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[ { "content": "All of the following statements about Lupus Anticoagulant are true, EXCEPT: \nSelect and explain. \nA. May present with an isolated prolongation ofAPTT, B. May present with Recurrent Aboions, C. May occur with minimal clinical manifestations, D. Thrombotic spells can be followed by severe life threatening hemorrhage", "role": "user" }, { "content": "Answer: D \nExplanation: Catastrophic Life threatening Antiphospholipid Syndrome results from rapid onset thrombosis and ischemia in multiple organ systems and not from severe bleeding. However such bleeding episodes are rare after thrombotic spells even with severe thrombocytopenia, not leading to life threatening hemorrhage and occur as a result of consumptive thrombocytopenia. Hemorrhage is rarely associated with Lupus anticoagulant. Ref: Hematological Complications in Obstetrics, Pregnancy and Gynecology By Rodger. L. Bick, Pages 150-152; Quality in Laboratory Hemostasis and Thrombosis By Steve Kitchen, Chapter 16;The Lupus Book: A Guide for Patients and Their Families By Daniel J. Wallace, 4th Edition, Chapter 21", "role": "assistant" } ]

[ { "content": "CT scan abdomen at the level of the twelfth thoracic veebra in a pt., Which structure provides an attachment of the suspensory muscle of the duodenum (ligament of Treitz)? \nSelect and explain. \nA. A, B. B, C. C, D. D", "role": "user" }, { "content": "Answer: B \nExplanation: The duodenojejunal flexure is suppoed by a fibromuscular band called the suspensory ligament of the duodenum (ligament of Treitz), which is attached to the right crus of the diaphragm. C. - The pancreas is an endocrine and exocrine gland; is retroperitoneal in position and receives blood from the splenic, gastroduodenal, and superior mesenteric aeries. E - The spleen lies in the left hypochondriac region, is hematopoietic in early life, and later functions in worn-out red blood cell destruction. It filters blood, stores red blood cells, and produces lymphocytes and antibodies. D - The splenic aery is a branch of the celiac trunk, follows a touous course along the superior border of the pancreas, and divides into several branches that run through the lienorenal ligament. A -. The common hepatic aery is divided into the proper hepatic and gastroduodenal aeries.", "role": "assistant" } ]

[ { "content": "Best method of treatment of ulner never abscess in case of leprosy is - \nSelect and explain. \nA. High does of steroid, B. incision and drainage, C. Thalidomide, D. High does of clofazamine", "role": "user" }, { "content": "Answer: B \nExplanation: Best method to treat ulnar nerve abscess is incision and drainage. folowed by treatment with coicosteroids and mbmdt iadvl textbook of dermatology page 2091", "role": "assistant" } ]

[ { "content": "Most common cause of sho stature is: \nSelect and explain. \nA. Constitutional, B. Hypothyroidism, C. Growth hormone deficiency, D. Systemic illness", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. A: Constitutional The causes of sho stature can be divided into 3 broad categories: Chronic disease (including undernutrition genetic disorders) Familial sho stature Constitutional delay of growth and development (commoner) Endocrine diseases are rare causes of sho stature. The hallmark of endocrine disease is linear growth failure that occurs to a greater degree than weight loss.", "role": "assistant" } ]

[ { "content": "Berkesonian bias in a case control study is a bias due to: \nSelect and explain. \nA. Presence of confounding factors, B. Different admission rates for different diseases, C. Bias introduced by investigator, D. Patient can not recall or gives false information", "role": "user" }, { "content": "Answer: B \nExplanation: None", "role": "assistant" } ]

[ { "content": "Frozen section is/are used for all except \nSelect and explain. \nA. Enzyme, B. Intraop Histopathological examination, C. Fat, D. Acid fast bacilli", "role": "user" }, { "content": "Answer: D \nExplanation: Frozen section Biopsy Biopsy technique in pathology laboratories for making urgent on-table diagnosis Frozen section biopsy is a procedure done in a pathological setup existing adjacent to the operation theatre Surgeons are the main users of this service Procedure An unfixed fresh tissue is frozen (using CO2 to - 25degC) and section are made and stained Uses of Frozen section Biopsy It is quick and surgeon can decide the fuher steps of procedure in the same sitting like nodal clearance /type of resection to be done During surgery after resection of the tumor to look for (on table) the clearance in margin and depth, also to study the lymph nodes for their positivity. Used for demonstration of ceain constituents which are lost in processing with alcohol or xylene, eg: Fat, enzyme Ref: Bailey and love 25th edition Pgno : 169-170", "role": "assistant" } ]

[ { "content": "Which of the following condition is associated with Osmotic diarrhoea? \nSelect and explain. \nA. Lactase deficiency, B. Ulcerative sprue, C. Surreptitious ingestion of laxatives, D. Endocrine tumors", "role": "user" }, { "content": "Answer: A \nExplanation: Clinical causes of osmotic diarrhea that causes an osmolar gap greater than 50 includes lactase deficiency, sorbitol foods, saline cathaics and antacids. Osmotic diarrhea occur when water soluble molecules are poorly absorbed, remain in the intestinal lumen and retain water in the intestine. It usually follows ingestion of osmotically active substances. In this, Stool volume is less than 1 litre /day Diarrhea stops with fasting Stool has an osmolar gap (normal stool osmolar gap is less than 50) Ref: Mayo Clinic Internal Medicine Review, Eighth Edition edited by M. Habermann Thomas, page 262.", "role": "assistant" } ]

[ { "content": "WHO recommended regime for the treatment of Brucella infection is ? \nSelect and explain. \nA. Streptomycin with doxycycline, B. Rifampicin with doxycycline, C. Rifampicin with ciprofloxacin, D. Streptomycin with erythromycin", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. is 'b' i.e., Rifampin with doxycyclinelRef : Harrison 18n/e p. 1299,1672 & I4/e p. 1268).The gold standard for the treatment of brucellosis in adults is IM streptomycin (0.75-1 g daily for 14-21 days) together with doxycycline (100 mg twice daily for 6 weeks).In both clinical trials and observational studies, relapse follows such treatment in 5-10 % of cases.The usual alternative regimen (and the current World Health Organization recommendation) k rifampin (600-9{n mg/it) plus doxycycline (100 mg twice daily) for 6 weeks.", "role": "assistant" } ]

[ { "content": "'Rosette cataract' is caused by: \nSelect and explain. \nA. Diabetes, B. After cataract, C. Trauma, D. Gaucher's disease", "role": "user" }, { "content": "Answer: C \nExplanation: Ans. c (Trauma) (Ref: Parson's Disease of Eye 19th/pg. 283; Basak Ophthalmology 2nd/pg. 82, 305).CATARACTContusion cataractContusion of the eyeball will produce a rosette-shaped subcapsular opacity on the anterior surface of the lens. It will normally remain unchanged but will migrate into the deeper cortex over time due to the apposition of new fibers.Lamellar (Zonular) cataractIt is the most common developmental cataract.Opacities are located in one layer of lens fibers, often as \"riders\" only in the equatorial region.Nuclear cataractIn the fourth decade of life, the pressure of peripheral lens fiber production causes hardening of the entire lens, especially the nucleus. The nucleus takes on a yellowish brown color (brunescent nuclear cataract). This may range from reddish brown to nearly black discoloration of the entire lens (black cataract). Nuclear cataracts develop very slowly. Due to the lenticular myopia, near vision (even without eyeglasses) remains good for a long time.Cortical cataractNuclear cataracts are often associated with changes in the lens cortex. It is interesting to note that patients with cortical cataracts tend to have acquired hyperopia in contrast to patients with nuclear cataracts, who tend to be myopic.# Berlin's edema (commotio retinae) is a condition caused by blunt injury to the eye. Berlin's edema is an acute traumatic maculopathy characterized by retinal opacification. Histopathologic studies have shown that it is characterized by disruption of photoreceptor outer segments and retinal pigment epithelial damage. OCT an effective tool for management of patients with posterior segment trauma. OCT is more comfortable for the traumatized patient than other imaging techniques because it is a non-contact method utilizing infrared illumination. OCT is also highly sensitive in identifying subtle anatomic changes.Educational points: CataractFeatureAfter-cataract (Post cap opacity)Elschnig pearl & Rings of SoemerringsBrown/Cataract brunescensNuclear/hard cataractBlack cataract/Cataract nigransNuclear/hard cataractBlue dot cataract (Punctate)Most common congenital cataractComplicated cataract'Bread crumb' appearanceConcussion cataract'Rossete-shaped' cataractCoronary cataractDevelopmental cataract at pubertyChalcosisSunflower cataractDiabetic cataract'Snow flake/storm' appearanceHypermature senile cataractMorgagnian cataractLamellar/ZonularRidersMyotonic dystrophyCataract with polychromatic dots (\"Christmas-tree\")", "role": "assistant" } ]

[ { "content": "Cork screw esophagus in barium swallow is seen in: \nSelect and explain. \nA. Achalasia cardia, B. Esophageal cancer, C. Diffuse esophageal spasm, D. Diverticulum", "role": "user" }, { "content": "Answer: C \nExplanation: Ans: C (Diffuse esophageal spasm) Ref: Sc ibis ion Textbook of Surgery, 19th Edition 1028Explanation:Diffuse Esophageal spasmHyper motili ty di sorderRepetitive, simultaneous, and of high amplitude esophageal contractionsMotor abnormality of the esophageal body that is more in the lower two thirds.Muscular hypertrophy and degeneration of the branches of the vagus observed.Clinical featuresChest pain and dysphagiaSqueezing pressure in the chest that may radiate to the jaw, arms, and upper back mimicking anginaSymptoms are more during times of emotional stress.Regurgitation of esophageal contents and saliva common.DiagnosisBy esuphagraphy and manometric studiesBarium swallow - Corkscrew esophagus or pseudodiverticulosis due to the presence of tertiary contractionManometrySimultaneous multipeaked contractions of high amplitude (>120 mm Hg> or long duration (>2.5 seconds)Due to spontaneous contractions and intermittent normal peristalsis, standard manometry mayNot be enough to identify DES.An ambulatory manometry has sensitivity of 90% and a specificity of 100% and is preferred.ManagementPharmacologic or endoscopic treatment preferredAll patients require psychiatric evaluationPharmacotherapyNitrates,Calcium channel blockersAnticholinergicsRelative efficacy of each of the drugs not clearEndoscopic managementBougie dilation of the esophagus up to 50 or 60 Fr provides relief for severe dysphagia and is 70% to 80% effective.Botulinum toxin injections have also been triedSurgeryIndicationsPatients with incapacitating chest pain or dysphagia who have failed medical and endoscopic therapyPresence of a pulsion diverticulum of the thoracic esophagus.ProcedureA long esophagomyotomy is performed through a left thoracotomy or a left video-assisted technique.Dor fundoplication - to prevent healing of the myotomy site and provide reflux protectionNote:Barium Swallow appearance of Carcinoma esophagus - Rat tail appearaneeBarium Swallow appearance of Achalasia - Bird's Beak appearance due to dilated esophagus with a distal narrowingGold standard for diagnosing Achalasia - Esophageal manometry.", "role": "assistant" } ]

