Q1. Which is a branch from trunk of brachial plexus ?1. SupraScapular Nerve2. Long Thoracic Nerve3. Axillary Nerve4. Nerve to Subclavius MuscleAnswer 1. SUPRASCAPULAR NERVEQ2. Autorikshaw run over an 8-year-old, tyre mark over leg is called?A. Patterned bruiseB. Imprint abrasionC. ContusionD. Pressure bruiseReferences : Given belowAnswer is B Imprint abrasionKrishan Vij ,Text Book of Forensic Medicine and Toxicology, Principles and Practice, 2008,4thEdn, Pages 282-283.Pressure Abrasions (Crushing Abrasions / Imprint Abrasions): When the impact is vertical tothe skin surface, the epidermis gets crushed and pressure type of abrasions result and theimprint of the impacting object may be produced. These may be seen in manual strangulation(abrasions produced by fingernails) and in hanging, where the weave of the ligature materialmay be reproduced.Patterned Abrasions: Patterned abrasions occur when the force is applied at or around rightangle to the surface of skin, as already mentioned……The classical example of this is seen intraffic accidents when tyre of a motor car passes over the skin leaving the pattern when theskin has been squeezed into the grooves of the rubber tread.Reddy.K.S.N,The Essentials of Forensic Medicine and Toxicology, 2006, 25th Edn, Pages 156-157.Patterned bruising is also seen in motor car accidents.Answer: Imprint Abrasion is to be preferred as most appropriate alternate to Patterned Bruise,since,1. Imprint abrasion and patterned abrasion are the same.2. Patterned abrasion (imprint abrasion) is the classical example of tyre mark3. Tyre will produce patterned bruise usually, if in association with abrasionsQ3. Mineralocorticoid receptors are present in all except ( REPEAT )1) Hippocampus2) Brain3) Liver4) KidneyAnswer 3) LiverQ4. Which is not autoimmune disease?1. SLE2. Grave’s Disease3. Myasthenia Gravis4. Sickle Cell DiseaseAnswer 4. Sickle Cell DiseaseQ5. A 40 year female underwent surgery. Post operatively she told the anaesthetist that shewas aware of per-operative agents. Individual intraoperative awareness is evaluated by1. Bispectral Index
2.Answer 1. Bispectral IndexBispectral index (BIS) is one of several recently developed technologies which purport tomonitor depth of anesthesia. BIS monitors can replace or supplement Guedels classificationsystem for determining depth of anesthesia. Titrating anesthetic agents to a specific bispectralindex during general anesthesia in adults (and children over 1 year old) allows the anesthetistto adjust the amount of anesthetic agent to the needs of the patient, possibly resulting in amore rapid emergence from anesthesia. Use of the BIS monitor may reduce the incidence ofintraoperative awareness in high risk procedures or patients and may also have a role inpredicting recovery from severe brain injuryQ6. Most common cause of death in schizophrenia patient1. Homicide2. Depression3. Suicide4. Due to Antipsychotic side effectsAnswer C ) SuicideQ7. All are pneumatic bones except1) Frontal2) Mandible3) Ethmoidal4) MastoidAnswer 2 ) MandibleQ8. Clue Cells are found inA) CandidaB) Bacterial VaginosisC) Trichomonas VaginalisD) Chlamydial infectionB) Bacterial VaginosisQ9. Nerve involved in supracondylar fracture1. Radial nerve2. Median nerve3. Ulnar nerve4. Ant int nerveAns- AIIMS CONTROVERSIAL QUESTIONQ11. Punett Square is used for1. Genotype2. Collecting datas in one group3.4.1. GenotypeThe Punnett square is a diagram that is used to predict an outcome of a particular cross orbreeding experiment. It is named after Reginald C. Punnett, who devised the approach, and isused by biologists to determine the probability of an offspring having a particular genotype.Q12. A teenage girl complaints of pain over the knee. The pain increase while starting to standfrom sitting position and while walking upstairs. What is the likely diagnosis?
1. Chondromalacia of patella2. Patellar Fracture3. Torn Meniscus4. Bipartite PatellaAnswer ) 1. Chondromalacia of patellaChondromalacia patellae means "soft cartilage under the knee cap," a presumed cause of painat the front of the knee. This condition often affects young .The pain of chondromalaciapatellae is typically felt after prolonged sitting, like for a movie, and so is also called "moviesign" or "theater sign".Q13. Blount’s disease is present as1. Genu recurvatum2. Genu varum3. Genu Valgum4.Answer 3. Genu ValgumBlounts Disease is one which affects the bone development of toddlers and older children.Most often, it starts as bow-leggedness which does not improve in a child between two andfour years of age.DEAR DOCTORS TIBIA VARA is other name for BLOUNTS DISEASE and it presents as GENUVALGUMRadiographic AppearancePhysiologic bowing typically show flaring and bowing of tibia and femur in a symmetric fashionand is normal in children < 2 years of age (maximal at about 18 mo);- physiologic genu valgum, or knock knees, develops next, w/ maximal deformity occurring at3 years of age;- gradual correction to ultimate alignment of slight genu valgum occurs by 9 years of age inthe great majority of patientsQ14. Which is not a neural tumor ?1. Ependymoma2.Neuroblastoma3. Gangliocytoma4. GangliogliomaAnswer. CONTROVERSIAL As Usual AIIMS ROCKS with dummy QuestionsREF Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.;Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: ElsevierSaunders. pp. 1406.Ganglioglioma is a tumour that arises from ganglion cells in the central nervous system.The term "gangliocytoma" is sometimes equated with ganglioglioma. However, it is alsosometimes equated with ganglioneuroma. The term "gangliocytoma" is sometimes used toimply that the tumor is entirely neuronal.Q15. Cadeveric transplant is done for A/E1. blood vessels2. liver3. lung4. bladder
Answer 4. BladderThe major donor organs and tissues are heart, lungs, liver, pancreas, kidneys, eyes, heartvalves, skin, bones, bone marrow, connective tissues, middle ear, blood vessels. Thereforeone donor can possibly give gift of life to many terminally ill patients who would not surviveotherwise.Q16. 32 yr male a known hypertensive planned for cholecystectomy . which of following iscontraindicated1. propofol2. ketamine3. midazolam4.ANS 2. KetamineKetamine causes a rise in intracranial pressure and should not be used in patients who havesustained a recent head injury.The blood pressure rises by about 25% (on average the systolic pressure rises by 20-30mmHg) and the heart rate is increased by about 20% - the overall effect is therefore toincrease the workload of the heart.The pressure within the eyeball (intra-ocular pressure) rises for a short time followingadministration.All pressures are increased.Q17. . One of the drug is contraindicated in Patients with lithium toxicity1.diuretics2. beta blocker3. ccb4.Answer 1. DiureticsDiuretics acting distally to the proximal tubule, such as thiazides and spironolactone, do notdirectly affect the fractional excretion of lithium (although they may affect serum lithium levelsindirectly through their effects on volume status). Reabsorption of lithium is increased andtoxicity is more likely in patients who are hyponatremic or volume depleted, both of which arepossible consequences of diuretic therapy.Q18. Which virus crosses placenta least likely1. rubella2. herpes simplex3. HIV4. Hepatitis BANS Hepatitis BHBV is a large virus and does not cross the placenta, hence it cannot infect the fetus unlessthere have been breaks in the maternal-fetal barrier, e.g. via amniocentesis.Q19. Which is present in Pentology of fallot :1. ASD2. VSD3. Right Ventricular Hypertrophy4. Pulmonary stenosis
Answer 1. ASDQ20. All are true about Nesidioblastosis except ?1. Hypoglycemic Episodes are seen2. Occurs in adults more than child3. Histopathology shows Hyperplasia of Islet cells4. Diazoxide is used in treatmentAnswer 2. Occurs in adults more than childNesidioblastosis is hyperinsulinemic hypoglycemia attributed to excessive function ofpancreatic beta cells with an abnormal microscopic appearance. The abnormal histologicaspects of the tissue included the presence of islet cell enlargement, islet cell dysplasia, betacells budding from ductal epithelium, and islets in apposition to ducts.Most common age group2 – 3 years.Q21. Epileptogenic1. Desflurane2. Sevoflurane3. Ether4. HalothaneAnswer 2. SevofluraneRef : A practice of anesthesia for infants and children By Charles J. CotéQ22. Most common tumor causing superior Vena cava syndrome.1. Lymphoma2. Small cell carcinoma3. Non small cell carcinoma.4.ANS Small cell CarcinomaNearly 95% of superior vena cava syndrome cases are attributed to cancer, with the mostcommon cause being small cell lung cancer, followed by squamous cell lung cancer,adenocarcinoma of the lung, non-Hodgkins lymphoma, and large cell lung cancer.Q23. Most common tumor causing superior Vena cava syndrome.1. Lymphoma2. Small cell carcinoma3. Non small cell carcinoma.4.ANS 3. Small cell CarcinomaNearly 95% of superior vena cava syndrome cases are attributed to cancer, with the mostcommon cause being small cell lung cancer, followed by squamous cell lung cancer,adenocarcinoma of the lung, non-Hodgkins lymphoma, and large cell lung cancer.Q23. Not a cause of primary amoenorrhoea1. kallman syndrome2. turner syndrome
3. sheehan syndrome4. rokitansky syndromeAnswer 3. sheehan syndromeQ24. All are indoor air pollutants except1.CO2. Chloroflurocarbons3. Nitrogen oxide4. MercuryAnswer 3) Nitrogen OxideQ25. Denominator in Maternal Mortality rate1. Total Number of Live birth2. Total Number of Married Women3. Total Number of Birth4.Answer 1. 1. Total Number of Live birthQ26.Contraceptive to be avoided in epilepsy1. OCP2. Condoms3. IUD4. Post Coital PillANSWER 1. OCPConfusion Lies Between OCP and POST COITAL PILL .But Check this standard reference fromThe morning after pill can be used in women with epilepsy after unprotected sexualintercourse. A higher dose is recommended in patients taking hepatic enzyme inducing drugs- 1st dose – Levenorgestrol 1.5mgs (2 tablets)- 2nd dose 12 hours later – Levenorgestrol 0.75mgs (1 tablet)Q27. People are separated into certain sub groups. People are selected randomly from subgroups. What type of sampling is done?1. Random sampling2. Stratified Sampling3. Quota Sampling4.Answer 2. Stratified SamplingQ28. NARP syndrome is seen in1. mitochondrial2. glycogen storage3. lysosomal4. lipid storageAnswer 1. Mitochondrial DisorderNeuropathy, ataxia, and retinitis pigmentosa, is a condition related to changes in
mitochondrial DNA.Mutations in the MT-ATP6 gene cause neuropathy, ataxia, and retinitis pigmentosa.The MT-ATP6 gene is contained in mitochondrial DNA. Mitochondria are structures within cellsthat convert the energy from food into a form that cells can use. Although most DNA ispackaged in chromosomes within the nucleus, mitochondria also have a small amount of theirown DNA (known as mitochondrial DNA or mtDNA).Q29. Which pass through Jugular foramen ?1. Vertebral artery2. Hypoglossal Nerve3. Internal Carotid artery4. Sympathetic chainCN IX, X, XI(descending), jugular vein passes through jugular foramenJugular Foramen or Vernets syndrome is characterized by the paresis of 9th–11th (with orwithout 12th) cranial nerves together.Q30. Necrotizing lymphadenitis is seen in1.Kimura disease2. kikuchi disease3. hodgkin disease4. castelman diseaseAnswer 2. Kikuchi DiseaseKikuchi disease ai also called histiocytic necrotizing lymphadenitis or Kikuchi-Fujimoto disease,is an uncommon, idiopathic, generally self-limited cause of lymphadenitis. The most commonclinical manifestation of Kikuchi disease is cervical lymphadenopathy. Several viral candidateshave been proposed, including cytomegalovirus, Epstein-Barr virus,16 human herpesvirus,varicella-zoster virus, parainfluenza virus, parvovirus B19, and paramyxovirus.Q31. Which is rave drug?1. Cannabis2. Cocaine3. Heroin4.Answer 2. CocaineYet another one from AIIMS Board"RAVE drugs - MDMA, cocaine, amphetamines and ketamine.Superior vena cava syndrome MOST common causea)metastasisb)nonsmall cell lung carcinomac)small cell carcinomaANS-BWilliam Hunter first described the syndrome in 1757 in a patient with syphilitic aorticaneurysm. In 1954, Schechter reviewed 274 well-documented cases of superior vena cavasyndrome (SVCS) reported in the literature; 40% of them were due to syphilitic aneurysms ortuberculous mediastinitis. In more recent times, these infections have gradually decreased asthe primary cause of superior vena cava (SVC) obstruction. Lung cancer, particularly
