AIM-Harvard/medmcqa_original · Datasets at Hugging Face

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9bfc722b-df7a-4f3a-b466-880bffbebb97	Antipsychotic with less extra pyramidal side effects -	Loxapine	Pimozide	Quetiapine	Resperidone	2c	single	Ans. is 'c' i.e., Quetiapine o Quetiapine, clozapine, aripiprazole have no (o) extrapyramidal symptoms. o Risperidone may or may not (o/+) have extrapyramidal effect.	Pharmacology	null	[ "quetiapine" ]	170,192
cb3cee3e-af62-45b6-bb83-4f5cc9ad6c4f	Administration of which of the following drug requires monitoring:	Lithium	Haloperidol	Diazepam	Acetazolamide	0a	single	Ans. A: Lithium Therapeutic drug monitoring is the measurement of medication levels in blood. Its main focus is on drugs with a narrow therapeutic index, i.e. drugs that can easily be under- or overdosed. Examples of drugs analysed by therapeutic drug monitoring: Aminoglycoside antibiotics (gentamicin) Antiepileptics (such as carbamazepine, phenytoin and valproic acid) Mood stabilisers, especially lithium citrate Antipsychotics (such as pimozide and clozapine) Theophylline Digoxin Antiarrhythmics	Pharmacology	null	[ "acetazolamide", "diazepam" ]	170,202
4a22bee8-44d3-44ad-b25f-22e7a10cf86c	Cephalosporin that does not require dose reductionin patient with any degree of renal impairment is aEUR'	Cefuroxime	Cefoperazone	Ceftazidime	Cefotaxime	1b	single	Cefoperazone [Ref: Goodman Gilman 17thie 1147, 1148; Katzung 10 p. 7371 Remember: ? Most cephalosporins are excreted mainly by tubular secretion. But ceftriaxone and cefoperazone are excreted mainly in bile and no dose adjustment is required in renal insufficiecy. The other unique feature of cefriaxone is its long half life. Thus it can be injected O.D. or B.D. in serious infections. According to Goodman and Gilman "All cephalosporins are excreted through kidney except celPiramide and cefoperazone which are excreted predominantly in the bile". About ceftriaxone Goodman Gilman mentions. "50% of this drug is excreted through urine while 50% of it is excreted through bile". But Katzung differs from Goodman Gilman "All cephalosporins are excreted through kidney except .for cefoperazone and ceftriaxone which are excreted mainly through the bilian' tract". Antimicrobial Drugs that do not require dosage adjustment in Renal Failure Cephalosporins Antitubercular * Cefoperaczone * Rifampicin * Ceftriaxone Other (miscellaneous) * Cefopiramide * Clindamycin * Chloramphenicol * Metronidazole Macrolides * Amphoterecin B * Erythomycin * Linezolid * Clarithomycin * Quinupristin / Dalfopristin * Azithromycin * Nafcillin / Oxacillin Fluoroquinolones Tetracycline * Trovafloxacin * Doxycycline * Grepafloxacin * Minocycline Use of Antimicrobial Agents in the Presence of Renal Dysfunction (Anesthesiology by Longnecker, Newman, Zapol'(2007J/285 Containdicated in the presence of dosage Require Require dosage adjustment only with severe adj adjustment with renal failures: renal failure: moderate renal failure: * Tetracyclines (except doxycycline), * Carbenicillin, ticarcillin, * Ampicillin, * Isoniazid, * Nitrofurantoin, * Cefazolin, * Mezlacillin. * Ethambutol, * Cephaloridine, * Aminoglycosides, * Piperacillin * Meropenem, * Long-acting sulfonamides, * Vancomycin, * Cefoxitin, * Nalidixic acid, * Methenamine, * Irnipenem, * Cefotaxime, * Ciprofloxacin, * Paraaminosalicylic acid * Flucytosine, * Penicillin G, * 5- fluorocytosine, * Fluconazole * Ceftizoxime, * Ofloxacin, * Ceftazidime, * Levofloxacin, * Cefuroxime, * Norfloxacin, * Cefotetan, * Itraconazole * Trimethoprim? * Sulfamethoxazole,	Pharmacology	null	[ "cefotaxime", "ceftazidime", "cefoperazone" ]	170,223
49c52182-963a-4d35-a498-63ee63b470fa	Fluorescein for ophthalmological diagnosis is injected in -	Antecubital vein	Popliteal vein	Femoral vein	Subclavian vein	0a	single	Ans. (a) Antecubital veinRef: Diagnostic Procedures by Nema, 2/e, p. 177The technique of fluorescein angiography comprises rapidly injecting 5 mL of 10% solution of sterile sodium fluorescein dye in the antecubital vein and taking serial photographs of the fundus.	Ophthalmology	Retina	[ "fluorescein" ]	170,237
ab43d339-8210-4804-a46d-cda710a4e419	Which of the following is selective alpha antagonist?	Propanolol	Prazosin	Phentolamine	Clonidine	1b	single	Ans. B. PrazosinPrazosin is selective alpha 1 blocker which used in patients suffering from BHP. They also used in hypertension. Phentolamine is nonselective alpha blocker. Clonidine is alpha 2 agonists.	Pharmacology	A.N.S.	[ "phentolamine", "clonidine", "prazosin" ]	170,244
8df86202-2b02-416f-9cb3-dfe4202c5097	Mechanism of action of Clomiphene citrate used for infeility:-	Block estrogen receptors in the hypothalamus	Negative feedback on HPO axis	Direct action on ovarian primordial follicles	Increase in tubal motility	0a	single	The ability of Clomiphene citrate (CC) to initiate an ovulatory sequence is primarily due to its ability to be recognized by and interact with the estrogen receptors in hypothalamus. In its capacity as an Estrogen antagonist,CC displaces endogenous estrogen from hypothalamic estrogen receptor sites and hence inhibiting the negative feedback of the endogenous estrogen on the hypothalamus (Reproductive Medicine & Surgery, Wallach and Zacur, Mosby '95). In simple terms, there is non recognition of the body's estrogens by the hypothalamus due to the blockade of estrogens receptors by CC and hence the hypothalamus directs the pituitary to make more of FSH which in turn drives the ovary to make a follicle to make estrogens.The development of follicle is the preceeding event before ovulation.	Gynaecology & Obstetrics	Infeility (Eggs'plantation!)	[ "clomiphene" ]	170,264
76588f42-ad08-4e6e-8051-59cb1b9faf9c	Which of the following drug is alpha–glucosidase inhibitor ?	Pioglitazone	Miglitol	Metformin	Nateglinide	1b	single	null	Pharmacology	null	[ "pioglitazone", "metformin", "miglitol" ]	170,296
b521ddee-9a0b-46ea-8afa-4508b2376b1f	Which of the following is drug of choice for CMV retinitis?	Acyclovir	Tenofovir	Ganciclovir	Abacavir	2c	single	Doc for CMV retinitis - Ganciclovir Other drugs used - Foscarnet, cidofovir Herpes simplex virus (HSV), Varicella zoster virus (VZV) - Acyclovir Anti HIV drugs - Tenofovir, Abacavir Ganciclovir: Activated intracellularly by virus specific thymidine kinase Due to poor oral absorption, bioavailability of ganciclovir is low (<10%) It's prodrug valganciclovir ,which is better absorbed orally, has replaced it for oral therapy Systemic S/E: Bone marrow depression Rash ,fever,vomiting Neuro psychiatric disturbances	Pharmacology	Anti-Viral Drugs	[ "ganciclovir" ]	170,298
19b03ca0-c8ef-47a8-b11d-9ea71efb71ea	When treating urinary tract infection (UTI) in the third trimester, the antibiotic of choice should be	Cephalosporin	Tetracycline	Sulfonamide	Nitrofurantoin	0a	single	Although quite effective, sulfonamides should be avoided during the last few weeks of pregnancy because they competitively inhibit the binding of bilirubin to albumin, which increases the risk of neonatal hyperbilirubinemia. Nitrofurantoin may not be tolerated in pregnancy because of the effect of nausea. It should also be avoided in late pregnancy because of the risk of hemolysis due to deficiency of erythrocyte phosphate dehydrogenase in the newborn. Tetracyclines are contraindicated during pregnancy because of dental staining in the fetus. Thus, the drugs of choice for treatment of UTI in pregnancy are ampicillin and the cephalosporins.	Gynaecology & Obstetrics	Medical & Surgical Illness Complication Pregnancy	[ "tetracycline", "nitrofurantoin" ]	170,322
5de20fc4-64f1-4589-b54f-261fcde24f86	All of the following statements about vincristine are true except	It acts by inhibiting mitosis	It prominent adverse effects is peripheral neuropathy	It does not suppression bone marrow	It is a drug of choice for solid tumors	3d	multi	Vincristine is a vinca allkaloid. It acts in M-phase of cell cycle by inhibiting the formation of spindle. It is a marrow sparing drug and causes peripheral neuropathy as a prominent adverse effect. It is used for the treatment of hematological malignancies like Hodgkin's lymphoma and leukemias.It is ineffective against solid tumors. Ref-KDT 6/e p824,825	Anatomy	Other topics and Adverse effects	[ "vincristine" ]	170,333
3b0a6985-f3ee-49b3-b055-7e7f7c25ecfb	Clopidogrel is an	Anti hypertensive	Antidiabetic	Antiplatelet	Anticoagulant	2c	single	null	Pharmacology	null	[ "clopidogrel" ]	170,347
