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AIM-Harvard 16

094026d4-ed29-4fac-b81a-062e2acc9c5f

Lary ngoscopes are sterilized by -

Glutaraldehyde

Formalin

Betadine

Boiling

0a

single

Ans. is 'a' i.e., Glutaraldehyde o Laryngoscope should be cleaned before and after use with spirit.o Disinfection can be done once a day by removing the bulb and immersing the blade in 2% cidex (glutaraldehyde) for 10 minutes.o They should be sterilized once a week by immersing in cidex for 10 hours or by autoclaving.

Microbiology

General

019fe1f6-37b6-4bfd-94ad-b11c6106f7df

Positive fluorescein dye disappearance test indicates that watering eye is due to:

Atonia of the sac

Mechanical obstruction in the lacrimal passages

Both of the above

None of the above

2c

multi

Ans. Both of the above

Ophthalmology

e75e7867-b670-4768-8e1c-ccaa271ea3df

The drug which does not cause myopathy is :

Chloroquine

Betamethasone

Chloramphenicol

Zidovudine

2c

single

Ans. is 'c' Chloramphenicol Drugs Causing MyopathyAmphotericin BCarbenoxoloneCimetidineChloroquineClofibrateGlucocorticoidGrowth hormoneZidovudineOral contraceptivesHMG COA reductase inhibitors.InfliximabInterferon alpha

Pharmacology

Adverse Drug Effect

d44fdb2f-cb94-4cdc-b0ff-547cd83e47a0

Which of the following supplements is used in the treatment of multiple carboxylase deficiency?

Biotin

Pyridoxin

Thiamine

Folic acid

0a

single

Biotin is a water soluble vitamin that is a cofactor for all carboxylase enzymes. Multiple carboxylase deficiency results from deficient carboxylase activity and is treated by biotin. Ref: Nelson's Textbook of Pediatrics 17th Edition, Page 412; Textbook of Clinical Pediatrics, Volume 1 By A. Y. Elzouki, F. B. Stapleton, R. J. Whitley, William Oh, H. A. Harfi, H. Nazer, 2011, Page 457

Biochemistry

b937f0c2-6060-4ec7-b6cc-2712fa55d973

A-female patint of childbearing age is on valproate for JME. Whichk drug should be used to replace valproate and can be prescribed as montherapy?

Levetiracetam

Zonisamide

Carbamazepine

Phenytoin

0a

single

It is known to cause serious abnormalities in the baby if taken during pregnancy. Because of this it is not typically recommended in women of childbearing age who have migraines. Common side effects include sleepiness, dizziness, feeling tired, and aggression. Severe side effects may include psychosis, suicide, and allergic reactions such as Stevens-Johnson syndrome and anaphylaxis. It is unclear if use is safe during pregnancy but it appears okay when breastfeeding.It is the S-enantiomer of etiracetam.How it works is not clear Ref Davidson 23rd edition pg 1036 With respect to major congenital malformations (MCM), levetiracetam taken in monotherapy can be considered a safer alternative to valproate for women with epilepsy of childbearing age as per studies Ref Harrison20th edition pg 2345

Medicine

C.N.S

b5c74b47-8318-445e-9d56-eda7993d45bb

The tricyclic antidepressant with LEAST autonomic and cardiotoxic effects: March 2004

Amitriptyline

Desipramine

Lofepramine

Protriptyline

2c

single

Ans. C i.e. Lofepramine

Psychiatry

9ebeb51e-0756-48b8-9641-597070a313f4

Pyruvate dehydrogenase complex contains all except

Biotin

NAD

FAD

CoA

0a

multi

Pyruvate dehydrogenase complex--thiamin diphosphate, lipoate, NAD+, FAD, and CoA Reference: Harper; 30th edition; Page no: 163

Biochemistry

Metabolism of carbohydrate

31f78e60-285f-4f4d-a72d-4999e2214b24

Most characteristic arrhythmia seen with Digoxin toxicity is

Ventricular Extrasystoles

Ventricular bigemini

Atrial tachycardia with AV nodal block

Atrial flutter

2c

single

Atrial tachycardia (because of increase intracellular calcium levels) and AV nodal blockade (because of parasympathomimetic activity) is the most characteristic arrhythmia seen with Digoxin toxicity. But Ventricular bigeminy is the most common arrythmia seen with Digoxin toxicity.

Pharmacology

ff02cf15-fe9d-4a2d-95b6-f48bdf033bea

Treatment of transverse lies at labour is

Artificial rupture of membrane

Oxytocin infusion

Caesarean section

Forceps delivery

2c

single

(Caesarean section): Ref: 393, 397-DTRANSVERSE LIE: - When the long axis of the fetus lies perpendicularly to the maternal spine or centralized uterine axis it is called transverse lies* In dorso-posterior, chance of fetal extension is common with increased risk of arm prolopse, left one being common than right* Dorso-anterior is the commonest (60%) positionManagement of Transverse lie at labourEarly labourLate labour* External cephalic version* Caesarian section is the preferred method of delivery, if version fails or contraindicated* Baby alive - caesarean section prefer* Internal version - Not only it might inflect injury to the uterus (rupture uterus) but the fetal mortality is increased to the extent of about 50%In modem obstetric practice internal version is not recommended except in the case of second twin* Baby dead - caesarean section is prefer.* There is no mechanism of labour in transverse lie

Gynaecology & Obstetrics

Miscellaneous (Gynae)

6d631fc9-0630-4f69-b84b-aee48feae4ef

All drugs decrease the moality in hea failure except:

Metoprolol

Enalapril

Telmisaan

Digoxin

3d

multi

Digoxin is used in acute CHF as well as maintenance therapy but do not retard cardiac remodelling or prolong survival in CHF patients Drugs that decrease the cardiac remodeling in a patient with CHF decrease the moality. They are: Beta blockers (metoprolol, bisoprolol) ACE inhibitors (enalapril) ARB (telmisaan) Aldosterone antagonist (spironolactone) Note Telmisaan is an ARB which has PPAR gamma agonist activity

Pharmacology

Hematology and CVS

3d4bbe15-a6f2-4dff-85c6-04cb23c3fc44

Which of the following drug is given for pulmonary hypeension?

Carboprost

Mispoprostol

Indomethacin

Bosentan

3d

single

Endothelin Antagonists (DOC) - Bosentan - Ambresenton - Macisentan If these are not effective then drugs used are Phosphodiesterase inhibitors like sildenafil and tadalafil. Prostaglandins - Iloprost (Not given orally) Selexipag (Prostacyclin Agonist) - PGI2 Agonist - Given orally

Pharmacology

Histamine, 5-HT and PGs

cdb94e0e-f82e-41a2-ab55-0fb27cff201e

Exenatide is drug prescribed for which disease:

Osteoporosis

Diabetes

Hyperthyroidism

Infertility

1b

single

Ans. B. DiabetesExenatide is new drug which is a GLP -1 analogue. It delays the gastric emptying, has a role in appetite control and also release of insulin. It controls post prandial hyperglycemia.

Pharmacology

Endocrinology

3944273a-7e50-44f8-bc42-59622f4f8aa6

Interaction of theophylline with ciprofloxacin is :

Ciprofloxacin increases theophylline metabolism

Ciprofloxacin decreases theophylline metabolism

Theophylline increases ciprofloxacin metabolism

Theophylline decreases ciprofloxacin metabolism

1b

single

Pharmacology

3a35a82b-5025-4286-97ae-d5556651f4c7

How to differentiate between psychological and organic erectile dysfunction?

Nocturnal penile tumescence

PIPE test

Sildenafil-induced erection

Squeeze technique

0a

single

Presence of early morning erections and erection during REM sleep (nocturnal erection) are suggestive of psychogenic erectile dysfunction as there is no anxiety. Whereas, a patient with organic erectile dysfunction (due to vascular or neurological causes) would not have erections even during sleep. Investigations, such as penile plethysmography and nocturnal penile intumescence (NPT) can be used to record nocturnal erections.

Psychiatry

Sexual Disorders

09192c6f-03ce-4d8c-8343-1f51fbfc404a

Drugs used in migraine prophylaxis are all except:

Flunarizine

Propanolol

Cyproheptadine

Sumatriptan

3d

multi

Drugs used for migraine prophylaxis: - A : Antiepileptic drug- B : Beta blocker : Propranolol, botulinum toxin- C : CCB: flunarizine, cyproheptadine, clonidine For acute migraine attack : We give sumatriptan and ergotamine.Triptans are contraindicated in patient with coronary aery disease due to it's vasospasm effect.