[ { "content": "Infant with cystic fibrosis (CF) are likely to develop \nSelect and explain. \nA. Meconium ileus, B. Loose motions, C. Vomiting, D. Constpation", "role": "user" }, { "content": "Answer: A \nExplanation: The common clinical presentations include meconium ileus in neonatal period,recurrent bronchiolitis in infancy and early childhod,recurrent respiratory tract infections ,chronic lung disease , bronchiectasis, steatorrhoea,with incresing age pancreatitis and azoospermia. Ref : Essential pediatrics,O.P.Ghai,7 th edition ,pg no:36", "role": "assistant" } ]

[ { "content": "The stabbing nature of pain in trigeminal neuralgia mimics pain caused by \nSelect and explain. \nA. A cracked tooth, B. Acute reversible pulpitis, C. Acute irreversible pulpitis, D. Acute apical periodontitis", "role": "user" }, { "content": "Answer: A \nExplanation: None", "role": "assistant" } ]

[ { "content": "Which of the following indicates radiograph contrast induced nephropathy? \nSelect and explain. \nA. Increased creatinine levels, B. Decreased urine output, C. Increased bilirubin, D. Decreased bilirubin", "role": "user" }, { "content": "Answer: A \nExplanation: Ans.Increased creatinine levels", "role": "assistant" } ]

[ { "content": "In postductal coarctation of aoa, collaterals may be formed by all of the following, except \nSelect and explain. \nA. Veebral aery, B. Suprascapular aery, C. Subscaular aery, D. Posterior Intercostals aery", "role": "user" }, { "content": "Answer: A \nExplanation: In post-ductal coarctation of the aoa, an extensive collateral circulation develops involving the branches of subclan & axillary aeries with the distal aeries given by aoa Veebral aery does not play a significant role in this collateral circulation. Ref: Gray's 40e/p984", "role": "assistant" } ]

[ { "content": "Which of the following is not a true association of thymoma ? \nSelect and explain. \nA. Myasthenia gravis may be seen, B. Hypergrammaglobulinemia, C. Pure red cell aplasia, D. Superior mediastinal compression syndrome", "role": "user" }, { "content": "Answer: B \nExplanation: The usual association is hypogamaglobuthemia not hyperglobulinemia.", "role": "assistant" } ]

[ { "content": "Which of the following statements about the pathology in Alzheimer's disease is not true: \nSelect and explain. \nA. Neuritic Plaques are formed of amyloid protein, B. Neurofibrillary tangles (NFT) are made of tau protein, C. NFTs appear extracellularly before intracellular appearance, D. Number of NFTs correlates with dementia", "role": "user" }, { "content": "Answer: C \nExplanation: Answer is C (NFTs appear extracellularly before intracellular appearance):NFTs are typically seen intracellularly within the soma and proximal dendrites of neurons. Neurofibrillary Tangles (NFTs) are intracellular accumulations of hyperphosphorylated 'tau' proteins.Neurofibrillary Tangles are Intracellular AccumulationsNeurofibrillary Tangles are intracellular accumulations of hyperphosphorylated microtubule binding protein 'tau'.Paired helical filaments of tau protein (NFTs) form intracellularly within the soma and proximal dendrites of neurons.These cytoskeletal protein tangles (NFTs), initially impede cellular metabolism and axosplasmic transpo leading to impaired synaptic function and eventually to neuronal death.These neurofibrillaty tangles may be seen as extracellular tangles after degeneration of the neuron as evidence of the neuronal cell's demiseNeurofibrillary Tangles are intracellular accumulations that may appear extracellularly alter degeneration of neuron (neuronal death)Histopathological Hallmarks of Alzheimer's DiseaseAmyloid Plaques (Extracellular)Amyloid Neuritic Plaques are formed by extracellular accumulation of beta amyloid deposits within the neutropil'Neuritic' or 'Senile' I3-amyloid plaques are an early histopathological sign of Alzheimer's disease (that occur rarely in healthy subjects)The amyloid 13-protein accumulated in single neuritic plaques is toxic to surrounding structures and adjacent neurons.Clinicopathological studies have shown that amy/aid burden does not directly correlate with severity or duration of dementia.Neurofibrillary Tangles (Intracellular)Neurofibrillary tangles arc formed by intracellular accumulation of hyperphosphorylated microtubule binding protein 'tau'.NFT's occur in many neurodegenerative diseases and /or a group of diseases called laupathies'.These include Frontotemporal dementia, Pick's disease etc. The cooccurance of fi-amyloid plaques with NFT's suggests a diagnosis of AD.The NFT's are toxic to the neurons and neurons with NFT's eventually die and degenerate leaving a residual `ghost tangle', in the extracellular space reminding of the pyramidal cell body in which it was initially formed.Clinicopathological studies have shown that dementia correlates more strongly with NFT's than with senile plaques (3-amyloid)", "role": "assistant" } ]

[ { "content": "Senescent RBC's are mainly attacked in- \nSelect and explain. \nA. Vivax malaria, B. Ovale malaria, C. Falciparum malaria, D. Quartan malaria", "role": "user" }, { "content": "Answer: D \nExplanation: P. malariae which attacks mainly senescent (old) RBC’s: Agent of Quartan malaria\nP. ovale and P. vivax: attack younger RBCs and reticulocytes: Agent of benign tertian malaria\nP. falciparum: attacks RBC of all ages: Agent of malignant tertian malaria.", "role": "assistant" } ]

[ { "content": "In depression, there is deficiency of : \nSelect and explain. \nA. 5–HT, B. Acetylcholine, C. Dopamine, D. GABA", "role": "user" }, { "content": "Answer: A \nExplanation: None", "role": "assistant" } ]

[ { "content": "Which of the following is spared in modified radical mastectomy (MRM)? \nSelect and explain. \nA. Pectoralis major, B. Pectoralis minor, C. Axillary lymph nodes, D. Nipple", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. a (Pectoralis major). (Ref. Bailey & Love Surgery, 25th ed., 842)MASTECTOMY is now only strictly indicated for large tumors, central tumor beneath or involving nipple, multifocal disease, and local recurrence or for patient preference.Simple mastectomyRadical mastectomy (Halsted)Modified radical Mastectomy (Patey's)# Only breast & Axillary tail of breast# Breast# Axillary lymph nodes# Pectoralis major# Pectoralis minor# Whole breast# Large portion of skin including nipple# Dissection of axilla# All fat, fascia & lymph nodes of axilla.# Pectoral minor either divided or retracted# Intercostal brachial nerves divided.STRUCTURES SPARED IN MRM1. Pectoralis major2. Axillary vein3. Nerve to serratus anterior & latissimus dorsiEducational points:# Conservative breast cancer surgery is QUART (Quadrantectomy Axillary Dissection & RT).# Sentinel node biopsy localized by radionuclide scan or by injection of patent blue dye.# Reconstruction materials:- Silicone gel,- Musculocutaneous Flaps {TRAM gives best cosmetic results)", "role": "assistant" } ]

[ { "content": "Painless effusion in congenital syphilis is called \nSelect and explain. \nA. Clutton joints, B. Baon joints, C. Chanrcot joinst, D. None of the above", "role": "user" }, { "content": "Answer: A \nExplanation: Skeletal manifestations of congenital syphilis Clutton's joints - Painless sterile effusions in the knees or elbows Parrot's joints - Effusion with epiphysitis and epiphyseal separation Erosion of the nasal boneThickening and expansion of the finger phalanges (dactylitis) Higoumenaki's sign - Bilateral enlargement of sternal end of the clavicle Saber tibia, Scaphoid scapula (Refer: Mohindra's Fundamentals of Ohopedics, 2nd edition, pg no. 291)", "role": "assistant" } ]

[ { "content": "Normal adult person's blood contains: \nSelect and explain. \nA. 40% neutrophils, B. 30% lymphocytes, C. 20% eosinophils, D. 10% basophils", "role": "user" }, { "content": "Answer: B \nExplanation: None", "role": "assistant" } ]

[ { "content": "Port wine stain of the face, seizures, hemiparesis, intracranial calcification and glaucoma are features of? \nSelect and explain. \nA. Neurofibromatosis, B. Tuberous sclerosis, C. Sturge-Weber syndrome, D. VHL", "role": "user" }, { "content": "Answer: C \nExplanation: Ans. c (Sturge-Weber syndrome) (Ref. Harrison's medicine 17th/Chapter 379; IADVL 2nd/ pg l68)PHAKOMATOSES (NEUROCUTANEOUS SYNDROMES = NEUROECTODERMAL DYSPLASIAS)# Autosomal dominant:- Neurofibromatosis (von Recklinghausen synd)# Not autosomal dominant:- Encephalotrigeminal angiomatosis (Sturge-Weber synd)- Tuberous sclerosis (Bourneville synd)- Retinocerebellar hemangioblastoma (VHL synd)- Neurocutaneous melanosis- Ataxia-telangiectasiaSTURGE-WEBER SYNDROME (ENCEPHALOTRIGEMINAL ANGIOMATOSIS)# Classical triad:- Facial portwine stain in distribution of VI (trigeminal nerve), present at birth and unilateral; may cross midline.- Mentral retardation- Seizures# Ocular features:- Ipsilateral glaucoma,- Buphthalmos,- Strabismus and- Loss of vision,# CT SCAN:- \"Tram-track\" or S-shaped intracranial calcifications, seen after the age of 2 years.- Ipsilateral Choroid plexus and venous angiomas with leptomeningeal angiomatoses over the parietoccipital lobes.VON HIPPEL-LINDAU DISEASE# Mutation of the von Hippel-Lindau (VHL) gene on chromosome 3p, a tumor-suppressor gene, causes this disorder.# Associated tumors:- Hemangioblastomas (Erythropoietin producing) - cerebellum, retina, medulla, spinal cord- Renal cysts 60%; Pancreatic, epididymis, or liver cysts- Renal cell carcinoma 45%- Pheochromocytoma (NIH Type 2a or 2b)- Islet cell tumors; Endolymphatic sac tumors; Serous adenomasTUBEROUS SCLEROSIS (BOURNEVILLPS DISEASE)# Autosomal dominant# Classical clinical triad of = EPIlepsy, LOw IQ, Adenoma sebaceum (EPDLOIA).# 'Ash leaf' macule - the earliest cutaneous sign & results in poliosis (circumscribed patch of gray-white hair)# Hamartomas involving many organs# Cardiac rhabdomyomas# Angiomyolipomas of kidneys, liver, adrenals, and pancreas (Angiomyolipomas are the most common renal abnormality, occur bilaterally, are often multiple, and are usually asymptomatic)# Brain -- periventricular subependymal nodules- Cortical tubers- 15% develop subependymal giant cell astrocytoma (SEGA) - the foramen Munro tumor# Lungs - LAM (Lymphangioleomyomatosis) and pulmonary interstitial fibrosisNEUROFIBROMATOSIS TYPE 1 (VON RECKLINGHAUSEN'S DISEASE)# NF1 is characterized by cutaneous neurofibromas, pigmented lesions of the skin called cafe au lait spots, freckling in non-sun-exposed areas such as the axilla, hamartomas of the iris (Lisch nodules), and pseudoarthrosis of the tibia.# Neurofibromas present as multiple, palpable, rubbery, cutaneous tumors.# Aqueductal stenosis (hydrocephalus), scoliosis, short stature, hypertension, epilepsy, & mental retardation may occur.# Patients with NF1 are at T risk of developing nervous system neoplasms, including plexiform neurofibromas, optic pathway gliomas, ependymomas, meningiomas, astrocytomas, and pheochromocytomas.# Mutation of NF1 gene on chromosome 17 causes von Recklinghausen's disease. The NF1 gene is a tumor-suppressor gene; it encodes a protein, neurofibromin, which modulates signal transduction through the ras GTPase pathway.NEUROFIBROMATOSIS TYPE 2 (MISME Complex)# bilateral vestibular schwannomas in >90% of individuals who inherit the gene.# Predisposition for the development of Meningiomas, gliomas, and Schwannomas of cranial and spinal nerves.# In addition, a characteristic type of cataract, juvenile posterior subcapsular lenticular opacity, occurs in NF2.# Multiple cafe au lait spots and peripheral neurofibromas occur rarely.# This syndrome is caused by mutation of the NF2 gene on chromosome 22q; NF2 encodes a protein called neurofibromin 2, schwannomin, or merlin, with homology to a family of cytoskeletal proteins that includes moesin, ezrin, and radixin.", "role": "assistant" } ]