adenocarcinoma, is now the underlying process in approximately 70% of the patients withsuperior vena cava syndrome (SVCS). However, up to 40% of the causes are due tononmalignant causes.Q. 32. Aprepitant is all except1. Agonist at NK12. Crosses Blood Brain Barrier3. Ameliorate Nausea Vomiting of chemotherapy4. Metabolized by CYP450Answer 1. Agonist at NK1Aprepitant is an antiemetic chemical compound that belongs to a class of drugs calledsubstance P antagonists (SPA). It mediates its effect by blocking the neurokinin 1 (NK1)receptor.Q. 33. Buprenorphine is a1. Partial agonist at MU Receptor2. Partial agonist at Kappa Receptor3. Full Agonist at Mu Receptor4. It is antagonist at Kappa receptorAnswer 1. . Partial agonist at MU ReceptorQ. 34. Local Anaesthetic agent with vasoconstrictor is not used in1. Spinal2. Epidural3. Digital finger block4. Skin AnaesthesiaAnswer 3. Digital Finger BlockThe toxicity of LA is related to the amount and speed of their absorption into the systemiccirculation !Vasoconstrictor ingredient (e.g., adrenaline, felypressin) is often added to LA with the aim toreduce the absorption of LA into the systemic circulation.Effects of vasoconstrictors:- increase in the effect of LA (increased concentration)- decrease in the toxicity of LA (decreased absorption)- increase in the duration of the effect of LAVasoconstrictors must not be used for producing ring-block of an extremity (e.g. finger or toe)because they may cause prolonged ischaemia and gangrene.Q. 35. All are true about Erlotinib except1. Used in Non Small Cell Carcinoma2. It is a small peptide acting as EGRF antagonist3. Food decreases absorption4. It causes skin rashesAnswer 3. Food decreases absorptionExplanation : Food enhances the oral absorption and bioavailability of erlotinib.Q36. Specific Compliance of lung is decreased by all except1. Chronic Bronchitis2. Pulmonary fibrosis
3. Pulmonary Congestion4. Decreased SurfactantAnswer 1. Chronic BronchitisEmphysema / COPD may be associated with an increase in pulmonary compliance due to theloss of alveolar and elastic tissue.Q37. Sparrow marks are seen in following condition1. gunshot injuries2. stab injry of face3 vitriolage4 windshield glass injuryAnswer 4 windshield glass injuryQ. Blount’s disease is a cause of?1. Coax vara2. Coax magna3. Genu valgum4. Genu varumAns: 4 it is a typical disorder affecting the postero-medial epiphysis of proximal tibia (due toavascular necrosis) thereby leading to over growth of the lateral epiphysis resulting in agene /tibia vara deformity. It is common in West Indies & Africans.Q. 1. Which is a branch from trunk of brachial plexus ?1. SupraScapular Nerve2. Long Thoracic Nerve3. Axillary Nerve4. Nerve to Subclavius MuscleAnswer 1. SUPRASCAPULAR NERVE or NERVE TO SUBCLAVIUS ????The nerve to the Subclavius MuscleThis nerve is from the anterior aspect of the superior trunk, from C5, with occasional additionsfrom C4 and C6.It descends posterior to the clavicle and anterior to the brachial plexus to supply thesubclavius muscle.The Suprascapular NerveThis nerve arises from the posterior aspect of the superior trunk, fibres from the ventral ramiof C5 and C6 and often C4 (50% of people).It supplies the supraspinatus and infraspinatus muscles and the shoulder joint.It passes laterally across the posterior triangle of the neck, superior to the brachial plexus andthen through the scapular notch.
1. Which is a branch from trunk of brachial plexus ? 1. SupraScapular Nerve 2. Long Thoracic Nerve 3. Axillary Nerve 4. Nerve to Subclavius Muscle Answer 1. SUPRASCAPULAR NERVE 2. Autorikshaw run over an 8-year-old, tyre mark over leg is called? A. Patterned bruise B. Imprint abrasion C. Contusion D. Ectopic bruise References : Given below Answer is B. Imprint abrasion Krishan Vij ,Text Book of Forensic Medicine and Toxicology, Principles and Practice, 2008, 4thEdn, Pages 282-283. Pressure Abrasions (Crushing Abrasions / Imprint Abrasions): When the impact is vertical to the skin surface, the epidermis gets crushed and pressure type of abrasions result and the imprint of the impacting object may be produced. These may be seen in manual strangulation (abrasions produced by fingernails) and in hanging, where the weave of the ligature material may be reproduced. Patterned Abrasions: Patterned abrasions occur when the force is applied at or around right angle to the surface of skin, as already mentioned……The classical example of this is seen in traffic accidents when tyre of a motor car passes over the skin leaving the pattern when the skin has been squeezed into the grooves of the rubber tread. Reddy.K.S.N,The Essentials of Forensic Medicine and Toxicology, 2006, 25th Edn, Pages 156-157. Patterned bruising is also seen in motor car accidents. Answer: Imprint Abrasion is to be preferred as most appropriate alternate to Patterned Bruise, since, 1. Imprint abrasion and patterned abrasion are the same. 2. Patterned abrasion (imprint abrasion) is the classical example of tyre mark 3. Tyre will produce patterned bruise usually, if in association with abrasions 3. Mineralocorticoid receptors are present in all except ( REPEAT ) 1) Hippocampus 2) Brain 3) Liver 4) Kidney Answer 3) Liver 4. Which is not autoimmune disease? 1. SLE 2. Grave’s Disease 3. Myasthenia Gravis 4. Sickle Cell Disease Answer 4. Sickle Cell Disease 5. A 40 year female underwent surgery. Post operatively she told the anaesthetist that she was aware of per-operative agents. Individual intraoperative awareness is evaluated by 1. Bispectral Index 2. Answer 1. Bispectral Index Bispectral index (BIS) is one of several recently developed technologies which purport to monitor depth of anesthesia. BIS monitors can replace or supplement Guedels classification system for determining depth of anesthesia. Titrating anesthetic agents to a specific bispectral index during general anesthesia in adults (and children over 1
year old) allows the anesthetist to adjust the amount of anesthetic agent to the needsof the patient, possibly resulting in a more rapid emergence from anesthesia. Use ofthe BIS monitor may reduce the incidence of intraoperative awareness in high riskprocedures or patients and may also have a role in predicting recovery from severebrain injury6. Most common cause of death in schizophrenia patient1. Homicide2. Depression3. Suicide4. Due to Antipsychotic side effectsAnswer C ) Suicide7. All are pneumatic bones except1) Frontal2) Mandible3) Ethmoidal4) MastoidAnswer 2 ) Mandible8. Clue Cells are found inA) CandidaB) Bacterial VaginosisC) Trichomonas VaginalisD) Chlamydial infectionB) Bacterial Vaginosis9. Nerve involved in supracondylar fracture1. Radial nerve2. Median nerve3. Ulnar nerve4. Anterior interosseous nerveAnswer 4. Anterior interosseous nerve10. Pain in ethmoidal disease travels through1. Nasociliary Nerve2. Lacrimal Nerve3. Frontal Nerve11. Punett Square is used for1. Genotype2. Collecting datas in one group3.4.Inheritance pattern1. GenotypeThe Punnett square is a diagram that is used to predict an outcome of a particularcross or breeding experiment. It is named after Reginald C. Punnett, who devised theapproach, and is used by biologists to determine the probability of an offspring havinga particular genotype.12. A teenage girl complaints of pain over the knee. The pain increase while starting tostand from sitting position and while walking upstairs. What is the likely diagnosis?1. Chondromalacia of patella2. Patellar Fracture3. Torn Meniscus4. Bipartite PatellaAnswer ) 1. Chondromalacia of patellaChondromalacia patellae means "soft cartilage under the knee cap," a presumed causeof pain at the front of the knee. This condition often affects young .The pain of
chondromalacia patellae is typically felt after prolonged sitting, like for a movie, and sois also called "movie sign" or "theater sign".13. Blount’s disease is present as (Repeat from ADrPlexus Mock series 3 on Dec30,2010 ) Q.No 1071. Genu recurvatum2. Genu varum3. Genu Valgum4.Answer 3. Genu Varum14. Diet Recommendations all except1. Cholesterol intake should be 100 gm/1000 kcal/day2. To avoid alcohol consumption3. Salt intake should be less than 5gm/day4. Saturated fat is about 10% of whole dietAnswer 4. Saturated fat is about 10% of whole diet15. People are separated into certain sub groups. People are selected randomly fromsub groups. What type of sampling is done?1. Random sampling2. Stratified Sampling3. Quota Sampling4. Cluster SamplingAnswer 2. Stratified Sampling16. Which pass through Foramen Magnum ?1. Vertebral artery2. Hypoglossal Nerve3. Internal Carotid artery4. Sympathetic chainAnswer 1. Vertebral arterySpinal roots of CN XI(ascending), brainstem, vertebral arteries.Jugular Foramen or Vernets syndrome is characterized by the paresis of 9th–11th(with or without 12th) cranial nerves together.1- HYPOGLOSSAL CANAL - hypoglossal nerve2- INTERNAL CAROTID ARTERY - passes thru both carotid canal and foramen lacerum3- GREATER PALATINE FORAMEN - anterior palatine nerve4- LESSER PALATINE FORAMEN - posterior palatine nerve5- NASOPALATINE NERVE - incisive foramen6- SUPRA ORBITAL FORAMEN OR NOTCH - supraorbital nerve7- SUPRA ORBITAL FISSURE - inferior opthalmic vein8- INFRA ORBITAL FORAMEN - infra orbital nerve9- ZYGOMATIC NERVE - infra orbital fissure10- ZYGOMATICO FACIAL FORAMEN - zygomatico facial branch of the sixth nerve11- OPTIC CANAL - central retinal vein12 - FORAMEN ROTUNDUM - maxillary division of the trigeminal nerve
13- FORAMEN OVALE - Mandibular nerve, Accessory meningeal artery, Lesser petrosalnerve and Emissary veins (mnemonic : MALE).14- FORAMEN SPINOSUM - middle meningeal artery15- JUGULAR FORAMEN - 9 , 10 , 11 th cranial nerves16- MASTOID FORAMEN - meningeal branch of occipital artery17- TYMPANO MASTOID FISSURE - auricular branch of vagus ( vidian r alderman n )18- FACIAL NERVE - stylomastoid foramen19- CHORDA TYMPANI NERVE - petro tympanic fissure.17. Which is not a neural tumor ?1. Ependymoma2.Neuroblastoma3. Gangliocytoma4. GangliogliomaAnswer CONTROVERSIALREF Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, StanleyL.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis,Mo: Elsevier Saunders. pp. 1406.Ganglioglioma is a tumour that arises from ganglion cells in the central nervoussystem.The term "gangliocytoma" is sometimes equated with ganglioglioma. However, it isalso sometimes equated with ganglioneuroma. The term "gangliocytoma" is sometimesused to imply that the tumor is entirely neuronal.18. Which is rave drug?1. Cannabis2. Cocaine3. Heroin4. EcstacyAnswer 4. EcstasyThere are a variety of substances that have been connected with Rave Clubs. This is abrief list of some of the drugs by slang names and some of their effects:Ecstasy – Hallucinogen/Stimulant Ecstasy is a synthetic drug that is similar tomethamphetamine and the hallucinogen mescaline. Ecstasy can produce a significantincrease in heart rate and blood pressure and a sense of alertness. The stimulanteffects, which enable users to dance for extended periods, may also lead todehydration, hypertension, and heart or kidney failure. Ecstasy can cause braindamage. It is one of the most widely used of the club drugs.Ephedrine – Stimulant This substance is sold over-the-counter at convenience stores,some food stores, and mail order. It is sold often as ‘Herbal Ecstasy’ and is touted as a‘safe’ and ‘legal’ form of Ecstasy. Ephedrine is in the Amphetamine family and cancause heart attacks, seizures, agitation, palpitations, and other health problems.Ephedrine is a common weight-loss substance. The FDA has proposed restrictions onephedrine after it received more than 800 reports of harmful effects to people, amongthem coronary problems that could put patients at risk for heart attacks, strokes anddeath.Ketamine – Hallucinogen Ketamine is an animal tranquilizer used by vets in petsurgery. Users say the effects of Ketamine are similar to PCP. Ketamine is usuallysnorted and is frequently used in combination with other drugs like ecstasy, heroinand cocaine. The high lasts anywhere from 30-minutes to about 2-hours. Special K orpowdered Ketamine, emerged as a recreational drug in the 1970s and was known as“Vitamin K’ in the underground club scene in the 1980s. It has since resurfaced as“Special K” in the 1990s rave scene.
