n\nSo the answer to this question is B"}
{"instruction": "A 65-year-old male develops the sudden onset of severe knee pain. The knee is red, swollen, and tender. He has a history of diabetes mellitus and cardiomyopathy. An x-ray of the knee shows linear calcification. Definitive diagnosis is best made by\nA. Serum uric acid\nB. Serum calcium\nC. Ahrocentesis and identification of positively birefringent rhomboid crystals\nD. Rheumatoid factor", "response": "(Braunwald, 15/e, pp 1995-1996.)The acute mono- aicular ahritis in association with linear calcification of the cailage of the knee suggests the diagnosis of pseudogout, also called calcium pyro-phosphate dihydrate deposition disease. The disease resembles gout. Positive birefringent crystals (looking blue when parallel to the axis of the red com- pensator on a polarizing microscope) can be demonstrated in joint fluid. Serum uric acid and calcium levels are normal, as is the rheumatoid factor. Pseudogout is about half as common as gout but becomes more common after age 65. Calcium pyrophosphate dihydrate deposition disease is diagnosed in symptomatic patients by characteristic x-ray findings or crystals in synol fluid. The disease is treated with NSAIDs or colchicine. Linear calcifications or chondrocalcinosis are often found in the joints of elderly patients who do not have symptomatic joint problems; such patients do not require treatment.\n\nSo the answer to this question is C"}
{"instruction": "The adenylate cyclase system is mediated by\nA. cAMP\nB. Phosphodiesterase\nC. GTP regulating proteins\nD. Nuclear receptors", "response": "The cAMP-dependent pathway, also known as the adenylyl cyclase pathway, is a G protein-coupled receptor-triggered signaling cascade used in cell communication G protein-coupled receptors (GPCRs) are a large family of integral membrane proteins that respond to a variety of extracellular stimuli. Each GPCR binds to and is activated by a specific ligand stimulus that ranges in size from small molecule catecholamines, lipids, or neurotransmitters to large protein hormones. When a GPCR is activated by its extracellular ligand, a conformational change is induced in the receptor that is transmitted to an attached intracellular heterotrimeric G protein complex. The Gs alpha subunit of the stimulated G protein complex exchanges GDP for GTP and is released from the complex. In a cAMP-dependent pathway, the activated Gs alpha subunit binds to and activates an enzyme called adenylyl cyclase, which, in turn, catalyzes the conversion of ATP into cyclic adenosine monophosphate (cAMP). Increases in the concentration of the second messenger cAMP may lead to the activation of cyclic nucleotide-gated ion channels\n\nSo the answer to this question is A"}
{"instruction": "Sustained neutropenia is seen with ?\nA. Vinblastin\nB. Cisplatin\nC. Carmustine\nD. None of the above", "response": "Carmustine Myelosuppression leading to neutropenia, thrombocytopenia and anemia is seen with most of the anticancer drugs. The characteristic feature of myclosuppression produced by carmustine is that it causes delayed myelosuppression that is prolonged too According to Goodman Gilman \"It causes profound and delayed myelosuppression with recovery 4-6 weeks after a single dose. The myelosuppression leads to leukopenia and thrombocytopenia (may be prolonged)\" More on Carmustine: Carmustine belongs to nitrosoureas class of anticancer drugs They have an impoant role in the treatment of brain tumours. It is highly lipophilic and thus it readily crosses the blood brain barrier. Other adverse effects of carmustine Delayed renal damage Reversible liver damage Leukemia Myocardial ischemia\n\nSo the answer to this question is C"}
{"instruction": "Which one of the following features may not be seen in hypothyroidism?\nA. Cold intolerance\nB. Deafness\nC. Pericardial effusion\nD. Pretibial myxedema", "response": "(D) Pretibial myxoedema > Blood flow is diverted from the skin, producing the cool extremities.cold intolerance is seen. Pericardial effusions occur in up to 30% of patients but rarely compromise cardiac function. Increased dermal glycosaminoglycan content traps water, giving rise to skin thickening without pitting (myxedema). Typical features include a puffy face with edematous eyelids and nonpitting pretibial edema.> Impaired hearing is present, but not deafness.SIGNS AND SYMPTOMS OF HYPOTHYROIDISM (DESCENDING ORDER OF FREQUENCY)SymptomsSigns* Tiredness, weakness* Dry skin* Feeling cold* Hair loss* Difficulty concentrating and poor memory* Constipation* Weight gain with poor appetite* Dyspnea* Hoarse voice* Menorrhagia (later oligomenorrhea or amenorrhea)* Paresthesia* Impaired hearing* Dry coarse skin; cool peripheral extremities* Puffy face, hands, and feet (myxedema)* Diffuse alopecia* Bradycardia* Peripheral edema* Delayed tendon reflex relaxation* Carpal tunnel syndrome* Serous cavity effusions\n\nSo the answer to this question is D"}
{"instruction": "All of the following are true of antrochoanal polyp except:\nA. Common in young\nB. Single and unilateral\nC. Bleeds on touch\nD. Treatment involves FESS", "response": "(c) Bleeds on touch(Ref. Scott Brown, 6th ed., 4/10/14)They have very poor blood supply because of which they do not bleed on touch.\n\nSo the answer to this question is C"}
{"instruction": "A 3-year-old recently adopted Romanian boy is referred after his initial pediatrician's assessment for an undescended testicle. On exam his left testicle is normal and in place. He has no evidence of hernias. However, his right hemiscrotum is empty and there is a testicule sized mass plapable at the pubic tubercle. The most appropriate next step is\nA. Observation until age 5\nB. Right orchiopexy\nC. Right orchiopexy and right inguinal hernia repair\nD. Right orchiopexy and right testicle biopsy", "response": "Although waiting until age 1 is acceptable, there should be little further delay. Waiting until puberty would subject the child to a high probability of abnormal development. Abdominal USG can be useful to search for an intra-abdominal testicle but this child's testicle was palpable. Since all cryptorchid testicles are accompanied by an inguinal hernia; herniorrhaphy should always accompany an orchiopexy for cryptorchidism. Testicular biopsy is unnecessary and may be injurious. The risk of malignancy, although increased 20-fold, does not manifest itself until at least the early twenties.\n\nSo the answer to this question is C"}
{"instruction": "Young female presents with hypeension with VMA >14 mg/day, associated with -\nA. Medullary Ca Thyroid\nB. Von Hippel Lindau disease\nC. Sturge weber syndrome\nD. All", "response": "Answer is D.)'a' i.e. Medullary Ca thyroid, 'b' i.e. Von-Hippel Lindau disease, ; 'c' i.e. Sturge-weber syndrome A young female patient with hypeension and VMA > 14 mg/24 hrs (Normal VMA excretion in urine is less than 7 mg/24 hrs) is suggestive of pheochromocytoma. Familial syndromes associated with pheochromocytomas include MEN 2A and 2B, neurofibromatosis (von Recklinghausen disease), and VHL disease.MEN 2A (Sipple syndrome) is characterized by the following: Medullary thyroid carcinoma Parathyroid adenoma Pheochromocytomas Hirschsprung disease. MEN 2B is characterized by the following: Medullary thyroid carcinoma Pheochromocytoma Mucosal neurofibromatosis Intestinal ganglioneuromatosis Hirschsprung disease Marfanoid body habitus. VHL disease is associated with the following: Pheochromocytoma Cerebellar hemangioblastoma Renal cell carcinoma Renal and pancreatic cysts Epididymal cystadenomas. Neurofibromatosis, or von Recklinghausen disease, is characterized by congenital anomalies (often benign tumors) of the skin, nervous system, bones, and endocrine glands. Only 1% of patients with neurofibromatosis have been found to have pheochromocytomas, but as many as 5% of patients with pheochromocytomas have been found to have neurofibromatosis.Other neuroectodermal disorders associated with pheochromocytomas include tuberous sclerosis (Bourneville disease, epiloia) and Sturge-Weber syndrome.\n\nSo the answer to this question is D"}
{"instruction": "A 68-year-old woman with a history of left ventricular congestive heart failure has had decreased visual acuity for the past 5 years. She has no ocular pain. Her intraocular pressure is normal. Findings on funduscopic examination include arteriolar narrowing, flame-shaped hemorrhages, cotton-wool spots, and hard, waxy exudates. Which of the following underlying diseases is she most likely to have?\nA. Advanced atherosclerosis\nB. Cerebral edema\nC. Diabetes mellitus\nD. Hypertension", "response": "Hypertensive retinopathy results from long-standing hypertension, with progressive changes that begin with generalized narrowing of the arterioles and proceed to the changes seen in this case. The pressure load from systemic hypertension causes hypertrophy and failure of the left side of the heart. Arteriosclerotic retinopathy causes vascular changes, including arteriovenous nicking and hyaline arteriolosclerosis with \"copper wire\" and \"silver wire\" arterioles. Cerebral edema may result in papilledema. Various findings are associated with diabetic retinopathy, including capillary microaneurysms, cotton-wool spots, arteriolar hyalinization, and more severe changes of proliferative retinopathy with neovascularization. Retinitis pigmentosa describes a variety of abnormalities that arise as an inherited condition that may begin later in life (but usually earlier) and produce a waxy pallor of the optic disc.\n\nSo the answer to this question is D"}
{"instruction": "A 62-year-old man presents to the OPD for an annual physical examination. After noting a PSA level of 12.3 ng/dL, you refer him to an urologist for fuher workup. Following a prostatic biopsy, the results show the presence of adenocarcinoma of the prostate, which is given a Gleason score of 8. The Gleason score is a measurement of:\nA. The extent of cancer within the prostate gland\nB. The extent of the cancer within the abdomen\nC. The likelihood that the cancer will grow and spread\nD. The number of cancer cells expressing prostate specific antigen (PSA) on their cell surface", "response": "Gleason grading system: Developed to provide a measurement of the potential for prostate cancer to grow and spread Prostate biopsies involve sampling of tissue from several different areas of the gland (normally at least six). Two samples that appear to be most heavily involved, then histologically graded on a scale from 1 to 5 numbers are combined to give a Gleason score of 2 to 10 Tumors graded from 2 to 4- Slow growing Tumors graded 5 to 6- Intermediate Tumour graded 7 to 10 considered highly aggressive. Gleason score has nothing to do with the: stage (extent) of the cancer, expression of prostate specific antigen estimated survival time.\n\nSo the answer to this question is C"}
{"instruction": "Pain rating index is provided by –\nA. Faces scale\nB. Visual analogue scale\nC. Mc Gill questionniare\nD. CHEOP scale", "response": "↵\nMcGill questionniare provides three quantitative measure : -\n\nPain rating index (PRI),\nNumber of words used, and\nPresent pain intensity (PPI).\n\nSo the answer to this question is C"}
{"instruction": "Regarding neonatal circumcision, which one of the following is true –\nA. It should be done without anaesthesia, as it is hazardous to give anaesthesia\nB. It should be done without anesthesia, as neonates do not perceive pain as adults\nC. It should be done under local anaesthesia only\nD. General anaesthesia should be given to neonate for circumcision as they also feel pain as adults", "response": "Neonates have immature brain, however they feel pain and analgesia is required.\nCircumcision is a painful procedure, therefore the American Academy of Pediatrics recommends using some type of local anesthesia for newborn circumcision. Several types of anaesthesia are available, including numbing cream or injecting a small amounts of anaesthetic around the penis. These are generally considered safe.\nSome text books (like S. Das operative surgery and Lee's have) different opinion. According to them neonatal circumcision should be done in general anaesthesia. But following statement will clear all doubts :-\n\n\"Local anaesthesia is all that is required for circumcision in neonate. General anaesthetics present unnecessary risks, including neurotoxicity that may affect the development of neuronal structures in brain. This adds to general advice that circumcision is best done using a local anesthetic\".\n\nSo the answer to this question is C"}
{"instruction": "A patient comes with history of unresponsive fever and cough. X-ray revealed pneumonia. Sputum examination showed gram positive, partially acid fast bacteria with branching filaments that grows on sheep blood agar. The most likely etiologic agents is:\nA. Actinomycetes\nB. Nocardia\nC. Aspergillosis\nD. Pneumococci", "response": "Ans. is 'b' i.e., NocardiaRef: (Ananthanarayan, 8th/e, p. 393; 9th/e, p. 394; Harrison, 18th/e, p. 1324; Jawetz, 24th/e, p. 182)The typical morphology of Nocardia is Acid Fast filamentous bacteria with right angle branching.\n\nSo the answer to this question is B"}
{"instruction": "'Swinging flashlight' test can be helpful to elicit NOT RELATED-MEDICINE\nA. Argyll Robeson pupil\nB. Argyll Robeson pupil\nC. Marcus Gunn pupil\nD. Subtle inequality in pupil size", "response": "The relative afferent pupillary defect(RAPD) - Marcus Gunn pupil- can be elicited with the swinging flashlight test.\n\nSo the answer to this question is C"}
{"instruction": "True regarding collagen synthesis is all except ?\nA. Synthesized in ribosomes as preprocollagen\nB. Hydroxylation of proline occurs in Golgi apparatus\nC. Hydroxylation of lysine occurs in ER\nD. Triple helix assembly occurs in ER", "response": "Ans. is 'b' i.e., Hydroxylation of proline occurs in Golgi apparatus\n\nSo the answer to this question is B"}
{"instruction": "Treatment of choice for genital was in pregnancy?\nA. Salicylic Acid with Lactic Acid Solution\nB. Podopylin\nC. Imiqi mod\nD. Cryotherapy", "response": "D i.e. Cryotherapy\n\nSo the answer to this question is D"}
{"instruction": "Activities of daily living to MR child can be taught by\nA. Self instruction\nB. Cognitive therapy\nC. Contingency management\nD. Cognitive remediation", "response": "Self -Instruction is used in substance abuse where the person keeps on instructing oneself for not taking the substance,Cognitive Behaviour therapy is based on correcting the faulty cognitive distoions and faulty ideas and belief ,,All needing normal IQ. Token economy is a component of Contingency management, wherein the Consequence is contingent upon the action done in aicular manner.\n\nSo the answer to this question is C"}
{"instruction": "Patient presents with peritonitis and during surgery a diveicular perforation is seen with fecal peritonitis. What is the Hinchey's stages?\nA. 1\nB. 2\nC. 3\nD. 4", "response": "Hinchey classification of complicated diveiculitis. GRADE Grade I Mesenteric or pericolic abscess Grade II Pelvic abscess Grade III Purulent peritonitis Grade IV Faecal peritonitis\n\nSo the answer to this question is D"}
{"instruction": "Rotation of a distal extension base around vertical axis is resisted by\nA. Rigidity of major connector\nB. Reciprocal clasp arms\nC. Retentive clasp arms\nD. All of the above", "response": "It is resisted by stabilizing components, such as reciprocal clasp arms and minor connectors that are in contact with vertical tooth surfaces. Such stabilizing components are essential to any partial denture design regardless of the manner of support and the type of direct retention employed. Stabilizing components on one side of the arch act to stabilize the partial denture against horizontal forces applied from the opposite side.\n\nSo the answer to this question is B"}
{"instruction": "Which is false regarding Spaulding's criteria?\nA. Non critical items require only decontamination\nB. Semi critical items are those which come in contact with mucous membrane or non intact skin\nC. Semi critical items need low level disinfection\nD. Cardiac catheters are examples of critical items", "response": "Semitcritical items need low level disinfection . Non Critical - Objects that touch only intact skin require low-level disinfection processing; noncritical items are divided into noncritical patient care items and noncritical environmental surfaces. Critical Semicritical Noncritical Sterilization High-level disinfection Low-level disinfection Level germicidal action Kill all microorganisms, including bacterial spores Kills all microorganisms except high numbers of bacterial spores Kill vegetative bacteria, fungi and lipid viruses. Device Surgical instruments and devices; cardiac catheters; implants; etc Respiratory therapy and anesthesia equipment, GI endoscopes, endocavitary probes, Tonometers, Diaphragm fitting rings, etc Bedpans; crutches; bed rails EKG leads; bedside table, walls floors and furniture Method Steam, gas (ethylene oxide), hydrogen peroxide plasma or chemical sterilization High level disinfection (hydrogen peroxide, ohophthalaldehyde, Glutaraldehyde) Low-level disinfection (or detergent for housekeeping surfaces) High-level disinfection traditionally is defined as complete elimination of all microorganisms in or on an instrument, except for small numbers of bacterial spores. The FDA definition of high-level disinfection is a sterilant used for a shoer contact time to achieve a 6-log10 kill of an appropriate Mycobacterium species\n\nSo the answer to this question is C"}
{"instruction": "A one-week-old baby develops nuchal rigidity and fever. A lumbar puncture is performed and the cerebrospinal fluid demonstrates large numbers of neutrophils. Which of the following is the most likely causative agent?\nA. Coxsackievirus\nB. Escherichia coli\nC. Herpes virus\nD. Mycobacterium tuberculosis", "response": "The nuchal rigidity (stiff neck) suggest meningitis. Numerous neutrophils in the cerebrospinal fluid suggests a bacterial pathogen. The best answer of those listed is Escherichia coli, which is normally a gut organism, but can infect neonates who acquire the organism during passage through the bih canal. Coxsackievirus is a cause of acute lymphocytic meningitis. Herpes virus is a cause of lymphocytic meningitis. Mycobacterium tuberculosis is a cause of chronic meningitis.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is a common side effect of cisplatin?\nA. Diarrhea\nB. Vomiting\nC. Pulmonary fibrosis\nD. Alopecia", "response": "Common side effect of cisplatin is vomiting. Drug of choice for cisplatin induced vomiting is 5HT3 antagonist like ondansetron.\n\nSo the answer to this question is B"}
{"instruction": "Best differentiating feature between ulcerative colitis and Crohn's disease is?\nA. Distributions of pseudo polyps\nB. Mucosal edema\nC. Crypt abscesses\nD. Lymphoid aggregates in the mucosa", "response": "Ans. is 'a' i.e., Distribution of pseudopolyps * Pseudopolyps (inflammatory polyps) can be seen in both crohn's disease and ulcerative colitis \"Pseudopolyps (inflammatory pseudopolyps) can be seen both in ulcerative colitis and crohns disease\". - Clinical pathology.* In ulcerative colitis the distribution of these pseudopolyps can be diffuse but in crohn's disease the distribution cannot be diffuse because a classic feature of crohn's disease is the sharp demarcation of diseased bowel segments from the adjacent uninvolved bowel. When multiple bowel segments are involved the intervening bowel is essentially normal (skip lesions).* Establishing the distribution and extent of disease is essential in differentiating Crohn's disease from ulcerative colitis, in guiding therapeutic decisions, and in assigning colorectal cancer risk. Biopsies must be obtained even from normal-appearing areas to evaluate for any histologic evidence of disease activity, because this approach is more sensitive than macroscopic evaluation for inflammation.\n\nSo the answer to this question is A"}
{"instruction": "Bone marrow stem cells differ from differentiated progenitor stem cells in what respect?\nA. Provide differentiated terminal cells\nB. Reconstitution of Bone marrow\nC. Formation of the ovum\nD. Act as a repair system for the body", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "What does a positive schick test indicate?\nA. Carrier of diphtheria\nB. Immune to diphtheria\nC. Susceptible to diphtheria\nD. Hypersensitivity to diphtheria", "response": "Immune status of an individual to Corynebacterium diphtheria is assessed by the presence of antitoxin levels or schick test. This test is done by injecting 0.1ml of highly purified toxin into one forearm and 0.1ml of heat inactivated toxin into another forearm as a control. A positive reaction is characterized by a local inflammatory reaction that reaches maximum intensity in 4-7 days and reduces gradually. This indicates absence of immunity to C. diphtheriae. Negative reaction indicates presence of antitoxin in the individual which neutralizes the toxin injected. Such individuals are immune to C diphtheriae infection. Ref: Sherris Medical Microbiology By Kenneth J. Ryan, 5th Edition, Chapter 26 ; Textbook of Microbiology and Immunology By Parija, Page 224\n\nSo the answer to this question is C"}
{"instruction": "In breast lactiferous ducts are formed under the influence of which hormone?\nA. Estrogen\nB. Progesterone\nC. LH\nD. FSH", "response": "Lactiferous ducts are one of the ducts, numbering 15-20, which drain the lobes of the mammary gland; they open at the nipple.Ref: Ganong&;s review of medical physiology; 24th edition; page no: 416\n\nSo the answer to this question is A"}
{"instruction": "In sensorineural hearing loss, weber's test is lateralized to\nA. Normal ear\nB. Defective ear\nC. Not lateralized\nD. May alternate", "response": "In Sendeafness deafness: Lateralised to better ear. In conductive deafness: Lateralised to worse ear. Ref: Dhingra; 6th Edition; pg no 22\n\nSo the answer to this question is A"}
{"instruction": "According to WHO, exclusive breast milk is given upto -\nA. 6 months\nB. 4 months\nC. 8 months\nD. 10 months", "response": "No other food is required to be given until 6 months after bih. REF. PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICAL 21ST EDITION. PAGE NO - 489\n\nSo the answer to this question is A"}
{"instruction": "All of the following statements about neural cells are true except\nA. The human CNS contains about (10)11 neurons\nB. Ependymal cells are involved in phagocytic functions\nC. Both\nD. None", "response": "Lining the CSF-filled ventricles, the ependymal cells play an impoant role in the production and regulation of CSF. Their apical surfaces are covered in a layer of cilia, which circulate CSF around the CNS. Ref: guyton and hall textbook of medical physiology 12 edition page number:813,814,815\n\nSo the answer to this question is B"}
{"instruction": "A 10-day old neonate is brought by her mother to the OPD with complaints of sneezing. On examination, the respiratory rate is 40/minute and conducted sounds are heard on auscultation. There are no intercoastal retraction. The neonate should be treated with -\nA. Normal saline nose drops\nB. Oral antihistamines\nC. Oral antibiotics\nD. Parenteral antibiotics", "response": "Park&;s texbook of Preventive and Social Medicine 23rd edition Page no:172 Fast breathing is present when the respiratory rate is 60 breaths/ min or more in a child less than 2 months of age Since no fast breathing and chest indrawing present child is treated symptomaticaly. DONOT require treatment with antibiotics\n\nSo the answer to this question is A"}
{"instruction": "Secondary attack rate of chicken pox is around:\nA. 60%\nB. 70%\nC. 80%\nD. 90%", "response": "Chicken pox is highly contagious with secondary attack rates of nearly 90%. The period of communicability ranges from 1 to 2 days before onset of rash to 4 to 5 days thereafter. Ref: Park 21st edition, page 134\n\nSo the answer to this question is D"}
{"instruction": "Differential expression of same gene depending on parent of origin is referred to as –\nA. Genomic imprinting\nB. Mosaicism\nC. Anticipation\nD. Nonpenetrance", "response": "The phenomenon referred to as genomic imprinting leads to preferential expression of an allele depending on the parental origin.\nGenomic imprinting\nHuman inherits two copies of each gene, i.e. two alleles, from homologous maternal and paternal chromosomes.\nThere is no functional difference between the genes derives from mother or the father.\nBut, with respect to some genes, there are functional differences between the paternal gene and maternal gene.\nThese differences result from an epigenetic process, called genomic imprinting.\nIn most cases, genomic imprinting selectively inactivates either the maternal or paternal allele.\nMaternal genomic imprinting :\nSelective inactivation of maternal allele.\nExample is Angelman syndrome.\nPaternal genomic imprinting :\nSelective inactivation of paternal allele.\nExample is Prader – Willi syndrome.\n\nSo the answer to this question is A"}
{"instruction": "Epistaxis in elderly patient is commonest in\nA. Nasapharyngeal carcinoma\nB. Foreign body\nC. Bleeding disorder\nD. Hypeension", "response": "The major cause for epistaxis in an elderly person is hypeension. Ref: Dhingra 7e pg 198.\n\nSo the answer to this question is D"}
{"instruction": "Triad of Plummer Vinson syndrome includes all of the following except:\nA. Iron Deficiency Anaemia\nB. Dysphagia\nC. Atrophic Glossitis\nD. Koilonychia", "response": "Koilonchyia is not pa of Plummer Vinson Syndrome. Plummer-Vinson syndrome (iron deficiency, angular stomatitis, glossitis and dysphagia) raises the risk of oral squamous cell cancer and esophageal cancer at all the post-cricoidal tissue web&;- Harrison Plummer Vinson Syndrome Plummer-Vinson syndrome typically describes iron-deficiency anemia and dysphagia caused by the formation of a keratinized web. Plummer-Vinson Syndrome Iron Deficiency anemia Dysphagia (due to Esophageal webs or Hypopharyngeal webs), and Atrophic glossitis/Angular stomatitis Plummer-Vinson syndrome, also known as the Paterson-Brown-Kelly Syndrome, predisposes to Hypopharyngeal squamous cell carcinoma. The condition is more common in women and is a recognized risk factor for post cricoid Hypopharyngeal carcinoma. Ref: Harrison&;s 19th edition Pgno: 237\n\nSo the answer to this question is D"}
{"instruction": "Reciprocal anchorage is offered by\nA. Activator\nB. Inter maxillary elastics\nC. Maxillary expansion appliance\nD. Catalan's appliance", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "False statement about TX A2 is\nA. It is formed in platelets\nB. It is formed from PGG2/h2\nC. It is having platelet anti aggregatory reactivity\nD. Asprin can inhibit its production", "response": "TX A2 is produced inside the platelets with the help of TX A2 synthetase It is formed from cyclic Endo peroxidase(PGG2/H2) with the help of an enzyme, cyclooxygenase Aspirin inhibit its production by reversible inhibition of cyclooxygenase enzyme TX A2 causes aggregation of platelets, therefore is prothrombotic Refer kDT 6/e p174\n\nSo the answer to this question is C"}
{"instruction": "Neurotransmitter depleted in Parkinson's disease: September 2007\nA. Dopamine\nB. Acetylcholine\nC. Glutamate\nD. GABA", "response": "Ans. A: Dopamine Parkinson's disease has both hypokinetic and hyperkinetic features. In this condition, which was originally described by James Parkinson and is named for him, the nigrostriatal dopaminergic neurons degenerate. The fibers to the putamen are most severely affected. Dopaminergic neurons and dopamine receptors are steadily lost with age in the basal ganglia in normal individuals, and an acceleration of these losses apparently precipitates parkinsonism. Symptoms appear when 60-80% of the nigrostriatal dopaminergic neurons are lost. Parkinsonism is also seen as a complication of treatment with the phenothiazine group of tranquilizer drugs and other drugs that block D2 dopamine receptors.\n\nSo the answer to this question is A"}
{"instruction": "A 17-year-old girl had been taking a drug for treatment of acne for the last 2 years, which has lead to pigmentation. Which drug could it be?\nA. Doxycycline\nB. Minocycline\nC. Azithromycin\nD. Chlorpromazine", "response": "Ans. (B) Minocycline(Ref: Harrison 17th/e p327-328, CMDT-2010/121)Both minocycline as well as chlorpromazine can cause pigmentation on long-term use.However, as the patient in question is being treated for acne, the answer should be minocycline. Antibiotics used in acne are erythromycin, clindamycin, tetracycline, doxycycline and minocycline.\n\nSo the answer to this question is B"}
{"instruction": "All are true about aneurismal bone cyst except ?\nA. Eccentric\nB. Expansile & lytic\nC. Treated by simple curettage\nD. Metaphysis of long bones", "response": "Ans. is 'c' i.e., Treated by simple curettage Aneurysmal bone cyst Aneurysmal bone cyst occur in children and young adults (5-20 years). The term aneurysmal is used because it causes expansion of overlying coex like vascular expansion of an aneurysm. The metaphysis of long bones is involved most commonly. Most common in femur and tibia; however any long bone can be involved. Other common sites are posterior elements of veebrae and pelvis. athology Cystic spaces of variable sizes & number which are filled with blood but not lined with vascular endothelium. The wall of vascular space is lined with fibroblast cells with collagen, giant cells, hemosiderin & osteoid (secondary to microfractures). Clinical features With expanding lesions, pain may be a presenting feature. Large cyst can also cause swelling Pathological fracture may occur (but less frequent than simple bone cyst). Radiological features of aneurysmal bone cyst Eccentric, expansile osteolytic lesion The characteristic feature is 'blown-out' distension of one surface of the bone. Overlying coex may be intact or disrupted. Extensive sclerosis at the interface between normal and expanded coex (buttersing) may be present. Delicate thin trabeculae is characteristic and an expansile ballooning lesion may produce a 'soap-bubble appearance'. Lesion occurs at metaphysis of long bones. Other common locations include the posterior elements of the spine(pedicle, lamina, transverse process, spinous process) and pelvis. Treatment Surgery is the treatment of choice. Curettage and bone grafting is the procedure commonly followed.\n\nSo the answer to this question is C"}
{"instruction": "In- right lateral rectus palsy, head is turned to -\nA. Right\nB. Left\nC. Up\nD. Down", "response": "Compensatory head posture - It is adopted to avoid diplopia and confusion Head is turned towards the direction of action of the paralysed muscle. Ref;A.K.Khurana; 6th edition; Page no: 354\n\nSo the answer to this question is A"}
{"instruction": "Coefficient of thermal expansion of amalgam is:\nA. 7.2a(ppm k-1).\nB. 10.0(ppm k-1).\nC. 25.0(ppm k-1).\nD. 48.5(ppm k-1).", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "An infant presented with erythematous lesions on cheek, extensor aspect of limbs, mother has history of bronchial asthma, the probable diagnosis is –\nA. Air borne contact dermatitis\nB. Atopic dermatitis\nC. Seborraehic dermatitis\nD. Infectious eczematoid dermatitis", "response": "Atopic dermatitis (Infantile form. i.e. Infantile eczematous dermatitis)\n\nStarts at the age of 2-3 months\nItchy papules and vesicles, lesions are intensively prurititic\nDistribution Begins on face but can involve rest of the body, sparing diaper area (napkin rash is absent)\nAfter face, neck and extensor surfaces (of knee, elbow) and groin are involved\nPersonal or family history of other atopic conditions -f Asthma, Haye fever, allergic rhinitis or conjuctivitis, urticaria, food allergies.\n\nSo the answer to this question is B"}
{"instruction": "Following grows in the cell free medium except -a\nA. Rickettsia\nB. M leprae\nC. Syphilis\nD. All", "response": "Ans. is 'a' i.e., Rickettsia; 'b' i.e., M leprae; 'c' i.e., Syphilis Obligate intracellular organisms . To grow in a medium which does not contain cells (cell free medium), organism should be capable of ATP synthesis. . Obligate intracellular organisms are not capable of the metabolic pathways for ATP synthesis. . So, these organisms are dependent on the ATP of host cells. . As they require host cell ATP, they can not grow in the media which do not contain cells (cell free media). . Such organisms are ? 1. Rickettsiae 2. Viruses 3. Pathogenic treponemes (syphillis) 4. Chlamydiae 5. M. leprae\n\nSo the answer to this question is D"}
{"instruction": "Poor prognostic factors for Hodgkin&;s disease are all except -\nA. Younger age\nB. Systemic manifestations\nC. Lymphocyte depletion\nD. stomach involvement", "response": "
REF.BDC VOL.3,Sixth edition pg 110\n\nSo the answer to this question is A"}
{"instruction": "A patient of Acute lymphocytic leukemia with fever and neutropenia develops diarrhoea after administration of amoxicillin therapy, which of the following organism is most likely to be the causative agent -\nA. Salmonella typhi\nB. Clostridium difficile\nC. Clostridium perfringens\nD. Shigella flexneri", "response": "Ans. is 'b' i.e., Clostridium difficile It is a case of Clostridium difficile - induced diarrhoea.Clostridium difficile should always be considered as a possible cause of diarrhoea in cancer patients who have received antibiotics.Two factor favours this diagnosis a) Cancer patient - Cancer patients are predisposed to the development of clostridium difficile diarrhoea as a consequence of chemotherapy alone, (do not always require antibiotics).This is much more common among patients with AML and ALL, than among those with other types of cancer. So these cancer patient may be positive in cl. difficile toxin tests even before receiving antibiotics, b) Ingestion of amoxicillin - Clostridium difficile induced diarrhoea is associated with antibiotic useAntibiotics associated with Clostridium difficile associated disease are -- Clindamycin}First antibiotics associated- Ampicillin}-with Clostridium difficile- Cephalosporins }associated disease2nd and 3rd generation cephalosporinsCefotaxime Ceftriaxone}These agents are now most- Cefuroxime}-- frequently responsible for- Ceftazidime}this condition- Penicillin/p lactamase combination - Ticarcillin/clavulanate}- Pose significantly less- Piperacillin/tazobactam}riskHowever all antibiotics including Vancomycin and Metronidazole have been found to carry a risk of subsequent Clostridium difficile associated diarrhoea.More about Clostridium difficile induced diarrhoeaAlso knowT/T of Clostridium difficile associated diarrhoea * Discontinuation of precipitating antibiotics and administration of following antibioticsMetronidazoleVancomycinTeicoplaninFusidic acidBacitracin\n\nSo the answer to this question is B"}
{"instruction": "Verres needle is used for\nA. Creating pneumoperitoneum\nB. Liver biopsy\nC. Bone marrow biopsy\nD. Spinal anaesthesisa", "response": "Verres needle is used for creation of a pneumoperitoneum in closed method.Although this method is fast and relatively safe, there is a small but significant potential for intestinal or vascular injury on introduction of the needleRef: Bailey and Love 27e pg: 108\n\nSo the answer to this question is A"}
{"instruction": "All of the following statements are true regarding the pudendal nerve, except:\nA. It is both sensory and motor\nB. It is derived from S2,3,4\nC. It leaves the pelvis through the lesser sciatic foramen\nD. It leaves through lesser sciatic foramen and enter pudendal canal", "response": "Pudendal nerve leaves the pelvis, to enter the gluteal region, by passing through the lower pa of the greater sciatic foramen. Pudendal nerve leaves the gluteal region by passing through the lesser sciatic foramen and enters the pudendal canal, and by means of its branches supplies the external anal sphincter and muscles and skin of the perineum. Ref: Clinical anatomy for Medical Students By Richard S Snell, 6th Edition, Pages 362-3 ; B.D.Chaurasia's Human Anatomy, 5th Edition, Volume 2, Page 365\n\nSo the answer to this question is C"}
{"instruction": "The following are causes of face presentation in a foetus? 1. Anencephaly 2. Multiparity 3. Hydraminos 4. Contracted Pelvis 5. Placenta prae\nA. 1, 2, 3 - False & 4, 5 - True\nB. 2, 3, 4 - True & 1, 5 - False\nC. 2, 3, 4 - False & 1, 5 - True\nD. 1, 2, 4 - True & 3, 5 - False", "response": "Face presentation can occur due to maternal and fetal factors. Maternal factors includes multiparity, lateral obliquity of uterus and contracted pelvis. Fetal factors includes anencephaly, congenital goitre, dolichocephalic head with long AP diameter, congenital branchocele, twisting of the cord round the neck and increased tone of extensor group of neck muscles. Ref: Textbook of Obstetrics by D.C Dutta 6th edition page 389.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is supplied by the abdominal aoa?\nA. Accessory lung lobes\nB. Bronchopulmonary segment\nC. Sequestrated lung tissue\nD. Base of lung", "response": "A pulmonary sequestration (bronchopulmonary sequestration or cystic lung lesion), is a condition wherein a piece of tissue that ultimately develops into lung tissue is not attached to the pulmonary aerial blood supply, as is the case in normally developing lung. As a result, this sequestered tissue is not connected to the normal bronchial airway architecture, and as a result, fails to function in, and contribute to, respiration of the organism. Sequestrated lung tissue receive it's blood supply from systemic circulation, directly from aoa or its branches Ref - pubmed.com\n\nSo the answer to this question is C"}
{"instruction": "The organism most frequently related to mediastina fibrosis is\nA. Actinomycosis\nB. Histoplasma\nC. Hansen's bacillus\nD. Staphylococcus", "response": "Fibrosing mediastinitis or mediastinal fibrosis is the least common,but the most severe ,late complication of histoplasmosis.It is due to an abnormal immunological response to antigens released by the soil based fungus Histoplasma capsulatum.It is characterised by invasive calcified fibrosis centered at locations of lymph nodes,which occludes major vessels & airways.\n\nSo the answer to this question is B"}
{"instruction": "Limb girdle muscle dystrophies include all of the following groups of disorders except:\nA. Sarcoglycanopathies\nB. Dystroglycanopathies\nC. Dysferlinopathies\nD. Calpainopathies", "response": "Ans. b. Dystroglycanopathies (Ref: Harrison 19/e p462e-6, 462e-6t. 462e-7t. 18/e pp 3492,3493, 3494)Calpain-J, Sarcoglycans (y,a,b and y) and dysferlin are all examples of defective gene/loeus in Limb girdle dystrophies. Dystrophin is associated with Duchenne's and Becker's type of muscular dystrophies and is not associated with Limb girdle dystrophies.\"The Limb girdle muscular dystrophies (LGMD) typically manifest with progressive weakness of pelvic and shoulder girdle musculature. Respiratory insufficiency from weakness of diaphragm and cardiomyopathy may occur. However unlike Duchenne dystrophies (Dystrophin) intellectual function remains intact.\"- Harrison 18/e p3492Progressive Muscular Dystrophies and Defective Gene/proteinDuchenne* DystrophinQBecker's* DystrophinQLimb girdle* Myotilin, Laminin A/c, Caveolin-3* Calpain-3, Dysferlin, y,a,B,y sarcoglycans* Telethonin, Fukutin related protein, Titin, TRIM 32 geneEmery Dreifuss* Emerin, LamininsMyotonic dystrophy* (DM1) Unstable expansion of a CTG trinucleotide repeat in a serine threonine protein kinase gene (named DMPK) on chromosome 19q 13.3 * (DM2) DNA expansion of a CcTG repeat in the ZNF9 gene on chromosome 3q 13.3-q24Fascioscapulohumeral* Deletion distal 4qOculopharyngeal* Expansion Poly-A RNA binding protein.\n\nSo the answer to this question is B"}
{"instruction": "Toxic shock syndrome is mostly due to which vaccine?\nA. Mumps\nB. Measles\nC. Salk\nD. Tetanus", "response": "TSS occurs when Measles Vaccine is Contaminated or the same l is used for more than one session on the same day or next day. It reflects poor Quality of Immunization Services . It is totally preventable. Symptoms are severe watery diarrohoea, vomiting and high fever. Case fatality rates are high. It may cause death within 48 hrs.\n\nSo the answer to this question is B"}
{"instruction": "False statement about macrophages -\nA. Can harbor mycobacteria\nB. Derived from blood monocytes\nC. Involved in type III hypersensitivity reactions\nD. Produce tumor necrosis factor and interleukins", "response": "Type III hypersensitivity occurs when there is an excess of antigen, leading to small immune complexes being formed that fix complement and are not cleared from the circulation. Large complexes can be cleared by macrophages but macrophages have difficulty in the disposal of small immune complexes.\n\nSo the answer to this question is C"}
{"instruction": "Anti thyrogiobulin antibodies seen in -\nA. Hashimoto thyroiditis\nB. Graves disease\nC. De quervain thyroiditis\nD. Subacute lymphocytic thyroiditis", "response": "Ans. is 'a' i.e., Hashimoto thyroiditis\n\nSo the answer to this question is A"}
{"instruction": "Transamination reaction requires -\nA. Biotin\nB. Folic acid\nC. Pyridoxin\nD. Niacin", "response": "Ans. is 'c- i.e., Pyridoxin o Transamination involves the reversible transfer of a-amino group of a-amino acid to an a-keto acidQ to form a new amino acid and a new keto acid.o The enzyme catalyze the reaction is called aminotransferase (transaminase).o Most transaminases use GL-ketoglutarate (a-keto acid) as a common acceptor of a-amino group of a-amino acids,o All transaminases require pyridoxal phosphate (Vitamin B6) as a coenzymneQ.VitaminActive form (coenzvmes)Reaction typeB1 (Thiamin)Thiamine pyrophosphate (TPP)Oxidative decarboxylation, TransketolationB2 (Riboflavin)FMNt FADOxidation / Reduction (Redox reaction)B3 (Niacin)NAD\\ NADP\"Oxidation / Reduction (Redox reaction)B6 (Pyridoxin)Pyridoxal phosphate (PLP)Transamination, deamination, decarboxylation, condensation, trans-sulfurationBp (cobolamin)Methylcobalamin, deoxyadenosylcobalaminIsomerization of methylmelonyl-CoA to succinvl-CoA, synthesis of methionine from homocysteineFolic acidTetrahydrofolate (THF)One carbon group transferBiotinBiocytinCarboxylationPantothenic acidPentothenate in CoA and ACPAcyl group transferVitamin KVitamin KCarboxylation of glutamic acid residue\n\nSo the answer to this question is C"}
{"instruction": "Which anticonvulsive agent would be MOST appropriate as first-line therapy for a 21-year-old woman recently diagnosed with complex paial seizures?\nA. Lamotrigine\nB. Carbamazepine\nC. Topiramate\nD. Phenytoin", "response": "Since the women is in reproductive age group so option B (Carbamazepine) is C/I as it may l/t neural tube defects. Therefore, option A\n\nSo the answer to this question is A"}