[ { "content": "Cis atracurium is better then atracurium because:- \nSelect and explain. \nA. Less histamine release, B. Less half life, C. Low drug dose, D. Low cost", "role": "user" }, { "content": "Answer: A \nExplanation: Atracurium Cis-atracurium Mixture of cis-isomers Pure cis-isomer Histamine release No / minimal release CVS unstable CVS stable Less potent Dose - 0.5-0.6mh/kg More potent Dose - 0.1-0.2 mg/kg - Cis-atracurium and atracurium are dependent on Hoffman elimination - Cis-atracurium's duration of action is more predictable because of spontaneous breakdown. Although atracurium undergoes similar elimination, it is less potent than cis-atracurium, so its breakdown product, laudanosine, is found in higher concentrations", "role": "assistant" } ]

[ { "content": "Kanagawa's phenomenon is seen in ? \nSelect and explain. \nA. Pseudomonea aeuroginosa, B. Vibrio parahemolyticus, C. Shigella sonie, D. Proteus mirabilis", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. is 'b' i.e., Vibrio parahemolyticus Strains of vibrio parahemolyticus isolated from patients are always hymolytic on Wagatsuma agar, while strains from environmental sources are always non-hemolytic. This linkage of enteropathogenicity to ability of hemolysis on Wagatsuma agar is called Kanagawa's phenomenon.", "role": "assistant" } ]

[ { "content": "The following are attributes of hepatitis B infection except - \nSelect and explain. \nA. Establishes chronic infections in those infected as infants, B. HBcAg in serum indicate active infection, C. Can cause hepatocellular carcinoma, D. Alpha interferon is used for the treatent of chronic infection", "role": "user" }, { "content": "Answer: B \nExplanation: Hepatitis B may cause an acute viral hepatitis; however, acute infection is often asymptomatic, paicularly when acquired at bih. Many individuals with chronic hepatitis B are also asymptomatic. The risk of progression to chronic liver disease depends on the source and timing of infection . Veical transmission from mother to child in the perinatal period is the most common cause of infection worldwide and carries the highest risk of ongoing chronic infection. In this setting, adaptive immune responses to HBV may be absent initially, with apparent immunological tolerance. Several mechanisms contribute towards this: Firstly, the introduction of antigen in the neonatal period is tolerogenic. Secondly, the presentation of such antigen within the liver, as described above, promotes tolerance; this is paicularly evident in the absence of a significant innate or inflammatory response. Finally, very high loads of antigen may lead to so-called 'exhaustion' of cellular immune responses. The state of tolerance is not permanent, however, and may be reversed as a result of therapy, or through spontaneous changes in innate responses, such as interferon alpha (IFN-a) and NK cells, accompanied by host-mediated immunopathology. Chronic hepatitis can lead to cirrhosis or hepatocellular carcinoma, usually after decades of infection . Chronic HBV infection is a dynamic process that can be divided into five phases ; these are not necessarily sequential, however, and not all patients will go through all phases. It is impoant to remember that the virus is not directly cytotoxic to cells; rather, it is an immune response to viral antigens displayed on infected hepatocytes that initiates liver injury. This explains why there may be very high levels of viral replication but little hepatocellular damage during the 'immune-tolerant' phase. Hepatitis B core antigen Hepatitis B core antigen (HBcAg) is not found in the blood, but antibody to it (anti-HBc) appears early in the illness and rapidly reaches a high titre, which subsides gradually but then persists. Anti-HBc is initially of IgM type, with IgG antibody appearing later. Anti-HBc (IgM) can sometimes reveal an acute HBV infection when the HBsAg has disappeared and before anti-HBs has developed Ref Davidson edition23rd pg 874", "role": "assistant" } ]

[ { "content": "MMR. vaccination is given at- \nSelect and explain. \nA. Bih, B. 6th month, C. One year, D. 11/2 years", "role": "user" }, { "content": "Answer: D \nExplanation: Ans. is 'd' i.e., 11/2 years o See IAP vaccination schedule.", "role": "assistant" } ]

[ { "content": "Which of the following has a normal level of alpha-fetoprotein value in serum? \nSelect and explain. \nA. Ovarian dysgerminoma, B. Hepatoblastoma, C. Embroynal carcinoma, D. Yolk sac tumours", "role": "user" }, { "content": "Answer: A \nExplanation: None", "role": "assistant" } ]

[ { "content": "Which bacteria acts by inhibiting protein synthesis- \nSelect and explain. \nA. Pseudomonas, B. Staphylococcus, C. Streptococcus, D. Klebsiella", "role": "user" }, { "content": "Answer: A \nExplanation: None", "role": "assistant" } ]

[ { "content": "Which of the following inducing agent produces cardiac stability? \nSelect and explain. \nA. Etomidate, B. Ketamine, C. Halothane, D. Thiopentone", "role": "user" }, { "content": "Answer: A \nExplanation: Etomidate \nIt is another induction anaesthetic (0.2- 0.5 mg/kg) which has a briefer duration of action  (4-8 min).\nthan thiopentone; produces little cardiovascular and respiratory depression, but motor restlessness and rigidity is more prominent as are pain on injection or nausea and vomiting on recovery. It is a poor analgesic and has not found much favour ,except for patients with compromised cardiovascular status. \nReference: Essentials of Medical Pharmacology Eighth Edition KD  TRIPATHI  page no 410", "role": "assistant" } ]

[ { "content": "Weight range of adrenal glands in most of cases of cushing's disease is - \nSelect and explain. \nA. 4-11gm, B. 11-13 gm, C. 14-24 gm, D. 25-40 gm", "role": "user" }, { "content": "Answer: D \nExplanation: Ans. is 'd' i.e., 25-40 gm o The weight of adrenal gland depends on the cause of cushing syndrome : ? Due to ACTH production by pituatory microadenoma (cushing disease) or by ectopic ACTH production. o ACTH stimulates the zona reticularis and zona fasciculata which results in either diffuse hyperplasia (25-40 gm) or nodular hyperplasia (30-50 gm) of adrenal. Primary pituitary adenoma Weight is less than 30 gm. Primary pituitary carcinoma -4 Weight is 200-300 gm. Exogenous glucocoicoid administration o Exogenously administered glucocoicoids inhibit the release of ACTH from pituitary by negative feed back mechanism. o So, there is no stimulatory signal on zona fasciculata and zona reticularis --> Both these layers undergo atrophy. o As zona glomerulosa function is independent of ACTH, its thickness remains normal. o Due to atrophy the weight of the gland is less than normal, i.e., < 4 gm.", "role": "assistant" } ]

[ { "content": "Which of the following aery is not a terminal branch of coeliac trunk ? \nSelect and explain. \nA. common hepatic aery, B. left gastric aery, C. splenic aery, D. gastroduodenal aery", "role": "user" }, { "content": "Answer: D \nExplanation: The coeliac trunk arises from the front of the abdominal aoa just below the aoic opening of the diaphragm at the level of the disc between veebrae thoracic twelve and first lumbar. The trunk is only about 1.25 cm long. It ends by dividing into its three terminal branches, namely the left gastric, hepatic and splenic aeries. Ref : B D Chaurasia's Human Anatomy ,seventh edition , volume 2 , pg. no., 302 ( fig. 21.3 to 21.5 ).", "role": "assistant" } ]

[ { "content": "Most reliable method of diagnosing pulmonary embolism is: September 2004 \nSelect and explain. \nA. Plain skiagram, B. Perfusion, C. Electrocardiography, D. Angiography", "role": "user" }, { "content": "Answer: D \nExplanation: Ans. D i.e. Angiography Pulmonary angiography has been now replaced by CT and MR angiography", "role": "assistant" } ]

[ { "content": "One of the earliest symptoms of Vit. A deficiency is: \nSelect and explain. \nA. Nyctalopia, B. Xerophthalmia, C. Bitot's spot, D. Keratomalacia", "role": "user" }, { "content": "Answer: A \nExplanation: Deficiency manifestations of Vitamin A: \n\nNight blindness (nyctalopia) is one of the earliest symptoms of vitamin A deficiency. \nThe individuals have difficulty to see in dim light since the dark adaptation time is increased.\nProlonged deficiency irreversibly damages a number of visual cells.\nSevere deficiency of vitamin A leads to xerophthalmia. This is characterized by dryness in conjunctiva and cornea, and keratinization of epithelial cells. \nIn certain areas of conjunctiva, white triangular plaques known as Bitot's spots are seen.\nlf xerophthalmia persisits for a long time, corneal ulceration and degeneration occur. \nThis results in the destruction of cornea ,a condition referred to as keratomalacia, causing total blindness\nVitamin A deficiency blindness is mostly common in children of the developing countries\n\nKey Concept:\nNight blindness (nyctalopia) is one of the earliest symptoms of vitamin A deficiency.\nRef : Textbook of Biochemistry, Satyanarayana", "role": "assistant" } ]

[ { "content": "How long after completion of root of primary tooth ; root of primary tooth start to resorb \nSelect and explain. \nA. 1 year approx, B. 2 year approx, C. 3 year approx, D. 4 year approx", "role": "user" }, { "content": "Answer: C \nExplanation: None", "role": "assistant" } ]

