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AIM-Harvard 16

53240aa6-90d3-4c41-b9c6-c6c450de85ba

Which of the following anti TNF-a agents binds to both soluble and transmembrane bound forms of TNF-a?

Etanercept

Infliximab

Adalimumab

Onercept

1b

multi

Anti-TNF-ALPHA blockers Initially developed for therapy of rheumatoid ahritis are in advanced trials for psoriasis. 2 main agents are Infliximab-Chimeric human-murine IgG antibody to TNF-ALPHA; Etanercept- Dimeric fusion protein consisting of the extracellular poion of the human p75 TNF-ALPHA receptor linked to the Fc poion of human IgG1.

Dental

Psoriasis

f021e521-c09b-4934-b481-9d3683e514ad

Which of the following is the most effective drug against M. leprae ?

Dapsone

Rifampicin

Clofazamine

Prothionamide

1b

single

Rifampicin is the only bactericidal drug amongst the anti leprosy drugs & can render Leprosy rapidly non contagious. It acts by inhibiting mycobacterial DNA dependent RNA synthesis. Ref: Essentials of Medical Pharmacology By KD Tripathi, 5th Edition, Pages 700, 709-11, 713.

Pharmacology

6df8a1ba-8326-426e-8984-df7e8346c09e

A man is planning to leave Miami (at sea level) and travel to Colorado to climb Mount Wilson (14,500 feet, barometric pressure = 450 mm Hg). Before his trip, he takes acetazolamide. What response would be expected before he makes the trip?

Alkalotic blood

Normal ventilation

Elevated ventilation

Normal aerial blood gases

2c

single

Acetazolamide Carbonic Anhydrase inhibitor Forces kidneys to excrete bicarbonate, the base form of CO2. This excretion reacidifies the blood, balancing the effects of the hyperventilation that occurs at altitude in an attempt to get O2. Such reacidification acts as a respiratory stimulant, paicularly at night, reducing the periodic breathing pattern common at altitude. This would increase ventilation, resulting in a | pCO2

Physiology

Respiratory System Pa 1

d044bb53-7c7a-47b0-9d31-ce91e142383c

the distention media used in diagnostic hysteroscopy with bipolar couesy is

CO2

NS

Dextran 70

Glycine

1b

single

ref : gynecology shaw

Gynaecology & Obstetrics

All India exam

eabfde0d-e1ed-4d13-9129-bb32f8369a97

Rizatriptan is a drug used for?(DNB 2012-section-1)

Prophylaxis of migraine

Acute migraine

Cluster headache

Chronc migraine

1b

single

Ans. (b) Acute migraineRefiHarrison's 18/e, ch 14

Pharmacology

C.N.S

645ba868-1056-409c-b083-9ac52892fee9

The topical use of following local anesthetic is not recommended?

Ligocaine

Bupivacaine

Cocaine

Dibucaine

1b

single

Bupivacine cannot be used as surface anesthetic agent Bupivacine is also contraindicated in regional IV anesthesia or Bier&;s block due to fear of cardiac arrhythmia It can be used in peripheral nerve block, epidural and intrathecal routes

Anaesthesia

Regional anaesthesia

95ef8688-80cb-426c-b27e-848b448776fb

A 68-year-old woman presents to the clinic with symptoms and signs of CHF. Which of the following is a contraindication to use furosemide?

has hypoalbuminemia

is oliguric

has acidosis

had a rash with trimethoprim-sulfamethoxazole

3d

single

Furosemide is related to sulfonamide, and severe allergic reactions can occur. Furosemide is effective despite gross electrolyte disturbances or hypoalbuminemia. Excretion of large volumes of bicarbonate-poor urine leads to alkalosis, so an acidosis is not a contradiction in severe fluid and electrolyte depletion; a trial in oliguric states is often appropriate.

Medicine

Miscellaneous

544fb2ff-5f14-4358-8756-049486c3916c

A 25-year-old man with major depression ' discusses the potential benefits and side effects of various antidepressants with his psychiatrist. He clearly indicates that he does not want a medication that could decrease his libido or interfere' with his ability to obtain and maintain an erection. Which of the listed antidepressants would be appropriate for this patient?

Bupropion

Clomipramine

Amitriptyline

Sertraline

0a

single

Tricyclic antidepressants such as clomipramine and amitriptyline and SSRIs such as paroxetine and sertraline, as well as MAOIs, can cause erectile dysfunction, delayed ejaculation, anorgasmia, and decreased libido. Buproppion, mirtazapine, trazodone, and nefazodone, in contrast, do not affect sexual functions in a negative way Trazodone and nefazodone, however, have been implicated in cases of priapism and should not therefore be used as first-line medications in male patients.

Unknown

86eba6fd-995a-432c-8a6e-ace4f2c2dee9

Triple therapy of H. pylori include all EXCEPT

Omeprazole

Clarithromycin

Metronidazole

Sucralfate

3d

multi

D. i.e. (Sucralfate) (949 -H17th)Recommended Regimens for Helicobacter PyloriRegimen DurationDrug 1Drug 2Drug 3Drug 4First line Treatment* Regimen 1 OCA (7-14 days)OmeprazoleClarithromycinAmoxicilline-* Regimen 2 OCM (7-14 days)OmeprazoleClarithromycinMetronidazole-Second Line Treatment Regimen 3 OBTM (14 days)OmeprazoleBismuth subsalicylateTetracycline HCLMetronidazole* H. pylori carriage peptic ulceration and gastric adenocarcinoma are falling while rates of esophageal reflux disease and its sequelae are increasingImmuno suppressive Drug Therapy in Kidney Transplantation (1353- CSDT)"Triple therapy" using1. Corticosteroid2. Calcineurin inhibitor3. Antimetabolite or a TOR (target or rapamycin) inhibitor

Medicine

G.I.T.

ac2daf7d-7706-4eb5-9c90-84579a777d85

The antidiabetic agents most likely to cause lactic acidosis is:

Chlorpropamide

Metformin

Glipizide

Phenformin

3d

single

Biguanides (phenformin and metformin) increase the insulin action in peripheral tissues and reduce hepatic glucose output due to inhibition of gluconeogenesis. They may decrease plasma glucose by  decreasing the intestinal absorption of glucose. They increase the utilization of glucose by enhancing anaerobic glycolysis. Lactic acid is the end product of anaerobic glycolysis. Most of it is extracted by the liver and utilized for gluconeogenesis. Use of phenformin was associated with lactic acidosis and metformin is rarely known to produce this complication. No case of lactic acidosis has been reported with use of sulfonylureas (chlorpropamide and glipizide).

Pharmacology

a57c343f-aa49-49d5-8dc3-26c018701b90

Muscle relaxant of choice in liver disease is

Atracurium

Pipecuronium

Rocuronium

Vecuronium

0a

single

Refer Katzung 11/e p456 Atracurium and cis-Atracurium are degraded spontaneously by Hoffman's elimination These don't require liver or kidney for elimination and thus are muscle relaxant of choice in a patient with renal and hepatic dysfunction

Pharmacology

Anesthesia

1249e3d7-9b96-4fec-ad46-e4856ad4b2da

A patient with bilirubin value of 8 mgldl and serum creatinine of 1.9 mg/dl is Planned for surgery.What is the muscle relaxant of choice in this patient-

vecuronium

Pancuronium

Atracurium

Rocuronium

2c

single

Atracurium is the drug of choice in liver and renal dysfunction . It is eliminated by Hoffman's degradation and alkaline Ester hydrolysis.

Anaesthesia

Muscle relaxants

30bfbb4d-f6b0-484b-b322-a999d86a4871

Sildenafil's mechanism of action can be best described as:

β–adrenoceptor blocking agent

Selective inhibitor of phosphodiesterase type 5

Inhibits reuptake of both serotonin and nor adrenaline

Selective serotonin reuptake inhibitor

1b

multi

Pharmacology

32546c99-60f1-4253-9f71-acb1300f9fbb

All have beta lactam ring EXCEPT -

Penicillin

Linezolid

Cefotaxime

Imipenem

1b

multi

Ans. is 'b' i.e., Linezolid beta-lactam antibiotics contain beta-lactam ring. These are penicillins, cephalosporins (e.g. cefotoxime), monobactams (aztreonam) and carbapenems (imipenem, meropenem).

Pharmacology

425e581f-4acb-47c8-845f-2c957367a4a7

A beta-hemolytic bacteria is resistant to vancomycin shows growth in 6.5% of NaCi, is non-bile sensitive. It is likely to be

Streptococcus agalactiae

Streptococcus pneumoniae

Enterococcus

Streptococcus bovis

2c

single

Enterococcus posses several distinctive features, they can grow in the presence of 40% bile, 6.5% NaCl, at PH 9.6, at 45degree celsius and in 0.1% methylene blue milk. Strains resistant to penicillin and other antibiotics occur frequently, so it is essential to perform antibiotic sensitivity testing for proper therapy. Enterococci are intrinsically resistant to cephalosporins and offer low resistance to some aminoglycosides; In penicillin sensitive strains, synergism occurs with combination treatment with penicillin and aminoglycosides. However, if the strain shows high-level resistant to aminoglycosides, this synergism does not occur. The choice of drugs for infections due to such strains is vancomycin. Recently vancomycin resistant has begun to emerge. Ref: Textbook of microbiology; Ananthanarayan and paniker's; 10th Edition; Pg:219, 220

Microbiology

Bacteriology

748fc2bc-0a75-4b7a-940f-0280d3c55d92

Monoclonal antibody that neutralizes anthrax toxin

Raxibacumab

Cetuximab

Panitumumab

Alemtuzumab

0a

single

Raxibacumab is Intended for the prophylaxis and treatment of inhaled anthrax.