{"instruction": "All of the following drugs can cause SLE like syndrome Except\nA. INH\nB. Diltiazem\nC. Procainamide\nD. Penicillin", "response": "The most common drugs that cause Drug-induced lupus erythematosus are hydralazine, procainamide, isoniazid, quinidine, diltiazem, minocycline Drugs most commonly associated with drug-induced SCLE include calcium-channel blockers, angiotensin-conveing enzyme inhibitors, thiazide diuretics, terbinafine, TNF-alpha antagonists. Penicillamine (not penicillin) can cause Drug-induced lupus erythematosus Penicillamine is a chelating agent REF: KD Tripathi 8th ed\n\nSo the answer to this question is D"}
{"instruction": "Retinal detachment in Eale's disease is\nA. Exudative RD\nB. Tractional RD\nC. Rhegmatogenous RD\nD. All of the above", "response": "Tractional RD - Eale's disease ,Trauma,Sickle cell retinopathy.\n\nSo the answer to this question is B"}
{"instruction": "Not true about aedes mosquitos -\nA. Are recurrent day time biters\nB. Eggs cannot survive more than 1 week without water\nC. Transmits dengue fever\nD. Prefer breeding in stagnant water", "response": "Even Under orable conditions, the egg stage of mosquitoes lasts for only 1-2 days. Aedes are fearless biters and chiefly bite during the day, Aedes prefer an aificial collection of water. Transmits dengue, dengue haemorrhagic fever. REFERENCE: PARK'S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE, 25TH EDITION, PG NO. 831\n\nSo the answer to this question is B"}
{"instruction": "Escitalopram is a\nA. Selective serotonin reuptake inhibitor.\nB. Nonspecific norepinephrine uptake inhibitor\nC. Atypical Antideppressants\nD. MAO Inhibitors", "response": "(A) Selective serotonin reuptake inhibitor # Mechanism of action of Escitalopram: Highly potent blockade of serotonin reuptake transport mechanism S CT without its inactive R-enantiomer.> Selective serotonin reuptake inhibitors: include Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Venlafaxine. Norepinephrine uptake inhibitors: Amitriptyline, Clomipramine, Doxepin, Imipramine, Desipramine.Trimipramine, Amoxapine, Maprotiline, Nortryptalline, protyptalline. Atypical Antideppressants: Amoxapine. Atomoxetin, Maprotiline, Trazodone and Bupropion, Venlafaxine, Mirtazapine, Nefazodone, and Duloxetine. MAO Inhibitors: Tranylcypromineto phenelzine, Selegiline\n\nSo the answer to this question is A"}
{"instruction": "Alcohol intoxication is a form of -\nA. Psychosis\nB. Anxiety neurosis\nC. Dependence\nD. Withdrawal syndrome", "response": "Alcohol-related psychosis is a secondary psychosis, with predominant hallucinations occurring in many alcohol-related conditions including intoxication.\n\nSo the answer to this question is A"}
{"instruction": "A 34-yrs-old woman is trying for a pregnancy for 3 years. On p/V these is a nodular, tender uterosacral ligament, a retroveed but normal-sized uterus, and a right adnexal mass. A recent pelvic ultrasound reveals a 6-cm right complex ovarian mass. Her CA-125 is elevated. What is the initial next step in management?\nA. GnRH agonist\nB. Diagnostic Hysterosalpingography\nC. Laparoscopy with cystectomy\nD. Laparoscopy and right oophorectomy", "response": "The most likely diagnosis here is an endometrioma of the right ovary. Because this patient has been attempting to get pregnant, conservative surgery to remove the endometrioma while preserving ovarian tissue and to ablate any endometriotic implants may improve her chances. Medical therapy with a GnRH agonist may treat her symptoms, but it will not treat the ovarian cyst or help her get pregnant. CA-125 can be elevated with endometriosis and is not specific to endometriosis alone\n\nSo the answer to this question is C"}
{"instruction": "Age group affected by Hepatitis 'A' virus ?\nA. Children\nB. Adult\nC. Old age\nD. Any age", "response": "Ans. is 'a' i.e., children Virus Age affected . Hepatitis A Children, young adults . Hepatitis B Young adults, babies, toddlers . Hepatitis C Any age (more common in adults) . Hepatitis D Any age . Hepatitis E Young adults\n\nSo the answer to this question is A"}
{"instruction": "Pit viper beongs to -\nA. Viperidae\nB. Elapidae\nC. Sea snakes\nD. Crotalidae", "response": "Ans. is 'd' i.e., Crotalidae o Poisonous snakes are divided into six families:Viperidae - Russell's viper, gaboon viper, saw scaled viper, puff adder. They are found in all parts of world except America.Crotalidae - Rattlesnakes, pigmy rattlesnakes, copperheads, pit viper & bush master. They are found in Asia and America.Elapidae - Cobras, kraits, mambas, tiger snake, death adder, copperhead snakes and coral snakes. They are found in all parts of world except Europe.Hydrophidae or sea snakes - All sea snakes are poisonous but they seldom bite.Colubridae - Boomslangs, bird snake of the African continent.Atractaspididae - African & Middle Eastern burrowing asps or stiletto snakes.\n\nSo the answer to this question is D"}
{"instruction": "A 4-year old boy presents with a history of left ankle joint swelling and pain for four days. It was preceded by an upper respiratory infection. On examination, the left ankle is swollen and tender. There is a petechial rash over the lower limbs. He is admitted two days later with bleeding per rectum. The most likely clinical diagnosis is:\nA. Acute rheumatic fever\nB. Juvenile rheumatoid ahritis\nC. Pyogenic ahritis\nD. Henoch-Schonlein purpura", "response": "Features of HSP are: 1. Aetiology is not known. 2. The hallmark of the disease is rash that progresses to petechiae or purpura. It is more prominent over the extensor aspect of lower extremities and buttocks. 3. Ahritis is seen in two-thirds of children and is localized to ankles and knees. 4. Abdominal pain and vomiting are common. 50% have occult blood in stool. Diarrhoea (with or without visible blood loss) or haematemesis are however' less common. 5. Renal involvement is seen in 25 to 50% of cases. 6. CNS involvement is rare but has potentially serious outcome.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is the preformed toxin involved in mechanism of allergic rhinitis -\nA. Histamine\nB. Leukotriene\nC. TXA2\nD. PGD2", "response": "Ans. is 'a' i.e., Histamine Examples of immediate hypersensitivity reaction includeAnaphylaxis (drugs, bee sting, food)Bronchial asthmaAllergic, rhinitis/ sinusitis (hay fever)Food allergieso Mediators of Immediate Hypersensitivity: Mast cell activation leads to degranulation, with the discharge of preformed (primary) mediators that are stored in the granules, and de novo synthesis and release of secondary mediators, including lipid products and cytokines.o Preformed (Primary) Mediators. Mediators contained within mast cel! granules are the first to be released and can be divided into three categories:Vasoactive amines - Histamine (most important). Enzymes - Neutral proteases (chymase, tryptase) and several acid hydrolases.# Proteoglycans-Heparin and chondroitin sulfate.# Lipid Mediators-Arachidonic acid-derived products: leukotrienes and prostaglandins# Leukotrienes-Leukotrienes C4 and D4 are the most potent vasoactive and spasmogenic agents known. They are several thousand times more active than histamine in increasing vascular permeability and causing bronchial smooth muscle contraction. Leukotriene B4 is highly chemotactic for neutrophils, eosinophils, and monocytes.Prostaglandin D2Platelet-activating factor (PAF).o Cytokines - Mast cells are sources of many cytokines, which may play an important role at several stages of immediate hypersensitivity reactions. The cytokines include: TNF, IL-1, and chemokines, which promote leukocyte recruitment (typical of the late-phase reaction); IL-4. which amplifies the TH2 response.\n\nSo the answer to this question is A"}
{"instruction": "All are true regarding Idiopathic edema of woman except-\nA. It is due to estrogen mediated sodium retention\nB. It is not related to menstrual cycle\nC. There is increased water retention in upright position\nD. ACE inhibitors can be useful in some cases", "response": "Idiopathic edema is a common cause of fluid retention and swelling (edema) in women. \"Idiopathic\" means that the cause of this condition is unknown. Idiopathic edema occurs in the absence of hea, kidney, or liver disease. It is often associated with diabetes, obesity, and emotional problems Ref Davidson 23rd edition pg 369\n\nSo the answer to this question is A"}
{"instruction": "Chronic liver disease is caused by\nA. Hepatitis B\nB. Hepatitis A\nC. Hepatitis C\nD. Hepatitis E", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Nissl substance is found in: March 2013\nA. Neuron\nB. Hepatocytes\nC. Cardiocytes\nD. ENterocytes", "response": "Ans. A i.e. Neuron Nissl body/Nissl or tigroid substance It is a large granular body found in neurons. These granules are rough endoplasmic reticulum (RER) with rosettes of free ribosomes, and are the site of protein synthesis. It was named after Franz Nissl, a German neurologist who invented the Nissl staining method\n\nSo the answer to this question is A"}
{"instruction": "Kussmaul's sign is positive in \na. Restrictive cardiomyopathy \nb. Constrictive pericarditis \nc. Cardiac tamponade \nd. Dilated cardiomyopathy \ne. Pneumothorax\nA. a,b,e\nB. a,b\nC. a,c,d,e\nD. a,b,c,d,e", "response": "Kussmaul's sign is rise in JVP with inspiration. It is seen in constrictive pericarditis and Restrictive cardiomyopathy.\n\nSo the answer to this question is B"}
{"instruction": "PCT secretes\nA. Sodium\nB. Glucose\nC. Hydrogen ions\nD. Amino acids", "response": "PCT secretes H+ into tubule thus helping in excretion . Ref: Ganong's review of medical physiology; 24th edition; page no: 685\n\nSo the answer to this question is C"}
{"instruction": "Which is a pro-drug?\nA. Cyclophosphamide\nB. Lisinopril\nC. Metochlopramide\nD. Ranitidine", "response": "Ans. is 'a' i.e., Cyclophosphamide\n\nSo the answer to this question is A"}
{"instruction": "Man coughed and developed sudden severe headache and fainting. The most probable diagnosis is:\nA. Subarachnoid hemorrhage\nB. Migraine\nC. Cluster Headache\nD. Posterior fossa tumor", "response": "Ans: A (Subarachnoid hemorrhage) Ref: Harrison's Principles of Internal Medicine 18th editionExplanation:Subarachnoid HemorrhageExcluding head trauma, the most common cause of S AH is rupture of a saccular aneurysm.Other causes include bleeding from a vascular malformation (arteriovenous malformation or dural arterial-venous listula)Saccular (\"Berry\") Aneurysm2% of adults harbor intracranial aneurysmsThe three most common locations are theTerminal internal carotid arteryMiddle cerebral artery (MCA) bifurcationTop of the basilar artery.Mycotic aneurysms are usually located distal to the first bifurcation of major arteries of the circle of Willis.Most result from infected emboli due to bacterial endocarditis causing septic degeneration of arteries and subsequent dilation and rupture.PathophysiologySaccular aneurysms occur at the bifurcations of the large- to medium-sized intracranial arteriesRupture is into the subarachnoid space in the basal cisterns and often into the parenchyma of the adjacent brain.Approximately 85% of aneurysms occur in the anterior circulation, mostly on the circle of Willis.About 20%' of patients have multiple aneurysms, many at mirror sites bilaterally.Clinical ManifestationsMost unruptured intracranial aneurysms are completely asymptomatic.At the moment of aneurysmal rupture w ith major SAH, the ICP suddenly rises.This may account for the sudden transient loss of consciousness that occurs in nearly half of patients.Sudden loss of consciousness may be preceded by a brief moment of excruciating headache, but most patients first complain of headache upon regaining consciousness.Severe headache associated with exertion is the presenting complaint. The patient often calls the headache ''the worst headache of my life '; however, the most important characteristic is sudden onset.The headache is usually generalized, often with neck stiffness, and vomiting is common.Sudden headache in the absence of focal neurologic symptoms is the hallmark of aneurysmal rupture.Focal deficits can occur rarely.Anterior communicating artery or MCA bifurcation aneurysms may bleed enough to produce mass effect. The deficits that result can include hemiparesis, aphasia, and abulia.A third cranial nerve palsy, particularly when associated with pupillary dilation, loss of ipsilateral (but retained contralateral) light reflex, and focal pain above or behind the eye, may occur with an expanding aneurysm at the junction of the posterior communicating artery and the internal carotid artery.A sixth nerve palsy may indicate an aneury sm in the cavernous sinus, and visual field defects can occur with an expanding supraclinoid carotid or anterior cerebral artery aneurysm.Occipital and posterior cervical pain may signal a posterior inferior cerebellar artery or anterior inferior cerebellar artery aneurysm.Pain in or behind the eye and in the low temple can occur with an expanding MCA aneurysm.\n\nSo the answer to this question is A"}
{"instruction": "The special tray which is used for agar impression material, has a water channel, which helps in setting of the material. The temperature of water flowing in channel is\nA. 25 deg - 35 deg\nB. 37 deg - 45 deg\nC. 15 deg - 17 deg\nD. 18 deg - 21 deg", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Antipsychotic drug with maximum hypotensive effect is\nA. Fluphenazine\nB. Trifluperazine\nC. Thioridazine\nD. Haloperidol", "response": "low potency antipsychotics like thioridazine and chlorpromazine are associated with lot of systemic side effects as mentioned in the below table. They have side effects like hypotension, sedation, giddiness, dryness of mouth and cardiac side effects. High potency has lot of neurological side effects. Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 972\n\nSo the answer to this question is C"}
{"instruction": "Presence of calcification in an intracranial lesion is best made out by:\nA. CT\nB. MRI\nC. Ultrasound\nD. Contrast study", "response": "Ans. CT\n\nSo the answer to this question is A"}
{"instruction": "YAG laser capsulotomy is used in-\nA. Retinal detachment\nB. Diabetes\nC. After-cataract\nD. Refractive errors", "response": "*After cataract is treated by Nd-YAG laser posterior capsulotomy. *YAG laser is used to create holes e.g. posterior capsulotomy,irototomy. Ref: Khurana 7th/e p.212\n\nSo the answer to this question is C"}
{"instruction": "A 25 yr old male having fever & malaise since 2 weeks, ahritis of ankle joint and tender erythematous nodules over the shin. Diagnosis is?\nA. Erythema nodosum\nB. Erythema marginatum\nC. Weber Christian disease\nD. Uicarial vasculitis", "response": "Erythema nodosum is most common on the shins, but it may also occur on other areas of the body (buttocks, calves, ankles, thighs, and arms). The lesions begin as flat, firm, hot, red, painful lumps approximately an inch across. Within a few days they may become purplish, then over several weeks fade to a brownish, flat patch. Other symptoms may include: a. Fever b. General ill feeling (malaise) c. Joint aches d. Skin redness, inflammation, or irritation e. Swelling of the leg or other affected area. Causes of erythema nodosum infections, such as Streptococcal pharyngitis or strep throat. bacterial infections, such as Mycoplasma pneumonia or tuberculosis. viral infections. deep fungal infections. sarcoidosis. cancer. antibiotics. oral contraceptives Ref Robbins 9/e pg 345\n\nSo the answer to this question is A"}
{"instruction": "Muscle spindle is -\nA. Receptor for a variety of multisynaptic reflexes\nB. Receptor for myotatic or stretch receptor reflex\nC. Occurs only in antigravity extensor muscles\nD. Excited by both stretch and contraction of the muscles in which it is Located", "response": "B i.e. Receptor for stretch receptor reflex\n\nSo the answer to this question is B"}
{"instruction": "Apoptotic bodies are -\nA. Clumped chromatin bodies\nB. Pyknotic nucleus without organelles\nC. Cell membrane bound with organelles\nD. No nucleus with organelles", "response": "Ans is 'c' i.e., Cell membrane bound with organelleso Apoptotic bodies are formed during the process ofApoptosis, by fragmentation of surface blebs of the apototic cell. These are membrane bound bodies composed of cytoplasm and tightly packed organelles, with or without nucleus.\n\nSo the answer to this question is C"}
{"instruction": "Vestibulo ocular reflex is concerned with\nA. Archicerebellum\nB. Flocculonodular lobe\nC. Neocerebellum\nD. Occipital lobe", "response": "The flocculonodular lobe is phylogenetically the oldest pa of cerebellum has vestibular connections and is concerned with equilibrium and eye movements (vestibulo ocular reflex). Ref: Ganong&;s review of medical physiology; 23rd edition; pg:257.\n\nSo the answer to this question is B"}
{"instruction": "Clostridium difficile causes -\nA. Pseudomembranous colitis\nB. Nosocomical diarrhea\nC. Gas gangrene\nD. Food poisoning", "response": "Ans. is 'a' i.e., Pseudomembranous colitis & 'b' i.e., Nosocomical diarrhea * Cl difficle causes Clostridium difficle - associated diseases (CDAD).* CDAD is the most commonly diagnosed diarrheal illness acquired in the hospital.* C. difficle is acquired exogenously, most frequently in the hospital.* C. difficle is the most common bacterial cause of nosocomial diarrhea.* Diarrhea is the most common symptom of CDAD.* Pseudomembranous colitis is the advanced form of CDAD.* CDAD is almost exclusively associated with antibiotic use. It is caused most commonly by 2nd generation cephalospirinsy clindamycin, ampicillin and fluoroquinolones.* Other important risk factors (beside antibiotic use) are old age, GI surgery, use of electrical thermometer, use of antacids and PPIs, and prolonged hospital stay.* Pseudomembranous colitis is caused by two large toxins of Cl difficle1) Toxin A (enterotoxin) : Causes disruption of cystoskeleton by glycosylation of GTP-binding proteins.2) Toxin B (cytotoxin) : Has effect similar to toxin A.\n\nSo the answer to this question is A"}
{"instruction": "Blood agar is\nA. Enrichment media\nB. Enriched media\nC. Selective media\nD. Transport media", "response": "Ans. (b) Enriched media\n\nSo the answer to this question is B"}
{"instruction": "Symptoms of narcolepsy are all except\nA. Cataplexy\nB. Catalepsy\nC. Daytime sleepiness\nD. hypnagogic hallucinations", "response": "NarcolepsyThe classic tetrad of symptoms is:i. Sleep attacks (most common): ii. Cataplexy: iii. Hypnagogic hallucinations: iv. Sleep paralysis (least common): Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 138\n\nSo the answer to this question is B"}
{"instruction": "At birth, which of the following structures is nearest to the size it will eventually attain in adulthood?\nA. Cranium\nB. Mandible\nC. Middle Face\nD. Nasal capsule", "response": "Timing of Cranial Base Growth:\n\nSo the answer to this question is A"}
{"instruction": "A young boy presented with high fever shows clinical features suggestive of Legionnaires' Disease. Treatment of choice is:\nA. Amoxicillin\nB. Azithromycin\nC. Penicillin\nD. Streptomycin", "response": "The macrolides (especially azithromycin) and the respiratory quinolones are now the antibiotics of choice and are effective as monotherapy. Compared with erythromycin, the newer macrolides have superior in vitro activity, display greater intracellular activity, reach higher concentrations in respiratory secretions and lung tissue, and have fewer adverse effects. Ref: Sabria M., Yu V.L. (2012). Chapter 147. Legionella Infections. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.\n\nSo the answer to this question is B"}
{"instruction": "IUCD having the longest life span is\nA. Progestase\nB. Cu T 380A\nC. Mirena\nD. Nova T", "response": "The time periods for replacement for various IUDs are: - Copper T 200:3years- Multiload Cu 250:3 years - Multiload Cu 375: 5 years- LNG-IUS/Mirena : 5 years- Cu T 380A : 10 years ( also known as Paraguard)- Nova : 3years - Progestase : 1 years\n\nSo the answer to this question is B"}
{"instruction": "All of the following cause visual loss in hypeension EXCEPT:\nA. Occipital infarct\nB. Anterior ischemic optic neuropathy\nC. Papilloedema\nD. Hemorrhage", "response": "Hypeension is a known cause of papilledema. Hemorrhage in the vitreous is caused by hypeension. Therefore by exclusion the answer is occipital infarcts. Fuher the aicle states that occipital infarcts are different from other infarcts because their etiology is also different and hypeension is not a usual cause. Causes of anterior ischemic optic neuropathy: *Idiopathic *Giant cell aeritis *Papilledema *Migraine *Malignant hypeension\n\nSo the answer to this question is A"}
{"instruction": "During pregnancy, fibroid may have all of the following complications except: March 2009\nA. Metastasis\nB. Pain\nC. Post paum hemorrhage\nD. Preterm labour", "response": "Ans. A: Metastasis Pregnant women with fibroids are at increased risk for: Pain Breech presentation Malposition Higher incidence of cesarean delivery Preterm bih Premature rupture of the membranes Postpaum hemorrhage Placental abruption Submucosal, fibroids located beneath the placenta, and fibroids 7 to 8 cm in diameter had the highest risk for abruption.\n\nSo the answer to this question is A"}
{"instruction": "Carcinoma cervix extends upto lateral pelvic wall. The stage would be :\nA. Stage I\nB. Stage II\nC. Stage III\nD. Stage IV", "response": "Ans. is c i.e. Stage III\n\nSo the answer to this question is C"}
{"instruction": "Kupffer cells in liver are responsible for:September 2007\nA. Lytic functions\nB. Excretory functions\nC. Absorptive functions\nD. Phagocytic functions", "response": "Ans. D: Phagocytic functionsKupffer cells/Browicz-Kupffer cells are specialized macrophages located in the liver lining the walls of the sinusoids that form pa of the reticuloendothelial system.\n\nSo the answer to this question is D"}
{"instruction": "Deep peroneal nerve supplies\nA. 1st web space of foot\nB. 5th web space of foot\nC. Antero lateral dorsum of foot\nD. Lateral pa of leg", "response": "DEEP PERONEAL:- Muscular branches to muscles of anterior compament of leg: Tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus teius.Extensor digitorum brevis Cutaneous: dorsal digital nerves for adjacent sides of big toe and second toe. Aicular branches: Ankle joint, tarsal joints, tarsometatarsal joints and metatarsophalangeal joint of big toe. {Reference:BDC 6E }\n\nSo the answer to this question is A"}
{"instruction": "Peripheral cell membrane proteins are -\nA. Pump\nB. Channel\nC. Adhesion molecules\nD. Enzyme receptors", "response": "Ans. is 'c' i.e., Adhesion molecules Proteins in cell membraneo Most of the membrane proteins are glycoproteins. There are following types of membrane proteins : -Integral (Transmembrane or intrinsic) Proteins : -These proteins pass 'through and through', i.e., they run (span) the entire length of lipid bilayer. Integral proteins are globular and amphipathic, consisting of two hy drophilic ends separated by an intervening hydrophobic region that traverses the hydrophobic core of the bilayer. Integral proteins interact by non-polar (hydrophobic) interacts with the fatty acyl groups of phospholipids in the cell membrane and require the use of detergents for their solubilization. Integral proteins are asymmetrically distributed across the membrane bi layer.Integral proteins function as channels (pores), receptors, ion pumps, carrier proteins and enzyme.Peripheral (Extrinsic) proteinsPeripheral proteins are present on the surface of the membrane and do not penetrate all the way through. They are located on both surface of membrane, outer and inner. Peripheral proteins do not interact directly with the phospholipid in the bilayer. They bound to the hydrophilic regions of the transmembrane proteins through electrostatic and hydrogen bonds. However, some (not all) proteins bind to membrane via a covalentently attached lipid anchor, i.e., interaction with polar (hydrophilic) lipid head groups in the membrane,As they do not interact directly with hydrophobic core of phospholipids, they do not require use of detergents for their release. They can be released by treatment with salt solutions of high ionic strength. Peripheral proteins serve as cell adhesion molecules (CAMs) that anchor cells to neighboring cells and to basal lamina. They also contribute to cytoskeleton when present on the inside of the membrane, e.g., spectrin, ankyrin, band 4.1 in RBCs.\n\nSo the answer to this question is C"}
{"instruction": "Aaron Beck's cognitive triad of depression includes all except\nA. Negative thought of self\nB. Negative thought of future\nC. Negative thought of friends\nD. Negative thought of environment", "response": "Negative thoughts about friends aren't included in triad.Environment, self and future -hopelessness, wohlessness, helplessness are only described as triad by Aaron Beck Ref: Essentials of postgraduate psychiatry By JN Vyas 1st ed Pg 604\n\nSo the answer to this question is C"}
{"instruction": "Intra enamel depth preparation in porcelain laminate\nveneer\nA. 0.5 mm\nB. 0.75 mm\nC. 1 mm\nD. 2 mm", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Local lymph nodules are enlarged near the infected wound. Increased amount of macrophages, lymphocytes, lymphatic follicles in the coical layer and large amount of plasma cells were revealed on histological examination. What process in the lymphatic nodules represent these histological changes?\nA. Antigen stimulation\nB. Acquired insufficiency of the lymphoid tissue\nC. Tumour transformation\nD. Innate insufficiency of the lymphoid tissue", "response": "In the given question there is enlargement of local lymph nodes near the infected wound. Histologically:- Presence of Macrophages, Lymphocytes, Lymphatic follicles in the coical layer and large amount of Plasma cells. It is because the antigens from the wound are going to be drained to the lymph node. These antigens will cause B cell activation, once the B cell are going to be activated, they are going to get conveed into the Plasma cell and that is responsible for causing enlargement of the lymph node. Therefore, after any kind of infection or any kind of inflammation the reactive lymph node enlargement will occur and this is explained on the basis of Antigen stimulation.\n\nSo the answer to this question is A"}
{"instruction": "(Weight = Height - 100) denotes which formula/ index-\nA. Corpulence index\nB. Broca index\nC. Lorentz's formula\nD. Ouetlef s index", "response": "Ans. is 'b' i.e., Broca index o Has been explained in All India Dec-15\n\nSo the answer to this question is B"}
{"instruction": "A 12 hour old male child of a diabetic mother is brought to you with seizures, which of the following is the least likely cause?\nA. Hypoglycemia\nB. Hypocalcemia\nC. Hypermagnesemia\nD. Bih asphyxia", "response": "It is possible for babies of diabetic mothers to suffer from hypoglycemia, hypocalcemia & hypomagnesemia resulting in seizure. The exact mechanism of hypomagnesemia and hypocalcemia is not clear. Ref: Karla Philip, 3rd Edition, Page 296\n\nSo the answer to this question is C"}
{"instruction": "The probable source of relaxin is:\nA. Ovary\nB. Adrenal cortex\nC. Liver\nD. Bartholins gland", "response": "• Relaxin is a peptide hormone. It is produced by the ovary to be specific by the corpus luteum of pregnancy If corpus\nluteum is in options, it should be the answer of choice. It has also been identified in :\n– placenta\n– decidua\n– chorion\n• It is not detected in men and non pregnant women.\n• Levels of Relaxin rise during 1st trimester when corpus luteum is dominant and declines in the second trimester. This\nsuggests a role in maintaining early pregnancy.\n• In animals, relaxin softens the cervix, inhibits uterine contractions and relaxes public symphysis.\n• It has no effect on prolactin secretion but enhances growth hormone secretion by the pituitary.\n\nSo the answer to this question is A"}
{"instruction": "Housemaid's knee affects which of the following?(MH 2014)\nA. Prepatellar bursa\nB. Infrapatellar bursa\nC. Suprapatellar bursa\nD. Anserine bursa", "response": "Ans. a (Prepatellar bursa). (Ref. Maheshwari, Orthopaedics, 2nd ed., 255)The 5 main bursae around the knee joint are - Prepatellar, Infrapatellar, Suprapatellar and Anserine bursa. Housemaid's knee is prepatellar bursitis (Irritation bursitis, or Infective bursitis). Named bursal diseaseMeans1Housemaid's kneePrepatellar superficial bursitis2Clergyman kneeInfrapatellar superficial bursitis3Student's elbowOlecranon bursitis4Weaver's bottomIschial bursitis5BunionBursitis at the first Metatarsophalangeal joint of foot causing swelling atmmedial aspect to the great toe base and lateral displacement of the toe.Bursae:# Sandwiched between tissues that slide past each other, bursae decrease the frictional forces present.# They are endothelialined cushions and normally contain little fluid.# If they are overloaded they can become inflamed, swollen and very painful.# Common sites for bursitis to develop are:- Olecranon;- Psoas tendon;- Greater trochanter; - Iliotibial band;- Prepatellar;- Infrapatellar;- Retro calcaneal.# Avoidance of the aggravating mechanical factors and a short course or anti-inflammatories is usually sufficient.# Intractable cases require aspiration and steroid injections and, more rarely, excision of the indurated bursal wall.\n\nSo the answer to this question is A"}
{"instruction": "All of the following lead to increased dissociation of O2 from Hb except\nA. HbF\nB. Increased CO2\nC. Increase H+\nD. Increase Temperature", "response": "Fetal hemoglobin or fetal hemoglobin, (also hemoglobin F or HbF) is the main oxygen transpo protein in the human fetus during the last seven months of development in the uterus and in the newborn until roughly 6 months old.Ref: Ganong&;s Review of Medical Physiology; 24th edition; page no:641\n\nSo the answer to this question is A"}
{"instruction": "Foamy liver is found in\nA. Drowning\nB. Putrefaction\nC. Adipocere\nD. Abortion", "response": "(Putrefaction) (3.25-P)PUTREFACTION - Liver becomes softened and flaby* Owing to the evolution of gases in its substances. It becomes spongy and present a honey- combed appearance (foamy or Swiss Cheese liver)* The patch of greenish discolouration appears early and gradually extends to the whole organ which ultimately becomes black.\n\nSo the answer to this question is B"}
{"instruction": "Most commonly involved organ in congenital tuberculosis is\nA. Lungs\nB. Liver\nC. Lymph nodes\nD. Skin", "response": "Ans. Answer is B (Liver): Most common primary site- LIVER (primary complex in liver is suggestive of congenital TB) Most common site is- LUNG The form of disease is usually miliary with multiple organ involvement. Lungs are involved in almost all cases. Other sites frequently involved are liver, spleen, lymph nodes, the gastrointestinal tract and kidney'. -Textbook of Pulmonary Medicine by Behera 2\"a/495\n\nSo the answer to this question is B"}
{"instruction": "Rubella vaccination is contraindicated in all except-\nA. Patient on immunosuppressant\nB. Girl with Leukemia\nC. Girls between 11-14 years\nD. Pregnancy", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Primary health care, true are all except -\nA. Essential health care for all\nB. Health services are taken to the doors of people\nC. Placing people's health in people's hands\nD. Sectors like agriculture, animal husbandry, food industry & communication are involved", "response": "The Alma -Ata international conference gave primary health care a wider meaning.The Alma-Ata conference defined primary health care as follows \"Primary health care is essential health care made universally accessible to individual and acceptable to them through their full paicipation and at a cost the community and county can afford \"(refer pgno:891 park 23rd edition)\n\nSo the answer to this question is B"}
{"instruction": "Most common site for trauma of spine is-\nA. Cervical veebrae\nB. Thoracic veebrae\nC. Lumbar veebrae\nD. Sacrum veebrae", "response": "*Traumatic spine injuries most commonly affect cervical spine (50-60%)followed by dorsolumbar junction. Ref: Clinical Ohopaedics maheswari 9th p.786\n\nSo the answer to this question is A"}
{"instruction": "A patient complaints of sadness of mood, increased letharg, early morning awakening, loss of interest and repos no will to live and hears voices asking her to kill self. What is the diagnosis?\nA. Schizophrenia\nB. Major depressive disorder plus psychosis\nC. Schizoaffective disorder\nD. Schizotypal personality disorder", "response": "The symptoms of depression are there plus adding psychotic symptoms of hallucinations make it a diagnosis of MDD PLUS PSYCHOSIS. SymptomsOF DEPRESSION -(SIGECAPSS) S- Sadness of mood/ depressed mood (persistent & pervasive) I- Loss of interest / pleasure (Anhedonia) G- Guilt/ Feeling of wohlessness . E- Energy (loss)/ Fatigue C- Concentration loss, cognition (negative thoughts) A- Appetite (loss/ gain) with significant weight changes (>5% change in 1 month) P- Psychomotor Agitation/ Retardation S- Suicidal thoughts Note:Suicidal thoughts are fuher classified into 3: Death wishes (patient feels death should come to me ) - GRADE 1 Suicidal wish (patient says I wish I could commit suicide ) - GRADE 2 Suicidal intent (patient says I would be killing myself ) - GRADE 3 S - Sleep abnormalities (decreased/ increased) Early morning insomnia ( getting up >2 hrs earlier than the usual waking time ) Reduced latency of REM sleep Sleep is usually decreased but it might be increased also. Criteria for defining depression ( according to DSM - 5 ) : From the above 9 symptoms 5 must be present & at least 1 must be present out of first 2 for at least 2 weeks duration.\n\nSo the answer to this question is B"}
{"instruction": "The stimulant drug is given to the child for -\nA. Conduct disorder\nB. Speech developmental disorder\nC. Pervasive disorder\nD. ADHD", "response": "Stimulants (like methylphenidate, dextroamphetamine) are the drugs of choice for ADHD.\n\nSo the answer to this question is D"}
{"instruction": "In a detached retina, the site of detachment is found\nA. Within the outer plexiform layer\nB. Within the inner plexiform layer\nC. Between the inner nuclear layer and the outer nuclear layer\nD. Between the pigment epithelial layer and the layer of outer segments of rods and cones", "response": "The site of retinal detachment is between the pigment epithelial layer and the layer of outer segments of rods and cones; this corresponds to the intraretinal space between the inner and outer layers of the optic cup. Retinal detachment occurs when fluid from the vitreous compament passes through a retinal hole and separates the pigment epithelial layer from the layer of outer segments of rods and cones.\n\nSo the answer to this question is D"}
{"instruction": "Drug of choice for rapid cyclers in manic-depressive psychosis is:\nA. Carbamazepine\nB. Valproate\nC. Phenytoin\nD. Lithium", "response": "uction in manic relapses is noted when valproate is used in bipolar disorder. It is now a first line treatment of acute mania in which high dose valproate acts faster and is an alternative to antipsychotic +- benzodiazepine. It can be useful in those not responding to lithium or not tolerating it. Patients with rapid cycling pattern may paicularly benefit from valproate therapy Ref: KD Tripati 8th ed.\n\nSo the answer to this question is B"}
{"instruction": "Best investigation for BCR-ABL\nA. Flow cytometry\nB. Fluorescent in situ hybridization\nC. EISA\nD. Polymerase chain reaction", "response": "Ans. (b) Florescent in situ hybrdization(Ref: Robbins 9th/pg 170)In PCV: Reddening, swelling, and pain in the digits (erythromelalgia) may occur and are typically associated with extreme platelet elevations.\n\nSo the answer to this question is B"}
{"instruction": "Conjunctivitis is caused by all EXCEPT :\nA. CMV\nB. Enterovirus 70\nC. Coxsackies A 24\nD. Adenovirus", "response": "Ans is 'a' i.e. CMV Enterovirus 70 causes - Acute hemorrhagic conjunctivitisCoxsackie A-24 causes - Acute hemorrhagic conjunctivitisAdenovirus causes - Epidemic keratoconjunctivitis (usually by type 8, 19, 37)Acute Follicular conjunctivitis (Type 3, 4 and 11 are commonly implicated)CMV does not cause conjunctivitis\n\nSo the answer to this question is A"}
{"instruction": "A 55 year old female patient has carcinoma ovary with bilateral involvement with ascitic fluid in the abdomen. The stage is:\nA. II\nB. III\nC. IV\nD. IC", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "EYE strategy is developed for elimination of\nA. Yaws\nB. Yellow fever\nC. Leptospirosis\nD. Zika virus", "response": "Ref:Park's Textbook of Preventive and Social Medicine 25th Ed pg.310\n\nSo the answer to this question is B"}
{"instruction": "Enzyme alpha naphtyl esterase is present in ?\nA. Neutrophil\nB. Eosinophil\nC. Lymphocyte\nD. Monocyte", "response": "Ans. is d i.e., Monocyte\n\nSo the answer to this question is D"}
{"instruction": "Iron content of MALA-D -\nA. 10 mg\nB. 19-5 mg\nC. 29-5 mg\nD. 40 mg", "response": "An. is 'b' i.e., 19 5 mg o MALA-D contains -30 mg (0- 03 mg) of ethinyl estradiol.0-15 mg of desogestrel (D-norgestrel).o Each brown coloured film coated tablet contains 60 mg ferrous fu mar ate equivalent to ferrous iron 19-5 mg.\n\nSo the answer to this question is B"}
{"instruction": "Surgery of choice for chronic acquired dacryocystitis\nA. Dacryocystorhinostomy\nB. Dacryocystectomy\nC. Conjunctivo-cystorhinostomy\nD. None", "response": "Ans. is 'a' i.e., Dacryocystorhinostomy Treatment of chronic dacryocystitis Congenital Adult (acquired) Massage over lacrimal sac with antibiotic eye drops Conservative :- Massage, antibiotic drops, probing, Syringing (irrigation) with normal saline & syringing antibiotic solution Dacryocystorhinostomy (DCR) :- Surgery of hoice Probing of nasolacrimal duct Dactyocystectomy (DCT) Intubation with silicone tube Conjunctivocystorhinostom Dacryocystorhinostomy (DCR)\n\nSo the answer to this question is A"}
{"instruction": "Clue cells are seen in: March 2004\nA. Gardenella vaginalis\nB. Candida\nC. Trichomoniasis\nD. Gonorrhoea", "response": "Ans. A i.e. Gardenella vaginalis\n\nSo the answer to this question is A"}
{"instruction": "Which of the following protein can't have quaternary structure?\nA. Albumin\nB. Immunoglobulin\nC. Hemoglobulin\nD. Collagen", "response": "For quaternary structure to be present you need more than one polypeptide chain Albumin is a single polypeptide. So, the highest structure it can have is teiary structure. Hemoglobin & Immunoglobulin are tetramer - option b and c are excluded. Collagen has the quaternary structure of quaer staggered arrangement - option d is excluded. fig:-Quaer stagger arrangement of tropocollagen\n\nSo the answer to this question is A"}
{"instruction": "What is the pathology of edema in nephrotic syndrome\nA. Reduced plasma protein\nB. Sodium and water retention\nC. Increased venous pressure\nD. Hyperlipidemia", "response": "Ans. b. Sodium and water retention Sodium and water retention is the pathology of edema in nephrotic syndrome. The nephrotic syndrome is characterized by proteinuria, edema, and hypoalbuminemia. Renal sodium retention and changes in variables of the Starling equation are fundamental to the pathophysiology of nephrotic edema. There is evidence for both intravascular volume expansion (overfilling) and intravascular volume depletion (under filling) in patients with nephrosis. Microvascular fluid exchange is described using a formulation of the Starling driving forces (DP and Dp) and it is through this equation that nephrotic edema is conceptualized. Previous theories have focused on abnormalities in DP and Dp to explain nephrotic edema. Studies have shown that hypoalbuminemia (and thus Dp) is not a likely cause of edema formation in most nephrotic patients owing to a parallel decrease in interstitial fluid albumin and an increase in interstitial fluid pressure, both of which serve to maintain edema driving forces constant. There is limited evidence suggesting that abnormalities in vascular permeability (Kf and s) may contribute to edema formation. A major advance in our understanding of the pathophysiologic basis of edema formation in the nephrotic syndrome is the discovery that proteinuria can cause primary renal sodium retention through ENaC activation. This mechanism is likely active in all patients with nephrotic syndrome, regardless of their intravascular volume status. Other causes of primary renal sodium retention include increased renal efferent sympathetic nerve activity, ANPase, and in the expression and activity of the Ne--le in the collecting duct in animal models. Fuhermore, excess serum vasopressin levels have been found to contribute to free water retention in some patients with the nephrotic syndrome.\"- Eric Siddall and Jai Radhakrishnan. The pathophysiology of edema formation in the nephrotic syndrome Nephrotic Syndrome Manifestations of Nephrotic Syndrome 1. Massive proteinuria, with the daily loss of 3.5 gm or more of proteinQ 2. Hypoalbuminemia, with plasma albumin levelsQ 3. Generalized edemaQ 4. Hyperlipidemia and lipiduriaQ Pathophysiology: Renal sodium retention and changes in variables of the Starling equation are fundamental to the pathophysiology of nephrotic edema. There is evidence for both intravascular volume expansion (overfilling) and intravascular volume depletion (under filling) in patients with nephrosis. Nephrotic Syndrome Mechanisms of Sodium Retention in the Nephrotic Syndrome Increased angiotensin 11-independent afferent and efferent aeriolar tone because of increased efferent sympathetic nerve activity. Tubular resistance to atrial natriuretic peptide (ANP). Increased number of open epithelial sodium channel (ENaC) channels in the coical collecting duct due to proteolytic activation of ENaC by plasmin. Increased number and activity of coical collecting duct Na/K ATPase channels Most impoant facts about Nephrotic syndrome The lipid appears in the urine either as free fat or as oval fat bodies, representing lipoprotein resorbed by tubular epithelial cells and then shed along with the degenerated cells. Most proteins are decreased in nephrotic syndrome except Fibrinogen and lipoproteins, due to increased synthesis. Proteins decreased Consequence Albumin Edema due to hypoalbuminemiaQ Transferrin Iron resistant microcytic anemiaQ Cholecalciferol binding proteins HypocalcemiaQ Thyroxin binding globulin Decreased thyroxin (Hypothyroid state)Q IgG Increased susceptibility of infectionsQ Renal vein thrombosis is paicularly common (up to 40%) in patients with nephrotic syndrome due to membranous glomerulopathy, memranoproliferative glomerulonephritis, and AmyloidosisQ. As a consequence of hypercoagulability and changes in proteins, patients can develop spontaneous peripheral aerial or venous thrombosis, renal vein thrombosis, and pulmonary embolismQ\n\nSo the answer to this question is B"}