[ { "content": "Chediak-Higashi syndrome is characterized by \nSelect and explain. \nA. Defects in phagolysosome function, B. Defects in macrophage production, C. Defects in leukocyte adhesion, D. Defects in microbicidal activity", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. a (Defects in phagolysosome function) (Ref. H - 17th/pg. Table 61-4)CHRONIC GRANULOMATOUS DISEASEChronic Granulomatous Disease presents before the age of 2 and can be transmitted through X-linked or autosomal pattern of inheritance. The defect lies in the inability to generate oxidative burst to kill organisms after being phagocytosed. The neutrophils lack enzyme NADPH oxidase, which plays an important role in production of microbicidal oxygen radicles. In the lab, the diagnosis can be confirmed through Nitro blue Tetrazolium reduction dye test, which will be negative. B cell and T cell functions are normal. Recurrent infections with catalase producing organisms are common. The NBT test is a measure of the respiratory burst in neutrophils and is used to screen for CGD. Neutrophils will reduce the dye NBT, a clear yellow water-soluble compound, to formazan upon stimulation of the respiratory burst. Formazan thus forms precipitates as a dark blue granular substance, which remains trapped in the cytoplasm. Patients with CGD lack a component of the oxidase system, which produces super oxide anion and thus cannot reduce NBT to formazan. Results are interpreted as follows: Normal (positive test) - cells with an orange-red nucleus and blue cytoplasm; Abnormal (negative test) - cells with an orange-red nucleus and colorless cytoplasm.Phagocytic cell deficiency:Leukocyte adhesion deficiency syndrome (type 1): Defect in LFA-1 integrin proteins on phagocytes. Presents early with recurrent bacterial infections, absent pus formation, and delayed separation of umbilicus.Chediak-Higashi disease:Autosomal recessive. Defect in microtubular function and lysosomal emptying of phagocytic cells. Presents with recurrent pyogenic infections by staphylococci and streptococci, partial albinism, and peripheral neuropathy.Chronic granulomatous disease:Defect in phagocytosis of neutrophils owing to lack of NADPH oxidase activity or similar enzymes. Presents with marked susceptibility to opportunistic infections with bacteria, especially S. aureus, E. coli, and Aspergillus. Diagnosis confirmed with negative nitroblue tetrazolium dye reduction test. Rx:Gamma Interferon.Inherited Disorders of Phagocyte Function: Differential FeaturesClinical manifestationsCellular or molecular defectsDiagnosisChronic Granulomatous Diseases (70% X-linked, 30% Autosomal Recessive)Severe infections of skin, ears, lungs, liver, and bone with catalase-positive microorganismsSuch as S. aureus, BurkholderiaChromobacterium violaceum; often hard to culture organism; excessive inflammation with granulomas, frequent lymph node suppuration; granulomas can obstruct GI or GU tracts; gingivitis, aphthous ulcers, seborrheic dermatitisNo respiratory burst due to the lack of one of four NADPH oxidase subunits in neutrophils, monocytes, and eosinophilsNBT or DHR test; no superoxide and H2O2 production by neutrophils; immunoblot for NADPH oxidase components; genetic detectionChediak-Higashi Syndrome(Autosomal Recessive)Recurrent pyogenic infections, especially with S. aureus; many patients get lymphoma-like illness during adolescence; periodontal disease; partial oculocutaneous albinism, nystagmus, progressive peripheral neuropathy, mental retardation in some patientsReduced chemotaxis and phagolysosome fusion, increased respiratory burst activity, defective egress from marrow, abnormal skin window; defect in LYSTGiant primary granules in neutrophils and other granule-bearing cells (Wright's stain); genetic detectionSpecific Granule Deficiency(Autosomal Recessive)Recurrent infections of skin, ears, and sinopulmonary tract; delayed wound healing; decreased inflammation; bleeding diathesisAbnormal chemotaxis, impaired respiratory burst and bacterial killing, failure to upregulate chemotactic and adhesion receptors with stimulation, defect in transcription of granule proteins; defect in C/EBPLack of secondary (specific) granules in neutrophils (Wright's stain), no neutrophil- specific granule contents (i.e., lactoferrin), no defensins, platelet granule abnormality; genetic detectionMyeloperoxidase Deficiency(Autosomal Recessive)Clinically normal except in patients with underlying disease such as diabetes mellitus; then candidiasis or other fungal infectionsNo myeloperoxidase due to pre- and posttranslational defectsNo peroxidase in neutrophils; genetic detectionLeukocyte Adhesion DeficiencyType 1: Delayed separation of umbilical cord, sustained neutrophilia, recurrent infections of skin and mucosa, gingivitis, periodontal diseaseImpaired phagocyte adherence, aggregation, spreading, chemotaxis, phagocytosis of C3bi-coated particles; defective production of CD18 subunit common to leukocyte integrinsReduced phagocyte surface expression of the CD18-containing integrins with monoclonal antibodies against LFA-1 (CD18/CD11a), Mac-1 or CR3 (CD18/CD11b), pl50,95 (CD1S/ CD11c); genetic detectionType 2: Mental retardation, short stature, Bombay (hh) blood phenotype, recurrent infections, neutrophiliaImpaired phagocyte rolling along endotheliumReduced phagocyte surface expression of Sialyl-Lewisx, with monoclonal antibodies against CD15s; genetic detectionPhagocyte Activation Defects(X-linked and Autosomal Recessive)NEMO deficiency: mild hypohidrotic ectodermal dysplasia; broad based immune defectrpyogenic and encapsulated bacteria, viruses, Pneumocystis, mycobacteria; X-linkedImpaired phagocyte activation by IL-1, IL-18, TLR, CD40 TNF-leading to problem with inflammation and antibody productionPoor in vitro response to endotoxin;lack of NF-B activation; genetic detectionClinical manifestationsCellular or molecular defectsDiagnosisIRAK4 deficiency: susceptibility to pyogenic bacteria such as staphylococci, streptococci, Clostridia; resistant to mycobacteria; autosomal recessiveImpaired phagocyte activation by endotoxin through TLR and other pathway; TNF-signaling preservedPoor in vitro response to endotoxin; lack of NF-B activation by endotoxin; geneticdetectionHyper IgE-Recurrent InfectionSyndrome (Autosomal Dominant)(Job's Syndrome)Eczematoid or pruritic dermatitis, \"cold\" skin abscesses, recurrent pneumonias with S. aureus with bronchopleural fistulae and cyst formation, mild eosinophilia, mucocutaneous candidiasis, characteristic facies, restrictive lung disease, scoliosis, delayed primary dental deciduationReduced chemotaxis in some patients, reduced suppressor T cell activityClinical features, involving lungs, skeleton, and immune system; serum IgE > 2000 IU/mL", "role": "assistant" } ]

[ { "content": "Safety valve mechanism is: \nSelect and explain. \nA. The anteroposterior increment in the maxilla at 14 years, B. Increase in the mandibular intercanine width at 14 years, C. Increase in the mandibular height at 12 years, D. Increase in the maxillary intercanine width at 12 years", "role": "user" }, { "content": "Answer: D \nExplanation: There is little change in the width of the dental arch anterior to the first permanent molars after the fifth or sixth year of life. \nIn the mandibular dentition, mandibular intercanine width is relatively complete by 9–10 years of age in both boys and girls.\nIn the maxilla, intercanine width is essentially completed by 12 years of age in girls, but continues to grow until 18 years of age in boys. \nHence, the maxillary intercanine dimension serves as a ‘safety valve’ for this basal discrepancy.", "role": "assistant" } ]

[ { "content": "Which of the following drugs is useful in prophylaxis of motion sickness? \nSelect and explain. \nA. Hyoscine, B. Metoclopramide, C. Prochlorperazine, D. Ondansetron", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. (A) Hyoscine(Ref: KDT 8th/e p132)Hyoscine is used for the prophylaxis of motion sickness whereas other drugs listed in the question are used for the treatment of vomiting.", "role": "assistant" } ]

[ { "content": "Middle meningel vessel damage results in - \nSelect and explain. \nA. Subdural hemorrhage, B. Subarachnoid hemorrhage, C. Intracerebral hemorrhage, D. Epidural hemorrhage", "role": "user" }, { "content": "Answer: D \nExplanation: Ans-D", "role": "assistant" } ]

[ { "content": "Most common mode of transmission of HIV world wide is - \nSelect and explain. \nA. Heterosexual, B. Homosexual, C. IV-drug abuse, D. Contaminated blood products", "role": "user" }, { "content": "Answer: A \nExplanation: most common mode of transmission of HIV virus is through hetrosexual REF:ANANTHANARAYANAN TEXT BOOK OF MICROBIOLOGY 9EDITION PGNO.570", "role": "assistant" } ]

[ { "content": "Annexin V is associated with which of the following? \nSelect and explain. \nA. Necrosis, B. Apoptosis, C. Atherosclerosis, D. Inflammation", "role": "user" }, { "content": "Answer: B \nExplanation: Annexin V is a calcium-dependent phospholipid binding protein that has a high affinity for the phophatidylserine (PS), a plasma membrane phospholipid. One of the earliest features of apoptosis is the translocation of PS from the inner to the outer leaflet of the plasma membrane, thereby exposing PS to the external environment. Annexin V binds to PS exposed on the cell surface and identifies cells at an earlier stage of apoptosis than assays based on DNA fragmentation. The Annexin V Assay, a classical technique for detecting apoptosis, is the most commonly used method for detecting apoptosis by flow cytometry.", "role": "assistant" } ]

[ { "content": "Pilocarpine reduce the intraocular pressure in persons with closed angle glaucoma by: \nSelect and explain. \nA. Reducing aqueous humor secretion, B. Contracting iris sphincter muscle, C. Increasing aqueous humor outflow, D. Relaxing ciliary muscle", "role": "user" }, { "content": "Answer: C \nExplanation: None", "role": "assistant" } ]

[ { "content": "Black gun pow der composition - \nSelect and explain. \nA. Charcoal 60% + Potassium nitrate 20% + sulphur 20%, B. Charcoal 25% + Potassium nitrate 70% + sulphur 05%, C. Charcoal 15% + Potassium nitrate 75% +- sulphur 10%, D. Charcoal 65% +Potassium nitrate 20% + sulphur 15%", "role": "user" }, { "content": "Answer: C \nExplanation: Ans. is 'c' i.e., Charcoal 15% + Potassium nitrate 75% + sulphur 10% The classical gun powder is known as black powder, consists of charcol (15%), Sulphur (10%), and potassium nitrate (75%). Depending on fineness, the black gun powder is designated as FG, FFG, FFFG. etc. (F = fineness). Pyrodex is another gun powder with same components, but with different ratios.Black gun powder produces smoke, i.e. It is smoke producing pow der. Smokeless powder, in addition to black powder, has nitrocellulose (single base), or nitrocellulose plus nitroglycerine (double base), or nitrocellulose plus nitroglycerine plus nitroguanidine (triple base). Semi smokeless pow der has 80% black pow der and 20% smokeless powder (nitrocellulose).", "role": "assistant" } ]

