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[ { "content": "Drug of choice for OCD is? \nSelect and explain. \nA. Clomipramine, B. Fluoxetine, C. Carbamezapine, D. Chlorpromazine", "role": "user" }, { "content": "Answer: B \nExplanation: ANSWER: (B) FluoxetineREF: Kaplan 9th ed p - 622OCDTreatment of choice: behaviour therapyDrug of choice: SSRI2nd drug of choice: comipramine", "role": "assistant" } ]

[ { "content": "PAS positive are all the following except - \nSelect and explain. \nA. Glycogen, B. Lipids, C. Fungal cell wall, D. Basement membrane of bacteria", "role": "user" }, { "content": "Answer: D \nExplanation: Ans-DThe basement membrane of bacteria", "role": "assistant" } ]

[ { "content": "Increased serum amylase in pleural effusion is seen in \nSelect and explain. \nA. Rheumatoid arthritis, B. Tuberculosis, C. Malignancy, D. Pulmonary embolism", "role": "user" }, { "content": "Answer: C \nExplanation: (Malignancy) (269- CMDT-08) (1658-H17th)Serum amylase level in PE - suggest pancreatits, pancreatic pseudocyst, adenocarcinoma of the lung or pancreas or esophageal rupture, - MalignancyGlucose < 60 mg/ dL - occurs in Malignancy, Bacterial infections, Rheumatoid pleuriticIncreased amvlase acids are found in perforated duodenal ulcers acute cholecystitis. High intestinal obstruction, acute mesenteric vascular occlusion, DKA leaking aortic aneurysm, mumps, ectopic pregnancy after administration of narcotics, after abdominal surgery* Bacterial pneumonia and cancer are the most common cause of exudative effusion* High concentration of cholesterol in most rheumatoid effusions", "role": "assistant" } ]

[ { "content": "Diffuse specific lesions on intestinal biopsy are seen in -a) Celiac sprueb) Whipples diseasec) Agammaglobulinemia d) Abetalipoproteinemal \nSelect and explain. \nA. abc, B. bcd, C. ac, D. bd", "role": "user" }, { "content": "Answer: B \nExplanation: None", "role": "assistant" } ]

[ { "content": "Pyrogens act on which site of brain ? \nSelect and explain. \nA. Basal ganglia, B. Limbic system, C. Thalamus, D. Hypothalamus", "role": "user" }, { "content": "Answer: D \nExplanation: Ans. is 'd' i.e., Hypothalamus PyrogenesPyrogenes are substances that cause fever.Pyrogens may be exogenous or endogenousExogenous - Bacterial toxinsEndogenous - IL-1, TNF-a, IL-6, Interferons, Ciliory's neurotropic factorThese pyrogenes increase the level of PGE, in the hypothalamus that elevates the thermoregulatory set point and causes fever.", "role": "assistant" } ]

[ { "content": "Hypertrophy means - \nSelect and explain. \nA. Increased protein content of the cells, B. Increase in size of cells, C. Increase in number of cells, D. None of the above", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. is 'b' i.e., Increase in size of cells Hypertrophy o Hypertrophy refers to an increase in the size of cells without increase in the number, resulting in an increase in the size of tissue. Hypertrophy involves cell enlargement without cell division. So, hypertrophied organ has just larger cells, but no new cells Hyperplasia o Hyperplasia refers to an increase in number of cells without increase in cell size. It occurs due to cell division and proliferation, in hyperplasia there is increase in number of new cells without increase in size.", "role": "assistant" } ]

[ { "content": "A patient was diagnosed with schizophrenia and was staed on haloperidol 5mg. On 3rd day he presented with uprolling of eyes. A complete neurological examination revealed no spasticity or any other abnormalities except uprolling of eyeballs. Visual acuity was found to be normal. What is your likely diagnosis? \nSelect and explain. \nA. Seizure, B. Acute dystonia, C. Malingering, D. Akathesia", "role": "user" }, { "content": "Answer: B \nExplanation: * <48 hours of staing antipsychotics * M.C in======Younger black males * If a patient develops dystonia he is more prone for eps Patient considers this as an Allergic reaction , thereby may stop drugs Layryngeal dystonia is a Psychiatric emergency, should be treated with IV lorazepam TREATMENT * Diphenhydramine * Benztropine mesylate * Prophylactic anticholinergics helps Ref.Kaplon and sadock, synopsis of psychiatry, 11 th edition, pg no. 923", "role": "assistant" } ]

[ { "content": "Risk factor prevention at which level \nSelect and explain. \nA. Primordial, B. Primary, C. Secondary, D. Tertiary", "role": "user" }, { "content": "Answer: A \nExplanation: (A) (Primordial) (39 - Park 22nd)PRIMORDIAL PREVENTION* Special attension is the prevention of chronic disease* Prevention of the emergence or development of risk factors in countries or population groups in which they have not yet appeared* For example, many adult health problems (eg obesity hypertension) have their early origins in childhood, because this is the time when life styles are formed (for example smoking, eating pattern, physical exercise)* Efforts are directed towards discouraging children from adopting harmful lifestyles* Main intervention in primordial prevention is through individual and mass educationTABLE Levels of preventionLevelPhase of diseaseAimActionsTargetPrimordialUnderlying economic, social, and environmental conditions leading to causationEstablish and maintain conditions hat minimize hazards to healthMeasures that inhibit the emergence of environmental, economic, social and behavioural conditionsTotal population or selected groups; achieved through public health policy and health promotion.PrimarySpecific causal factorsReduce the incidence of diseaseProtection of health by personal and community efforts, such as enhancing nutritional status, providingimmunizations, and eliminating environmental risks.Total population, selected groups and individuals at high risk; achieved through public health programmesSecondaryEarly stage of diseaseReduce the prevalence of disease by shortening its durationMeasures available to individuals and communities for early detection and prompt intervention to control disease and minimize disability (e,g. through screening programmes)Individuals with established disease; achieved through early diagnosis and treatmentTertiaryLate stage of disease (treatment, rehabilitation)Reduce the number and/or impact of complicationsMeasures aimed at softening the impact of long-term disease and disability; minimizing suffering; maximizing potential years of useful life.Patient achieved through rehabilitation* 'YOGA' is a practice that involves training of the mind, body and breathing to deliver various health benefits,Repular practice of yoga can be best defined as a form of \"Preventive Medicine\" that has shown beneficial effects on several ailments including Backache, Anxiety, Hypertension etc.Health promotionSpecific protection* Health education* Environmental modifications* Nutritional intervention* Lifestyle and behavioural changes* Immunization *** Use of specific nutrients eg vit A *** Chemoprophylaxis* Protection against accident carcinogen etc* Protection against occupational hazards* HIV sentinel surveillance is for Detecting trend of the disease* STEPS done for surveillance of risk factors of non communicable disease", "role": "assistant" } ]

[ { "content": "Venous drainage of upper pa of uterus and placenta is through : \nSelect and explain. \nA. Ovarian vein, B. Uterine vein, C. Internal iliac vein, D. None", "role": "user" }, { "content": "Answer: A \nExplanation: Ovarian vein", "role": "assistant" } ]

[ { "content": "As compared to permanent tooth, root formation in primary tooth: \nSelect and explain. \nA. Take less time, B. Take more time, C. Same time, D. Is complete when tooth erupts in oral cavity", "role": "user" }, { "content": "Answer: A \nExplanation: None", "role": "assistant" } ]

[ { "content": "Which of the following is true about venous thrombosis? \nSelect and explain. \nA. It affects only the deep venous system, B. Most impoant factor for development of deep venous thrombosis is hospital admission, C. Coralline thrombus is platelet aggregate surrounded by white blood cells, D. Lung infarction is a common complication of deep venous thrombosis", "role": "user" }, { "content": "Answer: B \nExplanation: Answer- B. Most impoant factor for development of deep venous thrombosis is hospital admissionVenous thrombosis is the formation of a semi-solid coagulum within the venous system and may occur in the superficial system.Patients are at risk of dweloping a post-thrombotic limb and venous ulceration Virchow triad-Changes in the wssel wall (endothelial damage)Stasis, which is diminished blood flow through the veinsCoagulability of blood (thrombophilia)The most impoant factor is a hospital admission for the treatment of a medical or surgcal condition.The coralline thrombus then progresses as a propagated loose red fibrin clot, containing many red cells.", "role": "assistant" } ]

[ { "content": "Gateway of tears is: \nSelect and explain. \nA. Rathke pouch, B. Sinus of morgagni, C. Killians dehiscence, D. Pharyngeal bursa", "role": "user" }, { "content": "Answer: C \nExplanation: Killians dehiscence is also called 'gateway of tears'", "role": "assistant" } ]