{"instruction": "The weakness of Vastus Medialis causes\nA. Patellar Clunk Syndrome\nB. Medial dislocation of patella\nC. Lateral dislocation of patella\nD. Weakness in abduction at Hip joint", "response": "The fibers of Vastus medialis are attached medial to cafue half of patella. They prevent lateral displacement of patella.\n\nSo the answer to this question is C"}
{"instruction": "True about mitochondrial DNA:\n(A)Linear\n(B)Circular\n(C)Transmitted by mother only\n(D)Transmitted by both parents\n(E)Contains less gene than nuclear DNA\nA. BCE\nB. ABD\nC. DAE\nD. CAB", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "A 33 year old lady present! with polydipsia and polyuria. Har symptoms staed soon after a road traffic accident 6 months ago. The blood pressure is 120/80 mm Hg with no postural drop. The daily urinary output Is 6-8 liters. Investigation showed, Na 130 mEq/L, KJ.5 mEq/L, urea 15mg/dL, sugar-65 mg/dL. The plasma osmolality is 268 mosmol/L and urine osmolatity 45 mosmol/L. The most likely diagnosis is-\nA. Central diabetes insipidus\nB. Nephrogenic diabetes insipidus\nC. Resolving acute tubular necrosis\nD. Psychogenic polydipsia", "response": "here there is no thirst and polydipsia due to psychosis ( Harrison 17 pg 2219)\n\nSo the answer to this question is D"}
{"instruction": "All are adulterants of heroin, except\nA. Chalk powder\nB. Quinine\nC. Charcoal\nD. Fructose", "response": "Adulterants of heroin are sucrose, dextrose, fructose, lactose, mannitol, starches, inositol, chalk powder, milk powder, talcum powder, flour, quinine, procaine, lidocaine, acetyl procaine, methaphyrilene and caffeine.\n\nSo the answer to this question is C"}
{"instruction": "Extended spatulation of GIC:\nA. Prolongs the setting time\nB. Decreases the setting time\nC. Does not alter the setting time\nD. Any of the above", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A 8-year old child was injected contrast in hand for CECT chest. Immediately he developed swelling in the arm which gradually increased. After 4 hours, there was numbness and pain, and he was not allowing the doctor to flex the hand. Pulse is present. What should be done?\nA. High dose prednisolone\nB. Arterial thrombectomy\nC. Immediate fasciotomy\nD. Angiography", "response": "Ans. c. Immediate fasciotomy (Ref: Rockwood 6/e p2127-2129; Apley 9/e p714, 8/e p728-729)Immediate development of swelling in the arm after contrast injection with numbness and pain is highly suggestive of compartment syndrome due to extravasation of contrast medium. Best treatment is immediate fasciotomy, so that contrast medium and fluid can be drained and patient can be relieved.Extravasation of Contrast and Compartment SyndromeExtravasation of contrast is a possible complication of imaging studies performed with contrast.Most cases of subcutaneous extravasation occur due to small volumes of extravasation of contrast causing pain, minimum swelling and localized erythema, that is rapidly resolved.If larger volumes are extravasated, extensive tissue and skin necrosis may occur. Compartment syndrome is a very rare complication.Acute compartment syndrome occurs when the tissue pressure within a closed muscle compartment exceeds the perfusion pressure and results in nerve and muscle ischemiaQ.It typically occurs subsequent to a traumatic event, most commonly a fractureQ.Clinical Features:Classic features: Pain (bursting sensation), altered sensibility and paresis (or more usually, weakness in muscle contraction).Ischemic muscle is highly sensitive to stretch.If the limb is unduly painful, swollen or tense, the muscles (which may be tender) should be tested by stretching them.Diagnosis:Confirmation of the diagnosis can be made by measuring the intra-compartmental pressure.Treatment:Emergency fasciotomyQ\n\nSo the answer to this question is C"}
{"instruction": "The neotatal kidney achieves concertratiug ability equivalent to adult's kidney by -\nA. One year of age\nB. Eighteen months of age\nC. Three to six months of age\nD. Just before puberty", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Drugs used in GTCS is/are:\nA. Ethosuximide\nB. Sodium-valproate\nC. Lamotrigine\nD. Propofol", "response": "Carbamazepine, phenytoin are the first line drugs in GTCS. Valporate, phenobarbitone are the second choice of drugs. Alternative/add on drugs are Lamotrigine, Gabapentine, topiramate, methadone, levetiracetam. Ethosuximide is used in absent seizures. Propofol is a general anesthetic. Ref: K D Tripati 8th edition Table 30.1\n\nSo the answer to this question is B"}
{"instruction": "in sodomy passive agent adult is named?\nA. catamite\nB. paedophile\nC. gerantophillia\nD. peadestry", "response": "SODOMY: Other names: 1. Greek love 2. Buggery 3. grantophilia -- when passive agent is adult 4. Paederasty -- when passive agent is child. Paedophil - Active agent - sexual activity with children below sexual age Catamite -- Passive agent -sexual activity with children below sexual age ref : narayanareddy\n\nSo the answer to this question is C"}
{"instruction": "When was ARDS first described?\nA. 1962\nB. 1967\nC. 1965\nD. 1964", "response": "ARDS was first described in 1967 by ashbaugh & petty. It was defined in 1994 by American European consensus.\n\nSo the answer to this question is B"}
{"instruction": "Aspirin acts by\nA. Cyclo oxygenase pathway\nB. Lipo oxygenase pathway\nC. Membrane phospholipases\nD. Cyclic AMP", "response": "(A) Cyclo oxygenase pathway # ASPIRIN prduces its antithrombotic effect by irreversibly acetylating and inhibiting platelet cyclo-oxygenase (COX)-1, a critical enzyme in the biosynthesis of thromboxane A2. At high doses, aspirin also inhibits COX-2, an inducible COX isoform found in endothelial cells and inflammatory cells.> Analgesic action of aspirin is mainly due to obstructing of peripheral pain receptors and prevention of prostaglandin mediated sensitization of nerve endings.> Aspirin & some NSAIDs blocked PG generation by inhibiting cyclooxygenase (COX) enzyme.> Aspirin, even in small doses, irreversibly inhibit TXA2 synthesis> Aspirin resets the hypothalamic thermostat & rapidly reduces fever by promoting heat loss but does not decrease heat production\n\nSo the answer to this question is A"}
{"instruction": "Vocal cord palsy in thyroid surgery is due to injury to\nA. Superficial laryngeal nerve\nB. Recurrent laryngeal nerve\nC. Ansa cervicalis\nD. Vagus nerve", "response": "Reccurent laryngeal nerve injury is classically described as a paralyzed vocal cord with loss of movement from the midline (supplies all the intrinsic muscles of the larynx, except cricothyroid muscles). Injury to the external branch of the superior laryngeal nerve leads to loss of tension in the vocal cord (supplies cricothyroid) with diminished power and range in the voice Source : Bailey and Love 26th edition Pg: 762\n\nSo the answer to this question is B"}
{"instruction": "True regarding rhinitis medica mentosa is/are?\nA. Caused by 132 - agonist sprays\nB. Caused by coicosteroids spray\nC. Spray itself can cause terbinate hyperophy\nD. There is inferior terbinate hyperophy", "response": "Answer- D. There is inferior terbinate hyperophyIt is a condition characterized by nasal congestion that is triggered by the extended use of topical decongestants and ceain oral medications that constrict blood vessels in the lining of the nose: recreational use of intranasal cocaine malt also cause a similar condition.The classic Presentation is that the nasal mucous membranes appear \"beefy-red,\" inflamed, and may show areas of punctate bleeding and scant mucus.The swelling of the nasal Passages caused by rebound congestion may eventually result in permanent turbinate hyperophy.ToPical intranasal coicosteroids aPPear to have beneft in rhinitis medicamentosa to control the inflammation caused by chronic vasoconstrictor use.\n\nSo the answer to this question is D"}
{"instruction": "WHO recommend evaluation of child vaccination in age group?\nA. 0-12m\nB. 6-12 m\nC. 12-23 m\nD. 9-12 m", "response": ".in case of mass immunisation programmes implemented by WHO ,including the immunisation programmes ,evaluation of the aaccessibility of such programmes to the populations is usually done among children of age 12 to 23 months. ref:park&;s textbook,22 nd ed,pg 189\n\nSo the answer to this question is C"}
{"instruction": "A 45-year-old male having a long history of cigarette smoking presented with gangrene of left foot. An amputation of the left foot was done. Representative sections from the specimen revealed presence of aerial thrombus with neutrophilic infliltrate in the aerial wall. The inflammation also extended into the neighbouring veins and nerves. The most probable diagnosis is:\nA. Takayasu aeritis\nB. Giant cell aeis\nC. Hypersensitivity angitis\nD. Thrmoboangitis obliterans", "response": "Ans. is 'd' i.e. Thromboangitis obliterans About other options Takayasu's Aeritis : - does not involve the peripheral limb vessels. Its an inflammatory and stenotic disease of medium and large-sized aeries characterized by a strong predilection for the aoic arch and its branches (thus also k/a aoic arch syndrome) Giant cell aeritis: - also k/a cranial aeritis or temporal aeritis is a systemic chronic inflammatory vascular disease with many characteristics similar to Takayasu disease involves medium and large sized aeries, characteristically one or more branches of the carotid aery, paicularly the temporal aery. Hypersensitivity angitis (Ref. Harrison 16/e, p 2011; Internet: emedicine) hypersensitivity angitis also k/a cutaneous vasculitis or leukocytoclastic vasculitis typically involves the small vessels of skin. Post capillary venules are most commonly involved vessels; capillaries and aerioles are involved less frequently. its the most commonly encountered vasculitis in clinical practice. the hallmark of idiopathic cutaneous vasculitis is the predominance of skin involvement. Skin lesions typically are palpable purpura.\n\nSo the answer to this question is D"}
{"instruction": "Buerger's Disease is associated with -\nA. Alcoholism\nB. Smoking\nC. Trauma\nD. Cold environment", "response": "Thromboangiitis obliterans (Buerger disease) \n\nThromboangiitis obliterans is a distinctive disease that is characterized by segmental, thrombosing acute and chronic inflammation of medium-sized and small-sized arteries, and sometimes secondarily extending to veins and nerves.\nThromboangiitis obliterans occurs almost exclusively among heavy-cigarette-smoking persons.\nIt is more common in men but the incidence is increasing in women because of increasing smoking habit in women.\nBuerger disease is associated with HLA -5 and HLA-A9.\nIn thromboangiitis obliterans there is acute and chronic segmental inflammation of vessels with accompanied thrombosis in the lumen.\nTypically, the thrombus contains microabscesses with a central focus of neutrophils surrounded by granulomatous inflammation.\nLater, the inflammatory process extends into contiguous veins and nerves and in time all three structures (arteries, veins and nerves) become encased in fibrous tissue, a characteristic that is very rare with another form of vasculitis.\n\nClinical manifestations\n\nThrombangiitis obliterans affects vessels of upper and lower extremities.\nSymptoms are due to vascular insufficiency, i.e. Ischemia of toes, feet and fingers that can lead to ulcer and frank gangrene.\nDue to neural involvement, there may be severe pain, even at rest.\n\nBuerger disease Vs atherosclerosis\n\nBuerger disease is almost exclusively associated with smoking. Atherosclerosis is also associated with smoking, but it has other predisposing conditions also, e.g. diabetes, hypertension, hypercholesterolemia etc.\nBurger disease affects smaller arteries. Atherosclerosis involves larger and medium-sized arteries.\nIn Atherosclerosis, pain occurs on movement due to vascular insufficiency, while in Buerger disease, pain occurs at rest also due to neural involvement.\n\nSo the answer to this question is B"}
{"instruction": "The pea-orbital view is carried out for -\nA. Petrous apex\nB. Mastoid process\nC. Bilateral mastoid pathologies\nD. Internal auditory meatus", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "SRY gene is located on -\nA. Short arm of X chromosome\nB. Long arm of X chromosome\nC. Short arm of Y chromosome\nD. Long arm of Y chromosome", "response": "Ans. is 'c' i.e., Short arm of Y chromosome o Y chromosome is necessary for development of Male :# The SRY gene present on the distal short arm of the Y chromosome is responsible for testicular development.\n\nSo the answer to this question is C"}
{"instruction": "True about critical path method are all except\nA. Network analysis\nB. Longest path\nC. Cannot be delayed\nD. Shoest path", "response": "Ans. is 'd' i.e., Shoest path Network analysis A network analysis is a graphic of all events and activities to be completed in order to reach an end objective. It brings greater discipline in planning. The two common types of network technique are : a) Programme Evaluation and Review technique (PE) b) Critical Path method (CPM) Programme Evaluation and Review technique (PE) PE is a management technique which makes possible more detailed planing and more comprehensive supervision. PE is method to analyze the involved tasks in completing a given project, especially the time needed to complete each task, and identifying the minimum time needed to complete the total project. The essence of PE is to construct an arrow diagram, which represents the logical sequence in which events must take place. It is possible with such a diagram to calculate the time by which each activity must be completed, and to identify those activities that are critical. Critical path method (CPM) The longest path of the network is called the critical path. Critical path method determines the activities of a project which are critical and are given longest path. Other activities are total float, i.e. they can be delayed without making the project longer. Any delay in activity on the critical path results in delay of the project. o In the above figure, the longest path is from equipment ordered to equipment installed. That means, this is the critical path and installating of equiment is the most critical step (taking 10 months). o Other activities are total float, i.e. they can be delayed for sometimes without delaying the project.\n\nSo the answer to this question is D"}
{"instruction": "A 64-year-old woman with a longstanding diagnosis of mixed connective tissue disorder and pulmonary fibrosis is admitted with symptoms of recent increase in postprandrial retrosternal distress, heaburn, and nocturnal cough. Her ECG shows nonspecific T-wave changes and she finds minimal relief of her symptoms with sublingual NTG. On examination, she is not in any acute distress and is afebrile. Chest exam reveals bilateral crackles. CXR is shown . The cause of this patient's acute symptoms may be\nA. Large hiatal hernia\nB. Mediastinal abscess\nC. Pneumopericardium\nD. Ileus", "response": "This chest x-ray shows a large, air-containing, hyperlucent opacity in the middle poion of the thorax representing a large hernia in the mediastinum. The lung parenchyma shows increased linear and reticular markings, predominantly in the lower zones, consistent with the diagnosis of interstitial disease. The symptoms described are due to an acid reflux disorder, and the chest x-ray shows a large hiatal hernia. Hiatal hernia represents herniation of the stomach through the esophageal hiatus and is frequently found in adults. It occurs as an oval retrocardiac mass, most often with an air-fluid level, and is due to laxity, stretching, and widening of the hiatus. Obesity and increased intraabdominal pressures are contributing factors. The majority of hernias spontaneously reduce and are called sliding hernias. A paraesophageal hernia occurs when the stomach herniates next to the distal esophagus. Patients may be asymptomatic or may have symptoms of reflux.\n\nSo the answer to this question is A"}
{"instruction": "Defficiency of which element can lead to syndrome of growth failure, anaemia and hypogonadism –\nA. Calcium\nB. Copper\nC. Zinc\nD. Magnesium", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which amongst the following biological agents has the highest potential for use as a vector in bioterrorism\nA. Plague (Yersinia pestis)\nB. Small pox (variola major)\nC. Botulism (Cl. Botulinum)\nD. Brucellosis (Brucella sp)", "response": "Plague - this disease has a history of its use in biological warfare dating back many centuries and is considered a thread due to its ease of culture and ability to remain in circulation among local rodents for a long period of time. Ref: Baveja textbook of microbiology; 4th edition\n\nSo the answer to this question is A"}
{"instruction": "Thermo philus sachari causes ?\nA. Bagassosis\nB. Siderosis\nC. Byssinosis\nD. Anthracosis", "response": "Ans. is 'a' i.e., Bagassosis Bagassosiso Bagassosis is the name given to an occupational disease of the lung caused by inhalation of bagasse or sugar- cane dust.o Bagassosis has been shown to be due to a termophilic actinomycete - Thermoactinomyces sacchari.Anthracosis-Coal dustSilicosis-SilicaSiderosis-ironByssinosis-Cotton dustFarmer's lung-Hay or grain dustSequousis-Moldy red wood saw dustSuberosis-Moldy cork dustDetergent worker's lung-Enzyme additivesBaggassosis-Sugarcane dust\n\nSo the answer to this question is A"}
{"instruction": "A 26 year old female patient reports to the clinic with gummy smile. The complaint of this patient can be described best by which of the following?\nA. Divergence\nB. Roll\nC. Pitch\nD. Yaw", "response": "For this girl, who does not have anterior open bite despite her long-face skeletal pattern, the entire dentition is translated down, but a downward pitch posteriorly can be observed clinically. Note that the esthetic line of the dentition tilts down posteriorly relative to the intercommissure line and that there is greater exposure of gingiva posteriorly than anteriorly. \nAn excessive upward/downward rotation of the dentition relative to the lips and cheeks would be noted as pitch (up or down, in front or back). Pitch of the dentition relative to the facial soft tissues must be evaluated on clinical examination.\nPitch is revealed as the orientation of the palatal, occlusal and mandibular planes relative to the true horizontal.\nRoll, which is analogous to the banking of an airplane, is described as rotation up or down on one side or the other.\nRotation of the jaw or dentition to one side or the other, around a vertical axis, produces a skeletal or dental midline discrepancy that is best described as yaw.\n\nSo the answer to this question is C"}
{"instruction": "The amount of sewage flowing in a system in 24 hours is called:\nA. Sewage rate\nB. Dry weather flow\nC. RCA index\nD. Sludge", "response": "Sewage is wastewater from a community, containing solid and liquid excreta, derived from houses, street and yard washings, factories and industries. It resembles dirty water with an unpleasant smell. The term \"sullage\" is applied to wastewater which does not contain human excreta, e.g., wastewater from kitchens and bathrooms. \nThe amount of sewage that flows in the sewers depends upon: \n\nHabits of the people: If people use more water, there will be more sewage. \nTime of day: Sewage does not flow uniformly throughout the day. \n\nThe average amount of sewage which flows through the sewerage system in 24 hours is called the \"dry weather flow.\"\nPark's textbook of preventive and social medicine 23rd edition\nPage.no.762\n\nSo the answer to this question is B"}
{"instruction": "Busacca and Koeppe nodules are characteristically seen in\nA. Residual uveitis\nB. Recurrent uveitis\nC. Granulomatous uveitis\nD. Non-granulomatous uveitis", "response": "Non granulomatous uveitisGranulomatous uveitisBehcet disease HLA - B27 associated ankylosing spondylitis Reiter syndrome Inflammatory bowel disease Idiopathic Infections - Lyme disease, Kawasaki disease, rickettsia, mumps, measles, Chlamydia, influenza, adenovirusPsoriatic ahritis Secondary syphilis Trauma UGH syndrome Glaucomatocyclitic crisis Lens induced uveitis Corneal graft rejection Sarcoidosis Sympathetic ophthalmitis Phacoanaphylaxis Vogt - Koyanagi - Harada syndrome Infections - Tuberculosis, Leprosy, Syphilis, Leptospirosis, Brucellosis, Herpes simplex, herpes zoster, varicella, systemic mycosis Koeppe' s nodules- situated at papillary border - posterior synechiae smaller in size Busacca' s nodules- situated at the collarette; larger in size(Refer: AH Khurana, Comprehensive Textbook of Ophthalmology,5thedition, pg no: 149)\n\nSo the answer to this question is C"}
{"instruction": "True regarding anaemia of chronic ds. are A/E -\nA. Decreased TIBC\nB. Increased macrophage iron in marrow\nC. Decrease serum ferritin level\nD. Decreased serum iron levels", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Marked deformity is due to\nA. Radial nerve\nB. Posterior interosseous nerve\nC. Ulnar nerve\nD. Median nerve", "response": "Given action - wrist drop Due to radial nerve injury PIN palsy causes - finger drop not wrist drop\n\nSo the answer to this question is A"}
{"instruction": "Preauricular lymphadenopathy not seen in\nA. Chlamydial conjunctivitis\nB. Herpes simplex keratoconjunctivitis\nC. Atopic conjunctivitis\nD. Staphylococcal conjunctivitis", "response": "Ans. is 'c' i.e., Atopic conjunctivitiso Preauricular lymphadenopathy is seen in -Bacteral conjunctivitis (staphylococcal, gonococcal, pneumococcal).Viral conjunctivitis (Herpes simplex, epidemic keratoconjunctivitis).Chlamydial conjunctivitiso It is not seen in allergic (atopic) conjunctivitis.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is true about parasympathetic nervous system?\nA. Ach is transmitter at both pre & post synaptic junction\nB. It causes dilatation of skeletal muscles\nC. Post-ganglionic fibres are longer than pre ganglionic fibres\nD. Noradrenalin is the neurotransmitter at post ganglionic junction", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "All of the following statement are true about Staphylococci except :\nA. A majority of infection caused by coagulase (-) ve Staph. are due to staph epidermidis\nB. β -Lactmase production is under plasmid control\nC. Expression of methicillin resistance in Staphylococcus aureus increases when it is incubated at 37 degree C on blood agar\nD. Methicillin resistance in Staph. aureus is independent of b-Lactmase production", "response": "“Methicillin resistance is expressed more when Staph. is incubated at 30 0 C than at 37 0 C.”\nPenicillin resistance in Staphylococcus is by following ways :\n1. Production of β lactmase :\n\nPlasmid mediated inducible enzyme which is transmitted by transduction (more commonly) or conjugation.\n\nNow only <5% of strains of staph are sensitive to penicillin.\n\nHospital strains mostly form type A penicillinase.\nSame plasmid carry genes for resistance to tetracycline, Erythromycin, Aminolgycoside too.\n\n2. Altered penicillin binding protein :\n\nDue to production of novel penicillin binding protein PBP2a. The protein is synthesized by mecAgene.\nChromosomally mediated expressed more at 30 0 C than at 37 0 C.\nResponsible for resistance against penicillinase resistant penicillin such as methicilin, cloxacillin. Strains are called MRSA (Methicillin resistant Staph. aureus).\n\n3. Tolerance to pencillin :\n\nBacteria only inhibited not killed.\n\nSo the answer to this question is C"}
{"instruction": "True about consensual light reflex is -\nA. Decussation of some fibres at optic chiasma is responsible for the consensual light reflex\nB. Oculomotor nerve carries afferent signals\nC. Decussation occurs at ciliary ganglion\nD. All are true", "response": "Ans. is 'a' i.e., Decussation of some fibres at optic chiasma is responsible for the consensual light reflex Pupillary light reflex (Light reflex)* Pupillary light reflex refers to constriction of pupil in response to light. When a sudden light is thrown into the eye, the pupil of that eye constricts (direct light reflex). The pupil of other eye also constricts (Consensual or indirect light reflex). The pathway for pupillary reflex involve (sequentialy): -i) Afferent: - Retina - Optic nerve- Optic chiasma - Optic tract - Pretectal nucleus - Internuncial neurons - EWN (Edinger westphal nucleus).ii) Efferent: - Edinger westphal nucleus- Occulomotor (3rd) nerve- Ciliary ganglion - Short ciliary nerve - Sphinctor pupillae.* Some fibres decussate at optic chiasma and go to contralateral side which is responsible for consensual or indirect light reflex. From retina upto the Pretectal nucleus is afferent pathway and from EWN of third nerve to sphincter pupillae is efferent pathway.\n\nSo the answer to this question is A"}
{"instruction": "HLA-I is present on ?\nA. All nucleated cells\nB. Only on cells of immune system\nC. Only on B-cells\nD. Only on T-cells", "response": "Ans. is 'a' i.e., All nucleated cells\n\nSo the answer to this question is A"}
{"instruction": "A person has an injury in the forefinger with glass and it is suspected that he has a retained piece of glass in his finger. What is the first investigation you will do?\nA. MRI\nB. CT scan\nC. Plain radiograph\nD. Ultrasonography", "response": "Ans. c. Plain radiograph 'Plain films can be clinically beneficial in locating glass foreign bodies in deep wounds with or without exploration.' Glass Foreign Body Patients with glass embedded in a wound are more likely to repo the sensation of foreign bodies. In patients with sensation of foreign body, superficial wounds that have been adequately explored do not require radiography. Plain films can be clinically beneficial in locating glass foreign bodies in deep wounds with or without explorationQ In patients without sensation, the history can guide the decision for fuher investigation. All glass is radiopaque; however, there is limited ability for radiography to detect glass fragments smaller than 2 mm. Glass is ine and can be left in place if it is difficult to locate or remove.\n\nSo the answer to this question is C"}
{"instruction": "Na/K pump which enzyme is used -\nA. ATPase\nB. GTPase\nC. Acetyl CoA\nD. None of these", "response": "Sodium-potassium pump is the most important pump for primary active transport Q in the body.\nNa + -K + pump is an electrogenic pump Q that is responsible for maintaining the Na + and K + concentration difference across the cell membrane.\nNa + - K + pump extrudes 3 Na + out from the cell and at the same time pump 2K + into the cell Q , i.e., Coupling ratio of Na + K + pump is 3 : 2 Q . Na + and K + transport by Na + - K + pump is primary active transport Q and both Na + and K + are transported against concentration gradient Q\n(intracellular fluid has high concentration of K + and ECF has high concentration of Na - ).\nNa + K + pump uses energy by hydrolysing ATP; this pump contains ATPase activity Q.\n\nNa + - K + pump is a carrier protein which is a heterodimer 0 made up of two separate globular proteins: a larger one called α-subunit with a molecular weight of 100,000 and a smaller one called β-subunit, with a molecular weight of about 55,000. Both α- and β- subunits span across the membrane with intracellular and extracellular sites. \nNa + and K + transport occurs through a-subunits.\n\nIntracellular portion of a-subunit has three Na + binding sites (three receptor sites for Na + ), an ATP binding site, a phosphorylating site and ATPase activity Q.\nExtracellular portion Q has two K + binding sites (two receptor sites for K + ), and an ouabain binding site Q.\nThe β- subunit has three extracellular glycosylation sites Q, all of which appear to have attached carbohydrate residue.\n\nThe Na + - K + pump is an electrogenic pump Q since it produces a net movement of positive charge out of the cell.\n\nThus, besides maintaining the ionic composition of the intracellular fluid, the Na + - K + pump helps to maintain the electrochemical potential difference across the cell membrane.\nHowever, Na + - K + pump contributes only 4 millivolts to the total resting membrane potential of 90 volts which is almost negligible Q.\n\nActive transport of Na+ and K+ - is one of the major energy-using processes in the body.\n\nOn average, it accounts for about 24% of the energy utilized by cell and in neurons, it accounts for 70%. o Activity of Na+ - K+ pump is stimulated by the increased intracellular concentration of Na +,\nthyroid hormones, aldosterone and insulin. Pump activity is inhibited by CHF, CRF, digoxin toxicity and dopamine.\n\nSo the answer to this question is A"}
{"instruction": "In microangiopathic hemolytic anemia, cells seen are -a) Fragmented RBC'sb) Schistocytesc) Spherocytesd) Anisocytes\nA. ac\nB. ab\nC. ad\nD. bc", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following causes the majority of UTIs in hospitalized patients?\nA. Lack of fluid intake\nB. Inadequate perineal care\nC. Invasive procedures\nD. Immunosuppression", "response": "Invasive procedures such as catheterization can introduce bacteria into the urinary tract.\nA lack of fluid intake could cause the concentration of urine, but wouldn’t necessarily cause infection.\n\nSo the answer to this question is C"}
{"instruction": "Egg shell calcification is seen in all except:\nA. Silicosis\nB. Sarcoidosis\nC. Coal worker's pneumoconiosis\nD. Osteogenic sarcoma", "response": "Ans: d (Osteogenic sarcoma)Egg shell calcification of lymph node in chest X-ray seen in:* Silicosis* Sarcoidosis* Coal worker's pneumoconiosis* Lymphoma following radiotherapy* Histoplasmosis* Amyloidosis* Scleroderma\n\nSo the answer to this question is D"}
{"instruction": "Least common site for lung abcess is\nA. Right upper lobe\nB. Right lower lobe\nC. Left lower lobe\nD. Left upper lobe", "response": "About the site of lung abscess associated with aspiration . \"Because of the effect of gravity, foci of infection tend to develop in the subpleural regions of the superior segments of the lower lobes and in the posterior segments of the upper lobes. The right lung is involved more frequently, presumably because of the less acute angle of the right main bronhus. thus the right upper and lower lobes are the most commonly affected, followed by the left lower lobe and right middle lobe.\" Ref : Schwaz 9/e p.549\n\nSo the answer to this question is D"}
{"instruction": "As per CEAP classification healed venous ulcer is\nA. C2\nB. C3\nC. C4\nD. C5", "response": "CEAP (Clinical-aEtiology-Anatomy-Pathophysiology) classification for chronic venous disorders Clinical classificationC0: no signs of venous disease;C1: telangectasia or reticular veins;C2: varicose veins;C3: oedema;C4a: pigmentation or eczema (some include malleolar flare in this category);C4b: lipodermatosclerosis or atrophie blanche;C5: healed venous ulcer;C6: active venous ulcer.Etiological classificationEc: congenitalEp: primaryEs: secondary (post-thrombotic)En: no venous cause identified.Anatomical classificationAs: superficial veinsAp: perforator veinsAd: deep veinsAn: no venous location identified.Pathophysiological classificationPr: refluxPo: obstructionPr,o: reflux and obstructionPn: no venous pathophysiology identifiable.Ref: Bailey and love pg: 974\n\nSo the answer to this question is D"}
{"instruction": "Hiatus semilunaris is present in?\nA. Superior meatus\nB. Middle meatus\nC. Inferior meatus\nD. Spheno-ethmoidal recess", "response": "Middle meatus: Uncinate process is a hook-like structure running in from anterosuperior to the posteroinferior direction in the middle meatus. It&;s postero superior border is sharp and runs parallel to the anterior border of bulla ethmoidalis. This gap between the two is called hiatus semilunaris .it is two-dimensional space of 1-2 mm width. (Ref: Diseases of Ear, Nose and Throat and head and neck surgery, Dhingra 7th edition, Pg no. 150)\n\nSo the answer to this question is B"}
{"instruction": "Best parameter by USG to assess fetal maturity:\nA. Crown rump length at 16 weeks\nB. Head circumference at 36 weeks\nC. Biparietel diameter at 12 weeks\nD. Femur length at 12 weeks", "response": "Ans. Biparietel diameter at 12 weeks\n\nSo the answer to this question is C"}
{"instruction": "Which is not a feature of MCA blockage?\nA. Anosognosia\nB. Apraxia\nC. Dysahria\nD. Abulia", "response": "Abulia is a feature of ACA territory stroke Features of entire MCA blockage at the origin: Acalculia, Agraphia, Finger agnosia, & Global aphasia is present due to the involvement of dominant lobe. Anosognosia, constructional apraxia, and neglect are found due to the involvement of non-dominant lobe. Contralateral hemiplegia Hemi-anesthesia Homonymous hemianopia Dysahria due to facial weakness.\n\nSo the answer to this question is D"}
{"instruction": "Coxsackie virus is implicated in\nA. Herpes zoster\nB. Measles\nC. Small pox\nD. Hand, Mouth & foot disease", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "An 18-year-old man, of Italian extraction, is found to have a hypochromic microcytic anemia of 10 g/dL. In addition, there are a fair number of anisocytosis, poikilocytosis, and target cells seen on the blood film. The WBC is 9500/mL, the platelet count is 240,000/mL, and the reticulocyte count is 7%. The spleen is palpated 5 cm below the left costal margin. Which of the following is the most likely diagnosis?\nA. sickle cell trait\nB. thalassemia minor\nC. HbS-C disease\nD. sideroblastic anemia", "response": "Thalassemia minor usually represents a heterozygous state and is often asymptomatic. Symptoms may develop during periods of stress such as pregnancy or severe infection. Hemoglobin values are usually in the 9-11 g/dL range. The red cells are small and poorly hemoglobinized.\n\nSo the answer to this question is B"}
{"instruction": "Immunoglobulin secreted by fetus as primary response\nA. IgA\nB. IgM\nC. IgG\nD. IgD", "response": "Ans. is 'b' i.e., IgM IgM is the first immunoglobulin class produced in a primary response to an antigen. IgM antibodies are relatively sho lived, disappearing earlier than IgG. IgM is the earliest immunoglobulin to be synthesized by the fetus beginning by about 20 weeks of age. IgM can not cross the placenta. The presence of IgM in the fetus or newborn indicates intrauterine infection and its detection is useful in the diagnosis of congenital infections such as Toxoplasmosis, syphilis, rubella, cytomegalovirus infection and HIV infection.\n\nSo the answer to this question is B"}
{"instruction": "Intracellular calcification begins in\nA. Mitochondria\nB. Golgi body\nC. Nucleus\nD. ER", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Upper Lid Retractors include ?\nA. Muller muscle and superior rectus\nB. Levator palpabrae superioris and superior oblique\nC. Superior oblique and superior rectus\nD. Levator palpabrae superioris & muller muscle", "response": "Ans. is 'd' i.e., Levator palpabrae superioris & muller muscleo The levator palpebrae superioris is the important upper eye lid retractor. Injury or weakness to this muscle leads to ptosis.o This muscle is supplied by occulomotor (3rd) nerve.o Deep part of the elevator muscle is the Muller's muscle, which is sympathetically innvervated.o In hyperthyroidism, sensitization of the Muller muscle leads to upper eyelid retraction and pseudoproptosis,o On the other hand, in Horner's syndrome loss of this muscle action leads to ptosis.o The capsulopalpebral fascia assists in lower eyelid retraction and coordinates with eyeball movement. It arises as an extension of the inferior rectus and inserts into the lower edge of the lower tarsus and the adjacent orbital septum.\n\nSo the answer to this question is D"}
{"instruction": "Massive bleeding per rectum in a 70 yr old patient is due to :\nA. Diveiculosis\nB. Carcinoma colon\nC. Colitis\nD. Polyps", "response": "Answer is A (Diveiculosis) Although anorectal disease is the most commonm cause of bleeding per rectum in the elderly, these lesions usually cause small amount of 'bright red' blood on the surface of stool and toilet tissue (small bleeds). Diveiculosis may give rise to massive colonic bleed. The usual presentation of diveicular hemorrhage is that of brisk painless passage of a maroon coloured stool. It is the most common cause of massive bleeding per rectum in those above 55 years of aze and hence the answer here. Angiodysplasias and diveiculosis were the most common reasons for LGIB Common causes of Acute Lower G.I. bleeding over 55 years of age are : Anorectal disease : Haemorrhoids and fissures Diveiculosis Angiodysplasia Polyps and Cancer Enterocolitis\n\nSo the answer to this question is A"}
{"instruction": "A patient on amphotericin B has weakness and cramps. Serum potassium = 2.3 mEq/dl. Calculate the total parenteral potassium supplementation to be given to the patient over the next 24 hous?\nA. 40mEq\nB. 80mEq\nC. 100mEq\nD. 140mEq", "response": "Ans. is 'd' i.e., 140 mEq o For causing a rise of potassium in blood by ImEq/dl, 200 mEq of potassium supplementation is required.o Since symptoms develop with serum potassium less than 3 mEq/dl, the clinician should give sufficient potassium to rise upto 3 mEq/dl via intravenous route. Following this oral potassium supplement will sufficeo Hence mathematically speaking this patient requires approximately 0.7 mEq/dl of potassium to rise in the blood leading to a requirement of0.7 * 200 = 140 mEq over 24 hours\n\nSo the answer to this question is D"}
{"instruction": "Which is seen in nephrotic syndrome-\nA. Low serum calcium\nB. Raised AT-III in serum\nC. LOw serum lipids\nD. Decreased Platelet activation", "response": "Nephrotic syndrome Results in Hyperlipidemia Urine loss of antithrombin III increased platelet aggregation Hypocalcemia is seen in severe NS Ref:Harrison 20 th edition, pg no. 293\n\nSo the answer to this question is A"}
{"instruction": "Cellular immunity is induced by-\nA. NK-cells\nB. Dendritic-cells\nC. TH1-cells\nD. TH2-cells", "response": "Cell mediated immunity (cellular immunity) is induced by TH-1 cells.\n\nSo the answer to this question is C"}
{"instruction": "Contraceptive efficacy expressed as\nA. 100 women months\nB. 1000 women years\nC. 100 women years\nD. 10 women years", "response": "Contraceptive efficacy is assessed by measuring the number of unplanned pregnancies that occur during a specified period of exposure and use of contraceptive methods.Contraceptive efficacy is measured using Pearl index and life table analysis. Pearl index is number of failure per 100 woman-years of exposure (HWY) HWY=total accidental pregnancies/total months of exposure.*1200 Life table analysis measure failure rate per month of exposure. Park&;s textbook of preventive and social medicine.K Park. Edition 23.Pg no: 510\n\nSo the answer to this question is C"}
{"instruction": "IPC 193 is for -\nA. Perjury\nB. Punishment for perjury\nC. Issuing false certificate\nD. Causing disappearance of evidence", "response": "Ans. is 'b' i.e., Punishment for perjury Perjury, Hostile witness and false certificate* 191 IPC: (i) Giving false evidence (perjury) under oath and (ii) hostile witness.* 192 IPC: Fabricating false evidence (perjury).* 193 IPC: Punishment for false evidence (punishment for perjury): imprisonment upto 7 years + fine.* 194 IPC: Giving or fabricating false evidence to procure conviction of capital offence.* 195 IPC: Giving or fabricating false evidence to procure conviction of offence punishable with imprisonment for life.* 197 IPC: Issuing or signing (attesting) false certificate by a doctor is a criminal offence.* 201 IPC: Causing disappearance of evidence.\n\nSo the answer to this question is B"}
{"instruction": "Which among the following is the commonest malignancy of childhood?\nA. ALL\nB. Brain tumor\nC. Lymphoma\nD. Neuroblastoma", "response": "The most common childhood malignancies are acute lymphoblastic leukemia, central nervous system (CNS) tumors and lymphomas. Together, these cancers account for 63 percent of cases. The frequency is ALL > Brain tumor > Lynphoma > Neuroblastoma. Neuroblastoma, retinoblastoma and Wilms' tumor most commonly occur in children between bih and four years of age, whereas osteosarcoma, Ewing's sarcoma and Hodgkin's disease tend to occur in children more than 10 years of age. Acute lymphoblastic leukemia is the most common type of leukemia in children. Acute lymphoblastic leukemia typically develops in children between one and 10 years of age. This leukemia is more common in males and in whites.\n\nSo the answer to this question is A"}
{"instruction": "Bird of prey sign is seen in\nA. Gastric volvulus\nB. Intussusception\nC. Sigmoid volvulus\nD. Caecal volvulus", "response": "Sigmoid volvulus is a cause of large bowel obstruction and occurs when the sigmoid colon twists on the sigmoid mesocolon. Imaging signs areRadiograph:coffee bean signFrimann Dahl&;s sign - three dense lines converge towards the site of obstructionabsent rectal gas water-soluble contrast enema - the beak sign (or bird beak sign). CTlarge gas-filled loop without haustral markings, forming a closed-loop obstructionwhirl sign: twisting of the mesentery and mesenteric vesselsbeak sign: if rectal contrast has been administered (Ref: Grainger and Allison&;s diagnostic radiology 6th edition, chapter 25)\n\nSo the answer to this question is C"}
{"instruction": "Definition and Detail Describes:\nA. Image sharpness.\nB. Increases as focal spot size reduce\nC. Reduces as focal spot size increases.\nD. All of the above", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Post dural puncture headache is\nA. Retro-orbital\nB. Frontal\nC. Occipital\nD. Temporal", "response": "Post dural puncture headache is occipital > frontal > retroorbital.\n\nSo the answer to this question is C"}
{"instruction": "When a person stands suddenly from lying down posture, there is\nA. Increased tone of capacitance vessels.\nB. Increase efferent discharge from IX cranial nerve\nC. Decreased heart rate\nD. All of the above", "response": "(A) Increased tone of capacitance vessels. > It occurs due to noradrenergic impulses causing venoconstriction via their action on a1 and a2 - adrenergic receptors on systo veins.\n\nSo the answer to this question is A"}
{"instruction": "Sphincter of Oddi consists of\nA. 2 sphincters\nB. 3 sphincters\nC. 4 sphincters\nD. 5 sphincters", "response": "The sphincter of Oddi is a muscular valve that controls the flow of digestive juices through the ampulla of vater into the second pa of the duodenum. It is named after ruggero oddi. Ref - BDC 6e vol2 pg259 , britannica.com\n\nSo the answer to this question is B"}