78d51779-e06a-4b5a-8edc-d119dbde5eef	Anti-craving agents for alcohol dependence are all except aEUR'	Lorazepam	Acamprosate	Topiramate	Naltrexone	0a	multi	Lorazepam Management of alcohol intoxicationDrugs used areLorazepam (can worsen the vitals because of C.N.S. depression)Haloperidol (can lower the seizure threshold)Other drugs which may be usedZiprasidoneOlanzapineManagement of alcohol withdrawlAll patients should be given oral multiple vitamin B1including 50-100 mg of thiamine daily for a week.Replace alcohol (CNS depressant) with any other C.N.S. depressant. Benzodiazepenes are commonly used for this purpose and chlordiazepoxide is the drug of choice because of its long half life.Delirium Tremens :?Some recommend, high dose Benzodiazepene while others recommend antipsychotics.Anticonvulsants are not given to control seizures seen in delirium Tremens.Management of alcoholic rehabilitationMainstay of alcoholic rehabilitation involves counselling, education and cognitive approaches. Several medications have also proved beneficial :-Naltrexone (opioid antagonist) ?It blocks opioid receptors and thus decrease the activity in dopamine rich ventral tegrnental reward system or decrease the feeling of pleasure or reward if alcohol is imbibed.Acamprosate ?Widely used in United States and Europe. The drug inhibits the action of NMDA receptors and has been hypothesized to act by decreasing mild symptoms of protracted withdrawl.Disulfiram (ALDH inhibitor)Drinking alcohol, while taking disulfiram, produces a reaction involving an increased pulse, changes in blood pressure, vomiting and diarrhoea. This can be dangerous especially for patients with hea disease, stroke, diabetes mellitus or hypeension.Thus most clinicians reserve this medication for patients who have a clear history of longer term abstinence associated with prior use of disulfiram and for those who might take the drug under the supervision of another individual.Other drugs under investigation for possible use in Alcoholics- Ondansetron (serotonin antagonist)- Topiramate (anticonvulsant)- Ratnonthant (cannabinoid receptor antagonist)	Psychiatry	null	[ "topiramate", "lorazepam", "naltrexone" ]	170,358
0a6afecc-fd25-4666-9aa1-6604604a57f7	Nitisinone is an example of	Enzyme activation therapy	Enzyme replacement therapy	Substrate addition therapy	Substrate reduction therapy	3d	multi	Nitisinone is prescribed for infantile tyrosinemia because it decreases production of the substrate (fumarylacetoacetate) for the hydrolase, thus decreasing the velocity of the reaction preventing substrate accumulation.	Biochemistry	Phenylalanine and Tyrosine metabolism Detail	[ "nitisinone" ]	170,370
f2e31b0d-af81-48cb-ac6c-9345c5382db2	Sirolimus is more likely than cyclosporine to cause:	Hypeension	Osteoporosis	Renal insufficiency	Thrombocytopenia	3d	single	(Ref: KDT 6/e p840) Cyclosporine and tacrolimus cause nephrotoxicity as an adverse effect. Sirolimus (rapamycin) results in bone marrow suppression and thus may cause anemia, thrombocytopenia and leukopenia.	Pharmacology	Other topics and Adverse effects	[ "cyclosporine" ]	170,376
e21c572c-7641-4ba0-93f8-aca084487f50	Which of the following Anti neoplastic drugs SHOULD NOT be given by rapid IV infusion?	Cyclophosphamide	Cisplatin	Bleomycin	Cytosine arabinoside	1b	single	Ans. is `b ' i.e., Cisplatin o Cisplatin is the most common culprit causing chemotherapy induced nausea and vomiting, therefore cisplatin is given as slow i.v. infusion(never bolus) to prevent vomiting.	Pharmacology	null	[ "cyclophosphamide", "cisplatin" ]	170,384
2d043eeb-a1c2-43c9-acb4-594b6e1c37df	Aspirin is contraindicated in a patient who is on treatment with:	Prednisolone	Warfarin	Theophylline	Oral contraceptives	1b	single	Aspirin can displace warfarin from protein binding sites elevating the free drug level, leading to prolongation of both bleeding time and prothrombin time. So it should not be used in patients on anticoagulation therapy due to increased risk of bleeding. Other drugs which were found to increase the level of warfarin are: Azapropazone Phenylbutazone Naproxen Mefenamic acid Ibuprofen Ref: Enzyme- and Transpoer-Based Drug-Drug Interactions: Progress and Future Challenges edited by K. Sandy Pang, page 656.	Pharmacology	null	[ "prednisolone", "warfarin", "theophylline" ]	170,385
9783eb08-29c3-4ae5-8587-366082dcd36a	All are features of emergence delirium with ketamine anesthesia except:-	Visual illusions	Coical blindness	No hallucination	Auditory, proprioceptive and confusional illusions	2c	multi	Despite its reputation as a hallucinogen, sub-anesthetic ketamine does not consistently produce frank hallucinations. 5 - 30 % patients receiving intravenous ketamine has incidence of postoperative delirium and hallucination associated with it. prevention and treatment - intravenous midazolam	Anaesthesia	Intravenous Anesthetic Agents	[ "ketamine" ]	170,389
3453950d-ac35-4677-83ea-9b562e94d8e9	Drugs used in ADHD are –	Atomoxetine	Methylphenidate	Dextroamphetamine	All the above	3d	multi	null	Pediatrics	null	[ "methylphenidate", "dextroamphetamine" ]	170,394
87f3b07c-6f3a-46e5-a6eb-1936c3856a18	Drug not deposited in cornea:	Gold	Chloroquine	Amiodarone	Antimony	3d	single	Ans. Antimony	Ophthalmology	null	[ "amiodarone", "chloroquine" ]	170,418
f54f37ca-4b82-4537-beda-9ff47310da88	Which one of the following drugs is most likely to be associated with elevations of pancreatic enzymes, including amylase and lipase?	Erythromycin	Didanosine	Isoniazid	Azidothymidine	1b	single	Pancreatic dysfunction, heralded by large increases in serum amylase and lipase, is associated with the use of several reverse-transcriptase inhibitors (RTIs). Didanosine appears to be the worst offender, and pancreatitis is the most characteristic adverse effect of this particular NRTI. Conditions enhancing susceptibility to drug induced pancreatic dysfunction include hypertriglyceridemia, hypercalcemia, and history of excessive ethanol use. Liver dysfunction including hepatitis may occur with the antitubercular drugs, isoniazid, and pyrazinamide. Cholestasis is associated with the estolate form of erythromycin.	Pharmacology	Anti Microbial	[ "erythromycin", "isoniazid" ]	170,427
3d462e52-518d-42cb-87b9-41a089837039	Radiocontrast is contraindicated in all except -	Renal failure	Patient on metformin	Dehydration	Obesity	3d	multi	Impoant risk factors for contrast induced nephropathy (CIN) : Renal failure Diabetes Hypeension Dehydration Patient on metformin Hyperuricemia	Radiology	Fundamentals in Radiology	[ "metformin" ]	170,429
4e589129-0d0c-4a28-86d4-2ec65b281c26	All the following hormones are secreted by adrenal cortex except:	Estriol	Cortisol	Corticosterone	Aldosterone	0a	multi	null	Physiology	null	[ "estriol" ]	170,459
140b888c-97ec-423b-b4cc-f16f6a1d14d2	The following type of glomerulonephritis should not be treated with prednisolone?	Minimal change disease	Lipoid nephrosis	Congenital Nephrotic Syndrome	Post-streptococcal GN	3d	single	By the time the child with acute PSGN presents with symptoms, the glomerular injury has already occurred and the healing process has begun. Only a small percentage of patients with acute glomerulonephritis require initial hospitalization and most of those are ready for discharge in 2-4 days. As soon as the blood pressure is under relatively good control and diuresis has begun, most patients can be discharged and monitored as outpatients. Local skin infections will be treated with penicillin for 10 days but steroids are not warranted.	Medicine	Nephrotic and Nephritic syndrome	[ "prednisolone" ]	170,469
47920b17-8516-4c09-9289-fbe467e62255	Drug safely given in Pregnancy -	Antifolate	Quinine	Chloroquine	Primaquine	2c	single	Ans. is 'c' i.e., Chloroquine	Pharmacology	null	[ "quinine", "chloroquine" ]	170,471
7be1562b-8836-48b4-92fe-f7ddeaec4395	Which of the following drug is a reverse transcriptase inhibitor?	Indinavir	Ritonavir	Nelfinavir	Abacavir	3d	single	ANTIVIRAL DRUG: CLASSI FICATION 1.Anti-Herpes virus Idoxuridine, Acyclovir, Valacyclovir, Famciclovir, Ganciclovir, Foscarnet 2 Anti-Retrovirus (a) Nucleoside reverse transcriptase inhibitors (Nis): Zidovudine (AZT), Didanosine, Zalcitabine, Stavudine, Lamivudine, Abaca vir (b) Nonnucleoside reverse transcriptase inhibitors (NNis): Nevirapine, Eirenz, Delavirdine (c) Protease inhibitors: Ritonavir, Indinavir, Nelfinavir, Saquinavir, Amprenavir, Lopinavir 3. Anti-Influenza virus Amantadine, Rimantadine 4. NonselectiVe antiviral drugs Ribavirin, Lamivudine, Adefovir dipivoxil, Interferon alpha. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:767	Pharmacology	Chemotherapy	[ "nelfinavir", "ritonavir", "indinavir" ]	170,479