Pharmacology

Histamine, 5-HT and PGs

ebeae449-4bdc-489e-a470-7b75ef9a160e

Opiate withdrawal is treated with -

CPZ

Nalorphine

Pethidine

Methadone

3d

single

Treatment of opioid (Morphine or heroin) withdrawal (detoxification):- Methadone is the DOC. Alternatives are clonidine, clonidine with naltrexone with or without BZDs, Lofexidine, dextropropoxyphene, diphenoxylate.

Psychiatry

94d6faaf-7382-41f0-9f06-437956ba9f04

Most common mode of treatment of a 1 year old child with asthma is -

Inhaled sho acting beta 2 agonist

Oral sho acting theophylline

Oral ketotifen

Leukotriene agonist

0a

single

Ans. is 'a' i.e., Inhaled sho acting beta 2 agonists Treatment ofAsthma a Treatment of asthma can be divided into ? A) Treatment of chronic asthma B) Treatment of acute excarhation ? a) Treatment of mild, moderate or severe exacerbation b) Treatment of life threatening exacerbation (status asthmaticus) Treatment of chronic asthma o Treatment of chronic asthma is given to control the asthma and to prevent acute exacerbation. o Severity of asthma is classified on the basis of ? 1) Frequency of daytime symptoms 3) Degree of airflow obstruction (FEV,) 2) Frequency of night time symptoms 4) Peak expiratory flow (PEF) variability o For children less than 5 years of age, severity is classified on the basis of (1) and (2) only because young children cannot perform the maneuver required for lung function measurment ((3) & (4)). 1) Mild intermittent 2) Mild persistent Symptoms for 2 days/week Symptoms > 2days / week Symptoms for 2 night/month Symptoms >2 night / months FEV1 80% FEV I 80% PEF variability < 20% PEF variability 20-30% 3) Moderate persistent 4) Severe persistent Day symptoms daily Continuous day symptoms Symptoms > 1 night/week Frequent night symptoms FEV1 > 60% - < 80% FEVI 60% PEF variability >30% PEF variability >30% o A stepwise pharmacological therapy is indicated.

Pediatrics

ba795a1c-0fce-45d8-b955-ee88cb1b1051

Alcohol, salicylates and pilocarpine can be used as: Odisha 11

Chelating agents

Diaphoretics

Purging

Forced alkaline diuresis

1b

single

Ans. Diaphoretics

Forensic Medicine

d3d7d5c6-d948-4bbc-ba2a-ba94afdd29db

Opioid with rnonoarnine action is?

Tramadol

Pentazocine

Pethidine

Meperidine

0a

single

Tramadol REF: Principles and practice of palliative care and suppoive oncology By Ann M. Berger, John L. Shuster, Jamie H. Von Roenn page 51 "Tramadol is synthetic analog of codeine that binds to the MOR (Mu opioid receptor) and blocks reuptake of serotonin and nor epinephrine. As a result of monoamine action naloxone cannot completely reverse its respiratory depression"

Pharmacology

b1330de3-5c18-4cda-9947-3b5fd695eb34

Following drug interact with cefotaxime -

Digoxin

Paracetamol

Loop diuretics

Nifedipine

2c

single

Ans. is 'c' i.e., Loop diuretics o Nephrotoxicity of cephalosporins is accentuated by concurrent administration of a loop diuretic.

Pharmacology

c28eef3e-db44-4c59-a8b2-6bf401163708

Which of the following induction agent is used to produce a `street-fit' person following surgery –

Midazolam

Propofol

Alfentanyl

Thiopentone

1b

single

Amongst the given options only propofol & thiopentone are inducing agents. Propofol is the inducing agent of choice for day care surgery (street-fit following surgery).

Anaesthesia

1e9fcec4-3362-4a71-b213-5f100dfc7789

Which of the following is a Dihydropteroate synthase (DHPS) inhibitor?

Pyrimethamine

Trimethoprim

Methotrexate

Dapsone

3d

single

Dapsone, PAS, Sulphonamide > inhibit DHPS enzyme Pyrimethamine, Methotrexate, Trimethoprim - acts by inhibiting DHFR (Dihydrofolate reductase) enzyme.

Pharmacology

7a9cbd01-ea0a-4d28-8896-02df79aefb23

In the management of patients with Vincent's infection, the preferred therapeutic agents are

Hydrogen peroxide mouthwash and metronidazole

Cephalosporins and hydrogen peroxide mouthwash

Chtorhexidine mouthwash and metronidazole

Crystalline penicillin and chlorhexidine mouthwash

0a

multi

Dental

317fbdf9-6524-4867-9f5b-74d24966767f

The prophylactic antibiotic indicated to prevent infection in lymphoedema is :

Vancomycin

Penicillin

Amikacin

Quinolones

0a

single

Pharmacology

8ba3627e-87cf-49ca-b379-a8c67bde3718

Shortest acting mydriatic and cycloplegic:

Cyclopentolate

Atropine

Homatropine

Tropicamide

3d

single

Ans. D. TropicamideMydriatic action is useful for fundus examination and cycloplegic is useful for correct measurement of refractive error.Atropine is longest acting and tropicamide is shortest acting drug Anticholinergic drugs are contraindicated in Glaucoma.

Pharmacology

Gram-Positive Infections - Corynebacterial Infections

fd583bec-af86-47e2-9263-79e1d1811aaa

Rituximab is used in all EXCEPT :

Non Hodgkins lymphoma

Paroxysomal nocturnal hemoglobinurea

Rheumatoid arthritis

Systemic lupus erythematosis

1b

multi

Pharmacology

00ccbfce-7492-4853-8dba-42b7569f0564

The Antiepileptic drug, Phenytoin therapeutic blood level is

0-9 mcg/ml

10-19 mcg/ml

20-29 mcg/ml

30-39 mcg/ml

1b

single

(B) 10-19 mcg/ml# SERUM PHENYTOIN LEVELS:> Therapeutic range is 10-20 mcg/mL.# Total phenytoin levels (mcg/mL) - Typical corresponding Signs & Symptoms: Lower than 10- Rare Between 10 and 20 - Occasional mild nystagmus Between 20 and 30 - Nystagmus Between 30 and 40 - Ataxia, slurred speech, nausea, and vomiting Between 40 and 50 - Lethargy and confusion Higher than 50 - Coma and seizures

Medicine

Miscellaneous

d7567844-92df-4024-9f8f-fca65a75b1f4

Which is the diuretic of choice in patients of pulmonary edema-

Furosemide

Thiazide

Spironolactone

Amiloride

0a

single

Ans. is 'a' i.e., Furosemide Pharmacological treatment of acute pulmonary edema* Acute left ventricular failure and pulmonary edema is a medical emergency.* In acute left ventricular failure, there is accumulation of fluid in lungs - acute pulmonary edema.* Loop diuretics (Furosemide) is the DOC for acute pulmonary edema.* In acute left ventricular failure and pulmonary edema, furosemide has benefical effect because of venodilatory action (not because of diuretic action).* Intravenous furosemide causes promt increase in systemic venous capacitance and decreases left ventricular filling pressure even before the diuretic action becomes apparent.I.V. Furosemide|Venodilation|| Venous capacitance|| Preload|| Lt. ventricle filling pressure|| Pulmonary pressurei| Pulmonary edema* In contrast, diuretic action of Furosemide is responsible for symptomatic improveml in chronic heart failure.* Other drugs used for acute pulmonary edema1. Morphine | is a transient venodilator that reduces preload while relieving dysnea and anxiety.2. Nitrates - Act by decreasing preload and L. V. filling pressure.3. ACE inhibitors - Act by reducing both afterload and preload.* Recommended in hypertensive patients.4. Recombinant BNP (Nesiritide) - Acts by reducing preload and afterload.5. Inotropic agents (Dopamine, dobutamine, milirinone)* They act by stimulating cardiac contractility.* They are indicated in patients with acute pulmonary edema with severe left ventricular dysfunction.6.Digitalis glycosides* Once a mainstay of treatment because of their inotropic action, digitalis glycosides are rarely used at present.* However, they may be useful for control of ventricular rate in patients with rapid atrial fibrillation or flutter and LV dysfunction, since they do not have negative inotropic effects of other drugs that inhibit AV node conuction.