Microbiology

1c78e652-b939-41e6-8930-c95c668e3ceb

In post op ward of ICU, five pts developed wound infection on same wound. The best way to prevent MRS A outbreak in indoor pts is:

Give vancomycin to all patients

Fumigation of ward

Disinfect floor with sodium hypochlorite

Practice proper meticulous hand washing

3d

multi

Ans is 'd' i.e. practice proper meticulous hand washing "Given the prominence of cross infection, hand washing is the single most important preventive measure in the hospital" - Harrison 15/eHarrison 17/e writes- "Given the prominence of cross-infection, hand hygiene is the single most important preventive measure in hospitals. Use of alcohol hand rubs between patient contacts is now recommended for all health care workers except when the hands are visibly soiled, in which case washing with soap and water is still required.""Expert groups agree that the major focus on MRSA control is the prevention of hand transfer of MRSA "- The Control and Prevention of MRSA in Hospitals and in the CommunityExtensive use of Vancomycin for prophylaxis has been found to lead to Vancomycin resistant Staph, aureus,

Social & Preventive Medicine

Communicable Diseases

5fc73b60-d22f-4fe2-9982-cea3ec5de2cd

Which of the following drug doesn't act on thyroid-

Propranolol

Propylthiuracil

Sodium iodide

Thiocyanote

0a

single

Ans. is 'a' i.e., Propranolol Thyroid inhibitorsInhibit hormone synthesis (antithyroid drugs)o Propylthiouracilo Methimazoleo CarbimazoleInhibit iodine trapping (ionic inhibitors)o Thiocyanateso Perchlorateso NitratesInhibit hormone releaseo Iodineo NaIo KIDestroy thyroid tissueo Radioactive iodineo Propranolol inhibits peripheral conversion of T4 and T3 in blood (but it does not act on thyroid gland).

Pharmacology

Anti Thyroid

2b565588-3d5a-4966-b346-3f0a5f088654

Mifepristone & misoprostol for MTP is allowed till -

6 weeks

7 weeks

9 weeks

12 weeks

2c

multi

Ans. is c i.e., 9 weeks Medical method for first trimester MTP* It is now officially allowed in India up to 9 weeks (63 days) of gestation.* Method: a combination of RU486 followed by PGE1.* Mifepristone, also known as RU-486, is an antiprogesterone compound* It acts preferentially on target cells of the endometrium and deciduas, counteracting the effect of progesterone, which is essential for the establishment and maintenance of pregnancy.* It affects the pituitary gonadotropic cells, producing a remarkable decrease of LH secretion, leading to luteolysis.* It causes softening and ripening of the cervix and produces increased contractibility of the myometrium.* It causes a marked increase in sensitivity of the uterus to exogenous PGs.Misoprostol (PGE1)* It acts by (a) enhancing uterine contraction and thus helping expulsion of the products of contraception and (b) causing cervical ripening or priming. It is used orally as tablets and vaginally as a suppository. The success rate of this combination is 96%.* Fewer than 5% of women undergoing medical methods of abortion will need surgical intervention (check curettage) for incomplete abortion.* For the medical abortion up to 9 completed weeks since last menstrual period, mifepristone plus PGs are used; the dosage regimens recommended by the World Health Organization are as follows:* 200 mg mifepristone followed after 36-48 h by 800 mg vaginal misoprostol or 400 pg oral misoprostol

Unknown

683b3619-6ee2-4249-8d80-01e06d992461

Oral contraceptives are not given with:

Streptomycin

Gresiofulvin

Pyraziniamide

Ethambutol

1b

single

Griseofulvin is an enzyme inducer which increases the metabolism of the oral contraceptives and thus causes its failure. (Ref.Essentials of medical pharmacology TD Tripathi 7th edition page no.326.)

Pharmacology

Endocrinology

fa6e9a2e-5251-469b-95bf-42004528e51e

Iron absorption is decreased by all except

Calcium

Tetracycline

Phytate

Ascorbic acid

3d

multi

Pathology

01c2d260-798e-4f13-8bed-468473f67aae

Which of the following represents an orally available fixed Beta-Lactamase Inhibitor and Antibiotic Combination.

Ampicillin-Sulbactum

Piperacillin-Tazobactum

Amoxicillin-Clavulanic acid

Ticarcillin-Clavulanic Acid

2c

multi

Amoxicillin and Clavulanic acid is the only Beta-Lactamase inhibitor + Antibiotic Combinations that is available for oral administration. Amongst the three most commonly available Beta-Lactamase inhibitor (Clavulanic acid, Sulbactum and Tazobactum), only Clavulanic acid is orally absorbed. Amoxicillin and clavulanic acid are well absorbed orally and also can be given parenterally. All other beta lactamase fixed dose combinations with antibiotics are available only for parenterally use. Beta-lactamase Inhibitor + Antibiotic Combinations Beta lactamases are antibiotic-inactivating enzymes produced by resistant bacteria that hydrolytically inactivate the Beta-lactam ring of penicillins, Cephalosporins, and related drugs like Carbapenems. Beta-Lactamase Inhibitor + Antibiotic combinations Penicillin-Beta Lactamase: Amoxicillin-Clavulanate Ticarcillin-Clavulanate Ampicillin-Sulbactum Piperacillin-Tazobactum Cephalosporin-Beta Lactamase Ceftolozane-tazobactum Ceftazidime-avibactum Carbapenem-Beta Lactamase Meropenem-vaborbactum Imipenem-Relebactum Ref: KDT 7th edition Pgno: 723

Pharmacology

Antibiotics

a9fc0795-7f01-462a-ac65-63f99dd7fb90

Which of the following muscle relaxant can cause pain on IV injection Site

Succinyl choline

Vecuronium

Rocuronium

Pancuronium

2c

single

C i.e. Rocuronium - Rocuronium is desacetoxy analog of vecuronium with a low potency (1/6 - 1/8 of vecuronium) and so rapid onset of action (because potency and speed of onset are inversely related). It is the fastest (most rapid) acting nondepolarizing muscle relaxantQ (75 sec), which is slightly slower than depolarizing muscle relaxant succinylcholine only. * Rocuronium injection can cause pain on injection siteQ, which may be decreased by alkalinizing the solution. Other painful injections include etomidate, propofol, methohexital and thiopentalQ.

Anaesthesia

1b9aeb05-ca65-4543-aca9-2d10c9d7cf3a

False about Aliskiren is:

It is an oral renin inhibitor

It can result in hyperkalemia

It is p-glycoprotein inhibitor

Blocks conversion of angiotensinogen to Angiotensin I

2c

multi

Aliskiren: MOA: Potent competitive inhibitor of renin. Binds the active site of renin and blocks conversion of angiotensinogen to Angiotensin I. Pk: Bioavailability of aliskiren is low but still used orally as it has high affinity and potency. It is a substrate for P- glycoprotein (Not the inhibitor). It can cause hyperkalemia by inhibiting the RAAS through which K+ is removed from the body. It is well tolerated in: Elderly population. Hepatic disease and renal insufficiency patients. Type 2 diabetes patients.

Pharmacology

Hypeension, Arrhythmias, Dyslipidemia

467e564b-aa59-474e-a051-8924acc0207d

In psoriatic ahritis, if the patient has liver fibrosis, ahropathy can NOT be treated with?

Methotrexate

Anti-TNF-alpha agents

Steroids

Sulfasalazine

0a

single

Methotreaxte is absolutely contraindicated in liver fibrois. In case of treatment for long duration liver fibrosis should be assessed by liver biopsy.

Medicine

e0c53a1d-c7c4-4a32-992d-2f1d9813f7f2

The most common adverse effect with ticlopidine is?

Neutropenia

Diarrhea

Hemorrhage

Thrombocytopenic purpura

1b

single

Ans. is 'b' i.e., Diarrhea o Common side effects of ticlopidine are diarrhea, vomiting, abdominal pain, headache, tinnitus and skin rash. o Serious adverse effects are neutropenia, thrombocytopenia, hemolysis, bleeding and jaundice.

Pharmacology

2fc7eb44-aa4c-44bb-a50c-87d045df3eee

Which of the following is a constituent of Cytochrome C reductase?