GHB – Depressant This substance comes in a liquid form and looks like water and hasa salty taste. GHB is used as a “club drug” for effects similar to those of Rohypnol,also known as “date rape drugs.” Coma and seizures can occur following of GHB andwhen combined with methamphetamine.Mixing GHB with alcohol could be a deadly combination. Excessive use of GHB canresult in loss of consciousness (G-hole), tremors, irregular and depressed respirationand coma.Methcathinone – Stimulant Known on the street as Khat or cat it produces anamphetamine like effect. The drug produces a burst of energy and feeling ofinvincibility, accompanied by a state of well being and euphoria. Effects includeparanoia, hallucinations, nervousness and anxiety. Physical effects can be poundingheart, headaches stomachaches, and shakes. Khat is most often snorted, but may alsobe injected with a needle or taken orally by mixing with a beverage such as a softdrink.LSD – Hallucinogen LSD induces abnormalities in sensory perceptions. Effects areunpredictable depending on the amount taken, on the surroundings in which the drugis used, and on the user’s personality, mood, and expectations. It can be in the formof a tablet, capsule, liquid, or on pieces of blotter paper that have absorbed the drugand is typically taken by mouth. Effects come on within 30 to 90 minutes after takingand can include physical effects of dilated pupils, higher body temperature, increasedheart rate and blood pressure, sweating, loss of appetite, sleeplessness, dry mouth,and tremors.Magic Mushrooms – Hallucinogen The effects of Mushrooms or “Shrooms” are similarto LSD. They include illusions and hallucinations, distorted perception of time anddistance. It is ingested orally in the form of tablets or powder. Trips or episodes canconsist of psychosis, convulsions, flashbacks, and possible death.Methamphetamine – Stimulant Methamphetamine affects many areas of the centralnervous system. The drug is often made in clandestine laboratories from relativelyinexpensive over-the-counter ingredients. Diverse groups, including young adults whoattend raves, in many regions of the country, are using it. It is available in manyforms, and can be smoked, snorted, injected, or orally ingested. Methamphetamineuse is associated with serious health consequences, including memory loss,aggression, violence, psychotic behavior, and potential cardiac and neurologicaldamage. Abusers typically are agitated, have excited speech, decreased appetite, andincreased physical activity levels.19. All are indoor air pollutants except1. Radon2. Carbon Monoxide3. Nitrogen oxide4. MercuryAnswer 3) Nitrogen Oxide20. Denominator in Maternal Mortality rate1. Total Number of Live birth2. Total Number of Married Women3. Total Number of Birth4.Answer 1. 1. Total Number of Live birth21. Cadeveric transplant is done for A/E1. blood vessels2. liver3. lung4. bladderAnswer 4. Bladderand this is why you have to read prospectus back page with specific linksThe major donor organs and tissues are heart, lungs, liver, pancreas, kidneys, eyes,heart valves, skin, bones, bone marrow, connective tissues, middle ear, blood vessels.
Therefore one donor can possibly give gift of life to many terminally ill patients whowould not survive otherwise.22. Not a cause of primary amoenorrhoea1. kallman syndrome2. turner syndrome3. sheehan syndrome4. rokitansky syndromeAnswer 3. sheehan syndrome23. 32 yr male a known hypertensive planned for cholecystectomy . which of followingis contraindicated1. propofol2. ketamine3. midazolam4.ANS 2. KetamineKetamine causes a rise in intracranial pressure and should not be used in patients whohave sustained a recent head injury.The blood pressure rises by about 25% (on average the systolic pressure rises by 20-30 mmHg) and the heart rate is increased by about 20% - the overall effect istherefore to increase the workload of the heart.The pressure within the eyeball (intra-ocular pressure) rises for a short time followingadministration.All pressures are increased.24. One of the drug is contraindicated in Patients with lithium toxicity1.diuretics2. beta blocker3. ccb4.Answer 1. DiureticsDiuretics acting distally to the proximal tubule, such as thiazides and spironolactone,do not directly affect the fractional excretion of lithium (although they may affectserum lithium levels indirectly through their effects on volume status). Reabsorption oflithium is increased and toxicity is more likely in patients who are hyponatremic orvolume depleted, both of which are possible consequences of diuretic therapy.25. Most common tumor causing superior Vena cava syndrome.1. Malignant Lymphoma2. Small cell carcinoma3. Non small cell carcinoma.4.ANS Small cell CarcinomaNearly 95% of superior vena cava syndrome cases are attributed to cancer, with themost common cause being small cell lung cancer, followed by squamous cell lungcancer, adenocarcinoma of the lung, non-Hodgkins lymphoma, and large cell lungcancer.26. Which virus crosses placenta least likely ( ADrPlexus Q )1. rubella2. herpes simplex3. HIV4. Hepatitis BANS 4. Hepatitis BHBV is a large virus and does not cross the placenta, hence it cannot infect the fetusunless there have been breaks in the maternal-fetal barrier, e.g. via amniocentesis.27. Deoxygenated Blood is carried in all blood vessels except
1. umbilical artery2. umbilical vein3. pulmonary artery4. right ventricleAnswer 2. Umbilical vein28. A patient with Solitary kidney having 4 cm solitary exophytic mass in lower pole.Management is1.Partial nephrectomy2. Radical nephrectmy with dialysis3. Radical nephrectomy with immediate renal transplant4. ObservationANS. Partial nephrectomy29. Which is present in Pentology of fallot :1. ASD2. VSD3. Right Ventricular Hypertrophy4. Pulmonary stenosisAnswer 1. ASD30. All are true about Nesidioblastosis except ?1. Hypoglycemic Episodes are seen2. Occurs in adults more than child3. Histopathology shows Hyperplasia of Islet cells4. Diazoxide is used in treatmentAnswer 2. Occurs in adults more than childNesidioblastosis is hyperinsulinemic hypoglycemia attributed to excessive function ofpancreatic beta cells with an abnormal microscopic appearance. The abnormalhistologic aspects of the tissue included the presence of islet cell enlargement, isletcell dysplasia, beta cells budding from ductal epithelium, and islets in apposition toducts.Most common age group 2 – 3 years.31. Epileptogenic1. Desflurane2. Sevoflurane3. Ether4. HalothaneRef : A practice of anesthesia for infants and children By Charles J. CotéAnswer 2. Sevoflurane32. Contraceptive to be avoided in epilepsy1. OCP2. Condoms3. IUD4. Post Coital PillANS. OCPThe morning after pill can be used in women with epilepsy after unprotected sexualintercourse. A higher dose is recommended in patients taking hepatic enzyme inducingdrugs- 1st dose – Levenorgestrol 1.5mgs (2 tablets)- 2nd dose 12 hours later – Levenorgestrol 0.75mgs (1 tablet)33. NARP syndrome is seen in1. mitochondrial2. glycogen storage3. lysosomal4. lipid storageAnswer 1. Mitochondrial Disorder
Neuropathy, ataxia, and retinitis pigmentosa, is a condition related to changes inmitochondrial DNA.Mutations in the MT-ATP6 gene cause neuropathy, ataxia, and retinitis pigmentosa.The MT-ATP6 gene is contained in mitochondrial DNA. Mitochondria are structureswithin cells that convert the energy from food into a form that cells can use. Althoughmost DNA is packaged in chromosomes within the nucleus, mitochondria also have asmall amount of their own DNA (known as mitochondrial DNA or mtDNA).34. Necrotizing lymphadenitis is seen in1. Kimura disease2. kikuchi disease3. hodgkin disease4. castelman diseaseAnswer 2. Kikuchi DiseaseKikuchi disease ai also called histiocytic necrotizing lymphadenitis or Kikuchi-Fujimotodisease, is an uncommon, idiopathic, generally self-limited cause of lymphadenitis.The most common clinical manifestation of Kikuchi disease is cervicallymphadenopathy. Several viral candidates have been proposed, includingcytomegalovirus, Epstein-Barr virus,16 human herpesvirus, varicella-zoster virus,parainfluenza virus, parvovirus B19, and paramyxovirus.35. A tennis player gets hurt by a ball in his eye, he complaints of decreased vision?what may be the cause for the condition?1 optic neuritis2 pars planitis3 . Avulsion of the Vitreous base4 . equatorial edemaShall Discuss Most Probable 3. Avulsion of the Vitreous baseChapter 12 BLUNT INJURY OF THE EYEBlunt injuries: the eye wall does not have a full thickness wound. Open globe orpenetrating injuries: the eye wall has a full thickness wound. A blunt force causes aglobe rupture and a sharp object causes a laceration at the site of impact. Lacerationsmay be penetrating with a single entrance wound, or a perforating with an entranceand exit wound.Symptoms and signs suggestive of globe rupture include pain, deceased visual acuity(a normal visual acuity is rarely present in a globe rupture), extensive subconjunctivalhaemorrhage (often involving 360 degrees of bulbar conjuctiva), a deep or shallowanterior chamber, hyphaema, low IOP (however IOP can be normal or high), irregularpupil, iridodialysis, cyclodialysis, lens subluxation, commotio retinae, retinal tears,vitreous haemorrhages, obvious corneal or scleral lacerations or intraocular contentsmay be outside the orbit.Direct blows to the eye transmit energy to the adjacent tissues as they producecompression,shearing, and tensile strains. The resultant great shearing forces are usually strongestat the posterior border of the vitreous base, and a linear tear of the retina may result.If traction is strongest at the anterior border of the vitreous base, the nonpigmentedciliary epithelium is torn. Strong traction at both the anterior and posterior bordersmay produce vitreous base avulsion, which is pathognomic of ocular36. Aprepitant is all except1. Agonist at Neurokinin receptor2. Crosses Blood Brain Barrier3. Ameliorate Nausea Vomiting of chemotherapy4. Metabolized by CYP450Answer 1. Agonist at NK1Aprepitant is an antiemetic chemical compound that belongs to a class of drugs calledsubstance P antagonists (SPA). It mediates its effect by blocking the neurokinin 1(NK1) receptor.