{"instruction": "Metastatic calcification is most commonly seen in\nA. Cornea\nB. Extensor tendons\nC. Brain\nD. Renal tubules", "response": "Metastatic calcification may occur in normal tissues whenever there is hypercalcemia. Metastatic calcification may occur widely throughout the body but principally affects the interstitial tissues of the gastric mucosa, kidneys, lungs, systemic aeries, and pulmonary veinsReference: Robbins and Cotran Pathologic Basis of Disease; 9th edition; Chapter 2; Cellular Responses to Stress and Toxic Insults: Adaptation, Injury, and Death\n\nSo the answer to this question is D"}
{"instruction": "Reversion of Neisseriagonorrhoeae from a fimbriated (fim 1) to a non-fimbriated (fim 2) state would result in which one of the following phenomena?\nA. Inability of N. gonorrhoeae to colonize the mucosal epithelium\nB. Reversion to a Gram-positive stain\nC. Death of the organism\nD. Loss of serologic specificity", "response": "Bacteria may shift rapidly between the fimbriated (fim +) and the non-fimbriated (fim -) states. Fimbriae function as adhesions to specific surfaces and consequently play a major role in pathogenesis. Lack of fimbriae prevents colonization of the mucosal surface by the bacterium.\n\nSo the answer to this question is A"}
{"instruction": "IUCD is made up of -\nA. Nickel\nB. Strontium\nC. Copper\nD. Polyethylane", "response": "park's textbook of preventive and social medicine 23rd edition. *The 1st generation IUD comprises the ine or non medicated devices usually made up of poly ethylene or other polymer.They appear in different shapes loops ,spirals,coils and rings .lippes loop is most commonly used.2nd generation IUDs are made by adding copper to the IUDs.\n\nSo the answer to this question is D"}
{"instruction": "Which is not involved in Ankylosing spondylitis :\nA. Knee & Ankle\nB. Sacroiliac joint\nC. Wrist & elbow\nD. Spine", "response": "Ans. is 'c' ie Wrist & elbow Ankylosing spondylitis also k/a Marie-Strumpell ds is a chronic ds characterized by progressive inflammatory stiffening of the joints with a predilection for the joints of axial skeleton. MC involved joint - Sacro iliac joint* , next is spine Also Remember Sex ratio : M>F (10:1)* Age gp : young (15-30 yr) X-ray appearance Bamboo spine* Squaring of vertebrae Ankylosing spondylitis is a very imp topic and a good look at it will definitely help you.\n\nSo the answer to this question is C"}
{"instruction": "Which is found in DiGeorge&;s syndrome -\nA. Tetany\nB. Eczema\nC. Total absence of T cells\nD. Absent B and T cells", "response": "Digeorge syndrome Digeorge syndrome is an example of a T cell deficiency that results from failure of development of the third and fouh pharyngeal pouches. * Clinical features * Enhanced susceptibility to viral, fungal (mucocutaneous candidiasis) and bacterial infections. * Facial abnormalities : Hypeelorism, abnormal ears, sho philtrum and micrognathia. Hypocalcemic tetany due to failure of parathyroid development. Congenital hea diseases eg fallot&;s tetralogy. * Absence of a normal thymus. * Serum immunoglobulin concentration are frequently normal, but antibody responses, paicularly of IgG and IgA isotypes, are usually impaired. * T cell levels are reduced (not total absence). * B cell levels are normal. REF: Harrison book of internal medicine 21ST EDITION\n\nSo the answer to this question is A"}
{"instruction": "Non specific esterase in present in –\nA. Megakaryocytic leukaemia\nB. Lymphocytic leukaemia\nC. Erythroleukaemia\nD. AML", "response": "Acute Myelogenous leukemia (AML)\n\nAML is a cancer of myeloid line of WBCs, characterized by the rapid proliferation of abnormal cells which accumulate in the bone marrow and interfere with the production of normal blood cells.\nAML is the most common acute leukemia affecting adults.\nThe diagnosis of AML is based on finding that myeloid blasts make up more than 20% of the cells in the marrow.\n\nMveloblasts are inyeloperoxidase (peroxidase) positive. \n\nAuer rods (Represent abnormal azurophilic granule) are also present in myeloblasts and their presence is taken to be definite evedence of myeloid differentiation.\nIn some AMLs, blast cells exhibit differentiation of other myeloid stem cell line (other than myeloblast), e.g.,\n\ni) Monoblast → Lack aver rods, peroxides negative, but nonspecific esterase positive.\nii). Megakaryocytic differentiation\niii) Erythroblast\n\nSo the answer to this question is D"}
{"instruction": "Which of the following condition is associated with limitation of both adduction and abduction of the affected eye?\nA. Duane retraction syndrome Type 1\nB. Duane retraction syndrome Type 2\nC. Duane retraction syndrome Type 3\nD. Double elevator palsy", "response": "Weakness of both adduction and abduction of the eye is a feature of Duane retraction syndrome type 3. Duane retraction syndrome is a congenital, incomitant ocular motility disorder characterized by abnormal function of lateral rectus muscle in the affected eye together with retraction of the globe and narrowing of the palpabrel fissure on attempted adduction. Retraction of the globe and narrowing of the palpabrel fissure occur due to simultaneous contraction of medial and lateral rectus muscles on attempted adduction. There are of 3 types: DRS type 1 - limited abduction, normal adduction DRS type 2 - limited adduction, normal abduction DRS type 3 - limited adduction and abduction\n\nSo the answer to this question is C"}
{"instruction": "The normal time required to culture mycobacterium TB is :\nA. 4-8 weeks\nB. 2-3 weeks\nC. 6-10 weeks\nD. 21 days", "response": "M. tuberculosis 4-8 weeks is required before growth is detected. New methods have decreased the time required for bacteriologic confirmation of TB to 2-3 weeks. Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 1350\n\nSo the answer to this question is A"}
{"instruction": "All are indications of lithium except\nA. Neutropenia\nB. Major Depression\nC. Vasculogenic Headache\nD. Generalized anxiety disorder", "response": "Lithium is a drug of its own kind to suppress mania and to exe a prophylactic effect in bipolar manic depressive illness (MDI) at doses which have no ove CNS effects. Ref KD T ripati 8th ed.\n\nSo the answer to this question is D"}
{"instruction": "Pandemic are caused by -a) Hepatitis Bb) Influenza-Ac) Influenza-Bd) Influenza-Ce) Cholera\nA. bd\nB. be\nC. bcd\nD. da", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is used for prostatic carcinoma-\nA. Danazole\nB. Clomiphene\nC. Finasteride\nD. None", "response": "Ans. is 'c' i.e., Finasteride\n\nSo the answer to this question is C"}
{"instruction": "All of the following statements are true about repair of groin hernias except:\nA. Lichtenstein tension free repair has a low recurrence rate\nB. TEP repair is an extraperitoneal approach to laparoscopic repair of groin hernia\nC. In Shouldice repair, non-absorbable mesh is used\nD. The surgery can be done under local anesthesia in selected cases", "response": "Ans. (c) In shouldice repair, non absorbable mesh is usedRef: Sabiston 19/e p1120-1126* Lichtenstein uses Tension free prolene mesh (procedure of choice for Inguinal hernia)* TEP repair - Total Extra Peritoneal repair* Shouldice- Anatomical repair- Double breasting of Fascia transversalis done* Hernia Surgeries are done by Local Anesthesia Infiltration\n\nSo the answer to this question is C"}
{"instruction": "Intermittent dysphagia is caused by -a) Strictureb) Reflux esophagitisc) Achalasia cardiad) Pharyngeal diverticulme) Diffuse esophageal spasm\nA. ab\nB. bc\nC. cd\nD. de", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "All of the following are true about Arnold-Chiari malformation except:\nA. Type I Chiari malformation is displacement of cerebellar tonsil into cervical canal\nB. Type II Chiari malformation is associated with syringomyelia of cervical canal\nC. Type II Chiari malformation is characterized by elongation of the 4th ventricle and kinking of the brainstem, with displacement of the inferior vermis, pons, and medulla into the cervical canal\nD. Type I Chiari malformation is not associated with hydrocephalus", "response": "Arnold-Chiari Malformation Type I Chiari malformation Type II Chiari malformation - Displacement of cerebellar tonsil into cervical canal - Associated with syringomyelia of cervical canal - Typically produces symptoms during adolescence or adult life - Not associated withhydrocephalus - Patients complain of recurrent headache, neck pain, urinary frequency, and progressive lower extremity spasticity - Lesion represents an anomaly of the hindbrain - Characterized by elongation of the 4th ventricle and kinking of the brainstem, with displacement of the inferior vermis, pons and medulla into the cervical canal. - Type II Chiari malformation is characterized by progressive hydrocephalus with a myelomeningocele. - Plain skull radiographs show a small posterior fossa and a widened cervical canalQ. - CT scanning with contrast and MRI display the cerebellar tonsils protruding downward into the cervical canal and the hindbrain abnormalities. - The anomaly is treated by surgical Decompression\n\nSo the answer to this question is B"}
{"instruction": "What is the major role of 2, 3 bisphosphoglycerate in RBCs?\nA. Acid-base balance\nB. Reversal of glycolysis\nC. Release of oxygen\nD. Binding of oxygen", "response": "2,3 BPG is responsible for significantly lowering the oxygen affinity of hemoglobin and and allowing the hemoglobin to more efficiently release oxygen at the typical Po2 of tissues. Only one molecule of 2,3 BPG interact with each hemoglobin tetramer. Rise in 2,3 BPG in RBCs promotes the shift of hemoglobin to the T form and subsequently release oxygen. In rbcs 2, 3 BPG rise as they adapt to conditions of tissue hypoxia ( from anemia, high altitude, pulmonary dysfunction).\n\nSo the answer to this question is C"}
{"instruction": "Dumbell tumour is seen in\nA. Meningioma\nB. Neurofibroma\nC. Ependymoma\nD. Thymoma", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Most common cause of persistent hypeension in child with Intrinsic Renal disease is\nA. CGN\nB. Chronic pyelonephritis\nC. Obstructive uropathy\nD. Renal tumor", "response": "ACEIs or ARBs, appropriate diuretic therapy, and dietary salt restriction make up the foundation for the treatment of HTN in CKD. Bedtime dosing of at least one antihypeensive medication improves BP control in patients with CKD. Reference: GHAI Essential pediatrics, 8th edition\n\nSo the answer to this question is B"}
{"instruction": "Most common Organism causing Bronchiolitis\nA. Respiratory syncytial Virus\nB. Parainfluenza virus\nC. Hemophilius Influenza A\nD. Hemophilius Influenza B", "response": "Most common Organism causing Bronchiolitis Respiratory Syncytial Virus.\n\nSo the answer to this question is A"}
{"instruction": "27. Topical steriods are not recommended post surgery for:\nA. allergic fungal sinusitis\nB. Chronic rhinosinusitis\nC. Antrochoanal polyp\nD. Ethmoidal polyp", "response": "For antrochoanal polyps cause is infection and not the allergy. antrochoanal polyps are single,unilateral and rarely recur. Topical steriods are rarely recommend ref Scott Brown 7/e,p 1553\n\nSo the answer to this question is C"}
{"instruction": "A 31-year-old man has an infertility work-up. He has aspermia. He also has chronic diarrhea with elevated quantitative stool fat. He has had recurrent, severe respiratory tract infections since early childhood. As a neonate, he had bowel obstruction from meconium ileus. He is most likely to have an abnormality involving mutation in which of the following genes?\nA. CFTR\nB. FGFR\nC. G6PD\nD. HFE", "response": "Cystic fibrosis can be accompanied by agenesis of the vas deferens, a common finding that leads to infertility. With good medical care, patients with cystic fibrosis are living longer, and childbearing becomes an issue. Disorders of fibroblast growth factor receptor (FGFR) can include dwarfism. Glucose-6-phosphate dehydrogenase (G6PD) deficiency results in hemolysis on exposure to oxidants such as antimalarial drugs (e.g., primaquine). The HFE gene is abnormal in hereditary hemochromatosis; however, the patient is young for the onset of this disease. NF1 (neurofibromatosis) is associated with the appearance of various neoplasms, including neurofibromas, pheochromocytomas, and gliomas. p53 is a tumor suppressor gene, and loss of both alleles can promote the appearance of various malignancies, mainly carcinomas.\n\nSo the answer to this question is A"}
{"instruction": "False statement about plague is -\nA. It is a gram-negative coccobacillus responding to streptomycin\nB. Bubonic plague is the most common form\nC. Pneumonic plague develops most rapidly and is most frequently fatal\nD. The bubo of plague is characterised by intense cellulitis", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Renal papillary necrosis is almost always associated with one of the following conditions: March 2004\nA. Diabetes mellitus\nB. Analgesic nephropathy\nC. Chronic pyelonephritis\nD. Post streptococcal glomerulonephritis", "response": "Ans. A i.e. Diabetes mellitus\n\nSo the answer to this question is A"}
{"instruction": "Which one of the following is an emerging viral disease?\nA. SARS\nB. Chicken pox\nC. Measles\nD. Rabies", "response": "Virus discovery in particular has been greatly facilitated by new nucleic acid technology. These frontiers were first notably explored with high-density microarrays containing spatially arrayed sequences from a phylogenetically diverse collection of viruses. Although biased toward those with homology to known viruses, novel viruses in clinical samples were successfully identified on the basis of their ability to hybridize to these prespecified sequences. This methodology famously contributed to identification of the corona virus causing severe acute respiratory syndrome (SARS). Once discovered, this SARS corona-virus was rapidly sequenced: the full genome was assembled in April 2003, less than 6 months after recognition of the first case. This accomplishment illustrated the advancing power and speed of new diagnostic technologies. \n \nHarrisson Principle of Internal Medicine Ed 19th Pg772\n\nSo the answer to this question is A"}
{"instruction": "Ethmoid bone forms A/E -\nA. Superior turbinate\nB. Middle turbinate\nC. Inferior turbinate\nD. Uncinate process", "response": "\"The inferior turbinate is a separate bone, while rest of the turbinates are a part of ethmoidal bone\". —Tuli 1st/e p. 135\n\nSo the answer to this question is C"}
{"instruction": "Which one of the following drugs is not used in the treatment of mycobacterium avium intercellulare infection ?\nA. Clarithromycin\nB. Eflornithine\nC. Ethambutol\nD. Rifabutin", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Chronic use of which of the following medications is most likely to cause osteoporosis?\nA. Lovastatin\nB. Propanolol\nC. Warfarin\nD. Prednisone", "response": "(Ref: KDT 6/e p286) * Steroids result in osteoporosis on long term use.\n\nSo the answer to this question is D"}
{"instruction": "In a coho study nonsmokers were found to have carcinoma lung. This indicates-\nA. Smoking does not cause lung cancer\nB. Etiology for lung Ca is multi factorial\nC. Smoking is the only cause of lung cancer\nD. Passive smoking also increase lung cancer", "response": "Coho study is also known as incidence study. The cohos are identified prior to the appearance of disease under investigation. The study group so defined are observed over a period of time to determine the frequency of disease among them. Ref: 25th edition, Park's Textbook of Preventive and Social Medicine, Page no. 83\n\nSo the answer to this question is B"}
{"instruction": "A child has staed mouthing objects, shows likes and dislikes, but has not yet developed stranger anxiety. The age of child is:\nA. 3 months\nB. 5 months\nC. 7 months\nD. 9 months", "response": "Stranger anxiety, that develops at around 7 months has not yet appeared. So, the age of the child is 5 months. Child stas mouthing object: 5-6 months.\n\nSo the answer to this question is B"}
{"instruction": "Normal corneal endothelial count in a young adult is\nA. 500/mm2\nB. 2500/mm2\nC. 4500/mm2\nD. 6500/mm2", "response": "Ans. (b) 2500/mm2Ref Parson's 21/e, p. 120* The cell density of endothelium is around 2800cells/mm2(2400-3000cells/mm2) in young adults, which decreases with the advancing age.\n\nSo the answer to this question is B"}
{"instruction": "Superior pancreaticoduodenal artery is a branch of\nA. Splenic artery\nB. Gastroduodenal artery\nC. Right gastric artery\nD. Superior mesenteric artery", "response": "(Gastroduodenal artery) (263-BDC-2 4th) (261-Snell 7th)* Superior pancreatico duodenal artery is a branch of Gastroduodenal artery* Inferior pancreatico duodenal artery is a branch of superior mesenteric arteryHEPATIC ARTERY - branchesSUPERIOR MESENTERIC ARTERY branches* Right gastric artery* Gastroduodenal artery-*Right gastroepiploic-*Superior pancreatico duodenal* Right and left hepatic arteries (Right hepatic artery gives off cystic artery)* *Left gastroepiploic artery is branch of splenic artery* *Inferior pancreatico duodenal artery* Middle colic artery* Iliocolic artery (Appendicular artery is a branch of the posterior cecal artery)* Jejunal and Ileal branches\n\nSo the answer to this question is B"}
{"instruction": "Best investigation for ureteric stones is:\nA. CT\nB. CECT\nC. USG\nD. IVP", "response": "Helical CT without oral or intravenous contrast is the preferred imaging modality for patients with renal colic or suspected urolithiasis\" -- Smith's Urology Ref : Smith's Urology 17/e p81, 261\n\nSo the answer to this question is A"}
{"instruction": "All of the following modalites can be used for in situ ablation of liver secondaries, except:\nA. Ultrasonic waves\nB. Cryotherapy\nC. Alcohol\nD. Radiofrequency", "response": "Ans. Alcohol\n\nSo the answer to this question is C"}
{"instruction": "A 10 year old child develops hematuria after 2 days of diarhoea. Blood film shows fragmented RBCs. Which of the following is likely diagnosis-\nA. Acute pyelonephritis\nB. Disseminated intravascular coagulopathy\nC. Haemolytic uremic syndrome\nD. Haemolytic crises", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Name the pathology seen in scalp\nA. Dermoid\nB. Sebaceous cyst\nC. Hemangioma\nD. Metastasis", "response": "Ans. (b) Sebaceous cyst* MC site of Sebaceous cyst is scalp.* Never seen in palms, soles, mucosa.* Ulcerated Sebaceous cyst of scalp is Cock's peculiar tumor.\n\nSo the answer to this question is B"}
{"instruction": "A patient has been diagnosed as having \"long QT syndrome.\" The patient is experiencing significant pain following a bout with shingles. What would be an appropriate drug for his pain?\nA. Amitriptyline\nB. Fentanyl\nC. Acyclovir\nD. Gabapentin", "response": "It's a case of post-herpetic neuralgia. Gabapentin is the drug of choice. Amitriptyline can also be used for pain but it can also cause arrhythmia.\n\nSo the answer to this question is D"}
{"instruction": "A number of enzymes take role in the formation of DNA synthesis. Unwinding of DNA is done by:\nA. Helicase\nB. DNA polymerase\nC. Primase\nD. Topoisomerases", "response": "A replication fork consists of four components that form in the following sequence: The DNA helicase unwinds a sho segment of the parental duplex DNA; A primase initiates synthesis of an RNA molecule that is essential for priming DNA synthesis; The DNA polymerase initiates nascent, daughter-strand synthesis; and Single-stranded DNA-binding proteins (SSBs) bind to ssDNA and prevent premature reannealing of ssDNA to dsDNA. Topoisomerases relieve torsional strain that results from helicase-induced unwinding. Must know: DNA ligase seals the single strand nick between the nascent chain and Okazaki fragments on lagging strand. Ref: Weil P. (2011). Chapter 35. DNA Organization, Replication, & Repair. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds), Harper's Illustrated Biochemistry, 29e.\n\nSo the answer to this question is A"}
{"instruction": "A 22-year-old man sustains severe blunt trauma to the back. He notes that he cannot move his lower extremities. He is hypotensive and bradycardic. Which of the following is the best initial management of the patient?\nA. Administration of phenylephrine\nB. Administration of dopamine\nC. Administration of epinephrine\nD. Intravenous fluid bolus", "response": "The patient is in neurogenic shock as a result of a spinal cord injury. Neurogenic shock is characterized by loss of sympathetic tone peripherally as well as bradycardia owing to loss of the reflexive increase in hea rate in response to hypotension. Initial treatment is with fluid resuscitation followed by initiation of vasoconstrictors such as dopamine or phenylephrine. Hypovolemia caused by hemorrhage should also be ruled out in trauma patients\n\nSo the answer to this question is D"}
{"instruction": "A 22-year-old man has symptoms of low back pain and stiffness. After several months of mild symptoms, he notes more severe stiffness at night and hip pain. On physical examination, there is paravertebral muscle tenderness and limited flexion of the lumbar spine. Figure shows an x-ray of the lumbar spine. Which of the following is the most likely diagnosis?\nA. Reiter syndrome\nB. Marfan syndrome\nC. ankylosing spondylitis (AS)\nD. RA", "response": "(c) Source: (Kasper, p. 1993) AS occurs in 1-6% of adults inheriting human lymphocyte antigen B27 (HLA-B27). However, the prevalence in B27-positive relatives of patients with AS is up to 30%. Men are three times more likely to be affected.\n\nSo the answer to this question is C"}
{"instruction": "Articulation of pisiform bone is with:\nA. Triquetral\nB. Lunate\nC. Scaphoid\nD. Trapezoid", "response": "Ans. A TriquetralRef: BDC, 6th ed. vol. I pg. 25; Snell's 8th ed. pg. 402PISIFORM* It is a sesamoid bone in the tendon of flexor carpi uinaris.* Its dorsal surface presents a smooth, oval facet, for articulation with the triquetral* The palmar surface is rounded and rough, and gives attachment to the transverse carpal ligament, and to the Flexor carpi uinaris and Abductor digiti quinti.\n\nSo the answer to this question is A"}
{"instruction": "Vit B1 is a cofactor for\nA. Transketolase\nB. Transaldolase\nC. Aldolase A\nD. Aldolase B", "response": "Vit B1 is a cofactor for Transketolase. Transketolase: The second group of enzymes that use TPP as co-enzyme are the transketolases, in the hexose monophosphate shunt pathway of glucose the main role is in carbohydrate metabolism Ref: DM Vasudevan - Textbook of Biochemistry, 8th edition, page no: 467\n\nSo the answer to this question is A"}
{"instruction": "Periventricular calcification is often due to:\nA. Toxoplasmosis\nB. Cytomegalic infection\nC. Congenital syphilis\nD. All of the above", "response": "B i.e. Cytomegalovirus\n\nSo the answer to this question is B"}
{"instruction": "The supraoptic nucleus of the hypothalamus is believed to control secretion of which of the following hormones?\nA. Antidiuretic hormone\nB. Oxytocin\nC. Growth hormone\nD. Adrenocoiocotrophic hormone", "response": "The supraoptic nucleus (SON) is a nucleus of magnocellular neurosecretory cells in the hypothalamus of the mammalian brain. The nucleus is situated at the base of the brain, adjacent to the optic chiasma. In humans, it contains about 3,000 neurons.Function; The cell bodies produce a peptide hormone: anti-diuretic hormone.Ref: Ganong&;s review of medical physiology; 24th edition; page no; 311\n\nSo the answer to this question is A"}
{"instruction": "Perikymata are the external surface manifestations of\nA. Enamel rods\nB. Incremental lines of retzius\nC. Nasmyth's membrane\nD. Pellicle", "response": "The number of perikymata gradually decreases form cervical region to occlusal or incisal region because of undisturbed development of enamel prior to birth. Perikymata are usually absent in prenatally developed occlusal parts of deciduous teeth, whereas they are present in postnatal cervical parts.\n\nSo the answer to this question is B"}
{"instruction": "A 17 year old unmarried girl presents with fever, nausea, vomiting, pallor and pain abdomen. She is having foul smelling blood stained discharge per vaginum. Your most likely diagnosis of this case is\nA. Twisted ovarian cyst\nB. Typhoid with enteric perforation\nC. Pelvic abscess with septic peritonitis\nD. Ruptured ectopic pregnancy", "response": "It is a case of septic aboion complicated by septic peritonitis and pelvic abscess. As the patient is unmarried she had some procedure as criminal aboion to terminate unwanted pregnancy. In case of twisted ovarian cyst, fever and vaginal discharge are absent. In ruptured ectopic pregnancy, same findings are there but fever is usually absent and vaginal discharge is not foul smelling, there is only slight bleeding\n\nSo the answer to this question is C"}
{"instruction": "Kiesselbach's area does not involve:\nA. Superior labial artery\nB. Anterior ethmoidal artery\nC. Greater palatine artery\nD. Posterior ethmoidal artery", "response": "Ans: D Posterior ethmoidal artery* Kiesselbach's area aka Kiesselbach;s plexus and Little's area, is an area on the nasal septum located on the antero inferior part of the septum* in this area four arteries anastomose to form a vascular plexus called Kiesselbach's plexus.* The arteries are# Sphenopalatine artery (from the maxillary artery): Main artery of plexus# Greater palatine artery (from the maxillary artery)# Anterior ethmoidal artery (from the ophthalmic artery)# Septal branch of the superior labial artery (from the facial artery)\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is a feature of gram-positive bacteria rather than gram-negative bacteria?\nA. Lipid A-containing lipopolysaccharide\nB. Lipoprotein in periplasmic space\nC. Outer membrane\nD. Thick peptidoglycan cell wall", "response": "Most of the features listed are those of gram-negative bacteria, which have a complex cell envelope consisting of a cytoplasmic (inner) membrane, a periplasmic space containing peptidoglycan and lipoprotein, an outer membrane, and sometimes a capsule. The outer membrane contains lipopolysaccharide which is a major component of endotoxin. The peptidoglycan cell wall of the gram-negative bacteria is thin, while that of the gram-positive bacteria is thick. Other features of gram- positive bacteria include a fairly simple surface with cytoplasmic membrane, peptidoglycan, cell wall, and sometimes, an outer capsule. The cell wall contains lipoteichoic acids.\n\nSo the answer to this question is D"}
{"instruction": "All are true regarding transforming growth factor? p except-\nA. Proliferation for fibroblast\nB. Proliferation of endothelial cells\nC. Chemotaxis of fibroblasts\nD. Activation of macrophages", "response": "Ans. is `d' i.e., Activation of macrophagesAlso see above explanation.Growth factors and cytokines involved in regeneration and wound healingGrowth factor Epidermal growth aTransforming growth factor aHeparin-binding EGFHepatocyte growth factor/scatter factorVascular endothelial cell growth factor (isoforms A,B,C,D)Platelet-derived growth factor (isoforms A,B,C,D)Fibroblast growth factor 1 (acidic), 2 (basic), and familyTransforming growth factor 13 (isoforms 1,2, 3); other members of the family are BMPs and activinFunctionsMitogenic keratinocytes and fibroblasts; stimulates keratinocyte migration and granulation tissue formationSimilar to EGF; stimulates replication of hepatocytes and most epithelial cellsKeratinocyte replicationEnhances proliferation of hepatocytes, epithelial cells, and endothelial cells; increases cell motility, keratinocyte replicationIncreases vascular permeability; mitogenic for endothelial cells; angiogenesisChemotactic for PMNs, macrophages, fibroblasts, and smooth muscle cells; activates PMNs, macrophages and fibroblasts; mitogenic for fibroblasts, endothelial cells, and smooth muscle cells; stimulates production of MMPs, fibronectin, and HA; stimulates angiogenesis and wound contractionChemotactic for fibroblasts; mitogenic for fibroblasts and keratinocytes; stimulates keratinocyte migration, angiogenesis, wound contraction and matrix depositionChemotactic for PMNs, macrophages, lymphocytes fibroblasts and smooth muscle cells; stimulates TIMP synthesis, angiogenesis and fibroplasia; inhibits production of MMPs and keratinocyte proliferationKeratinocyte growth Ka Fibroblasts Stimulates keratinocyte migration, proliferationfactor (also called and differentiationFGF-7)Tumor necrosis factor TNF Macrophages mast cells, Activates macrophages; regulates otherT lymphocytes cytokines, multiple functions\n\nSo the answer to this question is D"}
{"instruction": "Investigation using dye to find out stone in salivary gland\nA. Sialography\nB. Mammography\nC. MR angiography\nD. USG", "response": "Dye used is lipiodol or sodium diatrizoate(Hypaque).24-gauge cannula is passed into either Stenson's duct or Whaon's duct and one ml of the dye is injected into the duct and X-ray is taken. SRB,5th,406.\n\nSo the answer to this question is A"}
{"instruction": "What is the diagnosis in this patient with abdominal pain?\nA. Amyloidosis\nB. Familial Mediterranean fever\nC. Lead poisoning\nD. Leukemia", "response": "Answer C. Lead poisoningThe blue lines evident on the gums are Burton's lines, which can be present in patients with lead poisoning. The diagnosis of occupational lead poisoning was confirmed by an elevated serum lead level. The patient recovered following chelation therapy.\n\nSo the answer to this question is C"}
{"instruction": "In Nephrotic syndrome hypercoaguability occurs due to-\nA. Urinary loss of Antithrombin III\nB. Increase in serum protiens-c,s\nC. Decrease in serum Fibrinogen\nD. Factor vIII", "response": "Hypercoaguble state in nephrotic syndrome is due to Urine loss of Anithrombin III Hyperfibrinogenemia Decrease in serum protiens c, s Increase in platelet aggregation. Venous complications can occur due to Hypercoaguble state in nephrotic syndrome ,so anticoagulants are given to all patients Ref Harrison 20th edition pg. No. 2142,293\n\nSo the answer to this question is A"}
{"instruction": "Ecbolics are the drugs which\nA. Cause uterine contraction\nB. Increase menstrual blood flow\nC. Increases sweating\nD. Causes vomitting", "response": "Ecbolics: They increase uterine contractions, e.g. ergot preparations, synthetic estrogens, pituitary extract, strychnine or quinine. Ref - Krishan Vij textbook of forensic medicine and toxicology 5e pg - 383\n\nSo the answer to this question is A"}
{"instruction": "Advantage of newer liposomal preparation of amphotericin B\nA. Similar in efficacy and antifungal spectrum as conventional preparations\nB. Fewer chances of nephrotoxicity\nC. Lesser uptake in the tissues like the kidney\nD. All of the above", "response": "Newer liposomal preparations of amphotericin B have the following features:\n\nFewer chances of nephrotoxicity and infusion-related reactions\nLesser uptake in the tissues like kidney\nMore expensive\nSimilar in efficacy and antifungal spectrum as conventional preparations\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is the constituent of mini pill?\nA. Only progesterone\nB. Only estrogen\nC. Estrogen + progesterone\nD. Norethisterone + estradiol", "response": "Ans: a (Only progesterone) Ref: Shaw, 13th ed, p. 228The constituent of minipill is only progesterone. It does not contain estrogen. It is also known as progesterone only pill.OCP(a) Combined- Monophasic- Multiphasic -Sequential pill (only estrogen in 1st 14 days and estrogen + progesterone in next 14)(b) Minipill -Progesterone only pillMechanism of action of OCPCombined OC pills suppress pituitary hormones FSH and LH and through their suppression prevents ovulation. At the same time, progesterone causes atrophic changes in the endometrium and prevents nidation.Benefits of OCP(1) Contraceptive - Prevention of pregnancy(2) Non contraceptive(a) Cycle stabilization(b) Cure of menstrual disorder (c) Protection against cancer- Ovarian- Endometrial(d) Benign tumour- Benign breast disease- Ovarian functional cyst- Fibromyoma uterus(e) Protects against- P1D-Anaemia- Endometriosis- Acne, hirsuitism- Rheumatoid arthritis- OsteoporosisOCP reduces the incidence of ectopic pregnancy is due to suppression of ovlulation, and reduction inPIDSide effects of OCPI. MinorNausea, vomiting, lack of appetite, break- through bleedingBreast tendernessVaginal dischargeHeadache, migraineChloasmaWeight gainAcne, Oily skinII. Major(a) Cardiovascular disease- Stroke- Venous Thromboembolism- HT- Coagulation abnonnalities(b) Cancer - Breast Ca, Ca cervix, Liver Ca(c) Diabetes(d) Gall stones(e) Affects lactation\n\nSo the answer to this question is A"}
{"instruction": "An infant with failure to thrive, hypertension, metabolic alkalosis and hyperkalemia presents to a clinician. Most probable cause is\nA. Liddle's syndrome\nB. Bartter's syndrome\nC. Gittelman's syndrome\nD. Gordon syndrome", "response": "d. Gordon syndrome(Ref: Nelson 20/e p 2535)Out of the given causes, hyperkalemia is seen only in Gordon syndromeGordon syndrome or familial hyperkalemic hypertension, is due to gain-of-function mutations in WNK1 & ioss-of-funotion mutations in WNK4 in distal convoluted tubule, leading to excessive NCCT-mediated salt reabsorption with the clinical picture of pseudohypoaldosteronism type 2Liddle syndrome is due to gain-of-function mutations of the gene that encodes the epithelial sodium channel in the collecting duct, leading to hypertension, hypokalemia & suppressed aldosterone\n\nSo the answer to this question is D"}
{"instruction": "All are effect of parasympathetic system on hea except -\nA. Negative chronotropic\nB. Negative ionotrophic\nC. Negative dromotropic\nD. All are seen", "response": "Ans. is 'b' i.e., Negative inotropic\n\nSo the answer to this question is B"}
{"instruction": "Following drugs are used in the treatment of ADHD:\nA. Amphetamine\nB. Modafinil\nC. Methylphenidate\nD. All of the above", "response": "Pharmacotherapy: Stimulants Non stimulants Methylphenidate, dexmethylphenidate Atomoxetine Amphetamines Bupropion Modafinil Clonidine, Guanfacine Venlafaxine - Stimulants are the preferred group of drugs in children with ADHD - Methylphenidate is the drug of choice for ADHD children * Atomoxetine is efficacious for ADHD and has modest antidepressant activity. * Similarly, many studies have shown efficacy for depressive and ADHD symptoms with the use of bupropion. However, it is known to lower the seizure threshold and as such would not be a recommended drug of choice in a patient with a history of seizure disorder.\n\nSo the answer to this question is D"}
{"instruction": "Which of the drug Does not have active metabolite\nA. Diazepam\nB. Propanonol\nC. Allupurinol\nD. Lisnopril", "response": "(Ref KDT 6e p485). Captopril and lisinopril are ACE inhibitors that are not prodrugs. Diazepam produce many active metabolites like.oxazepam. Propranolol can produce 4-hydroxypropanolol .which has b-antagonist activity. Allopurinol gives rise to oxypurinol which can inhibit xanthine oxidase.\n\nSo the answer to this question is D"}
{"instruction": "Systemic Millary TB spreads\nA. Aery\nB. Vein\nC. Bronchus\nD. Lymphatic", "response": ". Ans. is 'a' i.e., Aery\n\nSo the answer to this question is A"}
{"instruction": "The classification proposed by the International Lymphoma Study Group for non Hodgkin&;s lymphoma is know as -\nA. Kiel classification\nB. REAL classification\nC. WHO classification\nD. Rappapo classification", "response": "International Lymphoma Study Group proposed a classification called revised European -American classification of lymphoid neoplasm abbrevated as REAL classification. This was based on the hypothesis that all forms of lymphoid malignancies represent malignant counterpa of normal population of immune cell present in lymph node and bone marrow . Kiel classification is an immunologic classification of NHL.It is a modification of Lukes- Collins classification. Divided all malignant lymphomas in to B cell or T cell origin WHO classification is an international classification of all lymphoid neoplasms together as a unified group under the ageis of WHO. Rappapo is a morphological classification based on low power and high power microscopy Ref: Harsh Mohan textbook of pathology, 7th edition.Pg no.344-346\n\nSo the answer to this question is B"}
{"instruction": "As a pa of space-research program, a physiologist was asked to investigate the effect of flight-induced stress on blood pressure. Accordingly, the blood pressure of the cosmonauts were to be measured twice: once before the takeoff and once after the spacecraft entered the designated orbit around the eah. For a proper comparison, the preflight blood pressure should be recorded in:\nA. The lying down position\nB. The sitting position\nC. The standing position\nD. Any position, as long as the post-flight recording is made in the same position", "response": "A i.e. The lying down position For two values to be comparable (to remove any bias) we must remove as many confounding variables as possible. The confounding variable in this question is gravity. Gravity is present on eah but is not present in space. The best position in which the effect of gravity is nullified is lying down.\n\nSo the answer to this question is A"}
{"instruction": "If stage Ib cervical cancer is diagnosed in a young woman, while performing radical hysterectomy which structure would you not remove:\nA. Uterosacral and uterovesical ligament\nB. Pelvic LN\nC. Both ovaries\nD. Upper third of vagina", "response": "Ans. is c, i.e. Both ovariesRef: Textbook of Gynecology sheila Balakrishnan 1st/ed, p255Cancer cervix rarely involves the ovaries.When radical/modified radical hysterectomy are being performed in young females, ovaries should not be removed.\n\nSo the answer to this question is C"}
{"instruction": "An 8 year old child diagnosed with Langerhans cell histiocytosis. Bone involvement is seen. All of the following are true about Langerhans cell histiocytosis, EXCEPT:\nA. Peak incidence less than 3 years of age\nB. Radiosensitive\nC. Diffuse form is known as litter-sewe-disease\nD. Enophthalmos present", "response": "Exophthalmos is present in only 10% to 30% of cases of Langerhans cell histiocytosis. It may be unilateral or bilateral and is due to retroocular bone infiltration by Langerhans cells. Langerhans cell histiocytosis is a disease of childhood. Letterer-Siwe disease is the prototype of the acute, disseminated, multisystemic form that usually appears in infants or newborns. The disease can occur in individuals of any age and can also be congenital, but is most common in children aged 1-3 years. Ref: Gelmetti C. (2012). Chapter 147. Cutaneous Langerhans Cell Histiocytosis. In L.A. Goldsmith, S.I. Katz, B.A. Gilchrest, A.S. Paller, D.J. Leffell, N.A. Dallas (Eds), Fitzpatrick's Dermatology in General Medicine, 8e.\n\nSo the answer to this question is D"}
{"instruction": "Filgrastim is a.\nA. T-cell stimulating factor\nB. GnRH analogue\nC. G-CSF\nD. GM-CSF", "response": "Filgrastim is a recombinant G-CSF. From medical pharmacology padmaja 4th edition Page no 333\n\nSo the answer to this question is C"}
{"instruction": "A thyroid nodule is found on a 40-year-old woman on routine evaluation. She has no prior history of thyroid disease and clinically feels well. There is a 15-mm nontender nodule on the right lobe of the thyroid with no associated lymphadenopathy. Thyroid function tests are normal. Which of the following is the most appropriate next step in management?\nA. thyroid scan\nB. fine needle aspiration (FNA) biopsy\nC. repeat assessment in 6 months\nD. partial thyroidectomy", "response": "Needle biopsy can be used in numerous diseases, but the main rationale is to differentiate benign from malignant nodules. A thyroid scan is appropriate if the TSH is suppressed suggesting a possible \"hot\" nodule (hyperfunctioning nodules are very rarely malignant). The specimen must be read by an experienced cytologist. It is difficult to diagnose differentiated follicular carcinoma or to differentiate lymphoma from Hashimoto's thyroiditis. Papillary carcinoma is the easiest diagnosis to make by needle biopsy.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is true about METFORMIN\nA. Hypoglycemia is very common\nB. Increases hepatic Gluconeogeneis\nC. Reduces the lipogeneis in adipose tissue\nD. Increases the secretion of Insulin", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "According to PALS, which of the following is not included in initial impression?\nA. Consciousness\nB. Color\nC. Airway\nD. Breathing", "response": "Initial impression includes: Consciousness Breathing Color. Airway is included in Primary assessment. Reference: GHAI Essential pediatrics, 8th edition\n\nSo the answer to this question is C"}
{"instruction": "false regarding neoplasms of the ovary are:\nA. Stromal invasion is commonly present in ovarian tumours of borderline malignancy\nB. Lymphocytic infiltration is characteristic to dysgerminoma\nC. Presence of ascites and pleural effusion in Brenner tumour indicates poor prognosis\nD. Endometrioid carcinoma of the ovary may coexist with endometrial adenocarcinoma", "response": "Borderline ovarian tumours grade 0 tumors may demonstrate papillary tufting,stratification,epithelial atypia,exfoliation of cellular clusters,minimal mitotic activity No stromal invasion Patients have a high survival rate. runs a typical indolent course spontaneous regression of peritonial implants multiple sections examined to exclude invasion SHAW&;S TEXTBOOK OF GYNECOLOGY,Pg no:373,374,15th edition\n\nSo the answer to this question is A"}
{"instruction": "Anterior cardiac vein opens into -\nA. Right atrium\nB. Coronary sinus\nC. Thebesian veins\nD. Middle cardiac vein", "response": "Ans. is 'a' i.e., Right atrium Veinous drainage of heart1. Coronary sinus: Opens into right atrium and has following tributries : (i) Great cardiac vein, (ii) Middle cardiac vein, (iii) Posterior vein of left ventricule, (iv) Small cardiac vein, (v) Oblique vein of left atrium and (vi) Sometimes right marginal vein.2. Anterior cardiac vein: Opens into right atrium.3. Venae cordis minimi (thebasian veins): Open into right atrium.4. Right marginal vein: More often opens into right atrium but sometimes into coronary sinus.\n\nSo the answer to this question is A"}
{"instruction": "A patient is receiving insulin and acarbose for diabetes mellitus and developed hypoglycemia. Which of the following should be used for the treatment of hypoglycemia in this patient?\nA. Sucrose\nB. Galactose\nC. Glucose\nD. Starch", "response": "Complex carbohydrates (polysaccharides and sucrose) are absorbed after conversion to simple carbohydrates by alpha-glucosidase. Inhibitors of this enzyme (acarbose and miglitol) decrease carbohydrate absorption from the GIT. Although these drugs themselves do not cause hypoglycemia blood sugar may decrease if these are combined with insulin or other drugs releasing insulin. In such a case of hypoglycemia, simple carbohydrates like glucose (not sucrose or other complex carbohydrates) should be used.\n\nSo the answer to this question is C"}