25f7823b-0332-4cf3-b22a-7600d16a4af8	Sterilising agents include -a) Dry heatb) Ethylene oxidec) Etherd) Alcohole) Chlorhexidine	ac	a	ab	bc	2c	single	null	Microbiology	null	[ "chlorhexidine" ]	170,492
f3c9fe5a-99b0-4269-994f-30a09d8d67f1	What is the most common immunosuppressant regimen used in renal transplant for maintainence?	Cacineurin inhibitors + Purine antagonists + Glucocoicoids	Cyclophosphamide + Purine antagonists + Glucocoicoids	Glucocoicoids + Cyclophosphamide	Cacineurin inhibitors + Purine antagonists + Basliximab	0a	single	Answer- A. Cacineurin inhibitors + Purine antagonists + GlucocoicoidsMaintenance immunosuppression for renal transplantation t)?ically consists of 3 types of drugs in combination: a glucocoicosteroid, purine antagonist (azathioprine or mycophenolate mofetil), and calcineurin inhibitor (cyclosporine or tacrolimus).	Surgery	null	[ "cyclophosphamide" ]	170,501
875832b8-eff9-4c2a-9109-dec78504ce12	Which of the following anti diabetic drugs can cause vitamin B12 deficiency	Glipizide	Acarbose	Metformin	Pioglitazone	2c	single	Refer Goodman Gilman 12/e p 1259 Lactic acidosis and Megaloblastic anemia due to vitamin B12 deficiency are the major adverse effects of these drugs Lactic acidosis is more likely to occur in the presence of hepatic and renal impairment or alcohol ingestion	Pharmacology	Endocrinology	[ "glipizide", "pioglitazone", "metformin", "acarbose" ]	170,513
ea3e388d-8398-4477-aabb-132e131bb48b	TNF-alpha inhibitor is	Infliximab	Efalizumab	Mannose-6-phosphate	Decorin	0a	single	(A) Infliximab [Harrison18-2491; G&G12-1018; Il,h-I419;# ANTI-TNF-ALPHA INHIBITORS:> Adalimumab, etanercept, and infliximab are antibodies that bind TNF alfa a proinflammatory cytokine.> Blocking TNF alfa from binding to TNF receptors on inflammatory cell surfaces results in suppression of downstream inflammatory cytokines such as IL-1 and IL-6 and adhesion molecules involved in leukocyte activation and migration.> An increased risk of lymphoma is common to each of these agents.> Infliximab is a human-mouse chimeric lgG1 monoclonal antibody possessing human constant (Fc) regions and murine var able regions.> Infliximab is currently approved for use in Crohn's disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.> Efalizumab is a recombinant humanized anti-CD11 a monoclonal antibody approved for the treatment of adult patients with severe psoriasis.> Binding of Efalizumab to CD11a (the alpha subunit of LFA-1) inhibits the interaction of LFA-1 on all lymphocytes with intercellular adhesion molecule-1 (ICAM-1), thereby inhibiting the adhesion, activation, and migration of lymphocytes into skin.> Efalizumab is administered by subcutaneous injection.Infliximab is a monoclonal antibody against TNF. It is used to treat autoimmune diseases.> Decorin & Mannose-6-phosphates are TGF-beta inhibitors.	Pharmacology	Miscellaneous (Pharmacology)	[ "infliximab" ]	170,515
fc4a09f6-d154-4879-93de-769d037b1f10	The following Thiazide diuretic is active if the GFR is 30-40 mm Hg	Metolazone	Benzthiazide	Chlorothiazide	Chlohalidone	0a	single	Although most thiazide diuretics lose their effectiveness in renal failure, metolazone remains active even when the glomerular filtration rate (GFR) is below 30-40 mL/min (moderate renal failure). This gives it a considerable advantage over other thiazide diuretics, since renal and hea failure often coexist and contribute to fluid retention(Refer: K. D. Tripathi&;s Essentials of Medical Pharmacology, 7th edition, pg no: 583)	Pathology	All India exam	[ "chlorothiazide" ]	170,516
a6041966-7695-426e-bd28-340545d93f0a	A 56-year-old woman presents to the hospital because of symptoms of dyspnea, blurry vision, and headaches. The symptoms started that morning and are getting worse. Her past medical history is significant for hypertension and osteoarthritis. She stopped taking her anti-hypertensive medications 3 months ago because of side effects.On examination, her blood pressure is 210/130 mm Hg, heart rate 100 beats/min, and oxygen saturation 95%. Her fundi reveal retinal hemorrhages and papilledema. The heart sounds are normal expect for an S4, and the lungs have lower lobe crackles. Which of the following is the most appropriate agent to reduce her blood pressure?	IV hydralazine	IV labetalol	oral methyldopa	IV nitroprusside	3d	single	Nitroprusside is very effective in lowering blood pressure and is easy to titrate and adjust to response. Labetalol is also useful since is can be administered in an oral preparation, but has more contraindications. It is particularly useful in the setting of angina or myocardial infarction. Regardless of which drug is selected, early administration of medications for long-term control is mandatory.	Medicine	C.V.S.	[ "methyldopa", "hydralazine", "nitroprusside", "labetalol" ]	170,525
37802559-d367-4fa6-ab20-74faa6f2997c	A 24 year old lady with a past history of psoriasis presents with fever and multiple pus filled lesions in a generalized distribution. What is the drug of choice?	Coicosteroids	Retinoids	Methotrexate	Psoralen with PUVA	2c	single	The patient described in this question is suffering from generalized pustular psoriasis, also known as impetigo herpetiformis, if it occurs in pregnancy. Treatment of choice in generalized pustular psoriasis is Methotrexate except in pregnancy where it is systemic steroids. Ref: Obstetric Dermatology: A Practical Guide By Arieh Ingber, Mark Lebwohl, Page 139; Primary Care for Women By Phyllis Carolyn Leppe, Jeffrey F. Peipe, Page 849; Rooks Textbook of Dermatology, 8th Edition, Pages 20, 53.	Skin	null	[ "methotrexate" ]	170,527
d7c29e86-157c-4675-8707-ec2e76c551aa	Donepezil has the following mechanism of action	Dopaminergic blockade	Cholinesterase inhibition	Serotonin blockade	Histaminergic action	1b	single	Donepezil: cerebro selective and reversible anti-AchE produces improvement in several cognitive as well as non cognitive (activities of daily living) scores in Alzheimer's Dementia. The benefit is ascribed to elevation of Ach level in the coex, especially in the surviving neurons that project from basal forebrain to cerebral coex and hippocampus. Therapeutic doses produce only weak peripheral AchE inhibition: cholinergic side effects are mild. Because of long t 1/2 (~70 hr), donepezil is administered once daily at bedtime It is generally well tolerated and is not hepatotoxic.	Pharmacology	Parasympathetic System & Glaucoma	[ "donepezil" ]	170,529
31f9107b-4b51-4102-87d6-fe7c979a990c	Muscle relaxant of choice in liver disease is ?	Atracurium	Pipecuronium	Rocuronium	Vecuronium	0a	single	null	Pharmacology	null	[ "atracurium", "vecuronium", "rocuronium" ]	170,532
01e845c6-51e9-418a-8023-9d156c95f5bd	Rate of newly formed Osteoid mineralization can be best estimated by?	Immunofluorescence	Von Kossa stain for calcium	Tetracycline labeling	Alizarin red stain	2c	single	Ans. C. Tetracycline labelingTetracycline labeling of bonea. Tetracycline labeling is used to determine the amount of bone growth within a certain period of time (approx. 21-day period).b. Osteoid is new bone that has been laid down by the osteoblasts and is non-mineralized.c. Usually tetracycline is given for several days in a row at 2 time points with a 10-day gap in between the dosing periods.d. It is recommended that the biopsy not be taken until at least 3-5 days after the last label.e. The label is incorporated into the mineralized bone and fluoresce under UV light microscopy.f. The bone must be processed mineralized in order to view the labels. Decalcification of the bone removes the labels.g. The quantitative interpretation of the bone histology, quantification of the various features, and bone dynamics with this method increases its sensitivity and aid in comparison of biopsy sample.h. If interested more in the measuring of osteoid, then staining the sections with Sanderson's Rapid Bone Stain (RBS) or McNeal's Tetrachrome is recommended. The RBS clearly differentiates the mineralized from the non-mineralized tissues in bone that has been processed in plastics.	Orthopaedics	Bone	[ "tetracycline" ]	170,543