37. Buprenorphine is a1. Partial agonist at MU Receptor2. Partial agonist at Kappa Receptor3. Full Agonist at Mu Receptor4. It is antagonist at Kappa receptorAnswer 1. . Partial agonist at MU Receptor38. Local Anaesthetic agent with vasoconstrictor is not used in1. Spinal2. Epidural3. Digital finger block4. Skin AnaesthesiaAnswer 3. Digital Finger BlockThe toxicity of LA is related to the amount and speed of their absorption into thesystemic circulation !Vasoconstrictor ingredient (e.g., adrenaline, felypressin) is often added to LA with theaim to reduce the absorption of LA into the systemic circulation.Effects of vasoconstrictors:- increase in the effect of LA (increased concentration)- decrease in the toxicity of LA (decreased absorption)- increase in the duration of the effect of LAVasoconstrictors must not be used for producing ring-block of an extremity (e.g. fingeror toe) because they may cause prolonged ischaemia and gangrene.39. All are true about Erlotinib except1. Used in Non Small Cell Carcinoma2. It is a small peptide acting as EGRF antagonist3. Food decreases absorption4. It causes skin rashesAnswer 3. Food decreases absorptionExplanation : Food enhances the oral absorption and bioavailability of erlotinib.40. Sparrow marks are seen in following condition1. gunshot injuries2. stab injry of face3 vitriolage4 windshield glass injuryAnswer 4 windshield glass injury41. All are supplied by the anterior division of Mandibular nerve except:1. lateral pterygoid2. medial pterygoid3. temporalis4. masseterAnswer 2: medial pterygoidThe nerve to medial pterygoid is a direct branch of the mandibular trunk.42. 39. All of the following decrease bone resorption in osteoporosis except?1.Alendronate2.Etidronate3.Strontium4.TeriparatideAnswer 4. TeriparatideTeriparatide increases both bone formation and bone resorption43. Onodi Cells & Haller Cells are associated with the following structuresrespectively?1.Optic Nerve & Orbital floor2.OPTIC NERVE & INTERAL CAROTID ARTERY
3.ICA & optic Nerve4.ORBITAL FLOOR & ICAAnswer 1. OPTIC NERVE & ORBITAL FLOOR44. Posterior relations of head of pancreas are all except1) Common Bile Duct2) duodenum first part3) Aorta4) IVCAnswer 2. Duodenum First partPosterior Surface.—The posterior surface is in relation with the inferior vena cava, thecommon bile duct, the renal veins, the right crus of the diaphragm, and the aorta.45. About yaws all are true except1. caused by t. pertenue2. transmitted non-venerally3. Secondary yaw can involve bones4. Last stages involve heart & nervesAnswer 4. Last stages involve heart & nervesYaws, like syphilis, has been classified into the following 4 stages:Primary stage: The initial yaws lesion develops at the inoculation site.Secondary stage: Widespread dissemination of treponemes results in multiple skinlesions similar to the primary yaws lesion.Latent stage: Symptoms are usually absent, but skin lesions can relapse.Tertiary stage: Bone, joint, and soft tissue deformities may occur.46. Mifepristone is used in1. Hydatiform Mole2. Abortion3. Ectopic4.Answer 2. AbortionMedical abortion using mifepristone plus prostaglandin is the most effective method ofabortion at gestations of less than 7 weeks. Mifepristone is contraindicated in thepresence of an intrauterine device (IUD), as well as with ectopic pregnancy, adrenalfailure, hemorrhagic disorders, inherited porphyria, and anticoagulant or long-termcorticosteroid therapy.47. Patient had cicatrical alopecia with grey pigmentation around hair follicles.Whatwill you look for?1. Whitish lesion in the buccal mucosa2. Nail dystrophy3. Arthritis4. Discoid Plaques in the faceAnswer 1. Whitish lesion in the buccal mucosa48. How to differentiate ASD from VSD in X-ray1. Enlarged Left atrium2. Pulmonary congestion3. Aortic shadowAnswer 1. Enlarged Left atrium49. Specific Compliance of lung is decreased by all except1. Chronic Bronchitis2. Pulmonary fibrosis3. Pulmonary Congestion4. Decreased SurfactantAnswer 1. Chronic BronchitisEmphysema / COPD may be associated with an increase in pulmonary compliance due
to the loss of alveolar and elastic tissue50. All are features of digitalis toxicity except1. Ventricular Bigeminy2. Regularisation of AF3. Delayed conduction across AV4. Biventricular tachycardiaAnswer CONTROVERSIAL AIIMS. HELP US WITH OPTIONSDigoxin toxicity is especially suggested by paroxysmal atrial tachycardia with AV blockand accelerated junctional rhythm in the presence of atrial fibrillation, so-called“regularization of atrial fibrillation. Prolonged PR intervals (greater than 0.20 second)may represent a conduction delay through the atria or AV junction due to digitalistoxicity or heart block.Bidirectional ventricular tachycardia is particularly characteristicof severe digitalis toxicity. The combination of increased (atrial) arrhythmogenesis andinhibited atrio-ventricular conduction (for example paroxysmal atrial tachycardia withA-V block - so-called "PAT with block") is said to be pathognomonic (i.e. diagnostic) ofdigoxin toxicity.51. A patient was started haloperidol for schizophrenia before four days. Now thepatient complaints of severe spasm of neck on one sidefor the past 2 hours. what isthe likely diagnosis?1. akathisia2. Acute dystonia3. malignant hyperthermia4. tardive dyskinesia.Answer: 2. Acute dystonia52. Diaphragm develops from all except1.pleuroperitoneal membrane2.septum transversum3.musculature of dorsal wall4.cervical somitesAnswer: 4.cervical somites53. Sterile pyuria is seen in1.chronic pyelonephritis2.wilms”s tumour3.tuberculosis4.cystitisAnswer: tuberculosis54. Haematological syndromes is seen in radiation doses of1.5 rad2.100 rad3. 200 rad4.Answer: 3. 200The hematologic syndrome is associated with radiation doses in the range of 150 to600 rad (1 .5 to 6 Gy).55. Best test to identify metastatic bone lesion is1.ct scan2.mri3.bone scan4.x rayAnswer. Bone scan56. Which is the commonly used fixative in histopathological specimen1.glutaraldehyde
2.formaldehyde3.alcohol4.picric acidAnswer: 2.formaldehydeThe most common fixative for light microscopy is 10% neutral buffered formalin (4%formaldehyde in phosphate buffered saline).57. All are given in total parenteral nutrition except1.carbohydrates2.fat3.fibre4.micronutrientsAnswer:fibre58. About parvovirus B19 all are true except1. spread by respiratory route2.has affinity for erythrocyte p antigen3.causes transient aplastic crisis4.about only 10%of cases it crosses the placentaAnswer: Ref Harrison 17th edition p 1116/1117 , Greenwood microbiology 6th e p452The risk of transplacental infection is 30%59. In patients receiving isoniazid theraphy which of the following micronutrients to besupplemented1. Vitamin B122. pyridoxine3.4.Answer.pyridoxine60. Which of the following is used to diagnose intraoperative myocardial infarction1.2.3.transesophagial echocardiogram4.ecgAnswer: Please Help us with correct options71 pt with solitary kidney hving 4 cm exophytic mass in lower pole. best managementpartial nephrectomyrdical nephrctmy with dialysisradical witth immediate renal transplantobservation72 NARP syndrome is seen inmitochondrialglycogen storagelysosomallipid storage73 hallmark of acute inflammation ??vasoconstrictionstasisvasodilation and increase in permeabilityleucocytic margination74 ONODI CELLS & HALLER CELLS are associated with the following structuresrespectively?a.OPTIC NERVE & ORBITAL FLOOR
b.OPTIC NERVE & INTERAL CAROTID ARTERY c.INTERNAL CAROTID ARTERY& OPTIC NERVE d.ORBITAL FLOOR & INTERNAL CAROTID ARTERY 75 amp b causes def of na ca k mg76 injury to common peronel n all except ??loss of senstion over solefoot dropinjury to neck of fibulaloss of dorsiflex of toe77 Nerve involved most commonly in supracondylar fractureRadial nerveMedian nerveUlnar nerveAnt int nerve78 definitive airway a/e:nasotracheal tubeorotracheal tubelmacricothyroidectomy76 not a cause of primary amoenorrhoeakallman syndrometurner syndromesheehan syndromerokitansky syndrome79 a 65 yrs old lady presenting wth swollen n painful knee...having grade III osteoarthriticchanges..wats the best management for her1.conservative2.arthroscopic washing3.partial knee replacement4.total knee replacement80 which is the integrase inhibitor used in treatment of hiv??raltegraseindinavirlopinavir81 A 6 year old child presents with pain in hip in femoral triangle region. X-ray does not revealany abnormality. What is the next step?A. USGB. MRIC. AspirationD. Traction82 Pasteurised milk is tested mostl commonly by:a. phosphatase testb. coliform testc. catalase test
84 Anaesthetic agent with vasoconstrictor C/I in:a. finger blockb. spinal blockc. epidural blockd. regional Anaesthesia85 a rickshaw runover thigh of child ..tyre marks over thigh represents ??patterned bruiseimprint abrasionectopic abrasion86 prophylaxis of migraine a/epropranololflunarizinetopiramatelevacetarem87 early sign of magnesium toxicity1.depression of deep tendon reflexes2.respiratory depression3.cardiac arrest4.decrease urine output88 all are actions of muscarinic antagonist except.a. decreses gastric secretionb. prolongs a-v conductionc. decreses resp secretionsd.contraction of radial muscles of iris89 all are seen in argyl robertson pupil except.near reflex normaldirect reflex absentconsensual reflex normalvision normal89 Branch of trunk of brachial plexusa. suprascalpurb. long thoracic nc.ant. Thoracicd. nerve to sub clavius.90 tolerance in opioids develops to all exceptmiosisanalgesiaeuphoria??91 diaphragm develops from a/e:septum transversumdorsal mesocardiumpleuroperitoneal membranecervical myotomes2 ecg is poor in detecting ischaemia in areas supplied byladlt circumflexlcarca
93 The primary action of NO in git is?A. VasodilatationB. VasoconstrictionC. GI smooth muscle relaxationD. Secretomotor94 Which is not seen in digoxin toxicity?A. Biventricular tachycardiaB. Proxysmal atrial tachycardia with ectopicsC. Ventricular bigeminyD. Regularisation of AF95 Which of the following does not cause indoor air pollution?A. COB. Nitrogen dioxideC. RadonD. Mercury vapor96 All are true about pheochromacytoma except?A. 90% are malignantB. 95% occur in the abdomenC. They secrete catecholaminesD. They arise from sympathetic ganglionsQ 97 Most important and hazardous agent that can be used in bioterrorism:A. PlagueB. Small poxC. TBD. Clostridium botulinum[snip] True about epidural opioids are all except?A. Acts on dorsal horn cellB. ItchingC. Nausea & vomitingD. Respiratory depressionQ99 Most common site of stricture formation after TURP?A. Navicullar fossB. BulbC. Prostatic membranous urethraD. Bladder neckQ100 Intraoperative myocardial infarction is best diagnosed by:A. ECGB. Invasive arterial pressureC. Central venous pressureD. Trans esophageal echocardiogramQ101 Pseudoisomorphic phenomenon seen inA. PsoriasisB. Lichen planusC. VitiligoD. Plane warts1 02 ova albumin antigen was injected into a rabbit. What antibody will it produce initially?A. IgGB. IgMC. IgED. IgD