[ { "content": "A 27 year old sexually active male develops a vesiculobullous lesion on the glans soon after within 8hrs taking tablet diclofenac for viral fever. The lesion healed with hyperpigmentation.The most likely dignosis is- \nSelect and explain. \nA. Behcet's syndrome, B. herpes genitalis, C. fixed drug erruption, D. pemphigus vulgaris", "role": "user" }, { "content": "Answer: C \nExplanation: Fixed drug eruption It characteristically recur at the same site following administration of offending drugs or occasionally a member of the same group of drugs. They occur 30min to 8hrs after drug administration Most common drugs: Sulfonamides NSAIDS Dapsone Batbiturates Ciprofloxacin Phenytoin Griseofulvin Metronidazole Antituberculous drugs Pathomechanism Drug induced CD8 positive Tcells induce INFs and TNFalpha dependent damage to keratinocytes Clinical features Single / multiple, round / oval lesions Well demarcated erythematous edematous plaques that resolve with violaceous /hyperpigmented macules Associated burning/ stinging and pruritus Most common sites: oral mucosa; glans penis; hands and feet Bulbous fed: generalised well defines erythematous and bulbous lesions bilateral and symmetrical. Pseudoephedrine causes nonpigmented FDE lesion heal without pigmentation Investigations: oral or topical provocation test. Test drug is taken orally or applied topically Treatment Discontinue the offending drug Coicosteroids: topical and systemic Antihistamines. IADVL textbook of dermatology page 1664", "role": "assistant" } ]

[ { "content": "Isotope (s) used in high dose rate brachytherapy – a) lr192b) Co–60c) Cs–l33d) Ra 226 e) Pd103 \nSelect and explain. \nA. ac, B. a, C. ab, D. bc", "role": "user" }, { "content": "Answer: C \nExplanation: \"Although cobalt - 60 and cesium - 137 have been used in the past, iridium - 192 is the most commonly used radioisotope in HDR brachytherapy\".                                                                       — The physics of radiation therapy\nNote - Cs-137 is used in HDR brachytherapy, while option c i.e. Cs - 133 (not Cs - 137).", "role": "assistant" } ]

[ { "content": "A patient presents with erythematous scaly lesions on extensor aspect of elbows and knee. The clinical diagnosis is got by : \nSelect and explain. \nA. Auspitz sign, B. KOH smear, C. Tzanck smear, D. Skin biopsy", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' ie Auspitz signErythematous scaly lesions on extensor aspect of elbow and knee favours the diagnosis of Psoriasis.The clinical diagnosis of psoriasis can be made by demonstrating Auspitz sign.It is a characteristic finding of psoriasis in which removal of scale leads to pinpoint bleeding.Tzanck testis used in the clinical diagnosis of PemphigusNote that Tzanck smear is used in the diagnosis of herpes virus infection.KOH smearis used for diagnosing fungal infections such as ringworm infections", "role": "assistant" } ]

[ { "content": "27-year-old white man presents to his family doctor complaining of being tired all the time and having a slight fever for the past two weeks. He recently returned from a trip to Las Vegas, where he indulged in some of the infamous nightlife. His physical exam is unremarkable except for a macular rash over his trunk and on the palms of his hands. There are no lesions or ulcers on the penis. What organism is causing this man's illness? \nSelect and explain. \nA. Chlamydia trachomatis, B. Neisseria gonorrhea, C. Treponema pallidum, D. Borrelia burgdorferi", "role": "user" }, { "content": "Answer: C \nExplanation: Treponema pallidum Transmitted through unprotected sexual activity with an infected individual. Presents with the symptoms of secondary syphilis, which includes malaise, mild fever, and rash on the palms and trunk. The primary lesion (chancre) may go unnoticed because it is painless and subsides in a few weeks.", "role": "assistant" } ]

[ { "content": "Which of the following is having a 90% associated with HLA B27 \nSelect and explain. \nA. Ankylosing spondylitis, B. Rheumatoid ahritis, C. Psoriasis, D. Reiter's syndrome", "role": "user" }, { "content": "Answer: A \nExplanation: Ref Robbins 9/e p205 A positive result meansHLA-B27 was found in your blood. You may have a higher-than-average risk of ceain autoimmune diseases, such as ankylosing spondylitis and reactive ahritis.", "role": "assistant" } ]

[ { "content": "Growth of oral structures is mainly influenced by factors: \nSelect and explain. \nA. Hereditary, B. Environmental, C. Hereditary-influenced by environmental factor, D. None of the above", "role": "user" }, { "content": "Answer: C \nExplanation: Van Limborgh after review of the sutural theory, cartilaginous theory and functional matrix theory has summarized the following features:\n1. Intrinsic genetic factor controls chondrocranial growth.\n2. Epigenetic factors originating from skull cartilages and head tissues control desmocranial growth.\n3. Local environmental factors, like tension forces and pressure, influence the growth of desmocranial growth.\n4. General epigenetic and general environmental factors are less significant in craniofacial growth.\nKey Concept:\nGrowth of oral structures is mainly influenced by factors Hereditary-influenced by environmental factors.", "role": "assistant" } ]

[ { "content": "Foramen of Morgagni refers to an opening in? \nSelect and explain. \nA. The brain, B. The lesser omentum, C. The skull, D. The diaphragm", "role": "user" }, { "content": "Answer: D \nExplanation: The sinus of Morgagni or ventricle of the larynx is a narrow fusiform cleft between the vestibular and vocal folds. the anterior pa of the sinus is prolonged upwards as diveiculum between the vestibular fold and the lamina of the thyroid cailage .this extension is known as the saccule of the larynx. The saccule contains mucous glands which help to lubricate the vocal folds.it is often called oil can of larynx. Ref BDC volume 3; 6th edition pg 256", "role": "assistant" } ]

[ { "content": "A 10-year-old boy presents with increase bilirubin, increased bilirubin in urine and no urobilinogen Diagnosis is: \nSelect and explain. \nA. Gilbert syndrome, B. Hemolytic jaundice, C. Viral hepatitis, D. Obstructive jaundice", "role": "user" }, { "content": "Answer: D \nExplanation: Ans. D. Obstructive jaundiceLaboratory tests in three different types of JaundiceConditionSerum BilirubinUrine UrobilinogenUrine BilirubinNormalDirect: 0.1-0.4mg/dL Indirect: 0.2-0.7mg/dL0-4mg/24hAbsentHemolytic anemiaIndirectIncreasedAbsentHepatitisDirect and indirectDecreased if micro-obstruction is presentPresent if micro-obstruction occursObstructive jaundiceDirectAbsentPresent", "role": "assistant" } ]

[ { "content": "Negative nitrogen balance is the characteristic feature of which phase of convalescence after surgery? \nSelect and explain. \nA. Catabolic phase, B. Anabolic phase, C. Fat gain phase, D. Tuning point phase", "role": "user" }, { "content": "Answer: A \nExplanation: None", "role": "assistant" } ]

[ { "content": "All are true regarding fetal BBC's except – \nSelect and explain. \nA. Elevated 2,3 DPG, B. Decreased carbonic anhydrase activity, C. Decreased life span, D. High RBC volume", "role": "user" }, { "content": "Answer: A \nExplanation: Fetal RBC contains less 2, 3 DPG.", "role": "assistant" } ]

[ { "content": "NREM sleep is associated with:- \nSelect and explain. \nA. Basal forebrain area, B. Dorsal raphe nucleus, C. Medulla, D. All of the above", "role": "user" }, { "content": "Answer: D \nExplanation: NREM sleep generation is associated with 5 anatomical sites: * Basal forebrain area Thalamus Hypothalamus Dorsal raphe nucleus Nucleus tractus solitaries of the medulla Preoptic lesions produce hyposomnia, whereas electrical and thermal stimulation of this area produces sleep changes. Thalamus (especially reticular formation) plays an active role in production of coical sleep spindles and delta waves.", "role": "assistant" } ]

[ { "content": "Which of the following is the most specific test for Rheumatoid ahritis \nSelect and explain. \nA. Anti-ccp antibody, B. Anti Igm antibody, C. Anti IgA antibody, D. Anti IgG antibody", "role": "user" }, { "content": "Answer: A \nExplanation: to establish diagnosis of rheumatoid ahritis are * Clinical criteria * ESR and CRP * Ultrasound or MRI * Rheumatoid factor and anti-citrullinated peptide antibodies DAVIDSON&;S 22nd EDITION;PAGE NO 1100", "role": "assistant" } ]

