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[ { "content": "FK 506 is a type of : \nSelect and explain. \nA. Immunoglobulin antibody, B. Non-depolarizing muscle relaxant, C. Macrolide antibiotic, D. Opioid anaesthetic", "role": "user" }, { "content": "Answer: C \nExplanation: Tacrolimus is also known as FK-506. It is an immunosuppressant macrolide antibiotic produced by Streptomyces tsukubaensis.\nMuromonab CD3 is also known as OKT3. It is a monoclonal antibody against CD3 cells.", "role": "assistant" } ]

[ { "content": "Hypnagogic hallucinations are seen in \nSelect and explain. \nA. Depression, B. Mania, C. Narcolepsy, D. Schizophrenia", "role": "user" }, { "content": "Answer: C \nExplanation: NarcolepsyThe classic tetrad of symptoms is:i. Sleep attacks (most common): ii. Cataplexy: iii. Hypnagogic hallucinations: iv. Sleep paralysis (least common): Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 138", "role": "assistant" } ]

[ { "content": "A baby is born with a large defect in the occipital bone through which the posterior poion of the brain has herniated. Which of the following terms best describes this lesion? \nSelect and explain. \nA. Encephalocele, B. Meningocele, C. Myelocele, D. Spina bifida", "role": "user" }, { "content": "Answer: A \nExplanation: The central neurons system and its overlying bones are subject to a variety of malformations and developmental diseases. The defect described in the question stem is a cranial encephalocele, in which brain herniates through a defect in the skull bones. The most common site for such a herniation is the occipital bone. Small defects in the occipital bone can be treated surgically, but large defects are very problematic, paicularly if significant herniation has occurred, since the brain becomes very vulnerable to trauma and infection. Meningocele is the term used when the meninges, but not the brain or spinal cord, herniate through a defect in the bony cranium or spinal column. Myelocele is the term used when the spinal cord herniates through a defect in the spinal column. Spina bifida refers to veebral defects through which the spinal cord or meninges may herniate. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 16. Fetal Imaging. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.", "role": "assistant" } ]

[ { "content": "Female sex chromatin is : \nSelect and explain. \nA. XX, B. XO, C. XY, D. XXX", "role": "user" }, { "content": "Answer: A \nExplanation: XX", "role": "assistant" } ]

[ { "content": "Most common site of GIST is - \nSelect and explain. \nA. Ileum, B. Esophagus, C. Colon, D. Stomach", "role": "user" }, { "content": "Answer: D \nExplanation: Ans. is 'd' i.e., Stomach Gastrointestinal stromal tumors (GlSTs)o GISTs are the most common mesenchymal neoplasm of gastrointestinal tumor.o GIST represents a distinct group of gastrointestinal tumors that originate from the interstial cells of cajal which control gastrointestinal peristalsis.o GISTs can occur anywhere in the gastroinstestinal tract; the most common site being the stomach followed by small intestine.Stomach-50-70%Small intestine -20-30%Colon & rectum-5-15%Esophagus -<5% Immunohistochemistrvo Following markers are present in GISTs:i) CD 117 (c kit)- 95%ii) CD 34-70%iii) Smooth muscle actin- 5%o CD 117 (c kit) is considered the most specific markero CD 117 (c kit) immunoreactivity is the best defining feature of GISTs distinguishing them from true smooth muscle tumors (leiomyoma) and tumors arising from neural crest.o Although CD 117 (c kit) is considered the most specific marker for GIST, it is not pathognomonic of GIST as other tumors may also express CD 117. These tumors include mast cell tumor, germ cell tumors (seminomas), leukemias, malignant melanoma, angiolipomas, and some sarcomas.o Gastrointestinal stromal tumors (GIST) originate from the interstitial cells of Cajal.", "role": "assistant" } ]

[ { "content": "The following statements are true about Tumor suppressor gene p53 except: \nSelect and explain. \nA. It regulates cetain genes involved in cell cycle regulation, B. Its increased levels can induce apoptosis, C. Its activity in the cells decreases following UV irradiation and stimulates cell cycle, D. Mutations of the p53 gene are the most common genetic alteration seen in human cancer", "role": "user" }, { "content": "Answer: C \nExplanation: . Its activity in the cells decreases following UV irradiation and stimulates cell cycle", "role": "assistant" } ]

[ { "content": "In which layer of cornea, copper is deposited to form Kayser-Fleischer ring in Wilsons disease? \nSelect and explain. \nA. Bowman's layer, B. Corneal stroma, C. Descemet's membrane, D. Corneal endothelium", "role": "user" }, { "content": "Answer: C \nExplanation: Nearly all patients with neurologic involvement in Wilson disease develop eye lesions called Kayser-Fleischer rings, green to brown depositsof copper in Descemet membrane in the limbus of the cornea.Wilson disease is an autosomal recessive disorder caused by mutation of the ATP7B gene, resulting in impaired copper excretion into bile and a failure to incorporate copper into ceruloplasmin. This disorder is marked by the accumulation of toxic levels of copper in many tissues and organs, principally the liver, brain, and eye.Ref: Robbins Pathology; 9th edition; Page no: 849", "role": "assistant" } ]

[ { "content": "True about autosomal dominant type of inheritance: \nSelect and explain. \nA. 25% affected & 50 % carrier, if one parent affected, B. 50% affected & 75 % carrier, if both parent affected, C. 75% affected, if both parent affected, D. 50% affected, if one parent affected", "role": "user" }, { "content": "Answer: D \nExplanation: Answer- D. 50% affected, if one parent affectedAutosomal dominant disorders are manifested in the heterozygous state .Both males and females are affected.Because the alleles segregate randomly at meiosis, the probability that an offspring will be affected is 50%.", "role": "assistant" } ]

[ { "content": "A microbiology laboratory repos growth of Staphylococcus aureus from pus drained from a breast abscess. What is the most likely condition predisposing the patient to the development of a breast abscess? \nSelect and explain. \nA. Breast feeding, B. Endocarditis, C. Inflammatory breast carcinoma, D. Menopause", "role": "user" }, { "content": "Answer: A \nExplanation: Acute mastitis, frequently complicated by breast abscess formation, typically develops in the postpaum period, when the nipples are first subjected to the physical stresses of breast feeding. Bacteria enter the breast cracks in the nipple, and flourish in the microenvironment of the lactating breast. Acute mastitis causes redness, pain, and swelling in the affected breast; Staph. aureus is the most common pathogen. Although endocarditis could send septic emboli to the breast, Staph. aureus endocarditis is more commonly associated with bacteremia and fevers, proliferative glomerulonephritis, valvular dysfunction, and emboli to the brain, kidneys, hea, and gut. Inflammatory breast carcinoma does not invoke an inflammatory response, and it is not associated with an infection. Inflammatory breast carcinoma is characterized by tumor spread into the dermal lymphatics, producing diffuse induration and skin tenderness with the typical peau d'orange appearance. Mastitis arising in the perimenopausal period is usually a chronic mastitis, caused by obstruction of ducts due to inspissated secretions. Chronic mastitis is sterile. The breast tissue shows lymphocytes and plasma cells surrounding dilated ducts filled by cellular debris. Ref: Wyatt C., Butterwoh IV J.F., Moos P.J., Mackey D.C., Brown T.G. (2008). Chapter 17. Pathology of the Male and Female Reproductive Tract and Breast. In C. Wyatt, J.F. Butterwoh IV, P.J. Moos, D.C. Mackey, T.G. Brown (Eds),Pathology: The Big Picture.", "role": "assistant" } ]

[ { "content": "Annexin V is associated with : \nSelect and explain. \nA. Apoptosis, B. Necrosis, C. Aherosclerosis, D. Inflammation", "role": "user" }, { "content": "Answer: A \nExplanation: Apoptosis", "role": "assistant" } ]

[ { "content": "Which of the following drugs have covalent interaction with its target \nSelect and explain. \nA. Aspirin, B. Penicillin, C. Nitric oxide, D. Basanta", "role": "user" }, { "content": "Answer: A \nExplanation: covalent interaction means Irreversible inhibition of enzyme. Aspirin irreversibly acitylates the cox enzyme Refer kDT 6/e p185", "role": "assistant" } ]

[ { "content": "Non-pitting oedema which does not reduce on elevation of limb belongs to which grade of lymphoedema \nSelect and explain. \nA. Latent, B. Grade I, C. Grade II, D. Grade III", "role": "user" }, { "content": "Answer: C \nExplanation: Brunner's grading of Lymphoedema:-\nLatent = Subclinical\nGrade I = Spontaneously reversible lymphoedema\nGrade II = Spontaneously irreversible lymphoedema\nGrade III = Irreversible skin changes like-fibrosis, fissuring in lymphoedema.", "role": "assistant" } ]

[ { "content": "When there is no other source of glucose, liver and muscle glycogen would be exhausted after \nSelect and explain. \nA. 12 hours, B. 18 hours, C. 24 hours, D. 36 hours", "role": "user" }, { "content": "Answer: B \nExplanation: Were there no other source of glucose, liver and muscle glycogen would be exhausted after about 18 hours of fasting. As fasting becomes more prolonged, so an increasing amount of the amino acids released as a result of protein catabolism is utilized in the liver and kidneys for gluconeogenesis. Reference: Harper; 30th edition; Chapter 14; Page no: 149", "role": "assistant" } ]

[ { "content": "Patient can hear music every time when he turns on the tap and hears the sound of water. This is an example of : \nSelect and explain. \nA. Reflex hallucination, B. Functional hallucination, C. Visual hallucination, D. 1st person auditory hallucination", "role": "user" }, { "content": "Answer: B \nExplanation: Functional hallucination : here the stimulus and perecption are in same modality.\nV/S\nReflex hallucination : here the stimulus and pereception are in different modality.", "role": "assistant" } ]