Pharmacology

Diuretic

2e1eaed6-f949-4b98-820e-b2af653288a0

Syringes and glassware are sterilized by?

Irradiation

Autoclave

Hot air oven

Glutaraldehyde

2c

single

Hot air oven REF: Ananthnarayan 8th e p. 35 Procedures of sterilization of some impoant materials Glasswares, syringes, petridishes, test tubes, flasks, surgical instruments, oily fluids and powders Hot air oven Serum, body fluids, bacterial vaccines Waterbath , vaccine bath Milk Pasteurization at 63deg c x 30 mins or 72deg c x 20 mins Cystoscope and endoscope Glutaraldehyde (cidex) or ethylene oxide Most culture media Autoclaving Culture media containing egg, serum, sugar Tyndallisation Rubber, plastic, polythene tubes, disposable syringes Glutaraldehyde , ethylene oxide gas Dressings, aprons, gloves, catheters, surgical instruments except sharps Autoclaving Sharps 5% cresol Suture material except cat gut Autoclaving Catgut Radiation Rubber or plastic disposable goods, disposable syringes, bone and soft tissue grafts, dressings Radiation Faeces, urine, vomitus, sputum Bleaching powder, cresol, formalin, burning, autoclaving, boiling Sterlisation of operation theatre Formaldehyde Wards and laboratory or operation theatre floor space Formaldehyde gas or cresol Skin Tincture iodine, spirit (70% ethanol ), savlon

Surgery

f9e02e89-e8ca-4c35-bc36-d6653ac50db2

Drug of choice for poisoning with Amanita muscaria

Atropine

Physostigmine

Diazepam

Pencillin

2c

single

Amanita muscaria signs and symptoms are mainly related to anxiety and insomnia which can be treated best with benzodiazepines like diazepam Atropine is contraindicated but for amanita inocybe poisoning atropine is drug of choice Ref: KDT 6th ed pg 98

Pharmacology

Autonomic nervous system

cd75aaf3-5325-4053-ae04-81c36574fa21

The addition of hyaluronidase to a local anesthetic solution might

Increase the duration of anesthesia

Limit the area of anesthesia

Reduce bleeding

Enhance diffusion of local anesthetic

3d

single

Surgery

81bbfec2-cd68-4f50-a625-6474626df761

Mrs. Reeta Wardhan, A 50-year old female with rheumatoid arthritis is being considered for infliximab therapy. Which of the following tests should be performed before beginning treatment?

Liver function tests

PPD skin test

Pulmonary function tests

Visual examination

1b

single

Infliximab is a monoclonal antibody against TNF-α. It is commonly used to treat moderate to severe rheumatoid arthritis particularly in patients who have failed methotrexate therapy. TNF-α inhibitors can cause serious adverse effects, includ­ing reactivation of latent tuberculosis. All patients being considered for TNF-α inhibitor therapy should have a baseline PPD skin test to screen for latent tuberculosis.

Pharmacology

3730cef6-56b6-4d93-996c-d757c2cf92f8

The drug of choice in the management of life threatening allergic reaction is:

Corticosteroids

Antihistamines

Adrenalin

Diazepam

2c

multi

Pharmacology

d3b92e69-d67f-48cb-b93b-9a259ca8d0cb

A gravida 3 with a history of 2 previous 2nd trimester aboions presents at 22 weeks of gestation with funneling of the cervix. Most appropriate management would be:

Administer Dinoprostone and bed rest

Administer mifepristone and bed rest

Apply Fothergill's stitch

Apply McDonald's stitch

3d

single

Previous history of mid trimester aboions and funneling of cervix are both suggestive of incompetent cervix McDonald's stitch is used for cervical encerclage, generally applied after 12 completed pregnancy weeks and removed at or beyond 37 weeks Dinoprostone is mainly used for induction of labour. Mifepristone which is an anti progestin is use for termination of pregnancy. Fothergill's stitch used for repair of cervical enlargement and is pa of management of UTERINE prolapse in younger parous women who want to save their uterus

Gynaecology & Obstetrics

Aboions, Spontaneous & Induced Emergency Contraception (Hey,whats the hurry !)

01f38679-d797-4d9f-9eb5-497c87723afa

Drug of choice for the treatment of a pregnant woman with P vivax malaria is :

Quinine

Chloroquine

Artemether

Paracetamol

1b

single

Pharmacology

b866d93f-aec0-4401-822d-6f02c6dd4371

Treatment of choice for Echinococcus granulosus is.

Albendazole

Mebendazole

Thiobendazole

Praziquantel

0a

single

Answer is A (Albendazole): The drug of choice for treatment of Echinococcus granulosus injection (Hydatid cyst) is Albendazole.

Medicine

3b038236-a75a-4281-8bb1-410a841a0010

When used for emergency contraception, What is the dose of ulipristal acetate?

300mg

30mg

300ug

30ug

1b

single

Emergency Contraceptives Drug Dose Levonorgestrel (POP) 1 dose 1.5 mg within 72 hrs Copper IUDs ( NOT THE DOC ! ) Inseion within 5 days Ulipristal acetate (SPRM) 30 mg orally within 120 hours Ethinyl estradiol 50 ug + Norgestrel 0.25 mg (COC) 2 tab stat and 2 after 12 hour Mifepristone RU 486 (PA) 25 to 100 mg single dose ICUDs are the most effective methods, no doubt, but they can never be the DOC. Thats because they require seeing a gynecologist take a prescription and then a specialist to inse the device. Emergency contraception is based on the principle of 'over the counter' easy to use medication to prevent a pregnancy and when there is unplanned intercourse, which can happen many times in a year, a person cannot be expected to take an IUCD every time! However, a LNG tablet can be easily, and effectively, be taken whenever there is unplanned intercourse * Please note: We are in the early pa of year 2020 now. Mifepristone or Ullipristal may be soon termed as the best drugs for EC. Please be on the look out for recent updates.

Gynaecology & Obstetrics

NEET 2019

8d7336c0-9c1f-4642-8ad3-af9d070141c6

Effective ulcer treatment that works by inhibitory action on gastric acid secretion is -

Lactulose

Aluminium hydroxide

Sucralfate

Ranitidine

3d

single

Ans. is 'd' i.e., Ranitidine o Among the given options, only ranitidine decreases acid secretion.Drugs for peptic ulcer1.Reduce gastric acid secretionH2 antihistaminic - Cimetidine, Ranitidine, Famotidine, Roxatidine.Proton pump inhibitors - Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole, Esomeprazole.Anticholinergics - Pirenzepine, propantheline, oxyphenonium.Prostaglandin analogue - Misoprostol, enprostil, rioprostil.2. Neutralization of gastric acid (antacids)Systemic - Sodium bicarbonate, sodium citrate.Non systemic - Magnesium hydroxide, Mag. trisilicate, aluminium hydroxide, Magaldrate, calcium carbonate.3. UlcerprotectivesSucralfate, colloidal bismuth subcitrate, Prostaglandin analogue.4. Anti H. pylori durgsAmoxicillin, clarithromycin, metronidazole, Tinidazole, tetracycline.Note - PG analogue have both antisecretory (i HC1 secretion) as well as cytoprotective action.