11e3bc45-8d1d-41b3-b4c9-b4edfb12ac7b	Adrenocoical suppression causing drugs are all except ?	Prednisone	Ketoconazole	Mitotane	Spironolactone	3d	multi	Ans. is 'd' i.e., Spironolactone Drugs causing adrenocoical suppression are: Steroids (prednisone, hydrocoisone, and dexamethasone) Aminoglutethimide Fludrocoisone Ketoconazole Megestrol Metyrapone Mitotane	Pharmacology	null	[ "spironolactone", "ketoconazole", "prednisone" ]	170,551
f46a0aec-4b09-4413-b995-0557fd1972d8	Treatment of choice for Kawasaki disease -	Ig immunoglobulin	Steroid	Azathioprine	Not recalled	0a	multi	Ans. is 'a' i.e., Ig immunoglobulin Intravenous immunoglobulin is the treatment of choice for Kawasaki disease Q.The mechanism of action of IVIg, in Kawasaki disease is unknown but treatment results in rapid deference and resolution of clinical signs of illness in most patients.Treatment of Kawasaki diseaseAcute stageIntravenous immunoglobulin with aspirin.Convalescent stageAspirin 3-5 mg/kg once daily orally until 6-8 week illness onset.Long-term therapy for those with coronary abnormalitiesAspirin 3-5 mg/kg once daily orally+- dipyridamole 4-6 mg/kg/24 hr, divided in two-three doses orally.Acute coronary thrombosisPrompt fibrinolytic therapy with tissue plasminogen activator, streptokinase or urokinase under supervision of cardiologistIVIG reduces the prevalence of coronary disease from 20-25% in children treated with aspirin alone to 2- 4% in the children treated with IVIG and aspirin within the first 10 days of illness.Also KnowUse of corticosteroid in Kawasaki diseaseUsed in patient who have persistent fever despite 2 doses of IVIG.KAWASAKI DISEASEKawasaki disease is generally divided into three clinical phase's acute febrile phase?Characterized by high spiking fever, remittent and unresponsive to antibioticsFever lasts for 1-2 weeks.Subacute phase? This phase is associated with desquamation Q, thrombocytosis, development of coronary aneurysms and the highest risk of sudden death.Convalescent phase Q:This phase begins when all clinical signs of illness have disappeared and continues until the ESR returns to normal, approximately 6-8 weeks after illness.	Medicine	Vasculitis	[ "azathioprine" ]	170,553
51416ad3-c3e7-41bd-ac80-d8c732d0d143	Which one of the following drugs does not have active metabolite?	Diazepam	Propanolol	Allopurinol	Lisinopril	3d	multi	Lisinopril is a lysine derivative of enalaprilat which is an active metabolite of enalapril. It is an oral prodrug that is conveed by hydrolysis to a conveing enzyme inhibitor, enalaprilat. Enalaprilat itself is available only for intravenous use, primarily for hypeensive emergencies. All other ACE inhibitors are prodrugs and are conveed to active metabolites by hydrolysis, primarily in the liver. Lisinopril doesn't require hydrolysis to become active metabolite. Its oral absorption is low and incomplete. Its half-life is about 12 hours. the active metabolite of diazepam-oxazepam Allopurinol is conveed to oxypurinol by xanthine oxidase propranolol undergoes hydrolysis to form active metabolite Pg no- 273 Basics and clinical Pharmacology G. Katzung 13th edition	Pharmacology	General pharmacology	[ "lisinopril", "allopurinol", "diazepam" ]	170,561
1bc38409-5e36-4707-a24d-4f1cbcdfea18	The receptors for umami taste are specifically stimulated by:	Glutamate	Sucrose	Quinine	Lysyltaurine	0a	multi	Umami taste is due to activation of a truncated metabotropic receptor, mGluR4, in the taste buds. Glutamate in food may also activate ionotropic glutamate receptors to depolarize umami receptors. Sucrose stimulates sweet receptors; quinine activates receptors for bitter taste. Lysyl taurine is a compound that activates receptors for salty taste. Salt and sour tastes are triggered by activation of ionotropic receptors (ligand-gated ion channel) Sour, bitter, and umami tastes are triggered by activation of metabotropic receptors (GPCRs).	Physiology	Special Senses	[ "quinine" ]	170,616
de2045fd-8e22-4388-8d81-4f2af30d16b7	The therapeutic effect of sulfasalazine in ulcerative colitis is exerted by :	Inhibitory action of the unabsorbed drug on the abnormal colonic flora	Breakdown of the drug in colon to release 5–amino-salicylic acid which suppresses inflammation locally	Release of sulfapyridine having antibacterial property	Systemic immunomodulatory action of the drug	1b	multi	null	Pharmacology	null	[ "sulfasalazine" ]	170,618
62363969-6b40-4482-8170-3cdd52c00378	Following drugs are effective in cases of pneumocystis jirovecii EXCEPT	Pentamidine	Trimethoprim-dapsone	Clindamycin plus primaquine	Cefepime	3d	multi	Trimethoprim-sulfamethoxazole,which acts by inhibiting folic acid synthesis,is considered the drug of choice for all forms of Pneumocystis jirovecii pneumonia.Therapy is continued for 14 days in non-HIV infected patients & for 21 days in persons infected with HIV.Alternative regimens include TMP plus dapsone and clindamycin plus primaquine.Parenteral pentamidine is also effective. Reference:. Davidson edition23rd pg 584	Medicine	Respiratory system	[ "clindamycin", "pentamidine", "trimethoprim", "dapsone" ]	170,622
99004bdd-b87f-45a7-a57b-a0c0d22363f8	All drugs can be used in the treatment of H. Pylori infection except	Omeprazole	Metronidazole	Amoxicillin	Mosapride	3d	multi	Ans. is 'd' i.e. Mosapride RECOMMENDED TREATMENT REGIMEN FOR HELICOBACTER PYLORI:Regimen durationDrug 1Drug 2Drug 3Drug 4First line treatmentRegimen 1OCA (7 days) Regimen 2OCM (2 days)OmeprazoleOmeprazoleClarithromycinClarithromycinAmoxicillinMetronidazole--Second line treatmentRegimen 3OBTM(14days)OmeprazoleBismuthTetracyclineMetronidazole	Pharmacology	Anti-Ulcer	[ "metronidazole", "omeprazole" ]	170,632
052b751b-9b8b-492e-b76e-7a010faf2eb6	Basanti devi 45 yrs old women presents with hot flushes after stopping of menstruation. 'Hot Flush' can be relieved by administration of following agents :	Ethinyl estradiol	Testosterone	Fluoxymesteron	Danazol	0a	single	Ans. is a i.e Ethinyl estradiol Hot Flushes : They are the 'hallmark' of menopause. Hot flushes are described as recurrent transient period of flushing, sweating and a sensation of heat often accompanied by palpitations. feelings of anxiety. and sometimes followed by chills. The entire episode lasts no more than 1-3 minutes and recurs 5-10 times / day (can occur upto 30 times a day). Sho term estrogen therapy results in resolution of hot flushes. Hormone therapy Estrogen therapydeg (most effective) Combined estrogen and progestin therapydeg Progestin therapydeg (to be given in those women in whom estrogen is contraindicated) Tibolonedeg Non hormonal prescription medicines :Not FDA approved Clonidinedeg Selective serotonin reuptake inhibitor : paroxetine, fluoxetine Serotonin and nor epinephrinedeg reuptake inhibitor : venlafaxinedeg Dopamine antagonist : Veralipridedeg Gabapentindeg Bellergal (combination of ergotamines, phenobarbital and belladona, approved for the treatment of migrain).deg) Meazapine Trazodone Non prescription medicines : Isoflavones (100 mg/day)deg Soy products (60 g/d)deg Vitamin E (800 IU/day)deg Life style changes : Reducing body temperaturedeg Maintaining a healthy weightdeg Smoking cessationdeg Paced respirationdeg Options for the treatment of Vasomotor symptoms	Gynaecology & Obstetrics	null	[ "danazol" ]	170,634
6b74a3f1-8fbb-4f49-ac8a-4f2a565073c8	Which one of the following is a mechanism underlying the resistance of strains of S. pneumoniae to the widely used antibiotic, ciprofloxacin?	Reduced topoisomerase sensitivity to inhibitors	Increased synthesis of PABA	Formation of methyltransferases that change receptor structure	Structural changes in porins	0a	single	Microbial resistance to fluoroquinolones is increasing, and some strains of Streptococcus pneumoniae are now resistant to ciprofloxacin. The mechanism can involve changes in the structure of topoisomerase IV, one of the "targets" of fluoroquinolones, which inhibit nucleic acid synthesis. Pneumococcal resistance to penicillins is also increasing via changes in penicillin-binding proteins (PBPs). The other mechanisms listed underlie microbial resistance to other antibiotics as follows: sulfonamides (choice B), macrolides (choice C), extended-spectrum penicillins (choice D), and beta-lactams (choice E).	Pharmacology	Anti Microbial	[ "paba", "ciprofloxacin" ]	170,639