[ { "content": "Which enzyme is a enzyme regulatory step in cholesterol synthesis? \nSelect and explain. \nA. HMG CoA synthase, B. HMG CoA reductase, C. Phosphomevalonate kinase, D. Diphosphomevalonokinase", "role": "user" }, { "content": "Answer: B \nExplanation: Ref: Textbook of Medical Biochemistry, Eighth Edition, Dr (Brig) MN Chatterjea Rana Shinde: page no: 431", "role": "assistant" } ]

[ { "content": "Which one of the following statements regarding water reabsorption in the tubules is true? \nSelect and explain. \nA. The bulk of water reabsorption occurs secondary to Na+ reabsorption, B. Majority of facultative reabsorption occurs in proximal tubule, C. Obligatory reabsorption is ADH dependent, D. 20% of water is always reabsorbed irrespective of water balance", "role": "user" }, { "content": "Answer: A \nExplanation: Maximum of filtered water (60-70%) is reabsorbed in the proximal tubule, with or without Vasopressin. This is independent of the fluid and electrolyte status of the body and is caused by the osmotic gradient created by Na+ reabsorption.\nObligatory water reabsorption- (Independent of ADH)- 85%\n-        Proximal tubule- 60-70%\n-        Descending limb of loop of Henle- 15%\nFacultative water reabsorption- (ADH dependent)- 15%\nThis depends on fluid and electrolyte status of the body\n-        Late distal tubule\n-        Cortical collecting duct\nMedullary collecting duct", "role": "assistant" } ]

[ { "content": "A case of suspected homicide comes to a doctor. He is supposed to inform police under section of CrPC: \nSelect and explain. \nA. 37, B. 39, C. 174, D. 176", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. b. 39 `Section 39 of CrPC gives a list of offences, the information regarding which is to be mandatorily provided to the police. That is, the doctor is duty bound to provide information about these enlisted offences (in Sec 39 CrPC) to the police.' Impoant Criminal Procedure Codes (CrPC) CrPC Description 39 Doctor is duty bound to provide information about enlisted offences to the policeQ 53 Examination of accused by medical practitioner at request of policeQ 53A Examination of accused of rapeQ 54 Examination of arrested person by medical officer at request of arrested personQ 61 Format of summonsQ 62 Summons how servedQ 70 Form of warrant of arrest and durationQ 174 Police inquestQ 176 Magistrates inquestQ 293 Exception to oral evidenceQ 327 Open trial-closed roomIn camera trial-rape casesQ", "role": "assistant" } ]

[ { "content": "If a normal individual receives an insulin injection that lowers plasma glucose to 30 mg/dl, which of the following hormones will NOT be released? \nSelect and explain. \nA. ACTH, B. Epinephrine, C. Growth hormone, D. Aldosterone", "role": "user" }, { "content": "Answer: D \nExplanation: None", "role": "assistant" } ]

[ { "content": "Supratemporal lental subluxation is seen in - \nSelect and explain. \nA. Weil's marchasani syndrome, B. Marfans, C. Hunters, D. Homocystinuria", "role": "user" }, { "content": "Answer: B \nExplanation: None", "role": "assistant" } ]

[ { "content": "Tetanus is noticed usually in \nSelect and explain. \nA. Burn cases, B. Wounds contaminated with faecal matter, C. Open fractures, D. Gunshot wounds", "role": "user" }, { "content": "Answer: B \nExplanation: B i.e. Wounds contaminated with faecal matter * Wounds containated with fecal matter & soil are most prone for tetanus developmentQ* Tetanus may develop in chronic conditions, such as skin ulcers, abscesses, and gangrene, burn, frost bite, middle ear infections. It is also associated with surgery, aboion, child bih, bodypiercing, and drug abuse notably skin popping\", and open fractures etc", "role": "assistant" } ]

[ { "content": "Maintainence of BP according to intracranial pressure is- \nSelect and explain. \nA. Cushing reflex, B. Cushing disease, C. Starling's reflex, D. Gometz reflex", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is ''a' i.e., Cushing reflex o When intracranial pressure is increased, the blood supply to RVLM neurons is compromised, and the local hypoxia and hypercapnia increase their discharge.o The resultant rise in systemic arterial pressure (Cushing reflex) tends to restore the blood flow to the medulla and over a considerable range, the blood pressure rise is proportional to the increase in intracranial pressure,o The rise in blood pressure causes a reflex decrease in heart rate via the arterial baroreceptors.o This is why bradycardia rather than tachycardia is characteristically seen in patients with increased intracranial pressure.o Cushing reflex consists of hypertension, bradyacardia and tachypnoea.", "role": "assistant" } ]

[ { "content": "True about Insulin action is: \nSelect and explain. \nA. Causes neoglucogenesis, B. Not useful for growth & development, C. Required for transpo of glucose, aminoacid, K+ & Na+0, D. Catabolic hormone", "role": "user" }, { "content": "Answer: C \nExplanation: C i.e. Required for transpo of glucose, aminoacid, K+ & Na+", "role": "assistant" } ]

[ { "content": "Low dose radiotherapy is given for: \nSelect and explain. \nA. Seminoma, B. Malignant melanoma, C. Osteosarcoma, D. Chondrosarcoma", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. Seminoma", "role": "assistant" } ]

[ { "content": "Metal on Metal articulation should be avoided in - \nSelect and explain. \nA. Osteonecrosis, B. Young female, C. Inflammatory arthritis, D. Revision surgery", "role": "user" }, { "content": "Answer: B \nExplanation: Based on the articulating surfaces of the prosthesis, THR may be of the following type:-\n\n\nMetal on poly: One surface is metallic (femoral side) and the other is of polyethene (on the acetabular side).\nMetal on metal: Both articulating surfaces are of metal.\nCeramic on ceramic: Both articulating surfaces are of ceramic.\n\nContraindications to Metal on Metal Bearing surfaces\n(Metal on Metal Total Hip Replacement or Metal on Metal Hip Resurfacing)\n\nPatients with Renal Insufficiency (Chronic Renal failure) (Kidney are chiefly responsible for eliminating metal ions from the blood)\nYoung females of childbearing age (Women who may potentially still have children) (Elevated levels of metal ions have harmful effects on the fetus)\nPatients with metal hypersensitivity\n\nContraindications to (Metal on Metal) Hip Resurfacing (Not contraindications to Metal on metal articulation)\n\nLoss of femoral head (severe bone loss: poor bone stock)\nLarge femoral neck cysts (poor bone stock: found at surgery)\nThe small or bone deficient acetabulum\n\nConditions that require caution: Associated with increased risk of failure\n\nTall thin patients\nFemale patients\nPatients with femoral head cysts > 1 cm (on preoperative radiographs)\nPatients with high body mass index > 35\nRheumatoid arthritis (Inflammatory arthritis) and Osteonecrosis (AVIV)\n\nRheumatoid arthritis (Inflammatory arthritis) and osteonecrosis of the hip/ perthe's disease were earlier considered contraindications/ semi- contraindications for Resurfacing. These have now shown to have successful results.", "role": "assistant" } ]

[ { "content": "A young man presents with asymptomatic macules and erythematous painless lesion over glans with generalised lymphadenopathy. Treatment of choice in this condition: \nSelect and explain. \nA. Ceftriaxone, B. Benzathine penicillin, C. Acyclovir, D. Fluconazole", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. b. Benzathine penicillin", "role": "assistant" } ]

[ { "content": "Quality indicator of MCH services \nSelect and explain. \nA. IMR, B. MMR, C. CMR, D. None", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' i.e., IMR o IMR is best indicator for:- i) Health status of a community. ii) Level of living. iii) Effectiveness of MCH services. o IMR is second best indicator of socioeconomic status of country (under 5 moality rate is more refined indicator for socioeconomic status).", "role": "assistant" } ]

[ { "content": "Ideal cholesterol level should be below \nSelect and explain. \nA. 300, B. 220, C. 200, D. 350", "role": "user" }, { "content": "Answer: C \nExplanation: None", "role": "assistant" } ]

[ { "content": "XXY klinfilter which has extra? \nSelect and explain. \nA. X-chromosome, B. Y chromosome, C. Both, D. None", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' i.e., X-chromosome The major numerical disorders of chromosomes are 3 autosomal trisomies Trisomy 21 -- Down syndrome Trisomy 18 -- Edwards syndrome Trisomy 13 -- Patau syndrome Four types of sex chromosomal aneuploidies: Turner syndrome (usually 45,X) Klinefelter syndrome (47,XXY) 47,XXX 47,XYY By far the most common type of trisomy in liveborn infants is trisomy 21 (karyotype 47,,+21 or 47,XY +21) or Down syndrome.", "role": "assistant" } ]

[ { "content": "A 5-year-old child presents with confusion, increased salivation, lacrimation, fasciculations, miosis, tachycardia, and hypotension. Which of the following poisons can cause these manifestations? \nSelect and explain. \nA. Opium, B. Organophosphorus, C. Dhatura, D. Organochlorine pesticide", "role": "user" }, { "content": "Answer: B \nExplanation: Increased salivation, lacrimation, miosis, fasciculation, tachycardia and confusion, all are seen in organophosphate poisoning.", "role": "assistant" } ]