B1

B2

Biotin

Pyridoxine

1b

single

RIBOFLAVIN (VITAMIN B2) Biological Active Forms The biologically active forms, in which riboflavin serves as the prosthetic group (as the coenzyme) of a number of enzymes are the phosphorylated derivatives. Two main derivatives are:FMN (Flavin Mononucleotide): In this, the phosphoric acid is attached to ribityl alcoholic group in position 5. Flavin-Ribityl-PO4FAD (Flavin adenine nucleotide): It may be linked to an adenine nucleotide through a pyrophosphate linkage to form FAD. Flavin-ribityl-P-P-ribose-Adenine Thus, FMN and FAD are two coenzymes of this vitamin. FMN contains in Warburg's yellow enzymeCytochrome-C-reductaseL-amino acid oxidase SECTION TWO (Fp is auto-oxidizable at substrate level by molecular O2 forming H2O2)Ref: MN Chatterjea Textbook of Medical Biochemistry, 8th edition, page no: 180

Biochemistry

Respiratory chain

ac5fbbec-91df-442f-9e68-b5a0b83dccf7

Doxycycline is used in the treatment of following diseases except:

Leptospirosis

Q fever

Borrelliosis

All of the above

3d

multi

Ans. (D) All of the above(Ref: KDT 8/e p788-789)Doxycycline is drug of choice for ricketssial infections including Q fever and for borrelliosis.It can also be used for leptospirosis for which the drug of choice is penicillin G

Pharmacology

Chemotherapy: General Principles

10296f16-3600-4fe5-8127-deca32c3bc03

Antibody in asthma treatment

Rituximab

Transtusuzumab

Omalizumab

Daclizumab

2c

single

Omalizumab o Omalizumab is an anti IgE agent approved by the (FDA) for use in patients age 12 and above with moderate to severe persistent allergic asthma with : - An IgE level of30-700 lu/ml. Positive allergen skin or specific IgE tests to a perenmial allergen and Incomplete symptom control with inhaled glucocorticoid treatment. o Omalizumab is administered by “subcutaneous injecon ” every mo to four weeks in a dose that is determined by- body weights and the level of serum IgE. o Omalizumab produces 25% reduction in rate of asthma exacerbations.  The response to omalizumab therapy is variable and dif icult to predict with overall response rates in patients with moderate to severe asthma averaging 30-50%.  A minimum of 12 weeks of treatment is necessary to determine the efficacy 1 ofanti-IgE theraphy

Medicine

302afa03-b4e1-4103-b52f-4a9b9cfa65cd

Which one of the following statements about doxycycline is FALSE?

It is bacteriostatic

It is excreted mainly in the feces

It is more active than tetracycline against H.pylori

It is used in Lyme's disease

2c

multi

(Ref: KDT 6/e p637, 710, 712, 713) Doxycycline is a bacteriostatic agent that acts by inhibiting protein synthesis. It is safe in renal failure as it is excreted mainly in feces. Doxycycline is useful in Lyme's disease. Tetracycline (and not doxycycline) is useful in H.pylori therapy.

Pharmacology

Other topics and Adverse effects

23a71183-cbf7-4382-8417-a00f8bb5482f

Anticoagulant of choice for ESR by Wintrobes method -a) Citrateb) Heparinc) Oxalated) EDTA

ab

cd

bd

ac

1b

single

Anticoagulant of choice for ESR by   Wintrobes method  → Double oxalate & EDTA Westergren method → Sodium citrate

Pathology

490df366-7f1a-429e-8714-40b3477faf45

Anesthesia of choice for induction of anesthesia in children is?

Desflurane

Halothane

Sevoflurane

Isoflurane

2c

single

Sevoflurane REF: Morgan's anesthesia 3" ed p. 404, 570, 860, 884 "Sevoflurane is anesthetic of choice for induction in pediatrics because of rapid onset and non-pungency" Induction in pediatrics patient Inhalation -- Sevoflurane in N20 Intravenous (preferred) - rapid acting barbiturate like thiopental or Propofol followed by non-depolarizing muscle relaxant. Intramuscular- Ketamine Muscle relaxant (MR)- Rocuronium

Anaesthesia

f761d7f8-7920-4ae5-a3fe-ce2103321cb4

Calcitriol acts on

G protein coupled receptor

Cytosolic receptor

Intranuclear receptor

Enzymatic receptors

1b

single

Bioactive vitamin D or calcitriol is a steroid hormone that has long been known for its impoant role in regulating body levels of calcium Nuclear or cytosolic receptors include the binding sites for steroid hormones, thyroid hormones, vitamin D, and retinoic acids Ref-Goodman and Gillman 12th/e p1282

Anatomy

General anatomy

7c0fe204-9243-4492-80c3-b48527fd4889

In the management of pulmonary emboli, -PA (alteplase) is infused for: March 2013

1-3 hours

4-6 hours

7-9 hours

10-12 hours

0a

single

Ans. A i.e. 1-3 hours Dose and time for infusion of Alteplase for Pulmonary embolism is 100 mg over 2 hours.

Pharmacology

1a364881-49a8-4d39-8a9f-ec3017a6d14b

A 30 yr old male presents to the OPD with Erectile dysfunction. Basic screening evaluation is unremarkable. Which of the following should be the next step in the evaluation/management of this patient?

Cavernosometry

Neurological testing

Oral Sildenafil citrate trial

Penile ultrasound doppler study

2c

multi

Specialised investigations such as Penile Doppler Ultrasound, Dynamic Infusion Cavernosography and Neurological testing are rarely necessary in the evaluation of Erectile Dysfunction. These investigations are indicated in selected complicated cases and are not indicated for the initial evaluation of Erectile Dysfunction. So the most appropriate next step in management in this patient would be a trial of oral phosphodiesterase type 5 inhibitor sildenafil. Evaluation of a patient with sexual dysfunction involves taking thorough history and performing physical examination. Basic laboratory investigations done includes estimation of CBC, lipid profiles, serum prolactin and testosterone. Additional diagnostic testing is rarely necessary in the evaluation of erectile dysfunction. Specialized test involves (1) studies of nocturnal penile tumescence and rigidity, (2) vascular testing (in-office injection of vasoactive substances, penile Doppler ultrasound, penile angiography, dynamic infusion cavernosography/cavernosometry), (3) neurologic testing (biothesiometry-graded vibratory perception, somatosensory evoked potentials), and (4) psychological diagnostic tests. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 48

Psychiatry

127e2103-8213-4554-a6a7-c63623be8a9a

Pigment deposition on cornea seen in –a) Chloroquineb) Digoxinc) Ranitidined) Amiodarone

b

ad

ac

ab

1b

single

Causing pigment deposition in cornea i) Superficial Amiodarone                                   Chloroquine  Chlorpromazine   Clofazimine    Indomethacin Naproxen     Suramine  Tilorone                                 ii) Stromal Phenothiazines (chlorpromazine)

Ophthalmology

3103539e-86b7-4866-8c5f-6f56573cff60

Which of the following drugs can produce a dramatic improvement in patients with resistant Type II lepra reaction?

Thalidomide

Steroids

Dapsone

Clofazimine

0a

single

Steroids are the drug of choice for both type 1 as well as type 2 lepra reaction. Thalidomide is used in steroid-resistant type 2 lepra reaction.

Pharmacology

6778d10f-4bd3-45d1-9728-85fd5190da24

A 70 kg young athlete was planned for surgery. During anaesthesia, vecuronium was not available, so repeated doses of succinylcholine was given intermittently up to 640 mg. During recovery, patient was not able to spontaneously respire and move limbs. What is the cause?

Pseudocholinesterase deficiency

Phase II blockade

Muscle weakness due to repeated fasciculations

Undiagnosed muscular dystrophy

1b

single

Continued presence of the drug causes persistent depolarization resulting in flaccid paralysis-phase blockade 1. Phase 2 blockade is slow in onset and results from desensitization of of the receptor to A-ch. Psuedocholinestrase enzyme deficiency usual dose results in prolonged apnea and paralysis which lasts for hours. From padmaja 4th edition Page no 86 And from KD Tripati 7th edition Page no 349

Pharmacology

Anesthesia

af5ed518-d047-4055-a95b-dd2f17f56014

Patients suffering from multidrug resistant tuberculosis can be treated with all the following drugs except

Tobramycin

Amikacin

Ciprofloxacin

Claruthromycin

0a

multi

Refer KDT 6/e p 748 Aminoglycosides effective in MDR tuberculosis are Amikacin, kanamycin, capreomycin Tobramycin is not effective against mycobacterium Ciprofloxacin and Clarithromycin are also used for tuberculosis

Pharmacology

Chemotherapy

06804b9b-c451-4b91-afb7-a8dcd830addb

For DNA test, liquid blood is preserved in: Karnataka 07; DNB 09; UP 10; NEET 13, 14

Sodium citrate

Potassium oxalate

EDTA

Sodium fluoride

2c

single

Ans. EDTA

Forensic Medicine

2af57865-e9cb-412b-9216-933ab9f5c6c2

All are true about ramelteon except :

Agonist at MT1 and MT2 receptors

Is a substrate of CYP1A2

Has high addiction liability

Approved for treatment of insomnia

2c

multi

Ramelteon is a non-addictive drug.

Pharmacology

01d2f239-8898-42ec-ae94-8c79425656eb

All are the side effects of tacrolimus EXCEPT :

Hepatotoxic

Nephrotoxic

Ototoxic

Neurotoxic

2c

multi

Ototoxicity is not a side effect of tacrolimus.                         Tacrolimus can cause nephrotoxicity, neurotoxicity, hepatotoxicity and diabetes mellitus. Unlike cyclosporine, it do not cause hirsutism.