103 a 50 yr lady has history of sprained ankle 2 months back followed by recovery. She nowcomplains of severe pain in that ankle with inability to flex that foot. Physician notes edemaand shiny skin in local examination. What is the probable diagnosis:a. Fibromyalgiab. Complex regional pain syndrome 1c. Complex regi...104 About yaws all are true except:A. Caused by Treponema pertenueB. Transmitted non-venerallyC. Secondary yaws can involve bonesD. Last stages involve heart and nerves105 Weight gain in pregnancy is related to all except?A. EthnicityB. SmokingC. Socioeconomic statusD. Pre conceptional weight106 Which virus among the following is least likely to cross placenta?A. RubellaB. Herpes simplexC. HIVD. HBV107 A fire breaks out during laser vocal cord surgery. What is not to be done?A. Pouring sterile waterB. Removing endotracheal tubeC. 100% oxygen after discontinuing anesthetic gasesD. Treatment with steroid & antibiotic108 A patient with history of discharge from right ear for past 1 year presented with severeear ache. The discharge was cultured and the organism was found to be gram positive cocci.The least likely cause is?A. PsuedomonasB. Streptococcus pneumoniaeC. StaphylococcusD. Haemophilus influenzae109 Which among the following is the most common tumour associated withneurofibromatosis in a child?A. Juvenile myelomonocytic leukemiaB. Acute lymphoblastic leukemiaC. Acute monocytic leukemiaD. Acute myeloid leukemia110 Common carotid artery is palpated at which site?A. Upper border of cricoid cartilageB. Upper border of thyroid cartilageC. Hyoid boneD. ???111 A 5 year old boy while having dinner suddenly becomes aphonic and is brought to thecasulty for the complaint of respiratory difficulty. What should be the appropriatemanagement?A. CricothyroidotomyB. Emergency tracheostomyC. Humidified oxygen
D. Heimlich maneuver112 Which among the following is the most common fungal infection seen in immunocompetent patients?A. AspergillusB. CandidaC. CryptococcusD. Mucor113 A teenaged girl complains of pain in knee on climbing stairs and on getting up after sittingfor a long time. What is the probable diagnosis?A. ChondromalaciaB. Plica syndromeC. Bipartite patellaD. Patello-femoral osteoarthritis114 cause of premature death in schizophrenia?a)homicideb)suicidec)toxicity of antipsychotic drugd)hospital acquired infection115 Which of the following is not an adverse effect of thalidomide?A. DiarrhoeaB. TeratogenicityC. DVTD. Peripheral neuropathy116 Superior vena caval syndrome is most commonly caused by?A. LymphomaB. Small cell lung caC. Non small cell lung caD. Secondary tumours117 Which of the following is a contraindication for medical treatment in gallstones?A. Radio opaque stonesB. Radiolucent stonesC. Normal functioning gall bladderD. Small stones18 lines of blashchko --lymphaticblood vesselnerveline of development119 deoxy blood flow thru a/e:umbilical aumbilical veinpulm aright ventricle120 best test for hcg ?radioimmunoassayelisalatex test121 aortic knuckle shadow on pa x ray..obliterated by consolidation of which portion of lung?upper lingula
lower lingulaapex of lower lobepost part ofupper lobe122 Tetracycline used in prophylaxis of ?cholerabrucellosisleptospirosis123 basal matabolic closely associated with ?a.lean body massb.body surface areac.body mass indexd.124 maximal water absorption of water in git?a jejunumb colonc ileumd ??125 pentology of fallot has which one of following extra entities:a. asdb. vsdc. rvhd. pulmonary stenosis126 free radicals in cells produced by a/eglut peroxidaseNO synthasesuperoxide dismutase127 all of done in management of shoulder dystocia excepta. fundal pressureb. suprapubic pressc. mc robertsd. woods128 Which one of the following is not neuron tumoura.ependymomab.gangliocytomac.gangliogliomad.??129 In L5 root involvement, which among the following is not affected?A. Thigh adductionB. Knee flexionC. Knee extensionD.great Toe extensionQ130 Which among the following is not a cause of fasting hypoglycemia?A. Glucagon excessB. Glucose 6 phospatase deficiencyC. UreamiaD. Glycogen synthase deficiency131 McKeons theory on reduced prevalence of TB?A. Increased awareness and knowledgeB. Medical advancement
C. Behavioural modificationD. Social and environmental factor132 A child presents with abdominal pain only during passage of stools. No other symptomslike vomiting or blood in stools. There are no signs of intestinal obstruction. Most probablediagnosis is?A. Rectal polypB. IntusseceptionC. Meckels diverticulumD. NECQ133 A man presents with a maculopapular rash. He gives a history of previous painless rash.Infection is due to?A. Treponema pallidumB. ChlamydiaC. Calymmatobacterium granulomatisD. Haemophilus ducreyiQ134 Meglitinides - all are true except:a. decreases post parendial hyperglycemiab. hypoglycemia less common than sulfonylureasc. it decreases insulin resistanced. it acts by releasing insulinQ135 Cleavage of which complement is involved in both -classical and alternate pathway a.C1b. C2c. C3d. C4Q136 what is not asso. with mestruation..?1. hormone2. vaginal cytology3. estrus profile4. cervical changesQ137 best treatment option for genuine stress incontinence?a. burch colposuspenssionb. kellysc. sling operationd.free vaginal tappingQ138 Xanthogranulomatous inflammation all are true except ?A. presence of foamy macrophageB. presence of tuberculous infectionC. multinucleatd giant cellD. yellow noduleQ139 Posterior relations of head of pancreas are all except?A. Common bile ductB. First part of duodenumC. right crus of diaphragmD. Inferior vena cava140 All are true about blood coagulation except.1 factor 10 in doth intrinsic and extrinsic2 extrinsic is activated by contact with plasma and -fly charged protein ans3 calcium is very important ion for coagulation4 intrinsic can be activated in vitro.
Q141 Late onset endophthalmitis after intraocular lens implantation caused bya)staph epidrmidisb)pseudomonasc) strptococcus pyogenespropionibacter acne142 Which of the following is not a contraindication for pregnancy?A. WPW syndromeB. Pulmonary hypertensionC. Eisenmenger syndromeD. Marfan syndrome with aortic root dilatationQ143 which one of the following is a cardio protective fattyacida.stearic,b.palmiticc.oleicd.w3 fatty acidsQ144 Which one of the following is not seen in floor of 3rd ventriclea.optic stalkb.mammilary bodyC.occulomotor nerved.infundibulum145 Which among the following not a component of hypogastric sheth?A. Broad ligamentB. Transverse cervical ligamentC. lateral ligamentd.??146 Child brought to casualty with reports of violent shaking by parents. Most likely injury?A. Long bone #B. Ruptured spleenC.subdural hematomaD.skull bone #147 arthropod transmitted virus diseases not found in india1.west nile fever2.dengue3.yellow fever4.148 open neural tube defects detected by increase in which of the following –acetylcholinesterasepseudocholinestraseAFP149 Which of the following is true abt HDI A/E?a) LIFE EXPECTANCY AT BIRTHb) LIFE EXPECTANCY AT 1 YEARc) EDUCATIONd) GDP in us $150 most potent activator of T cells?1. B cells2. follicular dendritic cells3. mature dendritic cells
4. macrophages151 Following abt Phagocytosis all true A/ea.<0.5 mcmb.>0.5 mcmc.Phagosome+lysosome=phagolysosomed. d.amoeba n other unicellular org make their living out of it152 APL Ab syndrome which Ab seen?a.beta 1 microglobulinb.ANAc. anti centromered.153 poor prognostic factor for ALL?a.hyperdiploidyb.t(9;22) t(4;11)c.2-8 yrsd.tlc <50000154 Pearsons skewness coefficientsa.(Mean-median)/sdb.Median-mean/sdc.Sd/mean-mediand.Sd/median-mean155 scarring alopecia with perifollicular greying .wth mucous mem n facial rashes /annularplaques?1.d l e2.lichen planus3.psorisis4.156 With delirium tremens,not seen:a.visual hallucinationb.unconsciousnessc.coarse tremorsd.opthalmoplegia157 A patient wth intestinal infection 7 days later presented with amoebic liverabscess..5cmX5cmX6cm deep liver abscess on right side Rx of choicea.Mz and antibiotics is choiceb.Repeated aspiration and antibioticsc.Surgical drainage is best for above mentioned patient wth antibioticsd.Resection of liver158 drug of choice for central Diab insipidus?a.desmopressinb.leuprolidec.thiazide159 first structure to b fixed after Amputation isa.Bone fixingb.arterial repairc.venous repaird.nerve repair160 fallopian tube immotility seen in:
a.churg strauss syndrb.kartaganers syndrc.noonans syndrd.turner syndrome161 Epileptic potential is present inA. DesfluraneB. HalothaneC. SevofluraneD. Ether162 which one is known as signature fracture?1.depressed skull fracture2.penetrating fracture3.counter coup4. # along the suture line163 A 7 yr old child with craniopharyngioma got cranial surgery done following which pituitarygot damaged.which hormone shld b replaced first-1.hydrocort2.thyroxine3.growth hormone4.164 A 45 yr old lady presented with dub & usg finding of 8mm endometrium.which is nextbest investigation to conclude diagnosis?1.endometrial histopathology2.hysterectomy3.ocp4.follow upQ165 Which one of the following is earliest to be diagnosed by USG?a.anencephalyb.prosencephalyc.meningoceled.spina bifida166 .A 5 yr ol child presented wth ballooning of perpuce while micturationperpuce adhesionwere there.whts the best treatment for hima.adhesiolysis and dilatationb.circumscisionc.dorsal slitd.conservative167 False about HDL?a.can oxidise LDLb.decreased levels fail to clear LDLc.best predictor for CADd168 A poison Illuminous, translucent, waxy1. Yellow phosphorus2.arsenic3.thalium4.?170 Gene for expession of protein.yield max production of enzyme.is ensured by introductionof following gene by virus
a.Promoter geneb.Initiator signalc.transln and transcription termination signald.171 Body plethysmography pressure findings when pt breathes aginst closed glottis in lungs nrecordings respectively1.bothdecreased2.both increased3.lungs increases n recording decreased4.in boxincrease lung decrease172. cartilage for growth plate is:a.fibrousb.prim cartilagenousc.sec cartilagenousd.plane jt173 Not a predisposer for atherosclerotic plaque formation?a.ApoEb.alpha-macroglobulinc.oxidised LDLd.?174. 7 mo child with cough ending in spasm.which is best way to sample?a.Nasophayngeal swabb.Cough sputum culturec.tracheal aspirated.??175 Unilateral undescended testis . ideal age of operationa.6 monthsb.12 monthsc.24 monthsd.36 months176Following are true Carbohydrate antigena.Memoryb.poly clonal responsec.?d. t cell stimulation177 Aflatoxin produced by which of the fungal species?a.aspergillus flavusb.aspergillus nigerc. candidad??178 A 3.8 kg baby of a diabetic mother developed seizure 16 hr after birth ...1.hypoglycemia2.hypocalcemia3. intraventricular hemorrhage4. ??179 girl presenting with occipital headache assoc wid ataxia vertigo.also similar complaints inmother ?