[ { "content": "Which of the following does not result in the release of nitric oxide \nSelect and explain. \nA. Fenoldopam, B. Hydralizine, C. Nitroprusside, D. Nitroglycerin", "role": "user" }, { "content": "Answer: A \nExplanation: Refer katzung 11e 180-181 nitric oxide donors include Sodium nitroprusside organic nitrates nitrates Hydralazine Propofol Nebivolol", "role": "assistant" } ]

[ { "content": "In which of the following infections mosquito is the main vector? \nSelect and explain. \nA. Hepatitis - A, B. Cholera, C. Yellow fever, D. Leprosy", "role": "user" }, { "content": "Answer: C \nExplanation: The yellow fever virus is transmitted by the bite of female mosquitoes (the yellow fever mosquito, Aedes aegypti. After transmission of the virus from a mosquito the viruses replicate in the lymph nodes and infect dendritic cells in paicular. Hepatitis-A and Cholera are transmitted through feco-oral route. Leprosy is transmitted by fomites.", "role": "assistant" } ]

[ { "content": "In a subclan aery block at outer border of 1st rib, all of the following aeries help in maintaining the circulation to upper limb, EXCEPT: \nSelect and explain. \nA. Subscapular aery, B. Superior thoracic aery, C. Thyrocervical trunk, D. Suprascapular aery", "role": "user" }, { "content": "Answer: B \nExplanation: A rich anastomosis exists around the scapula between branches of subclan aery (first pa) and the axillary aery (third pa). This anastomosis provides a collateral circulation through which blood can flow to the limb when the distal pa of subclan aery or the proximal pa of axillary aery is blocked. Scapular anastomoses occur between the following branches of proximal subclan and distal axillary aery: Branches of Subclan aery: Thyrocervical trunk, Suprascapular and Deep branch of transverse cervical. Branches of Axillary aery: Subscapular, Posterior circumflex humeral and Thoracoacromial aeires.", "role": "assistant" } ]

[ { "content": "A compound serving a link between citric acid cycle and urea cycle is: \nSelect and explain. \nA. Malate, B. Citrate, C. Succinate, D. Fumarate", "role": "user" }, { "content": "Answer: D \nExplanation: The fumarate formed may be funnelled into TCA cycle to be converted to malate and then to oxaloacetate to be transaminated to aspartate. Thus, the urea cycle is linked to TCA cycle through fumarate.\nReference: Vasudevan 7th  ed, pg 204", "role": "assistant" } ]

[ { "content": "A 8 years boy with headache, supracellar mass, with bilateral hemianopia, showing the following MRI scan of head. What is the diagnosis \nSelect and explain. \nA. Craniopharyngioma, B. Pituitary apoplexy, C. Nasopharyngeal fibroma, D. Hypothalamic glioma", "role": "user" }, { "content": "Answer: A \nExplanation: (A) Craniopharyngioma[?]Craniopharyngioma:Craniopharyngioma are pituitary gland tumor develop from the embryogenic remnants in pituitary gland.Present at any time during childhood, tumor is congenital &d arises from squamous epithelial cell rests of the embryonic Rathke's pouch.The neoplasm is usually cystic & benign.Clinical presentation:Headaches and raised ICPVisual symptoms: 20% of children & 80% adults.Hormonal imbalances:Short stature and delayed puberty in childrenDecreased libido; Amenorrhoea; Diabetes insipidusBehavioural change due to frontal or temporal extension.Growth failure; Signs of increased intracranial pressure; Endocrine abnormalities such as diabetes insipidus and delayed puberty (<10% of cases); Retarded Bone age.X-ray of skull may show calcificationMost preferred treatment is micro surgical excision & transcranial route through craniotomy.Tumor cyst can be aspirated or malignant craniopharyngiomas are treated with radiotherapy or implants.Types of Non Cancerous Brain Tumors seen in ChildrenChordomasMeningiomasCraniopharyngiomaPineocytomasGangliocytomasPituitary AdenomaGlomus JugulareSchwannomasOther Options[?]Pituitary apoplexy:Pituitary apoplexy or pituitary tumor apoplexy is bleeding into or impaired blood supply of the pituitary gland at the base of the brain. This usually occurs in the presence of a tumor of the pituitary, although in 80% of cases this has not been diagnosed previously.The most common initial symptom is a sudden headache, often associated with a rapidly worsening visual field defect or double vision caused by compression of nerves surrounding the gland.This is followed in many cases by acute symptoms caused by lack of secretion of essential hormones, predominantly adrenal insufficiency[?]Nasopharyngeal fibroma:Nasopharyngeal fibroma is a benign tumour but locally invasive and destroys the adjoining structures. It may extend into: Nasal cavity causing nasal obstruction, epistaxis and nasal discharge.Cranial cavity: Middle cranial fossa is the most common.There are two routes of entry:-By erosion of floor of middle cranial fossa, anterior to foramen lacerum. The tumour lies lateral to carotid artery & cavernous sinus.-Through sphenoid sinus, into the sella. Tumour lies medial to carotid artery.Surgical excision is now the treatment of choice. Radiotherapy has been used as a primary mode of treatment.Hormonal therapy as the primary or adjunctive treatment.Recurrent and residual lesions have been treated by chemotherapy.[?]Hypothalamic glioma:Rare tumors cause diencephalic syndrome in infants.Fail to thrive, loss of subcutaneous fat & suffer sleep & respiratory disturbances.Precocious puberty seen in older children.Associated histological types include glioma, pinealoma, teratomas & hamartomas.", "role": "assistant" } ]

[ { "content": "Drug of choice for schizophrenic patient with poor oral absorption is: \nSelect and explain. \nA. Haloperidol, B. Fluphenazine, C. Clozapine, D. Olanzapie", "role": "user" }, { "content": "Answer: C \nExplanation: Clozapine", "role": "assistant" } ]

[ { "content": "Nasopharyngeal carcinoma affects which age group \nSelect and explain. \nA. Children, B. Adolescents, C. 3rd decade, D. 5th decade", "role": "user" }, { "content": "Answer: D \nExplanation: * Age:- It is mostly seen in fifth to seventh decades but may involve younger age groups. It is not uncommon to see the cancer of nasopharynx in the twenties and thiies. * Sex:-Males are three times more prone than females. (Ref: Diseases of Ear, Nose and Throat, P.L Dhingra, 7th edition, page 284)", "role": "assistant" } ]

[ { "content": "The technique employed in radiotherapy to counteract the effect of tumour motion due to breathing is known as \nSelect and explain. \nA. Arc technique, B. Modulation, C. Gating, D. Shunting", "role": "user" }, { "content": "Answer: C \nExplanation: Gating Respiratory gating : It is a technique in radiotherapy in which the radiation is applied during that phase of respiratory cycle in which the tumour is in the best range. This is to prevent unnecessary radiation exposure to normal structures.", "role": "assistant" } ]

[ { "content": "paprika sign during debridement is crucial in management of which of the following condition? \nSelect and explain. \nA. chronic osteomyelitis, B. osteosarcoma, C. osteoid osteoma, D. brodie's abscess", "role": "user" }, { "content": "Answer: A \nExplanation: paprika sign is the appearance of live bone after removal of sequestrum. Bone Debridement: * The goal of debridement is to leave healthy, ble tissue. Debridement of bone is done until punctuate bleeding is noted called the \"PAPRIKA SIGN\" * Copious irrigation with io to 14 L of normal saline is expected. * The extent of resection during debridement is impoant in Type B host patient. Such patient is treated with marginal resection. * Repeated debridement may be required. REF :MAHESWARI 9TH ED", "role": "assistant" } ]

[ { "content": "Effect ot progesterone on lipids : \nSelect and explain. \nA. Lowers LDL, increases HDL, B. Lowers HDL and LDL, C. Lowers HDL & increases LDL, D. Increases LDL and HDL", "role": "user" }, { "content": "Answer: C \nExplanation: Lowers HDL & increases LDL", "role": "assistant" } ]

[ { "content": "In which of the following poisoning, pralidoxime is ineffective? \nSelect and explain. \nA. Organophosphorus, B. Carbaryl, C. Both of the above, D. None of the above", "role": "user" }, { "content": "Answer: B \nExplanation: Oximes are used to displace organophosphates from the active site of acetylcholinesterase, thus reactivating the enzyme. Pralidoxime is a specific antidote that restores acetylcholinesterase activity by regenerating phosphorylated acetylcholinesterase and appears to prevent toxicity by detoxifying the remaining organophosphate molecules. Clinically, pralidoxime ameliorates muscarinic, nicotinic, and central neurologic symptoms. Pralidoxime is not recommended for asymptomatic patients or for patients with known carbamate exposures presenting with minimal symptoms. There is increased toxicity of pralidoxime in carbaryl poisoning. Ref: Robey III W.C., Meggs W.J. (2011). Chapter 195. Pesticides. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.", "role": "assistant" } ]

[ { "content": "The earliest indicator of response after staing iron in a 6 year old girl with iron deficiency is: \nSelect and explain. \nA. Increased reticulocyte count, B. Increased hemoglobin, C. Increased ferritin, D. Increased serum iron", "role": "user" }, { "content": "Answer: A \nExplanation: Following iron therapy in a child with iron deficiency anemia, initial bone marrow response is seen within 48hours. The earliest response seen is a rise in the level of reticulocyte which occur by the 2nd to 3rd day. This is followed by elevation of hemoglobin level. After the correction of the hemoglobin levels, body iron stores are repleted. Ref: Essential Pediatrics, 6th Edition By O P Ghai, Page 302.", "role": "assistant" } ]