Pharmacology

a696a24c-bdd3-46ab-a52c-ea5dc3b09422

Sensorimotor neuropathy may be caused by all, except:

DM

Lead poisoning

Arsenic

Isoniazid

1b

multi

Answer is B (Lead poisoning): Inorganic lead poisoning is not associated with a sensorimotor neuropathy Inorganic lead poisoning is primarily associated with a pure motor neuropathy. Selective motor neuropathy with wrist drop is characteristic of lead poisoning. Conditions that may cause Sensorimotor Neuropathies Polyneuropathy associated with Sensorimotor neuropathies (Harrison) Systemic Disease Diabetes mellitus Sensory, Sensorimotor, Motor Uremia Sensorimotor Porphyria (3 types) Sensorimotor Vitamin deficiency excluding B12 Sensorimotor Chronic liver disease Sensory or Sensorimotor Primary systemic amyloidosis Sensorimotor Chronic obstructive lung disease Sensory or Sensorimotor Malabsorption (sprue, celiac disease) Sensory or Sensorimotor Carcinoma (sensorimotor) Sensorimotor Carcinoma (demyelinating) Sensorimotor Multiple Myeloma, lytic type Sensory, Motor or Sensorimotor MGUS IgA Sensori motor IgG Sensorimotor 1gM Sensorimotor or Sensory Cryoglobulinemia Sensorimotor Drugs Amiodarone (antiarrhythmic) Sensorimotor Aurothioglucose (antirheumatic) Sensorimotor Isoniazid Sensorimotor Metronidazole (antiprotozoal) Sensory or Sensorimotor Misonidazolc (radioscnsitizer) Sensory or Sensorimotor Environmental Toxins Arsenic (herbicide; insecticide) Sensorimotor Diptheria toxin Sensorimotor y-Diketone hexacarbons (solvents) Sensorimotor Organophosphates Sensorimotor Thallium (rat poison) Sensorimotor

Medicine

b5a02aff-2159-4f92-8c5f-59e00367fb22

The drug of choice in scleroderma induced hypeensive crisis is -

ACE inhibitors

Thiazides

b - blockers

Sodium nitroprusside

0a

single

Ans. is 'a' i.e., ACE inhibitors

Pharmacology

0d6af5e2-cb62-4f76-8dd5-4e07effe74bb

A term infant is born to a known HIV-positive mother. She has been taking antiretroviral medications for the weeks prior to the delivery of her infant. Routine management of the healthy infant should include which of the following?

Admission to the neonatal intensive care unit for close cardiovascular monitoring

HIV ELISA on the infant to determine if congenital infection has occurred

A course of zidovudine for the infant

Chest radiographs to evaluate for congenital Pneumocystis carinii

2c

single

The transmission of HIV from mother to infant has decreased in recent years, due in large part to perinatal administration of antiretroviral medications to the mother and a course of zidovudine to the exposed infant. Studies suggest that a better than 50% decrease in transmission can be seen with appropriate medications as outlined.IVIG has not been shown to have a role in decreasing perinatal transmission. Healthy asymptomatic term infants born to HIV-infected mothers do not need special monitoring, nor do they need routine radiographs.An HIV ELISA is an antibody test and will be positive in the infant born to an HIV-infected mother due to maternal antibodies that are passed through the placenta; it is not a useful test in the newborn infant to determine neonatal infection because of this expected transfer of maternal (and not infant) immunoglobulin. The confirmatory Western blot also assays for antibodies to HIV and is similarly unhelpful in the newborn period.

Pediatrics

New Born Infants

667a0ede-e851-42df-9aaf-dc11efce82ff

All are Anxiolytic Except

Buspirone

Fluoxetine

Diazepam

Nitrazepam

1b

multi

B i.e. Fluoxetine

Psychiatry

75fd865e-1982-4802-8b2b-f5add1a75c6c

Which inhibits adenyl cyclase enzyme?

Somatostatin

Calcitonin

Epinephrine

Thyroxine

0a

single

Somatostatin acts directly on the acid-producing parietal cells a G-protein coupled receptor which inhibits adenylate cyclase, thus effectively antagonising the stimulatory effect of histamine to reduce acid secretion.Ref: DM Vasudevan, 7th edition

Biochemistry

Endocrinology

2547ea24-8491-43c1-80f2-fd3a09d5c40b

A 40 yr old diabetic man comes with a complaint of inability to bend his ring finger and development small nodules on the palm.What will be not be a pa of your management in this patient?

Wait and watch

When more than 15 degree flexion deformity involved at PIP :Subtotal fasciectomy

When more than 30 degree flexion deformity involved at MCP :Subtotal fasciectomy

Collagenase injection

1b

multi

This is a condition of Dupuytren's contracture Flexion deformity- because of abnormal fibrosis of palmar aponeurosis leading to cord or nodule formation. M/C cause is Idiopathic MCP>PIP>DIP involved most commonly Ring finger more common than little finger involved Treatment: Conservative by stretching and inj. collagenase When more than 30 degree involved at MCP and more than 15-20 degree at PIP subtotal fasciectomy is done

Orthopaedics

Neuromuscular disorders

36f37718-f3ba-4dcb-8299-497b88378df0

Grey baby syndrome is caused by

Amikacin

Tetracycline

Vancomycin

Chloramphenicol

3d

single

Amikacin - nephrotoxicity, ototoxicity and neuromuscular blockade Tetracycline - nephrotoxicity when given along with diuretics, phototoxicity, , affect dentition and bones in young children, Fanconi syndrome and Renal tubular acidosis. Vancomycin - red man syndrome Chloramphenicol- grey baby syndrome,nephrotoxicity,ototoxicity.

Pharmacology

Protein Synthesis Inhibitors

2c17dc50-1d9d-41e7-94ee-6cea88544b6b

Clomiphene citrate is not known to produce which of the following effects in a young female of 30 years of age (child bearing age group) ?

Hot flushes

Ovulation

Decreased FSH and LH secretion

Polycystic ovaries

2c

single

Pharmacology

df03c7ed-7acf-4804-9d1c-08a6fde815ec

Antidepressant used in the prophylaxis of migraine -

Amitrvptiline

Fluoxetine

Citalopram

Trazadone

0a

single

Ans. is 'a' i.e.. Amitryptiline Prophylaxis of migraineAatrhypertensivesAntidepressantsAnticonvulsantsBeta blockersCalciumACETricyclycicSerotonin/horepinephrineValproateTopiramateGabapentino Metoprolol channel inhibitorsantidepressantsreuptake inhibitor o Propranolol bolckers ARB's|| o Timololo Verapamil o Amitryptilineo Venaiafaxine o Nimodiptne o Nortriptiline o Doxepin o Protriptyline

Medicine

Headache

ba21aab6-7f9a-454d-b2cc-589c06bea513

Which of the following is an ester linked local anaesthesia –

Cocaine

Lidocaine

Bupivacaine

Dubicaine

0a

single

Anaesthesia

0e4bcd69-feca-42a6-8bf8-a4c6ce03a8f9

Biotin is needed in

Krebs cycle

Urea cycle

Fatty acid synthesis

Pyruvate dehydrogenase

2c

single

Biotin acts as co- enzymes for carboxylation reactions .Bioitin captures a molecule of CO2 which is attached to nitrogen of biotin molecule.Energy required for this reaction is provided by ATP.Tgen activated carboxyl group is transferred to the substrate.Biotin requiring CO2 Fixation reactions. Acetyl CoA + CO2 + ATP=Methyl malonyl CoA + ADP+ Pi This is the rate limiting reaction in fattyacid synthesis. Propionyl CoA + CO2 + ATP = Methyl malonyl CoA + ADP + Pi In oxidation of odd chain fatty acids. Pyruvate+ CO2 + ATP = Oxaloacetate + ADP + Pi Oxaloacetate acts as catalyst for TCA cycle and as enzyme in gluconeogenic pathway Reference: DM.VASUDEVAN.TEXTBOOK SEVENTH EDITION page no 485 Co-enzyme Main reaction using the co -enzyme Group transferred Thiamine pyrophosphate(TPP) oxidativedecarcoxylation of alpha keto acids in BPG shunt Hydroxyethyl Pyridoxalphosphate(PLP) Transamination, decarcoxylation of amino acids Aminogroup Biotin fatty acid synthesis, TCA cycle carbondioxide Co- enzyme-A ( Co-A) TCAcycle, fatty acid synthesis,gluconeogenisis, activation of acetoacetate, detoxification Acylgroup Tetrahydrofolate (FH4) Transmethylation reactions where methyl group required for synthesis of choline , epinephrine , creatine. One carbon groups Adenosinetriphosphate(ATP) universal energy currwncy Phosphate

Biochemistry

vitamins

e19d7c48-e038-4252-973e-3bf8af82455b

Atropine is substituted by phenylephrine to facilitate fundus examination when:

Mydriasis is required without cycloplegia

Cycloplegia is required

Mydriasis and cycloplegia both are required

Cycloplegia and Mydriasis both are not required

0a

multi

Pharmacology

97fa2499-26a6-43e3-bd86-cdaecda1c71d

Flumazenil false is ?