Pharmacology

G.I.T

e0fba5e9-2d96-486e-b9c6-1ecf49c0f048

One of the following antihypeensive is NOT used in pregnancy:

Enalapril

Methyldopa

Hydralazine

Nifedipine

0a

single

Enalapril is an ACE INHIBITOR which causes oligohydramnios, hypocalvaria and renal dysfunction which leads to IUGR. Commonly Used Drugs in the Management of Pre-eclampsia Drug Mode of action Labetalol Adrenoceptor antagonist (a and b blockers) Nifedipine Calcium channel blocker Methyl-dopa Central and peripheral anti adrenergic action Hydralazine Vascular smooth muscle relaxant

Gynaecology & Obstetrics

Pregnancy induced Hypeension

d2092992-012b-49e3-b22d-15ff0381db58

Glycoprotein II b / III a receptor antagonists is

Clopidogrel

Abeiximab

Tranoxaemic-acid

Ticlopidine

1b

single

(Abciximab) (573-KDT) (610-11-KDT 6th)Antiplatelet Drugs (Antithrombotic drugs)* Aspirin* Dipyridamole* Ticlopidine* Clopidogrel* * Glycoprotein lib /Ilia receptor antagonists - Abciximab, Eptifibatide and TirofibanAbciximab* Given along with aspirin + heparin during PTC A it has markedly reduced the incidence of restenosis, subsequent MI and death* Used in unstable angina and as adjuvant to coronary thrombolysis* Non antigenic, the main risk is haemorrhage. Thrombocytopenia is another complications.Antifibrinolvtics - EACA, Tranexaemic acid, Aprotinin

Pharmacology

Hematology

e01c0216-2606-464b-949d-c3e4c9a5e027

Fatty change in liver is seen with use of -

Tetracycline

Erythromycin

Chlorpromazine

Acetoaminophen

0a

single

Pathology

f45139c3-9908-4f4d-a762-a5dd078d603c

Which of the following is shortest acting non depolarizing Muscle Relaxant:

Vecuronium

Mivacurium

Succinylcholine

Atracrium

1b

single

Ans: (b) MivacuriumRef: KDt 6th ed. / 343* Shortest acting non-depolarizing muscle relaxant: Mivacurium* Shortest acting depolarizing muscle relaxant: Sch* Overall shortest acting muscle relaxant: Sch.* Shortest acting local anaesthetic: chlorprocaineClassification of Muscle RelaxantsNeuro Muscular Blocking agentDepolarizing (Non- competitive) M.R.Non-depolarizing (Competitive) M.R.Suxamethonium/succinyl choline/ ScolineDecamethoniumAll others, For eg: Gallamine,D-tubocurarine, Atracurium,Mevacurium/ Vecuronium/Pancuronium/Rocuronium

Anaesthesia

Non-depolarising Neuromuscular Blocking Agents

a6c7afb1-c6d3-4d60-a387-df23f60fc16e

Which of the following antihypertensives is not given in pregnancy? (AllMS May 2015. May 2014)

Enalapril

a-methyldopa

Labetalol

Nifedipine

0a

multi

Ans. a. Enalapril (Ref: Goodman and Gilman 12/e pe p736)Enalapril is not given in pregnancy."ACE inhibitors inhibit the conversion of angiotensin-I to the potent vasoconstrictor angiotensin-II. They can cause severe fetal malformations that include hypocalvaria when given in the second and third trimesters. Because of this, they are not recommended during pregnancy. Angiotensin-receptor blockers act in a similar manner but instead of blocking the production of angiotensin-II, they inhibit binding to its receptor. They are presumed to have the same fetal effects as ACE inhibitors and are also contraindicated." - Goodman and Gilman 12/e pe p736Antihypertensives to be avoided in Pregnancy (Mnemonic: SAAND)Sodium nitroprussideQACE inhibitorsQARBsQNon-selective beta blockersQDiureticsQ

Gynaecology & Obstetrics

Management and Long-Term Consequences

239f5443-f53e-414c-93b2-51219f6f4c19

A 40 year old primiparous woman suspected to be suffering from endometriosis is subjected to diagnostic laparoscopy. Findings indicate - Uterus normal, both the ovaries show presence of chocolate cysts; endometriotic deposits are seen on the round ligament right side, both the fallopian tubes and the pouch of Douglas; moderately dens adhesions are present between the fallopian tubes and the pouch of Douglas. The treatment of choice in this case is :

Total hysterectomy with bilateral salpingooophorectomy

Danazol therapy

Progesterone therapy

Fulguration of endometriotic deposits

3d

multi

Ans. is d i.e. Fulguration of endometriotic deposits The situation given in the question is such that it points towards moderate endometriosis (as chocolate cyst, dense adhesions are present). Dense adhesions and cysts cannot be fully treated by medical therapy and so, some form of surgery is required. Main question is whether we would like to go for conservative surgery or Radical surgery (i.e. TAH with BSO). Conservative surgery : The clinical situations involving conservative surgery include ovarian endometrioma, pelvic adhesions, peritoneal implants and deep infiltrative recto vaginal septum disease. In addition laser laparoscopy can be used in order to perform uterine nerve ablation. .. Radical Surgery : Whilst repeated conservative surgery and medical therapy help many women, only some women fail to find pain relief after recurrence, which is the major drawback of conservative surgery. For these women, radical surgery is the only option and involves Hysterectomy with Bilateral salpingo-oophorectomy. According to "Hysterectomy with bilateral oopherectomy should be reserved for women who have completed childbearing and recognise the risk of premature hypoestrogenism including possible osteoporosis and decrease libido." Note : Hysterectomy without BSO is not done in case of endometriosis due to 6 fold increase risk of recurrent chronic pelvic pain and 8 fold risk of repeat surgery.

Gynaecology & Obstetrics

7ecbb16b-0367-49ac-a857-17e99689864e

True regarding morphine

Tolerance develps for all except miosis and constipation

Tolerance to all effects develops with chronic usage

Tolerance develops for all except euphoria and sedation

Tolerance can develop to all effects in high doses

0a

multi

A i.e. Toerance develops for all except miosis & constipation

Anaesthesia

4696014a-a39a-45f6-acbe-7943be26d9ca

Which of the following is a low molecular weight heparin:

Hirudin

Enoxaparin

Tranexamic acid

Lepirudin

1b

single

Ans. (b) Enoxaparin* Enoxaparin is a low molecular weight heparin.* It acts by inhibiting factor Xa.* LMWH usually doesn't need monitoring because of consistent bioavailability.* Drugs under LMWH:# Enoxaparin# Dalteparin# Tinzaparin# RabiparinAlso Know* Hirudin along with Lepirudin and Bivalirudin is an anticoagulant which is act by direct thrombin (factor IIa) inhibition.* Tranexamic acid is an anti-fibrinolytic agent.

Pharmacology

Anticoagulants and Coagulants

392e7d76-2372-4d9f-8e96-70f42ec89e95

Which of the following antibiotics is NOT indicated for periodontal therapy?

Erythromycin

Metronidazole

Tetracycline

Augmentin

0a

single

Dental

8b214b00-10af-42b8-8128-b02dc11ea832

Antidote for Strychnine poisoning is -

Barbiturates

Physotigmine

Fomepizole

Naloxone

0a

single

Management of convulsions is impoant and can be treated by lorazepam or diazepam. If benzodiazepines are ineffective, sho acting barbiturate can be administered. Intractable convulsions may need muscle relaxants such as pancuronium. REF;THE SYNOPSIS OF FORENSIC MEDICINE:KS NARAYANA REDDY;28th EDITION;PAGE NO 353

Forensic Medicine

Poisoning

294786c1-df91-4745-89c2-63499aef7ecf

Orally active hormone is

TSH

Thyroxine

GH

Prolactin

1b

multi

Levothyroxine is an orally active hormone- T4 given daily on empty stomach in doses of 12.5, 25, 50,75 or 100 mcg depending on the clinical condition of hypothyroidism REF KD Tripathi 8th ed

Pharmacology

Endocrinology

b00c2bd0-63a9-4b02-8be3-9997c46979cf

TADALAFIL false is ?

It is longest acting phosphodiesterase inhibitor

It cannot be used for the treatment of PAH

It is used in erectile dysfunction

Its half life is 17-5 hours

1b

multi

Ans. is 'b' i.e., It cannot be used for the treatment of PAH Tadalafil is the longest acting phosphodiesterase inhibitor used for erectile dysfunction. Its half life is 17.5 hours. It can be used as once-daily phosphodiesterase type 5 (PDE5) inhibitor for the treatment of pulmonary aerial hypeension (PAH).

Pharmacology

a14fb06d-8b86-4c25-b6e5-52db426a04d6

All of the following drug inhibit the cell wall synthesis except:

Penicillin

Fosfomycin

Vancomycin

Tetracycline

3d

multi

Ans. D. TetracyclineDrugs inhibiting the cell wall synthesis- beta lactam, bacitracin, vancomycin, cycloserine, Fosfomycin. Tetracycline acts via protein synthesis inhibition.