[ { "content": "The patient with oro-cutaneous hamaomatous tumours, gastrointestinal polyps, abnormalities of the breast, thyroid gland and genitourinary system is suffering from which of the following? \nSelect and explain. \nA. Familial adenomatous polyposis, B. Cowden's syndrome, C. Peutz Jeghers' syndrome, D. Juvenile polyposis", "role": "user" }, { "content": "Answer: B \nExplanation: Cowden's syndrome or multiple hamaoma syndrome is a rare autosomal dominant syndrome characterised by orocutaneous hamaomatous tumours, gastrointestinal polyps, abnormalities of the breast, thyroid gland and genitourinary system. The gastrointestinal polyps are generally benign and malignant transformation is seen very rarely. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 3384", "role": "assistant" } ]

[ { "content": "Vaccine routinely given in pregnancy : \nSelect and explain. \nA. Influenza, B. Oral polio, C. Tetanus, D. Rabies", "role": "user" }, { "content": "Answer: C \nExplanation: Tetanus", "role": "assistant" } ]

[ { "content": "Shortest acting local anaesthetic agent is – \nSelect and explain. \nA. Procaine, B. Lidocaine, C. Tetracaine, D. Bupivacaine", "role": "user" }, { "content": "Answer: A \nExplanation: Chlorprocaine is the shortest acting LA. Amongst the given options procaine is shortest acting.", "role": "assistant" } ]

[ { "content": "Indication for fundoplication? \nSelect and explain. \nA. GERD, B. Gastric volvulus, C. Diaphragmatic eventration, D. Bockdelec's hernia", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' i.e., GERD o Fundoplication is indicated in patients of GERD in following conditions-Patients with evidence of severe esophageal injury (ulcer/stricture/barrett's).No response''relapse/incomplete resolution on medical therapy.Patients with long duration of symptoms.Patients with persistant symptoms at a young age.", "role": "assistant" } ]

[ { "content": "Contraindications for Medical aboions are all except: \nSelect and explain. \nA. Age more than 35 years, B. Hemoglobin less than 8 gm%, C. Undiagnosed adnexal mass, D. Uncontrolled seizure disorder", "role": "user" }, { "content": "Answer: A \nExplanation: Age is no contraindication for medical aboion. Contraindications for medical aboions; Hemoglobin less than 8 gm% Undiagnosed adnexal mass Uncontrolled seizure disorder Uncontrolled coagulation disorders etc", "role": "assistant" } ]

[ { "content": "All of the following are true about bacillus anthrax except \nSelect and explain. \nA. Plasmid is responsible for toxin production, B. Cutaneous anthrax generally resolves spontatneously, C. Capsular polypeptide aids virulence by inhibiting phagocytosis, D. Toxin is a complex of two fractions", "role": "user" }, { "content": "Answer: D \nExplanation: The anthrax toxin is encoded by a separate plasmid. It is a complex of three fractions: A)Edema factor B)Protective antigen factor and C)Lethal factor Reference: Textbook of Microbiology; Anathanarayan and panicker's; 10th edition; Page no: 249", "role": "assistant" } ]

[ { "content": "Concentration of agar used for solid agar to Inhibit Proteus swarming \nSelect and explain. \nA. 1-2%, B. 0.50%, C. 6%, D. 5%", "role": "user" }, { "content": "Answer: C \nExplanation: For solid agar - 1-2%\nFor Semisolid agar - 0.5%\nFor solid agar to inhibit proteus swarming - 6%", "role": "assistant" } ]

[ { "content": "Actions of cholecystokinin include which one of the following? \nSelect and explain. \nA. Contraction of gall bladder, B. Secretion of pancreatic juice rich in enzymes, C. Increases the secretion of enterokinase, D. All", "role": "user" }, { "content": "Answer: D \nExplanation: FUNCTIONS: Stimulates pancreatic acinar cell enzymes secretion. Causes contraction of gallbladder. Secretion of enzyme-rich pancreatic juice. Increases enterokinase secretion", "role": "assistant" } ]

[ { "content": "For anesthesiology mild systemic disease included in ASA grade- \nSelect and explain. \nA. 1, B. 2, C. 3, D. 4", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. is 'b' i.e., 2 ASA GradePatient conditionASA 1Normal healthy patient (no physical or mental illness)ASA 2Mild systemic disease not limiting functional activity(mild heart disease, DM, Mild hypertension, Anemia, Old age, obesity, mild chronic bronchitis)ASA 3Severe systemic disease that limits activity but not incapaciating (Angina, Severe DM, cardiac failure)ASA 4Severe systemic disease that is life-threatening(Marked cardiac insufficiency; presistent angina; severe renal, respiratory or hepatic insufficiency)ASA 5Moribund patient who is not expected to survive without operationASA 6Brain dead patient (for organ donation).", "role": "assistant" } ]

[ { "content": "A 40 year old female reports of sudden bouts of anxiety which would occur anytime and associated with sweating, palpitation, derealization, and feeling of going crazy. These episodes would last for 20 -25 minutes. So much so that she fears of having these episodes in future. All routine investigations are normal. What is the diagnosis? \nSelect and explain. \nA. Generalized anxiety disorder, B. Obsessive-compulsive disorder, C. Panic disorder, D. Tourette's syndrome", "role": "user" }, { "content": "Answer: C \nExplanation: Ans. C. Panic disorderPanic attack: acute intense attack of anxiety accompanied by feelings of impending doom.Symptoms during panic attack usually involve* Sudden onset of palpitations, Sweating, Trembling or shaking,* Shortness of breath, Feelings of choking, Chest pain,* Nausea/abdominal distress, Feeling dizzy, unsteady,* Chills or heat sensations,* Paresthesias, derealization or depersonalization.* Fear of losing control or \"going crazy or fear of dying.Recurrent panic attacks is Panic disorder", "role": "assistant" } ]

[ { "content": "Which one of the following is a stomach poison for the larvae of insects of medical importance? \nSelect and explain. \nA. DDT, B. Paris green, C. Pyrethrum, D. Antilarva oil", "role": "user" }, { "content": "Answer: B \nExplanation: Insecticides are substances used to kill insects.\nThey are contact poisons,stomach poisons,fumigants. \nStomach poisons are those which when ingested cause death of the insects. \nExamples are paris green and sodium flouride. DDT and pyrethrum are synthetic and natural contact poisons respectively. \nParks textbook of preventive and social medicine.K Park.", "role": "assistant" } ]

[ { "content": "Which of the following change occur secondary to hypercarbia? \nSelect and explain. \nA. Miosis, B. Cool extremities, C. Bradycardia, D. Hypeension", "role": "user" }, { "content": "Answer: D \nExplanation: Hypercarbia from any cause increase the release of catecholamines and cause hypeension. It cause increase in HR, myocardial contractility, high systolic blood pressure, wide pulse pressure, greater cardiac output and higher pulmonary pressures. Effects of hypercarbia are: Increased respiratory drive Anxiety, restlessness, tachycardia, hypeension and arrhythmias Peripheral vasodilatation Increases in cerebral blood flow and intracranial pressure Decreased level of consciousness and coma Causes of hypercarbia: Most common cause: alveolar hyperventilation. It can be due to airway obstruction, narcotics, CNS disorders, PNS disorders, chest wall disorders. V/Q inequality Increased dead space Ref: Clinical Intensive Care and Acute Medicine By Ken Hillman page 291. Essentials of Anaesthesiology By Arun Kumar Paul page 218", "role": "assistant" } ]

[ { "content": "Vaccine preventable neonatal disease is \nSelect and explain. \nA. Tuberculosis, B. Tetanus, C. Pertussis, D. Measles", "role": "user" }, { "content": "Answer: B \nExplanation: None", "role": "assistant" } ]

[ { "content": "Sumatriptan exerts antimigraine action through which receptors? \nSelect and explain. \nA. 5HT1D/1B, B. 5 HT2, C. 5HT3, D. 5HT4", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' i.e., 5HT ID/IB * Sumatriptan is the first selective 5-HT1D/1B receptor agonist; activates other subtypes of 5-HT1 receptors only at very high concentrations, and does not interact with 5-HT2, 5-HT3, 5-HT4-7, a or b adrenergic, dopaminergic, cholinergic or GABA receptors.", "role": "assistant" } ]

[ { "content": "Birth rate is - \nSelect and explain. \nA. Live birth/1000 mid yr. population, B. Birth/1000 mid yr population, C. Live birth/10000 mid yr. population, D. Live birth/10,000 population of reproductive age group (15-45)", "role": "user" }, { "content": "Answer: A \nExplanation: Fertility \n\nBy fertility is meant the actual bearing of children.\nA woman's reproductive period is roughly from 15 to 45 years - a period of 30 years.\nMeasurement of fertility are :-\n\n\nBirth rate   \nGeneral fertility rate (GFR) \nGeneral marital fertility rate (GMFR) \nAge specific fertility rate (ASFR)    \nAge specific marital fertility rate (ASMFR) \nTotal fertility rate (TFR)    \nTotal marital fertility rate (TMFR)\nGross reproduction rate (GRR)\nNet reproduction rate (NRR)\nChild woman ratio\nPregnancy rate\nAbortion rate\nAbortion ratio\nMarriage rate\n\nBirth rate\n\nBirth rate defined as \"the number of live birth per 1000 estimated mid yr. populations in a give yr.\"\n\nBirth rate = Number of live birth during the year / Estimated mid year population x 1000", "role": "assistant" } ]