9bfc722b-df7a-4f3a-b466-880bffbebb97

Antipsychotic with less extra pyramidal side effects -

Loxapine

Pimozide

Quetiapine

Resperidone

2c

single

Ans. is 'c' i.e., Quetiapine o Quetiapine, clozapine, aripiprazole have no (o) extrapyramidal symptoms. o Risperidone may or may not (o/+) have extrapyramidal effect.

Pharmacology

null

[ "quetiapine" ]

170,192

cb3cee3e-af62-45b6-bb83-4f5cc9ad6c4f

Administration of which of the following drug requires monitoring:

Lithium

Haloperidol

Diazepam

Acetazolamide

0a

single

Ans. A: Lithium Therapeutic drug monitoring is the measurement of medication levels in blood. Its main focus is on drugs with a narrow therapeutic index, i.e. drugs that can easily be under- or overdosed. Examples of drugs analysed by therapeutic drug monitoring: Aminoglycoside antibiotics (gentamicin) Antiepileptics (such as carbamazepine, phenytoin and valproic acid) Mood stabilisers, especially lithium citrate Antipsychotics (such as pimozide and clozapine) Theophylline Digoxin Antiarrhythmics

Pharmacology

null

[ "acetazolamide", "diazepam" ]

170,202

4a22bee8-44d3-44ad-b25f-22e7a10cf86c

Cephalosporin that does not require dose reductionin patient with any degree of renal impairment is aEUR'

Cefuroxime

Cefoperazone

Ceftazidime

Cefotaxime

1b

single

Cefoperazone [Ref: Goodman Gilman 17thie 1147, 1148; Katzung 10 p. 7371 Remember: ? Most cephalosporins are excreted mainly by tubular secretion. But ceftriaxone and cefoperazone are excreted mainly in bile and no dose adjustment is required in renal insufficiecy. The other unique feature of cefriaxone is its long half life. Thus it can be injected O.D. or B.D. in serious infections. According to Goodman and Gilman "All cephalosporins are excreted through kidney except celPiramide and cefoperazone which are excreted predominantly in the bile". About ceftriaxone Goodman Gilman mentions. "50% of this drug is excreted through urine while 50% of it is excreted through bile". But Katzung differs from Goodman Gilman "All cephalosporins are excreted through kidney except .for cefoperazone and ceftriaxone which are excreted mainly through the bilian' tract". Antimicrobial Drugs that do not require dosage adjustment in Renal Failure Cephalosporins Antitubercular * Cefoperaczone * Rifampicin * Ceftriaxone Other (miscellaneous) * Cefopiramide * Clindamycin * Chloramphenicol * Metronidazole Macrolides * Amphoterecin B * Erythomycin * Linezolid * Clarithomycin * Quinupristin / Dalfopristin * Azithromycin * Nafcillin / Oxacillin Fluoroquinolones Tetracycline * Trovafloxacin * Doxycycline * Grepafloxacin * Minocycline Use of Antimicrobial Agents in the Presence of Renal Dysfunction (Anesthesiology by Longnecker, Newman, Zapol'(2007J/285 Containdicated in the presence of dosage Require Require dosage adjustment only with severe adj adjustment with renal failures: renal failure: moderate renal failure: * Tetracyclines (except doxycycline), * Carbenicillin, ticarcillin, * Ampicillin, * Isoniazid, * Nitrofurantoin, * Cefazolin, * Mezlacillin. * Ethambutol, * Cephaloridine, * Aminoglycosides, * Piperacillin * Meropenem, * Long-acting sulfonamides, * Vancomycin, * Cefoxitin, * Nalidixic acid, * Methenamine, * Irnipenem, * Cefotaxime, * Ciprofloxacin, * Paraaminosalicylic acid * Flucytosine, * Penicillin G, * 5- fluorocytosine, * Fluconazole * Ceftizoxime, * Ofloxacin, * Ceftazidime, * Levofloxacin, * Cefuroxime, * Norfloxacin, * Cefotetan, * Itraconazole * Trimethoprim? * Sulfamethoxazole,

Pharmacology

null

[ "cefotaxime", "ceftazidime", "cefoperazone" ]

170,223

49c52182-963a-4d35-a498-63ee63b470fa

Fluorescein for ophthalmological diagnosis is injected in -

Antecubital vein

Popliteal vein

Femoral vein

Subclavian vein

0a

single

Ans. (a) Antecubital veinRef: Diagnostic Procedures by Nema, 2/e, p. 177The technique of fluorescein angiography comprises rapidly injecting 5 mL of 10% solution of sterile sodium fluorescein dye in the antecubital vein and taking serial photographs of the fundus.

Ophthalmology

Retina

[ "fluorescein" ]

170,237

ab43d339-8210-4804-a46d-cda710a4e419

Which of the following is selective alpha antagonist?

Propanolol

Prazosin

Phentolamine

Clonidine

1b

single

Ans. B. PrazosinPrazosin is selective alpha 1 blocker which used in patients suffering from BHP. They also used in hypertension. Phentolamine is nonselective alpha blocker. Clonidine is alpha 2 agonists.

Pharmacology

A.N.S.

[ "phentolamine", "clonidine", "prazosin" ]

170,244

8df86202-2b02-416f-9cb3-dfe4202c5097

Mechanism of action of Clomiphene citrate used for infeility:-

Block estrogen receptors in the hypothalamus

Negative feedback on HPO axis

Direct action on ovarian primordial follicles

Increase in tubal motility

0a

single

The ability of Clomiphene citrate (CC) to initiate an ovulatory sequence is primarily due to its ability to be recognized by and interact with the estrogen receptors in hypothalamus. In its capacity as an Estrogen antagonist,CC displaces endogenous estrogen from hypothalamic estrogen receptor sites and hence inhibiting the negative feedback of the endogenous estrogen on the hypothalamus (Reproductive Medicine & Surgery, Wallach and Zacur, Mosby '95). In simple terms, there is non recognition of the body's estrogens by the hypothalamus due to the blockade of estrogens receptors by CC and hence the hypothalamus directs the pituitary to make more of FSH which in turn drives the ovary to make a follicle to make estrogens.The development of follicle is the preceeding event before ovulation.

Gynaecology & Obstetrics

Infeility (Eggs'plantation!)

[ "clomiphene" ]

170,264

76588f42-ad08-4e6e-8051-59cb1b9faf9c

Which of the following drug is alpha–glucosidase inhibitor ?

Pioglitazone

Miglitol

Metformin

Nateglinide

1b

single

null

Pharmacology

null

[ "pioglitazone", "metformin", "miglitol" ]

170,296

b521ddee-9a0b-46ea-8afa-4508b2376b1f

Which of the following is drug of choice for CMV retinitis?