{"instruction": "Protein synthesis takes place in:\nA. Stratum basale.\nB. Stratum spinosum.\nC. Stratum granulosum.\nD. Stratum corneum.", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Dermatophytes primarily involves _______:\nA. Stratum corneum\nB. Stratum granulosum\nC. Stratum basale\nD. Stratum spinosum", "response": "Ans. A. Stratum corneumDermatophytes infect and survive only in the dead keratin layers of skin (stratum corneum), hair and nails as they are keratinophilic.\n\nSo the answer to this question is A"}
{"instruction": "Greater petrosal nerve is formed from ?\nA. Geniculate ganglion\nB. Plexus around ICA\nC. Plexus around middle meningeal aery\nD. None of the above", "response": "Ans. is 'a' i.e., Geniculate ganglion Petrosal nervesGreater petorsal nerveFirst branch of facial nerveArises from geniculate ganglionIn foramen lacerum it joins deep petorsal nerve and forms the nerve to pterygoid canalSupplies lacrimal glands, nose, mucosal glands of pharynx, palate.Lesser petorsal nerveBranch of 9th cranial nerve through tympanic plexus (passes otic ganglion)It suplies parotid gland.Deep petorsal nerveIt is a branch of sympathetic plexus around internal carotid aery.It contains cervical sympathetic fibers.External petorsal nerveIt is an inconsistant branch of sympathetic plexus around middle meningeal aery.\n\nSo the answer to this question is A"}
{"instruction": "Simian crease is not seen in -\nA. Down\nB. Trisomy 13\nC. Atopic dermatitis\nD. Noonan syndrome", "response": "Ans. is 'c' i.e., Atopic dermatitisSimian creaseo Single transverse palmer creaseo Resembles non-human-simian so K/a simian crease,o It is seen inDown syndromeFetal alcohol syndromeCri-du chat syndrome (Chr. 5)Klinefelter (XXY)Noonan (Chr. 12)Patau (Chr. 13)Edward (Chr. 18)\n\nSo the answer to this question is C"}
{"instruction": "All of the following are centrally acting antihypeensive drugs except:-\nA. Alpha methyl dopa\nB. Clonidine\nC. Guanabenz\nD. Trimethoprim", "response": "Stimulation of a2 receptors in CNS leads to decrease in sympathetic outflow Therefore, a2 agonists can decrease the sympathetic activity and are useful for the treatment of hypeension. These include: Clonidine a-methyl dopa Guanafacine Guanabenz\n\nSo the answer to this question is D"}
{"instruction": "Most impoant pathophysiological cause of GERD is\nA. Hiatus hernia\nB. Transient LES relaxation\nC. LES hypotension\nD. Inadequate esophageal clearance", "response": "\"Transient LES relaxations account for at least 90% of reflux in normal subjects or GERD patients without a hiatus hernia\"- Harrison Transient lower oesophagal sphincter relaxations account for essentially all reflux events in individuals with a normal LES pressure at the time of reflux. Pathogenesis of gastroesophageal reflux disease (GERD) The primary event in the pathogenesis of gastroesophageal reflux disease (GERD) is a movement of gastric juice from the stomach into the oesophagus. The three dominant pathophysiologic mechanisms causing gastroesophageal junction incompetence are: Transient lower esophageal sphincter relaxations (tLESRs) A hypotensive lower oesophagal sphincter (LES) Anatomic disruption of the gastroesophageal junction, often associated with a hiatal hernia The latest concept is that the dominant mechanism varies as a function of disease severity with tLESRs predominating with mild disease and mechanisms associated with a hiatus hernia and/or a weak sphincter predominating with more severe disease Transient LES relaxations are different from swallow-induced LES relaxation: tLESRs occur without an associated pharyngeal contraction, are unaccompanied by oesophagal peristalsis, and persist for longer periods (>10 sec) than do swallow-induced LES relaxations. tLESRs are the physiological mechanism of belching. Ref : Harrison 18/e p2433\n\nSo the answer to this question is B"}
{"instruction": "Extensive surgical debridement, decompression or amputation may be indicated in the following clinical setting except -\nA. Progressive synergistic gangrene\nB. Acute thrombophlebitis\nC. Acute haemolytic streptococcal cellulitis\nD. Acute rhabdomyolysis", "response": "Ans. is 'b' i.e., Acute thrombophlebitis\n\nSo the answer to this question is B"}
{"instruction": "Which of the following is phase -2 reaction -\nA. Oxidation\nB. Reduction\nC. Cyclination\nD. Glucuronidation", "response": "Ans. is 'd' i.e., Glucuronidation o Phase I reactions: - Oxidation, reduction, hydrolysis, cyclization, decyclization.o Phase II reactions: - Acetylation, glutathione conjugation, glucoronide conjugation (glucuranization), glycine conjugation, methylation, sulfate conjugation (sulfuranation), nucleotide synthesis.\n\nSo the answer to this question is D"}
{"instruction": "On the articulator the incisal guidance is the\nA. Horizontal guidance\nB. Same as condylar guidance\nC. Mechanical equivalent of curve of space\nD. Mechanical equivalent of horizontal and vertical over lap", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "All are clinical features of pheochromocytoma, except :\nA. Increased hematocrit\nB. Ohostatic hypotension\nC. Low coisol level\nD. Impaired glucose tolerance", "response": "Answer is C (Low coisol level) Pheochromocytoma is not associated with low coisol levels. Pheochromocytoma is unique in presentation as it may present both with, Hypeension and hypotension. Hypeension occurs in paroxysms and is the most common manifestation - Hypotension occurs as `ohostatic hypotension' and it occurs as a consequence of diminished plasma volume and blunted sympathetic reflexes. Carbohydrate intolerance: Over half of patients have impaired carbohydrate tolerance due to suppression of insulin and stimulation of hepatic glucose output. Hematocrit: An elevated hematocrit may be secondary to diminished plasma volume.\n\nSo the answer to this question is C"}
{"instruction": "Anemic hypoxia is due to :\nA. 113O2 in aerial blood\nB. TPO2 in aerial blood\nC. TPCO2 in aerial blood\nD. L O2 content in aerial blood", "response": "D i.e. L O2 content in aerial blood\n\nSo the answer to this question is D"}
{"instruction": "Inflation of lungs induces fuher inflation is called\nA. Hering-Breuer inflation reflex\nB. Heads paradoxical reflex\nC. Frank-starling law\nD. J reflex", "response": "Definition. The Head's paradoxical reflex occurs in case of cold block (or in general irritation) of the vagus nerve. The inflation inhibition explained by Hering-Breuer inflation reflex is annulled and a deep breath occurs Ref: guyton and hall textbook of medical physiology 12 edition page number: 334,335\n\nSo the answer to this question is B"}
{"instruction": "NOT true about co-relation is-\nA. Doesn't tell about causation\nB. Tells about risk of the disease\nC. -1.0 correlation shows linear relationship\nD. Tells association between two variables", "response": "Ref:Parks 23rd edition pg 852 In order to find out whether there is significant association or not between the two variables , coefficient or Corelation is calculated . r lies between -1 and +1 r near -1 : indicates strong negative correlation . r = 0 : indicates no association r near +1: indicates strong positive correlation. Note: correlation does not necessarily prove causation .\n\nSo the answer to this question is B"}
{"instruction": "The typical 'Orphan-Annie eye' nucleus is described in -\nA. Serous cystadenocarcinoma of ovary\nB. Renal cell carcinoma\nC. Papillary carcinoma of thyroid\nD. Seminoma", "response": "Papillary carcinoma: Accounts for 85% of thyroid malignancy in iodine-deficient areas Most common thyroid cancer in children and in persons exposed to external radiation Most often in women between 30-40 years Excellent prognosis Characteristic nuclear features: Ground glass (Orphan Annie) nuclei pseudoinclusions Nuclear grooves. Nuclear features are used as diagnostic criteria even in the absence of papillae. Papillary carcinoma: Most commonly spreads through lymphatics. Papillary carcinoma: Metastasize through lymphatics and have an excellent prognosis.\n\nSo the answer to this question is C"}
{"instruction": "Drug of choice in MDP is:\nA. Lithium\nB. Amphetamine\nC. Diazepam\nD. Alprazolam", "response": "Lithium\n\nSo the answer to this question is A"}
{"instruction": "Exposure of left subclan aery by supraclavicular approach does not require cutting of ?\nA. Sternocleidomastoid\nB. Scalenus anterior\nC. Scalenus medius\nD. Omohyoid", "response": "Scalenus medius lies posterior to the subclan aery and thus need not be divided to expose the aery. Whereas, sternocleidomastoid & scalenus anterior lie anteriorly and omohyoid lies superiorly and thus are cut during exposure of the subclan aery.\n\nSo the answer to this question is C"}
{"instruction": "Weakness of both Adduction and abduction is seen in\nA. Duane's retraction syndrome type 1\nB. Duane's retraction syndrome type 2\nC. Duane's retraction syndrome type 3\nD. Double elevator palsy", "response": "Ans. c. Duane's retraction syndrome type 3 Weakness of both adduction and abduction is seen in Duane c retraction syndrome type 3. Duane's Retraction Syndrome Congenital strabismus that is usually caused by failure of normal development of the abducens nerve. Absence of the abducens nerve and fascicle with anomalous innervation of the lateral rectus muscle by the oculomotor nerve Patients may have esotropia or exotropia Mostly unilateral, commonly affecting the left eye more than right Characteristic feature of Duane's Retraction Syndrome Retraction of the globe and narrowing of the palpebral fissure during attempted adductionQ. This feature is caused by the simultaneous contraction of the medial and lateral rectus muscle that occurs during attempted adductionQ Duane's Retraction Syndrome Type I (Esotropic Duane's Syndrome) Most common typeQ Absence or limitation of abduction and normal adductionQ Type II (Exotropic Duane's Syndrome) Least common typeQ Limited adduction with normal abductionQ Type III Limitation of both adduction and abductionQ Double Elevator Palsy All horizontal gaze movements are normal. Double elevator palsy (mono ocular elevator palsy) is caused by tight oblique contracted inferior rectus muscle or hypoplastic/ineffective superior rectus muscle\n\nSo the answer to this question is C"}
{"instruction": "A gardener was accidentally poisoned by a weed killer that inhibits acetylcholinesterase. Which of the following alterations in neurochemical transmission at brain cholinergic synapses is the most likely result of this poisoning?\nA. Blockade of cholinergic receptors\nB. A pileup of choline outside the cholinergic neuron (in the synaptic cleft)\nC. A pileup of acetylcholine outside the cholinergic neuron (in the synaptic cleft)\nD. Up-regulation of postsynaptic cholinergic receptors", "response": "Ans. C. A pileup of acetylcholine outside the cholinergic neuron (in the synaptic cleft)Acetylcholinesterase is the enzyme that breaks acetylcholine down into acetate and choline. The acetate diffuses away, and choline is taken back up into the presynaptic nerve terminal for the synthesis of more ACh. Blocking the function of acetylcholinesterase would prevent the breakdown of ACh, which would accumulate in the cleft because there is no uptake mechanism for ACh and it diffuses away more slowly than acetate.\n\nSo the answer to this question is C"}
{"instruction": "Foramen spinosum transmits the following\nA. Meningeal branch of the mandibular nerve , middle meningeal aery\nB. Superior ophthalmic vein from the cavernous sinus\nC. Both of the above\nD. None of the above", "response": "Foramen spinosum transmits Middle meningeal aery & vein Emissary vein Nervosus spinosus - Meningeal branch of the mandibular nerve\n\nSo the answer to this question is A"}
{"instruction": "Corneal sensation is lost in –\nA. Herpes simplex\nB. Conjunctivitis\nC. Fungal infection\nD. Trachoma", "response": "There is marked diminution of corneal sensations in herpetic dendritic ulcer.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following cells predominate on vaginal cytology in menopausal women\nA. Intermediate cells\nB. Superficial cells\nC. Parabasal cells\nD. Superficial cells and intermediate cells", "response": "Predominance of parabasal cells is seen in menopausal patients.\n\nSo the answer to this question is C"}
{"instruction": "All of the followings are true about Narcolepsy; except:\nA. Strong association with HLA class II\nB. Sudden loss of voluntary muscle tone\nC. NREM abnormality\nD. Irresistible desire to sleep", "response": "NARCOLEPSY Narcolepsy is a condition characterized by excessive sleepiness, as well as auxiliary symptoms that represent the intrusion of aspects of REM sleep into the waking state . The sleep attacks of narcolepsy represent episodes of irresistible sleepiness, leading to perhaps 10 to 20 minutes of sleep. They can occur at inappropriate times (e.g., while eating, talking, or driving and during sex). The REM sleep includes hypnagogic and hypnopompic hallucinations, cataplexy, and sleep paralysis. Diagnosis-* polysomnographic - reveals a characteristic sleep-onset REM period * HLA ASSOCIATION - HLA - DR2\n\nSo the answer to this question is C"}
{"instruction": "A 20-year-old female presents with excess facial hair and oligomenorrhea, increased levels of free testosterone, and normal ovaries on USG. Most likely diagnosis is:\nA. PCOD\nB. Adrenal hyperplasia\nC. Idiopathic hirsutism\nD. Testosterone-secreting tumor", "response": "Ans. A. PCODa. PCOS/PCOD is a disorder of chronically abnormal ovarian function (oligo/anovulation) and hyperandrogenism frequently a/w hyperinsulinemia and insulin resistance, resulting in menstrual irregularity, infertility, and hirsutism.b. Rotterdam 2003 criteria for diagnosis of PCOS/PCOD:c. At least 2 of 3 should be present:i. Oligo/anovulation (causes oligomenorrhea, amenorrhea, and infertility)ii. Hyperandrogenism: Biochemical or clinical (increased serum androgens or acne, hirsutism)iii. 12 or more than 12 follicles 2-9mm in size present within or both ovaries on USG and/or ovarian volume >10mL (necklace-of pearl pattern).* As the patient in the question satisfies first 2 criteria, she is a case of PCOS.\n\nSo the answer to this question is A"}
{"instruction": "Red or brown discoloration of teeth is seen in\nA. Porphyra\nB. Internal resorption\nC. Nasmynth membrane\nD. Silver", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "False positive rheumatoid factor can be associated with all except -\nA. Inflammatory bowel disease\nB. HbsAg\nC. VDRL\nD. Coombs test", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Hypomagnesemia is associated with which of the following-\nA. Alcoholism\nB. Hypothyroidism\nC. Both\nD. None", "response": "A rising blood concentration of ethanol directly impairs tubular magnesium reabsorption, thus leading to hypomagnesemia. Hypehyroidism is a cause for hypomagnesemia and hypothyroidism causes hypermagnesemia. Reference : page 2462-63 Harrison's Principles of Internal Medicine 19th edition\n\nSo the answer to this question is A"}
{"instruction": "The best skin graft for open wound is\nA. Isograft\nB. Homograft\nC. Allograft\nD. Autograft", "response": "Autograft or autologous graft means skin grafts from one site of body to another. They are the best skin grafts.\n\nSo the answer to this question is D"}
{"instruction": "Zero order kinetics is followed by all of the following drugs EXCEPT:\nA. Phenytoin\nB. Barbiturates\nC. Alcohol\nD. Theophylline", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A patient on warfarin sodium following myocardial infarction reports for an oral surgical procedure. Which one of the following Laboratory tests should be preferred to ascertain the fitness\nA. Prothrornbin time\nB. Tourniquet time\nC. Clotting time\nD. Bleeding time", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "In acute exacerbations of COPD, noninvasive positive pressure ventilation (NIPPV) is initiated when\nA. Paco2 >45 mmHg\nB. PaO2 <80 mmHg\nC. FEV1 <30\nD. FEV1/FVC <0.7", "response": "In acute exacerbations of COPD, noninvasive positive pressure ventilation (NIPPV) is initiated in patients with respiratory failure, which is defined as Paco2 > 45 mmHg, This results in a significant reduction in moality rate, need for intubation, complications of therapy, and hospital length of stay.Ref: Harrison 19e pg: 1707\n\nSo the answer to this question is A"}
{"instruction": "Which test differentiate maternal and fetal blood CellaEUR'\nA. Apt test\nB. Kleihauer-Betke test\nC. Bubblin test\nD. Osmotic fragility test", "response": "Apt test Both Apt test and Kleihaur-betke test can be used to detect the presence of fetal blood within a sample. Apt Test -Is used to detect the presence or absence of fetal blood (qualitative) in a vaginal discharge to rule out vasa pre late in pregnancy or to detect the origin of a neonatal bloody, vomiting whether it's a genuine upper GI hemorrhage/hemoptysis or simply a swallowed maternal blood during delivery or from cracked nipple. Kleihauer-Betke Test -The sample is maternal peripheral smear and is used to see how much of fetal blood (quantitative) has been transfused into the maternal serum in order to assess the risk of isoimmunization and then the risk of hemolytic disease of the newborn. Both of them relies on the fact that HbF is resistant to alkali (Apt) and acids (Kleihauer) and so the HbA containing RBCs (maternal) will be hemolyzed but not the fetal RBCs as they contain the HbF. In simple words When fetal blood needs to be differentiated from adult (maternal) blood Apt test is used --> (qualitative estimation). When the amount of fetal bleeding needs to estimated Kleihauer Betke test is used --4 (quantitative estimation). The question has asked about the test used to differentiate between maternal and *fetal blood therefore the answer should he Apt test. Apt test Kleihaur Betke test Source of sample Maternal or neonatal Maternal How it works Adding 1% NaOH destroys adult HbA but not fetal HbF Adding acid destroys adult HbA but not fetal HbF Assessement type Qualitative Quantitative Result Positive means blood is of fetal origin Repoed in estimated 'inr s of fetal blood\n\nSo the answer to this question is A"}
{"instruction": "A 40 year old farmer with history of recurrenmt attack of porphyria complains of itching when exposed to the sun and maculopapular rashes on sun exposed area. His symptoms are exaggerated in summer. The diagnosis is :\nA. Seborrheic dermatitis\nB. Contact dermatitis\nC. Psoriasis\nD. Porphyrea Cutanea tarda", "response": "D i.e. Porphyria cutanea tarda Two types of porphyria are photosensitive Porphyria cutanea tarda Is most common type of porphyria and is caused by decreased activity of enzyme uroporphyrinogen decorboxylase. - Two types of PCT are: (1) Sporadic or acquired type, seen in individuals ingesting ethanol or estrogens; (2) inherited type. Both forms are associated with increased hepatic iron stores. Predominant clinical feature is a chronic photosensitivity characterized by increased fragality of sun exposed skin, paicularly areas subject to repeated trauma such as dorsum of hands, forearms, face and ears. The predominant skin lesions are vesicles and bullae, that rupture, producing moist erosion, often with a hemorrhagic base, that heal slowly with crusting and purplish discolouration of the affected skin. Hyperichosis, mottled pigmentary change, and scleroderma like induration are associated features. - Confirmation of diagnosis is done by measurement of urinary porphyrin excretion, plasma porphyrin assay and by assay of erythrocyte and/or hepatic uroporphyrinogen decorboxylase. Erythropoietic porphyria - Erythropoietic porphyria originate in the bone marrow and is d/t decrease in mitochondrial enzyme ferrochelatase; congenital type is d/t deficiency of URO synthetase. - Clinical features include an acute photosensitivity, characterized by subjective burning and stinging of exposed skin that often develops during or just after sun exposure. These may be skin swelling, and after repeated episodes, wax like scarring. - Diagnosis is confirmed by demonstration of elevated levels of free erythrocytes protoporphyrins Detection of increased plasma protoporphyrin helps to differentiate lead poisoning & iron deficiency anemia; in both of which elevated erythrocyte protoporphyrin levels occur in the absence of cutaneous photosensitivity & of elevated plasma protoporphyrin levels. * Seborrhic Dermatitis: presents with greasy scales & severe dandruff. Cradle cap is seborrhic dermatitis of scalp, face & groin in infant. But infant cradle cap is found in ptyriasis capititis complicated by seborrheic dermatitis.\n\nSo the answer to this question is D"}
{"instruction": "Erection is associated with all except\nA. Sacral plexus\nB. Hypogastric plexus\nC. Pudendal nerves\nD. Nervi erigentes", "response": "Autonomic control In the presence of mechanical stimulation, erection is initiated by the parasympathetic division of the autonomic nervous system (ANS) with minimal input from the central nervous system. Parasympathetic branches extend from the sacral plexus into the aeries supplying the erectile tissue; upon stimulation, these nerve branches release acetylcholine, which, in turn, causes release of nitric oxide from endothelial cells in the trabecular aeries. Nitric oxide diffuses to the smooth muscle of the aeries (called trabecular smooth muscle), acting as a vasodilating agent. The aeries dilate, filling the corpora spongiosum and cavernosa with blood. The ischiocavernosus and bulbospongiosus muscles also compress the veins of the corpora cavernosa, limiting the venous drainage of blood. Erection subsides when parasympathetic stimulation is discontinued; baseline stimulation from the sympathetic division of the ANS causes constriction of the penile aeries, forcing blood out of the erectile tissue. After ejaculation or cessation of stimulation, erection usually subsides, but the time taken may vary depending on the length and thickness of the penis. Voluntary and involuntary control The cerebral coex can initiate erection in the absence of direct mechanical stimulation (in response to visual, auditory, olfactory, imagined, or tactile stimuli) acting through erectile centers in the lumbar and sacral regions of the spinal cord. The coex may suppress erection, even in the presence of mechanical stimulation, as may other psychological, emotional, and environmental factors.Ref: Ganong&;s review of medical physiology 23rd edition Page no: 405\n\nSo the answer to this question is C"}
{"instruction": "The highest incidence of ectopic pregnancy amongst contraceptive users is observed with:\nA. Combined contraceptive pills\nB. Copper T intrauterine contraceptive device\nC. Progestase intrauterine device\nD. Levonorgestrel intrauterine system", "response": "- There is a slight increase in propoion of ectopic pregnancy post-failure of IUCD. The failure is highest with progesterone IUD. Progestase intrauterine device: - Rate of progesteron release = 65 mcg/day - Total progesteron content = 38mg - Shelf life = 1 to yrs - MC side effect is bleeding - 2nd MC side effect - pain\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is an exception of Courvoisier's law?\nA. Double Impaction\nB. Poal lymphadenopathy\nC. Periampullary Carcinoma\nD. None of the above", "response": "Exceptions to courvoisier's Law Double impaction of stones i.e. one in the cystic duct and other in CBD. Oriental cholangiohepatitis Pancreatic calculus obstructing the ampulla of Vater Mucocele due to stone in the cystic duct\n\nSo the answer to this question is A"}
{"instruction": "A pregnant female presented with itching in genital area. What is the MOST common vaginal infection in pregnancy?Gonorrhoea z\nA. Gonorrhoea\nB. Trichomoniasis\nC. Candidiasis\nD. Bacterial vaginosis", "response": "Candida species are normal flora of the oropharynx, bowel, and vagina. Candida overgrowth of these surfaces may arise in the setting of broad spectrum antibiotics, diabetes mellitus, or HIV infection, resulting in oral thrush, Candida esophagitis, and vaginal candidiasis. High estrogen states, such as pregnancy or oral contraceptive use, are an additional risk factor for vaginal yeast infection. Candida skin infections are often seen in moist, macerated interigenous folds, such as in the groin, perineum (diaper rash), pannus, axillae, and breasts. Ref: Matloff J. (2012). Chapter 192. Candida and Aspergillus. In G.V. Lawry, S.C. McKean, J. Matloff, J.J. Ross, D.D. Dressler, D.J. Brotman, J.S. Ginsberg (Eds), Principles and Practice of Hospital Medicine.\n\nSo the answer to this question is C"}
{"instruction": "Histological benign lesion can be fatal if\nA. Induce organ dysfunction\nB. Transform to carcinoma\nC. Metastasize to different organs\nD. All of the above", "response": "CharacteristicsBenignMalignantDifferentiation Well differentiated; structure may be typical of tissue of origin Some lack of differentiation with anaplasia; structure is often atypicalRate of growth Usually progressive & slow; may come to a standstill or regress; mitotic figures are rare & normal Erratic & may be slow to rapid; mitotic figures may be numerous & abnormal Local invasion Usually cohesive & expansile well-demarcated masses that do not invade or infiltrate surrounding normal tissuesLocally invasive, infiltrating the surrounding normal tissues; sometimes may be seemingly cohesive & expansile Metastasis Absent Present; the larger and more differentiated the primary , the more likely are metastases\n\nSo the answer to this question is B"}
{"instruction": "In ankle sprain, the commonest ligament torn is?\nA. Tibio-talar ligament\nB. Deltoid ligament\nC. Posterior talo-fibular ligament\nD. Anterior talo-fibular ligament", "response": "Ankle sprain is an inversion injury and anterior talo-fibular ligament is first to be damaged. More severe injury can also damage origin of extensor digitorum brevis and calcaneo-fibular ligament.\n\nSo the answer to this question is D"}
{"instruction": "Adenocarcinoma in oesophagus occurs in\nA. Midline oesophagus\nB. Upper oesophagus\nC. Barrett's esophagus\nD. Zenkers diveiculum", "response": "BARRETT's ulcer is an ulcer in columnar epithelium lined Barrett's oesophagus. It is more prone for Bleeding, Perforation, and Adenocarcinoma of oesophagus( very high, more than 40 times). Treatment for Barrett's ulcer is endoscopic biopsy and resection. Reference: SRB's Manual of Surgery, 6th Edition, page no= 788.\n\nSo the answer to this question is C"}
{"instruction": "Sarcoma botryoides is also known as?\nA. Embryonal Rhabdomyosarcoma\nB. Alveolar Rhabdomyosarcoma\nC. Leiomyosarcoma\nD. Lipoblastomatosis", "response": "Embryonal Rhabdomyosarcoma REF: Devita's oncology 6th edition p. 1325, Gynecologic Pathology By Marisa R. Nucci, Esther Oliva page 325 Benign tumors of striated muscle are rare. There are three main types of Rhabdomyosarcoma; Embryonal, Pleomorphic and Alveolar. 1. Embryonal Rhabdomyosarcoma (Sarcoma botryoides) Usually arises in the orbit or genitourinary tract in children. The botryoid type of Embryonal Rhabdomyosarcoma, which frequently originates in mucosa-lined visceral organs such as the vagina and the urinary bladder, generally grows as a polypoid tumor. These tumors may disseminate widely, but are responsive to chemotherapy and radiation. Embryonal Rhabdomyosarcoma occasionally arise in adults. Although regression of tumor in response to pediatric chemotherapy regimens usually occurs, age is an impoant prognostic factor for survival, with worse outcomes in older patients. 2. Alveolar Rhabdomyosarcoma Extremity Rhabdomyosarcoma in adolescents and young adults often has an alveolar histology. Alveolar Rhabdomyosarcoma is composed of ill-defined aggregates of poorly differentiated round or oval cells that frequently show central loss of cellular cohesion and formation of irregular alveolar spaces. These tumors appear to have a worse prognosis than Embryonal Rhabdomyosarcoma in younger children, but not in adults. A specific translocation, t (2, 13) (q37; q14) involving the PAX3 gene on chromosome 2 and the FKHR gene on chromosome 13, is seen in the majority of alveolar Rhabdomyosarcoma. 3. Pleomorphic Rhabdomyosarcoma In adults, Pleomorphic Rhabdomyosarcoma is the most common form of Rhabdomyosarcoma.\n\nSo the answer to this question is A"}
{"instruction": "A child with protein-energy malnutrition is brought to the outpatient depament. TRUE about Gomez classification of malnutrition of children is:\nA. Weight is compared with height\nB. Height is the only parameter\nC. Weight is the only parameter\nD. It doesn't take account of height and weight", "response": "The degree of malnutrition is almost always based on the child's percentage of standard weight for age. The child's weight is compared to that of a normal child (50th percentile) of the same age. It is useful for population screening and public health evaluations. Percent of reference weight for age = ((patient weight)/(weight of normal child of same age)) x 100. According to Gomez classification, Classification Percentage of standard weight for age Normal Grade I (Mild malnutrition) Grade II (Moderate malnutrition) Grade III (Severe malnutrition) >90 75-89.9 60-74.9 <60 Ref: Achars Textbook Of Pediatrics (4Th Edn) By Swarna Rekha Bhat (ed.), Page 46 ; Essence of Paediatrics Prof. MR Khan, Page 72.\n\nSo the answer to this question is C"}
{"instruction": "The principle used in radiotherapy is:\nA. Cytoplasmic coagulation\nB. Ionising the molecules\nC. DNA damage\nD. Low dose causes tissue necrosis", "response": "Ans. DNA damage\n\nSo the answer to this question is C"}
{"instruction": "Voissus ring is seen in:\nA. Cornea\nB. Retina\nC. Anterior capsule\nD. Posterior capsule", "response": "Anterior capsule\n\nSo the answer to this question is C"}
{"instruction": "Alpha-fetoprotein is increased in following except:\nA. Open neural tube defect\nB. Down's syndrome\nC. Oesophageal atresia\nD. Exomphalos", "response": "Down's syndrome\n\nSo the answer to this question is B"}
{"instruction": "Karyotype of a patient shows the following. What is the clinincal abnormality that is expected? NOT RELATED-MEDIICNE\nA. Gynecomastia with long thin limbs\nB. Sho stature with polydactyly\nC. Webbed neck with widely spaced nipples\nD. Rockerbottom feet", "response": ".\n\nSo the answer to this question is D"}
{"instruction": "Earliest sign of Diabetic retinopathy is\nA. Micro-aneurysm\nB. Cotton wool spots\nC. Hard exudates\nD. Flame shaped haemorrhage", "response": "(Microaneurysm) (295-Person 20th) (260-62-Khurana 4th)* Earliest detactable lesion is microaneurysm in the macular area in NPDRDIABETIC RETINOPATHYOphthalmoscopic features of Non-proliferativediabetic retinopathy (NPDR)* Microaneurysm at the macular area (the earliest detectable lesion)*** Retinal haemorrhage both deep (dot and blot haemorrhage) and superficial haemorrhages (flame shaped)* Hard exudates** - yellowish- white- waxy looking patches are arranged in clumps or in the circinate pattern - seen in macular area* Retinal oedema characterized by retinal thickening* Cotton -wool spots** (if >8, there is high risk of PDR)* Venous abnormalities - beading, looping and dilatation* Intraretinal microvascular abnormalities (IRMA)* Dark-blot haemorrhages representing haemorrhagic retinal infarctsThe hall mark of proliferative diabetic retinopathy (PDR) is the occurrence of neovascularization over changes of very severe NPDRComments cause of moderate (diminuation) of vision is Macular oedema*** Advanced diabetic eve disease - It is marked by complication such as- Persistent vitreous haemorrhage**- Tractional retinal detachment**- Neovascular glaucoma**Most common cause of vitreous hemorrhage in adults is - Diabetes (PDR) (297-Parson 20th)HARD EXUDATES - seen in -DR, Hypertensive retinopathy, coat's disease, circinate retinopathySoft exudates seen in - Hypertensive retinopathy DR, Toxemic retinopathy of pregnancy, Anemia, collagen vascular disease like- SLE, PAN, SclerodermaManagement of diabetic retinopathyType of retinopathyTherapy* Background* MaculopathyCSME* Difuse leak around macula- Circinate* Preproliferative retinopathy* Proliferative retinopathy* Advanced diabetic eye diseaseControl of diabetic, regular reviewFocal photocoagulation- Grid laserFocal photocoagulation**- Frequent reviewPan retinal photocoagulation**- Vitreo, retinal surgery** with photocoagulation* Gentamicin - can cause macular or retinal toxicity even at therapeutic and low doses when given intravitreally* NIDDM with history of DM for years should have an ophthalmic examination - As early as feasible in IDDM- 5 years after the onset of diabetes\n\nSo the answer to this question is A"}
{"instruction": "Discoloration and accelerated wear is seen in composite restoration, if a patient is using a toothpaste having:\nA. Stannous flouride\nB. Calcium carbonate\nC. Chloroform\nD. Both 2 and 3", "response": "Calcium carbonate is a surface abrasive and causes wear.\nChloroform causes softening of the composite matrix and causes discoloration.\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is a pan T lymphocite marker -\nA. CD2\nB. CD3\nC. CD 19\nD. CD 25", "response": "The TCR is a disulfide-linked membrane-anchored heterodimeric protein normally consisting of the highly variable alpha (a) and beta (b) chains expressed as pa of a complex with the invariant CD3 chain molecules. Reff: Ananthanarayanan & Panikers textbook of microbiology 9th edition pg: 133\n\nSo the answer to this question is B"}
{"instruction": "False statement about Familial Adenomatous polyposis is\nA. Most common genetic polyposis syndrome\nB. >100 polyps may be seen in colon\nC. Colon cancer usually develops around 20 years of age\nD. Caused by mutation in APC gene", "response": "Familial Adenomatous Polyposis\nThey are precancerous lesion and without intervention risk of developing colon cancer is 100% by 5th decade of life that is around 40 years.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is used as epidural anaesthetic agent commonly?\nA. Chloroprocaine\nB. Lidocaine\nC. Mepivacaine\nD. All of the above", "response": "Commonly used sho- to intermediate-acting agents for epidural anesthesia include, Chloroprocaine Lidocaine Mepivacaine Longer acting agents include, Bupivacaine Levobupivacaine Ropivacaine Ref: Butterwoh IV J.F., Butterwoh IV J.F., Mackey D.C., Wasnick J.D., Mackey D.C., Wasnick J.D. (2013). Chapter 45. Spinal, Epidural, & Caudal Blocks. In J.F. Butterwoh IV, J.F. Butterwoh IV, D.C. Mackey, J.D. Wasnick, D.C. Mackey, J.D. Wasnick (Eds), Morgan & Mikhail's Clinical Anesthesiology, 5e.\n\nSo the answer to this question is D"}
{"instruction": "\"Nerve terminals release chemicals\" release chemicals\" ? discovered by:\nA. Dale\nB. Withering\nC. Domagk\nD. Loewi", "response": "D i.e. Loewi Otto Loewi discovered that nerve terminals or synapse release chemicals. In his most famous experiment, Loewi took fluid from one frog hea and applied it to another, slowing the second hea and showing that synaptic signaling used chemical messengers. Before Loewi's experiments, it was unclear whether signalling across the synapse was bioelectrical or chemical. Loewi's famous experiment, published in 1921, largely answered this question. He dissected out of frogs two beating heas: one with the vagus nerve which controls hea rate attached, the other hea on its own. Both heas were bathed in a saline solution (i.e. Ringer's solution). By electrically stimulating the vagus nerve, Loewi made the first hea beat slower. Then, Loewi took some of the liquid bathing the first hea and applied it to the second hea. The application of the liquid made the second hea also beat slower, proving that some soluble chemical released by the vagus nerve was controlling the hea rate. He called the unknown chemical Vagusstoff. It was later found that this chemical corresponded to Acetylcholine\n\nSo the answer to this question is D"}
{"instruction": "Mother to child transmission in vectors is called?\nA. Transovarian\nB. Mechanical transmission\nC. Propagative transmission\nD. Cyclodevelopmental transmission", "response": "Ans. is 'a' i.e., Transovarian When the infectious agent is transmitted veically from the infected female to her progeny in the vector, It is known as trasnovarian transmission. Transovarian transmission is seen in :- Scrub typhus Rickettsial pox Rocky mountain spotted fever Indian tick typhus Q. fever Yellow fever Note : In Q fever also, there is transovarial transmission in tick. (But no ahropod is involved in its transmission to man). Also know Transmission of the disease agent from one stage of life cycle to another as for example nymph to adult is known as trans-stadial transmission.\n\nSo the answer to this question is A"}
{"instruction": "All are associated with paraneoplastic syndromes except -\nA. Cerebeller degeneration\nB. Progressive multifocal leucoencephalopathy\nC. Amyotropic lateral sclerosis\nD. Opsoclonus myoclonus", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "The most impoant cells in type I hypersensitivity\nA. Macrophages\nB. Mast cells\nC. Neutrophils\nD. Lymphocytes", "response": "Ans. is 'b' i.e., Mast cells Type I hypersensitivity (Immediate hypersensitivity) o It is a rapidly developing immunological reaction occuring within minutes after the combination of an antigen with antibody bound to mast cells in individuals previously sensitized to the antigen. o Immediate hypersensitivity reactions are mediated by Ig E, but T and B cells play impoant role in the development of these antibodies. o Type I reaction requires prior sensitization to a specific antigen (allergen). o Most exposures occur either by inhalation (respiratory route) or ingestion (GIT) of antigen. o Type one hypersensitivity has two phases :- 1.Initial response o After first antigen exposure, this antigen is presented to CD-4 helper T cells (TH2 type) by antigen presenting cells. These primed TH2 cells release IL-4 that acts on B-cells to form Ig E specific for that paicular antigen. The antigen specific lg E antibodies then bind to the surface receptors of mast cells and basophils. The process from first antigen exposure to the coating of mast cells by Ig E acts as sensitization (prior sensitization) and first exposure is also called priming or sensitizing exposure (dose). Subsequent exposure (shocking dose) to same antigen then result in activation of mast cells and basophils with release of mediator from these cells that leads to ? Smooth muscle spasm Increase mucus secretion from the epithelial cells. Vasodilatation Increased vascular permeability Recuritment of inflammatory cells Note - Most of the clinical effects are due to smooth muscle spasm. 2. Late phase response In this phase additional leukocytes are recruited. These cells amplify and sustain the inflammatory response without additional exposure to the triggred antigen. Among the cells that are recruited in the late-phase reaction, eosinophils are paicularly impoant. Eosinophils produce major basic protein and eosinophilic cataionic protein that are toxic to epithelial cells. Platelet activating factor (PAF) recruits and activates inflammatory cells and is most impoant cytokine in the initatiation of late phase response. Type I hypersensitivity occurs in two forms Anaphylaxis --> Acute, potentially fatal, systemic. Atom --> Chronic, Nonfatal, Lacalized. Remember o Mast cells are the most impoant cells in type I hypersensitivity. o Eosinophils are the most impoant cells in the late phase reaction of type I hypersensitivity. o Histamine is the most impoant mediator in type I hypersensitivity. o IL-4 is paicularly impoant, it is essential for turning on IgE secreting B cells. o PAF is the most impoant cytokine in the initiation of late phase reaction. o Most potent eosinophilic activating cytokine is IL-5.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following antimalarial is a slow acting schizonticide-\nA. Aemether\nB. Mefloquine\nC. Pyrimethamine\nD. Quinine", "response": "Ans. is 'c' i.e., Pyrimethamine o Antimalarials that act on erythrocytic phase of schizogony are called erythrocytic schizontocides. The available drugs can be divided into ? 1. Fast acting - Chloroquine, amodiaquine, quinine, mefloquine, halofantrine, lumefantrine, atovaquone, aemisinin. 2. Slow acting - Pyrimethamine, Proguanil, sulfonamides, tetracyclines.\n\nSo the answer to this question is C"}
{"instruction": "Substrate-level phosphorylation seen in a reaction catalysed in\nA. Succinate dehydrogenase\nB. Alpha-ketoglutarate dehydrogenase\nC. Succinyl CoA thiokinase\nD. Malate dehydrogenase", "response": "Substrate level phosphorylation is catalysed by : (i) In glycolysis: Phosphoglycerate kinase, pyruvate kinase; and (ii) In TCA cycle: Succinate thiokinase.\n\nSo the answer to this question is C"}
{"instruction": "Following is not used in the management of Post dural headache -\nA. Propped up position\nB. Sumatriptan\nC. Hydration\nD. Epidural blood patch", "response": "Ans. is 'a' i.e., Propped up position * Supine (recumbent) position and not propped up is recommended for the management of post dural headache.* Post dural puncture headache is due to CSF leak. Typical location is bifrontalor occipital.* Headache gets worsen on sitting or upright posture and is relieved by lying down position and abdominal pressure - The hallmark of postdural puncture headache i.e., association with body position.* The onset of headache is usually 12-72 hours following the procedure, however, it may be seen almost immediately. In most cases it lasts for 7-10 days.* PDPH is believed to result from leakage of CSF from a dural defect and decreased ICT. Loss of CSF at a rate faster that it can be produced causes traction on structure supporting the brain, particularly dura and tentorium. Traction on cranial nerve (particularly 6th nerve) produces diplopia.* Factors that increase the incidence of PDPH are young age, female sex, Pregnancy, large bore needle and multiple punctures. Timing of ambulation has no effect on incidence of PDPH* Use of small bore needle can prevent PDPH.* Intially conservative treatment is given which includes analgesics (NSAIDs), oral or i.v. fluids, Sumatriptan, cosyntropin, caffeine and recumbent position.* If conservative treatment fails, epidural blood patch can be used. It involves injecting 15-20 ml of autologous blood into the epidural space which stop leakage of CSF by coagulation and mass effect.\n\nSo the answer to this question is A"}