[ { "content": "Patient with 20 weeks size uterus & vesicular mole. Treatment is: \nSelect and explain. \nA. Induction of labour, B. Methotrexate, C. Hysterotomy, D. Suction evacuation", "role": "user" }, { "content": "Answer: D \nExplanation: Ans. is 'd' i.e., Suction evacuation * Vacuum aspiration: Suction evacuation is the treatment of choice for hydatidiform mole, regardless of uterine size. After most of the molar tissue has been removed by aspiration, oxytocin is given. After the myometrium has contracted, thorough but gentle curettage with a large sharp curette usually is performed.* Intraoperative ultrasonographic examination may help document that the uterine cavity has been emptied.* Induction of labour is contraindicated.", "role": "assistant" } ]

[ { "content": "Influenza virus belongs to family - \nSelect and explain. \nA. Picomaviridae, B. Calciviridae, C. Orthomyxoviridae, D. Paramyxoviridae", "role": "user" }, { "content": "Answer: C \nExplanation: Ans. is 'c* i.e., Orthomyxoviridae RNA VirusesPicornaviridae:Poliovirus, Coxsackievirus, Eehovirus, Enterovirus, Rhinovirus, Hepatitis A virusCalicivtridae: Norwalk virus. Hepatitis E virusTogaviridae: Rubella virus, Eastern equine encephalitis virus, Western equine encephalitis virusFlaviviridae: Yellow fever virus, Dengue virus, St. Louis encephalitis virus. West nile virus. Hepatitis C virus. Hepatitis G virusCoronaviridae: Coronavi rusesRhabdoviridae: Rabies virus. Vesicular stomatitis virusFiloviridae :: Marburg virus, Ebola virusParamyxoviridae: Parainfluenza virus, Respiratory syncytial virus, Newcastle disease virus , Mumps virus. Rubeola (measles) vimsOrthomyxoviridae: Influenza vims", "role": "assistant" } ]

[ { "content": "Diabetic neuropathy is a: \nSelect and explain. \nA. Distal symmetric sensory polyneuropathy, B. Mononeuritis, C. Autonomic neuropathy, D. All above", "role": "user" }, { "content": "Answer: D \nExplanation: ANSWER: (D) All aboveREF: Harrison 16th ed page 2165'Diabetic neuropathy occurs in 50% of individuals with long-standing type 1 and type 2 DM. It may manifest as polyneuropathy, mononeuropathy, and/or autonomic neuropathy\"\"Most common form of diabetic neuropathy is distal symmetric polyneuropathy. It most frequently presents with distal sensory loss.\"", "role": "assistant" } ]

[ { "content": "Vitamin K is required for \nSelect and explain. \nA. Hydroxylation, B. Chelation, C. Transamination, D. Carboxylation", "role": "user" }, { "content": "Answer: D \nExplanation: Carboxylation The only known biological role of vitamin K is as a cofactor for an enzyme carboxylase that catalyzes carboxylation of glutamic acid residues on vitamin K-dependent proteins. The key vitamin K-dependent proteins include: Coagulation proteins: factors II (prothrombin), VII, IX and X Anticoagulation proteins: proteins C, S and Z Bone proteins: osteocalcin and matrix-Gla protein Gas6 is a vitamin K-dependent protein that is found throughout the nervous system, as well in the hea, lungs, stomach, kidneys, and cailage. These proteins have in common the requirement to be post-translationally modified by carboxylation of glutamic acid residues (forming gamma-carboxyglutamic acid) in order to become biologically active. Prothrombin, for example, has 10 glutamic acids in the amino-terminal region of the protein which are carboxylated. Without vitamin K. the carboxylation does not occur and the proteins that are synthesized are biologically inactive. Carboxylation of glutamic acid residues is critical for the calcium-binding function of those proteins. Also Know There are two naturally occurring forms of vitamin K: - phylloquinone synthesized by plants - menaquinones synthesized by intestinal bacteria Synthetic forms of vitamin K are: - menadiotze - menadiol - menadiol acetate", "role": "assistant" } ]

[ { "content": "Which of the following most often causes cholestatic jaundice: \nSelect and explain. \nA. INH, B. Erythromycin estolate, C. Pyrazinamide, D. Ethionamide", "role": "user" }, { "content": "Answer: B \nExplanation: Erythromycin estolate", "role": "assistant" } ]

[ { "content": "Commonest cause of loss of vision in non- proliferative diabetic retinopathy is – \nSelect and explain. \nA. Vitreous heamorrhage, B. Macular edema, C. Detachment of retina, D. Subretinal haemorrhage", "role": "user" }, { "content": "Answer: B \nExplanation: Macular edema is the most common cause of loss of vision in NPDR.", "role": "assistant" } ]

[ { "content": "\"Telescope fingers\" occur in \nSelect and explain. \nA. Rheumatic ahritis, B. Rheumatoid ahritis, C. Psoriatic ahritis, D. Reiter's ahritis", "role": "user" }, { "content": "Answer: C \nExplanation: Ahritis mutilans (A feature of psoriatic ahritis) This is a deforming erosive ahritis targeting the fingers and toes; it occurs in 5% of cases of PsA. Prominent cailage and bone destruction results in marked instability. The encasing skin appears invaginated and 'telescoped' ('main en lorgnette') and the finger can be pulled back to its original length. Ref Davidsons 23e p1033", "role": "assistant" } ]

[ { "content": "Vasanti, a 25-year-old-girl, presents with complaints of fever and weakness. On examination there is splenomegaly of 3 cm below the costal margin.Hb is 8 gm/dL, TLC is 3,000/mm3 , platelet count is 80,000 mm3. Which of the following is the least likely diagnosis - \nSelect and explain. \nA. Acute lymphocytic leukemia, B. Anemia of chronic disease, C. Aplastic anemia, D. Megaloblastic anemia", "role": "user" }, { "content": "Answer: C \nExplanation: None", "role": "assistant" } ]

[ { "content": "A 30-year-old patient complains of pain abdomen for 5 days, with similar history in recent past as well. On examination, localized tenderness in right upper quadrant on deep palpation is observed. A slight yellowish discoloration of skin is noted as well. USG examination reveals the following findings. If this patient had associated gallstones, which of the following would it be? \nSelect and explain. \nA. <img style=\"max-width: 100%\" src=\" />, B. <img style=\"max-width: 100%\" src=\" />, C. <img style=\"max-width: 100%\" src=\" />, D. Gallstones are not associated with above clinical scenario.", "role": "user" }, { "content": "Answer: B \nExplanation: Cholesterol stone Pigment stone Mixed stone The USG shows BILIARY ASCARIASIS which is associated with pigment gall stones. Unconjugated bilirubin is normally a minor component of bile, but it will increase when infection of the biliary tract occurs that leads to release of microbial b-glucuronidases, which hydrolyze bilirubin glucuronides. Thus, infection of the biliary tract with Ascaris lumbricoides, and others that increases the likelihood of pigment stone formation.", "role": "assistant" } ]

[ { "content": "Which muscle originates from tibia, fibula and interosseous membrane? \nSelect and explain. \nA. Popliteus, B. Flexor digitorum longus, C. Flexor hellus longus, D. Tibialis posterior", "role": "user" }, { "content": "Answer: D \nExplanation: TIBIALIS POSTERIOR:Origin: upper two-thirds of lateral pa of posterior surface of tibia below the soleal line.Posterior surface of fibula in front of medial crest Posterior surface of interosseous membrane.Popliteus: arises from lateral surface of lateral condyle of femur.origin is intracapsular.lateral meniscus of knee joint.Flexor digitorum longus: uppercut two third of medial pa of posterior surface of tibia below soleal line.Flexor hallucis longus: posterior surface of fibula and interosseous membrane.{Reference: BDC 6E pg no.106}", "role": "assistant" } ]

[ { "content": "Boutonneuse fever is caused by- \nSelect and explain. \nA. Rickettsia japonica, B. Rickettsia conorii, C. Rickettsia sibirica, D. Rickettsia australis", "role": "user" }, { "content": "Answer: B \nExplanation: Boutonneuse fever (also called, fievre boutonneuse, Kenya tick typhus, Indian tick typhus, Marseilles fever, African tick-bite fever, or Astrakhan fever) is a fever as a result of a Rickettsial infection caused by the bacterium Rickettsia conorii Transmitted by the dog tick - Rhipicephalus sanguineus.", "role": "assistant" } ]

[ { "content": "Which of the following is the least filtered in glomerules? (Which substance is least lost in urine) \nSelect and explain. \nA. Haemoglobin, B. Albumin (<150mg/24 hrs normally), C. Myoglobin, D. Inulin", "role": "user" }, { "content": "Answer: A \nExplanation: Hemoglobin is the least filtered in glomerules and when it is secreted in high levels it is called hemoglobinuria most common in porphyrias. Ref: Ganong's review of medical physiology; 24th edition; page no; 678", "role": "assistant" } ]