a.vestibular neuronitisb.basillar migrainec.d.180 18yr male with hemetemesis & melena and splenomegaly ....1.NCPF2.CIRRHOSIS3.MALARIA with dic4.extra hepatic portal venous obstruction181 Pregnancy induced cholestasis marker... isa.Bilirubinb.Bile saltsc.Sgot or sgptd.Alp182 ph 7.5 pco2 30.po2 102 is partially ,compensated bymet acidosismet alkalosisresp acidosisresp alkalosis183 pulmonary toxicity is seen with1. bleomycin2.cisplatin3.methotrexate4.actinomycin d184 A female wid depressed mood,loss of appetite n no interest in surrounding wid insomniaspecially wid time lag in iniating n wakes up 1 hr early for 1 yr aftr her husband death isdiagnosed as a case of depression..most appropiate treatmenta.start wid a SSRIb.two antideprassant combined therapyc.no treatmnt asD start antidepressant according to side affect profileQ185 A pt comes with history of unresponsive fever n cough. xray pneumonia, gram positivand partially acid fast branchin filaments grows on sheep blood agar1.actinomycosis2.nocardiosis3.aspergillus4.186 not a disorder of protein misfolding?1.alzeimer2.TB3.cystic fibrosis4.cjdQ187 70yr old with intemittent jerks of recent origin, EEG showing b/L periodic spikes,diagnosis?a)Hepes simplex encephalitisb)Lewy body dementiac)Alzheimersd)CJDQ188 15 DAYS old baby comes with ca: 5 po4 :9 pth 30 (n=10-60) & seizures1.psuedo hypo para thyroid2.Vit d def
3.Hyperparathyroidism4.HIEQ189 most common cause of meningoencephalitis in children1.hsv2.enterovirus3.mumps4.listeriaq is pulm compliance decreased in all exceptA)pulm congestionB)pulm fibrosisC)decreased surfactantD)chronic bronchitis191 all of the following true abt erlotinib except1. tyrosine kinase inhibitor2. food delays its absorption3. rashes s/e4. used in non small cell ca lung when not responded to other chemotherapeutic agents192 People are separated into certain sub groups. People are selected randomly from subgroups. What type of sampling is done?1. Random sampling2. Stratified Sampling3.cluster sampling4.systemic samplingQ194 capsule virulence in a/e -1.nisseria memingitis2.pneumococcus3.bordetella pertussis4.streptococcusQ195 superior oblique palsy-a.horizontal and downb.horizontal and upc.vertical and dwnd.vertical and upQ196 muscle of dorsal aorta develops frma.paraxialb.intermediatec.lateral plated.197 Uretheral Crest is seen ina. bulbar urteherab. prostatic uretherac. membranous urethera198 Site not affected in posterior cerebral artery infarct is?A. MidbrainB. PonsC. ThalamusD. Cortex199 Visceral larva migrans seen in1.strongyloides
2.ancylostoma3.toxocara canis200. psammoma bodies seen in all except1.follicular ca thyroin2.papillary ca thyroid3.cystadenoca4.meningioma201 Denominator in Maternal Mortality rate1. Total Number of Live birth2. Total Number of Married Women3. Total Number of Birth4.202 a tennis player gets hurt by a ball, he complaints of decreased vision.what may be findings/o this trauma1 optic neuritis2 pars planitis3 vitrious detachment/ avulsion4 equatorial edema203 A 35 year old female has proximal weakness of muscles, repeated ptosis and eastfatiguability. The best test to diagnose her condition is:1) Muscle biopsy2) CPK3) Edrophonium test4) EMG204 For Pcod all r true except1 high lh/fsh2 high dheas3 very high prolactin4 raised lh205 most imp prognostic factor in Cong Dia Herniaa.pulmonary htb.timing of surgeryc.size206 dental numbering is done by all excepta.FDI two digit systemb.anatomic n diagramatic chartingc.pamer notationd.??207 Sterile Pyuria present in...a.Tbb. Chronic hydronephrosis??c. Wilms tumourd. Neuroblastoma208 parvovirus b19 a/ea.<10 % transmitted by blood/placentab.Resp routec.its a dna virusd.affects erythroid progenitor cells209 a mother with 33weeks gestation with sle. drugs not to be administered
1. sulfadiazine2. hydroxychloroquine3.prednisolone4.methotrexate209 mifepristone used ina.molarb.threatened abortionc.fibroidEctopic pregnancy210 hematuria in 55 yr old man for past 5 years.. 5 episodes lasting for 4 -5 days.wat will bnext best inv to come to diagnosis?a.urine exam nd microscopyb.x ray kubc.abdominal usgd.211 during TURP surgeon takes care to dissect above verumontenum so as not to injure the1.external urethral sphincter2.urethral crest3.prostatic utricle4.? d is sphincter vesicae212 least common cause of ambiguous genitalia in female child---a.placental steroid sulfataseb.fetal aromatasec.wt4 mutationd.cah213 medical treatment for variceal bleeda.octreotideb.pantaprazolec.d.214 lady 25 yr old presents with high tsh and low t4 .which is most common cause for herillness1.hashimotos2.graves3. pit macroadenoma4. pseudohypothyroidism...215 vit k carboxylates1.aspartate2.glutamate3.4.216 false about C.diphtheriae:a.toxin producn chromosome mediatedb.org cnfd by toxin productionc? toxic to heart and neurond?217 stab injury with omentum protrusion in umbilical area ,vitals stable.immediate next step1.fast2.laparotomy3.suturing with wound exploration4.cect
218 The shaded area in graph (showing diabetic cut off n diabetic n non diabetic distribution)isa] true +veb] true –vec] false +ved] false –ve219 man with maculopapular rash with prev h/o painless rash n genital painless ulcer.diagnis:a.treponema pallidumb.chlamydiac.c.granulomatisd.H.ducreyi220 false about strep pneumoniae?a.capsule aids in infectionb.commonest cause of o.media and pneumoniac. least likely cause of meningitisd.bile sensitive221 a schizophrenic pt started on haloperidol since 2 days comes with c/otorticollis,orofaciolingual movements. what is the diagnosis1. acute dystonia2.tardive dyskinesia3.parkinsonism4.akithisia222 no carrier state is seen in?1.measels2.typhoid3. diptheria.4.polio223 Pt. wt hypothyrodism wt IHD . Wts d Rx ?1.low dose of levothyroxin2. normal dose3.no levothyroxin4.thyroid extract224 a primigravida in 1st trimester had sputum positive 4 afb..treatmenta) deferred to 2nd trimesterb) cat1c)cat2d)cat3225 A patient had head injury with opening of eyes with stimulation to pain, inappropriatewords, and moving limbs what is the score:a. 10b. 8c. 12d. 14226 Which of the following is true?a. Acetylcholinesterase inhibited by malathion can be reversed with increasing levels ofacetylcholinesteraseb. Sulphonilamide inhibits folate reductase irrevesibly.c. flouoroacetate competetively inhibits aconitase
ethenol inhibit aldehd dehydrogenase when used in methanol poisoning227 Secondary hemorrhage after how many days of tonsillectomy?1: 24 hrs2: 6 days3: 12 days4:12 hrs228 Aprepitant is all except1. Agonist at NK12. Crosses Blood Brain Barrier3. Ameliorate Nausea Vomiting of chemotherapy4. Metabolized by CYP450229 Buprenorphine is a1. Partial agonist at MU Receptor2. Partial agonist at Kappa Receptor3. Full Agonist at Mu Receptor... antagonist at mu..230 blood chimerism is maintained by??a) monochorionin dizygoticb)dichorionic dizygoticc) vaninshin twinsd) singleton preganancy231 crp stands for??1.capsular polysaccharide in pneumococcus126.96.36.199 features of bstructive azoospermia??1.high fsh high testosterone2.low fsh high testosterone3.normal fsh normal testosterone4.233 principle mediator of apoptosis?1.nucleus2.lysosome3.mitochondria4.?234 regarding Leptospirosis.true isa.rats only reservoirb.fluroquinolones r docc.person to person transmissiond. oro fecal transmission235 5 year old child and burned are of the size of palm is equal to1. 1%2. 5%3. 10%4.236 Q:All are true about ranalozine except?a)causes hypotensionb)1st line antianginalc)hyoglycemicD?