It is a specific antagonist of BZD

It may be used in barbiturate poisoning as it acts on the same receptor GABAA

Given intravenously

Acts on GABAA receptor

1b

multi

Ans. is 'b' i.e., It may be used in barbiturate poisoning as it acts on the same receptor GABAA Flumazenil is specfic antagonist of BZDs. i.e., it acts on BZDs binding site of GABAA receptors, which is different from Baributurate binding site. Therefore, flumazenil does not antagonize barbiturates not effective in barbiturates poisoning.

Pharmacology

910b08bd-ea83-4e91-a829-358bfc30c681

True statement about Neuro-cysticercosis is -

Usually presents with seizures

Albendazole is more effective than praziquantel

Usually presents with 6th nerve palsy and hemiparesis

High does steroid are given for hydrocephalus

0a

multi

Answer- A. Usually presents with seizuresMost common site of neurocysticercosis is brain parenchyma."Parenchymal brain calcifications are the most common fnding of neurocysticercosis on neuroimaging.

Medicine

10e852a6-17ab-4a08-9be4-c87b5e86892c

A woman attends antenatal clinic with complaint mild pain in lower abdomen on left side, her periods are regular and UPT was positive at home. A TVS was done and uterine cavity is empty, and no adnexal mass is seen. Her serum beta HCG is 700 IU/L. what is the next step?

Give single dose of methotrexate

Perform laparoscopy

Perform serum beta HCG after 48 hr

Perform serum Beta HCG after 7 days

2c

multi

Ans. C. Perform serum beta HCG after 48 hrThis is a case of pregnancy of unknown location. The beta HCG value is less than the discriminatory zone of 1500mIU/ml on TVS. "With these PULs, serial b-hCG level assays are done to identify patterns that indicate either a growing or failing IUP. Levels that rise or fall outside these expected parameters increase the concern for ectopic pregnancy. Thus, appropriately selected women with a possible ectopic pregnancy, but whose initial b-hCG level is below the discriminatory threshold, are seen 2 days later for further evaluation. Trends in levels aid diagnosis."

Gynaecology & Obstetrics

Ecotopic Pregnancy

862ee773-a036-49ad-a84d-1144e7eebf25

Anesthetic agent (s) safe to use in ICP

Halothane

Thiopentone

Ketamine

Ether

1b

single

Anesthetic agents safe to use in raised intracranial pressure (ICP) are thiopentone, propofol & etomidate. Ref: Manuel C Pardo Jr and Ronaldo D Miller 7th Ed.

Anaesthesia

84a2c889-5043-4383-820e-8a3cd64379e9

A 60 year old male comes to casuality with acute retention of urine since 12 hours. On examination there was distended bladder. His son gives a history of taking some drug by the patient. Since 2 days as he is suffering from depression. The most likely drug is -

CPZ

Amitriptyline

Haloperidol

Pimozide

1b

single

Amitriptyline can cause urinary retention due to anticholinergic action.

Psychiatry

033bb428-4650-48db-a3db-3830fe117449

All of the following are true about depolarizing agents, EXCEPT:

Rocuronium undergoes no metabolism

Pancuronium resembles noradrenaline

Atracurium's duration of action can be markedly prolonged by hypothermia

Vecuronium effect is not altered in renal failure

1b

multi

Pancuronium consists of a steroid ring on which two modified ACh molecules are positioned. It resembles ACh enough to bind (but not activate) the nicotinic ACh receptor. Rocuronium undergoes no metabolism and is eliminated primarily by the liver and slightly by the kidneys. Because of its unique metabolism, atracurium's duration of action can be markedly prolonged by hypothermia and to a lesser extent by acidosis. Vecuronium is metabolized to a small extent by the liver. It depends primarily on biliary excretion and secondarily (25%) on renal excretion. Although it is a satisfactory drug for patients with renal failure, its duration of action is somewhat prolonged. Ref: Butterwoh IV J.F., Mackey D.C., Wasnick J.D. (2013). Chapter 11. Neuromuscular Blocking Agents. In J.F. Butterwoh IV, D.C. Mackey, J.D. Wasnick (Eds), Morgan & Mikhail's Clinical Anesthesiology, 5e.

Anaesthesia

17bfd869-5204-4027-a005-3a56b81beaa6

Which is a soft steroid used in bronchial asthma

Budesonide

Dexamethosone

Ciclesonide

Fluisolide

2c

single

Ciclesonide has got high topical, systemic activity ratio Refer Katzung 11/e p348

Pharmacology

Respiratory system

07d1d7fa-9005-4e33-8aec-da8c2c5c6ee0

A 47yrs old female c/o headache, changes in vision, seizures from past 2yrs. Now she has developed weakness . side of body. A CT scan was being ordered by the physician which showed well circumscribed mass abutting the skull in left hemisphere. On contrast enhanced MRI shows - What is the next step in management of this patient?

Surgical excision

Chemotherapy with Adriamycin

Cerebral angiography with tumor embolization

Preoperative radiation therapy followed by surgical excision

0a

multi

Most likely diagnosis in this patient is meningioma (CECT finding & findings points towards it) it is a slow growing tumor arising from arachnoid layer. predominately occurs in females peak incidence around 45yrs primary treatment of meningioma includes - surgical excision (with radiation therapy - if complete resection is not possible) 11 -15% recurrence is there, even after gross total resection.

Surgery

CNS Tumors

9e8e5a43-b7b3-4015-9394-1ee1a1005ac3

Treatment of 42-year-old obese man with blood glucose 450 mg, urine albumin 2+ Sugar 4+ Ketone 1+ is -

Insulin

Glibenclamide

Glipizide

Metformin

0a

single

Medicine

0b12a527-751f-492a-bd96-fab61129e430

A 55-year-old female who is taking propanolol for the management of a cardiovascular disease experiences an acute asthmatic attack. Which of the following drugs would you prescribe to attenuate this asthmatic attack?

Cromolyn sodium

Salbutamol

Beclomethasone

Ipratropium bromide

3d

single

(Ref: KDT 6/e p222) Inhaled b2 agonists are the agens of choice for termination of acute attack of bronchial asthma. However, as the patient is receiving b-blockers, treatment with b2 agonists will be ineffective (receptors are already blocked). Therefore, other bronchodilators like anticholinergic agents (ipratropium) or methylxanthines (theophylline) will be useful in such a case.

Pharmacology

Other topics and Adverse effects

5b0a82a5-9260-4e87-9653-5641ff9b2ebe

Drugs that act on microtubules are all except

Colchicine

Vinblastine

Paclitaxel

Fluconazole

3d

multi

Ceain drugs bind to microtubules and thus interfere with their assembly or disassembly. These include colchicine, vinblastine, paclitaxel, and griseofulvin.Fluconazole inhibits the fungal cytochrome P450 enzyme 14a-demethylase.

Physiology

General physiology

fb47d590-26ea-4780-aad0-88d47fe31e5e

A 49-year-old male is diagnosed with hypertension. He is a known asthmatic. His creatinine and potassium are both slightly elevated. Which of the following drugs would be appropriate in his case?