{"instruction": "Patient is having bronchodilation, increased temperature, constipation and tachycardia. The diagnosis is:\nA. Organophosphate poisoning\nB. Paracetamol poisoning\nC. Mushroom poisoning\nD. Atropine poisoning", "response": "Atropine poisoning All the symptoms mentioned in this question are seen with anticholinergic compounds. Atropine, hyoscine (scopolmaine) & hyoscyamine are natural alkaloids with anticholinergic action. They are found in Dhatura, Atropa belladena, Hyoscyamus niger. Poisoning with these substances are characteristically described as - Dry as a bone (Dryness of mouth & skin) - Red as a beet (Flushed face) - Blind as a bat (Dilated pupil) - Hot as a hare (Hyperpyrexia) - Mad as a wet hen (Delirium) Symptoms can also be described as 8D's Other symptoms which can occur are tachycardia, constipation, bronchodilation and reduced airway resistance (esp. in COPD and asthma patients) and urinary retention.\n\nSo the answer to this question is D"}
{"instruction": "The most common presentation of IgA nephropathy\nA. Nephritic syndrome\nB. Nephrotic syndrome\nC. Microscopic hematuria\nD. Repeated gross hematuria", "response": "The two most common presentations of IgA nephropathy are - Recurrent episodes of macroscopic hematuria during or immediately following an upper respiratory infection often accompanied by proteinuria . Persistent asymptomatic microscopic hematuria. Nephrotic syndrome is uncommon . Ref:Harrison 20 th edition pg no 2140\n\nSo the answer to this question is D"}
{"instruction": "All of the following are present in sweat except -\nA. Calcium\nB. Lactic acid\nC. Urea\nD. Uric acid", "response": "Ans D- Uric acidnote : calcium is excreted in sweat daily by 140 mg/day\n\nSo the answer to this question is D"}
{"instruction": "Malignant hyperthermia is a rare complication of the use of the following anaesthetic:\nA. Ketamine\nB. Thiopentone sodium\nC. Halothane\nD. Ether", "response": "Rarely, halothane can cause malignant hyperthermia, which is treated with dantrolene.\n\nSo the answer to this question is C"}
{"instruction": "Best site to demonstrate capillary filling in infants?\nA. Nail bed\nB. Sternum\nC. Ear lobule\nD. Great toe", "response": "Ans. is 'b' i.e., Sternum o The state of microcirculation can be assessed by capillary filling time (CFT) o Firm pressure is applied over sternum or forehead by a ball of the thumb for 5 seconds. This leads to blanching. o On removal of pressure color returns. The time taken for complete return of color is designated as capillary filling time, the normal is less than or equal to 3 sec. o Prologed CFT is the earliest sign signifying impairment or microcirculation.\n\nSo the answer to this question is B"}
{"instruction": "Bull's neck is characteristically seen in:\nA. Hamaoma of Lung\nB. Diphtheria\nC. Glaucoma\nD. Hepatic Candidiasis", "response": "Faucial diphtheria : commonest type of diphtheria. Characterized by fever, sore throat, pseudo membrane over fauces. Cervical adenitis with sub-mandibular edema is called bull neck.\n\nSo the answer to this question is B"}
{"instruction": "Not a feature of Congenital rubella syndrome is\nA. Congenital Cataract\nB. Microphthalmia\nC. Salt and pepper retinitis\nD. Anterior Uveitis", "response": "Anterior Uveitis is Not a feature of Congenital rubella syndrome.\n\nSo the answer to this question is D"}
{"instruction": "A 30 year old patient presented with history of jaundice for 10 days. His liver function tests showed bilirubin of 10 mg/dl, SGOT/SGPT - 1100/1450, serum alkaline phosphatase - 240 LU. He was positive for Hbs Ag. What should be the confirmatory test to estabilish acute hepatitis B infection -\nA. Ig M anti-HBc antibody\nB. Hbe Ag\nC. HBV DNV by PCR\nD. Anti-HBc antibody", "response": "Ans. is 'a' i.e., Ig M anti-HBc antibody . Has been explained . Ig M anti-HBc antibody is the marker of acute or recent HBV infection.\n\nSo the answer to this question is A"}
{"instruction": "Immunoglobulins are produced by -\nA. Macrophages\nB. B-cells\nC. T-cells\nD. NK-cells", "response": "Immunoglobulin (Ig),is a large, Y-shaped protein produced mainly by plasma cells that is used by the immune systema Ref: Ananthanarayan & Panikers textbook of microbiology 9th edition pg:94\n\nSo the answer to this question is B"}
{"instruction": "A 5 year old child is admitted with headache, vomiting and difficulty in walking. Physical findings include truncal ataxia, papilloedema and left lateral rectus palsy. No finger-to-nose ataxia could be detected on the left side or right side. The most likely diagnosis is –\nA. Dandy walker syndrome\nB. Syringobulbia\nC. Arnold-chiari malformation\nD. Medulloblastoma", "response": "Congenital lesions would present Hydrocephalus since birth (for a & c)\n\nSo the answer to this question is D"}
{"instruction": "Osteoid osteoma consists of -\nA. Osteoblasts\nB. Osteoclasts\nC. Both of above\nD. None of the above", "response": "Ans. is 'c' i.e., Both of above Osteoid Osteoma Osteoid osteoma is the most common true benign tumor of the bone. This is a benign circumscribed lesion that may arise in the coex of long bones or occasionally in the cancellous bone of spine. The characteristic feature is the formation of a small nidus of osteoid tissue, surrounded by a reactive zone of dense sclerosis (Sclerotic new bone formation). Microscopically, the tumor is composed of thin, irregular, trabeculae within a cellular granulation tissue containing osteoblasts and osteoclasts.Trabeculae are more mature in the center, which is often paially calcified. Reactive, sclerotic bone surrounds the nidus. Clinical features of osteoid osteoma The tumor occurs between 10-30 years of age and is more common in males. The diaphysis of long bones is involved, most common bone involved is the tibia followed by femur. Posterior elements of the veebrae may also be involved. The presenting complaint is a nagging pain, worst at night, and is relieved by salicylates or other NSAIDs, a diagnostic feature. On X-ray, there is a small radiolucent area (nidus) surrounded by dens sclerosis. X-ray, in some cases, show local sclerotic thickening of the shaft that may obscure the small central nidus within the area of rarefaction. Bone scan shows increased uptake in the nidus. The only treatment is wide en block excision along with internal fixation with or without bone grafting.\n\nSo the answer to this question is C"}
{"instruction": "The most common manifestation of congenital toxoplasmosis:\nA. Hydrocephalus\nB. Chorioretinitis\nC. Hepatosplenomegaly\nD. Thrombocytopenia", "response": "Characteristic triad of Congenital Toxoplasmosis: Chorioretinitis (most common) Hydrocephalus Cerebral calcifications.\n\nSo the answer to this question is B"}
{"instruction": "Birth weight of all 10 babies born an in a nursing home on a day was 2.7 kg. Standard deviation is -\nA. 0\nB. 1\nC. 0. 27\nD. 2.7", "response": "Standard deviation is a measure of dispersion from central value.\nIn the question, there is only one central value (2.7 Kg) as all 10 babies have same weight. Thus, there is no dispersion.\n\nSo the answer to this question is A"}
{"instruction": "Apple core appearance on barium enema is seen in?\nA. Carcinoma Colon\nB. TB caecum\nC. Crohns disease\nD. Ulcerative colitis", "response": "Ans. (a) Carcinoma ColonRef: Bailey 26th ed. 170* On double contrast barium enema of the rectum and distal sigmoid colon demonstrates a typical annular constricting carcinoma of the colon with overhanging edges on both the proximal and distal margins forming a so called \"apple-core\" lesion.\n\nSo the answer to this question is A"}
{"instruction": "First symptom in vulval cancer is-\nA. Pain\nB. Pruritus\nC. Ulceration\nD. Bloody discharge", "response": "Ans. is 'b' i.e., Pruritus o Women with VIN and vulvar cancer commonly present with pruritus and a visible lesion.# However, pain, bleeding, and ulceration may also be initial complaints.\n\nSo the answer to this question is B"}
{"instruction": "For treatment of paucibacillary leprosy drugs used are -\nA. Rifampicin & dapsone\nB. Rifampicin, dapsone, steroids\nC. Rifampicin, clofazimine, dapsone\nD. None", "response": "Paucibacillary cases should also recieve combined therapy in the view of primary dapsone resistance .The recommended standard adult regimen includes rifampicin and dapsone Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 341\n\nSo the answer to this question is A"}
{"instruction": "Which among Following drugs does not commonly produce fixed drug eruptions:\nA. Tetracycline\nB. Ibuprofen\nC. Sulphonamides\nD. Mepacrine", "response": "Mepacrine\n\nSo the answer to this question is D"}
{"instruction": "Findings of trigeminal nerve injury include -\nA. Pupillary dilation\nB. Loss of blinking reflex of eye\nC. Normal jaw reflex\nD. Ptosis", "response": "Shining a bright light into one eye causes reflex closure of both eyes the blink reflex ophthalmic division of trigeminal nerve. Pupillary dilation and ptosis is seen in 3rd nerve injury In trigeminal nerve injury their is loss of jaw reflex which is mediated by mandibular nerve\n\nSo the answer to this question is B"}
{"instruction": "the distention media used in diagnostic hysteroscopy with bipolar couesy is\nA. CO2\nB. NS\nC. Dextran 70\nD. Glycine", "response": "ref : gynecology shaw\n\nSo the answer to this question is B"}
{"instruction": "Which of the following anticholinergic is used for peptic ulcer disease\nA. Dicyclomine\nB. Methacoline\nC. Pirenzepine\nD. Aclidinium", "response": "Pirenzepine is a M1 receptor antagonist.\nAcetyl choline acts on M1 receptors present on gastric glands to increase acid secretion and Pirenzepine is used to treat peptic ulcer disease by blocking these receptors.\n\nSo the answer to this question is C"}
{"instruction": "Inverse agonist of benzodiazepine receptor is :\nA. Phenobarbitone\nB. Flumazenil\nC. Beta carboline\nD. Gabapentin", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "The Millennium Development Goals (MUG) is to be achieved by the year -\nA. 2010\nB. 2015\nC. 2020\nD. 2030", "response": "Ans. is 'b' i.e., 2015\n\nSo the answer to this question is B"}
{"instruction": "Treatment for peritonsillar abscess is -\nA. Tonsillectomy\nB. Incision and drainage\nC. Antibiotics alone\nD. I & D + antibiotics", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Which of the following is not a trace element?\nA. Zinc\nB. copper\nC. Selenium\nD. calcium", "response": "Definition of trace elements : Elements present at concentrations of mg/dl in body fluids and mg/kg in tissues are referrd to as trace elements . Calcium reference range in blood : 8.6 - 10.3 mg/dl. Teitz textbook of clinical biochemistry, chapter Vitamins and trace elements.\n\nSo the answer to this question is D"}
{"instruction": "D-tubocurarine acts by -\nA. Inhibiting nicotinic receptors at myoneural junction\nB. Inhibiting nicotinic receptors at autonomic ganglion\nC. Producing depolarizing block\nD. By inhibiting reuptake of acetylcholine", "response": "Ans. is 'a' i.e., Inhibiting nicotinic receptors at myoneural junction o D-tubocurarine is a skeletal muscle relaxant that acts by competitive inhibition of NM receptors at neuron-muscular junction.\n\nSo the answer to this question is A"}
{"instruction": "Most common cause of biliary stricture is\nA. CBD stone\nB. Trauma\nC. Asiatic cholangitis\nD. Congenital", "response": "Most common cause of benign biliary stricture is laparoscopic cholecytectomy I.e., operative trauma Incidence of bile duct injury during laparoscopic cholecystectomy is 0.3-0.85 % Ref:Sabiston 20th edition Pgno :1502\n\nSo the answer to this question is B"}
{"instruction": "Trolly tract sign is seen in -\nA. Achondroplasia\nB. Psoriatic ahritis\nC. Osteopetrosis\nD. Ankylosing spondylitis", "response": "Trolly track sign : The Central radiodense line on frontal radiographs is related to ossification of supraspinous and interspinous ligaments. In addition, there are two more lateral veical linear lines, which represent ossification of the apophyseal joint capsules. The three veical ossified lines together make up the trolley-track sign. Radiological features of Ankylosis spondylitis are : Sacroiliitis Enthesopathy Romanus lesions Bamboo spine Rugger Jersy spine Interveebral disc calcification Dagger sign Trolley track sign Squarring of veebrae.\n\nSo the answer to this question is D"}
{"instruction": "A girl presents with, primary amenorrhea, grade V thelarche, grade II pubarche, no axillary hair, likely diagnosis is:\nA. Testicular feminization\nB. Mullerian agenesis\nC. Turners syndrome\nD. Gonadal dysgenesis", "response": "Tanner's Stage V thelarche means : 'Mature' breast development Stage II pubarche means : Sparse growth; We therefore have to look for a condition where development of breast is unaffected despite poor development of pubic hair. Thus, testicular feminization is the only condition out of these with well developed breast & poorly developed axillary hair or pubic hair. Ref: Textbook of Gyanaecology By Copeland, Page 601 ; Harrison's Principles of Internal Medicine, 14th Edition, Page 2122 and 15th Edition, Page 2181-2\n\nSo the answer to this question is A"}
{"instruction": "A 38-year-old man has had thyroid surgery to remove his papillary carcinoma. The external laryngeal nerve that accompanies the superior thyroid aery is damaged during the surgery.This injury could result in a severe impairment of function of which of the following\nA. Relaxing the vocal cords\nB. Rotating the arytenoid cailages\nC. Tensing the vocal cords\nD. Widening the rima glottidis", "response": "The External laryngeal nerve innervates the cricothyroid muscle (major tensor), which tenses the vocal cord. Hence damage to this nerve will lead to inability to tense the vocal cords.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following has the largest relative mesiodistal dimension of the root canal?\nA. Maxillary Lateral incisor\nB. Mandibular second premolar\nC. Palatal root of maxillary 1st molar\nD. Distal root of the mandibular 1st molar", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "All the following factors stimulate Growth hormone secretion except\nA. Deep sleep\nB. Increased blood amino acids\nC. Exercise\nD. Increased blood glucose", "response": "Factors That Stimulate or Inhibit Secretion of Growth HormoneStimulate Growth HormoneSecretionInhibit Growth HormoneSecretionDecreased blood glucoseIncreased blood glucoseDecreased blood free fattyacidsIncreased blood free fattyacidsIncreased blood aminoacids (arginine)AgingStarvation or fasting,protein deficiencyObesityTrauma, stress, excitement, ExerciseGrowth hormone(exogenous)Testosterone, estrogenSomatomedins (insulin-likegrowth factors)Deep sleep (stages II and IV)Growth hormone inhibitoryhormone (somatostatin)Growth hormone-releasinghormoneIncreased blood glucoseGhrelinIncreased blood free fattyacidsRef: Guyton; 13th edition; Chapter 76; Pituitary Hormones and Their Control by the Hypothalamus\n\nSo the answer to this question is D"}
{"instruction": "Eczema herpeticum seen with:\nA. HSV\nB. EBV\nC. CMV\nD. VZV", "response": "A (HSV) ECZEMA HERPATICUM/KAPOSi'S VARICEL1FORM ERUPTIONS KVE is wide spread cutaneous infection with a virus which normally causes localized or mild vesicular eruption occurring in patients with pre-existing skin disease | | |Infectious agentPredisposing factor (damaged skin)||* Herpes simplex virus (HSV1) is mostcommon cause (Eczema berpaticum)* Coxsackie A 16* Vaccinia* Small pox vaccination (Eczema vaccinatum)^ * Atopic eczema (most common predisposing factor). Allergic contact dermatosis, Darrier's disease* Pemphigus foliaceous, benign familial pemphigus* Icthysosis vulgaris, congenital ecthyosiform erythroderma* Mycosis fungiodes, Sezary synodrome* Bums (2nd and 3rd degree) Eczema HerpeticumIt is a disseminated herpes infection generally at sites of epidermal disruption such as atopic dermatitis, burns, eczema etc.The causative organism is herpes simplex virus type 1Exzema herpeticum results in a severe disseminated infection, involving multiple organs - eyes, brain, lung, liver and others and can be fatal.Treatment of choice is systemic antiviral drugs, such as acyciovir or vataeyclovir.When smallpox vaccination was still being routinely administered, the vaccinia virus used in the smallpox vaccine could cause a similar syndrome if the patient had an active eczema. This condition is called eczema vaccinatum.Eczema herpeticum and eczema vaccination are collectively known as Kaposi's varicelliform eruption\n\nSo the answer to this question is A"}
{"instruction": "A 37-day-old baby presented to the Pediatrics ER with increased respiratory effo along with grunting. Mother says he is always irritable, feeds very poorly and has not gained weight. History of frequent respiratory infections in the past 2 weeks O/E, Wide pulse pressure along with bounding peripheral pulses Hyperkinetic apex Continuous murmur in 2nd left intercostal space. The structure involved in the above condition develops from which embryological structure: -\nA. Left sixth arch\nB. Right sixth arch\nC. Left fifth arch\nD. Right fifth arch", "response": "Chest x-ray shows marked cardiomegaly with dilatation of the main pulmonary aery and bilateral pulmonary plethora ECG tells la dilatation, LV hyperophy and left axis detion which points towards the diagnosis of PDA. The left sixth aoic arch is responsible for the development of both the pulmonary aeries and the ductus aeriosus. Without regression of the ductus aeriosus, a patent connection remains between aoa and the pulmonary trunk. The ductus aeriosus often reaches functional closure within 24 hours after bih, whereas anatomic closure and subsequent formation of the ligamentum aeriosum often occur by the twelfth postnatal week.\n\nSo the answer to this question is A"}
{"instruction": "Commonest cause of nosocomial infection\nA. Pseudomonas\nB. Staphylococci\nC. Klebsiella\nD. Enterobacteriacea", "response": "Controversial MCQ, no where there is clear cut reference for MC agent of HAI\nInitially hospital outbreaks were caused by Gram positive organisms like Streptococcus pyogenes and the methicillin resistant Staphylococcus aureus (MRSA)\nPresently Gram negative enteric pathogens (Enterobacteriaceae) including Escherichia coli, Klebsiella and Enterobacter species have emerged as an important cause\nPseudomonas and Acinetobacter species are also common nosocomial pathogens and are extremely resistant to common antibiotics and antiseptics.\n\nSo the answer to this question is B"}
{"instruction": "Primary biliary cirrhosis is most commonly associated with______\nA. Systemic sclerosis\nB. Sjogren syndrome\nC. Ulcerative colitis\nD. Pancreatitis", "response": "Primary Biliary Cirrhosis Autoimmune disorder Clinical manifestation - obstructive jaundice F > M Antibody seen in antimitochondrial ab which is formed against E2 subunit of PDH enzyme. Interlobular bile ducts are actively destroyed by lymphoplasmacytic inflammation with or without granulomas.\n\nSo the answer to this question is B"}
{"instruction": "The mechanism responsible for sustained vascular smooth muscle contraction is\nA. Sustained calcium release from SERCA pump\nB. Vascular smooth muscle tone\nC. Latch bridge mechanism\nD. Henneman principle", "response": "Latch bridge mechanism: - Once smooth muscle has developed full contraction, the amount of continuing excitation can usually be reduced to far less than the initial level even though the muscle maintains its full force of contraction. Fuher the energy consumed to maintain contraction is often miniscule, sometimes as little as 1/ 300 the energy required for comparable sustained skeletal muscle contraction. This mechanism is k/a 'latch' mechanism. The impoance of latch mechanism is that it can maintain prolonged toxic contraction in smooth muscle for hours with little use of energy. Little continued excitatory signal is required from nerve fibres or hormonal source.\n\nSo the answer to this question is C"}
{"instruction": "A 50 year old male presents with cicatricial entopion of uper and lower eyelid. On eversion of upper eyelid, linear conjunctival scars - Arlt line are seen. What is the diagnosis?\nA. Trachoma\nB. Sprisng catarrah\nC. Ligneous conjunctivitis\nD. Parinaud oculoglandular syndrome", "response": "Arlt line is a feature of trachoma. Ref: Kanski 8th/e Chap.5, p.138\n\nSo the answer to this question is A"}
{"instruction": "The most common primary cause of intraocular tumor in children -\nA. Retinoblastoma\nB. Rhabdomyosarcoma\nC. Neuroblastoma\nD. Melanoma", "response": "Malignant tumor arising from the neurosensory cells of retina due to deletion of RB gene located on the long arm of chromosome 13(13q14). Ref: ak khurana 6th edition\n\nSo the answer to this question is A"}
{"instruction": "Mirror test is used to\nA. Assessment of cessation of respiration\nB. Assessment for tremors\nC. Assessment for hea function\nD. Assessment for brain function", "response": "Cessation of respiration : this should be complete and continuous. Complete stoppage of respiration for more than 5 minutes usually causes death. Respiration may stop for very sho period without causing death. Feather test, mirror test and Winslow's test have only historical impoance. Ref: Dr. NARAYANAN REDDYS TEXTBOOK OF FORENSIC MEDICINE PAGE 144\n\nSo the answer to this question is A"}
{"instruction": "Average central aortic pressure in full-term neonate is_____ mm Hg?\nA. 75/50\nB. 60/40\nC. 40/20\nD. 20/10", "response": "Ans. a (75/50) (Ref. Nelson Paediatrics 18th/1856; OP Ghai 6th/393)Nelson pediatrics 18th/p. 1856 under heading Neonatal Circulation:# The average central aortic pressure in a term neonate is 75/50 mm Hg.THE NEONATAL CIRCULATION# At birth, the fetal circulation must immediately adapts to extrauterine life as gas exchange is transferred from the placenta to the lung.- After an initial slight fall in systemic blood pressure, a progressive rise occurs with increasing age.0- The heart rate slows as a result of a baroreceptor response to an increase in systemic vascular resistance when the placental circulation is eliminated.- The average central aortic pressure in a term neonate is 75/50 mm Hg.- The onset of ventilation, pulmonary vascular resistance is markedly decreased as a consequence of both active (PO2 related) and passive (mechanical related) pulmonary vasodilation.* The major decline in pulmonary resistance from the high fetal levels to the low \"adult\" levels in the human infant at sea level usually occurs within the 1st 2-3 days but may be prolonged for 7 days or more.* Over the 1st several weeks of life, pulmonary vascular resistance decreases even further, secondary to remodeling of the pulmonary vasculature, including thinning of the vascular smooth muscle and recruitment of new vessels.Significant differences between the neonatal circulation and that of older infants include:- right-to-left or left-to-right shunting may persist across the patent foramen ovale;- in the presence of cardiopulmonary disease, continued patency of the ductus arteriosus may allow left-to-right, right-to-left, or bidirectional shunting;- the neonatal pulmonary vasculature constricts more vigorously in response to hypoxemia, hypercapnia, and acidosis;- the wall thickness and muscle mass of the neonatal left and right ventricles are almost equal; and- newborn infants at rest have relatively high oxygen consumption, which is associated with relatively high cardiac output.# The newborn cardiac output is about 350 mL/kg/min.# CO falls in the 1st 2 months of life to about 150 mL/kg/min# Then more gradually to the normal adult cardiac output of about 75 mL/kg/min.# The foramen ovale is functionally closed by the 3rd mo of life.# Functional closure of the ductus arteriosus is usually complete by 10--15 hr in a normal neonate0# The normal ductus arteriosus differs morphologically from the adjoining aorta and pulmonary artery in that the ductus has a significant amount of circularly arranged smooth muscle in its medial layer.# During fetal life, patency of the ductus arteriosus appears to be maintained by the combined relaxant effects of low oxygen tension and endogenously produced prostaglandins, specifically prostaglandin E2# In a full-term neonate, orygen is the most important factor controlling ductal closure.0# 'When the PO2 of the blood passing through the ductus reaches about 50 mm Hg, the ductal wall constricts.\n\nSo the answer to this question is A"}
{"instruction": "Marcus gunn jaw winking phenomenon due to relation between which cranial nerves\nA. VII + VIII\nB. III + V\nC. V + VII\nD. III + VI", "response": "Ans. is 'b' i.e., III + V Marcus Gunn phenomenon (a.k.a. Marcus Gunn Jaw-Winkingor Trigemino-oculomotor Synkineses) IT is an autosomal-dominant condition with incomplete penetrance, in which nursing infants will have rhythmic upward jerking of their upper eyelid. This condition is characterized as a synkinesis: when two or more muscles that are independently innervated have either simultaneous or coordinated movements.\n\nSo the answer to this question is B"}
{"instruction": "Phenytoin is a drug that follows zero order kinetics at high doses and first order kinetics at low doses. Suppose, 400 mg phenytoin is present in the body and its rate of elimination at this dose is 200 mg/hr, how much will remain in plasma after 2 hours?\nA. 200 mg\nB. 100 mg\nC. Zero\nD. Can not be predicted from this information", "response": "* We cannot predict because we don't know when it will sta following first order kinetics. Order of kinetics: FIRST ORDER ZERO ORDER Constant fraction of drug is eliminated Constant amount is eliminated Rate of elimination is directly propoional to plasma concentration Rate of elimination is constant Clearance is constant Clearance is inversely propoional to plasma concentration Half life is constant Half life is directly propoional to plasma concentration.\n\nSo the answer to this question is D"}
{"instruction": "What is the best guide for the management of fluid resuscitation?\nA. CVP\nB. Blood pressure\nC. Oxygen saturation\nD. Urine output", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Indication for prophylaxis in pneumocystis carini pneumonia include\nA. CD4 count < 200\nB. Tuberculosis\nC. Viral load > 25,000 copies/ml\nD. Oral candidiasis", "response": "Ans. is 'a' i.e., CD4 count < 200 PROPHYLAXIS OF PNEUMOCYSTIC CARINH PNEUMONL4 Primary prophylaxis is indicated for Patients with CD4- cell counts of< 200/4 History of oropharyngeal candidiasis Secondary prophylaxis is indicated for Both HIV infected and non HIV infected patients. Who have recovered from pneumocystosis. Primary and secondary prophylaxis may be discontinued in HIV infected persons once. CD4+ counts have risen to > 200/p1 and remained at that level for 3 months. Also know First choice agent for prophylaxis Trimethoprim, sulphamethoxazole. Other agents used in prophylaxis. Dapsone, pentamidine.\n\nSo the answer to this question is A"}
{"instruction": "A patient presented with unilateral proptosis, which was compressible and increases on ending forward. No thrill or bruit was present. MRI shows a retro-orbital mass with enhancement. The likely diagnosis is:\nA. AV malformations\nB. Orbital encephalocoecle\nC. Orbital varix\nD. Neurofibromatosis", "response": "Ans. Orbital varix\n\nSo the answer to this question is C"}
{"instruction": "IL -1 helps in:\nA. Stimulation of T-lymphocytes\nB. Inhibits of B-lymphocytes\nC. Inhibits the chemotaxis of neutrophils and macrophages\nD. Decreases fibroblast and bone resorption activity", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Regression of Mullerian duct in males occurs at:\nA. 5 weeks\nB. 6 weeks\nC. 7 weeks\nD. 8 weeks", "response": "Ans. is d, i.e. 8 weeksRef: Leon Speroff 8th/ed, p342\"AMH gene expression is induced by SOX-9 in sertoli cells and results in the ipsilateral regression of mullerian ducts by 8 weeks in males\"\n\nSo the answer to this question is D"}
{"instruction": "Approved drug for prostate cancer is\nA. Bicalutamide\nB. Apalutamide\nC. Ibalizumab\nD. Ivacaftor", "response": "Apalutamide was approved by FDA in 2018 for the treatment of HIV. It is androgen antagonist. Nilutamide, flutamide, bicalutamide are old drugs used in prostate cancerRef: 25 mg / dL ⇒ Continue breast feed\n\tb) < 25 mg / dL ⇒ 2ml / kg of 10% dextose given\nSymptomatic individual\n\tGive iv fluids 2ml /kg of 10% dextrose.\n\nSo the answer to this question is B"}
{"instruction": "Cephalosporin with anti pseudomonal activity ?\nA. Cefazoline\nB. Cefoperazone\nC. Ceftriaxone\nD. Cefuroxime", "response": "Ans. is 'b' i.e., Cefoperazone Drugs acting against Pseudomonas. Penicillins - Piperacillin, Carbenicillin, Ticarcillin, Mezlocillin. Cephalosporins - Ceftazidime, Cefoperazone, Cefepime. Carbapenems - Imipenem, meropenem Monobactams - Aztreonam. Aminoglycosides - Tobramycin, Gentamycin, Amikacin. Fluroquinolones - Ciprofloxacin, Levofloxacin, Norfloxacin.. Other - Polymixin B, Colistin.\n\nSo the answer to this question is B"}
{"instruction": "Tunica reaction is positive in ?\nA. R prowazekii\nB. R typhi\nC. R tsutsugamushi\nD. R akari", "response": "Ans. is 'b' i.e., R typhi Neill - Mooser (Tunica) reaction When male guinea pigs are inoculated intraperitoneally with blood from a case of endemic typhus or with a culture of R. typhi (R. mooseri) they develop fever and a characteristic scrotal inflammation. This reaction is used to differentiate R. typhi and R. prowazekii.\n\nSo the answer to this question is B"}
{"instruction": "For therapeutic effect in manic depressive illness, steady-state serum lithium concentration should be maintained between\nA. 0.2-0.4 mEq/L\nB. 0.5-0.8 mEq/L\nC. 1.0-1.3 mEq/L\nD. 1.5-2.5 mEq/L", "response": "The margin of safety is narrow for lithium. monitoring of serum lithium concentration is essential for optimising therapy. Serum lithium level is measured 12 hours after the last dose to reflect the steady-state concentration; 0.5-0.8 mEq/L is considered optimum for main- tenance therapy in bipolar disorder, while 0.8-1.1 mEq/L is required for episodes of acute mania. Toxicity symptoms occur frequently when serum levels exceed 1.5 mEq/L. Ref:- kd tripathi;pg num:-449\n\nSo the answer to this question is B"}
{"instruction": "All are true about cohort studies except -\nA. Prospective\nB. Useful for rare diseases\nC. Necessary for incidence\nD. Costly", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "The sputum examination under DTP is done when the patient present with – a) Cough of 1–2 wks durationb) Persistent cough of 1–2 wks durationc) Hemoptysisd) Chest paine) Intermittent fever\nA. ab\nB. bc\nC. bd\nD. cd", "response": "Sputum exam. done under DTP if :\nPersistent cough of about 3-4 weeks duration.\nContinuous fever\nChest pain\nHaemoptysis\nUnexplained weight loss\nReduced appetite\n\nSo the answer to this question is D"}
{"instruction": "Widely accepted theory of dental caries\nA. Proteolytic theory\nB. Proteolytic chelation theory\nC. Acidogenic theory\nD. Autoimmune theory", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is a synol joint of the condyloid variety?\nA. First carpometacarpal joint\nB. Metacarpal phalanges joint\nC. Interphalangeal joint\nD. Radiocarpal joint", "response": "A condyloid joint is a modified ball and socket joint that allows primary movement within two perpendicular axes, passive or secondary movement may occur on third axes. These joints allow flexion, extension, abduction, and adduction movements (circumduction). Examples include the wrist-joint (Radiocarpal joint ) metacarpophalangeal joints metatarsophalangeal joints Carpometacarpal joint of the thumb is saddle joint\n\nSo the answer to this question is D"}
{"instruction": "Which of the following antibiotic can cause cholestatic jaundice\nA. Erythromycin\nB. Isoniazid\nC. Amikacin\nD. Azithromycin", "response": "Antibiotics like Erythromycin, Nitrofurantoin, Flucloxacillin can lead to cholestatic jaundics.\n\nSo the answer to this question is A"}
{"instruction": "Which of the following constitute grevious injury :\nA. Incised wound of scalp\nB. Incised wound of thigh\nC. Fracture Tibia\nD. Laceration of the scalp", "response": "C i.e. Fracture tibia\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is false?\nA. Cofactors have functions similar to those of prosthetic groups.\nB. Cofactors bind in a transient,dissociable manner to enzymes\nC. The most common cofactors are metal ions\nD. Enzymes that require metal ion cofactors are termed as metalloenzymes", "response": "Enzymes that require metal ion cofactor are termed metal activated enzymes,whereas enzymes for which metal ions serve as prosthetic groups are termed as metalloenzymes. If a metal is tightly bound to an enzyme(prosthetic group),it is called metalloenzyme, while an enzyme(without the metal ion)showing enhanced activity on the addition pf a metal ion(co factor)is called as metal ion activated enzyme/metal activated enzyme. Metalloenzymes:Cytochromes(Fe,Cu),aldehyde oxidase(Mo),catechol oxidasse(Cu),Carbonic anhydrase(Zn). Cofactors: A cofactor is a non protein chemical compound or metallic ion that is required for an enzymes activity. cofactor bind in a transient,dissociable manner to enzymes.Therefore,unlike associated prosthetic groups,cofactors must be present in the medium surrounding the enzyme for catalysis to occur. The most common cofactors are metal ions Reference: Harpers illustrated biochemistry 31st edition pg 58\n\nSo the answer to this question is D"}
{"instruction": "The intermediate syndrome in organophosphorus poisoning refers to the occurence of which of the following?\nA. Cholinergic syndrome with hypersecretion\nB. Organophosphate induced polyneuropathy\nC. Organophosphate induced delayed neuropathy\nD. Motor cranial nerve palsies", "response": "Intermediate Syndrome: This has been repoed in some patients and is characterized by weakness of the upper extremities and neck musculature, cranial nerve palsies and secondary respiratory arrest. It may occur between 24 and 96 hours after ingestion.Delayed Neuropathy: May sometimes occur 1-4 weeks after exposure. The symptoms occur distally and progress proximally. The neuropathy is usually mixed with the patients complaining paraesthesias and motor weakness.Krishan Vij textbook of forensic medicine and toxicology 5e pg:533\n\nSo the answer to this question is B"}
{"instruction": "Vaccine CONTRAINDICATED in pregnancy is: March 2013 (d, h)\nA. Hepatitis A vaccine\nB. MMR\nC. Tetanus toxoid\nD. Hepatitis B vaccine", "response": "Ans. B i.e. MMR No evidence exists of risk to the fetus from vaccinating pregnant women with inactivated virus or bacterial vaccines or toxoids. Live vaccines administered to a pregnant woman pose a theoretical risk to the fetus; therefore, live, attenuated virus and live bacterial vaccines generally are contraindicated during pregnancy.\n\nSo the answer to this question is B"}
{"instruction": "Blood pressure measured using a sphygmomanometer\nA. May be falsely low with too narrow cuff\nB. May be falsely low in patients with badly stiffened aeries\nC. May be falsely high in obese patients\nD. Gives a direct reading of mean aerial pressure", "response": "If the cuff is too small, it takes a falsely high pressure in the cuff to transmit sufficient pressure to the vessel wall for total occlusion of the aery.Blood pressure may be falsely high in patients with badly stiffened aeries because of the extra pressure needed to compress the aeries.\n\nSo the answer to this question is C"}
{"instruction": "True about Hirschsprung's disease:a) Pathology of myenteric plexus of Auerbachb) Blood in stoolsc) May involve small intestine rarelyd) Involved segment of intestine is dilatede) Present only in infant & children\nA. a\nB. ac\nC. ad\nD. b", "response": "Small intestine may be involved rarely (~5%) - CSDT 13/e p1180 (11/e p1321)\n\nSo the answer to this question is B"}
{"instruction": "A 60-year-old female present with history of recurrent abdominal pain. Imaging shows multiple small cystic lesions like bunch of grapes in the head of pancreas with a grossly dilated main pancreatic duct. The most likely diagnosis is:\nA. SCN\nB. MCN\nC. IPMA\nD. Pancreatic pseudocyst", "response": "Ans. (c) Intraductal papillary mucinous neoplasm* Bunch of grapes appearance in Head of Pancreas - Typical of IPMN* Dilated Pancreatic duct typical of IPMN* Fish mouth lesion on Endoscopy seen in IPMN\n\nSo the answer to this question is C"}
{"instruction": "The earliest manifesation in the fatty streak of Atherosclerosis is -\nA. Collection of lipid in endothelial cells\nB. Collection of lipid in smooth muscule\nC. Endothelial cell damage\nD. Noneof the above", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "A 30 year old lady c/o sudden onset breathlessness, anxiety, palpitation & feeling of impending doom. Physical examination is normal. What is the diagnosis -\nA. Panic attack\nB. PTSD\nC. Conversion disorder\nD. Acute psychosis", "response": "Ans. is 'a' i.e., Panic attack DSM-IV Criteria for a Panic AttackA panic attack is a period of intense fear or discomfort, developing abruptly and peaking within 10 minutes, and requiring at least four of the followingChest pain or discomfortQChills or hot flushesDerealization (feeling of unreality) or depersonalization (being detached from oneself)Fear of losing controlFeeling of chokingNausea or abdominal distressPalpitations or tachycardia QParesthesiasSensations of shortness of breath Q or smotheringSense of impending doomQSweatingTrembling or shaking\n\nSo the answer to this question is A"}
{"instruction": "The immediate treatment of unstable tibial plateau fracture is:\nA. Internal fixation with plate & screw\nB. Internal fixation with nail\nC. External fixator\nD. Complete bed rest", "response": "(Internal fixation with plate & screw) (720-ApIey's 8th)* Unstable fracture of Tibial plateau - In younger patient, and more so those with a central depression of more than 5 mm, open reduction with elevation of the plateau and internal fixation with a buttress plate is preferred.* Stable fracture - depression is slight (less than 5 mm), if the patient is old and frail or osteoporotic the fracture is treated with closed reduction (Skeletal traction for 3-4 weeks and then hinged cast brace for another 6 weeks.\n\nSo the answer to this question is A"}
{"instruction": "Posterior capsulotomy after cataract is done using-\nA. Argon Laser\nB. Nd YAg\nC. Holmium\nD. Diode laser", "response": "Ans. is 'b' i.e., Nd YAg o After cataract, if thin, can be cleared centrally by Nd: YAG laser capsulotomy. Discission with cystitome or zeigler's knife may also be used. Thick membranous after cataract needs surgical membranectomy.\n\nSo the answer to this question is B"}
{"instruction": "Taurine is synthesized from which amino acid?\nA. Tryptophan\nB. PhenylAlanine\nC. Cysteine\nD. Alanine", "response": "Taurine, a major constituent of bile is synthesized from cysteine\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is not a component of cell rich zone\nA. Collagen Type 1\nB. Collagen type 3\nC. Collagen type 5\nD. Stem cells", "response": "Collagen fibers type 1 and type 3 are present in cell rich zone while type 5 is absent.\n\nSo the answer to this question is C"}
{"instruction": "Pitying testing for lower motor neuron lesion involving nucleus ambiguous; uvula\nA. Is deted to the affected side\nB. Is deted to the normal side\nC. Remains in midline\nD. Is not used in testing", "response": "Answer- B. Is deted to the normal sideIt is the column of cells running almost the entire length of medulla.Motor neurons in the nucleus ambiguous innervate the constrictor muscles of the pharynx, muscles of the velopharynx (such as constrictor veli palatine), intrinsic muscle of the larynx, and single muscle of the tongue.In case of unilateral lower motor neuron lesion, when the patient phonates the soft palate will raise asymmetrically, with higher elevation on the healthy side and the uvula pulled of the midline in the same direction i.e. it is deted to the normal unaffected side.\n\nSo the answer to this question is B"}
{"instruction": "A 30 year old male had severely itchy papula-vesicular lesions on both knees, elbows, upper back and buttocks for one year. Direct immunofluorescence staining of the lesions showed IgA deposition at dermoepidermal junction and dermal papilla. The most probable diagnosis is :\nA. Pemphigus vulagris\nB. Bullous pemphigoid\nC. Dermatitis herpetiforms\nD. Nummular eczema", "response": "C i.e. Dermatitis herpetiformis\n\nSo the answer to this question is C"}
{"instruction": "50 years old patient development wound infection post laparotomy for pyoperitoneum, was treated conservatively. Now granulation tissue is seen in the wound. what is the next step of management?\nA. Daily dressing\nB. Mesh repair\nC. Incision and drainage\nD. Resulting with interrupted stitches", "response": "After the developpment of granulation tissue in thw wound, resulting with interrupted stitches done.\n\nSo the answer to this question is D"}
{"instruction": "The Sengstaken tube must maintain a pressure of ...... to stop bleeding from varices:\nA. 20 mm Hg\nB. 25 mm Hg\nC. 35 mm Hg\nD. 45 mm Hg", "response": "Sengstaken tube - have 2 balloon 1)Gastric balloon 2)Esophageal balloon It is triple lumen; double ballooned tube. It is used mainly during transpoation of patient. Total amount of air inseed in gastric balloon = 50 + 250 ml (min air) =300 ml Maximum pressure exeed by esophageal balloon = 35-40 mm of Hg Every 12 hrs the esophageal balloon has to be deflated to prevent Ischemia & necrosis of the esophagus.\n\nSo the answer to this question is C"}
{"instruction": "Treatment modalities which are carried out to cure ANUG are all except:\nA. 3%H2O2.\nB. Gingivoplasty.\nC. Gingivectomy.\nD. None.", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Ligament below head of talus is\nA. Spring\nB. Deltoid 13\nC. Cervical\nD. None", "response": "SPRING LIGAMENT:- Also known as plantar calcaneonavicular ligament. Attachments-Anteriorly: plantar surface of navicular bone.Posteriorly: anterior margin of sustentaculum tali. Head of talus directly rests on upper surface of the ligament. The plantar surface of the ligament is suppoed by tendon of tibialis posterior medially,and by tendons of flexor hallucis longus and flexor digitorum longus laterally. Most impoant ligament for maintaining the medial longitudinal arch of foot. TALUS:-Second largest tarsal bone.Head, neck and body. Tibia above and calcaneum below, Attachments:-Devoid of muscular attachment.Numerous ligaments attached to it because it takes pa in three joints- ankle, talocalcanean, and talonavicular .Neck:- Capsular ligament of ankle joint.Dorsal talonavicular Interosseus talocalcanean and cervical ligament.Anterior talofibular ligament. Medial surface of body:- deep fibres of deltoid. Medial tubercle - superficial fibres of deltoid ligament. Groove on posterior surface lodges flexor hallucis tendon. Posterior talofibular ligament attached to posterior process.Plantar border: posterior talocalcanean ligament.