237 true abt sodium fluoride in treatment of otosclerosis?1.inhibits osteblastic activity2.used in active phase of otosclerosis when schwartz sign positive3. has proteolytic activity(bone enzymes)4.238 wat is true abt ranula1.epulis2.swelling in floor of mouth3.4.239 A 6 week old male infant was brought in a state of dehydration and shock . Na levels werelow 124 k levels 7 meq per l , hyper pigmentation present with normal genitalia . Diagnosis ?1.Congenital adrenal hyperplasia2.adrenal hmg n shock3.Acute gastroenteritis with dehydration4.240 In pseudohyperparathyroidism what is true ?1.Gain of function mutation2.Decreased conversion of gtp to gmp3.Decreased inositol tri phosph production4.no response due to increase c amp241 all true except selective estrogen receptor downregulator (serd), fulvestrant1. Used for breast cancer2. is selective oestrogen antagonist3. Is slower acting, safer, more effective than SERM4.given as once a month dose242 which drug not used to control bleeding while delivery of a woman with heart disease ?1.methylergometrime2.carboprost3.syntocin4.misoprostol243 not a autoimmune disease outta following??1.sle2.myasthenia fravis3.sickle cell disease4.graves disease244 treatment wth INH leads to deficiency of ?1.thiamine2.niacin3.pyridoxine4.pantothenic acid245 surgeon removes a part of liver to the left of falciform legiment. which segment thesurgeon has removed1. 1 & 4a2. 2 & 33. 1 & 4b4.246 diminished kidney function which is done1.N acetylcysteine2.fenoldopam3.low osmolar contrast
...247 a patient had running nost and pain over medical aspect of eye foll that the patientdeveloped, chemosis,protosis,diplopia of right eye on abduction with congestion of optic disc.what is the prbable diagnosis?1.acute ethmoidal sinusitis2.orbital cellulitis3.cavernous sinus thrombosis4.orbital apex syndrome248 which one of the folloeing not used in diagnosis of insulinoma ?1.fasting glucose test2. d xylose3. c peptide levels4. insulin /glucose ratio249 A young lady presents with fever , dysuria and pain abdomen . Uncomplicated acutecystitis was diagnosed . Which of these is false ?1.Nitrate test positive2.e coli ct was < 10 power 33.1 pus cell per 7 field4.1 bacilli per field250 pt with malaria, given primaquine develops hemolysis, diagnosis?1.g 6 pd def2.glucose 6 phosphate3.4.251. Best investigation for bone metastases?a.MRIb.CTc.bone scand. x ray252. CT least accurate for:a. 1 cm of aneurysm in hepatic arteryb.1 cm of lymph node inpara-aortic regionc.1 cm of pancreas mass in tail251 anaesthesia avoided in sickle cell patient...a. iv anaesthesiab. regional anaes252 Pregnancy induced cholestasis marker... isa. Bilirubinb. Bile saltsc. Sgot/sgptd. Alp253 pt with b/l central loss of vision, normal retinogram.no systemic features. no history ofsimilar complaints in any family members.which condition?a) bests diseaseb) stargardts diseasec) Retinitis pigmentosad) macualr hole
254 poor prognostic factor for ALL?a.hyperdiploidyb.t(9;22).....ansc.2-8 yrsd.?255 commonest cause for b/l proptosis in children?a.cavernous haemangiomab.rhabdomyosarcomac,d?256 most reliable radiological sign of pulmonary hypertension-----a. descending branch of right pulmonary artery > 16mmb. desc of lt pul a. >16mmc. lt. Pul a. >16 mmd. pul a. >16mm257 primi in labour with uterine contractions since last 10 hrs,cx not effaced?;next step?a.sedate n observeb.syntocin inductionc.c.s.d.?258 earliest to be diagnosed by USG?a.anencephalyb.prosencephalyc.meningoceled.259 An amoebic liver abscess..5cm-5cm Rx of choicea. Mz amd antibiotics is choiceb. Repeated aspiration and antibioc. Surgical drainaged. Resection of liver260 perpuce adhasion 2yr child.rxa. adhesiolysis and dilatationb. circumscisionc. dorsal slit261 all true except:a.human anatomical waste disposed in yellow bagb.red bag contents can be source of contaminationc.black bag for incineration ashd.blue bag contents always disposed in secure landfill262 not a c/i for pregnancy - wpw syndrome263 no carrier state – measels264 man with maculopapular rash with prev h/o painless rash.diagn is:a.treponema pallidumb.chlamydia.C.granulomatisd.H.ducreyi265 false about strep pneumoniae?a.capsule aids in infectionb.commonest cause of o.media and pneumonia
c.??266 Amputation 1st done isa. Bone fixing267 mineralocorticoid receptor not present ina.liverb.colonc.hippocampusd.kidney268 pasteurised milk is tested mostly by:a.phosphatase testb.coliform test269 d/o/c for central Diab insipidus?a.vasopressinb.leuprolidec.thiazide270 fallopian tube immotility seen in:a.churg strauss syndrb.kartaganer;sc.?d.?271 child got cranial sx done ... pituitary got damaged.. which hormone shld b replaced first-hydrocortthyroxinegrowth hormone272 delirium tremens,not seen:a.visual hallucinationb.unconsciousnessc.coarse tremorsa. opthalmoplegia273 pnt with low Ca,high phosphorus,raised PTH..inv not to be done:a.urine microscopyb.PTH levelsc.vit D levelsd.??274 miglitinides all are true except1decreases post parendial hyperglycemia2 hypoglycemia less than sulfonylurease3 it decreases insulin resistance ans its (thiazolidinedions acts as insulin sensitizer)4 it acts by releasing insulin (yes just like sulfonylurease but less hypoglycemia)275 Pearsons skewness coefficientsa. (Mean-median)/sdb. Median-mean/sdc. Sd/mean-mediand. Sd/median-mean276.Question about contrast used in imagingTest dose to be given277.Test for milkphospatase test
indole test278.child with seizure within 16hrs of birthhypoglycemiahypocalcemia279. Gun powder canUV lightANSIR lightA 5 year old boy while having dinner suddenly becomes aphonic and is brought to the casultyfor the complaint of respiratory difficulty. what should be the next appropriate treatment:-1) cricothyroidotomy2) emergency tracheostomy3) humidified oxygen4) Hemlich maneouvreAns is Emergency tracheostomyheimlichs maneuver is not tried in partial or incomplete obstruction as it can cause completeobstruction.Cricothyrotomy is performed as an intervention of choice in complete obstruction and whenthere are no or minimal surgical instruments available.Emergency tracheostomy followed by removal of foriegn body by direct laryngoscopy is theprocedure to be followed.there is no point of doing tracheostomy if the thing can be managed with lessor invasiveprocedure"Chocking" redirects here. For the mechanical tool, see Wheel chock.For the act of compressing someones neck, see Strangling. For other uses, see Choke.ChokingClassification and external resourcesICD-10 F41.0, R06.8, T17, W78-W80ICD-9 784.9, 933.1MeSH D000402Choking is the mechanical obstruction of the flow of air from the environment into the lungs.Choking prevents breathing, and can be partial or complete, with partial choking allowingsome, although inadequate, flow of air into the lungs. Prolonged or complete choking results inasphyxia which leads to anoxia and is potentially fatal. Oxygen stores in the blood and lungskeep the victim alive for several minutes after breathing is stopped completely.Choking can be caused by:* Physical obstruction of the airway by a foreign body.* Respiratory diseases that involve obstruction of the airway.* Compression of the laryngopharynx, larynx or trachea in strangulation.Contents* 1 Choking in non-humans* 2 Foreign objects* 3 Symptoms and clinical signs* 4 Treatmento 4.1 Encouraging the victim to cough
o 4.2 Back slapso 4.3 Abdominal thrusts+ 4.3.1 Self treatment with abdominal thrustso 4.4 Modified chest thrustso 4.5 Finger sweepingo 4.6 Direct vision removal* 5 CPR* 6 Notable victims* 7 Other uses of abdominal thrusts* 8 References* 9 External linksChoking in non-humansWiki letter w.svg This section is empty. You can help by adding to it.Foreign objectsThe type of choking most commonly recognised as such by the public is the lodging of foreignobjects (also known as foreign bodies, but consisting of any object which comes from outsidethe body itself, including food, toys or household objects) in the airway.This type of choking is often suffered by small children, who are unable to appreciate thehazard inherent in putting small objects in their mouth. In adults, it mostly occurs whilst thepatient is eating. In one study, peanuts were the most common obstruction.Symptoms and clinical signs* The person cannot speak or cry out, or has great difficulty and limited ability to do so.* Breathing, if possible, is labored, producing gasping or wheezing.* The person has a violent and largely involuntary cough, gurgle, or vomiting noise, thoughmore serious choking victims will have a limited (if any) ability to produce these symptomssince they require at least some air movement.* The person desperately clutches his or her throat or mouth, or attempts to induce vomitingby putting their fingers down their throat.* If breathing is not restored, the persons face turns blue (cyanosis) from lack of oxygen.* The person does any or all of the above, and if breathing is not restored, then becomesunconscious.TreatmentChoking can be treated with a number of different procedures, with both basic techniquesavailable for first aiders and more advanced techniques available for health professionals.Many members of the public associate abdominal thrusts, also known as the HeimlichManeuver with the correct procedure for choking, which is partly due to the widespread use ofthis technique in movies, which in turn was based on the widespread adoption of thistechnique in the United States at the time.Most modern protocols (including those of the American Heart Association and the AmericanRed Cross, who changed policy in 2006 from recommending only abdominal thrusts)involve several stages, designed to apply increasingly more pressure.The key stages in most modern protocols include:Encouraging the victim to coughThis stage was introduced in many protocols as it was found that many people were too quickto undertake potentially dangerous interventions, such as abdominal thrusts, for items whichcould have been dislodged without intervention. Also, if the choking is caused by an irritatingsubstance rather than an obstructing one, and if conscious, the patient should be allowed todrink water on their own to try to clear the throat. Since the airway is already closed, there is
very little danger of water entering the lungs. Coughing is normal after most of the irritant hascleared, and at this point the patient will probably refuse any additional water for a shorttime.Back slapsThe majority of protocols now advocate the use of hard blows with the heel of the hand on theupper back of the victim. The number to be used varies by training organization, but is usuallybetween five and twenty.The back slap is designed to use percussion to create pressure behind the blockage, assistingthe patient in dislodging the article. In some cases the physical vibration of the action mayalso be enough to cause movement of the article sufficient to allow clearance of the airway.Almost all protocols give back slaps as a technique to be used prior to the consideration ofpotentially damaging interventions such as abdominal thrusts, but Henry Heimlich, noted forpromulgating abdominal thrusts, wrote in a letter to the New York Times that back slaps wereproven to cause death by lodging foreign objects in to the windpipe.The findings of a 1982 Yale study by Day, DuBois, and Crelin that "persuaded the AmericanHeart Association to stop recommending back blows for dealing with choking...was partiallyfunded by Heimlichs own foundation." According to Roger White MD of the Mayo Clinic andAmerican Heart Association (AHA), "There was never any science here. Heimlich overpoweredscience all along the way with his slick tactics and intimidation, and everyone, including us atthe AHA, caved in."Abdominal thrustsA demonstration of abdominal thrustsAbdominal thrusts, also known as the Heimlich Maneuver (after Henry Heimlich, who firstdescribed the procedure in a June 1974 informal article entitled "Pop Goes the Cafe Coronary",published in the journal Emergency Medicine). Edward A. Patrick, MD, PhD, an associate ofHeimlich, has claimed to be the uncredited co-developer of the procedure. Heimlich hasobjected to the name "abdominal thrusts" on the grounds that the vagueness of the term"abdomen" could cause the rescuer to exert force at the wrong site.Performing abdominal thrusts involves a rescuer standing behind a patient and using theirhands to exert pressure on the bottom of the diaphragm. This compresses the lungs andexerts pressure on any object lodged in the trachea, hopefully expelling it. This amounts to anartificial cough.Due to the forceful nature of the procedure, even when done correctly it can injure the personon whom it is performed. Bruising to the abdomen is highly likely and more serious injuriescan occur, including fracture of the xiphoid process or ribs.In some areas, such as Australia, authorities believe that there is not enough scientificevidence to support the use of Abdominal thrusts and their use is not recommended in firstaid.Self treatment with abdominal thrustsA person may also perform abdominal thrusts on themselves by using a fixed object such as arailing or the back of a chair to apply pressure where a rescuers hands would normally do so.As with other forms of the procedure, it is possible that internal injuries may result. Modified chest thrustsA modified version of the technique is sometimes taught for use with pregnant and/or obesepatients. The rescuer places their hand in the center of the chest to compress, rather than inthe abdomen.