[ { "content": "Ultrasound scanning of a fetus shows asymmetric growth retardation. It may be associated with the following pathology: \nSelect and explain. \nA. Anencephaly, B. Trisomy 18, C. Congenital rubella syndrome, D. Placenta pre", "role": "user" }, { "content": "Answer: D \nExplanation: Asymmetric intrauterine growth retardation (IUGR) is seen in chronic placental insufficiency due to inadequate substrate transfer. The fetus is affected in later months during the phase of cellular hyperophy. The placental pathology includes, Placenta prae Abruption Circumvallate Infarction Mosaicism Poor placentation Symmetric IUGR is seen in genetic disease or infection. The fetus is affected from the noxious effect very early in the phase of cellular hyperplasia. Ref: Textbook of Obstetrics by DC Dutta, 6th edition, Page 463-464.", "role": "assistant" } ]

[ { "content": "Which of the following is not a heterophile reaction? \nSelect and explain. \nA. Weil Felix test, B. Paul Bunnell test, C. Frie's test, D. Cold agglutinin test", "role": "user" }, { "content": "Answer: C \nExplanation: HETEROPHILE REACTION :- Similar antigens on dissimilar organisms are called heterophile antigens Closely related antigens can occur on a wide variety of organisms. Antibodies reacting with such antigens are called heterophile antibodies. Serologic tests employing such antigens are called heterophile tests. Frie's test is used in the diagnosis of LGV. Antigen made from sterile pus aspirated from previously unruptured LGV abscesses, produces a reaction in patients with lymphogranuloma inguinale when injected intradermally.", "role": "assistant" } ]

[ { "content": "Tumor commonly seen in the area marked below \nSelect and explain. \nA. Insulinoma, B. Gastrinoma, C. Non-functional tumours, D. VIPoma", "role": "user" }, { "content": "Answer: B \nExplanation: Most sporadic gastrinomas are located in the first and second pa of the duodenum. The anatomical area comprising the head of the pancreas, the superior and descending poion of the duodenum and the relevant lymph nodes has been called the 'gastrinoma triangle' because it harbours the vast majority of these tumoursRef: Bailey and Love 27e pg: 851", "role": "assistant" } ]

[ { "content": "Most of the incidentalomas are \nSelect and explain. \nA. Non-functioning adenoma, B. Adrenocoical carcinoma, C. Adrenal metastasis, D. Pheochromocytoma", "role": "user" }, { "content": "Answer: A \nExplanation: An incidentaloma is an adrenal mass, detected incidentally by imaging studies conducted for other reasons, not known previously to have been present or causing symptomsMore than 75% are non-functioning adenomas but Cushing's adenomas, phaeochromocytomas, metastases, adrenocoical carcinomas and Conn's tumours can all be found this wayRef: Bailey and Love 27e pg: 839", "role": "assistant" } ]

[ { "content": "A patient presented with neck swelling. Cytology showed showed parafollicular cells along with clusters of plasmacytoid and few spindle shaped cells. What investigation should be done to follow up the patient? \nSelect and explain. \nA. Calcitonin, B. TSH level, C. Anti TPO antibody, D. TRH", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. (a) CalcitoninCytology showed showed parafollicular cells along with clusters of plasmacytoid and few spindle shaped cells are suggestive of medullary ca thyroid and so should be followed up by its tumor marker calcitonin.", "role": "assistant" } ]

[ { "content": "Treatment of choice of small preputial Penile carcinoma is \nSelect and explain. \nA. Total Penectomy, B. Partial Penectomy, C. Wide excision, D. Emasculation", "role": "user" }, { "content": "Answer: C \nExplanation: Wide local excision with 2 cm margin is done for small preputial penile carcinoma.", "role": "assistant" } ]

[ { "content": "All are impoant laboratory features of hereditary spherocytosis, EXCEPT: \nSelect and explain. \nA. Reduced MCHC, B. Normocytic anemia, C. Positive pink test, D. Normal WBC count", "role": "user" }, { "content": "Answer: A \nExplanation: Laboratory diagnosis of hereditary spherocytosis The anemia is usually normocytic. Increase in mean corpuscular hemoglobin concentration (MCHC)- (The only condition in which an increased MCHC is seen.) The diagnosis is on the basis of red cell morphology and osmotic fragility, a modified version called the pink test. Ref: Harrison, E-18, P-875.", "role": "assistant" } ]

[ { "content": "All are transmitted by blood except aEUR' \nSelect and explain. \nA. Parvovirus B-19, B. Hepatitis G, C. Epstein Bar virus, D. Cytomegalovirus", "role": "user" }, { "content": "Answer: C \nExplanation: Epstein Barr Virus ??? Viruses associated with blood transfusion: Hepatitis C virus: Hepatitis G virus: Hepatitis B virus HIV type I HTLV Type Cytomegalovirus Parvovirus 13-19 HGV A recently discovered and identified non A-E hepatitis virus has been designated the name Hepatitis G virus (HGV) which is a member afflaviviridae HGV is distinct.from hepatitis C virus (HCV) and the newly discovered GBVA and GBV-B agents. The structure of the HGV genome resembles that of HCV. The structure of the HGV genome resembles that of HCV. HGV replicates in peripheral blood eels! while replication in liver cells has not been observed till date. It does nor appear to cause liver disease. Epidemiological data indicates that virus is prevalent throughout the world and has clearly resblished transmission modes which are: ? - Blood abd Blood products - Sexual transmission EBV can also be transmitted by blood transfusion. EBV as present in the transfused WBC. The leucocyte associated viruses are : ? CMV EBV HHV-8 (Human herpes virus type 8) HTLV-1 & HTLV-11 HIV We are not sure of the answer. Now we should look for the virus which is least commonly transmitted. There is confusion in this too because both EBV and Parvovirus are rare with transfusion. An impoant point All the viruses mentioned in the question are not routinely screened for blood transfusion. The America' Red cross performs laboratory tests for multiple infectious disease markers on every unit of donated blood. These tests includes: ? - Chagas disease - Hepatitis B virus (HBV) - Hepatitis C virus (HCV) - HIV (1,2) - HTLV-I - Syphilis - West nile virus (WNV)", "role": "assistant" } ]

[ { "content": "Drug of choice for treatment of epiglottitis is \nSelect and explain. \nA. Ceftriaxone, B. Sulphamethoxazone, C. Chloramphenicol, D. Clindamycin", "role": "user" }, { "content": "Answer: A \nExplanation: Ampicillin or third generation cephalosporins are effective against H. influenzae and are given by parenteral route (i.m. or i.v.) without waiting for results of throat swab and blood culture. Ref: PL Dhingra 7th edition of Ear, Nose and Throat; Pg no 328", "role": "assistant" } ]

[ { "content": "APRV stands for: \nSelect and explain. \nA. Adult pressure release ventilation, B. Airway pressure release ventilation, C. Air pressure reverse ventilation, D. Airway pressure reduction ventilation", "role": "user" }, { "content": "Answer: B \nExplanation: APRV - Airway Pressure Release Ventilation Mode of mechanical ventilation that is less common than pressure control or volume control, APRV was described initially by Stock and Downs in 1987 as a continuous positive airway pressure (CPAP) with an intermittent release phase. APRV applies CPAP (P high) for a prolonged time (T high) to maintain adequate lung volume and alveolar recruitment, with a time-cycled release phase to a lower set of pressure (P low) for a sho period of time (T low) or (release time) where most of ventilation and CO2 removal occurs Using high-flow (demand valve) CPAP circuit, unrestricted spontaneous breathing can be integrated and can happen any time regardless of the ventilator cycle. If the patient has no spontaneous respiratory effo, APRV becomes typical to 'inverse ratio pressure'-limited, 'time cycle'-assisted mechanical ventilation (pressure-controlled ventilation).", "role": "assistant" } ]

[ { "content": "Which of the following is an ocular emergency ? \nSelect and explain. \nA. CRAO, B. Optic neuritis, C. Acute congestive glaucoma, D. All of the above", "role": "user" }, { "content": "Answer: D \nExplanation: Ans. is 'd' i.e., All of the above Ocular emergencies include those conditions that result in acute, severe pain in association with sudden vision loss, or that may lead to vision loss if left untreated; and traumatic conditions that affect globe or adnexa. Comon ophthalmic emergencies are :- Acute congestive glaucoma Ruptured globe Ulcerative or traumatic corneal diseases Optic neuritis Hyphema Endophthalmitis Acute blindness Orbital cellulitis Eyelid or conjunctival laceration Central retinal aerial occlusion (CRAG) Anterior lens subluxation Retinal detachment", "role": "assistant" } ]

[ { "content": "Most sensitive diagnosis test for ectopic pregnancy \nSelect and explain. \nA. Transvaginal USG, B. Culdocentesis, C. MRI, D. Serial monitoring of (-HCG", "role": "user" }, { "content": "Answer: A \nExplanation: Transvaginal ultrasound Diagnosis of Ectopic pregnancy Pregnancy is definitely diagnosed by demonstrating intrauterine sac. - A normal intrauterine sac appears regular and well defined on ultrasound. So ectopic pregnancy can be diagnosed by demonstrating the absence of the intrauterine sac. In a woman in whom ectopic pregnancy is suspected because of pain, bleeding and positive pregnancy test, performance of vaginal sonography is the logical first step. If the sonography demonstrates live intrauterine fetus then ectopic pregnancy is extremely unlikely. Alternatively if the uterus is empty, an ectopic pregnancy can be diagnosed based on the visualization of an adnexal mass separate from the ovaries. 3-hCG hormones also play an impoant role in the diagnosis of pregnancy. fi HCG is a hormone secreted during pregnancy. It is positive in viually 100% of ectopic pregnancies. However, a positive test only confirms pregnancy and does not indicate whether it is intrauterine or extrauterine. In normal pregnancy pHCG should double up every 2 days but in ectopic pregnancy the rate of increase of fl hCG is slow. 13 hCG litres and ultrasound complement one another in detecting ectopic pregnancy and have led to earlier detection. By correlating fl hCG titres with ultrasound .findings an ectopic pregnancy can often be differentiated.from intrauterine pregnancy. An intrauterine sac should be visible by transvaginal ultrasound when the p hCG is approximately 1000 ml p/m1 and by transabdominal ultrasound approximately 1 week later when the fi hCG is 1800-3600 ?nip/int. Thus when an empty uterine cavity is seen with a 13 hCG litre above this threshold, the patient is likely to have an ectopic pregnancy. An empty cavity is less of a concern when a fihCG below this threshold is obtained. Serum progesterone measuremen A single measurement of serum progesterone may sometimes clarify the diagnosis when ectopic pregnancy is suspected, but Its accuracy is crude and the customary thresholds are < 5 ng/m and > 25 'tend. i.e.a value exceeding 25 ng/m1 excludes ectopic pregnancy with 97.5% sensitivity, value below 5 ng/ml occur in only .3 percent of normal regnancies. So normal pregnancies can be excluded if the progesterone level is below 5%. Surgical diagnosis of ectopic pregnancy :- Laparoscopy Direct visualization of the ,fallopian tubes and pelvis by diagnostic laparoscopy offers a reliable diagnosis in most cases of suspected ectopic pregnancy and a ready transition to definitive operative therapy. At times, identification of an early unruptured tubal pregnancy may be difficult even if the tube is .fully visualized. Inspite of the low morbidity and quick recovery time, laparoscopy usually is performed when, on the basis of noninvasive test or curettage results, the diagnosis of ectopic pregnancy is fairly ceain and medical therapy is not planned. In these cases laporoscopy is used both for therapeutic and diagnostic purpose. Laparotomy Open abdominal surgery is preferred when the woman is hemodynamically unstable or when laparoscopy is not feasible. Laparotomy should not be delayed while laparoscopy is performed in a woman with obvious abdominal hemorrhage that required immediate definitive treatment. Culdocentesis Culdocentesis is the transvaginal passage of a needle into the posterior cul-de-sac in order to determine whether free blood is present in the abdomen. This procedure is useful in the diagnosis of intraperitoneal bleeding. This procedure will reveal nonclotting blood if intra-abdominal bleeding has occurred. If culdocentesis is positive, laparoscopy or laparotomy should be performed immediately. Indeed, some argue that the main purpose of culdocentesis is, not in diagnosis but to better prioritize patients so that those with positive culdocentensis are taken immediately to the operating room. More on imaging procedures used in the diagnosis of ectopic pregnancy Vaginal sonography There has been much improvement in the early diagnosis of ectopic pregnancy using vaginal sonography. Its use results in earlier and more specific diagnosis of uterine pregnancy than abdominal sonography and it has become the imaging method of choice in early pregnancy. Abdominal sonography:- Id entification of pregnancy products in the fallopian tube.", "role": "assistant" } ]