Acyclovir

Tenofovir

Ganciclovir

Abacavir

2c

single

Doc for CMV retinitis - Ganciclovir Other drugs used - Foscarnet, cidofovir Herpes simplex virus (HSV), Varicella zoster virus (VZV) - Acyclovir Anti HIV drugs - Tenofovir, Abacavir Ganciclovir: Activated intracellularly by virus specific thymidine kinase Due to poor oral absorption, bioavailability of ganciclovir is low (<10%) It's prodrug valganciclovir ,which is better absorbed orally, has replaced it for oral therapy Systemic S/E: Bone marrow depression Rash ,fever,vomiting Neuro psychiatric disturbances

Pharmacology

Anti-Viral Drugs

[ "ganciclovir" ]

170,298

19b03ca0-c8ef-47a8-b11d-9ea71efb71ea

When treating urinary tract infection (UTI) in the third trimester, the antibiotic of choice should be

Cephalosporin

Tetracycline

Sulfonamide

Nitrofurantoin

0a

single

Although quite effective, sulfonamides should be avoided during the last few weeks of pregnancy because they competitively inhibit the binding of bilirubin to albumin, which increases the risk of neonatal hyperbilirubinemia. Nitrofurantoin may not be tolerated in pregnancy because of the effect of nausea. It should also be avoided in late pregnancy because of the risk of hemolysis due to deficiency of erythrocyte phosphate dehydrogenase in the newborn. Tetracyclines are contraindicated during pregnancy because of dental staining in the fetus. Thus, the drugs of choice for treatment of UTI in pregnancy are ampicillin and the cephalosporins.

Gynaecology & Obstetrics

Medical & Surgical Illness Complication Pregnancy

[ "tetracycline", "nitrofurantoin" ]

170,322

5de20fc4-64f1-4589-b54f-261fcde24f86

All of the following statements about vincristine are true except

It acts by inhibiting mitosis

It prominent adverse effects is peripheral neuropathy

It does not suppression bone marrow

It is a drug of choice for solid tumors

3d

multi

Vincristine is a vinca allkaloid. It acts in M-phase of cell cycle by inhibiting the formation of spindle. It is a marrow sparing drug and causes peripheral neuropathy as a prominent adverse effect. It is used for the treatment of hematological malignancies like Hodgkin's lymphoma and leukemias.It is ineffective against solid tumors. Ref-KDT 6/e p824,825

Anatomy

Other topics and Adverse effects

[ "cyclosporine" ]

170,376

e21c572c-7641-4ba0-93f8-aca084487f50

Which of the following Anti neoplastic drugs SHOULD NOT be given by rapid IV infusion?

Cyclophosphamide

Cisplatin

Bleomycin

Cytosine arabinoside

1b

single

Ans. is `b ' i.e., Cisplatin o Cisplatin is the most common culprit causing chemotherapy induced nausea and vomiting, therefore cisplatin is given as slow i.v. infusion(never bolus) to prevent vomiting.

Pharmacology

null

[ "cyclophosphamide", "cisplatin" ]

170,384

2d043eeb-a1c2-43c9-acb4-594b6e1c37df

Aspirin is contraindicated in a patient who is on treatment with:

Prednisolone

Warfarin

Theophylline

Oral contraceptives

1b

single

Aspirin can displace warfarin from protein binding sites elevating the free drug level, leading to prolongation of both bleeding time and prothrombin time. So it should not be used in patients on anticoagulation therapy due to increased risk of bleeding. Other drugs which were found to increase the level of warfarin are: Azapropazone Phenylbutazone Naproxen Mefenamic acid Ibuprofen Ref: Enzyme- and Transpoer-Based Drug-Drug Interactions: Progress and Future Challenges edited by K. Sandy Pang, page 656.

Pharmacology

null

[ "prednisolone", "warfarin", "theophylline" ]

170,385

9783eb08-29c3-4ae5-8587-366082dcd36a

All are features of emergence delirium with ketamine anesthesia except:-

Visual illusions

Coical blindness

No hallucination

Auditory, proprioceptive and confusional illusions

2c

multi

Despite its reputation as a hallucinogen, sub-anesthetic ketamine does not consistently produce frank hallucinations. 5 - 30 % patients receiving intravenous ketamine has incidence of postoperative delirium and hallucination associated with it. prevention and treatment - intravenous midazolam

Anaesthesia

Intravenous Anesthetic Agents

[ "ketamine" ]

170,389

3453950d-ac35-4677-83ea-9b562e94d8e9

Drugs used in ADHD are –

Atomoxetine

Methylphenidate

Dextroamphetamine

All the above

3d

multi

null

Pediatrics

null

[ "methylphenidate", "dextroamphetamine" ]

170,394

87f3b07c-6f3a-46e5-a6eb-1936c3856a18

Drug not deposited in cornea:

Gold

Chloroquine

Amiodarone

Antimony

3d

single

Ans. Antimony

Ophthalmology

null

[ "amiodarone", "chloroquine" ]

170,418

f54f37ca-4b82-4537-beda-9ff47310da88

Which one of the following drugs is most likely to be associated with elevations of pancreatic enzymes, including amylase and lipase?

Erythromycin

Didanosine

Isoniazid

Azidothymidine

1b

single

Pancreatic dysfunction, heralded by large increases in serum amylase and lipase, is associated with the use of several reverse-transcriptase inhibitors (RTIs). Didanosine appears to be the worst offender, and pancreatitis is the most characteristic adverse effect of this particular NRTI. Conditions enhancing susceptibility to drug induced pancreatic dysfunction include hypertriglyceridemia, hypercalcemia, and history of excessive ethanol use. Liver dysfunction including hepatitis may occur with the antitubercular drugs, isoniazid, and pyrazinamide. Cholestasis is associated with the estolate form of erythromycin.

Pharmacology

Anti Microbial

[ "erythromycin", "isoniazid" ]

170,427

3d462e52-518d-42cb-87b9-41a089837039

Radiocontrast is contraindicated in all except -

Renal failure

Patient on metformin

Dehydration

Obesity

3d

multi

Impoant risk factors for contrast induced nephropathy (CIN) : Renal failure Diabetes Hypeension Dehydration Patient on metformin Hyperuricemia

Radiology

Fundamentals in Radiology

[ "metformin" ]

170,429

4e589129-0d0c-4a28-86d4-2ec65b281c26

All the following hormones are secreted by adrenal cortex except:

Estriol

Cortisol

Corticosterone

Aldosterone

0a

multi

null

Physiology

null

[ "estriol" ]

170,459

140b888c-97ec-423b-b4cc-f16f6a1d14d2

The following type of glomerulonephritis should not be treated with prednisolone?

Minimal change disease

Lipoid nephrosis

Congenital Nephrotic Syndrome

Post-streptococcal GN

3d

single

By the time the child with acute PSGN presents with symptoms, the glomerular injury has already occurred and the healing process has begun. Only a small percentage of patients with acute glomerulonephritis require initial hospitalization and most of those are ready for discharge in 2-4 days. As soon as the blood pressure is under relatively good control and diuresis has begun, most patients can be discharged and monitored as outpatients. Local skin infections will be treated with penicillin for 10 days but steroids are not warranted.

Medicine

Nephrotic and Nephritic syndrome

[ "prednisolone" ]

170,469

47920b17-8516-4c09-9289-fbe467e62255

Drug safely given in Pregnancy -

Antifolate

Quinine

Chloroquine

Primaquine

2c

single

Ans. is 'c' i.e., Chloroquine

Pharmacology

null

[ "quinine", "chloroquine" ]

170,471

7be1562b-8836-48b4-92fe-f7ddeaec4395

Which of the following drug is a reverse transcriptase inhibitor?

Indinavir

Ritonavir

Nelfinavir

Abacavir

3d

single

ANTIVIRAL DRUG: CLASSI FICATION 1.Anti-Herpes virus Idoxuridine, Acyclovir, Valacyclovir, Famciclovir, Ganciclovir*, Foscarnet* 2 Anti-Retrovirus (a) Nucleoside reverse transcriptase inhibitors (Nis): Zidovudine (AZT), Didanosine, Zalcitabine*, Stavudine, Lamivudine, Abaca vir (b) Nonnucleoside reverse transcriptase inhibitors (NNis): Nevirapine, Eirenz, Delavirdine* (c) Protease inhibitors: Ritonavir, Indinavir, Nelfinavir, Saquinavir, Amprenavir*, Lopinavir 3. Anti-Influenza virus Amantadine, Rimantadine* 4. NonselectiVe antiviral drugs Ribavirin, Lamivudine, Adefovir dipivoxil, Interferon alpha. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:767

Pharmacology

Chemotherapy

[ "nelfinavir", "ritonavir", "indinavir" ]

170,479

25f7823b-0332-4cf3-b22a-7600d16a4af8

Sterilising agents include -a) Dry heatb) Ethylene oxidec) Etherd) Alcohole) Chlorhexidine

ac

a

ab

bc

2c

single

null

Microbiology

null

[ "chlorhexidine" ]

170,492

f3c9fe5a-99b0-4269-994f-30a09d8d67f1

What is the most common immunosuppressant regimen used in renal transplant for maintainence?