Pharmacology

Anti Microbial

7e20471d-8638-45e4-949b-584f72b147c3

Tadalafil acts on Phosphodiesterase 5 and causes accumulation of-

cAMP

cGMP

PAF

IL10

1b

single

Ans. is 'b'i.e., cGMP o Inhibition of PDE-5 prevents degradation of cGMP which results in accumulation of cGMP and marked potentiation of NO action - Relaxation of smooth muscle in corpus cavemosum and blood vessels supplying it - Erection of penis,o Drugs are : -SiledenafilTodafilVardenafil

Pharmacology

Asthma

a2a98a90-f4bb-4a8c-aa65-348ffa4c8f63

Which of the following is not given in the treatment of cyanotic spells in a patient of TOF?

Phenylephrine

Propranolol

Calcium chloride

Sodium bicarbonate

2c

single

Ans. c. Calcium chloride (Ref: Ghai 7/e p410; Myong K. Park 5/e p238)Calcium chloride is not given in the treatment of cyanotic spells in a patient of TOF.Management of Anoxic Spells in Tetralogy of FallotKnee chest positionHumidified oxygenMorphineQ 0.1 to 0.2 mg/kg SCObtain venous pH; sodium bicarbonateQ 1-3 ml/kg (diluated) IVPropranolol 0.1 mg/kg/IV (during spell)Q; 0.5-1 mg/kg/6 hourly orally (alternatives: metoprolol, esmoiol)Vasopressors: Methoxamine (Vasoxy1) IM or IV drip (Phenylephrine is a vasopressor)QCorrect anemiaConsider surgeryTetralogy of FallotCommonest congenital cyanotic congenital heart diseaseQ in children above the age of 2 years constituting almost 75 percent of all blue patients.Hemodynamics:Physiologically the pulmonary stenosis causes concentric right ventricular hypertrophy without cardiac enlargementQ and an increase in right ventricular pressure.Severity of cyanosis is directly proportional to the severity of pulmonic stenosis, but the intensity of the systolic murmur is inversely proportional to the severity of pulmonic stenosisQ.Since the right ventricle is e.ffectively decompressed by the ventricular septal defect, congestive failure never occurs in TOFQ.The late and soft P2 is generally inaudible in TOF. The S2 is therefore single and the audible sound is A2.On auscultation, the diastolic interval is completely clear in TOF as there is no third or fourth sound or diastolic murmur.Clinical Features:MC symptoms are dyspnoea on exertion and exercise intoleranceQ.Squatting is not specific for TOF, TOF is the commonest congenital lesion in which squatting is notedQ.Characteristic features:Normal sized heart with upturned apexQ (suggestive of RVH)Absence of main pulmonary artery segment gives it the shape described as 'Cor-en Sabot'Q Pulmonary fields are oligaemicQAortic-mitral valve continuity is maintainedQ.Complications:Anemia, infective endocarditis, venous thrombosisParadoxical embolism, hemiplegia, brain abscessQTreatment:Medical management for anemia and management of complications.Palliative operations in TOF1. Blalock-Taussig shunt: Subclavian artery-pulmonary artery anastomosisQ.2. Potts shunt: Descending aorta is anastomosed to pulmonary arteryQ.3. Waterston's shunt: Ascending aorta-right pulmonary artery anastomosisQ.Definitive operations: Closing the VSD and resecting the infundibular obstructionQ.Fallot'sTrilogyTetralogyPentalogy* Pulmonary stenosisQ* Atrial septal defectQ* Right ventricular hypertrophQ* Pulmonary stenosisQ* Ventricular septal defectQ* Right ventricular hypertrophyQ* Ovemding or dextroposed aortaQ.* Tetralogy of Fallot + ASDQ or patent foramen ovaleQ

Pediatrics

Cyanotic Congenital Heart Disease

57c8d24e-6195-4890-bc94-7c746d4bd7b6

An infant had a high-grade fever and respiratory distress at the time of presentation to the emergency room. The sample collected for blood culture was subsequently positive showing growth of alpha haemolytic colonies. On Gram staining, these were gram positive cocci. In the screening test for identification, the suspected pathogen is likely to be susceptible to the following agent:

Bactiracin

Novobiocin

Optochin

Oxacillin

2c

single

Ans. is 'c' i.e. Optochin Respiratory tract infection in an infant, together with the presence of alpha hemolytic gram-positive cocci suggests the presence of Streptococcus pneumonia The sensitivity of pneumococci to optochin is useful in differentiating it from other alpha hemolytic streptococci. Streptococcus pneumoniae is susceptible to optochin while other alpha hemolytic streptococci are not sensitive to optochin. If the diagnosis is still not certain, streptococcus pneumococci can be diagnosed by its bile solubility. Also know Classification of Streptococci and Enterococci Hemolytic reaction Lancefield group Species A Streptococcus pyogenes B Streptococcus agalactiae Beta C S. dysgalactia subspecies D Enterococcus species Small colony variants of A, C, F, G or ungroupable Anginosus group D Enterococcus species D Streptococcus bovis Alpha or Gamma Small colony variants of A, C, F, Anginosus group G or ungroupable None Streptococcus pneumoniae None Viridans streptococci

Unknown

c2e97b61-d0ca-4391-89c4-d8b08f1355e5

Which of the following drugs is not a pa of the &;Triple Therapy&; immunosuppression for post-renal transplant patients?

Cyclosporine

Azathioprine

FK 506

Prednisolone

2c

single

Initial therapy is the treatment given to all recipients (except where the donor is an identical twin) for 0-3 months after transplantation. Initial therapy is usually 'triple therapy', in which a calcineurin inhibitor (traditionally ciclosporin) is used as the 'primary agent'in combination with a coicosteroid (prednisolone) and azathioprine. Calcineurin inhibitor with anti-proliferative agent alone or with steroids alone(DUAL THERAPY) REF.Bailey and Love 27e pg 1540.

Surgery

General surgery

1992c62c-7b55-4f29-bfa7-46d1bfc22c33

Naltrexone is used for:

Cocaine

Alcohol dependence

Anorexia

Cannabis toxicity

1b

single

Ans. B. Alcohol dependenceExplanationNaltrexone is a opioid receptor antagonist used to reduce or eliminate the subjective high associated with consumption of opioid and alcohol.It is approved by US FDA for alcohol dependence and for blockade of effects of exogenously administered opioids.

Psychiatry

Substance Abuse

0d3f706c-ecbd-456d-a07f-04877090b001

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?

Urgent upper gastrointestinal contrast study to delineate site of bleeding

Immediate selective aeriography the left gastric aery to diagnose and treat presumed stress ulceration

Urgent esophagogastroduodenoscopy to diagnosis the cause of bleeding

Urgent intravenous infusion of vasopressin at 0.2-0.4 IU/min

2c

single

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.

Surgery

Stomach & Duodenum

4acdbe72-d0b1-455b-b136-d4edc37dffaa

Drug used in uncomplicated alcohol withdrawal?

Diazepam

Clonidine

Propanalol

Methadone

0a

single

Ans. is 'a' i.e. Diazepam Medications used in Alcohol WithdrawlThe important point to emphasize about the treatment of Alcohol Withdrawl is that it is caused by the removal of a CNS depressant i.e. AlcoholSo the Withdrawl symptoms can be initially controlled by replacing alcohol with any other C.N.S. depressant drug and subsequently the dose of the C.N.S. depressant can be tapered.Most of the C.N.S. depressant drugs are effective but benzodiazepines have the highest margin of safety and lowest cost and are therefore the preferred class of drugs.Most clinicians use long acting benzodiazepines such as chlordiazepoxide or diazepam because short acting benzodiazepines can produce rapidly changing blood levels.Enough dose of chlordiazepoxide is administered on day one to alleviate symptoms and then the dose is gradually decreased.Also knowT/T of patients with delirium tremens in Alcoholic WithdrawlThe important point to consider about delirium tremens is that the course is likely to continue for 3-5 days.High doses of benzodiazepines are used.Sometimes antipsychotic medications such as haloperidol, ziprasidone or olanzapine have been used.T/T of patients with alcohol Withdrawl seizuresBenzodiazepines are used.Use of anticonvulsants is not indicated.Drugs used in Rehabilitation of Alcoholics:NaltrexoneIt is a opioid-antagonistic drug.It decreases the feeling of pleasure on ingestion of Alcohol.AcamprosateIt inhibits NMDA receptors.DisulfiramIt is an ALDH inhibitor.It produces an unpleasant reaction in the presence of alcohol.Drinking alcohol while taking disulfiram produces a reaction involving an increased pulse changes in blood pressure, vomiting and diarrhoea.