[ { "content": "A young male presents with ear discharge since three years; recently developed swelling in the neck below and behind the angle of mandible, toicollis; on the examination, the external auditory canal was filled with granulation tissue. What is the diagnosis? \nSelect and explain. \nA. Luc's abscess, B. Citelli's abscess, C. Bezold's abscess, D. Parapharyngeal abscess", "role": "user" }, { "content": "Answer: C \nExplanation: Bezold's abscess It can occur following acute coalescent mastoiditis when pus breaks through the thin medial side of the tip of the mastoid and presents as a swelling in the upper pa of the neck. The abscess may Lie deep to sternocleidomastoid, pushing the muscle outwards. Follow the posterior belly of digastric and present as swelling between the tip of mastoid and angle of the jaw. Present in the upper pa of the posterior triangle. Reach the parapharyngeal space. Track down along the carotid vessels. Clinical features: Onset is sudden. Pain Fever Tender swelling in the neck Toicollis The patient gives a history of purulent otorrhoea. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 87)", "role": "assistant" } ]

[ { "content": "Not a pa of kangaroo mother care - \nSelect and explain. \nA. Skin to skin contact, B. Early discharge, C. Free nutritional supplements, D. Exclusive breast feeding", "role": "user" }, { "content": "Answer: C \nExplanation: The 4 components of kangaroo mother care are all essential for ensuring the best care option especially for low bih weight babies. This include: Skin to skin contact on mothers chest Adequate nutrition through breast feeding Ambulatory care as a result of earlier discharge Suppo for mother and family in caring baby. Parks textbook of preventive and social medicine.K Park. Edition 23.Pg no: 537", "role": "assistant" } ]

[ { "content": "A 6-year-old child has an accident and had elbow, after 4 years presented with tingling and numbness in the ulnar side of finger, fracture is \nSelect and explain. \nA. supra condylar humerus, B. lateral condylar humerus, C. olecranon, D. dislocation of elbow", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. is 'b' i.e.lateral condyle humerus This child had lateral condyle of humerus 4 yrs back. He is now presenting with symptoms of tardy ulnar palsy. Lateral condyle of humerus may lead to cubitus valgus deformity because of diminished growth at the lateral side of distal humeral epiphyses. Cubitus valgus deformity leads to late ulnar palsy (tardy ulnar nerve palsy) because of friction neuritis of the ulnar nerve as it moves over the medial epicondyle every time the elbow is flexed and extended. Ulnar nerve palsy presents as tingling and numbness in the distribution of ulnar nerve.Treatment- Anterior transposition of ulnar nerve.", "role": "assistant" } ]

[ { "content": "All of the following can be used to treat alcohol dependence except \nSelect and explain. \nA. Naltrexone, B. Acamprosate, C. Flumazenil, D. Disulfiram", "role": "user" }, { "content": "Answer: C \nExplanation: Naltrexone is orally effective opiod antagonist useful in alcohol withdrawal. Acamprosate an NMDA receptor antagonist is useful in preventing relapse. Disulfiram is used to make alcohol consumption an unpleasant experience. It inhibit the enzyme aldehyde dehydrogenase. Ref: KD Tripathi 8th ed.", "role": "assistant" } ]

[ { "content": "A 26 years old G2P1L1 at 10 weeks complains of pain abdomen and bleeding per vaginum. On examination products of conception are seen paially extruding through the cervix. What is your diagnosis? \nSelect and explain. \nA. Inevitable aboion, B. Threatened aboion, C. Complete aboion, D. Incomplete aboion", "role": "user" }, { "content": "Answer: D \nExplanation: Bleeding follows paial or complete placental separation and dilation of the cervical os in incomplete aboion. The fetus and the placenta may remain entirely within the uterus or paially extrude through the dilated os.Management is Evacuation or medical termination (if stable).Reference: William's Obstetrics; 25th edition; Chapter 18; Aboion", "role": "assistant" } ]

[ { "content": "Initial ECG change in Hyperkalemia is? \nSelect and explain. \nA. Tall tented T waves, B. PR prolongation, C. qRS widening, D. ST segment depression", "role": "user" }, { "content": "Answer: A \nExplanation: Ans.(a) Tall tented T wavesRef: Harrison 19th ed. / 310Serum potassium > 5.5 mEq/L is associated with repolarization abnormalities:* Peaked T waves (usually the earliest sign of hyperkalemia) Serum potassium >6.5 mEq/L is associated with progressive paralysis of the atria:* P wave widens and flattens* PR segment lengthens* P waves eventually disappearSerum potassium >7.0 mEq/L is associated with conduction abnormalities and bradycardia:# Prolonged QRS interval with bizarre QRS morphology# High-grade AV block with slow junctional and ventricular escape rhythms* Any kind of conduction block (bundle branch blocks, fascicular blocks)* Sinus bradycardia or slow AF* Development of a sine wave appearance (a pre-terminal rhythm)Serum potassium level of > 9.0 mEq/L causes cardiac arrest due to:* Asystole* Ventricular fibrillation", "role": "assistant" } ]

[ { "content": "ANCA positive vasculitis include all of the following Except: \nSelect and explain. \nA. Wegner's granulomatosis, B. Churg strauss syndrome, C. Microscopic PAN, D. Good pasture's syndrome", "role": "user" }, { "content": "Answer: D \nExplanation: Answer is D (Good pasture's syndrome): Goodpasture's syndrome is not classified as an ANCA positive vasculitis.", "role": "assistant" } ]

[ { "content": "The type of estrogen found in highest concen- tration in adult female is- \nSelect and explain. \nA. Estrone, B. Estriol, C. Estradiol, D. None", "role": "user" }, { "content": "Answer: C \nExplanation: Ans. is 'c' i.e.. Estradiol f Ref: Principles of medical physiology p. 216]o Estradial, estrone and estrial, all three are found in blood, but estradiol is the most potent estrogen.o Major estrogen in normal adult women - Estradiolo Major estrogen in postmenoapusal women - Estroneo Major estrogen in pregnant women - Estriol.o In post menopausal women estrogen is formed in peripheral tissues most commonly in adipose tissue, liver kidney and brain.", "role": "assistant" } ]

[ { "content": "Apical transportation is also known as \nSelect and explain. \nA. Curing, B. Zipping, C. Ledging, D. Apical perforation", "role": "user" }, { "content": "Answer: B \nExplanation: None", "role": "assistant" } ]

[ { "content": "Pro - inflammatory cytokine is? \nSelect and explain. \nA. IL-1, B. IL-3, C. IL-6, D. IL-10", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' i.e., IL-1 Proinflammatory cytokinesi) Major:- IL-1, TNF- a, IL-6ii) Other:- IL-2, IL-4, IL-5, IL-6, IL-8, IL-11, IL-12, IL-15, IL-21, IL-23, IFN- g, GM-CSFAnti-inflammatory cytokines* IL-4, IL-10, IL-13, and transforming growth factor-b (TGF-b).", "role": "assistant" } ]

[ { "content": "Direct standardization is used to compare the moality rates between two countries. This is done because of the difference in - \nSelect and explain. \nA. Cause of death, B. Numerators, C. Age distributions, D. Denominators", "role": "user" }, { "content": "Answer: C \nExplanation: ref: Park&;s 23rd edition pg 58 A standard population is defined as the one for which the numbers in each age and sex group are known.", "role": "assistant" } ]

[ { "content": "Which is the most common cause of thrombocytopenia in an ICU patient? \nSelect and explain. \nA. Sepsis, B. Bone marrow failure, C. ITP, D. Drug induced", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' i.e., Sepsis Thrombocytopenias in ICU patients :* Thrombocytopenia is a common laboratory abnormality that has been associated with adverse outcomes in ICU patients.* Thrombocytopenia is defined as platelet count < 150 X 103 cells / mcL.* Following table depicts the probable mechanisms and the causes for presence of thrombocytopenia in ICU patients.Thrombocytopenia in ICU : mechanisms and causesSix possible mechanisms* Hemodilution* Increased consumption* Increased destruction* Decreased production* Increased sequestration* Laboratory artifact (pseudothrombocytopenia) Specific causes* Sepsis, multiorgan failure* Trauma or major surgery* Bone marrow failure (leukemia, aplastic anemia)* Immune-mediated platelet consumption (ITP)* Drug induced (heparin, GPIIb/GPIIa inhibitors, antibiotics)* TIP and related disorders (HUS, TMA, and peripartum HELLP syndrome)* Sepsis is the most common cause accounting for 48% of the total patients of thrombocytopenia in ICU patients.* More than 25% of the patients have more than one associated cause.", "role": "assistant" } ]

[ { "content": "Which is not primary amenorrhea? \nSelect and explain. \nA. Sheehan's syndrome, B. Kallmann's syndrome, C. Mayer Rokitansky Koster Hauser syndrome, D. Turner syndrome", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is a, i.e. Sheehan's syndromeRef: Shaw 14th/ed, p256-257* Kallmann's sydnrome is due to hypothalamic dysfunction characterized by a deficiency of gonadotropin releasing hormone (GnRH) causing a hypogonadotrophic hypogonadism. This is associated with anosmia. It can occasionally be associated with optic problems, such as color blindness or optic atrophy, nerve deafness, cleft palate, cryptorchidism, renal agenesis, and mirror movement disorder.* MRKH syndrome, also known as Mullerian agenesis is due to anatomical absence of uterus. This is the second most common cause of primary amenorrhea.* Turner's syndrome is a type of gonadal dysgenesis and is overall the most common cause of primary amenorhea* Sheehan's syndrome is postpartum pituitary necrosis. It leads to secondary amenorrhea and not primary amenorrhea.", "role": "assistant" } ]