Cacineurin inhibitors + Purine antagonists + Glucocoicoids

Cyclophosphamide + Purine antagonists + Glucocoicoids

Glucocoicoids + Cyclophosphamide

Cacineurin inhibitors + Purine antagonists + Basliximab

0a

single

Answer- A. Cacineurin inhibitors + Purine antagonists + GlucocoicoidsMaintenance immunosuppression for renal transplantation t)?ically consists of 3 types of drugs in combination: a glucocoicosteroid, purine antagonist (azathioprine or mycophenolate mofetil), and calcineurin inhibitor (cyclosporine or tacrolimus).

Surgery

null

[ "cyclophosphamide" ]

170,501

875832b8-eff9-4c2a-9109-dec78504ce12

Which of the following anti diabetic drugs can cause vitamin B12 deficiency

Glipizide

Acarbose

Metformin

Pioglitazone

2c

single

Refer Goodman Gilman 12/e p 1259 Lactic acidosis and Megaloblastic anemia due to vitamin B12 deficiency are the major adverse effects of these drugs Lactic acidosis is more likely to occur in the presence of hepatic and renal impairment or alcohol ingestion

Pharmacology

Endocrinology

[ "glipizide", "pioglitazone", "metformin", "acarbose" ]

170,513

ea3e388d-8398-4477-aabb-132e131bb48b

TNF-alpha inhibitor is

Infliximab

Efalizumab

Mannose-6-phosphate

Decorin

0a

single

(A) Infliximab [Harrison18-2491; G&G12-1018; Il,h-I419;# ANTI-TNF-ALPHA INHIBITORS:> Adalimumab, etanercept, and infliximab are antibodies that bind TNF alfa a proinflammatory cytokine.> Blocking TNF alfa from binding to TNF receptors on inflammatory cell surfaces results in suppression of downstream inflammatory cytokines such as IL-1 and IL-6 and adhesion molecules involved in leukocyte activation and migration.> An increased risk of lymphoma is common to each of these agents.> Infliximab is a human-mouse chimeric lgG1 monoclonal antibody possessing human constant (Fc) regions and murine var able regions.> Infliximab is currently approved for use in Crohn's disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.> Efalizumab is a recombinant humanized anti-CD11 a monoclonal antibody approved for the treatment of adult patients with severe psoriasis.> Binding of Efalizumab to CD11a (the alpha subunit of LFA-1) inhibits the interaction of LFA-1 on all lymphocytes with intercellular adhesion molecule-1 (ICAM-1), thereby inhibiting the adhesion, activation, and migration of lymphocytes into skin.> Efalizumab is administered by subcutaneous injection.Infliximab is a monoclonal antibody against TNF. It is used to treat autoimmune diseases.> Decorin & Mannose-6-phosphates are TGF-beta inhibitors.

Pharmacology

Miscellaneous (Pharmacology)

[ "infliximab" ]

170,515

fc4a09f6-d154-4879-93de-769d037b1f10

The following Thiazide diuretic is active if the GFR is 30-40 mm Hg

Metolazone

Benzthiazide

Chlorothiazide

Chlohalidone

0a

single

Although most thiazide diuretics lose their effectiveness in renal failure, metolazone remains active even when the glomerular filtration rate (GFR) is below 30-40 mL/min (moderate renal failure). This gives it a considerable advantage over other thiazide diuretics, since renal and hea failure often coexist and contribute to fluid retention(Refer: K. D. Tripathi&;s Essentials of Medical Pharmacology, 7th edition, pg no: 583)

Pathology

All India exam

[ "chlorothiazide" ]

170,516

a6041966-7695-426e-bd28-340545d93f0a

A 56-year-old woman presents to the hospital because of symptoms of dyspnea, blurry vision, and headaches. The symptoms started that morning and are getting worse. Her past medical history is significant for hypertension and osteoarthritis. She stopped taking her anti-hypertensive medications 3 months ago because of side effects.On examination, her blood pressure is 210/130 mm Hg, heart rate 100 beats/min, and oxygen saturation 95%. Her fundi reveal retinal hemorrhages and papilledema. The heart sounds are normal expect for an S4, and the lungs have lower lobe crackles. Which of the following is the most appropriate agent to reduce her blood pressure?

IV hydralazine

IV labetalol

oral methyldopa

IV nitroprusside

3d

single

Nitroprusside is very effective in lowering blood pressure and is easy to titrate and adjust to response. Labetalol is also useful since is can be administered in an oral preparation, but has more contraindications. It is particularly useful in the setting of angina or myocardial infarction. Regardless of which drug is selected, early administration of medications for long-term control is mandatory.

Medicine

C.V.S.

[ "methyldopa", "hydralazine", "nitroprusside", "labetalol" ]

170,525

37802559-d367-4fa6-ab20-74faa6f2997c

A 24 year old lady with a past history of psoriasis presents with fever and multiple pus filled lesions in a generalized distribution. What is the drug of choice?

Coicosteroids

Retinoids

Methotrexate

Psoralen with PUVA

2c

single

The patient described in this question is suffering from generalized pustular psoriasis, also known as impetigo herpetiformis, if it occurs in pregnancy. Treatment of choice in generalized pustular psoriasis is Methotrexate except in pregnancy where it is systemic steroids. Ref: Obstetric Dermatology: A Practical Guide By Arieh Ingber, Mark Lebwohl, Page 139; Primary Care for Women By Phyllis Carolyn Leppe, Jeffrey F. Peipe, Page 849; Rooks Textbook of Dermatology, 8th Edition, Pages 20, 53.

Skin

null

[ "methotrexate" ]

170,527

d7c29e86-157c-4675-8707-ec2e76c551aa

Donepezil has the following mechanism of action

Dopaminergic blockade

Cholinesterase inhibition

Serotonin blockade

Histaminergic action

1b

single

Donepezil: cerebro selective and reversible anti-AchE produces improvement in several cognitive as well as non cognitive (activities of daily living) scores in Alzheimer's Dementia. The benefit is ascribed to elevation of Ach level in the coex, especially in the surviving neurons that project from basal forebrain to cerebral coex and hippocampus. Therapeutic doses produce only weak peripheral AchE inhibition: cholinergic side effects are mild. Because of long t 1/2 (~70 hr), donepezil is administered once daily at bedtime It is generally well tolerated and is not hepatotoxic.

Pharmacology

Parasympathetic System & Glaucoma

[ "donepezil" ]

170,529

31f9107b-4b51-4102-87d6-fe7c979a990c

Muscle relaxant of choice in liver disease is ?

Atracurium

Pipecuronium

Rocuronium

Vecuronium

0a

single

null

Pharmacology

null

[ "atracurium", "vecuronium", "rocuronium" ]

170,532

01e845c6-51e9-418a-8023-9d156c95f5bd

Rate of newly formed Osteoid mineralization can be best estimated by?

Immunofluorescence

Von Kossa stain for calcium

Tetracycline labeling

Alizarin red stain

2c

single

Ans. C. Tetracycline labelingTetracycline labeling of bonea. Tetracycline labeling is used to determine the amount of bone growth within a certain period of time (approx. 21-day period).b. Osteoid is new bone that has been laid down by the osteoblasts and is non-mineralized.c. Usually tetracycline is given for several days in a row at 2 time points with a 10-day gap in between the dosing periods.d. It is recommended that the biopsy not be taken until at least 3-5 days after the last label.e. The label is incorporated into the mineralized bone and fluoresce under UV light microscopy.f. The bone must be processed mineralized in order to view the labels. Decalcification of the bone removes the labels.g. The quantitative interpretation of the bone histology, quantification of the various features, and bone dynamics with this method increases its sensitivity and aid in comparison of biopsy sample.h. If interested more in the measuring of osteoid, then staining the sections with Sanderson's Rapid Bone Stain (RBS) or McNeal's Tetrachrome is recommended. The RBS clearly differentiates the mineralized from the non-mineralized tissues in bone that has been processed in plastics.

Orthopaedics

Bone

[ "tetracycline" ]

170,543

11e3bc45-8d1d-41b3-b4c9-b4edfb12ac7b

Adrenocoical suppression causing drugs are all except ?