Amlodipine

Spironolactone

Propranolol

Hydrochlorthiazide

0a

multi

Answer: a) Amlodipine* Amlodipine is a dihydropyridine-type calcium channel blockers. Dihydropyridine calcium channel blockers (amlodipine) do not have contraindications related to renal impairment or potassium levels and can be safely administered in patients with asthma.* Hydrochlorothiazide is metabolized by the kidney, so it would not be a good choice in this patient as there is renal impairment (as indicated by elevated creatinine), because the drug itself can aggravate renal failure.* Spironolactone is a potassium-sparing diuretic. In this patient, it would only worsen the already elevated potassium level.* Beta-blockers are contraindicated in the presence of asthma.TREATMENT OF HYPERTENSION WITH CO-EXISTING CONDITIONSConcomitant conditionDrugs preferredDrugs to be avoidedAnginab blocker ,CCBVasodilatorsBHPa-blocker Diabetes and hyperlipidemiaACEI, ARB, CCB, a-blockerb-blocker, diureticsElderly and isolated systolic hypertensionDiuretics, CCB Low renin hypertensionDiuretics, CCB High renin hypertensionACEI, ARB, b-blocker AsthmaCCB, diuretics, ACEI, ARBb-blockerCHFACEI, diureticsCCBPost MIb-blocker, ACEI DM with CRF/proteinuriaACEI Peripheral Vascular DiseaseCCB, a-blockerb-blockerThyrotoxicosisb-blockerVasodilators* Dihyropyridine calcium channel blockers work to block vascular calcium channels resulting in vascular smooth muscle relaxation and have no specific contraindications.* They can cause peripheral edema (due to venous dilation) and dizziness.* Non-dihydropyridine calcium channel blockers (verapamil and diltiazem) work mostly on cardiac calcium channels and thus decrease the heart rate and inotropy of the heart.* They can also be used to treat hypertension and are contraindicated in systolic congestive heart failure.* Hydrochlorothiazide is not effective to treat hypertension when renal insufficiency is present. Propranolol is a non-cardioselective beta-blocker (blocks both beta-1 and beta-2 receptors) which can worsen asthmatic bronchoconstriction (cardioselective beta-blockers do this to a lesser degree). Spironolactone, an aldosterone antagonist, is also contraindicated in renal insufficiency and with elevated potassium levels.Recommendations of JNC-8 (Joint National Committee)* >60 years of, not diabetic/ not CKD:, target BP level; <150/90 mmHg* 18 to 59 years without major comorbidities + >60 years with DM/ CKD/Both; goal is <140/90 mmHg.* First-line medications: thiazide-type diuretics, calcium channel blockers (CCBs), ACEIs, and ARBs* Second- and third-line: higher doses or combinations of ACEIs, ARBs, thiazide-type diuretics, and CCBs.* Later-line alternatives: Beta-blockers, Alpha-blockers, Alphal/beta-blockers (eg, carvedilol), Vasodilating beta-blockers (eg, nebivolol), Central alpha2-adrenergic agonists (eg, clonidine), Direct vasodilators (eg, hydralazine), Loop diuretics (eg, furosemide), Aldosterone antagonists (eg, spironolactone), Peripherally acting adrenergic antagonists (eg, reserpine),* When initiating therapy, patients of African descent without chronic kidney disease should use CCBs and thiazides instead of ACEIs.* Use of ACEIs and ARBs is recommended in all patients with CKD.* ACEIs and ARBs should not be used in the same patient simultaneously.* CCBs and thiazide-type diuretics should be used instead of ACEIs and ARBs in patients over the age of 75 with impaired kidney function due to the risk of hyperkalemia, increased creatinine, and further renal impairment.Preferred Parenteral Drugs fc>r Selected Hypertensive EmergenciesHypertensive encephalopathyNitroprusside, nicardipine, labetalolMalignant hypertension (for IV therapy)Labetalol, nicardipine, nitroprusside, enalaprilatStrokeNicardipine, labetalol, nitroprussideMyocardial infarction/unstable anginaNitroglycerin, nicardipine, labetalol, esmololAcute left ventricular failureNitroglycerin, enalaprilat, loop diureticsAortic dissectionNitroprusside, esmolol, labetalolAdrenergic crisisPhentolamine, nitroprussidePostoperative hypertensionNitroglycerin, nitroprusside, labetalol, nicardipinePreeclampsia/eclampsia of pregnancyHydralazine, labetalol, nicardipine

Pharmacology

C.V.S

b41cbe2d-f92f-4a50-bd89-bf500f2823bd

Pralidoxime acts in organophosphorus poisoning by-

Regenerating Cholinesterase

Inhibiting cholinesterase

Cholinergic action

None of the above

0a

multi

Ans-A

Unknown

4c7cc459-b2c9-4f65-8e1f-8b84881d19d8

Which of the following is an antifibrinolytic agent?

Dabigatran

Protamine

Alteplase

Epsilon aminocaproic acid

3d

single

Ans. d. Epsilon aminoeaproic acid (Ref: Goodman Gilman 12/e p867; Katzung 12/e p616; KDT 7/e p628, 6/e p608) Epsilon-aminocaproic acid is a synthetic inhibitor of the ptasmin-plasminogen system. It is the only potent antifibrinolytic agent, which is commercially available."Aminoeaproic acid is a lysine analog that competes for lysine binding sites on plasminogen and plasmin, blocking the interaction of plasmin with fibrin. Aminocaproic acid is thereby a potent inhibitor of fibrinolysis and can reverse states that are associated with excessive fibrinolysis. "-- Goodman Gilman 12/e p867Aminoeaproic AcidEACA is a synthetic inhibitor of the plasmin-piasminogen systemQ.It is the only potent antifibrinolytic agent, which is commercially availableQ.Mechanism of Action:Aminoeaproic acid is a lysine analog that competes for lysine binding sites on plasminogen & plasmin, blocking the interaction of plasmin with fibrinQ.Aminocaproic acid is a potent inhibitor of fibrinolysis & can reverse states that are associated with excessive fibrinolysisQ.Therapeutic Uses:Used to reduce bleeding after prostatic surgery or after tooth extractions in hemophiliacsQ.Used to treat the overdose and/ or toxic effects of the thrombolytics like tissue plasminogen activator & streptokinaseQ.Side-effects:Hypotension, cardiac arrhythmias, rhabdomyolysis & generation of thrombiQ.

Pharmacology

Antiplatelets and Fibrinolytics

999ad80b-3580-4273-9cec-3b35b67627b3

Steroid receptor superfamily is present in:

Vitamin D3

Insulin

Glucagon

None of the above

0a

multi

All steroid, thyroid, Vit.D and retinoids includes in steroid hormone superfamily.

Physiology

99152b70-683e-45df-b54b-fdb0291e7c50

Drug of choice for hypeensive emergency in pregnancy is:

Methyldopa

Nitroprusside

Labetalol

Nicardipine

2c

single

Labetalol is DOC for hypeension in pregnancy whether it is routine or emergency HTN. DOC for hypeensive emergency in non pregnant patients is Nicardipine.

Pharmacology

Hypeension, Arrhythmias, Dyslipidemia

dd501ad8-90df-4254-89ce-221375ba676d

Which of the following drug used against glaucoma is contraindicated in patients with urine retention

Disopyramide

Flecainide

Lidocanine

Tocainide

0a

single

Class Ia Antiarrhythmics have anticholinergic property. Disopyramide is a class Ia antiarrhythmic with maximum anticholinergic action & hence contraindicated in patients with urine retention & glaucoma.

Pharmacology

967d8f54-10a0-44a7-8a29-77f84c8705b2

All of the following belong to the steroid receptor superfamily except-

Vit D3 receptors

Thyroid receptors

Retinoid receptors

Epinephrine receptors

3d

multi

Ans. is d i.e., Epinephrine receptors o All steroidal hormone (glucocoicoids, mineralocoicoids, androgens, estrogens, progesterone), thyroxine, vit D and vit A (retinoid) function through transcription factor.

Pharmacology

1f4ebfc9-a112-49da-8ea9-1fc045ec1964

All of the following are anticholinergics, except

Ipratropium bromide

Dicyclomine

Atropine

Amphetamine

3d

multi

Pharmacology

3e9d46c9-a572-4351-a638-488a1bc532a2

A child has phocomelia. This is due to drug taken by mother -

Tetracycline

Thalidomide

Warfarin

Chloroquine

1b

single

Ans. is 'b' i.e., Thalidomide Thalidomide is the worst teratogen known in the history of medicine.It was widely used as sedative and hypnotic.It was also believed to reduce vomiting in pregnancy.It was a routine hypnotics in hospitals, was even recommended to help children adapt themselves to a convalescent home atmosphere. The indiscrete use of these drugs in pregnant women resulted in an outbreak of Phocomelia. Phocomelia means "seal extremities", it is a congenital deformity in which the long bones of the limbs are defective and substantially normal or rudimentary hands and feet arise on or nearly on the trunk like the flippers of seal. Thalidomide was subsequently banned.Now, decades later thalidomide has received approval from the food and drug administration in certain conditions.According to Indian Journal of pharmacology Clinical uses of thalidomideAIDS related aphthous ulcers(r)AIDS related wasting syndrome^Multiple myeloma and other solid tumoursQPrevention of graft versus host disease after transplantationQRheumatoid arthritisQAnkylosing spondylitisQCrohn's disease and Bechet's syndromErythema nodosum leprosumQ

Pharmacology

Adverse Drug Effect

56f16301-fafb-4cdd-b96a-d5ad7fad3d9a

pancreatitis is a side effect of

valproate

clonazepam

clozapine

amisulpride

0a

single

LETHAL SIDE EFFECTS OF VALPROATE - Hyperammonemia - Pancreatitis - Hepatic failure - Neural tube defects - Thrombocytopenia MINOR SIDE EFFECTS OF VALPROATE - Hair loss - PCOD - WEIGHT GAIN - TREMORS Ref.Kaplon and Sadock, synopsis of psychiatry, 11 th editiojn, pg no.935

Anatomy

Pharmacotherapy in psychiatry

b53f4060-1f11-4a17-a34c-1d495637abe7

Which of the following drug is not used in MDB under RNTCP

Levofloxacin

Cycloserine

PAS

Ethionamide

2c

single

Regimen for MDR-TB This regimen comprises of 6 drugs Kanamycin, Levofloxacin, Ethionamide, Pyrazinamide, Ethambutol and Cycloserine during 6-9 months of the intensive phase and 4 drugs-Levovfloxacin, Ethionamide, Ethambutol and Cycloserine during the 18 months of the continuation phase. RNTCP regimen for MDR-TB : 6 (9) Km Lvx Eto Cs Z E/ 18 Lvx Eto Cs E* (Reserve/substitute drugs : PAS, Mfx, Cm) Special adjustments to the standard regimen for MDR-TB are as follows: In case of intolerance to Kanamycin, then Capreomycin (or PAS if injectable agent not feasible) is the available substitute drug. - In case of intolerance leading to discontinuation of other oral second-line drug, p-aminosalicylic acid (PAS) is the available substitute drug. - Baseline Kanamycin mono-resistance should lead to substitution of Kanamycin with Capreomycin. - Baseline Ofloxacin mono-resistance should lead to substitution of Levofloxacin with the combination of Moxifloxacin and PAS. - Baseline Ofloxacin and Kanamycin resistance (i.e. XDR-TB) should lead to declaration of outcome, referral to DR-TB Centre for pre-treatment evaluation for regimen for XDR-TB. Ref : Park 23rd edition Pgno : 191