[ { "content": "A female undergone surgery for left breast cancer 3 yrs back now developed blue nodule on same side \nSelect and explain. \nA. Lymphangiosarcoma, B. Recurrence, C. Hemangioma, D. Cellulitis", "role": "user" }, { "content": "Answer: A \nExplanation: Answer- A. LymphangiosarcomaAngiosarcoma is a vascular tumor which may arise de novo in the breast or as a complication of the radiation therapy.", "role": "assistant" } ]

[ { "content": "An expansion alliance made with an expansion screw is an example of: \nSelect and explain. \nA. Simple anchorage, B. Reciprocal anchorage, C. Multiple anchorage, D. Reinforced anchorage", "role": "user" }, { "content": "Answer: B \nExplanation: None", "role": "assistant" } ]

[ { "content": "Day care anesthesia is best achieved with \nSelect and explain. \nA. Enflurane, B. Isoflurane, C. Propofol, D. Methoxyflurane", "role": "user" }, { "content": "Answer: C \nExplanation: Propofol", "role": "assistant" } ]

[ { "content": "Not true about post-transcriptional modification of RNA- \nSelect and explain. \nA. 5' Capping, B. Addition of poly A tail, C. Removal of introns, D. Glycosylation", "role": "user" }, { "content": "Answer: D \nExplanation: Ans. is 'd' i.e., Glycosyiution.m-RNA processingo Prokaryotic mRNA is functional immediately upon synthesis, i.e. prokaryotic primary transcript of mRNA is functional. Thus it does not require post-transcriptional modification. In Eukaryotes the primary transcript of mRNA is the hn RNA (hetrogeneous nuclear RNA). After transcription hnRNA is extensively modified to form functional mRNA. These modifications are as follows.The 51-cappingThis is the first processing reaction. 5l-end of mRNA is capped with 7-methylguansosine. This cap helps in initiation of translation (protein synthesis) and stabilizes the structure of mRNA by protecting from 5'-exonuclease.Addition of poly 'A' tail As the name suggests, multiple4A' (adenylate) residues are added at 31 end.This poly-A tail is not transcribed from DNA. but rather added after transcription. These tails helps to stabilize the mRNA (by protecting from 31-exonuclease), facilitate exit from the nucleus, and aid in translation. After mRNA enters the cytosol, the poly-A tail is gradually shortened. Some mRNAs do not have poly-A tail, e.g. mRNAs of histones and some interferons.Removal of introns (splicing) Eukaryotic genes contain some coding sequences which code for protein and some intervening non-coding sequences which do not code for protein. The coding sequences are called 'exons'and intervening non-coding sequences are called 'introns'. The process by which introns are excised and exons are linked to form functional mRNA is called splicing. Thus mature mRNA does not contain introns.# Spitcesome :- Splicesome is an assembly made up of small nuclear RNA (snRNA), some proteins and hnRNA. snRNA combines with proteins to form small nuclear ribnonucleoprotein particles (snRNPs or snurps) that mediate splicing. It is snRNA component of snurps that catalyzes splicing. Snurps are U1, U2, U3, U4, U5 and U6-o Only about 1[?]5% of human DNA has coding sequence (exons). Remaining is non-coding (introns).Alternate splicing :- The hn-RNA molecules from some genes can be spliced in alternative way in different tissues. Thus two or more different mRNA (and therefore 2 or more proteins) can be synthesized from same hnRNA. For example, difference isoforms of tropomyosin in different tissues in due to alternate splicing.", "role": "assistant" } ]

[ { "content": "Rigor mois not seen in: AIIMS 13 \nSelect and explain. \nA. Fetus < 7 months of age, B. Full term fetus, C. Elderly, D. Anemic person", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. Fetus < 7 months of age", "role": "assistant" } ]

[ { "content": "Most commonly used tuning fork in ear examination is \nSelect and explain. \nA. 128 Hz, B. 256 Hz, C. 512 Hz, D. 1024 Hz", "role": "user" }, { "content": "Answer: C \nExplanation: 512Hz is used normally Note: These tests are performed with tuning forks of different frequencies such as 128, 256, 512, 1024, 2048 and 4096 Hz, But for routine clinical practice, tuning fork of 512 Hz is ideal. Forks of lower frequencies produce a sense of bone vibration while those of higher frequencies have a shoer decay time and are thus not routinely preferred. Ref: Dhingra; 6th Edition; pg no 21", "role": "assistant" } ]

[ { "content": "Subtrochanteric fractures of the femur can be treated by all of the following methods except \nSelect and explain. \nA. Skeletal traction on Thomas' splint, B. Smith Petersen Nail, C. Condylar blade plate, D. Ender's nail", "role": "user" }, { "content": "Answer: B \nExplanation: Smith Peterson Nail is a cannulated tri-flanged nail that was used for internal fixation of fracture neck of femur Results obtained by S-P nail were dissatisfactory and it is no more recommended for use these days.\nOther three options are used for the treatment of the subtrochanteric fracture.", "role": "assistant" } ]

[ { "content": "All of the following side effects are produced by Cisplatin except \nSelect and explain. \nA. Ototoxicity, B. Nephrotoxicity, C. Coasting effect, D. Pulmonary fibrosis", "role": "user" }, { "content": "Answer: D \nExplanation: Cisplatin can cause ototoxicity, nephrotoxicity, coasting effect (peripheral neuropathy) and severe nausea and vomiting.\nPulmonary fibrosis is seen with Bleomycin and Busulfan.", "role": "assistant" } ]

[ { "content": "True about measles is/are a) Incubation period (I.P.) is 10-12 days b) Confunctivitis common c) Rash starts on abdomen d) Koplik spots are seen on fundus examination \nSelect and explain. \nA. ab, B. bc, C. cd, D. bd", "role": "user" }, { "content": "Answer: A \nExplanation: None", "role": "assistant" } ]

[ { "content": "Depressor reflex, Bezold-Jarisch reflex, produced by the following stimulus: \nSelect and explain. \nA. Atrial overload, B. Myocardial infarction, C. Ventricular distension, D. Isotonic exercise", "role": "user" }, { "content": "Answer: C \nExplanation: Ventricular distension can produce a powerful depressor reflex called the Bezold-Jarisch reflex; vagal afferents of this cardiopulmonary reflex are also activated by chemical stimulation (eg, prostanoids, cytokines, serotonin, and classically, Veratrum alkaloids). The central connections for this reflex are in the nucleus tractus solitarii, which has both sympathetic and parasympathetic synapses. Ref: Hoit B.D., Walsh R.A. (2011). Chapter 5. Normal Physiology of the Cardiovascular System. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e.", "role": "assistant" } ]

[ { "content": "Shape of birbeck granules is - \nSelect and explain. \nA. Tennis racket, B. Hockey stick, C. Bat, D. Ball", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' i.e., Tennis racket o Under the electron microscope, Birbeck granules have a pentalaminar, rodlike, tubular appearance and some- times a dilated terminal end resembling tennis-racket appearance.", "role": "assistant" } ]

[ { "content": "Extremely low birth weight - \nSelect and explain. \nA. <1000, B. <1500, C. <2500, D. <2800", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. (a) <1000 gmRef : OP Ghai 8th ed./125* Normal birth weight - 2800 gm- 3000gm* Low birth weight(LBW) - < 2500 gm* Very low birth weight(VLBW) - < 1500 gm* Extremely low birth weight (ELBW) - < 1000 gm.", "role": "assistant" } ]

[ { "content": "Memory T cells can be identified by using the following \nSelect and explain. \nA. CD 45RA, B. CD45RB, C. CD45RC, D. CD45RO", "role": "user" }, { "content": "Answer: D \nExplanation: Ref Harrison 17/e p2021 CD45 (lymphocyte common antigen) is a receptor-linked protein tyrosine phosphatase that is expressed on all leucocytes, and which plays a crucial role in the function of these cells. ... These CD45-associated molecules may play an impoant role in regulatingCD45 tyrosine phosphatase activity and function. Present on memory T cells", "role": "assistant" } ]

[ { "content": "Which of the following fuel gases used for soldering, has the highest heat content \nSelect and explain. \nA. Hydrogen, B. Natural gas, C. Acetylene, D. Propane", "role": "user" }, { "content": "Answer: D \nExplanation: None", "role": "assistant" } ]