Finger sweepingThe American Medical Association advocates sweeping the fingers across the back of thethroat to attempt to dislodge airway obstructions, once the choking victim becomesunconsciousSome protocols advocate the use of the rescuers finger to sweep foreign objects away oncethey have reached the mouth. However, many modern protocols recommendagainst the use of the finger sweep as if the patient is conscious, they will be able to removethe foreign object themselves, or if they are unconscious the rescuer should simply place themin the recovery position (where the object should fall out due to gravity). There is also a riskof causing further damage (for instance inducing vomiting) by using a finger sweeptechnique.Direct vision removalThe advanced medical procedure to remove such objects is inspection of the airway with alaryngoscope or bronchoscope, and removal of the object under direct vision, followed by CPRif the patient does not start breathing on their own. Severe cases where there is an inability toremove the object may require cricothyrotomy.CPRIn most protocols, once the patient has become unconscious, the emphasis switches toperforming CPR, involving both chest compressions and artificial respiration. These actions areoften enough to dislodge the item sufficiently for air to pass it, allowing gaseous exchange inthe lungs.Notable victims* United States President George W. Bush survived choking on a pretzel on January 13, 2002,receiving major media coverage.* Jimmie Foxx, a famous Major League Baseball player, died by choking on a bone.* Tennessee Williams, the playwright, died after choking on a bottle cap.* An urban legend states that obese singer Mama Cass choked to death on a ham sandwich.This was borne out of a quickly discarded speculation by the coroner, who noted a partly eatenham sandwich and figured she may have choked to death. In fact, she died of a heartcondition, often wrongly referred to in the media as heart failure but specified on her deathcertificate as fatty myocardial degeneration.* The Queen Mother was admitted to a UK Hospital for an operation in May 1993 after chokingon a fish bone.Other uses of abdominal thrustsDr. Heimlich also advocates the use of the technique as a treatment for drowning and asthmaattacks, but Heimlichs promotion to use the maneuver to treat these conditions resulted inmarginal acceptance. Criticism of these uses has been the subject of numerous print andtelevision reports which resulted from an internet and media campaign by his son, Peter M.Heimlich, who alleges that in August 1974 his father published the first of a series offraudulent case reports in order to promote the use of abdominal thrusts for near-drowningrescue.A 35 year old female has proximal weakness of muscles, repeated ptosis and east fatiguability.The best test to diagnose her condition is:1) Muscle biopsy2) CPK3) Edrophonium test
4) EMGAnswer: Edrophonium test.Explanation: Muscle biops, EMG and CPK are primarily used for diagnosis of inflammatorymyopathies e.g. polymyositis, inclusion body myositis. Here the clinical picture is clearly ofMG, which most common presentataion is extraocular muscle palsies. Plus inflammtorymyopathies usually spare extraocular muscles. BUT proximal muscle weakness is included inthe syndrome of myapthic muscle weakness. Anyways, I think what they wanted is to focus onhow to distinguish between MG and inflammatory myopathies using a single test and not adiagnostic test. So the answer is Edrophonium which will help us to clarify it in a splitsecond( figuratively) Edrophonium Positive=MG, negative, test further for myopathies.What are the methods for diagnosing Myasthenia Gravis and how long do they take toperform?The initial diagnostic exam for Myasthenia Gravis includes the following:* Evaluation begins with examination by a neurologist. 1 hour.* " Tensilon test. (A Tensilon test is positive in many patients who have MG, but may actuallybe negative in 20-30% patients with MG diagnosed by other methods.) 15-30 minutes in thephysicians office.* Acetylcholine receptor antibodies (a blood test). Acetylcholine receptor antibodies arepositive in 90% of patients with general myasthenia. The results usually take a week to returnfrom the laboratory.* EMG (electromyogram) is a test to determine the electrical response from the muscle afterstimulation of the nerve. 1 hour.ans: EMGAn additional test is:* Single-fiber EMG. This test is only performed at specialized centers. The exam itself takes 1-3 hours to perform. A single fiber EMG is considered the best test, being positive in 95-99% ofMG patients.In rare patients all these tests are normal, but examination by a neurologist suggestMyasthenia Gravis. If the disease is mild or purely ocular (symptoms of the eye muscles), thenthe tests are more frequently negative then in the case of the generalized disease.Q: which is NOT a definite airwaya. nasotracheal tubeb. orotracheal tubec. LMA......ANSd. cricothyroidtomy..Ref:A definitive airway can be: an endotracheal tube, an nasotracheal tube, or a surgical airway(cricothroidotomy).The need for a definitive airway is based upon a number of clinical findings:the presence of apneainability to maintain a patent airway by less invasive meansneed to protect the lower airway from aspiration of blood or vomitusimpending or potential airway compromise (following inhalational injury, facial fractures,retroparygeal hematoma or sustained seizure activity)presence of a closed head injury requiring assisted ventilation
inability to maintain adequate oxygenation by face mask oxygen supplementationany patient with a Glasgow coma score of 8 or less17. Which is not a neural tumor ?1. Ependymoma2. Neuroblastoma3. Gangliocytoma4. GangliogliomaAnswer CONTROVERSIAL (cant ans be neuroblastoma,neuroendocrine tumor)Neuroblastoma is the most common extracranial solid cancer in childhood and the mostcommon cancer in infancy, with an annual incidence of about 650 new cases per year in theUS. Close to 50 percent of neuroblastoma cases occur in children younger than two years old.It is a neuroendocrine tumor, arising from any neural crest element of the sympatheticnervous system or SNS.REF Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.;Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, Mo: ElsevierSaunders. pp. 1406.Ganglioglioma is a tumour that arises from ganglion cells in the central nervous system.The term "gangliocytoma" is sometimes equated with ganglioglioma. However, it is alsosometimes equated with ganglioneuroma. The term "gangliocytoma" is sometimes used toimply that the tumor is entirely neuronal.Q-Epileptic potential is present inA. DesfluraneB. HalothaneC. SevofluraneD. EtherBest Ans-Sevoflurane• SEVOFLURANE, ISOFLURANE, ENFLURANE Have epileptic potential.• "ISOLATED EPILEPTIFORM PATTERNS SOMETIMES CAN BE SEEN DURINGINTERSUPPRESSION ACTIVITY AT 1.5 TO 2 MAC ISOFLURANE. SEVOFLURANE CAUSESSIMILAR DOSE-DEPENDENT EEG EFFECTS. EQUI-MAC CONCENTRATIONS OF SEVOFLURANEAND ISOFLURANE CAUSE SIMILAR EEG CHANGES.• EPILEPTIFORM ACTIVITY HAS BEEN INDUCED BY ADMINISTRATION OF SEVOFLURANE INPATIENTS WITHOUT EPILEPSY, AND SEIZURE ACTIVITY ON EEG, BUT NOT CLINICAL SEIZUREACTIVITY, HAS BEEN REPORTED IN PEDIATRIC PATIENTS WITH A HISTORY OF EPILEPSYDURING INDUCTION OF ANESTHESIA WITH SEVOFLURANE.• DESPITE THESE OBSERVATIONS, SEVOFLURANE, SIMILAR TO OTHER INHALATION AGENTS,IS NOT SUITABLE FOR USE DURING ELECTROCORTICOGRAPHY FOR LOCALIZATION OFSEIZURE FOCI.• EEG PATTERNS SEEN WITH ENFLURANE ARE SIMILAR TO THE PATTERNS SEEN WITHISOFLURANE EXCEPT THAT EPILEPTIFORM ACTIVITY IS CONSIDERABLY MORE PROMINENT.• At 2 to 3 MAC, burst suppression is seen, but virtually all intersuppression activity consists oflarge spike/wave pattern discharges. Hyperventilation with high concentrations of enfluraneincreases the length of suppression, decreases the duration of bursts, but increases theamplitude and main frequency component of the intersuppression epileptiform activity. FrankEEG seizures also may occur with enflurane that produce the same cerebral metabolic effectsas pentylenetetrazol, a known convulsant.
• Halothane also produces EEG patterns similar to those of isoflurane, but dosages ofhalothane that would produce burst suppression in the EEG (3 to 4 MAC) are associated withprofound cardiovascular toxicity.• Desflurane produces EEG changes similar in nature to equi-MAC concentrations of isoflurane.In limited clinical studies,• THERE HAS BEEN NO EVIDENCE OF EPILEPTIFORM ACTIVITY WITH DESFLURANE, DESPITEHYPERVENTILATION AND 1.6 MAC DOSAGE, AND DESFLURANE HAS BEEN USED AS ATREATMENT OF REFRACTORY STATUS EPILEPTICUS.• “SEIZURES OCCUR DURING INDUCTION OF ANESTHESIA WITH HIGH CONCENTRATIONS OFSEVOFLURANE IN CHILDREN, INCLUDING THOSE WITHOUT A RECOGNIZED SEIZUREDIATHESIS.• IN TWO HEALTHY HUMAN SUBJECTS, EEG BURST SUPPRESSION WITH 2 MACSEVOFLURANE WAS ACCOMPANIED BY EPILEPTIFORM DISCHARGES THAT WERE OBSERVEDDURING EEG MONITORING.• These discharges were associated with a significant increase in CBF, thus demonstrating thatflow-metabolism coupling was preserved. In patients with temporal lobe epilepsy,administration of 1.5 MAC sevoflurane elicited widespread paroxysmal interictal EEG activity.Of note was the observation that paroxysmal activity was not restricted to the ictal focus andthat the administration of sevoflurane was not of any assistance in localization of theepileptogenic region of the brain.• The development of tonic-clonic movements indicative of seizure activity has also beenreported in otherwise healthy patients on emergence from sevoflurane anesthesia. In all of thereported cases of seizure activity attributable to sevoflurane anesthesia, untoward sequelaehave not been documented. These reports highlight sevofluranes ability, albeit small, to evokeepileptiform activity, and accordingly, the use of sevoflurane in patients with epilepsy shouldbe undertaken with appropriate caution.”----------------- Millers Anesthesia• “Potential for cerebral toxicity has been studied for sevoflurane as compared to halothane.At• normal CO2 and blood pressure no evidence of sevoflurane toxicity exists.• With extreme hyperventilation to decrease cerebral blood flow by half, brain lactate levelsincrease, but significantly less than with halothane. There are conflicting data as to whethersevoflurane has a proconvulsant effect.• High, long-lasting concentrations of sevoflurane (1.5 to 2.0 MAC), a sudden increase incerebral sevoflurane concentrations, and hypocapnia can trigger EEG abnormalities that oftenare associated with increases in heart rate in both adults and• children. This has raised the question as to the appropriateness of sevoflurane in patientswith epilepsy.”• “Sevoflurane has the potential for toxicity, since it can be converted to toxic agents;however, the concentration of these agents is normally below• the toxic threshold. Sevoflurane has been shown to be a useful alternative to halothane for• p ediatric induction, however there are reports of epileptiform discharges in patients givensevoflurane at induction doses (1.5 to 2 MAC).”---------- Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K.Clinical Anesthesia, 5th EditionLippincott Williams & WilkinsDrug issuesThe following anaesthetic and allied drugs should be used with caution in epileptics:-----oxford anesthesia 1. Most common nerve injured in supracondylar fracture humerus? a. Median
b. Radialc. Ulnard. Anterior interosseus nerveAns: DThe Mnemonic for the order of nerves injured in Supracondylar fracture is AMRUThat is:Ant . Interosseus Nerve> Median > Radial >Ulnar2. Earliest symptom of GERD in an infant is?A. Respiratory distress answerB. Upper GI bleedC. regurgitationD.obstructionAns: C REGURGITATION....Reference from Nelson PediatricsInfantile reflux manifests more often with regurgitation (especially postprandially),signs of esophagitis (irritability, arching, choking, gagging, feeding aversion), andresulting failure to thrive; symptoms resolve spontaneously in the majority by 12–24mo. Older children, in contrast, may have regurgitation during the preschool years;complaints of abdominal and chest pain supervene in later childhood and adolescence.Occasional children present with neck contortions (arching, turning of head)designated Sandifer syndrome. The respiratory presentations are also age dependent:GERD in infants may manifest as obstructive apnea or as stridor or lower airwaydisease in which reflux complicates primary airway disease such as laryngomalacia orbronchopulmonary dysplasia. Otitis media, sinusitis, lymphoid hyperplasia,hoarseness, vocal cord nodules, and laryngeal edema have all been associated withGERD. In contrast, airway manifestations in older children are more frequently relatedto asthma or to otolaryngologic disease such as laryngitis or sinusitis.3. Basal metabolic rate is closely associated with?A. Lean body massB. Body surface areaC. Body mass indexD. Body weightAns: A Lean Body mass (REPEAT...shall not spend much time on repeats)4. A girl presented with recurrent occipital headache associated with ataxia andvertigo. Mother also has similar complaints. Most probable diagnosis is?A. Vestibular neuronitisB. Basillar migraineC. TIAD. –Ans: b Basilar migraine(REPEAT)5. Drug of choice for central Diabetes Insipidus is?a. Desmopressinb. Leuperolidec. Thiazide diureticsd. –Ans: A DesmopressinReference: Harrispn 17th edThe signs and symptoms of uncomplicated pituitary DI can be eliminated completelyby treatment with desmopressin (DDAVP), a synthetic analogue of AVP (Fig. 334-1). Itacts selectively at V2 receptors to increase urine concentration and decrease urineflow in a dose-dependent manner (Fig. 334-4). It is also more resistant to degradationthan AVP and has a three- to fourfold longer duration of action. Desmopressin(DDAVP) can be given by IV or SC injection, nasal inhalation, or oral tablet.