[ { "content": "Maternal mortality rate (MMR) is defined as - Number of maternal deaths per \nSelect and explain. \nA. 1000 live births, B. 1,00,000 live births, C. 10,000 live births, D. 100 live births", "role": "user" }, { "content": "Answer: B \nExplanation: (B) 1,00,000 live births # Maternal mortality rate (MMR) - number of maternal deaths per 1,00,000 women of reproductive age per year. In India it is about 120 as compared to 0.5 of United States.", "role": "assistant" } ]

[ { "content": "A 10-mm calculus in the right lower ureter associated with proximal hydroureteronephrosis is best treated with: \nSelect and explain. \nA. Extracorporeal shockwave lithotripsy, B. Antegrade percutaneous access, C. Open ureterolithotomy, D. Ureteroscopic retrieval", "role": "user" }, { "content": "Answer: D \nExplanation: Answer is D (Ureteroscopic Retrieval) : The patient in question has a small calculus (1.0 cm) in size, which is located in the distal ureter and hence is amenable to ureteroscopic removal. The presence of proximal hydroureteronephrosis indicates obstruction and forms- the indication for clone removal. Indications and mahods for removal of stone Indications for stone removal Repeated attacks of colic Stone is too large to pass Stone is enlarging Stone is not moving Stone is causing complete obstruction of the kidney Urine is infected Ureteroscopic Removal Small stone Stone in lower pa of ureter within 5-6 cm of ureteric orfice Extracorporal shock wave Lithotripsy Best for proximal stones that can be identified by the imaging system of Lithotriptor Stones in miduretor can be pushed up in the pelvis and then exposed to shock waves Not appropriate if complete obstruction is present Stones < 2.0 to 2.5 cm can be removed Percutaneous Nephrolithotripsy It is done for proximal ureteric cacluli Stones > 2.5 cm, those that are resistant to shock waves Open Surgery is done very rarely nowadays when all methods have failed, Urethrolithotomy is done for long standing calculi not accessible by instruments and ESWL.", "role": "assistant" } ]

[ { "content": "Mother to child transmission of HIV - \nSelect and explain. \nA. 25%, B. 50%, C. 60%, D. 75%", "role": "user" }, { "content": "Answer: A \nExplanation: HIV may pass from infected mother to foetus through placenta or to her infant during delivery. In absence of any intervention rate of this vary from 20-25%. Reference; Park&;s Textbook of preventive and social medicine, 24th edition.Pg no. 364", "role": "assistant" } ]

[ { "content": "False statement regarding xenon is_____ \nSelect and explain. \nA. Rapid induction and emergence, B. Free from greenhouse effects, C. Teratogenic, D. Does not trigger malignant hypehermia", "role": "user" }, { "content": "Answer: C \nExplanation: Xenon is Non- teratogenic.Option A: Xenon has a very low blood-gas solubility coefficient (0.115) and produces rapid induction of and emergence from anaesthesia.Option B: Xenon produces no green house effect or ozone depletion and is environmentally safe, unlike the other inhaled anaesthetics.Option D: Does not trigger malignant hypehermia Other advantages of xenon:IneMinimal cardiovascular effects- It produces minimal cardiovascular depression, and it is not arrhythmogenic.Non explosiveHas Analgesic activity - reduces intraoperative opioid requirements Disadvantages of Xenon High costLow potency (MAC = 70%)Xenon gas has a very high density (5.9 g/L) resulting in increased flow resistance and work of breathing. Thus, it may be a poor choice for patients wicompromised respiratory function", "role": "assistant" } ]

[ { "content": "Androgenic alopecia in female is caused by: \nSelect and explain. \nA. Myxedema, B. Cushing disease, C. Stein-Leventhal syndrome, D. Addison's disease", "role": "user" }, { "content": "Answer: C \nExplanation: Ans. C. Stein-Leventhal syndromeAndrogenetic Alopecia (Male pattern; Female pattern): AssociationsIn women, features of hyperandrogenism may be present inthe form of hirsutism, acne & clitoromegaly.Always rule out polycystic ovary disease (PCOD).Stein-Leventhal syndrome, also called polycystic ovary syndrome (PCOS)Myxedema:Hair texture may become fine, and a diffuse alopecia occurs in up to 40% of patients, persisting for months after restoration of euthyroidism.", "role": "assistant" } ]

[ { "content": "True about Burkitt's lymphoma are: \nSelect and explain. \nA. Associated with t(14:8), B. Express BCL-2, C. Starry sky pattern on histology, D. Slow progressing", "role": "user" }, { "content": "Answer: C \nExplanation: Burkitt's lymphoma is associated with t(8:14). It has an increased MYC and BCL6 protein expression. Characteristic \"starry sky\" pattern is seen.", "role": "assistant" } ]

[ { "content": "Singers Alkali denaturation test is done with : \nSelect and explain. \nA. Maternal Hb, B. Fetal Hb, C. Amniotic fluid, D. Menstrual fluid", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. is b i.e. Fetal Hb Ref. Dutta Obs. 6/e, p 247-248: Williams Obs. 23/e, p 583, 584; Text book of Ohs. by Sheila Balakrishnan, p 167-168 Fetal hemoglobin can be distinguished from Adult hemoglobin by : Wright stain : On staining blood with wright stain if RBC's appear nucleateddeg the blood is of fetal origindeg. Singers alkali denaturation test : It is based on the fact that fetaldeg hemoglobin is more resistant to alkali denaturationdeg. Test -- Blood + Sodium hydroxide/ Potassium hydroxide", "role": "assistant" } ]

[ { "content": "NOT a feature of Atrial Septal defect among the\nfollowing \nSelect and explain. \nA. Complications include Left Atrial hypertrophy, B. Complications due to ASD are of late onset, C. Most Common Congenital heart disease presenting in Adult age, D. Wide fixed Split in 2nd heart sound", "role": "user" }, { "content": "Answer: A \nExplanation: Left Atrial hypertrophy is never seen in ASD.", "role": "assistant" } ]

[ { "content": "Which of the following drug causes Pseudotumour cerebri - \nSelect and explain. \nA. Sparfloxacin, B. Tetracycline, C. Gentamicin, D. Clofazimine", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. is 'b' i.e., Tetracycline Drugs causing Pseudotumour cerebri o A miodarone o Mineralocoicoids (withdrawl) o Oral contraceptives o Glucocoicoids (withdrawl) o Hypervitaminosis A o Tetracyclines o Quinolones", "role": "assistant" } ]

[ { "content": "Last taste sensation discovered is- \nSelect and explain. \nA. Umami, B. Sweetness, C. Bitter, D. Sour", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' i.e., Umami o Umami a savory taste s one of the five basic tastes (together with sweetness, sourness, bitterness, and saltiness)o People taste umami through receptors specific to glutamate. Glutamate is widely present in savory foods, such as meat broths and fermented products, and commonly added to some foods in the form of monosodium glutamate (MSG) Since umami has its own receptors rather than arising out of a combination of the traditionally recognized taste receptors, scientists now consider umami to be a distinct taste", "role": "assistant" } ]

[ { "content": "All can cause peripheral neuropathy except \nSelect and explain. \nA. Uraemia, B. HIV, C. Chronic liver disease, D. Hypothyroidism", "role": "user" }, { "content": "Answer: D \nExplanation: All other options are commonly associated with peripheral neuropathy except hypothyroidism", "role": "assistant" } ]

[ { "content": "Estimation of serum levels is impoant for which of the following drug: September 2009 \nSelect and explain. \nA. Haloperidol, B. Benzodiazepines, C. Lithium, D. Chlorpromazine", "role": "user" }, { "content": "Answer: C \nExplanation: Ans. C: LithiumLithium has been the drug of choice for the treatment of maniac episode (acute phase) as well as for prevention of fuher episodes in bipolar mood disorder.It has also been used in the treatment of depression with less success.Lithium needs to be closely monitored by repeated blood levels, as the difference between the therapeutic (0.8-1.2 mEq/ L) and lethal blood levels (more than 2.5-3.0 mEq/1) is not very wide (narrow therapeutic index).", "role": "assistant" } ]

[ { "content": "Curie is the unit for – \nSelect and explain. \nA. Radiation emitted, B. Radiation absorbed, C. Radioactivity, D. All of the above", "role": "user" }, { "content": "Answer: C \nExplanation: Units of Activity .\nThe activity of radioactive material is the number of nuclear disintegration per unit of time.\nThe units of activity.\n\nBacquerel\nCuries", "role": "assistant" } ]

[ { "content": "Linitus plastic is the type of - \nSelect and explain. \nA. Gall bladder cancer, B. Stomach cancer, C. Pancreac cancer, D. Renal cell cancer", "role": "user" }, { "content": "Answer: B \nExplanation: Stomach cancer  Ca stomach may be divided into five morphological subtypes, that correlate loosely with the natural history and outcome.\n\nUlcerang Ca\nPolypoidal Ca\nSuperficial spreading Ca Also known as early gastric cancer, superficial ca is confined to mucosa and submucosa.\nThese cancers have an excellent prognosis (-90% 5-year survival rate) are resection 4 Lins plasma or Scirrhous Ca These tumors infiltrate the entire thickness of the stomach and cover a very large surface area, commonly involve the entire stomach. The marked desmoplastic reason is noted, the stomach loses its pliability. It has the worst prognosis of all types as the spread is early.\nAdvanced carcinoma This largest category' contains the big tumors that are found partly within and partly outside the stomach.\n\nThey may originally have qualified for inclusion in one of the preceding groups but have outgrown that early stage", "role": "assistant" } ]