[ { "content": "Which is true of typhoid - \nSelect and explain. \nA. Female carriers are less common, B. Male carriers though less are more dangerous, C. Gall bladder usually not involved in carrier state, D. Tetracycline is the DOC for carriers", "role": "user" }, { "content": "Answer: B \nExplanation: None", "role": "assistant" } ]

[ { "content": "All of the following are globular proteins except: \nSelect and explain. \nA. Prolamines, B. Albumin, C. Globulin, D. Myosin", "role": "user" }, { "content": "Answer: D \nExplanation: None", "role": "assistant" } ]

[ { "content": "A 4-month-old infant has undergone surgical treatment for meningomyeloencephalocele. At bih, an operation was carried out in the posterior cranial fossa to paially replace brain cerebellar contents to an intracranial position. In investigations for progressive hydrocephalus, it is noted that there is herniation of the cerebellar tonsils through the foramen magnum, and a diagnosis of Arnold-Chiari syndrome is established. This syndrome may also include which of the following? \nSelect and explain. \nA. Fusion of the frontal lobes, B. Fusion of the temporal, parietal, and occipital lobes, C. Abnormal elongation of the medulla and lower cranial nerves, D. Paial or complete absence of the pituitary gland", "role": "user" }, { "content": "Answer: C \nExplanation: Abnormal elongation of the medulla and lower cranial nerves may be evident in Arnold-Chiari syndrome. Additional features include fusion of the corpora quadrigemina, leading to a \"beaked\" tectum; paial or complete absence of the corpus callosum; and microgyria.", "role": "assistant" } ]

[ { "content": "A patient of RHD developed infective endocarditis after dental extraction. Most likely organism causing this is - \nSelect and explain. \nA. Streptococcus viridans, B. Streptococcus pneumoniae, C. Streptococcus pyogenes, D. Staphylococcus aureus", "role": "user" }, { "content": "Answer: A \nExplanation: Viridans streptococci Commensals in the mouth and upper respiratory tract. Cause transient bacteremia following tooth extraction or other dental procedures; -MC cause of subacute endocarditis: Streptococcus Viridans - MC Streptococcal species in Viridans group causing endocarditis: S. sanguis mc cause of Native valve endocarditis : S. aureus", "role": "assistant" } ]

[ { "content": "Disease highly transmitted during incubation period is - \nSelect and explain. \nA. Peussis, B. Cholera, C. Measles, D. Brucellosis", "role": "user" }, { "content": "Answer: A \nExplanation: Whooping cough is most infectious during the catarrhal stage. The infective period may be considered to extend from a weak after exposure to about 3 weeks after the onset of the paroxysmal stage although communicability diminishes rapidly after the catarrhal stage. (refer pgno:163 park 23 rd edition)", "role": "assistant" } ]

[ { "content": "Uveitis is associated most commonly with : \nSelect and explain. \nA. Rheumatoid arthritis, B. Systemic JRA, C. Pauciarticular JRA, D. Poly articular JRA", "role": "user" }, { "content": "Answer: C \nExplanation: Ans. is 'c' ie Pauciarticular JRA Uveitis can be seen in both pauciarticular and polyarticular JRA but is much more commonly associated with pauciarticular JRA.It is seen in about 20-25% of cases of pauciarticular and only 5% of polyarticular JRA.", "role": "assistant" } ]

[ { "content": "A 10-mm calculus in the right lower ureter associated with proximal\nhydroureterone-phrosis is best treated with \nSelect and explain. \nA. ESWL, B. PCNL, C. Open ureterolithotomy, D. Ureteroscopic retrieval", "role": "user" }, { "content": "Answer: D \nExplanation: None", "role": "assistant" } ]

[ { "content": "All of the following are seen in deep vein thrombosis except \nSelect and explain. \nA. Pain, B. Discolouration, C. Swelling, D. Claudication", "role": "user" }, { "content": "Answer: D \nExplanation: Claudication occurs in arterial occlusion", "role": "assistant" } ]

[ { "content": "Integrated management of childhood illness (IMCI) intiative was taken to prevent morbidity and moality from all of the following except - \nSelect and explain. \nA. Malaria, B. Malnutrition, C. Otitis Media, D. Neonatal tetanus", "role": "user" }, { "content": "Answer: D \nExplanation: Ans. is `d' i.e., Neonatal tetanus Integrated management of childhood iliness.tIMCD The extent of childhood morbidity and moality caused by following diseases is substantial. i) Diarrhea iii) Malaria v) Malnutrition ii) ARI (pneumonia, otitis media) iv) Measles o Most sick children present with signs and symptoms of more than one of these conditions. o This overlap means that a signle diagnosis may not be possible or appropriate, and treatment may be complicated by the need to combine for several conditions. o Therefore, an integrated approach to menage Sick children is necessary. IMCI is a strategy for an integrated approach to the management of childhood illness as it is impoant for child health programmes to look beyond the treatment of a single disease. o This is cost effective and emphasizes prevention of disease and promotion of child health and development besides provision of standard case management of childhood illness. The target of IMCI --) Children < 5 years of age (0-2 months, 2 months - 5 years). o Health promotive and preventive components include:- I) Breast feeding: ii) Nutritional counseling; iii) Vitamin A & iron supplementation: iv) immunization; v) Treatment of helminthic infestation.", "role": "assistant" } ]

[ { "content": "Hostile witness is covered under IPC section \nSelect and explain. \nA. 191, B. 192, C. 193, D. 194", "role": "user" }, { "content": "Answer: A \nExplanation: Sec 191 IPC states that whoever, being legally bound by an oath or by an express provision of law to state the truth, or being bound by law to make a declaration upon any subject, makes any statement which is false, and which he either knows or believes to be false or does not believe to be true, is said to give false evidence. This is a hostile witness. REF: Dr K. S. Narayan Reddys Synopsis of Forensic Medicine & Toxicology 29th edition pg. 31.", "role": "assistant" } ]

[ { "content": "All statements are true except remifentanil is true except \nSelect and explain. \nA. Useful for sho painful procedures, B. Metabolized by plasma esterases, C. Equipotent as fentanyl, D. Long acting anesthetic", "role": "user" }, { "content": "Answer: D \nExplanation: Refer Goodman Gilman 11/e p 572 Remifentanil is shoest acting opioid due to its metabolism by plasma esterases Due to its sho duration of action, it is indicated for sho term painful procedures Intravenous bolus dosing is not practical Potency is equal to fentanyl", "role": "assistant" } ]

[ { "content": "EMLA constituent is – \nSelect and explain. \nA. Lidocaine + Cocaine, B. Lidocaine + Prilocaine, C. Lidocaine + Bupivacaine, D. Bupivacaine + Prilocaine", "role": "user" }, { "content": "Answer: B \nExplanation: Eutectic mixture of local anaesthetics (EMLA) is a mixture of 2.5% lidocaine and 2.5 prilocaine.", "role": "assistant" } ]

[ { "content": "Keratic precipitates are most commonly seen in - \nSelect and explain. \nA. Corneal ulcers, B. Uveitis, C. Nuclear cataracts, D. Keratoconus", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. is 'b' i.e., Uveitis o Keratic precipitates (KPs) are proteinaceous cellular deposits occurring at the back of cornea (corneal endothelial deposits). Keratic precipitates are formed by the aggregation of polymorphonuclear cells, lymphocytes, and epitheloid cells. In the setting of uveitis, the bimicrosopic appearance of KP may yeild important diagnostic clues for the identification of the underlying inflammatory disorder1) Mutton fat KP Large, yellowish KPs, are characteristic of granulomatous uveitis .These are composed of epitheloid cells and macrophages. They are large, thick fluffy, lardaceous KPs, having a greasy or waxy appearance.2) Small or medium KPs (granular KPs):- These are composed of lymphocytes and are characteristic of nongranulomatous uveitis. These are small, round and whitish precipitates3) Red KPs:- Composed of RBCs and inflammatory cells. These are seen in hemorrhagic uveitis.4) Old KPs:- In healed uveitis. The above described KPs shrink, fade, become pigmented and irregular in shape with crenated margins.", "role": "assistant" } ]