Prednisone

Ketoconazole

Mitotane

Spironolactone

3d

multi

Ans. is 'd' i.e., Spironolactone Drugs causing adrenocoical suppression are: Steroids (prednisone, hydrocoisone, and dexamethasone) Aminoglutethimide Fludrocoisone Ketoconazole Megestrol Metyrapone Mitotane

Pharmacology

null

[ "spironolactone", "ketoconazole", "prednisone" ]

170,551

f46a0aec-4b09-4413-b995-0557fd1972d8

Treatment of choice for Kawasaki disease -

Ig immunoglobulin

Steroid

Azathioprine

Not recalled

0a

multi

Ans. is 'a' i.e., Ig immunoglobulin Intravenous immunoglobulin is the treatment of choice for Kawasaki disease Q.The mechanism of action of IVIg, in Kawasaki disease is unknown but treatment results in rapid deference and resolution of clinical signs of illness in most patients.Treatment of Kawasaki diseaseAcute stageIntravenous immunoglobulin with aspirin.Convalescent stageAspirin 3-5 mg/kg once daily orally until 6-8 week illness onset.Long-term therapy for those with coronary abnormalitiesAspirin 3-5 mg/kg once daily orally+- dipyridamole 4-6 mg/kg/24 hr, divided in two-three doses orally.Acute coronary thrombosisPrompt fibrinolytic therapy with tissue plasminogen activator, streptokinase or urokinase under supervision of cardiologistIVIG reduces the prevalence of coronary disease from 20-25% in children treated with aspirin alone to 2- 4% in the children treated with IVIG and aspirin within the first 10 days of illness.Also KnowUse of corticosteroid in Kawasaki diseaseUsed in patient who have persistent fever despite 2 doses of IVIG.KAWASAKI DISEASEKawasaki disease is generally divided into three clinical phase's acute febrile phase?Characterized by high spiking fever, remittent and unresponsive to antibioticsFever lasts for 1-2 weeks.Subacute phase? This phase is associated with desquamation Q, thrombocytosis, development of coronary aneurysms and the highest risk of sudden death.Convalescent phase Q:This phase begins when all clinical signs of illness have disappeared and continues until the ESR returns to normal, approximately 6-8 weeks after illness.

Medicine

Vasculitis

[ "azathioprine" ]

170,553

51416ad3-c3e7-41bd-ac80-d8c732d0d143

Which one of the following drugs does not have active metabolite?

Diazepam

Propanolol

Allopurinol

Lisinopril

3d

multi

Lisinopril is a lysine derivative of enalaprilat which is an active metabolite of enalapril. It is an oral prodrug that is conveed by hydrolysis to a conveing enzyme inhibitor, enalaprilat. Enalaprilat itself is available only for intravenous use, primarily for hypeensive emergencies. All other ACE inhibitors are prodrugs and are conveed to active metabolites by hydrolysis, primarily in the liver. Lisinopril doesn't require hydrolysis to become active metabolite. Its oral absorption is low and incomplete. Its half-life is about 12 hours. the active metabolite of diazepam-oxazepam Allopurinol is conveed to oxypurinol by xanthine oxidase propranolol undergoes hydrolysis to form active metabolite Pg no- 273 Basics and clinical Pharmacology G. Katzung 13th edition

Pharmacology

General pharmacology

[ "lisinopril", "allopurinol", "diazepam" ]

170,561

1bc38409-5e36-4707-a24d-4f1cbcdfea18

The receptors for umami taste are specifically stimulated by:

Glutamate

Sucrose

Quinine

Lysyltaurine

0a

multi

Umami taste is due to activation of a truncated metabotropic receptor, mGluR4, in the taste buds. Glutamate in food may also activate ionotropic glutamate receptors to depolarize umami receptors. Sucrose stimulates sweet receptors; quinine activates receptors for bitter taste. Lysyl taurine is a compound that activates receptors for salty taste. Salt and sour tastes are triggered by activation of ionotropic receptors (ligand-gated ion channel) Sour, bitter, and umami tastes are triggered by activation of metabotropic receptors (GPCRs).

Physiology

Special Senses

[ "quinine" ]

170,616

de2045fd-8e22-4388-8d81-4f2af30d16b7

The therapeutic effect of sulfasalazine in ulcerative colitis is exerted by :

Inhibitory action of the unabsorbed drug on the abnormal colonic flora

Breakdown of the drug in colon to release 5–amino-salicylic acid which suppresses inflammation locally

Release of sulfapyridine having antibacterial property

Systemic immunomodulatory action of the drug

1b

multi

null

Pharmacology

null

[ "sulfasalazine" ]

170,618

62363969-6b40-4482-8170-3cdd52c00378

Following drugs are effective in cases of pneumocystis jirovecii EXCEPT

Pentamidine

Trimethoprim-dapsone

Clindamycin plus primaquine

Cefepime

3d

multi

Trimethoprim-sulfamethoxazole,which acts by inhibiting folic acid synthesis,is considered the drug of choice for all forms of Pneumocystis jirovecii pneumonia.Therapy is continued for 14 days in non-HIV infected patients & for 21 days in persons infected with HIV.Alternative regimens include TMP plus dapsone and clindamycin plus primaquine.Parenteral pentamidine is also effective. Reference:. Davidson edition23rd pg 584

Medicine

Respiratory system

[ "clindamycin", "pentamidine", "trimethoprim", "dapsone" ]

170,622

99004bdd-b87f-45a7-a57b-a0c0d22363f8

All drugs can be used in the treatment of H. Pylori infection except

Omeprazole

Metronidazole

Amoxicillin

Mosapride

3d

multi

Ans. is 'd' i.e. Mosapride RECOMMENDED TREATMENT REGIMEN FOR HELICOBACTER PYLORI:Regimen durationDrug 1Drug 2Drug 3Drug 4First line treatmentRegimen 1OCA (7 days) Regimen 2OCM (2 days)OmeprazoleOmeprazoleClarithromycinClarithromycinAmoxicillinMetronidazole--Second line treatmentRegimen 3OBTM(14days)OmeprazoleBismuthTetracyclineMetronidazole

Pharmacology

Anti-Ulcer

[ "metronidazole", "omeprazole" ]

170,632

052b751b-9b8b-492e-b76e-7a010faf2eb6

Basanti devi 45 yrs old women presents with hot flushes after stopping of menstruation. 'Hot Flush' can be relieved by administration of following agents :

Ethinyl estradiol

Testosterone

Fluoxymesteron

Danazol

0a

single

Ans. is a i.e Ethinyl estradiol Hot Flushes : They are the 'hallmark' of menopause. Hot flushes are described as recurrent transient period of flushing, sweating and a sensation of heat often accompanied by palpitations. feelings of anxiety. and sometimes followed by chills. The entire episode lasts no more than 1-3 minutes and recurs 5-10 times / day (can occur upto 30 times a day). Sho term estrogen therapy results in resolution of hot flushes. Hormone therapy Estrogen therapydeg (most effective) Combined estrogen and progestin therapydeg Progestin therapydeg (to be given in those women in whom estrogen is contraindicated) Tibolonedeg Non hormonal prescription medicines :Not FDA approved Clonidinedeg Selective serotonin reuptake inhibitor : paroxetine, fluoxetine Serotonin and nor epinephrinedeg reuptake inhibitor : venlafaxinedeg Dopamine antagonist : Veralipridedeg Gabapentindeg Bellergal (combination of ergotamines, phenobarbital and belladona, approved for the treatment of migrain).deg) Meazapine Trazodone Non prescription medicines : Isoflavones (100 mg/day)deg Soy products (60 g/d)deg Vitamin E (800 IU/day)deg Life style changes : Reducing body temperaturedeg Maintaining a healthy weightdeg Smoking cessationdeg Paced respirationdeg Options for the treatment of Vasomotor symptoms

Gynaecology & Obstetrics

null

[ "danazol" ]

170,634

6b74a3f1-8fbb-4f49-ac8a-4f2a565073c8

Which one of the following is a mechanism underlying the resistance of strains of S. pneumoniae to the widely used antibiotic, ciprofloxacin?

Reduced topoisomerase sensitivity to inhibitors

Increased synthesis of PABA

Formation of methyltransferases that change receptor structure

Structural changes in porins

0a

single

Microbial resistance to fluoroquinolones is increasing, and some strains of Streptococcus pneumoniae are now resistant to ciprofloxacin. The mechanism can involve changes in the structure of topoisomerase IV, one of the "targets" of fluoroquinolones, which inhibit nucleic acid synthesis. Pneumococcal resistance to penicillins is also increasing via changes in penicillin-binding proteins (PBPs). The other mechanisms listed underlie microbial resistance to other antibiotics as follows: sulfonamides (choice B), macrolides (choice C), extended-spectrum penicillins (choice D), and beta-lactams (choice E).

Pharmacology

Anti Microbial

[ "paba", "ciprofloxacin" ]

170,639