Pharmacology

C.N.S

3d7441d9-de76-4377-a95c-f1ef7a206b02

Haemolysis in G6PD (glucose 6 phosphate dehydrogenase) enzyme deficiency may occur with all of the following drugs except:

Primaquine

Phenacetin

Probenecid

Penicillin

3d

multi

Ans. (d) Penicillin(Ref: Robbins 9th ed. Pg. 644-645)Penicillin causes hemolysis by mechanism of autoimmune hemolytic anemia and not G6PD deficiency mediated.

Pathology

Misc. (R.B.C)

4f6bf9ee-cee2-44be-b444-3bd4a6425aa4

All of the following must be done for management of patient with the following ECG, except?

CPR for 60-90 seconds

Epinephrine

Vasopressin

Soda bicarbonate

3d

multi

Ans. (d) Soda bicarbonate.* The rhythm strip shows a chaotic activity of ventricular fibrillation.* CPR for 60-90 seconds should be given with chest compressions times per minute if delay > 5 minutes on reaching the patient.* Epinephrine is given to improve coronary perfusion and reduce hypoxia which is responsible for development of ventricular fibrillation.* Vasopressin improves cerebral perfusion.* Soda bicarbonate is mentioned in current edition as not indicated for routine usage.

Medicine

Arrhythmias

83c2b200-d87a-4bbe-a367-5eed5aa9d3d9

Longest acting muscle relaxant is?

Atracurium

Vecuronium

Doxacurium

Rocuronium

2c

single

Ans. is 'c' i.e., Doxacurium Amongst the given options doxacurium is longest acting (Duration of action 90-120 minutes). Rocuronium (duration of action 30-60 minutes), Atracurium (duration of action 30-60 minutes) and vecuronium (duration of action 60-90 minutes) have shoer duration of action than doxacurium.

Pharmacology

6c15362a-7680-4586-95bb-92a53ccb974c

Which one of the following acts commonly both on parasympathetic and sympathetic division ?

Atropine

Pilocarpine

Acetylcholine

Adrenaline

2c

multi

Pharmacology

15109a1e-ed23-4af7-ac1f-6a11c52211c3

Most potent antiemitic agent used in preoperative period

Glycopyrolate

Hyoscine

Atropine

Metochlorpromide

3d

single

D i.e. Metochlopromide Metochlopramide increases lower esophageal sphinter tone, speeds gastric emptying & lowers gastric fluid volume & decreases risk for aspiration pneumonia due to antiemetic effect

Anaesthesia

5e587769-1313-4e62-bbaf-7833d96d725b

A child presents with infective skin lesion of the leg. Gram stain from the specimen shows pus cells with gram+ve cocci in chains and culture is done which shows hemolytic colonies. The test to confirm the organism is -

Bile solubility

Optochin sensitivity

Bacitracin sensitivity

Catalase positive

2c

single

* Infective skin lesion with gram positive cocci in chains and hemolytic colonies suggest infection of Streptococcus pyogenes. Option 1, 2 Pneumococcus: Bile solubility Positive (Bile soluble) Optochin sensitivity Option 3 Streptococcus Pyogenes Transpo medium: Pike's medium Direct smear microscopy: Pus cells with gram-positive cocci in sho chains Culture: Blood agar: Pinpoint colony with a wide zone of b-hemolysis Selective media: Crystal violet blood agar and PNF (polymyxin B, neomycin, fusidic acid) media Liquid media: Granular turbidity with powdery deposit Biochemical: Catalase negative, Bacitracin sensitive (Maxted's observation) Pyrrolidonyl Arylamidase (PYR) test is positive. Option 4 Catalase +ve: Staphylococcus spp. Catalase -ve: Streptococcus spp.

Microbiology

Systemic Bacteriology Pa 1 (Gram Positive Cocci, Gram Negative Cocci)

9b425f04-f5a8-458a-94b1-d970126899bc

Which of the following is not related to kala azar?

Pancytopenia

Oral miltefosine

Hyperpigmentation

Tropical splenomegaly syndrome

3d

single

- Tropical splenomegaly syndrome is now known as Hyperreactive malarial syndrome (HMS) is prevalent in native residents of regions where malaria is endemic.Patients with HMS have high levels of antibody for Plasmodium falciparum, Plasmodium vivax, or Plasmodium ovale. - Presentation of Kala Azar -fever, chills and spleen progressively becomes greatly enlarged, and bone marrow damage leads to pancytopenia. The liver is somewhat enlarged, and generalized lymphadenopathy may occur. Hyperpigmentation of skin can be seen, leading to the name Kala Azar. Oral miltefosine can be used for treatment.(Liposomal Amphotericin B is preferred)

Medicine

parasitic infection

cae1d27d-60bf-4e06-9dce-04ae5ee221f2

Least teratogenic antiepileptic drug in pregnancy is;

Valproate

Phenytoin

Carbamazepine

Levetiracetam

3d

single

Anti-epileptic with highest risk of teratogenicity - Valproate - causes neural tube defects Anti-epileptic with lowest risk of teratogenicity- Lamotrigine >Levetiracetam

Pharmacology

FMGE 2019

daddeef9-f43c-46b7-8b30-4b7547be0ab9

True statement about dezocine is:

It is slower acting than morphine

It is less potent than morphine

It acts GABA receptors

It doesn't increase histamine release

3d

multi

Ref: Goodman and Gilman 10/e p602 *Dezocine is slightly more potent and faster acting opioid than morphine with a similar duration of action. It is a paial agonist antagonist opioid. *It is active at u receptors and side effect are similar to those of morphine. *Dezocine doesn't increase plasma histamine and produces less hypotension than morphine or pentazocine. *Dezocine is effective for moderate to severe pain but can cause myocardial depression.

Pharmacology

Central Nervous system

4b6f124b-fa88-4f14-a4a6-124dcdc47551

The following drugs can produce ototoxicity except :

Ethacrynic acid

Aztreonam

Gentamicin

Frusemide

1b

multi

Pharmacology

a762ea03-7e3d-42cd-906a-d0360a157ceb

The most impoant channel of elimination of digoxin is:

Glomerular filtration

Tubular secretion

Hepatic metabolism

Excretion in bile

0a

single

Digoxin is primarily eliminated unchanged by glomerular filtration Digitoxin is eliminated by hepatic metabolism.

Pharmacology

CHF, Angina Pectoris and Myocardial Infarction

7f6c304d-b573-43ec-9895-f56cc42ce5bf

A 7 - year - old boy underwent neurosurgery for craniopharyngioma following which pituitary functions were lost. Which of the following hormone should be replaced first?

Hydrocortisone

Thyroxine

Growth hormone

Prolactin

0a

single

Hydrocortisone, followed by GH is vital to be given in a child with lost pituitary function.

Pediatrics

aa51643c-0006-4001-9dcf-6c2f9ab56f85

If a patient starts getting convulsions following the use of Lignocaine as local anaesthetic, the Drug of choice for the control of convulsions would be

Diazepam

Chlorpromazine

Scoline

Any

0a

single

(A) Diazepam > If a patient starts getting convulsions following the use of Lignocaine as local anaesthetic, the Drug of choice for the cortrol of convulsions is the> diazepam# DIAZEPAM> Relatively lipid soluble, water insoluble; crosses placenta.> Should be administered orally or i.v. as i.v. route is slow, incomplete, erratic.> Elimination half life 20-40 hours. (Enterohepatic recirculation),> Its metabolite N-desmethyldiazepam is pharmacologically active with half life of 100 hours; Age tends to reduce clearance of Diazepam> Complications of Diazepam: i.v. Injection causes high incidence of thrombophlebitis and pain.

Anaesthesia

Miscellaneous

c1fc3549-62b2-479b-95f5-1b96fe2cd5a8

Which of the following is most likely to be used in a young child with chronic renal insufficiency?