[ { "content": "Structures lying deep to posterior belly of digastricare all. Except: \nSelect and explain. \nA. Retromandibular vein, B. Hypoglossal nerve, C. Hyoglossus muscle, D. Occipital aery", "role": "user" }, { "content": "Answer: A \nExplanation: Retromandibular vein Ref: BDC Anatomy 4/e vol. III p157; Gray's Anatomy 40/e p441The Retromandibular vein lies superficial to the posterior belly of digastric.Structures lying deep to the posterior belly of digastric are:a.Transverse process of atlasb.Muscles- hyoglossus, superior oblique and the rectus capitis lateralisc. Aeries- internal carotid, external carotid, lingual, facial and occipital aeriesd.Vein- internal jugular veine. Nerves- vagus, accessory and hypoglossal cranial nerves.The digastric muscle (named digastric as it has two bellies) lies below the body of the mandible, and extends, in a curved form, from the mastoid process to the symphysis menti. C-,11.fvn-*/The digastric muscle consists of two fleshy bellies united by an intermediate rounded tendon. The two bellies of the digastric muscle have different embryological origins, supplied by different cranial nerves.Posterior belly- The posterior belly arises from the mastoid notch on the medial surface of the mastoid process of the temporal bone, and passes downwards and forwards.- The posterior belly is supplied by the digastric branch of facial nerve.Anterior belly- The anterior belly arises from the digastric fossa, on the base of mandible, close to the symphysis, and passes downward and backward.- The anterior body is supplied by the mylohyoid nerve, a branch of the inferior alveolar nerve, itself a branch of the mandibular division of the trigeminal nerve.Intermediate tendon- The two bellies end in an intermediate tendon which perforates the Stylohyoid muscle, and run in a fibrous loop attached to the body and the greater cornu of the hyoid boneAction- When the digastric muscle contracts, it acts to elevate the hyoid bone.- If the hyoid is being held in place (by the infrahyoid muscles), it will tend to depress the mandible (open the mouth).", "role": "assistant" } ]

[ { "content": "A 60-year-old woman with no past medical history has an elevated blood pressure of 165/80 mm Hg on routine evaluation. Repeated measurements over the next month confirm the elevated pressure. Physical examination, routine blood count, and biochemistry are all normalFor patient with high blood pressure, select the most appropriate medication \nSelect and explain. \nA. thiazides, B. spironolactone, C. clonidine, D. prazosin", "role": "user" }, { "content": "Answer: A \nExplanation: Thiazides have been a cornerstone in most trials of antihypertensive therapy. Their adverse metabolic consequences include renal potassium loss leading to hypokalemia, hyperuricemia from uric acid retention, carbohydrate intolerance, and hyperlipidemia. The current U.S. Joint National Committee (JNC-7) guidelines suggest starting with thiazide diuretics because of their proven efficacy in lowering mortality and morbidity in large clinical trials. Other agents are considered if there are comorbidities such as diabetes or CAD.", "role": "assistant" } ]

[ { "content": "In which of the following types of Carcinoma Breast, Comedo growth pattern in seen ? \nSelect and explain. \nA. Ductal carcinoma in situ, B. Medullary carcinoma, C. Lobular carcinoma in situ, D. Infiltrating lobular carcinoma", "role": "user" }, { "content": "Answer: A \nExplanation: - Historically, ductal carcinoma in situ (intraductal carcinoma) has been divided\ninto five architectural subtypes : comedocarcinoma, solid, cribriform, papillary and micropapillary.\nComedocarcinoma is characterized by solid sheets of pleomorphic cells with high grade nuclei and central necrosis\nThe necrotic cell membranes commonly calcify and are detected on mammography as clusters of linear and branching microcalcifications.", "role": "assistant" } ]

[ { "content": "Syndrome of Inappropriate secretion of Anti-Diuretic hormone (SIADH) may be seen in all of the following except? \nSelect and explain. \nA. Use of vincristine, B. Oat cell carcinoma of lung, C. Porphyria-acute attack, D. Primary pulmonary emphysema", "role": "user" }, { "content": "Answer: D \nExplanation: CAUSES OF SIADH: Neoplastic Pulmonary CNS Drugs Other Small cell Mesothelioma Stomach Pancreas Bladder Prostate Endometrium Thymoma Leucaemia LymphomaSarcoma Pneumonia Abscess TB Aspergillosis Asthma Cystic fibrosis PPV Abscess Meningitis AIDS SDH SAH CVA Head Trauma MS GBS Desmopressin Oxytocin* Vasopressin SSRIs* Anti-epileptics * NSAIDs * MDMA Idiopathic Hereditary (V2 receptor)", "role": "assistant" } ]

[ { "content": "An increase in the concentration of 2,3 DPG may be seen in all of the following, except \nSelect and explain. \nA. Anemia, B. Hypoxia, C. Inosine, D. Hypoxanthine", "role": "user" }, { "content": "Answer: D \nExplanation: None", "role": "assistant" } ]

[ { "content": "Norepinephrine is metabolized by which of the following enzymes \nSelect and explain. \nA. COMT, B. MAO, C. Both, D. Neither", "role": "user" }, { "content": "Answer: C \nExplanation: Both COMT and MAO breakdown norepinephrine. Ref:- KD Tripathi", "role": "assistant" } ]

[ { "content": "Force not acting in an enzyme substrate complex : \nSelect and explain. \nA. Electrostatic, B. Covalent, C. Van der waals, D. Hydrogen", "role": "user" }, { "content": "Answer: C \nExplanation: Vander Walls' forces are too weak, to actively paicipate in formation of enzyme- substrate complex. Forces contribute in binding are:- Hydrogen bondingQ- Ionic (electrostatic) bonding- Hydrophobic interactionEnzymes function to decrease the activation energy so that reactions can occur at normal body temperature. The substrate form a covalent bond with the enzymes active site, & accelerates the reaction.", "role": "assistant" } ]

[ { "content": "Thrombocytopenia is caused by: - \nSelect and explain. \nA. Aspirin, B. Acyclovir, C. DIC, D. Henoch-schonlein purpura (HSP)", "role": "user" }, { "content": "Answer: C \nExplanation: Causes of thrombocytopenia: I. -Decreased production of platelets: 1)selective impairment of platelet production: a)drug induced : alcohol , thiazides . b) Infections : measles, HIV .Disseminated intravascular coagulation (DIC) occurs as a complication of a wide variety of disorders. DIC is caused by the systemic activation of coagulation and results in the for- mation of thrombi throughout the microcirculation. As a conse- quence, platelets and coagulation factors are consumed and, secondarily, fibrinolysis is activated. Thus, DIC can give rise to either tissue hypoxia and microinfarcts caused by myriad microthrombi or to a bleeding disorder related to patho- logic activation of fibrinolysis and the depletion of the ele- ments required for hemostasis (hence the term consumptive coagulopathy). This entity probably causes bleeding more commonly than all of the congenital coagulation disorders combined. 2)nutritional deficiency: B12 and folate deficiency. 3) Bone marrow failure: aplastic anemia 4) Bone marrow replacement: Leukemia , disseminated cancer 5)Infective hematopoiesis:MDS II. -Decreased platelet survival 1) immunologic destruction: a)primary autoimmune:a/c & c/c immune thrombocytopenic purpura. b) secondary autoimmune:SLE, B-cell lymphoid neoplasms, Alloimmune , drug induced : (quinidine , heparin ,sulfa compounds.),infections:HIV , IMN. 2)non immunologic destruction: DIC, thrombotic microangiopathies , giant hemangiomas. III.- Sequestration: Hypersplenism IV. -Dilution :Transfusions Ref :Robbins pathologic basis of disease ; south east asia edition-9 ;pg450:table: 14-9.", "role": "assistant" } ]

[ { "content": "Which of the following is not a stimulus for normal/resting ventilation? \nSelect and explain. \nA. Stretch receptors, B. J receptors, C. PO2, D. PCO2", "role": "user" }, { "content": "Answer: B \nExplanation: J receptors are activated by pulmonary congestion, increase in the interstitial fluid volume of the alveolar wall, hyperventilation, and intravenous injection of chemicals like capsaicin. So, J receptors are not a stimulus for normal respiration Ref: Ganong 25th ed/page 658", "role": "assistant" } ]

[ { "content": "Most common recurrence sites or metastatic sites of malignancy following pelvic surgery are all except : \nSelect and explain. \nA. Carcinoma cervix -- Lateral pelvic wall and central pelvis, B. Carcinoma ovary -- Lung, C. Chorionepithelioma - Suburethral anterior vaginal wall, D. Carcinoma body --Vault of vagina", "role": "user" }, { "content": "Answer: B \nExplanation: Recurrence sites of malignancy Ca Cervix : 30% recurrence after 5 years and sites are pelvic side walls and central pelvis Choriocarcinoma : lower third of the vagina and vulva Carcinoma body : by implantation in vulva,vaginal vault pg no:365] SHAW'S TEXTBOOK OF GYNECOLOGY,15th edition D.C.DUTTA'S TEXTBOOK OF GYNECOLOGY,6TH EDITION", "role": "assistant" } ]

[ { "content": "Bifurcation of trachea is at \nSelect and explain. \nA. Upper border of T5, B. Lower border of T4, C. Upper border of T4, D. Lower border of T5", "role": "user" }, { "content": "Answer: B \nExplanation: Trachea bifurcates at the lower border of fouh thoracic veebrae. <img src=\" /> BA CHAURASIA'S HUMAN ANATOMY VOLUME 1. 6TH EDITION.page no-280", "role": "assistant" } ]

[ { "content": "Alopecia universalis is? \nSelect and explain. \nA. Loss of all the scalp hair, B. Loss of all body hair, C. Loss hair at the scalp margin, D. Male pattern hair loss", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. is 'b' i.e., Loss of all body hair * In alopecia aerata, when there is total loss of scalp hair it is called Alopecia totalis. When there is loss of total body hair it is referred as Alopecia universalis. Alopecia along the scalp margin is called ophiasis. An inverse ophiasis pattern (sisaphio) is when it spares occipital region and affects rest of the scalpPresentation of alopecia areata* Young adults are affected, but can occur at any age. Round or oval circumscribed patches of hair loss, which may be single or multiple. Alopecia is sharply defined. Scalp is the first affected site in most cases but any hair bearing skin, e.g. beard, eyebrows and eyelashes can be involved. Exclamation mark hair - These are diagnostic and are characterized by broken-off stubby hair (distal end is broader than proximal end). Exclamation mark hair are seen at the margins of hair loss area.* The characteristic feature is sparing of gray/white hair and preferentially affecting pigmented (black/brown) hair. This results in a dramatic change in hair colour if alopecia progress rapidly and referred to as \"going white overnight phenomenon\".* In 10-15% of patient's there is nail involvement - Fine stippled pitting (\"hammered brass\"), mottled lunula, trachynonychia (rough nails), onychomadesis (separation of nail from matrix).", "role": "assistant" } ]