[ { "content": "Regarding glutathione which of the following is/are true: \nSelect and explain. \nA. It helps in absorption of ceain amino acids, B. It inactivates some enzymes, C. It helps in membrane transpo, D. All", "role": "user" }, { "content": "Answer: C \nExplanation: Ans:C.)It helps in membrane transpo. GLUTATHIONE: Glutathione is a tripeptide made up of glutamate, cysteine and glycine (T-glutamyl-cysteinyl-glycine). Glutathione is present in all mammalian cells except neurons. The sulphydryl (-SH) group of cysteine residue is the reactive poion of glutathione which can undergo oxidation and reduction. Thus, glutathione may exist as the reduced (G-SH) or oxidized form (G-S-S-G) and can play a role in some oxidation-reduction reactions. In oxidized form two molecules of glutathione are linked by disulfide bond. Cysteine in glutathione act as reducing agent FUNCTIONS : - It helps in keeping some enzyme in active state by preventing the oxidation of sulphydryl (-SH) group of enzyme. It helps in detoxification of H2O2 by reducing it. Superoxide anion (O2) first conveed to H2O2 by superoxide dismutase. Glutathione helps in membrane transpo H2O2 is then reduced to H2O2 by glutathione perioxidase, a reaction requires reduced glutathione. Thus, glutathione scavenges free radicals and superoxide anion. It helps in detoxification of xenobiotics by their conjugation (conjugation reaction). Reduced form of glutathione (GSH) with a free sulphydryl (-SH) group serves as a redox buffer, regulating redox state of the cell. Reduced glutathione is essential for maintaining the normal structure of RBCs and for keeping hemoglobin iron in ferrous state (prevents formation of methemoglobin). It is involved in the transpo of amino acids across the cell membane of kidney and intestine.", "role": "assistant" } ]

[ { "content": "Presenting symptom of nasal myiasis is \nSelect and explain. \nA. Severe irritation with sneezing, B. Maggots, C. Nasal pain, D. Impaired olfaction", "role": "user" }, { "content": "Answer: A \nExplanation: Clinical features of nasal myiasisInitial symptoms (3-4 days maggots):- Intense irritation, sneezing, headache, blood stained discharge, lacrimationLater:- Maggots may crawl out of the nose and there is a foul smellRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 181 - 182", "role": "assistant" } ]

[ { "content": "Fouh ventricle develops from? \nSelect and explain. \nA. Telencephalon, B. Mesencephalon, C. Diencephalon, D. Rhombencephalon", "role": "user" }, { "content": "Answer: D \nExplanation: Lateral ventricle develops from the cavity of telencephalon. Third ventricle develops from diencephalon. Cavity of mesencephalon remains narrow and forms the aqueduct, while the cavity of rhombencephalon forms the fouh ventricle.", "role": "assistant" } ]

[ { "content": "Diabetic neuropathy is a \nSelect and explain. \nA. Distal symmetric sensory polyneuropathy, B. Mononeuritis, C. Autonomic neuropathy, D. All of the above", "role": "user" }, { "content": "Answer: D \nExplanation: Diabetic neuropathy causes substantial morbidity and increases moality. It is diagnosed on the basis of symptoms and signs, after the exclusion of other causes of neuropathy . Depending on the criteria used for diagnosis, it affects between 50% and 90% of patients with diabetes, and of these, 15-30% will have painful diabetic neuropathy (PDN). Like retinopathy, neuropathy occurs secondary to metabolic disturbance, and prevalence is related to the duration of diabetes and the degree of metabolic control. Pathological features can occur in any peripheral nerves. They include axonal degeneration of both myelinated and unmyelinated fibres, with thickening of the Schwann cell basal lamina, patchy segmental demyelination and abnormal intraneural capillaries (with basement membrane thickening and microthrombi). Ref - Davidsosn 23e p780", "role": "assistant" } ]

[ { "content": "Chronotrophic means: March 2010 \nSelect and explain. \nA. Drugs affecting the contractility of hea, B. Drugs affecting hea rate, C. Drugs affecting the myocardial blood flow, D. Drugs affecting diastolic relaxation", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. B: Drugs affecting hea rate Chronotropic effects are those drugs that change the hea rate. Chronotropic drugs may change the hea rate by affecting the nerves controlling the hea, or by changing the rhythm produced by the sinoatrial node. Positive chronotropes increase hea rate; negative chronotropes decrease hea rate. A dromotrope affects Atrioventricular node (AV node) conduction. A positive dromotrope increases AV nodal conduction, and a negative dromotrope decreases AV nodal conduction. A lusitrope is an agent that affects diastolic relaxation. Inotropes affects contractility of the hea. Chronotropic variables in systolic myocardial performance can be split left and right. Left sided systolic chronotropy can be appreciated as Aoic Valve open to close time. Right sided variables are represented by Pulmonary valve open to close time. Inveed as diastolic chronotropy, the variables are aoic valve close to open and pulmonic close to open time.", "role": "assistant" } ]

[ { "content": "In measuring Vickers hardness no. which of the following is used: \nSelect and explain. \nA. Spherical indenter, B. Steel ball indentation, C. Rhomboid shaped indenter, D. 136-degree diamond pyramid", "role": "user" }, { "content": "Answer: D \nExplanation: None", "role": "assistant" } ]

[ { "content": "For pericardial calcifications, which is the best investigation- \nSelect and explain. \nA. MRI, B. Transesophageal echocardiography, C. USG, D. CT scan", "role": "user" }, { "content": "Answer: D \nExplanation: Calcification anywhere in the body - IOC is CT scan Except for gall stones - IOC is USG So, for pericardial calcifications, the best investigation is CT scan. Figure: An incidental discovery of focal calcific plaque within the visceral pericardium. The patient was asymptomatic.", "role": "assistant" } ]

[ { "content": "Most specific test for organophosphorous poisoning is: \nSelect and explain. \nA. RBC cholinesterase level, B. Plasma cholinestrase level, C. RBC uroporphyrin level, D. Measurment of serum level of organophosphorous", "role": "user" }, { "content": "Answer: B \nExplanation: B i.e. Plasma cholinesterase level", "role": "assistant" } ]

[ { "content": "Lambda is meeting point of: \nSelect and explain. \nA. Coronal and sagittal suture, B. Coronal and lambdoid suture, C. Sagittal and lambdoid suture, D. None of the above", "role": "user" }, { "content": "Answer: C \nExplanation: The lambda is the meeting point between the sagittal and lambdoid sutures. In the foetal skull, this is the site of the posterior fontanelle which closes at two to three months of age.", "role": "assistant" } ]

[ { "content": "CSF examination in a one day old term male infant with convulsions reveals cell count -- 10 RBCs/HPF, 50 cells; protein -- 70 mg/dl.; sugar -- 30 mg/dl/Blood sugar 40 mg/di The child is likely to be suffering from \nSelect and explain. \nA. Meningitis, B. Intracranial bleed, C. Hypoglycemia, D. None of the above", "role": "user" }, { "content": "Answer: B \nExplanation: (B) Intracranial bleed # RBCs are normally not present in the CSF and their presence indicates traumatic tap or subarachnoid hemorrhage.# CSF characteristics:> Idiopathic seizures --Clear CSF with normal protein, normal glucose, no WBC's, no RBC's, normal opening pressure and normal % Gamma globulin.> Bacterial meningitis --Milky CSF with increased protein, decreased glucose, high WBC's (PMN predominate), few RBC's, mildly increased opening pressure and normal % Gamma globulin.> Guillain Barre Syndrome --Yellow CSF with very high protein (up to a gram), normal glucose, no WBC's, no RBC's, normal opening pressure and normal % Gamma globulin> Subarachnoid haemorrhage -- Yellow CSF with increased protein, normal glucose, few WBC's, inumerable RBC's, mildly increased opening pressure & normal % Gamma globulin.> Benign intracranial hypertension --Clear CSF with normal protein, normal glucose, no WBC's, no RBC's, increased opening pressure and normal Gamma globulin.", "role": "assistant" } ]

[ { "content": "Feature of osteoahritis is - \nSelect and explain. \nA. Heberden node, B. Increased ESR, C. Onycholysis, D. Z deformity", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' i.e., Heberden node Joint involvement in OA Common joints : Knee, Hip, Spine (cervical, lumbosacral), Hand (PIP, DIP, first carpometacarpal), first tarsometatarsal. Uncommon joint : Shoulder Spared : Wrist, elbow, ankle, metacarpophalangeal. In osteoahritis of hand : Distal interphalangeal joint :- Heberden's node. Proximal interphalangeal joint :- Bouchard's node", "role": "assistant" } ]

[ { "content": "Most common cause of UTI in a neonate is \nSelect and explain. \nA. E.coli, B. S. aureus, C. Enterococcus, D. Anerobes", "role": "user" }, { "content": "Answer: A \nExplanation: Causative agents of UTI:Uncomplicated UTIComplicated UTI*E.coli *Klebsiella*Proteus species*Enterobacter*Staphylococcus saprophyticus*Enterococci *Chlamydia , Neisseria *Ureaplasma, Mycoplasma . Adenovirus *E.coli *Klebsiella*Proteus species*Serratia marcescens*Pseudomonas *Enterococci Staphylococci Ref:Harrison's infectious disease 2nd edition, p296", "role": "assistant" } ]

[ { "content": "Epinephrine added to a solution of lignocaine for a peripheral nerve block will : \nSelect and explain. \nA. Increase risk of convulsions, B. Increase the duration of action of the local anesthetic, C. Both (a) and (b), D. None of these", "role": "user" }, { "content": "Answer: B \nExplanation: None", "role": "assistant" } ]