Cyanocobalamin

Desferrioxamine

Erythropoietin

Filgrastim (G-CSF)

2c

single

Erythropoietin is produced by kidneys, in CRF production of erythropoietin is reduced and we need to supplement it from outside. Preprations used in CRF are Epoietin, Darbopoietin, Peginesatide. Its also used in anaemia due to myelosuppressive Drugs(zidovudine)and cancer chemotherapy. Cyanocobalamine is used in treatment of megaloblastic aneamia Desferroxamine(S.C.) is used as an antidote of acute iron poisoning Filgrastim is (G-CSF) used in neutropenia due to anticancer drugs

Pharmacology

Hematology

8721015a-52df-4f7c-94ac-adb513fe2c24

Beta blocker with membrane stabilizing propey are all except ?

Acebutolol

Betaxolol

Carvedilol

Bevantolol

3d

multi

Ans. is 'd' i.e., Bevantolol

Pharmacology

ca55caf4-d18e-4a37-8c53-48f340334994

OCP's are C/I in pts receiving:

Rifampicin

Ethambutol

Streptomycin

Pyrazinamide

0a

single

Gynaecology & Obstetrics

c303caf7-3503-4c9d-839b-05aa0a62c4bc

Which among the following anti-HIV drugs is an inhibitor of viral fusion?

Enfuvirtide

Nelfinavir

Efavirenz

Etanercept

0a

single

Pharmacology

c1ec8fe8-e380-41d5-9f6c-2f1d26918c53

There has been an outbreak of infections caused by methicillin resistant Staphylococcus aureus in the surgical intensive care unit. The most effective means of limiting the spread is -

Treatment with cephalosporins to which most strains are sensitive

Treatment with naficillin and gentamicin, which have a synergistic effect

Use of high-dose naficillin alone and isolation

Treatment with glycopeptide

3d

single

Medicine

98e69aa6-af36-4949-8f3c-4f46aa00e548

Drug of choice in delirium tremens is

CPZ

Phenytoin

Chlordiazepoxide

Morphine

2c

single

The drugs of choice for alcoholic detoxification are usually benzodiazepines. Chlordiazepoxide (80-200 mg/day in divided doses) and diazepam (40-80 mg/day in divided doses) are the most frequently used benzodiazepines. The higher limit of the normal dose range is used in delirium tremens. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no.40

Psychiatry

Substance abuse

f9b5c9c8-4d50-4638-a4f9-3e8530a3cd9b

Sumatriptan is

5-HT 1D/1B agonists

5-HT 1D/1B antagonist

5-HT 1A agonist,

5-HT 1A antagonist

0a

single

Sumatriptan a 5-HT 1D/1B agonist is used for acute migraine attacks. Buspirone, a 5-HT 1A agonist is an effective nonbenzodiazepine anxiolytic. ref - harrisons internal medicine 20e pg3100

Medicine

C.N.S

586d7603-94e2-4d51-992e-ef0425c29277

Diabetes insipidus treatment includes all EXCEPT:

Metformin

Chlorpropamide

Desmopressin

Carbamazepine

0a

multi

(A) Metformin # Desmopressin: Desmopressin acetate is the treatment of choice for central diabetes in insipidus associated with pregnancy or the puerperium, since desmopressin is resistant to degradation by the circulating vasopressinase> It is usually given intranasally (100 pg./mL solution) every 12-24 hours as needed for thirst and polyuria.> It may be administered via metered-dose nasal inhaler containing 0.1 ml/spray or via a plastic calibrated tube.> Patients are started with 0.05-0.1 ml_ every 12-24 hours, and the dose is then individualized according to response.

Medicine

Miscellaneous

6b6a22e2-ef59-4d14-b527-d662c4eb6f6a

Insulin secretion increasing drug by acting on beta cells of pancreas is -

Rapaglinide

Metformin

Poiglitazone

Acarbose

0a

single

Ans. is 'a' i.e., Rapaglinide Oral hypoglycemic drugs may be divided into two groups. 1. Group 1 These drugs reduce plasma glucose by stimulating insulin production, therefore called insulin secretogogues. Hypoglycemia is a well known side effect. Examples are: i) Sulfonylureas: first generation (chlorpropamide, tobutamide); second generation (Glimipiride, glyburide, glipizide, gliclazide). ii) Megalitinnide/D-phenylalanine analogues: Nateglinide, Rapaglinide. 2. Group 2 These drugs reduce blood glucose without stimulating insulin production, therefore are insulin nonsecretogogues. These durgs do not cuase hypoglycemia when used alone and can cause hypoglycemia, only when used with other oral hypoglycemics. Examples are: i) Biguanides: Metformin, Phenformin ii) Thiazolidinediones: Rosiglitazone, Pioglitazone, Troglitazone. iii) a - glucosidase inhibitors: Acarbose, miglital.

Pharmacology

481214ac-f5dc-4e75-b333-652ad6ca47c1

Verapamil is associated with all of the following except ?

Constipation

Bradycardia

Hyperglycemia

Increased PR interval

2c

multi

Pharmacology

f8a62f00-ffcf-46f2-bd43-4b42d4e4eb00

Treatment of choice for lichen planus ?

Topical coicosteroids

Systemic coicosteroids

Antihistaminics

Acitretin

0a

single

Ans. is 'a' i.e., Topical coicosteroids Treatment of Lichen planus The first line treatment of lichen planus are topical coicosteroids. Second choice would be systemic coicosteroids for symptom control and possibly more rapid resolution. Oral antihistaminics are given for pruritic. PUVA can be used for extensive lesions. Acitretin can be used for mucosal lesions.

Skin

be267362-2a3d-4582-9d34-74c5ecc7d5ff

A 70 year old male patient presented to the emergency depament with pain in epigastrium and difficulty in breathing for 6 hours. On examination, his hea rate was chest examination was normal. The patient has been taking omeprazole for gastresophageal reflux disease for last 6 months. What should be the intial investigation :

An ECG

An upper GI endoscopy

Urgent ultrasound of the abdomen

An x-ray chest

0a

single

Answer is A (An ECG) The patient in question may well be suffering from an acute myocardial infarction. An ECG to exculde an acute MI should be the initial Investigation. `Presence of Epigastric pain in association with breathlessness and evidence of parasympathetic overactivity (bradycardia and hypotension) suggests the diagnosis of an acute (inferior) MI.' ECG therefore should be done as an initial investigation to exclude / confirm a diagnosis of acute MI.' The following lines from Harrison give away the answer to the question : 'Typically the pain involves the central poion of chest and / or epigastrum'. 'The frequent location of the pain beneath the xiphoid and patients denial that they may be suffering a hea attack are chiefly responsible for the common mistaken impression of indigestion. In the elderly, MI may present with sudden onset breathlessness. Although many patients have a normal pulse and blood pressure about one fouh of patients with anterior infarction have manifestations of sympathetic nervous system hyperactivity (tachycardia and / or hypeension) and upto one half with inferior infarction show evidence of parasympathetic hyperactivity (bradycardia and /or hypotension).

Medicine

aa2dcc50-96ee-4442-bbee-a09de2dfbc77

True statement/ s regarding sevoflurane are all except

Ideal agent for pediatric anaesthesia

Can interact with sodalime and forms compound A

Can be used safely in malignant hyperpyrexia

Causes tachycardia

2c

multi

All potent inhalational agents are contraindicated in malignant hypehermia. It has sweet smell so very useful in pediatrics for induction. Sevoflurane reacts with strong bases like sodium hydroxide and potassium hydroxide present in soda lime and baralyme leading to the formation of a haloalkene (fluoromethyl-2,2-difluoro-1- vinyl ether), known as compound A. Compound A has the potential to cause proximal tubular necrosis.

Anaesthesia

Inhalational Anesthetic Agents

7a5792e2-4dce-4b5a-a27d-daf579a1530a

Physiologically most active form of Vitamin D is

Calciferol

Calcitriol

Ergocalciferol

Cholecalciferol

1b

multi

Social & Preventive Medicine

722e561e-58f7-4150-ac13-b5a34563e03e

3 ml of LA solution contains 2% lignocaine with 1:100000 epinephrine how many milligrams of each are present in the solution?