[ { "content": "Bent inner tube sign is seen in \nSelect and explain. \nA. Volvulus, B. Intussusception, C. Intestinal obstruction, D. Gastric antral vascular ectasia", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. (a) VolvulusRef: Manipal Manual of surgery, 4th ed./739* In sigmoid volvulus, the X ray abdomen erect shows hugely dilated sigmoid loop called bent inner tube sign.* Acute sigmoid volvulus presents as intestinal obstruction and starts after straining at stool. It occurs in anti-clockwise direction and after one and a half turns, the entire loop becomes gangrenous.* The percussion note on the abdomen shall be tympanitic note.", "role": "assistant" } ]

[ { "content": "Von-Meyenburg's complexes are seen in - \nSelect and explain. \nA. Brain, B. Liver, C. Kidney, D. Spleen", "role": "user" }, { "content": "Answer: B \nExplanation: Von Meyenburg Complexes\n\nClose to or within the portal tract, these are small clusters of modestly dilated bile ducts embedded in a fibrous, sometimes hyalinised stroma.\nAlthough these \"bile duct microhamartomas\" may communicate with the biliary tree, they generally are free of the pigmented material tree.\nThey presumably arise from residual embryonic bile duct remnants. Occasionally, a triangular bile duct hamartoma may lie just under Glisson's capsule.\n\nPolycystic liver disease\n\nThere are multiple diffuse cystic lesions in the liver.\n\nCongenital hepatic fibrosis\n\nPortal tracts are enlarged by irregular, broad bands of collagenous tissue, forming septa that divide the liver into irregular islands.\nVariable numbers of abnormally shaped bile ducts are embedded in the fibrous tissue and are in continuity with the biliary tree.\n\nCaroli disease\n\nThe larger ducts of the intrahepatic biliary tree are segmentally dilated and contain inspissated bile.", "role": "assistant" } ]

[ { "content": "A male patient 56 year old complains of swelling in legs. He is a known case of hypertension and is under treatment. On general physical examination pitting oedema is seen on legs and TSH level 3mU/L. Which of the following is not a cause of this condition? \nSelect and explain. \nA. Increase in hydrostatic pressure, B. Decreased colloid osmotic pressure, C. Due to lymphatic obstruction, D. Myxedema", "role": "user" }, { "content": "Answer: D \nExplanation: Most leg swelling is caused by oedema, the accumulation of fluid within the interstitial space. Unilateral swelling usually indicates a localised pathology in either the venous or the lymphatic system, while bilateral oedema often represents generalised fluid overload combined with the effects of gravity. However, all causes of unilateral leg swelling may present bilaterally, and generalised fluid overload may present with asymmetrical (and therefore apparently unilateral) oedema. Fluid overload may be the result of cardiac failure, pulmonary hypertension (even in the absence of right ventricular failure), renal failure, hypoalbuminaemia or drugs (calcium channel blockers, glucocorticoids, mineralocorticoids, non-steroidal anti-inflammatory drugs (NSAIDs) and others).\n Approximately 60% of lean body weight is water, two-thirds of which is intracellular. Most of the remaining water is found in extracellular compartments in the form of interstitial fluid; only 5% of the body’s water is in blood plasma. As noted earlier, edema is an accumulation of interstitial fluid within tissues. \n\nIncrease in hydrostatic pressure are mainly caused by disorders that impair venous return. Local increases in intravascular pressure caused, for example, by deep venous thrombosis in the lower extremity can cause edema restricted to the distal portion of the affected leg.\nReduction of plasma albumin concentrations leads to decreased colloidal osmotic pressure of the blood and loss of fluid from the circulation.\nEdema may result from lymphatic obstruction that compromises resorption of fluid from interstitial spaces.\n\n \nReference:Davidson’s Internal Medicine 23rd edition, page no.186", "role": "assistant" } ]

[ { "content": "Open anterior fontanelle, bruit present. Midline lesion in brain diagnosis - \nSelect and explain. \nA. Malformation of vein of galen, B. Congenital hydrocephalus, C. Down syndrome, D. Rickets.", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. is 'a' i.e., Malformation of vein of galen o Open anterior fontanel seen in all 4 condition.o Cranial Bruits which is heard over anterior fontanel may be seen normally in children upto 4 years of age.o AV malformation of middle cerebral artery or vein of galen.o Severe anemia, raised intracranial pressure may also produce cranial bruit.", "role": "assistant" } ]

[ { "content": "FeCl3 test is used in diagnosis of: NEET 14 \nSelect and explain. \nA. Hydrochloric acid, B. Acetic acid, C. Alcohol, D. Phenol", "role": "user" }, { "content": "Answer: D \nExplanation: Ans. Phenol", "role": "assistant" } ]

[ { "content": "Enchondral ossification is/are seen in- \nSelect and explain. \nA. Long bones, B. Flat bones of skull, C. Clavicle, D. Mandible", "role": "user" }, { "content": "Answer: A \nExplanation: Endochondral (enchondral) ossification → long bones, vertebrae, pelvis, skull base bones.\nIntramembranous ossification → Skull vault, maxilla, most of mandible, and clavicle.", "role": "assistant" } ]

[ { "content": "Cubitus varus deformity in supracondylar fracture of humerus is usually due to \nSelect and explain. \nA. Posterior displacement, B. Posterior angulation, C. Coronal tilt, D. All of the above", "role": "user" }, { "content": "Answer: C \nExplanation: Ans. c (Coronal tilt) (Ref. Bailey & Love surgery, 24th/pg. 375; Orthopedics by John Ebnezar - Pg.155)Malunion (gunstock deformity/cubitus varus) can result from tilt in the coronal plane, and is the most common late complication of supracondylar fracture.SUPRACONDYLAR FRACTURE OF HUMERUS# There are two types of supracondylar fracture--the extension type (95%), in which the anterior cortex fails first with resultant posterior displacement of the distal fragment, and the flexion type, in which the opposite occurs.# Extension type supracondylar fractures are classified using Gartland's classification:- Type I fractures are nondisplaced,- Type II fractures are displaced but hinged on the posterior cortex, and- Type III fractures are completely displaced, as in this case (have potentially serious complications).Early Complications# Vascular damage- As the distal fragment and forearm are pushed backward, the brachial artery and median nerve are pulled violently against the sharp lower edge of the proximal fragment. Circulation must be assessed looking for pulselessness, pallor, pain, paresthesia, and paralysis (the five p's), and capillary refill.# Compartment syndrome# Nerve damage- The median, radial, and ulnar nerves may be injured, with potential long-term pain and functional deficit. Fortunately, the injury is usually a neuropraxia, which recovers with conservative treatment.# Myositis ossificansLate Complications# Volkmann's ischemic contracture# Malunion- Cubitus varus (gun stock deformity) is the most common long-term complication resulting from a malunion of a supracondylar fracture of the humerus in children.- The deformity occurs as a result of residual coronal angulation. Corrective supracondylar osteotomy is performed mainly to improve the cosmetic appearance and not for functional reasons. The most popular method was lateral closing wedge osteotomy but it needs detailed preoperative planning, careful surgical technique but can still cause recurrent varus and lateral condylar prominence in older children.- In Dome osteotomy vulnerability of the radial nerve is the problem. Osteotomy with T-plate fixation gives very good correction of varus deformity, with stable fixation and good functional result but care must be taken to avoid injury to the radial nerve.# Supracondylar fracture of humerus undergoes medial tilt and can lead to varus deformity.- It can cause tardy ulnar nerve palsy.Rx of Supracondylar Fracture:", "role": "assistant" } ]

[ { "content": "An 80-year-old man is brought to dermatology OPD by his son for recently noticed skin lesion. A biopsy is carried out with HPE as shown. Which of the following option cannot be used as a management for the above clinical scenario? \nSelect and explain. \nA. Moh's micrographic surgery, B. Photodynamic therapy, C. Electrodessication, D. NONE", "role": "user" }, { "content": "Answer: D \nExplanation: All of the given options are used in the management of the basal cell carcinoma. Skin lesion shows pearly rolled telangiectatic borders with central ulceration suggestive of BCC. HPE: shows lobulated nest of neoplastic cells with retraction and palisaded basal layer. Findings are suggestive of BASAL CELL CARCINOMA. Treatments options for Basal Cell Cancer include electrodesiccation and curettage (ED&C) excision cryosurgery radiation therapy () laser therapy Mohs micrographic surgery (MMS) topical 5-fluorouracil photodynamic therapy (PDT) topical immunomodulators such as imiquimod The choice of therapy depends on tumor characteristics depth location patient age, medical status patient preference.", "role": "assistant" } ]

[ { "content": "The antibiotic of choice of pertussis is – \nSelect and explain. \nA. Ampicillin, B. Gentamicin, C. Erythromycin, D. Penicillin", "role": "user" }, { "content": "Answer: C \nExplanation: Treatment of pertussis\n\nDOC → Macrolides (Erythromycin, Azithromycin, Clarithromycin)\nAlternative → Cotrimoxazole", "role": "assistant" } ]