[ { "content": "In Patey's mastectomy all the following are removed except \nSelect and explain. \nA. Pectoralis major, B. Skin of the breast, C. Pectoralis minor, D. Ductular system of the breast", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. (a) Pectoralis major(Ref. Bailey and Love 26th edition Page 813)Structures removed in Patey's mastectomy:* Breast, nipple, areola including the skin overlying the tumor* Level 1,2,3 Lymphnodes* Fascia over Pectoralis major* Pectoralis minor muscle", "role": "assistant" } ]

[ { "content": "Axis is the name for: \nSelect and explain. \nA. IV cervical vertebra, B. III cervical vertebra, C. II cervical vertebra, D. I cervical vertebra", "role": "user" }, { "content": "Answer: C \nExplanation: Second cervical vertebra (axis)\n\nPresence of odontoid process.\nTransverse processes are small and lack the anterior tubercle.\nAnterior margin of the inferior surface of the body projects downwards to a considerable extent.\nForamen transversarium is directed superolaterally (expand in typical vertebrae it is directed vertically)\nInferior surface presents a deep and wide inferior vertebral notch placed in front of the inferior articular process. The superior vertebral notch is shallow and is present behind the superior articular process.\n\nKey concept:\nSecond cervical vertebra is called the axis. it is identified by the presence of the dens or odontoid process which is a strong, tooth-like process projecting upwards from the body. The dens is usually  believed to represent the centrum or body of the atlas which has fused with the centrum of the axis.", "role": "assistant" } ]

[ { "content": "Reed sternberg cells are found in- \nSelect and explain. \nA. Hodkin's disease, B. Sickle cell anaemia, C. Thalassemia, D. CML", "role": "user" }, { "content": "Answer: A \nExplanation: Hodgkin&;s lymphoma is characterised by the presence of neoplastic giant cells called Reed Sternberg cells.These cells release factors that induce the accumulation of reactive lymphocytes, macrophages, and granulocytes, which typically make up greater than 90% of tumour cellularity. RS cells are derived from the germinal centre or post germinal centre B cells. Reference : Robbins and Cotran Pathologic basis of disease.South Asia Edition volume 1.page no. 607", "role": "assistant" } ]

[ { "content": "16 yr unmarried girl came for vaccination against cervical cancer. Which vaccine to he given: \nSelect and explain. \nA. Gardasil, B. Rabivac, C. Biovac, D. Tvac", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. (A) Gardasil(Ref: Shaw's Textbook of Gynecology 16th Ed; Page No 495)Gardasil is the vaccine of choice in this situation.Other options:Biovac: It is freeze-dried live attenuated vaccine indicated for the prevention of Hepatitis A in persons of age 1 year or older.Rabivac: It is monovalent inactivated rabies vaccine for cats and dogs.Tvac: It is tetanus vaccine.HPV vaccinesHPV vaccines have been developed from the inactivated capsid coat of the virus.HPV vaccines were earlier of two types. During its Feb 2015, meeting Advisory Committee on Immunization Practises (ACIP) recommended 9-valent HPV vaccine (9V HVP) as one of the three vaccines for preventive HPV.CharacteristicBivalent (2V HPV)Quadrivalent (4V HPV)9 Valent (9VHPV)Brand nameCervarixGardasilGardasil-9HPV subtypes16,186,11,16,186, 11, 16, 18, 31, 33, 45, 52, 58Protects againstCIN, Ca cervixAnogenital warts, CIN, Ca cervixAnogenital warts CIN, Ca cervix, vulva intraepithelial neoplasia, vaginal intraepithelial neoplasiaManufacturingTrichoplusia insect line infected with L1 encoding baculovirusSaccharomyces cerevisiae expressing L1Saccharomyces cerevisiaeexpressing L1Adjuvant500 mcg aluminum hydroxide with monophosphoryl lipid A225 mcg Al(OH)PO4 SO4 500 meg Al(OH)PO4 SO4 Dose0.5 mL0.5 mL0.5 mLAdministration1/m1/m1/mAdministered to males or femalesOnly femalesBoth males and femalesBoth males and femalesAge in females Ideal age range11-12 years9-26 years11-12 years9-26 years11-12 years9-26 yearsAge in males Ideal age range---11-12 years9-26 years11-12 years9-15 years--FDA approved9-26 years--ACIP recommendation", "role": "assistant" } ]

[ { "content": "Insulin stimulated glucose entry in seen in- \nSelect and explain. \nA. Cardiac muscles, B. Smooth muscles, C. Brain, D. Intestines", "role": "user" }, { "content": "Answer: A \nExplanation: Insulin stimulated glucose entry in seen in Cardiac muscles. Name Location Features GLUT-1 & GLUT-3 Brain, RBC, placenta Concerned with basal uptake of glucose GLUT-2 Liver, kidney, b-cells of pancreas Allows both entry & release of glucose GLUT-4 Skeletal muscles, adipocytes, cardiac muscles Insulin dependent transpoer GLUT-5 Spermatozoa, testis, intestines Transpos fructose", "role": "assistant" } ]

[ { "content": "Cribriform hymen is seen - \nSelect and explain. \nA. Post paum, B. Septate hymen, C. Sieve hymen, D. Virgin", "role": "user" }, { "content": "Answer: D \nExplanation: Ref: Textbook of Forensic medicine and toxicology (V.V.Pillay) 17th edition, page no.354 Hymen is a thin fold of connective tissue, covered by mucous membranes, about 1 mm in overall thickness, situated at the vaginal orifice. They are of different types. cribriform is one of them, characterized by many small holes. As a result of sexual intercourse, hymen is usually tornfrom posteriorly, with unilateral or bilateral tears extending to the point of its attachment to the vaginal wall. So presence of hymen most probably indicate virginity.", "role": "assistant" } ]

[ { "content": "A 7 year old child with rheumatic heart disease presents with pallor, fever and a palpable spleen. The following investigations would be needed to arrive at a diagnosis except – \nSelect and explain. \nA. Electrocardiogram, B. Echocardiogram, C. Blood culture, D. Urine examination", "role": "user" }, { "content": "Answer: A \nExplanation: None", "role": "assistant" } ]

[ { "content": "In metabolic alkalosis, which Is true about excretion in urine \nSelect and explain. \nA. More of NH3, B. Less of aceto-acetic acid, C. Betahydroxy butyric acid, D. Less ammonia", "role": "user" }, { "content": "Answer: D \nExplanation: The NH3 production is greatly increased in metabolic acidosis and negligible in alkalosis. It is also observed that activity of renal glutaminase is enhanced in acidosis. The NH3 mechanism is a valuable device for the conservation of fixed base. Under normal conditions, 30 to 50 mEq of H+ ions are eliminated per day, by combination with NH3 and about 10 to 30 mEq, as titratable acid, i.e. buffered with PO4. Ammonia Mechanism A third mechanism operates in the distal renal tubule cells, for the elimination of H+ ions and the conservation of Na+, by production of NH3 by the renal tubular epithelial cells. Source of NH3 in Distal Tubular Epithelial Cells 1. NH3 is produced by the hydrolysis of Glutamine by the enzyme Glutaminase which is present in these cells. 2. In addition to above, if the cells require NH3 more *NH3 can also be formed from other amino acids by oxidative deamination by L-amino acid oxidase. *NH3 can also be formed from glycine by glycineoxidase. The NH3 thus formed forms NH+4 ions by combining with H+ ions and NH+4 ions can exchange Na+ ion from NaCl. NH+4 ions formation *NH3 can diffuse into the tubular filtrate and there forms NH+4 ions in combination with H+ ions. *NH3 can combine with H+ ions inside the cells and then NH+4 ions come into tubular filtrate. This probably is not the principal mechanism as NH+4 ions are less SECTION FIVE readily permeable to tubular epithelial cells (Fig. 41.4).Ref: M.N. Chatterjea - Textbook of Biochemistry, 7th edition, page no: 716", "role": "assistant" } ]

[ { "content": "In which of the following condition local excision in rectal carcinoma can not be done? \nSelect and explain. \nA. Within 10 cm of the dentate line, B. Lesion 2.7 cm, C. Involvement of <30% bowel circumference, D. T1 and T2 cancer with lymph node involvement", "role": "user" }, { "content": "Answer: D \nExplanation: Suggested criteria for local excision in rectal cancer: Physical examination Imaging Histology Tumor <3 cm Tumor <30% of bowel circumference Tumor within 15 cm of dentate line Tumor freely mobile Tumor limited to submucosa (T1) No lymph node involvement (N0) Well to moderately differentiated Absence of lymphovascular invasion or perineural invasion No mucinous or signet cell component", "role": "assistant" } ]