[ { "content": ". In the fed state, major fate of Glucose 6-PO4 in tissues is : \nSelect and explain. \nA. Storage as Fructose, B. Storage as Glyceraldehyde 3-PO4, C. Enters HMP shunt Ribulose 5-PO4, D. Storage as glycogen", "role": "user" }, { "content": "Answer: D \nExplanation: D i.e. Storage as glycogen", "role": "assistant" } ]

[ { "content": "The CAT in pediatric dentistry is \nSelect and explain. \nA. Caries Activity Test, B. Caries Advancement Test, C. Caries Risk Assessment Tool, D. Child Aptitude Test", "role": "user" }, { "content": "Answer: C \nExplanation: None", "role": "assistant" } ]

[ { "content": "Which of the following disease shows autosomal dominant pattern of inheritance? \nSelect and explain. \nA. Best's disease, B. Bassen-Kornzwig disease, C. Gyrate atrophy, D. Laurence-Moon-Biedle syndrome", "role": "user" }, { "content": "Answer: A \nExplanation: Best's disease is an autosomal dominant disorder with variable penetrance and expressivity. Bassen-Kornzwig disease is an autosomal recessive inherited disorder of lipoprotein metabolism. Gyrate atrophy is an autosomal recessive dystrophy with peripheral choroidal degeneration. Laurence-Moon-Biedle syndrome is also inherited in autosomal recessive manner. Best's disease: It is caused by a mutation in the BEST1 (VMD2) gene, which encodes a transmembrane calcium-sensitive chloride channel (bestrophin) expressed in retinal pigment epithelium. Fundus examination ranges from a mild pigmentary disturbance within the fovea to the typical vitelliform or \"egg yoke\" lesion located in the central macula. Visual acuity is good and electro retinogram is normal. An abnormal electro-oculogram (EOG) is the hallmark of the disease. Ref: Vaughan & Asbury's General Ophthalmology, 18 Edition, Chapter 10", "role": "assistant" } ]

[ { "content": "Non-absorption of fat-soluble vitamins is due to \nSelect and explain. \nA. Steatorrhoea, B. Pancreatic endocrine insufficiency, C. Both, D. None", "role": "user" }, { "content": "Answer: A \nExplanation: Steatorrhoea is an increase in stool fat excretion of >6% of dietary fat intake seen in malabsorption syndromes.Steatorrhoea may lead to weight loss, it is often associated with fat-soluble vitamin deficiency.Elevated alkaline phosphatase and reduced calcium levels suggest vitamin D deficiency and elevated prothrombin time suggests vitamin K deficiency.The gold standard test for steatorrhoea is quantitative stool fat estimation and the qualitative test is done using Sudan III stain, best used as a preliminary screening test.Chronic pancreatitis causes steatorhoea due to lipase deficiency(exocrine defect).Ref: Harrison's 18th e p2460, 2466", "role": "assistant" } ]

[ { "content": "Speed of rabies virus progress in axon is \nSelect and explain. \nA. 100 mm/day, B. 150 mm/day, C. 200 mm/day, D. 250 mm/day", "role": "user" }, { "content": "Answer: D \nExplanation: Speed of rabies virus progress in axon is 250 mm/day.", "role": "assistant" } ]

[ { "content": "A child makes tower of 4 cubes at – \nSelect and explain. \nA. 1 year, B. 1&1/2 years, C. 3 years, D. 4 years", "role": "user" }, { "content": "Answer: B \nExplanation: None", "role": "assistant" } ]

[ { "content": "A 20 year old patient presented with early pregnancy for Medical termination of Pregnancy (MTP) in day care facility. What will be the anaesthetic induction agent of choice ? \nSelect and explain. \nA. Thiopentone, B. Ketamine, C. Propofol, D. Diazepam", "role": "user" }, { "content": "Answer: C \nExplanation: Propofol is considered the anaesthesia of choice for day care surgery (out patient surgery) as induction is smooth & pleasant and recovery is rapid.", "role": "assistant" } ]

[ { "content": "Precocious puberty in girl age limit - \nSelect and explain. \nA. 8 year, B. 10 year, C. 9 year, D. 11 year", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' i.e., 8 year o precocious puberty is defined as appearence of secondary' sexual character before 8 year of age in girl and 9.5 year of age (Nelson says 9 year) in bodys.o Thelarche = Isolated breast development.o Premature, Pubarche/Adrenarche - Appearance of sexual hair before age of 8 year in girl and before 9 year is boys without other evidence maturation.o Premature menarche - Isolated uaginal bleeding in the absence of other secondary sexual charater.", "role": "assistant" } ]

[ { "content": "Longest acting cephalosporin: \nSelect and explain. \nA. Ceftriaxone, B. Ceftazidime, C. Cefoperazone, D. Cefotaxime", "role": "user" }, { "content": "Answer: A \nExplanation: Ans: a (Ceftriaxone) Ref: Tripathi, 6th ed, p. 706 10th ed, p. 735- Ceftriaxone has a long duration of action with half life of 8 hrs- Ceftazidime has half life of 1.5-1.8 hrs- Cefaperazone has half life of 2 hrs- Cefotaxime has half life of 1 hrFirst-generation cephalosporinsThird- generation cephalosporinsCefadroxil (PO)Cefotaxime (IV)Cephalexin (PO) Cephradine (PO)Ceftazidime (IV)Cefazolin (IV)Ceftriaxone (IV) Ceftizoxime (IV) Cefoperazone (PO)Second-generation cephalosporinsCefixime (PO)Cefoxitin (IV)Cefpodoxime proxetil (PO)Cefotetan (IV)Cefdinir (PO)Cefuroxime (TV)Ceftamet pivoxil (PO)Cefuroxime axetil (PO) Fourth-generation cephalosporins Cefepime (IV) Cefpirome (IV)Cephalosporins are not active against enterococci and L monocytogenes.Cefazolin penetrates well into most tissues. It is a drug of choice for surgical prophylaxisCeftriaxone and cefotaxime are the most active cephalosporins against penicillin-resistant strains of pneumococci and are recommended for empirical therapy of serious infections that may be caused by these strains.Cephalosporins that contain a methylthiotetrazole group (e.g., cefamandole, cefmetazole, cefotetan, cefoperazone) frequently cause hypoprothrombinemia and bleeding disorders", "role": "assistant" } ]

[ { "content": "A patient presents with Ahritis, hyperpigmentation of skin and hypogonadism, likely diagnosis is. \nSelect and explain. \nA. Hemochromatosis, B. Ectopic ACTH secreting tumour of the lung, C. Wilson's disease, D. Rheumatoid ahritis", "role": "user" }, { "content": "Answer: A \nExplanation: Answer is A (Hemochromatosis):The association of Ahritis, hyperpigmentation of skin and hypogonadism suggests the diagnosis of hematochromatosis.", "role": "assistant" } ]

[ { "content": "Which among the following is common cause for transverse lie \nSelect and explain. \nA. Prolonged labor, B. Nulliparity, C. Placenta previa, D. Oligohydramnios", "role": "user" }, { "content": "Answer: C \nExplanation: Most common causes of transverse lie are:\n\nMultiparity\nPreterm fetus\nAbnormal uterine anatomy\nHydramnios\nContracted pelvis.", "role": "assistant" } ]

[ { "content": "Habitat of hookworm is - \nSelect and explain. \nA. Jejunum, B. ileum, C. Colon, D. Duodenum", "role": "user" }, { "content": "Answer: A \nExplanation: The adult worms live in the small intestine of infected persons mostly in the jejunum,less often in the duodenum, and infrequently in the ileum Ref : panikers textbook of Medical parasitology 8th edition page 187", "role": "assistant" } ]

[ { "content": "What is the percentage of patients with disseminated discoid lupus erythematosus who develop SLE? \nSelect and explain. \nA. 2%, B. 22%, C. 52%, D. 82%", "role": "user" }, { "content": "Answer: B \nExplanation: The risk is higher in patients with disseminated DLE (22%) than in DLE confined to the head and neck (1.2%). Females developing DLE before the age of 40 years,with HLA-B8 in their histocompatibility type, have an increasedrisk of 'conveing' to SLE. Neither immunological nor biochemical abnormalities appear to alter the patient's progress. Note: Carpet tack/tin tack sign is positive in DLE lesions. Ref: Rook's textbook of dermatology, Edition-8, Page 51.20.", "role": "assistant" } ]

[ { "content": "Pineal gland forms ? \nSelect and explain. \nA. Floor of third ventricle, B. Anterior wall of third ventricle, C. Posterior wall of thrid ventricle, D. Roof of third ventricle", "role": "user" }, { "content": "Answer: C \nExplanation: Ans. is 'c' i.e., Posterior wall of thrid ventricleBoundries of third ventricle are :-Anterior wall : Lamina terminal, anterior commissure, anterior columns of fornix.Posterior wall : Pineal body, posterior commissure, cerebral aqueduct.Roof : Ependyma lining of under surface of tela choroidea of r ventricle. The choroid plexus of third ventricle projects downwards from roof.Floor : Optic chiasma, tuber cinereum, infundibulum (pituitary stalk), mammillary body, posterior perforated substance and tegmentum of midbrain.Optic recess is seen at the junction of floor with anterior wall.Lateral wall : Medial surface of thalamus, hypothalamus and hypothalamic nuclei. Interventricular foramen (of Monro) is seen at the junction of roof with anterior and lateral wall.", "role": "assistant" } ]

[ { "content": "Stage of contraction of family stas at - \nSelect and explain. \nA. Marriage, B. Bih of fis child, C. Bih of last child, D. Leaving home of first child", "role": "user" }, { "content": "Answer: D \nExplanation: -family is a group of biologically related individuals living together and eating from a common kitchen. - the stage of contraction of family begins when the first child leaves the home and ends when the last child leaves the home of parents. Reference : Park's textbook of preventive and social medicine, 23rd edition, pg no:683 <\\p>", "role": "assistant" } ]

[ { "content": "A child presents with \"freckles\" all over his body, including the buccal mucosa, lips, palms, soles, and skin not exposed to sun. Which of the following additional findings would most likely be present? \nSelect and explain. \nA. Colonic polyps, B. Desmoid tumors, C. Epidermoid cysts, D. Osteomas of the jaw", "role": "user" }, { "content": "Answer: A \nExplanation: The widespread \"freckles\" (spots of melanin pigmentation) described in this case are associated with hamaomatous colonic polyps in Peutz-Jeghers syndrome. The polyps in Peutz-Jeghers syndrome do not progress to colon cancer. Interestingly, Peutz-Jeghers syndrome is associated with an increased potential to develop carcinomas of the pancreas, breast, ovary, uterus, and lung. All of the other features listed are components of Gardner's syndrome, a variant of familial adenomatous polyposis syndrome, which carries a greatly increased risk of colon cancer. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 20. Dermatopathology. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds), Pathology: The Big Picture.", "role": "assistant" } ]