Social & Preventive Medicine

Communicable diseases

24ef88d9-39f2-42a5-82c8-a8eaabbfc5a9

Drug of choice for tonic–clonic seizures is:

Sodium valproate

Carbemazepine

Phenobarbitone

Felbamate

0a

single

Pharmacology

1b47d8af-7c21-40f0-bb99-0495d1a05285

Kidney secretes: March 2013

Erythropoietin

Angiotensin I

Angiotensin II

Thrombodulin

0a

single

Ans. A i.e. Erythropoietin

Physiology

36dd9f81-9ac3-473a-98f3-716f27774873

A 44-year-old man with a prior renal transplant presents to the clinic for evaluation of symptoms consisting of a cough and shortness of breath on exertion. There is no sputum production and he has no prior respiratory or cardiac illnesses. On physical examination, he appears dyspneic, respirations 24/min, pulse 110/min, and oxygen saturation 88%. His lungs are clear on auscultation and heart sounds are normal. CXR shows bilateral diffuse perihilar infiltrates. Bronchoscopy and bronchial brushings show clusters of cysts that stain with methenamine silver. Which of the following is the most appropriate next step in management?

amphotericin B

cephalosporins

trimethoprim-sulfamethoxazole

aminoglycosides

2c

multi

The treatment of choice is trimethoprim-sulfamethoxazole. The patient has Pneumocystis jiroveci pneumonia, since he is immunocompromised from antirejection medications for his renal transplant. Alternate therapies include IV pentamidine or IV clindamycin and primaquine.

Medicine

Infection

715360bf-f392-4495-a70e-9d739d36a3ae

The drug which is a specific inhibitor of the enzyme alcohol dehydrogenase and is useful in the treatment of methanol and ethylene glycol poisoning is:

Disulfiram

Ethylene glycol

Calcium leucovorin

Fomepizole

3d

single

Fomepizole (4-methylpyrazole) is a specific inhibitor of alcohol dehydrogenase and the drug of choice for methanol poisoning by retarding its metabolism. A loading dose of 15 mg/kg i.v. followed by 10 mg/kg every 12 hours till serum methanol falls below 20 mg/dl, has been found effective and safe. It has several advantages over ethanol, viz. longer t 1/2 and lack of inebriating action, but is not available commercially in India.

Pharmacology

Opioids and Alcohols

fe5c2c5d-159b-4cbe-8e26-17ed89258bfe

Which of the following muscle relaxant causes pain on injection.

Vecuronium

Pancuronium

Rocuronium

Succinylcholine

2c

single

Most of the patients who received rocuronium before loss of consciousness after induction with barbiturates or other drugs complained of severe burning pain in their vein and arm. Rocuronium is supplied in a sterile, nonpyrogenic, isotonic solution. The isotonicity is obtained using sodium chloride, and the pH of 4 is achieved by adding acetic acid or sodium hydroxide . The pain can be decreased by prior administration of intravenous lidocaine. Rocuronium produces a burning pain in the vein or arm if administered before the loss of consciousness after induction of anesthesia. Prior administration of lidocaine may reduce the pain. Otherwise, rocuronium should be administered after induction of anesthesia and loss of consciousness.

Anaesthesia

Neuromuscular Blocker

1330f224-72f3-4566-94dc-c0a6e0fc3bab

All of the following drugs are bactericidal except :

Isoniazid

Tigecycline

Daptomycin

Ciprofloxacin

1b

multi

Tigecycline is a newer drug in the class 'Glycylcyclines.' Its mechanism of action and most properties are similar to tetracyclines. However, it is resistant to the efflux pump (major mechanism of resistance against tetracyclines). Most protein synthesis inhibiting drugs (including tetracyclines and tigecycline) are bacteriostatic except aminoglycosides. Isoniazid, ciprofloxacin and daptomycin are bactericidal.

Pharmacology

502af582-7737-4f64-8026-5d7194fd7087

Therapeutic monitoring of plasma level of drug is done when using all of the following drugs except:

Warfarin

Gentamicin

Cyclosporine

Phenytoin

0a

multi

Therapeutic drug monitoring (TDM) is useful in the following situations: 1. Drugs with low safety margin-digoxin, anticonvulsants, antiarrhythmics, theophylline, aminoglycosides, lithium, tricyclic antidepressants, vancomycin In case of failure of response without any apparent reason-antimicrobials, To check patient compliance-psychopharmacological agents Monitoring of plasma concentration is of no value for1. Drugs whose response is easily measurable antihypeensives, hypoglycaemics, diuretics, oral anticoagulants(Warfarin), general anesthetics.2. Drugs activated in the body-levodopa.3. 'Hit and run drugs' (whose effect lasts much longer than the drug itself)-reserpine, guanethidine, MAO inhibitors, omeprazole.4. Drugs with irreversible action-organophosphate anticholinesterases, phenoxybenzamine. ref ; KD Tripathi pharmacology 7th edition (page no; 34)

Pharmacology

General pharmacology

ad015d82-60d9-4e0b-88f5-a9d6915968ac

Antihormonal substance used to induce ovulation :

Mifepristone

Clomiphene citrate

Tamoxifen

Raloxifen

1b

single

Ans. is b i.e. Clomiphene citrate 1. Clomiphene citrate is the initial treatment for most anovulatory infeile women. It is chemically similar to tamoxifen Clomiphene is a non steroidal triphenylethylene derivative which demonstrates both estrogen agonist and antagonist propeies (predominant). It is the agent of choice for women with oligomenorrhea or amenorrhea having sufficient ovarian function to maintain estrogen at a serum level of 40pg/ml. Patient selection : Normal gonadotropicdeg normoprolactinemicdeg patients with normal cycle with absent or infrequent ovulation.deg PCOSdeg Post pill amenorrhea.deg Dose : Initial dose of 25 to 50mgdeg is given daily from D2 - D 5. Ovulation is expected to occur about 5 - 7 days after the last day of therapy. If ovulation doesnot occur, dose is increased in 50mg steps to a maximum of 250mg daily. (Although doses > 100 mg /day are not approved by FDA). Therapy is in given for 4-6 cycles. Clomiphene will be successful in inducing ovulation in about 70% of women, with ovaries producing estrogen Switch over from clomiphene to more aggressive therapy is done when : There is no response to clomiphenedeg (even with 100 mg / day dosing). There is ovulatory response to clomiphene but no pregnancydeg (following 3 to 6 months of ovulatory response to clomiphene). Patients with pituitary insufficiencydeg These patients usually respond to Gonadotropins. Note : Letrozole - 2.5mg (non steroidal aromatase inhibitor) is found superior to clomiphene. 2. Gonadotropin therapy : Prerequisite for Gonadotropin therapy : Ovarian reserve must be present. The Gonadotropins used are Human menopausal Gonodotropin : -- It is a formulation containing equal amounts of FSH and LH (751U each). -- It is prepared from hormones obtained from urine of postmenopausal women. HCG is required as an ovulatory trigger. FSH : purified urinary FSH and Recombinant FSH are also available. 3. Gonadotropin releasing hormone : Pulsatile GnRH : If other methods have failed then pulsatile GnRH is needed in patients with anovulation and hypothalamic insufficiency. Other drugs which can be used to for ovulation : Bromocriptine/Cabergoline : Are used to to treat anovulation caused by increase in serum prolactin level. Coicosteroids : Use to treat anovulation due to congenital adrenal hyperplasia. Also know : Mangement of unilateral proximal tubal block : Hysteroscopic cannulation or microsurgical tubo cornual anastomosis (if any periadenaxal adhesions are also present). Management of distal tubal block : Best is IVF. Surgical procedures like fimbrioplasty (lysis of fimbrial adhesions or dilatation of fimbrial stenosis) or neosalpingostomy may be done. Management of distal tubal block by hydrosalperix First laparoscopic salpingectomy followed by IVF Management of Bipolar tubal obstruction i.e. both proximal and distal tubal obstruction. Best is IVF Extra Edge : Lets quickly revise the tests for tubal patency. Tests for tubal patency : Rubins test : Outdateddeg Hysterosalpingography : screening procedure.deg Hystero contrastosonography Laparoscopy : Best technique for diagnosis of tubal and peritoneal pathology.deg Selective salpingography and falloscopy For evaluation of proximal tube obstruction. By falloscopy : tubal ostia and intra tubal architecture can also be seen. Time for performing tubal patency tests : D6-D 11 of the cycle.