[ { "content": "Electron microscopy finding indicating irreversible cell injury is: \nSelect and explain. \nA. Dilation of ER, B. Dissociation of ribosomes from rough ER, C. Flocculent densities in the mitochondria, D. Intact cell membrane", "role": "user" }, { "content": "Answer: C \nExplanation: Irreversible injury is associated morphologically with:- Mitochondrial swelling Plasma membrane damage which forms myelin figures Lysosomal swelling. Large, flocculent, amorphous densities develop in the mitochondrial matrix", "role": "assistant" } ]

[ { "content": "Which of the following excludes painful stimuli from awareness? \nSelect and explain. \nA. Repression, B. Reaction formation, C. Projection, D. Rationalization", "role": "user" }, { "content": "Answer: A \nExplanation: Repression is the defense mechanism which removes painful memories or unacceptable desires away from the consciousness or awareness.", "role": "assistant" } ]

[ { "content": "Risk factor for suicide - \nSelect and explain. \nA. Female sex, B. Unmarried, C. Age 30 years, D. Married", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. is 'b' i.e., Unmarried Causes/Risk factors for suicidePsychiatric disorders : - Depression (most common), alcoholism (2nd me), Drug/Substance dependence, Schizophrenia, Dementia.Physical illness : - Cancer, AIDS, Multiple sclerosis, Head trauma.Psychosocial factors : - Failure in love, marital difficulties, family dispute, illegitimate pregnancy.Biological factors : - Decrease in serotoninOther - Male sex, Age > 40 years. Single (Unmarried, divorced or widowed), previous suicide attempt, social isolation.", "role": "assistant" } ]

[ { "content": "At the level of Arch of aoa, the relationship of left vagus nerve and left phrenic nerve? \nSelect and explain. \nA. Phrenic nerve anterior, vagus nerve posterior, B. Phrenic nerve posterior, vagus nerve anterior, C. Both in same plane anteroposteriorly, D. Variable in relationship", "role": "user" }, { "content": "Answer: A \nExplanation: Phrenic nerve anterior, vagus nerve posterior", "role": "assistant" } ]

[ { "content": "ACE inhibitor contraindicated in which of the following condition: \nSelect and explain. \nA. Bilateral renal artery stenosis, B. Chronic kidney disease, C. Post myocardial infarction, D. Diabetes mellitus", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. (a) Bilateral renal artery stenosisRef. Katzung's pharmacology 10th ed. Ch 11* ACEI inhibits the converting enzyme peptidyl dipeptidase that hydrolyzes angiotensin I to angiotensin II and (under the name plasma kininase) inactivates bradykinin, a potent vasodilator, which works at least in part by stimulating release of nitric oxide and prostacyclin.* Drugs under this class are: Captopril, Enalapril, Lisinopril, Benazepril, fosinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril.* ACE inhibitors have a particularly useful role in treating patients with chronic kidney disease because they diminish proteinuria and stabilize renal function (even in the absence of lowering of blood pressure).* ACE inhibitors have also proved to be extremely useful in the treatment of heart failure, and after myocardial infarction, and* There is recent evidence that ACE inhibitors reduce the incidence of diabetes in patients with high cardiovascular risk.", "role": "assistant" } ]

[ { "content": "Nipple retraction in Ca breast due to infiltration of \nSelect and explain. \nA. Suspensory ligaments, B. Lactiferous ducts, C. Lymphatics, D. Pectoralis fascia", "role": "user" }, { "content": "Answer: B \nExplanation: Answer- B. Lactiferous ductsIt is seen in breast carcinoma due to infltration of the lactiferous ducts by carcinoma.It is due to extention of the growth along the lactiferous ducts and subsequent fibrosis.Nipple retraction is circumferential in carcinoma and slit like in periductal mastitis.", "role": "assistant" } ]

[ { "content": "Regarding spring catarrh, all of the following are true, except: \nSelect and explain. \nA. Cobblestone appearance of conjunctiva, B. Common in spring months, C. Limbus conjunctival thickening, D. Sodium cromoglycate is a form of therapy", "role": "user" }, { "content": "Answer: C \nExplanation: Limbus conjunctival thickening", "role": "assistant" } ]

[ { "content": "All the following malignancies are associated with HIV, except- \nSelect and explain. \nA. Kaposi's Ca., B. Non Hodgkin's lymphoma, C. Astrocytoma, D. Gastric adeno Ca.", "role": "user" }, { "content": "Answer: C \nExplanation: Ans. is 'c' i.e., Astrocytoma Neoplastic disease in AIDS o Kaposi sarcoma (most common tumor) o Non Hodgkin lymphoma Immunoblastic lymphoma (most common lymphoma) Primary CNS lymphoma (associated with EBV) Burkitt's lymphoma Other less common neoplasm are Hodgkin's disease Leukemia Cervical Ca Brain tumor Testicular Ca Multiple myeloma Melanoma Lung Ca Anal Ca Oral Ca o Not sure about option", "role": "assistant" } ]

[ { "content": "Genetic material is transferred from one bacteria to another by all except \nSelect and explain. \nA. Transduction, B. Transformation, C. Transfection, D. Conjugation", "role": "user" }, { "content": "Answer: C \nExplanation: Transfection is the method by which DNA is transferred into eukaryotic cell.", "role": "assistant" } ]

[ { "content": "True about Hodgkin's lymphoma are all except? \nSelect and explain. \nA. Often localized to single axial group of lymph nodes, B. Hepatomegaly is always present, C. Contiguous spread of lymph nodes, D. Can be cured by Chemotherapy and Radiotherapy", "role": "user" }, { "content": "Answer: B \nExplanation: HODGKIN'S LYMPHOMA : - HL arises in lymphoid tissue & spreads to adjacent lymph node areas in a relatively orderly fashion. -Patients commonly present with painless, non-tender, firm, rubbery, cervical or supraclavicular lymphadenopathy and usually some degree of mediastinal involvement. HEPATOSPLENOMEGALY IS A FEATURE BUT NOT ALWAYS PRESENT - Chemotherapy & radiation therapy are both effective in treatment of HL. TREATMENT- A- Adriamycin (Doxorubicin) B - Bleomycin V - Vinblastine D - Dacarbazine", "role": "assistant" } ]

[ { "content": "25 years old female has palatal ulcer and skin blister most likely diagnosis is – \nSelect and explain. \nA. Pemphigus vulgaris, B. Pemphigus foliaceous, C. Dermatitis herpetiformis, D. Pemphigoid", "role": "user" }, { "content": "Answer: A \nExplanation: Skin blister\nOral mucosa involvement (palatal ulcer)", "role": "assistant" } ]

[ { "content": "Concerning contraction of the diaphragm: \nSelect and explain. \nA. The nerves that are responsible emerge from the spinal cord at the level of the lower thorax, B. It tends to flatten the diaphragm, C. It reduces the lateral distance between the lower rib margins, D. It causes the anterior abdominal wall to move in", "role": "user" }, { "content": "Answer: B \nExplanation: When the diaphragm contracts, it becomes flatter The phrenic nerves that innervate the diaphragm come from high in the neck, that is, cervical segments 3, 4, and 5. Contraction of the diaphragm causes the lateral distance between the lower rib margins to increase and anterior abdominal wall to move out. The intrapleural pressure is reduced because the larger volume of the chest cage increases the recoil pressure of the lung.", "role": "assistant" } ]

[ { "content": "Infants of diabetic mothers are likely to have the following cardiac anomaly: \nSelect and explain. \nA. Coarctation of aorta, B. Fallot's tetralogy, C. Ebstein's anomaly, D. Transposition of great arteries", "role": "user" }, { "content": "Answer: D \nExplanation: Ans. is d, i.e. Transposition of great arteriesRef. Fernando Arias 3/e, p 454As VSD is not given in the options, transposition of great vessels is the single best answer.", "role": "assistant" } ]

[ { "content": "Congo red staining of abdominal fat has confirmed a diagnosis of Amyloidosis in a 28-year-old man. Which is the most common cause of death in primary AL Amylodosis? \nSelect and explain. \nA. Respiratory failure, B. Cardiac failure, C. Renal failure, D. Septicemia", "role": "user" }, { "content": "Answer: B \nExplanation: Cardiac failure is the most common cause of death in primary or AL amyloidosis. Cardiac involvement is seen in 40% of patients with AL amyloidosis. Amyloid involvement of myocardium, intramural coronary aeries and conduction system may cause congestive hea failure, ischemic syndrome and rythm disturbances. Diagnosis of amyloidosis should be considered in patients with unexplained nephropathy, cardiomyopathy (diastolic dysfunction), neuropathy, enteropathy, or pathognomonic soft tissue findings of macroglossia or periorbital ecchymoses. Pathologic diagnosis of amyloid fibrils can be made by congo red staining of aspirated abdominal fat or of an involved organ biopsy specimen.", "role": "assistant" } ]