[ { "content": "All the above loud S1 caused by \nSelect and explain. \nA. Calcified Valve, B. MVP, C. Sho PR interval, D. Dilation or widening of mitral valve after valvotomy", "role": "user" }, { "content": "Answer: C \nExplanation: Ref Harrison 19 th ed pg 1447 The intensity of S1 is determined by the distance over which the ante- rior leaflet of the mitral valve must travel to return to its annular plane, leaflet mobility, left ventricular contractility, and the PR interval. S1 is classically loud in the early phases of rheumatic mitral stenosis (MS) and in patients with hyperkinetic circulatory states or sho PR inter- vals", "role": "assistant" } ]

[ { "content": "Autism is characterised by all EXCEPT \nSelect and explain. \nA. Motor abnormalities, B. Less eye contact, C. High intelligence, D. Unusual gestures", "role": "user" }, { "content": "Answer: C \nExplanation: (C) High intelligence # AUTISM is a neurodevelopmental disorder characterized by impaired social interaction, verbal and non-verbal communication, and by restricted and repetitive behavior.> Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name.> Sensory abnormalities are found in over 90% of those with autism, and there is no good evidence that sensory symptoms differentiate autism from other developmental disorders.> 60%-80% of autistic people have motor signs that include poor muscle tone, poor motor planning, and toe walking, deficits in motor coordination are pervasive across ASD and are greater in autism proper.", "role": "assistant" } ]

[ { "content": "A 60-year old patient underwent renal aery doppler which shows narrowing and turbulence in right renal aery. If radius of the aery is reduced by 1/3rd, resistance to blood flow in right kidney would have increased by: \nSelect and explain. \nA. 3 times, B. 9 times, C. 16 times, D. 81 times", "role": "user" }, { "content": "Answer: D \nExplanation: \"Fouh power law\" of radius ~ Blood flow varies directly and resistance inversely with the fouh power of the radius (r 4). If the radius is changed by a factor of 3 (reduced by 1/3rd), resistance would change by (34).", "role": "assistant" } ]

[ { "content": "In starvation, the gall bladder may be - \nSelect and explain. \nA. Atrophied, B. Distended, C. Show stones, D. Normal", "role": "user" }, { "content": "Answer: B \nExplanation: PM appearance in death due to starvation\n\nComplete disappearance of body fat.\nLoss of mesenteric and omental fat, atrophic digestive tract, empty stomach no wider than colon, thin and transparent small intestine.\nDistension of gallbladder due to the accumulation of bile from lack of stimulation.", "role": "assistant" } ]

[ { "content": "All of the following are true for pseudopelade of brocq except? \nSelect and explain. \nA. Scarring Alopecia, B. Inflammation is absent, C. Foot print in snow appearance is seen, D. Presence of pustules", "role": "user" }, { "content": "Answer: D \nExplanation: Pseudopelade of brocq Scarring Alopecia Inflammation is absent Absence of pustules Foot print in snow appearance is seen", "role": "assistant" } ]

[ { "content": "The main cause of minimal change ds is \nSelect and explain. \nA. Increase in pore size, B. Loss of negative charge on membrane, C. Loss of cells, D. Decreased circulation", "role": "user" }, { "content": "Answer: A \nExplanation: Etiology of minimal change ds is unknown. Electron microscopy reveals the primary injury to the visceral epithelial cells, which may be caused by:- A) immunological mechanism: Lack of immune deposits in the glomerulus exclude the possibility of immune complex mechanism. But several features suggest immunological mechanisms like 1.H/o respiratory infection or routine prophylactic immunization 2.dramatic response to coicosteroids 3.asscoiated with allergies or atopic disorder 4.increased incidence in Hodgkin&;s lymphoma patient s. Immune dysfn _>increased cytokine production_these damage visceral epithelial cells _ increase glomerular permeability _proteinuria B) Non-immunological mechanism:- 1.mutations in structural proteins -nephrin(found in congenital nephrotic syndrome -Finnish type)& podocin. MCD is accompanied by loss of glomerular polyanions on GBM. Defects in charge barrier allows selective proteinuria-albumins. Ref: General and systemic pathology -Ramadas Nayak-First edition -page no: 521", "role": "assistant" } ]

[ { "content": "MTP can be done upto \nSelect and explain. \nA. 12 weeks, B. 16 weeks, C. 20 weeks, D. 10 weeks", "role": "user" }, { "content": "Answer: C \nExplanation: MTP act 1971, provides safeguards to the mother by authorizing only a Registered Medical Practitioner having experience in gynecology and obstetrics to perform aboion where the length of Pregnancy does not exceed 12 weeks Where the pregnancy exceeds 12 weeks and is not more than 20 weeks, the opinion of two Registered Medical Practitioners is necessary to terminate the pregnancy Reference : Park&;s textbook of preventive and social medicine, 23rd edition, Page no: 506", "role": "assistant" } ]

[ { "content": "All of the following murmurs may be heard in patients with aoic regurgitation except : \nSelect and explain. \nA. High-pitched decrescendo diastolic murmur., B. Soft, low pitched mid distolic rumbling murmur, C. Mid-systolic ejection flow murmur, D. Pansystolic murmur.", "role": "user" }, { "content": "Answer: D \nExplanation: Answer is D (Pansystolic murmur)", "role": "assistant" } ]

[ { "content": "The treatment of choice for bacterial vaginosis is : \nSelect and explain. \nA. Clindamycin, B. Erythromycin, C. Ampicillin, D. Metronidazole", "role": "user" }, { "content": "Answer: D \nExplanation: None", "role": "assistant" } ]

[ { "content": "All are about brucella except \nSelect and explain. \nA. B. abous is capnophilic, B. Transmission by aerosol can occur occasionally, C. Paesturisation destroys it, D. 2ME is used to detect IgA", "role": "user" }, { "content": "Answer: D \nExplanation: 2ME is used to detect IgA Brucella is a wides pread zoonotic disease mainly seen in cattle sheep, goats, pigs and camels. - Brucella is strictly a parasite of animals. -No human to human transmission has been identified and infection in human occurs only by contact with infected animals or animal products. - The disease in the man is known as Malta fever, Mediterranean fever or undulant fever.", "role": "assistant" } ]

[ { "content": "Which of the following is the definition of conscious sedation? \nSelect and explain. \nA. A minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command., B. A significantly depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command., C. A minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway., D. A significantly depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway.", "role": "user" }, { "content": "Answer: A \nExplanation: Conscious sedation is defined as a minimally depressed level of consciousness as opposed to deep sedation or general anesthesia. Remember that there are four stages of anesthesia (analgesia → delirium → surgical anesthesia → respiratory paralysis) and only in the first stage (analgesia) is the patient conscious. The patient should be able to maintain an airway and respond to stimulation and command.", "role": "assistant" } ]

[ { "content": "Which of the following statements about amoebicide is least accurate \nSelect and explain. \nA. Diloxanide furoate it is a luminal amoebicide, B. Emetine is contraindicated in pregnancy and in patients with Cardiac disease, C. Metronidazole has little activity in the gut lumen, D. Paromomcin is effective in extraintestinal amoebiasis", "role": "user" }, { "content": "Answer: D \nExplanation: Ref-KDT 6/e p896,807 Paromomycin and diloxanide furoate are luminal ameobicamo", "role": "assistant" } ]

[ { "content": "What is the age limit for further developmental assessment in a child not reaching for objects \nSelect and explain. \nA. 3 months, B. 5 months, C. 9 months, D. 12 months", "role": "user" }, { "content": "Answer: C \nExplanation: A developmental assessment for children under age 3 is an attempt to assess various aspects of the child's functioning, including areas such as cognition, communication, behavior, social interaction, motor and sensory abilities, and adaptive skills. Assessment of the family and the child's environment also provides important contextual information.\nTopics covered in this section\nThis section covers the basic aspects of the general developmental assessment for young children with suspected developmental problems including possible autism. This section focuses on the general approach to the developmental assessment, including some specific components of such an assessment, but does not review information on specific autism assessment instruments.\nBasis for guideline recommendations about the general developmental assessment\nIn the previous section on the use of autism assessment instruments, the guideline recommendations are based on the panel's interpretation of an extensive and systematic review of the scientific literature. The panel did not attempt to systematically evaluate the research evidence on effectiveness of the general developmental assessment methods discussed in this section as this was considered outside the specific scope of the guideline. Therefore, guideline recommendations in this section are based on the consensus opinion of the panel, using its collective knowledge and experience in assessing children with autism. In the panel's opinion, these recommendations reflect appropriate practices for assessing children with possible autism and are generally consistent with the scientific knowledge in this field.", "role": "assistant" } ]

[ { "content": "True about H. mole:a) Complete mole seen in human onlyb) Trophoblastic proliferationc) Hydropic degenerationd) Villus pattern absent \nSelect and explain. \nA. a, B. bc, C. ac, D. ad", "role": "user" }, { "content": "Answer: B \nExplanation: H mole:\nMicroscopically: It is characterised by :\n\nMarked proliferation of the syncytial and cytotrophoblastic epithelium.\nThinning of the stromal tissue due to hydropic degeneration (edema of villous stroma).\nAvascular villi.\nMaintenance of villus pattern.\n\nAbsence of villus pattern is characteristic of choriocarcinoma and not H mole:", "role": "assistant" } ]

[ { "content": "Endemic ascites is associated with the following ? \nSelect and explain. \nA. Pyrrolizidine, B. Aflatoxin, C. Sanguinarine, D. Beta oxalylamino alanine (BOAA)", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' i.e., Pyrrolizidine Endemic ascites o Endemic ascites is caused by a hepatotoxin - pyrralizidine alkaloid found in weed seeds of Crotolariu (Jhunjhunia). o These weed seeds of Jhunjhunia contaminate the millet seeds Panicum ',Ware (locally k/a Gondhli) o Endemic ascites presented in Sarguja district of Madhya Pradesh during 1973 & 1976 as outbreak of rapidly developing ascites and jaundice with high moality. Preventive measures Educating the people Deweeding of Jhunjhunia plants which grow along with the staple food-millet. o Sieving to separate out the Jhunjhunia seeds from millet seeds.", "role": "assistant" } ]

[ { "content": "Gandy gamma body is typically seen in chronic venous congestion of which of the following? \nSelect and explain. \nA. Lung, B. Spleen, C. Kidney, D. Liver", "role": "user" }, { "content": "Answer: B \nExplanation: Gamna-Gandy bodies in chronic venous congestion (CVC) of the spleen is characterized by calcific deposits admixed with haemosiderin on fibrous tissue.", "role": "assistant" } ]