Gynaecology & Obstetrics

e03ddcac-8ac0-4bbf-8145-4668099bd831

Treatment of Behcet's syndrome consists of: (A)Vincristine (B)Aspirin (C)Glucocorticoids (D)Thalidomide

ABC

BCD

CAD

BCA

1b

single

The severity of the syndrome usually abates with time. Apart from the patients with CNS-Behcet's syndrome and major vessel disease, the life expectancy seems to be normal, and the only serious complication is blindness.  Mucous membrane involvement may respond to topical glucocorticoids in the form of mouthwash or paste. In more serious cases, thalidomide (100 mg/d) is effective. Thrombophlebitis is treated with aspirin, 32 5 mg/d. Colchicine can be beneficial for the mucocutaneous manifestations of the syndrome. Uveitis and CNS-Behcet’s syndrome require systemic glucocorticoid therapy (prednisone, 1 mg/kgperdav) and azathioprine, 2-3 mg/kg per day. Interferon has proved to be very effective not only for CNS-Behcet's syndrome but also for refractory uveitis. ''Topical agent used in Behcet's syndrome: Steroids, tacrolimus & local anesthetics"- Neena Khanna 3rd/204 Chlorambucil, pentoxifylline & cyclosporine are also used in Behcet's syndrome-CMDT 06/851 INTERNET Anti-TNF therapy such as infliximab has shown promise in treating the uveitis associated with the disease. Another Anti-TNF agent, Etanercept. may be useful in patients with mainly skin and mucosal symptoms. Interferon alfa-2a may also be an effective alternative treatment, particularly for the genital and oral ulcers Dapsone and rebamipide have been shown, in small studies, to have beneficial results for mucocutaneous lesions. Given its rarity, the optimal treatment for acute optic neuropathy in Behcet's disease has not been established. Early identification and treatment is essential. Response to ciclosporin. perioculartriamcinolone and IV methylprednisone followed by oral prednisone has been reported although relapses leading to irreversible visual loss may occur even with treatment.

Pathology

a0ece626-e1d7-4466-ac44-7e619d2b0193

Minimum dose of tetracycline which causes discoloration of teeth:

10mg/kg Body weight.

20mg/kg Body weight.

30mg/kg Body weight.

40mg/kg Body weight.

1b

single

Pathology

da90f89b-855e-42df-856a-b4b336168127

The following drugs are useful in the treatment of isoniazid poisoning:

Pyridoxine

Diazepam

Bicarbonate

All of the above

3d

multi

Ans. (D) All of the above style="font-size: 1.04761904761905em; font-family: Times New Roman, Times, serif">(Ref: Harrison 17th ed/Table e35.4; American academy of family physicians, )MANAGEMENT OF ISONIAZID TOXICITYFive gram of IV pyridoxine given over 5 to 10 minutes is sufficient to counteract the neurotoxic effects of isoniazid in most cases.Diazepam, 5 to 10 mg administered intravenously, is the initial approach to seizure control, with the dose repeated as necessary.The acidosis associated with isoniazid toxicity appears to be lactic acidosis secondary to the seizure activity. Therefore, as the seizures are controlled, the acidosis usually decreases in severity. Since sodium bicarbonate may assist in correcting severe cases of acidosis, its administration should be considered if the pH is less than 7.1.

Pharmacology

Chemotherapy: General Principles

46958a2e-f5e0-47e1-8976-6b79820a2641

Which of the following drugs can be used for the treatment of chloroquine resistant malaria in children ?

Chloroquine

Doxycycline

Tetracycline

Clindamycin

3d

single

Pharmacology

15c4caf4-72c8-4f54-a087-14f6b74b9dae

Which of the following drugs, if given with terfenadine, can cause ventricular arrhythmias ?

Ketoconazole

Griseofulvin

Ampicillin

Sparfloxacin

0a

single

Pharmacology

e0eca0e1-adaf-4eab-a5b1-063a05545fc7

A patient on phenytoin therapy develops depression, for which he was prescribed tricyclic anti–depressants. He now complains of lassitude and his Hb reading is 8 gm/dl, the next step in the management of this patient

Chest X ray

MCV should be estimated

GGT should be estimated

None of the above

1b

multi

Pharmacology

e60b4320-08a2-479e-8245-53faf4cb619e

Drug inhibiting bacterial protein synthesis are all except-

Aminoglycosides

Chloramphenicol

Clindamycin

Sulfonamides

3d

multi

Ans. is `d' i.e., Sulfonamides o Sulfonamides affect intermediary metabolism by inhibiting folate synthase.

Pharmacology

edc2e5e5-fb19-4d1d-8597-df0d884d2daf

What diagnosis is implied by the results of this gallium scan?

Mumps

Paget's disease

Sarcoidosis

Septic emboli

2c

multi

Answer C. SarcoidosisThe gallium scan shows nasal, parotid, lung, liver, spleen, subcutaneous-nodule, and mediastinal and epitrochlear lymph-node uptake. This pattern is most consistent with a diagnosis of sarcoidosis.

Medicine

Immunology and Rheumatology

956ae8e9-4ddf-4982-8bd2-d351fbf271c6

Drug used in case of Herpetic lesions

Acyclovir

Penicillin

Tetracycline

Ciprofloxacin

0a

single

Pathology

4b93dda3-3261-43c2-9340-8e0f558dd4ac

A patient of endogenous depression was administered imipramine. After how much time interval the therapeutic effect of Imipramine is likely to manifest?

3 days

1 week

3 weeks

3 months

2c

single

.

Pharmacology

All India exam

9d298814-ac70-422e-a5bf-4dfc7d65eee7

A 30 yr old male presents to the OPD with Erectile dysfunction. Basic screening evaluation is unremarkable. The next step in the evaluation/management should be

Oral sildenafil citrate trial

Cavernosonometry

Doppler study

Neurological testing

0a

multi

Sildenafil citrate has been used for the treatment of erectile dysfunction. It is a competitive and selective inhibitor of cGMP (cyclic guanosine monophosphate)-specific PDE-5 (phosphodiesterase type 5). It prevents the rate of breakdown of cGMP causing enhanced relaxationof cavernosal smooth muscle, increase in aerial flow into corpus cavernosa, compression of subtunical veins, and hence penile erection. Other similar drugs include tadalafil and vardenafil. Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 132

Psychiatry

Sleep disorders and eating disorders

c500be94-ddfb-41e2-a95c-549f94da10be

Which of the following is the drug of choice for follicle induction for infeility in PCOS:

Clomiphene citrate

GnRH agonist

Combined oral Pills

Letrozole

3d

single

Letrozole is the Drug of choice for Induction of ovulation in a case of PCOS; Mode of action- Aromatase Inhibitor Decrease Estrogen production Inhibit Negative feedback on FSH Letrozole preferred over Clomiphene Citrate because less chances of multifetal pregnancy high live bih rate OHSS : Rare with it Given for 5 days (D5-D9) Sta with 2.5mg Max dose 7.5mg

Gynaecology & Obstetrics

Infeility (Eggs'plantation!)

f66eb1e0-56e8-48d9-af09-0e582cc7d55b

An infant had a high-grade fever and respiratory distress at the time of presentation to the emergency room. The sputum sample showed gram-positive cocci having an a hemolytic activity. The suspected pathogen is susceptible to which of the following agent:

Novobiocin

Bacitracin

Oxacillin

Optochin

3d

single

Sputum showing gram-positive cocci with alpha-hemolytic activity in a patient with high-grade fever and respiratory distress is suggestive of pneumococcal pneumonia which shows optochin susceptibility. Both pneumococcus and Streptococcus viridans produce alpha-hemolysis on blood agar. Optochin sensitivity test is done to differentiate Pneumococcus from commensal like Streptococcus viridans. Reference: Ananthanarayan and Paniker&;s Textbook of Microbiology Tenth edition

Microbiology

Bacteriology

5c911115-3283-462e-9130-93b2569f79aa

Not an antidepressant-

Amitriptilline

Fluoxetine

Trazodone

Pimozide

3d

single

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

Pharmacology

f9512dec-53a2-459d-9870-fac1716342ff

Renal plasma flow is best determined by:

Inulin

Creatinine

PAH

Mannitol

2c

single

Ans. C. PAHa. Renal plasma flow - RPFi. Can be measured by infusing para-amino hippuric acid (PAH) and determining its urine and plasma concentration.ii. 90% of the PAH in arterial blood is removed in a single circulation through the kidney. It is therefore become common place to calculate the "renal plasma flow" by dividing the amount of PAH in urine by the plasma PAH level.iii. Effective renal plasma flow (ERPF): -iv. ERPF = UPAH X V = Clearance of PAHv. PPAH = 625 ml/min.vi. Actual - RPF = ERPF = 630 Extraction ratio 0.9 = 720 ml/min.b. Renal Blood flow = RPF x 11- Hematocrit =700x10.55=1273ml/mm.c. "for determination of the GFR do a creatinine or Inulin clearance test and for determination of RBF or RPF the PAH clearance is to be done"

Physiology

Glomerular Filtration, Renal Blood Flow, and Their Control

77f6efa7-c1c3-4111-98d8-19fb9b64fc37

Which of the following is preferred for infertility treatment of a female with increased prolactin levels ?

Dopamine

Carbidopa

Cabergoline

Bromocriptine

2c

single

Pharmacology