{Reference: BDC 6E pg no. 30}\n\nSo the answer to this question is A"}
{"instruction": "Telefona is:\nA. Pulling of hairs\nB. Beating of soles\nC. Beating on both ears\nD. Beating on head", "response": "ANSWER: (C) Beating on both earsREF: Reddy 5th edition page 257See list of corporal punishment in Forensic medicine, June 2010\"Telefona is simultaneous beating of both ears by both palms of hand, which may leads to torn external ear, rupture of tympanic membrane causing pain, bleeding and hearing loss\"\n\nSo the answer to this question is C"}
{"instruction": "All of the following are features if CD4 count drop below 50cells/ mmcubic, except\nA. HIV associated dementia.\nB. CMV retinitis.\nC. Disseminated mycobacterium avium intracellulare.\nD. None.", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "A young female patient presented with symptoms related to anemia. Peripheral blood smear showed neutrophil hypersegmentation and bone marrow aspirate smear showed giant myelocytes. Which of the following is the likely etiology?\nA. Sideroblastic anemia\nB. Iron deficiency anemia\nC. Thalassemia\nD. Folic acid deficiency", "response": "Both the above mentioned findings are features of megaloblastic anemia. Folic acid deficiency is one of the causes of megaloblastic anemia. Ceain peripheral blood findings are common to all forms of megaloblastic anemia: Macrocytic red cells which may lack central pallor Macro-ovalocytes Low reticulocyte count Neutrophils are also larger than normal and show nuclear hypersegmentation, having 5 or more nuclear lobules instead of the normal 3-4 The marrow is hypercellular with megaloblastic changes detected at all stages of erythroid development. As DNA synthesis is impaired in all proliferating cells, granulocytic precursors also display dysmaturation in the form of giant metamyelocytes and band forms.\n\nSo the answer to this question is D"}
{"instruction": "Investigation of choice for ureteric stones for ureteric stone\nA. CT scan\nB. USG\nC. MIBG scan\nD. DMSA scan", "response": "Ans. is `a' i.e., CT scan CT scan has become the diagnosis of choice for ureteric stones The \"gold standars\" diagnostic test is holical CT without contrast. All of routine methods have become less usefull with the advent of more sensitive and specific nonenhanced computed tomography (CT) scanning. When CT is available, it is now considered the examination of choice for the detection and localization of urinary stones\n\nSo the answer to this question is A"}
{"instruction": "The left testicular vein drains into which of the following veins?\nA. Left internal iliac vein\nB. Left common iliac vein\nC. Inferior vena cava\nD. Left renal vein", "response": "The left testicular vein drains into the left renal vein. The right testicular vein drains directly into the inferior vena cava. This difference in venous drainage is believed to explain the greater incidence of varicocele on the left side than on the right. The venous drainage from the penis is to the internal vein, which then drains into the internal iliac vein.\n\nSo the answer to this question is D"}
{"instruction": "The mydriatic drug with a short duration of action is:\nA. Cyclopentolate\nB. Tropicamide\nC. Homatropine\nD. Atropine", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following are not included in Gurd's criteria?\nA. Central nervous system depression dispropoionate to hypoxaemia\nB. Tachycardia<1l0bpm\nC. Deep vein thrombosis\nD. Axillary or subconjunctival petechiae", "response": "Ans. c. Deep vein thrombosis\n\nSo the answer to this question is C"}
{"instruction": "A 32-year-old woman has had a chronic cough with fever for the past month. On physical examination, her temperature is 37.5deg C. A chest radiograph shows many small, ill-defined nodular opacities in all lung fields. A transbronchial biopsy specimen shows interstitial infiltrates with lymphocytes, plasma cells, and epithelioid macrophages. Which of the following infectious agents is the most likely cause of this appearance?\nA. Candida albicans\nB. Cytomegalovirus\nC. Enterobacter aerogenes\nD. Mycobacterium tuberculosis", "response": "These findings suggest a granulomatous inflammation, and tuberculosis is a common cause. Candida is often a commensal organism in the oropharyngeal region and rarely causes pneumonia in healthy (non-immunosuppressed) individuals. Viral infections tend to produce a mononuclear interstitial inflammatory cell response. Bacteria such as Enterobacter and Staphylococcus are more likely to produce acute inflammation. Plasmodium produces malaria, a parasitic infection without a significant degree of lung involvement.\n\nSo the answer to this question is D"}
{"instruction": "Anaesthesia for Cesarean delivery of patients with stable placenta pre is-\nA. Spinal Anaesthesia\nB. Epidural Anaesthesia\nC. General Anaesthesia\nD. Combined spinal + Epidural", "response": "Indications of general anesthesia:General anesthesia is preferred in ceain emergency conditions such as - Massive bleeding (placenta pre or accreta, abruption placentae, or uterine rupture) Coagulopathy Hemodynamic instabilty Severe fetal distress when placenta pre patient is stable then epidural is preferred.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following has small representation in somatosensory area of cerebral cortex\nA. Lips\nB. Thumb/fingers\nC. Tongue\nD. Trunk", "response": "Ans. (d) Trunk(Ref: Ganong, 25th ed/p.169)Lips and thumb has got the maximum representation in somatosensory areaRepresentations for trunk and back are small\n\nSo the answer to this question is D"}
{"instruction": "True about IgM\nA. Fix Complement\nB. Increased in primary response\nC. Fab region is composed of variable region\nD. Fc is antibody - binding option", "response": "IgM Produced in the primary response to an antigen Fixes complement.Does not cross the placentaAntigen receptors are on the surface of B cells.IgG is also involved in complement fixationReference: Harper biochemistry 30th edition page no 681\n\nSo the answer to this question is A"}
{"instruction": "Hampton hump is seen in:\nA. Pulmonary TB\nB. Bronchogenic carcinoma\nC. Pulmonary embolism\nD. Pulmonary hemorrhage", "response": "Ans. (c) Pulmonary embolismRef: Harrison 19th ed. /1633HAMPTON HUMP is a radiologic sign which consists of a shallow wedge-shaped opacity in the periphery of the lung with its base against the pleural surface.\n\nSo the answer to this question is C"}
{"instruction": "Paralytic ileus caused by\nA. Hypokalemia\nB. Hypoglycemia\nC. Hyperkalemia\nD. Hypercalcemia", "response": "Hypokalemia leads to decreased smooth muscle contraction leading to decreased peristalsis and thus paralytic ileus. Pg NO.1296 BAILEY 27TH EDITION\n\nSo the answer to this question is A"}
{"instruction": "DPT is contraindicated in\nA. Family history of convulsions\nB. Acute respiratory tract infections\nC. Progressive neurological illness\nD. Mild diarrhea", "response": "C. i.e. (Progressive neurological illness) (191 - Ghai 6th) (168- 69- Ghai 7th)Following are NOT contraindication for administration of vaccine1. Mild acute illness2. Low grade fever3. Mild diarrheal4. Current antibiotic therapy5. Prematurity6. Recent exposure to an infectious disease7. History of allergies8. Allergy to penicillin9. Malnutrition* Children suffering from progressive neurological disorders or with history of convulsions to a previous dose are at a higher risk of adverse reactions following whole cell pertuessis vaccine* The vaccine is relatively contraindicated in children with progressive neurological disease, but children with stable neurological disease like developmental delay cerebral palsy and idiopathic epilepsy may be vaccinated (169 - Ghai 7th)\n\nSo the answer to this question is C"}
{"instruction": "Trichomoniasis is transmitted through which stage\nA. Cyst\nB. Oocyst\nC. Sporozoite\nD. Trophozoite", "response": "Trichomonas vaginalis exists only as a trophozoite; no cyst stage has been identified.\n\nSo the answer to this question is D"}
{"instruction": "All are indicators of active bleeding from varices during endoscopy, EXCEPT:\nA. Active bleeding from a varix\nB. White nipple overlying a varix\nC. Clots overlying a varix\nD. Yellow nipple", "response": "Classification of the varices: Size of varix Two-size classification Three-size classification 1. Small < 5 mm Minimally elevated veins above the esophageal mucosal surface 2. Medium Touous veins occupying less than one-third of the esophageal lumen 3. Large > 5 mm Occupying more than one-third of the esophageal lumen Variceal hemorrhage is diagnosed on the basis of one of the following findings on endoscopy: Active bleeding from a varix White nipple overlying a varix Clots overlying a varix Varices with no other potential source of bleeding Ref: WGO Practice Guidelines Esophageal varices\n\nSo the answer to this question is D"}
{"instruction": "After laproscopic appendicectomy, patient had fallen from bed on her nose after which she had swelling in nose and difficulty in breathing. Next step in management:\nA. IN antibiotics for 7-10 days\nB. Observation in hospital\nC. Surgical drainage\nD. Discharge after 2 days and follow up of the patient after 8 weeks", "response": "She has possibly developed septal hematoma. A septal hematoma has to be drained as early as possible (Generally within 72 hrs) or else it can lead to necrosis of septal cailage and loss of suppo of dorsum leading to sadding of nose. It can also get infected and lead to formation of septal abscess.\n\nSo the answer to this question is C"}
{"instruction": "Victim was strangled with elbow around neck. It is called as: NEET 13\nA. Garrotting\nB. Mugging\nC. Bansadola\nD. Burking", "response": "Ans. Mugging\n\nSo the answer to this question is B"}
{"instruction": "After using transdermal nitroglycerin skin patches for 1 week, a patient with an 8-month history of chronic stable angina pectoris observes an increasing frequency of mild angina episodes during exeion. The patient has been conscientiously applying a new patch every morning immediately after removing the old one. The patient's increased frequency of anginal attacks is most likely because of\nA. A sudden onset of vasospastic angina\nB. Engaging in vigorous exercise\nC. Cellular tolerance to organic nitrates\nD. Induction of cytochrome P450 enzyme by nitroglycerin", "response": "Tolerance to organic nitrates may develop in a few days or less, depending on the dose and frequency of administration. Continuous exposure to nitroglycerin through use of a transdermal skin patch has frequently caused nitrate tolerance. A daily 10-to-14-hour drug-free period will prevent nitrate tolerance. Nitrate tolerance is a cellular tolerance caused by depletion of sulfhydryl groups required for receptor signal transduction. The drug-free interval allows time for these groups to replenish before the next period of drug exposure. Nitrates are metabolized by hepatic nitroreductase, and there is neither evidence of cytochrome P 450 involvement nor of induction of this enzyme by drugs. Although the patient's symptoms could be caused by increased physical activity or onset of vasospasm, these are less likely causes in a patient with continuous nitroglycerin exposure. Vasospasm is also unlikely because the episodes occurred during exeion. Ref - Harrison's principles of internal medicine 20e pg427,1860 / researchgate.net\n\nSo the answer to this question is C"}
{"instruction": "Regarding syphilis, all are true, except -a) VDRL titre decreases or even absent after treatmentb) VDRL becomes positive after 10-14 days of infectionc) Earliest serological test to become positive in untreated primary syphilis is TPHAd) Yaws and Pinta cannot be differentiated\nA. bc\nB. c\nC. ac\nD. ad", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Normal expiratory reserve volume of adult-\nA. 500 ml\nB. 3000 ml\nC. 1200 ml\nD. 4500 ml", "response": "Ans. is 'c' i.e., 1200 ml o Inspiratory reserve volume - 3000 mlo Expiratory reserve voulume - 1200 mlRespiratory Volumes and Capacities for an Average Young Adult MaleMeasurementTypical valueDefinition Respiratory volumes1. Tidal volume (TV)500 mlAmount of air inhaled or exhaled in one breath during relaxed, quiet breathing2. Inspiratory reserve volume (IRV)3000 mlAmount of air in excess of tidal inspiration that can be inhaled with maximum effort3. Expiratory reserve volume (ERV)1200 mlAmount of air in excess of tidal expiration that can be exhaled with maximum effort4. Residual volume (RV)1200 mlAmount of air remaining in the lungs after maximum expiration, keeps alveoli inflated between breaths and mixes with fresh air on next inspiration Respiratory Capacities5. Vital capacity (VC)4700 mlAmount of air that can be exhaled with maximum effort after maximum inspiration (ERV+TV+IRV); used to assess strength of thoracic muscles as well as pulmonary function6. Inspiratory capacity (IC)3500 mlMaximum amount of air that can be inhaled after a normal tidal expiration (TV + IRV)7. Functional residual capacity (FRC)2400 mlAmount of air remaining in the lungs after a normal tidal expiration (RV + ERV)8. Total lung capacity (TLC)5900 mlMaximum amount of air the lungs can contain (RV + VC)\n\nSo the answer to this question is C"}
{"instruction": "Capnography is useful for:\nA. determining Vaporizer malfunction or contamination\nB. determining circuit hypoxia\nC. determining the appropriate placement of endotracheal tube.\nD. detetcing concentration of oxygen in the anesthetic circuit", "response": "Ans. C. Determining the appropriate placement of endotracheal tube. (Ref. Clinical Anesthesia by Paul 5th/pg. 670-671)Clinical Anesthesia by Paul 5th Edition/pg. 671..........\"Capnography is an essential element in determining the appropriate placement of endotracheal tubes. The presence of a stable ETCO2 for three successive breaths indicates that the tube is not in the esophagus. A continuous, stable CO2 waveform ensures the presence of alveolar ventilation but does not necessarily indicate that the endotracheal tube is properly positioned in the trachea. For example, the tip of the tube could be located in a main-stem bronchus. Capnography is also a monitor of potential changes in perfusion or dead space, is a very sensitive indicator of anesthetic circuit disconnects and gas circuit leaks, and is a method to detect the quality of CO2 absorption\".Endotracheal intubation or laryngeal mask airway insertion requires qualitative identification of carbon dioxide in the expired gas. During general anesthesia, capnography and end-tidal carbon dioxide analysis are encouraged. Capnometry is the measurement and numeric representation of the C02 concentration during inspiration and expiration. A capnogram is a continuous concentration-time display of the C02 concentration sampled at a patient's airway during ventilation.Capnography# is the continuous monitoring of a patient's capnogram.# The capnogram is divided into four distinct phases (Fi. The first phase (A-B) represents the initial stage of expiration. Gas sampled during this phase occupies the anatomic dead space and is normally devoid of CO2. At point B, CO2- containing gas presents itself at the sampling site, and a sharp upstroke (B-C) is seen in the capnogram. The slope of this upstroke is determined by the evenness of ventilation and alveolar emptying. Phase C-D represents the alveolar or expiratory plateau. At this phase of the capnogram, alveolar gas is being sampled. Normally, this part of the waveform is almost horizontal. Point D is the highest CO2 value and is called the end-tidal CO2 (ETCO2). ETCO2 is the best reflection of the alveolar CO2 (PACO2). As the patient begins to inspire, fresh gas is entrained and there is a steep downstroke (D-E) back to baseline. Unless rebreathing of CO2 occurs, the baseline approaches zero.# The utility of capnography depends on an understanding of the relationship between arterial CO2 (PaCO2), alveolar CO2 (PACO2), and ETCO2. If the PaCO2-PACO2 gradient is constant and small, capnography provides a noninvasive, continuous, real-time reflection of ventilation. During general anesthesia, the ETC02-PaC02 gradient typically is 5 to 10 mm Hg.# Maldistribution is a common cause of an increased PaCO2-PACO2 gradient. Other patient factors that may influence the accuracy of ETCO2 monitoring by widening the PaCO2-ETCO2 gradient include shallow tidal breaths, prolongation of the expiratory phase of ventilation, or uneven alveolar emptying.# Increases in ETCO2 can be expected when CO2 production exceeds ventilation, such as in hyperthermia or when an exogenous source of CO2 is present# A sudden drop in ETCO2 to near zero followed by the absence of a CO2 waveform is a potentially life-threatening problem that could indicate malposition of an endotracheal tube into the pharynx or esophagus, sudden severe hypotension, pulmonary embolism, a cardiac arrest, or an artifact resulting from disruption of sampling lines. During life-saving cardiopulmonary resuscitation, the generation of adequate perfusion can be assessed by the restoration of the CO2 waveform.# Whereas abrupt decreases in the ETCO2 are often associated with an altered cardiopulmonary status (e.g., embolism or hypoperfusion), gradual reductions in ETCO2 more often reflect decreases in PaCO2 that occur after increases in minute ventilation where ventilation overmatches CO2 production.# Several methods for the quantification of CO2 have been applied to patient monitoring systems. One of the most commonly used methods is based on infrared absorption spectrophotometry (IRAS).Additional Educational points:# ETCO2 is the best reflection of the alveolar CO2 tension.# Increase in ETCO2 is the most sensitive early sign of malignant hyperthermia.6Most Sensitsive|||||Transesophageal echocardiographyPrecordial DopplerPulmonary artery catheter (| PAP)Capnography (|ETCO2)Mass spectrometry (| ETN2 most specific and quantitative)Least SensitivePAP= pulmonary artery pressure; ETCO2= end-tidal carbon dioxide; ETN2=end-tidal nitrogen.\n\nSo the answer to this question is C"}
{"instruction": "Inguinal L.node is found to be involved in a case of ovarian Ca. Revised FIGO staging would be ?\nA. Stage III A\nB. Stage IV B\nC. Stage III C\nD. Stage IV A", "response": "Ans- B\n\nSo the answer to this question is B"}
{"instruction": "All of the following are false about Tenapanor except:\nA. It is indicated for use in diarrhoea predominant IBS\nB. Can be used in children < 6 years\nC. Acts by inhibiting NHE3 on enterocytes, reducing reabsorption of sodium in small intestine\nD. Constipation is a serious adverse effect", "response": "Tenapanor Small molecule medication approved in September 2019 for the treatment of constipation-predominant irritable bowel-syndrome (IBS-C). MOA - Inhibitor of the sodium/hydrogen exchanger isoform 3 (NHE3) transpoer First and currently only medication within its class By inhibiting NHE3 on the apical surface of the enterocytes, tenapanor reduces absorption of sodium from the small intestine and colon, Resulting in an increase in water secretion into the intestinal lumen, which accelerates intestinal transit time and results in a softer stool consistency. Recommended dosage in adults - 50 mg orally twice daily- prior to breakfast or the first meal of the day and immediately prior to dinner C/I Patients< 6 years of age due to the risk of serious dehydration, Patients with known or suspected mechanical gastrointestinal obstruction\n\nSo the answer to this question is D"}
{"instruction": "The structure derived from the right fourth aortic arch-\nA. Right common carotid artery\nB. Right subclavian artery\nC. Aortic arch\nD. None of the above", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following statement about Standard Distribution curve is true?\nA. Mean = 2 Median\nB. Mean = Median\nC. Median = Variance\nD. Standard Detion = 2 Variance", "response": "The standard distribution curve (Normal distribution) is a perfectly symmetrical, bell shaped curve such that the mean, median and mode, all have the same value and coincide at the centre. Mean is obtained by adding individual observations and then divided by the number of observations. Median is obtained by arranging the data in ascending or descending order of magnitude and then the value of the middle observation is located which is called the median. Mode is the most frequently occurring value. Ref: Park's Textbook of Preventive and Social Medicine, By K. Park, 19th Edition, Pages 699-702\n\nSo the answer to this question is B"}
{"instruction": "In a young patient presenting with recurrent vitreous hemorrhage, diagnosis is –\nA. Eale's disease\nB. CRVO\nC. Proliferative retinopathy\nD. Coat's disease", "response": "Eale's disease is characterized by recurrent bilateral vitreous hemorrhage in young adult (20-30 yrs) males.\n\nSo the answer to this question is A"}
{"instruction": "Elemental iron supplementation in Iron deficiency anemia is –\nA. 300 – 400 mg\nB. 150 – 200 mg\nC. 100 – 150 mg\nD. < 100 mg", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Iron source of poor man\nA. Soya\nB. Orange fruit\nC. Jaggery\nD. Almond", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Judet view of X-ray is used for viewing injury of what ?\nA. Pelvis\nB. Calcaneum\nC. Scaphoid\nD. Spine", "response": "*Judet view of X- ray is for acetabular (pelvis) fracture. Ref : Maheshwari J Essential Ohopaedics 9th/e p.38 & 5th/e p.38,369\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is used in the treatment of well differentiated thyroid carcinoma -\nA. Il31\nB. 99m Tc\nC. 32p\nD. MIBG", "response": "Ans. is 'a' i.e., I131\n\nSo the answer to this question is A"}
{"instruction": "The RPR test uses VDRL antigen containing fine\nA. Carbon paicles\nB. Iodine paicles\nC. Silver ions\nD. Sodium ions", "response": "The rapid plasma reagin (RPR) test is a macroscopic, nontreponemal flocculation card test used to screen for syphilis. RPR antigen is prepared from a modified VDR antigen suspension containing choline chloride to eliminate the need to heat inactivate serum, ethylenediaminetetraacetic acid (EDTA) to enhance the stability of the suspension, and finely divided charcoal paicles as a visualizing agent. Ref: Ananthanarayana textbook of Microbiology 9th edition Pgno : 374\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is the best marker for diagnosing thyroid related disorder?\nA. T3\nB. T4\nC. TSH\nD. Thyroglobulin", "response": "Thyroid Stimulating Hormone assay is highly sensitive and specific in the laboratory assessment of thyroid function. TSH levels change dynamically in response to alterations of T4 and T3, so while evaluating a case of thyroid dysfunction, first we have to determine whether TSH is suppressed, normal or elevated. With rare exceptions a normal TSH level excludes a primary abnormality of thyroid function. The finding of an abnormal TSH level must be followed by measurements of circulating thyroid hormone levels to confirm the diagnosis of hypehyroidism or hypothyroidism. TSH should not be used as an isolated laboratory test to assess thyroid function in patients with suspected or known pituitary disease. Ref: Harrison's Internal Medicine, 18th Edition, Pages 2916-2917, Chapter 341 ; Principles of Critical Care, 3rd Eedition, Jesse B. Hall, Chapter 80.\n\nSo the answer to this question is C"}
{"instruction": "Which of the following medications is typically avoided in patients with pheochromocytoma due to the risk of hypeensive crisis?\nA. Promethazine\nB. Metoclopramide\nC. Haloperidol\nD. Ondansetron", "response": "For pheochromocytoma patients, METOCLOPRAMIDE is C/I as it can lead to Hypeensive crisis. The gastroprokinetic agent metoclopramide is known to stimulate catecholamine secretion from pheochromocytomas. Metoclopramide is contraindicated in patients with pheochromocytoma due to the risk of hypeensive crisis. Metoclopramide induced hypeensive crisis can be treated with phentolamine. If the patient has emesis, a serotonin 5-HT3 receptor antagonist should be used. Ondansetron does not have any effect on dopamine or norepinephrine\n\nSo the answer to this question is B"}
{"instruction": "NRHM (National Rural Health Mission) done in\nA. 2002\nB. 2005\nC. 2006\nD. 2011", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Large kidney is seen in A/E -\nA. Benign nephrosclerosis\nB. Lymphoma\nC. Amyloidosis\nD. DM", "response": "Ans. is 'a' i.e., Benign nephrosclerosis 2Kidney sized is increased ino Diabetes mellitus (Diabetic nephropathy) o Amyloidosiso Polycystic kidney disease o Lymphoma\n\nSo the answer to this question is A"}
{"instruction": "Hernia through foramen of Bochdalek true is -\nA. Congeniatal hernia\nB. Is asymptomatic\nC. Seen especially in males\nD. Least common", "response": "Answer is 'a' i.e. Congenital hernia\n\nSo the answer to this question is A"}
{"instruction": "For diagnosis of lunacy a person can be kept under observation at a streach for :\nA. 2 Days\nB. 7 Days\nC. 10 Days\nD. 30 Days", "response": "C i.e. 10 days\n\nSo the answer to this question is C"}
{"instruction": "Hockey stick appearance on echo is a feature of\nA. Mitral stenosis\nB. Mitral incompetence\nC. Aoic stenosis\nD. Aoic regurgitation", "response": "Echocardiographic features of mitral stenosis:-Thickened and calcified mitral leaflets and subvalvular apparatus -Decreased E-F slope (M-mode)-Hockey stick appearance of the anterior mitral leaflet in diastole(long axis view)-Immobility of the posterior mitral leaflet (a similar appearance can be seen in hypereosinophilia or ergot use)-Fish mouth orifice in the sho axis view-Increased LA size, with the potential for thrombus formationDynamic CT: the Restricted opening of the thickened valve from commissural fusion (especially with rheumatic valve disease), valve calcification, or both results in a \"fish-mouth\" appearance on sho-axis images. Bowing of a thickened and fibrotic anterior leaflet during diastole may result in a \"hockey-stick\" appearance which is best seen on two- or four-chamber images(Ref: The echo manual by Jae K Oh; J B Seward; A Jamil Tajik, page no 202)\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is characterised by typical ash - grey slough\nA. Furuncle\nB. Carbuncle\nC. Erysipeals\nD. Cellulitis", "response": "Ash - grey slough is typical of carbuncle.\n\nSo the answer to this question is B"}
{"instruction": "Ground glass appearance is not seen in –\nA. Hyaline membrane disease\nB. Left to right shunts\nC. Pneumonia\nD. Obstructive TAPVC", "response": "Ground grass appearance is seen in right to left shunt (not in left to right shunt).\nAll other options, pneumonia (interstitial pneumonia), HMD, and obstructive TAPV, can cause ground glass appearance.\n\nSo the answer to this question is B"}
{"instruction": "Decrease number of melanocyte is seen in:\nA. Albinism\nB. Piebaldism\nC. Ichthyosis\nD. Chemical leucoderma", "response": "Piebaldism is a Autosomal dominant disease characterized by patches of skin that lack melanin as a result of defect in migration of melanoblast from neural crest to skin.\nSkin biopsy: Hypo melanotic area-few to no melanocytes. Vitiligo: is an acquired disease and similar patch of loss ofmelanin, but the loss develops after birth and progressive. Albinism: Congenital inability to synthesize melanin.\n\nSo the answer to this question is B"}
{"instruction": "Which of the following abnormality is seen in a preoperative pulmonary function test, done in a patient with severe kyphoscoliosis?\nA. Increased FRC\nB. Increased RV/TLC\nC. Reduced FEV1/FVC\nD. Reduced FEV25-75", "response": "Kyphoscoliosis is a combination of excessive anteroposterior and lateral curvature of thoracic spine. The major pathophysiologic effect of severe kyphoscoliosis are restrictive lung disease and ventillation perfusion imbalance resulting in chronic hypoventilation, hypoxic vasoconstriction pulmonary aery hypeension and cor pulmonale. Pulmonary function test shows a decrease in vital capacity and total lung capacity and an increase in residual volume, resulting in an increased residual volume/total lung capacity. Flow is reduced only in propotion to the reduction in vital capacity. Ref: Pulmonary Function Testing and Cardiopulmonary Stress Testing By Vincent C. Madama, 2nd Edition, Page 102; Chest Medicine: Essentials of Pulmonary and Critical Care Medicine By Ronald B. George, 5th Edition, Pages 440-1\n\nSo the answer to this question is B"}
{"instruction": "Floatation of a body in water is due to :\nA. Flesh being eaten by fishes\nB. Presence of gases\nC. Water logging of body\nD. All of the above", "response": "B i.e. Presence of gasses\n\nSo the answer to this question is B"}
{"instruction": "Rods and cones differ in all, Except:\nA. Signal transduction\nB. Light sensitivity\nC. Wavelength\nD. Acuity", "response": "Ans is 'a' i.e. signal transduction \"The process of phototransduction in cones is virtually the same as in rods: the only major difference is in the types of opsin in the membranous disks of the cone outer segments.\" -Neuroscience By Mark F. Bear, Barry W. Connors,Michael A. Paradiso 3/e p296The retina is organized in 10 layers and contains rods and cones, the photoreceptor cells along with 4 other types of neurons- bipolar cells, ganglion cells, horizontal cells and amacrine cells.The rods and cones synapse with bipolar cells, and the bipolar cells synapse with ganglion cells. The axons of ganglion cells converge and leave the eye as the optic nerve.Differences between rods and conesThe two photoreceptors differ from each other in several ways. Rods and cones differ in structure, photochemical molecules, sensitivity, retinal distribution, synaptic connections, and function.The total number of rods in the human retina (approx. 90 million) far exceeds the number of cones (roughly 4.5 million). As a result, the density of rods is much greater than cones throughout most of the retina. However, this relationship changes dramatically in the fovea, a highly specialized region of the central retina that measures about 1.2 millimeters in diameter. In the fovea, cone density increases almost 200-fold, reaching, at its center, the highest receptor packing density anywhere in the retina. The increased density of cones in the fovea is accompanied by a sharp decline in the density of rods. In fact, the central 300 pm of the fovea, called the foveola, is totally rod-free. The extremely high density of cone receptors in the fovea, and the one-to- one relationship with bipolar cells and retinal ganglion cells (see later), endows this region (and the cone system generally) with the capacity to mediate high visual acuity. As cone density declines with eccentricity and the degree of convergence onto retinal ganglion cells increases, acuity is markedly reducedThe two types of receptors differ in their size and their disk morphology. The outer segments of rods contain approximately 1000 to 2000 identical disks. The disks in rods contain more photopigment (rhodopsin) and consequently capture more photons of light than cones.There is also a higher amplification in the rods than in the cones. This means that, in rods, more cGMP gets hydrolyzed for each absorbed photon of light. This amplification leads to a longer integration and a more sensitive cell. The high amplification and long integration leads to high sensitivity to scattered light. The high sensitivity is the reason that rods are effective in weak light. The rods are thus responsible for vision when the light is dim (scotopic vision), whereas the cones are responsible in good light (photopic vision).In contrast, the cones do not have individual disks to hold the photochemical used in the transduction process. The photochemical in cones are in the outer membrane of the cell and the shape of the cone is determined by the folding of the outer membrane. The cones require more light because they have fewer photochemical and less amplification.The opsin molecules in the photochemical differ in the two receptors. All rods have the same opsin molecule. Because the opsin molecule determines the particular wavelength that can be absorbed most readily by the retinal, all the rods are similar in their response to light. The rods have an absorption peak near 500 nm.Each cone, on the other hand, has one of three different opsin molecules. Thus there are three different types of cones- red cone, blue cone and the green cone. The wavelength absorption characteristic of each cone depends on which opsin is bound to the retinal. The opsin determines the cone-wavelength absorption sensitivity. This means that cones differ from each other as well as from the rods in their absorption characteristics. Thus the cones are responsible for color vision.Other important difference between rods and cones concern their connections with other neurons in the retina.Properties of Rod and Cone SystemsRodsConesCommentMore photopigmentLess photopigment Slow response: long integration timeFast response: short integration time High amplificationLess amplification Saturating Response (by 6% bleached)Non-saturating response (except S- cones)The rods' response saturates when only a small amount of the pigment is bleached (the absorption of a photon by a pigment molecule is known as bleaching the pigment).Night visionDay vision Highly convergent retinal pathwaysLess convergent retinal pathwaysSpatial integrationHigh sensitivityLower absolute sensitivity Low acuityHigh acuityResults from degree of spatial integrationAchromatic: one type of pigmentChromatic: three types of pigmentColor vision results from comparisons between cone responsesNotably, many rods are connected to one bipolar cell- i.e. there is a high degree of convergence. For the cones, on the other hand, there is typically much less convergence, with a few cones connected to one bipolar cell. This explains more sensitivity of the rods over cones. The difference in convergence means that the cones provide information with a higher spatial resolution than the rods. Signal transduction in the RetinaThe mechanism of signal transduction or phototransduction i.e. the process by which light is converted into electrical signals, is almost similar in both the rods and cones. But both the photoreceptors have differences with other sensory receptors.The photoreceptors do not behave like other receptors when exposed to their stimulus: they are hyperpolarized instead of depolarizedThe photoreceptors are in a depolarized state in the dark. This is probably caused by Na+ channels that are open under such conditions. Unlike other receptors, the photoreceptors (and the bipolar cells) do not produce action potentials but only graded changes of the membrane potential (k/a local graded potential). Because the distance is very short from the outer segment-where the membrane potential changes are produced-to the synapses between the photoreceptors and the bipolar cells, even small fluctuations of the membrane potential cause alterations of the transmitter release from the photoreceptors. There is thus no need for the production of action potentials, which are important when signals are to be propagated over long distances.Light falling on the photoreceptor cells alters the configuration of the retinene (from 11-cis configuration to 11- Trans' isomer). This in turn alters the configuration of the opsin, and the opsin change activates the associated G protein. This ultimately leads to closure of the Na+ channels.Closure of the Na+ channels hyperpolarizes the cell. The hyperpolarization reduces the release of synaptic transmitter, and this generates a signal in the bipolar cells that ultimately leads to action potentials in ganglion cells.* In contrast to the photoreceptors and the bipolar, the ganglion cells produce action potentials (conducted in the optic nerve to the higher visual centers).\n\nSo the answer to this question is A"}
{"instruction": "Mechanism of action of streptomycin-\nA. Inhibition of translation\nB. Inhibition of signal transduction\nC. Inhibition of citric acid cycle\nD. Inhibits mitochondria", "response": "Ans. is 'a' i.e., Inhibition of translation o Streptomycin inhibit protein synthesis (translation).\n\nSo the answer to this question is A"}
{"instruction": "Growth on a cell-free aificial solid medium is possible for following except -\nA. Ureaplasma urealyticum\nB. Mycoplasma Pneumoniae\nC. C & L form of proteus vulgaris\nD. Chlamydia", "response": "They are bacteria but may be considered as viruses on account of their filterability and failure to grow in cell-free culture media. REF: Textbook of microbiology Ananthanarayan, and Paniker. Page no.: 415\n\nSo the answer to this question is D"}
{"instruction": "Most common type of intususucption is?\nA. Ileo-ileal\nB. Ileo colic\nC. Ileo-ileo-colic\nD. Colo-colic", "response": "ANSWER: (B) Ileo colicREF: Bailey and love 24th ed p. 1195Most common type of intussuseption is ileocolic\n\nSo the answer to this question is B"}
{"instruction": "Telmisartan lowers blood pressure by:\nA. Inhibiting formation of angiotensin I to angiotensin II\nB. Inhibiting conversion of renin to angiotensin I\nC. Blocking AT1 receptors\nD. Interfering with degradation of bradykinin", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "Which statement best describes the stomach?\nA. Lymph from the superior 2/3 of the stomach drains into the suprapancreatic nodes\nB. All lymph from the stomach drains through the coeliac nodes\nC. The gastric branches of the vagi are given of in the greater curve\nD. The lower oesophageal sphincter is supplied by the nerves of Latarjet", "response": "All the lymph drainage from the stomach eventually drains into the coeliac nodes and then into the cisterna chyli. All the lymph drainage from the stomach initially drains in three directions. On the right side the lymph drains to the left and right gastric nodes. On the left the superior poion drains into the pancreaticosplenic nodes and suprapancreatic nodes and the inferior poion drains into nodes around the pylorus. The anterior and posterior vagi pass along the lesser curvature of the stomach and give off gastric branches as they descend. Ref: Gray's Anatomy 41st edition Pgno: 1118\n\nSo the answer to this question is B"}
{"instruction": "True about pKa is:\nA. pH at which ionized fraction of drug equals to unionized fraction\nB. pH at which ionized fraction of drug is more than unionized fraction\nC. pH at which ionized fraction of drug is less than unionized fraction\nD. pH at which ionized fraction of drug is twice unionized fraction", "response": "Ans. a. pH at which ionized fraction of drug equals to unionized fractionRef: Goodman Gilman 12th E/P 18pKa is the pH at which as drug is 50% ionized and 50% unionized, i.e. the fraction of ionized drug equals to the fraction of unionized drug.The effect of pH on drug ionization and unionization can be calculated for acidic and basic drug by Hasselbalch equations given below:Basic drug: Log10 (Unionizeddrug)(Ionizeddrug) =pK4 -PHAcidic drug: Log10 (Ionizeddrug)(Ionizeddrug) =pKa -PHWhat is pKa ?If the ionized drug=unionized drug, i.e. 50% each, then the equation becomes,Log10 1=PKa -PHOr,0=pKa -pHOr. pKa =pHHencepKa is the pH at which the drug is 50% ionized and 50% unionized.\n\nSo the answer to this question is A"}
{"instruction": "Monogenic &Autosomal II> ominant cause of HTN is/are -a) 17-α Hydroxylase deficiencyb) Familial Conn's syndromec) Pregnancy induced HTNd) Glucocorticoid remediable hyperaldosteronism\nA. cd\nB. bc\nC. bd\nD. ac", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Best method of estimation of amount of proteinuria in a 2 year old child with nephrotic syndrome is\nA. Dipstick test\nB. 24 hr urine protein\nC. Microalbuminuria\nD. Spot urine sample for Protein/ Creatinine ratio", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Sacrotuberous ligament is pierced by-\nA. S1 nerve\nB. L1 nerve\nC. Coccygeal nerve\nD. None", "response": "Ans. C. Coccygeal nerveSacrotuberous ligamenta. The sacrotuberous ligament is attached by its broad base to the posterior superior iliac spine., the posterior sacroiliac ligaments (with which it is partly blended), to the lower transverse sacral tubercles and the lateral margins of the lower sacrum and upper coccyx.b. Its oblique fibres descend laterally, converging to form a thick, narrow band that widens again below and is attached to the medial margin of the ischial tuberosity. It then spreads along the ischial ramus as the falciform process, whose concave edge blends with the fascial sheath of the internal pudendal vessels and pudendal nerve.c. The lowest fibres of gluteus maximus are attached to the posterior surface of the ligament; superficial fibres of the lower part of the ligament continue into the tendon of biceps femoris.d. The ligament is pierced by the coccygeal branches of the inferior gluteal artery, the perforating cutaneous nerve and filaments of the coccygeal plexus.\n\nSo the answer to this question is C"}
{"instruction": "Thoracic outlet syndrome is seen most commonly in which age group\nA. Children\nB. Elderly\nC. Middle aged women\nD. Atheletes", "response": ".THORACIC OUTLET SYNDROME (TOS) It is syndrome complex due to neurovascular bundle compression in the thoracic outlet. Thoracic outlet has got two main spaces: * Scalene triangle is bound by scalenus anterior, scalenus medius and first rib. It contains subclan aery and brachial plexus. * Costoclavicular space is bound by clavicle, first rib, costoclavicular ligament and scalenus medius. It contains subclan aery and vein and brachial plexus. Causes - * Cervical rib. * Long C7 transverse process. * Anomalous inseion of scalene muscles. * Scalene muscle hyperophy. * Scalene minimus. * Abnormal bands and ligaments. * Fracture clavicle or first rib. * Exostosis. * Tumours in the region. * Brachial plexus trauma and diseases. ref:SRB&;s manual of surgery,ed 3,pg no 378\n\nSo the answer to this question is C"}
{"instruction": "Investigation of choice in clinical suspicion of stroke\nA. Noncontrast head CT\nB. Contrast head CT\nC. Noncontrast head MRI\nD. Contrast head MRI", "response": "After the clinical diagnosis of stroke is made, an orderly process of evaluation and treatment should follow. The first goal is to prevent or reverse brain injury. Attend to the patient's airway, breathing, and circulation (ABCs), and Treat hypoglycemia or hyperglycemia if identified. Perform an emergency noncontrast head CT scan to differentiate between ischemic stroke and hemorrhagic strokeRef: Harrison 19e pg: 2561\n\nSo the answer to this question is A"}
{"instruction": "A CKD patient had to undergo dialysis. His Hb was 5.2gm% so two blood transfusions were to be given. First bag was completed in 2 hours. Second was staed and midway he developed shoness of breath, hypeension. Vitals: BP 180/120 mm Hg and pulse rate 110/min. What is the cause?\nA. Allergic\nB. Transfusion related circulatory overload (TACO)\nC. TRALI\nD. FNHTR", "response": "This C.K.D patient has developed severe anemia which is a compensated hea failure state. The patient was given first unit of blood in two hours instead of standard four hours and he is already in compensated hea failure. The acute decompensation due to volume overloading that has subsequently occurred will result in pulmonary edema and shoness of breath. This presentation is called as transfusion associated circulatory overload. Ideally patients of CKD should be given erythropoietin injections to reduce the incidence of having severe anemia.\n\nSo the answer to this question is B"}
{"instruction": "Rabies is identified by -\nA. Guarnieri bodies\nB. Negri bodies\nC. Cowdry A bodies\nD. Cowdry B bodies", "response": "Few Important Bodies in Microbiology\n\n Bollinger bodies — Fowlpox\n Brassy body — Dark shrunken blood corpuscle found in malaria\n Call exner bodies — Granulosa theca cell tumour\n Chromatid bodies — Entamoeba histolytica precyst\n Citron bodies — cl. Septicum\n Cigar bodies — Sporotrichosis\n Councilman bodies — Yellow fever/viral hepatitis\n Coccoid X bodies — Psittacosis\n Donovan bodies — Granuloma inguinale (LGV)\n Guarnieri bodies — Inclusion bodies of vaccinia\n Henderson paterson bodies — Molluscum contagiosum\n Levinthal cole lillie bodies — Psittacosis\n Mooser bodies — Endemic typhus\n Negri bodies — Rabies\n Paschen bodies — Vaccinia, variola\n Ross’s bodies — Syphilis\n Sclerotic bodies — Chromoblastomycosis\n\nSo the answer to this question is B"}
{"instruction": "A hypertensive, diabetic is having proteinuria,antihypertensive of choice is -\nA. Propanolol\nB. Clonidine\nC. Enalapril\nD. Alpha methyldopa", "response": "None\n\nSo the answer to this question is C"}