[ { "content": "Most common indication for operation in tuberculosis of intestine is - \nSelect and explain. \nA. Obstruction, B. Perforation, C. Mass abdomen, D. GI symptoms", "role": "user" }, { "content": "Answer: A \nExplanation: None", "role": "assistant" } ]

[ { "content": "Hepatitis virus without envelope: \nSelect and explain. \nA. HAV, B. HBV, C. HCV, D. HDV", "role": "user" }, { "content": "Answer: A \nExplanation: Ans. (a) HAV Ref. Harrison 19/e, p 2006, 18/e, p 2539 HAV is a nonenveloped ss RNA virus of picorna family For details see answer no 12 of chapter 27.", "role": "assistant" } ]

[ { "content": "Most common tumor to extend from intracranial to orbit is- \nSelect and explain. \nA. Astrocytoma, B. Pituitary adenoma, C. Craniopharyngioma, D. Sphenoidal wing meningioma", "role": "user" }, { "content": "Answer: D \nExplanation: *Meningiomas commonly arise from the dura of sphenoid wing, i.e.sphenoid wing meningioma. Ref:Opthalmic oncology p.84.", "role": "assistant" } ]

[ { "content": "Ninhydrin test is used for ? \nSelect and explain. \nA. Bile salts, B. Amino acids, C. Nucleic acid, D. Lipids", "role": "user" }, { "content": "Answer: B \nExplanation: Ans. is 'b' i.e., Amino acids Impoant chemical reactions of amino acids Following are some impoant chemical reactions. A. Reaction used to determine amino acid sequence in polypeptide chain : - Generally, amino terminal (N-terminal) of amino acid is tagged with some reagent. It is split off by hydrolysis and tagged amino acid is identified. The reaction is, then, repeated with new N-terminal of subsequent amino acid and so on. The two reactions are used for identification of amino acid sequence : ? Sanger's reaction : - Uses Sanger's reagent ( 1 -fluoro-2,4-dinitrobenzene) to tag amino terminal. Edman's reaction : - Uses Edman's reagent (phenylisothiocyanate) to tag amino terminal. B. Reaction used to identification of individual or group of amino acids : - These reactions are frequently used for qualitative detection and quantitative measurement of various amino acids. Ninhydrin tese : - All a-amino acids. Xanthophoretic reaction : - Aromatic amino acidse (Tyrosine, tryptophan, phenylalanine). Millan's teste (Millon-Nasse reaction) : - Tyrosinedeg (phenol group of tyrosine). Therefore millon's test is positive in tyrosinosisdeg. Aldehyde test : - Tryptophan (indole ring) Hopkins-tole reaction : - Tryptophan (indole ring) Sakaguch's reaction : - Arginine (guanidinium group of arginine). Sulphur test : - Cysteine (sulphydryl group) Nitroprusside test : - Cysteine (sulphydryl group) Pauly's test : - Histidine (imidazole group) Biuret reaction : - Peptide bond Diazo reaction Q (Pauli's) : - Histidine or tyrosine.", "role": "assistant" } ]

[ { "content": "Colipase is an enzyme found in--------? \nSelect and explain. \nA. Saliva, B. Bile, C. Pancreatic juice, D. Succus entericus", "role": "user" }, { "content": "Answer: C \nExplanation: Pancreatic juice contains lipase, colipase, phospholipase A & B Colipase: Facilitates the action of lipase Prevents inactivation of lipase by bile salts SALIVA: 2 types of secretion 1. Serous: contains ptyalin (a amylase ) - digest carbs 2. Mucus: contains mucin - for lubrication & protection STOMACH: Mucus neck cells - secrete mucus Peptic/chief cells - Pepsinogen Parietal / oxyntic - HCL, intrinsic factor Pyloric glands - gastrin PANCREATIC JUICE: For protein : trypsin , chymotrypsin , carboxypolypeptidase Carbohydrates : pancreatic amylase Fat: pancreatic lipase, cholesterol esterase, phospholipase BILE: composition: Liver Bile Gallbladder Bile Water 97.5 g/dl 92 g/dl Bile salts 1.1 g/dl 6 g/dl Bilirubin 0.04 g/dl 0.3 g/dl Cholesterol 0.1 g/dl 0.3 to 0.9 g/dl Fatty acids 0.12 g/dl 0.3 to 1.2 g/dl Lecithin 0.04 g/dl 0.3 g/dl Na+ 145.04 mEq/L 130 mEq/L K+ 5 mEq/L 12 mEq/L Ca++ 5 mEq/L 23 mEq/L CI- 100 mEq/L 25 mEq/L HCO3- 28 mEq/L 10 mEq/L", "role": "assistant" } ]

[ { "content": "Thrush refers to \nSelect and explain. \nA. Acute atrophic candidiasis, B. Acute pseudomembranous candidiasis, C. Chronic atrophic candidiasis, D. Chronic hyperplastic candidiasis", "role": "user" }, { "content": "Answer: B \nExplanation: None", "role": "assistant" } ]

[ { "content": "Optic atrophy can be caused by....poisoning : \nSelect and explain. \nA. Phosphrous, B. Ethyl alcohol, C. Methyl alcohol, D. Lead", "role": "user" }, { "content": "Answer: C \nExplanation: C i.e. Methyl alcohol", "role": "assistant" } ]

[ { "content": "Which of the following is the least likely complication after massive blood transfusion, except \nSelect and explain. \nA. Hyperkalemia, B. Citrate toxicity, C. Hypothermia, D. Metabolic acidosis", "role": "user" }, { "content": "Answer: D \nExplanation: Massive transfusion can lead to coagulopathy and metabolic complications. MC cause of death after massive transfusion: dilutional coagulopathy or DIC. Transfusion of 15-20 units of blood components causes dilutional thrombocytopenia. After massive blood transfusion initially transient hyperglycemia due to glucose in preservatives leading to insulin release and causing hypoglycemia (MC) Galvimetric method of estimation of blood loss: Blood loss during operation is measured by weighing the swabs after use & substracting the dry weight plus volume of blood collected in suction or drainage. Metabolic complications of Massive Transfusion: General Electrolyte Fluid overload Hypothermia Impaired oxygen delivery capacity of Hb (decreased 2,3-DPG) Hyperkalemia Hypocalcemia Hypomagnesemia Metabolic acidosis(rare) Metabolic alkalosis Transfusion Protocols BT should commence within 30 minutes or removing blood bag from refrigerators because of increased risk of bacterial contamination. Whole blood or packed RBC transfusion must be completed within 4 hours. Platelet and FFP transfusion should be completed within 20 minutes. Transfusion set should have standard filter of 170microm size. Usual transfusion needle size should be of 18-19 gauge. Ref: Harrisons 19th edition Pgno: 138", "role": "assistant" } ]

[ { "content": "The drug X is used in osteoporosis. Its mechanism of action is shown in the Figure below. X is likely to \nSelect and explain. \nA. Teriparatide, B. Alendronate, C. Denosumab, D. Estrogen", "role": "user" }, { "content": "Answer: C \nExplanation: New drug for osteoporosis: 1. Teriparatide: PTH with 1-34 amino acid, stimulates osteoblast.2. Strontium ranelate: dual action: stimulate osteoblast and inhibit osteoclast.3. Denosumab: monoclonal antibody against rank ligand.", "role": "assistant" } ]

[ { "content": "Pharmacodynamics includes \nSelect and explain. \nA. Drug Elimination, B. Drug excretion, C. Drug Absorption, D. Mechanism of action", "role": "user" }, { "content": "Answer: D \nExplanation: Pharmacodynamics- the branch of pharmacology concerned with the effects of drugs and the mechanism of their action. Ref-KDT 7/e p1", "role": "assistant" } ]

[ { "content": "In an RTA, a patient sustained soft tissue and Brachial plexus injuries with nerve affected in weakness of extensors of entire arm, forearm, hand with shoulder flexion, and extension. This is suggestive of involvement of \nSelect and explain. \nA. Middle and lower cord, B. C5,6,7, C. C5 to T1, D. Posterior trunk", "role": "user" }, { "content": "Answer: C \nExplanation: (C) C5 to T1 # Preganglionic lesions have a poor prognosis as these do not recover and are surgically irreparable.> Postganglionic lesions have better prognosis than preganglionic lesions and histamine test is useful in making the distinction> Postganglionic lesions: Disruption proximal to the dorsal root ganglion Avulsion of nerve root from the spinal cord Cannot Recover Surgically irreparable Histamine test is positive Pseudomeningoceles on CT myelography or MRI due to root avulsion may be seen (positive result is unreliable during first few days). Sensory conduction from anaesthetic dermatome on nerve conduction studies suggests a preganglionic lesion (i.e. nerve distal to ganglion is not interrupted)> Erb's palsy: Upper obstetric palsy C5-C6 roots are affected Abductors and external rotators of the shoulder are paralysed Arm is held to the side (adducted), internally rotated and pronated (Waiter's tip deformity)> Klumpke's palsy: Lower obstetric palsy C8-T1 roots are affected (Involvement of T1 root may cause a homer's syndrome due to sympathetic nerve disturbance) This is a complete plexus lesion and more severe. Arm is frail and pale. Generalized wasting of all intrinsic muscles and a claw hand deformity is seen. Unilateral (ipsilateral) Horner's syndrome is often associated.> Histamine test: Intradermal injection of histamine usually causes a triple response in the surrounding skin. Central capillary dilatation Wheel Surrounding flare> If the flare reaction persists in an anaesthetic area of skin, the lesion must be proximal to the posterior root ganglion i.e. it is probably a root avulsion.> Postganglionic lesions have better prognosis than preganglionic lesions and histamine test is useful in making the distinction.", "role": "assistant" } ]