6mg lidocaine, 0.3mg epinephrine

60 mg lidocaine, 0.03 mg epinephrine

6 mg lidocaine, 0.03 mg epinephrine

600 mg lidocaine, 0.3 mg epinephrine

1b

single

Learn the following facts, and you can solve all numerical of LA. % (per cent--'cent' means 100) means g/100ml, so 2% lignocaine means 2g/100ml, or 2000mg/100ml of solution = 20mg/ml. 1 cartridge contains around 2 ml solution. Thus, 3 ml contains 60mg lidocaine.   1 in 1 lakh adrenaline means 1g in 1 lakh ml or 1000mg Adr in 1,00,000 ml solution = 1000/100000 = 0.01mg/ml Thus, 3ml contains 0.03mg adrenaline. To know: Safe dose of LA (with or without Adr) = 7mg/kg body weight. Safe dose of Adr in healthy patient = 0.2 mg Safe dose of Adr in cardiac patient = 0.04 mg

Surgery

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A fungicidal drug that can be used orally for the treatment of onychomycosis is:

Griseofulvin

Amphotericin B

Clotrimazole

Terbinafine

3d

multi

Fungicidal drugs are amphotericin B and terbinafine. Out of these, amphotericin B cannot be given orally. Thus, the answer is terbinafine.

Pharmacology

Anti-Fungal Drugs

dfcc91d2-653b-4105-bdcb-b939834a8f49

Most emetogenic drug is aEUR'

Cisplatin

Carboplatin

High dose cyclophosphamide

High dose methotrexate

0a

single

Cisplatin; 'c' i.e., High dose cyclophosphamide The most common side effect of chemotherapy administration is nausea and vomiting. Antineoplastic agents may vary in their capacity to cause nausea and vomiting.

Pharmacology

bb29cb43-a91e-486a-9a0b-a530a18a3208

Which of the following antiepileptic is also a free radical scavenger?

Levetiracetam

Topiramate

Zonisamide

Gabapentin

2c

single

Zonisamide is a Na+ channel blocker & also a free radical scavenger.

Pharmacology

c5dff84a-ae1f-41b8-aabf-2e5a9ded6dcd

Therapeutic level of phenytoin is:

0-9 mu g/ml

10-19 mu g/ml

20-29 mu g/ml

30-39 mu g/ml

1b

single

Ref: Katzung 11/e p404 The therapeutic level of phenytoin is 10-20 micro g/ml.

Pharmacology

Central Nervous system

db423e02-c694-43ac-a813-edf44c44fb00

Digoxin is useful in -

Atrial fibrillation in thyrotoxicosis

Complete hea-block with CHF

Ventricular tachycardia

Myocarditis

1b

single

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.

Pharmacology

ea7c2283-12ac-43fc-a350-5031be31dd79

Receptors are located in the nucleus for all the following except

Insulin

Vitamin D

Thyroxine

Vitamin A

0a

multi

Insulin receptors are enzyme-linked tyrosine kinase receptors on cell surface. nuclear or cytosolic receptors include steroid hormone,vit A, vit D, thyroid hormones Ref: HL Sharma 3rd ed Pg 66

Pharmacology

General pharmacology

9188da13-58d7-43af-8798-71188571e982

Which of the following neurotransmitter is MOST impoant for the induction of REM sleep?

Acetylcholine

Dopamine

Epinephrine

Norepinephrine

0a

single

Acetylcholine is the neurotransmitter of primary impoance for the induction of REM sleep. Some of the other neurotransmitters do function in sleep, but REM sleep can occur in their absence. Dopamine is a neurotransmitter with a role in voluntary movement, mood, cognition, and regulation of prolactin release. Epinephrine is impoant in sympathetic nervous system responses. It is also a CNS neurotransmitter. Norepinephrine is impoant in sympathetic nervous system responses. It is also a CNS neurotransmitter involved in attention, arousal, and mood.

Physiology

7699073c-5125-42ca-b7d7-6003ef55840b

Relaxation of mesangial cells of kidney is brought about by ?

cAMP

Endothelin

PGF2

Vasopressin

0a

single

A i.e. C-Amp

Physiology

a252fd6c-1926-4188-bd46-444bbd3cfc0e

Least toxic organiophosphorus compound is -

DDT

Paris green

Malathion

Parathion

2c

single

Malathion has the least toxicity of all organophosphorus compounds. Yellow/clear brown liquid used in dose of 100-200 mg.per.sq.ft. every 3 months because of its low toxicity, malathion has been recommended as an alternative insecticide to DDT. as a low volume spray (ULV) spray it has been widely used to kill adult mosquitoes to prevent or interrupt dengue hemorrhagic fever and mosquitoes borne encephalitis epidemics. Park's Textbook of Preventive and Social Medicine, 25th Edition, Pg 844

Social & Preventive Medicine

Environment and health

d81d4529-76c2-4874-ac65-b9d600a47db7

Drugs used in emergency contraception are all except :

Levonorgestrel

Estrogen + progesterone

Danazol

Mifepristone

2c

multi

Danazol is not used as an emergency contraceptive. It is used in the medical treatment of endometriosis. OXFORD HANDBOOK OF OBSTETRICS AND GYNAECOLOGY THIRD EDITION PAGE NO 587

Gynaecology & Obstetrics

Contraception

4f7fcb3e-9985-4d0c-9269-ec2b362c4aa1

Not true regarding atropine

Used as an eye ointment

Used in refraction in less than 5 yr of children

Fast action

Experimentally used in treatment of myopia

2c

multi

Atropine is slow acting and not fast acting ATROPINE( antimuscranic) causes cycloplegia as ciliary muscles are supplied by Parasympthetic sytem sho ciliary nerve , branch of 3rd cranial nerve Used as eye ointment Children < 5 yr, Children with Squint slow action Three times for 3 days Peak Effect- 3 Days Complete cycloplegia, but less potent mydriasis Retinoscopy - 3 Days PMT - 14 Days Tonus - 1 D experimentally used in treatment of myopia. Homatropine=> 5 yr

Ophthalmology

Optics and Errors of Refraction

fb20aad4-6d70-4df5-a709-9ea14d0d5fe8

Which of the following is the most potent H2 blocker used in peptic ulcer disease

Cimetidine

Famotidine

Ranitidine

Nizatidine

1b

single

Famotidine is the most potent H2 blocker.

Pharmacology

0c1200c7-dba3-40f4-a5d6-af03e75e26c5

A 32yr old patient came to the Gyne. OPD with complains of bleeding per vaginum . Bleeding was for a prolonged period of time than her usual number of days in her regular menses. There was no significant finding on examination. On fuher examination, she told that she was on warfarin therapy for past 1 yr. And also told that she took some medication recently before the symptoms appear. Which of the following drug is not responsible for the condition ?

Clarithromycin

Sulphonamide

Ciprofloxacin

Carbamazepine

3d

single

These are those drugs which inhibit cyt 450 and increase the half life of warfarin resulting in increased bleeding.sulphonamides don't allow degradation of warfarin : Increased bleeding, but carbamazepine is enzyme inducer and hence not responsible for the condition and decreases the half life of warfarin leading to decreased activity. Must know table:

Pharmacology

Pharmacokinetics

fa7c8e37-26ac-4e8e-baa6-0478f4bc328d

All of the following are true regarding sumatriptan except: September 2009

99% oral bioavailability

Contraindicated in coronary aery disease

Constricts cranial vessels

Selective 5-HT 1B/1D receptor agonist

0a

multi

Ans. A: 99% oral bioavailability Sumatriptan is structurally similar to serotonin, and is a selective 5-HT 1B/1D receptor agonist. The specific receptor subtypes it activates are present on the cranial aeries and veins. Acting as an agonist at these receptors, Sumatriptan reduces the vascular inflammation associated with migraine. It causes constriction of dilated cranial extracerebral blood vessels, especially the aerio-venous shunts in the carotid aery. Dilatation of these shunt vessels during migraine attack is believed to dive blood flow away from the brain parenchyma. Sumatriptan is administered in several forms; tablets, subcutaneous injection, and nasal spray. Oral administration (as succinate) suffers from poor bioavailability, paly due to presystemic metabolism -- some of it gets broken down in the stomach and bloodstream before it reaches the target aeries. Sumatriptan is metabolised primarily by monoamine oxidase A into an indole acetic acid analogue, pa of which is fuher conjugated with glucuronic acid. These metabolites are excreted in the urine and bile. Large doses of sumatriptan (200 mg/ day) can cause sulfhemoglobinemia, a rare condition in which the blood changes from red to greenish-black, due to the integration of sulfur into the hemoglobin molecule. Serious cardiac events include coronary aery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular tachycardia, and ventricular fibrillation.

Pharmacology