{"instruction": "All the following conditions cause thrombocytopenia except-\nA. Giant hemangioma\nB. Infectious mononucleosis\nC. HIV infection\nD. Iron deficiency anemia", "response": "Iron deficiency anemia develops when body stores of iron drop too low to suppo normal red blood cell (RBC) production. Inadequate dietary iron, impaired iron absorption, bleeding, or loss of body iron in the urine may be the cause. Iron equilibrium in the body normally is regulated carefully to ensure that sufficient iron is absorbed in order to compensate for body losses of iron (see the image below). The total body iron in a 70-kg man is about 4 g. This is maintained by a balance between absorption and body losses. Although the body only absorbs 1 mg daily to maintain equilibrium, the internal requirement for iron is greater (20-25 mg). An erythrocyte has a lifespan of 120 days so that 0.8% of red blood cells are destroyed and replaced each day. A man with 5 L of blood volume has 2.5 g of iron incorporated into the hemoglobin, with a daily turnover of 20 mg for hemoglobin synthesis and degradation and another 5 mg for other requirements. Most of this iron passes through the plasma for reutilization. Iron in excess of these requirements is deposited in body stores as ferritin or hemosiderin Ref Robbins 9/e pg 440\n\nSo the answer to this question is D"}
{"instruction": "Pseudo Koebner's phenomenon is seen in -\nA. DLE\nB. Lichen planus\nC. Kaposis sarcoma\nD. Plane was", "response": "Ans. is'd' i.e., Plane was\n\nSo the answer to this question is D"}
{"instruction": "Eruption cyst\nA. Transforms into dentigerous cyst\nB. Regresses after eruption of the tooth\nC. Is found in the place of the missing tooth\nD. Is a type of dentigerous cyst", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "A 71/2 year old girl with non productive cough, mild stridor for 3 months duration, patient is improving but suddenly developed wheeze, productive cough, mild fever and on x-ray hyperlucency and PFT shows obstructive curve. The most probable diagnosis is,\nA. Bronchiolitis obliterans\nB. Hemosiderosis\nC. Pulmonary alveolar microlithiasis\nD. Follicular bronchitis", "response": "Bronchiolitis obliterans Repeat from Nov 08 Q no.130\n\nSo the answer to this question is A"}
{"instruction": "All of the foramens are found in sphenoid bone except:\nA. Foramen rotundum\nB. Foramen lacerum\nC. Optic canal\nD. Foramen ovale", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "IV dose of 1: 10000 concentration of epinephrine in pre term baby is?\nA. 0.1m1\nB. 0.2 ml\nC. 0.3 ml\nD. 0.4 ml", "response": "Ans. is 'b' i.e., 0-2 ml Epinephrine The IV dose of 1: 10,000 concentration is 0.1m1/Kg. Thus it is about 0.5ml for term baby and 0.2 ml for pre term baby. Endotracheal tube dosing is 1m1/ Kg. thus it is about 3m1 for term baby and 1 ml for preterm.\n\nSo the answer to this question is B"}
{"instruction": "Physiological unlocking is caused by -\nA. Popliteus\nB. Rectus femoris\nC. Semimembranosus\nD. Sartorius", "response": "During last stages of extension, femur rotates medially on tibia due to quadriceps femoris to lock the knee joint. Femur rotates laterally on tibia during flexion. \nQuadriceps femoris- Vastus medialis, vastus lateralis, vastus intermedius, rectus femoris. Unlocking occurs with popliteus.\n\nSo the answer to this question is A"}
{"instruction": "Trypsin, Chymotrypsin & Elastases - What type of enzymes are they?\nA. Hydrolases\nB. Lyases\nC. Synthases\nD. Synthetases", "response": "Ans. is 'a' i.e., Hydrolases* Trypsin, Chymotrypsin and Elastase are endopeptidases secreted by Pancreas* Trypsin acts at Lys - X or Arg - X linkage* Chymotrypsin acts at Aro - X linkage* Elastase acts on Ali - X linkage* All these break a peptide linkage by adding water. Hence they are hydrolases\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not the function of zinc in 2nd generation amalgam alloy?\nA. Increase plasticity\nB. Decrease brittleness\nC. Act as deoxidizer\nD. Act as scavenger", "response": "Traces of zinc (up to 1%) were added to act as a deoxidizer or scavenger for the alloy and to decrease its brittleness.\nReference: Marzouk Operative dentistry, pg-106\n\nSo the answer to this question is A"}
{"instruction": "Boerhaave&;s syndrome is due to\nA. Drug induced esophagus perforation\nB. Corrosive injury\nC. Spontaneous perforation\nD. Gastro-esophageal reflux disease", "response": "BOERHAAVE&;S syndrome is a tear in the lower third of oesophagus which occurs when a person vomits against a closed glottis, causing leaks into the mediastinum, pleural cavity, and peritoneum.site of perforation is about 2-10 cm of posterolateral pa of the lower oesophagus.investigations include chest Xray, MRI/CT, and total count.treatment includes feeding by jejunostomy, surgery with resection. Ref: SRB&;s manual of surgery,5th ed, pg no 802\n\nSo the answer to this question is C"}
{"instruction": "A male aged 60 years has foul breath. He regurgitates food that is eaten 3 days ago : Likely diagnosis is ?\nA. Zenkers diveiculum\nB. Meckels diveiculum\nC. Scleroderma\nD. Achalasia cardia", "response": "Ans. is 'a' i.e., Zenker's diveiculum\n\nSo the answer to this question is A"}
{"instruction": "In an after coming head the following bone Is perforated during craniotomy:\nA. Occiput\nB. Parietal\nC. Palate\nD. Frontal", "response": "Craniotomy : Consists of perforating the fetal skull, evacuating the contents and then delivering rest of the fetal pas. Indications : Delivery of dead fetus in obstructed labour with a cephalic presentation Delivery of the arrested after coming head in vaginal breech delivery Hydrocephalus Ref: Dutta Obs 9e pg 544.\n\nSo the answer to this question is A"}
{"instruction": "In Intrapaum Fetal Monitoring of women with pregnancies at risk, fetal hea auscultation is performed at least every --- minutes during first-stage labor and every --- minutes during the second stage\nA. 60min and 30min\nB. 30min and 15min\nC. 15min and 5min\nD. 5min and 1min", "response": "Intrapaum fetal monitoring:Briefly, the American Academy of Pediatrics and American College of Obstetricians and Gynecologists (2012) recommend that during first-stage labor, in the absence of any abnormalities, the fetal hea rate should be checked immediately after a contraction at least every 30 minutes and then every 15 minutes during the second stage. If continuous electronic monitoring is used, the tracing is evaluated at least every 30 minutes during the first stage and at least every 15 minutes during second-stage labor. For women with pregnancies at risk, fetal hea auscultation is performed at least every 15 minutes during first-stage labor and every 5 minutes during the second stage. Continuous electronic monitoring may be used with evaluation of the tracing every 15 minutes during the first stage of labor, and every 5 minutes during the second stage.(Ref: William's Obstetrics; 25th edition)\n\nSo the answer to this question is C"}
{"instruction": "Posterior staphyloma is associated with\nA. Pathological myopia\nB. Uveoscleritis\nC. Pseudocornea\nD. Angle closure glaucoma", "response": "Posterior staphyloma is a condition that can be present in highly myopic individuals with long axial lengths. It is caused by elongation of the globe due to thinning and bulging of the sclera and results in an irregular configuration of the retina at the posterior pole. ref img\n\nSo the answer to this question is A"}
{"instruction": "Alderman's nerve is a branch of -\nA. Superior cervical ganglion\nB. Inferior cervical ganglion\nC. Auricular branch of vagus nerve\nD. None", "response": "C i.e. Auricualr branch of vagus nerve The auricular branch of vagus nerve is often termed as Alderman's nerve or Arnold's nerveQSince the Alderman of the Anglo-saxon empire was habitually eating and then putting some cold water in the ear to stimulate this nerve to initiate vomiting, this name came into being. In this way they could empty their stomach quickly and resta eating.\n\nSo the answer to this question is C"}
{"instruction": "Corneal layer which does not regenerate\nA. Bowman's layer\nB. Stroma\nC. Descemet's membrane\nD. Epithelium", "response": "The layers of cornea are -(anterior to posterior) Epithelium Bowman's membrane Substantia propria(corneal stroma) Pre- Descement's membrane(Dua's layer) Descement's membrane Endothelium Bowman's membrane consists of acellular mass of condensed collagen fibrils. It is not a true elastic membrane but simply considered superficial pa of stroma. It shows considerable resistance to infection. But once destroyed, it is unable to regenerate and, therefore, heals by scaring. Ref;A.K.Khurana;6 th Edition; Page no: 96\n\nSo the answer to this question is A"}
{"instruction": "Broca's area is located in\nA. Inferior frontal lobe\nB. Parietal lobe\nC. Superior temporal gyrus\nD. Angular gyrus", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "A coronally positioned pedicle graft is used when a single tooth exhibits gingival recession and\nA. Bleeding\nB. Pus discharge\nC. Irreversible pulpitis\nD. Sensitivity", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "Life time risk of TB in HIV Patients -\nA. 20%\nB. 50%\nC. 10%\nD. 5%", "response": "Tuberculosis Preventing exposure to tuberculosis is impoant when there is an infectious case in the household, in clinics and in hospitals.Adequate ventilation, masks and safe coughing procedures reduce the risk of exposure. For HIV-uninfected individuals with latent TB infection (LTBI), the lifetime risk of developing active TB due to reactivation is 8 to 10%. In contrast, this risk is approximately 10% per year for HIV-infected persons (128, 142, 227, 228). Ref Harrison 20th edition pg 879\n\nSo the answer to this question is A"}
{"instruction": "Vitamin C is required for ?\nA. Posttranslational modification\nB. Synthesis of epinephrine\nC. Tyrosine metabolism\nD. All of the above", "response": "Vitamin C (ascorbic acid) Ascorbic acid (Vitamin C) is also called antiscorbutic factor. It is very heat labile, especially in basic medium. Ascorbic acid itself is an active form. Maximum amount of vitamin C is found in adrenal coex. Ascorbic acid functions as a reducing agent and scavanger of free radicals (antioxidant). Its major functions are :- i) In collagen synthesis :- Vitamin C is required for post-translational modification by hydroxylation of proline and lysine residues conveing them into hydroxyproline and hydroxylysine. Thus vitamin C is essential for the conversion of procollagen to collagen, which is rich in hydroxyproline and hydroxylysine. Through collagen synthesis, it plays a role in formation of matrix of bone, cailage, dentine and connective tissue. ii) Synthesis of norepinephrine from dopamine by dopamine-(3-monoxygenase (dopamine-13-hydroxylase) requires Vitamin C. iii) Carnitine synthesis iv) Bile acid synthesis :- 7-a-hydroxylase requires vitamin C. v) Absorption of iron is stimulated by ascorbic acid by conversion of ferric to ferrous ions. vi) During adrenal steroid synthesis, ascorbic acid is required during hydroxylation reactions. vii) Tyrosine metabolism - Oxidation of P-hydroxy-phenylpyruvate to homogentisate. viii) Folate metabolism - Folic acid is conveed to its active form tetrahydrofolate by help of Vitamin C.\n\nSo the answer to this question is D"}
{"instruction": "40-year-old female, chronic smoker, presented to the surgical depament with a reddish, painful subareolar mass in the right breast. She is most likely suffering from?\nA. Carcinoma breast\nB. Periductal mastitis\nC. Fat necrosis\nD. Granulomatous mastitis", "response": "She is most likely suffering from Periductal mastitis. Aka Zuska's disease /Recurrent subareolar abscess/Squamous metaplasia of lactiferous ducts Smoking has been implicated as a risk factor. Smokers - relative Vit A deficiency - Squamous metaplasia - Obstruction - Dilation of duct Features: Subaerolar mass Pain and redness Nipple retraction Fistula formation May mimic malignancy\n\nSo the answer to this question is B"}
{"instruction": "Polycystic ovarian disease not related to\nA. Hypertension\nB. DM\nC. Obesity\nD. Hirsutism", "response": "(A) (Hypertension) (459,469, Dutta Gynae 6th)POLYCYSTIC OVARIAN SYNDROME (PCOS)Multifactorial and polygenic conditionsMost obese woman with oligomenorrhea have the polycystic ovarian syndrome (PCOS), with its associated anovulation and ovarian hypcrandrogenism 40% of women with PCOS are absess (Not always). Most non obese with PCOS are also insulin resistance, hyperinsulinemia or the combination of the two are causative or contribute to the ovarian pathophysiology in PCOS in both obese and lean individuals (476-H17th)PCOS (Novak's Gynaecology)Clinical characteristicDiagnostic Criteria* Hirsutism* Obesity* Oligomenorrhea or AmenorrheaMajor criteria Minor criteria* Chronic anovulation* Pre menarchial onset of* Infertility* Hyper androgcncmia (in absence of any notable cause)- Hirsutism- Obesity* Insulin resistance (Abnormal glucose tolerance)* Elevated LH (LH/FSH ratio>2)* Intermittent anovulation associated with hyperandrogenemia (| ed free estosterone, |ed DHEAS)* Multiple cysts are located peripherally along the surface of the ovary giving a ''Necklace\" appearance in UCG is diagnostic* The increased conversion of androstenedione to estrogen which occurs to a greater degree in women with lower body obesity may contribute to the increased incidence of uterine cancer in post menopausal women with obesity (467-HI 7th)* PCOS is most strongly associated with a risk of endometrial carcinoma and may also be associateed with an increased risk of ovarian and breast cancer**** Long term sequelae of PCOS- Diabetes mellitus- CVS disorders- MI- Lipidaemia- Hypertension- Endometrial cancer- Breast cancer- Premature ovarian failure following surgery* Autosomal dominant inherited factor** were added as aetiological factor in the development of PCOS CYP21 gene mutation has been discovered in this connectionSerum level in PCOSAndrogens (|)Estrogens (|)LH/FSHInsulinAndroeen excessEstroeen excessLH levels are |edInsulin |ed* Excess production of androgens is seen from both the ovaries and adrenals, (postulated to be due to abnormal regulation of androgen forming enzyme)* Estrogen levels are increased due to peripheral aromatization of androgens* EstrogenQ levels are raised(Estrone>Estradiol)* Enhanced estrogen levels exert a- Positive feedback on LH levels (|ed)- Negative feedback on FSH levels (|ed)* | ed insulin resistance LH/FSH Ratio is characteristically >2\n\nSo the answer to this question is A"}
{"instruction": "NADPH+ is generated in the reaction catalysed by\nA. LDH\nB. G–6 PD\nC. G–3 PD\nD. Alcohol dehydrogenase", "response": "Amongst the given options, only G6-PD (glucose-6-phosphate dehydrogenase) is NADP linked enzyme.\nNAD+ -linked dehydrogenases: Pyruvate dehydrogenase, isocitrate dehydrogenase, malate dehydrogenase. α -ketoglutarate dehydrogenase, glutamate dehydrogenase, glyceraldehyde-3-P dehydrogenase, lactate dehydrogenase, β -hydroxy acyl CoA dehydrogenase, glycerol 3-P dehydrogenase (cytoplasmic).\n\nNADP+-linked dehydrogenases :Glucose-6-P dehydrogenase, 6-Phosphogluconate dehydrogenase, 3-ketoacyl reductase, Enoyl reductase.\n\nFAD-linked dehydrogenases: Succinate dehydrogenase, fatty acyl CoA dehydrogenase, glycerol-3P dehydrogenase (mitochondrial).\n\nSo the answer to this question is B"}
{"instruction": "\"Mellanby effect\" is seen with\nA. Paracetamol\nB. Aspirin\nC. Alcohol\nD. LSD", "response": "Mellanby effect: Intoxicating effect of alcohol are greater at a given BAC (blood alcohol concentration) when blood alcohol level is increasing than for the same BAC when blood alcohol level is falling.\n\nSo the answer to this question is C"}
{"instruction": "Most common cause of trichiasis is-\nA. Stye\nB. Trachoma\nC. Blephritis\nD. Congenital", "response": "*The Most common among these are trachoma, Steven-Johnson syndrome, and trauma Ref: Textbook of Clinical ophthalmology 21st/e p.319\n\nSo the answer to this question is B"}
{"instruction": "Maximum unsaturated fatty acids are seen in\nA. Mustard oil\nB. Groundnut oil\nC. Safflower oil\nD. Coconut oil", "response": "FatsPUFASafflower oil75Sunflower seed oil65Soya bean oil62Margarine 50Groundnut oil31Palm oil10Butter 3Coconut oil2(Refer: K. Park's Textbook of Preventive and Social medicine, 24thedition, pg no: 649)\n\nSo the answer to this question is C"}
{"instruction": "A 75-year-old male develops a cough that produces blood-tinged sputum. He has a fever of 104degF. Gram-positive cocci in clusters are found in a sputum smear. A chest x-ray shows increased density in the right upper lobe. Of the following penicillins, which is most likely to be ineffective?\nA. Oxacillin\nB. Cloxacillin\nC. Ticarcillin\nD. Nafcillin", "response": "Ticarcillin resembles carbenicillin and has a high degree of potency against Pseudomonas and Proteusorganisms but is broken down by penicillinase produced by various bacteria, including most staphylococci. Oxacillin, cloxacillin, nafcillin, and dicloxacillin are all resistant to penicillinase and are effective against staphylococci.\n\nSo the answer to this question is C"}
{"instruction": "All are used in treating spasmodic dysmenorhoea except :\nA. Bromocriptine\nB. Ibuprofen\nC. Mefanamic acid\nD. Norethisterone and Ethinyl estradiol", "response": "Bromocriptine\n\nSo the answer to this question is A"}
{"instruction": "All of the following are causes of pneumoperitoneum except -\nA. Perforated peptic ulcer\nB. Laproscopic Procedure\nC. Perforated Appendix\nD. Hirschsprung's Disease", "response": "Ans. is 'd' i.e., Hirschsprung's Disease o Gas under left hemidiaphragm is due to fundal gas, a normal finding. When gas is present under right hemidiaphragm also it's due to pneumoperitoneum.Causes of Pneumoperitoneum1. Perforation of GI tract# Peptic ulcer# Inflamamtion (diverticulitis, appendicitis, toxic megacolon, necrotizing enterocolitis)# Infarction# Malignant neoplasm# Obstruction# Pneumatosis cystoides rupture# Iatrogenic-endoscopy2. Iatrogenic# Surgery, peritoneal dialysis, drainage catheters, biopsies3. Penetrating abdominal injury.4. Through female genital tracta. Spontaneousb. Iatrogenic# Iatrogenic perforation of uterus or vagina# Culdocentesis# Tubal patency test5. Gas forming peritonitis6. Pneumothorax with pleuroperitoneal fistula\n\nSo the answer to this question is D"}
{"instruction": "Pontic design not indicated in the anterior region is:\nA. Spheroidal pontic\nB. Ovate pontic.\nC. Modified Ridge lap pontic.\nD. None.", "response": "None\n\nSo the answer to this question is A"}
{"instruction": "Transtuzumab is targeted against?\nA. Her 2 neu\nB. CD 20\nC. EGFR\nD. VEGF", "response": "Ans. is 'a' i.e., Her 2 neu\n\nSo the answer to this question is A"}
{"instruction": "______________ is not a property of X-rays\nA. Ionization\nB. Action on photographic film\nC. Excitation\nD. Collimation", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "At distal end of mandibular arch pear shaped structure which is composed of typical gingival tissue known as?\nA. Retromolar pad\nB. Retromolar papilla\nC. Pterygomandibular raphe\nD. Masseteric notch", "response": "Retromoplar papilla:\n\nIt is an scar/remnants of gingival tissue of last mandibular molar extraction\n\nRetromolar Pad:\n\nTriangular pad of soft tissue at distal end of lower ridge.\n\nSo the answer to this question is B"}
{"instruction": "Which is not a complication of chicken pox -\nA. Pancreatitis\nB. Pneumonia\nC. Encephalitis\nD. Thrombocytopenia", "response": "Complications\n\nThe most common infectious complication of varicella is the secondary bacterial superinfection of the skin, which is usually caused by Streptococcus pyogenes or Staphylococcus aureus.\nThe most common extracutaneous site of involvement in children is CNS.\nVaricella pneumonia is the most serious complication following chickenpox in adults.\n\nSo the answer to this question is A"}
{"instruction": "All are true about composite skin graft EXCEPT\nA. Covers skins and under tissue\nB. High risk failure\nC. Skin grafting requires to fill the gap\nD. Can be useful in fingertip amputation", "response": "(High risk failure): (7094- CSDT 13th edition; 404-Baily & Love 26th)COMPOSITIVE GRAFTS (usually skin and fat or skin and cartilage)* Free graft that must reestablish its blood supply in the recipient area* Often taken from the ear margin and useful for rebuilding missing elements of nose, eyelids andfingertips* Composite graft must be small or at least relatively thin and will require recipient sites with excellent vasularity* These grafts are generally used in the facesAdvantages and Disdvantages of Various Types of Skin Grafts.Type of GraftAdvantagesDisadvantagesThin split thicknessSurvive transplantation most easily. Donor sites heal most rapidlyFewest qualities of normal skin.Maximum contraction. Least resistance to trauma. Sensation poor. Aesthetically poor.Thick split thicknessMore qualities of normal skin.Less contraction. More resistant to trauma. Sensation fair.Aesthetically more acceptableSurvive transplantation less well.Donor site heals slowlyFull-thicknessNearly all qualities of normal skin.Minimal contraction. Very resistant to trauma. Sensation good. Aesthetically good.Survive transplantation least well.Donor site must be closed surgically. Donor sites are limited.\n\nSo the answer to this question is B"}
{"instruction": "Largest protozoan is?\nA. E. Histolytica\nB. Balantidium coli\nC. E.coli\nD. Plasmodium", "response": "ANSWER: (B) Balantidium coliREF: Jawett's 24th edition Section VI. Parasitology > Chapter 46-Medical Parasitology\"Balantidium coli, the cause of balantidiasis or balantidial dysentery, is the largest intestinal protozoan of humans\"\n\nSo the answer to this question is B"}
{"instruction": "The most commonly practiced operative procedure for a perforated duodenal ulcer is\nA. Vagotomy and pyloroplasty\nB. vagotomy and antrectomy\nC. Vagotomy and perforation closure\nD. Graham's omentum patch repair", "response": "Here perforation is identified and an omental patch is placed & closed with interrupted, horizontal sutures. Because of its adhesion propey, it seals perforation, maintain good vascularity, and promote lymphatic drainage Reference: SRB 5th edition, page no: 832\n\nSo the answer to this question is D"}
{"instruction": "In a patient with hypertriglyceridemia and low HDL, which of the following drug will be best without risk of myopathy as side effect ?\nA. Fibric acid derivatives\nB. Nicotinic acid\nC. Atorvastatin\nD. Clofibrate", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which of the following drug is a 5HT2c agonist approved for treatment of obesity and causes Serotonin Syndrome as an adverse effect?\nA. Lorcaserin\nB. Sibutramine\nC. Modafinil\nD. Rimonabant", "response": "Lorcaserin: 5HT2c agonist Causes weight loss S/E: Serotonin syndrome Sibutramine: Serotonin and nor-adrenaline reuptake inhibitor Discontinued due to increased risk of stroke Modafinil: used in treatment of Narcolepsy Rimonabant: Inverse agonist of cannabinoid receptor - 1 Causes weight loss Prevents craving of alcohol S/E: psychological problems (withdrawn)\n\nSo the answer to this question is A"}
{"instruction": "Which of the following is not associated EBV virus ?\nA. IMN\nB. Kapasi sarcoma\nC. Oral hairy leukoplalkia\nD. NHL", "response": "Ans. is 'b' i.e., Kaposi sarcoma\n\nSo the answer to this question is B"}
{"instruction": "Radiographically a ragged or poorly defined margin is seen in\nA. squamous cell carcinoma\nB. osteomyelitis\nC. secondarily infected cyst\nD. all of the above", "response": "None\n\nSo the answer to this question is D"}
{"instruction": "The egg of which helminth can be concentrated in saturated salt solution -\nA. Taenia saginata\nB. Taenia solium\nC. Unfeilized egg of Ascaris\nD. Ancylostoma duodenale", "response": "Ans. is 'd' i.e., Ancylostoma duodenale\n\nSo the answer to this question is D"}
{"instruction": "A one month old baby presents to the emergency room with history of vomiting, irritability and jaundice. The baby was previously healthy without any symptoms. One week ago cereals and fruit juices were introduced into the diet. USG revealed hepatomegaly and liver functions test were abnormal. The deficient enzyme is\nA. Fructokinase\nB. Aldolase-B\nC. Galactose-1 phosphate uridyl transferase\nD. Acid alpha glucosidase", "response": "Answer: b) Aldolase-B (NELSON 20th ED, p-727)HEREDITARY FRUCTOSE INTOLERANCEDeficiency of fructose-1,6-bisphosphate aldolase (aldolase B)Patients are asymptomatic until fructose or sucrose (table sugar) is ingested (usually from fruit, fruit juice, or sweetened cereal)Symptoms may occur early in life, soon after birth if foods or formulas containing these sugars are introduced into the diet.Early clinical manifestations resemble galactosemia and include jaundice, hepatomegaly, vomiting, lethargy, irritability, and convulsionsLaboratory findings include prolonged clotting time, hypoalbuminuria, elevation of bilirubin and transaminase levels, and proximal tubular dysfunctionTreatment - complete elimination of all sources of sucrose, fructose, and sorbitol from the dietGalactose-1-phosphate uridyl transferase deficiency - Onset of symptoms typically by the second half of the 1st wk of lifeFructokinase deficiency - not associated with any clinical manifestations.Lysosomal acid alpha glucosidase (Pompe's disease) - affected infants present in the first few weeks to months of life with hypotonia, generalized muscle weakness with a \"floppy infant\" appearance, neuropathic bulbar weakness, feeding difficulties, macroglossia, hepatomegaly, and a hypertrophic cardiomyopathy followed by death from cardiorespiratory failure or respiratory infection usually by 1 yr of age\n\nSo the answer to this question is B"}
{"instruction": "A 27 year old man with AIDS develops a reddish, slightly raised rash on his face, neck, and mouth, consistent in appearance with Kaposi's sarcoma. Microscopically, the proliferating cells in this malignancy most closely resemble which of the following?\nA. Angiosarcoma\nB. Carcinosarcoma\nC. Lymphoma\nD. Malignant fibrous histiocytoma", "response": "Kaposi's sarcoma is a spindle cell neoplasm that is highly associated with AIDS and with the Herpes simplex virus type 8. The tumor has an appearance very similar to that of angiosarcoma-proliferating stromal cells and endothelium creating vascular channels that contain blood cells. Carcinosarcoma is a tumor that contains malignant epithelial cells and malignant stromal cells. There is no epithelial element in Kaposi's sarcoma. Although lymphoma occurs with increased frequency in AIDS, it does not resemble Kaposi's sarcoma. Lymphoma involves neoplastic lymphocytes, whereas Kaposi's sarcoma involves neoplastic vascular structures. Malignant fibrous histiocytoma (MFH) is an extremely poorly differentiated (anaplastic) stromal malignancy. MFH does not produce any recognizable mesenchymal structures- thus, the production of vascular structures by Kaposi's sarcoma differentiates the two tumors. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 9. Vascular Pathology. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture.\n\nSo the answer to this question is A"}
{"instruction": "Preterm infant is defined as -\nA. Born between 37-42 weeks\nB. Born > 42 weeks\nC. Born < 37 weeks\nD. Born <25 weeks", "response": "Preterm is defined as babies born alive before 37 weeks of pregnancy are completed. Subcategories include- 1. Extremely preterm is less than 28 wks 2. Very preterm 28 to 32 wks 3. Moderate to late preterm 32 to 37 wks Reference Park&;s textbook of preventive and social medicine 23rd edition pg 536\n\nSo the answer to this question is C"}
{"instruction": "The following condition is not associated with an Anti phospholipid syndrome -\nA. Venous thrombosis\nB. Recurrent foetal loss\nC. Thrombocytosis\nD. Neurological manifestation", "response": "The clinical manifestations of APLA syndrome includes adverse pregnancy outcome (recurrent first trimester aboion ),venous thromboembolism,aerial thromboembolism,livedo reticularis,transverse myelitis,skin necrosis,chorea.Davidson's principles &practice of medicine 22nd edition pg no 1055.\n\nSo the answer to this question is C"}
{"instruction": "The drug which causes renal papillary necrosis is?\nA. Acetophenetidin\nB. Gentamicin\nC. Gold\nD. Methicillin", "response": "Ans. (a) AcetophenetidinRef: Robbiris pathology 9th ed. /423. 936t* Renal papillary necrosis due to acetophenetidin/ phenacetin is a gradual process with slow loss of renal function.* The most common cause of renal papillary necrosis is diabetic glomerulopathy\n\nSo the answer to this question is A"}
{"instruction": "Only definitive indication of systemic steroids in psoriasis is\nA. Pustular psoriasis\nB. Erythroderma\nC. Psoriatic ahropathy\nD. Impetigo herpetiformis", "response": "D i.e. Impetigo herpetiformis - Systemic steroids should be avoided in routine care of psoriasis Q because the disease usually breaks through, requiring progressively higher doses to control symptoms and withdrawl of drug is usually associated with frequent relapse in form of life threatening erythrodermic psoriasis (with exfoliative dermatitis) and pustular psoriasis (with pus lakes)Q. - However, systemic steroids may have a role in management of Persistent, otherwise uncontrollable (e.g. with metabolic complications), psoriatic erythroderma and in fulminant generalized pustular psoriasis (von Zumbusch type) if other drugs are ineffective or contraindicatedQ. Pustular psoriasis in pregnancy is called impetigo herpatiformis. In pregnancy, safest drug for treatment of pustular psoriasis is prednisoloneQ. Severe psoriatic polyahritis threatening severe irreversible joint damageQ. Pustular psoriasis may develop after strong topical or systemic steroids have been used and then abruptly withdrawnQ. It presents with development of generalized pustules all over the bodyQ. Erythematous skin rash with multiple pus lakes suggests a diagnosis of generalized pustular psoriasis. As retinoids, methotrexate & PUVA cannot be used (or contraindicated) in pregnancy. Coicosteroids form the mainstay of treatment for generalized pustular psoriasis in pregnancyQ. Localized disease is best treated with topical steroid & fulminating generalized disease is best treated with systemic prednisolone (oral).\n\nSo the answer to this question is D"}
{"instruction": "Kit 3 is given for :\nA. Urethral discharge\nB. Genital ulcer (herpetic)\nC. Genital ulcer (non herpetic)\nD. Genital ulcer (non herpetic), allergic to penicillin", "response": "Kit 3(white) is given for Non-herpetic genital ulcer.\n\nSo the answer to this question is C"}
{"instruction": "Bradycardia is seen with:\nA. Midazolam\nB. Epinephrine\nC. Succinyl choline\nD. Dopamine", "response": "Ans: C (Succinyl choline) Ref: Ajay Yadav, Short textbook of Pediatrics, 1st editionExplanation:Cardiac Sideeffects of Anesthetic DrugsDrugsCardiac Side effectsMidazolamMinimal reduction in Heart rate, Blood pressure and cardiac outputEpinephrineProduces tachycardia, hypertension and ventricular arrhythmiasSuccinyiCholineIt produces muscarinic effects, similar to Acetyl cholineIt causes Profound BRADYCARDIA, so atropine should be given prior to use of Succinylcholine Choline, especially in childrenDopamineProduces tachycardia, hypertension and ventricular arrhythmiasThiopentoneit causes Hypotension, which is more because of venodilatation and direct depression of vasomotor centreDirect myocardial depressant\n\nSo the answer to this question is C"}
{"instruction": "Epstein-Barr virus causes all the following EXCEPT:\nA. Burkitt's lymphoma\nB. Nasopharyngeal carcinoma\nC. Carcinoma cervix\nD. Infectious mononucleosis", "response": "Ans. c (Carcinoma cervix). (Ref. Harrison, 17th/Table 105-4; Microbiology by Anantanaray an, 6th/448). Infectious AgentLymphoid Malignancy1.Epstein-Barr virus (EBV)Burkitt's lymphomaPost-organ transplant lymphomaPrimary CNS diffuse large B cell lymphomaHodgkin's diseaseExtranodal NK/T cell lymphoma, nasal type2.HTLV-IAdult T cell leukemia/lymphoma3.HIVDiffuse large B cell lymphomaBurkitt's lymphoma4.Hepatitis C virusLymphoplasmacytic lymphoma5.Helicobacter pyloriGastric MALT lymphoma6.Human herpesvirus 8Primary effusion lymphomaMulticentric Castleman's diseaseEducational point:# Carcinoma cervix is supposed to be caused by HPV 16, 18, 31, 33.\n\nSo the answer to this question is C"}
{"instruction": "True about the chronic obstructive pulmonary disease (COPD)\nA. FEVI <30 of predicted value\nB. FEV1/FVC<0.7\nC. total lung capacity increased\nD. All", "response": "In COPD, airflow obstruction is demonstrated by spirometry in which the post-bronchodilator FEV1/FVC is less than 70%. \nThe severity of COPD may be defined in relation to the post-bronchodilator FEV1 which is <30% predicted in very severe type. \nMeasurement of lung volumes provides an assessment of hyperinflation.COPD is characterised by an increase in residual volume, residual volume/total lung capacity ratio, and progressive hyperinflation(increased total lung capacity) late in the disease.\n\nSo the answer to this question is D"}
{"instruction": "All are involved in non toxic transpo of ammonia except\nA. Glutamine synthetase\nB. Glutaminase\nC. Alanine cycle\nD. SGPT", "response": "The amino acid used primarily by muscle, for transpo of ammonia to liver is alanine. Most other tissues however use glutamine\n\nSo the answer to this question is B"}
{"instruction": "Gall stone causes intestinal obstruction when it gets impacted in which part of the intestine commonly\nA. Proximal ileum\nB. Distal ileum\nC. Duodenum\nD. Jejunum", "response": "This type of obstruction tends to occur in the elderly secondary to erosion of a large gallstone through the gall bladder into the duodenum. Classically, there is impaction about 60 cm proximal to the ileocaecal valve. The patient may have recurrent attacks as the obstruction is frequently incomplete or relapsing as a result of a ball-valve effect.\n\nSo the answer to this question is B"}
{"instruction": "HCN causes -\nA. Histotoxic anoxia by inhibiting carbonic anhydrase\nB. Histotoxic anoxia by inhibiting succinyl oxidase\nC. Cytotoxic anoxia by inhibiting cytochrome oxidase\nD. Cytotoxide anoxia by inhibiting succinyl oxidase", "response": "Hydrocyanic acid Cyanide occurs as solid, liquid or in gaseous state as: * Gas form -- Hydrogen cyanide (HCN) * Liquid form -- Hydrocyanic acid (Prussic acid) * Solid form -- occurs as salts such as potassium cyanide/ sodium cyanide. Mechanism of Action Cyanide reversibly inhibits ferric iron containing enzymes. Cyanide attaches to the iron of the prosthetic group of cytochrome oxidase resulting in disturbance of the transpo and utilization of oxygen in cells and causing a cytotoxic anoxia. Fatal Dose * 50 to 100 mg for hydrocyanic acid * 200 to 300 mg for sodium/potassium cyanide * 50 to 80 bitter almonds * Inhalation of 1 pa in 2000 -- hydrogen cyanide Fatal period: 2 to 10 minutes. Clinical Features Inhalation * Constriction about throat * Dizziness * Loss of consciousness * Coma * Death Ingestion * CNS: Headache, anxiety, agitation, dizziness, confusion, convulsions, coma * CVS: Initially bradycardia and hypeension and latter tachycardia and hypotension, arrhythmias * RS: Tachypnea followed by bradypnea * GIT: Nausea, vomiting, abdominal pain, numbness. Skin * Perspiration * Bullae. Chronic poisoning: Chronic low level of exposure leads to: * Headache * Amblyopia * Optic atrophy * Peripheral neuropathy * Ataxia * Deafness * Glossitis * Stomatitis. Management * Ingestion: gastric lavage with 5 percent sodium thiosulfate solution * Antidote- amyl nitrate -- inhaled * Sodium nitrate slowly I.V. * Sodium thiosulfate 25 percent solution I.V. * Mechanism of action of nitrites: nitrates induce methemoglobinemia, which causes detachment of cyanide from the heme group of cytochrome oxidase since methemoglobin has a higher binding affinity for cyanide. Cyanide combines with methemoglobin and form non-toxic cynmethemoglobin. * Mechanism of action of sodium thiosulfate: sodium thiosulfate serves as a substrate for the enzyme rhodanese to catabolise cyanide to non-toxic thiocyanate, which is excreted in the urine. Autopsy Findings * Bitter almond like smell * Cherry red color of postmoem lividity * Cyanosis * Froth at mouth and nose * Bright red color blood9 * Pulmonary edema * Serosal surface may show hemorrhages * Stomach mucosa may be eroded and blackened due to formation of alkaline hematin. Samples to be preserved for chemical analysis * Blood * Routine viscera * Lung * Brain * Hea * Spleen is considered as best specimen due to presence of more RBCs. REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO 362\n\nSo the answer to this question is C"}
{"instruction": "Which of the following is true of fat embolism -\nA. Thrombocytopenia\nB. Macroglobulinemia\nC. Prothrombin time increased\nD. Fat globules in urine", "response": "symptomatic fat embolism syndrome characterized by pulmonary insufficiency, neurologic symptoms, anemia, thrombocytopenia, and a diffuse petechial rash, which is fatal in 10% of cases. Clinical signs and symptoms appear 1 to 3 days after injury as the sudden onset of tachypnea, dyspnea, tachycardia, irritability, and restlessness, which can progress rapidly to delirium or coma ( Robbins Basic Pathology, 9 th edition, page 91 )\n\nSo the answer to this question is A"}
{"instruction": "The ratio of the dose that produces toxicity to the dose that produces a clinically desired or effective response in a population of individual is known as:DELETE REPEAT\nA. Efficacy\nB. Potency\nC. Therapeutic index\nD. Paial agonist", "response": "ref ; KD Tripathi pharmacology 7th edition (page no; 55) The gap between the therapeutic effect DRC (Dose Response Curve) and the adverse effect DRC defines the safety margin or the therapeutic index of a drug. Therapeutic index =median lethal dose /median effective dose or LD 50/ ED 50\n\nSo the answer to this question is C"}
{"instruction": "Resonance of tympanic membrance is\nA. 800 Hz\nB. 800-1600 Hz\nC. 3000 Hz\nD. None", "response": "External auditory canal 3000 Hz Tympanic membrane 800-1600 Hz Middle ear 800 Hz Ossicular chain 500-2000 Hz Ref: Dhingra 7e pg 17.\n\nSo the answer to this question is B"}
{"instruction": "The external urethral sphincter is located in which of the following regions?\nA. Ischiorectal fossa\nB. Extrapeoneal space\nC. Retropubic space\nD. Deep perineal space", "response": "The external urethral sphincter is the voluntary sphincter composed of skeletal muscle, the sphincter urethrae muscle. This muscle, along with the deep transverse perineal muscle, are in the deep perineal space and form the muscular layer of the urogenital diaphragm. The internal urethral sphincter is composed of smooth muscle in the neck of the bladder. The internal and external sphincters are both open during micturition. During ejaculation, the external sphincter is open and the internal sphincter is closed.\n\nSo the answer to this question is D"}
{"instruction": "Most common histological type of the thyroid carcinoma is:\nA. Medullary type\nB. Follicular type\nC. Papillary type\nD. Anaplastic type", "response": "Thyroid cancers are classified according to their histopathological characteristics and they are: ? Papillary thyroid cancer (75% to 85% of cases ) - often in young females - excellent prognosis ? Follicular thyroid cancer (10% to 20% of cases ) ? Medullary thyroid cancer (5% to 8% of cases)- cancer of the parafollicular cells, often pa of MEN-2 syndrome. ? Anaplastic thyroid cancer (Less than 5%). It is not responsive to treatment and can cause pressure symptoms. ? O thers ? ? Lymphoma ? ? Squamous cell carcinoma, sarcoma Ref: Robbin's Basic Pathology, 7th Edition, Page 1177; Harrison's Internal Medicine, 18th Edition, Page 2243; Bailey and Love's Sho Practice of Surgery, 25th Edition, Page 792\n\nSo the answer to this question is C"}
{"instruction": "A 35 year old alcoholic presents with diarrhoea and scaly rash on his neck, hands and feet. He will improve if he is treated with which one of the following ?\nA. VitaminA\nB. Thiamine\nC. Folic acid\nD. Niacin", "response": "*Niacin encompasses nicotinic acid and nicotinamide . *Niacin deficiency causes pellagra - diarrhea,dermatitis, dementia,death Niacin encompasses nicotinic acid and nicotinamide. Nicotinamide is an essential pa of the two pyridine nucleotides, nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), which play a key role as hydrogen acceptors and donors for many enzymes. Niacin can be synthesised in the body in limited amounts from the amino acid tryptophan. Deficiency - pellagra Pellagra was formerly endemic among poor people who subsisted chiefly on maize, which contains niacytin, a form of niacin that the body is unable to utilise. Pellagra can develop in only 8 weeks in individuals eating diets that are very deficient in niacin and tryptophan. It remains a problem in pas of Africa, and is occasionally seen in alcoholics and in patients with chronic small intestinal disease in developed countries. Pellagra can occur in Hanup's disease, a genetic disorder characterised by impaired absorption of several amino acids, including tryptophan. It is also seen occasionally in carcinoid syndrome (p. 678), when tryptophan is consumed in the excessive production of 5-hydroxytryptamine (5-HT, serotonin). Pellagra has been called the disease of the three Ds: * Dermatitis. Characteristically, there is erythema resembling severe sunburn, appearing symmetrically over the pas of the body exposed to sunlight, paicularly the limbs and especially on the neck but not the face (Casal's necklace, Fig. 19.13). The skin lesions may progress to vesiculation, cracking, exudation and secondary infection. * Diarrhoea. This is often associated with anorexia, nausea, glossitis and dysphagia, reflecting the presence of a non-infective inflammation that extends throughout the gastrointestinal tract. * Dementia. In severe deficiency, delirium occurs acutely and dementia develops in chronic cases. Treatment is with nicotinamide, given in a dose of 100 mg 3 times daily orally or parenterally. The response is usually rapid. Within 24 hours the erythema diminishes, the diarrhoea ceases and a striking improvement occurs in the patient's mental state. Ref Harrison 20th edition pg 98e\n\nSo the answer to this question is D"}
{"instruction": "Commonest site of feilization is :\nA. lsthmic\nB. Ampulla\nC. lnfundibulum\nD. lnterstitial", "response": "Ampulla\n\nSo the answer to this question is B"}
{"instruction": "500 people of viral fever are treated with a medicine. 80 percent were cured in 3 days. True statement about efficacy of medicine -\nA. Medicine is effective\nB. Cannot be commented\nC. Medicine is ineffective\nD. None of the above", "response": "None\n\nSo the answer to this question is B"}
{"instruction": "Which Rectus muscle is not supplied by occulomotor nerve ?\nA. Medial rectus\nB. Lateral rectus\nC. Superior rectus\nD. Inferior rectus", "response": "Ans. is 'a' i.e., Right side TestisTestis is the male gonad. It is suspended in the scrotum by spermatic cord.Left testis is slightly (1 cm) lower than the right one.The average testicular dimensions are 5 cm (length), 25 cm (breath), 3cm (anteroposterior diameter or thickness) and 10.5-14 gms (weight).The epididymis is attached to is posterolateral surface.Vas (ductus) deference arises from lower pole of epididymis.Lateral pa of epididymis is separated from testis by an extension of cavity of tunica vaginalis, called sinus of epididymis.There is small oval body attached to upper pole of testis called appendix of testis, a remnant of paramesonephric duct.Testis is covered by three coats (from outside to inside) :- (i) tunica vaginalis (which has a parietal and a visceral layer); (ii) tunica albuginea; and (iii) tunica vasculosa. Outside these three coats, there are layers of scrotum. StructureTestis consists of 200-300 lobules.Each lobules consists of 2-3 seminiferous tubules (where spermatozoa are formed).Seminiferous tubules join at the apex of lobules to form straight tubules, which anastomose with each other to form rete testis.Which emerge from upper pole and enter the epididymis. Each tubule becomes highly coiled to form a lobe of the head of epididymis.All tubules end in a single duct which is coiled on itself to form the body and tail of the epididymis. It is continuous with ductus deference.Aerial supplyTestes are supplied by testticular aery, a branch of abdominal aoa, arises at L2 veebral level. Venous drainageThe veins emerging from the testis and epididymis form the pampiniform plexus.Anterior pa of the plexus is arranged around the testicular aery, middle pa around ductus deferens and its aery, and posterior pa is isolated.The plexus condenses into 4 veins at the superficial inguinal ring and 2 veins at the deep inguinal ring. Ultimately, one vein is formed which drains into inferior vena cava on the right and into left renal vein on the left side.Lymphatic drainageLymphatics from the testis run back with the testicular aery to para-aoic nodes along side the aoa at the level of origin of testicular aeries (L2 veebra).\n\nSo the answer to this question is A"}
{"instruction": "Most common type of twin pregnancy is-\nA. veex + transverse\nB. Both veex\nC. Veex + breech\nD. Both breech", "response": "